Doctors in training have highlighted circumstances where they believe bullying and undermining is more likely to occur in a pivotal new report published by the General Medical Council (GMC).
| Bullying and undermining have no place in medical education and training and we are working on a range of fronts to tackle the problem|
| Professor Terence Stephenson|
The findings come from a representative sample of 12 UK hospitals which the GMC visited. These were chosen because concerns had previously been raised through the GMC’s national survey of doctors in training and for their size, type and geographic location. In many sample sites the issues had been resolved prior to the visit subsequently resulting in examples of good practice.
The review focused on obstetrics and gynaecology, and surgery as these specialities were identified as among those having the most issues with bullying and undermining.
Professor Terence Stephenson, Chair of the GMC Council and a consultant paediatrician, said:
“Bullying and undermining have no place in medical education and training and we are working on a range of fronts to tackle the problem.
“Having been on the frontline of medicine working alongside doctors in training, I am all too aware that this issue is not only bad for doctors, but also for patient safety.”
The GMC is working with clinical and training leaders to ensure doctors in training are able to learn in a supportive and open environment. Where there are requirements and recommendations for change and improvement we will be monitoring the site.
The GMC, which regulates all stages of doctors' training and development, found that a number of factors can contribute to doctors in training feeling bullied or undermined including:
- feeling undervalued by their employers after being overlooked or criticised for their work or lack of knowledge
- being caught in the middle of arguments because of a lack of leadership or cohesion among senior doctors
- a belief that when overworked, senior doctors did not have time to focus on the education and training of doctors in training
- the difficulty in raising concerns to senior doctors. We found some senior doctors were shocked to hear that bullying and undermining was happening at their hospital
During the checks GMC visitors met with doctors in training, senior doctors, management teams and medical education directors to discuss these concerns.
Senior doctors and managers at nearly all the hospitals visited said they were “saddened by the findings and wanted to make sure such behaviour did not take place in future”.
Sites that have established good practices share a number of broad themes that contribute to a positive and safe environment. These are highlighted in the GMC report and include:
Professor Terence Stephenson added:
- doctors in training feel valued and supported
- strong clinical leadership
- effective senior leadership and departmental cohesion
- appropriate time and resources for training with extra staff employed if necessary
- strong communication with doctors in training and acknowledgement of training issues.
“Though doctors are much more likely today to raise concerns about standards of care than they were a generation ago, as the Freedom to Speak Up review has shown, in too many institutions fear and hierarchy still inhibit honest and open reflection. And a system where staff are frightened to raise concerns is not a safe system.
“Sir Anthony Hooper, a former Lord Justice of Appeal, is looking at how we at the GMC deal with doctors who raise concerns in the public interest. Sir Anthony has also liaised with Sir Robert Francis to take into account findings from the Freedom to Speak Up review.
“We are committed to doing all we can to eradicate bullying and undermining in the health system and expect all those working with doctors in training to join us in this. Whatever training stage doctors are at, they deserve to feel that they are working in a safe and supportive environment.”
Following the GMC’s visit, each hospital has been given a report that highlights both good practice and sets out recommendations for improvement. Where improvement is required, the GMC will then monitor the hospital’s progress.
| Whatever training stage doctors are at, they deserve to feel that they are working in a safe and supportive environment|
| Professor Terence Stephenson |
To encourage a supportive working environment for doctors in training, the GMC will include questions in its annual national training survey on how much teams of doctors are valued and supported, and report on them. It is also consulting on whether new standards for undergraduate and postgraduate medical education and training should, for the first time, include an explicit requirement for organisations to provide a supportive training environment.