Bullies sometimes wear white coats, and they may be in charge of educating the next generation of doctors. In a survey administered to a national cohort of internal medicine residents, 14% reported that they had been subjected to repeated harassment by someone in a position of authority at some point during their residency, researchers report in a study published online today in JAMA. Most of the reported harassment was verbal, but physical, sexual, and other forms of bullying were also noted. And of those who experienced bullying, most kept the problem to themselves, write Manasa S. Ayyala, MD, of Rutgers New Jersey Medical School in Newark, and colleagues. The phenomenon of workplace bullying has emerged as a pressing issue in healthcare and healthcare training programs in recent years. And it is unacceptable, according to Scott M. Wright, MD, of Johns Hopkins School of Medicine, who was senior author of the current investigation. "There is no place for harassment in medicine or medical education. These individuals should not be teaching or interacting with the next generation of physicians," he said in an interview with Medscape Medical News. Previous studies that looked at the prevalence of bullying among medical trainees produced a wide range of estimates, from 10% to 48%. The current research was designed to clarify the actual prevalence of residents who felt they had been bullied by superiors during their training, the authors explain. The researchers gathered information about residents' perception of bullying via a supplementary survey attached to the end of the Internal Medicine In-Training Examination (IM-ITE), which is administered annually at each training site to provide residents with an assessment of their progress. For the study, bullying was defined as repeated harassment by an individual in a position of power. Residents were asked if they had ever been bullied during their residency training. Those who perceived being bullied were asked to characterize the type of harassment (verbal, physical, sexual, or other) and to identify the personal consequences of bullying from a list of eight possibilities. They were also asked whether they sought help. Of 21,212 residents included in the analysis, 13.6% said they had been bullied during their training. Of these, 80% reported experiencing verbal harassment, 5.3% reported physical harassment, and 3.6% reported sexual harassment. One quarter of those who had been bullied reported "other" harassment. The most common reported consequences of being bullied were burnout (57%), poorer professional performance (39%), and depression (27%). Other consequences included weight change (15%), alcohol use (6%), and illicit drug use (1%). In addition, 2% of the bullied population reported that the experience led to their leaving the residency program, while 6% attributed improved performance to the experience. Nearly one quarter of the residents who had been bullied did not identify any of the consequences listed. "In addition to the negative consequences of bullying, we uncovered that most victims to do not tell anyone about their experiences with bullying," lead author Ayyala said in an interview. She noted that fewer than one third (31%) of the bullied population said they had sought help to deal with the harassment. Looking at the relationship between reported bullying and resident and residency program characteristics, the researchers identified significant associations between bullying and speaking a native language other than English, being an international medical graduate, higher postgraduate year level, lower IM-ITE performance, and international residency training. Although the findings may be limited by several considerations, including the lack of data on the frequency or severity of bullying, lack of detail about the bullies, and limited information about the training programs, the prevalence points to a problem that warrants immediate attention given the potential consequences to future practitioners and the patients they care for, Ayyala explained. "The first step to stopping bullying is to increase awareness that it is a problem in medical education," she stressed. "Educational leaders and training program directors need to be aware in order to begin working to further understand and eradicate bullying from medical education." Addressing bullying requires going to the source, Wright said. "This is not a question of building resilience among residents. Resilience does not come into play with bullying," he explained. "The problem sits entirely with the bullies." The authors have disclosed no relevant financial relationships. JAMA. 2019;322:576-578. Abstract Source
