All four students interviewed said hierarchy was problematic and created barriers to reporting mistreatment. Photo / 123rf
Sam* recalls the incident vividly.
Being told indirectly that, unless you're a white man, no one is going to want your sperm is not something you forget.
But medical students say racist slurs, social exclusion, gender discrimination and inappropriate jibes from their superiors are a common experience and it highlights the need for urgent changes in the industry.
Sam, a fifth-year medical student, who is a person of colour, says bullying is "endemic" in medicine, especially if you are not white.
He has been subject to a number of slurs, including one incident a few weeks ago involving a midwife in the IVF ward of a Sydney hospital.
The student was in the room when a group of nurses were discussing a female patient who had requested an Asian sperm donor.
"[The midwife] said, 'I don't understand why you wouldn't want to use Caucasian sperm'," Sam explained.
And Sam's not alone. Many of his peers have also endured deeply unpleasant experiences.
Another fifth-year student, Tim*, said he benefited from being a white man in the medical industry and wanted to do more to help his international colleagues.
"It's difficult to report because a lot of this stuff toes the line. It's not like someone has slapped you across the face; it's usually much less obvious," Tim said.
One example he gave involved a teacher who was very particular about students arriving to class on time, and wouldn't let them in if they were late.
"One day I arrived a few minutes late and he said, 'Don't worry, come in and sit down.' But a student from an Indian background arrived straight after me and he wouldn't let him in," Tim explained.
"Then I noticed it was a repetitive thing. He'd let the Caucasian students in, but not the international students. It's just not good enough."
From belittling, to sexist comments and favouring male colleagues, sexism in medicine has also been allowed to flourish.
One female medical students told NCA NewsWire she was placed in a male-dominated team that made jokes about women being in surgery.
"They would say, 'Why are you here? You need a family-friendly career,'" the student said.
"I couldn't report it because I was the only female student in there and it would have been obvious that it was me."
A second female student said while her experiences had been good, everyone assumed she was a nurse, not a doctor.
"Most of my teachers always refer to doctors being a 'he' and nurses being a 'she'," the student explained.
Sam supported those comments, saying when he entered a theatre no one asked any questions, but when females did they were queried.
All four students described being ignored or hounded in front of patients or fellow staff.
When Tim spent time as part of a neurosurgery team, he should have done ward rounds and accompanied seniors into surgery. Instead, he was ignored.
"When they found out I was a student and not doctor, they wouldn't even acknowledge me or say hello. This continued the entire time," he said.
"For the majority of that term, it wasn't what they were saying; it was them not saying anything."
And when they were speaking, they often spent it belittling the Sydney student.
He said things escalated when he noticed a patient wasn't responding to questions and failed to open her eyes, or move her hands.
"I thought, 'this could be life-threatening' so I said to the doctor, 'Shouldn't we do something? She doesn't look good.' But in front of everyone, they would be really dismissive and start asking things like, 'What do you think is wrong with her? What should you do?'" he said.
"That patient was quite ill and no one was doing something about it."
While not all doctors gave students a rough time, many have experienced verbal abuse, social exclusion, racial discrimination, gender stereotyping and general rudeness, usually from surgeons and physicians.
A report, published by BMC Medical Education and driven by fifth year UNSW Medicine student Laura Colenbrander, found in the past year alone Bankstown-Lidcombe, St George, Royal Prince Alfred, Westmead and Tamworth hospitals had all made headlines regarding mistreatment of junior doctors.
The hierarchical structure of medicine fuelled the "endemic culture" of bullying and harassment, often perpetrated by senior staff, Colenbrander's study found.
All four students said the hierarchy created barriers to reporting mistreatment, as they feared they would be labelled a troublemaker.
Students were also concerned it would affect career progression or that reporting avenues did not guarantee confidentiality or an outcome.
"Senior doctors were overwhelmingly considered unapproachable because they were 'self-important', sexist, uninterested, too busy, or participants feared verbal abuse," the report states.
Australian Medical Students Association president Daniel Zou said the reporting processes for bullying and harassment remained unclear to many medical students.
"There should be confidential, easily accessible, clearly communicated and consistent reporting pathways available for all medical students," he told NCA NewsWire.
"In many hospitals and medical schools, there are no guaranteed confidential reporting processes or anonymous reporting processes. For those hospitals and medical schools that do, they are oftentimes confusing pathways, inaccessible and ineffectual."
Tim argued the industry had a responsibility to teach students about what bullying and harassment was.
"There are a lot of things we didn't realise were serious," he said.
"And a lot of medical students won't report it because we know nothing will happen. It's not a big enough issue to bring up with top-level hospital management."
Of the four study participants in Colenbrander's research who had reported an incident or knew someone who had, none had experienced desired outcomes.
This included sexist behaviour from surgeons on which the clinical school had insufficient authority to act.
The harassment extends beyond students.
In 2015, the Australian Medical Association (AMA) confirmed more than 50 per cent of doctors and trainees (not including medical students) had been bullied or harassed. Verbal harassment among consultants was most commonly cited.
Colenbrander said the issue of bullying and harassment "spoke to her" because she knew many students who had experienced this in a hospital setting.
"It just seemed widespread," Colenbrander told NCA NewsWire.
"Personally, my experiences have been really positive. I've had great teachers and experiences but I've also definitely experienced the underbelly of medicine."
According to a survey released by the Medical Board of Australia, one in three trainee doctors in Australia have experienced or witnessed bullying, harassment or discrimination in the past 12 months.
However, only a third have done anything about it, with 57 per cent believing they would suffer negative consequences if they reported the inappropriate behaviour.
And mistreatment of medical students will no doubt have long-term consequences on the nation's future doctors.
"It has an epidemic bullying culture. Medicine isn't immune from the stuff that happens in other professions. It's still very rife and still there," Sam said.
"These are the people that look after you, so why can't they look after their own."
* Some names in the article have been changed to protect the privacy of individuals.
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