Belittlement and harassment of medical students

Editor—Until recently I would have disagreed with Aref-Adib,¹ but now I am inclined to agree. Last summer I was involved in the production of a BBC programme Thoroughly Modern Medic, in which six third year medical students were subjected to a week of 1950s' style ward based teaching. In essence, we subjected them to a traditional regime of education by humiliation in which, although to some extent artificially staged for the TV cameras, the action was unscripted and was treated seriously by all concerned.

At the outset, the students had a good grasp of the basic skills required to take a history and examine a patient, but most of them struggled to place the information gathered into any sort of diagnostic framework. After a week of being put on the spot and being forced to face up to the shortcomings of their thought processes, their approach to the task was dramatically transformed, being able to present the information clearly and systematically and arrive at a rational and justifiable differential diagnosis.

Having kept in contact with several of the students since filming was completed, they confirmed that the experience had been carried over into their normal practice and had proved beneficial to them in their fourth year of learning. In at least one case, the result was a significant improvement in performance, demonstrated by a rise from consistently being in the bottom fourth of examination results to becoming one of the higher performers.

When I was at medical school, I dreaded the ward round as I knew that I would be made to appear a fool, but maybe it was my desire to avoid that fate that ultimately made me a better doctor.