Appendix 3b - Cynical

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Traumatic De-idealization

The Journal of Medical Education, "Many writers blame the medical school for producing such strong feelings of inferiority in medical students that they defend themselves by becoming cynical."[54] Quoting from Harper's Magazine: "Trained in a harsh and unforgiving environment, too many go on to become harsh and unforgiving professionals themselves."[55] "Slowly," one student explains, "I'm seeing my classmates become 'destroyed' and it scares me! I've become so cynical that it's just not right!!"[56]

Although physicians are expected to be caring and compassionate, the socialization process in medical school often leads to development of cynicism, a process that has been termed "traumatic de-idealization."

Cynicism, "a contemptuous disbelief in the sincerity of motives."[57]

"One of the few areas of universal agreement concerning students' development," a researcher writes in Academic Medicine, "is that medical training can make students and residents more cynical and insensitive."[58]

As far back as 1975 it was noted:

Certainly there is no evidence that medical education increases humanitarianism or benevolence in students, or enhances any other attitudes we may deem desirable. At the very best, it may not grossly interfere with these attitudes in students who arrive at medical school strongly imbued with them.[59]

Since then, numerous studies have demonstrated that the expression of cynical attitudes increase and humanitarian feelings decrease as students progress through medical school.[60] One study followed medical and law students and found an increase in cynicism and decrease in humanitarianism in the medical students, but not in the law students. In contrast, the law students actually became more humanitarian by the end of their schooling.[61]

Quoting from JAMA, "Students, while eager and enthusiastic at the time of admission to medical school, became cynical, frightened, depressed, or frustrated men and women after they had been in medical school for a while."[62] Investigators have traced the progression of intellectual curiosity, optimism, and empathy for patients during the first year to feelings of cynicism and hostile regard for patients during the fourth year.[63] Faculty members themselves sometimes refer to the clinical and pre-clinical years as the "cynical and pre-cynical years."[64]


[54] Rezler, AG. "Attitude Changes During Medical School." Journal of Medical Education 489(1974):1023-1030.

[55] Duncan, DE. "Is this Any Way to Train a Doctor." Harper's Magazine 1993(April):61-66.

[56] Academic Medicine 69(1994):670.

[57] Testerman, JK, et al. "The Natural History of Cynicism in Physicians." Academic Medicine 71(1996):S43-S45.

[58] Hundert, EM. "Characteristics of the Informal Curriculum and Trainees' Ethical Choices." Academic Medicine 71(1996):624-640.

[59] "Attitude Change in Medical Students." The Lancet 1 February 1975:262.

[60] Wolf, TM, et al. "Perceived Mistreatment and Attitude Change by Graduating Medical Students." Medical Education 25(1991):182-190.

[61] Kopelman, L. "Cynicism Among Medical Students." Journal of the American Medical Association 250(1983):2006-2010.

[62] Rosenberg, DA and HK Silver. "Medical Student Abuse." Journal of the American Medical Association 251(1984):739-742.

[63] Sparr, LF et al. "The Doctor-Patient Relationship During Medical Internship." Social Science and Medicine 26(1988):1095-1101.

[64] Ehrlich, DA. "Idealism of Medical Students: What Happens to It?" New Physician 7(1958):33.

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