In academic medicine, harsh treatment of medical students and trainees has too often gone ignored or excused. That culture is now changing, both at the national level and at Johns Hopkins, where new efforts are aimed at preventing — and addressing — mistreatment, harassment and discrimination.
The professor pulled the medical student aside, loudly berated him and threw him against a wall.
The student, Roy Ziegelstein, was rattled. But he didn’t report the incident.
In fact, he forgot all about it for 30 years, until he was reminded by his work. He was addressing learner mistreatment in his role as vice dean for education at the Johns Hopkins University School of Medicine.
“When I began speaking to different groups about this issue, they would often ask if I experienced mistreatment when I was a student,” says Ziegelstein. “I would tell them I couldn’t recall.
“Then one day, I thought more about it and realized that for some reason, I had forgotten the times I was publicly humiliated or berated, even the time I was literally thrown against the wall by a faculty member who didn’t like what I had written in a patient’s chart. I guess it just seemed like a part of the medical student culture.”
That culture is finally changing, both nationally and at Johns Hopkins.
Learners are recognizing and reporting mistreatment, harassment and discrimination more frequently. And institutions such as Johns Hopkins are working hard to prevent it, and to address it seriously when it occurs.
In July 2019, for example, a professor of molecular biology and genetics in the school of medicine resigned after the university’s Office of Institutional Equity found he had violated the school’s sexual misconduct policy. The medical faculty advisory board, the dean of the school of medicine and the university’s provost had recommended his termination.
The faculty member was accused of “sexual harassment of a student, abusive and bullying behavior toward trainees, and other inappropriate behaviors,” according to an internal email sent at the time from Johns Hopkins leadership.
Kyle Cavagnini, then president of the school of medicine’s 800-member Graduate Student Association (GSA), praises the university’s response. “The complaint was taken seriously, it was investigated, consequences occurred and the consequences were made public,” he says. “That shows me that the school of medicine is committed to holding individuals accountable for unacceptable behaviors.”
The Scope of the Problem
The concept of medical school mistreatment first appeared in a 1982 JAMA article by Colorado pediatrician Henry Silver, who decried the transformation of too many medical students from bright and eager to cynical and depressed. “Is it possible that medical school is a place where medical students are actually abused?” he wrote. The answer, of course, was yes.
Yet for decades, harsh treatment of medical students was routinely ignored or excused, physicians, trainees and academicians agree. Ziegelstein notes that some faculty members in academic medicine believe that teachers have to be tough and demanding in order to teach. Ziegelstein says teachers who yell at students and demand perfection typically don’t recognize that aspects of their behavior and teaching style constitute mistreatment.
A survey by the Association of American Medical Colleges’ Medical School Graduation Questionnaire showed that 40.4% of medical students in the country experienced some form of mistreatment in 2019, a number that has scarcely budged since 2015.
In 2016, the GSA at Johns Hopkins added questions about mistreatment to the annual surveys it began in 2012. Each year, dozens of master’s and doctoral students in the school of medicine anonymously document mistreatment they experience and observe, including public humiliation, abusive comments, unwanted sexual advances and threats of physical harm. The numbers have risen slightly over the years, probably because awareness of mistreatment has grown, says Cavagnini.
Yet the GSA surveys also show that most graduate students still don’t report the mistreatment they experience or observe. “I am scared of how reporting will affect my reputation as a student among faculty,” one student wrote in 2019.
The university forbids retaliation for reporting mistreatment, but repercussions can be difficult to prevent.
“Let’s say you’ve spent a year and a half in a lab,” says Kaitlin Wood, a doctoral candidate in the Department of Cell Biology. “Problematic behaviors escalate over time, so things that didn’t seem bad at the start have now crossed a line. You have a year and a half of data but no rights to that data. If you report misconduct, you’re most likely not going to stay in the lab. You’re throwing away that work.”
In recent months, Johns Hopkins has taken several steps to address learner mistreatment, working closely with Cavagnini and other students and trainees on anti-mistreatment policies for several years.
“Students going through these issues may feel frustrated, partly because the reporting and investigation process can feel slow,” says Wood, GSA president for the 2019–20 academic year. “But the school is working to make it better.”
Notably, a new discrimination and harassment policy and new procedures went into effect June 1, 2019, replacing the general anti-harassment policy and providing “a more robust statement of prohibited conduct” and “rights and options for addressing issues of protected status based discrimination and harassment,” says Joy Gaslevic, the university’s interim vice provost for institutional equity. In addition to many other rights, parties to a matter under the new policy may have a supporter accompany them to any meeting or hearing.
The school of medicine also created the Resources for Reporting Mistreatment portal in 2019, which provides easy-to-navigate information about how to report mistreatment and where to find counseling or emotional support.
Another improvement has been the addition of a second location for the Office of Institutional Equity (OIE), which investigates reports of discrimination and sexual harassment for all Johns Hopkins University schools. The office also ensures the university is complying with affirmative action and equal opportunity laws, and it is a resource for people requiring accommodations for religion or a disability. While its main office is on the Homewood campus, an OIE satellite office, newly located in Reed Hall on the East Baltimore medical campus, is now open during business hours every other Tuesday.
“The new office hours create a more regular presence for us, especially for walk-ins,” Gaslevic says.
“Graduate students told me that having to travel to the Homewood campus to the OIE added a barrier to reporting discrimination and harassment,” says Ziegelstein. “I’m absolutely delighted … that we found an appropriate space that is off the beaten path so those who wish to report issues can feel comfortable that they won’t be seen walking in.”
Better Training for Faculty
Cavagnini, a doctoral candidate in biological chemistry, says that some of the mistreatment comes from the fact that many faculty members have not been trained to teach or mentor. “Their training may be solely as researchers,” he says.
Jennifer Haythornthwaite, professor in the Department of Psychiatry and Behavioral Sciences, is working with Cavagnini and others on a series of workshops to help faculty members develop mentoring strategies through role-playing scenarios, such as a mentor being rude to a student.
The program is not specifically designed to address learner mistreatment. But “we are going to have cases that bring up topics like bullying and social disparagements,” Haythornthwaite says.
Ziegelstein promotes the idea of “microaffirmations,” — “relatively small acts, which generally don’t take much time, and affirm another person’s humanity. It could be a quick email that says, ‘Great job today with your presentation.’ How long does that take? Thirty seconds?”
These positive comments can help students learn better, and eventually make them more compassionate as physicians and more innovative and creative as scientists, he says.
“What I tell people who practice microaffirmations is they’re not only uplifting their students, but the more they practice this behavior, the less likely they are to engage in bad behavior,” Ziegelstein says.
“We have the best and brightest learners in the world. If we can’t allow them to learn and be productive without the stress of experiencing negative behaviors, we’ve not just failed them and failed Johns Hopkins, we’ve really failed the world.”