Residents report that the impacts of being bullied include feeling depressed and burned out.
Bullying of medical residents is a significant concern, new research shows.
Widespread burnout among clinicians and other medical staff has raised alarm about the mental health of healthcare professionals. Recent research indicates that nearly half of physicians are experiencing burnout symptoms, and a study published last October found that burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction.
New research published by the Journal of the American Medical Association includes a dire warning from the article's authors: "Bullying during medical education can have negative consequences that range from the well-being of the trainees to compromised patient care."
The JAMA research is based on data collected from the Internal Medicine In-Training Examination, a self-assessment exam administered annually to internal medicine residents by the American College of Physicians. In 2016, the examination included a brief survey on bullying during residency training, and the JAMA researchers analyzed data from more than 21,000 trainees who participated in the survey.
In the survey, bullying was defined as harassment on more than one occasion by someone in a position of greater power.
The JAMA research features several key data points:
- 13.6% of the survey respondents reported being subjected to bullying since the beginning of their residency training
- Verbal harassment was the most common form of bullying reported (80%), followed by the "other" category (25%), physical harassment (5.3%), and sexual harassment (3.6%)
- The most common impacts of bullying were feeling burned out (57%), diminished professional performance (39%), and depression (27%)
- Four resident characteristics were associated with those trainees who reported being bullied: having a native language other than English, high postgraduate year level, being an international medical graduate, and posting a relatively low rating for the Internal Medicine In-Training Examination
A broader definition of bullying would have resulted in higher levels of reported bullying, the researchers wrote. "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."
Interpreting the findings
Discrimination is a likely factor in the bullying of medical residents, the lead author of the research told HealthLeaders.
"Our research supports previous studies that note that international medical graduates are more likely to be bullied than those graduating from U.S. medical schools. A perhaps related observation is the independent association between reported native language and perceived bullying, which may in part be due to bias and stereotyping," said Manasa Ayyala, MD, an assistant professor of medicine in the Department of Medicine at Rutgers New Jersey Medical School in Newark.
It is unclear whether bullying during residency sets the stage for burnout and depression later in physicians' careers, she said. "Additional research is needed regarding longer-term sequelae experienced by residents who perceived bullying and reported burnout and depression as consequences. However, it is definitely concerning that such significant consequences starting in residency could affect one's future career."
Although further research is necessary, medical educators should step up efforts to curb bullying of medical residents, Ayyala said.
"To start addressing bullying, educational leaders and training program directors need to be aware that bullying is a significant problem in medical education and work toward creating effective reporting structures where trainees feel empowered to report bullying. Further research is also needed to effectively inform strategies and programs that will aim to reduce bullying of medical trainees."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Verbal harassment was the most common form of bullying reported, at 80%.
In the research, bullying was defined narrowly, so the full extent of bullying is likely higher.
Resident characteristics associated with being bullied included having a native language other than English and being an international medical graduate.