Bullying among undergraduate medical students at Tanta University, Egypt: a cross-sectional study

Prevalence and Characteristics of Medical Student Mistreatment in Lebanon

Objective

This study aimed to determine the prevalence of medical student mistreatment in Lebanon, the framework of the incidents, and the extent of students' knowledge on mistreatment characteristics.

Methods

This is a cross-sectional study conducted using an online-based survey among medical students who have performed clinical rotations in Lebanon.

Results

Out of 300 respondents, 48.7% reported being subjected to mistreatment during clinical practice, which was significantly associated with gender, type of university, and family income. The two most common sources of mistreatment were patients and their families/friends (77.4%), and attending physicians (52.7%), followed by residents (49.3%). Students mostly chose to be passive and pacifying. Additionally, 64.7% of students stated they were not trained about the ideal way to handle these incidents.

Conclusion

This study showed that medical student mistreatment is highly prevalent in Lebanon. It also highlighted the lack of proper education on mistreatment characteristics and the necessity for investigating its effects.

Prevalence of bullying and its impact on self-esteem, anxiety and depression among medical and health sciences university students in RAS Al Khaimah, UAE

Bullying and peer victimization among medical and health sciences students is a public health issue. This is owing to its detrimental impact and greater risk of psychiatric diseases and psychopathology in childhood, adolescence, and adulthood. As a result, a descriptive cross-sectional research study was conducted to investigate the prevalence of bullying and its influence on self-esteem, anxiety, and depression among medical and health sciences university students in RAS Al- Khaimah, United Arab Emirates. Approximately 369 students from MBBS, BDS, B Pharm, and BSN colleges were selected. The instruments included sociodemographic questions, bullying queries, the Rosenberg Self-Esteem Scale, and the Primary Care Anxiety and Depression Scale. Participants averaged 21.49 ± 2.95. 34.1 % of medical students were bullied. 44.4 % of individuals were called insulting names, making verbal bullying the most common method. The linear regression analysis of bullying data shows that girls (53.2 %) are bullied more than boys (46.8 %). Bullied individuals had a mean score of 43.30 ± 19.74, indicating a higher rate of depression and anxiety. Bullied students had a mean score of 44.62 ± 9.94, indicating lower self-esteem. Significant differences were observed in relation to bullying when considering the variables of the university year, mother's education, and previous experience of bullying (P = 0.002, 0.038, 0.001). It is imperative that universities establish comprehensive protocols to identify instances of such behaviour and provide necessary assistance to victims and their families.

Medical Students' Experiences of Mistreatment by Clinicians and Academics at a South African University

Phenomenon: Tertiary education in post-apartheid South Africa has faced many challenges regarding class, language, and race. Even though previously white Afrikaans-rooted universities now have a diverse student population, recent student protests have highlighted the ongoing need for decolonization in higher education. In addition, the majority of public hospitals in the country function under significant staffing, infrastructure, and equipment shortages. Although the mistreatment of medical students has been well described internationally, to date no South African data exists. The aim of this study was to identify experiences of mistreatment of medical students by clinicians and academics at a South African university and to describe the type of mistreatment experienced, the perceived mental health effects, and the influence on academic performance, resilience, and students' knowledge of current reporting systems. Approach: A cross-sectional study was conducted through a locally developed online survey of 443 medical students at a South African university in May to June 2018, comprising of both open and closed ended questions. Levels of psychological distress (K10) and resilience (CD-RISC -10) were measured. Chi-square and student t-tests were used for the analysis of associations, and linear regressions were used to assess predictors of psychological distress. Qualitative data were analyzed thematically using the approach described by Braun and Clarke. Findings: Of 800 eligible medical students at Stellenbosch University, 443 students (55.4%) completed the survey. Mistreatment, comprising of being ignored/excluded (83.4%), offensive gestures (75.0%), verbal abuse (65.1%) and discrimination (64.4%), was prevalent and pervasive, and was perpetrated mainly by registrars (46.7%) and other medical staff (43.8%). Mistreatment was associated with psychological distress, which was generally high and more severe for females. Resilience, which was higher for males, moderated the effects of gender and perpetrator type on distress. Only 15% of students who had experienced mistreatment, either directly or indirectly, reported it, of which more than half (52.8%) were not happy with the outcome. Most students (80.9%) were not aware of the systems in place to report mistreatment. Insights: Student mistreatment is more highly prevalent among medical students at a South African university compared with studies conducted internationally. Despite over 20 years of democracy in South Africa, high rates of racial and gender discrimination were reported and descriptions of racial, language and gender discrimination were particularly concerning. Since the findings of this study, an anti-bullying poster-campaign has been initiated at the university as well as an online reporting system.

The Relationship between Bullying and Emotional State among Undergraduate Nursing Students: A Cross-Sectional Correlation Study

Introduction

Bullying behavior by nursing students is a serious problem that has contributed to the drop in numbers in the nursing profession.

Aim

The study investigated the relationship between bullying and the emotional state of undergraduate nursing students.

Methods

The study used a cross-sectional correlation design with a sample of 286 undergraduate nursing students from multiple nursing colleges located in the western region of Saudi Arabia. The 21-item depression, anxiety, and stress scale (DASS-21) was used to measure the study outcomes. A revised version of the Bullying Assessment Questionnaire was used to assess bullying experiences. Statistical analyses, including a t-test, Pearson correlation coefficient, and a one-way between-subjects ANOVA, determined the significance of the relationship between study variables.

Results

There was a high prevalence of depression, anxiety, and stress symptoms among Saudi nursing students. Most of the respondents reported mild to extremely severe symptoms of depression (58.7%), anxiety (58%), and stress (44.8%). Around 90.1% of the nursing students reported exposure to a form of bullying over the previous 12 months. The most common items reported as part of this behavior included continually being assigned tasks beyond their capacity. Family members were the most frequently reported source of bullying (29.8%), followed by nursing faculties (20.9%). Bullying behavior was positively correlated with students' scores for depression, r (284) = 0.49, n = 286, p < 0.01; anxiety, r (284) = 0.54, p < 0.01; and stress, r (284) = 0.56, p < 0.01.

Conclusion

The study's findings raise concerns and highlight the importance of decreasing the risk of depression, anxiety, and stress among undergraduate nursing students. Nurse educators must ensure that students receive psychological support to decrease these psychological outcomes. Regularly monitoring bullying behavior is essential to maintain students' psychological stability, which could eventually reduce professional dropout rates.

Moderating role of mental health literacy on the relationship between bullying victimization during the life course and symptoms of anxiety and depression in Chinese college students

BACKGROUND

Exposure to persistent bullying victimization across multiple periods results in a high risk of worse consequences. Although amples studies support the association between bullying victimization and symptoms of anxiety and depression, whether mental health literacy can serve as a moderator on this relationship remains unknown. Therefore, the aim of this study was to examine the patterns of bullying victimization across the life course, and disentangle the moderating effect of mental health literacy between bullying victimization patterns and symptoms of anxiety and depression in Chinese college students.

METHODS

A total of 4036 college students were enrolled by cluster sampling from November 2020 to January 2021. Bullying victimization, mental health literacy, and symptoms of anxiety and depression were measured by self-report validated questionnaires. A latent class analysis was applied to identify bullying patterns. The PROCESS program was conducted to analyze whether mental health literacy moderates the link between bullying victimization patterns and symptoms of anxiety and depression.

RESULTS

Three latent patterns of bullying victimization were identified as follows: persistent bullying pattern (6.2%), moderate bullying pattern (10.5%), and low bullying pattern (83.3%). Logisitic regression analysis of anxiety and depressive symptoms indicated that compared with low bullying pattern, persistent bullying pattern had the highest risk. Specifically, mental health literacy moderated the association between bullying victimization pattern and anxiety symptoms (B = -0.039, P < 0.05).

CONCLUSIONS

It is important for practitioners to examine bullying victimization across the life course concurrently rather than a single period in isolation. Interventions and research should enhance mental health literacy to improve the mental health in college students with a history of bullying victimization.

An exploratory university-based cross-sectional study of the prevalence and reporting of mistreatment and student-related factors among Thai medical students

BACKGROUND

Mistreatment is a behavior that reflects disrespect for the dignity of others. Mistreatment can be intentional or unintentional, and can interfere with the process of learning and perceived well-being. This study explored the prevalence and characteristics of mistreatment, mistreatment reporting, student-related factors, and consequences among medical students in Thai context.

METHODS

We first developed a Thai version of the Clinical Workplace Learning Negative Acts Questionnaire-Revised (NAQ-R) using a forward-back translation process with quality analysis. The design was a cross-sectional survey study, using the Thai Clinical Workplace Learning NAQ-R, Thai Maslach Burnout Inventory-Student Survey, Thai Patient Health Questionnaire (to assess depression risk), demographic information, mistreatment characteristics, mistreatment reports, related factors, and consequences. Descriptive and correlational analyses using multivariate analysis of variance were conducted.

RESULTS

In total, 681 medical students (52.4% female, 54.6% in the clinical years) completed the surveys (79.1% response rate). The reliability of the Thai Clinical Workplace Learning NAQ-R was high (Cronbach's alpha 0.922), with a high degree of agreement (83.9%). Most participants (n = 510, 74.5%) reported that they had experienced mistreatment. The most common type of mistreatment was workplace learning-related bullying (67.7%), and the most common source was attending staff or teachers (31.6%). People who mistreated preclinical medical students were most often senior students or peers (25.9%). People who mistreated clinical students were most commonly attending staff (57.5%). Only 56 students (8.2%) reported these instances of mistreatment to others. Students' academic year was significantly related to workplace learning-related bullying (r = 0.261, p < 0.001). Depression and burnout risk were significantly associated with person-related bullying (depression: r = 0.20, p < 0.001, burnout: r = 0.20, p = 0.012). Students who experienced person-related bullying were more often the subject of filed unprofessional behavior reports, concerning conflict or arguments with colleagues, being absent from class or work without reasonable cause, and mistreatment of others.

CONCLUSIONS

Mistreatment of medical students was evident in medical school and was related to the risk for depression and burnout, as well as the risk of unprofessional behavior.

TRIAL REGISTRATION

TCTR20230107006(07/01/2023).

Systematic review of academic bullying in medical settings: dynamics and consequences

PURPOSE

To characterise the dynamics and consequences of bullying in academic medical settings, report factors that promote academic bullying and describe potential interventions.

DESIGN

Systematic review.

DATA SOURCES

We searched EMBASE and PsycINFO for articles published between 1 January 1999 and 7 February 2021.

STUDY SELECTION

We included studies conducted in academic medical settings in which victims were consultants or trainees. Studies had to describe bullying behaviours; the perpetrators or victims; barriers or facilitators; impact or interventions. Data were assessed independently by two reviewers.

RESULTS

We included 68 studies representing 82 349 respondents. Studies described academic bullying as the abuse of authority that impeded the education or career of the victim through punishing behaviours that included overwork, destabilisation and isolation in academic settings. Among 35 779 individuals who responded about bullying patterns in 28 studies, the most commonly described (38.2% respondents) was overwork. Among 24 894 individuals in 33 studies who reported the impact, the most common was psychological distress (39.1% respondents). Consultants were the most common bullies identified (53.6% of 15 868 respondents in 31 studies). Among demographic groups, men were identified as the most common perpetrators (67.2% of 4722 respondents in 5 studies) and women the most common victims (56.2% of 15 246 respondents in 27 studies). Only a minority of victims (28.9% of 9410 victims in 25 studies) reported the bullying, and most (57.5%) did not perceive a positive outcome. Facilitators of bullying included lack of enforcement of institutional policies (reported in 13 studies), hierarchical power structures (7 studies) and normalisation of bullying (10 studies). Studies testing the effectiveness of anti-bullying interventions had a high risk of bias.

CONCLUSIONS

Academic bullying commonly involved overwork, had a negative impact on well-being and was not typically reported. Perpetrators were most commonly consultants and men across career stages, and victims were commonly women. Methodologically robust trials of anti-bullying interventions are needed.

LIMITATIONS

Most studies (40 of 68) had at least a moderate risk of bias. All interventions were tested in uncontrolled before-after studies.