Traumatic Deidealization and the Future of Medicine

The articles in this issue ofThe Journalon medical student abuse by Silver and Glicken1and Sheehan et al2are provocative and disturbing. While neither study is perfect methodologically, the fact that each reported that a majority of their student subjects experienced episodes of mistreatment and insensitivity from their teachers warrants careful examination. Particularly disturbing is that both the studies indicate that two thirds of abusive experiences were of significant intensity to have created emotional vulnerability in the students. Thus, these studies did not assess minor student irritations, frustrations, misunderstandings, or disappointments, and the seriousness of the abusive practices is dramatized in the findings of Sheehan et al of multiple instances of sexual harassment of women and racial prejudice against minorities. For many years, medical educators and researchers have struggled with so-called medical student cynicism—those well-known attitudinal changes of deflation, pessimism, and loss of humanitarianism and enthusiasm