ABSTRACT
Background and Aims
Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program.
Methods
The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning–related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment.
Results
The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP.
Conclusions
Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.
KEYWORDS: Burnout, depression, harassment, resident, teachers
Introduction
Resident wellness was built upon five basic psychological needs based on the modified Maslow’s hierarchy of needs: self-actualization, physiologic, safety, love and belonging, and esteem [1]. A resident’s sense of self-esteem is a crucial contributor to their wellness. A lack of respect could result in mistreatment and diminish residents’ esteem [2]. Thus, the exposure to mistreatment plays an essential role in the residents’ wellness [3].
Mistreatment is a situation in which hostile and aggressive actions are systematically directed at one or more students in such a way that they are stigmatized and victimized in a clinical workplace learning environment [4]. Mistreatment in the learning environment is associated with several adverse outcomes in the residents. Thirty-nine percent of the US residents experienced events in which public humiliation and being subject to offensive sexist comments are the most common types of mistreatment [5]. Not only colleagues such as clinical faculty, residents, nurses, and medical students but also patients and their families can cause mistreatment situations. Clinical faculty members (59%) and other residents (28%) are the most frequent instigators of mistreatment towards residents in one study [5]. A recent study investigating US surgical residents found an association of mistreatment with burnout and even suicidal thoughts [6]. For Asian countries, studies conducted in 304 Japanese medical students reported a prevalence of abuse in 68.5%. Verbal abuse is the most commonly reported form of abuse (57.5%), and faculty members were the most common instigator (45%). Furthermore, only 8.5% reported the incidences to the respective authorities [7]. Another study from Pakistan reported mistreatment in 62.5%, but the mistreatment was not significantly associated with psychological morbidity [8]. Another study from Finland also reported various forms of medical students’ mistreatment in three-quarters of the respondents. The authors raised an international awareness and argument with regard to this important issue in medical schools [9].
To lower the mistreatment, established mistreatment programs from previous studies among medical students, to share and determine suitable learning environment and promote a mistreatment reporting system, have been shown to reduce mistreatment, resulting in improvement of their learning environment and wellness [10]. However, most studies with regard to the prevalence and related factors of mistreatment have been performed in the western countries which may have different socio-cultural background and educational and training systems than the other parts of the world. In brief, the paediatric residency training in Thailand is a 3-year program with a mix of outpatient and inpatient exposures as well as elective rotation either inside and outside the institution or even abroad.
Therefore, our aims were to (1) determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) for paediatric residents in our training program.
Methods
This study consisted of two phases. Phase 1 is a national cross-sectional survey. Phase 2 is a quasi-experimental comparison between pre- and post-intervention.
Setting and participants
Phase 1, all current paediatric residents from 19 accredited training programs (n = 510) were invited to participate in the survey. Participants provided informed consent before completing the survey. Participation was voluntary and confidential.
Phase 2, after the MAP was launched for 3 months, paediatric residents at our centre were invited to participate in the survey again. Individuals with incomplete responses were excluded.
Instruments and data collection
Phase 1, we conducted a national survey using an online self-evaluation form. The survey consists of demographic data, the Negative Acts Questionnaire-Revised (NAQ-R), the Patient Health Questionnaire-9 (PHQ-9) for major depression, and a self-evaluated burnout question.
The Thai version of NAQ-R has 31 mistreatment-related questions in five domains, namely workplace learning–related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment [4,11]. The Thai version of NAQ-R questionnaire had a satisfactory internal consistency with a Cronbach’s alpha of 0.92 and a good degree of inter-rater agreement with the original version (84%). The content validity index for scale and average congruency percentage were both 0.91 (unpublished data). The NAQ-R questionnaire included questions on whether the resident had experienced mistreatment during the prior 6 months and a list of different mistreatment types with choices of person engaged in the events. The results were categorized by a 5-point Likert scale (daily, weekly, monthly, now and then, and never). Frequent mistreatment was further classified if the residents perceived that the events occurred ≥1/week. The Thai version of PHQ-9 also demonstrated acceptable psychometric properties for screening for major depression with a recommended cut-off score of ≥9 giving an area under the ROC curve of 0.89 (95% CI: 0.85, 0.92) [12]. We used a self-reported question for burnout as ‘Over the past 6 months, how often have you felt burnout?’ with four responses (always, frequent, now and then, never) and defined ‘burnout’ in respondents who answered always, frequent, or now and then.
The survey was sent to current paediatric residents via an electronic mail and a messaging application up to three times within a 6-month interval from September 2021 to February 2022.
Phase 2, The MAP was launched after analysing the results from Phase 1. Residents with high NAQ-R scores volunteered to reveal their experiences as examples of mistreated events, including in the content of the MAP media. The MAP consisted of (1) posters that showed the definition of ‘mistreatment’, the prevalence of mistreatment from the national survey in Phase 1, the common instigators, and some verbally explained experiences as the examples of mistreated events and (2) mistreatment-related videos from Stanford School of Medicine [10]. We distribute posters in both the outpatient and inpatient settings to enhance visibility and videos via announcement posts and electronic mails every 2 weeks within a 3-month period. After the MAP, the survey was again sent to the paediatric residents at our centre to re-evaluate the perception of mistreatment.
This study was reviewed and approved by the Institution Review Board’s committee.
Statistical analyses
The analyses were performed using the STATA statistical software 15.0 (StataCorp, College Station, TX, USA). Data were expressed as mean, standard deviation (SD), median, interquartile range (IQR), and proportion, with a 95% confidence interval (CI). If applicable, the comparison of discrete variables across different groups was assessed using a chi-square test or Fisher’s exact test.
Results
We received responses from 140 participants (27% response rate) in Phase 1. The mean age of the participants was 28.4 years (SD 1.4). Most were females (76%), third-year residents (47%), and working in the central part of the country (69%). The median number of residents per year was 11.5 (IQR 7, 25.5). The demographic and baseline data are shown in Table 1.
Table 1.
Demographic and baseline data of the study participants.
| Characteristics | Our centre (N = 48) |
Other centres (N = 92) |
Overall (N = 140) |
|---|---|---|---|
| Age, y, mean (SD) | 28.7 (±1.1) | 28.2 (±1.5) | 28.4 (±1.4) |
| Gender | |||
| Female | 40 (83.3%) | 66 (71.7%) | 106 (75.7%) |
| Underlying diseases | |||
|
39 (81.3%) | 79 (85.9%) | 118 (84.3%) |
|
6 (12.5%) | 6 (6.5%) | 12 (8.6%) |
|
3 (6.3%) | 7 (7.6%) | 10 (7.1%) |
| Psychiatric disorders | |||
|
48 (100.0%) | 80 (87.0%) | 128 (91.4%) |
|
- | 6 (6.5%) | 6 (4.3%) |
|
- | 4 (4.4%) | 4 (2.9%) |
|
- | 1 (1.1%) | 1 (0.7%) |
|
- | 1 (1.1%) | 1 (0.7%) |
| Academic year | |||
|
14 (29.2%) | 19 (20.7%) | 33 (23.6%) |
|
15 (31.3%) | 26 (28.3%) | 41 (29.3%) |
|
19 (39.6%) | 47 (51.1%) | 66 (47.1%) |
| Geographic regions | |||
|
- | 16 (17.4%) | 16 (11.4%) |
|
- | 24 (26.1%) | 24 (17.1%) |
|
48 (100%) | 48 (52.2%) | 96 (68.6%) |
|
- | 4 (4.4%) | 4 (2.9%) |
In total, 91.4% of the participants experienced ≥1 mistreatment situation during the previous 6 months, and 40% of the affected residents experienced ≥1 item of mistreatment ≥1/week. The highest scores on mistreatment were within the WLRB and PRB domains such as ‘being ordered to do tasks above the level of competence’, ‘being exposed to an unmanageable workload’, or ‘having key areas of responsibility removed or replaced with more trivial or unpleasant tasks.’ A substantial proportion of mistreated residents have been involved in the situations of either ‘having key areas of the trainee role removed or replaced with more trivial or unpleasant tasks’ or ‘being exposed to an unmanageable workload’ (79% and 78%, respectively), with almost one-quarter reported the two aforementioned mistreatment items occurred ≥1/week (Table 2). Several WLRB and PRB items had been reported by >50% of the respondents, including withholding information which affects learning, being ordered to do tasks above the competency level, ignoring opinions and views, humiliating/ridiculing in connection with the learning, repeating reminders of errors and mistakes, and persistently criticizing the work and effort. The frequencies of sexual harassment and ethnic harassment were relatively low. The residents reported that the clinical faculty, nurses, doctors from different departments, and colleagues within the training program were the most frequent instigators (Table 3). Most residents believed that the situations were mainly caused by individual instigators’ personalities (77%), pre-existing work-related stresses (59%), and mistreatment-accepted norms at the institution (55%) (Table 4).
Table 2.
Overall frequency of mistreatment.
| Clinical workplace learning on the Negative Acts Questionnaire-Revised Scale items (experienced during the previous 6 months) |
Experienced at least one mistreated situation (n, %) |
Frequent exposure (more often than once weekly) (n, %) |
|---|---|---|
| Total incidents | 128 (91.4) | 56 (40) |
| Workplace learning–related bullying | ||
| Item 1: someone withholding information which affects your learning | 84 (60.0) | 7 (5.0) |
| Item 3: being ordered to do tasks above your level of competence | 95 (67.9) | 21 (15.0) |
| Item 19: having your opinions and views ignored | 80 (57.1) | 6 (4.3) |
| Item 20: being exposed to an unmanageable workload | 109 (77.9) | 30 (21.4) |
| Item 22: being given tasks with unreasonable or impossible targets or deadlines | 66 (47.1) | 3 (2.1) |
| Item 24: excessive monitoring of your work | 58 (41.4) | 8 (5.7) |
| Item 28: being assigned work for punishment rather than for educational value | 19 (13.6) | 0 |
| Item 31: having learning opportunities blocked or withheld by others | 45 (32.1) | 3 (2.1) |
| Person-related bullying | ||
| Item 2: being humiliated or ridiculed in connection with your learning | 88 (62.9) | 7 (5.0) |
| Item 4: having key areas of your student role removed or replaced with more trivial or unpleasant tasks | 111 (79.3) | 38 (27.1) |
| Item 5: spreading of gossip and rumours about you | 67 (47.9) | 5 (3.6) |
| Item 6: being ignored or excluded from the clinical team | 34 (24.3) | 2 (1.4) |
| Item 8: having insulting or offensive remarks made about your person (i.e. habits and background), your attitudes or your private life | 36 (25.7) | 3 (2.1) |
| Item 12: repeated reminders of your errors or mistakes | 83 (59.3) | 8 (5.7) |
| Item 16: being ignored or facing a hostile reaction when you approach | 51 (36.4) | 7 (5.0) |
| Item 17: persistent criticism of your work and effort | 72 (51.4) | 7 (5.0) |
| Item 23: having allegations made against you | 26 (18.6) | 2 (1.4) |
| Item 25: being the subject of excessive teasing and sarcasm | 38 (27.1) | 2 (1.4) |
| Item 30: hints or signals from others that you should quit studying your profession | 12 (8.6) | 0 |
| Physically intimidating bullying | ||
| Item 9: being shouted at or being the target of spontaneous anger | 86 (61.4) | 7 (5.0) |
| Item 11: intimidating behaviour such as finger-pointing, invasion of personal space, shoving, blocking/barring the way | 25 (17.9) | 1 (0.7) |
| Item 27: threats of violence of physical abuse or actual abuse | 3 (2.1) | 0 |
| Sexual harassment | ||
| Item 13: sexual slurs | 7 (5.0) | 1 (0.7) |
| Item 15: inappropriate physical contact | 5 (3.6) | 1 (0.7) |
| Item 21: sexually explicit or offensive jokes | 1 (0.7) | 0 |
| Item 26: questions or insinuations about your sexual or private life | 8 (5.7) | 0 |
| Item 29: unwanted sexual advances | 0 | 0 |
| Ethnic harassment | ||
| Item 7: told jokes about your racial or ethnic group | 11 (7.9) | 0 |
| Item 10: made derogatory comments about your racial or ethnic group | 6 (4.3) | 0 |
| Item 14: made racist comments (for example, says people of your ethnicity aren’t very smart or can’t do the job) | 3 (2.1) | 0 |
| Item 18: used racial or ethnic slurs to describe you | 7 (5.0) | 0 |
Table 3.
Instigators of the mistreatment.
| Instigators | Overall (N = 128) |
|---|---|
| Clinical faculty | 79 (61.7) |
| Nurses | 72 (56.3) |
| Doctors from different departments | 39 (30.5) |
| Colleagues | 37 (28.9) |
| Administrators and institutional employees | 15 (11.7) |
| Staffs not involved in either inpatient or outpatient settings | 12 (9.4) |
| Medical students | 4 (3.1) |
| Patients’ families | 1 (0.8) |
| Missed data | 11 (8.6) |
Table 4.
Causes of mistreatment in the learning environment.
| Perceived causes of mistreatment | Our centre (N = 48) | Other centres (N = 92) | Overall (N = 140) |
|---|---|---|---|
| Individual manner | 37 (77.1) | 71 (77.2) | 108 (77.1) |
| Pre-existing work-related stresses | 32 (66.7) | 50 (54.4) | 82 (58.6) |
| Strict hierarchical system | 20 (41.7) | 52 (56.5) | 72 (51.4) |
| Lacks of suitable policies | 20 (41.7) | 46 (50.0) | 66 (47.1) |
| Organizational cultures | 18 (37.5) | 59 (64.1) | 77 (55.0) |
With regard to the coping mechanism and process of mistreatment, the mistreated residents formally reported the events only in 16.4%. They mainly decided to vent and discuss the problems only with their friends without reporting to the designated bodies. The most common reason of non-reporting was a concern about their future study or work (52.5% at our centre and 65.9% in other centres). Other common reasons were lack of support, risks of either being a victim, unbelieved by others, and blamed after reporting (Table 5). However, for those who reported the problems, they may usually choose to inform their mentors (data not shown).
Table 5.
Rate of reporting mistreatment and its concerning factors.
| Mistreatment report | Our centre (N = 40) | Other centres (N = 88) |
|---|---|---|
| Previous report in the past 6 months | 8 (20.0) | 13 (14.8) |
| Being mistreated without any reports | 28 (70.0) | 70 (79.6) |
| Missed data |
4 (10.0) |
5 (5.7) |
| Concerning factors of not reporting mistreatment |
Our centre (N = 28) |
Other centres (N = 70) |
| Future working/educational concerns | 21 (52.5) | 58 (65.9) |
| Risks of being a victim | 13 (32.5) | 29 (33.0) |
| Lack of support | 7 (17.5) | 33 (37.5) |
| Risks of being unbelieved by others and the problems might be unsolved | 11 (27.5) | 24 (27.3) |
| Risks of being blamed after reporting | 8 (20.0) | 25 (28.4) |
| Stresses after reporting | 6 (15.0) | 20 (22.7) |
| Self-image concerns | 5 (12.5) | 18 (20.5) |
| Effects to instigators’ images | 4 (10.0) | 8 (9.1) |
| Others: faculties’ unawareness hence reporting | 1 (2.5) | 0 |
Most (65%) residents were not aware that the institution had policies against mistreatment. We noted only two residents with positive PHQ-9 screening for depression. Residents reported burnout in 37% during the past 6 months (19% at our centre vs. 47% from other centres). Among the residents who exposed to frequent mistreatment, 30/43 (70%) from other centres exhibited burnout (P < .05). However, we did not perform multivariable analyses due to P-value of interested data did not reach statistical significance to enter the model (Table 6).
Table 6.
Factors associated with residents’ burnout.
| Our centre (N = 48) Total N with burnout = 9 (19%) |
Other centres (N = 92) Total N with burnout = 43 (47%) |
|
|---|---|---|
| Factors | P value | P value |
| Female gender | 0.14 | 0.94 |
| Underlying disease (any) | 0.21 | 0.57 |
| Psychiatric disorders | N/A | 0.39 |
| Year in training | 0.02 | 0.16 |
| Number of residents per year | N/A | 0.26 |
| Mistreatment ≥1/week | 0.41 | <0.001 |
As our centres had relatively low rates of mistreatment, we decided to stratify the mistreatment frequency furthermore to ≥ vs. <1/month. The top five most frequently mistreated situations were similar to the pre-intervention results, mostly in the WLRB and PRB domains (Table 7). We noted that some of the commonly mistreated items in Phase 1 had positive changes (i.e. drop in mistreatment frequency), including: (1) being ordered to do tasks above the competency, (2) being exposed to an unmanageable workload, and (3) having key areas of the trainee role removed or replaced with more trivial or unpleasant tasks.
Table 7.
Frequency of mistreatment (>1/month) at our centre, comparing between pre- & post-mistreatment awareness program.
| Clinical Workplace Learning on the Negative Acts Questionnaire-Revised Scale Items (Experienced during the previous 6 months) |
Pre-intervention (N = 48) |
Post-intervention (N = 31) |
|---|---|---|
| Workplace learning–related bullying | ||
| Item 1: someone withholding information which affects your learning | 1 (2.1%) | 1 (3.2%) |
| Item 3: being ordered to do tasks above your level of competence | 5 (10.4%) | 1 (3.2%) |
| Item 19: having your opinions and views ignored | 3 (6.3) | 0 |
| Item 20: being exposed to an unmanageable workload | 10 (20.8%) | 4 (12.9%) |
| Item 22: being given tasks with unreasonable or impossible targets | 0 | 2 (6.5%) |
| Item 24: excessive monitoring of your work | 2 (4.2%) | 0 |
| Item 28: being assigned work for punishment rather than for education | 0 | 0 |
| Item 31: having learning opportunities blocked or withheld by others | 3 (6.3%) | 1 (3.2%) |
| Person-related bullying | ||
| Item 2: being humiliated or ridiculed in connection with your learning | 3 (6.3%) | 1 (3.2%) |
| Item 4: having key areas of your student role removed or replaced with more trivial or unpleasant tasks | 11 (22.9%) | 5 (16.1%) |
| Item 5: spreading of gossip and rumors about you | 2 (4.2%) | 1 (3.2%) |
| Item 6: being ignored or excluded from the clinical team | 1 (2.1%) | 0 |
| Item 8: having insulting or offensive remarks made about your person (i.e. habits and background), your attitudes or your private life | 1 (2.1%) | 0 |
| Item 12: repeated reminders of your errors or mistakes | 2 (4.2%) | 1 (3.2%) |
| Item 16: being ignored or facing a hostile reaction when you approach | 0 | 0 |
| Item 17: persistent criticism of your work and effort | 2 (4.2%) | 0 |
| Item 23: having allegations made against you | 0 | 0 |
| Item 25: being the subject of excessive teasing and sarcasm | 1 (2.1%) | 0 |
| Item 30: hints or signals from others that you should quit studying your profession | 0 | 0 |
| Physically intimidating bullying | ||
| Item 9: being shouted at or being the target of spontaneous anger | 1 (2.1%) | 0 |
| Item 11: intimidating behaviour such as finger-pointing, invasion of personal space, shoving, blocking/barring the way | 0 | 0 |
| Item 27: threats of violence of physical abuse or actual abuse | 0 | 0 |
| Sexual harassment | ||
| Item 13: sexual slurs | 0 | 0 |
| Item 15: inappropriate physical contact | 0 | 0 |
| Item 21: sexually explicit or offensive jokes | 0 | 0 |
| Item 26: questions or insinuations about your sexual or private life | 1 (2.1%) | 0 |
| Item 29: unwanted sexual advances | 0 | 0 |
| Ethnic harassment | ||
| Item 7: told jokes about your racial or ethnic group | 0 | 0 |
| Item 10: made derogatory comments about your racial or ethnic group | 0 | 0 |
| Item 14: made racist comments (for example, says people of your ethnicity aren’t very smart or can’t do the job) | 0 | 0 |
| Item 18: used racial or ethnic slurs to describe you | 0 | 0 |
Examples of description of the mistreated events expressed by the volunteered residents included ‘(some) clinical faculty criticized them about knowledge during the ward round and conferences even if they had limited time for preparation’; ‘(some) residents had more workload because (some) staffs were not responsible for their works’; ‘(some) nurses responded to them impolitely using aggressive conversations’; and ‘(some) fellows asked them to do tasks during their lectures and didactic classes’. Residents also exhibited several suggestions such as ‘empathy and sympathy are important’, “not only residents should be evaluated by the colleagues according to the training program, but the faculty members should also have a system to develop co-workers’ evaluation and feedback systems on a regular basis”.
Discussion
This national survey to determine the prevalence of residents’ mistreatment in the paediatric residency training programs revealed a high rate of mistreatment (91% of at least one mistreated situation during the previous 6 months, and 40% frequently experienced the situation at least once weekly). The frequency of mistreatment was higher than the previous studies performing in medical students in Thailand (63%), Japan (68.5%), Pakistan (62.5%) [7,8,13], and the US residents (39%) [5]. WLRB and PRB were the two most common domains of mistreatment, the results were similar to the previous studies [5,13]. However, the studies from the US found various forms of discrimination (i.e., gender, race, sexual orientation, and pregnancy) as one of the main issues [14]. The contradiction may result from different social-cultural contexts and teaching styles in the particular fields of education and training. Clinical faculty was the most frequent instigator in this study and was similar to many previous studies [5,7,13]. Residents mostly believed that mistreatment occurs due to individual personalities and work-related stresses. Interestingly, one of the important reasons that the residents perceived were that the mistreatment can routinely occur because it is a ‘norm’ in the training program as well as in the institution level (i.e., organizational culture) (Table 4). The mistreated residents in our study reported the events only in 16.4%, the proportion that was slightly higher when compared to the survey in Japanese medical students (8.5%) [7]. Various reasons of non-reporting included concerns about their future professional life and risks of being a victim, unbelieved by others, and blamed after reporting. Furthermore, most residents also believed that the institution had no policies against mistreatment. Safe and organized reporting and management systems dealing with residents’ mistreatment would likely help in dealing with this important problem. This study, including previous studies, demonstrated similar results regarding the association between frequent mistreatment exposures and burnout [6,14]. Puranitee et al. found that the three main themes related to paediatric residents’ burnout were the following: inappropriate tasks, teachers and teaching styles, and time dimensions, which mainly can also be classified as WLRB- and PRB-related domains [15].
According to the results of this study, raising mistreatment awareness might have a potential role to lower the mistreated situations. Even with limited time period after launching MAP, we found an overall decrease in mistreatment especially in the WLRB and PRB domains within our paediatric residency training program. Previous studies reported that the participants had more realization and confidence in reporting mistreatment after the intervention on mistreatment awareness [10,16]. Therefore, a future study of the MAP design, reporting system, and its effectiveness was suggested to prevent and manage the mistreatment problem.
Strengths and limitations
This study is a national-level survey using validated online questionnaires which enabled us to gather various data from different institutions across the country. However, the relatively low response rate and the absence of LGBTQ-related data might limit the representativeness to the population. In Phase 2, we could observe and inspect some changes in mistreatment situations after the intervention. However, this could not be concluded as a causal relationship between MAP and mistreatment. Moreover, the follow-up time after launching MAP may be too short to observe significant (and possibly subtle) changes of the mistreatment frequency. Furthermore, we did not have a formal way of knowing whether the potential instigators (i.e., clinical faculty, nurses, or colleagues in the department) had watched the videos or seen the posters. Further MAPs with a longer follow time and a workshop with known participation may help minimizing the resident’s mistreatment.
Conclusion
Paediatric residents were frequently subjected to mistreatment in their learning environment, most of which occurred as a workplace learning–related bullying or a person-related bullying. Mistreatment was underreported and associated with burnout. Two aforementioned aspects of mistreatment should be carefully explored and managed through particular groups of instigators. The MAP may decrease mistreated events by raising awareness in the training program that should be further investigated in various settings.
Funding Statement
The author(s) reported there is no funding associated with the work featured in this article.
Abbreviations
- MAP
Mistreatment awareness program
Disclosure statement
No potential conflict of interest was reported by the authors.
Data availability statement
Upon request from the corresponding author.
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Data Availability Statement
Upon request from the corresponding author.