Perception, typology, consequences and perpetrators of mistreatment in medical students: a cross-sectional study in Ecuador 2024

Background: Mistreatment of medical students represents a widely documented structural problem in medical training institutions worldwide. Its high prevalence, adverse effects in mental health and academic performance, as well as low reporting rates, highlight the urgent need to characterize this phenomenon in local contexts. In Ecuador, there are few studies that address this issue from an empirical perspective. Objective: To analyze the perception, types, perpetrators, effects and reporting of mistreatment among medical students at a public Ecuadorian university, differentiating findings by training cycle (basic vs clinical) and gender. Material and methods: A descriptive cross-sectional study was conducted with a random sample of 556 students. An online questionnaire was administered, adapted from a previously validated instrument (Cronbach’s α = 0.96) structured into five sections: sociodemographic data, perception of mistreatment, involved perpetrators, perceived effects and reporting. Descriptive and inferential statistics (Chi-square and Fisher’s exact tests) were performed using R software. The study protocol was approved by an institutional ethics committee. Results: Overall, 96.2% of participants reported experiencing at least one episode of mistreatment, yet only 72.5% explicitly recognized it as such. Prevalence was higher in the clinical training phase. Psychological mistreatment was the most frequent type, followed by academic, physical and sexual. Faculty physicians were identified as the main perpetrators 87.9%. Over 90% reported negative effects, primarily personal, with higher effects in the clinical cycle students. Female students had lower risk of physical mistreatment (OR: 0.60; IC 95%: 0.36–0.99) but higher risk of sexual mistreatment (OR: 1.77; 95% CI: 1.23–2.55). Non-reporting rates were 90.6%, primarily due to fear of retaliation and perception of institutional ineffectiveness. Conclusions: Mistreatment in medical education is highly prevalent, particularly during clinical training, with significant personal, academic, and social consequences. The lack of recognition and low reporting rates reflect an institutional culture that normalizes these behaviors. There is an urgent need to implement support strategies of prevention, detection and attention of mistreatment focused on gender with safe and effective reporting mechanisms.