The Stanford Prison Experiment in Scrubs: How Medical Training Dehumanizes by Design
In 1971, psychologist Philip Zimbardo conducted one of the most disturbing and insightful psychological studies in history: the Stanford Prison Experiment. This experiment, which assigned college students roles as either guards or prisoners in a simulated prison environment, revealed the impact of situational factors on human behavior. The 'guards' began to engage in acts of psychological torture, humiliation, and dehumanization toward the 'prisoners,' who in turn became passive, depressed, and compliant. The experiment ended after only six days due to the ethical concerns with continuing it.
Zimbardo's conclusion was clear: abuse does not require evil individuals; it simply needs a system that enables it.
This analogy highlights a significant issue within the U.S. medical education system. The residency system, much like the Stanford Prison Experiment, removes autonomy from residents, isolates them, and diminishes their sense of identity, while granting programs near-total authority. The problem of abuse does not arise solely from the actions of a few problematic attendings; rather, it is rooted in a system that is intrinsically designed to enable such behavior.
Power Without Accountability
In the Stanford Prison Experiment, the guards were given complete control over the prisoners without facing any consequences for their actions or having their power checked. They were not instructed to harm anyone, yet they chose to do so, feeling justified in their cruelty. They rationalized their behavior, and the structure of the experiment made their actions easy, even inevitable.
In residency, a similar dynamic exists. Program leadership and attending physicians have near-total control over residents' schedules, evaluations, careers, and reputations. Residents are often discouraged from speaking out or advocating for themselves, as reporting abuse can lead to retaliation. This abuse can take various forms, from verbal harassment to excessive work hours. There is no truly neutral human resources department to protect them, and there is no easy way to exit the situation. Residents must either endure mistreatment or risk jeopardizing their careers. Many are burdened with six-figure debt, which adds considerable pressure to comply.
Loss of Identity and Dehumanization
In Zimbardo's study, the guards forced prisoners to wear numbers instead of names, along with uniforms and mirrored sunglasses, to depersonalize themselves. This strategy made it easier for the guards to act cruelly. When you strip someone of their identity and humanity, it becomes much easier to justify mistreatment.
In medical training, residents can often be recognized by their year rather than by their names, such as "the intern" or "the second year." They are discussed as resources rather than as individuals, viewed as "coverage for overnight call" or simply "extra sets of hands" in the operating room. Their output measures their value. This is a form of dehumanization that devalues the contributions of residents and strips them of their dignity.
Consequently, residents often develop chronic depression, anxiety, and emotional numbness. Studies show that major depressive disorder is significantly more prevalent among these residents, with some estimates reaching up to 28%.
Learned Helplessness
As the simulated prisoners endured arbitrary punishments, sleep deprivation, and the loss of autonomy, many stopped resisting entirely. They became passive, lying on their cots, internalizing their feelings of blame, and deferring to authority without question. These behaviors are classic signs of learned helplessness.
This is easily comparable to the situation at many residency programs. After facing repeated humiliation, mistreatment, and feelings of powerlessness, many residents stop advocating for themselves, resigning to the mindset of "this is just how residency is." Their silence becomes a survival mechanism to cope with their circumstances. This response is the expected outcome of sustained coercion within relentless power structures. This behavior is well-recognized as a trauma response.
Situational Ethics Overrule Personal Morality
One of Zimbardo's most powerful insights is that people don't have to be inherently evil to cause harm. They simply need to be in a situation that removes accountability and normalizes cruelty. The guards in his study didn't believe they were doing anything wrong; they were just "doing their job."
In the field of medicine, we encounter similar phrases: "Everyone went through it," and "This is how it's always been." Trainees may also adopt the same abusive behaviors they were once subjected to when they become attendings who have power over vulnerable residents. Those who question this cycle are usually labeled as soft, weak, or unsuited for the profession.
The Medical Education System Enables Abuse
The Residency Match effectively locks residents into their training programs, granting leadership complete control over their schedules, daily lives, and careers. Residents inherently feel powerless. Speaking up is discouraged due to fears of retaliation, and the consequences can be severe, especially when there is no alternative path to practice and individuals are burdened with six-figure debt. These conditions create an environment that enables abuse by those in power (the programs) over vulnerable residents, often making mistreatment inevitable.
Residents are often recognized by their year or role rather than seen as individuals, reflecting the deindividuation experienced by the prisoners in the experiment. Sleep deprivation is not only a consequence of medical demands but also serves as a control mechanism that weakens resistance; exhausted residents have less energy to challenge authority. The absence of proper avenues for recourse or unbiased reporting makes retaliation easy and accountability almost impossible. Residents find themselves functionally trapped, with few ways to advocate for themselves without risking their careers. Learned helplessness helps them survive this environment.
A 2019 study in JAMA Internal Medicine found that nearly half of residents experienced mistreatment, with many reporting feeling unable to speak up due to fear of retaliation. 1 in 4 interns report having suicidal thoughts.
Psychiatric experts have warned that the rigid hierarchies and unchecked authority structures within medicine pose inherent risks for abuse. Their recommendations include flattening these hierarchies, incorporating training on power dynamics, providing anonymous reporting mechanisms that are independent of program control, and establishing dedicated time for therapy and rest. These suggestions are not radical; they are supported by both psychiatric literature and common ethical frameworks. Yet, the medical education system continues to resist change.
Why Do We Continue this Abusive Cycle in Medical Training?
Zimbardo ended his experiment, recognizing that no amount of data was worth the harm being inflicted on the study participants. In medicine, however, this harm has become normalized. We are aware of burnout rates, resident suicides, and the way that unchecked power can erode trust and compassion.
Yet, we do not end the experiment.
This is not an accusation against individual attendings, nor is it a plea to coddle trainees. Instead, it is a call to recognize what social psychology has demonstrated: when people are given unchecked power over others who are stripped of their identity, isolated, and placed in a system that emphasizes obedience and compliance, abuse becomes not just possible but inevitable.
The Stanford Prison Experiment was ended after only six days. In contrast, residency training perpetuates this harmful environment. It is time for a more humane and ethical approach to medical education.