The anatomy and physiology of conflict in medical education: a doorway to diagnosing the health of medical education systems

Figures & data

Table

Practice points

•This paper discusses interviews with medical learners, educators and administrators and is part of a large interdisciplinary study on conflict in professional education.

•The authors found that studying how conflict is handled is a doorway to understanding medical education as a system.

•In some instances, learning can be experienced as painful and dangerous, leading to a culture of fear rather than one of caring.

•Markers of health of the medical education system are described, and include realistic expectations, transparency, natural justice, participation, direct and clear communication, and discussion of the moral implications of behaviors.

Table 1.  Some suggestions for maintaining a healthy education system

(a)	Avoid secrecy and lack of transparency
(b)	Ensure due process
(c)	Be thorough in data gathering
(d)	Review policy regularly
(e)	Reflect periodically on the morality of the system. Is it fair? Respectful? Empowering of individuals? Inclusive?
(f)	Minimize threat, confrontation and fear
(g)	Make respect for persons a central feature
(h)	Those with power should strive to de-triangulate those in conflict
(i)	Discourage gossip, encourage direct communication
(j)	Do not remain silent when others are treated unfairly
(k)	Use specific examples to document concerns in a manner that the student (or faculty) can clearly understand
(l)	Discuss expectations at the outset of educational experiences
(m)	Ensure resources are in place to help prior to negative feedback
(n)	Install a student and faculty development position to act as ombudsman
(o)	Provide a forum at which the student (or faculty) has an opportunity to know what the complaint is and the opportunity to respond
(p)	Make moral development part of the curriculum along with ethics

Table 2.  Suggestions for healthy educational systems

(a)	Discourage excessive rivalry. Pass/fail grading
(b)	Unmask the ‘myth of perfection’
(c)	Be sure there are carefully designed assessment processes
(d)	Condemn humiliation and shaming as techniques
(e)	Employ a neutral ombudsman with power to act
(f)	Provide opportunities for self-reflection for students and faculty
(g)	Provide personal growth opportunities and access to counselors
(h)	Insist on openness and transparency
(i)	Insist that administrators understand how to ‘de-triangulate’
(j)	Review policy frequently
(k)	Ensure faculty also have support and the means to upgrade knowledge and skills on ongoing basis
(l)	Encourage balance amongst students regarding their personal/professional lives. Model the same
(m)	Ensure that due process occurs when student or faculty are being accused of inadequate performance
(n)	Always have clear expectations laid out in writing prior to an educational experience
(o)	Experiment with a ‘Pedagogy of Discomfort’ (Aultman, 2005)

Aultman JE. Uncovering the hidden medical curriculum through a pedagogy of discomfort. Advances in Health Science Education 2005; 10: 263–273

 PubMed Web of Science ®Google Scholar