Sexual harassment of psychiatric trainees: experiences and attitudes

Workplace bullying of psychiatric trainees: systematic review

AIMS AND METHOD

We aimed to systematically review primary studies exploring workplace bullying of psychiatric trainees, including rates, forms of bullying, perpetrators and help-seeking. We searched Ovid MEDLINE, PubMed, CINAHL, PsycINFO and Embase using PRISMA guidelines. The inclusion criterion was primary research papers surveying or interviewing psychiatry trainees with respect to perceived workplace bullying by staff members. Exclusion criteria were secondary research papers and papers whose only focus was bullying by patients or carers.

RESULTS

Substantial levels of bullying were reported in all five included studies. Perpetrators were often reported to be consultants, managers or peers. Most trainees did not obtain help for bullying and harassment. All of the studies had methodological limitations.

CLINICAL IMPLICATIONS

Concerning levels of workplace bullying have been reported by psychiatric trainees in the UK and abroad. Further methodologically robust studies are required to evaluate the current levels and nature of this bullying, and strategies to prevent and manage it.

Intimate and sexual feelings in psychotherapy: educational topic or still taboo?

BACKGROUND

Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately.

AIMS

This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs.

METHOD

In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 - June 2018), using inferential and thematic analyses respectively.

RESULTS

The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change.

CONCLUSION

Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

How Therapists Experience and Manage Patients' Romantic and Sexual Feelings for Them

OBJECTIVE

Many therapists will one day be confronted with a patient who develops romantic or sexual feelings toward them. Studies on this topic often remain theoretical in nature and less often focus on how therapists manage such situations. Therefore, this study aimed to investigate how therapists experience this occurrence and manage their feelings.

METHODS

Eight focus groups were conducted with 36 participants in Flanders (Belgium). Both therapists-in-training and therapists-in-practice participated, having different educational backgrounds. The data were explored using the principles of thematic analysis.

RESULTS

Therapists indicated that they try to dissuade any further development of their patients' romantic or sexual feelings by using strategies such as emphasizing their personal relational status, adjusting their appearance, and avoiding any physical contact with their patients. Some therapists question their own professional behavior, feeling guilty, confused, or insecure, wondering if they may have, in some way, provoked these feelings. Therapists who are at an earlier stage in their careers experience more difficulties managing their patients' romantic or sexual feelings toward them and worry they will not be considered a good professional therapist if such a situation occurs.

CONCLUSIONS

Educational programs in psychotherapy should be more cognizant of the incidence of patients' developing romantic or sexual feelings toward therapists and provide more comprehensive and practical instruction on how to cope with such feelings.

Prevalence of intimidation, harassment, and discrimination among resident physicians: a systematic review and meta-analysis

BACKGROUND

The aim of this study was to establish the prevalence of intimidation, harassment, and discrimination (IHD) reported by resident physicians during their training, to identify factors associated with reported IHD, and to identify adverse sequalae associated with IHD.

METHODS

This review followed the PRISMA guidelines. Eight electronic databases were searched for cross-sectional studies reporting the prevalence of IHD among resident physicians. Prevalence estimates were pooledacross studies using random-effects meta-analysis, with variance stabilization using Tukey double arcsine transformation. Heterogeneity was assessed with forest plots, the I ² statistic, subgroup analyses, and multivariate meta-regression.

RESULTS

52 cross-sectional studies were included in the meta-analysis. The overall pooled prevalence of IHD was 64.1% (95% confidence interval [CI], 51.0-77.1). Verbal, physical, and sexual IHD were the most common forms of IHD reported by residents. Training status (55.5%), gender (41.7%), and ethnicity (20.6%) were the most commonly cited risk factors for IHD. The most common sources of IHD were relatives/friends of patients, nurses, and patients (cited by 50.7%, 47.8, and 41.7%, respectively).

CONCLUSIONS

The prevalence of IHD among resident physicians is high and associated with multiple negative outcomes, including burnout. Despite the availability of multiple anti-IHD interventions, reports of IHD appear to be rising in many residency programs.

Prevalence of and Preparedness to Address Inappropriate Sexual Behavior from Patients During Psychiatry Training: a Pilot Study

OBJECTIVE

Mental health providers experience inappropriate sexual behavior from patients. It is unclear if training programs adequately prepare trainees to respond to such behaviors. Additionally, trainees may not seek support and guidance from supervisors after an incident. This is an exploratory study to document the prevalence of and assess the preparedness of trainees to deal with inappropriate sexual behavior.

METHODS

A survey was administered to 58 psychiatry residents and 14 psychology interns at the NYU School of Medicine. A total of 22 questions were asked regarding participants' experiences with inappropriate sexual behavior, including prevalence of, and preparedness during, and support received after the behavior.

RESULTS

Of those who completed the survey, 89% of respondents had experienced inappropriate sexual behavior. Seventy percent said they had no training in responding to inappropriate sexual behavior, and 95% wanted more training. A minority of respondents consistently sought support after these events, and of those who did, only 60% of trainees did so with a supervisor.

CONCLUSION

Experiences involving inappropriate sexual behavior are prevalent among the mental health trainees surveyed, but most trainees did not feel that they received adequate training in preparation for or supervision after their experiences. Creating training or establishing protocols to respond to inappropriate sexual behavior may help trainees feel more capable and safer. Further studies are needed to understand inappropriate sexual behavior's impact on trainees and patient care, as well as to assess the efficacy of training and protocols developed to manage inappropriate sexual behavior.

Sexual Harassment in the House of Medicine and Correlations to Burnout: A Cross-Sectional Survey

Background: Burnout is a major problem among physicians in the United States. Women physicians experience higher rates of both burnout and sexual harassment than their male counterparts. Some studies from Asia and Europe have shown a correlation between sexual harassment at work and burnout in women physicians, but no studies on this topic have been done in the United States.

Methods: For this study, women physicians with active Louisiana licenses were invited to complete a cross-sectional self-report survey to assess burnout and sexual harassment. Burnout was assessed with the 2-item Maslach Burnout Inventory, and sexual harassment was assessed with a questionnaire adapted from the Sexual Experiences Questionnaire and a series of follow-up items.

Results: The survey response rate was 13% (129 of 970 invitees). Of the 129 participants, 36% reported feeling burned out from their work at least once a week and 38% reported having experienced at least one inappropriate sexual incident in their career. Ninety-six percent of respondents reported having experienced gender harassment from their colleagues, while 69% had experienced unwanted sexual attention from the same. Additionally, 69 (53%) participants reported experiencing some form of sexual harassment from patients or their families. Colleague gender harassment was significantly correlated with burnout scores.

Conclusion: This study found that reports of burnout and gender harassment from colleagues were significantly correlated. The results also align with previous findings of high rates of sexual harassment in medical school and residency. More research should be done in this area, especially focusing on women in training, women of color, and sexual and gender minority individuals.

Stalking by females

The aim of this review was to study "female stalking" in the sense of the specific traits characterizing the phenomenon of stalking behaviour committed by women. The main medical databases were searched (Medline, Social Science Research Network, Apa Psyc Net), and 67 articles were selected, reporting studies conducted in clinical populations, case series, reports, reviews, retrospective studies and original articles. We outline a variety of different tactics adopted by female stalkers and a lesser propensity to pass on to physical violence. Nevertheless, female stalkers are more frequently affected by erotomania, and this condition generally increases the risk of violence. If there have previously been intimate relations between the stalker and her victim, this will increase the risk of violence. In a significant proportion of female stalkers, the behavior is carried out in the occupational setting, especially in the field of psychotherapy, where the male-female ratio is reversed. No significant differences emerged between the motivations of heterosexual or homosexual stalkers. In the category of crimes of harassment committed by women, stalking, at least in Italy, seems to be among the most prominent.

Think globally, act locally: understanding sexual harassment from a cross-cultural perspective

OBJECTIVES

Sexual harassment in medical education has been studied in the Americas, Europe and Asia; however, little is known about sexual harassment in Middle Eastern cultures. Our initial aim was to describe the sexual harassment of female doctors-in-training by male patients and their relatives in Turkey. During our analysis of data, we expanded our objectives to include the formulation of a framework that can provide a theoretical background to enhance medical educators' understanding of sexual harassment across cultures.

METHODS

Questionnaires were provided to female resident doctors. Respondents were asked about their experiences of sexual harassment, about their reactions and about any precautionary measures they had used. Descriptive statistics were generated using SPSS software. Qualitative data were analysed using content analysis.

RESULTS

Forty-nine (51.0%) of 96 distributed questionnaires were completed. Thirty-three (67.3%) participants stated that they had been sexually harassed by a patient or patient's relative at some point in their career. 'Gazing at the doctor in a lewd manner', selected by 25 (51.0%) participants, was the most common form of harassment. The methods of coping selected by the highest numbers of respondents involved seeking the discharge of the patient (24.2%), avoiding contact with the patient or relatives (24.2%) and showing rejection (21.2%). Participants' comments about the prevention of sexual harassment revealed a deep sense of need for protection. The interface between quantitative and qualitative findings and a review of the literature supported the development of a value-based, cross-cultural conceptual framework linking the valuing of hierarchy and conservatism with the occurrence of sexual harassment.

CONCLUSIONS

We relate our findings to issues of patriarchy, power and socio-cultural influences that impact both the perpetrator and the target of sexual harassment. Medical educators are responsible for the control and prevention of sexual harassment of students. The globalisation of medical education requires that medical educators use a multi-cultural approach which considers socio-cultural influences and the diversity of female and male students' actions and perceptions of sexual harassment.

Supervisor-trainee relationship boundaries in medical education

Despite concerns about the prevalence and ramifications of medical student mistreatment, the boundaries of faculty-student relationships have not been studied systematically in medical training programs. This study aimed to identify behaviours that occur with some frequency and potentially raise issues related to boundaries in the supervisor-trainee relationship. An anonymous questionnaire was distributed to the mailboxes of 154 residents in the departments of psychiatry, internal medicine, and obstetrics and gynaecology at four hospitals affiliated with Brown University Medical School. Residents were asked to report whether they had encountered specific behaviours from supervisors during medical training, the frequency of these experiences, and the professional status of the supervisor involved in each episode. There was a significant reported incidence of behaviours related to academic/professional boundaries, personal boundaries, and dating boundaries. Some of these behaviours raise issues related to exploitation. The major sources of these reported boundary behaviours were hospital-based clinical faculty, university-based academic faculty, and senior house staff. The potentially adverse effects of boundary behaviours on the individual student, the teacher-student relationship, and the doctor-patient relationship are discussed. Future research is recommended to clarify the limits of appropriate behaviour between supervisors and trainees in the medical learning environment

Psychiatric trainees in Finland 2001

This study examined Finnish psychiatric trainees' views on their education. This was a survey study of nationwide data on Finnish psychiatric trainees in 2001. The quality of training was considered at least moderate by 84% of the respondents. Training on epidemiology, on taking history and status, and on psychopharmacology was considered the best. Quality was rated bad for training in leadership and administration, and educating the community. Research was done by 20%, and a personal clinical supervisor was appointed to 52% of the respondents. Offensive treatment had been experienced by 49% of the trainees in this study. Generally, studies of training also reflect strengths and weaknesses of the profession. Based on our results, it seems especially that training in leadership and in educating the community need to be improved; both of these are quintessential skills to survive in the struggle for economic and human resources. Furthermore, treatment of the trainees could still be better; attention should be paid to supervision of all trainees. Moreover, research must become more attractive. Psychiatry can be developed by the development of psychiatric training.