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Turning the tide of bullying and harassment in medical education and training

In this series Medical Deans profiles the anti-bullying programs implemented by seven Australian and New Zealand medical schools in recent years and explores how well they are working.

Over the past half decade, medical schools have designed and implemented a variety of initiatives to address the bullying, discrimination, harassment and intimidation (BDHI) of their medical students, wherever it occurs.

Multiple surveys and reports during the last decade have shone a light on the problem, which tends to occur mainly during medical students’ clinical training in hospitals and other immersive learning environments. Bullying and intimidation also occurs on campus, and from student to student, but students report the incidence is relatively small compared to their experience in the medical workplace. Interns and junior doctors also report they are subject to bullying behaviours[1], confirming that the problem is endemic right along the medical training continuum.

Unsurprisingly, there are many barriers to achieving the cultural change required to put a stop to bullying – from the reluctance of students to report inappropriate behaviour for fear it will negatively impact their career, to the lack of control medical schools have over the behaviour of clinicians who are not their employees.

What schools are doing

This series looks at how some of the 23 medical programs in Australia and New Zealand are working to drive and support change. Together these stories showcase the diversity of the programs implemented, the dedication of medical school staff working in this area, and the vital role students are playing in the co-design of anti-bullying strategies.

A cornerstone of these programs is establishing accessible, trusted reporting pathways for students. Running in parallel are a suite of training programs – such as ethical bystander training, understanding the different motivations for bullying, and conflict avoidance – which empower students by providing them with choices about how to respond, depending on the individual situation.

Achieving cultural change is never easy. However, there is immense hope amongst students and the medical school staff who support them that, as new generations of doctors move through the medical workforce, the abusive behaviours which were sometimes normalised or tolerated in the past will no longer be accepted, and that students, interns and junior doctors are better equipped to deal with conflicts that inevitably arise during their career.

[1] Medical Training Survey, 2020, Medical Board of Australia and Ahpra.