Letters to the Editor
To the Editor: Leape et al1,2 highlighted the importance of a safe educational environment for medical education, one where learners are protected from harm. That harm may be intellectual, if learners cannot ask questions and express ideas; emotional, if learners are subject to belittlement or humiliation; or cultural, if learners cannot inform their interpersonal interactions and relationships with individual cultural perspectives. Harm may even be physical, if learners are physically intimidated or are subjected to excessive demands, such as long work hours or heavy patient loads.
We believe that safety and respect are two sides of the same coin. The best way to protect our learners is to establish a culture where they are respected intellectually, emotionally, culturally, and physically. The intrinsic value of each individual student should be affirmed. Moreover, affirmation must occur in the context of respect for every individual in the medical education environment—not only physicians but all other health professionals as well—because each individual is unique and has intrinsic value, no matter how different. Similarly, every patient has value and is worthy of respect. We must acknowledge that we are all learners—faculty, residents, and students. As learners we will make mistakes; these are not occasions for shame but are opportunities to learn. To learn from our mistakes, we must be honest and transparent, both with ourselves and our colleagues. Our students must directly experience how it feels to be respected so they can grasp how important it is to ensure their patients and colleagues are treated similarly.
We recommend several interventions to cultivate a culture of respect and safety. One is to introduce an assessment of ethical and professional behavior during the admission process. Also, students should see patients in an interprofessional ambulatory setting from the first weeks of their first year. Inpatient “week on the ward” experiences in the first three months of the first year can help students uncover the “hidden curriculum.” Simultaneously, residents should be enrolled in a project to identify elements of the hidden curriculum in graduate medical education through ongoing, collaborative reflection.
All of us involved in medical education at our institution are implementing the above recommendations and educational strategies. Although we have identified a few principles to guide us, “walking the walk” is a lot tougher. We are committed to holding one another accountable to these principles. We know it won’t be easy, but we believe it is the right thing to do if we are to continue to learn, as well as set the right example for our new colleagues.
James B. Alexander, MD
Associate professor of surgery, Cooper Medical School of Rowan University, Camden, New Jersey; email@example.com.
Vijay Rajput, MD
Professor of medicine, Cooper Medical School of Rowan University, Camden, New Jersey.
Paul Katz, MD
Dean, Cooper Medical School of Rowan University, Camden, New Jersey.
1. Leape LL, Shore MF, Dienstag JL, et al. Perspective: A culture of respect, part 1: The nature and causes of disrespectful behavior by physicians. Acad Med. 2012;87:845–852
2. Leape LL, Shore MF, Dienstag JL, et al. Perspective: A culture of respect, part 2: Creating a culture of respect. Acad Med. 2012;87:853–858