Medical students are subjected to humiliation and intimidation from senior male doctors in front of patients, other students and medical staff, researchers said today.
A study of one UK medical school found that students reported a hierarchical and competitive atmosphere during their training.
Researchers, writing in the British Medical Journal, said a "hidden" curriculum of teaching by humiliation and haphazard tuition existed in undergraduate medical education.
The team, from King's College London and Brunel University, interviewed 36 students about their experiences and perceptions of the quality of teaching they received. While many reported positive role models, others had more negative opinions of those training them.
Twenty-five students said their teaching was haphazard in nature, with many clinical staff disregarding the formal timetable. "Final year students were especially critical of what they perceived as a lack of commitment and poor teaching skills in some teachers," the researchers said.
The study also found that 21 students reported 29 incidents of humiliation, particularly during ward round in their clinical years. Almost all the perpetrators were male doctors - 28 out of 29 incidents - and three-quarters involved senior medical staff.
One student told the researchers: "I've found my first rotation was very stressful, humiliating. I worked and read because of fear, because of being targeted - and that was just miserable.
"One time, the consultant came in when I was examining the patients... and just started asking me questions. I just went blank and didn't know the answers to his questions - and then he got angrier... after things like that you don't even have the confidence to take blood or anything."
Half of the students - 18 - reported that competition rather than co-operation was the defining characteristic of medicine. Thirteen said one "module" of the hidden curriculum concerned the need to impress senior medical staff - seen to prepare the way for prestigious jobs in the future.
The researchers said: "Although some NHS trusts have introduced measures intended to stamp out bullying among staff members, these measures have not yet been widely adopted within teaching hospitals. Indeed, this would involve a change in the core organisational culture and identity of medicine.
"Such policies could be framed in terms of 'zero tolerance' towards the humiliation of students, made explicit in the contract of teaching staff, with workable ways to allow confidential reporting of such behaviour without damage to the career prospects of whistleblowers."
Dr Peter Dangerfield, chairman of the British Medical Association's board of medical education, said there should be no place for humiliation or poorly organised teaching in the 21st century medical school.
"The idea that students learn best when they're terrified is outdated and has been rejected by the vast majority of academics and consultants. Medical school should be a place where students learn from role models in a positive and friendly atmosphere."
He added: "But while the culture of learning is changing, we need to see practical action to address the staffing crisis in medical schools. Many of the problems experienced by students in this study are the result of shortages of medical academics.
"The medical career structure needs to be reformed so that teaching becomes an attractive option, rather than a poor relation to clinical work and research."
