Learning, Satisfaction, and Mistreatment During Medical Internship: A National Survey of Working Conditions

Abstract

Context.-Concerns about the working and learning environment of residency training continue to surface. Previous surveys of residents have focused on work hours and income, but have shed little light on how residents view their training experience.Objective.-To provide a description of the internship year as seen by a large cross section of second-year residents.Design.-Mail survey conducted in 1991.Setting.-Residency programs in the United States.Participants.-Random 10% sample (N=1773) of all second-year residents listed in the American Medical Association's medical research and information database.Main Outcome Measures.-What and who contributes most to residents' learning during internships, degree of satisfaction with the internship experience, on-call and sleep schedules, incidents of perceived mistreatment or abuse, observations of unethical behavior, and experiences of harassment or discrimination.Results.-A total of 1277 surveys (72%) of 1773 mailed were returned. Overall, respondents reported a moderate level of satisfaction with their first year of residency. On a scale of 0 to 3, residents rated other residents as contributing most (score of 2.3) to their learning, with special patients ranked second (2.1). During a typical work week, residents reported that they spent an average of 56.9 hours on call in the hospital. A total of 1185 (93%) residents reported experiencing at least 1 incident of perceived mistreatment, with 53% reporting being belittled or humiliated by more senior residents. Among women residents, 63% reported having experienced at least 1 episode of sexual harassment or discrimination. A total of 45% of residents reported having observed another individual falsifying medical records, and 70% saw a colleague working in an impaired condition, most often lack of sleep. Regression analyses suggest that satisfaction with the residency experience was associated with the presence of factors that enhanced learning, and fewer experiences of perceived mistreatment.Conclusions.-Residents report significant problems during their internship experience. Satisfaction with internship is enhanced by positive learning experiences and lack of mistreatment.

Percepción de bullying en alumnos de sexto año de la escuela de medicina de una universidad pública de Lima 2015

“…La violencia institucional se da a todas las edades, desde la edad preescolar hasta en adultos universitarios (4)(5)(6)(7)9,15) . Entre los estudiantes de medicina, se han descrito hechos de bullying entre pares y también de docentes hacia los estudiantes y viceversa (8,10,12,13,16) . La encuesta mide percepciones de los estudiantes y no hechos objetivables.…”

“…El acoso sexual también lo reportan otros estudios en nuestro país y el extranjero (9,10,14,29) . En el último año de la carrera se evidencia un incremento notorio en la percepción de abuso sexual, lo que se podría explicar por el aumento del contacto individual docente-estudiante y las largas horas de trabajo propias del internado (13) . Además, se ha descrito que ese año es el de mayor riesgo con incremento de la ideación suicida, por lo que se sugiere, a nivel internacional, la implementación de programas de prevención (35) .…”

“…Se han realizado diversas publicaciones sobre su presentación durante el desarrollo de la educación médica en Estados Unidos y Europa (4,(10)(11)(12)(13) , y fue considerada por algunos investigadores como la principal fuente de estrés entre los estudiantes de medicina (14)(15)(16) .…”

Factors Associated with Intern Fatigue

“…7,8 For some, sleepiness is a near daily occurrence. 9 Resident sleep deprivation has been associated with diminished well-being and objectively measured worsened educational performance. 10 Studies note diminished workplace performance, particularly for tasks that are dependent on a high level of vigilance or newly learned procedural skills.…”

O plantão noturno em anestesia reduz a latência ao sono

“…Entretanto, essa ligação não foi definitivamente estabelecida em Medicina, e em especial na Anestesiologia, embora seja inegável que os médicos em geral e os anestesiologistas, em particular, possam ter jornadas de trabalho prolongadas 2,8 . Os médicos residentes, mais do que outros médicos, podem ter fadiga e estresse significativos decorrentes dos plantões, notadamente se ocorrem sem os adequados períodos subseqüentes de descanso, associados a jornadas diárias extensas, com sobrecarga de trabalho e de privação de sono [9][10][11][12][13] . O objetivo deste trabalho foi verificar, em residentes de Anestesiologia de primeiro e segundo anos, a latência do sono após uma noite regular de sono comparada com situações de privação de sono, decorrentes de plantão médico.…”