Bullying in Academic Medicine: A Hidden and Pervasive Threat

As a young medical student, Ron Young II, MD, knew he would have to deal with extreme pressure and a grueling workload.

But he didn’t expect that he would also have to face another huge challenge: bullying from other doctors.

The first time this happened to Young, who is black, was in 1986 when he was interviewing for medical school.

During a routine entrance interview at the University of Oklahoma, the general surgeon assigned to screen applicants looked at him and said bluntly, “I’m not sure you’ll attend this school, but you have the advantage of black.”

The obvious implication: Young’s only chance of being accepted hinges on his leg of affirmative action on white applicants.

Although he was surprised, Young shot back. He referred to his academic text and said to him:who – which It was my advantage and this Why would I enter?”

Young attended the University of Oklahoma School of Medicine and is now a successful neurosurgeon in South Florida.

He says this wasn’t the first time he had been racially bullied and that, looking back now, he realizes the interview was just a tasting of things to come on his medical journey.

Young’s experience sheds personal light on bullying in academic medicine which, even after 35 years, remains a very common fact for many clinicians. One study It is estimated that about 4 in 10 young doctors and medical students experience bullying from their peers.

The true prevalence of bullying in medicine is still unknown, given how often it is likely to go unreported.

For some, sharing past experiences with bullying remains off-limits. Nearly thirty doctors have contacted them Medscape Medical News He declined to comment on their experiences, even when they promised not to reveal their identity.

“It’s ugly, and there’s a lot of suffering,” says Harriet JC Van Spall, MD, MPH, assistant professor of medicine, McMaster University, in Hamilton, Canada, who has researched bullying.

The many faces of bullying

Defining bullying can be tricky, in part because it can take many forms.

“It’s everything from abusive language to subtle attacks,” says Jonathan Hyman, a workplace attorney whose clients include health care providers. “It really runs a whole gamut of potential misconduct.”

in Analysis published last year in BMJ is openVan Spall and colleagues reviewed 68 studies on bullying in academia. The studies documented the experiences of more than 82,000 medical consultants or trainees.

The authors found that academic medicine was riddled with bullying. These behaviors manifest themselves in several central ways: overwork, threats to professional status, isolation, and destabilization.

More than 38% of respondents said they felt pressure to put in unreasonably long hours (tiredness). Nearly 36% reported receiving orders to work below their level of proficiency, while information that affected their personal performance (destabilization) was withheld for 31%. About 30% were subjected to excessive surveillance or faced undue criticism (occupational threats). About the same percentage felt they were routinely socially and occupationally excluded (isolation).

Men were mostly the aggressors, accounting for nearly 70% of the perpetrators of bullying, while women were more often the recipients.

Although she refuses to go into details, Van Spall says the research is inspired by her personal experiences.

However, the shock remained with her.

“Every day was filled with dread,” Van Spall says. “It required an absolute will to show up at work to care for patients, to complete the research I was leading. My academic productivity, my income, and my personal well-being declined during those years.”

Although he never felt isolated, Young says he experienced the other three forms of bullying behavior during medical school and residency. He routinely worked long hours – his longest working week was around 126 hours. He also suffered from bouts of excessive surveillance and destabilization.

As a surgical resident, for example, Young was mentored by an overbearing surgeon.

“He was telling me to stand in a place where I couldn’t see what was going on,” he says. And then he’d tell me where to put a surgical instrument and… kind of point my hand in there and then say, ‘Okay, now take [cut there]“- So I was doing it blindly.”

The message Young received was loud and clear, “I’m in control and you’re not.”

But Young backed down, and the surgeon eventually relented and allowed him to carry out the procedures with minimal intervention.

Young also worked with a surgical resident whose interactions were routinely peppered with racial comments, even while examining patients.

“I remember I was involved in a case and there was a blood clot we were taking out and the resident said, ‘That clot looks like a dead illegitimate black baby.'”

Shrine of Fear and Secrecy

Young did not officially report these behaviors, believing that doing so would come back to bite him.

He is not alone.

Tauben Averbuch, MD, co-author of BMJ is open studyYoung’s concerns have been echoed by many residents and medical students who have been bullied, he says. Less than 1 in 3 of those who experienced bullying said they had officially reported it. Of those who did, only 14% noticed an improvement. 36 approx % It found no effect, and 22% exhibited worse bullying behaviors afterward.

Hyman, a workplace attorney, says fear of retaliation is one reason why bullying in medicine continues to go unreported and thus not acknowledged and untreated.

Another: Bullying does not violate any laws in the workplace.

“Businesses, including health care providers, have largely ignored bullying because it is not illegal per se,” says Heymann. “It’s only illegal if the bullying is because of a protected category – if it’s sexual or racial harassment or a disability.”

Some medical schools and health care institutions have moved to institute anti-bullying policies, but they are still in the minority.

new study Posted in open gamma network It found that only four of the 91 best medical schools had anti-bullying policies. But even the policies in those schools failed. Three schools, for example, did not include confidential reporting procedures, and one did not include policies prohibiting retaliation.

Without clear anti-bullying policies, the identification of bullying behaviors is vague, reports are low to absent, and bullying has non-uniform consequences.

Academic medical centers need to do a better job of recognizing the problem, establishing clear anti-bullying guidelines, and taking reports of such incidents seriously.

The biggest takeaway from BMJ is open The study is “normalizing bullying behavior,” says Averbush, MD, a cardiology fellow at the University of Calgary, in Alberta, Canada.

As for solutions, he notes, “I don’t think it’s as simple as just reporting and shooting everyone who bullies them. I think it goes deeper into the culture of academic medicine, and we have to be more thoughtful about how we tackle it.”

Young agrees, but notes that medical students and residents can take steps to confront bullies and manage the stress that comes with medical training.

“I think a lot of people feel a little helpless when they do that [bullying] “But standing up for yourself sometimes, even just a little bit, can change things dramatically,” he says.

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