Medical education

Bullying in residency: Nearly 14% of internal med trainees report harassment

Roughly 1 in 7 internal medicine residents say they’ve been bullied during their training, according to a new JAMA study.

Using data from a 2016 survey of over 21,000 internal medicine residents, a new JAMA study examines bullying in residency programs.

Nearly 14% of respondents said they’d been bullied by a colleague in a position of greater power at some point in their training.

“The bullying estimates in this study most likely represent an underestimate of mistreatment because less consequential hassling or microaggressions by superiors and harassment by those of equal or less power would not have been counted,” the study’s authors wrote.

Of those who reported being bullied, 31% sought help. Trainees also noted the types of harassment they experienced and how the bullying affected them.

Most common forms of bullying
Type of harassment Percentage of bullied residents affected
Verbal harassment 80%
Other 25%
Physical harassment 5.3%
Sexual harassment 3.6%

The two most common ways bullying affected residents include burnout and worsened performance, according to the study.

Consequences of bullying
Consequence Percentage of bullied residents affected
Feeling burned out 57%
Worsened performance 39%
Depression 27%
Change in weight 15%
Alcohol use 6%
Improved performance 6%

Residents whose native language isn’t English, international medical graduates and those with lower scores on a widely used internal medicine self-assessment exam were more likely to report experiencing bullying. Nearly equal numbers of male and female residents said they’d been bullied during training.

Related reading:

Time’s Up has hit health care. Meet two DOs helping lead the charge.

First year of residency: What to expect as an intern

9 comments

  1. Actually bullying in residency may be a good thing. It gives the resident a preview of the world outside of residency.
    Physicians are bullied by corporate employers, hospital medical staff (which are just extensions of the corporate hospital entity.).

    The may be bullied by physicians who are in competition. They will be bullied by insurance companies. And lest I not forget, various forms of government. Medicare, medicaid, specialty boards.

    Some of this bullying will come under the guise of ‘quality medicine’. Some will be much more transparent.

    It is hard enough to practice good, compassionate medicine. To maintain high ethical standards. There are numerous forces to push, especially the young physician, off course.

    Bullying in residency is a form of train for the real world.

    1. That doesn’t make it right. Or necessary. The suicide rate of physicians is more than 1 per day in this country, and that is only the ones we know about; some of those are residents. Maybe instead of “preparing” residents for lifelong bullying, we should be trying to fix the system from the bottom up. Or the top down. Or both. Just my $0.02.

    2. Yes, all of those entities bully us, but why add to it? If you’re bullying training physicians, less and less will make it out of training alive. Just look at the suicide rates for resident physicians over the years. We’re in this profession to save lives, right?

      Also, not for nothing, but there are more and more non-traditional medical students entering residency as the years go on. They’re not children. Before starting medical school, some of which were graduate students, in the workforce for a while, or even professionals in other fields. Some of them did this while raising children. My point is that they’ve been through the real world. Making their residencies more difficult by bullying will not teach them anything and will be nothing but harmful.

      I get that you’re playing devil’s advocate, but come on. There’s no need to eat the young. Why not use that same energy to support residents/students/colleagues? You’ll most likely have a more pleasant time teaching, and you’ll be playing a part in creating a great physician with a high self-esteem and mental fortitude.

      This does not mean show up to work every Monday with donuts, hand-written thank you cards for simply being present, or give post-op cuddles. Just be a decent person. That’s it. That’s all we want. We know this profession is taxing in every aspect.

    3. You are wrong trying to justifying bullying residents is trying to legitimize abuse. It’s wrong to bully at any level. As a practicing physician you have the right to fight back as a resident you can’t.

      Abuse does not make anything better and the only lesson it teaches is that is ok to do it others.

      STOP THE BULLYING

  2. I got horribly bullied when I was a med student by a staff physician and you know what? I deserved it. I was young, cocky and needed a butt kicking. The guy made me a better Dr and ultimately I thank him for it. (He eventually treated me like gold when I proved my worth to him ). It worries me that things have gotten far too cordial. Sometimes youngsters need that tough love and they aren’t getting it today.

  3. I worked in the business world prior to medical school including a company out of Berlin.
    I found a vast difference in “bullying” between business and medical training. In fact, it was stunning to me what physicians/trainers got away with compared to supervisors or managers who would have been fired on the spot. Don’t kid yourselves, there is no real broad-based benefit receiving sadistic treatment from anyone. Its a distraction from quality education.
    As for me, I can look myself in the mirror knowing those who I train are focused and all my employees enjoy and feel safe coming to work to do what we do best: patient care.

  4. That seems like a pretty low number.
    We probably ought to be ok with that
    given that some people are quite
    “sensitive” and overly prone to reporting
    grievances. That doesn’t mean that REAL
    hazing doesn’t happen, only that it is uncommon, perhaps rare.

  5. I received harassment in training and taught residents afterward. Once, in med school a female colleague and I gave a presentation on Rape to our mentor and discussed a rape kit. The mentor said “My rape kit is in the trunk of my car”. We collectively went to the dean with documentation. The guy was transferred out.
    Once, my friend and I were assisting in surgery when my friend’s glasses fell off into the abdominal cavity while retracting. The surgeon said to him: “Why didn’t you just sh8! into it?!”; Both harassment and only one requiring a report. Not all perceived harassment is that. Harassment is wrong and should be reported. Strong, hard, embarrassing lessons should teach. It’s not an all or nothing issue; know the difference and report illegal and unethical activity. But either way, be prepared for the consequences of your own responses and lead professional lives worthy of imitation.

    1. This is an excellent point and gives good examples of both sides of this.

      I understand concerns that being overly concerned for sensitivity may get in the way of harsh lessons that may need to be taught, but I think that’s the crux of the matter.

      Being blunt or curt can be appropriate in the right context, but it has to be in service to a lesson and have some kind of point behind it. Just bullying to “toughen someone up” or even worse doing it because it was done to you when you were in the junior position is teaching the wrong lessons – that personal power and prestige takes priority over ethical conduct. That’s the sort of thinking that sets us up for a bad outcome later on.

      I had my share of harsh criticisms during my training, many of them well-deserved. I also once had my upper-level resident refuse to assist me in crisis because I didn’t call him “sir”, a doctor also in training and only one year ahead of myself. All I learned that night was the content of his character.

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