Bullying in medical academia: time to enforce the policies

With increasing recognition of bullying in academic settings, it is vital that institutions adhere to their own policies and protocols when supporting victims of bulling and abusive behaviour in medical academia.

In his pioneering 1976 book on workplace harassment, Brodsky coined the term “bullying” to mean “persistent attempts on the part of one or more persons to annoy, wear down, frustrate or elicit a reaction in another.” He noted that such harassment reflected “continual behavior that provokes, presses, frightens, humiliates or in some other way creates unpleasantness in the recipient.” Negative verbal and non-verbal behaviour are recurrent features of workplace harassment and bullying.

In Nature 2021, Gewin described bullying as “endemic in academia, an environment riddled with hierarchies and hyper-competition, exacerbated by an over-reliance on temporary contracts and the pressure to land highly powered tenured positions.” For anyone who has ever attempted to eke out a fledgling research career in medicine or health sciences, the words will be a chilling reminder of a perilous existence almost entirely dependent on short term research funding and exposure to research colleagues whose personalities and career aspirations may not always be in harmony with yours.

Extent of the problem

In recent years, there has been an increased focus on the range and extent of bullying experienced by medical students as part of their clinical clerkships. What appears clear from the emerging literature is that bullying is very common with up to 40% of French and American medical students reporting their experiences with bullying. In New Zealand, the evidence is even greater with 54% reporting exposure to bullying in the clinical setting and, disturbingly, 74% reporting they had witnessed another medical student being bullied.

It is unlikely that the problem is solely related to medical students and their training. A key question is whether the apprenticeship model commonly used in medical education clinical teaching is itself a part of the problem. Are the power disparities that are an integral part of the hierarchical structure in the teacher–student relationship too skewed? Do similar power inequalities also strangle relationships in the research arena? Is there a failure of the institution (medical school, university, research institute) to recognise psychopathic tendencies and bad behaviour in some of their staff members or do some covertly tolerate it? How many research leaders, medical and non-medical deans have had blatant examples of bullying and staff abuse reported to them and yet they have done nothing about it or, worse still, allowed the processes of the institution to cover it up?

Clinical and research settings

The impact of the COVID-19 pandemic has particularly impacted on the health and research communities. Mahmoudi and Keashly recognise this link and feel it has contributed to a worsening of factors that influence abusive workplace behaviours such as academic bullying. They feel such bad behaviours exist not just in research settings but also in hospitals and medical communities and have potential to negatively affect medical decision making.

The increasing recognition of bullying and abusive behaviours in academic settings means that most universities and research institutes have developed their own sets of policies and protocols to deal with such issues. The victims of bullying and abusive behaviour deserve procedural fairness to ensure that the institution involved adheres to their own policies in the area, something they are legally obliged to do but may not always do so. Gewin notes that some institutions may deliberately use delaying tactics in the hope the whistle-blower will tire of the endless process, give up or drop their accusation.

The failure to investigate

The role of human resources in the management of reported episodes of workplace bullying can be critical. Some of the literature, including victim reports on academic bullying, is keen to advise potential accusers that it would be wrong to assume that human resources will be on your side or will have no conflict of interest in how they investigate a complaint of abuse. One anonymous blogger stated “HR doesn’t exist to protect you, it exists to protect the employer from you.” What if the research institute leader or dean are themselves latent victims of a bullying subculture and they lack the moral and ethical fortitude to speak up and tell the truth?

For many, it is all about a power struggle that results in talented young researchers being driven away, those in leadership positions getting ridiculed and blackmailed into doing nothing while the toxic environment engendered by the bullies holds sway – for now. Sadly the loss of academic and research capital often has a very detrimental effect while the bully is tolerated or just moved to another location where the behaviour is likely to re-emerge in the future. Edmund Burke’s comment “The greater the power, the more dangerous the abuse” is particularly apt.

Conclusion

The recent position statement from the Australian National Health and Medical Research Council (NHMRC) – Figure 1 – is a good starting point in support of research institutions willing to acknowledge that a problem exists and that they are prepared to support efforts to provide “… a respectful workplace that is completely free of workplace bullying and harassment.”

All research institutions should ensure their grant applications are free of researchers/investigators with a history of bullying and harassment. The de-funding of such grants could be a powerful weapon to ensure that the NHMRC policy is strictly adhered to and not covered up.

An acknowledgement that bullying complaints have been made could be a useful first step to ensure some transparency in investigating such allegations including any sanctions applied. Hiding behind institutional process is no help and should never be allowed to thwart the truth emerging. Likewise, vexatious counter allegations against the whistle-blower should be recognised as such and not used to impede a proper and ethical investigation of the facts. Anyone who has ever experienced bullying and witnessed nothing being done about it should welcome this viewpoint on confronting and eradicating it from the workplace. All employers have a responsibility to make sure that their employees, and people who apply for a job with them, are treated fairly.

Ideally, institutions in society serve as organisations to promote some public object, meet the needs of people, persist over time and tend to be stable. Institutions that fail to confront and deal with bullying, do their members considerable disservice.

Tom Brett is a practising general practitioner in Mosman Park, Perth as well as Professor and Director of the General Practice and Primary Health Care Research Unit, School of Medicine, The University of Notre Dame Australia, Fremantle. He was Lead Investigator on NHMRC Partnership Grant into ‘Improving the detection and management of familial hypercholesterolaemia in Australian General Practice’ with other research interests in multimorbidity and the primary prevention of cardiovascular disease.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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