Demanding, intolerant, short-tempered. The towering, cartoon-like figure of Sir Lancelot Spratt as chief surgeon in the old Doctor in the House series of comedy films is clearly a figure from a bygone age. In this era it was accepted and even expected that senior figures should strike terror into less experienced and ‘less important’ people. How things change we’d like to think.
Yet the GMC’s recent report, Building a Supportive Environment, explores the topics of bullying and undermining within modern medical education and training. Within the content is comes a reminder of the 2013 NHS Staff survey where 23% of staff in England reported they had been bullied, harassed or abused by other staff members in the previous year. This was starkly illustrated by the Francis Report into Mid Staffordshire released the same year and the GMC remind us of the consequences.
Doctors in training who have been bullied are more likely to make mistakes at work, are less likely to work well in a team and less likely to raise concerns they have over patient safety.
‘Bullying’ has many levels and at the lowest end we may be less likely to use that label for demanding, intolerant or short-tempered attitudes. This is especially true when the perpetrator is tired, alarmed or stressed themselves. The danger, however, is that the “well that’s what I experienced” approach continues to stifle the cultural change required.
Thankfully many doctors in training have good experiences. On our Teach the Teacher Course for Doctors we regularly ask delegates to picture and describe their best teacher: “Challenging”; “High expectations”; “Put me on the spot”; “Kept me on my toes”, are common answers. Standing alone, these behaviours may not seem to be distinct from the problem attitudes mentioned earlier, however they are always countered by a second dimension: “Understood me”; “Recognised when I was struggling”; “Re-assuring”; “Celebrated my progress” are also common responses.
When we have low challenge and low support the learner is less likely to push themselves. “If no-one else is bothered, then why should I?”
High challenge with low support is stressful and is often accompanied by the fear of mistakes, stifling initiative and growth.
Low challenge with high support feels very pleasant short term, but if learners are not made aware when they have gone wrong, or of the standards required then they are again unlikely to make progress and learn from mistakes.
Striking a balance with both high challenge and high support on the other hand creates an exciting, rewarding environment, where learning is a stimulating experience.