Medical Technology

The issue of bullying is a ‘permanent and important’ issue for cardiology trainees

A high rate of bullying towards UK cardiology trainees by their superiors has been revealed in a new survey. More than 10% of doctors training to be cardiologists in the UK say they have been bullied in the last 4 weeks, and one third report having witnessed bullying on a cardiology rotation, the survey reports.

In addition, 33% of cardiology trainees said they had been on the receiving end of inappropriate behavior, including having their opinions and views ignored, being made to feel worthless/useless, and being shouted at or targeted with spontaneous anger.

Senior doctors (consultants) in cardiology were cited as the main perpetrators of such bullying and inappropriate behavior.

Women trainee cardiologists and those who attended medical school outside the UK were more likely to report having been bullied, suggesting a sexist and racist element.

“In this large and repeated survey of British cardiology trainees, we have shown a persistent and important problem with bullying,” the authors conclude.

Results of the survey from the British Junior Cardiologists’ Association (BJCA), were published online in a paper in Heart on December 6.

Examples of such bullying behavior by consultant cardiologists towards their trainees reported in the survey included being belittled in front of others, having their filing cabinet drawer thrown across the room, use of foul language toward trainees, and using previous mistakes as an excuse to humiliate and ridicule them, lead author of the survey, Christian Fielder Camm, MD, Keble College, Oxford University, told | Medscape Cardiology.

Trainees also reported being made to feel inadequate when struggling to achieve unrealistic tasks and being pressured into not taking holidays and study leave.

Many respondents said they did not report such behavior for fear of repercussions and in some cases because the perpetrators were known for their bullying behavior, and previous attempts to intervene had not resulted in any change.

Camm, who is a cardiology trainee himself, says he has not personally been the victim of bullying, but as secretary of the BJCA he regularly receives reports about it happening.

“We wanted to look at this issue in our survey as we had been hearing anecdotal reports of bullying from cardiology trainees for a number of years,” Camm said. “We wanted to put it out there that this is not just an isolated issue and shine a light on the problem.”

Noting that the UK General Medical Council’s annual survey has found that bullying is seen across all disciplines in medicine, Camm says that cardiology has the highest reported rate of bullying among the medical specialties.

“This is not a new story ― it has been played out throughout history, but things are not magically improving. Over the 4 years of our survey, rates of reported bullying have stayed the same,” he noted. “Our survey is asking more questions about bullying to find more detail on what is happening.”

The current data come from the BJCA annual survey from 2017 to 2020. As part of the survey, trainee cardiologists were asked about direct and indirect experiences of bullying and inappropriate language/behavior in cardiology departments in the preceding 4 weeks.

In all, 2057 responses were received, 73% were from men, and the average age of respondents was 33 years. Over half (59%) were working in a specialist center for cardiology (tertiary referral center), and 94% had a national training number, which guarantees a continued place on a training program, subject to performance.

“This project has upset me to realize what my colleagues are experiencing. This is the working environment we are creating, and it is not good enough,” Camm said.

At present, the bullying behavior is not often reported, he explained. “Usually, the only person to report it to is the senior person in the department, who is frequently the cause of the problem, so most people just put up with it until they move on to their next training rotation. The working environment should not be so difficult,” he said.

The authors note that bullying has been shown to significantly affect trainees, with those subject to bullying being 70% more likely to report serious or potentially serious medical errors, and more likely to take time off work and cease direct patient care.

They stress that addressing bullying of trainees needs to be a priority both to ensure patient safety and to reduce trainee attrition in a time of unprecedented workforce pressures.

Camm believes a national plan needs to be put in place to deal with this issue and says the BJCA is keen to work with British Cardiovascular Society to develop a zero-tolerance policy, with a clear strategy to address allegations of bullying.

“The world is changing. Hopefully this publication will be the start of some change,” he added.

Bullying Culture Is “Endemic”

In an accompanying editorial, consultant cardiologist Resham Baruah, MBBS, PhD, of Chelsea and Westminster Healthcare NHS Trust, London, and independent professional coach Emma Sedgwick say the findings offer a “sobering insight into current practice” and indicate that “a bullying culture is endemic in many UK cardiology departments.”

“These trainee cardiologists are actually quite senior doctors with many years of experience. They work extremely hard. These surveys show that we are not valuing them enough,” Baruah told | Medscape Cardiology.

“Cardiology is a really competitive specialty. There is a lot of pressure. All the way through training the message is competitive,” she said. “Being collegiate and working as a team is not rewarded. We have to rethink this as we train the next generation.”

“We believe that publishing these data acknowledges bullying is not going unnoticed, although this alone is not enough,” the editorialists say.

Noting that labels matter, they propose a rejection of the term “juniors” and a return to the old system of calling colleagues senior house officers, registrars, and senior registrars.

They also propose sanctions for institutions that ignore bullying, but stress that better working conditions for all staff are needed.

“Bullies are usually feeling defensive, overwhelmed, and stressed and take these feelings out on others,” Baruah commented. “I think what we are seeing in this paper is not just restricted to cardiology but happens all though the NHS and is related to workload, lack of autonomy, and burnout. Work culture is crucial to well-being and job satisfaction. Nobody wants to work in a toxic environment.”

She emphasizes that bullying behaviors must not be accepted. “They can have catastrophic consequences for the trainees and for patient safety. While working in high-pressure specialties and emergency situations may foster such behavior, it is vitally important to arm trainees with the recognition of bullying and how to deal with it. They must feel empowered to speak up in an appropriate way.”

The editorialists note that the Royal College of Obstetricians and Gynaecologists responded to high levels of bullying by creating behavior toolkits, workshops, and behavior champions. “This survey should act as a call to arms for cardiology to introduce similar initiatives,” they state.

“While times are changing, the corporate environment has moved forward in encouraging positive workplace behavior faster than is happening in medicine,” Baruah says. “But there is an appetite for change. We have to have an environment where people can speak up.”

The study received no specific funding. The authors report no competing interests.

Heart. Published online December 6, 2021. Full text, Editorial

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