Medical education: a neglectful and abusive family system.

Conceptualizing medical education as a family system facilitates recognition of the dynamics within the system which perpetuate many of the problems facing teachers, students, and practicing physicians. Neglectful and abusive families are often characterized by their unrealistic expectations, denial, indirect communication patterns, rigidity, and isolation. The medical education system has similar patterns of behavior that contribute to problems at all levels of the training process and include practicing physicians. The communication patterns within the teaching hospital reinforce trainees' strivings for perfectionism and devalue the contributions of nonphysician staff to the supervision of the physician-in-training. Excluding the potentially healing influence of "outsiders" contributes to the rigidity within the system. Like parents who raise their children as they themselves were raised, each generation teaches as they were taught, and the patterns are loyally perpetuated. Teachers will need to address their own training experiences, acknowledging the dysfunctional behavior patterns learned and the pain those behaviors cause. Then educators can begin to change how they teach and break the cycle of physical neglect and emotional abuse that has been inherited.