“You have it so much better than we did; you have strict work hours, you report ‘abuse’ if an attending screams at you, and you are becoming unionized. I wonder if you will be trained well enough to be out on your own with all of these cushions now implemented in residency.”
This was a statement I overheard an attending tell his resident as I was seeing a patient in the adjacent ER bay.
I was crushed by this statement, but not surprised. I lost one of my best friends to suicide while we were in residency. He was in a very competitive general surgery residency, working over 100 hours a week despite work-hour restrictions.
He told me that it was normal for his attending surgeons to throw tools at interns and surgical scrub techs in the operating room, and “pimp” out residents on rounds (meaning, ask them difficult questions in hopes they would not be able to answer in front of the rounding group). He said attendings and upper-level residents would berate him weekly, and eventually, he couldn’t take any more of this emotional or mental abuse.
The practice of academic hazing
Resident abuse, or “academic hazing,” as they call it, is an insidious toxic practice within academic medicine that is still alive and well today.
The good 'ol boys club lurks in the hallways during rounds and shows up in the OR, hoping to overwork and exploit residents to see if they will break. Residents are human, and therefore, they do break.
Unfortunately, this academic hazing culture would have you believe that you must be “resilient” and overcome the hurdles of 24-hour calls, depression, burnout, and exploitation if you want to become a competent doctor. Mantras such as “sleep and wellness are for the weak” often make residents feel they need to work harder to be accepted as good enough.Related: Coping with bullying during residency
The link between academic hazing and suicide
According to a study in Academic Medicine, suicide is the second leading cause of death among physicians in training, followed by cancer. “Between 2000 and 2014, 324 individuals (220 men, 104 women) died while in residency. The leading cause of death was neoplastic disease, followed by suicide, accidents, and other diseases.
As just one recent occurrence, InsideTheMatch released a heartbreaking statement on Twitter about a recent resident physician suicide:
TW: Suicide. A #NYC resident died by suicide this past week. Our thoughts are with the family, friends, and colleagues of Dr. Nakita Mortimer, who was an Anesthesia Resident. We must do a better job caring for medical trainees and discussing their mental health. cc: @drjessigold— Inside The Match (@Inside_TheMatch) June 1, 2023
'Pimping' on rounds
Pimping is one common form of academic hazing used on rounds or in the operating room, and its practice is discussed in an article published by Academic Medicine.
Although it needs to be better-defined in medical literature, anyone who has gone through medical school or residency is well aware of this term. It is a form of questioning of junior-level colleagues by a person in power to affirm the hierarchical order.
Of course, there is always a hierarchical order in medical education. These questions usually start with the lowest person on the totem pole, medical students, and move up the chain to interns, residents, and chief residents, but they may start with the person in power and move down the chain. For example, if a medical school student answers correctly after the chief resident answers incorrectly, the goal of humiliation is deemed successful.
"In its worst form, pimping uses the power of status to embarrass and humiliate the learner in a group environment."
— Authors, Academic Medicine
"At its foundation, the goal of pimping is evaluative," wrote the authors of the Academic Medicine article. "Who knows the answer? Who doesn’t? But answering questions becomes a competition among peers, and, to the student, learning may appear secondary to the social dynamic invoked through the questioning.”
Taking a stance
I believe academic hazing is not as prevalent or as bad as it was, say, 20 or 30 years ago, but it still exists, and residents still suffer because of it.
Yes, we talk more about our mental health, burnout, wellness, and therapy, and thankfully, we are breaking down the stigma associated with mental illness and burnout among physicians. But many of us still suffer immensely. Academic hazing is still alive and well, and as attending physicians and educators, we must foster an environment of wellness for our residents, medical students, and ourselves.
We can do this by speaking out, addressing academic hazing when we see it happening, asking how our residents and medical school students are doing, and supporting our colleagues who engage in self-care, therapy, and wellness initiatives.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.