The Learning Environment in Medicine is Toxic

I’ve noticed a few things after starting clinical placement in med school. There are days I enjoy myself, other days it’s a complete waste of time to the point it makes me question why I chose this degree in the first place. A few reasons have left me feeling this way and one reason is due to the toxic learning environment created within hospitals. Over time, this environment leaves a group of future doctors (including myself) uninspired, disempowered and neglected.

My interactions on the wards have led me to this conclusion, some of which I will share in this piece. I am certain that my experiences are not unique and the fact that some will inevitably relate to these experiences will show that a cultural shift is needed in medicine.

I’ve always found the need to shame medical students very unnecessary. It leaves individuals demoralised before they start practising as a doctor. Quite recently, I had an experience with a consultant who deliberately went out of his way to embarrass a colleague and me in front of patients for not knowing information. Both of us were only a few months into clinical placement and after taking a year out to do intercalated degrees, it was only right that we were going to be rusty. The consultant asked us to take a look up the patient’s nose and try to diagnose the pathology. Personally, all I could recall was the sight of nose hairs and the consultant took it upon himself to belittle us in front of the patient.

At the time, I thought what did this consultant gain from doing that. We are here to learn yet his response sought to demoralise us and invoke fear, whether or not he realised it. It immediately laid out the foundations of what is yet to come when practising as a healthcare professional. Instead of being encouraged to learn because of passion for medicine, you are expected to learn out of the fear of being embarrassed (and the need to pass exams!).

Personally, I did not take it to heart. I’ve had a few interactions like that in my lifetime. I think what made this situation very unfortunate, is that there was a list of other qualities this doctor had which affected his interactions with patients. The consultations felt condescending and it did not seek to encourage patients to take healthy ownership over their health but tell them what to do. That same attitude contributed to my colleague and me being shamed in the clinic.

When compared to the interactions I had with other consultants who actively took the time out to teach, encourage students to learn, and thoroughly listen to patients you could see a stark difference. Both patients and students left feeling encouraged and listened to.

Another striking issue that I noticed is feeling like a second class citizen on the wards. An issue that is all too common, that students complain about all the time. It is a multifaceted problem that is caused by a range of individual, environmental and systemic factors. On an individual level, some doctors are repulsed by the idea of teaching, some choose not to make time and some cannot make time. Environmental factors contribute to this, particularly in hospitals. Some hospitals are incredibly open to the idea of teaching students. In fact, in some hospitals teaching is ingrained into hospital culture. In other hospitals, it’s the exact opposite. And then there are the systemic issues. Oftentimes doctors cannot give us the time they need because of chronic understaffing, underpayment and increased demands for healthcare services. These issues have manifested due to poor levels of organisation within the NHS and poor government decisions. We see the effects of this as future healthcare professionals are often neglected on clinical placement. How many times has teaching been cancelled because of short staffing? These issues are not solely due to coincidence.

The consequences of this are dire. It once again results in uninspired, demotivated medical students who feel as though they are not valuable members of the team. When students finally find the doctors who are able to give their time to students, it usually comes as a surprise. When in reality it should be the norm. The best way to learn in medical school is to be taught by those who have come before you.

What does this toxic environment mean for healthcare professionals currently and in the future? From a personal standpoint, I have seen a major shift in the attitude that I had when I first came to medical school compared to now. I entered full of confidence and I am currently in the unsettled phase of knowing what is yet to come. In all honesty, I can feel this energy throughout the cohort - with the exception who love their degree. I can see the toll the learning environment in medicine takes on individuals’ confidence. Many have developed problems with mental health, confidence, self-esteem and anxiety. In fact, I have been in situations where I have seen students begin to shake and sweat when asked a question.

At what point do we say this is not okay. We will continue to raise a generation of future doctors who leave medical school with a plethora of problems that they did not have when they first entered. Medical students once they graduate will feel disempowered, uninspired and neglected. We will continue to raise doctors who have taken on the condescending nature of doctors that came before them, doctors who choose to leave the country and doctors who choose to abandon the profession entirely. In a situation where the NHS already has dwindling morale, is this really what we need to have going forward.

Going forward, medical institutions, governments and hospitals need to acknowledge the issues that have been created and play their part to improve the hospital environment for the better.

Written by: Bimpe Adeyemi (Co-Founder of The Black & Forth Platform)


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