To the Editor:
Caruso Brown1 acknowledges the important role discomfort plays in fostering humility within medicine. However, we do not believe there is a threatened loss of humility in medicine and we fear potential confusion between the innate discomfort of learning and practicing medicine and something more serious—medical student humiliation.
It is important to identify what is meant by discomfort. On one hand, there is the discomfort felt in an unfamiliar situation, illustrated when Caruso Brown visited a Kenyan children’s hospital. This discomfort, from an internal source, stems from uncertainty and self-doubt, which is all too familiar to students. As medical students ourselves, we recognize the internal embarrassment of identifying a gap in our knowledge.2 With an overwhelming wealth of information to learn, medical students are burdened by fear of failure, worrying that their knowledge will never be enough. In reality, medicine is a career of lifelong learning and patients rarely present as “textbook” cases. Clinicians are frequently challenged by the discomfort of unfamiliar situations in which they do not know the answers. This form of discomfort in itself promotes a humility that is inherent within medicine.
However, there is a fine line between this internal discomfort and the intentional discomfort created by teachers, which may be regarded as humiliation.2 Worse still is public humiliation, when teachers actively criticize students in front of other students, patients, or clinicians. This merely highlights a lack of knowledge, rather than utilizing the potential learning opportunity. While effective in the short term, research shows that scaring students into studying can lead to students missing teaching sessions, reduced motivation and self-esteem, burnout, psychiatric issues, and career change.3
Medical students are extremely impressionable; teachers are not only responsible for imparting their medical knowledge but also for acting as role models, shaping the types of doctors these students will become. Thus far, this power imbalance has perpetuated a vicious cycle of mistreatment and humiliation, which will only be interrupted by acknowledgment of the issue and evolution of new teaching styles. We must not reject the pursuit of a healthier teaching culture for fear of a loss of humility.
Fifth-year student, GKT School of Medical Education, King’s College London, London, United Kingdom; firstname.lastname@example.org.
Fourth-year student, GKT School of Medical Education, King’s College London, London, United Kingdom.
Third-year student, Barts and The London School of Medicine and Dentistry, London, United Kingdom.
1. Caruso Brown AE. Embracing discomfort on the path to humility. Acad Med. 2019;94:795.
2. Markman JD, Soeprono TM, Combs HL, Cosgrove EM. Medical student mistreatment: Understanding ‘public humiliation.’ Med Educ Online. 2019;24:1615367.
3. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: Causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80:1613–1622.