Mistreatment of Trainees: Verbal Abuse and Other Bullying Behaviors

Abstract

Medical school and residency training programs are intended to provide positive educational and mentorship experiences and to inculcate a culture of professionalism and collegiality. Academic psychiatrists often contribute greatly to these positive efforts, given the emphasis in their work on psychotherapeutic and interpersonal skills and their attentiveness to conflict prevention and resolution. It is very reasonable to expect, therefore, that occasions of verbal abuse or bullying of trainees would be very low in prevalence in psychiatric settings. Is this a realistic expectation or merely a statement of what we would like to believe about our profession? In their cross-sectional survey study of 71% of all trainees in psychiatry registered with the College of Physicians and Surgeons in Pakistan, Ahmer and colleagues (1) demonstrated that disrespectful interactions may be the rule rather than the exception in psychiatric residents’ educational experience. Fully 80% of the psychiatry trainees in this study (60 respondents, response rate 71%) had been the victim of at least one bullying behavior in the preceding 12 months. The most commonly encountered behaviors were persistent attempts to belittle and undermine the work of the trainee or to humiliate the trainee in front of colleagues. The greatest source of mistreatment was from consultants (74%), as well as peers (36%), managers (22%), and nurses (13%). Interestingly, patients (16%) also were identified as engaging in verbal abuse and bullying behaviors toward psychiatric trainees. To what degree are the findings of Ahmer et al. (1) likely similar or dissimilar to other educational settings in psychiatry and beyond? One of our goals for this editorial is to try to answer this question. We also intend to place this information on the verbal abuses or bullying of psychiatry trainees into context with relevant findings from medical students, residents in other specialties, and nurses. Finally, we will make recommendations for future research in this area. As Ahmer et al. (1) noted, the possible consequences of any attempts to belittle or undermine and humiliate residents are serious and warrant attention. Verbal aggression, abuse, or bullying incorporates a wide range of behaviors including threats, intimidation, humiliation, excessive criticism, covert innuendo, exclusion or denial of access to opportunity, undue additions to work requirements, and shifting of responsibilities without appropriate notice (2, 3). Such occasions, especially when repeated, could take the form of psychological harassment, creating distress and dissatisfaction in the training environment. Indeed, mistreatment in professional settings unfortunately comes in many forms. These are widely varying behaviors that are not easily defined or validated as abuse or bullying; therefore, in capturing relevant information on mistreatment in psychiatry training, a key challenge was to find all the relevant articles pertaining to the verbal abuse or bullying of psychiatry residents. We used a combination of search teams including “abuse,” “bullying,” “harassment,” “intimidation,” “discrimination,” “horizontal violence,” “aggression,” and “interpersonal conflict” and “psychiatry residents.” We searched databases including PubMed, Embase, and PsycINFO. The reference lists of relevant articles were also searched for additional references. Furthermore, because articles published in Academic Psychiatry prior to 2001 were not readily located through PubMed, we searched the indexes of Academic Psychiatry for additional information. We Received April 7, 2009; accepted April 8, 2009. Dr. Coverdale is affiliated with the Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston; Dr. Balon is affiliated with Wayne State University, Detroit; Dr. Roberts is affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Address correspondence to John H. Coverdale, M.D., Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, One Baylor Plaza BCM 350, Houston, TX 77030; jhc@bcm.tmc.edu (e-mail). Copyright © 2009 Academic Psychiatry