Revenge Pedagogy: Institutional Violence and Mental Health in Postgraduate Medical Education

Abstract

Postgraduate medical education has historically reproduced patterns of authoritarianism, hostility, and insensitivity that generate systematic suffering among residents. This essay proposes the concept of "revenge pedagogy" as an analytical category to describe the cultural logic that sustains this model.

This article analyzes recurrent affective, cultural, and institutional patterns observed in three postgraduate medical residency settings in Asunción, Paraguay, and proposes “revenge pedagogy” as a conceptual category for understanding the intergenerational reproduction of institutional violence in medical training.

This is an exploratory qualitative study based on three facilitated team-care conversations held between 2018 and 2021 with residents from obstetrics and gynecology, surgery, and internal medicine programs. Each session lasted approximately three hours and included 15 to 40 participants. Narrative records and reflective field notes were reviewed through an interpretive thematic procedure. Emergent patterns were identified by recurrence across groups, intensity of participant narratives, and relevance to the literature on mistreatment, hidden curriculum, burnout, and physician suicide.

Seven cross-cutting patterns were identified: normalization of suicidal expressions, emotional prohibition, authoritarian submission, cruel humor with a victim, fear as institutional climate, intergenerational legitimation of suffering, and alcohol as an informal mode of care. Together, these patterns suggest a hidden curriculum in which suffering becomes a credential for belonging and later authority.

Revenge pedagogy describes an implicit training model that transforms previous suffering into permission to reproduce suffering. Team inter-care offers a culturally situated counter-practice by making existing care resources visible, collective, and institutionally discussable.