Violence and Clinical Learning Environments in Medical Residencies.

Area of Science:

• Medical Education Research
• Healthcare Environment Analysis
• Socio-cultural Dynamics in Medicine

Background:

• Understanding residents' perceptions of their clinical learning environment is crucial for improving medical training.
• The expansive/restrictive continuum offers a framework to analyze the quality of these environments.
• Previous research has not fully explored the nuanced characteristics contributing to restrictive learning settings.

Purpose of the Study:

• To describe and analyze residents' perceptions of characteristics defining their clinical learning environment on an expansive/restrictive continuum.
• To identify factors contributing to restrictive clinical learning environments.
• To investigate the influence of resident demographics and experiences on these perceptions.

Main Methods:

• Quantitative, descriptive, cross-sectional study involving 12,612 residents from 113 medical units and 78 specialties.
• Self-administered questionnaire with high reliability (alpha omega = 0.835), focusing on clinical environments and violence.
• Data collected from the Faculty of Medicine of the National Autonomous University of Mexico, with an 85% response rate.

Main Results:

• Restrictive environments were associated with unpleasant, competitive, tense, and conflictive contexts.
• Gender minorities experienced more exclusionary clinical settings due to discriminatory comments related to sexual orientation.
• First-year residents reported more aggressive environments, with perceptions becoming less aggressive in later residency years.

Conclusions:

• Abuse of power, rigid hierarchies, and offensive interactions contribute to restrictive clinical learning environments.
• Restrictive settings can perpetuate socio-culturally learned violence.
• Asymmetrical relationships within clinical environments can be deconstructed and transformed to foster more positive learning experiences.