INTIMIDATION: A TOOL OF LEARNING?

DO WE LEARN BETTER UNDER THE GUN?

REVEALING THE UGLY TRUTH AND THE NEED OF INTIMIDATION POLICY

Budi Iman Santoso, SpOG(K)
Departemen Obstetri dan Ginekologi FKUI / RSCM
OUTLINE
INTRODUCTION
DEFINITION , TYPE, SYMPTOM
INTIMIDATION IN MEDICAL EDUCATION
THE SURVEY
CONCLUSION
INTRODUCTION
INTIMIDATION is always an interesting problem at any level of education
or simply at any stage of life.

INTRODUCTION
At the beginning, everything was beautiful and exciting

Especially, when receiving the letter of acceptance to the residency
LATER, ITS ALL ABOUT THE ENDLESS
NIGHTMARES
Tight
schedule
Unfriendly
learning
atmosphere
Im nothing but 'a piece of s*** with a badge'.
Lowest
status in
hierarchy
TO SOME OTHERS IT MAY BE
NOTHING.
YOU LEARN BETTER UNDER
THE GUN !!!
Which is true?
THE GUN
INTIMIDATION , HARASSMENT ,
BULLYING
Have similar meaning:
to frighten, threat or hurt a weaker person
DEFINITION: INTIMIDATION, BULLYING,
HARASSMENT
University of New Jersey, Mistry & Latoo, Dan Olweus:
Is intended to cause harm or distress
Occurs repeatedly over time
Occurs in a relationship in which there is an imbalance of power or
strength
By definition, INTIMIDATION = NO GOOD

TYPE OF INTIMIDATION
SYMPTOMS
Table 2. Symptoms of intimidation
Physical Emotional
Sleeplessness Acute anxiety
Nausea Feeling isolated
Migraine/severe
headaches
Loss of confidence/self-
esteem
Palpitations Depression
Skin complaints Panic attacks
Sweating/shaking Anger
Backache Mood swings
Loss of appetite Lack of motivation
Lethargy Suicidal thoughts
INTIMIDATION AS LEARNING TOOL
IN MEDICAL EDUCATION

GOOD BAD
GOOD INTIMIDATION
Could be simply named as SUPERVISION
BAD INTIMIDATION
It is difficult to settle or even discuss problems in an
atmosphere of intimidation

(J.F.Kennedy, 35
th
President of US, 1917-1963)
INTIMIDATION IS A CYCLE
THE SURVEY

Research question: Is intimidation a good learning tool?
Subject: all residents at Department of Obstetri-
Gynecology, FMUI, Cipto Mangunkusumo Hospital
Site: Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Period: End of November Early December 2011
Method:
Simple survey by questionnaire
A questionnaire consists of 3 parts
8 questions on demographic characteristic
Statement on definition of intimidation to prevent bias
15 questions on respondents opinion as bullies, bullied or
bystanders
RESULTS AND DISCUSSION
We are all either bullies, bullied or bystanders
(Richard L. Gross, MD American Academy of Child and adolescent psychiatry, 2011)
THE RESULTS
Demographic characteristics
Profile on the Bullied
The Bystanders ~ similar to the bullied
The Bullies
Opinions on intimidation as a learning tool
Opinions on the needs of policy to prevent
intimidation
DEMOGRAPHIC CHARACTERISTICS
Of all 85 residents at Department Ob-gyn FMUI,
76 (89%) participated in the study
44.7% male and 55.3% female
Range of age : mostly at 26-30 years, others 31-35 years
Marital status:
50% married, 48.3% single and 1.7% had divorced
94.1% were from State University; 5.9% of Private
University
81.5% had urban and 18.5% had rural childhood
PROFILE OF INTIMIDATION ON THE
BULLIED / VICTIM PERSPECTIVE
Yes
51.3%
No
48.8%
Being intimidated
PROFILE ON THE BULLIED / VICTIM
Once a month
66.7%
Less than once a month 16.7%
Once a week 13.9%
Every day 2.8%
PROFILE ON THE BULLIED / VICTIM
TYPE of intimidation
Words (70%), written (17.1%), gesture (17.1%)
Physical (23%), cyber-bullying (2.4%)
BULLIERS
Peer-residents (80.5%), Consultant s(46.3%)
Nurses (14.6%), Patients (12.2%)
IMPACT
Wasted time (85.9%), financial problem (34.1%)
No effect (28.8%), Health (14.9%)
Family (7.3%), study program (2.4%)


PROFILE ON THE BULLIED / VICTIM
How to deal with the stress:
Talk to others (39,0%)
Wish the situation would go away(36.6%)
Praying more (29.3%), positive thinking (24.4%)
Doing nothing (14.6%). more sleep (12.2%),
Eating more (9.8%), eating less(4.9%)
Smoking (4.9%)
Adequate supporters
Colleague (95.8%), others (24.4%), no one (9.8%),
Chief resident (12.2%), Head of Study Program(2.4%)
PROFILE OF INTIMIDATION ON THE
BULLIER PERSPECTIVE
No
91.7%
Yes
8.3%
PROFILE OF INTIMIDATION ON THE
BULLIER PERSPECTIVE
Less than
once a month
50%
At least once
a month
50%
PROFILE OF INTIMIDATION ON THE
BULLIER PERSPECTIVE
Profile of Bullier vs. Bullied
BEING INTIMIDATED
Bullied Not Bullied
INTIMIDATING

Bullier

100.0%


Non-Bullier

45.5%

54.5%
INTIMIDATION AS A LEARNING TOOL
Will you do intimidation
in the future?
93.0% NO

If intimidation continues
Disagree 58.2%
Try other specialty 11%
NO
60.9%
YES
13.0%
YES/NO
26.1%
THE NEED OF POLICY
Policy Maker
Head of Department - 47.7%
Head of Study Program - 35.4%
Dean - 18.5%
Head of University - 15.4%
Chief Resident - 12.3%
Minister of Health - 3.1%

Includes: Rewards and punishment
75% agree to punish bullier
94.0% disagree giving reward to
bullier

Necessary
81.2%
Unnecessary
18.8%
DISCUSSION
The survey has good response rate 89%
Cohen 51% response rate
Incidence of intimidation 50%
Similar to other studies
Ahmer 52%, medical students in Pakistan
Frank 40%, medical students in US
Scot 50%, junior residents in Auckland Hospital, New Zealand
Mostly who had been intimidated were male, had rural
childhood similar to study by Ahmer in Pakistan
No sexual harassment has been revealed

DISCUSSION
The majority of bullier were peer-residents and
consultant instead of being role-model
Similar to Ahmer and Frank
All of the bullier had prior experience of been
bullied (100%) indicating transgenerational legacy
Mostly disagree that intimidation is a learning tool
It is different from findings in Musselman study that
indicate the acceptable good intimidation
Different acceptance is affected by different assumption,
life background and interpretation
Further studies are necessary

DISCUSSION
If intimidation continues, 11.9% would consider to
quit and try other specialty
Frank 13% for other profession; Cohen - 14% for
other specialty and 22% for other profession
Policy to prevent intimidation was regarded as
necessary
BMA - Integrated in Strategic Health Care Alliance
National bullying hotline
Head of Department would be the best policy
maker (47.7%) and the least popular was Minister
of Health (3.1%)
CONCLUSION
Intimidation, harassment and bullying have similar
meaning to threat, to harm weaker person
Role of intimidation as learning tool in medical
education is still on debate.
Good intimidation is simply called SUPERVISION
CONCLUSION
Our survey indicates high incidence of intimidation
and bad impacts in Obs-gyn residents at
Department of Obstetri and Ginekologi FMUI
Cipto Mangunkusumo hospital
Policy to prevent intimidation is necessary
Intimidation is a cycle; therefore it should be
managed by multi-disciplinary experts

Those who can do; but those who cant bully
(Tim Field, British Anti-bullying Activist, 1952)

A man who is intimate with God is not intimidated by man
(Leonard Ravenhill, Christian Evangelist, Author, 1907-1994)



FIGHT BULLYING AND INTIMIDATION
BREAK YOUR FEAR
Once upon a time, there was a Korean Slave, who
did not dare to free herself
Even when a hero has come to set her free
The hero told her,
Youll be a SLAVE forever if you always think you are.
Freedom is earned, not given and it starts when youre
WILLING to free yourself
The words inspired her, her will had set her free
and
made her have a peaceful life
THANK YOU