Approximately 1 in 7 internal medicine physicians reported being bullied during their residency training, according to a new study.
The study, published Tuesday in JAMA, analyzed survey results from more than 21,000 internal medical trainees who took the 2016 Internal Medicine In-Training Examination and found 14% of respondents reported experiencing bullying during their residency.
Bullying was defined in the study as repeated harassment by someone in a position of greater power.
Study co-author Dr. Scott Wright, director of the general internal medicine division at Johns Hopkins Bayview Medical Center in Baltimore, said the size of the study group provides a more comprehensive account of the prevalence of bullying among medical residents. Still, he said bullying is most likely underreported.
"Before now, the prevalence of bullying in graduate medical education was not understood," Wright said. "Our study of more than 20,000 medical residents shows just how common it is … this needs to change."
Verbal harassment was the most common form of bullying, experienced by 80% of residents who reported being bullied.
Women and men reported bullying at similar rates, 14% of women and 13% of men, respectively. International medical students, particularly those whose first language isn't English, experienced higher rates of bullying.
A quarter of residents who attended a residency program outside the U.S. reported bullying compared with 13% of trainees who participated in training programs in the U.S. Trainees who attended medical school outside of the U.S. had a higher occurrence of reporting bullying at 17%, compared with 11% of those who attended U.S.-based medical schools.
The residents said bullying increased each postgraduate year, while trainees that scored in the bottom third in the Internal Medicine In-Training Examination were also more likely to report bullying.
"Much like the schoolyard, bullies may prey on groups who are perhaps less likely to retaliate or who are perceived to be vulnerable," Wright said.
Wright said the study did not examine the root causes of bullying, but he estimated some of the likely drivers relate to an imbalanced power dynamic in which younger trainees fear repercussion to their career if they report being harassed. Only 31% of residents who were bullied sought help.
"The traditional training of medicine has been to pimp trainees during rounds and to try to find things that they don't know," said Dr. Roberta Gebhard, president of the American Medical Women's Association and founder of the AMWA's Gender Equity Task Force, referring to the practice of medical training involving asking a rapid series of questions. "And traditionally, especially in some of the more competitive residencies like surgery, the goal is to weed out people, and so that's just a way to do so."
Dr. Darilyn Moyer, executive vice president and CEO of the American College of Physicians, said harassment is a concern because of its impact on the workforce. Bullying between physicians can add to an already highly stressful work environment and has been associated with depression, feeling burned out and poorer performance among residents.
"A big concern is that when people are harassed, when they start to feel depressed, get burned out and get compassion fatigue that leads to less engagement," Moyer said. "We know that the more burned out healthcare workers are, the lower the quality of the care environment is and that ultimately leads to worse patient outcomes."
Wright said he hoped the study's findings would help to spark conversation in teaching hospitals and medical schools about bullying to make it easier for trainees to report incidents and harder for perpetrators to get away with those actions.
"I hope that leaders will reprimand bullies so that they can't work with learners anymore — mentors and advisors will hopefully start asking their trainees about whether they are experiencing any bullying," Wright said. "So, the heightened awareness, these new conversations, and instituting expectation for trainees to report bullying should all improve the learning environment and culture of medical education."