Exploitation and psychological strain in residency training: workload and shift violations in Turkish medical schools and research hospitals.

backgroundIn Turkey, the path to specialisation is a highly demanding and costly process. After completing six years of intensive medical education, general practitioners must pass the highly competitive Medical Specialisation Examination (TUS) to enter residency training. To pass the examination for entry into specialist training, medical students in Turkey are compelled to attend highly expensive preparatory courses during the final two years of their six-year medical education. Additionally, graduates working as general practitioners often struggle to prepare for the specialist examination due to intense working conditions and, therefore, may be forced to resign from their positions. The difficulty of this process has contributed to the growing shortage of specialist doctors in the country. Particularly, the heavy working conditions and workplace bullying by senior faculty members further exacerbate the challenges faced by residents. The 2022 Regulation on Medical and Dental Specialisation Training (TUEY) aims to improve working conditions and has come into force. However, issues such as excessive workload and non-compliance with on-call regulations continue to persist. In addition, psychological pressures, including threats of extending the duration of specialisation training or withholding certification, are still reported. Within the scope of the Regulation on Medical and Dental Specialisation Training, the Medical Speciality Board (TUK) has undertaken the responsibility of planning specialist training, supervising educational institutions, and determining policies related to specialist education. METHODOLOGY: This study employs a phenomenological research approach to explore the experiences of 25 medical residents in Turkey. Participants were purposefully selected from 25 different medical faculties across the country, representing various specialisations and hospital settings. Data were collected through semi-structured interviews focusing on shift regulations, psychological impacts, and compliance with TUEY. The collected data were systematically analysed using MAXQDA software, and thematic content analysis was applied.

findingsThe study identified four main themes: (1) Shift Scheduling and TUEY Implementation - Most participants reported that the rule of a maximum of eight shifts per month was generally observed, but post-shift rest periods were often denied. (2) Psychological and Emotional Well-being of Residents - Excessive workload and stress were found to negatively affect residents' mental health and personal lives. (3) Supervisors' Role and Pressure Mechanisms - The findings suggest a lack of sufficient oversight mechanisms for TUEY compliance, with supervisors continuing to delegate excessive workloads to residents. (4) Psychological Pressure from Faculty Members - Residents reported experiencing verbal abuse, belittlement, and being assigned menial tasks by faculty members, leading to professional dissatisfaction and increased early resignation rates.

conclusionDespite the existence of TUEY, medical faculties in Turkey fail to fully adhere to the regulations. Medical residents face severe issues, including excessive workload, lack of post-shift rest, psychological pressure, and inadequate training. To address these problems, independent oversight mechanisms should be established, ethical training should be provided to faculty members, and legal support should be made available to residents.