Women and non-British graduates are more likely to report being subjected to this.

According to the findings of a survey published online in the journal Heart, one in ten junior doctors training to be cardiologists in the UK has been bullied.

Women and individuals who earned their medical degrees outside of the United Kingdom are the most likely to have been subjected to this behavior, the responses say.

Bullying of junior doctors in the United Kingdom and internationally is rather prevalent, with surveys estimating a prevalence of approximately 40%.

It has been associated with poorer professional performance and mental health, as well as poorer patient outcomes. Bullying can also have repercussions for those who see it.

It’s unclear whether it’s more prevalent in certain specialities, therefore the researchers used responses from the British Junior Cardiologists Association’s yearly surveys of UK cardiology trainees from 2017 to 2020 to estimate its frequency in cardiology.

Since 2017, survey participants have been questioned about direct and indirect encounters of bullying and improper language/behavior in cardiology departments in the previous four weeks.

In total, 2057 responses were collected, with 1358 specialized trainees filling out the entire survey.

Men made almost about three out of every four respondents (73 percent ). The average age was 33 years old. The majority (76 percent) had graduated from a UK medical school and were employed full-time (96 percent ).

Over half (59 percent) were working in a cardiology specialist center (tertiary referral center), and the majority (94 percent) held a national training number, which secures a spot on a training program based on performance.

One in ten people (152;11 percent) indicated they had been bullied, according to the results. Across all four survey years, this prevalence was quite consistent.

A third (431; 32 percent) acknowledged they had witnessed bullying while on a cardiology rotation, with those who were further along in their training being more than twice as likely to encounter bullying.

Bullying was reported by 55 percent more women than men, and doctors who had completed their training outside of the UK were even more likely to report it.

Those who graduated from a European medical school were twice as likely as those who graduated from a UK medical school to indicate they had been bullied. Those who received their medical education outside of Europe were three times as likely to do so.

There were significant disparities in bullying rates between training regions (deaneries). East Midlands South (22 percent) and Northern (21 percent) had the greatest bullying rates (21 percent ). Mersey, Peninsula (Devon and Cornwall), and Yorkshire, North and East were the three regions with the lowest bullying rates (all 4 percent).

Women were also more likely than men to report encountering sexist language (14 percent vs. 4 percent), and graduates from medical schools outside the UK were more likely to encounter racist language: European medical school qualifications account for 6 percent of the total, while other locations account for 7 percent.

These findings contrast with a 1.5 percent graduation rate from a UK medical school.

In 2020, one-third of trainees (33 percent) reported they had experienced at least one improper conduct, including having their opinions and views ignored (12 percent), being made to feel worthless/useless (9 percent), and being shouted at or targeted with spontaneous anger (8 percent).

When asked who the bullies were, 82 percent and 70 percent of respondents in the 2019 and 2020 questionnaires, respectively, named senior doctors (consultants) in cardiology and other specialities as the culprits.

Other medical staff was mentioned by 61 percent of respondents, while non-medical staff was mentioned by two-thirds. It was unusual for a trainee to be bullied by another trainee.

Respondents mentioned the emotional impact of bullying in the free text: some stated it caused them to want to quit training or prompted them to change supervisors/placements.

Others discussed how bullying had become commonplace in the field. When the issue was brought up, the behavior was frequently reported as remaining uncontested or as if nothing changed.

The researchers emphasized that only members of the British Junior Cardiologists’ Association participated in the survey, and that not all of the same queries were answered each year.

Nevertheless, they acknowledged: “Higher rates of bullying in female trainees and those undertaking undergraduate medical training outside the UK are worrying.”

They point out that few women specialize in cardiology to begin with, and those who do are less likely to complete their training than those in other specialities. Moreover, despite the fact that cardiology has a higher proportion of ethnic minority trainees than other specialities, there is evidence that they are subjected to systematic bias during training and testing.

“Workplace bullying in medicine is undoubtedly a problem in specialties other than cardiology, and the degree to which the prevalence reported here represents a specific problem to be solved, or merely reflects general dissatisfaction may be considered to be an open question,” they added.

“However, the prevalence of bullying in our results is double that found by the [General Medical Council] training survey in 2018 (5.8%).”

And they concluded: “…bullying of trainees needs to be a priority both to ensure patient safety and to reduce trainee attrition in a time of unprecedented workforce pressures.”

Cardiologist Dr. Resham Baruah of the Chelsea and Westminster Healthcare NHS Trust in London and independent professional coach Emma Sedgwick said that the findings provide a “sobering insight into current practice” and show that “a bullying culture is endemic in many UK cardiology departments.”

“Bullying behaviours towards those further down the hierarchy could represent maladaptive responses to increasing pressure, burn out, loss of status and financial reward experienced by consultants,” adding that consultants, generation after generation, model similar behavior, which not only normalizes, but may also promote, these behaviors.

Source: 10.1136/heartjnl-2021-319882

Image Credit: Getty

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