The Power Imbalance Personified: A Mixed-Methods Analysis of Senior-to-Junior Bullying in Indonesia's Medi-cal Residency Programs

Abstract

Background. Bullying during medical residency harms residents’ mental health and threatens patient safety. In Indonesia, where medical hierarchies are firmly entrenched, bullying of junior residents by senior residents has received little study.

Objective. To examine the prevalence, forms, and lived experience of senior-to-junior bullying in Indonesian residency programs from the perspective of junior residents.

Methods. A sequential explanatory mixed-methods design was used. An anonymous online survey including the Negative Acts Questionnaire-Revised (NAQ-R) was completed by 584 junior residents at five teaching hospitals. Twenty-five residents with high exposure were purposively selected for semi-structured interviews. Data were analyzed with descriptive and inferential statistics and reflexive thematic analysis.

Results. Of the respondents, 81.3% (n = 475) reported at least one negative act weekly or daily. Work-related acts and personal humiliation were the most common forms. Bullying was associated with year of residency (87.2% vs 72.1%) and specialty (70.5% in pediatrics to 89.9% in surgery), but not with gender or marital status. Four themes emerged: hierarchy as a mandate for abuse, a pedagogy of fear, silent suffering, and a perpetuating cycle.

Conclusion. Bullying by senior residents was highly prevalent, was often justified as training, and was sustained by silence. Systemic change, faculty training, and confidential reporting systems are needed.