Academic journal article American Journal of Pharmaceutical Education

Bullying in the Clinical Training of Pharmacy Students

Academic journal article American Journal of Pharmaceutical Education

Bullying in the Clinical Training of Pharmacy Students

Article excerpt


The Centers for Disease Control and Prevention (CDC) now recognizes bullying as a major public health problem and provides support for measuring bullying behaviors. (1) Stories of bullying in schools and juvenile suicide caused by bullying are common in the news, with the latest focus being on cyber bullying. (2,3) Bullying also occurs in the health professions, albeit to an unknown extent. A special concern for those involved in health professions education is bullying as part of clinical training. Behaviors commonly reported by trainees include persistent attempts to belittle, severely criticize, and undermine the work of the trainee or to humiliate the trainee in front of colleagues. (4,5) A seminal reference in this area notes, "The abuse of students is ingrained in medical education, and has shown little amelioration despite numerous publications and righteous declarations by the academic community over the past decade." (6)

Bullying and similar behaviors can have serious, long-term consequences in the workplace. For example, in 2009, a report from the Governance Institute, an advisory group within The Joint Commission, concluded that ... intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and preventable adverse outcomes, increase the cost of care, and cause qualified clinicians and managers to seek new positions in more professional environments." (7)

Patient safety was the focus of a 2003 Institute for Safe Medication Practices (ISMP) survey that investigated whether disrespectful behaviors in the healthcare environment were adversely affecting medication safety. (8) The survey, which received more than 2,000 responses from healthcare providers, found high incidences of "... impatience with questions, reluctance or refusal to answer questions, strong verbal abuse" and many other damaging behaviors. A similar ISMP survey in 2013 tracked the frequency of 13 disrespectful behaviors (4,884 responses) and concluded that little improvement or progress had occurred over the previous 10 years. The 2013 ISMP report concluded that "these behaviors are clearly learned, tolerated, and reinforced in both the healthcare culture and the societal culture." (9) This conclusion is reinforced by a report of persistent abusive behaviors in medical training over a 13-year study period despite efforts toward change. (10) Beyond deleterious effects in the workplace, victims of bullying scored higher for depression and somatic symptoms, and had lower cortisol levels and higher incidences of posttraumatic stress syndrome (PTSD)-like conditions, recurring nightmares, and other harmful personal consequences. (11-13)

A search for statutes governing bullying in an educational environment revealed that such behavior was prohibited by state laws only in grades K-12. Expanding the search to bullying in the workplace found no results in any state. Legislation to prohibit workplace bullying has been introduced in at least 20 state legislatures since 2003, although none of these bills was ever enacted. (14) The only groups of people protected from workplace bullying and harassment are those those protected by the Civil Rights Act of 1964 (ie, bullying based upon race, ethnicity, national origin, religion, or gender) or the Americans with Disabilities Act of 1990 (based upon a disability, actual or perceived). In court cases, attempts have been made to recover damages in lawsuits for intentional infliction of emotional distress, but these cases are difficult to prove in the first place and the maj ority of cases are decided for the defendant in the case. Recent articles in the news media may be the impetus for change as the public becomes more aware that these problems exist in the workplace. (15,16)

We asked whether bullying is a significant factor in the clinical training of pharmacy students. A preliminary PubMed literature search limited to the period 2003 through 2013 and using the combinations of search terms "bullying" and "nurse education," "bullying" and "physician education," and "bullying" and "pharmacist education" yielded 80 publications related to nurse education and 18 publications related to physician education. …

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