Council on Medical Student Education in Pediatrics


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Horror Stories from the Hidden Curriculum

Crystal clear or tin ear: how do medical students interpret derogatory comments about patients and other professionals? Tariq SG, Thrush CR, Gathright M, Spollen JJ, Graham J, Shorey JM. Med Educ Online 2016, 21: 31221 -

Reviewed by Ginny Randall

Tags: clerkship, professionalism, qualitative

What was the study question?
How do medical students interpret derogatory comments about patients and other professionals?

How was the study done?
Researchers from a single institution conducted seven focus groups (one from each clerkship, held immediately after the clerkship ended) on the subject of derogatory comments overheard by students. Each focus group was facilitated by two faculty members, one of whom was a note taker. The groups were audiotaped.   The tapes were transcribed and then read aloud as researchers shared the themes they identified.

What were the results?
82 students participated. Students reported that the majority of comments they overheard were professional, but when an unprofessional remark was heard, the learning “fell flat” and the students were distracted from the clinical learning that had been taking place. Three themes regarding the derogatory comments emerged. “Onstage-offstage” referred to comments spoken outside the hearing of the patient, often expressing frustration with the patient. Some students overhearing these comments felt flattered to be “one of the club” while others believed these remarks to be unprofessional. “Bad apple” referred to one or two physicians on a given clerkship who exhibited unprofessional behavior toward other team members, often medical students, that affected the students’ perception of the entire clerkship. “Pressure cooker” comments were made when physicians were under extreme stress and frequently consisted of negative comments about another service.

What are the implications?
It is during clerkships that students may internalize and learn to repeat this form of unprofessional behavior. The authors suggest that curricula using reflective learning (writing exercises and facilitated conversations) may mitigate this negative effect on student learning.

Editors’s Note: Students reported that even effective teachers undermined their own teaching when they made such comments.   So much for the excuse “…but he’s a great teacher.” (JG)

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