藤兒點評：要了解美國醫學院無處不在的霸凌文化（The Bullying Culture）傳統歷史，還是從原汁原味的美國文化開始吧。也就是說，先看看那些處於這種霸凌文化（The Bullying Culture）漩渦中心的各色人等是贊同或反對這一美國醫學院的霸凌文化（The Bullying Culture）傳統。
否則，就會是隔靴搔癢！
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來源：紐約時報 2013-11-19
天下烏鴉一般黑 要當美國醫生 從被欺負開始
孔武有力的身形，拳擊手的面孔，每當他走進醫院，便會投下一道令人膽戰心寒的陰影。
至少，這是我和我的醫學院同學們當年對那位比我們只高出幾屆的住院醫生的看法。
回首前塵，我現在意識到，那個年輕人是個時刻把病人狀況放在心上的大有作為的好醫生。可是他的
那股子火爆脾氣，實在讓醫學院的學生把與其共事當成一場噩夢。我的無數同學被他罵作“蠢貨”、“廢物”。他可以在大庭廣眾之下毫無徵兆地突然沖人發作。我
們一個個恍如受驚的小白鼠，將如此折磨當成醫學專業訓練不可避免的一部分，生怕稍有異議便會招來差評或低分，令自己的事業毀於一旦。
然而，突然有一天，我的一個屢次成為這位醫生痛斥對象的同學終於忍不住回嘴了。她當着其他醫學小組成員的面，對他的結論加以質疑，要求他給出解釋。當他開始沖她大叫大嚷的時候，她也以尖叫回應。
我們全都被這件事嚇壞了。在接下來的幾個星期里，我們一方面讚嘆着她的勇氣，另一方面惴惴不安，覺得她的前途一準兒完蛋了。但這一事件中的某個細節令
我們更加困惑。一個目睹了這場“尖叫對決”的同學這樣描述當時的情形：向那位醫生發出挑戰時，我們的這位女同學提高了聲線，擺出一副戰鬥準備就緒的姿勢。
“太奇怪了，”他回憶道，“就好像眼看着她變身為那個醫生一樣。”
Odilon Dimier/PhotoAlto via Getty Images
30多年來，從事醫學教學的人均已深知，想要成為一名醫生，你不僅要通過不計其數的標準化考試、捱過沒完沒了的病房值班、經歷過年復一年的醫學培訓。對於許多醫學院學生來說，言語和肉體上的凌辱也是這令人精疲力竭的旅程中的一部分。
終於，一位在被虐待兒童研究領域做出開創性貢獻的兒科學家第一個注意到這一問題的存在。此前的多項研究發現，醫學院學生遭受凌辱的問題在第三學年最為
嚴重。在這一年裡，學生們開始與醫院中的資深醫生和住院醫以一對一或是小團隊的形式合作。第一批調查結果顯示，高達85%的學生認為在第三學年中遭受過凌
辱。具體情況包括被大聲呵斥，罵為“窩囊廢”或是“最蠢的醫學院學生”，以低分或不及格相威脅，甚至被打、被推，或是成為飛擲而來的醫療器械的攻擊對象。
儘管如此，許多研究者仍認為，如果所有醫學院都承認這一情況確實存在，凌辱是可以被消除，或者是起碼可以被顯著減少的。制定基本的反騷擾政策，成立申訴委員會，開展教育、培訓和諮詢項目，都有助於打破凌辱的惡性循環。
一所醫學院率先做出改變。從1995年開始，加州大學洛杉磯分校大衛·格芬醫學院(David Geffen School of
Medicine)着手實行了一系列全校範圍的改革。該所醫學院批准通過了旨在減少凌辱學生事件和強化預防的政策，成立了性別歧視及權力濫用委員會，將相
關講座、研討會和培訓課程列為學生、住院醫和教職人員的必選科目，並設立了一個專門接收匿名報告的辦公室，對相關指控加以調查和處理。
為了評估這些創舉的有效性，該所醫學院還對所有即將結束第三學年學習的學生進行問卷調查。問卷包含5個問題，圍繞學生是否覺得曾在這一年中被凌辱而展開。
該所醫學院剛剛發表了一項發人深省的研究結果。跨越13年的調查結果顯示，儘管提出相關指控的學生人數總體上有所下降，但仍有半數以上的醫學院學生表示，他們曾經被威脅或是被騷擾——無論是肢體上還是言語上。
據學生們反映，他們曾經被厲聲呵斥、推來搡去並出言威脅。一名學生回憶道，一名資深醫生一邊打他的手板一邊說，“教都教不會你，總打得會吧。”一些學
生提及種族歧視的存在，描述那些資深的教員如何發怪聲，模仿外國口音。還有一些學生表示曾被“吃豆腐”及強迫約會，或是因為性別而備受冷落。
“看到這些結果時，我們都啞口無言，”該論文的主要作者、大衛·格芬醫學院性別歧視及權力濫用委員會主席兼副會長喬伊斯·M·弗萊德(Joyce M. Fried)如是說，“我們都為積習難改而深感失望。”
加州大學洛杉磯分校的問題並非個案。事實上，全美醫學教育調查中，也涉及了有關凌辱學生的問題，結果顯示，情況差不多是天下烏鴉一般黑。同一屆學生所
反映出來的個人經歷的驚人相似程度，更表明這不是某一所醫學院的問題，而與整個醫學教育培訓的傳統及體制問題相關。弗萊德說，“這是一個全國性的問題。我
們學校的教職人員和住院醫生來自全美各地，他們中的一些人就曾在其他醫學院受到過凌辱。”
儘管調查結果令人沮喪，弗萊德女士及其同事仍舊相信，對醫學院學生的凌辱可以得到顯著控制——前提是所有的醫學院聯起手來，共同解決這個問題。“移風
易俗是件相當困難的事，而且需要全國性行動，”弗萊德女士說。這些行動包括設立合作培訓項目，制定有關凌辱學生的政策規範，以及增加對現有各醫學院凌辱學
生事件的透明度等等。
“醫學界好人眾多，也不乏道德楷模，”弗萊德女士說，“但這麼多年來，對凌辱學生事件置若罔聞而不發一言的確已經成為一種風氣。”
“這種做法一直都是不對的，現在更不應該繼續得到縱容，”她補充說。
作者PAULINE W. CHEN, M.D.2013年11月20日。本文最初發表於2012年8月10日。 翻譯：倚櫓
（續......）
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來源：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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