藤儿点评：要了解美国医学院无处不在的霸凌文化（The Bullying Culture）传统历史，还是从原汁原味的美国文化开始吧。也就是说，先看看那些处于这种霸凌文化（The Bullying Culture）漩涡中心的各色人等是赞同或反对这一美国医学院的霸凌文化（The Bullying Culture）传统。
否则，就会是隔靴搔痒！
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来源：纽约时报 2013-11-19
天下乌鸦一般黑 要当美国医生 从被欺负开始
孔武有力的身形，拳击手的面孔，每当他走进医院，便会投下一道令人胆战心寒的阴影。
至少，这是我和我的医学院同学们当年对那位比我们只高出几届的住院医生的看法。
回首前尘，我现在意识到，那个年轻人是个时刻把病人状况放在心上的大有作为的好医生。可是他的
那股子火爆脾气，实在让医学院的学生把与其共事当成一场噩梦。我的无数同学被他骂作“蠢货”、“废物”。他可以在大庭广众之下毫无征兆地突然冲人发作。我
们一个个恍如受惊的小白鼠，将如此折磨当成医学专业训练不可避免的一部分，生怕稍有异议便会招来差评或低分，令自己的事业毁于一旦。
然而，突然有一天，我的一个屡次成为这位医生痛斥对象的同学终于忍不住回嘴了。她当着其他医学小组成员的面，对他的结论加以质疑，要求他给出解释。当他开始冲她大叫大嚷的时候，她也以尖叫回应。
我们全都被这件事吓坏了。在接下来的几个星期里，我们一方面赞叹着她的勇气，另一方面惴惴不安，觉得她的前途一准儿完蛋了。但这一事件中的某个细节令
我们更加困惑。一个目睹了这场“尖叫对决”的同学这样描述当时的情形：向那位医生发出挑战时，我们的这位女同学提高了声线，摆出一副战斗准备就绪的姿势。
“太奇怪了，”他回忆道，“就好像眼看着她变身为那个医生一样。”
Odilon Dimier/PhotoAlto via Getty Images
30多年来，从事医学教学的人均已深知，想要成为一名医生，你不仅要通过不计其数的标准化考试、捱过没完没了的病房值班、经历过年复一年的医学培训。对于许多医学院学生来说，言语和肉体上的凌辱也是这令人精疲力竭的旅程中的一部分。
终于，一位在被虐待儿童研究领域做出开创性贡献的儿科学家第一个注意到这一问题的存在。此前的多项研究发现，医学院学生遭受凌辱的问题在第三学年最为
严重。在这一年里，学生们开始与医院中的资深医生和住院医以一对一或是小团队的形式合作。第一批调查结果显示，高达85%的学生认为在第三学年中遭受过凌
辱。具体情况包括被大声呵斥，骂为“窝囊废”或是“最蠢的医学院学生”，以低分或不及格相威胁，甚至被打、被推，或是成为飞掷而来的医疗器械的攻击对象。
尽管如此，许多研究者仍认为，如果所有医学院都承认这一情况确实存在，凌辱是可以被消除，或者是起码可以被显著减少的。制定基本的反骚扰政策，成立申诉委员会，开展教育、培训和咨询项目，都有助于打破凌辱的恶性循环。
一所医学院率先做出改变。从1995年开始，加州大学洛杉矶分校大卫·格芬医学院(David Geffen School of
Medicine)着手实行了一系列全校范围的改革。该所医学院批准通过了旨在减少凌辱学生事件和强化预防的政策，成立了性别歧视及权力滥用委员会，将相
关讲座、研讨会和培训课程列为学生、住院医和教职人员的必选科目，并设立了一个专门接收匿名报告的办公室，对相关指控加以调查和处理。
为了评估这些创举的有效性，该所医学院还对所有即将结束第三学年学习的学生进行问卷调查。问卷包含5个问题，围绕学生是否觉得曾在这一年中被凌辱而展开。
该所医学院刚刚发表了一项发人深省的研究结果。跨越13年的调查结果显示，尽管提出相关指控的学生人数总体上有所下降，但仍有半数以上的医学院学生表示，他们曾经被威胁或是被骚扰——无论是肢体上还是言语上。
据学生们反映，他们曾经被厉声呵斥、推来搡去并出言威胁。一名学生回忆道，一名资深医生一边打他的手板一边说，“教都教不会你，总打得会吧。”一些学
生提及种族歧视的存在，描述那些资深的教员如何发怪声，模仿外国口音。还有一些学生表示曾被“吃豆腐”及强迫约会，或是因为性别而备受冷落。
“看到这些结果时，我们都哑口无言，”该论文的主要作者、大卫·格芬医学院性别歧视及权力滥用委员会主席兼副会长乔伊斯·M·弗莱德(Joyce M. Fried)如是说，“我们都为积习难改而深感失望。”
加州大学洛杉矶分校的问题并非个案。事实上，全美医学教育调查中，也涉及了有关凌辱学生的问题，结果显示，情况差不多是天下乌鸦一般黑。同一届学生所
反映出来的个人经历的惊人相似程度，更表明这不是某一所医学院的问题，而与整个医学教育培训的传统及体制问题相关。弗莱德说，“这是一个全国性的问题。我
们学校的教职人员和住院医生来自全美各地，他们中的一些人就曾在其他医学院受到过凌辱。”
尽管调查结果令人沮丧，弗莱德女士及其同事仍旧相信，对医学院学生的凌辱可以得到显著控制——前提是所有的医学院联起手来，共同解决这个问题。“移风
易俗是件相当困难的事，而且需要全国性行动，”弗莱德女士说。这些行动包括设立合作培训项目，制定有关凌辱学生的政策规范，以及增加对现有各医学院凌辱学
生事件的透明度等等。
“医学界好人众多，也不乏道德楷模，”弗莱德女士说，“但这么多年来，对凌辱学生事件置若罔闻而不发一言的确已经成为一种风气。”
“这种做法一直都是不对的，现在更不应该继续得到纵容，”她补充说。
作者PAULINE W. CHEN, M.D.2013年11月20日。本文最初发表于2012年8月10日。 翻译：倚橹
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来源：http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/?_r=0
 Odilon Dimier/PhotoAlto via Getty Images
Powerfully built and with the face of a boxer, he cast a bone-chilling shadow wherever he went in the hospital.
At least that is what my medical school classmates and I thought
whenever we passed by a certain resident, or doctor-in-training, just a
few years older than we were.
Dr. Pauline Chen on medical care.
With the wisdom of hindsight, I now see that the young man was a
brilliant and promising young doctor who took his patients’ conditions
to heart but who also possessed a temper so explosive that medical
students dreaded working with him. He had called various classmates
“stupid” and “useless” and could erupt with little warning in the middle
of hospital halls. Like frightened little mice, we endured the
treatment as an inevitable part of medical training, fearful that doing
otherwise could result in a career-destroying evaluation or grade.
But one day, one of our classmates, having already been on the
receiving end of several of this doctor’s tirades, shouted back. She
questioned one of his conclusions in front of the rest of the medical
team, insisted on getting an explanation, then screamed back when he
started yelling at her.
The entire episode unnerved us all; and over the next few weeks, we
marveled at her courage and fretted over her potentially ruined career
prospects. But there was one aspect of the event that disturbed us even
more. One classmate who had witnessed the “screaming match” described
how our fellow medical student had raised her voice and positioned her
body as she threatened the doctor. “It was weird,” he recounted. “It was
like watching her turn into him.”
For 30 years, medical educators have known that becoming a doctor
requires more than an endless array of standardized exams, long hours on
the wards and years spent in training. For many medical students,
verbal and physical harassment and intimidation are part of the
exhausting process, too.
It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital. The first surveys found that as many as 85 percent of students felt they had been abused during
their third year. They described mistreatment that ranged from being
yelled at and told they were “worthless” or “the stupidest medical
student,” to being threatened with bad grades or a ruined career and
even getting hit, pushed or made the target of a thrown medical tool.
Nonetheless, many of these researchers believed that such
mistreatment could be eliminated, or at least significantly mitigated,
if each medical school acknowledged the behavior, then created
institutional anti-harassment policies, grievance committees and
educational, training and counseling programs to break the abuse cycle.
One medical school became a leader in adopting such changes. Starting in 1995, educators at the David Geffen School of Medicine at the University of
California, Los Angeles, began instituting a series of schoolwide
reforms. They adopted policies to reduce abuse and promote prevention;
established a Gender and Power Abuse Committee, mandated lectures,
workshops and training sessions for students, residents and faculty
members; and created an office to accept confidential reports,
investigate and then address allegations of mistreatment.
To gauge the effectiveness of these initiatives, the school also
began asking all students at the end of their third year to complete a
five-question survey on whether they felt they had been mistreated over
the course of the year.
The school has just published the sobering results of the surveys over the last 13 years. While there appears to have been
a slight drop in the numbers of students who report experiencing
mistreatment, more than half of all medical students still said that
they had been intimidated or physically or verbally harassed.
Students described being yelled at, pushed and threatened. One
student recounted being slapped on the hand by a more senior doctor who
said, “If teaching doesn’t help you learn, then pain will.” Some
students wrote about racial insults, with senior staff members making
noises to mimic a foreign language; others reported being grabbed, asked
out on a date or passed over because of their sex.
“We were really crushed when we saw the results,” said Joyce M.
Fried, lead author of the paper and assistant dean and chairwoman of the
Gender and Power Abuse Committee at the medical school. “We were
disappointed that it was so difficult to change.”
U.C.L.A.’s experience is not isolated. In fact, national medical education surveys that include questions about mistreatment indicate that the environment
at that school is about average. And the striking similarity of
experiences across a generation of students suggests problems not just
with one institution, but with the culture of medical training itself.
“This is a national problem,” Ms. Fried said. “Our faculty and
doctors-in-training come from all over, including schools where some of
them might have been mistreated.”
While their findings are disheartening, Ms. Fried and her colleagues
continue to believe that medical student mistreatment can be
significantly reduced — but only if all medical schools come together to
work on the issue. “We’re talking about the really hard task of
changing a culture, and that has to be done on a national level,” Ms.
Fried said. Such an effort would include shared training programs,
common policies regarding mistreatment and greater transparency about
the mistreatment that currently exists in medical schools.
“There are a lot of really good people and role models out there,”
Ms. Fried said. “But the culture for all these years has been to just
take the mistreatment and not say anything.”
“It wasn’t right back then, and it shouldn’t be tolerated anymore,” she added.
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