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How Can We Eliminate the Abuse of Power in Medical Training?

The hierarchy in medicine can spawn tensions between residents, physicians, and patients. Mistreatment is common throughout clinical training, and there are limited standards for preventing abuse. However, in 2000, Yale University initiated an annual Power Day for third-year medical students and advanced nursing students to assess and create solutions for the problems that arise from power dynamics. As a result, departments have implemented measures for cultivating a culture that fosters more collaboration and positive role modeling.

Residents and medical students have long grappled with mistreatment during their training programs. A 1990 study found that 85 percent of students experienced abuse during their third year, and over a third of students surveyed said they considered dropping out of medical school because of rampant unprofessional behavior.

Some schools like the University of California Los Angeles have responded by developing programs to spread awareness of abuse and policies to evaluate and investigate mistreatment allegations. At Yale’s Power Day, students get together in small groups and discuss incidents where they felt “mute” and “complicit.” They provide “advice, support, and professional identity formation.” Power Day has also encouraged faculty to be more transparent about their role in the medical school hierarchy. In 2005, students honored residents who “used power positively” with Power Day awards. In 2010, OB/GYN, surgery, psychiatry, and pediatric departments started hosting weekly Power Hour discussions.

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