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Pei KY, Hafler J, Alseidi A, Slade MD, Klingensmith M, Cochran A. National Assessment of Workplace Bullying Among Academic Surgeons in the US. JAMA Surg. 2020;155(6):524–526. doi:10.1001/jamasurg.2020.0263
Workplace incivility is well known among surgeons; there are stories of instrument throwing, verbal tirades, and sexual harassment.1,2 Fear of humiliation and bullying is strong among medical students,3 and examples of student mistreatment almost invariably involve some surgical anecdote. These stories may reflect a specialty culture of acceptance and a code of silence that facilitate bullying at the workplace.
There is no consensus definition of bullying, but an operational one for this study is “a situation where one or several individuals persistently over a period of time perceive themselves to be on the receiving end of negative actions from one or several persons”4; such interactions usually involve a power differential.5,6 Not all unprofessional conduct involves bullying, and the lack of a practical standard definition has made it difficult to assess its prevalence among surgeons.
Anecdotally, workplace bullying is a common occurrence among surgeons, but little is known about its prevalence and effect. The aim of this study is to assess the prevalence of bullying and barriers to its eradication among US surgeons.
US surgeons from 4 societies (Association for Academic Surgery [n = 2732], Resident and Associate Society of the American College of Surgeons [unknown distribution sample size], Association for Surgical Education [n = 2480], and Society of University Surgeons [n = 1235]) were invited to participate in an anonymous, online survey using the Negative Acts Questionnaire–revised (NAQ-R). The survey consisted of questions about demographics, NAQ-R, and institutional policies and perceptions. The NAQ-R is a validated instrument measuring bullying in diverse workplaces5 that consists of 22 questions about the frequency with which one personally experienced negative acts (listed as observable behaviors) using a Likert-type scale (1 indicates never; 2, now and then; 3, monthly; 4, weekly; 5, daily). In addition, this instrument also asks whether participants have witnessed others being bullied within the last 6 months. Participants are also asked about the source of bullying and barriers to reporting bullying. NAQ-R scores are presented as mean (SD). This study was approved by the institutional review board at Yale School of Medicine and deemed exempt. Participants were provided informed electronic consent. Multivariate logistic regression was used to assess factors associated with bullying. Data were collected from July to August 2018, and analysis began September 2018.
Of 775 respondents, 180 (23.2%) were residents. Most faculty respondents were male (345 [58%]) and from universities (481 [81.0%]); 204 (36%) were professors. The mean (SD) NAQ-R score was 40.3 (17.8) among residents and 34.8 (14.7) among faculty (scores >34 suggest risk of bullying). Female sex was associated with being bullied after adjusting for other participant characteristics (odds ratio, 1.98; 95% CI, 1.45-2.70). A total of 59 residents (39.9%) and 212 faculty (40.0%) reported being bullied, and 83 residents (58.5%) and 283 faculty (54.3%) witnessed bullying. Reasons cited for bullying included stressful work, strict hierarchy, and lack of institutional policy. Barriers to reporting included negative effect on career, reputation, and additional bullying. Eight residents (20.0%) and 38 faculty (24.4%) experienced retaliation after reporting (Table 1), while 83 residents (60.6%) and 242 attending physicians (48.4%) reported no institutional policy against bullying (Table 2). Overall, 118 residents (85.5%) and 411 attending physicians (82%) valued 360° evaluations.
In this study, bullying was reported to be common among participants, and most did not report to leadership fearing negative consequences. Perhaps the most important findings were the lack of reporting and the fear of retaliation. This study is limited by lack of response rate and potential for participant bias. Work remains to be done in this field and will likely take the collaborative efforts of the academic medical community to eradicate surgical workplace bullying.
Corresponding Author: Kevin Y. Pei, MD, MHSEd, Department of Surgery, Houston Methodist Hospital, 6550 Fannin St, Ste SM1661, Houston, TX 77030 (email@example.com).
Accepted for Publication: January 27, 2020.
Published Online: April 1, 2020. doi:10.1001/jamasurg.2020.0263
Author Contributions: Dr Pei had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Pei, Hafler, Alseidi, Klingensmith, Cochran.
Acquisition, analysis, or interpretation of data: Pei, Hafler, Slade, Cochran.
Drafting of the manuscript: Pei, Hafler, Cochran.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Pei, Slade.
Administrative, technical, or material support: Pei, Cochran.
Supervision: Hafler, Alseidi, Klingensmith, Cochran.
Conflict of Interest Disclosures: None reported.
Disclaimer: Dr Cochran is the Web and Social Media Editor of JAMA Surgery, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.
Meeting Presentation: This study was presented at the American College of Surgeons Clinical Congress; October 28, 2019; San Francisco, California.
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