Tackling systematic behavioural change across the specialist medical sector: 12-months in

The medical profession has grappled with the pervasive issues of bullying, discrimination, and sexual harassment (BDSH), particularly within medical training. While some strides have been made, recent data and voices of those with lived experiences reveal that the challenges persist.

Recognising the urgency of the matter, the Royal Australasian College of Medical Administrators (RACMA), in collaboration with other medical colleges, has embarked on A Better Culture project. Funded by the Department of Health, this two-year project which commenced in January 2023, aims to instigate systemic and sustained behavioural change across the healthcare sector.

The national findings from the Medical Training Survey, encompassing over 23,000 doctors in training, showed that 35% experienced or witnessed bullying, discrimination, and sexual harassment, with the figures escalating to 54% for Aboriginal and Torres Strait Islander trainees. Disturbingly, the survey revealed that 68% of those experiencing such behaviours did not report the incidents and 75% of those who witnessed it did not report it.

Dr Jillann Farmer, CEO of A Better Culture and former Deputy Director General in Queensland Health, said “I hope for intersectional equity to permeate the way we work, how we interact with one another and how we shape the future of healthcare. We can expect pushback from those who benefit from the current culture, or who struggle to share the vision of what could be better,”

The challenges primarily manifest in hospital environments and specialist clinics, where trainees are employed. Recognising the pivotal role of employers, addressing BDSH requires active involvement from the actual employers, in addition to medical colleges.

Dr Farmer elaborated on the project, stating “A Better Culture is setting up a place where those who are the future can be supported by those of us who are willing to relinquish the past, and move together and purposefully forward to the healthcare system we aspire to.”

The organisation reviewed the policies of 16 medical colleges, of which 14 were identified as having BDSH policies. The scores ranged from 14 to 29 (out of a possible 32) representing disparity in the quality and potential effectiveness of the policies in place.

Voices from A Better Culture working groups underscored the lived experiences of those affected by BDSH.

A/Professor Rhea Liang, Past Chair of the Operating With Respect Education Committee at Royal Australasian College of Surgeons (RACS), shared insights on the Building Respect program born out of the need for change within the surgical community.

“I’m not going to talk about my experiences as a woman in surgery, because even though it has involved bullying, discrimination, sexual harassment and even a sexual assault, the high prevalence of my experiences has been well documented already.

“It took a sentinel event in 2015 to prompt action within RACS. While the event was shocking to the general public, we surgical women knew it was common. The public scrutiny of RACS in the days after the disclosure of this event made it impossible not to take action.”

A nurse, describing a workplace where bullying was not only known but accepted by management, said “It seems like we go to great lengths to make policies and procedures to combat bullying, but their efficacy doesn’t reach beyond the computer screen.”

A female psychiatrist discussed the toll of moral injury resulting from workplace bullying, emphasising the need for psychological safety.

“Although it feels like post-traumatic stress disorder, the most appropriate name for my experience is moral injury,” she shared.

A female consultant physician captured the collective aspiration for change, stating, “For those of us that are told ‘There’s no point in making a complaint about bullying as it never ends well for anyone‘, for those of us that hear ‘Oh that is just how he is‘,…for women leaders so we have a seat at the table where the decisions are made.

“Most of all, I want a better culture for the people we care for as healthcare professionals – our patients, their families and our colleagues across all disciplines and stages of training.”

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