Alessandri-Angela-AProf Nov15The cone of silence on bullying has been cracked open.

Recent media reports have highlighted the prevalence of discrimination, bullying and harassment in clinical medicine that have led to the establishment of the Expert Advisory Group to inform and advise the Royal Australasian College of Surgeons on the matter.Bullying--Fatigue-workplace74% of students experienced,
and 83.6% witnessed,
‘teaching by humiliation’

Its final report states that nearly 50% of College fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment.

The importance of this issue to medical students was highlighted by the current AMSA president, James Lawler, at a recent national conference.

He stated that along with mental health issues, bullying, harassment and sexual harassment were the biggest problems affecting medical students. A recent pilot study conducted in two Australian medical schools reported 74% of students experienced, and 83.6% witnessed, ‘teaching by humiliation’ during their adult clinical rotations.

The Australian experience is not isolated. Mistreatment of medical students appears to be equally common internationally. In the US, two large studies (16 and 24 medical schools respectively) that surveyed third year medical students report high rates of harassment (42%), belittlement (84%) and mistreatment (64%).

A recent systematic review and meta-analysis with the majority of studies from the US, Canada, Pakistan, the UK, Israel and Japan reported a 59.6% prevalence of medical student mistreatment.

Clearly, there is an urgent need to address this ‘dark side’ of medicine more comprehensively in the medical curriculum including providing students with skills to effectively deal with negative behaviours.

Notre Dame’s School of Medicine is meeting this challenge with a multi-faceted approach including:
•    Building on the previously informal dialogue around this issue with students by establishing a Positive Workplace Behaviours Working Group;
•    Organising a forum on Bullying and Harassment in Medicine early in the 2016 academic year;
•    Establishing a local baseline of workplace behaviours by surveying third-year students regarding their experiences in the clinical setting;
•    Consolidating the curriculum in the clinical years with workshops on topics such as assertive communication, conflict resolution, developing resilience and practical approaches to bullying and harassment;
•    Incorporating elements of the established first-year Physician Wellness Program (ESSENCE+) into the latter years with an emphasis on mindfulness and reflective practice.

While the aim of these initiatives is to equip students with skills to improve their practice and experience of the medical workplace, it is recognised that they alone will not change the culture that has enabled bullying and harassment to reach such alarming levels.

Notre Dame like any other institution or college involved in the training of health care professionals must review its own practices and model the humility, respect and compassion required to support the significant cultural change that the Australian health care system urgently requires.

References on request
ED: A/Prof Angela Alesandri is a paediatric haematologist/oncologist and an academic at University of Notre Dame.

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