Respect: An Analysis of Medical Student Narratives Concerning Respect/Disrespect in the Clinical Environment

Respect: An Analysis of Medical Student Narratives Concerning Respect/Disrespect in the Clinical Environment

This month’s journal club was written by Nate Rogers, MS4, with reference to the following article:  Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives by Karnieli-Miller O, Taylor AC, Cottingham AH, et al.

Respect is an aspect of communication that is vital in developing a trustful and a supportive environment, whether in educational, professional, or clinical settings. Widely recognized in society and the medical literature as a requisite characteristic of a good physician, respect has variably been described as:

• Positive attitudes towards the dignity and value of others
• Remaining non-judgmental toward diversity and the uniqueness of others
• Ensuring patient autonomy
• Attention to codes of conduct
• Maintenance of confidentiality and privacy

Disrespectful behavior towards students affects more than the individuals experiencing the disrespect—patients suffer too. Research shows that medical students’ ability to provide respectful care to their patients declines when those students feel abused and belittled. Despite wide recognition of respect as a crucial physician attribute, relatively little research has been performed to clarify the definition and experience of respect in social interactions. The following research by Karnieli-Miller et al. aims to initiate the bridging of this knowledge gap by describing narratives of respect and disrespect experienced by third-year medical students during their internal medicine training. Please consider the following questions for discussion as you review the attached article:

1. As can be seen above, disrespect is quite a broad term with many possible interpretations. List some general examples of disrespectful behavior, whether intended or unintended. Is there a difference between these types of disrespectful behavior? Why or why not?
2. What incidents of disrespect have you witnessed in your medical training? Consider all the different possible interactions in the hospital (e.g., between attending physicians, residents, medical students, nurses, administration, janitorial staff, etc.). What was the outcome of this event?
3. What are examples of times you have been treated with disrespect? How did they make you feel? Do you believe the disrespect was intended? How did you respond? Why?
4. What is an example of a time you may have treated someone else with disrespect? How did it make you feel? Was the disrespect intended? How do you believe it made the other person feel? How did they respond?
5. What are concrete steps you can take to reduce disrespect in the clinical environment and in medical education? Steps you can take to become kinder/more respectful personally? How would you respond to disrespect now, whether as a victim or a bystander?

 References:

1. Karnieli-Miller O, Taylor AC, Cottingham AH, et al. Exploring the Meaning of Respect in Medical Student Education: an Analysis of Student Narratives. J Gen Intern Med. 25(12):1309-14. doi:10.1007/s11606-010-1471-1.
2. Baldwin DC Jr, Daugherty SR, Eckenfels EJ. Student perceptions of mistreatment and harassment during medical school—A survey of ten United States schools. West J Med. 1991;155:140–5.