The impact of bullying and harassment on the mental health of junior doctors in the UK: a qualitative study Sian Thompson (1522990), Ruth Riley (Primary Supervisor)

• Doctors under increased pressure à increased Design: Exploratory qualitative study in the UK. risk of mental health problems – bullying & Pilot: Questions trialled on a foundation doctor in the NHS so to develop a flexible topic guide. harassment influence this. Participants: Current NHS junior doctors who have experienced/witnessed bullying or harassment. • Bullying & harassment = behaviour that makes Recruitment: Advertising posters on Twitter, Facebook, and junior doctor Facebook groups. someone feel intimidated or offended. Sampling: A convenience sample was used due to issues with recruitment. • 20-40% doctors = bullied in the last 12 months. Data collection: Semi-structured interviews, face-to-face or via telephone – audio-recorded. • Bullying & poor mental health = linked Analysis: Thematic analysis using the 6-step method outlined by Braun and Clarke. repeatedly à increasing anxiety & depression, Validation: Respondent validation was undertaken – feedback was given by 6 participants. decreasing self-esteem & job confidence à lull in junior doctor morale. Total N=9 • Negative effects on patient care & the NHS as a Gender Age N(%) Age Gender N(%) Specialties: whole - bullying costs the NHS ~£13 billion/year. Vc25 or younger 1 (11.1) Male 5 (55.6) • A&E 26-30 3 (33.3) Female 4 (44.4) • C31 or older 5 (55.6) Year graduated CTF • To explore experiences of bullying & harassment Ethnicity 2017 or later 3 (33.3) • Surgery c Ethnicity Year graduated of UK junior doctors, & to understand the mental White British 7 (77.8) 2014-2016 2 (22.2) • Anaesthetics impact of these incidents. VMR – Caribbean 1 (11.1) 2011-2013 2 (22.2) • Obs & Gynae • To explore experiences of reporting or not MR – Latin 1 (11.1) 2010 or earlier 1 (11.1) • Psychiatry reporting incidents. VxAmerican Missing data 1 (11.1) • Medicine

“She made quite undermining “I suppose it affected my X “…it was just a bit toxic “…so this on top of comments to her and her confidence. It makes you question on the wards to be everything else just X kind of skills.” – P2 if it’s you, […] you start to wonder if honest with you.” – P6 made me dread going it’s something you’ve done.” – P9 into work.” – P6 X Undermining and humiliation Confidence and shame X Stress of job Depression Anger Bullying reputation X “It was just really Resilience “…I don’t get embarrassing, ‘cause upset I get more “…and with experience I Xx he shouted at me in like, ‘oh that’s “There is one have learnt how to deal front of all the people really annoying’.” consultant who has a with difficult nursing staff that I work with like – P3 bit of a reputation in Bullying Mental […] and […] difficult every day.” – P3 X my hospital.” – P4 acts impact consultants.” – P5

“…he’s abusing his position of power to achieve Abuse of Barriers to “It’s kind of seen as part of the job, […] it would whatever his own personal ends are.” – P1 power reporting kind of be a case of […] grow a pair…” – P4 “I spoke to the X “The support has “…cultures of “It’s a really The medical Culture of foundation been very good, now, bullying and difficult one Personal X Age hierarchy tolerance programme part of the reason I harassment that’s to tell other reluctance director who just think that, is that I’m Bullies as victims how they get set up, people […] X Eased with said, ‘oh you a bit older…” – P1 people learn these almost cause Vulnerabilities abnormal there’s support know […] he X doesn’t really behaviours, […] shame in it.” “I know a lot of people who have “I just think that if there’s mean it, he nobody realises – P8 been in that situation who have X anything that makes doesn’t mean to they’ve crossed that largely relied on just having a people different then come across in line, but then they supportive colleague who they they can be bullied.” – P2 that way’.” – P9 have.” – P7 really liked.” – P7

Discussion Key points and in the future Strengths • There is a culture of workplace bullying that • Small undermining events often add up - this • First UK study to research this specific topic. occurs as people treat others as they were. humiliation must not be overlooked anymore. • Pre-determined aims were achieved. • Shame à lack of self/job confidence à affects • There is a cycle of doctors treating younger • Good representation of gender & grades. work behaviours and patients. trainees poorly, abusing their power. • Wide geographical representation. • Depression, anxiety, & anger also result. • Issues with shame & confidence can go on to • Any trait that is outside of the usual medical affect not just the individual, but all work Limitations mould can increase one’s vulnerability. aspects, including patients & the NHS. • Predominantly White British participants – • Incidents are not reported enough, due to • The reporting process is difficult, especially if could affect generalisability. personal and staff reluctance. support is insufficient. • Self-selecting participants = those most affected • Senior back-up eases the pathway to reporting. • More support is needed = awareness is needed. may feel unable to speak out about topic. • Doctors should be empowered. I would like to thank my supervisor, Ruth Riley, as well as my two secondary supervisors, Anya Gopfert and Maria Vanhove for their help in developing the project; I would also like to thank all of the participants for giving up their time to take part in the interviews and respondent validation.