Coping with bullying during residency

Not all heroes wear capes; many wear white coats. But unfortunately, some of these white coats disguise a bully—and those bullies are in charge of educating the next generation of doctors.

Workplace bullying in medicine has emerged as a pressing issue in residency training programs in recent years, and more people are now speaking out about their experiences.

The cycle of residency bullying

Medical students, perhaps the most vulnerable in the medical training community due to their relatively low level on the totem pole, often experience verbal abuse, humiliation, and (nonsexual or sexual) harassment.

Such behaviors continue into, throughout and beyond residency. The historical hierarchical structure and extremely competitive nature of the medical profession may result in these bullying cycles.

Unfortunately, many residents accept this type of treatment by their supervisors as a rite of passage or way to “weed out the weak.”

This unhealthy “tough love” approach can create a cycle of abuse in which residents who endure bullying become supervisors who reciprocate this behavior upon the next generation of residents.^[]

A look at the numbers

Nearly 14% of internal medicine residents in a large-scale study published in JAMA in 2019 said they had been bullied at some point during their residency training.^[]

Eighty percent of this harassment was verbal, and less than 30 percent of individuals sought help to deal with the effects of this bullying. For this study, bullying was defined as repeated harassment by an individual in a position of power.

Previous studies on bullying among medical trainees produced a wide range of estimates, from 10% to 48%.

Examples of residency bullying

Working long hours in the hospital, low residency pay, poor social support and the lack of healthy outlets are some of the factors that lead to resident burnout. This can potentially cause senior residents to misplace their stress and anger on junior residents and medical students, especially if the senior residents witness bullying behavior from an attending physician.

It is not uncommon to hear of attending surgeons throwing tools in the operating room, smacking the resident’s hand out of the way, or kicking the resident out of a surgery for giving a wrong answer. Bullying also comes in the form of supervisors who punish a resident who asks for a break with extended work hours.

Being bullied because of speaking a non-native language or having an accent or being an international medical graduate, being humiliated in front of patients and peers on rounds, and being put under pressure to perform a procedure without attending supervision are common examples of bullying residents often face.

Although intimidation and verbal abuse are the most common forms of bullying in residency, sexual and physical harassment also occur during residency training.^[]

Effects of bullying on residents

Bullying residents threatens patient safety because it inhibits cooperation among the medical team, cuts off healthy communication, diminishes morale, and hinders compliance with and implementation of new practices. It can also lead to:

• Low job satisfaction

• Depression, anxiety or anger

• Substance misuse

• Low self-confidence

• Burnout

• Quitting residency 

• A continual cycle of bullying for next-generation students/doctors 

Stop the cycle

Increasing awareness that bullying is a problem in medical education is the first step to ending this unhealthy cycle. Medical students, residents, attending physicians and program directors must acknowledge these unhealthy behaviors.

Although this behavior must ultimately be stopped by educational leaders and training program directors, residents must get beyond the mistreatment they have suffered. They must demonstrate compassionate behavior towards all colleagues—especially junior-level residents and medical students—to break this ugly cycle.

Many residents may feel uncomfortable coming forward about bullying, or may not come forward at all for fear of being punished or looking “weak” to peers, but reporting your experiences is essential to driving change.

If you're bullied in residency, it’s not only important that you document and report this to your program director and hospital administration, but that you also seek help. Continual bullying can have drastic effects on your performance and mental health.^[]

Make sure you have healthy outlets outside of medicine, a strong support system you can lean on, and, if necessary, a therapist or psychiatrist you can talk with about your experiences.^[]

Steps to take if you are being bullied in residency:

• Do not react with your emotions or confront the bully.

• Act professionally at all times.

• Document any incident right after it happens.

• Report incidents to your program director and hospital administration.

• Talk honestly about your experiences and feelings with a trusted friend or mentor.

• Practice positive coping skills outside of medicine to help you work through any negative feelings associated with bullying.

• Avoid using drugs, food or alcohol to numb your feelings.

• Seek professional help if needed.