Assaults by patients against psychiatric residents at a public psychiatric hospital

Assaults by patients on psychiatric trainees: frequency and training issues

Aims and Method

To conduct a survey on the frequency and severity of assaults by patients on psychiatric trainees, and the availability of training on managing violent patients; a self-report questionnaire developed in the USA was adapted to the Flemish situation. Data were collected from 99 psychiatric trainees from the Dutch speaking part of Belgium, representing a 60% response rate.

Results

As many as 56% of the respondents had been confronted with at least one physical assault by a patient during their residency, whereas 72% had already been threatened by a patient. Only a small minority had received any training related to patient violence.

Clinical Implications

Some formal teaching or training in managing (potentially) violent patients should be incorporated in psychiatric training in Flanders.

Violence against physicians in training. A Romanian perspective

The main purpose of this study was to assess whether there are differences between perceived and actual aggressions directed towards medical trainees from different medical specialties and different stages of medical training, and to characterize various types of aggressions against physicians in training in Romania. A multi-institutional survey was conducted in order to assess the prevalence of perceived and actual violence during medical residents; it included a total number of 384 medical residents from various specialties. Thirty two cases declared perceived physical aggression, most often in psychiatry. Actual physical aggression was 48% higher compared to perceived physical aggression. A similar situation occurred for sexual harassment, with only 9 perceived and 65 actual cases (an increase of 722%). Psychological abuse was the easiest to identify by the physicians in training, as the difference between perceived and actual aggression was minimal (202 and 205 respectively). The degree of perceived violence against physicians in training was much lower than the actual prevalence of the phenomenon, especially for physical and sexual types. This decreased awareness may lead to a failure in taking necessary safety measures and may subsequently increase the severity and consequences of the violent acts directed towards them.

A systematic review of the prevalence of patient assaults against residents

OBJECTIVES

The purpose of this study is to systematically review the literature on the prevalence of patient assaults against residents in all specialties, and to identify curricula that address this issue.

METHODS

The authors searched published English-language literature using PubMed and Scopus databases using key terms including "patient," "assaults," "threats," "violence," "aggression," and "residents." A separate search to identify curricula used the same terms in combination with key words including "curriculum," "didactics," and "course." Bibliographies of studies found by electronic searches were also searched manually.

RESULTS

Fifteen studies met the inclusion criteria. Of these, 7 were conducted on psychiatry residents alone, 6 assessed assaults on residents in nonpsychiatric specialties, and 2 reported cross-specialty data. The prevalence of assaults was defined as the percentage of residents who have experienced at least one assault. The prevalence of physical assaults on residents was 38% in surgery, 26% in emergency medicine, 16% to 40% in internal medicine, 5% to 9% in pediatrics, and 25% to 64% in psychiatry. All studies were cross-sectional; none collected data prospectively. Definitions of assault were heterogeneous or not specified. Few of the assaults were reported to clinical supervisors or training directors, and no programs had a formal reporting process. Approximately 21% to 79% of psychiatry residents and 30% of residents in other specialties had received some training on how to manage violent patients. We found no descriptions of formal curricula for managing the possibility of patient violence against residents or for preparing for the aftermath.

CONCLUSIONS

Although the data are limited, assaults by patients are commonly experienced by residents in training. There is a paucity of information and curricula that pertain to reducing the prevalence of these incidents and to addressing potential psychologic consequences, especially in nonpsychiatric specialties.

A survey of threats and violent acts by patients against training physicians

OBJECTIVES

The primary purpose was to determine the prevalence of various types of threats or assaults by patients against training physicians and to determine the psychological impact of the most distressing incidents. Differences between specialty of training and gender were examined.

DESIGN

An anonymous mailed questionnaire.

SETTING

The Medical School of the University of Auckland, New Zealand.

SUBJECTS

All 160 postgraduate trainees in psychiatry, general medicine, surgery, and obstetrics and gynaecology. A response rate of 84% (n=135) was obtained.

RESULTS

The majority of trainees had been verbally threatened (n=91, 67%) or physically intimidated (n=73, 54%) at some time during specialty training, while another 41% (n=55) had witnessed Health Board property being damaged in their presence and 39% (n=53) had been physically assaulted. Psychiatry trainees were significantly more likely to experience the various types of threat or violence. Females (n=20, 38%) were significantly more likely than men (n=8, 10%) to report having been sexually harassed (chi2=14, d.f.=1, P < 0.001). The overall mean on the Impact of Event Scale for those who described the most distressing incident was 8. On only one occasion was a training director directly informed about a trainee's most distressing incident and most trainees (n=95, 70%) had not had training on protecting against assault or on managing violence.

CONCLUSION

These findings underscore a priority for developing programmes which effectively reduce threats and violence against trainees and which lessen the psychological sequelae of these incidents.

A study of assaults against psychiatric residents

There are few studies of assaults against psychiatric residents. The only two domestic studies specifically investigating assaults against residents each surveyed a single residency program. In the present study, 333 psychiatric residents in 11 training programs in Pennsylvania were surveyed about assaults and threats on them during residency. One hundred fifty-five questionnaires (46%) were completed and returned. Of the respondents, 41 % experienced a physical assault and 48% were threatened at some time during their training. Ten percent of the respondents were assaulted more than once, and 30% of the respondents were threatened more than once. There was no significant correlation between rates of threats or assaults and age, sex, or training sites. The majority of threats and assaults occurred in either an inpatient setting (56%) or a psychiatric emergency service (31%). The authors found that residents were provided with minimal training in aggression management during their residency.