I trained to be a doctor in the bad old days — not the worst old days, but the bad old days. Humiliation was part of the deal, sometimes deliberately inflicted by certain grandstanding, sadistic attending physicians, sometimes more casually, because everyone could see that you didn’t know something you should have known.

Now we are aware of the consequences of harassment and unconscious bias, and we are trying to give medical students room to learn and grow — but many medical students and residents continue to experience harassment and discrimination and bullying. At the same time, some faculty members worry that they cannot discuss difficult subjects, or give negative feedback of any kind, for fear of upsetting students. In other words, though the training environment now looks much gentler to those of us who trained in the bad old days, we still don’t seem to be consistently getting it right.

In August, a commentary in JAMA Pediatrics addressed the intrinsic complication that medical training inevitably makes people uncomfortable: “Walking on Eggshells With Trainees in the Clinical Learning Environment — Avoiding the Eggshells Is Not the Answer.” You can’t avoid the eggshells, they argue, because medicine is going to bring you up against difficult situations and tricky conversations, and also because part of the responsibility of those who train doctors is to tell them when they’re messing up.

The lead author, Dr. Melanie A. Gold, a professor of pediatrics and population and family health at Columbia, said that she and her co-authors had repeatedly heard medical school faculty members express concerns about trainees feeling penalized when they heard feedback that was not positive.