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Exploring Medical Students' Perceptions and Experiences of Bullying Amongst Hospital-Based Doctors

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Exploring Medical Students’ Perceptions and Experiences of Bullying Amongst Hospital-Based Doctors Caroline Lambert ORCID: orcid.org/0000-0002-5442-711X Submitted in total fulfilment of the requirements of the degree of Doctor of Philosophy October 2017 Department of Social Work School of Health Sciences Faculty of Medicine, Dentistry & Health Sciences The University of Melbourne Abstract Historically, in Australia, the topic of bullying amongst doctors has been investigated sporadically. This has recently changed with an increase in research being conducted. However, the focus of this research is often on measuring and establishing the prevalence and impact of bullying in medicine, and is sometimes limited to a specialty, such as surgery, or a particular behaviour such as academic humiliation. Furthermore, both nationally and internationally, the settings for many investigations are educational rather than practice ones. Much research on medical students, and abrasive, bullying behaviours, focuses on gauging prevalence and impact, and often labels these behaviours as something other than bullying. To date, medical student perceptions and experiences of these bullying behaviours amongst hospital-based doctors have been overlooked. The aim of this study was to extend the current understanding of medical students’ perceptions and experiences of workplace bullying amongst hospital-based doctors. To achieve this aim, the research centred on three core questions, asking how medical students perceived and experienced bullying amongst hospital-based doctors, and how power and oppression dynamics might contribute, or extend, the current discourse on bullying and medical student insights and experiences. The sample targeted in the research were medical students who attended one of the medical schools in the State of Victoria, Australia. The participants did not necessarily need to identify as having experienced or witnessed bullying, rather recruitment was based on having insights on hostile or abrasive behaviours amongst hospital-based doctors, therefore based on having some clinical experience within a hospital setting. The research design was qualitative in nature. Sixteen medical students participated in semi-structured interviews. The findings of this study provide an expanded understanding of how medical students perceive and experience bullying amongst hospital-based doctors. New knowledge identifies that using theories, and an associated language of oppression, may assist in understanding further why some medical students report using criteria to define bullying behaviours that is different from that found in policies or legislation. In addition, these theories may explain why medical students will not report bullying behaviours even if they have experienced or witnessed the negative impact of it. Models i of oppression can also assist in illuminating why some medical students suggested that bullying behaviours amongst doctors were inevitable or even, at times, reasonable. The individualistic focus of existing studies was also identified as a key issue. Medical students’ inability to explain contextual factors. and dynamics inherent to much bullying amongst doctors was also noted. This study has generated a number of implications for medical education and further research, including the observation that disciplines outside medicine may have unique potential for powerful contributions to the current conversation. The research confirms the complexity of the issue, and establishes the need to keep the subject of workplace bullying amongst doctors firmly on the agenda. ii Declaration This is to certify that: i. the thesis comprises only my original work toward the PhD ii. due acknowledgment has been made in the text to all other material used iii. the thesis is less than 100,000 words in length, exclusive of tables, maps, bibliographies and appendices. Signed: Caroline Lambert iii Preface Professional editors Dr Haydie Gooder & Dr Gillian Dite provided reference proofreading and document formatting services according to standards D and E of the Australian Standards for Editing Practice and the Guidelines for Editing Research Theses from the Institute of Professional Editors. iv Acknowledgments Thank you to the University of Melbourne, the Department of Social Work, and my very favourite supervisors Professor Lou Harms and Dr David Rose. Lou, you are the very embodiment of all that is virtuous in academic supervision, and I am eternally grateful for your wisdom, patience and professionalism. Thank you to Professor Lynn Gillam and Professor Geoff McColl for your invaluable input. Thank you to the contributions and conversations of the medical students who were courageous enough to share their stories with me. Without your generosity, giving both your time and insights, there would be no research. To my beautiful boys, James and Gilbert, this is actual proof that anyone can do anything - when they don’t give up. Andrew, I am enormously grateful for your never- ending support in my never-ending quest to know more. This thesis has been made possible, due to the superb support of a ratbaggery of animals, Possy, Boots, Leonard and Lily. Finally, much gratitude to Mum and Dad, for having such a lovely, unwavering faith in my ability. It’s finally done. v Table of contents Abstract ............................................................................................................................. i Declaration ...................................................................................................................... iii Preface ............................................................................................................................. iv Acknowledgments ........................................................................................................... v List of figures .................................................................................................................. xi List of tables ................................................................................................................... xii Chapter 1. The perfect storm: A convergence of elements, creating a context ripe for investigation ....................................................................................................... 1 1.1. Fundamental elements of the research ....................................................................... 3 Research aim ............................................................................................................ 3 Research aim and researcher reflexivity .................................................................. 3 Key areas investigated ............................................................................................. 4 Research questions................................................................................................... 7 Research overview ................................................................................................... 7 1.2. Medical students......................................................................................................... 7 Medical hierarchy in Victoria .................................................................................. 9 1.3. Outline of the thesis ................................................................................................. 10 Part one .................................................................................................................. 10 Part two .................................................................................................................. 11 Chapter 2. What is workplace bullying? ..................................................................... 12 2.1. The tension of subjectivity and objectivity .............................................................. 12 2.2. Core criteria for workplace bullying ........................................................................ 15 Negative impact ..................................................................................................... 16 Repeated behaviours .............................................................................................. 16 Duration and systematic ........................................................................................ 18 Power differential .................................................................................................. 18 Targets of bullying label themselves as having been bullied................................. 19 2.3. Why is it important to define the term ‘bullying’? .................................................. 19 2.4. Prevalence of workplace bullying ............................................................................ 20 Bullying in healthcare ............................................................................................ 21 Bullying in the education sector ............................................................................ 25 vi Bullying within the legal system ........................................................................... 27 2.5. Consequences of workplace bullying ...................................................................... 28 Negative individual effects of workplace bullying ................................................ 28 Organisational effects of workplace bullying ........................................................ 30 Impact of workplace bullying on the medical profession .....................................
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