Between learning and suffering in medical residency: violence, harassment, and quality of life

Santos, Débora Vianna dos; Ribeiro, Laísa Viana Barroso; Fernandes, Ana Clara Cardoso; Sá, Henrique Luis do Carmo e; Bessa, Olivia Andrea Alencar Costa

doi:10.1590/1981-5271v50.supl.1-20260076

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ORIGINAL ARTICLE • Rev. bras. educ. med. 50 (Suppl 1) • 2026 • https://doi.org/10.1590/1981-5271v50.supl.1-20260076.ING linkcopy

Between learning and suffering in medical residency: violence, harassment, and quality of life

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction: Medical residency is recognized as the best model for specialist training but may expose physicians to stressors such as harassment, discrimination, and violence, which can affect quality of life.

Objective: To assess the prevalence and factors associated with harassment in medical residency programs and its effect on quality of life.

Method: A cross-sectional, descriptive-analytical study with a quantitative approach was conducted among residents from 12 programs. The instruments used were a sociodemographic questionnaire, the Negative Acts Questionnaire - Revised (NAQ-R), the Questionnaire on Discrimination, Violence, and Harassment (QDVA), and the WHOQOL-Bref.

Result: A total of 224 residents participated in the study, 68.8% from clinical areas and 31.2% from surgical areas. Most participants were female, heterosexual, white, Catholic, single, and childless. The prevalence of harassment was 51.5%, higher in surgical areas (68.9%) than in clinical areas (44.1%) (p = 0.001). Other associated factors included a higher workload during training and being single. No associations were identified between harassment and other sociodemographic variables. A total of 85.7% of surgical residents and 62.7% of clinical residents reported experiencing at least one act of discrimination and/or violence during residency, most commonly verbal abuse (52.6%), gender-based discrimination (33.1%), and age-based discrimination (27.9%). Among those harassed, 41.1% did not report the incident, mainly because they believed it would worsen the situation or due to fear of retaliation (50%), with some even considering quitting residency. The overall quality of life score was 3.37 (± 0.57), and higher levels of harassment were associated with lower quality of life.

Conclusion: Harassment showed a high prevalence, particularly among surgical residents, with a significant impact on quality of life. Strategies for prevention and management are necessary within the medical residency environment.

Keywords:
Medical Residency; Medical Education; Non-Sexual Harassment; Workplace Bullying; Quality of Life

Characteristics	N = 224
Age
No information	7.0
Mean (SD)	28.2 (3.9)
Min-Max	23.0 - 52.0
Sex
No information	6.0
Female	144.0 (66.1%)
Male	73.0 (33.5%)
I don’t want to declare	1.0 (0.5%)
Gender
No information	6.0
Man	73.0 (33.5%)
Woman	143.0 (65.6%)
Transgender woman	1.0 (0.5%)
Others	1.0 (0.5%)
Sexual orientation
No information	6.0
Heterosexual	183.0 (83.9%)
Homosexual	13.0 (5.9%)
Bisexual	19.0 (8.7%)
I don’t want to answer	3.0 (1.4%)
Race
No information	6.0
White	137.0 (62.8%)
Brown	73.0 (33.5%)
Black	8.0 (3.7%)
Religion
No information	6.0
Catholic	131.0 (60.1%)
Evangelical	27.0 (12.4%)
Spiritist	4.0 (1.8%)
Umbanda and Candomblé	1.0 (0.5%)
Buddhist	1.0 (0.5%)
Others	3.0 (1.4%)
No religion	46.0 (21.1%)
I do not wish to declare	5.0 (2.3%)
Characteristics	N = 224
Marital status
No information	6.0
Single	160.0 (73.4%)
Married	56.0 (25.7%)
Divorced	2.0 (0.9%)
Children
No information	6.0
No	195.0 (89.4%)
Yes	23.0 (10.6%)

Academic characteristics	N = 224
Medical residency area
No information	6.0
Surgical area	68.0 (31.2%)
Clinical area	150.0 (68.8%)
Year
No information	6.0
R1	95.0 (43.6%)
R2	76.0 (34.9%)
R3	47.0 (21.6%)
Weekly workload
No information	6.0
Up to 60 h	147.0 (67.4%)
> 60 h < 80 h	55.0 (25.2%)
> 80 h	16.0 (7.3%)
Engages in professional activity outside of medical residency.
No information	6.0
No	47.0 (21.6%)
Yes	171.0 (78.4%)
Time since graduation before entering the program (in years)
No information	6.0
Mean (SD)	2.1 (3.2)
Min-Max	0.0 - 36.0
Monthly income
No information	6.0
Up to R$ 4,500	56.0 (25.7%)
From R$ 4,500 to R$ 8,000	58.0 (26.6%)
From R$ 8,000 to R$ 11,500	62.0 (28.4%)
From R$ 11,500 to R$ 15,000	26.0 (11.9%)
More than R$ 15,000	16.0 (7.3%)
Workload outside of medical residency
No information	54.0
Mean (SD)	20.9 (13.7)
Min-Max	4.0 - 90.0

NAQ-R	frequency
NAQ-R	Never	Eventually	Monthly	Weekly	Daily
1. Someone withheld information that interferes with your performance	100 (49%)	68 (33.3%)	13 (6.4%)	16 (7.8%)	7 (3.4%)
2. You were humiliated or ridiculed because of your work	94 (46.1%)	86 (42.2%)	14 (6.9%)	8 (3.9%)	2 (1%)
3. You were forced to perform activities below your capacity	67 (32.8%)	72 (35.3%)	19 (9.3%)	24 (11.8%)	22 (10.8%)
4. Your main areas of responsibility were replaced by activities below your capacity	69 (33.8%)	81 (39.7%)	11 (5.4%)	30 (14.7%)	13 (6.4%)
5. Rumors or gossip have been spread about you.	125 (61.3%)	63 (30.9%)	11 (5.4%)	1 (0.5%)	4 (2%)
6. You were ignored, excluded, or isolated from the group.	123 (60.3%)	61 (29.9%)	7 (3.4%)	6 (2.9%)	7 (3.4%)
7. You received offensive comments about yourself.	138 (67.6%)	54 (26.5%)	8 (3.9%)	3 (1.5%)	1 (0.5%)
8. You were insulted or targeted with anger (or rage) for no reason.	125 (61.3%)	64 (31.4%)	8 (3.9%)	5 (2.5%)	2 (1%)
9. You experienced intimidating behavior, such as being pointed at, having your personal space invaded, being pushed, having your path blocked or barred.	155 (76%)	38 (18.6%)	7 (3.4%)	2 (1%)	2 (1%)
10. You received hints or signals from others that you should give up.	148 (72.5%)	40 (19.6%)	9 (4.4%)	3 (1.5%)	4 (2%)
11. You received reminders of mistakes or errors made	89 (43.6%)	92 (45.1%)	12 (5.9%)	10 (4.9%)	1 (0.5%)
12. You were ignored or faced a hostile reaction when you approached.	127 (62.3%)	56 (27.5%)	9 (4.4%)	6 (2.9%)	6 (2.9%)
13. You have received persistent criticism regarding your work and effort.	125 (61.3%)	60 (29.4%)	9 (4.4%)	8 (3.9%)	2 (1%)
14. Your opinions and viewpoints are ignored	82 (40.2%)	91 (44.6%)	15 (7.4%)	6 (2.9%)	10 (4.9%)
15. Disrespectful jokes are made by people you’re not very close to.	130 (63.7%)	55 (27%)	11 (5.4%)	4 (2%)	4 (2%)
16. You received tasks with goals or deadlines that are impossible to meet or unreasonable.	106 (52%)	73 (35.8%)	15 (7.4%)	5 (2.5%)	5 (2.5%)
17. Allegations have been made against you.	150 (73.5%)	47 (23%)	4 (2%)	2 (1%)	1 (0.5%)
18. Your work is being excessively monitored.	104 (51%)	59 (28.9%)	13 (6.4%)	9 (4.4%)	19 (9.3%)
19. You received pressure not to assert your rights	93 (45.6%)	57 (27.9%)	19 (9.3%)	12 (5.9%)	23 (11.3%)
20. You were the target of sarcasm and excessive teasing.	133 (65.2%)	51 (25%)	13 (6.4%)	2 (1%)	5 (2.5%)
21. You have been exposed to a workload that is impossible to manage.	103 (50.5%)	69 (33.8%)	15 (7.4%)	10 (4.9%)	7 (3.4%)
22. You have received threats of violence or physical abuse, or you have suffered actual abuse.	187 (91.7%)	14 (6.9%)	-	-	3 (1.5%)

	Surgical area (N=68)	Clinical area (N=150)	Total (N=218)	p-value
1. Discrimination based on gender				0.244
No information	12.0	16.0	28.0
never	35.0 (62.5%)	92.0 (68.7%)	127.0 (66.8%)
some/year or month	17.0 (30.4%)	39.0 (29.1%)	56.0 (29.5%)
some/week or day	4.0 (7.1%)	3.0 (2.2%)	7.0 (3.7%)
2. Discrimination based on sexual orientation				0.717
No information	12.0	16.0	28.0
never	52.0 (92.9%)	123.0 (91.8%)	175.0 (92.1%)
some/year or month	3.0 (5.4%)	10.0 (7.5%)	13.0 (6.8%)
some/week or day	1.0 (1.8%)	1.0 (0.7%)	2.0 (1.1%)
3. Discrimination based on race				1.000
No information	12.0	16.0	28.0
never	54.0 (96.4%)	129.0 (96.3%)	183.0 (96.3%)
some/year or month	2.0 (3.6%)	5.0 (3.7%)	7.0 (3.7%)
some/week or day	0.0 (0.0%)	0.0 (0.0%)	0.0 (0.0%)
4. Discrimination based on age				0.937
No information	12.0	16.0	28.0
never	41.0 (73.2%)	96.0 (71.6%)	137.0 (72.1%)
some/year or month	13.0 (23.2%)	34.0 (25.4%)	47.0 (24.7%)
some/week or day	2.0 (3.6%)	4.0 (3.0%)	6.0 (3.2%)
5. Discrimination based on religious orientation				0.120
No information	12.0	16.0	28.0
never	45.0 (80.4%)	122.0 (91.0%)	167.0 (87.9%)
some/year or month	10.0 (17.9%)	11.0 (8.2%)	21.0 (11.1%)
some/week or day	1.0 (1.8%)	1.0 (0.7%)	2.0 (1.1%)
6. Discrimination based on pregnancy or childcare.				0.004
No information	12.0	16.0	28.0
never	46.0 (82.1%)	129.0 (96.3%)	175.0 (92.1%)
some/year or month	6.0 (10.7%)	3.0 (2.2%)	9.0 (4.7%)
some/week or day	4.0 (7.1%)	2.0 (1.5%)	6.0 (3.2%)
7. Physical abuse (physical violence)				0.026
No information	12.0	16.0	28.0
never	53.0 (94.6%)	134.0 (100.0%)	187.0 (98.4%)
some/year or month	2.0 (3.6%)	0.0 (0.0%)	2.0 (1.1%)
some/week or day	1.0 (1.8%)	0.0 (0.0%)	1.0 (0.5%)
8. Verbal or emotional abuse				<0.001
No information	12.0	16.0	28.0
never	14.0 (25.0%)	76.0 (56.7%)	90.0 (47.4%)
some/year or month	35.0 (62.5%)	52.0 (38.8%)	87.0 (45.8%)
some/week or day	7.0 (12.5%)	6.0 (4.5%)	13.0 (6.8%)
	Surgical area (N=68)	Clinical area (N=150)	Total (N=218)	p-value
9. Sexual harassment				<0.001
No information	12.0	16.0	28.0
never	41.0 (73.2%)	127.0 (94.8%)	168.0 (88.4%)
some/year or month	15.0 (26.8%)	6.0 (4.5%)	21.0 (11.1%)
some/week or day	0.0 (0.0%)	1.0 (0.7%)	1.0 (0.5%)
10. Bullying / cyberbullying				0.012
No information	12.0	16.0	28.0
never	46.0 (82.1%)	124.0 (92.5%)	170.0 (89.5%)
some/year or month	7.0 (12.5%)	10.0 (7.5%)	17.0 (8.9%)
some/week or day	3.0 (5.4%)	0.0 (0.0%)	3.0 (1.6%)

Score	Correlation	Surgical area	Clinical area
Score	Correlation	NAQ-R Total	NAQ-R Total
Overall quality of life	Rho	-0.50	-0.34
Overall quality of life	p value	<.001	<.001
Perception of quality of life	Rho	-0.41	-0.37
Perception of quality of life	p value	0.002	<.001
Personal satisfaction with health	Rho	-0.50	-0.36
Personal satisfaction with health	p value	<.001	<.001
Physical domain	Rho	-0.55	-0.31
Physical domain	p value	<.001	<.001
Psychological domain	Rho	-0.49	-0.26
Psychological domain	p value	<.001	0.003
Social Relationships domain	Rho	-0.37	-0.30
Social Relationships domain	p value	0.006	<.001
Environmental domain	Rho	-0.41	-0.26
Environmental domain	p value	0.002	0.003

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[TFN6] Source: prepared by the authors.