Prevalence of Mistreatment or Belittlement among Medical Students – A Cross Sectional Survey at a Private Medical School in Karachi, Pakistan

Abstract

BackgroundMistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified.MethodsA cross sectional study was carried out on medical students from Aga Khan University Hospital, Karachi, Pakistan during the period of June–September 2007. A self administered questionnaire, adapted from Frank et al and Baldwin et al was distributed to a total of 350 students. The questionnaire consisted of three parts: the first dealing with the demographics of the population, the second concerning the various forms of mistreatment, while the third assessed the mental health of students using the General Health Questionnaire 12(GHQ12). Descriptive statistics were performed. The Chi-square test and Fisher's exact tests were applied.ResultsA total of 350 students were approached out of which 232 completed the questionnaire giving a response rate of 66.2%. Mistreatment was reported by 62.5% (145/232) of the respondents. Of these, 69.7% (83/145) were males and 54.9% (62/145) were females. There was a significant relationship between gender, year division, stress at medical school and possible use of drugs/alcohol and reported mistreatment but no statistical relationship was seen with psychiatric morbidity. The overall prevalence of psychological morbidity was 34.8% (77/221).ConclusionThis study suggests high prevalence of perceived mistreatment and psychological morbidity among Pakistani medical students. However, no association was found between these two aspects of medical student education. There is a need to bring about changes to make the medical education environment conducive to learning. Increased student feedback, support systems and guidance about progress throughout the year and the provision of adequate learning resources may provide help with resolving both of these issues.

Mistreatment among undergraduate medical trainees: A case study of a Nigerian medical school

“…This may be attributed to the fact that the consultants or senior doctors are the ones with the highest degree of authority in our set up of clinical rotations with almost no checks and balances, so they tend to misuse the given authority. [2] Consistent with the findings of other studies, significantly higher proportions of students in the clinical years of study had experienced at least one form of mistreatment. [1,3,24] This was also more prevalent amongst medical students in the 5 th year on clinical rotations in Paediatrics and Obstetrics/ Gynecology compared to those in the 4 th year who have just begun their clinical rotations in Medicine and Surgery.…”

“…This stressor was experienced by more than a third (35.5%) of the medical students interviewed. This figure was lower than what was observed in a study by Shoukat and colleagues in Pakistan [2] and Owoaje et al, in South western Nigeria, [24] where almost all the students interviewed experienced one form of abuse or the other. This may be attributable to the fact that in Owoaje et al, study only final year students were included in the study.…”

“…The perception of being taken advantage of or abused is common among medical students. [1][2][3][4] The overall prevalence of abuse ranges from 74%to 98%, with verbal abuse being the most commonly reported ranging from 87% to 98%, respectively. A number of studies have shown that bullying, abuse, harassment, mistreatment, or belittlement affect not only medical students, [1,3,5] but also doctors in training, [6][7][8][9][10] doctors undertaking research, [11] and other healthcare professionals.…”

Medical student mistreatment by patients in the clinical environment: prevalence and management

“…The prevalence of medical student mistreatment by patients and their families in our study was comparable to that reported in the West (3,10,14) but slightly lower than that in Japan and Arab countries. (11,15,16) These differences could have been a result of culture, education system and patient demographics. While Singapore mainly comprises Asian ethnic populations, it contains a blend of Western and Asian cultures, hence local patients may have a different outlook from traditional Asians.…”

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

“…Mistreatment can have deleterious effects on medical students’ emotional well-being and professional attitudes [1,2]. Specifically, medical students who are subject to abusive behaviors are more likely to experience mental health issues such as post-traumatic stress [3,4], depression and low career satisfaction [5], and even suicidality [6].…”