A Systematic Review and Meta-analysis on Teaching by Humiliation in Medical Training: Its Frequency and Impact on the Mental Health Outcomes of Medical Trainees

This systematic review and meta-analysis investigated the frequency of teaching by humiliation (TBH) in medical science education and its impact on the mental health outcomes of medical trainees. TBH is defined as teaching activities by educators resulting in feelings of humiliation amongst trainees. Seven databases were searched. Twenty-eight studies with 34,821 participants were retrieved for systematic review using narrative synthesis, 20 of which were included in the meta-analysis. The pooled frequency of TBH was 57.1% (95%CI [0.413, 0.716], ranging from 8.0 to 90.8%. Experiencing TBH appears to be associated with mental health problems in medical trainees, including symptoms of depression, anxiety, stress, burnout, substance abuse, and suicidal ideation. Experiencing TBH also seems to be associated with fear, anger, frustration, humiliation, shame, and embarrassment. Built upon the findings, a model has been proposed to explain how experiencing TBH affects mental health through basic and self-conscious emotions.