Mistreatment of Dalhousie medical residents is common and underreported, study says

A newly published peer-reviewed study found that mistreatment of medical residents in the Maritimes remains common and underreported.

From October to November 2021, all 645 medical residents associated with Dalhousie University were invited to answer questions about their experiences on the job since graduating. Residents are medical school graduates who are doing training focused in a specific area, such as oncology or family medicine.

Nineteen per cent responded including residents working in Nova Scotia, New Brunswick and Prince Edward Island. 

Twenty per cent of those said they have sometimes experienced mistreatment — defined as behaviour disrespectful of the dignity of others and which interferes with learning — since beginning residency. About eight per cent reported it happening very often or almost daily. About one in five respondents said they have never been mistreated. 

Qëndresa Sahiti, a fourth-year medical student and a lead author for the study, said the issue can also affect the wider community. "Research has shown that when our doctors are well, our patients are well," she said.

Sahiti said another takeaway is that residents are very interested in helping to improve their learning environments.

Dr. Patrick Holland, a fourth-year oncology resident, said he's experienced mistreatment and that the hierarchical nature of the medical system is a contributing factor.

 "Any time there's a power differential between people, there's always the possibility for abuse of that," said Holland, who is also the president of advocacy group Maritime Resident Doctors.

He said the likelihood of mistreatment can also change depending on where residents are working. For example, decisions often need to be made quickly in emergency departments and operating rooms where patients are very sick. That can make those environments more emotionally charged.

Holland noted residents have a unique position in the medical hierarchy as both learners and people who can practice medicine with supervision.

The study found that when mistreatment happens, many don't report incidents because of confidentiality concerns and fear of retaliation.

Residents can accumulate tens of thousands of dollars in debt over the course of their typically eight years of education. Because of this, "there's very little incentive for them to rock the boat and jeopardize their training opportunities and … their further careers," Sahiti said. 

Dr. David Bowes, an assistant dean who helps manage medical residency programs at Dalhousie University, said the school has acted to improve accountability of people involved in training physicians. The medical school launched an office of professional affairs in December 2022 which acts on reports of mistreatment.

Bowes, the paper's co-author, said people reporting incidents can now do so anonymously, if they wish, through a communication program allowing them to speak with people at the professional affairs office.

"Depending on the … nature of the incident, people may want it managed in different ways," he said.

Some cases may fall under the purview of the health authority rather than Dalhousie University, and so there are different ways a report could be addressed based on who is involved.

This includes a way for the university to remove a faculty member from teaching. Bowes said, "We consider the ability to teach residents not to be a right, but … a privilege."