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Healthcare delivery, economics and global health
Original research
Bullying in UK cardiology: a systemic problem requiring systemic solutions
  1. Christian Fielder Camm1,2,3,
  2. Abhishek Joshi4,
  3. Abigail Moore5,
  4. Hannah C Sinclair6,
  5. Mark Westwood7,8,
  6. John Pierre Greenwood9,10,11,
  7. Alison Calver6,12,
  8. Simon Ray13,14,
  9. Christopher Allen15,16
  1. 1Keble College, Oxford University, Oxford, UK
  2. 2Department of Cardiology, Royal Berkshire NHS Foundation Trust, Reading, UK
  3. 3British Junior Cardiologists Association, London, UK
  4. 4Cardiology Department, Barts Health NHS Trust, London, UK
  5. 5Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  6. 6Cardiology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  7. 7Bart's Heart Centre, St Bartholomew's Hospital, London, UK
  8. 8Vice-Chair, Cardiology Specialist Advisory Committee, London, UK
  9. 9Cardiology Department, Leeds General Infirmary, Leeds, UK
  10. 10Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  11. 11President, British Cardiovascular Society, London, UK
  12. 12Chair, Cardiology Specialist Advisory Committee, London, UK
  13. 13Immediate Past-President, British Cardiovascular Society, London, UK
  14. 14Cardiology Department, Manchester University Hospitals, Manchester, UK
  15. 15Guy's & St Thomas' Hospital, King's College, Rayne Institute, London, UK
  16. 16British Junior Cardiologists' Association, London, UK
  1. Correspondence to Dr Christian Fielder Camm, Keble College, Oxford University, Oxford, OX1 3PG, UK; cfcamm{at}gmail.com

Abstract

Objectives Bullying of trainee doctors has been shown to be associated with detrimental outcomes for both doctors and patients. However, there is limited evidence regarding the level of bullying of trainees within medical specialties.

Methods An annual survey of UK cardiology trainees was conducted through the British Junior Cardiologists’ Association between 2017 and 2020 and asked questions about experiencing and witnessing bullying, and exposure to inappropriate language/behaviour in cardiology departments. Fisher’s exact tests and univariable logistic regression models were used to describe associations between trainee characteristics, and reports of bullying and inappropriate language/behaviour.

Results Of 1358 trainees, bullying was reported by 152 (11%). Women had 55% higher odds of reporting being bullied (OR: 1.55 95% CI (1.08 to 2.21)). Non-UK medical school graduates were substantially more likely to be bullied (European Economic Area (EEA) OR: 2.22 (1.31 to 3.76), non-EEA/UK OR: 3.16 (2.13 to 4.68)) compared with those graduating from UK-based medical schools. Women were more likely than men to report sexist language (14% vs 4%, p<0.001). Non-UK medical school graduates were more likely to experience racist language (UK 1.5%, EEA 6%, other locations 7%, p=0.006). One-third of trainees (33%) reported at least one inappropriate behaviour with 8% reporting being shouted at or targeted with spontaneous anger. Consultants in cardiology (82%) and other specialties (70%) were most commonly implicated by those reporting bullying.

Discussion Bullying and inappropriate language are commonly experienced by cardiology trainees and disproportionately affect women and those who attended non-UK medical schools. Consultants both in cardiology and other specialties are the most commonly reported perpetrators.

  • education
  • medical
  • inservice training
  • quality of healthcare

Data availability statement

Data are available upon reasonable request. Deidentified participant data is available to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement.

https://doi.org/10.1136/heartjnl-2021-319882

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    Data availability statement

    Data are available upon reasonable request. Deidentified participant data is available to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author. To gain access, data requestors will need to sign a data access agreement.

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    Footnotes

    • Contributors CFC, AJ, HCS and CA were involved in the development of the survey and acquisition of survey data. CFC, CA, AC and SR developed the analysis plan. CFC undertook statistical analysis. AM undertook qualitative analysis. All authors were involved in the interpretation of data and results. All authors contributed to the preparation, critical review and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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