Cannibalismus of the Foregin Female Doctor During Her Final Stage of Surgery Residency in Switzerland. Example of an Academic Mobbing – Editorials for Trainees and Residents in Training

ERASMUS : European Community Action Scheme for the Mobility of University Students 

ECFMG : Educational Commission for Foreign Medical Graduates

Mobbing in a residency program is an intersting topic. Health system needs a well trained future specialists. Every resident in a training has his / her own rights to choose his / her training program and to graduate it. At every step of the training the resident is at risk of mobbing. In some cases mobbing turns unexpecet brutal and such cases should be presented to protect future residents in training.

I would like to share a case report of a young female doctor from Poland who came to the Switzerland to finalise her residency in general surgery in Switzerland. She was a sucessfull and promising young surgeron in a training. She has already graduated two years of general surgery in academic hospitals in her own country. Than she moved to Switzerland and she took part in rotations in urology, traumatology and heart surgery also in academic hospitals. Her rotation in orthopedic surgery she did again in her own country. After that time she moved once more back to Switzerland to take part in her final stage of residency program and to become a general surgeron. She has already graduated 5 years of a training in a general surgery. At the begining after coming back to Switzerland everything was normal, she took part in regular rotation in general surgery. 

It was Winter 2018 and she worked in the emergency room for surgical rotation in regular hospital. There were many patients with influenza in that time, she unfortunately got sick and was written ill for a week. Meanwhile she applied for a finanial support for paying the fee for necessery course for her residency program. Both her residency program director and the hospital refused paying it and cut her employment contract to minimum period of time, which were three months. So she paid for a course by herself and her employment agreement was extended for the next 3 months. After that time she had to leave the hospital and she also had unexpected difficulty in getting her residency papers. She asked many times the residency director to sign them. Finally she took a lawyer and got her signed residency certificat. However she did not recive her certificat of employment. 

She got a new job this time in a private clinic als in surgery departament. For her first time in her life she worked in a private hospital. She liked her job from the very first day and she was very enthusiastic about begining her career there. She also was qualificated for taking part in a general surgery board written exam. She was on her way to become a surgeron. She took only one day off before taking her exam to relax. She passed that exam. She recived many congratulations. Meanwhile she worked a lot, that private hospital hired only few residents so she was overworked. That time she was the only resident in her surgical departament. Her work and regeneration balance was on the edge. She got a leg pain and visited a primary care doctor who wrote her ill for a week. Meanwhile she scheduled an appointmet in an orthopedic clinic. The orthopedic doctor found the overload of the joint of a gluteal muscle and she was found able to work in surgery departament 50% for the following two weeks. Unfortunately the director of residency program has changed and the new one, an academic surgeron suspected her psychiatric ill and sent her for a check up into psychiatrist office. She agreed because she wanted to keep her position. She was very close to graduate and become a surgeron. Her oral board exam was coming pretty soon. The psychiatrist did not found her mentaly ill, he found her overworked and suggested a training to improve her balance between work and regeneration time at her hospital. Instead being sent to take part in that training, she was fired. 

After some time she found a new job in a surgery in a beautiful mountain region. It was winter and the countryside was very beautiful. The begining was not easy, hospital refused to pay for her two courses needed for her residency and refused to give her paid days off to take part in those courses. Exectly for that period of time the hospital made her unemployment. She had no choice. She did her courses and after that period of time she was allowed to work there. Meanwhile she was also qualificated for her general surgery board oral exam. She was very proud of herself. The biggest drama in her life was coming. Her residency director asked her not to take part in that exam, she refused and she was fired. 

Because of the Covid-19 pandemie her writen exam was rescheduled. She found a work in an orthopedic clinic. She was able to take part in her general surgery board oral exam and passed it. She was very happy and proud of herself. She was fired again. Unfortunately that female had to go through very unfair finish of residency program in general surgery abroad. She had no malpractice case in her training career and she should be allowed to finish in regular way. Taking part in courses and examinations is a natural process of training in every residency program also in a surgery. Residency director program should be non judgemental and allow his / her residents to achive the goal. They should act proffesional in every stage of the residency training.

Migration can be a risk facktor for bulling. A women in a general surgery can be an easy target for a discrimination [1]. However it was not her first proffesional experience with living and working abroad especially in Switzerland. As a student she took part in ERASMUS program exchange in Germany. She was a visitor doctor in Surgery Departament in United States and owned an ECFMG Certificate. All her foregin programs were successfully completed. This woman suffered from a classic academic mobbing culture. She was a victim of the professor and few residency directors, their targets are usually women at their workplace [2]. She expirienced an attack on her proffesional life such as taking part in board examinations and becoming a surgeron. She also suffered an attack on physical and mental health. Many targets are choosen because they like their work and are achiving good results at work. She was one of them. Mobber is usually jealous of the talent or performence of the co-worker and her / his reaction is to exclude the worker [2]. This resident doctor got many damages during her final stage of her residency. She had to cope with finaciall stress. Not only most of her courses she had to pay by herself but also her salary was cut down. She was given a short time unemployment to take part in her courses. She suffered anxiety about her future. Her desperation to become a surgeron was always present and she had to cope with unhappiness. She found a strenght and hope to overcome those problems and achive her goal [2]. In Switzerland between 2010 and 2022 the discrimintation and violence have rised and in 2022 achived at the level of 27% [3]. An apogeum was between 2016-2020. The highest level was observed at work, it was about 50% [3]. The risk factor were nationality 50%, speech and accent 34% and gender 27% [3]. Being a foregin women and having a different accent, made her the target in bulling her proffessional carrier [3]. Switzerland is a country of Europe which has about 37% of foregin doctors. 20% of them are form Germany, 3.4% from Italy, 2.6% form France, 2.3% from Austria and 9.4% from other countries [4,5]. About 47% of doctors in Switzerland are women [5]. 27% of surgerons are women [5]. We are observing an increasing number of women taking part in all residency programs in 2023 and it is about 60.1% [5]. In such cases the most promoted solution from hospital is forsing to change the speciality. Is it a point in sending almost full trained general surgeron with passed board exam into the other speciality? Academic mobbing is not only present in a general surgery training. Starting a new speciality from the very beininig is not the right solution and does not protect from being bulled again. I find it unethical and uncorret to offer such unfair solution. It causes moral and finacial damages. Each general surgeron after graduation can find his/her own way not only be a good general surgeron but also graduate an additional follow-up program. This priceless chance should not be limited or taken away due to an academic mobbing. Residency program shoud be supervised and residents allowed to graduate in a regular way.

We expect from our residency directors and especially from professor or academic stuff high proffessional and ethic standards of work. Unfortunately that female surgeron rights to regular finishing her residency program were taken away. Depsite many damages she could find her individuall way to achive her goal. However some damages are priceless and she will never fully recover form them. This woman should be let to graduate her residency in regular way [6]. It is unethical to fire somebody being qualificated or passing board exam in any residency program. Every resident in training has the right to the equal education as well as in their proffesional educational journey [6]. I find it very improtant to raport and publish such cases.

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1. Facts and Statistics (justice.gov) (2021) Hate Crime Statistic, The United States Departament of Justice.
2. Academic mobbing (2010) Hidden health hazard at workplace. SB Khoo, Malaysian Family Physician Volume 5: 2.
3. Diskriminierungserfahrung, Bundestamt für Statistik, Switzerland.
4. Hostettler S, Kraft E (2021) FMH-Ärztestatistik 2020. Schweizerische Ärztezeitung 102: 417-422.
5. FMH-Ärztestatistik 2023 – 40% ausländische Ärztinnen und Ärzte. Hostettler S, Kraft E (2024) Schweizerische Ärztezeitung, 105: 32-36.
6. Universal Declaration of Human Rights, Article 26.