Navigating Harassment as Bystanders: A Thematic Analysis of Internal Medicine Residents' Responses in Simulation-Based Training During Simulation After Video-Based Training

Introduction: Harassment is a persistent issue in medical training, negatively impacting trainees' well-being, learning, and professional development. Although bystander intervention programs aim to address harassment, little is known about how medical residents respond in real-time situations. This study examines internal medicine (IM) residents' bystander responses during a simulation-based anti-harassment training. Methods: We used an interpretivist thematic analysis to address our research questions in this article as part of a larger anti-harassment research study. Seventeen IM residents watched an educational anti-harassment video and then participated in a standardized simulation of a central line procedure, where they witnessed a senior resident (SR) harassing a medical student (MS), both portrayed by actors. Video and audio recordings captured verbal and nonverbal responses, which were coded iteratively. Descriptive frequency analysis tracked response patterns over time. Results: All residents used all 3 main categories of responses in the following order of frequency: MS-centered (reassuring, empathetic, or knowledge driven), passive (education focused, reattribution, avoidant, or unreactive), or SR-related (immediate direct, immediate indirect, or delayed responses). All residents used both reassuring and unreactive responses. Residents' use of the 3 main response categories varied over the course of the simulation. MS-centered responses were used throughout the simulation, whereas SR-related responses only started to appear midway through the simulation. Conclusion: IM residents used varied intervention strategies, yet many defaulted to passive responses, potentially indicating hesitancy, uncertainty, or deference to hierarchy. These findings highlight the need for structured bystander training to build confidence in active intervention and improve responses to harassment in medical training.