During bedside rounds, a medical student is asked by the senior resident to describe the differential diagnosis of hematuria. After listing several diagnostic possibilities, but neglecting to mention nephrolithiasis, the resident sarcastically says, "What year of medical school are you in? When I was a student, I could recite this in my sleep." The student is upset by this comment and speaks to the resident privately later in the day, saying, "I am open to feedback on my performance but would hope that you would not belittle me in public." Earlier that day the resident was reprimanded by the chief of service for mismanaging the care of a private patient. The resident did not agree with the attending's assessment but said nothing. Which of the following defense mechanisms is exhibited by the resident's behavior toward the student?

Question

During bedside rounds, a medical student is asked by the senior resident to describe the differential diagnosis of hematuria.  After listing several diagnostic possibilities, but neglecting to mention nephrolithiasis, the resident sarcastically says, "What year of medical school are you in?  When I was a student, I could recite this in my sleep."  The student is upset by this comment and speaks to the resident privately later in the day, saying, "I am open to feedback on my performance but would hope that you would not belittle me in public."  Earlier that day the resident was reprimanded by the chief of service for mismanaging the care of a private patient.  The resident did not agree with the attending's assessment but said nothing.  Which of the following defense mechanisms is exhibited by the resident's behavior toward the student?

Quizplus · Accepted Answer

11ec25c8_d7b2_aa24_bc81_a7f509403bb4_MD0003_00 Psychological defense mechanisms are unconscious means of responding and adapting to different situations while preserving self-image. These mechanisms serve to decrease anxiety associated with shame and vulnerability and ensure a feeling of safety in the face of disappointments. Immature defense mechanisms are more commonly used in children and adolescents but can also be seen in adult psychopathology (eg, personality disorders) or in adults in times of stress. Immature defense mechanisms provide short-term relief but often result in long-term complications. Mature defense mechanisms are most often used by well-adjusted individuals and allow for a "healthy" and more constructive approach to reality. Displacement is an immature defense mechanism that involves transferring emotions associated with an upsetting object or person to a safer alternate object or person. The resident likely was shamed and angered by being reprimanded by the attending and instead of acknowledging his feelings, he displaces his negative emotions onto a "safer" target by making sarcastic, shaming comments to a junior member of the team. (Choice A) Acting out involves expressing unacceptable feelings through impulsive physical actions (eg, if the resident pounded the desk or destroyed items in the attending's office in reaction to being criticized). (Choice C) Projection involves attributing one's own feelings to someone else (eg, if the resident thought that the student was being angry and sarcastic). (Choice D) Reaction formation involves transforming unacceptable feelings into their extreme opposite (eg, the resident acting in an overly deferential manner to the attending when he was really angry). (Choices E and F) Sublimation and suppression are mature defense mechanisms. In sublimation, aggressive feelings are channeled into socially acceptable behavior (eg, a competitive tennis match). In suppression, unwanted feelings are consciously put aside (eg, if the resident had made the conscious decision to put his anger and shame aside and interact professionally with the student). Educational objective: Displacement is an immature defense mechanism in which the individual displaces negative feelings associated with a person or situation onto a "safer," more acceptable object or situation. References: Change in coping and defense mechanisms across adulthood: longitudinal findings in a European American sample. (http://www.ncbi.nlm.nih.gov/pubmed/23834293)

During Bedside Rounds, a Medical Student Is Asked by the Senior