Why is medical education so demoralizing?

My first year of residency training has ended. As I sit awaiting the start of a new year and new responsibilities that come with being a senior resident, the accomplishments of last year and the excitement of what comes next are overwhelmed by dread - I am not excited and cannot wait for residency to end.

I look around me in the health care sphere and most of what I see is negativity. Exacerbated by the failure of our health care systems, sure, but that is not the brunt of it. As I take leave from medical training and step outside to work on my personal projects in non-health care related fields during vacation, I realized I fear returning to work, to medical training, like a little kid fearing a trip to the dentists.

I look back over my training this past year and realize that everyday is a beating- from my colleagues and never from patients. Every day on rounds, we residents put ourselves up to mean scrutiny - we give presentations on patients we admitted to hospitals, we devise a plan on how to help them feel better - and, of course, we take great pride in what we do and pour a lot of thoughts and heart into these presentations. What we get in return from most attendings and senior residents are often agreements, sometimes additions to the plan, other times harsh criticisms on systematic failures attributed to individual's carelessness (which is seldom true - when things fall through the cracks in hospitals, it is usually due to a systematic flaw bigger than one person), but rarely an acknowledgement that creates a positive work environment. The focus seems to be on what is not perfect, and hardly on what was done well - strides are rarely celebrated in medical education.

There are many instances when residents are "pimped" by attendings - that is, being asked questions to see how much we know. The original intention of pimping (I hope) is to teach, but nowadays I would say that goal is rarely accomplished. Most clinician educators take less than a few seconds to wait for answers while pimping - when do residents have time to think and formulate their responses? A question answered correctly is rarely followed by a pat on the back, only harder questions, some so vague and uneducational most residents don't bother learning answers to. Many times residents are pimped tactlessly in front of patients, whose trusts and confidence are needed for us to do our jobs. I wonder why I feel that the goal of pimping is to embarrass and make us feel stupid.

Last but not least, I feel that my time is not valued. There are many instances when I sit around without any responsibility, waiting just to be let out at 5PM like a 5-year-old because that is when my attendings deem appropriate - I look at people who have autonomy over their own time (like Google employees) and wonder why we are not treated like adults, who can make our own decisions regarding which activities are useful in our training and which are not. There are many occasions when I try to eat lunch in 5 minutes, when I miss a meal completely, when I do not go to the bathroom for 10 hours, when I sleep 4 hours a night, when I work 21 days in a row - and I look at people in other jobs, sometimes nurses, who have a real lunch break, who have real weekends, and I wonder what kind of existence I was living.

On a Southwest plane during my vacation, I read a Southwest magazine featuring its 40th anniversary in business, and a heart-warming theme throughout the whole magazine was how thankful the company was to its employees, how each one of them takes great pride in what Southwest offers and how each one of them was excellent in what they do. Most successful companies have the right idea - the funny thing about humans is if you tell them they are excellent, they become excellent, and compliments and appreciation are rare in medical training.

I can already foresee comments telling me to tough it up and stop whining, but I look at great companies in other industries and employee's morale is never allowed to be quite as low with such daily beatings and abuse. Talk to a resident, and what you will most likely hear are complaints - about long hours, about mean attendings/senior residents, about inefficiency in their workplace. If residency is a long-term job that you can keep until 60, most doctors will not stick with it or want to return to it.

If I could do it all over, I would still pick residency, because my patients made everything worth it, but really, does medical education have to be so demoralizing? Why do we teach people by making them feel small instead of empowered? Does adequate medical training have to come at the price of 10 hours without urination? I challenge us to do better, to build a system where self-esteem is high and residents are well-rested. If Southwest can do it, so can we!