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Bullying, undermining and harassment in vascular surgery training: a stubborn problem that damages the specialty

Background: Bullying, undermining and harassment (BUH) behaviours are present amongst healthcare workers and have detrimental effects on the victim’s well-being and adversely affect patient outcomes. Although it is known that these problems are prevalent within surgery, there are few data on the extent of the issue amongst UK vascular trainees specifically. Methods: The Rouleaux Club (RC), representing UK vascular trainees, has conducted two surveys which were distributed amongst 137 members of the RC between May and July 2017 and 831 between March and April 2021. Data were collected on demographics and personal experiences of BUH behaviours as well as those witnessed by trainees. Comparisons were made between the responses of each survey. Results: The 2017 survey yielded 71 responses and the 2021 survey resulted in 86 responses, with estimated response rates of 51.8% and 10.3%, respectively. In 2017, 33 (47.1%) respondents reported personally experiencing BUH compared with 57 (72.2%) in 2021 (p=0.002). In 2017, seven (20%) reported witnessing BUH compared with 45 (57.7%) four years later. The most frequent perpetrators were vascular consultants (31 (81.6%) in 2017 and 55 (96.5%) in 2021, p= 0.020). BUH behaviours related to gender or sexual orientation increased from affecting two respondents (5%) in 2017 to 18 respondents (28.1%) in 2021 (p=0.004). Conclusions: BUH behaviours are an ongoing problem within UK vascular training. Despite recent attempts to tackle these issues, there is no evidence of improvement and a signal for possible worsening of the problem. There is a need for further research to understand this issue in more detail in order to plan long-lasting interventions that will minimise detriment to individual trainees, protect the reputation of the specialty and maintain the safety of patients and optimal delivery of care.