Rites and Mistreatment During Medical Residency: A Qualitative Study

Mistreatment is a pervasive and normalized feature of medical culture. In medical residencies, it functions as a structural rite of passage that shapes professional socialization. While the prevalence of mistreatment is documented, there is a lack of qualitative research exploring its role as a mechanism of identity construction. The aim of this study was to understand the experiences of mistreatment among internal medicine residents in Medellín, Colombia, through the lens of ritual theory and symbolic violence. A particularistic ethnographic study was conducted with 12 residents selected via theoretical sampling. Data were collected through semi-structured interviews and a reflexive field journal. Rigor was ensured using investigator triangulation and analytical bracketing to manage researchers’ biases. The training process follows a three-stage rite. (1) Separation: Symbolic violence and social pressure to specialize frame general medicine as “mediocre,” turning admission into a “battlefield” where self-worth is tied to success. (2) Marginalization (Liminality): Residents endure systemic mistreatment, including sleep deprivation (3.5 h rest cycles), public ridicule (“pimping”), and physical/verbal abuse (e.g., being hit with stethoscopes or called “testicles/jerks”). This stage is governed by a “purificatory logic” where suffering is internalized as a meritocratic requirement. This leads to high morbidity, with clinical diagnoses of anxiety and depression. (3) Integration (Postliminality): Professional autonomy and financial stability act as a “redemption” that justifies past suffering. Mistreatment is not an isolated interpersonal issue but a structurally embedded ritual and a core element of the hidden curriculum. It reinforces toxic hierarchies and a “tyranny of merit” that obscures structural barriers. These findings offer analytically transferable insights for global medical education, calling for a deconstruction of ritualized violence to foster more humanistic training environments.