Effects of mistreatment in medical schools: how to evaluate? A brief review

Abstract

Introduction: The occurrence of abuse, harassment and mistreatment of medical students is a widespread phenomenon and not a problem limited to certain countries or particular schools. Such behavior during medical training creates hostile learning environments, induces stress, depressive symptoms, may impair performance and patient care. Objective: To analyze the methodology used in recent studies to describe the consequences of mistreatment on medical student’s life and academic performance. Method: A brief review of the literature indexed in 6 international databases was carried out (PubMed, Scopus, Web of Science, SciELO, PsycINFO and Cochrane Library). The descriptors were categorized into two groups, one containing different types of violence and the other contemplating the studied population. Results: A total of 20 articles were selected for this study and all of them based their research methodology on the use of questionnaires, scales and/or interviews. The strengths and weaknesses of these methodologies were discussed, and the use of simulation was suggested as a new methodological alternative. Conclusion: This review reinforces that mistreatment of medical students has remained frequent over time and it is closely related to the students’ mental health and performance impairment. The authors recommend a new methodological approach to collect data related to the effects arising from a hostile learning environment.

Maltrato a estudiantes de medicina del Paraguay en 2022: estudio multicéntrico

“…La frecuencia del maltrato hallado en esta muestra puede catalogarse como leve en 58,9 %, moderado en 11,2 % y grave en 29,9 %. En un metaanálisis realizado en 2014, la frecuencia del maltrato fue tan elevada como 60 % (6). Pero reportes recientes describen frecuencias más elevadas: 98 % en estudiantes de medicina de México y Colombia, 79,9 % en Chile, 92 % en Brasil, 87,4 % en Nigeria, 96 % en Estados Unidos, 63 % en Reino Unido, 40 % en Finlandia, 28 % en Arabia Saudita, 52 % en Pakistán, 18 % en Panamá (2,(13)(14)(15)(16).…”

“…Esto crea la posibilidad de la existencia de un ciclo de abuso, en el cual los estudiantes de medicina que han sido maltratados se convierten en perpetradores en el futuro. Las bajas tasas de éxito de las estrategias implementadas para reducir las actitudes inapropiadas en el entorno académico también son responsables de la persistencia del maltrato (6,(22)(23)(24)(25). Lastimosamente en este estudio no se evaluaron estas causas, pero los hallazgos obligan a seguir estudiando este fenómeno de manera a suprimir o mitigar el maltrato.…”

“…El uso de cuestionarios y el llenado de escalas validadas representan métodos establecidos en el análisis de situaciones de maltrato en el ámbito académico (6). Se prefieren las encuestas anónimas pues permiten obtener información muy sensible.…”

Elaboration and validation of an Instrument to Identify Sexual Harassment of Medical Students (MESSHII)

“…Of the 20 articles analyzed, only one had sexual harassment as its main focus 15 . Moreover, no methodologically validated instrument was found to identify this event in the medical field.…”

Elaboração e validação de Instrumento de Identificação de Assédio Sexual de Estudantes de Medicina (IIASEM)

“…Em um trabalho de revisão de 2021 que objetivou analisar a metodologia utilizada para descrever as consequências de maus-tratos na vida de estudantes de Medicina, dos 20 artigos analisados, apenas um possuía como foco principal o assédio sexual 15 . Ademais, não foi encontrado nenhum instrumento metodologicamente validado para identificação desse evento na área médica.…”