A quarter of newly qualified doctors are subjected to persistent and serious bullying, a recent survey in the BMJ has found.

Researchers at the London Deanery conducted a cross sectional questionnaire of doctors in training in London using electronic survey units and then by postal questionnaire.

They found that 25% of preregistration house officers reported that they had been subjected to persistent behaviour by others that eroded their self confidence or self esteem compared with 14% of specialist registrars and 20% of senior house officers.

Consultants were found to be the main source of bullying reported by all grades (27%). However, 42% of preregistration house officers reported that other trainees were the main source of bullying.

The authors say that workplace bullying can lead to stress, depression, and intention to leave. It is an important issue for the health service because of its potential impact on staff health, retention, and patient care.

Elisabeth Paice, London Deanery director and one of authors said, “Medicine has a hierarchical structure that gives people power over each other and that is an environment prone to bullying. Also, medicine is stressful by nature and mistakes can cost lives, so people are not as kind to each other in picking up mistakes as they could be.”

Dr Paice also says that it may be hard for supervisors to find a way of giving negative feedback that is not undermining: “Many consultants learned how to teach or supervise from senior doctors whom they respected but who taught them in a way that we would now call teaching by humiliation.

“Everyone needs help in learning how to be a good boss without undermining junior colleagues. And junior colleagues also need to learn how to accept constructive objective criticism and learn from it. That’s why I think an educational rather than a punitive approach is likely to be better and in two trusts where they did this after getting their results of the survey a repeat survey showed a significant drop in the prevalence [of bullying].”

Jenny Firth-Cozens, a psychologist and another author agrees: “Education with bullies does work—in Sweden it was the school bullies who were worked with rather than the victims, and this worked well. Punishing only perpetuates the culture—people do learn by punishment but not as effectively as other ways.”


Ahmed Magdy, BMJ akassem@bmj.com

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