Residency training is no childhood schoolyard, except in one respect—bullying. Nearly 14% of internal medicine residents said they had been bullied during their residency training program, according to the authors of a research letter published in JAMA. At the same time, only 31% of residency directors reported being aware of any bullying of their trainees.

“We hope our study will further raise awareness among educational leaders of just how ubiquitous bullying is, and that it will encourage them to do more to prevent it,” said study co-author Scott Wright, MD, professor, Department of Medicine, and director, General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD.

In a survey that included responses from more than 21,000 residents, researchers defined bullying as “harassment that occurs repeatedly (> once) by an individual in a position of greater power.” The survey was included in a standard self-assessment exam given to internal medicine residents in 2016.

Of the residents who reported being bullied, verbal harassment (80%) was the most common form. This was followed by “other” types of harassment (25%), physical harassment (5.3%), and sexual harassment (3.6%).

More than 41% of residents who reported being bullied spoke a native language other than English. On the other hand, residents who trained at international programs had 61% higher odds of being bullied than those in US residency programs.

Also, more women (14.4%) than men (12.9%) reported bullying, as well as more third-year (17%) than second-year (15%) or first-year residents (10%).

Negative consequences

“Bullying during medical education can have negative consequences that range from the well-being of the trainees to compromised patient care,” Dr. Wright and co-authors wrote.

Consequences of bullying that residents reported most were:

It doesn’t have to happenOf those who said they were bullied, 31% reported seeking help to handle it. At least 62 residents said they left the program because of it.

Worse yet, the problem may be even worse than these results show. “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 authors noted.

Although all residents experience stress, these findings highlight that bullying contributes significantly to burnout and other problems among residents—but it’s a factor that can be entirely prevented, Dr. Wright emphasized.

“Taking steps to eliminate bullying is essential to ensure supportive learning environments that will promote the professional development of all medical trainees,” he and his co-authors concluded.

This story is contributed by John Murphy and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.