27th July 2018, Volume 131 Number 1479

Althea Gamble Blakey, Lynley Anderson, Kelby Smith-Han, Tim Wilkinson, Emma Collins, Elizabeth Berryman

Having designed, implemented and evaluated an anti-bullying intervention for the clinical workplace over the last three years, we have come to better understand the current situation regarding student bullying in…

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In this article we argue that bullying intervention is failing because of how it is done. We argue for a new focus for bullying intervention, based on adult learner needs.


Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentially sizeable financial and personal costs associated with continued bullying and undertaking an intervention, it would seem sensible that any selected intervention method avoids those shown to be potentially ineffective or deleterious. Such avoidance would likely help to move the student bullying research forward, prevent further suffering and reduce the waste of valuable taxpayer resources.

Author Information

Althea Gamble Blakey, Research Fellow, Otago Medical School & Professional Practice Fellow, Early Learning in Medicine Programme, University of Otago, Dunedin;
Lynley Anderson, Associate Professor and Head of Department, Bioethics Centre, University of Otago, Dunedin; Kelby Smith-Han, Research Fellow, Otago Medical School, Medical Education Research Academic Lead, University of Otago, Dunedin; Tim Wilkinson, Professor, Associate Dean of Medical Education & Director, MBChB Programme, Otago Medical School, University of Otago, Dunedin; Consultant Physician in Geriatric Medicine, Canterbury District Health Board, Christchurch;
Emma Collins, Senior Lecturer in Nursing, Otago Polytechnic & Staff Nurse, Southern District Health Board, Dunedin; Elizabeth Berryman, Registered Medical Officer, Waitemata DHB, Auckland.


Althea Gamble Blakey, Research Fellow, Otago Medical School & Professional Practice Fellow, Early Learning in Medicine Programme, University of Otago, Dunedin.

Correspondence Email


Competing Interests



  1. Martin W. Is your hospital safe? Disruptive behaviour and workplace bullying. Hosp Top. 2008;86(3):21–28.
  2. Fnais N, Soobiah C, Chen M, Lillie E, et al. Bullying and discrimination in medical training: A systematic review and meta-analysis. Acad Med. 2014; 89(5):187–827.
  3. Jamieson J, Mitchell R, Le Fevre J, Perry A. Bullying and harassment of trainees: An unspoken emergency? Emerg Med Australas. 2015; 27(5):464–467.
  4. NZMSA. Press release: Final results for New Zealand Medical Student Association medical student bullying survey. NZMSA, Wellington, NZ. 2015. 
  5. Building respect, improving patient safety: RACS action plan on discrimination, bullying and sexual harassment in the practice of surgery. Royal Australasian College of Surgeons, Melbourne, Australia. 2017.
  6. Unison-Pace W. Investigating generational differences of perceived uncivilized behaviors between students and faculty in nursing education (Doctoral dissertation, Capella University). 2015.
  7. Boyle M, McKenna L. Paramedic and midwifery student exposure to workplace violence during clinical placements in Australia – a pilot study. Int J Med Educ. 2016; 7:393–399.
  8. Biggs J, Tang C. Teaching for quality learning at university (2nd Ed.) Buckingham, UK: SRHE & OUP. 2011.
  9. Sheehan D, Wilkinson T, Paltridge D. A tool to evaluate effective learning environments within clinical attachments for interns. Foc Health Prof Educ, 2008; 10(1):1–10.
  10. Kassebaum D, Cutler E. On the culture of student abuse in medical school. Acad Med, 1998; 73(11):1149–1158.
  11. Ahmer S, Yousafzai A, Bhutto N, Alam S, et al. Bullying of medical students in Pakistan: a cross-sectional questionnaire survey. PLoS one. 2008; 3(12):e1–4.
  12. Thomas C. Teaching nursing students and newly registered nurses’ strategies to deal with violent behaviors in the professional practice environment. J Cont Ed Nurs.2010; 41(7):299–308.
  13. Spence Laschinger H, Nosko A. Exposure to workplace bullying and post-traumatic stress disorder symptomology: the role of protective psychological resources. J Nurs Manage, 2015; 23(2):252–262.
  14. Einarsen S, Hoel H, Zapf D, Cooper C. [2nd Ed.] The concept of bullying and bullying at work: The European tradition. Bullying and bullying in the workplace: Developments. 2011. 
  15. Clarke C, Kane D, Rajacich D, Lafreniere K. Bullying in undergraduate clinical nursing education. Journal of Nursing Education.2012; 51(5):269–276.
  16. Gamble Blakey A, Smith-Han K, Anderson L, Collins E, Berryman E, Wilkinson T. Interventions addressing student bullying in the clinical workplace: A narrative review. 2018 (In review). 
  17. Curtis J, Bowen I, Reid A. You have no credibility: Nursing students’ experiences of horizontal violence. Nurse Ed in Prac. 2007; 7(3):156–63.
  18. Rosenstein A. Addressing the causes and consequences of disruptive behaviours in the healthcare setting. J Psych Clin Psych. 2015; 3(3):e1–10.
  19. Souba W, Way D, Lucey, C, Sedmak, D, Notestine, M. Elephants in academic medicine. Acad Med. 2011; 86(12):1492–9. 
  20. Hodgins M, MacCurtain S, Mannix-McNamara P. “Workplace bullying and incivility: a systematic review of interventions.” International Journal of Workplace Health Management. 2014; 7(1):54–72.
  21. McGregor F. Bullying: The Perspective of the Accused. In: The Handbook of Dealing with Workplace Bullying, pp.77–195.Surrey: Gower Publishing Limited. 2015.
  22. Barnsteiner J, Madigan C, Spray T. Instituting a disruptive conduct policy for medical staff. AACN Adv Crit Care. 2001; 12(3):378–382.
  23. Hollins-Martin C, Martin C. Bully for you: Bullying and bullying in the workplace. Br J Midwifery. 2010; 18(1):25–31.
  24. Lachman V. Practical use of the nursing Code of Ethics: Part I. Med Surg Nurs. 2009; 18(1):55–7.
  25. Lachman V. Practical use of the nursing Code of Ethics: Part II. Med Surg Nurs. 2009; 18(3):191–4.
  26. Walton M. Sexual equality, discrimination and harassment in medicine: It’s time to act. Addict, 2015; 165(24):167–9.
  27. NZ Health and Safety at Work Act 2015. Special Guide downloaded from: http://www.worksafe.govt.nz/worksafe/information-guidance/legal-framework/introduction-to-the-hsw-act-2015/special-guide 8 Nov 2017.
  28. Blakey A. Cultivating student thinking and values in medical education: What teachers do, how they do it and who they are. PhD thesis. University of Otago, NZ. 2016.
  29. Gamble Blakey A, Pickering N. Putting it on the table: Towards better cultivating medical student values. Med Sci Educ. 2018 (In press).


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