Journal of Bioethical Inquiry

, Volume 13, Issue 2, pp 203–213

Power Day: Addressing the Use and Abuse of Power in Medical Training

  • Nancy R. Angoff
  • Laura Duncan
  • Nichole Roxas
  • Helena Hansen
Symposium: Structural Competency

DOI: 10.1007/s11673-016-9714-4

Cite this article as:
Angoff, N.R., Duncan, L., Roxas, N. et al. Bioethical Inquiry (2016) 13: 203. doi:10.1007/s11673-016-9714-4


Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well.


Power Medical training Hierarchy Medical education Mistreatment Inter-professional education 

Copyright information

© Journal of Bioethical Inquiry Pty Ltd. 2016

Authors and Affiliations

  • Nancy R. Angoff
    • 1
  • Laura Duncan
    • 2
  • Nichole Roxas
    • 3
  • Helena Hansen
    • 4
    • 5
  1. 1.Office of Student Affairs and Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.University of California, San Francisco (UCSF) School of MedicineSan FranciscoUSA
  3. 3.University of Rochester School of Medicine and DentistryRochesterUSA
  4. 4.Departments of Psychiatry and AnthropologyNew York UniversityNew YorkUSA
  5. 5.Nathan Kline Institute for Psychiatry ResearchOrangeburgUSA

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