Medical students enter training driven by a passion to heal, yet all too often the journey through medical school leaves them burnt out, depressed, and demoralized. In recent years, the alarming prevalence of burnout and mental health struggles among medical students has reached crisis levels worldwide; studies estimate that roughly half of all medical students experience burnout before they even graduate. A 2018 systematic review and meta-analysis that included 17431 medical students reported a pooled burnout prevalence of 44.2% (95%CI, 33.4-55.0); the main reported causes were emotional exhaustion, depersonalization, and the pursue of a personal accomplishment (1). This meta-analysis provides foundational data on global depression prevalence among medical students, but it was conducted before the COVID-19 pandemic and may not fully capture more recent shifts in mental health trends (1). Another pre-pandemic study reported that one in three medical students have had depression with less than one in ten seeking proper help (4). Subsequent studies and meta-analyses conducted during and after the COVID-19 era have reported high rates of depression among medical students, often exceeding pre-pandemic estimates and highlighting persistent stressors associated with training and pandemic-related disruptions (2,3). For example, meta-analytic evidence suggests that pooled prevalence of depression during the COVID-19 pandemic ranged from approximately 30 % to nearly 50 % depending on region and measurement approach (2). This quiet epidemic not only harms future physicians, but also threatens the quality of care they will provide to patients. Therefore, in this opinion article I would like to pose and confront an urgent question: If we continue to burn out our healers in training, who will be left to care for us? For conceptual clarity, it is important to distinguish between related but non-equivalent terms used throughout this opinion article. Burnout refers to a work-related syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, whereas depression denotes a clinical or subclinical mood disorder with broader affective and cognitive features. In contrast, mistreatment, harassment, and abuse describe forms of inappropriate conduct within educational or clinical environments. Mistreatment encompasses a broad range of behaviors perceived as disrespectful or humiliating; harassment typically involves repeated, targeted behaviors often linked to protected characteristics or power asymmetries; and abuse refers to more severe or coercive actions that may be psychological, verbal, or physical. While these constructs are interrelated and may co-occur, they are conceptually distinct and play different roles as exposures or outcomes within health professions education.Burnout in medical school is characterized by emotional exhaustion, depersonalization (cynicism), and a diminished sense of accomplishment (5). These symptoms, first noted in medical trainees decades ago, have only become more prevalent (6). Recent meta-analyses put the global prevalence of medical student burnout at around 37-45% on average, meaning nearly one in two students is affected; with some reporting prevalences as high as 88% (1,7). This far outpaces burnout levels seen in many other high-stress fields (8). Equally concerning are the rates of depression and suicidal ideation among medical students. A comprehensive 2016 review in JAMA reported that 27.2% of medical students worldwide showed depression or depressive symptoms, a rate several times higher than that of their peers in the same age group; with 11% of them reporting suicidal ideation and only 15.7% seeking psychiatric aid (4). To put that in perspective, medical students' risk of depression is estimated to be 2.2 to 5.2 times higher than for individuals of similar age in the general population (4). In fact, some research indicates that medical students may suffer higher rates of depression, suicidal ideation, and feelings of low achievement than even resident physicians or young doctors; highlighting that medical school itself is a uniquely intense crucible of distress (9). This combination of burnout and mental health struggles has serious consequences: it impairs students' learning, affects their empathy towards patients, and has been linked to increased risk of medical errors and future career dissatisfaction (10)(11)(12). If half of our future doctors are burning out before they can wear the white coat as physicians, the downstream effects on healthcare quality and physician workforce stability are profound and worrisome.Why are medical students so burned out? The causes are multi-factorial, but a toxic culture of overwork and mistreatment is often at the center (11,13,14). A survey that included more than 500 third year medical students reported that medical students had had at least one incident of mistreatment by faculty (64%) or by residents in hospitals/clinics (76%); furthermore, 10% and 13% of students reported several mistreatments by faculty and residents, respectively (15). Beyond burnout, sustained exposure to mistreatment and chronic academic stress has been consistently associated with increased depressive symptomatology among medical students, including feelings of hopelessness, persistent low mood, and, in severe cases, suicidal ideation (2,28,30). Unlike burnout, which is conceptualized as a work-related syndrome, depression carries broader functional and long-term mental health implications, further underscoring the gravity of institutional neglect.Medical training is notoriously demanding; long hours of study and clinical duties, high-stakes exams, fierce competition, and the ever-present weight of expectations from family and teachers alike (16)(17)(18)(19)(20). Students often find themselves sacrificing sleep, basic self-care, and personal relationships in order to meet relentless academic requirements (16)(17)(18)(19)(20). Over time this chronic stress and imbalance significantly affects their well-being. It's no surprise that by the end of the first year, many students report high emotional exhaustion (16)(17)(18)(19)(20). Beyond workload, the cultural norms of medical education have historically downplayed student wellness (21). The field has long glorified toughness and stamina, the ability to "push through" fatigue and emotional strain, as a badge of honor or as a rite of passage (21). In some environments, taking time for oneself or admitting to stress is stigmatized as a sign of weakness (22,23); my country is one of these environments. This mentality pressures students to suffer in silence rather than seek help, fueling cycles of anxiety and burnout. Indeed, researchers note that many medical students hide their struggles "for fear of being stigmatized," which can lead to underreporting of burnout and delay in getting support (22)(23)(24).Alarmingly, mistreatment and bullying remain common experiences for medical students, further contributing to burnout. From public belittlement on ward rounds to sexist or racist remarks, harassment in the training environment adds an extra layer of psychological harm (14,25). Surveys in the United States have found that the majority of medical students experience at least one incident of mistreatment during their training. Repeated abuse is not rare; in one multicenter U.S. study, about 11-13% of third-year students reported being mistreated "numerous times" by faculty or residents (15). Crucially, those who endured frequent mistreatment had dramatically higher burnout rates (approximately 57%) compared to those who did not (32%) (15). This data underscores what should be obvious, a culture of harassment and humiliation is fundamentally incompatible with student well-being. Yet despite decades of calls for change, mistreatment persists in medical schools worldwide, especially in countries were well-being and mental health are still taboo topics or are seen as non-important ramblings of the youth that "likes to complain".In my view, the consistency of these findings across countries and institutional settings makes it difficult to interpret burnout and depression as isolated or purely personal phenomena. Rather, they reflect systemic features of how medical education is organized and legitimized. It showcases the daily struggles of medical students as well as the mistakes we, as educators and trainers, need to face and work to correct.Burnout and mistreatment of medical trainees are global phenomena, but it is important to consider regional contexts. In Latin America, medical students face many of the same stressors seen elsewhere, often compounded by resource constraints and cultural norms. Notably, some evidence suggests a paradox in reported burnout rates versus experiences of mistreatment in the region. A 2019 international meta-analysis found that the highest burnout prevalence among medical students was observed in the Middle East, while the lowest was in South America (1). For example, one Brazilian meta-review in 2017 reported a burnout prevalence of only 13.1% among medical students (26); far lower than estimates from North America or Europe. On the surface, this could imply South American students are faring better. However, such numbers may be misleading or reflect differences in measurement. In the same Brazilian analysis, nearly 30.6% of students screened positive for depression, suggesting significant distress persists (26). Some experts speculate that burnout might be underreported or defined differently in Latin American studies, or that strong family/social support networks could be buffering stress even as academic pressures mount. However, another systematic review focused solely on Latin American medical students reported prevalences of burnout syndrome ranging from 4.3% to 43.9% (27).On the other hand, evidence of medical student mistreatment in Latin America is disturbingly high. In Brazil, a cross-sectional study in a public medical school found that 30.1% of students recurrent mistreatment, with 92.3% reporting at least one event of mistreatment during their training years and 64.2% reported being exposed to severe mistreatment (28). Even worse, a 2024 descriptive cross-sectional study done in Ecuadorian medical students reported that 96.2% of participants had experienced at least one episode of mistreatment and only 72.5% recognized it as such (16); meaning that, in my country and, I believe, in many more Latin American countries than those reported in the literature, abuse and mistreatment is so pervasive that students perceive it as "normal" and have difficulty identifying it. The abuse was predominantly verbal and psychological; cruel teasing, humiliation, and harsh scolding, most often perpetrated by faculty members in positions of power in 87.9% of cases (16). As students advanced in training, incidents of mistreatment only increased, peaking during the clinical internship years. The impacts were severe; 90% of affected students reported feeling "diminished and depressed" as a result of the abuse, but the rate of non-reporting such abuse is worrisomely high, as 90.6% of students decided to not speak due to fear of retaliation and institutional ineffectiveness (16). Distressingly, studies from other Latin American countries echo similar of mistreatment. Surveys in Chile, Peru, Mexico, and elsewhere have documented prevalence of student abuse exceeding 90% of those surveyed at some point in training (29)(30)(31)(32). In other words, virtually all students in certain institutions reported experiencing belittlement, harassment or other forms of academic violence. These figures contradict and disprove any notion that Latin America's lower reported burnout in global reviews means students are sailing through unscathed; on the contrary, many are enduring a toxic training environment, even if they don't label the outcome as burnout. The institutional failure to address mistreatment does not merely contribute to burnout; it may also exacerbate or precipitate depressive disorders, particularly in environments where stigma and fear of retaliation discourage help-seeking. This dual impact strengthens the ethical imperative for structural reform.Moreover, evidence from Bolivia, Colombia and Argentina further illustrates that burnout, depressive symptomatology, and mistreatment during medical training are not isolated national phenomena but part of broader regional patterns (33,34). Studies conducted in Colombian medical schools have reported high prevalence rates of burnout and clinically significant depressive symptoms among medical students, with emotional exhaustion and hopelessness frequently associated with academic overload and perceived lack of institutional support (35,36). Importantly, these findings mirror patterns observed elsewhere in the region, where psychological distress is closely intertwined with structural and cultural aspects of medical training rather than solely individual vulnerability. Similarly, research from Argentina has documented mistreatment and hierarchical abuse during both undergraduate medical education and residency training (37,38). Reports of humiliation, verbal aggression, and normalization of harsh supervisory practices suggest that deeply embedded academic hierarchies continue to shape training environments in ways that may contribute to burnout and depressive outcomes. These findings reinforce the argument that the problem is not confined to a limited subset of countries but reflects recurring institutional dynamics across diverse Latin American contexts.In many Latin American medical schools and teaching hospitals, institutional and organizational structures play a central role in shaping trainee experiences. Academic hierarchies are often highly vertical, with strong asymmetries of power between students, residents, faculty, and senior clinicians. In such environments, mistreatment may be normalized as part of professional socialization, while fear of retaliation can discourage reporting. Formal mechanisms for addressing complaints, where they exist, are frequently perceived as opaque, ineffective, or insufficiently independent, limiting trust in institutional accountability. These structural features may contribute to the persistence of mistreatment and to the underrecognition of its psychological consequences. It is also important to recognize that Latin America encompasses diverse educational systems, regulatory frameworks, and institutional cultures. The organization of medical training, availability of mental health resources, and enforcement of professional standards vary considerably across countries, as well as between public and private institutions. While some universities have begun to implement wellness initiatives and reporting pathways, others lack formalized policies or the resources required for sustained intervention. Consequently, the patterns described here should be understood as uneven and context-dependent rather than uniform across the region.It is worth noting that Latin America's medical education culture has traditionally been quite hierarchical. The professor or attending wields tremendous authority, and open critique of superiors is rare. In such settings, I believe that abusive teaching practices can become ingrained and perpetuated as a rite of passage or as a normality; "I suffered through it, so you must as well." The lack of robust institutional policies against mistreatment until recently has allowed this cycle to continue. Furthermore, resource limitations (high student-to-teacher ratios, limited support services) in some Latin American institutions can leave students feeling especially helpless and unsupported (39). The result is a perfect storm for burnout, even if not always formally measured, resulting in high stress, high abuse, and little relief. This regionspecific context highlights that while the burnout crisis is global, solutions must be culturally tailored. Latin American medical schools may need to place extra focus on eradicating deeply rooted mistreatment and expanding mental health resources, alongside the general wellness strategies applicable everywhere. I'm certain that Latin America now faces a strategic opportunity: to move from documenting harm toward institutional reform grounded in accountability and transparency.A critical and often underaddressed dimension of mistreatment in medical education is the role of institutional power and the persistent failure of accountability mechanisms. Although mistreatment of medical students, interns, and residents has been repeatedly documented and reported to academic and hospital leadership, meaningful consequences for perpetrators remain uncommon (12,13,19). In many institutions, particularly those with rigid hierarchies, abusive behaviors by senior faculty or supervisors are tacitly tolerated, minimized, or actively concealed to protect institutional reputation or influential individuals (19,23). This dynamic creates an environment in which reporting is perceived as futile or dangerous, reinforcing silence and normalizing abuse (13,14). Existing reporting mechanisms frequently fail to deliver justice. Students and trainees often fear retaliation, negative evaluations, or damage to future career prospects, especially when the accused individual holds evaluative or supervisory authority (20)(21)(22). Moreover, complaint processes are commonly managed internally by the same structures that benefit from maintaining the status quo, creating conflicts of interest and undermining trust (19). As a result, many institutions prioritize risk management and reputational protection over ethical responsibility, allowing patterns of mistreatment to persist across cohorts (12,13,26).While some medical schools have introduced wellness programs, counselling services, and peer-support initiatives, these measures primarily offer symptomatic relief and do not address the underlying power imbalances that enable abuse (4,11). Ethical and professional accountability requires more than support services; it demands enforceable standards of conduct. Potential mechanisms include independent offices, anonymous reporting systems with external oversight, and the of teaching and trainee well-being faculty and suggests that such measures are only when they are and by institutional to enforcement persistence of mistreatment in medical education reflects not a lack of about the but a failure of and I believe that addressing this requires institutions to move policies and confront the that in clinical does not ethical The central is not mistreatment evidence makes that but institutions are to confront the hierarchical structures that enable it. 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