“There are no two words more harmful in the English language than good job.

So says Terence Fletcher, an abusive jazz music conductor played to perfection by J.K. Simmons in the Oscar-winning film Whiplash. That one line sums up the spirit of the film—Fletcher is never satisfied with his students. He berates them. Humiliates them. Breaks them mentally and emotionally. He is forever obsessed with finding his “Charlie Parker”—his outstanding and legendary student who can weather the brutality of his drill-sergeant routine and reach out for greatness.

My housemate had this to say after the movie: “This is so much like medical school.”

For years, the archetype of the medical educator has been someone like Terence Fletcher. Demanding, stentorian, and merciless, expecting nothing less of his students than total mastery of the course material. My senior was once accosted by a consultant on the ward who grilled him relentlessly on the causes of secondary amenorrhea. He was brusquely told to “go home, because you’re wasting everybody’s time.” He left the ward reluctantly in sunken spirits.

It can be argued that such an approach is necessary. After all, the ultimate aim of medical school is to produce competent doctors. When it’s three in the morning and everything has gone straight to hell on the wards, we need doctors level-headed enough to hold the fort—and save lives. What better way to inoculate future doctors against this astronomical level of stress than to introduce it in medical school, in the form of teachers every bit as demanding and ruthless as the consultants on the wards? To have mentors and lecturers push students again and again past their limits, ensuring that every mistake made in the classroom—as it would be in real life—is severely punished.

Maybe we need that inhuman consultant yelling at medical students, pouncing on each mistake like a tiger after fresh blood. Abusive drill sergeants exist for a reason—their training saves soldiers on the battlefield. Perhaps the same treatment, as applied to fresh-faced recruits to the field of medicine, would help save patients.

Or would it? Studies suggest that medical students are already under tremendous amounts of stress. Most of them grapple with meeting academic standards and adapting to the pace of medical school; a number struggle with family financial difficulties and living away from home for the first time. While the medical workplace can indeed be hectic and hellish, stressed doctors have been shown to perform worse, make more mistakes, and be less competent in interacting with patients—a vital skill of the profession.

A lecturer of mine provided an apt analogy: “If you’re stressed when a tiger’s chasing you, that’s good. You escape, or you’re dead. Either way, the stress doesn’t last very long. But getting stressed due to work means you’ll always be stressed, because there’s no getting away from work.” Depression and burnout rates among medical students and doctors are alarmingly high—and prolonged stress has been shown to make doctors perform worse, not better.

Is it fair to add to that burden by militaristically drilling students, for the purpose of pushing students forward? More than that, is it productive?

For years—centuries even—that answer was yes. Traditional education was “imposed from above and from outside”—according to educational reformer John Dewey—students were given facts to commit to memory, and punished for failure to do so; heavy emphasis was given to standardized learning materials, rote memorization, and stringent assessments.

Medicine has changed much between then and now, and with it, medical education. Educators recognized that different students learn differently. Medical knowledge has exploded, its dimensions growing so rapidly that any medical textbook would be outdated as soon as it went to print. And medical educators have changed also—many universities now place heavy emphasis on a strong and supportive relationship between students and their tutors, focusing on helping each student meet individualized goals. Time and time again, reality has proven that students improve more when they are pulled rather than pushed, and that a balanced teaching style of positive reinforcement does not have to compromise the essential demands of excellence and professional integrity.

The ultimate danger of such an unpleasant teaching style is that it inevitably segues into outright bullying.  A study conducted in an unidentified medical school found that 46.4% of students were abused or bullied during the course of their program; students reported being shouted at, physically roughed-up, or made the target of racist or sexist epithets. One student said that a particularly irritated consultant once picked up a surgical scalpel and used him for target practice!

The David Gessen School of Medicine at the University of California, Los Angeles (U.C.L.A.) conducted a study of thirteen years with sobering results: at one point, 75% of medical students reported mistreatment from a member of staff. As a norm, students would simply take the abuse and shut up; many of them fear reprisal, and loss of esteem among colleagues. The reason that they keep their silence, despite repeated incidents, is one simple and devastating perception: “This is the way it is.” The line between running a tight ship and straight-up abusing students is a thin one.

Yet by and large, there is still something alluring about the idea of a drill sergeant-slash-consultant, forever putting his students through hell so that by the time they actually get to hell, they manage to save the day. Why are we so attracted to this idea? Maybe it’s because we’ve seen it so often—not so often in medicine, but in the sports arena, and in the glabrous stories of the battlefield. The coach that trains his team at six o’clock every morning, every day, and screams in their faces until they improve. The team of Navy SEALs that weather the abuse of their drill sergeants and band together, surviving under the mortar fire of the battlefield.

We forget that medicine is not like sports, or war. Not just a science, it is an art. Rather than an unchanging game with a fixed goal, it is the unending quest to treat the human body—that infinitely complex, paradoxical organism we have yet to fully understand. To impose drill-sergeant teaching methods on students, day in and day out, is to cultivate an environment of rigidity, inflexibility, and hostility in a profession where the human touch is not only desired but absolutely required.

Whiplash drops one last anvil by the film’s end—emotionally scarred, bitter and cynical, having broken up with his girlfriend and ruined any chances of moving past his disappointments and hurts, the main character takes the stage and plays a brilliant and perfectly executed drum piece that finally earns an approving nod from Fletcher, his (tor)mentor. And the audience is left with the bitter sense that by now, it all means so little.

Drill sergeants may manufacture efficient and calculative machines, and machines excel on the battlefield and in the arena. But machines cannot treat patients—those unpredictable, unique, thinking and feeling entities whose well-being are our life’s calling. Machines cannot provide the compassion and insight that doctors must supply in times of crisis. An impersonal, paternalistic, and punitive method of teaching, without being balanced by positive guidance and the human touch, saps medical students of the very qualities they will need when they finally don that white coat.

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Benjamin

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