The Junior Doctor Workplace—Still Not Always Safe and Supportive

The beginning of one's medical career is often described as a defining milestone; the point at which years of study crystallise into real clinical practice. For many junior doctors, the experience is overwhelmingly positive: supportive teams, generous teachers, and the early satisfaction of meaningful patient care. Yet this transition can be overshadowed by transient moments of intimidation or belittlement that quietly shape how we view medicine and ourselves. A curt remark on a ward round, a public reprimand, or a dismissive tone in theatre may seem an insignificant part of “just another day” to senior staff, but for a vulnerable junior doctor still finding their footing, these moments land heavily. They can erode self-confidence, make one fearful of speaking up, suppress questions or requests for clarification, and encourage the normalisation of discomfort as an expected experience towards developing resilience. These behaviours can profoundly affect individuals. A capable and motivated junior registrar known to us was subjected to such persistent bullying within their intended specialty that they ultimately abandoned their aspirations, moved hospitals, and relaunched in a different field, prioritising psychological safety over a long-held career ambition. Among interns and residents, the effects can be subtle, but no less significant. Some call in sick to avoid consultants known for public humiliation, while others delay referrals in anticipation of hostile responses. These experiences are rarely spoken aloud, yet they influence how junior doctors navigate the system, with effects that extend beyond individual wellbeing. Bullying undermines team cohesion, discourages collaboration, and ultimately compromises patient care. We have seen hesitation paralyse a team when tempers flare, leaving questions unasked and concerns unraised. It is often in these silences that errors take root. There are, however, many clinicians who already model the culture our profession should aspire to. A surgical fellow known to us recently paused a busy list to explain a technique, simply stating, “Ask as many questions as you need, that's how you learn.” Small gestures like these foster a safe, collegial environment in which junior doctors are far more likely to engage with a specialty and consider it a viable career path. Although exemplary mentors are common, their positive influence can be diluted by the conduct of a minority, and repeated exposure to even minor negative interactions or microaggressions can compound to shape wellbeing and career trajectory. The way junior doctors are treated by their seniors also informs how they will later lead, allowing inherited cultural patterns, constructive or otherwise, to persist across generations. Junior doctors learn not only clinical practice but also the norms and values that will define our profession. If medicine is to reflect the compassion it promotes, that must begin within our own ranks. Professional courtesy and respect should not be earned through endurance of mistreatment, but rather they should be the foundation on which every career is built. …there must be a profound shift in the culture of surgery and an unwavering commitment to achieving this. Long-established traditions that have been inherited and have normalised unprofessional, and sometimes illegal, behaviours must be relinquished. Gender inequity must be addressed. Discrimination, bullying and sexual harassment must become problems of the past… The decade that just passed has witnessed similar findings and reports by other International Surgical Colleges such as the Royal College of Surgeons in Edinburgh's Let's Remove It addressing bullying and undermining in surgery. Although surgeons' behaviours were amongst the first to have the whistle blown within the medical profession, similar findings emerged as other specialty colleges surveyed their members [4]. The “Me Too” movement, originally founded in 2006 by Tarana Burke, took off when it became a hash tag drawing attention to the prevalence of sexual harassment by survivors from many different professions. But what is it really like at the coal face in Australia and Aotearoa New Zealand for junior doctors today, 10 years after RACS' apology and action plan? A scoping review in this issue of the journal reports that the above bad behaviours remain persistent and prevalent across both our countries [5]. The evidence cited associates discrimination, bullying and harassment with junior doctors feeling disillusioned, inadequate, vulnerable and belittled at their place of work. These experiences and the feelings they evoke affect their mental health and career trajectory [5]. Discrimination, bullying, undermining and sexual harassment should never be normalised or accepted. Those who witness it should not be silent bystanders but have the courage to speak up to counter it. Facing up to these behaviours does not build resilience, as some would like to suggest, but rather the behaviours become role modelled, with those who were previously victimised at risk of developing into perpetrators if they do not reflect on what might have been ‘not OK but tolerated’ in the past, being unacceptable today. Whilst many health services at least pay lip service to promoting a safe work culture, their Human Resources departments and senior staff are often unable to respond to allegations appropriately; often their investigations both further traumatise the victim and deal inadequately with the perpetrator. The junior doctor moves on wounded, whilst the culture does not change for those in the next rotation of juniors who are destined to suffer. Fortunately, Medical Colleges are increasingly making the assessment of workplace culture and the safety of trainees an important component of the accreditation of hospitals and health services [6]. Regulators such as the Medical Board of Australia also survey trainees [7]. Their interactive report confirms that a quarter of trainees have experienced in the last year some form of discrimination, bullying or harassment; a third have witnessed it; but only a third report it. Commonly, the perpetrator is a team member, most frequently a supervisor. The paper by Dwyer et al. [5], the 2024 Medical Training Board report [7] and our personal experience show there is still a long way to go to ensure our junior doctors have a safe place to work. This paper does not provide any data that isn't provided in the cited references as it is an editorial.