Shaping Surgical Futures: How Resident Mistreatment Alters Medical Students’ Perspectives on Surgery in the Dominican Republic

Shaping Surgical Futures: How Resident Mistreatment Alters Medical Students’ Perspectives on Surgery in the Dominican Republic

Paria Remolina , Dennsys De La Cruz Rodriguez , Vianny Alejandra Ramirez Polanco , Angel Creciano Mendoza Barrera , Chrisleydi Reynoso Rodriguez , Grosmery Milagros Santana Heredia , Marian Emil Fernández Díaz , Daniela Emilia Javier Silfa , Walid Ali Malik Rodriguez
Universidad Nacional Pedro Henríquez Ureña, Santo Domingo, Dominican Republic; La Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic

Background:
A sustainable surgical workforce depends on the interest and motivation of medical students. This study explores how witnessing the treatment of residents impacts students’ perceptions of surgery in a low- middle-income country (LMIC).

Methods:
A cross-sectional survey was conducted among 100 final-year medical students in the Dominican Republic who had completed a surgical rotation within the past six months. Students reported exposure to resident punishment, types and duration of mistreatment, and whether it influenced their perception of surgery as a specialty choice.

Results:
A total of 93% of medical students reported witnessing resident punishment during their surgical rotation. The most commonly observed forms included extended work hours (92.9%), public humiliation or verbal abuse (72.4%), and additional repetitive or physically exhausting tasks (63.3%). Other forms of mistreatment were reported by 3.1% of students. The duration of punishment varied, with students noting instances lasting less than 24 hours (19.4%), 1–2 days (20.4%), 3–4 days (13.3%), 5–6 days (7.1%), one week (23.5%), and more than a week (28.6%). Regarding career impact, 72.7% stated witnessing punishment made them less likely to pursue surgery, 26.3% reported no impact, and 1% said it increased their interest. When asked about specialty choice, 60.6% indicated it discouraged them from choosing surgery, 23.2% reported no effect, 13.1% remained undecided, and 3% said it reinforced their interest.

Conclusion:
Punitive training environments contribute to negative perceptions of surgical careers, posing a threat to the sustainability of surgical systems in LMICs. Addressing mistreatment may improve recruitment and retention of future surgeons, particularly in under-resourced health systems.

Keywords: Low-middle-income country, Resident punishment, Surgical education, Career impact