We hope you find useful the miscellaneous articles and resources that we have written, come across and update as we examine the topics discussed on these pages.
Last updated: 21 June 2022
The GMECP Resident Advocate original article series:
Understand Your Resident Contract: What You Don’t Know May Hurt You. 14 June 2020 (Also found at KevinMD.com)
U.S. Physician Residency Funding: Unravel the Mystery, Participate in the Conversation. 14 Oct 2018
Anatomy of a Resident Lawsuit: A $50 Million False Negative? 29 July 2018
Academic Due Process: Residents, Know Your Rights! 25 April 2018 (Also found at KevinMD.com)
St. Louis: Dysfunctional Physician Capital of America? 16 Mar 2018, addended 21 Mar 2022 (Also found at KevinMD.com)
Influencing Your Resident Evaluations for Success. 02 Feb 2018. (Also found at KevinMD.com)
Proactively Manage Your Resident Progress. 20 Jan 2018. (Also found at KevinMD.com)
The ACGME: an Impediment to Progress? 05 Nov 2017
http://www.pamelawible.com/ Dr. Pamela Wible is a practicing physician and advocate for physician trainees. We’re just starting to grasp the scope of the work that Dr. Wible is doing. We’ll keep you updated as we explore the many resources and insights that she provides. Check out her blog, books, and her TEDMED talk (“Why Doctors Kill Themselves”). With producer Robyn Symon, Dr. Wible is also creating a documentary, Do No Harm, on the epidemic of physician suicide. Anticipated release is in April 2018.
The Association of American Physicians and Surgeons is a physician rights and doctor-patient relationship advocacy organization. The AAPS has done significant legal and research work exposing sham peer review by hospitals, which parallels the offenses and issues found in resident sham due process by programs, medical schools and the ACGME. Dr. Huntoon has written and spoken extensively on the topic: here is a sample of his articles and recorded lectures.
KevinMD is the self-proclaimed “social media’s leading physician voice.” The blog hosts a wide variety of topics of interest, including articles and commentary on issues associated with GMECP’s topics.
Medical Residents Advocacy Group – based in Chicago, this trio of attorneys specializes in representing residents. “We address injustices at every level, ranging from individual cases to nationwide systemic failures and abuses.” If you need a legal opinion and don’t know who to ask, start here.
Brown, Goldstein and Levy – a Baltimore law firm that represents and Blogs on resident issues. Another great legal resource.
The Health Law Firm has experience with and blogs regarding residency/fellowship and physician issues. They are based in Florida, but able to consult in many states.
The SECOND Trial: Surgical Education Culture Optimization through targeted interventions based on National comparative Data (SECOND) Trial. Based on findings of the NEJM survey. “Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. …occurs frequently among general surgery residents, especially women….”
Rovner, J. Medical Students See Their Mentors As Marauding Monsters. NPR online. Dec 8, 2015. (Excerpt: “Green says the system needs to stop the abuse of medical students and residents by professional superiors. ‘There has to be a message that this is not OK and there will be consequences for treating people badly,’ he said.”)
DiRosa, G and Goodwin, G. Moving Away from Hazing: The Example of Military Initial Entry Training. AMA Journal of Ethics. March 2014, Volume 16, Number 3: 204-209.
Cottingham, AH, et al. Enhancing the Informal Curriculum of a Medical School: A Case Study in Organizational Culture Change. J Gen Intern Med. 2008 Jun; 23(6): 715–722. (Excerpt: “Calls for organizational culture change are audible in many health care discourses today, including those focused on medical education, patient safety, service quality, and translational research. In spite of many efforts, traditional ‘top–down’ approaches to changing culture and relational patterns in organizations often disappoint.”)
Hoff, TJ, et al. Creating a Learning Environment to Produce Competent Residents: The Roles of Culture and Context. Academic Medicine: June 2004; 79(6): 532-540. (Excerpt:”… it is important to consider the role of residency culture and work context in helping residents achieve the required competencies. Specifically, the development of a learning-oriented culture and favorable work conditions that facilitate the presence of that culture should be a high priority for residency programs and the organizations (e.g., hospitals) in which they are housed.”)
Leape, LL, et al. Perspective: A Culture of Respect, Part 1 The Nature and Causes of Disrespectful Behavior by Physicians. Academic Medicine: July 2012; 87(7): 845–852. (Excerpts:”At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change.”
“… Disrespectful behavior is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture.”)
Poorman, Elisabeth. “What I wish my family had known about medical residency.” Committee of Interns and Residents (CIR) Keynote Address 2018: Depression and Suicide in Residency. KevinMD link. Youtube link. GMECP’s summary: It’s not “burnout,” it’s systemic abuse. Over 70% of surgical residents work over 80 hours/week. 60% lie about it every week. In the past 20 years, hospital admissions are up by 46%, length of stay down by a third, case complexity has risen, administration/ documentation burdens have grown exponentially, residency positions have only increased by 13%, the doubling time of medical knowledge was 7 years, now it is a matter of months. The system is controlled by “back in my day,…” sorts that perpetuate the historic ills and abuses of medical training. Dr. Poorman’s presentation is a must watch for anyone involved in medical and resident training. For those that disregard these issues, you may be the Perpetuator, the Perpetrator, part of the Root Cause of Systemic Ills.
Steenhuysen, J. Counting the costs: U.S. hospitals feeling the pain of physician burnout. Reuters online. Nov 21, 2017. (SLUCP facebook comment by its administrator, Todd Rice, MD, on this posting 11/22/2017:”‘Burnout‘ is a misnomer. It isn’t about exhaustion or being over-worked. It isn’t a physician trait or weakness. It isn’t fixed with wellness programs. What is termed ‘burnout’ is merely physicians saying to components of The System and its Interlopers, ‘I’m not going to put up with you, your hostile culture, your arbitrary demands, your self-appointed authoritarianism – none of which is about the patient-physician relationship.’ As physicians in training and practice push back against the toxic and unproductive components in THEIR profession, expect some turmoil and healthy disruption.”) Picture from the article: “Dr. Brian Halloran. a vascular surgeon at Saint Joseph Mercy Ann Arbor, shows the canned vegetables from his garden across from Saint Joseph Mercy hospital.”
Moutier, C., et al. The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment. Acad Psychiatry. July 1, 2016. (“Conclusions: In order to enhance a culture of respect in the learning environment, institutions can effectively engage academic leaders and faculty at all levels to address disruptive behavior and enhance positive climate factors.)
Oaklander, Mandy. Doctors on Life Support. TIME. Aug 27, 2015. (Excerpt: “The mistreatment of people at the bottom part of the clinical team–third-and fourth-year medical students, interns and residents–has been a topic in medical literature for decades, and research by Sen and Mata confirms that it’s still a problem. When asked about the toughest part of their first year as doctors, 20% of the interns in Sen’s study mentioned the ‘toxic’ culture of their program. Some people said the memory that stuck with them most was when an attending physician screamed at them and belittled them in front of their peers and made them cry.”)
Leisy, HB and Ahmad, M. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review. BMC Medical Education (2016) 16:127. (Excerpt: “Physicians-in-training are challenged every day with grueling academic requirements, job strain, and patient safety concerns. Residency shapes the skills and values that will percolate to patient care and professional character. Unfortunately, impediments to the educational process due to medical resident mistreatment by bullying remain highly prevalent in training today.)
Sentinel Event Alert, Issue 40: Behaviors that undermine a culture of safety. Joint Commission. July 9, 2008 and updated Sept 2016. (Excerpt: “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.”)
The Center for Physician Rights – “CPR Is A New Resource for Physicians and Counsel In Dealing With Regulatory Administrative Legal Matters…. the first of its kind to offer specialized informational, consultative and advocacy for physicians and their counsel focusing on ensuring that fair and transparent processes are undertaken by Medical Licensing Boards, Physician Health Programs and Peer Review entities in all of their disciplinary, rehabilitative and remedial actions.”
Park, Alice. Researchers Find Women Make Better Surgeons Than Men. TIME. Oct 10, 2017. (Excerpt: “The authors attribute the favorable patient outcomes to the female doctors’ ability to communicate and engage with their patients to ensure compliance with medications and therapy, their adeptness at collaborating with colleagues and their tendency to adhere to guidelines when treating patients.”)
Frellick, Marcia. Nearly 20% of General Surgery Residents Quit Their Program. Medscape. Published online (requires Medscape access login) Dec 16, 2016. (Excerpt:”Women were much more likely to leave than men…. Possible reasons for that include lack of role models; perception of sex discrimination or negative attitudes toward women in surgery by colleagues or patients; or perception of lack of support from their programs, the authors write.”)
Morris, Nathaniel. Medical school can be brutal, and it’s making many of us suicidal. Wash Post. Oct 9, 2016. (Excerpt: “Rather than receiving support in these situations, these students often suffer humiliation from senior clinicians. Doctors work in a hierarchy, with attending physicians above residents, who are above interns. At the bottom of the totem pole are medical students.This hierarchy engenders a culture of bullying toward medical trainees. More than 80 percent of medical students report mistreatment from supervisors. I’ve seen classmates shouted at, cursed at and mocked in clinical settings. A surgeon referred to me as ‘Helen Keller’ because I couldn’t suture fast enough.”)
Macdonald, Owen. Disruptive Physician Behavior. QuantiaMD. White paper, in association with the American College of Physician Executives. May 15, 2011. (Excerpt: “Disruptive Physician Behavior: the issue that just won’t go away. Despite the best efforts of many, our profession is still plagued by doctors acting in a way that is disrespectful, unprofessional, and toxic to the workplace….”)
Pei, Kevin and Cochran, Amalia. Workplace Bullying Among Surgeons – the Perfect Crime. Ann Surg 2019;269:43-44. (Some excerpt phrases: “… senior leadership positions… systemic abuse of power… aggressive behavior or intentional harm doing… abusive conduct akin to psychological violence… threatening, humiliating, intimidating… other specialties are afraid of us and we are afraid of our leaders… unspoken code of silence… fear of retaliation… hiding behind the veil of patient care… perfect crime… strategic isolation of the victim….”
Chen, Pauline. The Bullying Culture of Medical School. NY Times. August 9, 2012. (Excerpt: “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.”)
Castillo-Angeles, Manuel, et al. Mistreatment and the learning environment for medical students on general surgery clerkship rotations: What do key stakeholders think? Am J Surg. Feb 2017; 213(2): 307-312. (Excerpt: “Medical student mistreatment persists and is a threat to the learning environment and individual learning process. Passive mistreatment (neglect) represents the most distressing component of mistreatment. These findings suggest a need for education aimed at surgical residents and others in the learning environment.”)
Phillips, Diana. “Alarming” Burnout Rate in General Surgery Residents. Medscape online. June 20, 2016. (Excerpt: “… the high prevalence of burnout in this population threatens the well-being of these trainees, and potentially that of the patients they care for, according to senior author Isaiah R. Turnbull MD, PhD, from the Department of Surgery, Washington University School of Medicine, St Louis, Missouri. ‘We need to better understand the drivers and implications of burnout in surgical residents so we can identify who is at risk and develop strategies to reduce that risk,’ Dr Turnbull told Medscape Medical News. This is especially true,’ Dr Turnbull said, given the higher attrition rates observed among general surgery residents compared with medical residents, despite comparable burnout rates. ‘The question we need to ask is, “What is it about general surgery training and expectations specifically that is putting these trainees at risk, and what can we do about it?”‘) Original article here.
Botha, Danie. Are we at risk of losing the soul of medicine? Canadian Journal of Anesthesia/Journal canadien d’anesthésie. Feb 2017; 64(2): 122–127. (Summary: Work environment, harassment, bullying, intimidation, stigma, burnout, depression, a “culture of abuse,”… detriments to the “soul of medicine.” Aside from First, Do No Harm, …”The time has come to learn four new Latin words, ultimum, medico nihil nocet – last, do the physician no harm.”)
Awdish, Rana. A View from the Edge — Creating a Culture of Caring. N Engl J Med. January 5, 2017; 376:7-9. (Excerpt: By illuminating our failures, we can begin an authentic conversation about shared purpose, resilience, and building an engaged culture. We believe that by focusing on our missteps, we can ensure that the path ahead is one of compassionate, coordinated care.”)
Student Doctor Network: a non-profit forum for all manner of physician-related and similar topics.
Bernstein, Jennifer. The Surgical Resident Life. Catapult online. Jan 17, 2017. (Excerpts: “Alternating ecstasy and despair characterize resident life in particular, and medical practice in general.”
“The tiered structure of medical training (college, med school, residency, fellowship) relies on a compelling myth: The illusion that each progressive level of accomplishment ushers one closer to a culmination of one’s efforts, which will serve as final proof of one’s worth, and bring an end to a long phase of striving and uncertainty.” )
Holloway, Elizabeth and Kusy, Mitchell. Disruptive and Toxic Behaviors in Healthcare: Zero Tolerance, the Bottom Line, and What to do About It. mitchellkusy.com online. 2010, accessed Dec 13, 2017. (Excerpt: In this economic downturn, healthcare settings’ attention to two bottom lines is critical – the human and the financial. Unfortunately, one significant problem affecting personal and financial costs has long been ignored: disruptive behaviors by healthcare personnel. People who habitually exhibit these behaviors have been referred to in many ways – toxic, uncivil, disruptive, and intimidating, to name a few.”)
Topin, Jeremy. The day my wife miscarried, I went back to work at the hospital. I still regret that. statnews.com online. Dec 7, 2017. (Excerpt: “The culture of medicine promotes as a binary choice either spending time at work to care for our patients or spending time with our families. That’s a zero-sum game. But it doesn’t have to be. We need a culture that promotes both.”)
Anonymous physician. There is something rotten inside the medical profession. KevinMD.com online. Jan 26, 2017. (Excerpt: “It is time for the medical profession to look deep inside itself and fix the cancer that has been growing for far too long.”)
residencyrehab.com is a site run by a physician who shares his own history of fighting unjust residency decisions. He shares many resources, including a collection of known legal cases. Insightfully, he points out that although many of the known cases with verdicts did not end in favor of the resident, the ones that likely would have found in favor of the resident never saw a courtroom. They were settled. Do not become discouraged. He says, “You are not a failure, and you are not alone. There are literally dozens of physicians just like you at any given point in time, out there looking for a path out of the darkness, looking for some help figuring it all out. I hope this site can answer some of your questions.”
Unmatched MD: When the Algorithm Fails. “Unmatched But Not Unwilling. At Unmatched MD, we are a team of fellow medical graduates, who understand the hardships and the lack of resources that come along this path. Amazingly, after combining our hard work and resources, we were all able to support and help each other find opportunities and residencies. Success is Not a Straight Line. Inspired by our experiences, we decided to create this, as a free resource to help find different opportunities to stay ‘clinically relevant,’ to match, or even find different careers in medicine to help support whatever path you choose.”
YouTube: Racial Discrimination at University of Missouri. Dr. Valentine Nofong describes his battle with the surgery residency program regarding subjective and discriminatory evaluation allegations. (The video was taken down at some point prior to 01 Dec 2018.) Dr. Nofong’s status is currently unknown. He ran a change.org petition for the university’s president with over 1500 supporters . He also made a public statement on reddit in July 2017. In his conclusion, he encourages: “Share your own experiences. Exposure is what brings about real change.”
ImproveMedicalCulture.com. “… where healthcare workers and patients can come together to work on improving the way people treat each other in the medical setting.”
JusticeInMedicine.com. “The purpose is to use the internet to unite the silos of medicine. Gaps in communication between and within medical training, patient advocacy, healthcare worker rights and scientific integrity create injustice in medicine.”
American College of Legal Medicine. “… the most prominent professional society in the United States concerned with addressing issues that arise at the interface of law and medicine.”
Resident dismissal: Suing the system. 08 May 2000. American Medical News (the publication has since closed, but archives remain available.)
Latino resident physician fired from Johns Hopkins Hospital. 13 Sept 2009. Latino Med Journal.
Due process legal update: a victory for due process in Indiana. 18 May 2017. Foundation for Individual Rights in Education (FIRE). Excerpt: “It’s not enough for a student to have counsel present — but silent — at a hearing. Without counsel who can actively participate in a hearing, students may miss critical opportunities to respond to evidence, challenge testimony, and present an adequate defense.”
Residency training: New grounds for legal liability. Oct 2014. Orthopedics Today. Residents, employment status, due process and litigation. Excerpt: “The courts will generally allow the institutions to design their own due process requirements provided they meet standards of objectivity and fairness.”
Binder R, et al. Preventing and Managing Unprofessionalism in Medical School Faculties. Academic Medicine. April 2015; 90(4):442–446. Abstract excerpt: “The authors describe issues of unprofessionalism that culminate in allegations of faculty misconduct or filing of grievances in academic medicine and outline strategies for early intervention and prevention.”
Weinstein, Michael. Out of the Straightjacket. N Engl J Med. 2018; 378:793-795. This 48-year old trauma surgeon describes the conditions of medicine and surgery which exacerbated his own mental illness. “I am concerned for future generations of clinicians unless we change how we teach and practice medicine.”
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