COLUMBIA — Matt Darrough didn’t take a traditional path to the MU School of Medicine.
When he applied in November 2013, he was 43 and working full time as a lawyer. He was also preparing to have his legs amputated below the knee and get prosthetics. An accident years earlier had left him paralyzed from the knees down.
Darrough was worried that his age and disability would make medical school more difficult, but in his interview, the chief of surgery said he was exactly the type of student the school was seeking. The admissions committee wanted greater diversity, including students like Darrough with no background in science.
Three years later, Darrough dropped out, frustrated with what he described as constant bullying, a lack of accommodation of his disability and an overall hostile environment.
He filed a complaint — one of 15 filed by students against the medical school in the past two years, according to documents requested by the Missourian in September and obtained Dec. 8 through a Sunshine Law request. Most of the complaints involved public humiliation, and others described experiences of gender discrimination.
Levels of student mistreatment much higher than the national average caused the Liaison Committee on Medical Education, which accredits medical schools, to deem the school noncompliant in that area in its June accreditation report.
When committee members visited the school in January and met with administrators, faculty and students, they found that School of Medicine students reported experiencing gender discrimination, public humiliation and offensive remarks at much higher rates than the national average:
- About 14 percent of MU medical students said they had been denied opportunities based on gender at least once, according to data from the Association of American Medical Colleges. The national average is about 6 percent.
- About 43 percent of students said they had experienced public humiliation at least once. The national average is about 19 percent.
- About 22 percent of students said they had been subjected to offensive or sexist remarks at least once. The national average is about 14 percent.
The school submitted an action plan to the committee on Nov. 30, detailing the steps it will take to improve in the noncompliant areas, another of which is diversity. They’ve taken steps to address mistreatment, including creating a committee to review student reports and drafting a code of professional conduct.
Administrators and students agree that the problem is concerning, but the boundaries of mistreatment are hard to define. They hope a new, streamlined reporting system will increase student reports of mistreatment so they can better understand the problem.
'A nonstop horrible environment'
Darrough was accepted and started medical school in a wheelchair in July 2014, still recovering from surgery.
“Immediately, I had a lot of problems,” Darrough said. “Not just living life in a wheelchair, which is really difficult. But the school isn’t very accessible.”
The orientation in Memorial Student Union wasn’t wheelchair accessible, and the school’s bathrooms weren’t large enough for him to use in the chair.
Accessibility wasn’t the only problem. When he talked to his small group facilitator in the first week of school because he was concerned about the time commitment, his facilitator and an administrator at the Office of Medical Education suggested he take a leave of absence from the school or leave entirely.
"That wasn't an option," Darrough said. "I'd given up my law practice to start medical school. I couldn't just jump back in and pick that up."
So he stayed, and the problems continued. The Anatomy Department volunteered extra time to Darrough during anatomy lab exams because the tables were too tall to be viewed from a wheelchair. However, the Office of Medical Education refused to grant any accommodation unless it was pre-approved through the Office of Disability Services. The same small group facilitator who’d suggested he drop out criticized him daily in front of the rest of his lab group, he said.
“It was a nonstop horrible environment,” Darrough said. “I was very, very unhappy, and I was struggling.”
Darrough eventually filed a complaint with the Office of Medical Education. Administrators dismissed his complaint, saying he had filed it in the wrong place. After meeting with the MU Disability Center, he filed another complaint with the Office for Civil Rights and Title IX.
School of Medicine spokeswoman Mary Jenkins declined to comment on Darrough's report, citing the Family Educational Rights and Privacy Act.
After an investigation, Senior Associate Provost Ken Dean wrote that he was concerned about the issues Darrough’s complaint raised. He said he planned to recommend that Dean Patrice Delafontaine review “the manner in which students are handled” in the medical school.
However, Dean found that the evidence didn’t prove that Darrough was discriminated against because of his disabilities, and the complaint was closed, according to an email from Dean. Darrough left the school in January and doesn't plan on returning.
Darrough said a large part of his problem was that he wasn’t sure where to report his experiences. There wasn’t a place designed specifically for medical students to report incidents until fall 2015, when administrators created a streamlined system in students’ online portfolios, Senior Associate Dean for Education Linda Headrick said. Darrough made his first report through the portfolio system, but the Office of Medical Education told him it wasn't designed for disability complaints.
The new reporting system allows students to choose the level of confidentiality and when they want the report to be reviewed. Headrick said more students have made reports since the new system was adapted, and that’s what she wants. An increase in reports might look like more incidents are happening, but it really shows that students feel safe sharing their experiences, she said.
“We’ve focused on trying to understand what the problem is and therefore being able to address it, both in terms of if there’s a particular area or particular group of people that’s a problem, or if it’s a general thing that’s happening,” Headrick said. “The only way you can find that out is to get students to tell their stories.”
Students’ reports are sent to Associate Dean for Student Programs Laine Young-Walker, who replaced Rachel Brown on Nov. 1. Young-Walker works with the students making reports and investigates the incidents.
The school also created a committee of administrators, faculty, staff and students in summer 2015 to review student reports. The Committee on Civility and Respect in the Learning Environment met eight times in the 2015–16 school year and reviewed six reports that were made during that time, according to a report obtained by the Missourian through a Sunshine Law request.
Second-year medical student Benjamin Vega presented on the committee at the Association of American Medical Colleges meeting in July. The presentation was well-received, he said, and seen as a new approach to a problem that schools across the nation are facing.
“The idea is that having students on that committee is going to make students more comfortable making those reports, knowing they have advocates from the student side and it’s not just a random group of faculty who aren’t invested in it,” Vega said. “We hope we’re not more poorly treated than students in other institutions but that MU students feel more comfortable reporting.”
The root of the problem
The source of the high mistreatment numbers isn’t clear, and it concerns Dean Patrice Delafontaine, he said in an October interview.
“That issue is perplexing in spite of all the explanations,” Delafontaine said. “There’s still the reality that we’re proportionally outside the mean, and it’s a little mystifying. It may well reflect that students feel comfortable reporting, which would be a nice thing, but we don’t yet know that for sure.”
The boundaries of mistreatment are hard to define, especially public humiliation, Headrick said. If a student is in a surgical clerkship and can’t identify a structure when they’re asked to, that’s not mistreatment, it’s just part of learning, she said.
“One would expect that to be done in a civil fashion and a professional way, but being shown to not know something is part of learning,” Headrick said. “We’re having conversations to help everyone agree on and understand those boundaries.”
Students' treatment in medical schools has been studied since the 1980s, and although MU's numbers are higher than average, the problem is a national one. Medical school is a high-stress environment simply because no one is ever happy to be in a hospital, Vega said.
“There are a lot of theories, and none of them are very good,” Vega said. “A lot of it comes from surgical fields, which is always the go-to example. It’s a very high-stress environment, and it’s fraught with anger and frustration and fear.
"Part of being in a learning environment is making mistakes, and when you make a mistake in a surgical clerkship, things can go very badly for patients," he said. "Physicians often take action in a way students find humiliating.”
Gender discrimination issues affect both men and women in the medical field. Surgical clerkships are often dominated by men and intimidating to women, Vega said. On the other hand, men studying women’s reproductive health care often face an uphill battle because some women aren’t comfortable with a male obstetrician-gynecologist.
When specific faculty members or residents are the cause of mistreatment, Delafontaine wants students to feel like they can respond to them directly.
“I’ve publicly told the students that I’m completely behind them and I’d like them to feel like they can do that,” Delafontaine said. “You’re going to meet unprofessional people during your career. I want our students to feel comfortable dealing with that openly and without fear of retribution. That’s hard to do when you’re a student.”
But Darrough said he believes the source of the problem is deeper than a lack of reporting — it’s the hostile environment that faculty members create.
“Getting people to report doesn’t fix it,” Darrough said. “What fixes it is teaching these people who are educators that you don’t say these things or do these things or treat people this way.”
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