A pilot study on the prevalence of abuse and mistreatment during medical internship at various hospitals under Sultan Qaboos University has revealed disturbing details.
The study, conducted in May 2010, invited 69 medical residents in their late 20s to take part in the study of whom 58 participated. Fifty-six respondents perceived that mistreatment existed.
Titled 'Pilot Study on the Prevalence of Abuse and Mistreatment During Clinical Internship: A Cross Sectional Study Among First Year Residents in Oman’, the study shows that first year medical residents experienced mistreatment in the form of sexual harassment, physical abuse, verbal abuse and academic abuse from top-ranked medical staff including consultants and specialists during their three to four-month internship period at SQU Hospital.
Among the different types of mistreatment reported, verbal and academic abuse were the most common (88 per cent), followed by sexual harassment (24 per cent) and physical abuse (22 per cent). Following this, 76 per cent respondents had advised at least one of their relatives not to join medical school.
Dr Mohammad al Shafaee, head of the Department of Family Medicine and Public Health at the College of Medicine and Health Sciences, SQU, and the principal investigator in this study, said, “We initiated the study as interns complain of mistreatment. We too have faced the problem during our times. Bullying behaviour has been reported in this fraternity in different countries. In the Arab world including Oman evidence abounds that much emotional distress is present among medical trainees.
“As per Ministry of Health data, 60 per cent of the workforce in medical and health field in Oman is female. Since no data has been produced in Oman, the present study aimed to quantify mistreatment or abuse of Omani medical interns by seeking response to their perception of abuse and then understand factors leading to mistreatment so that we could draw guidelines to limit this problem and provide evidence-based interventions appropriate for the context of Oman.”
Internship is the period in which new medical graduates practise in a hospital setting under supervision, prior to beginning of specialisation course. In Oman internship consists of three to four-month rotations during which each intern is put in the fields of general medicine, general surgery, either paediatrics or obstetrics and gynaecology.
The study was published in the British Medical Journal Open last month and Dr Shafaee claims it to be the first of its kind in the country and Middle East.
The participants were assured in writing that their identities would not be revealed. Women constituted 52 per cent of the respondents, while the rest (48 per cent) were men.
The study defined physical abuse as slapping, pushing, hitting, kicking or having objects thrown at them, all if executed, would likely cause physical harm.
Academic abuse consisted of being coerced into carrying out personal services unrelated to the expected roles of interns. It also included instances of interns being excluded from reasonable learning opportunities offered to others or threatened with poor evaluation for reasons unrelated to academic performance.
Sexual abuse meant being subjected to jokes on or against gender, compliments or comments on body or figure or being subjected to repeated leering or offered unwanted gifts with sexual connotations. The offer of private tutorial sessions or better grades in exchange for an illicit affair as well as inappropriate touching also constituted sexual harassment.
Male residents responded that they had experienced higher levels of perceived mistreatment than women particularly academic abuse.
The figures on sexual abuse show that 18 per cent male and 13 per cent female received jokes or comments against their gender; seven per cent male and 17 per cent female were commented or complimented about their body or figure. Twenty per cent of the women respondents and four per cent of men faced offensive body language (repeated leering and standing too close).
More than 50 per cent of the total respondents reported maltreatment from consultants followed by specialists, resident doctors, nurses, patients' relatives and others.
Indices of mistreatment were significantly higher during medical rotation than in paediatrics or surgical rotation. Maltreatment experienced in the paediatric rotation was second highest.
Citing reasons for not reporting maltreatment, a majority of respondents said that they wanted to avoid further trouble as they believed that reporting could adversely effect evaluation and professional career. Some did not know whom to report and how to make a complaint, Dr Shafaee said.
“The findings are shocking,” he said. “Since there is no magic bullet to mitigate the prevailing maltreatment of medial trainees, a possible strategy could be to institute mandatory courses for medical staff on awareness about the consequences of abuse and maltreatment,” he said.
Others who conducted the study included Younis al Kaabi, Yousuf al Farsi, Gillian White, Abdullah al Maniri, Hamed al Sinawi and Samir al Adawi. The study was approved by the local Institutional Review Board and the Research and Ethics Committee of the College of Medical and Health Sciences, SQU.
CLASSIFICATION OF ABUSE MEN WOMEN
(Figures in percentage) Men Women
Forced to refer patients without giving cause 50 54
Made to do work unrelated to study or patient care 36 23
Threatened with failure/poor evaluation 29 13
Queries ignored intentionally 39 20
Jokes/comments against gender 18 13
Comments/compliments on body/figure 7 17
Offensive body language 4 20
Total sample size 58; percentage of respondents: 48% men, 52% women
Source: SQU study