Ethical bystanders moving into the medical workforce

Ethical bystanders moving into the medical workforce

The University of Queensland (UQ) is working to change the culture of bullying in medical workplaces – generation by generation. From 2021, all UQ’s medical students must do Ethical Bystander training, delivered by their Medical Student Support Team.

Many of the challenges of becoming a doctor can be addressed through academic work and placement; others, like bullying and harassment, require tailored support. The University of Queensland aims to provide that support through its Ethical Bystander Training, which is now mandatory for our medical students.

The training helps the students understand that rather than just being a bystander, they can be an ethical bystander – by doing something to help when they find themselves in a conflict situation. It grew out of the national Ethical Bystander program developed to help combat sexual harassment, which had been rolled out by UQ some years before. The training has since been customised specifically for medical students and is delivered by our Medical Student Support Team.

Ethical Bystander Training focuses on the 5Ds of intervention:

• Distract: a technique where you can intervene indirectly in a conflict situation by introducing some distracting activity.
• Delegate and Document: when it is not safe to intervene directly at the time, you can note what happened and later speak to a suitable university staff member about what happened.
• Delay: if something happened to your friend, and you didn’t do something at the time, you can check in with them later.
• Direct: when you intervene directly in an unacceptable situation.

A key focus is whether students can intervene safely. For example, if they see someone in a position of power being racist, they may not feel safe to directly intervene, so they can choose to delay and check in on the victim afterwards.

Positive feedback

Students use the sessions to share instances where they have used one of the 5Ds, and they express relief at being able to discuss these difficult situations. We have not yet been able to evaluate how effective the Ethical Bystander training is, but feedback from the training sessions indicates that the students have found it thought-provoking, practical and relevant.

“The students who made the complaint told me they had remembered the Ethical Bystander course in deciding to take action.”

In a case at one our clinical sites, three students became aware that a consultant was making subtle sexist comments to female students. They went to the team leader of the clinical unit to complain, and the consultant was removed from working with students and required to do training to avoid something like that happening again. The students who made the complaint told me they had remembered the Ethical Bystander course in deciding to take action.

Another student told me of his experience going out with a group of male medical student friends and noticing that one of them was being very rude to a quiet member of the group. The student successfully opted for distraction, calling out “my shout” to the group.

Building resilience

While Ethical Bystander training is useful, we need to increase students’ skill and resilience in dealing with any form of harassment directed at them. This is particularly important for students entering new placements, where they are likely to face harassment, bullying, racism and sexism, as well as other challenges such as homesickness.

We aim to upskill each new generation of doctors to create a supportive and encouraging workplace. There is still a lot to be done but many clinicians are changing for the better, and if we can change each generation of students, in the end the whole medical system will be the better for it.

This story is part of a series: Turning the tide of bullying and harassment in medical education and training