How widespread is bullying in university-affiliated hospitals in Isfahan? a cross-sectional study from Iran
Abstract
Bullying behaviors may undermine ethical standards in clinical education. This study aimed to assess the prevalence of bullying behaviors in university-affiliated hospitals and to identify the characteristics of victims and perpetrators.This cross-sectional study was conducted among undergraduate medical students during the autumn of 2022. Data were collected using a validated and reliable researcher-designed questionnaire that assessed demographic characteristics, experiences with different types of bullying, perceived perpetrators, inquiries about seeking support, and awareness of preventive policies.Among the 297 participants (response rate: 72.4%; mean age: 24.50 ± 1.36 years; females: 65.3%; interns: 46.8%), 90.6% reported experiencing at least one form of bullying during clinical training. The most frequently reported types of bullying were psychological (81.1%), behavioral (80.5%), and verbal (61.3%). Internship and a self-declared history of psychological problems were associated with higher reports of bullying (P-value < 0.05). Residents (93.7%) and clinical faculty members (91.4%) were most commonly identified as perpetrators. These findings indicate that bullying in clinical education is a significant ethical issue that may undermine professional development and respectful clinical practice. The results underscore the need for ethically grounded institutional interventions to prevent mistreatment and support the students at risk.
National Center for Biotechnology Information. Bethesda: MeSH.2011 [cited 2015 Sep 7].; Available from: http://goo.gl/i45MQh. Mesh.
Gredler GR. Olweus, D. (1993). Bullying at school: What we know and what we can do. Malden, MA: Blackwell Publishing, 140 pp., $25.00. Psychol Sch [Internet]. 2003;40(6):699–700. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/pits.10114
Rettew DC, Pawlowski S. Bullying: An Update. Child Adolesc Psychiatr Clin N Am. 2022 Jan;31(1):1–9.
Field T. Bullying in medicine. Those who can, do; those who can’t, bully. Vol. 324, BMJ (Clinical research ed.). England; 2002. p. 786.
Chávez-Rivera A, Ramos-Lira LL, Abreu-Hernández F. A systematic review of mistreatmen in medical students. Gac Med Mex. 2016;152(6):796–811.
Norton P, Costa V, Teixeira J, Azevedo A, Roma-Torres A, Amaro J, et al. Prevalence and Determinants of Bullying among Health Care Workers in Portugal. Work Heal Saf. 2017;65(5):188–96.
Hinduja S, Patchin JW. Bullying Beyond the Schoolyard: Preventing and Responding to Cyberbullying. Second. Corwin; 2014. 312 p.
Health Policy and Economic Research Unit. British Medical Association. 2006. Bullying and harassment of doctors in the workplace. Available from: www.bma.org.uk/ap.nsf/Content/ bullying2006
Bully OnLine (UK National Workplace Bullying Advice Line). Bullying: surveys, facts, figures and costs [Internet]. Available from: www.bullyonline.org/work bully/costs.html
Rautio A, Sunnari V, Nuutinen M, Laitala M. Mistreatment of university students most common during medical studies. BMC Med Educ. 2005 Oct;5:36.
Al-Hussain SM, Al-Haidari MS, Kouri NA, El-Migdadi F, Al-Safar RS, Mohammad MA. Prevalence of mistreatment and justice of grading system in five health related faculties in Jordan University of Science and Technology. Med Teach. 2008;30(3).
Frank E, Carrera JS, Stratton T, Bickel J, Nora LM. Experiences of belittlement and harassment and their correlates among medical students in the United States: Longitudinal survey. Br Med J. 2006;333(7570):682–4.
Uhari M, Kokkonen J, Nuutinen M, Vainionpaa L, Rantala H, Lautala P, et al. Medical student abuse: an international phenomenon. JAMA. 1994 Apr;271(13):1049–51.
Ahmer S, Yousafzai AW, Bhutto N, Alam S, Sarangzai AK, Iqbal A. Bullying of medical students in Pakistan: A cross-sectional questionnaire survey. PLoS One. 2008;3(12):3–6.
Mahood SC. Medical education: Beware the hidden curriculum. Can Fam Physician. 2011 Sep;57(9):983–5.
Brown MEL, Coker O, Heybourne A, Finn GM. Exploring the Hidden Curriculum’s Impact on Medical Students: Professionalism, Identity Formation and the Need for Transparency. Med Sci Educ. 2020 Sep;30(3):1107–21.
Kendall MJ. Those who can, do; those who can’t, bully. Br Med J. 2002;324(7340):792.
Gianakos AL, Freischlag JA, Mercurio AM, Haring RS, LaPorte DM, Mulcahey MK, et al. Bullying, Discrimination, Harassment, Sexual Harassment, and the Fear of Retaliation During Surgical Residency Training: A Systematic Review. World J Surg. 2022 Jul;46(7):1587–99.
Björkqvist K. Social defeat as a stressor in humans. Physiol Behav. 2001 Jun;73(3):435–42.
Monrouxe L V, Rees CE, Dennis I, Wells SE. Professionalism dilemmas, moral distress and the healthcare student: insights from two online UK-wide questionnaire studies. BMJ Open [Internet]. 2015;5(5). Available from: https://bmjopen.bmj.com/content/5/5/e007518
Fried JM, Uijtdehaage S. An abuse-free medical school environment: an ethical imperative. Virtual Mentor. 2014 Mar;16(3):187–91.
Moradi E. Examining Hofstede’s Cultural Dimensions in Iranian and Chinese Context: A Mixed Methods Approach. Innovare J Educ. 2024;12(2):6–14.
Colenbrander L, Causer L, Haire B. “If you can’t make it, you’re not tough enough to do medicine”: A qualitative study of Sydney-based medical students’ experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020;20(1):1–12.
Abdollahi Z, Barkhordari-Sharifabad M, Nasiriani K, Fallahzadeh H. Investigation of bullying behaviors in clinical settings from the nursing students’ views. Iran J Med Educ [Internet]. 2020;20(0). Available from: http://ijme.mui.ac.ir/article-1-5056-fa.html
Salimi H, Mehralitabr Firozjaie A, Najarpourian S, Ziaaddini Z. Investigation of Bullying and Harassment in the Workplace Using the Psychometric Properties of the Negative Acts Questionnaire-Revised (NAQ-R) in Nurses. Qom Univ Med Sci J [Internet]. 2019;12(11). Available from: http://journal.muq.ac.ir/article-1-1963-en.html
Golparvar M, Khatonabadi G. Structural Model of the Relationship between Bullying in Hospital Environments and Negative effect and Psychosomatic Complaints among female Nurses. J Nurs Educ [Internet]. 2017;4(5). Available from: http://ijpn.ir/article-1-699-en.html
Elghazally NM, Atallah AO. Bullying among undergraduate medical students at Tanta University, Egypt: a cross-sectional study. Libyan J Med [Internet]. 2020;15(1). Available from: https://doi.org/10.1080/19932820.2020.1816045
AlMulhim AA, Nasir M, AlThukair A, Alnasser M, Pikard J, Ahmer S, et al. Bullying among medical and nonmedical students at a university in Eastern Saudi Arabia. J Fam Community Med. 2018;25(3):211–6.
Lund EM, Ross SW. Bullying Perpetration, Victimization, and Demographic Differences in College Students: A Review of the Literature. Trauma Violence Abuse. 2017 Jul;18(3):348–60.
Waseem M NA. Identifying and Addressing Bullying. [Updated 2023 Dec 13] [Internet]. Updated 20. (FL) S [Internet]. TI, editor. Treasure Island (FL): StatPearls Publishing; Available from: https://www.ncbi.nlm.nih.gov/books/NBK441930/
McMahon L. Bullying and harassment in the workplace. Vol. 12, International Journal of Contemporary Hospitality Management. 2000. 384–387 p.
Mukhtar F, Daud S, Manzoor I, Amjad I, Saeed K, Naeem M, et al. Bullying of medical students. J Coll Physicians Surg Pak. 2010 Dec;20(12):814–8.
Averbuch T, Eliya Y, Van Spall HGC. Systematic review of academic bullying in medical settings: Dynamics and consequences. BMJ Open. 2021;11(7):1–17.
Ferine KF, Aditia R, Rahmadana MF, Indri. An empirical study of leadership, organizational culture, conflict, and work ethic in determining work performance in Indonesia’s education authority. Heliyon [Internet]. 2021;7(7):e07698. Available from: https://www.sciencedirect.com/science/article/pii/S2405844021018016
Heidarzadeh AH, Hedayati BH, Huntington MKH, Alvandi MA, Aarabi AA, Farrokhi BF, et al. Challenges Associated with the Education of Family Physicians in Iran: A Systematic Review. J Med Educ Futur Demands [Internet]. 21(1):e130153. Available from: http://publish.brieflands.com/articles/jme-130153.bib
Fnais N, Al-Nasser M, Zamakhshary M, Abuznadah W, Dhukair S Al, Saadeh M, et al. Prevalence of harassment and discrimination among residents in three training hospitals in Saudi Arabia. Ann Saudi Med. 2013;33(2):134–9.
Sager F, Gofen A. The polity of implementation: Organizational and institutional arrangements in policy implementation. Governance. 2022;35(2):347–64.
| Files | ||
| Issue | Vol 19 (2026) | |
| Section | Original Article(s) | |
| Keywords | ||
| Bullying; Harassment; Medical ethics; Medical student; Education. | ||
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