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      Bullying of Medical Students in Pakistan: A Cross-Sectional Questionnaire Survey

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          Abstract

          Background

          Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country.

          Methodology/Principal Findings

          We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment during their medical education, about 28% of them experiencing it once a month or even more frequently. The overwhelming form of bullying had been verbal abuse (57%), while consultants were the most frequent (46%) perpetrators. Students who were slightly older, males, those who reported that their medical college did not have a policy on bullying or harassment, and those who felt that adequate support was not in place at their medical college for bullied individuals, were significantly more likely to have experienced bullying.

          Conclusion

          Bullying or harassment is faced by quite a large proportion of medical students in Pakistan. The most frequent perpetrators of this bullying are consultants. Adoption of a policy against bullying and harassment by medical colleges, and providing avenues of support for students who have been bullied may help reduce this phenomenon, as the presence of these two was associated with decreased likelihood of students reporting having being bullied.

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          Most cited references21

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          The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching.

          To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum. Semistructured interviews with individual students. One medical school in the United Kingdom. 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame. Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training. Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years. Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.
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            Workplace bullying in NHS community trust: staff questionnaire survey.

            L Quine (1999)
            To determine the prevalence of workplace bullying in an NHS community trust; to examine the association between bullying and occupational health outcomes; and to investigate the relation between support at work and bullying. Questionnaire survey. NHS community trust in the south east of England. Trust employees. Measures included a 20 item inventory of bullying behaviours designed for the study, the job induced stress scale, the hospital anxiety and depression scale, the overall job satisfaction scale, the support at work scale, and the propensity to leave scale. 1100 employees returned questionnaires-a response rate of 70%. 421 (38%) employees reported experiencing one or more types of bullying in the previous year. 460 (42%) had witnessed the bullying of others. When bullying occurred it was most likely to be by a manager. Two thirds of the victims of bullying had tried to take action when the bullying occurred, but most were dissatisfied with the outcome. Staff who had been bullied had significantly lower levels of job satisfaction (mean 10.5 (SD 2. 7) v 12.2 (2.3), P<0.001) and higher levels of job induced stress (mean 22.5 (SD 6.1) v 16.9 (5.8), P<0.001), depression (8% (33) v 1% (7), P<0.001), anxiety (30% (125) v 9% (60), P<0.001), and intention to leave the job (8.5 (2.9) v 7.0 (2.7), P<0.001). Support at work seemed to protect people from some of the damaging effects of bullying. Bullying is a serious problem. Setting up systems for supporting staff and for dealing with interpersonal conflict may have benefits for both employers and staff.
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              Experiences of belittlement and harassment and their correlates among medical students in the United States: longitudinal survey.

              To determine medical students' perceptions of having been harassed or belittled and their correlates, for the purposes of reducing such abuses. Longitudinal survey. 16 nationally representative US medical schools. 2884 students from class of 2003. Experiences of harassment and belittlement at freshman orientation, at entry to wards, and in senior year by other students, by residents or fellows, by preclinical professors, by clinical professors or attendings, or by patients. 2316 students provided data (response rate 80.3%). Among seniors, 42% (581/1387) reported having experienced harassment and 84% (1166/1393) belittlement during medical school. These types of abuse were caused by other students (11% (158/1389) and 32% (443/1390) of students experienced such harassment or belittlement, respectively). Harassment and belittlement was also caused by residents (27% (374/1387) and 71% (993/1393)), preclinical professors (9% (131/1386) and 29% (398/1385)), clinical professors (21% (285/1386) and 63% (878/1390)), and patients (25% (352/1387) and 43% (592/1388)). Only 13% (181/1385) of students classified any of these experiences as severe. Medical students who reported having been harassed or belittled did not differ significantly from those not reporting such experiences by sex, ethnicity, political orientation, or religion. They did differ significantly by chosen specialty and were significantly more likely to be stressed, depressed, and suicidal, to drink alcohol or to binge drink, and to state that their faculty did not care about medical students. They were also significantly less likely to be glad they trained to become a doctor. Most medical students in the United States report having been harassed or belittled during their training. Although few students characterised the harassment or belittlement as severe, poor mental health and low career satisfaction were significantly correlated with these experiences.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2008
                8 December 2008
                : 3
                : 12
                : e3889
                Affiliations
                [1 ]Department of Psychiatry, Aga Khan University, Karachi, Pakistan
                [2 ]Department of Psychiatry, Services Institute of Health Sciences, Lahore, Pakistan
                [3 ]Department of Medicine, Aga Khan University, Karachi, Pakistan
                [4 ]Aga Khan University Medical College, Karachi, Pakistan
                Aga Khan University, Pakistan
                Author notes

                Conceived and designed the experiments: SA AWY. Performed the experiments: SA AWY NB SA AKS AI. Analyzed the data: SA AWY. Contributed reagents/materials/analysis tools: SA AWY NB SA AKS AI. Wrote the paper: SA AWY NB SA AKS AI.

                Article
                08-PONE-RA-06727R1
                10.1371/journal.pone.0003889
                2586648
                19060948
                940c3b1a-91e7-4c79-8f43-07e3ea510fa6
                Ahmer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 6 October 2008
                : 14 November 2008
                Page count
                Pages: 4
                Categories
                Research Article
                Mental Health
                Public Health and Epidemiology
                Public Health and Epidemiology/Occupational and Industrial Medicine

                Uncategorized
                Uncategorized

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