UCLA Journal of Radiation Oncology FALL 2023 - Flipbook - Page 31
UCLA RADIATION ONCOLOGY JOURNAL
Through 2012, the most common mistreatment
reported was public humiliation, with 34% of
students that year saying they had felt publicly
humiliated at least once during training. 1
explanation behind why we hear about hardship
in medicine more frequently these days. 5 I see
value in discussing hardship, in acknowledging
failures, large and small.
Seems pretty high, right?
Here’s another entry in my encyclopedia of
shame: It was a typical fall morning. I was a
fresh-faced radiation oncology resident on
my first prostate service—a busy service with
many patients to see. Before clinic, we had
lecture, delivered remotely via Zoom owing
to COVID-19 restrictions. I was at my desk,
logged into the lecture but with my attention
firmly directed elsewhere, toward preparing for
a packed day of clinic.
Perhaps the AAMC thought so too, because
in 2013, they added a new category: public
embarrassment. They explained that the term
humiliation “may have been more inclusive
than intended,” 2 so by differentiating between
humiliation and embarrassment, they could
tease out true mistreatment from run-of-themill egg on the face.
Lo and behold, the 2013 questionnaire showed
the desired effect: students reported a high
rate of public embarrassment at 47%, but the
proportion disclosing public humiliation fell to
23%. Since then, embarrassment has been the
most prevalent behavior reported—hovering just
above 40% for each of the past 5 years (20172021)—but the AAMC specifically does not
count it as mistreatment, unlike humiliation. 3
“Matt,” the lecturer said, his words registering
with me for the first time. “Can you identify this
structure?”
I was surprised. Except in specific lectures, we
were not typically asked questions. I quickly
located the Zoom window buried beneath my
other work. The entire department was listening,
faculty included.
There is an obvious distinction—humiliation
is purposeful and embarrassment is not. 4 The
former results when there is negative intent
from an outside source, and the latter comes
from within, when you fall short of your
own expectations (though the sting is greater
when people are watching). But even if public
embarrassment doesn’t qualify as mistreatment,
I wouldn’t want it to be disregarded entirely, and
I am glad the AAMC collects data on it.
On the screen was an axial slice of the pelvis
from a T2-weighted magnetic resonance image.
I could see the bladder and rectum, the femoral
heads and obturator internus muscles. The
cursor was pointed at a round structure between
the bladder and rectum. Thank goodness. Being
on the prostate service, I knew the answer.
I haven’t experienced abuse in my training. I
made it through medical school without serious
trauma—something I wish all trainees could
say—and I am in a healthy residency program.
I have supportive friends and family. I’m lucky.
Then why am I being so sensitive? Am I just
another coddled millennial? Maybe, though the
“whiny child” hypothesis is likely not the whole
“Not even close,” the lecturer said. “It’s the
cervix.”
“The prostate,” I said confidently.
There was a pause. Some laughter.
Turns out, this was a lecture on cervical cancer,
and I had just identified the prostate on a female
patient with squamous cell carcinoma of the
cervix.
That one was not easy to live down.
Again, I don’t want to trivialize more scarring
experiences in medicine, when someone in
power behaves badly and causes harm. But when
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