Bullying and Harassment

In 2015, when New Zealand’s medical student union brought the issue of bullying and intimidation to the attention of the University of Otago’s medical school, the school became one of the earliest adopters of a formal program to combat bullying and abusive behaviours.  

 The impetus for our launching a formal system to deal with intimidation and bullying came from a 2015 survey conducted by the New Zealand Medical Students’ Association (NZMSA). Nearly 800 medical students responded to the survey, with 54 per cent saying they had experienced what they perceived as bullying when on clinical placements, and 76 per cent saying they had witnessed another student being bullied. 

The then-president of NZMSA, Elizabeth Berryman, wrote in an editorial in the NZ Medical Journal: “A new approach is needed to the teacher-student relationship. We call on all teachers and students to value and respect the relationship as much as we do the patient-doctor relationship… We cannot change the culture overnight, but this renewed approach … can develop into a relationship of trust, communication, improved learning and positive outcomes.” 

“We cannot change the culture overnight, but this renewed approach can develop into a relationship of trust.”

The survey clearly showed that something had to be done about the problem, and we responded immediately. We already had informal processes in place, but they were not sufficiently transparent and didn’t always take into account the power differential between, say, a student and a clinician. A workshop was organised that same year, which led to the development of formal pathways for dealing with intimidating and bullying behaviour. A very important aspect of this policy was that it was co-designed with the students, and I suggest that this approach be adopted by any university working to improve the situation. 

Our fundamental starting point was that intimidating or abusive behaviour towards students has no place in modern medical education.  

Our pathways

1. Reports of serious or egregious intimidating/bullying behaviour are passed immediately to the Dean, who takes appropriate action in consultation with human resources. When necessary, the Dean will also involve the head of department, the proctor and the district health board. Formal disciplinary action may then be taken.  
2.  All other reports of intimidating behaviour – confidential but not anonymous – are  considered by our Behavioural Assessment Team, which has an independent chair and decides when further action is necessary. If the team determines that an appropriate threshold has been reached, and the student reporting is in agreement, the information is passed to the Dean, who, together with the appropriate head of department or health board/health provider management, will address the issue with the staff member concerned.  
3.  Anonymous reports are collected, collated and monitored, so that patterns of behaviour of both individuals and health services can be identified and acted on as required.  

Working towards attitudinal change 

At the beginning of each of the clinical years, I give a session in which I cover all sorts of aspects of being a medical student, including the possibility of being bullied. I encourage students to come to me if they have a problem. We also work continuously with students through the staff/student representative committees.  

One of the trickiest parts of this issue is dealing with bullying in the clinical setting, because we are dealing with non-university employees. A factor here is that many clinicians feel they did it tough as medical students, so why shouldn’t the current generation do it tough as well? They say the current generation is too sensitive; if they want to get into the hard world of medicine, they must develop resilience. This attitude helps to perpetuate bullying. 

“Many clinicians feel they did it tough as medical students, so why shouldn’t the current generation do it tough as well?”

We have had several cases where students have complained about how clinicians have treated them, and the clinicians have said they’re not prepared to change their ways and are no longer prepared to work with students. 

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

The Universities of Newcastle and New England launched their Respectful Learning Environments program in 2017. The journey continues in 2021, with the addition of a program of small group tutorials for final-year students about to transition to practice.

We began work back in 2017 on developing a strategy across the Joint Medical Program of the Universities of Newcastle and New England to address the problem of medical students experiencing bullying, discrimination, harassment and incivility (BDHI).

Our survey of Year 4 and 5 students in early 2018 showed that as many as 31 per cent of Year 4 students and 45 per cent of Year 5 students reported having experienced some aspects of BDHI during their training. Also, 41 per cent of Year 4 and 61 per cent of Year 5 respondents said they had observed another student experiencing these behaviours.

The students identified the sources of unacceptable behaviour as being overwhelmingly from the clinical environments in which they were training: consultants (40 per cent), registrars (25 per cent), nurses/midwives (20 per cent), junior doctors (six per cent), administrative staff (five per cent).

While bullying complaints had always been taken seriously within our schools, our response tended to be reactive. We realised that we needed to raise the profile of the problem and make dealing with bullying a priority.

Building trust between students and the school

Our Respectful Learning Environments program was the outcome. It aims to build trust between students and the school, and to persuade students that they don’t have to tolerate unacceptable behaviours – there are a number of options they can take to address the problem.

There were two key issues we had to deal with to get involvement with the program. Firstly, students sometimes don’t come forward with a bullying or harassment complaint because they don’t trust their medical schools to manage this information well and worry that a complaint will in some way negatively impact their progression or career.

“We want our students to feel there is always someone they can talk to about BDHI and to feel confident that if they do come forward, the medical school won’t be overly prescriptive or push them into situations that would make things worse.”

We want our students to feel there is always someone they can talk to about BDHI and to feel confident that if they do come forward, the medical school won’t be overly prescriptive or push them into situations that would make things worse. So we’ve tried to promote a very tailored approach that takes into account the individual circumstances. For example, in some situations it may be appropriate for the student to address the problem directly themselves, while clearly in other situations that would not be advisable.

The other issue was students not reporting BDHI behaviour because they were concerned they might be overreacting or were unsure they could do anything about the problem. Our Respectful Learning Environment program encourages students to talk through their concerns with someone they trust within the medical program – it can be course co-ordinators, clinical deans, year managers, head of student wellbeing or any other university staff member or mentor. A trusted support person can answer students’ questions about whether the behaviour they are experiencing is BDHI and advise on whether to take action.

Once the student has decided they want to take action, our program offers of number of pathways for them to do so, both within the medical school and at university level.

Preparing students for practice

In 2021 we added a new program of small group tutorials for final-year students, to help them to become better communicators and to understand how to avoid, or optimally manage, workplace conflict when it arises.

The students are shown realistic workplace scenario videos and then:

1. Identify incivility and conflict in the scenarios
2. Consider their reactions to incivility and the potential value of self-reflection in responding
3. Identify a range of alternate approaches, avoiding incivility
4. List potential reasons behind incivility
5. Describe situations in which action should be taken regarding incivility and what this action should be.

The tutorials are also an opportunity to discuss the students’ own experiences, consider why incidents of incivility and conflict may occur, and discuss how each situation can best be addressed and managed.

Anecdotal evidence of early successes

So far we have not been able to measure the take-up by students of our Respectful Learning Environments program but have had some strong anecdotal feedback indicating that students have come forward and had their issues resolved – particularly in the context of COVID-19, where Year 5 students have had much longer clinical placements in a single team, rather than moving regularly from one team to another.

In one case, two students were upset by offensive, sexist remarks made by a clinician. A university staff member met with them to learn about the situation and find out how much information could be made available to the hospital. A complaint was then made to the hospital governance, which resulted in the clinician being allowed no further contact with students and being counselled by the health service on the inappropriateness of his behaviour. The students were offered support by the university to deal with the stress the clinician’s behaviour had caused.

Our approach in this kind of situation is to offer a senior staff member to progress a complaint on behalf of the more junior person, as well as to ensure that senior support and engagement is available for the students.

We recently did a wellbeing survey of all our medical students and while there were positive signs, we found there were still some comments that BDHI wasn’t taken seriously enough in the medical school and that some students still did not know who to talk to about it. So clearly we still have work to do in raising awareness of the program. But that survey also collected lots of positive feedback about the support received from the local clinical deans at placement sites, so that is a positive.

Lessons learned

The intention behind our anti-bullying initiatives was to develop a straightforward process that all students could understand. However, the wide range of behaviours that need to be considered, from uncivil to criminal, has made that difficult.

“Clinical environments are high-pressured and there are massive workloads for staff. This can lead to people developing bad ways of working with their colleagues.”

We have learnt that once a system is developed and made available, ongoing promotion to students is required, together with reassurance that the medical program is interested in helping the students in this way. Reinforcement of the message needs to take priority over concerns about repetitive messaging.

Another consideration at the heart of our program is developing partnerships with the hospitals. Clinical environments are high-pressured and there are massive workloads for staff. This can lead to people developing bad ways of working with their colleagues.

We are continuing to work to refine our strategy to make it as effective as possible in dealing with the difficult problem of BDHI faced by our students.

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

Sydney University has taken a creative approach to the issue of bullying and harassment. It uses theatre, as well as workshops featuring role-play by actors, to focus clinicians and students on the need for workplace culture reform.

In 2015, several young Australian doctors committed suicide. This clearly sounded the alarm about systemic problems in the way interns and junior doctors were being treated. At the University of Sydney, we already knew something was seriously wrong with the medical workplace culture; we knew we needed to highlight the problem and start a conversation about how to address it.

Also in 2015, one of our team, Karen Scott, was lead author of a paper published in the Australian Medical Journal: “Teaching by humiliation and mistreatment of medical students in clinical rotations: a pilot study”. The paper reported the results of a survey of final-stage students from two Australian medical schools about their experiences of teaching by humiliation during their clinical rotations in Semester Two of 2013.

As many as 74 per cent of the students who completed the survey reported experiencing teaching by humiliation during rounds when on adult clinical placements, and 83 per cent said they had witnessed it. The humiliating and intimidating behaviours students experienced were generally more subtle than overt, and included aggressive and abusive questioning techniques. The students’ responses to these practices included disgust and regret about entering the medical profession.

“The humiliating and intimidating behaviours students experienced were generally more subtle than overt, and included aggressive and abusive questioning techniques.”

The study called for these behaviours to be eradicated, given the evidence of negative effect on students’ learning and mental health, and the dissonance with formal professionalism curricula. “Interventions are needed to interrupt the transgenerational legacy and culture in which teaching by humiliation is perpetuated,” it concluded.

Creative interventions

We knew that changing this entrenched culture would require novel, creative approaches, focused particularly on the clinical environment.

In 2017, with an education innovation grant from the University of Sydney, a grant from the University of NSW Big Anxiety Festival and support from the Seymour Centre, a group called the Sydney Arts and Health Collective was formed.^[1]  Together we produced a verbatim theatre production called Grace Under Pressure, written by Dr Paul Dwyer from Performance Studies and Dr David Williams from The Seymour Centre.

Verbatim theatre is a form of documentary theatre that explores themes through the words of the people at the heart of the subject. In this case the production was developed through interviews with a range of health professionals and healthcare students, to highlight the complexity of healthcare workplaces, encourage critical reflection and support long-term culture change.

Grace Under Pressure was performed to health professionals, healthcare students and the general public over seven sessions at The Seymour Centre in Sydney in 2017. In addition, we developed short, professional quality videos of key segments of the play, and teaching materials to accompany them, for subsequent workshops and presentations.

“A survey conducted after the play in a Sydney LHD indicated that the audience overwhelmingly saw the play as important because it acknowledged that bad experiences occurred in healthcare workplaces and made talking about workplace culture issues easier.”

We also presented a book-in-hand performance of the play in Lismore, for health professionals, healthcare students and the general public, and ran two workshops for students at the University Centre for Rural Health in Lismore.

In 2019, a one-hour, pared down version of the play was performed at a number of local health districts (LHDs) in urban, rural and regional NSW – funded by NSW Health and coordinated by the Pam MacLean Centre, which ran workshops with staff afterwards. Focus groups with medical students were conducted across two of these sites.

A survey conducted after the play in a Sydney LHD indicated that the audience overwhelmingly saw the play as important because it acknowledged that bad experiences occurred in healthcare workplaces and made talking about workplace culture issues easier.

A planned tour of Grace Under Pressure across regional Australia in 2020 was cancelled after the first few performances, due to COVID-19, but the tour resumed in 2021.

Triaging bad behaviour 

In another intervention developed by Sydney University in 2017 (by Prof Stewart Dunn and Dr Renee Lim), a series of actor-based workshops were conducted for clinical and administrative staff at Sydney LHDs.

In one workshop scenario in an Emergency Department, involving a possible fracture and potential compartment syndrome, Professor Black (actor) was called for an opinion and was belligerent and bullying. Experienced clinicians provided feedback on the possible reasons for this behaviour and in response, the workshop was revised so that the actor adopted three different motivations for the behaviour: personal stress, bullying as an educational tool, and being a pathological bully. This allowed workshop participants to triage the reasons behind Professor Black’s behaviour and to develop appropriate responses.

“63 per cent of students said it had helped them to categorise bullying behaviour, and 41 per cent reported that triaging protected their mental health.”

These actor-based workshops were repeated for students at our medical school in 2017. In 2018, approximately one year into their internship, a total of 42 of these students responded to survey follow-up. 95 per cent of them recalled the workshop, 63 per cent said it had helped them to categorise bullying behaviour, and 41 per cent reported that triaging protected their mental health.

These results showed that gaining an insight into the causes of bullying can reduce its detrimental effects on health and well-being for many students. However, a significant number (21 per cent) did not feel more confident as a result of the workshop.

More to be done 

While this work has helped to get recognition of the extent of the problem, we still need to get the health system to fully accept and act on this issue. There have been encouraging signs, such as posters appearing on hospital walls advising people where they can go for help if they are being subjected to harassment. In addition, the NSW Ministry of Health has made junior doctors’ wellbeing a priority.

Some doctors who are empathetic with their patients can treat students and junior doctors very badly. This disconnect can result from overwork, long hours, or the odd justification that “it happened to me”.

The problem will only end when the healthcare workplace culture is fully transformed. That involves developing rich and creative ways of approaching the problem.

__________________________________________________________________________________________________

^[1] Comprising the three authors of this story, Dr Kimberley Ivory from Public Health, Dr Jo River from Nursing, A/Prof McNeill from Sydney Health Ethics, Dr David Williams from The Seymour Centre and Dr Paul Dwyer from Performance Studies

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

Griffith University’s medical school is focused on empowering students to create change, from the bottom up, in the clinical training environment.

In 2019, final-year medical student Dr Danielle Walker and I ran a survey of our medical students which pointed to an ongoing epidemic of bullying and harassment in the medical workplace culture. The students who responded generally believed that reporting incidents would have negative ramifications for them, both personally and professionally. They believed that the repercussions could come from future employers, colleagues, their clinic site or the School of Medicine, and affect their physical and mental health.

Danielle, a mature-age student, had herself experienced bullying during clinical placements. Being older, she could stand up to the bullies and had the courage to tell them their behaviour was inappropriate. But she saw the fear of the other students, and that many of them would rather struggle through than speak out or report their experiences of BHD&SH. It was clear a bottom-up change was needed, through the empowering of students.

Taking action

Griffith has a zero tolerance approach to bullying and we have appointed three trained Harassment and Discrimination Contact Officers (HDCOs), including myself, for our medical campuses on the Gold Coast and the Sunshine Coast.

HDCOs are available to people (staff or students) who feel they have been the subject of BHD&SH. Our role is to be a confidential point of contact, to listen to concerns, explain university policies and procedures, and provide information on the resolution options that are available to staff and students.

To get the message out to students, we deliver lectures on BHD&SH each year – to first- and second-year medical students – with regularly updated information. We place flyers around the clinical zones to remind students of the availability of the contact officer, and we continue to survey students about how best we might be able to assist them.

To give an example of how we work, when a complaint was made by a couple of students in one of the clinical zones about the bullying and discrimination they experienced, it was first discussed with the contact officer and then brought to the attention of both the school and the clinical sub-dean. The initial management response was the delivery of a grand rounds presentation on the impact of BHD&SH on medical students and staff, with the alleged perpetrator present to hear this information. After that, the individual was removed from teaching medical students at that zone.

“The individual was removed from teaching medical students at that zone.”

Often students seek help for all levels of distress and, after discussing what has taken place, about 50 per cent of the time we find that bullying has occurred. In many of these situations, the students want to know how to manage the matter themselves. I often find that leaving a record with me of what has happened is enough for the student. In effect they are being heard and are documenting the events in case they happen again.

Unfortunately, while students can bring their issues to us and we have full awareness of them, unless they give us permission to go ahead and do something about it, nothing further takes place. There is undoubtedly still a fear factor that reporting an event could adversely affect them in future. The catch cry I hear all the time is: “these are the people who are going to employ me”.

Connecting into the hospital system

We have had a number of meetings with the clinical teaching staff within the hospital and they are aware of the problem and want to stop it as much as we do, however we do not have any direct power over the medical professionals employed by Queensland Health and NSW Health.

“We have had a number of meetings with the clinical teaching staff within the hospital and they are aware of the problem and want to stop it as much as we do.”

It is a very frustrating situation and one of the things we were going to look at doing was to take the survey results around to the hospitals to inform them that we are aware of what is happening with our students. Like a lot of things, this has been held up by the pandemic.

Another possible strategy is perhaps creating a ‘champion’ within the hospital system.

The long-term solution is to find a way that students feel they can report and be protected – not just as students but also as future doctors. Much more needs to be done to address this situation, however I think it is not going to come about as a top-down change, but more of a bottom-up change. Assisting students to know that their concerns will be listened to and addressed gives a growing confidence to the student.

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

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

UNSW is taking a new, faculty-wide approach to the bullying and harassment of Medical students. The project also links into existing best practice, university-wide programs and the national wellbeing framework released last year, Every Doctor Every Setting.

In May 2021, about one year after appointing Catherine Marley as their first Faculty Wellbeing Officer, the senior leadership team of UNSW Medicine and Health endorsed her plan for a Medicine & Health Taskforce to deal with the issue of bullying and harassment of students.

The taskforce currently includes the Senior Vice Dean Education^[1] and three Associate Deans, and will soon recruit medical student representatives. The following step will be to engage champions from each clinical school, campus, centre and institute, as well as a coursework program for each school, to work closely with the taskforce. These key stakeholders will be integral to ensuring that tangible steps are taken.

“The project draws on the “Every Doctor, Every Setting” Framework to ensure that all initiatives are relevant for all students in undergraduate, postgraduate and research programs within the faculty.”

The Medicine & Health Taskforce is one strand of a comprehensive new anti-bullying and harassment project developed by Catherine and endorsed by faculty senior leadership. The project draws on the Every Doctor, Every Setting Framework^[2] to ensure that all initiatives are relevant for all students in undergraduate, postgraduate and research programs within the faculty.

 Primary interventions

Like Every Doctor, UNSW Medicine and Health’s anti-bullying project consists of primary, secondary and tertiary interventions and prevention strategies. The primary strategy focuses on raising awareness and providing education, in safe and inclusive training environments, that make clear the faculty’s zero tolerance approach to bullying, harassment, sexual harassment and discrimination.

The training explores how to manage and report incidents so as to break cultural expectations that bullying is commonplace and acceptable – particularly within learning environments such as university campuses and clinical training.

Catherine also delivers annual lectures to senior medical students and invites students to open up a dialogue about these serious issues. From 2022, these lectures will be extended to Years 1 to 3 of the Medicine program.

“The project calls for specific training for faculty staff, informed and guided by data obtained through student and PhD candidate surveys.”

Another part of this strand is the proposed development of online and face-to-face training for faculty staff on bullying and harassment. Although this already exists in a broad sense within UNSW (as part of Responsible Employee Training), the project calls for specific training for faculty staff, informed and guided by data obtained through student and PhD candidate surveys. UNSW medical students will be formally surveyed for the first time in relation to experiences of bullying, harassment, and discrimination in August 2021.

Secondary

The proposed secondary intervention and prevention initiatives focus on the management of incidents of bullying and harassment that may not need to be managed through a formal process. This includes the promotion of active bystander training for both staff and students, and the development of stronger relationships and anti-bullying campaigns with clinical schools and affiliated organisations.

In addition, we will link into broader university initiatives such as the UNSW ‘Be a Better Human’ campaign, which aims to help strengthen a more respectful and inclusive culture where issues such as bullying and harassment are openly discussed.

Tertiary

Tertiary intervention specifically relates to support after an event occurs. Again, this sits within broader university pathways such as the UNSW Sexual Misconduct Portal, UNSW’s Student Integrity Unit, the Human Resources Team and NSW Health policies and procedures.

It is our hope that this multi-pronged approach to addressing bullying and harassment within the faculty and broader learning environments will significantly reduce, and ideally eradicate, these issues.

^[1] Professor Gary Velan

^[2] Launched nationally in October 2020, this framework aims to guide coordinated action on the mental health of doctors and medical students and was developed under the guidance of a national working group and in consultation with doctors and medical students.

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

The University of Western Australia’s medical school turned to the Medical Student Society to help them address the high levels of bullying and harassment reported by students on clinical placements

We ran a survey of student experiences in clinical placements in 2018, which showed that approximately 40 per cent of students had experienced bullying while on placement, and 10 per cent had experienced sexual harassment. Half of these students had not spoken to a student or staff member about the incident, and only 33 per cent said they knew what action to take if they were to experience bullying or harassment on placement.

We know that our medical school has always had good relations with its students and we have well-established channels to support them. So what we needed to do was to articulate those pathways as clearly as possible, and ensure that support was easily accessible for students on placement.

We met with our Medical Student Society to collaborate to produce a resource for students. A third-year student representative then began work developing the resource as a Scholarly Activity Service Learning project. The result was our publication “Bullying, discrimination and sexual harassment on clinical placements: a resource for UWA medical students”.

Here are some of the most useful features of our approach.

• Acknowledging and responding to reasons why students don’t report

The stress and work of making a complaint. The resource demystifies the process, so stress from uncertainty is reduced, and the responsibility and workload is transferred from the student to the medical school.

Concerns about confidentiality. The resource assures students that their identity will never be shared with anyone without their knowledge.

Not realising it was bullying at the time. The resource supports students who want to discuss their experiences with fellow students or academic staff, to help them to process their experiences better and help others identify bullying.

• Providing clear definitions of inappropriate behaviour

The resource defines bullying as a pattern of repeated unreasonable behaviour that is intimidating, humiliating, undermining or threatening. It may be subtle or overt. Examples include repeated hurtful remarks, and abuse such as making fun of a person’s work.

It also makes clear that bullying is not one-off abrupt comments, differences of opinion or fair, constructive criticism.

Discrimination is defined as treating a person with an identified attribute or personal characteristic less favourably than another person. Such characteristics include gender, age, race, religious belief, sexual orientation and cultural background. Examples include denying students learning opportunities due to their family or parental responsibilities.

Sexual harassment is defined as unwelcome sexual advances, requests for sexual favours or other unwelcome conduct of a sexual nature. It includes unnecessary touching and sexual blackmail involving threats, benefits or promises.

• Suggestions for what to do when you’re being grilled

Socratic instruction – a series of questions posed by the teacher for the students to answer – is commonly used in medicine. Unfortunately, many have experienced situations where a series of difficult and often intentionally unanswerable are asked. There is little evidence of the efficacy of this teaching method and growing evidence of potential harm, yet it remains commonplace in hospitals.

The resource states: “Every medical student will have had an experience where they will be asked a question that they don’t know the answer to. What happens when the questions keep coming? Is it teaching or is it bullying?”

The resource outlines ways of dealing with this situation in an assertive, positive way.

Is the resource proving valuable?

Culture change takes time and we have no overall evaluation yet; however, anecdotal evidence is encouraging.

“The outcome was that the student felt heard, their distress abated, and they were able to continue and perform well in that rotation.”

For instance, there was the case of a student in an operating theatre who was subjected to demeaning and bullying conduct from a consultant, to the extent that the student had to leave the theatre. The resource gave us a structure with which to deal with the complaint systematically and rapidly. The complaint was escalated to a clinical lead in the hospital, who addressed the matter with the consultant. Meanwhile the student was placed at a different clinical site for the remainder of their rotation and the academic support staff network provided support after the event.

The outcome was that the student felt heard, their distress abated, and they were able to continue and perform well in that rotation.

We are very proud of our resource and see it as an example of the success of projects that are co-designed with students. While it doesn’t change the behaviour of all who work in the clinical environment, we hope that it will raise awareness of the issue, empower students to respond to the issue and, over time, generate the change we wish to see, so that all our students are treated with respect and continue to treat others with respect once they are clinicians.

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