Persuading students that the school can help
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:
- Identify incivility and conflict in the scenarios
- Consider their reactions to incivility and the potential value of self-reflection in responding
- Identify a range of alternate approaches, avoiding incivility
- List potential reasons behind incivility
- 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.
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