Bullying and Intimidation in Clinical Supervision Tackling problematic treatment of students requires speaking up, intervening and working on prevention. From My Perspective
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From My Perspective  |   December 01, 2017
Bullying and Intimidation in Clinical Supervision
Author Notes
  • James M. Mancinelli, PhD, CCC-SLP, is assistant professor and director of clinical education in the Department of Communication Sciences and Disorders at La Salle University in Philadelphia. He is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 10, Issues in Higher Education; and 11, Administration and Supervision. mancinelli@lasalle.edu
    James M. Mancinelli, PhD, CCC-SLP, is assistant professor and director of clinical education in the Department of Communication Sciences and Disorders at La Salle University in Philadelphia. He is an affiliate of ASHA Special Interest Groups 4, Fluency and Fluency Disorders; 10, Issues in Higher Education; and 11, Administration and Supervision. mancinelli@lasalle.edu×
Article Information
Professional Issues & Training / From My Perspective
From My Perspective   |   December 01, 2017
Bullying and Intimidation in Clinical Supervision
The ASHA Leader, December 2017, Vol. 22, 8-10. doi:10.1044/leader.FMP.22122017.8
The ASHA Leader, December 2017, Vol. 22, 8-10. doi:10.1044/leader.FMP.22122017.8
“I was so humiliated,” the student said. “A medical resident came over and said to my supervisor, ‘You can’t talk to a student like that.’” I learned of her treatment eight weeks into the practicum. She wanted to “tough it out.” This student lost 20 pounds by the time I requested a new clinical educator to take over.
“She told me she could fail me. But she said it in a mocking tone. It made me so nervous.” I learned of this three weeks into the practicum. This student was not sleeping and crying every morning on the way to the site.
“I never know which way to turn. I feel off balance. I can’t even think. I can’t take this anymore.” I learned of this four weeks into the practicum. This student asked me to pull her from the site because her fear and uncertainty were affecting her confidence and learning.
“She told me to ‘Sit over there until we get back from lunch,’ so I sat in the waiting room while everyone else went to lunch.” I learned of this incident nine weeks into the practicum. This student suffered symptoms consistent with post-traumatic stress disorder. She did not seek a clinical fellowship until six months after graduation.
Over the years, I—director of clinical education in a graduate speech-language pathology program—have heard many comments like the ones above. Fortunately, in most instances, the student and field clinical educator (FCE) are able to find a way to build a fruitful, working relationship, even though every day was not perfect. In the cases noted here, the students were either pulled from the site due to physical and psychological distress, or clinical supervision was passed to another member of the team.
There is precedent for identifying and handling bullying and intimidation in the nursing education literature, in the psychology education literature and in the physical therapy literature (see sources). A literature search on bullying in graduate student education in communication sciences and disorders did not yield any systematic studies or reports.
It is important to this discussion to differentiate—and then relate—the terms “bullying” and “intimidation.” Intimidation is associated with instilling fear in another party, and bullying is associated with the powerful preying on the weaker party. Across disciplines, the power gradient in the context of clinical education is never in the student’s favor, but this is not unusual in any student-teacher dyad. Problems arise when the power difference is exploited by a clinical educator, easily translating into bullying.
The FCE may believe that this pedagogical approach is valid and appropriate, and provides the best learning outcomes and facilitates the transition from a student mindset to a professional one. However, the student can become paralyzed with fear and uncertainty, as intimidation is injected into the relationship. This FCE may have been trained by someone who used this style, evoking the very common “this is how I was trained” refrain.
Finally, the FCE may have no insight into the fact that clinical instruction must meet the student where they are, and that the tried-and-true methods of the past may not be applicable for every 21st-century student. Unfortunately, when an FCE chooses to use these methods in clinical teaching, especially with a highly sensitive, anxious or non-confrontational student, the educational context becomes the perfect scenario for bullying and intimidation to arise. The bully relishes the power, and the victim seeks safety and shelter.
A perfect storm
An event several years ago exemplifies the problem: Two weeks into a second-level, external health care clinical practicum, a graduate student came to tell me that she was shaken by the day’s events. She was crying and visibly trembling in her chair in my office. “I’m sorry. I know I shouldn’t be crying,” she said. She blamed herself for her negative experiences that day—self-blaming behavior due to the erosion of self-confidence has been documented in the physical therapy literature (see sources).
This student was very bright and did very well in her first internal clinic assignment and in her first external assignment in a school-based setting. She was, however, extremely sensitive and not very assertive. She was also somewhat perfectionistic. She reported anxiety, lack of sleep and uncertainty about her status at the clinical site. She told me these feelings were directly related to her clinical assignment under the supervision of her current FCE.
In that first meeting, she clearly described bullying and intimidation by her FCE: personal attacks, threats regarding her grade, public humiliation, and comments about her commitment to the program, often delivered in a derisive, mocking style. The student was in a place of psychological imbalance: On Monday all could be well, but Tuesday could be horrific. This is the modus operandi of the bully—keep the victim off balance, making manipulation and control easier.
At the end of our meeting, I asked the student to document her experiences, and I sent her material on dealing with difficult people and identifying bullying and intimidation in the workplace. I then arranged a meeting with the FCE and the student, which was congenial but frank. I told the FCE that the student would be removed due to significant stress that was affecting her physically and psychologically.
The question of intent arises. What does the FCE gain by bullying and intimidating a student? Are they even aware that their teaching style includes elements of bullying and intimidation? Perhaps this FCE believed that a militaristic and aggressive approach was needed to meet her productivity requirements, provide optimal care to her patients and educate the student. Unfortunately, when that philosophy was combined with the student’s personality traits, the outcome was an interpersonal and clinical disaster.

Graduate student clinicians must learn and grow professionally through their clinical practicum assignments. There are some students, however, who are challenged by the transition and appear immature.

Your side, my side and the truth
Did the student’s behavior play a role in the demise of the personal relationship and, as a consequence, her clinical education experience? I believe that it did, and it was directly related to a mismatch of expectations. All graduate students in our program must be interviewed by the FCE and judged to be suitable for that practicum assignment. That interview took place, and the student was accepted. As it turns out, however, the FCE was expecting a student who was more professionalized, and the student was expecting a “teacher” who would understand her struggles.
This student felt comfortable requesting time off to study and leaving early to “prepare for class.” In the health care facility where she was placed, however, these requests are viewed as a lack of commitment and engagement in the day’s work. Graduate student clinicians must learn and grow professionally through their clinical practicum assignments. There are some students, however, who are challenged by the transition and appear immature.
This does not exonerate the FCE who is bullying and intimidating the student. On the contrary, the FCE should work out a plan for success with the student. Nevertheless, to reach a solution, all parties need to understand their role in creating the problem.
The old adage, “There are three sides to every story: my side, your side and the truth,” does apply in these scenarios. But this does not negate the cold, hard fact that bullying and intimidation as a clinical teaching method has no place in the development of the student’s ability to think critically, solve problems and optimally treat the people we serve.
Bullying and intimidation in clinical education is happening to our graduate students. The lack of documentation may be due to the “grin-and-bear-it” attitude that most students adopt. It may be due to the fact that it doesn’t happen often enough to warrant investigation. Or are we as a discipline ignoring it, not with self-serving intent, but because we view it as the cost of doing business? Before we can provide solutions, we must start by asking questions:
  1. How prevalent is bullying and intimidation at the clinical site?

  2. Why are some students targeted and not others?

  3. What role does the student play in the development of this negative relationship?

  4. What do we need to add to our FCE training so that they refrain from such behavior?

  5. What role do the productivity, fiscal and managerial responsibilities of the FCE play in the development of a bullying and intimidation situation?

The steps in changing any negative behavior begin with an awareness that the problem exists, then identifying when it is observed, and finally preventing it from happening again. Shall we begin?
Sources
Birks, M., Cant, R, P., Budden, L. M., Russell-Westhead, M., Özçetin, Y., & Tee, S. (2017). Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students’ experience during clinical placement in Australia and the UK. Nurse Education in Practice, 25, 14–21. [Article] [PubMed]
Birks, M., Cant, R, P., Budden, L. M., Russell-Westhead, M., Özçetin, Y., & Tee, S. (2017). Uncovering degrees of workplace bullying: A comparison of baccalaureate nursing students’ experience during clinical placement in Australia and the UK. Nurse Education in Practice, 25, 14–21. [Article] [PubMed]×
Hewett, D. (2010). Workplace violence targeting student nurses in the clinical areas. Master of nursing thesis. Stellenbosch University, Stellenbosch, South Africa. http://hdl.handle.net/10019.1/5183
Hewett, D. (2010). Workplace violence targeting student nurses in the clinical areas. Master of nursing thesis. Stellenbosch University, Stellenbosch, South Africa. http://hdl.handle.net/10019.1/5183×
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Rayner, C., & Hoel, H. (1997). A summary review of literature relating to workplace bullying. Journal of Community & Applied Social Psychology, 7, 181–191. doi/10.1002/(SICI)1099-1298 (199706)7:3 <181::AID-CASP416 >3.0.CO;2-Y. [Article]
Rayner, C., & Hoel, H. (1997). A summary review of literature relating to workplace bullying. Journal of Community & Applied Social Psychology, 7, 181–191. doi/10.1002/(SICI)1099-1298 (199706)7:3 <181::AID-CASP416 >3.0.CO;2-Y. [Article] ×
Whiteside, D., Stubbs, B., & Soundy, A. (2014). Physiotherapy students’ experiences of bullying on clinical internships: A qualitative study. Physiotherapy, 100, 41–46. [Article] [PubMed]
Whiteside, D., Stubbs, B., & Soundy, A. (2014). Physiotherapy students’ experiences of bullying on clinical internships: A qualitative study. Physiotherapy, 100, 41–46. [Article] [PubMed]×
Yamada, Y. M., Cappadocia, C., & Pepler, D. (2014). Workplace bullying in Canadian graduate psychology programs: Student perspectives of student-supervisor relationships. Training and Education in Professional Psychology, 8(1), 58–67. [Article]
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December 2017
Volume 22, Issue 12