Undermining and bullying in surgical training: A review and recommendations by the Association of Surgeons in Training

Abstract

The 2012 General Medical Council National Trainees' Survey found that 13% of UK trainees had experienced undermining or bullying in the workplace. The Association of Surgeons in Training subsequently released a position statement raising concerns stemming from these findings, including potential compromise to patient safety. This article considers the impact of such behaviour on the NHS, and makes recommendations for creating a positive learning environment within the NHS at national, organisational, and local levels. The paper also discusses the nature of issues within the UK, and pathways through which trainees can seek help.

Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review

“…Some have suggested that increased pressure and intimidation serves to sharpen a resident’s skills or determination to be a physician, and as such, is a rite of passage. However, survey-based research has shown that only 2 % of medical doctors who experienced abuse agreed that it “increased eagerness and indomitable determination to learn medicine [ 16 ].” In actuality, residents most often experience anger, diminished eagerness to work, depression, increased feelings of difficulty at work, health problems, and thoughts of dropping out in response to intimidation [ 16 , 46 ].…”

“…Another study showed that almost half of surgical team members who had witnessed disruptive behavior by attending surgeons were aware of adverse events resulting from this behavior [ 50 ]. The article, “Creating a Culture of Mutual Respect,” states that “rude, abusive, or intimidating behavior can hamper the ability to provide effective and safe patient care [ 34 ].” Organizations that encourage their members to suppress effective communication and teamwork by promoting fear or ridicule hold increased risks to patient safety and litigation [ 38 , 46 , 51 ]. Direct patient mistreatment may occur by providers who experience mistreatment during their training, as described in Legacy of Abuse .…”

“…Finally, bullying decreases quality of care by affecting individual job performance and an organization’s financial bottom-line [ 28 , 46 ]. Costs can occur from replacement training of those individuals who left the organization, from medical errors, and from litigation for lapses in patient safety.…”

Students to Surgeons

“…32 By British estimates, 60% of all trainees have personally been bullied and 94% of all trainees have observed it in the workplace, yet only a third of trainees have been willing to report the offenders. 33 Sadly, residents seem to encounter bullying not only from senior surgeons but also from colleagues in other health care professions. 34 This hidden curriculum is often internalized such that the bullied trainee propagates the cycle of abuse when he or she becomes a surgeon.…”

Bullying in surgical training – where are we and where are we going?

“…11 ASiT has published recommendations to create a positive and supportive training environment at organisational and departmental levels, advising how to raise concerns and manage identified cases appropriately. 12 The action points include raising the profile of bullying and undermining within trust and deanery training schemes, such that trainees are removed from unsuitable environments with these behaviours. It also encourages the implementation of systems that facilitate the reporting of concerns, with professional consequences for both the perpetrator and the organisation.…”