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

Raúl Emilio Real Delor; Américo Ayala Saucedo

doi:10.31053/1853.0605.v80.n2.40440

Authors

Raúl Emilio Real Delor Dpto. de Medicina Interna. Hospital Nacional. Itauguá, Paraguay http://orcid.org/0000-0002-5288-5854
Américo Ayala Saucedo National University of Itapúa

DOI:

https://doi.org/10.31053/1853.0605.v80.n2.40440

Keywords:

hospital medical staff, sexual harassment, social behavior, surveys and questionnaires

Abstract

Introduction: Postgraduate residents tend to suffer mistreatment during their hospital practices and these abusive behaviors should not be considered normal. The objective of this study was to describe the frequency and characteristics of abuse in medical residents of Paraguay in 2022.

Methodology: An observational cross-sectional design was applied. Residents of Paraguayan hospitals who agreed to complete an online survey disseminated through social networks were included. A 23-question questionnaire that assesses psychological, physical, academic, and sexual abuse was used. Additionally, demographic, academic data and aspects related to the reporting of abuse were requested.

Results: The questionnaire was filled out by 348 residents. The mean age was 28 ± 2 years and there was a predominance of the female sex (63.2%). Residents of 32 hospitals participated, most of 1st year (50.3%) and clinical specialties (60.6%). According to the questionnaire, 339 residents (97.4%) reported some degree of abuse. Relating the specialties with the abuse, it was higher in the surgical ones: RR 1.4 95% CI 1.0-1.9 (p 0.01). The main perpetrators of mistreatment were senior residents (53.7%) and ward managers (31%). Only the 8% of mistreatment were reported. The main reason for not reporting abuse was fear that it could cause problems (67.8%).

Conclusions: Mistreatment was reported by 97.4% of residents, being higher in surgical specialties. It is urgent to apply preventive measures to avoid this type of abuse during medical residency.

Downloads

Download data is not yet available.

Author Biographies

Raúl Emilio Real Delor, Dpto. de Medicina Interna. Hospital Nacional. Itauguá, Paraguay

Jefe del Dpto. de Medicina Interna del Hospital Nacional, Itauguá, Paraguay
Coordinador del Postgrado en Medicina Interna, Facultad de Medicina, Universidad Nacional de Itapúa, Paraguay
Américo Ayala Saucedo, National University of Itapúa

Professor of the Faculty of Medicine, National University of Itapúa, Paraguay

References

1. Sierra Córdova A, Zárate Cáceres J, Mejia C. Maltrato asociado al acoso laboral a internos de Medicina en hospitales peruanos. Educ Med Super. 2019;33(4):37–50. Recuperado a partir de: http://scielo.sld.cu/pdf/ems/v33n4/1561-2902-ems-33-04-e1720.pdf

2. Munayco-Guillén F, Cámara-Reyes A, Muñoz-Tafur LJ, Arroyo-Hernández H, Mejia CR, Lem-Arce F, Miranda-Soberón U. Características del maltrato hacia estudiantes de medicina de una universidad pública del Perú. Rev Peru Med Exp Salud Pública. 2016;33(1):58–66. doi: 10.17843/rpmesp.2016.331.2008.

3. Mavis B, Sousa A, Lipscomb W, Rappley MD. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Acad Med. 2014 May;89(5):705-11. doi: 10.1097/ACM.0000000000000199.

4. Barbanti PCM, Oliveira SRL de, Pelloso SM, Carvalho MD de B. Effects of mistreatment in medical schools: how to evaluate? A brief review. Rev Bras Educ Med. 2021;45(3):e138. doi: 10.1590/1981-5271v45.3-20210054.ING

5. Mejia CR, Quiñones-Laveriano DM, Chacón JI, Aguirre-Valenzuela EA, Heredia-Torres PL, Miñan-Tapia A. Factores socioeducativos asociados a la percepción de maltrato en estudiantes de medicina peruanos. Educ Med Super. 2018;32(1):74–84. Recuperado a partir de: http://scielo.sld.cu/scielo.php?script=sci_arttext&amp%0Apid=S0864-21412018000100008

6. Peres MF, Babler F, Arakaki JN, Quaresma IY, Barreto AD, Silva AT, Eluf-Neto J. Mistreatment in an academic setting and medical students' perceptions about their course in São Paulo, Brazil: a cross-sectional study. Sao Paulo Med J. 2016 Apr;134(2):130-7. doi: 10.1590/1516-3180.2015.01332210.

7. Bastías-Vega N, Pérez-Villalobos C, Alvarado-Figueroa D, Schilling-Norman MJ, Espinoza-Riffo M, Parra-Ponce P, Matus-Betanocurt O, Toirkens-Niklitschek J. Maltrato en el pregrado de la carrera de Medicina: percepción de los estudiantes [Students' perception about mistreatment in undergraduate medical training]. Rev Med Chil. 2021 Apr;149(4):617-625. Spanish. doi: 10.4067/s0034-98872021000400617.

8. Lall MD, Bilimoria KY, Lu DW, Zhan T, Barton MA, Hu YY, Beeson MS, Adams JG, Nelson LS, Baren JM. Prevalence of Discrimination, Abuse, and Harassment in Emergency Medicine Residency Training in the US. JAMA Netw Open. 2021 Aug 2;4(8):e2121706. doi: 10.1001/jamanetworkopen.2021.21706.

9. Oku AO, Owoaje ET, Oku OO, Monjok E. Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school. Niger J Clin Pract. 2014 Nov-Dec;17(6):678-82. doi: 10.4103/1119-3077.144377.

10. De la Cerda-Vargas MF, Stienen MN, Campero A, Pérez-Castell AF, Soriano-Sánchez JA, Nettel-Rueda B, Borba LAB, Castillo-Rangel C, Navarro-Domínguez P, Muñoz-Hernández MA, Segura-López FK, Guinto-Nishimura GY, Sandoval-Bonilla BA. Burnout, Discrimination, Abuse, and Mistreatment in Latin America Neurosurgical Training During the Coronavirus Disease 2019 Pandemic. World Neurosurg. 2022 Feb;158:e393-e415. doi: 10.1016/j.wneu.2021.10.188.

11. Bedoya Jojoa CM. Covid-19: the pandemic of abuse against health personnel in times of pandemic. Interdiscip J Epidemiol Pub Health 2020;3(1):e6276. doi: 10.18041/2665-427X/ijeph.1.6276.

12. Vittale Acosta F, Velázquez Abente S, Ortiz Galeano I. Frecuencia del síndrome de Burnout en residentes de Medicina Interna del Hospital de Clínicas. Rev virtual Soc Parag Med Int. 2020;7(2):72–9. doi: 10.18004/rvspmi/2312-3893/2020.07.02.72.

13. Torres Romero AD, Alcaraz Romero IA. Síndrome de Burnout en médicos residentes de un hospital público de la ciudad de Aregua en el año 2020. Med Clin Soc. 2020;4(3):98–103. doi: 10.52379/mcs.v4i3.151.

14. Delgado Maidana W, Vega Carduz E, Sanabria L, Figueredo Thiel SJ. Prevalencia del síndrome de Burnout en médicos anestesiólogos del Paraguay durante el año 2010. Mem Inst Investig Cienc Salud. 2011;9(1):13–20. Recuperado a partir de: http://scielo.iics.una.py/scielo.php?script=sci_arttext&pid=S1812-95282011000100003&lng=es.

15. Samudio Domínguez G, Abe Abe E, Ortiz Cuquejo LM. Agresiones violentas contra los trabajadores de la salud pediátrica en el ámbito laboral: una realidad que no debe ser ignorada. Rev Salud Pública Parag. 2017;7(1):28–32. doi: 10.18004/rspp.2017.junio.28-32.

16. Ehie O, Muse I, Hill L, Bastien A. Professionalism: microaggression in the healthcare setting. Curr Opin Anaesthesiol. 2021 Apr 1;34(2):131-136. doi: 10.1097/ACO.0000000000000966

17. Moreno-Tetlacuilo LMÁ, Quezada-Yamamoto H, Guevara-Ruiseñor ES, Ibarra-Araujo N, Martínez-Gatica L, Pedraza-Moreno R. Las relaciones de género y el maltrato en las escuelas de medicina: una agenda pendiente en México y el mundo. Gac Med Mex. 2016;152(6):812–8. Recuperado a partir de: http://www.anmm.org.mx/GMM/2016/n6/GMM_152_2016_6_812-818.pdf

18. Oser TK, Haidet P, Lewis PR, Mauger DT, Gingrich DL, Leong SL. Frequency and negative impact of medical student mistreatment based on specialty choice: a longitudinal study. Acad Med. 2014 May;89(5):755-61. doi: 10.1097/ACM.0000000000000207.

19. Hu YY, Ellis RJ, Hewitt DB, Yang AD, Cheung EO, Moskowitz JT, Potts JR 3rd, Buyske J, Hoyt DB, Nasca TJ, Bilimoria KY. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019 Oct 31;381(18):1741-1752. doi: 10.1056/NEJMsa1903759.

20. Lind KT, Osborne CM, Badesch B, Blood A, Lowenstein SR. Ending student mistreatment: early successes and continuing challenges. Med Educ Online. 2020 Dec;25(1):1690846. doi: 10.1080/10872981.2019.1690846.

21. Leisy HB, Ahmad M. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review. BMC Med Educ. 2016 Apr 27;16:127. doi: 10.1186/s12909-016-0639-8.

22. Gan R, Snell L. When the learning environment is suboptimal: exploring medical students' perceptions of "mistreatment". Acad Med. 2014 Apr;89(4):608-17. doi: 10.1097/ACM.0000000000000172.

23. Hammoud MM, Appelbaum NP, Wallach PM, Burrows HL, Kochhar K, Hemphill RR, Daniel M, Clery MJ, Santen SA. Incidence of resident mistreatment in the learning environment across three institutions. Med Teach. 2021 Mar;43(3):334-340. doi: 10.1080/0142159X.2020.1845306.

24. Griffith M, Clery MJ, Humbert B, Joyce JM, Perry M, Hemphill RR, Santen SA. Exploring Action Items to Address Resident Mistreatment through an Educational Workshop. West J Emerg Med. 2019 Dec 9;21(1):42-46. doi: 10.5811/westjem.2019.9.44253.

25. Alsuliman T, Mouki A, Rahman WA. Need for guidelines on prevention of abuse in the health-care sector. Bull World Health Organ. 2022 Jun 1;100(6):409-410. doi: 10.2471/BLT.21.287555.

26. Kulaylat AN, Qin D, Sun SX, Hollenbeak CS, Schubart JR, Aboud AJ, Flemming DJ, Dillon PW, Bollard ER, Han DC. Perceptions of mistreatment among trainees vary at different stages of clinical training. BMC Med Educ. 2017 Jan 14;17(1):14. doi: 10.1186/s12909-016-0853-4.

27. Cheng MY, Neves SL, Rainwater J, Wang JZ, Davari P, Maverakis E, Rea M, Servis M, Nuovo J, Fazel N. Exploration of Mistreatment and Burnout Among Resident Physicians: a Cross-Specialty Observational Study. Med Sci Educ. 2020 Jan 7;30(1):315-321. doi: 10.1007/s40670-019-00905-z.

28. Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD. The prevalence of medical student mistreatment and its association with burnout. Acad Med. 2014 May;89(5):749-54. doi: 10.1097/ACM.0000000000000204.

29. Siad FM, Rabi DM. Harassment in the Field of Medicine: Cultural Barriers to Psychological Safety. CJC Open. 2021 Sep 23;3(12 Suppl):S174-S179. doi: 10.1016/j.cjco.2021.08.018.