Brief Communication
Perceptions of Intimidation in the Psychiatric Educational Environment
in Edmonton, Alberta
Phil Tibbo, MD, FRCPC1, CJ de Gara, MBBS, FRCS2,
Treena M Blake, BSc3, Carolyn Steinberg, MD4, Brian Stonehocker,
MD5
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Objective: To examine the perceptions of intimidation
in the psychiatric educational environment in Edmonton, Alberta.
Methods: We distributed a 7-point modified Likert
scale questionnaire that included questions with respect to
intimidation perceptions and experience in psychiatry during
a
1-week period to all student interns on psychiatry rotations,
residents, and teaching faculty in the 5 teaching hospitals
in Edmonton.
Results: A total of 92 individuals responded, with
response rates of 81% for faculty, 82% for residents, and
84% for students. Response rates did not differ among sites.
While there were differences between site and group with respect
to comparing the perceived intimidation in psychiatry with
other specialties, respondents did not view psychiatry as
worse than other specialties. Although, overall, women perceived
intimidation as more prevalent at their sites than did men,
the overall means reflect sites that are relatively free from
intimidation. Faculty and student interns within sites, except
for the university hospital, tended to disagree on management’s
approach to perceived intimidation. All groups, however, reported
little personal experience and felt their sites had little
tolerance for intimidators.
Conclusions: Reported perceptions and personal experiences
of intimidation within the psychiatric learning environment
in Edmonton are low.
(Can J Psychiatry 2002;47:562–567)
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Clinical Implications
Limitations
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Resident training was not compared by year, owing
to a small sample size.
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The cross-sectional nature of this study does not
permit examination of changes over time.
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Key Words: intimidation, psychiatric learners,
teaching environment
Résumé
: Perceptions d’intimidation dans le milieu de la formation
psychiatrique à Edmonton, en Alberta
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Historically, intimidation has been perceived as part of the medical
training process, a “rite of passage.” Literature exists
that documents this perception as a real entity, with the most common
intimidation occurring between residents and faculty (1–4).
However, perceptions of degree of intimidation differ, depending
on the training specialty. Surgery, for example, has been viewed
as having the highest amount of intimidation as part of its training
program, but this has changed in recent years (4). One reason for
this change may be the recent focus on intimidation in medical education
in Canada, resulting in national position papers that make this
behaviour unacceptable (5). The occurrence of intimidation as part
of psychiatry training programs in Canada has never been studied,
although policies exist within our university settings to address
the same.
In 1998, the Council of Academic Health Centres of Alberta, as
well as the Professional Association of Interns and Residents of
Alberta (PAIRA), developed and approved a policy regarding the elimination
of harassment and intimidation in the working environment. In this
policy, intimidation is defined as either implied or explicit but
not limited to the following: 1) behaviours or threats that imply
loss of future opportunity, worsening abuse, or compromise of education,
and 2) abuse of power through threats or coercion. This policy states
that intimidation does not include the legitimate exercise of individual
supervisory authority in an appropriate manner.
There is a paucity of research in the field of intimidation for
learners in the psychiatry field; therefore, the goal of this study
was to examine perceptions of intimidation that exist today among
undergraduate (student) and postgraduate (resident) learners and
faculty at the University Hospital and the other teaching hospitals
in Edmonton, Alberta.
Methods
In Edmonton, psychiatric learners are spread out over 5 sites:
the University of Alberta Hospital (UAH); the Alberta Hospital,
Edmonton (AHE), the provincial psychiatric hospital; the Royal Alexandra
Hospital (RAH), an inner-city hospital; and the Grey Nuns Hospital
(GNH) and the Misericordia Hospital (MIS), 2 community hospitals.
Psychiatrists acting as their preceptors have university appointments
(with most being part-time clinical appointments). Learners are
allocated to each site to meet the requirements of either their
core or elective rotations.
We developed an intimidation questionnaire
specifically for psychiatry from modifications of an intimidation
questionnaire that the Department of Surgery had developed at the
University of Alberta (4). The Department of Psychiatry’s questionnaire
included questions with respect to attitude, personal experience,
and intimidation management at the learner’s site during the
time of the survey. We developed a 7-point modified Likert scale
for data capture that also included root descriptive statements
at the extremes of the scale. Table
1 provides the University of Alberta, Department of Psychiatry,
Intimidation Questionnaire.
During a 1-week period in October 2000, 2 senior residents visited
each hospital site and distributed the questionnaire to all psychiatric
learners and faculty that had teaching responsibilities. The questionnaire
included a cover letter ensuring the anonymity of the respondent
and giving the specific definition of intimidation.
The intimidation questionnaire results were analyzed to determine
whether responses differed among sites, professional group (students,
residents, and faculty), and by sex. The responses to each individual
question were examined using the General Linear Model (GLM) Univariate
test, with the dependent variable being the response to the question
and the fixed factors being the site, the professional group, and
the sex. Further analyses using 1-way analysis of variance (ANOVA)
and independent sample t-tests were performed where appropriate.
For each question, we tested the null hypothesis that there were
no differences among sites, professional group, or by sex. We used
an alpha of 0.05 for the level of significance.
Results
Response Rates
A total of 92 individuals responded: 42 faculty, 23 residents,
and 27 students. Of these respondents, 24 were from the UAH, 20
were from the RAH, 19 were from the GNH, 15 were from the MIS, and
14 were from the AHE. Chi-square tests revealed that the response
rate did not vary significantly by site (c2 = 3.5, P = 0.47).
Across sites, faculty response rates averaged 81%, resident response
rates averaged 82%, and student response rates averaged 84%.
Question 2
“This institution is free/rife with intimidation.” There
is no evidence that responses to Question 2 differed among the 5
sites or the 3 professional groups; however, while a main effect
of sex was found (F = 4.499, P < 0.05), it was not specific
to site or professional group. Examination of the means reveals
that women respondents viewed intimidation as more prevalent at
their sites at the time of sampling than did men. Even so, the overall
women mean response of 2.81 (SD 1.96) indicates that women perceived
their sites as relatively free from intimidation (overall male mean
1.89, SD 0.97).
Question 3
“Comparing this specialty to others, intimidation at this
institution is worse, or better, or the same.” There was a
main effect of site and professional group (F = 5.475 and 7.429,
respectively, P = 0.001), which must be interpreted in light
of the significant interaction between site and professional group
(F = 2.545, P < 0.05), illustrated in Figure
1. In general, faculty and students at the AHE and the RAH viewed
intimidation in psychiatry as more similar to that occurring in
other specialties. A significant difference occurred between faculty
and residents at the AHE (1-way ANOVA: F = 4.278, P <
0.05, Fisher’s least-significant-difference [LSD] post hoc
test), wherein faculty felt that intimidation was similar to other
specialties, while the resident group felt intimidation was better
than in other specialties. Other groups and sites perceived intimidation
in psychiatry as a lesser problem than in other disciplines.
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