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Violencias de género en la educación médica. Reflexiones teórico-metodológicas situadas, descoloniales y restaurativas.
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La crítica arendtiana a un punto arquimédico de conocimiento se muestra a lo largo de diversos trabajos de su producción teórica. La cuestión del método, no acometida de modo sistemático por Arendt, contribuye a dilucidar las líneas rectoras de una hermenéutica del "acontecimiento" alejada de categorías como la de ciencia, causalidad u objetividad. Su limitación de la noción de comprensión del acontecimiento frente a la explicación positivista nos puede dar pistas o pautas para llevar a cabo una reflexión que no eluda la contingencia y fragilidad del ámbito de la acción humana. La metodología arendtiana pone de manifiesto las trampas ideológicas de un conocimiento basado en la excesiva abstracción de sus conceptualizaciones y en una pretendida universalidad. Se pone de relieve la imposibilidad de un conocimiento histórico neutro. A través del relato se hace patente la auténtica naturaleza de lo real, su incompletitud y maleabilidad. Ningún relato agota las posibilidades de lo real, no existe en este punto ningún privilegio epistémico. Podemos establecer un paralelismo entre el método arendtiano y la idea de "comprensión situada" enarbolada por la Feminist Standpoint Theory y por aquellas hermenéuticas fundamentadas en la defensa de epistemologías parciales, situadas y contextuales.
The objective of this article is to know the experience (s) of sexual harassment suffered (s) by the students of a higher education institution in Ciudad Juárez, Chihuahua, Mexico. In it, special attention is paid to the harassment suffered, spaces where it was suffered, feelings of security and insecurity in different spatiality’s and feelings in different spatiality’s, within the urban epistemology. In the present work, a cross-sectional and descriptive study was carried out whose data were obtained by a questionnaire with a sample of 414 students in a period of 3 months from May to July 2021. The conclusions are aimed at offering suggestions that support the implementation of measures prevention to reduce and / or eradicate sexual harassment in spaces.
In this article I will address the implications of making a feminist ethnography from collaborative methodologies. These collaborative methodologies recognize the privilege, but also the vulnerabilities, that we have as anthropologist-activists in social contexts marked by patriarchal violence. Taking as case studies three activist-research experiences with indigenous women victims of sexual violence, women in prison, and relatives of the disappeared persons, I reflect on the methodological strategies that can be used to make a feminist ethnography from an ethic of care and a decolonial perspective.
Introduction:
The aim of the study is to determine the changes in psychological distress and depressive symptoms of medical students in the first two years of their education process, in comparison with other faculty students.
Methods:
All first-year students in the Faculties of Medicine, Economics and Sport Sciences were asked to fill out a detailed self-reported questionnaire aimed at measuring possible stressful life events and habits, General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI) during the first week of their first semester in 2017-2018. This process was repeated to the same students again in the second year, and the change was examined prospectively.
Results:
The GHQ-12 score average increased from 11.19 to 13.7 in medical students (p<0.001). The prevalence of psychological distress increased from 53.8% to 61.8%. The BDI score average was 8.04 in the beginning and reached 10.1 in the second year (p<0.001). Depressive symptom prevalence increased from 8.8% to 19.5%. No significant increase was observed in the GHQ-12, BDI score average, depressive symptoms, and psychological distress prevalence of other faculty students. The incidence of depressive symptoms in medical students was 15.9%. As a result of multivariate analysis, "dissatisfaction with social activities" and "exposure to psychological pressure and violence" which were stressful life events were statistically associated with both GHQ-12 and BDI.
Conclusion:
It was determined that the mental health of the students was negatively affected in the first year of medical school education. It is recommended to raise awareness for medical students at risk of mental illness and to plan interventions that will protect their mental health.
El maltrato y acoso en estudiantes de medicina es un tema que requiere atención y prevención. Diversos estudios demuestran la necesidad de crear un ambiente de formación seguro dentro y fuera de las instituciones educativas a lo largo del programa, incluyendo escenarios clínicos y el servicio social. El presente trabajo conjunto entre la AMFEM y la AMMEF muestran un diagnóstico sobre la situación actual y una propuesta para prevenirla. No hay pretexto para seguir postergando acciones contundentes desde las Escuelas y Facultades de Medicina.
(analítico)En los últimos años, la violencia de género se ha instalado en la agenda pública mexicana. Este artículo analiza el activismo feminista onlife que desarrollaron colectivas estudiantiles del Colegio de Ciencias y Humanidades de la Universidad Nacional Autónoma de México, entre 2018 y 2020. Se realizó un análisis temático sobre páginas de Facebook, comunicados estudiantiles y de autoridades universitarias, notas periodísticas y observaciones participantes. Entrelos hallazgos se destacan tres modalidades de acción: la creación de perfiles en redes sociodigitales, la realización de tendederos de denuncia y la toma estudiantil de los planteles. Se concluye que, en el marco de cambios de la configuración emotiva en el trato intergéneros, la violencia contra las mujeres por motivos de género adquiere una visibilidad preponderante y se erige en foco de conflicto dentro de las instituciones educativas. Palabras clave: Estudiantes, universidad, internet, brecha generacional.
Background
Sexual violence has globally been recognized as harmful to young people’s health. In medical school, which is a highly competitive environment, the risk is supposedly even bigger. In this study we firstly aimed to investigate the magnitude and precipitating factors of sexual violence in medical students and specialty registrars in Flanders, Belgium. Secondly, we wanted to assess the reactive behaviours as well as the knowledge of possible types of bystander reactions as well as potential support resources for victims of sexual violence.
Methods
This study was initiated and coordinated by the Flemish medical student representation organisation (VGSO). A survey containing demographic and behaviour-specific questions based on the UNMENAMAIS and SAS-V questionnaire was sent to all undergraduate, graduate and postgraduate students of the 5 medical schools in Flanders. Participants were asked to limit their responses to internship-related events. Further questions concerning reactions to sexual violence, assailants, bystander reactions and general knowledge concerning support after sexual violence were asked.
Results
We received 3015 valid responses to our survey, obtaining a response rate of 29% in the potential target population. Within the total study population, 1168 of 3015 participants (38,73%) reported having been victim of at least one type of sexual violence as explored by our survey. This percentage was the highest in GP specialty registrars (53%), followed by specialty registrars (50%) and master students (39%). Assailants of sexual violence varied, most often they were medical staff members, students or patients. In most types of sexual violence, nobody reacted to this behaviour. Women (57.3%) talked about what happened afterwards more often than men (39.7%). When asked about their knowledge of possible bystander reactions and support services for sexual violence, 60% of the respondents did not know about their existence.
Conclusions
Sexual violence is still a relatively frequent issue in medical students and specialty registrars. Patients form an important part of the assailants. In a third of reported sexual violence cases, nobody reacted. In addition, male victims seem to underreport. There is still much need for sensitisation on support mechanisms and centres for victims and witnesses of sexual violence.
This document presents results of the research on the conformation of feminist collectives of university students in Mexico that emerged since 2014 in order to denounce and demand attention to the university authorities to cases of violence and harassment in their study centers. The hypothesis that guides this work holds that these organizations of young feminists are part of the new activisms that emerged in Latin America confronting structural violence against women, but at the same time, they present particular characteristics as a result of the transformation processes in the field of university education, in what I call the double anchoring of the processes of institutionalization of gender perspective in universities. As adversary groups, they are likely to be analyzed from the perspective of social movements, with special emphasis on the relationship they build with social actors and institutions, the novelty of their processes of internal organization and their positioning as central political actors in the current scenario of feminist protest at a global level.
Background
Psychological violence is a persistent issue in academic medicine and affects the health and safety of health care workers. This violence is also debated as part of medical culture. Third parties, persons learning about violations after it happened, may provide an understanding of the interplay between gender and psychological violence. Perspectives on research on psychological violence in academic medicine are currently lacking.
Methods
In this qualitative exploratory study, interviews were conducted with women from a working group on equal treatment at one medical university in Austria. This group monitors discrimination and harassment and consists of medical doctors, natural scientists, administrative staff, and students. To recruit participants, an email invitation was sent to members of the working group. Of 20 eligible persons, 12 women participated. After written consent from participants, individual interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed with grounded theory.
Findings
Participants described a firm organizational culture with persistent, historically grown gendered structures. Potential threat of psychological violence affected mostly “weaker,” less powerful persons, and often women. Descriptions of violence indicated harm to those affected, but intent to harm was doubted. Interventions strengthened the individual, but some participants demanded collective responsibility.
Conclusion/application to practice
Few descriptions could be classified as psychological violence. Findings indicated a need to change organizational cultures where lower positions pose a potential threat to experiencing harm. Occupational health practice should include training in sensitization to psychological violence, protection of those targeted, deconstructing power accumulation, and promoting diversity in career patterns and working styles.
RESUMEN Con el propósito de conocer el trabajo realizado por estudiantes feministas cuyas colectivas hicieron suya la tarea de denunciar la violencia machista ocurrida en diversos espacios de la Universidad Nacional Autónoma de México, solicité la participación de 11 de ellas para esta investigación. El análisis de la información recolectada en las entrevistas que me concedieron, así como en otras fuentes, permiten apreciar, entre otras cosas, la importante labor que han cumplido con el acompañamiento brindado a quienes han sufrido tal tipo de violencia, así como al hacer visible la presencia continuada de ésta dentro de una institución en la que, al igual que sucede en casi todas las universidades, esa conducta se ha normalizado.
Palabras clave: educación superior, estudiantes feministas, violencia sexista, acoso sexual, movimientos estudiantiles, México.
Background
Mistreatment of trainees, including discrimination and harassment, is a problem in graduate medical education. Current tools to assess the prevalence of mistreatment often are not administered institutionally and may not account for multiple sources of mistreatment, limiting an institution's ability to respond and intervene.
Objective
We describe the utility of a brief questionnaire, embedded within longer institutional program evaluations, measuring the prevalence of different types of trainee mistreatment from multiple sources, including supervisors, team members, colleagues, and patients.
Methods
In 2018, we administered a modified version of the mistreatment questions in the Association of American Medical Colleges Graduation Questionnaire to investigate the prevalence and sources of mistreatment in graduating residents and fellows. We conducted analyses to determine the prevalence, types, and sources of mistreatment of trainees at the institutional level across graduate medical education programs.
Results
A total of 234 graduating trainees (77%) from the University of Minnesota—Twin Cities completed the questions. Patients were cited as the primary source of mistreatment in 5 of 6 categories, including both direct and indirect offensive remarks, microaggressions, sexual harassment, and physical threats (paired t test comparisons from t = 3.92 to t = 9.71, all P < .001). The only category of mistreatment in which patients were not the most significant source was humiliation and shaming.
Conclusions
Six questions concerning types and sources of trainee mistreatment, embedded within an institutional survey, generated new information for institutional-, departmental- and program-based future interventions. Patients were the greatest source for all types of mistreatment except humiliation and shaming.
Se analiza la violencia de género que sufren las estudiantes de medicina en México considerando su condición de internas en una institución total. Con base en investigación cualitativa se documenta cómo los hospitales escuela operan como un mundo propio con tendencias totalizantes donde prevalece una “cultura de acoso a las estudiantes” institucionalmente legitimada. Se muestra que el acoso sexual a las estudiantes está enmarcado por un sistema de privilegios y castigos característico de las instituciones totales, ante el cual las alumnas han desarrollado adaptaciones secundarias para sobrellevar la violencia de género. Se concluye que las estudiantes de medicina se encuentran cautivas en una institución total que legitima el acoso sexual del que son objeto.
Background
Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students’ perception of university climate for reporting sexual harassment was assessed. Method
In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students’ experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment. ResultThe most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men. Conclusion
Mistreatment of female and male students should be focused on using a gender perspective because types of mistreatment can differ by gender. Additionally, interventions should include the societal level as there was a high prevalence of mistreatment perpetrated by strangers. Also the issue of trust in the university needs to be addressed and the organization is called on to visibly demonstrate that it represents and protects its students as well as its staff.
Este artículo fue publicado originalmente en Cary Nelson y Larry Grossberg (eds.). Marxism and the interpretation of Culture. University of Illinois Press. Chicago. 1988. Además, en el libro, A critique of poscolonial reason. Toward a history of vanishing present. Harvard University Press. Cambridge. Existe otra traducción al castellano publicada en Orbis Tertius. VI. 1998: 175-235 (Argentina). Traducción del inglés de Antonio Díaz G., estudiante de antropología de la Universidad Nacional de Colombia. Revisada por Santiago Giraldo y María Teresa Salcedo, investigadores del ICANH.
Authoritarian medical habitus in Mexico begins during the years of medical school training, residency and specialization. Elements of this process include the hierarchies of the profession, gender inequality and punish-ment as a teaching resource. This article describes the functioning of the medical habitus on the basis of observations in delivery rooms in public hospitals. The solution to the problem of human rights violations of women in health services would involve a restructuring of the medical field and the development of users' citizenship.
Resumen
Introducción
el maltrato en la carrera médica es frecuente, aunque escasamente estudiado con diseños analíticos en múltiples realidades latinoamericanas, que determinen sus factores asociados, por ello el objetivo fue determinar los factores asociados al maltrato universitario y hospitalario a los estudiantes de Medicina de 7 países latinoamericanos.
Material y métodos
diseño transversal analítico, de análisis secundario de datos. Mediante un cuestionario autoadministrado entre 2016 y 2017, se obtuvieron las variables de desenlace y auto-reporte del maltrato físico, sexual, académico y psicológico percibido por los estudiantes de Medicina, asociándose a variables socioeducativas mediante modelos lineales generalizados.
Resultados
el principal maltrato fue el psicológico, de 7,3 y 2,7% en la universidad y el hospital, respectivamente, siendo Colombia y Chile los que más maltrato tuvieron en todos los rubros. En la universidad, el maltrato físico, fue mayor al estudiarlo en Ecuador (p < 0,001), pero menor en las mujeres (p = 0,019) y en Argentina (p < 0 ,001); el psicológico, menor en las universidades privadas (p < 0,001), mayor según la edad (p < 0,001), con diferencias significativas en todos los países (p < 0,001); el académico, menor en universidades privadas (p < 0,001), mayor según la edad (p < 0,001) con diferencias significativas en los países (p < 0,001). En el hospital, el psicológico fue mayor en universidades privadas (p < 0,001) con diferencia estadística en los países (p < 0,05), excepto Argentina; el académico, fue mayor según edad (p < 0,001), pero menor en Argentina y Ecuador (p < 0,001).
Conclusión
el maltrato es muy frecuente en la carrera médica, con diferencias estadísticas según variables socioeducativas, siendo altamente heterogéneo entre países; por lo cual, es muy importante que se generen programas encaminados a intervenir este aspecto tan marcado en medicina.
Introduction:
An observatory of sexual harassment and psychological abuse was set up at one of France's largest schools of medicine to both quantify and reduce sexual harassment or psychological abuse of medical students.
Methods:
Over a 2-year period, we described the evolution of sexual harassment and psychological abuse and explored for associated factors. Moreover, a qualitative analysis using an inductive approach was performed from students' verbatim.
Results:
2795 responses were collected. Sexual harassment was reported in 7% and psychological abuse in 15%, at baseline, and decreased after the observatory was set up. Women had higher odds of being a victim of sexual harassment. Older students reported less often psychological abuse and being a witness of sexual harassment. Surgery departments were associated with up to 5.7-fold increased odds of sexual harassment. Surgery and pediatrics departments were associated with a 2-fold increased odds of psychological abuse. Qualitative analysis revealed four categories: humiliation, the feeling of inferiority, sexual harassment, and manifestations of violence.
Conclusion:
During clerkships, factors associated with higher odds of sexual harassment and psychological abuse were female gender, younger age, and departments of surgery. Setting up such an observatory may contribute to reduce this burden and provide a useful tool to raise awareness.
Background
Physicians are at risk of anxiety and depression.
Objectives
To determine the prevalence of anxiety and depression in a national sample of young physicians and their associated factors.
Methods
The study is a cross-sectional observational epidemiological national study. An online anonymous questionnaire was administered to the young physicians of all French medical faculties. Anxiety and depression were assessed with the Hamilton Anxiety & Depression scale subscores for anxiety and depression. Psychotropic drug consumption, psychotherapy follow-up and other variables were self-declared.
Results
Of the 2003 study participants, 32.3% reported a current anxiety disorder and 8.7% a current major depressive disorder according to their HAD scores and less than one on five of them was followed-up in psychotherapy or treated by antidepressant. Moral harassment, a bad quality of initial formation regarding dealing with disease and alcohol consumption were all associated with respectively anxiety disorder and major depression in multivariate analyses. Medical vocation was specifically associated with decreased major depression while being woman and increased coffee consumption were specifically associated with increased anxiety disorders.
Conclusion
Almost one third of medical students reported anxiety disorder or major depression and less than one on five received the recommended treatment (psychotherapy or antidepressant). The prevention and treatment of psychiatric disorders should be improved in this population. Moral harassment exposure, alcohol and coffee consumptions, bad quality of initial formation regarding dealing with disease have been identified as modifiable factors associated with poor mental health. Despite the absence of causal associations, these results yield some clues to guide future mental health prevention strategies in this population.
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