Physiotherapy 99 (2013) 178180

Short communication

Physiotherapy students experiences of bullying on clinical internships: an

exploratory study
Brendon Stubbs a, , Andy Soundy b
a

University of Greenwich, London, UK

University of Birmingham, Birmingham, UK

Abstract
Objectives To consider the prevalence and type of bullying behaviours experienced whilst on clinical placement in a cohort of final-year BSc
undergraduate students.
Design Cross-sectional survey.
Setting University in the West Midlands, UK.
Participants Fifty-two final-year undergraduate students.
Main outcome Prevalence of incivility and bullying behaviours.
Results Twenty-five percent of students reported at least one incident of bullying behaviour. The perpetrator of the bullying behaviour was
most often the clinical educator (8/13, 62%). Despite the negative effects caused, the majority of students (11/13, 84%) did not report this
experience to the university.
Conclusion Bullying behaviour may take many forms and can have a negative effect on the well-being of students. It should be addressed by
all stakeholders including universities, National Health Service trusts and researchers. Possible strategies to move forwards and better protect
the future of the physiotherapy profession are briefly considered.
2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Keywords: Bullying; Students; Education; Clinical education; Physiotherapy

Introduction
Workplace bullying has received increased attention in
all health-related professions in recent years [13]. The
Chartered Society of Physiotherapy [4] defined bullying
as Offensive, abusive, intimidating, malicious or insulting
behaviour or abuse of power, which makes the recipient feel
upset, threatened, humiliated or vulnerable, undermines their
self confidence and may cause them stress. Pope and Burnes
[5] consider bullying to be one of three negative behaviours
(the others being incivilitya and aggressionb ). Bullying is
more intense than incivility, with the intent to control an

Corresponding author. Tel.: +4420 8331 9000; fax: +44 1604696126.

E-mail addresses: b.stubbs@greenwich.ac.uk,
brendonstubbs@hotmail.com (B. Stubbs).
a A low-intensity behaviour that is rude, insensitive or disrespectful
towards others in the workplace [12] with ambiguous/unclear intent to harm
a factor that distinguishes it from bullying [13].
b Aggressive behaviour with the unambiguous, clear intent of causing
harm to a person.

individual and cause psychological pain through systematic

harassment [6].
The reported incidence of bullying in health settings has
varied greatly, with some studies reporting rates as high as
70% [7]. However, the prevalence of bullying among UK
physiotherapists is unclear. For example, one National Health
Service trust in the South-East of England reported that 37%
of community therapists (definition of therapist not provided) had experienced bullying [8]. In Australia, a study
reported bullying as a cause of stress for approximately 20%
of physiotherapy staff [9]. Thus, there is a relative paucity of
empirical data on the phenomenon of bullying in the physiotherapy profession.
Strong associations have been identified between workplace bullying and poorer mental health, including increased
anxiety, low mood, anger, frustration and loss of selfconfidence [2,3]. Workplace bullying may also affect job
satisfaction and an individuals willingness to remain in their
current position or profession [5,8]. Student physiotherapists entering the profession may be particularly vulnerable

0031-9406/$ see front matter 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.physio.2013.01.001

B. Stubbs, A. Soundy / Physiotherapy 99 (2013) 178180

to bullying due to their lack of experience, position or

authority [1,8]. The aim of this study was to investigate
the incidence of bullying experienced amongst a cohort of
final-year physiotherapy students on clinical internships in
the UK.

Methods
Design and instrumentation
Following ethical approval, a questionnaire was designed
to assess the incidence of bullying during clinical internships.
Previous research considering bullying, incivility and aggression [1,6,10] helped the authors identify four domains and 22
questions. The questionnaire is available upon request from
the corresponding author.
Participants
Seventy-two final-year physiotherapy students at a university in the West Midlands, UK were invited to take part
in the study. All students had completed six clinical placements.
Procedure and analysis
The questionnaire was distributed to all final-year physiotherapy students. Responses to questions are represented
by frequencies and percentages. The types of bullying and
incivility were analysed using quantitative content analysis
[11].

Results
In total, 52 questionnaires (72%) were returned. Bullying was evident and reported by 25% (13/52) of students.
On average, students reported four (standard deviation 2)
experiences of bullying across their placements (median
3, range 1 to 10). The types of bullying and incivility
reported by students are shown in Table 1. The perpetrator of the bullying was identified as the clinical educator
(8/13, 62%), another physiotherapist (3/13, 23%) or a patient
(2/13, 15%). Eighty-four percent of students (11/13) did
not report incidents to the university (including coordinators of clinical education). Six students (6/13, 46%)
suggested that their experience of bullying resulted in
negative psychological consequences. These consequences
were mainly associated with anxiety (3/6, 50%), loss of
confidence (2/6, 33%) and stress (1/6, 17%). Somatic
experiences were reported less frequently; one student
identified a negative impact on their irritable bowel syndrome.

179

Table 1
Types of incivility and bullying behaviour experienced on placement
(n = 13).
Experience

Experiences
n (%)

Belittling remarks
Inaccurate/false accusations
Given an unreasonable workload and unrealistic
deadlines
Intimidation
Persistent criticism
Swearing
Ignoring a person
Being shouted at
Excessive/unjustified monitoring of ones work
Persistently picked on in front of others or in private
Not returning emails/telephone calls
Setting up a subordinate to fail by unrealistically
overloading them with work or setting impossible
expectations
Given meaningless tasks beneath an individuals level of
competence
Withdrawing an individual from key areas of their work
Changing work responsibilities unreasonably or without
justification and or altering guidelines without
warning
Unwelcome sexual advances touching, standing too
close, display of offensive materials, asking for
sexual favours, making decision on the basis of
sexual advances being accepted or rejected
Spreading malicious rumours or insulting someone by
word or behaviour

7 (54)
7 (54)
6 (46)
5 (38)
4 (31)
4 (31)
4 (31)
3 (23)
3 (23)
3 (23)
2 (15)
2 (15)

1 (8)
1 (8)
1 (8)

1 (7)

1 (7)

Discussion
To the authors knowledge, this is the first study to consider workplace bullying in a population of physiotherapy
students whilst on their clinical internships. One-quarter of
respondents had experienced bullying on clinical internships. A range of adverse effects were experienced by
almost half of the victims. It is troubling and not acceptable
that physiotherapy students are subject to such behaviour,
and it is highly concerning that over 80% of victims did
not inform their university. Changes should be considered
by the different stakeholders involved with student wellbeing.
Previous research [8] has demonstrated that bullying
affects job satisfaction, increases absenteeism and induces
higher levels of stress, and such experiences have the potential
to impact patient care. Physiotherapy students are the future
of the profession, and encountering bullying behaviours
whilst on clinical internships is very concerning. For those
who experience bullying, this will undoubtedly affect their
desire to remain in the profession. This experience would
also mean more immediate consequences, such as fearing
going into a clinical internship [1].
It is concerning and completely unacceptable that the
majority of perpetrators were clinical educators. Educators
are placed in a trusted position where they should serve as
good role models to student. The students decision to remain

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B. Stubbs, A. Soundy / Physiotherapy 99 (2013) 178180

silent could have been affected by the perception that revealing such behaviour would result in a negative clinical mark.
This barrier highlights the need for a support mechanism that
is sensitive to students needs. Students need to feel that there
are open and confidential channels of communication with
either or both of the stakeholders involved. One option to
assist students would be to introduce the topic of workplace
bullying as a mandatory facet of qualifying programmes.
Limitations and future research
The current study was conducted at one university in the
UK and had a small sample. Another limitation is that whilst
the questionnaire was based on previous research, it was not
tested for validity. In addition, this research could not consider a full range of negative behaviours that are associated
with bullying.
Future research is warranted to establish the national and
international incidence of bullying in physiotherapy, and to
provide further insight into the causes of negative behaviours.
Future research should encompass qualitative methods to
capture the personal meaning and experience of bullying as
described by the individual.
Summary
The prevalence of workplace bullying appears to be high
in physiotherapy students on clinical internships. Training
for students and clinical educators is essential to ensure that
they are happy to deal with and report bullying incidents. It
may be instructive to incorporate this information through
training programmes.
Ethical approval: University of Birminghams Life and
Health Sciences Ethical Review Committee (Ref. No.:
ERN 10-0037).

Funding: This project was self funded.

Conict of interest: None declared.
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