Public humiliation remains a common teaching tool in medical education. Here’s how it makes patients’ situations worse

Imagine being quizzed on complex technical knowledge in front of your peers, supervisors, and members of the public, knowing that a wrong answer could lead to public ridicule.

This is the reality for many medical students, with up to 90% experiencing public humiliation during their training.

Our research focused on teaching through humiliation. This is when medical trainees are intentionally humiliated or humiliated in front of their peers, other healthcare personnel, and sometimes even patients.

This can create doctors who are anxious, less confident, and more likely to make mistakes. Despite this, we found that teaching by humiliation remains common in medical training.

What we did and what we found

First, we (Wendy Li and Carolyn Heward) conducted a systematic review of what research says about public shaming in different contexts such as schools, police forces, social media, medical training, etc.

We analyzed 33 studies involving more than 40,000 people. We found that on average, 34.9% of people experience public humiliation. However, we found that teaching by public humiliation was surprisingly common in medical educational institutions.

These concerning results led to a targeted follow-up study, published recently in the journal Medical sciences educator and run by one of us (Luisa Wigg). This study focused specifically on humiliation teaching in medical education.

This follow-up research analyzed 28 published studies involving nearly 35,000 medical trainees across multiple countries.

The results showed that on average, 57% of medical students and junior doctors reported experiencing teaching through humiliation, although there were large differences between different medical schools and healthcare institutions.

Surprisingly, a US study found that 90.8% of graduating medical students experienced teaching through humiliation at some point during their training.

Surveys by the Association of American Medical Colleges have also shown that public humiliation is consistently reported as the most common form of mistreatment experienced by medical students.

What Teaching Through Humiliation Looks Like

Teaching by humiliation typically occurs when an educator embarrasses a trainee in public teaching spaces such as hospital wards, operating rooms, or medical conferences.

Here are some common examples:

• when students are aggressively questioned about their medical knowledge
• when wrong answers are ridiculed
• when people make derogatory comments about a student’s abilities in front of others.

These incidents most often occur in operating rooms and during hospital rounds (when doctors visit patients, often in the morning).

Senior doctors are often the ones who teach out of humiliation. However, research has shown a worrying trend in which nurses, fellow students and even junior doctors are also doing it.

This suggests that humiliated people might later commit it themselves, because they view it as a normal part of medical culture.

How does this affect patient care?

For patients, the implications of this practice are worrying.

Most people want the doctor who treats them to be competent, but also confident and emotionally stable.

Research has shown that doctors who have experienced humiliation in teaching often develop mental health problems. One study showed they were nearly eight times more likely to report burnout and nearly four times more likely to report symptoms of anxiety and depression.

Many doctors are reluctant to ask questions or seek help when they are unsure about something.

This is the exact opposite of what most patients expect from a healthcare professional making critical decisions about their care.

Research has also shown that medical trainees who experience humiliation often find themselves isolated from their peers and disengaged from learning.

Some end up abandoning medicine altogether, contributing to the shortage of healthcare workers.

Those who remain in medicine may perpetuate the cycle, because they have internalized the belief that humiliation is an integral part of medical training.

A deeply hierarchical culture

The medical profession has a deeply hierarchical structure. Senior doctors hold significant power over the training and future careers of their trainees. This hierarchical culture can contribute to the problem of teaching by humiliation.

Many educators simply want to maintain high standards through rigorous questioning. Research shows, however, that this can too easily cross the line into harmful shaming.

Some argue that teaching through humiliation prepares doctors for high-pressure situations or helps maintain professional standards.

However, the facts show that it produces the opposite effect. This creates anxious and less confident doctors who are more likely to make mistakes and less likely to work effectively with their colleagues.

For change to occur, medical schools and hospitals must recognize that this problem exists and implement clear policies to prevent teaching by humiliation.

This does not mean lowering standards. Rather, it is about finding better ways to maintain excellence while promoting the well-being of trainees.

Alternative teaching methods, such as structured feedback sessions, simulation-based training, and constructive mentoring programs, can help maintain high standards.

How doctors are trained affects how they will treat their patients.

With the healthcare system under pressure and workforce shortages common, we cannot afford to harm medical staff through outdated and harmful educational practices.

Patients have the right to be treated by trained health professionals in a supportive and psychologically safe environment.

This article is republished from The Conversation under a Creative Commons license. Read the original article.