A SENATE inquiry into hospital educational cultures occurred in November 2016. Being a medical student, I followed its coverage with interest. The inquiry heard evidence presented by the Australian Medical Students’ Association (AMSA) of widespread hostile teaching practices within hospitals, and of individual cases of students being bullied or overtly harassed by their medical supervisors.

AMSA evidence suggested that bullying of medical students in Australian hospitals is rife. Perhaps more worryingly though, most of the harassment of medical students is likely to go unreported.

I know firsthand that abuse is going unreported because, in 2016, I was the recipient of a targeted and prolonged episode of bullying at a metropolitan hospital, which I did not report. In the absence of an anonymous reporting system, I was unable to talk to anyone at the hospital or faculty for fear of career blocking and reputation tarnishing.

However, hearing other students’ stories of harassment – and hearing how alarmingly prevalent bullying is in Australian hospitals – has empowered me to add my story to the unravelling narrative.

At the beginning of 2016, I was systematically demoralised by one of my university-assigned supervisors over a period of 6 weeks. By the final weeks of the rotation, I was waking up struggling to summon the strength and motivation to get out of bed. Throughout the day, I was constantly on edge, not knowing when the next random public attack on my character and intelligence was coming. I was routinely ridiculed and laughed at in front of peers, and yelled at in public areas without cause. I was even challenged and encouraged in a conversation with my supervisor to drop out of medical school.

The implication was that I was unwanted, unvalued and, moreover, unfit to be a medical student. Which was untrue.

I became so stressed that my hair began to fall out and I lost weight because I wasn’t eating. I found myself relying on alcohol to unwind each night, which was confusing and worrying. Suicidal thoughts even passed through my mind as the rotation got worse each day. I had not previously experienced mental illness, unlike many other medical students. So I can only imagine how traumatic and destabilising medical school could be for those with mental health problems.

My supervisor repeatedly crossed the line of what should be acceptable behaviour in any context. However, despite most of the harassment transpiring in public, it was tolerated by my peers and other medical staff, because hostility towards students in hospitals is normalised and even expected. This culture is enabled by a lack of anonymous reporting mechanisms for students, and by a general lack of awareness and education around bullying at all levels.

Without exaggeration, the bullying that I experienced, combined with an insidious baseline disregard for student welfare among some medical teams, has left me disillusioned and not wishing to actively pursue a career in medicine.

I want to be a fulfilled, caring and respectful person, always. I want to be able to enjoy the company of my colleagues at work and remain unjaded until the day I retire. Many of my assigned role models throughout medical school have taught me, through their example and through their behaviour towards students, that being a doctor does not necessarily facilitate these wishes. I know of other careers that do.

In my view, there is a simple solution to unopposed bullying and unsafe educational cultures in hospitals; namely, the installation of an anonymous feedback system for students. This system would ensure the identification of senior medical staff who consistently act unprofessionally.

Students should be required to fill in a compulsory but brief online survey about the professionalism of their teachers after each rotation. De-identified data could be collected over time, and at the end of each semester or year, trends would be uncovered, and constructive feedback could be given to teachers. And if some medical teachers were consistently identified by students as unprofessional, faculties should reconsider their endorsement and support of those educators.

I would love to assume, as our profession always has, that doctors are universally virtuous, respectful, caring and courteous people, immune from regulation or investigation.

However, the emerging data about the prevalence of bullying, intimidation and hostile learning cultures in hospitals are imploring us to reconsider this assumption. Based on the evidence, AMSA has repeatedly called for an urgent reform of the student reporting systems, and yet nothing has been done.

I don’t know what it will take for those in positions of power to act swiftly and bring about change in medical education practices and cultures by introducing a simple reporting safeguard. I can only hope that senior faculty members show strong leadership on this problem for the sake of their medical students, junior doctors and the patients they serve.

The author is a Victorian medical student who has chosen to remain anonymous.

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12 thoughts on “Anonymous reporting vital to student mental health

  1. Anonymous says:

    I was systematically bullied and harrassed during my last gen-med term of medical school. This included threats of physical violence and repeated public humiliation.
    “Support” by the senior consulant consisted of extra duties, longer hours and more scrutiny. Discussing with the location education coordinator resulted in “you must be mistaken..” and my term changed so that I would NOT be rotated onto the more supportive half of the team.

    Had I been treated that way when I was in the Army, the perpetrator would have been charged.

    In the Profession of Arms, juniors are cultivated and raised to become strong leaders.

    In Medicine, we eat our young.

  2. Henry Woo says:

    It saddens me that we continue to hear these stories. There is still denial that bullying of medical students and junior doctors actually occurs.

    I had one physician colleague who whispered in my ear that he had never seen or experienced bullying although he did express concern that it was happening. I explained to him that this was of no surprise. He was a white male, raised in an exclusive private school system (all boys school), was exceptionally talented in every sport, and had a large number of successful doctors in his family. Privilege often provided immunity from bullying culture in medicine. Those with privilege were often blind to the fact that they had it.

    Whilst the culture of bullying is not unique to surgery, the issue has made frequent appearances in headline news. Although the RACS response to the problem has been admirable, we know that we have a serious uphill battle when so far, only a miserable 20% of surgeons have taken the effort to complete the compulsory online Operating With Respect module. If surgeons as individuals were keen to demonstrate acknowledgement of a systematic problem of sexual harrassment, bullying and discriminatinon, they should have been scampering to complete the module; this would make clear on where they, as a profession, truly stand on the issue.

    Sadly, the worst perpetrators of past and present bullying behaviour will likely go unpunished. For as long as hospital management and universities fail to tackle the problem seriously and beyond mission and policy statements, these stories will continue. Due to the fact that so many stories go unreported, the problem by default is not considered to officially exist. I totally agree that anonymous reporting strategies should be put into place as without this, I cannot see anything materially changing in the future.

    I wish the student author of this piece the very best for the future.

  3. Anonymous says:

    Couldn’t agree more with the author. I’ve just completed medical school, and was subject to bullying by an all-women surgical team in a large NSW hospital, and I’m a woman! And all occurring at the time the RACS revelations came out, you’d think women would support each other.

    I reported it to my placement facilitator, himself a Dr, and he told me literally to put up or shut up, whilst admitting if he personally took it further it would make my life even harder on the rotation.

    It’s a disgraceful state of affairs for medical students, one that I hope to help change when I’m a senior clinician.

  4. Dr Mitchell Smith says:

    This is simply not to be tolerated. Those doctors must have personality disorders. Any students reporting such severe harassment need to be supported actively by the AMA – because the AMA is now aware and so is required to act – as do we all. The AMA needs to identify the perpetrators and have them reported to HCCC and the CEs of the relevant health services.

  5. Erin says:

    I am myself a DIT, a learner and an educator of junior medical students and (more) junior doctors.

    We must support each other and realise that the behaviour we bypass or ignore, we tacitly endorse as acceptable. I have come to think of it like the broken windows theory in criminology.

    Unfortunately, it is all too common that aspiring junior doctors (young or otherwise) accept that ‘it’s just the way it has to be’ in order to pursue their own career agendas – they recall being exploited as interns and now, as (slightly) more senior DITs, they would essentially have to call ‘accepted’ practices out as unacceptable unless they also exploit their junior proteges (in order to complete the required tasks in their own days and carry favour with their bosses), and in doing so, would very realistically expect to jeopardise their own ‘good’ standing in their chosen specialty career-path.

    There is a major cultural shift that is required to come from the senior leadership amongst us. Bosses need to ask specifically how it is that the things they take for granted actually come about in public hospitals. Credit needs to be assigned where it is due (rather than where it is taken/accepted but those most easily able to access their supervisors).

    We’ve all had the privilege of working in coherent, respectful and truly collaborative teams. We look forward to work and to contributing – even more than is the accepted requirement – in order to perpetuate the excellence we all work so hard for in these teams. Simply avoiding ridicule means we don’t feel safe to reach the goals of self-actuation. This leads to dysfunctional teams and burn out – and this is most evident in our most senior clinicians.

    We are family and we need to treat each other as such. Ultimately for the benefit and safety of our patients.
    It’s trite, but really – how do we wish it had been different for us? And what possible incentive do we have to inflict the suffering of trainees past upon those in our charge now that we have the minimal powers we hold so desperately within our grasp?

    Thanks for reading. I suspect those most in need of some ‘schooling’ wouldn’t even have opened the link to this article anyway.

  6. Leong Ng says:

    The real issue here is that the threshold of ‘reasonble belief’ can ruin anyone’s career at any stage. Briginshaw needs to be thrown out and a criminal standard established. And, the adjudication by medically qualified persons, not retired meter maids or policemen or security guards. Nuff said!

  7. Anonymous says:

    It’s not just senior doctors. I was bullied by administration staff. I was also sexually assaulted by another medical student and I didn’t know how or where to report it.

  8. Anonymous says:

    Hmmm and what about non-medical professional staff being bullied by senior clinicians. With even less professional capital and status than medical students, being attacked and undermined in one’s position as a health professional (AH), with complaints to senior executive being whitewashed to avoid institutional disrepute, is pretty devastating. Health professionals often don’t have the same options for mobility that medical staff have so the effect can be even more severe and long lasting. This conversation should include all members of the health team, not just medical. Making this only about medical staff just underlines the invisibility of other health professional team members.

  9. Anonymous says:

    Agree with comment about other health staff, and other students on placement as well – all need protection and a safe workplace of course.
    The perpetrators must be outed or it will never end. Each facility needs a trained, specialised discrimination officer to whom confidential reporting can occur.

    To the med stu who was assaulted: phone your nearest sexual assault helpline, and, go to the Police.

  10. Anonymous says:

    To the author – that you have had the strength to write this article says a lot about your resilience, and I wish you all the best in the future. The very best thing you can do is become the opposite of your tormentor, and help all those around you throughout your career. To the respondent who implied this problem has been “solved” in Australia’s military – I think you are very mistaken, as examples that keep surfacing remind me.

    I am a senior clinician in the public system. I complained about our junior doctors being bullied by a department in my hospital. I was asked why it was I who was complaining, and I said that it was because they were too scared to complain. And so then I was asked to provide specific examples. Soon after this I was able to provide what I considered a serious example and was told to investigate it.

    I looked into this case and came back to my boss with the conclusion that not only did it constitute bullying, but it may also have been a breach of our state’s laws. Very soon after sending this conclusion by email I was rung by my boss who said they had just spoken to the junior doctors concerned (out of hours, at home), and that they did not want to take it any further.

    I responded that in that case I didn’t want to “bully them back into complaining”, though I think my boss missed the obvious implication of what I thought of these out-of-hours calls to those junior doctors from a Department Head. One of those doctors moved to a different health service the next year, and I think this incident very strongly influenced their decision. The other lasted another year.

    And all this in a health service with an “anti-bullying” program, and of course a lovely, caring mission statement.

  11. Anonymous says:

    There is bullying going on but the worst I have observed has been by nursing staff of junior doctors unfortunately. An even more difficult practise to deal with.
    On the other hand I have also witnessed registrars allege they are being bullied when they are asked questions about their patient care or if they don’t receive the grades they believe they are entitled to.
    This is a more complex problem than many of the commentators reflect.

  12. Anonymous says:

    I am a medical student in a NSW university. If I am being honest, the level of harassment felt from medical staff has been minimal. It is the administrative staff that have been unreasonable in my experience. They tell you that there is support for students and yet openly treat us with disdain. I get menacing emails at 3am to complete deadlines and almost every email sent has an implication of irresponsibility and lackadaisical attitudes of the students.

    In a presentation organised by my university, I was told that medical student burn out and substance abuse was at an all time high and the presenter, who was a staff member of my university, told us that it was our fault and that we need to adjust our attitudes instead. What irresponsible behaviour, the university openly telling the students that we are the problem, despite almost every resource available stating otherwise.

    I am a human being too. Attempting to juggle a family, a job to support my education and the sheer stress of medical school has left me 25kgs lighter. I try my best every day but sometimes the pressure is too great and I make mistakes. Students need to feel, I need to feel, that I am a human being too. We should be allowed to make mistakes and learn from them without being accused of being a completely useless human being. There needs to be measures to protect us too.

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