Incivilities in medical education and clinical care. : Need for a cultural change

Abstract

The article examines incivility in medical education and healthcare as a widespread, frequent and culturally embedded problem. Mistreatment is defined as behaviors such as disrespect, humiliation, or abuse that undermine human dignity, affecting both educational and clinical relationships. These behaviors range from overt aggression to subtle, normalized practices such as sarcasm, exclusion, and excessive or punitive workloads.

Incivility is highly prevalent, frequently with significant consequences such as including anxiety, burnout, reduced motivation, and even dropout. It affects more women and those perceived as hierarchically inferior. Additionally, these behaviors negatively impact patient care by disrupting communication, teamwork, and safety practices.

The phenomenon is multifactorial, including individual traits, rigid hierarchical structures, heavy workloads, and a culture that normalizes abuse as part of professional training. Intergenerational transmission reinforces its persistence. Institutional barriers such as underreporting, ineffective investigation processes, and lack of follow-up further perpetuate the problem.

The article highlights the urgent need for a profound cultural change grounded in unrestricted respect. It proposes comprehensive interventions, including the integration of medical humanities into curricula, faculty training in respectful teaching practices, zero-tolerance policies, ethical leadership, and improved working conditions. A systemic approach that integrates education and clinical care is essential. Only sustained commitment from institutions and stakeholders can ensure ethical medical training and high-quality healthcare delivery.