Bullying During Medical Residency May Cause Depression, Burnout

Researchers evaluated survey results to determine the prevalence and impact of perceived bullying during residency.

Perceived bullying during medical education may have negative consequences including compromised patient care and increased depression and burnout in affected residents, according to study results published in the Journal of the American Medical Association.

Researchers evaluated results from a supplemental survey attached at the end of the Internal Medicine In-Training Examination completed by internal medicine residents in 2016. The survey, which is administered by the American College of Physicians, focused on bullying during residency, with bullying defined as “harassment that occurs repeatedly (>once) by an individual in a position of greater power.”

Residents were asked if they were ever bullied during their residency programs and to characterize the type of bullying (verbal, physical, sexual, or other) if bullying was perceived. Residents were also asked to disclose whether they suffered consequences as a result of the incidents and whether they sought help.

Assessment of the survey results revealed that of the internal medicine residents (N=26,021) who took the examination, 93% (n=24,104) completed the survey and 88% (n=21,212) allowed their surveys to be used for research purposes. Of these residents who allowed their surveys to be evaluated, 13.6% (n=2876) reported being bullied at some time during their residency programs. Of the residents who perceived bullying, 80% reported verbal harassment, 5.3% experienced physical harassment, 3.6% experienced sexual harassment, and 25% reported other forms of harassment. A total of 31% of residents who perceived bullying sought help to deal with it.

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The most common consequences of bullying cited by residents were feeling burned out (57%), worsened performance (39%), and depression (27%). Resident characteristics most significantly associated with perceived bullying included speaking a language other than English, being at a higher postgraduate year level, being an international medical school graduate, and being in a lower Internal Medicine In-Training Examination tertile.

The main limitation of this study was that the definition of bullying could have been interpreted differently. Other limitations include lack of information about the perpetrators or the frequency and severity of bullying, as well as limited availability of information about the surveyed resident and program characteristics.

The researchers stated that these numbers likely reflect an underestimation of mistreatment of medical residents since less consequential behaviors (eg, being hassled or other lesser aggressions) would not have been reported in this survey. The researchers concluded that it is critical to find ways to better address bullying during medical residency to support improved learning environments and ensure appropriate professional development of medical students.

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Ayyala MS, Rios R, Wright SM. Perceived bullying among internal medicine residents. JAMA. 2019;322(6):576-578.

This article originally appeared on Medical Bag