The Culture of Bullying in Medical Training Must Stop

Abstract

Among the Science, Technology, Engineering, and Mathematics professions, medical training continues to carry remnants of the medieval concept of apprenticeship. A lingering hangover of apprenticeship in medicine is the culture of teaching through shame, embarrassment, and humiliation that has persisted over the years. Estimates of the prevalence of bullying in medicine vary from as little as 13% to as high as 81%, with considerable reason to suspect under-reporting. The consequences of bullying approximate that of abuse in early childhood and are often long-lasting. Burnout, a decline in performance as a resident doctor, and depression are commonly reported consequences of bullying and abuse on medical students. Only a minority of medical students ever report abuse due to trust deficit and fear of retribution. Most medical program directors appear to be unaware of the scope and extent of abuse occurring under their watch. Most victims of bullying appear to become bullies themselves, perpetuating the bully-victim cycle of abuse. Traditional power hierarchies play a role in bullying in the medical profession, as in other professions. The cost of bullying and abuse to the health and welfare of medical students is considerable. There is a strong case to be made for compassion in medicine and for bringing back humanity into the medical humanities. Medical training must not a barrier to medical learning. The safety of survivors of abuse must also be addressed while reporting to protect them from repercussions. We must work to make training spaces safe for medical students.