When Professional and Educational Feedback Turns into a Cycle of Violence: A Qualitative Study of Educational and Punitive Interactions During Medical Residency

Background Medical residents’ education and learning are inherently situated within hierarchical clinical environments shaped by power relations. Professional feedback is a central component of clinical education and plays a critical role in residents’ professional and clinical development. However, evidence shows that feedback is often influenced by power imbalances and, rather than serving a formative and educational role, may become punitive, non-constructive, or even violent. Given frequent reports of burnout, bullying, harassment, and adverse psychological outcomes among medical residents in Iran, a qualitative examination of residents’ lived experiences of feedback, punishment, and violence in clinical education is warranted. Method This qualitative study used conventional qualitative content analysis based on the Graneheim and Lundman approach. Participants were 8 medical residents (currently in training or graduated within the past 3 years) from diverse medical specialties and educational centers across Iran who had experienced feedback and punishment during residency. Data were collected through in-depth semi-structured interviews conducted between January and March 2024 and analyzed inductively. Peer debriefing enhanced the credibility of the findings. Results The analysis yielded 4 main categories, 9 subcategories, and 20 initial codes. Participants described professional feedback as a continuum ranging from “supportive and corrective feedback” to “punishment” and ultimately “violence.” Feedback delivered with respect, clarity, and an explicit educational purpose supported learning, error correction, and professional development. In contrast, feedback provided in humiliating, nontransparent, or rigidly hierarchical contexts often lost its educational value. Punishment—particularly informal practices such as assigning extra on-call shifts—was perceived as a gray zone between feedback and violence. Participants reported multiple forms of violence, including soft and hard, as well as structural and institutional violence. The normalization and repetition of violent behaviors, hierarchical organizational structures, conflicts of interest, and gaps in legal protections facilitated the transformation of feedback into a harmful experience. Conclusion The findings reveal a violence-based pedagogy embedded in medical residency education, linking learning to fear, humiliation, and compliance. Creating a more humane and ethical training environment requires revising disciplinary policies, strengthening supportive and legal frameworks, and equipping clinical educators with skills in power awareness, participatory power, effective communication, and care-cantered ethics.