Specialty Disrespect Fact Sheet

“Specialty badmouthing,” “career choice bullying,” or “specialty disrespect” is defined as “unwarranted, negative, and denigrating comments made …about different specialties.” [1]

 It affects as many as 80% of students and can impact students interested in almost any specialty, but its frequently experienced by students interested in emergency medicine, family medicine, general surgery, OB/GYN, pediatrics, and psychiatry. [2] Students and residents may both be propagating misinformation about other specialties as well as being recipients themselves of specialty disrespect.

It happens when we share incorrect or stereotypical information about other fields and results in students being dissuaded from pursuing their intended career choice. [2] More frequent negative comments were correlated with a higher negative impact. [3] It is one element of the “hidden curriculum” and maybe a form of learner mistreatment. Negative comments actually can dissuade students from both the disrespected specialty AND the specialty providing the comment.[2]

These comments come from fellow students, residents, nurses, staff, as well as attending physicians.¹

 Being respectful of other specialties is measured on the AAMC Graduation Questionnaire, taken by Georgetown M4s just before Graduation. In 2019, 60.0% of students said that faculty were respectful of other specialties, falling below the national mean of 63.1%.

We all want students to go into our own specialty! But if a student is to avoid burnout and be happy for their full career, a career decision should be based on factual information about all specialties. The power differential between attendings or residents and students means that negative comments about other specialties have disproportionate effects. Reducing specialty disrespect improves MedStar’s learner environment and furthers Georgetown University School of Medicine’s mission to create and sustain a culture of respect.

Comments about other specialties are often based on incorrect, stereotypical, outdated, or false information. Furthermore, a student receiving these comments may perceive that they are being dissuaded based on sex, race, or other personal factors.

Episodes of specialty disrespect are challenging to deal with. One way to think about them is as a form of microaggression. The HEALS model for dealing with microaggressions from UCSF proposes several steps:

• Halt – Pause and clarify what was said
• Engage – Let’s talk about the issue you bring up
• Allow – Discussion, reactions
• Learn– Listen to each other
• Synthesize – Why does it matter, how is it related to health care?

• specialty
• Refrain from telling students why they should or should not go into other specialties
• Educate yourself and your Department about the issue by attending a talk or reviewing the Specialty Disrespect PowerPoint
• Host or give a talk using the Specialty Disrespect PowerPoint
• Take the Specialty Disrespect Pledge and require you faculty and resident to do the same. You can do so at https://georgetown.az1.qualtrics.com/jfe/form/SV_afKFpEDOEMSUuVf 
• Stress to faculty that this is a way to reduce student mistreatment and improve the environment of learning

If you experience anything that you feel rises to the level of mistreatment, we strongly encourage you to report this to the Medical School. Options for reporting can be found at https://som.georgetown.edu/mission-and-culture/culture-of-respect/reportingprocedures/ .

1. Kamien BA, Bassiri M, Kamien M. Doctors badmouthing each other. Does it affect medical students’ career choices? Aust Fam Physician. 1999;28(6):576-579.
2. Alston M, Cawse-Lucas J Hughes LS et al. The Persistence of Specialty Disrespect: Student Perspectives. PRiMER. 2019;3:1. Published: 1/11/2019.DOI: 10.22454/PRiMER.2019.983128.
3. Oser TK, Haidet P, Lewis PR, et al. Frequency and Negative Impact of Medical Student Mistreatment Based on Specialty Choice: A Longitudinal Study. Acad Med. 2014;89:755–761. doi: 10.1097/ACM.0000000000000207
4. UCSF Office of Diversity and Outreach, HEALS for Faculty Developers Slides, used by permission CCL 3.0, https://diversity.ucsf.edu.