Bullying in Med School

[TulipsAndSunscreen]

I just think we are all becoming a bunch of wimps. Okay not exactly, but I get to read med student evaluations of services at work. Examples of "bullying complaints" include: "I got yelled at for showing up late", "resident wouldn't let me do anything but drive the camera, and was annoyed when I asked if I could do more", "faculty scolded me in front of my peers when I didn't know the answer", etc. If anything, some people should probably be "bullied" more.

Those are whining and should be dealt with appropriately (though I would still argue that screaming at people like this isn't the best way to handle it). Trust me, I don't put up with crap or whining at all. I used to be way, way harsher but I've learned that even true development issues (showing up late, whining, being unprepared) cannot be well handled through yelling.

Performance issues of any kind can be dealt with effectively without screaming/bullying. Showing up late or being unprepared are unacceptable but yelling isn't going to address it any better than direct, calm feedback.

I think the real problem comes though when the expectations are unreasonable AND there is bullying but I think regardless of the issue, bullying is simply not an acceptable way for adults to communicate or encourage junior people to achieve.

ETA: I agree with you HoW that excessive praise is totally unnecessary and people are wimpy. I'm just saying that no matter the expectation, a performance issue is better handled calmly than losing your cool. Losing it on someone just makes you look bad whereas calmly addressing the issue (even if you're f*&*ing frustrated because it should be OBVIOUS what the right thing to do is) is usually better. I don't always achieve this standard but I know intellectually that it's best.

[corn poffi]

I agree that yelling is not always the best strategy. But by the time you get to med school, you should know that something like being late is not acceptable. I'm all about character development yadda yadda yadda but there comes a time when somebody is too old to be "talked through it" and just needs a good ass reaming. (The student who complained about being yelled at for being late had been disciplined for it multiple times on another surgical rotation.)

ETA: Obviously, some faculty and residents are particularly mean to students, and that's absolutely not okay. And I do realize that those people are usually not disciplined for their behavior, which cultivates a culture of fear, which is also not okay. But, I do think that surveying med students and asking if they've been bullied would not give you a fair representation of what really happens. We are being conditioned to complain about everything.

[poky]

Those are whining and should be dealt with appropriately (though I would still argue that screaming at people like this isn't the best way to handle it). Trust me, I don't put up with crap or whining at all. I used to be way, way harsher but I've learned that even true development issues (showing up late, whining, being unprepared) cannot be well handled through yelling.

Performance issues of any kind can be dealt with effectively without screaming/bullying. Showing up late or being unprepared are unacceptable but yelling isn't going to address it any better than direct, calm feedback.

I think the real problem comes though when the expectations are unreasonable AND there is bullying but I think regardless of the issue, bullying is simply not an acceptable way for adults to communicate or encourage junior people to achieve.

ETA: I agree with you HoW that excessive praise is totally unnecessary and people are wimpy. I'm just saying that no matter the expectation, a performance issue is better handled calmly than losing your cool. Losing it on someone just makes you look bad whereas calmly addressing the issue (even if you're f*&*ing frustrated because it should be OBVIOUS what the right thing to do is) is usually better. I don't always achieve this standard but I know intellectually that it's best.

This, exactly. There's a huge difference between rebuking/criticism and yelling/screaming/namecalling. And yes, overly-praised and coddled whiners may conflate the two when they're on the receiving end, but that doesn't mean there isn't a difference.

[poky]

I agree that yelling is not always the best strategy. But by the time you get to med school, you should know that something like being late is not acceptable. I'm all about character development yadda yadda yadda but there comes a time when somebody is too old to be "talked through it" and just needs a good ass reaming. (The student who complained about being yelled at for being late had been disciplined for it multiple times on another surgical rotation.)

OK, so at that point there should obviously be more concrete consequences than the immediate reaction of the attending. Shit, if you're in classes where attendance is necessary and you're habitually late, generally you get a lower grade, right? If chronic lateness being mentioned in your rotation review and/or lowering your grade for the rotation isn't enough motivation to get a med student to show up on time, why would yelling at them make it any better? What does it accomplish?

[SuzySunshine]

I totally agree that namecalling and yelling have no place in the adult world regardless of the profession, etc.

However, DH and I were just having this conversation last night as we watched Project Runway and not one, but TWO (one probably old enough to be my grandmother) left the competition because they just couldn't hack it and the competition has only been on for like 3 weeks. I think overly praised and overly coddled is definitely a generational issue. DH and I are trying REALLY hard to get this through to our kids early. A broke a toy this morning and her response was, well I'll just have to get another one and DH's response was very calm but matter of fact that she shouldn't have broken it and she wasn't getting another one and she got really sad but hopefully things like that will stick with her.

[scrub-jay]

(1) Corporate example of bullying: Yelling across the entire office to one person: "I can't believe you sent that [wrong email chain], you are the stupidest person I've ever known, I have no idea why I ever hired you in the first place. Could you #$%@$ up any worse?"

(2) Corporate example of discipline: Private discussion between boss/direct-report: "That was a huge mistake that may cost us a contract, I'm very disappointed. I think it would be appropriate if you took responsibility sent an explanation email to all parties involved, and please include me as well."

A mistake (such as coming in late repeatedly) is inappropriate, but not knowing the details of the rebuke, I can't say that it was not bullying. Depending on how it is handled determines whether it is bullying or not. Yes, coming in late is inexcusable, but public humiliation/extreme degrading is a form of bullying and harassment and regardless of the mistake, I don't condone the use of bullying. Additionally, research has shown that it is not an effective form of motivating behavior change in an employee (or resident/med student).

ETA: Those are REAL examples btw.

[HouseofWool]

(1) Corporate example of bullying: Yelling across the entire office to one person: "I can't believe you sent that [wrong email chain], you are the stupidest person I've ever known, I have no idea why I ever hired you in the first place. Could you #$%@$ up any worse?"

(2) Corporate example of discipline: Private discussion between boss/direct-report: "That was a huge mistake that may cost us a contract, I'm very disappointed. I think it would be appropriate if you took responsibility sent an explanation email to all parties involved, and please include me as well."

A mistake (such as coming in late repeatedly) is inappropriate, but not knowing the details of the rebuke, I can't say that it was not bullying. Depending on how it is handled determines whether it is bullying or not. Yes, coming in late is inexcusable, but public humiliation/extreme degrading is a form of bullying and harassment and regardless of the mistake, I don't condone the use of bullying. Additionally, research has shown that it is not an effective form of motivating behavior change in an employee (or resident/med student).

ETA: Those are REAL examples btw.

I dunno, think back to when our parents were kids and the thought of public humiliation was enough to check their behaviors. I don't mean that someone should get an ass chewing in front of the world, but concerns about being dressed down in front of my peers is enough motivation that I don't do stupid things in public.

To be clear, bullying is not acceptable. But public humiliation is a traditional form of behavior control across civilizations. "What would the neighbors think" sort of mentality.

[GrayMatterWife]

Maybe DH and I just function in different worlds, with him being a NSG and me a lawyer. We are surrounded by profanity, anger, selfishness, pettiness, and short-temperedness all the time. We don't think about it and our feelings don't get hurt. You f**k up, you pay for it. You do something right, no one says anything, other than how it could have been even more correct.

[corn poffi]

I guess I'm just thick-skinned and jaded by working with old-school doctors for my entire career. While I don't agree with name-calling, I don't necessarily think yelling is inappropriate 100% of the time. I wouldn't do it to my employees, but I've definitely been yelled at before and you can bet I've never made that mistake again!

It's really interesting about the "praise" thing. The school recently did a survey on how staff felt about working here. The #1 complaint was lack of praise, which I thought was pretty amusing. Praise for exceptional effort is one thing, but I think there are more and more people who believe they should be praised just for doing their job. Kind of a tangent, but I thought it was interesting.

[scrub-jay]

I dunno, think back to when our parents were kids and the thought of public humiliation was enough to check their behaviors. I don't mean that someone should get an ass chewing in front of the world, but concerns about being dressed down in front of my peers is enough motivation that I don't do stupid things in public.

To be clear, bullying is not acceptable. But public humiliation is a traditional form of behavior control across civilizations. "What would the neighbors think" sort of mentality.

Unfortunately, I don't have my textbooks and readings handy (as I'm at work), but I will provide the references to the research on employee motivation that I mentioned. Public humiliation builds resentment and decreases productivity in the workplace in the majority of individuals and is not a recommended form of discipline. Obviously, on an individual scale, public humiliation may be a motivator, but statistically, as a whole it is not. The research I am pulling this from was only looking at management techniques and workplace motivation/productivity/retention, not societal behavior change, so I can't comment on effectiveness on that scale.

[scrub-jay]

On the praise thing, there has been some very interesting research in the past couple of decades. I definitely don't think "lack of praise" is a bullying issue at all and it does seem to be emerging as a generational difference. Personally, I only want to receive praise if it is actually earned. It should not be something I get for completing responsibilities. Where is the value if it is tossed out at random? Do I ever expect it? Absolutely not, I value it so much more if it is rare and well-deserved. One of my younger co-workers actually asked for a raise after being on the job for 3 months...because "he showed up on time every day" My boss laughed him out of her office. She literally thought he was kidding. He is fresh out of college, but REALLY?!

[ladymoreta]

Public humiliation builds resentment and decreases productivity in the workplace in the majority of individuals and is not a recommended form of discipline.

This. I guarantee that a non-violent workplace will yield more productivity and more employees stepping forward with suggestions for improving systems. That includes doctors, nurses, techs, etc. Like HoW stated, if you get chewed out in front of your peers for something, chances are you won't do it again. That's true. But what if it's for something the attending just doesn't want to do, like a checklist (which has been shown to decrease errors). That employee will *learn* that suggesting changes is bad, and you can count on them never bringing up anything else. You can't conform to industry best-practices if everyone is afraid to bring them up.

As for yelling at someone for actual mistakes, like being habitually late, I'm sure the attending feels much better after yelling at the resident or student. It feels good to "put them in their place". You know what feels even better? Publically humiliating someone. When done in front of other people, I bet that attending walks away feeling 20 feet tall. And that's about the end of the benefit. I'm sorry to those who regularly lose your temper in public, but I lose respect for anyone who can't control themselves. In my opinion, it's a sign of immaturity. I don't indulge my 2 year old's tantrums, so I certainly won't indulge a 30 or 40-year old's.

[TulipsAndSunscreen]

I feel like medicine of all places is a place where bullying is COMPLETELY counterproductive and actually could be dangerous.

As I've previously stated, I'm completely in support of addressing performance issues but public humiliation and bullying has been demonstrated to discourage speaking up or suggesting ideas as well. If a junior person (med student or resident) is completely terrified of their seniors or they're attending, they're much less likely to ask questions or admit a mistake. Is it annoying that someone junior is asking questions, YES potentially it is. However, there's a patient's life in the balance as well and that question could save a life. I believe it should be the responsibility of senior residents/attendings to say, "listen, I'm not going to entertain silly questions ad nauseam but if you ever, EVER have a concern that something is wrong/unsafe/a mistake has been made, it's your responsibility to speak up." The answer might be, "it's fine, you need to read on X, Y, or Z" but if you have not created that culture because you bully people, it won't happen.

If the junior doesn't have that freedom, you're going to have people trying to cover mistakes/their asses instead of bringing things to the attention of seniors/attendings because people are terrified of them.

They've done tons and tons of studies on this including in medical settings about how teams working together at ALL levels (including junior residents, med students, nurses, etc.) creates better patient care than authoritarian decision making by only the most senior physicians.

[SoonerTexan]

As for yelling at someone for actual mistakes, like being habitually late, I'm sure the attending feels much better after yelling at the resident or student. It feels good to "put them in their place". You know what feels even better? Publically humiliating someone. When done in front of other people, I bet that attending walks away feeling 20 feet tall. And that's about the end of the benefit. I'm sorry to those who regularly lose your temper in public, but I lose respect for anyone who can't control themselves. In my opinion, it's a sign of immaturity. I don't indulge my 2 year old's tantrums, so I certainly won't indulge a 30 or 40-year old's.

This. There is a certain person in a dept. I support that is KNOWN for his hissy fits. I've witnessed a few already. And they are exactly that. He is indulged because he has been there a long time, but NO ONE around him has any respect for him. I was scared of him at first and now I just view him like a spoiled child. No respect whatsoever.

[v-girl]

If I had a boss who used a lot of profanity in the workplace, I would not be working for them for long. I just find it disrespectful and petty. Same with yelling unnecessarily and name-calling. So glad I'm out of the workforce now and don't have to deal with that kind of behavior.

Oh, and yes, I always did a good job and had multiple managers wanting me as their assistant. I chose the nicest one.