How to change a toxic medical school environment

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Has anybody noticed OP has been MIA since Sunday? 🤔

Maybe his med school got to him!

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Burnett's Law reached in only two pages.
Is this a record?! Yeah, there’s not an eye roll emoji large enough for those of us who actually provide excellent care for a LOT of truly marginalized and indigent people every day. If it seems we have less sympathy for students, it might be in part because we see what actual disability and marginalization look like on a daily basis.

Here’s how the Med student disability play tends to go in my experience:

Successful student matriculates after being academic rockstars in high school and undergrad, with high GPAs and MCAT scores. They’ve had no accommodations needed for the last 8 years of academic success. They get to Med school and the pressure cooker gets to them. They fall behind, struggle, and start showing up on the radar of at risk students. They get evaluated and diagnosed with usually some combination of ADHD, anxiety, depression and sometimes something like dyslexia.

Those who continue to struggle academically start asking for exceptions to the rules rather than accommodations. They want a redo of a test they bombed or a postponement on a test coming up. They want extra time on exams. They want want to split long exams into multiple days. They want to be excused from mandatory activities. And yes, some even want a separate testing room with a precise temperature.

This inevitably gets into some grey areas where schools have to decide what is reasonable. Typically, it’s a very tough argument to say that a previously successful student needs an accommodation they haven’t needed before for a condition they’ve had the entire time. There’s also the logistical issue that giving someone a week longer to student for one exam just puts them a week behind for the next one because their class is moving on regardless. It’s in this context that people are steered toward LOAs to get their new diagnoses under better control before coming back and trying again.

Schools will provide oodles of resources and help, but there’s only so far they can or should bend the rules and the burden of proof is on the student. The curriculum is pretty set as is the timetable for completion, so there’s very little wiggle room.
 
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I'm getting whiplash. On the one hand we have surfingdoc telling us that people are replaceable; that the system we're all buying into, does not care about accommodating people because there are others waiting in line to take peoples' place.

Then on the other hand we have operaman saying that medical schools bend over backward to be nice to students and make sure they succeed.

If the first premise is true, why is it not feasible that the same mentality of residencies/employers has trickled down and is being applied at some (not ALL) schools? Vice versa with accommodating schools integrating their policies upward to residency/jobs?

I think there is middle-ground in both environs that you're both not acknowledging.
 
I'm getting whiplash. On the one hand we have surfingdoc telling us that people are replaceable; that the system we're all buying into, does not care about accommodating people because there are others waiting in line to take peoples' place.

Then on the other hand we have operaman saying that medical schools bend over backward to be nice to students and make sure they succeed.

If the first premise is true, why is it not feasible that the same mentality of residencies/employers has trickled down and is being applied at some (not ALL) schools? Vice versa with accommodating schools integrating their policies upward to residency/jobs?

I think there is middle-ground in both environs that you're both not acknowledging.
I mean, they are accommodating so much as they don't want the student body to create an LCME/ACGME audit and worse yet close the program. The paperwork, the administrative burden and the cost all make those undesirable. Same could be said for hospital systems that require JCAHO/CMS accreditation. What they aren't accommending in are things that will hurt the bottom line and have no ROI. Is there some variation on that? Sure, but not as much as people probably think.

Now, of course, just like I mentioned, the bottom line is that any institution wants a ROI and within the field of academics, this is no less true. Of course, it needs to be collective and the most bang for the buck. If the student body or whoever has a whole thinks doing "X" will improve recruitment, leading to better outcome "Y" which in turn funds endowments (the real money makers for universities), then they will do it. If however, a vocal minority are just complaining about "X" and the ROI is negliable, then won't do it (again, assuming its not breaking federal or accrediting body regulations). There aren't enough details in the original post to say which of those two categories this falls under, but I doubt it's the first one.

And yes, generally speaking, in any job, you are replaceable. There are countless examples in medicine I could give you. I mean, sure if you are some big wig who generates a lot of good PR and thus, a good ROI, then they are willing to bend the rules, but they can only bend them so far. If you aren't a big wig, the leash is much shorter. And yes, I can tell you that from a hiring perspective, for every 1 spot we have for attending positions, there are at least 20-30 unsolicited applications submitted.

If you are looking for a middle ground in that... I mean, I guess there's one.
 
I'm getting whiplash. On the one hand we have surfingdoc telling us that people are replaceable; that the system we're all buying into, does not care about accommodating people because there are others waiting in line to take peoples' place.

Then on the other hand we have operaman saying that medical schools bend over backward to be nice to students and make sure they succeed.

If the first premise is true, why is it not feasible that the same mentality of residencies/employers has trickled down and is being applied at some (not ALL) schools? Vice versa with accommodating schools integrating their policies upward to residency/jobs?

I think there is middle-ground in both environs that you're both not acknowledging.
Well, we DO accomodate people. They just have to be within reason. Providing a room without windows for someone with ADD/ADHD is a valid request. Having a room at a precise temperature is not. Asking for a retest for a failed exam is not. Asking for extra credit is just pure pre-med thinking. (Note, these are real life examples at my school and others).

Note that OP has disappeared and was extremely nebulous about their complaints, other than to constantly gravitate back to hiding behind "how dare you make fun of disabled people!". Personally, I was getting a whiff of someone who was paranoid, rather than trolling.
 
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Of course, it needs to be collective and the most bang for the buck. If the student body or whoever has a whole thinks doing "X" will improve recruitment, leading to better outcome "Y" which in turn funds endowments (the real money makers for universities), then they will do it. If however, a vocal minority are just complaining about "X" and the ROI is negliable, then won't do it (again, assuming its not breaking federal or accrediting body regulations).
How should we go about turning the vocal minority into the vocal majority when the vocal minority keep getting railed against by people who either
1. don't care and are content sitting back and letting the minority get screwed/beat themselves against the wall a la:
You want to rise up against the system... have at it. I'll cheer you on... whilst making sure my 401 K and kids future from a college standpoint is secured. You go though... I'll get my gin and juice...

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or 2. even worse, actively decry any possibility that abuse could be happening without even knowing the full details of the situation. I.E.

1) if a student has a chronic illness that is so bad it precludes them from scheduling routine appointments around their academic responsibilities, they need to consider a LOA. A doctors appointment is not carte Blanche to miss mandatory activities.

2) the school is under no obligation to indulge anyone’s religious beliefs. Most will work with students as best they can, but there is no world in which you can look at 7-10 years of medical educations and expect no conflicts with religious observance. In reality, the only times I’ve ever seen this be a problem are when students wait til the last minute to ask for time off. The responsible ones are emailing admin months in advance and adjusting their schedules as needed and have no problems at all.

3) why on earth would a school postpone a test date because a family member is sick or having surgery? They frequently offer a LOA if things are bad and nearly always make exceptions for emergencies. If something is planned enough in advance that there’s time to ask for a postponement, it probably doesn’t merit a postponement. Life happens while you’re in training or in practice.

4) medical schools have no obligation to treat a student’s illness. That’s between them and their physicians. Students are adult professionals and are perfectly capable of reaching out to admin on their own

5) based on the other examples, I’m going to guess that the accommodations requested were a stretch. Schools are required to make reasonable accommodations, but I’m willing to bet the requested accommodations were not only unreasonable, but stretched the limits of credulity to the point it was actually funny enough to be a punchline.

I have to say, based on what I’m hearing so far your school is being quite reasonable. These forums are littered with stories like yours of big bad schools and training programs that end up looking extremely reasonable once all the facts are known.


You've both just shown that anyone seeking any kind of advice about changing the status quo will be met with derision or disbelief. Your attitudes are not conducive to delineating whether this was a legitimate situation where reporting was necessary or if it was just smoke.


OP asked how we go about changing the toxic med school environment. Let's start with first not actively discouraging those who are trying to speak up, or telling them that its futile and you'll do nothing to help.
 
How should we go about turning the vocal minority into the vocal majority when the vocal minority keep getting railed against by people who either
1. don't care and are content sitting back and letting the minority get screwed/beat themselves against the wall a la:


or 2. even worse, actively decry any possibility that abuse could be happening without even knowing the full details of the situation. I.E.




You've both just shown that anyone seeking any kind of advice about changing the status quo will be met with derision or disbelief. Your attitudes are not conducive to delineating whether this was a legitimate situation where reporting was necessary or if it was just smoke.


OP asked how we go about changing the toxic med school environment. Let's start with first not actively discouraging those who are trying to speak up, or telling them that its futile and you'll do nothing to help.
Well the full details weren't offered, so not much can be said about that. I previously linked the LCME reporting website to the OP if they were interested, but who knows.

And it's relatively easy to convert the vocal minority to the vocal majority, assuming the majority see it as a problem to (or can at least be persuaded to). If the majority can't be persuaded, well then... you're out of luck and by continuing to be a vocal minority, you end up making less friends and more enemies. I can't imagine any scenario where that leads to a wanted or desirable outcome. Again, thinking back to the times there was a vocal minority in our program... all they did was poison the well to the point when that person needed career help later on, no one wanted to help and were instead like "sorry".

As far as to the original discussion, I guess if people are okay with stirring the pot and the consequences be damned... so be it. I have just never seen that work out well. I'm just trying to suggest that falling on ones own sword isn't usually the best idea... but who's to stop them if that is their desired path. Not me.
 
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Well the full details weren't offered, so not much can be said about that. I previously linked the LCME reporting website to the OP if they were interested, but who knows.

And it's relatively easy to convert the vocal minority to the vocal majority, assuming the majority see it as a problem to (or can at least be persuaded to). If the majority can't be persuaded, well then... you're out of luck and by continuing to be a vocal minority, you end up making less friends and more enemies. I can't imagine any scenario where that leads to a wanted or desirable outcome. Again, thinking back to the times there was a vocal minority in our program... all they did was poison the well to the point when that person needed career help later on, no one wanted to help and were instead like "sorry".

As far as to the original discussion, I guess if people are okay with stirring the pot and the consequences be damned... so be it. I have just never seen that work out well. I'm just trying to suggest that falling on one own sword isn't usually the best idea... but who's to stop them if that is their desired path.
Fully agree with you here, if someone is making a stink just to make a stink or an unwarranted stink, let that stench follow them.

That being said its their prerogative to do so, and I appreciated you giving OP those resources to do with as they see fit. Thats really all that needed to be done in this thread instead of the judgment and all that ensued.
 
Fully agree with you here, if someone is making a stink just to make a stink or an unwarranted stink, let that stench follow them.

That being said its their prerogative to do so, and I appreciated you giving OP those resources to do with as they see fit. Thats really all that needed to be done in this thread instead of the judgment and all that ensued.
I certainly can't judge the OPs issues without knowing them. Even so, I doubt a online forum would give the actual breath and scope of the problem.

But I don't think its fair to be dishonest with people either seeking advice that somehow 1) there is some easy path forward and 2) the grass is always greener. That tone is pretty much the summation of my posts in this thread, more or less, a majority of which weren't directed at the OP but more of a general FYI. Some people just have unrealistic expectations sometimes and it doesn't do anyone any good to reinforce them.
 
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