Medical student mistreatment: understanding ‘public humiliation’

Introduction: Mistreatment in medical school is an enduring problem in medical education. Little is known about the concept of ‘public humiliation,’ one of the most common forms of mistreatment as identified on the AAMC Graduation Questionnaire. The objective of this study was to further investigate ‘public humiliation’ and to understand the underpinnings and realities of ‘public humiliation’ in medical education. Method: Focus groups of medical students on clinical rotation at the University of Washington School of Medicine were conducted over one and a half years. Qualitative analysis of responses identified emergent themes. Results: Study results included responses from 28 third year and one fourth-year medical student obtained over five different focus groups. Participants defined the term ‘public humiliation’ as negatively, purposefully induced embarrassment. Risk factors for the experience of public humiliation in educational settings were found to include the perceived intent and tone of the teacher, as well as situations being ‘public’ to patients and taking place during a medical or surgical procedure. Socratic teaching or ‘pimping’ was not found to be a risk factor as long as learners were properly oriented to the teaching practice. Discussion: This study investigated and defined ‘public humiliation’ in the setting of medical student mistreatment. More subtle forms of mistreatment, like public humiliation, may be amenable to interventions focused on teaching educators about the importance of orientation and clear communication of intent during the teaching process.