The Chilling Reality of Ethical Dilemmas in Medical Training

As a medical student, the journey into the world of healthcare is not merely about mastering the intricacies of the human body and disease but also about navigating the moral and ethical landscape that defines the profession. This blog post dives into the disheartening experience of medical trainees who face ethical dilemmas and the repercussions of advocating for what is right, inspired by a series of troubling events that came to light involving Dr. Melani Cargle and Dr. Louis Kwong at UCLA-Harbor Medical Center.

The Courage to Report Unethical Behavior

Several years ago, Dr. Melani Cargle, then an orthopaedic surgery resident, found herself in a precarious situation when she witnessed and anonymously reported unethical behavior by a senior physician, Dr. Louis Kwong. Instead of being protected as an anonymous whistleblower, her identity was disclosed by the administration, leading to severe consequences. Dr. Cargle was accused of fabricating her story, which eventually led to her dismissal from the residency program, tarnishing her professional reputation and derailing her career.

A Delayed Justice

It is profoundly depressing to learn that it took years for the truth to surface. Recent developments have revealed that Dr. Kwong was indeed guilty of the allegations Dr. Cargle had made, along with similar accusations from other physicians and staff over a decade. Despite the continuous unethical behavior, it appears that the institution had protected Dr. Kwong until overwhelming evidence made his dismissal inevitable.

The Culture of Silence in Medical Education

This incident is emblematic of a broader issue prevalent in medical training environments across the United States. Recent research, including a study conducted by myself and colleagues, highlights the reluctance among medical students and residents to report sexual misconduct and other unethical behavior. The fear of retaliation or being ostracized from the community discourages many from speaking out, perpetuating a culture of silence that conflicts starkly with the ethical doctrines taught in medical schools.

The Dichotomy of Medical Ethics and Reality

Entering the medical field, trainees are indoctrinated with principles of nobility, ethics, and advocacy. However, the reality often does not reflect these ideals. The discrepancy between what is taught and what is practiced can disillusion and deter trainees from taking a stand against wrongdoing. The lack of robust protective mechanisms for whistleblowers in medical institutions only exacerbates this issue.

Navigating the Path Forward

Experienced physicians often advise young trainees to navigate their training years with caution, suggesting that to survive the process and attain the coveted title of a physician, one must often turn a blind eye to malpractice and injustice. This pragmatic yet disheartening advice underscores a critical need for systemic changes within medical training institutions to foster an environment where ethical concerns are genuinely valued and addressed.

Conclusion

The firing of Dr. Kwong, albeit delayed, is a small step toward justice for Dr. Cargle and many others who have suffered under similar circumstances. However, it also serves as a stark reminder of the ongoing struggles within the medical community regarding ethics and integrity. For those of us still training, these revelations are not just stories but cautionary tales that shape how we perceive our future roles within this noble profession. We must strive to be part of the change, advocating for a system that upholds the true values of medicine and protects those who dare to speak the truth.

The Ominous Symphony of Flaring: A Call to Action for Environmental Health in Osteopathic Medicine

As dawn broke over San Antonio this morning, the serene silence was shattered by the roar of flaring from a nearby petroleum facility. This facility, merely blocks away from my medical school, UIW School of Osteopathic Medicine, stands in contrast to the mission of healing and health promotion championed within my medical schools walls. The sound from the flaring, akin to a jet engine, is not just a disruptive auditory occurrence but a harbinger of deeper environmental and health concerns that resonate through the community — one of the poorest in San Antonio, as characterized by the Texas Department of Health & Human Services. Moreover, this community is burdened with one of the highest cancer rates in Texas, a statistic that is hard to overlook as a mere coincidence.

The process of flaring, while a safety measure, emits a cocktail of pollutants, including volatile organic compounds (VOCs), sulfur dioxide, nitrogen oxides, and greenhouse gases like carbon dioxide and methane. The proximity of this facility to the San Antonio River raises grave concerns about potential runoff and the impact on aquatic ecosystems, which can affect water quality and biodiversity. It is not just the river that suffers but the very soil on which children play, and families build their lives—a soil that may carry the remnants of these pollutants.

This intersection of industry, health, and environment near my medical school where future osteopathic physicians are trained should provoke a profound reconsideration of the osteopathic philosophy. Osteopathic medicine has long recognized the interdependence of body, mind, and spirit. It is high time that this interdependence is extended to include the environment in which individuals are born, live, and pass away. The principles of osteopathy emphasize the body's ability to self-heal and self-regulate, but this natural capacity is compromised when the environment is laden with toxins.

Osteopathic medical students are taught to treat the patient, not the disease. Yet, when the environment itself contributes to disease, our approach must evolve. Environmental health needs to become a fundamental pillar of osteopathic medical education, encouraging students to consider the external factors influencing their patients' health. This approach aligns with the growing understanding of social determinants of health and their impact on patient outcomes.

To address this multidimensional challenge, I propose the adoption of a new osteopathic tenet: "Recognize the environment as a partner in health." This tenant would promote awareness and advocacy for environmental health as a component of holistic patient care. It would encourage future osteopathic physicians to consider how climate change and environmental degradation contribute to health disparities and to advocate for sustainable practices and policies.

Osteopathic medicine, with its holistic approach, is uniquely positioned to lead this charge. It has the potential to redefine the health narrative by including environmental stewardship as a component of compassionate patient care. As osteopathic physicians and educators, we must champion this cause, integrating environmental health into our curricula, research, and community engagement efforts.

The time for action is now. The roar of flaring at dawn should not be the legacy we leave but rather the alarm that awakens us to the urgency of protecting the health of our patients and our planet. It is our duty to respond, not only with concern but with a steadfast commitment to fostering environments that promote—not endanger—human health and well-being.

The Little Joys in Life

As I left school today, I noticed these clouds. There was nothing particularly special about these clouds, but what struck me was the fact that I noticed the clouds. I also noticed the smell of the fresh-cut grass on campus and I noticed how blue the sky was. In class, one of my small group members asked the question, "What are you most thankful for in this last month?" I thought for a moment and then I replied that I was thankful for making the purposeful decision to care for myself while I complete medical school. Last year, there wasn't much joy in learning. My head was always down as I was always thinking about school or grades or my performance or comparing myself to my peers. This year, I vowed not to do that, and I am making time to notice little details about the world around me.

One of the most significant changes I've made is learning to appreciate the present moment. It's astonishing how easy it is to rush through life without truly experiencing it. Those clouds in the sky, the scent of fresh grass, and the vibrant blue of the sky—they're all there, waiting to be noticed. And when we take the time to notice them, life becomes richer.

Supporting Loved Ones

I've also started paying closer attention to the changes my wife is making in her life. Sometimes, amidst our busy schedules, we forget to truly engage with our loved ones. But it's these subtle transformations that make life beautiful. Taking the time to understand her journey has not only brought us closer but has also enriched my own life.

Rediscovering Passions

In the hustle and bustle of medical school, I had set aside some of my greatest joys—cooking and lifting weights. But this year, I've reclaimed them. Spending time on activities that truly make me happy has rejuvenated my spirit. The simple act of cooking a delicious meal or pushing my limits in the gym has a profound impact on my overall well-being. Eboni and I plan to compete in the PF Changs Rock & Roll Marathon in Tempe, AZ in January. What she doesn't know is that I want us to compete in the 5k that will be here in San Antonio in December!

Connecting with the Furry Friends

Playing with my cats may seem trivial, but these small interactions have a way of grounding us. Their unfiltered joy and curiosity remind me of the simple pleasures in life. Taking a moment to pet them or play with them provides a welcome break from the demands of medical school.

Prioritizing Health and Well-being

Perhaps the most significant shift I've made is developing a new, more respectful relationship with my overall health. Instead of viewing it as something to be neglected in pursuit of academic excellence, I've come to see it as an integral part of my journey. Enjoying what I eat again and making conscious choices about my health has not only boosted my energy but also my enthusiasm for learning.

Embracing the Joy of Learning

With these changes, learning is fun again. I appreciate being in school, but I appreciate being able to notice the world around me even more. Life isn't just about the destination; it's about the journey. And it's in the little details, the clouds, the scent of grass, the laughter of my cats, and the taste of a well-cooked meal, that we find the true essence of life.

So, here's to a new chapter in my medical school journey—one filled with self-care, appreciation for the world around me, and the pursuit of joy in every moment. Because in the end, it's not just about becoming a doctor; it's about becoming a more fulfilled and present human being.

Reflections on Resilience

Embarking on the medical school journey is a path filled with triumphs and tribulations. Here at the end of my second week of classes, I found myself reflecting on last year’s challenge that tested my determination and resolve. The setback of failing the unit 4 anatomy exam, after having failed the unit 2 and 3 anatomy exams, cast a shadow of doubt on my dreams, making me question if I had what it takes to continue this journey. The daunting prospect of repeating the year and the tantalizing thought of returning to my previous life as full-time university faculty loomed large. However, a series of experiences and revelations steered me away from the brink of giving up and has allowed me to emerge stronger, more resolute, and determined to succeed.

When the unit 4 exam results were released last year, I thought that I’d passed and would have the opportunity to remediate the units 2 and 3 exams. Successfully remediating them would have meant that I would have moved into my OMS-2 year. However, the news of failing the unit 4 anatomy exam struck me with a wave of sadness, disappointment, and self-doubt. The initial excitement and optimism I had carried with me into medical school were quickly overshadowed by feelings of inadequacy. Being told that I would have to repeat the year was a significant setback. It was during this juncture that I contemplated returning to my former, comfortable, and predictable life as faculty. I sought solace in familiarity rather than persisting through uncertainty.

Amidst the internal struggle, a profound discovery turned the tide of my emotions. After my mother passed on 17-July 2023, Eboni stumbled upon some of my mother's writings and prayers. I never knew that she was that interested in the personal, academic, and career goings on in my life, but her writings and prayers captured her unwavering belief in my potential to not only enter medical school but to become the physician she had never had the opportunity to be treated by. This realization struck a chord deep within me and reignited the fire of my initial aspirations. I realized that my journey wasn't just for myself but was a testament to the hopes and dreams of those who believed in me.

As I navigated the decision to return to my previous life or stick with medical school, friends and mentors emerged as guiding lights in my darkest moments. The outpouring of support, encouragement, and assistance I received from those around me breathed new life into my wavering determination. Their belief in my abilities and willingness to extend a helping hand rekindled my faith in myself. With their guidance, I began to prepare to repeat the year by focusing on studying anatomy during my summer break.

The conclusion of this second week has marked a significant turning point in my journey. A newfound sense of confidence has begun to bloom within me. The once-confusing concepts in anatomy and overwhelming academic pressure has started to recede, and I have a newfound sense of clarity and understanding. I don’t feel constantly behind. Astonishingly, I discovered that I am not only embracing the subject matter but I’m also beginning to excel in it.

Crucially, the start of this term has been marked by a profound shift in perspective regarding success and self-care. I have learned to liberate myself from the unhealthy habit of comparing my progress to that of my classmates. I have embraced the truth that success is a personal journey and cannot be measured solely by study hours or sleepless nights. Rejecting the notion that burning the midnight oil is the only path to success, I am prioritizing self-care, spending time with my wife, and having weekly check in’s with my brother-from-another-mother, Rob, recognizing their pivotal role in helping me to maintain both mental and physical well-being.

Central to this transformation has been the unwavering support of an incredible study partner. A former soldier like me, a devoted family man, and a kindred spirit, he understands the challenges of this journey on a deep level. Sharing a similar mindset, we not only push each other to excel but also provide the support necessary to overcome obstacles. His presence has been a source of inspiration, reminding me that resilience and determination are key to overcoming adversity.

At the end of this second week of medical school, I have found myself reflecting on the whirlwind of emotions, challenges, and triumphs that define this brief yet transformative period. From the brink of giving up to the realization that quitting was not in my DNA, this journey has been one of growth, resilience, and self-discovery. With a renewed sense of purpose, a network of support, and a newfound understanding of success and self-care, I embark on the rest of this term with confidence, ready to face the upcoming challenges and emerge stronger on the other side.

Research study: Sexual harrassment and sexual violence in U.S. medical schools

👋

🏼 Attention all allopathic (MD) & osteopathic (DO) medical students currently enrolled in a U.S. medical school! 🩺📚 Are you interested in participating in an important research study on sexual violence and harassment within U.S. medical schools? 🌟

My name is Daryl Traylor, and I'm a medical student at the University of the Incarnate Word School of Osteopathic Medicine (IRB Approval #2023-1425-EXP-v4). I am conducting a cross-sectional study to address the lack of comprehensive quantitative research on this issue and aim to promote a safer and more inclusive educational environment for medical students. 🎓✨

Participation is completely anonymous and confidential, with no identifying information collected. By completing a short 10-12 minute Qualtrics survey, you can contribute to the development of evidence-based interventions and policies. 📝

Again, 🔒 No identifying information, including IP addresses, will be collected. If you're interested in taking part or would like more information, click the link below to check eligibility and access the survey. Feel free to share this opportunity with your colleagues too! 📩🤝

🔗 Survey Link: https://lnkd.in/eNwr9GVP

For any additional questions, please contact the study Principal Investigator, Daryl Traylor, at dtraylor@student.uiwtx.edu or call (623) 295-9081. 📧📞

Join me in making a difference and creating a safer environment for all medical students! Together, we can address and combat sexual violence and harassment. 💪🌍

A failure

Failure. In Western society, we teach children lots about why its important to win, how to win, and the benefits of winning. However, we don’t often teach anything about failure. I started medical school in 2021 at 49 years old. This was something that I’ve wanted for as long as I can remember and virtually everything that I’ve done, from my military career up until now, was geared to not only get into medical school but to successfully finish medical school. Unfortunately, despite my best efforts, things have not gone how I’d hoped.

Midway through my first unit, I had a medical emergency and had to take a leave of absence for close to a year. I came back to school at 51 and essentially started over with unit 1. I successfully passed the unit and started unit 2 and promptly went on to contract COVID. I missed a significant amount of school in unit 2 and 3 and subsequently failed the anatomy exams in both units. Going into unit 4, I knew that I had to pass everything in the unit, to have the opportunity to remediate the two failed units (along with passing everything in unit 5) and advance to my second year of medical school. Unfortunately, I failed the anatomy exam in unit 4 and I was informed today, two weeks into unit 5, that I cannot continue with my class. I can either start over as a year one medical student again, at 51 years old, or I can walk away from this dream…

Right now, I’m in a bad, dark place and I don’t know what I am going to do. I can try to rationalize things by blaming things on my first medical leave of absence and on having COVID but at the end of the day, I failed, and I must live with that. The problem is that I don’t know how to do that. Medical schools damn sure don’t do anything to help build you up and the competitive nature of school doesn’t lend itself to being able to confide in your classmates (One of my classmates had to send a reminder this week, in. our class GroupMe, asking people to be sensitive to the fact that some did not pass the unit and that jokes shouldn’t be made at their expense…) In many ways, you feel very much alone when you have failed as a medical student. #medicalstudent #failure

Disaffected osteopathic medical student

I have been carrying a weight on my shoulders for a while now, and while I am busy studying for exams, I need to unburden myself. I recently failed two out of three exams in my previous unit and had to face the Student Performance Committee (SPC). When summoned before the committee, students receive a terse email with the date, time, and location of the meeting. We are instructed to dress in business casual attire and wear our white coats. It's a well-known fact among the students that the sight of groups of students in white coats walking across campus on a Wednesday means that they are headed to an SPC meeting.

I am frustrated with the way these meetings are conducted, and I don't understand why the school doesn't take steps to protect the privacy and mental health of students during such a challenging time. It seems that all DO programs handle SPC meetings in the same way, which is disappointing. On the day of the meeting, I walked into the SPC office, and I was met with a long table with 8-12 faculty members sitting around it. There was a large monitor at the head of the table displaying my grades, and I was bombarded with questions such as "What happened?" "Why do you want to be a doctor?" and "Are you sure that you can handle this?"

Despite feeling angry and distressed inside, I had to keep a smile on my face and take full responsibility for my failure, even though it was not entirely my fault. I was stricken with COVID in Unit 2 and again in Unit 3, which caused me to miss two full weeks of classes in Unit 3. My school does not give us access to lecture recordings until after we prove that we are ill. Unfortunately, by the time I received access to the recorded lectures I had missed, it was too late for me to view them before the final exam period. The entire SPC process felt degrading to me, and I would have preferred to go through an Article 15 hearing instead.

The reason I am sharing all of this is that being an osteopathic medical student has not been what I had hoped for. I first learned about osteopathic medicine in my senior year of high school back in 1989. I was impressed by the ideas of holistic, nurturing, and different approaches to medicine, which I had read about in a catalogue from UNTHSC-Texas College of Osteopathic Medicine. Later in 2007, when A.T. Still University School of Osteopathic Medicine, Arizona opened, I became enamored and almost star-struck with the ideas espoused by osteopathic medicine.

After many struggles, I finally earned a seat at UIW School of Osteopathic Medicine in San Antonio, TX, and I was excited to start living my dream. However, I soon realized that there was nothing different between a DO school and an MD school, and the ideas espoused by osteopathic proponents did not measure up to the actions taken in the schools or at higher levels of leadership.

For example, osteopathic medicine has the Four Tenants of Osteopathic Medicine, which are closely related to the Social Determinants of Health (SDOH). However, very little of our education focuses on these tenants or SDOH. I recently submitted an idea for an article to The DO, the journal of the profession, and was told to focus on HIV prevention. The underlying subtext was to stay away from political and policy advocacy that might make the AOA look bad.

When it comes to the educational curriculum, there is an underlying patriarchal and controlling atmosphere that is prevalent in many schools. Despite being labeled as adult learners, students often feel like they are not given the autonomy and respect that comes with that label. Instead, there is a one-size-fits-all approach to learning that does not consider individual learning styles and preferences. We have mandatory attendance; most students work on Anki or study and the faculty get angry, but again, we all learn in different ways. Mandatory attendance does not make for better educational outcomes. The hesitance to change within osteopathic medicine is truly frustrating.

While some schools are better than others, there is still a long way to go in terms of providing a truly equitable and empowering education. As a student, it can be frustrating to feel like you are being educated in a broken system, only to be sent out to work in a similarly broken healthcare system. It raises the question of what the point of all this effort and time is.

As I reflect on my journey towards earning my DO and pursuing medicine, I find myself praying fervently to God for guidance. I question whether this is truly the path that He wants me to take. The arduous process of education and training in the current system can make it feel like the effort is not worth it.

Despite these doubts, I am committed to giving my all to the upcoming Unit 4 exam. If I pass, I will move on to Unit 5 and prepare for my exam retakes from the unit I failed. Assuming that I am successful, I will move into my OMS-2 year in late July.

As I move forward, I plan to spend time this summer in deep reflection and communication with God to determine if pursuing medicine is truly the path I should be on. I know that His guidance and wisdom will lead me to the right decision.