'You learn better under the gun': intimidation and harassment in surgical education

BACKGROUND Medical literature has documented a high prevalence of intimidation and harassment in the educational context. However, the research has failed to adequately delineate the nature of these phenomena as well as the different ways in which diverse actors perceive the behaviours in question. METHODS Based on qualitative methodology anchored in a social constructionism framework, how teachers (staff surgeons) and learners (surgical residents) define intimidation and harassment were documented and compared. In addition, teachers' and learners' perceptions of the impact of these behaviours on the learning environment, including their effects on the socialisation of surgeons in training, were examined. FINDINGS Five group interviews and 22 individual interviews were conducted across 2 university departments of surgery with a total of 22 faculty and 14 resident participants. Interviewees acknowledged the existence of intimidation and harassment, while at the same time rationalising its occurrence. This paradox was encapsulated in participant descriptions using terms such as 'good intimidation'. Our examination of the data helped us to understand that participants sustained the paradox of beneficial intimidation and harassment by rationalising questionable behaviours on 3 specific dimensions, namely: whether an acceptable purpose could be attributed to the perpetrator; whether positive effects of the behaviour existed, and whether there was a perceived necessity for the behaviour. INTERPRETATIONS Even while their dysfunctional characteristics are recognised, intimidation and harassment are often seen as functional educational tools. The cultural value currently accorded these behaviours needs to be taken into account in educational interventions designed to shift attitudes and actions in this domain.