Trust and safety

Today I simply present a longish quote from the book "Evidence-Based Medicine: How to Practice and Teach EBM".  Those long-time readers familiar with my tribulations in 2010 will understand why it resonates with me.

First, an extract from a table:

"Table 7.3 The top 10 mistakes we've made or seen in in teaching EBM.
Teaching EBM fails when:
...
9. When it humiliates learners for not already knowing the "right" fact or answer.
10. When it bullies learners to decide or act based on fear of others' authority or power, rather than on authoritative evidence and rational argument."

Then, the discussion:

"The ninth and tenth entries are included here because they are still commonplace among medical education programs, and at some of these institutions they remain a source of twisted pride.  Such treatment of learners by their teachers is not simply wrong in human terms, it is demonstrably counterproductive.  First, the resulting shame and humiliation learners feel will strongly discourage the very learning that the teacher's ridicule was meant to stimulate.  Second, in adapting to the rapid loss of trust and safety in the learning climate, learners will start employing strategies to hide their true learning needs and protect themselves from their teachers, undermining future learning and teaching efforts.  Understandably, learners with prior experiences of these behaviours may be very reluctant to even start the practice of EBM by asking a question, since it exposes them to the potential threat of repeated abuse.*

"*Contrast this with the actions of colleague David Pencheon, who asks new medical students questions of increasing difficulty until they respond with "I don't know".  Upon hearing these words, he rewards them with a box of Smarties and tell them that these are the three most important words in medicine."