Julie Browne: Why do some clinical supervisors become bullies?

Julie BrowneThe literature on bullying in the medical workplace makes disturbing reading. In the General Medical Council’s 2013 national training survey, 13.2% of respondents said that they had been victims of bullying and harassment in their posts, nearly one in five had seen someone else being bullied or harassed, and over a quarter had experienced “undermining” (unfair or belittling treatment).

These findings were closely echoed in a recent survey of medical students (funded by the Higher Education Funding Council for England) about their work placement experiences. Again, around one in five respondents had personally experienced, or witnessed, bullying and harassment. One comment in Anja Timm’s report of the survey struck me forcibly:

“Medical students . . . often describe being belittled by the clinicians who teach them and they recount observing trainees being bullied by senior doctors. This finding mirrors the GMC’s NTS survey, which found that in 44% of cases, trainees identified their consultant (or general practice (GP) trainer) as the source.”

A single bad clinical supervisor can potentially damage the education and subsequent medical practice of hundreds of trainees. The risk of ensuing harm to patients is incalculable. How can it possibly happen that the very people trusted to teach junior doctors to become effective and principled practitioners, end up abusing and bullying them?

Funnily enough, the literature is rather quiet on this. Beyond a general feeling that perhaps it is something to do with work pressures, corrosive and unsupportive NHS cultures, or perhaps the dismissive idea that some people are just plain bad or mad, there is very little hard evidence.

Yet there are many busy, stressed, and exhausted doctors who don’t bully trainees. What could turn a member of a caring profession into a tyrant? Part of the answer, to my mind, lies in the lack of teacher training available to clinical supervisors. Let me explain.

Early in their careers, all teachers—clinical or otherwise—are forced to face up to some very unpleasant doubts and fears. These inner demons can be devastatingly destructive if allowed to get out of hand.

I confess to having encountered most of them myself. Here are just a few:

• The subtle suspicion that you are not as good as your own teachers were; and that unless you teach and behave the way they did, you must be doing it wrong.
• The worry that if you relax for even a minute your students will learn nothing, cease to respect you, or run riot in some way.
• The fear that you don’t have all the right answers and will let your students down or look ridiculous.
• The uneasy realisation that the students outnumber you.
• The sneaking anxiety that they may actually be cleverer than you are.
• The nervousness that if you show any weakness in front of students, they may tell you something about yourself and your teaching that you don’t want to hear.

You may be able to add some of your own to this list, but I defy any teacher to claim that he or she hasn’t experienced several of these worries at some point. Where responsibility to safeguard patients is added to the teaching mix, the stress potential on the teacher is multiplied many times. To an inexperienced or untrained clinical teacher, students can start to seem like a threat that has to be confronted, rather than junior colleagues anxious to learn.

Inevitably, some supervisors will respond to these stressful and destructive demons by trying to maintain a sense of control in illegitimate and damaging ways: haranguing, lecturing, discouraging challenges and questions, refusing to listen, belittling and undermining learners, and so on. If such teachers lack the skills, attitudes, and strategies to help them cope with the pressures, then bullying is all too likely to follow.

The GMC wants all doctors to be competent teachers. Yet there is still no systematic training or support for the supervising doctors who actually have to do this vitally important work.

As I said in a previous post, medical students are eager to learn and excel, and it is actually surprisingly easy to abuse that; it takes real professional skill to teach them well. Good teacher training helps nervous teachers develop confidence in their own abilities. Above all, it shows them how students can be taught on a basis of mutual respect and trust. To this end, all supervising doctors must have formal training, early in their careers, to develop the fundamental attitudes, skills, and coping strategies of professional teachers.

Julie Browne is currently external relations manager at Wales Deanery. She was previously managing editor of two medical education journals, is co-author of a book on medical education, and she is an elected council member and trustee of the Academy of Medical Educators.

Competing interests: The author has no competing interests to declare.