Medical student perceptions and experiences of incivility: a qualitative study.

BACKGROUND: Incivility is rude, dismissive or aggressive behaviour in the workplace. Rates of incivility are increasing in healthcare settings, with minority groups at greatest risk. Medical students are particularly vulnerable to incivility whilst on clinical placements, with detrimental consequences on students' learning and mental health. Therefore, this study explored the perceptions and experiences of incivility from healthcare workers amongst medical students. METHODS: An online qualitative questionnaire study employing a thematic analysis. Students in years 3-5 or intercalating at a large West Midlands medical school were recruited between May-June 2022. Qualitative free-text questions explored students' experiences of incivility from healthcare workers over the past 12 months, and actions in response to incivility. Data were analysed using thematic analysis. All researchers agreed thematic saturation was reached at 50 responses, with all year-groups represented. RESULTS: Five core themes were identified: abuse of hierarchy; exclusion; discrimination; response to incivility; barriers to action. Participants reported a range of uncivil behaviour from staff, including mocking, exclusion and discrimination. Discriminatory incivility targeted students' protected characteristics, including race, sex, sexual orientation and disability. In response to experiencing or witnessing incivility, participants varied in their preferred mode of action. Many viewed formal escalation to senior staff as favourable action. Meanwhile, other participants would not escalate concerns and instead respond with peer support or allyship. Marked barriers prevented students from challenging or reporting incivility, including a lack of confidence; failures and fears of reporting systems; and perceived severity of abuse. CONCLUSION: Our findings identify the extensive incivility experienced by medical students on clinical placements, which is frequently perpetuated by abusive workplace hierarchy. Whilst students recognise the importance of reporting uncivil behaviours, barriers to reporting include unrecognised incivility, psychological consequences and failed reporting systems. In order to reform toxic educational environments, we recommend medical schools to integrate formal civility training into the curriculum and restructure accessible, supportive reporting systems.

Fifteen-minute consultation: Recognising and addressing rude, undermining and bullying behaviour.

We set ourselves very high standards at work and when there is a sense that somehow we have failed, we are left feeling disappointed and frustrated. We all set very high standards for ourselves. When those feelings are exacerbated by the embarrassment of a public dressing down, especially if there isn't an opportunity to explain just how difficult the situation had been, we are left feeling angry and let down. Most of us learn how a bully behaves in the playground or at nursery school-and yet, when it happens as an adult at work we often fail to realise what is happening. Harassment or undermining behaviour can be more challenging to identify because it isn't always obvious and can happen without colleagues being aware. Sometimes, it isn't even apparent to those who experience it, until an event means the problem becomes overwhelming. In fact, many people who experience undermining at work perceive the problem as their own and this can have a far more insidious impact on well-being, professional performance and mental health.

A cross-sectional audit of the risk of burnout among senior medical staff in a UK district general hospital.

OBJECTIVE: The objective was to assess burnout in senior hospital doctors (consultants and staff grade, associate specialist and specialty (SAS) doctors) within a UK-based NHS district general hospital (DGH). METHOD: A web-based survey was created using the validated abbreviated Maslach Burnout Inventory (aMBI) with consultants and SAS doctors in a DGH. PRIMARY AND SECONDARY OUTCOME MEASURES: We measured scores on aMBI subscales: depersonalisation, emotional exhaustion, personal accomplishment and efficacy. RESULTS: One-hundred and seventy-eight senior clinicians (60% of consultant and SAS doctors) completed the survey with 85% of these being substantive consultants. Forty-nine per cent of senior clinicians were found to be at high risk of burnout using metrics from the aMBI. CONCLUSIONS: Burnout is prevalent among senior clinicians at this DGH.

Maintaining compassion and preventing compassion fatigue: a practical guide.

Compassion is innate in us as human beings. Compassion can be defined as a deep awareness of the suffering of another individual, coupled with the wish to relieve it. It has been increasingly topical, recently, in situations where an apparent breathtaking absence of compassion has allowed great harm to come to patients. So, how do we sustain compassion and prevent this loss? Central to our ability to maintain compassion is how we look after ourselves and those in our teams.