title: Bullying in the American Graduate Medical Education System: A National Cross-Sectional Survey.
abstract: OBJECTIVE
  To deliver an estimate of bullying among residents and fellows in the United States graduate medical education system and to explore its prevalence within unique subgroups.
  
  
  METHODS
  A national cross-sectional survey from a sample of residents and fellows who completed an online bullying survey conducted in June 2015. The survey was distributed using a chain sampling method that relied on electronic referrals from 4,055 training programs, with 1,791 residents and fellows completing the survey in its entirety. Survey respondents completed basic demographic and programmatic information plus four general bullying and 20 specific bullying behavior questions. Between-group differences were compared for demographic and programmatic stratifications.
  
  
  METHODS
  Self-reported subjected to workplace bullying from peers, attendings, nurses, ancillary staff, or patients in the past 12 months.
  
  
  RESULTS
  Almost half of the respondents (48%) reported being subjected to bullying although both those subjected and not subjected reported experiencing ≥ 1 bullying behaviors (95% and 39% respectively). Attendings (29%) and nurses (27%) were the most frequently identified source of bullying, followed by patients, peers, consultants and staff. Attempts to belittle and undermine work and unjustified criticism and monitoring of work were the most frequently reported bullying behaviors (44% each), followed by destructive innuendo and sarcasm (37%) and attempts to humiliate (32%). Specific bullying behaviors were more frequently reported by female, non-white, shorter than < 5'8 and BMI ≥ 25 individuals.
  
  
  CONCLUSIONS
  Many trainees report experiencing bullying in the United States graduate medical education programs. Including specific questions on bullying in the Accreditation Council for Graduate Medical Education annual resident/fellow survey, implementation of anti-bullying policies, and a multidisciplinary approach engaging all stakeholders may be of great value to eliminate these pervasive behaviors in the field of healthcare.
authors.affiliation: Department of Internal Medicine, Advocate Health Care, Oak Lawn, Illinois, United States of America.|University of Illinois at Chicago, Department of Medicine, Chicago, Illinois, United States of America.|Rosalind Franklin University of Medicine and Science, Department of Medicine, North Chicago, Illinois, United States of America.
authors.forename: Amar R
authors.initials: AR
authors.lastname: Chadaga
authors.affiliation: Department of Administration, Advocate Health Care, Chicago, Illinois, United States of America.
authors.forename: Dana
authors.initials: D
authors.lastname: Villines
authors.affiliation: Department of Internal Medicine, Advocate Health Care, Oak Lawn, Illinois, United States of America.|University of Illinois at Chicago, Department of Medicine, Chicago, Illinois, United States of America.
authors.forename: Armand
authors.initials: A
authors.lastname: Krikorian
mesh_terms: D000328:Adult; D058445:Bullying; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D008297:Male; D014481:United States