No place for bullying in modern medical training
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.
- 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.
- 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.
- 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