The professional practice of medicine requires an environment in which patients, staff, colleagues, physicians, trainees, and all other individuals are treated with respect, civility, and tolerance. All members of the surgical team have a shared responsibility to create a culture that values all individuals equally.
Harassment, bullying, and discrimination are three distinct interpersonal behaviors that can negatively affect professional relationships, physical health, mental health, and job satisfaction. These behaviors create a hostile work environment that can compromise patient safety and jeopardize patient outcomes, in addition to damaging the well-being of staff.
Harassment includes, but is not limited to, offensive remarks and actions based on or about gender, race, religion, sexual orientation, age, culture, or ethnicity. Similar to bullying behaviors, harassment can lead to a hostile and intimidating work environment.
Bullying can be defined as the use of negative and aggressive interpersonal behaviors to intimidate and dominate others. Bullying behaviors often are persistent and repeated. Examples include humiliation, insults, threats, coercion, isolation, and overwork—sometimes involving repetitive or meaningless tasks. Bullying often arises in contexts in which there is an imbalance of power. It, therefore, can be common in the surgical environment.
Discrimination entails negatively charged, differential treatment based on one’s personal characteristics or attributes, including, but not limited to, gender, race, religion, sexual orientation, culture, ethnicity, disability, or age. The effects may be more subtle than those associated with bullying and harassment and can manifest as punitive actions or impediments in employment, practice, and/or career advancement. Actual or perceived discrimination may cause a decline in work morale and job satisfaction, ultimately affecting patient care. Implicit bias may contribute to discrimination unless institutions commit to adequate training and cultural change.
The American College of Surgeons values respect, fairness, and professionalism in all interactions with patients, staff, colleagues, and trainees. The following guidelines provide a framework for surgical departments and practices to create a work environment free of bullying, harassment, and discrimination:
- It is essential to build a culture of respect and collaboration in all aspects of surgical practice.
- Health care professionals should have zero tolerance for discrimination, harassment, or bullying based on personal attributes, including, but not limited to, age, sexual preference, gender, race, religion, culture, ethnicity, disease, disability, or religion.
- Administrators should develop and implement transparent policies to address bullying, discrimination, and harassment.
- Staff, physicians, and trainees must have access to nonpunitive reporting structures, counseling services, and remediation programs.
- Surgical training should include a curriculum to address implicit bias, bullying, harassment, and discrimination.
