Guidance for medical students on harassment, intimidation, victimisation and bullying
21 December 2007
This is a guide aimed at students who are experiencing problems in their medical schools in the form of harassment, intimidation, victimisation or bullying.
The law in this area is complex but it is useful to understand some of the key legislation that aims to stamp out all forms of bullying and discrimination. Therefore, the Annex lists the relevant acts in the UK.
How people deal with harassment, intimidation, victimisation and bullying is very personal and often influenced by their life experiences. The stress on people who are slowly and persistently undermined can cause physical and emotional symptoms. It is important that students take advice before taking action.
2. Definitions
Harassment, intimidation, victimisation and bullying are large concepts that are difficult to define. In general terms, they can be defined as unwanted conduct affecting the dignity of people in the workplace or place of study, related to age, sex, religion, race, disability, sexual orientation or any other personal characteristic. It may be persistent or an isolated event, but in all cases, the actions or comments are demeaning and unacceptable to the victim.
Medical professionals may abuse their position of authority. We may find ourselves in receipt of unwelcome actions from our student peers or even from service users. We therefore need to know how to deal with such circumstances should they arise.
(i) Harassment
Harassment can take many forms but essentially consists of behaviour which is unacceptable to, and diminishes the dignity of the recipient(s) and which creates an intimidating, hostile or offensive workplace environment for that individual or group.
Examples of harassment:
Sexual
- Unwanted, non-accidental, physical contact of any form, including inappropriate touching and assault to the point where an individual becomes uncomfortable. Unwelcome sexual advances or suggestions that sexual favours may progress a person's career.
- An offensive working environment including inappropriate posters, images and other paraphernalia
- Inappropriate and/or offensive comments or behaviour regarding a person’s sexuality or sexual orientation.
- Verbal harassment including the use of foul language or electronic communication systems that harass others on the basis of sex, race, age, or religion.
- Conduct that denigrates or ridicules a colleague because of their race or religion.
- Displaying or sending racially offensive letters or publications.
- Conduct that denigrates or ridicules a colleague because of their disability
- Mimicking the effect of a disability or speech impediment.
- Touching a visually impaired person with the intention to annoy.
Intimidation specifically involves fear – and can be broadly defined as the act of making others do what one wants through fear and discouragement, and introducing a sense of inferiority into others.
Often people use intimidation as a form of self-empowerment and can be manifested in various ways; examples include:
- Physical threat
- Emotional manipulation
- Verbal abuse
- Purposeful embarrassment
- Actual physical assault
Victimisation is where a person is systematically selected for ill treatment or is treated differently to others because s/he has made a complaint.
Victimisation can arise in retaliation against a student who has asserted their rights and made a complaint of harassment and/or bullying. This, along with all other forms of intimidation, harassment and bullying, is a disciplinary and fitness to practise issue. Students should also be protected from intimidation, victimisation or discrimination where a complaint of harassment and/or bullying has been made about them, but not evidenced.
Examples of victimisation:
- Refusing reasonable requests such as unjustifiably blocking access to promotion
- Refusing access to training or continuing profession development
- Subjecting a person to unwarranted disciplinary action or any other detriment
Bullying can be defined as behaviour which consistently undermines another's confidence, reducing feelings of self-esteem and self-worth leaving the recipient feeling hurt, vulnerable, angry or powerless. It may be psychological and/or physical.
Examples of bullying:
- Aggression, e.g. the use of threats, abusive comments or obscenities and shouting at colleagues. As well as aggressive communication of any form, including electronic format and any form of physically or verbally threatening behaviour.
- Persistent humiliation, ridicule or criticism, including negative and inaccurate attacks on a colleague’s personal or professional performance. This can be in private or in front of others.
- Unjustifiably changing areas of responsibility and relegating people to demeaning and inappropriate tasks.
- Deliberately excluding someone from discussions or decisions.
- Setting objectives with impossible deadlines.
- Withholding information with the intent of deliberately affecting a person's performance or health or endangering them in some way.
3. What you can do:
If someone believes they alone have been singled out for attack, they can end up feeling it’s their own fault. In accepting the blame, their self-confidence crumbles and this inevitably undermines their performance. However, your Medical School should be able to help.
The Medical School Charter as agreed upon by the Medical Schools Council (formerly the Council of Heads of Medical Schools) sets out the responsibilities of both the medical student and the Medical Schools. Section 2.3 of the Medical School Charter outlines that the Medical School is obliged to “provide a diverse environment which takes positive action to protect students from bullying, discrimination, victimisation or harassment of any kind and promote equality and value diversity”.
Medical Schools are obliged to provide the student with information and advice on how to make a complaint. Complaints should remain confidential to those involved at all times and the complainant should be protected from any form of victimisation following a complaint.
For further information, the Charter can be found in full online at http://www.medschools.ac.uk and on the BMA’s website: http://www.bma.org.uk/ap.nsf/Content/medschcharter
All Medical Schools have different ways of dealing with bullying and harassment and it is important that you familiarise yourself with the local procedures. We have attempted to draw out generic principles in order to help you along but you should seek as much advice and support as possible.
Confidentiality
It is important to state to those handing your complaint that you wish to have your confidentiality maintained. If you want to remain anonymous you may need to discuss the events before disclosing names, as fitness to practise issues must be followed up. You must realise that any disciplinary proceedings may require you to give evidence and anonymity may not be maintained in these instances.
Medical school contact
You must have contact with at least one trusted member of the medical school staff. In this discussion you should be prepared to produce the following:
- Name of individual
- Complaint with details of behaviour
- What you would like to do
Keep written records
It is advisable to keep a written record if you feel you are being bullied, and when you make a complaint. This record should include dates, incidents, any witnesses, meeting dates, who you discussed the situation with etc.
Investigation
Be prepared for a formal investigation and be well organised. Provide evidence, witness details, event descriptions and any other information that you feel is relevant. Times and dates are also very important in order to detail time periods etc.
Separation
If there is likely to be a time delay between complaint and formal proceedings, the medical school should make alternative arrangements e.g. for teaching. They should attempt to discreetly reallocate students to avoid any more stress. Be sure to ask to be moved if the school does not suggest it.
Formal meeting
If the perpetrator is found to be guilty a formal meeting may be held. Make sure you are being updated on the progress of any procedures.
The Medical School process can be fairly arduous but will be worthwhile if it puts an end to any stress you have faced. If the medical school fails to act then you can take your complaint to somebody else in the university or to a professional body. It is important to note, that whatever the outcome of the Medical School process, the Medical School should be supporting you, even if they cannot prove that the perpetrator has committed any offence.
Recommended action:
Keep a record or diary
This will allow you an opportunity to reflect on the behaviour and to develop a strategy in which you can deal with the bullying. It is vitally important to record the nature of the events. Record the words used as accurately as possible.
Seek support
Never try to deal with it alone, the more support you have, the more likely it is that you will be able to bring this situation under control. It is always sensible to deal with things as quickly as possible so that situations do not get out of hand. Harassment, intimidation, victimisation and bullying are fitness to practise issues so it is extremely important that you report any incident to your tutor or point of contact in the Medical School. Failing that, seek support from your BMA representatives who will seek professional support on your behalf.
Every situation is different and the action you take depends on your particular circumstances whether you choose to communicate directly or indirectly with the perpetrator or walk away.
If you are reading this now and you are experiencing harassment, intimidation, victimisation or bullying in the medical school or on clinical attachment, the most important message is, you are not alone, and you do not have to suffer in silence.
4. Sources of help:
The following people may be able to help:
Medical school:
Medical school counselling service
Bullying and Harassment Officer
Students Union support services
Dean of Students Office
Student welfare officers
University Welfare Officer
University tutor
BMA support:
BMA Representatives – ISC Chairs or MSC Reps
askBMA
BMA Regional Office
BMA Counselling Service
External support:
GP practice
Personal advisors
All schools should have ways of dealing with these problems and if you do not feel comfortable using these methods, a number of support agencies will be able to to offer support and advice. BMA Medical Students Committee Representatives should also be able to point you in the right direction (see the student pages of the BMA website www.bma.org.uk contact askBMA on 0870 60 60 828)
BMA Counselling Service and Doctors for Doctors
The BMA Counselling Service is staffed by professional telephone counsellors, 24-hours a day, seven days a week. All counsellors are members of the British Association for Counselling and Psychotherapy and are bound by strict codes of confidentiality and ethical practice. The service is confidential, and when making contact you can chose to remain anonymous.
Ongoing counselling is available and you can arrange regular appointments. There is no restriction on the number of calls you can make and, having spoken to a counsellor, you can request to speak to that person again. It may be more helpful to speak to the same counsellor each time, giving you continuity of care and providing you with more effective support and assistance.
Doctors for Doctors
Doctors for Doctors is an enhancement of the BMA Counselling Service giving doctors in distress or difficulty the choice of speaking in confidence to another doctor. If you wish to speak to a doctor-adviser you will be given the name of a doctor to contact and details of their availability. The service is not an ‘emergency service’. In an emergency you should obtain appropriate help from either your GP or usual medical adviser.
The Doctors for Doctors service is completely confidential and is not linked to any other external or internal agencies. Any data recorded is anonymised and used to focus resources appropriately, and for lobbying for improved services for doctors’ health issues. www.bma.org.uk/doctorsfordoctors
BMA Counselling Service (24-hours a day, seven days a week) and Doctors for Doctors
Telephone: 08459 200 169 (calls charged at local rates)
Andrea Adams Trust
The Andrea Adams Trust is the world’s only non-political, non-profit making charity operating as the focus for the diverse and complex problems caused by bullying behaviour in the workplace. www.andreaadamstrust.org
Bully OnLine
Bully OnLine is the web site of the UK National Workplace Bullying Advice Line and the world’s leading source of bullying help with extensive resources on workplace bullying and related issues. Bully OnLine also contains pages on harassment, workplace violence, family bullying, domestic abuse, trauma, Complex PTSD, suicide, child bullying, bullying in schools, stalking, and other related issues. www.bullyonline.org
Dignity at Work Partnership
Amicus is heading this vital initiative in collaboration with industry leaders and the anti bullying charity, Andrea Adams Trust. The aim is to encourage employee representatives and employers to build cultures in which respect for individuals is regarded as an essential part of the conduct of all those who work in the organisation. The project will also increases awareness and knowledge of ‘dignity at work’ issues, and encourage the development of partnership working in the workplace through the promotion of joint working on dignity at work. www.dignityatwork.org
Equality and Human Rights Commission
The Equal Opportunities Commission deal with sex discrimination and inequality related to gender, including good practice in the fair and equal treatment of men and women as a main priority http://www.equalityhumanrights.com
Wired Teens:
Electronic bullying is a newly emerging phenomenon threatening all age groups, but students in particular. Electronic bullies use the popular student mediums of email, mobile phone and text messaging to harass, abuse and scare others. According to charity campaigners, this kind bullying is escalating at a worrying rate with around half a million young people experiencing it. More information can be found at www.wiredteens.org
Useful publications
Bullying and harassment of doctors in the workplace
BMA Report
May 2006
Available in pdf format at http://www.bma.org.uk/doctorsfordoctors
We hope that you find this guidance helpful. Please email info.students@bma.org.uk if you have any comments or suggestions.
5. Annex: The legal position
Human Rights Act, 1998
This act ratifies the European Convention of Human Rights in to the UK law, in lay terms it sets out some fairly broad rights owed to individuals in society and countries can be challenged if they fail to protect those fundamental human rights. A small number of bullying and harassment cases have made their way to the European Courts and the legal precedent set has influenced much of the legislative material in the UK (e.g. retraction of UK’s policy on prohibition of homosexual recruitment into the armed forces, this was overturned by the ECHR and primary legislation amended to comply with ruling).
Sex Discrimination Act, 1975 (as amended)
The act prohibits discrimination on the grounds of a person’s sex.
Disability Discrimination Act, 1995 (DDA)
The act prohibits discrimination on the grounds of a person’s disability. (Disability is a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day to day activities. The DDA applies to educational institutions and they can be expected to make reasonable adjustments in order to ensure that there are no negative repercussions for students in the work environment.
Age Discrimination Act, 2006
The act prohibits discrimination on the grounds of age. This legislation, although being contested by medical schools as applying to them, only excludes some professions (armed forces, police) and therefore, any form of discrimination on the basis of age should be reported. This is particularly pertinent as more mature medical students enter medical schools in the UK.
Sexual Orientation Regulations, 2003
The resolutions cover discrimination, harassment and victimisation in work and vocational training. They make it unlawful to deny people jobs because of prejudice about their sexual orientation. They enable individuals to take prompt and effective action to tackle harassment, and enable people to have an equal chance of training and promotion, whatever their sexual orientation. The Regulations also cover perceived sexual orientation and association, i.e. being discriminated against on grounds of the sexual orientation of those with whom you associate (for example, friends and/or family).
Race Relations Act, 1976 (as amended)
It makes it unlawful to discriminate (including subjecting a person to harassment) in admission, treatment as a pupil or student, and exclusion, as well as decisions by local education authorities and education authorities (in Scotland), such as decisions on special educational needs. It is also worth noting that a number of groups at a local, national and european level have been established to deal with race relation issues. It is also worth looking at the Commission for Racial Equality. See above