Violence and Clinical Learning Environments in Medical Residencies

Liz Hamui-Sutton, Francisco Paz-Rodriguez (), Alejandra Sánchez-Guzmán, Tania Vives-Varela and Teresa Corona
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Liz Hamui-Sutton: Division of Graduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Unidad de Posgrado, Coyoacán, Mexico City 04510, Mexico
Francisco Paz-Rodriguez: Laboratory of Clinical Neuropsychology, National Institute of Neurology and Neurosurgery, Av. Insurgentes Sur 3877, La Fama, Tlalpan, Mexico City 14269, Mexico
Alejandra Sánchez-Guzmán: Division of Graduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Unidad de Posgrado, Coyoacán, Mexico City 04510, Mexico
Tania Vives-Varela: Department of Research in Medical Education, Faculty of Medicine, National Autonomous University of Mexico, Av. Universidad 3000, Coyoacán, Mexico City 04510, Mexico
Teresa Corona: Division of Graduate Studies, Faculty of Medicine, National Autonomous University of Mexico, Unidad de Posgrado, Coyoacán, Mexico City 04510, Mexico

IJERPH, 2023, vol. 20, issue 18, 1-15

Abstract: Introduction: The objective of this study was to describe and analyze residents’ perceptions of characteristics on the expansive/restrictive continuum of their clinical learning environment. Methods: We conducted a quantitative, descriptive and cross-sectional study. A self-administered questionnaire was designed, programmed and applied to residents at the Faculty of Medicine of the National Autonomous University of Mexico. The instrument was structured in eight sections, and for this article, Section 3, which referred to clinical environments and violence was considered. The questionnaire had an 85% response rate, with 12,612 residents from 113 medical units and 78 specialties participating. The reliability and internal consistency measured with alpha omega obtained a value of ω 0.835 (CI; 0.828–0.843). Results: Unpleasant, competitive, tense and conflictive contexts were related to restrictive environments. Sexual orientation influenced the perception of intolerance in the clinical setting with respect to discriminatory comments, such that for gender minorities, the environment was experienced as exclusionary. First-year residents perceived environments as more aggressive, a perception that tended to decrease in later years of residency. Discussion: Abuses in power relations, rigid hierarchical positions and offensive clinical interactions may foster restrictive environments. In such settings, the reproduction of socio-culturally learned violence is feasible; however, asymmetrical relationships may be deconstructed and transformed.

Keywords: violence; gender identity; clinical settings; medical residencies; inappropriate behaviors (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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