http://bmj.com/cgi/content/full/324/7342/878
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 Collections under
which this article appears: Psychology
Postgraduate:
Residency / House staff |
Lyn Quine
Centre for Research in Health Behaviour, Department of Psychology, University of Kent at Canterbury, Canterbury CT2 7NP
In the United Kingdom a growing literature has identified workplace bullying
as a major occupational stressor among health professionals. A study
carried out in an NHS community trust found that 1 in 3 staff
reported being bullied in the previous year,1
while a report by the King's Fund, an independent health think
tank, found that bullying, racial harassment, and discrimination were
daily experiences for black and Asian doctors. In the United States
several studies have reported that medical students suffer high
levels of mistreatment or bullying during training, which increase
with progression through medical school, spilling over into the early
training years.2-4 We report here findings from
a study of workplace bullying among junior doctors in the United
Kingdom.
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Participants, methods, and results |
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An anonymous questionnaire was sent out with BMA News Review to 1000 doctors with job grades from house officer to senior registrar, randomly selected from the BMA members' mailing list. The questionnaire collected information about the participant's age, sex, job grade, and ethnic group. Participants were presented with a definition of bullying and asked to indicate whether they had been subjected to it in the past 12 months and whether they had witnessed others being bullied. They also completed a bullying scale which asked whether they had experienced 21 bullying behaviours from peers, senior staff, or managers in the past 12 months.1
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The response rate was 62%: 594 competed questionnaires were returned and
48 were returned undelivered by the post office. Not all questions
were answered by all participants. Fifty four per cent (321) of the
participants were house officers or senior house officers, 39% (230)
registrars, 3% (18) senior registrars, and 3% (20) other junior
grades. Half were men (294 v 296) and 70% (413 v 174)
were white. Overall, 220 of the 594 junior doctors (37%) identified
themselves as having been bullied in the past year, though 486 (84%)
had in fact experienced one or more of the bullying behaviours
described on the bullying scale; 407 (69%) had witnessed the bullying
of others. Black and Asian doctors were more likely to report being
bullied than white doctors (78 (45%) v 139 (34%);
2=6.3, df=1, n=585,
P=0.01; relative risk 1.59 (95% confidence interval 1.11 to 2.28))
and women were more likely to report being bullied than men (43%
(126) v 32% (92); 2=7.7,
df=1, n=588, P=0.005; relative risk 1.61 (1.14 to 2.26); see table).
Reports of bullying did not vary by job grade or age.
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Comment |
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methods, and... Comment
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In this study 37% of junior doctors reported being bullied in the previous year and 84% had experienced at least one bullying behaviour. Black and Asian doctors were more likely to be bullied than other doctors. This should be a cause for concern, particularly since several recent studies show a pattern of discrimination at all levels in the medical profession from application to medical school to examination success, job application, and the allocation of distinction awards to consultants.5 Women were more likely than men to be bullied, and this finding is consistent with a study of university employees by Bjorkvist et al.4
We should interpret these findings cautiously. The study relied on self
reports of bullying, and a higher response rate would have been
desirable. Nevertheless, the findings suggest that disturbingly high
levels of bullying and mistreatment during training are part of many
junior doctors' perceptions and experience.
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Acknowledgments |
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Thanks to Jon Deeks for statistical comments and to Annette Barrett, Sarah Bell, and Lesley Marquis for help with data collection.
Contributors: LQ had the idea for the study, carried out the statistical analyses, and is the guarantor.
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Footnotes |
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Funding: None.
Competing interests: None declared.
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References |
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Top Participants,
methods, and... Comment References
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| 1. | Quine L. Workplace bullying in NHS community trust: staff
questionnaire survey. BMJ 1999; 318: 228-232 |
| 2. | Daugherty SR, Baldwin Jr DC, Rowley BD. Learning,
satisfaction, and mistreatment during medical internship. JAMA 1998;
279: 1194-1199 |
| 3. | Kassebaum DG, Cutler ER. On the culture of student abuse in
medical school. Acad Med 1998; 73: 1149-1158 |
| 4. | Bjorkqvist K, Osterman K, Hjelt-Back M. Aggression among
university employees. Aggressive Behaviour 1994; 20: 173-184 |
| 5. | Esmail A, Everson D. Tackling racism in the NHS: we need
action not words. BMJ 1997; 314: 618 |
(Accepted 29 August 2001)
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