Perception of mistreatment during medical residency in Mexico: evaluation and bioethical analysis

Percepción de maltrato durante la residencia médica en México: medición y análisis bioético
Stéphanie Derivea, M. de la Luz Casas Martíneza, Gregorio T. Obrador Verab, Antonio R. Villab y Daniela Contrerasb

a Centro Interdisciplinario de Bioética, Universidad Panamericana, Campus México, Ciudad de México, México
b Escuela de Medicina, Universidad Panamericana, Campus México, Ciudad de México, México

Recibido el 31 de enero de 2017; aceptado el 25 de abril de 2017

Palabras Clave

Maltrato; Residencias médicas; Abusos; Depresión

Keywords

Mistreatment; Medical residency; Abuse; Depression


Abstract

Introduction: Multiple interpersonal interactions are one of the many challenges faced by medical residents. Mistreatment towards residents has been shown to interfere with their training. However, there are few data about this phenomenon in Mexico.

Objective: To evaluate the perception of different types of mistreatment among medical residents and to make a bioethical analysis of the results.

Method: An electronic, 107-question survey was sent to medical residents of the Mexico State to assess their perception about psychological, physical, academic mistreatment, and sexual abuse. Attempts were also made to identify the person responsible for the mistreatment and its consequences. Analyses included descriptive statistics of mistreatment and its types, as well as sociodemographic data of participants. Logistic regression was used to assess risk factors for mistreatment.

Results: A total of 143 responses were obtained (8.2% response rate), with 84% of the residents reported having suffered mistreatment. The most frequent type was psychological (humiliation 78%), followed by academic (50% staying on call as a punishment and denial of education in 40%), and physical abuse (16% were beaten, 35% were deprived of food, and 21% were not allowed to go to the bathroom while being on call, as punishment). Also, 21% were pressured to consume alcohol against their will. Psychological and physical mistreatment were more frequent in surgical than medical specialties. As a result of mistreatment, 89% of residents reported burnout, 71% depression, 78% anxiety, and 58% sub-optimal patient care. The main perpetrators of the mistreatment were senior residents and attending physicians.

Conclusions: Abuse during residency is very frequent, and affects the human rights and dignity of residents. It also reduces the learning capacity and efficiency of specialty training, in a country with a high demand for health care that requires optimisation of economic and human resources.