Graduate Medical Education Bullying: A Survey of Podiatry Residency Programs

Document Type : Original Article

Authors

1 The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

2 Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA

3 Louisiana State University Health Sciences Center, New Orleans, LA, USA

10.22038/fmej.2025.86532.1636

Abstract

Background:  Bullying during Podiatric Medical and Surgical residency has not been previously assessed and published. It is important to study bullying in podiatric medical residency programs because it may contribute to resident burnout and other psychological harm, as well as poor quality care.
Method:  The purpose of this study was to survey current podiatry residents, recent podiatry residency graduates/fellows, and program directors to determine if there was a significant difference in the acknowledgement of bullying being a problem in podiatric residency programs amongst the groups.  An electronic survey was administered via the American Podiatric Medical Association’s (APMA) membership list.  Fisher’s exact test was used to determine if there was a significant association between residents, recent graduates/fellows, and program directors’ perceptions of bullying being a significant problem in podiatric residency programs and acknowledgement of residents being bullied.
Results:  The survey was emailed to 1,163 eligible participants.  The completion rate of those who accessed the survey was 58/67 (86.6%).  Of those who responded, 53% (n=31) reported that residents were bullied at their program. Decline in performance (22%) and depressive behavior (22%) were the most reported consequences of bullying. Of those who reported bullying at their residency program, they most frequently reported “5 or more” occurrences. There was a statistically significant difference of (p=0.013) and (p=0.014), respectively, between residents, recent graduates/fellows, and program directors’ perception and acknowledgement of bullying being a significant problem in podiatric residency programs.
Conclusion:  Our results indicated that bullying occurs at Podiatric residency programs, that it has harmful consequences, and perceptual differences exist between residents, past residents/fellows, and program directors. 

Keywords

Main Subjects


  1. Ayyala MS, Rios R, Wright SM. Perceived Bullying Among Internal Medicine Residents. JAMA. 2019 Aug 13;322(6):576.
  2. Chadaga AR, Villines D, Krikorian A. Bullying in the American Graduate Medical Education System: A National Cross-Sectional Survey. Amaral LAN, editor. PLOS ONE. 2016 Mar 16;11(3):e0150246
  3. Ullah R, Siddiqui F, Zafar MS. Bullying among healthcare professionals and students: Prevalence and recommendations. J TaibahUniv Med Sci. 2023 Oct;18(5):1061–4.
  4. Volk AA, Dane AV, Marini ZA. What is bullying? A theoretical redefinition. Dev Rev. 2014 Dec;34(4):327–43.
  5. Marini ZA, Dane AV, Bosacki SL, CURA Y -. Direct and indirect bully-victims: differential psychosocial risk factors associated with adolescents involved in bullying and victimization. Aggress Behav. 2006;32(6):551–69.
  6. O’Flynn-Magee K, Rodney P, Pearson M, Afonso Burnay M, Daly Z. Interrupting the cycle of bullying witnessed or experienced by nursing students: An ethical and relational action framework. Nurse Educ Today. 2020 Aug;91:104458.
  7. Gamian-Wilk M, Bjorkelo B, Mikkelsen EG, D’Cruz P, Madeja-Bien K. Workplace bullying: individual hostility, poor work environment or both? Exploring competing explanatory models in a single longitudinal study. Int Arch Occup Environ Health. 2022 Jun 22;95(10).
  8. Fleming C, Humm G, Wild JF, Mohan H, Hornby ST, Harries RL, et al. Supporting doctors as healthcare quality and safety advocates: Recommendations from the Association of Surgeons in Training (ASiT). Int J Surg. 2018 Apr 1;52:349–54.
  9. Nasca BJ, Cheung EO, Eng JS, Zhang L, Smink DS, Greenberg JA, et al. National Comparison of Program Director Perceptions vs. Resident Reports of the Learning Environment and Well-Being. J Surg Educ. 2023 Jan 1;80(1):72–80.
  10. Kemper KJ, Schwartz A. Update on Mistreatment and Burnout in Pediatric Residents. Acad Pediatr. 2022 Dec;23(5).
  11. Kelly S. Workplace bullying: the silent epidemic. N Z Med J. 2004 Oct 22;117(1204):U1125.
  12. Council on Podiatric Medical Education. About the Council – Council on Podiatric Medical Education [Internet]. www.cpme.org. 2024 [cited 2024 Jun 5]. Available from: https://www.cpme.org/about-the-council/
  13. Eysenbach G. Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34 URL: http://www.jmir.org/2004/3/e34/doi:10.2196/jmir.6.3.e34 PMID:99981231160000-080015471760
  14. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008; 61(4):344-9.
  15. Council on Podiatric Medical Education. CPME 320 Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies [Internet]. 2022 [cited 2024 Jun 5]. Available from: https://cpme-320-updated-april-2022-new-logging-code.pdf
  16. StataCorp. 2023. Stata Statistical Software: Release 15.1. College Station, TX: StataCorp LLC.
  17. Averbuch T, Eliya Y, Van Spall HGC. Systematic review of academic bullying in medical settings: dynamics and consequences. BMJ Open. 2021 Jul;11(7):e043256.
  18. Loerbroks A, Weigl M, Li J, Glaser J, Degen C, Angerer P. Workplace bullying and depressive symptoms: A prospective study among junior physicians in Germany. J Psychosom Res [Internet]. 2015 Feb 1;78(2):168–72. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0022399914003729
  19. Paice E, Smith D. Bullying of trainee doctors is a patient safety issue. Clin Teach. 2009 Mar;6(1):13–7.
  20. Leisy HB, Ahmad M. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review. BMC Med Educ. 2016 Apr 27;16(1).
  21. Orlino JP, Sura TA, Pei KY, Smeds MR. Bullying of vascular surgery trainees. J Vasc Surg. 2022 Jun;75(6):2065-2071.e3.
  22. Cunningham CT, Quan H, Hemmelgarn B, Noseworthy T, Beck CA, Dixon E, et al. Exploring physician specialist response rates to web-based surveys. BMC Med Res Methodol. 2015 Apr 9;15(1).
  23. James KM, Ziegenfuss JY, Tilburt JC, Harris AM, Beebe TJ. Getting Physicians to Respond: The Impact of Incentive Type and Timing on Physician Survey Response Rates. Health Serv Res. 2010 Sep 28;46(1p1):232–42.
  24. Fan W, Yan Z. Factors affecting response rates of the web survey: A systematic review. Comput Human Behav. 2010 Mar;26(2):132–9.
  25. Ang J, Schneider H. Harassment in Residency: An Anonymous Survey of Podiatry Residents. J Foot Ankle Surg. 2021 Jan;60(1):25–9.