Promoting ‘resilience’ is wrong because it normalises bullying

Medical politics

By Tessa Hoffman

1 Mar 2018

Resilience training for junior doctors is a band aid solution that won’t stop workplace bullying in hospitals and may even be unethical, researchers say.

Instead, workplaces need to target senior medical staff with anti-bullying programs and even encourage ‘bystander’ interventions to ensure bullying is not normalised.

This is the message delivered by the authors of a new study that investigated rates of bullying and harassment via a survey of over 800 first and second-year post-graduate doctors working in the NSW and ACT health systems.

More than half of trainees had experienced bullying and nearly one fifth experienced sexual harassment, the survey carried out in 2015 and 2016  revealed. However almost half the victims did not report incidents, often due to fear of reprisal or because they did not believe it was worth it.

The data “confirm a systemic problem of bullying” concluded researchers from the Health Education and Training Institute of NSW in a Australian Health Review article.

In their survey responses, most junior staff said bullying had occurred occasionally (less than monthly) and was perpetrated by a senior medical staff member.

Forty per cent of victims did not report an incident, their reasons including not knowing how to make a report, a belief that reporting would amount to nothing, or being discouraged by other staff.

Of the 60% who did complain, most described ineffective or personally harmful outcomes.

“Many respondents described a workplace culture where they perceived bullying and harassment to be normalised by senior staff”, the authors wrote.

“Complaints were often dismissed or behaviours blamed on the sensitivity of the complainant and/or no further action taken by senior medical staff member after the complaint had been lodged.”

The authors said their findings suggested that many junior medical staff will tolerate bullying or harassment for the sake of perceived job security.

“Recent calls to implement systems that improve resilience in junior doctors withstanding workplace stress could be seen as unethical if not implemented as part of a broader systematic suite of interventions,” they concluded.

The findings showed a need for new approaches, such as better education and training for staff who support, work with or supervise junior doctors, they said.

“Different and multipronged approaches (e.g. raising awareness in senior colleagues and training bystanders to intervene) should be tried and studied,” they recommended.

Professor Michelle Leech, consultant rheumatologist and deputy dean of Monash University, told the limbic one of the biggest barriers to addressing workplace bullying was an “intergenerational gulf” in perceptions of  terms such as “resilience” and “bullying”.

“What I see at the moment is a lot of junior doctors calling for senior doctors to say ‘yes it’s a horrible bullying culture’ and senior doctors saying ‘I can’t see your problem’.”

Professor Leech said junior doctors and medical students  were developing scepticism to the concept of resilience because they felt it was being used an excuse or a copout.

“So what’s not going to work is more senior [staff] calls for resilience. To continue to say ‘toughen up’ is not the answer, it’s going to create a wider gulf.

“I think there is a need for a coming together of those generations and an honest dialogue about ‘what does resilience mean to you? What does resilience mean to me? Let’s agree not to use that word because that word does seem to cause a lot of tension between the generations’.”

Professor Leech said training doctors in by-stander intervention could prove to be a successful strategy in some environments.

Equally important was the role of self-reflection in which doctors at all stages of their careers considered their own capacity to bully others, or be perceived as doing so.

“So if you put it that we’ve got to educate senior doctors, I would also put it that we’ve got to educate junior doctors about self-awareness, how they’re coming across, and own it together across the generations.”

Cardiologist Dr Geoff Toogood told the limbic that he also would like to see the term “resilience” dropped from the debate, because it could be used to blame and shame victims.

The focus must shift to addressing a “culture of fear” prevalent in many hospitals and other medical institutions, said Dr Toogood, who is based at Alfred Health in Melbourne.

“Too many interventions, also for depression and burnout, focus on individuals rather than the system that surrounds the individual,” he said.

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