Resident intimidation—a form of bullying—is too common, and it is corrosive everywhere it spreads. A learning module created especially for medical residents explains how they can effectively deal with intimidation and mistreatment and avoid bullying behavior of their own.
In addition to adversely affecting patient safety and fruitful communication, “intimidation also can severely impact a resident’s emotional state,” according to the module. That can play out as a decrease in professional satisfaction, anger and less eagerness to work.
A 14-minute module from the AMA takes a point-by-point approach to explaining intimidation and mistreatment in training, and offers step-by-step advice on how to deal with it. “Resident Intimidation” is one of the AMA GME Competency Education Program offerings, which include dozens of courses that residents can access online, on their own schedule. The modules are available to residency institutions that have subscribed to the AMA’s program.
Among the program’s experts are several who contributed to the AMA’s Health Systems Science textbook, which draws insights from faculty at medical schools that are part of the Association’s Accelerating Change in Medical Education Consortium.
Modules cover five of the six topics—patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice—within the Accreditation Council for Graduate Medical Education’s core competency requirements. The sixth requirement, medical knowledge, is one that is typically addressed during clinical education.
Four things to know about bullying
Once finished with the module, a medical resident will be confidently equipped to do the following.
Define resident mistreatment and resident intimidation. The recommended responses to the two may be essentially the same, but the module points out that intimidation occurs “when someone in a position of authority uses that position to make someone do something he or she wouldn't normally do.” Mistreatment comes from other sources and the module provides examples, such as resident peers or nurses. The module also offers a short course in constructive criticism and how it differs from intimidation.
List the different forms of resident mistreatment and intimidation. There are four distinct types of intimidation, ranging from old-as-time physical intimidation to that insidious contemporary iteration: cyberbullying. The module provides general guidance on recognizing intimidation of each type, as well as commentary that relates more specifically to medical training.
Respond appropriately and professionally to mistreatment and intimidation. The module provides a comprehensive list of what to do in the moment. The course also tackles what for many residents is intimidating in its own right—how to report behavior to the proper authorities. It describes the “stepwise” approach to take the reporting up the chain of authority.
Model behaviors to change a culture of mistreatment and intimidation. In two instances, the module features a scenario during which an attending physician inadvertently oversteps the intimidation line in a way that can put a resident in a bind, for example, falsifying logged work hours. Those examples, combined with other course content, provide a comprehensive view of how intimidation should be viewed, avoided and addressed.