Bullying in surgery

“The standard you walk by is the standard you accept”

Lieutenant General David Morrison

The External Advisory Group report on discrimination, bullying & sexual harassment advising the Royal Australasian College of Surgeons makes grim reading. Approximately 50% of Fellows, trainees and international medical graduates report being subjected to discrimination, bullying or sexual harassment. Of those,  39% report bullying, 18% report discrimination, 19% report workplace harassment and 7% sexual harassment. This is unacceptable in any workplace and can have wide ranging effects, not only for the trainee but also for patients.

Unfortunately, this problem is not unique to Australia. We also have a similar issue in the UK. A survey published by RCSEd in May 2014 found that 3 out of 5 surgical trainees had been victims of undermining and bullying at work, and 9 out of 10 have observed it first hand. This figure is three times higher than recorded across other healthcare professions in the NHS (BMJ 2013). The figures from the RCSEd survey are backed up by the GMC trainee survey in 2013, where surgery was found to be an outlier with respect to bullying & undermining in the workplace.

There is a reluctance to speak out about these issues for fear of reprisal, that the behaviour will actually get worse or that it could be seen as “career suicide”. In fact, only a third of those who experienced or witnessed bullying behaviour felt able to report it. But where this behaviour is experienced or witnessed but not reported, it contributes to normalising the behaviour. This means a lot of the time we laugh it off, “suck it up” and get on with things.

Surgery is seen as a macho culture, where you have to be tough to survive and unfortunately this kind of behaviour is often seen as part of the training & culture. This may be partly due to the hierarchy within the profession with there often being a parent/child approach with trainees. We should be treating our trainees as equal adults, albeit with less experience. The culture of “junior” and “senior” doctors means that you are still regarded as junior even when you are highly trained & deserve to be treated like the professional that you are. As a senior surgical registrar nearing the end of my training, It was very frustrating not be taken seriously because you are seen as “junior” and therefore are undermined. However, history shows us that we tend to emulate the behaviours of our seniors and so the cycle continues.

This is a significant issue and the RCSEd is determined to address it head on. The college has set up Professional Excellence groups to provide a safe forum to raise concerns. They have also set the Faculty of Surgical Trainers to provide a forum for accrediting surgical teaching.

But we need to do more. We need to change the culture. The days of teaching by humiliation should be long gone. Creating a toxic environment where trainees are scared to speak up can have a detrimental impact on patient safety as they are less likely to raise concerns or ask for help when they need it. It affects good communication and team working. This kind of environment also has a negative effect on the quality of training and the quality of life of the trainee who feels undermined. We need to act as positive role models for our trainees and teach appropriate behaviours.

We need to create an open culture within our organisations where people feel they can raise concerns without fear of repercussion or a lack of faith that anything will be done.
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