From the Journals

Bullying a ‘persistent, important’ problem for cardiology trainees



A high rate of bullying towards U.K. cardiology trainees by their superiors has been revealed in a new survey. More than 10% of doctors training to be cardiologists in the United Kingdom say they have been bullied in the last 4 weeks, and one-third report having witnessed bullying on a cardiology rotation, the survey reports.

In addition, 33% of cardiology trainees said they had been on the receiving end of inappropriate behavior, including having their opinions and views ignored, being made to feel worthless/useless, and being shouted at or targeted with spontaneous anger.

Senior doctors (consultants) in cardiology were cited as the main perpetrators of such bullying and inappropriate behavior.

Women trainee cardiologists and those who attended medical school outside the United Kingdom were more likely to report having been bullied, suggesting a sexist and racist element.

“In this large and repeated survey of British cardiology trainees, we have shown a persistent and important problem with bullying,” the authors conclude.

Results of the survey from the British Junior Cardiologists’ Association, were published online in a paper in Heart on Dec. 6, 2021.

Examples of such bullying behavior by consultant cardiologists toward their trainees reported in the survey included being belittled in front of others, having their filing cabinet drawer thrown across the room, use of foul language toward trainees, and using previous mistakes as an excuse to humiliate and ridicule them, lead author of the survey, Christian Fielder Camm, MD, Keble College, Oxford (England) University, told this news organization.

Trainees also reported being made to feel inadequate when struggling to achieve unrealistic tasks and being pressured into not taking holidays and study leave.

Many respondents said they did not report such behavior for fear of repercussions and in some cases because the perpetrators were known for their bullying behavior, and previous attempts to intervene had not resulted in any change.

Dr. Camm, who is a cardiology trainee himself, says he has not personally been the victim of bullying, but as secretary of the BJCA he regularly receives reports about it happening.

“We wanted to look at this issue in our survey as we had been hearing anecdotal reports of bullying from cardiology trainees for a number of years,” Dr. Camm said. “We wanted to put it out there that this is not just an isolated issue and shine a light on the problem.”

Noting that the U.K. General Medical Council’s annual survey has found that bullying is seen across all disciplines in medicine, Dr. Camm said that cardiology has the highest reported rate of bullying among the medical specialties.

“This is not a new story – it has been played out throughout history, but things are not magically improving. Over the 4 years of our survey, rates of reported bullying have stayed the same,” he noted. “Our survey is asking more questions about bullying to find more detail on what is happening.”

The current data come from the BJCA annual survey from 2017 to 2020. As part of the survey, trainee cardiologists were asked about direct and indirect experiences of bullying and inappropriate language/behavior in cardiology departments in the preceding 4 weeks.

In all, 2,057 responses were received, 73% were from men, and the average age of respondents was 33 years. Over half (59%) were working in a specialist center for cardiology (tertiary referral center), and 94% had a national training number, which guarantees a continued place on a training program, subject to performance.

“This project has upset me to realize what my colleagues are experiencing. This is the working environment we are creating, and it is not good enough,” Dr. Camm said.

At present, the bullying behavior is not often reported. “Usually, the only person to report it to is the senior person in the department, who is frequently the cause of the problem, so most people just put up with it until they move on to their next training rotation. The working environment should not be so difficult,” he said.

The authors noted that bullying has been shown to significantly affect trainees, with those subject to bullying being 70% more likely to report serious or potentially serious medical errors, and more likely to take time off work and cease direct patient care.

They stressed that addressing bullying of trainees needs to be a priority both to ensure patient safety and to reduce trainee attrition in a time of unprecedented workforce pressures.

Dr. Camm believes a national plan needs to be put in place to deal with this issue and said the BJCA is keen to work with the British Cardiovascular Society to develop a zero-tolerance policy, with a clear strategy to address allegations of bullying.

“The world is changing. Hopefully this publication will be the start of some change,” he added.


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