Workplace bullying within the medical profession is a silent epidemic, with junior doctors being the most vulnerable, KwaZulu-Natal researchers have found.
Writing in the SA Medical Journal, researchers from the College of Health Sciences, University of KwaZulu-Natal expressed concern that few cases are reported and that responses and feedback are weak and ineffectual. They called for greater awareness and action from, particularly, hospitals that host interns.
The issue of intimation and bullying of young medical interns in South African institutions came to the fore in May with the unexpected death on duty at Prince Mshiyeni Hospital, uMlazi, of a diabetic doctor, Alulutho Mazwi, who was allegedly forced to work despite having told his supervisor he was ill, notes MedicalBrief.
Now, A Issak, P Mngomezulu, V Ntlansana, A Tomita and A Paruk write that in global studies, the lifetime prevalence of bullying among medical students and doctors is estimated to range from 10% to 98%. In the UK, junior medical doctors reported a 37% prevalence of workplace bullying, while a figure of 42% has been reported for the USA and 78% for South Africa.
An international systematic review and meta-analysis found that the pooled prevalence of bullying among medical registrars (residents) was 51% (95% confidence interval (CI) 36 – 66), while a survey in 2019 among 70 (39.1%) of the 179 psychiatry registrars from all specialist training institutions in SA found that ~48% reported being bullied. Of this sample, 21 reported consultants as the main perpetrators, followed by patients and patients’ relatives, hospital management, other registrars, nurses and university management.
The most common form of abuse was belittling/humiliation, followed by threats/insults, deliberate prevention from accessing training, and other forms of bullying, researchers found.
KZN investigation
The present study probed the lifetime prevalence and six-month prevalence of bullying among medical interns in KZN, types of bullying, alleged perpetrators, help-seeking behaviour, and the association between bullying and the interns’ mental health and quality of life.
The information and participation request were sent to the intern curators of King Edward VIII Hospital, Prince Mshiyeni Memorial Hospital, Addington Hospital, RK Khan Hospital, Mahatma Gandhi Memorial Hospital/Dr Pixley Ka Isaka Seme Memorial Hospital, the Pietermaritzburg Complex, Ladysmith Hospital, Newcastle Hospital, General Justice Gizenga Mpanza Regional Hospital and Ngwelezane Hospital.
The Department of Health District Office said 270 first- and second-year medical interns were allocated to these hospitals during 2023, and based on an estimated population size of 250 interns and a bullying prevalence rate of 49% reported by Beath et al in 2021 among psychiatry registrars, the present study aimed for a sample size of 152 participants.
Victims
The study found that almost all participants (n=125; 92.6% of the total number) reported being bullied during one or more clinical rotations, often by workplace personnel, including medical officers, consultants and nurses.
Another 52 said they were bullied by patients or their relatives. Of the participants, 107 (79.3%) completed the Negative Acts Questionnaire (NAQ). Notably, nine (90.0%) of the 10 participants who indicated that they had not been bullied on the socio-demographic questionnaire completed the NAQ (one did not complete it), on which they all scored high and were classified as having been a target of bullying in the past six months.
The median (interquartile range) NAQ score was 46.0 (35.0 – 58.0), and all participants who completed the tool scored high as bullying targets. The most common form of bullying as reported on the sociodemographic questionnaire was psychological bullying (n=116; 91.3%), followed by intellectual bullying (n=112; 88.2%).
The least common were cyberbullying (n=10; 9.7%) and physical bullying (n=9; 8.7%).
More than one type of bullying was commonly experienced. Most participants identified medical officers (n=99; 83.2%) as the primary perpetrators, followed by nurses (n=73; 67.6%), consultants (n=71; 65.1%), registrars (n=52; 51.0%), patients (n=43; 43.4%), patients’ relatives (n=36; 37.1%), and managers (n=26, 26.5%).
Prevalent
The authors concluded that workplace bullying is highly prevalent among medical interns, who also reported elevated levels of anxiety, depression and psychosomatic symptoms.
It was concerning, they added, that most participants did not report the bullying, and that those who did were dissatisfied with the responses.
There is a need to raise awareness of bullying and its negative effects in medical institutions and to share these findings with hospitals that host interns.
Standardised reporting procedures and clear consequences for perpetrators must be established to prevent variations in disciplinary actions across institutions. Mechanisms to address mental health challenges resulting from work-related stress should be implemented, and better reporting systems for bullying should be put initiated to ensure victims are heard and perpetrators are held accountable.
Qualitative research is also recommended to give voice to the lived experiences of those in the workplace, particularly junior staff who often find themselves interacting with more senior members, they suggested.
Study details
Workplace bullying and mental health of medical interns in KwaZulu-Natal Province, South Africa
Published in SA Medical Journal in July 2025
Background
There is a silent epidemic of workplace bullying among medical doctors, with junior doctors being the most vulnerable. Little research has been conducted to establish the nature and extent of bullying of medical interns in KwaZulu-Natal.
Objectives
To describe the prevalence and types of workplace bullying, identify alleged perpetrators, and explore the association between bullying and the mental health and quality of life of medical interns in KZN.
Methods
A cross-sectional online survey was conducted across all state hospitals in KZN designated for training first- and second-year medical interns, from 1 June to 31 August 2023, using snowball sampling. Participants completed a newly designed sociodemographic, clinical and bullying questionnaire, the Negative Acts Questionnaire (NAQ), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the World Health Organization Quality of Life scale.
Results
Of the 270 medical interns employed in KZN, 182 responded, and 135 were included in the study. All interns were classified as having experienced bullying according to the NAQ, and 61.8% screened positive for symptoms of anxiety and/or depression on the PHQ-9 and GAD-7. The most commonly reported somatic symptoms and work-related behaviours caused by workplace bullying were recurrent headaches (42.5%), chronic lethargy (79.3%), gastrointestinal illnesses (42.7%), sleep disturbances (67.8%), loss of interest in work (81.0%) and absenteeism from work (43.5%). Most participants (61.2%) did not report the bullying to senior staff, and most of those who did report were dissatisfied with the outcome of the investigation (91.2%).
Conclusions
Medical interns in KZN have a high prevalence of anxiety and depressive symptoms, with a negative impact on their quality of life. Bullying by senior medical and nursing staff is pervasive. However, it was not possible to explore the associations between bullying and mental health, as all participants had high bullying scores on the NAQ.
A Issak,1 MB ChB; P Mngomezulu,1 MMed (Psych); V Ntlansana,1MB ChB; A Tomita,2BSc,PhD; S Paruk,1 MB ChB, PhD
1Discipline of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal.
2Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal.
SA Medical Journal article – Workplace bullying and mental health of medical interns in KwaZulu-Natal Province, South Africa (Creative Commons Licence)
https://samajournals.co.za/index.php/samj/article/view/2589/1462
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