In my second year of medical school, amidst the frequent exams and impending doom of third year rotations, I would often look forward to Tuesday nights. On these nights, students and residents would come together to play pick-up basketball at a local gym, removed from the stresses of medical school. On the court, we played as equals, without our labels within the medical hierarchy; a first-year medical student could compete against a chief resident on a level playing field without fear of repercussion. As I would soon learn, however, even these pick-up games were not immune to the power dynamics inherent to medical education.
One night, I was especially eager to play basketball after a three-week hiatus. Unsurprisingly, over 30 people showed up itching to play after the long absence. This anticipation and limited availability of playing spots led to particularly competitive games. As games became closer in score, people played harder, which led to some physicality and trash talking.
In one heated exchange, my defender taunted, “I’m too big for you!” Bothered by his remarks, I shot back saying, “It’s easy to be big when you’re slapping at my arms!” Usually, these exchanges are common and harmless. However, on the very next play, he drove his shoulder through my chest with enough force to knock me to the ground, turning our verbal sparring into a physical contest. He then stood over me with a smile on his face, a strong insult in basketball. Normally, I would not tolerate this act of intimidation. But he was not just any basketball player, he was a third-year resident in my field of interest. This was no longer an interaction between two basketball players, this was a third-year resident exercising his power over a second-year medical student. As such, I elected to not say anything and continued playing.
After the game, I approached another player, a third-year medical student. I asked him privately, “That was completely inappropriate, right?” He responded, “Yeah, that was totally uncalled for and unnecessary.” But before I could feel validated, he followed up with, “But don’t let that affect your view of him, he’s actually a really nice guy.” I was speechless. Not only had he ironically recognized the injustice and immediately dismissed its significance, but his advice was to forget the incident even happened. Not wanting to cause trouble, I agreed that he was indeed a “nice guy.”
As I drove home that night, I felt powerless. I received little support and guidance on how to navigate these feelings. The prevailing wisdom was just to do my best to reconcile the situation with the resident to avoid possible repercussions during rotations the following year. Before this incident, I had only heard stories from upperclassmen about how residents could take advantage of students on the hospital floors. I anticipated that I would experience this firsthand during my third-year clinical rotations, but looking back this was my first encounter with the infamous toxic medical hierarchy that pervades medical education, a hierarchy so powerful that it revealed itself in a simple game of basketball outside the confines of the hospital and the classroom.
From this disturbing experience has come an even harsher lesson. The medical hierarchy pervades our daily lives both inside and outside the healthcare setting as medical professionals and especially as medical students. As such, we cannot simply advise students to “avoid conflict”, which would only empower abusers of the system.
With third-year rotations approaching, I worry that these instances will become more common. But having experienced the dangerous repercussions of complacency, I now recognize the importance of always speaking up against injustice within the medical hierarchy. Doing so will not only help me but also empower others to speak about their experiences when they previously had no support. In addition, a clear avenue for reporting these occurrences is essential so individuals are not left feeling powerless. Through this, we can begin to breakdown the longstanding misuse of power within the medical education system.
Image credit: “Details of basketball hoop” (CC BY 2.0) by dejankrsmanovic
Contributing Writer
Albany Medical College
Nathan is a second-year medical student at Albany Medical College in Albany, New York class of 2025. In 2021, he graduated from Union College with a Bachelor of Science in Biology and Psychology and from Clarkson University with a Masters in Business Administration in Healthcare Management. He enjoys playing basketball and guitar in his free time. After graduating medical school, Nathan would like to pursue a career in internal med/cardiology with involvement in healthcare administration and public health.