'I Felt Very Small': Confronting The 'Culture Of Bullying' Among Medical Students

On one day during his final year of medical school, Ben Bravery's legs were trembling, his mouth dry, heart racing. 

He was the only student on placement at a medical facility when he came up against his bully -- a senior doctor who asked him, among other questions, to name an artery.

"When I got it wrong, they would overtly roll their eyes, laugh, raise their voice and declare loudly that maybe they needed to email the dean of my medical school to report me as incompetent," Bravery told 10 daily.

"The questioning became even more bizarre. When I wasn't able to keep up, the bully stopped the session saying I reminded them of themselves when they were in medical school, when they 'didn't know anything and didn't care'."

It's an interrogative approach to teaching known by many, but one that can often feed mistreatment from senior doctors to junior doctors, and from junior doctors to medical students.

For students like Bravery, who had a different career before moving into medicine, it's shocking. For others, it is accepted. And it can often go too far.

"I felt myself withdrawing. I felt very small and realised the bully was reducing me; using their power to make me doubt myself and question the very reason I entered medicine in the first place."

Bullying and harassment in the medical profession has become topical in recent weeks after allegations prompted two Colleges to strip two Sydney hospital departments of their accreditation to train junior doctors.

The College of Intensive Care Medicine (CICM) revoked Westmead Hospital, in Sydney's west, of its ICU training credentials over allegations of bullying and harassment against senior medical staff, Fairfax Media revealed.

Days later, it emerged the Royal Australasian College of Surgeons (RACS) withheld training accreditation for Royal Prince Alfred Hospital's cardiothoracic surgery program in 2019.

While these measures will affect junior doctors and patients, they point to an embedded culture of "micro-aggression" that also targets some medical students.

President of the Australian Medical Students Association (AMSA) Alex Farrell said the revelations were upsetting but not surprising.

"It's not a secret, and it's happening nationally," she told 10 daily.

According to a 2015 study of 16,959 medical students across the country, over one third have experienced or witness mistreatment during their education, including  teaching by humiliation, bullying and harassment.

Most common was "belittlement" of a student's competence and capacity to be a good doctor.

Farrell has been shaken by "hundreds" of stories, particularly from women and Indigenous students.

"They face a barrage of sexist comments under the care of doctors -- from being told that they shouldn't do certain specialties because they're unable to, to comments about their physical appearance and sexual harassment," she said.

"Then we have Indigenous medical students being told they don't deserve their spot, or that they have taken it from someone else."

This has an impact on students' mental health.

A beyondblue study in 2013 found 20 percent of doctors and medical students had been diagnosed with depression. Twenty-five percent had contemplated suicide, while one in 50 had attempted it.

"When you are put down and belittled -- particularly when that is being done consistently -- that has a very real impact on your mental well being, particularly when that’s tied to the way you see your medical future," Farrell said.

For Bravery, this ultimately extends to a student or doctor's ability to provide patient care.

"My experience showed me that when you feel attacked, you withdraw and stop trusting others. That is the antithesis to healthcare," he said.

"It's a complex business that is inherently time and resource poor and we need to work together. The minute your team members stop engaging, it becomes dangerous."

'It wouldn't enter my mind to report it'

In recent weeks, *Sarah, a medical student in Sydney, completed a clinical test and received some particularly nasty feedback.

"I was told that I had to go back and learn medicine, and 'what was I thinking'" she told 10 daily.

She only spoke of the incident with a friend -- a mature medical student -- weeks later after feeling ashamed.

"It never occurred to me that it actually wasn't my fault, that it was the system's fault," she said.

Sarah describes the culture as having "a baseline of disdain".  And yet, "it wouldn't enter her mind" to report an incident.

She's not alone. According to the AMSA, only 40 percent of medical students feel comfortable reporting bullying and harassment.

"You're far more vulnerable as a student; the professional risks are too high to report and often there are no consequences for the perpetrator who, in some cases, could be your own supervisor," Farrell said.

"A big part of why this has become so ingrained culturally is the difficulty in reporting and speaking up."

It's one system where the AMSA want to see reform, alongside a response from other Colleges, hospitals and universities following action by RACS and CICM.

"This is one of the first times we have seen a really serious response to bullying ... that the medical community is starting to put its foot down and say enough is enough," Farrell said.

President of the New South Wales Medical Students' Council Liam Mason agreed, saying it sends a "clear message that this type of behaviour is completely unacceptable", but warned recent allegations are the "tip of the iceberg".

"The message that students are seeing come out of this story, and that we’d like organisations to take on, is if you want the right to teach, then your culture matters," continued Farrell.

"If the medical community can really take that on, and we see that internalised by even more Colleges and hospitals,  hopefully we'll see some change."

Contact the author: ebrancatisano@networkten.com.au.

*Sarah is not her real name.