Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

It’s time to end the medical hierarchy

Jorge Roman
Education
July 6, 2016
Share
Tweet
Share

I was a few weeks into my surgery clerkship and was on the tail end of a student call shift. I had been at the hospital for almost 24 hours, and the last thing left to do before I embraced the comfort of my own bed was to round with the faculty surgeon on call that weekend. The night had been busy, but I was prepared to update my attending on every vital, every new lab, and change in medications. I knew my patients well; everything from the character of their pain to when they last had a bowel movement.

After seeing the first two patients on our list, the attending turns to me and asks me an obscure question about the criteria for abdominal compartment syndrome. I replied that I didn’t know, and his response was “shame.”

He proceeded to ask, “You’re about a year away from being an intern correct?” I nodded my head and said yes. Again he remarked, “shame” while looking down and shaking his head in disbelief.

Commencing the clinical years means entering an institution in which our role as students is muddled.  We enter a hierarchy in which our worth depends on our level of experience and wisdom. As such, medical students are usually at the bottom of the pecking order. We enter the hospital eager to immerse ourselves into the world of medicine but to do so we must follow several unwritten rules.

In this system we are bred not to show weakness; as students we do not tire, appear unhappy, or underperform. In this apprenticeship model, we become sort of like “yes men” going with the flow. The ability to challenge those higher up on the chain is very limited, perhaps due to the limited amount of authority we hold or perhaps due to the ever-present clinical evaluations that can “make or break” us as we climb the ladder. As the most naïve member of the team, students sometimes feel like they don’t have a “proper” place in the hospital. There is a lack of belonging and because of our peculiar positions most of the time we are left on the outside looking in. Our very existence on a team is transient, with hundreds of us constantly moving through the system, it’s easy to regard medical students as “just another student.”

While patients seldom note the distinctions between student, resident, and attending, these divisions are very tangible to those of us within the system. Conceivably, this structure is still in existence for good reason. There is a chain of command with each level of personnel having their own sets of duties and responsibilities. The system allows for organization, accountability, and efficiency. All of those before us have gone through the same process so why fix what’s been working for years?

While my experience with the surgeon who responded with “shame” has not been uniform throughout my clinical training, it was definitely not an isolated event. It is not unusual to hear about the occasional “malignant” attending or resident from my classmates.

I believe that we perform at our finest when working with mentors who teach with kindness and sympathy. Teachers who inspire us to perform at our best for the sake of our patients rather than shame us for not knowing. Over decades, the tangible lines of the medical hierarchy have introduced unnecessary stress and pressure into our system of learning. This trial by fire may have worked for past generations but for the health and well-being of our current and future physicians, the culture has to change.

Hundreds of physicians die annually from suicide and as many as 21 percent of medical students suffer from depression. What if we could change the fraternity of medicine into something healthier for the well-being of those within the institution? Instead of relying on the familiar what if we could change the scheme to one that supports innovation, encouragement, and reinforcement of the principles that brought us to the profession in the beginning.

Jorge Roman is a medical student.

Image credit: Shutterstock.com

Prev

Hamilton mirrors the duel between doctors-patients and insurance companies

July 5, 2016 Kevin 2
…
Next

The end of residency means difficult goodbyes

July 6, 2016 Kevin 0
…

Tagged as: Medical school

Post navigation

< Previous Post
Hamilton mirrors the duel between doctors-patients and insurance companies
Next Post >
The end of residency means difficult goodbyes

ADVERTISEMENT

Related Posts

  • It’s time to focus medical education on training the whole person

    Tracy Asamoah, MD
  • A medical student’s reflection on time, the scarcest resource

    Natasha Abadilla
  • Digital advances in the medical aid in dying movement

    Jennifer Lynn
  • The next time you see a medical student, give support

    Gurbaksh Esch, MD
  • The medical education system hates families

    Anonymous
  • America’s inadequate LGBTQ medical education

    Haidn Foster

More in Education

  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Why medical student debt is killing primary care in America

    Alexander Camp
  • Why the pre-med path is pushing future doctors to the brink

    Jordan Williamson, MEd
  • Graduating from medical school without family: a story of strength and survival

    Anonymous
  • 2 hours to decide my future: Why the NRMP’s SOAP process is broken

    Nicolette V. S. Sewall, MD, MPH
  • What led me from nurse practitioner to medical school

    Sarah White, APRN
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 17 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • A physician’s reflection on love, loss, and finding meaning in grief [PODCAST]

      The Podcast by KevinMD | Podcast
    • How fragmented records and poor tracking degrade patient outcomes

      Michael R. McGuire | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How I learned to stop worrying and love AI

      Rajeev Dutta | Education
    • Understanding depression beyond biology: the power of therapy and meaning

      Maire Daugharty, MD | Conditions
    • Why compassion—not credentials—defines great doctors

      Dr. Saad S. Alshohaib | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

It’s time to end the medical hierarchy
17 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...