How Can We Make Medical Training Less Toxic

Robert D. Glatter, MD; Amy Faith Ho, MD, MPH; and Júlia Loyola Ferreira, MD, discuss ways to address and reform the toxic culture associated with medical training.
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This discussion was recorded on May 16, 2023. This transcript has been edited for clarity.
Robert D. Glatter, MD: Welcome. I'm Dr Robert Glatter, medical advisor for Medscape Emergency Medicine. Joining me today to discuss ways to address and reform the toxic culture associated with medical training is Dr Amy Faith Ho, senior vice president of clinical informatics and analytics at Integrative Emergency Services in Dallas, Texas. Also joining us is Dr Júlia Loyola Ferreira, a pediatric surgeon originally from Brazil, who just completed her Master's degree at McGill University and is focused on advocacy for gender equity and patient-centered care.
Welcome to both of you. Thanks so much for joining me.
Amy Faith Ho, MD, MPH: Thanks so much for having us, Rob.
Glatter: Amy, I noticed a tweet recently where you talked about how your career choice was affected by the toxic environment in medical school, affecting your choice of residency. Can you elaborate on that?
Ho: This is a super-important topic, not in just one specialty but in all of medicine, because what you're talking about is toxic workplace culture that is certainly directed toward certain groups. In this instance, what we're talking about is gender, but it can be directed toward any number of other groups as well.
What you're alluding to is a tweet by Stanford Surgery Group showing their next residency class, and what was really stunning about this residency class was that it was almost all females. And this was something that took off on social media.
When I saw this, I was really brought back to one of my personal experiences that I chose to share, which was basically that, as a medical student, I really wanted to be a surgeon. I'm an emergency medicine doctor now, so you know that didn't happen.
The story that I was sharing was that when I was a third-year medical student rotating on surgery, we had a male attending who was very well known at that school at the time who basically would take the female medical students, and instead of clinic, he would round us up. He would have us sit around him in the workplace room while everyone else was seeing patients, and he would have you look at news clippings of himself. He would tell you stories about himself, like he was holding court for the ladies.
It was this very weird culture where my takeaway as a med student was like, "Wow, this is kind of abusive patriarchy that is supported," because everyone knew about it and was complicit. Even though I really liked surgery, this was just one instance and one example of where you see this culture that really resonates into the rest of life that I didn't really want to be a part of.
I went into emergency medicine and loved it. It's also highly procedural, and I was very happy with where I was. What was really interesting about this tweet to me, though, is that it really took off and garnered hundreds of thousands of views on a very niche topic, because what was most revealing is that everyone has a story like this.
It is not just surgery. It is definitely not just one specialty and it is not just one school. It is an endemic problem in medicine. Not only does it change the lives of young women, but it also says so much about the complicity and the culture that we have in medicine that many people were upset about just the same way I was.
Medical Training Experience in Other Countries vs the United States
Glatter: Júlia, I want to hear about your experience in medical school, surgery, and then fellowship training and up to the present, if possible.
Júlia Loyola Ferreira, MD: In Brazil, as in many countries now, women have made up the majority of the medical students since 2010. It's a more female-friendly environment when you're going through medical school, and I was lucky enough to do rotations in areas of surgery where people were friendly to women.
I lived in this tiny bubble that also gave me the privilege of not facing some things that I can imagine that people in Brazil in different areas and smaller towns face. In Brazil, people try to not talk about this gender agenda. This is something that's being talked about outside Brazil. But in Brazil, we are years back. People are not really engaging on this conversation. I thought it was going to be hard for me as a woman, because Brazil has around 20% female surgeons.
I knew it was going to be challenging, but I had no idea how bad it was. When I started and things started happening, the list was big. I have an example of everything that is written about - microaggression, implicit bias, discrimination, harassment.
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