Mistreatment in paediatric residency programs in Thailand: a national survey

Background and Aims: Mistreatment in the learning environment is associated with adverse outcomes for residents. Most studies with that regard have been performed in western countries which may have different socio-cultural background and educational and training systems than the non-Western Asian countries. This study aimed (1) to determine the national prevalence of mistreatment in Thai paediatric residents and a correlation with the risk for burnout and other factors and (2) to launch a mistreatment awareness program (MAP) in our training program. Methods: The study was divided into two phases. Phase 1, an online survey of mistreatment-related questions, was sent to current paediatric residents across the country. Burnout and depression were also self-evaluated by formal screening questions. The results were categorized by the Negative Acts Questionnaire-Revised into five domains of mistreatment: workplace learning–related bullying (WLRB), person-related bullying (PRB), physically intimidating bullying, sexual harassment, and ethnic harassment. Frequent mistreated exposure was defined as if mistreatment occurred >1/week. Phase 2, MAP was conducted by distributing the results of the first phase with some examples of mistreatment events and mistreatment-related videos. After 3 months, at our centre, the survey was resent to evaluate mistreatment. Results: The response rate was 27% (n = 140). We found that 91% experienced ≥1 mistreated situation in the prior 6 months. Most mistreatment domains were WLRB and PRB, and residents were commonly instigated by clinical faculty and nurses. Most (84%) mistreated residents did not report the events. An association between frequent mistreated exposure and burnout was also found (P < 0.001). For Phase 2, the mistreated situations especially the WLRB and PRB domains dropped after the launch of MAP. Conclusions: Thai paediatric residents frequently perceive mistreatment in their learning environment. Specific aspects of mistreatment, such as WLRB and PRB, should be carefully explored and managed through particular groups of instigators.