Kassebaum D G, Cutler E R
Division of Medical School Standards and Assessment, Association of American Medical Colleges (AAMC), Washington, D.C., USA.
Acad Med. 1998 Nov;73(11):1149-58. doi: 10.1097/00001888-199811000-00011.
The abuse of students is ingrained in medical education, and has shown little amelioration despite numerous publications and righteous declarations by the academic community over the past decade. The culture of abuse conflicts with the renewed commitments of medical educators and practice professionals to imbue students with a higher degree of professionalism and cultural sensitivity. The authors describe the profiles of student abuse, drawn from recent national surveys of medical students using the AAMC Medical School Graduation Questionnaire, and focus on the most common forms of reported mistreatment--public belittlement and humiliation--that appear to be misguided efforts to reinforce learning. Along with others, the authors believe that the use of aversive methods to make students learn and behave is likely to foster insensitive and punitive behaviors that are passed down from teacher to learner, a "transgenerational legacy" that leads to future mistreatment of others by those who themselves have been mistreated. The undesirable result is compounded when these behaviors are adopted and directed toward patients and colleagues. The authors advocate more concerted action to curtail the abuse of medical students, citing current and proposed accreditation standards that will be employed more stringently by the LCME, and propose a series of more assertive actions that schools should take. The authors stress that the attitudes, behaviors, and values that students acquire in medical school are as much the products of their socialization as the outcomes of curricular design and pedagogy, and implore medical educators to tidy up the environment for learning.
学生受虐现象在医学教育中根深蒂固，尽管在过去十年里学术界发表了大量文章并做出了正义的声明，但这种现象几乎没有得到改善。虐待文化与医学教育工作者和执业专业人员重新做出的承诺相冲突，这些承诺旨在向学生灌输更高程度的专业精神和文化敏感性。作者们根据最近使用美国医学协会医学院毕业调查问卷对医学生进行的全国性调查，描述了学生受虐的情况，并重点关注报告中最常见的虐待形式——公开贬低和羞辱，这些似乎是强化学习的错误做法。与其他人一样，作者们认为，使用厌恶方法让学生学习和表现可能会助长麻木不仁的惩罚性行为，这种行为会从教师传给学生，形成一种“跨代传承”，导致那些自己曾遭受虐待的人在未来虐待他人。当这些行为被采用并针对患者和同事时，不良后果会更加严重。作者们主张采取更协调一致的行动来减少对医学生的虐待，引用了当前和拟议的认证标准，这些标准将由医学教育联络委员会更严格地执行，并提出了学校应该采取的一系列更果断的行动。作者们强调，学生在医学院获得的态度、行为和价值观，既是他们社会化的产物，也是课程设计和教学方法的结果，并恳请医学教育工作者清理学习环境。
