Hierarchy in Medical Education
- a boon or a bane?
It is my 14th year of entering the ceaseless saga of medical education. And it is time to reflect on my experiences and observations in this journey so far.
Students in India are trained to give utmost respect to their teachers and elders. Some say they are next to God! When we enter the university, the position of “teacher” gets blurred. I dare say there is hardly any school-type teaching (I realized why we don’t call it “Medical School” in India) in most medical colleges. However, the hierarchy solidifies as we proceed further, from the students to the house-surgeons to the post-graduates, assistant professors all the way up to the head of the department and the director of the institution. The hierarchy is stronger in some places in India, and it is more fraternal in other places. It is almost unanimously agreed that an institution will require certain amount of discipline and a hierarchy needs to be maintained. But where do we draw the line? A seniority of six months gives an exceptional off-label privilege to humiliate his/her juniors in some institutions. Some are okay with verbal abuse, but physical abuse is a red line. Someone uses embarrassment in public as a tactic of establishing his/her authority and getting things done. If someone who knows essentials of psychology and psychiatry does this, can we expect an unknowledgeable person to uphold the moral values?
Learning requires that you respect the ones who impart knowledge. You take someone’s words seriously if you respect him/her. Even at work for example, the assistants have to respect and follow the lead surgeon during a surgery. But is it okay if the lead surgeon abuses one of his/her juniors or team members? What culture are such abusive bosses passing on to their juniors? If we do not stand on the side of justice within the fraternity, how can we point fingers when someone outside of the medical fraternity abuses a doctor?
I have heartfelt appreciation for institutions that have mechanisms to counter such abuse of position/power. And I strongly despise those that do not! While it is implied that equality cannot be imposed at every level if an institution has to be successful, it is to be noted that innovative ideas and depth of knowledge come only when the learning/working atmosphere is conducive to think freely.
A balance has to be struck between one’s sovereignty and giving and taking respect to make a fruitful and productive career.
What are your thoughts?