Abstract
ObjectivesTo deliver an estimate of bullying among residents and fellows in the United States graduate medical education system and to explore its prevalence within unique subgroups.Design/Setting/ParticipantsA national cross-sectional survey from a sample of residents and fellows who completed an online bullying survey conducted in June 2015. The survey was distributed using a chain sampling method that relied on electronic referrals from 4,055 training programs, with 1,791 residents and fellows completing the survey in its entirety. Survey respondents completed basic demographic and programmatic information plus four general bullying and 20 specific bullying behavior questions. Between-group differences were compared for demographic and programmatic stratifications.Main Outcomes/MeasuresSelf-reported subjected to workplace bullying from peers, attendings, nurses, ancillary staff, or patients in the past 12 months.ResultsAlmost half of the respondents (48%) reported being subjected to bullying although both those subjected and not subjected reported experiencing ≥ 1 bullying behaviors (95% and 39% respectively). Attendings (29%) and nurses (27%) were the most frequently identified source of bullying, followed by patients, peers, consultants and staff. Attempts to belittle and undermine work and unjustified criticism and monitoring of work were the most frequently reported bullying behaviors (44% each), followed by destructive innuendo and sarcasm (37%) and attempts to humiliate (32%). Specific bullying behaviors were more frequently reported by female, non-white, shorter than < 5’8 and BMI ≥ 25 individuals.Conclusions/RelevanceMany trainees report experiencing bullying in the United States graduate medical education programs. Including specific questions on bullying in the Accreditation Council for Graduate Medical Education annual resident/fellow survey, implementation of anti-bullying policies, and a multidisciplinary approach engaging all stakeholders may be of great value to eliminate these pervasive behaviors in the field of healthcare.
Highlights
Over three decades have passed since Henry Silver first shined a light on the potential of abuse in medical education.[1]
While mistreatment was confirmed in undergraduate medical education during ensuing years,[2] it was not until 1997 that the focus briefly turned to bullying among medical residents in the United States.[3]
Contact information for graduate medical education (GME) programs was obtained via the American Medical Association’s FREIDA Online1, a database with over 9,600 GME programs accredited by the Accreditation Council for Graduate Medical Education (ACGME)
Summary
Over three decades have passed since Henry Silver first shined a light on the potential of abuse in medical education.[1] While mistreatment was confirmed in undergraduate medical education during ensuing years,[2] it was not until 1997 that the focus briefly turned to bullying among medical residents in the United States.[3]. The following year, working again with Baldwin, Daugherty et al published a national cross sectional study of medical internship surveying a random 10% sample of all secondyear residents listed in the American Medical Association’s database.[4] A total of 1277 surveys were returned and over 90% of residents described experiencing at least 1 incident of perceived mistreatment, with 53% reporting being belittled or humiliated by more senior residents.[4]
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