Mistreatment in medical residencies: a qualitative study into the shaping of professional identities

Abstract

Introduction: Medical residencies are in-service postgraduate programs in which professional competencies are acquired to practice a specialty, and a professional identity is shaped. Medicine supports more demanding criteria and responsibilities as it is considered a social risk profession, and reports high levels of prevalence of mistreatment during training. The introjection of violence in the training experience generates, in several senses, high costs to the health system and its members.

Objective: To recognize the implications of hostile learning environments in the shaping of professional identities in medical residency programs.

Method: A descriptive-interpretative qualitative design was carried out with a sample of 307 residents from Argentina. Data were analyzed based on coding and contextualizing strategies.

Results: Four different attitudes towards the presence of mistreatment were identified: invisibilization, naturalization, critical stance and transformation perspective. These positionings reflect identity aspects of the medical community that are reproduced and disputed in the learning contexts.

Discussion: The shaping of identity is multifaceted, complex, and is influenced by informal daily interactions during the formative processes. The emergence of novel subjective positions that enter into tension with the values and practices that traditionally defined a “good doctor” is observed. Abuses of power and mistreatment practices are identified as traditional values that do not represent the current aspirations and needs of the professional staff.

Conclusions: Tensions are identified in relation to the validity, legitimacy and reproduction of traditional values and practices in the field of medical education. A challenging scenario is posed for the medical community and the health system as a whole, reflected in the growing demand for careful training and working conditions for all people: patients and health professionals.