A nervous disposition
The GMC uses national training surveys to capture data and ensure that medical education and training across the United Kingdom (UK) is adhering to and delivering the standards it expects.
The GMC recently released its 2014 national training survey: bullying and undermining. The respondents included 50,000 doctors in training. The results showed that:
8% of the respondents had experienced bullying; and
13.6% of the respondents had witnessed bullying.
In addition, the evidence suggested that the respondents were reluctant to report bullying and undermining behaviour, as only 1% used the free text comment to describe their experiences.
A doctor in training notices an unsafe practice. They report this incident to their supervisor or a respective consultant. Subsequently they are subjected to bullying. Will that doctor report any issues of concern in the future and what will the impact be?
A crucial element of maintaining and improving the standard of healthcare, and thereby ensuring patient safety is open communication and teamwork. If bullying is active within a department, and is not dealt with, the effect on collaborative working and openness cannot be overlooked.
The answer to the scenario posed above must surely be that the doctor will be reluctant to report issues in future, and therefore matters occurring on the frontline may not be swiftly identified and dealt with. This can have a detrimental effect on issues which touch on patient care and safety.
How does bullying affect doctors in training?
The health system, whether private or NHS, needs confident and competent doctors. The survey figures showed a link between the quality and effectiveness of training and bullying. Some respondents reported receiving feedback which undermined their confidence, and thereby affected the way in which they engaged with their training.
Undoubtedly, a supportive and constructive environment is essential to promoting effective and successful training placements for doctors.
Many doctors in training report that to avoid confrontation, they ‘keep their heads down’ and tolerate bullying. One respondent stated:
‘If you get on the wrong side of a consultant it may have a big impact on your future career. I’ve experienced this myself and it definitely makes me think twice about reporting instances of bullying, either locally or to the GMC.’
The other issue that stems from bullying in the workplace which is not tackled, is the unfortunate consequence of perpetuation. The survey results also revealed that where doctors in training are regularly subjected and/or exposed to bullying, and nothing is actively done about it, it can lead to acceptance that this behaviour is ‘normal’ and thereby create a repetitive cycle.
This, amongst other reasons, is why bullying must not be tolerated in the workplace, and must be openly discussed and tackled.
Bullying in the workplace can have a significant effect on teamwork, amongst other things. Within the health system, specifically doctors in training, the results of the survey show that bullying is also stunting the development of doctors and potentially impacting patient safety. Doctors in training should not have to ‘put up’ with being bullied in order to avoid being singled out amongst peers. These issues must be tackled in order to avoid a culture which repeats the cycle of bullying. Most importantly, reports by doctors in training of bullying must be dealt with in a sensitive but effective manner.
The training doctors of today are the pioneers of medical practice in the future, and we must ensure that their experiences of medical education and training are constructive and effective.
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