Abstract | | |
Introduction: of bullying are common in field of medicine. However, the extent of this problem remains unknown. Bullying among students and professionals has been studied in developed countries, but has received limited, practically, no attention in India. This study was thus planned with an aim to know the prevalence and the perceptions of bullying by the post-graduate dental college students of Andhra Pradesh, India. Objectives: This study aimed to find out bullying practices experienced by the students and the sources of bullying. To assess the extent of reporting of bullying faced at the workplace. Materials and Methods: A descriptive cross sectional study was conducted among post-graduate students of five randomly selected dental colleges of A.P. The students, belonging to 2, 3 years of the course were approached to fill in a self-administered questionnaire to record details regarding bullying practices, sources of bullying and the extent of reporting to the respective authorities. Results: A total of 156 post-graduates participated in the study. Bullying was experienced by 79% of them during their training. Pressure to overwork (69.9%) and threat to professional status (60.3%) were the most prevalent forms of bullying. Main source for bullying was the department staff (89.1%) followed by administrative staff (16%). Only 34% of prevalent bullying was being reported to authorities and no anti bullying policies and measures are in vogue at present in the dental colleges. Conclusions: The prevalence of bullying is high and it acts as a chief stress or among the post-graduate dental students. Keywords: Bullying, perceptions, post-graduate students
How to cite this article: Lahari A, Fareed N, Shanthi M, Sudhir K M, Kumar RK. Bullying perceptions among post-graduate dental students of Andhra Pradesh, India. J Educ Ethics Dent 2012;2:20-4 |
How to cite this URL: Lahari A, Fareed N, Shanthi M, Sudhir K M, Kumar RK. Bullying perceptions among post-graduate dental students of Andhra Pradesh, India. J Educ Ethics Dent [serial online] 2012 [cited 2024 Mar 28];2:20-4. Available from: https://www.jeed.in/text.asp?2012/2/1/20/115143 |
Introduction | | |
Stress appears to be an unavoidable and common aspect of daily life. It may have positive aspects that some individuals may feel challenged and may be able to raise productivity and standard to meet increasing demands. [1],[2] However, among students, work related stress, and anxiety have been shown to lead to a low morale and poorer work performance and to adversely affect the quality of work delivered. [1],[3],[4] Research has shown that perceived mistreatment is viewed by medical students as a major source of stress. [5],[6]
A number of studies have shown that one specific stressor, work place bullying, is frequently experienced by students and leads to depression and anxiety, sickness absence, and intention to leave. [2],[6],[7]
Bullying can be defined as "persistent, offensive, abusive, intimidating, malicious or insulting behavior, abuse of power or unfair penal sanctions, which makes the recipients feel upset, threatened, humiliated or vulnerable and undermines their self-confidence and may cause them to suffer stress." [8],[9] Bullying may also be known as mobbing, abuse, work place aggression, horizontal or lateral violence, victimization and social undermining. Bullying is usually seen as acts or verbal comments that could "mentally" hurt or isolate a person in the work place.
In the case of doctors in training, it may impact on their learning and their ability to deliver patient care. Some bullying behaviors may be motivated by a desire to improve performance, but the impact on recipients is likely to have the opposite effect. A trainee who feels humiliated and under mined by a senior will not find it easy to ask questions or to seek support from him or her. [10] Persistent destructive criticism, sarcastic comments and humiliation in front of colleagues will cause all but the most resilient of trainees to lose confidence in them. [10]
So why does it happen? Health-care is stressful. Dealing with death, disease, and suffering is emotionally draining, and can lead to early burnout. Demands exceed capacity, and medical practice is unforgiving of human error or "off days." Doctors who feel burnt out and alienated may take their disaffection out on junior colleagues, leading to a climate of anger and disillusionment. [10],[11] Stress, burnout, and overload are factors in the under performance, and bullying is one manifestation of this poor performance. [12]
Harassment at places that necessitate an unavoidable social interface has always been considered more of a civilization outcome than an adverse and abominable human behavioral pattern. Some forms of bullying are more insidious such as threats over references. [13] Part of the problem is that progress in the medical profession still works on a system of patronage and word of mouth. [13]
In a hierarchical profession like medicine, medical students lie at the bottom of the hierarchy. [7] Various studies from around the world have shown that medical students suffer high levels of mistreatment or bullying during training, which increases with progression through medical school, spilling over into early training years. [8],[13],[14],[15]
The extent of this problem remains unknown in Indian health system as bullying among students and professionals has been studied only in developed countries and has received limited, if any, attention in India and other developing countries.
In this context, our study was planned with the aim of assessing bullying perceptions among post-graduate dental students of Andhra Pradesh, India. The objectives were to identify potential bullying sources and the extent of bullying being reported to the authorities in the colleges. Additional objective of the study was to suggest remedial measures to counteract bullying based on the above findings.
Materials and Methods | | |
A descriptive cross-sectional study was designed to assess the perceptions of bullying among post-graduate students of Andhra Pradesh. Data regarding the list of number of dental colleges offering post-graduation course and the total number of students pursuing them was collected from the N.T.R. University of Health Sciences manual. Five dental colleges were included for the study.
The Ethical approval for the study was granted by Institutional ethics committee, Narayana Dental College and Hospital, Nellore, A.P. Consent was obtained from study participants before the administration of the questionnaire.
Students pursuing 2 and 3 year of post-graduation were included in the study. The students belonging to 1 year of the course were excluded from the study as their exposure to the department settings was very short (2 months) at the beginning of study during June and July 2011.
A self-administered questionnaire was used as study instrument. The questionnaire consisted of two parts. Part one consists of basic demographic data of the subjects. This was followed by a stem question that had previously been used by Hicks: [16] "In this post, have you been subjected to persistent behaviors by others which have eroded your professional confidence or self-esteem?" Respondents who replied in the affirmative to this question were asked about the different types of bullying behaviors they had experienced, through the use of a previously validated list of 20 such behaviors adopted from modified bullying survey questionnaire by Quine, 1999. [17] The questionnaire assesses bullying under five categories viz. Threat to professional status, threat to personal standing, pressure to overwork, destabilization, and Isolation. The questions pertaining to identifying potential sources of bullying and the extent of reporting bullying to the concerned authorities were included in the second part of the questionnaire. The questionnaire was pilot tested to standardize the methods. Necessary modifications were made to suit the Indian scenario.
The post-graduate students were approached after their working hours in their respective colleges and were requested to participate in the study.
All the relevant tests were carried out using the SPSS software, version 17.
Results | | |
Total number of post-graduate students approached in the respective colleges was 196 students, of which 156 (N) agreed to participate accounting for response rate of 81%. The mean age of the sample was 27.4 years with 54% were male. The highest representation of post-graduates was from the Department of Oral Medicine (n = 22). Lowest representation was from the Department of Oral Pathology (n = 12) [Table 1]. The post-graduates in the 2 year of study was 49% (n = 77) and 51% (n = 79) were in the final year of the course.
Overall prevalence of perceived bullying was 79%. [Table 2] shows the proportion of students reporting each type and category of bullying. The most commonly encountered bullying phenomenon was "Pressure to Overwork" (69.9%) followed by "Threat to Professional status" (60.3%) The least experienced phenomenon was "destabilization" (9%). | Table 2: Proportion of respondents who reported the occurrence of each category of bullying (n=156)
Click here to view |
Department staff was the chief source of bullying accounting for 89.1%. [Table 3] presents the details pertaining to the sources of bullying. The other potential sources identified for bullying, were the administrative staff (16%) followed by other trainees/colleagues (12%).
The percentage of perceived bullying being reported to the respective authorities by victims was 34%. The chief reason for not reporting bullying is the fact being "afraid of consequences that may follow" as implied by 35.9% of the students. One more constraint for not reporting bullying is that the problem encountered was "not perceived to be sufficiently serious" to report by 25% of the students [Table 4]. Bullying of others in the department was witnessed by 79% of the post-graduates during the course of study.
Discussion | | |
Bullying is a kin to an endemic disease that runs across borders and cultures. [18] It is highly prevalent among professional, research and training fields and has been identified as a potential stress or among the students. [15],[17],[18]
The outcomes of bullying have been reported to decrease the ability of students to work and affect them in unpredictable ways. Threat to the personal and professional status is the most alarming of all the outcomes. Doctors in training, like all employees, have the right to be treated with dignity, respect, and consideration. They should not be subjected to behaviors that undermine their self-confidence and professional self-esteem. Not only is such behavior stressful fort hem, it is bad for retention with in the profession and is unsafe for patients. [10]
The results of the study are to be interpreted with caution as the study is first of its kind among post-graduate Dental students of India. The specialty of Dentistry differs vastly from the prescription based treatment approach of Medical field incurring the patients. The specialty demands technical skills and abilities along with the fair knowledge of subject, to treat the disease concerned. The post-graduate students are under continuous stress to achieve the impeccable standards expected by the trainer's. Approval for his or her technical skill from authority concerned remains judgmental in determining the ability of the student. It provides a scope for the subjective evaluation of the student, paving away for Bullying, and threatening practices at the work place.
The overall prevalence of bullying in our study was 79%, much higher than that reported in the literature. The study results correlate with those of the study conducted by Stebbing et al. [2] in UK among doctors undertaking research. Studies by Quine, in UK have found varying rates of bullying 10.5%, among the Community trust staff [17] and 38%, among junior doctors. [19] Study among medical trainee doctors in India by Bairy KL et al., [13] has reported that about 50% doctors are bullied. Study among junior doctors in Pakistan by Imran et al., [9] reported bullying prevalence rate of 63.8%.
The reason behind the wide variation of findings may be due to the fact that most of the studies were conducted among junior doctors and trainees whose personal encounter with staff and higher authorities would be much lower when compared to that of post-graduate students.
The most frequent perpetrators of bullying were the department staff followed by the administrative staff in the present study. The finding rings a warning bell and it adversely affects the relations of the trainee with the trainer. The only welcoming aspect from the study results is that nurses and patients, who were identified as important bullying sources in the western community and in the study by Imran et al., [9] were not posing a threat in the Indian scenario.
The comments by staff on the failures to meet standard of expected competence are felt as being bullied by the students. The former think they are fair, though firm and the comments are apart of inevitable part of relationship between trainee and a trainer. [18] The accused feels bullied by such behavior that the accuser perceives reasonable. [18],[19] Such disagreements add to dilemma between trainee and the trainer, particularly in a setting like teaching institution.
Another area of concern is the significant under reporting of bullying. Only 34% prevalent bullying is being reported to the respective authorities in the colleges in contrast to the 67% reporting rate as reported by Quine, [17] among junior doctors, UK. Being afraid of the consequences that may follow was the main confounder in reporting bullying. Study by Imran et al., [9] in Pakistan among junior doctors also reported significant under reporting of bullying.
Nevertheless, a consideration of the cultural and traditional norms in India may help to explain the low reporting rate in spite of the high prevalence of bullying found in the study. Right from a very young age, in the majority of Indian households, it is inculcated in a child that authority figures (elders and teachers) are to be obeyed without question. It is a common phrase in Indian households to quote "The little ones are meant to be seen, but not to be heard." A child growing up with these values is likely to consider bullying an acceptable part of relation with elderly individuals, even in professional institutions and is very unlikely to complain when it does occur.
The interpretation of these findings should be done cautiously as the study relied on self-reports of bullying. However, Mac Pherson stated that "if a person feels bullied then they are being bullied." [9],[20] Unfortunately, victims of bullying may themselves go on to harass others when they themselves become seniors, thus continuing the vicious cycle of abuse.It is believed that medical students learn not only medicine but also behavior patterns of their seniors and mentors, the so-called "hidden curriculum of medical education." [7]
It is therefore extremely important for bullying to be recognized and dealt with in order to avoid adverse consequences in the health-care education system. "He who passively accepts evil is as much involved in it as he who helps to perpetrate it"-Martin Luther King. Authorities need to be more proactive in preventing bullying practices and offer support to victims in non-threatening ways so as to encourage the reporting of bullying behaviors. Support at work to the victims has been found to be protective against the damaging effects of bullying. Therefore, development of clear policies regarding prevention of bullying may be one way forward.
Conclusions | | |
An alarming rate of bullying is prevalent among post-graduate dental students. Staffs in the departments were regarded as the potential bullying source. There is a significant under reporting of the prevalent bullying phenomenon. There are no anti-bullying policies in vogue in the majority of dental institutions and even if they do exist, the dissemination of information about the policy and it simple mentation are questionable.
Recommendations
It is high time now to show zero tolerance and say no to bullying. The problem of bullying should be stopped at the grass root level in the institutional settings. A few measures to combat the issue are suggested.
The starting point could be the acknowledging existence of the problem. Development, dissemination and implementation of anti-bullying policies are to be encouraged. Informative sessions at the administrative levels could be used to increase the awareness of bullying as an organizational problem. Provision of support and helping to the victims in terms of dispute resolution can be a step forward. Involvement of the students in the bullying preventive programs can make the program more effective. Developing role models, both among trainees and the trainers would also be helpful in this regard.
References | | |
1. | Newbury-Birch D, Kamali F. Psychological stress, anxiety, depression, job satisfaction, and personality characteristics in preregistration house officers. Postgrad Med J 2001;77:109-11. [PUBMED] |
2. | Stebbing J, Mandalia S, Portsmouth S, Leonard P, Crane J, Bower M, et al. A questionnaire survey of stress and bullying in doctors undertaking research. Postgrad Med J 2004;80:93-6. [PUBMED] |
3. | Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: Results from the women physicians' health study. society of general internal medicine career satisfaction study group. Arch Intern Med 1999;159:1417-26. [PUBMED] |
4. | Firth-Cozens J, Mowbray D. Leadership and the quality of care. Qual Health Care 2001;10:Suppl ii, 3-7. |
5. | Ahmer S, Yousafzai AW, Bhutto N, Alam S, Sarangzai AK, Iqbal A. Bullying of medical students in Pakistan: A cross-sectional questionnaire survey. PLoS One 2008;3:335-339. |
6. | Daugherty SR, Baldwin DC Jr, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: A national survey of working conditions. JAMA 1998;279:1194-9. [PUBMED] |
7. | Hsu K, Marshall V. Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows. Am J Psychiatry 1987;144:1561-6. [PUBMED] |
8. | Lyons R, Tivey H, Ball C. Bullying at work: How to tackle it. A guide for MSF representatives and members. London: MSF; 1995. |
9. | Imran N, Jawaid M, Haider II, Masood Z. Bullying of junior doctors in Pakistan: A cross-sectional survey. Singapore Med J 2010;51:592-5. [PUBMED] |
10. | Paice E, Smith D. Bullying of trainee doctors is patient safety issue. Clin Teach 2009;6:13-7. |
11. | Paice E, Moss F, Heard S, Winder B, McManus IC. The relationship between pre-registration house officers and their consultants. Med Educ 2002;36:26-34. [PUBMED] |
12. | Paice E, Rutter H, Wetherell M, Winder B, McManus IC. Stressful incidents, stress and coping strategies in the pre-registration house officer year. Med Educ 2002;36:56-65. [PUBMED] |
13. | Lone R, Lone A. Work place bullying among junior doctors in Kashmir-A questionnaire survey. Middle East J Fam Med 2009;7:22-4. |
14. | Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med 1998;73:1149-58. [PUBMED] |
15. | Bjorkqvist K, Osterman K, HjeltBack M. Aggression among university employees. Aggress Behav 1994;20:17384. |
16. | Hicks B. Time to stop bullying and intimidation. Hosp Med 2000;61:428-31. [PUBMED] |
17. | Quine L. Workplace bullying in NHS community trust: Staff questionnaire survey. BMJ 1999;318:228-32. [PUBMED] |
18. | Bairy KL, Thirumalaikolundusubramanian P, Sivagnanam G, Saraswathi S, Sachidananda A, Shalini A. Bullying among trainee doctors in Southern India: A questionnaire study. J Postgrad Med 2007;53:87-90. [PUBMED] |
19. | Quine L. Workplace bullying in junior doctors: Questionnaire survey. BMJ 2002;324:878-9. [PUBMED] |
20. | Stephen Lawrence. Inquiry. Report of an enquiry by Sir William Mac Pherson of Cluny. London: Stationary Office; 1999. |
Correspondence Address: ASR Lahari Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore - 524 002, Andhra Pradesh India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0974-7761.115143
[Table 1], [Table 2], [Table 3], [Table 4] |