Collaboration, mentorship, and sponsorship are essential for success in academic medicine, with leaders playing a crucial role in mentoring junior faculty and fostering career development. However, when this responsibility is exploited, infrastructures intended to promote growth can instead create inequity and academic decline. Two examples include academic bullying and moral injury. Stemming from the hierarchical power imbalances, academic bullying involves recurring harmful behaviors, including intimidation, social exclusion, and deliberate obstruction of academic progress, used to embarrass, threaten, or undermine an individual’s credibility, success, or sense of belonging.1-4 Closely related to bullying is moral injury, the emotional and psychological distress that occurs when individuals are forced to violate core ethical values, or when betrayed by a once-trusted mentor or institution.5 Although anyone may experience academic bullying, it is more frequently reported among women, affecting up to 62% of female physician leaders.4 As part of a broader initiative to promote gender equity in transplantation, the editors introduced a 5-part series focused on empowering women and supporting an inclusive academic environment. UNDERSTANDING ACADEMIC BULLYING The following vignettes are inspired by the combined experiences of colleagues and illustrate the range of academic bullying. Four common patterns emerge: misuse of authority, public undermining, exclusion from opportunities, and social isolation. Misuse of Authority Academic bullying can manifest as the arbitrary use and abuse of power. Faculty summoned to emergency departmental meetings by the Chair without an agenda, solely to exert power. Faculty told by their Chair they are not meeting financial benchmarks, without transparency. Program Directors dismiss protocols when proposed by female physicians, only to accept them immediately when suggested by male colleagues. Public Undermining Bullying often occurs in public arenas, deepening the humiliation experienced by the targeted recipient. A senior female physician’s clinical judgment was openly challenged in a meeting, with inaccurate data cited to discredit her expertise. A junior faculty member volunteered to evaluate a living donor but asked publicly to state her qualifications to the entire team—despite male peers with comparable training routinely undertaking the same task. Exclusion From Opportunities Career advancement in academic medicine requires leadership roles, inclusion in high-visibility projects, and senior authorship. Yet women and marginalized faculty are frequently excluded despite demonstrating meaningful contributions.6 A junior female investigator was removed from a highly coveted study following a disagreement with her Chief, who later justified the decision by citing her “lack of experience.” A leadership position was awarded to a less experienced male colleague over a senior female faculty member, based on his perceived “likeability.” Social Isolation Informal professional gatherings—dinners at a department chair’s home or networking events at conferences—can also exclude women. An impromptu gathering of journal associate editors included only male physicians, leaving female faculty excluded. Such practices restrict access to mentorship and sponsorship critical for advancement. These examples highlight that academic bullying is not always overt acts of discrimination or hostility but can be subtle and insidious, corroding credibility and hindering advancement. Although each vignette reflects a lived experience, collectively they demonstrate the pervasiveness of power imbalances. The hierarchical structure of academic medicine not only enables bullying but also allows it to persist. Importantly, such hierarchy is compounded by gender, race, ethnicity, sexual orientation, and other marginalized identities that experience higher rates of bullying and fewer protections.2,4 Although all ranks and genders can engage in bullying within power differentials, most aggressions are committed by men across career stages, with senior faculty more commonly exerting undue influence over junior faculty’s research, publications, promotions, and leadership opportunities. Bullying also includes witnessing mistreatment but being unable to speak up due to fear of retaliation. Gaslighting represents another form of moral injury, in which concerns are minimized or dismissed, causing individuals to question their perceptions. Moral injury is further compounded when institutions overlook or protect those who engage in bullying, particular individuals who bring research funding, lead high-profile clinical trials, or confer national and international recognition.1 Such actions normalize harmful behaviors and reinforce a culture of silence, leaving those affected with limited support and inadequate reporting mechanisms. CONSEQUENCES OF ACADEMIC BULLYING AND MORAL INJURY Academic bullying has lasting impacts not only on individuals but also on their peers, patients, and institutions. Although not studied directly in academic settings, existing data link bullying to adverse physical health outcomes, including headaches, insomnia, cardiovascular disease, and increased absenteeism.7 Compounding moral trauma may lead to anxiety, shame, suicidal ideation, loss of confidence, posttraumatic stress, depression, and burnout.5 Professionally, bullying can damage reputations, obstruct promotions, limit leadership opportunities, and stall career advancement. Affected individuals may be forced to choose less visible roles or leave academic medicine for self-preservation.4 Studies also associate bullying with worsened team morale, increased medical errors, and lower patient satisfaction.2 STRATEGIES FOR OVERCOMING ACADEMIC BULLYING AND MORAL INJURY A systemwide failure to prevent or investigate academic bullying puts the onus on those targeted, and not the institution, to overcome adversity. Timely intervention, validation, and support is crucial to prevent workforce loss, especially among women and other marginalized groups. Success after adversity requires institutional support, a strong foundation of allies, sponsors, and mentors, and grounding in personal values. Institutional Interventions Addressing bullying and moral injury requires institutions and professional societies to explicitly recognize the problem and educate faculty and trainees on response and prevention. The American Medical Association has issued guidance to help healthcare institutions develop effective strategies to prevent and address workplace bullying (Table 1).3 National societies need to promote leadership initiatives that support affected colleagues and foster external professional networks to help navigate these experiences. Institutions should mandate training on academic bullying, similar to required modules on sexual harassment or compliance. Policies must clearly define the institutions’ commitment to safe open dialogue, outline antibullying policies, provide confidential reporting mechanisms, and prohibit retaliation.4 Institutions must also enforce clear consequences for bullying and establish transparent pathways for investigation, such as an ombuds office or antibullying committee.1 Supporting affected individuals is equally essential. Peer support programs, especially those that connect individuals with shared experiences, can offer guidance, foster community, and help rebuild confidence.8 TABLE 1. - Institutional interventions to address bullying and moral injury3 Intervention area Description Recognition and education • Formally acknowledge bullying and moral injury• Provide education to faculty and trainees on recognition, prevention, and resolution Antibullying policy development • Adopt clear, comprehensive policies that outline unacceptable behaviors• Reinforce a culture of inclusivity and open dialogue Anonymous reporting mechanisms • Create safe, anonymous pathways for reporting bullying• Include explicit guarantees of confidentiality and nonretaliation Enforcement and accountability • Enforce transparent consequences for those found to engage in bullying• Continue to reinforce the severity of the policy Confidential oversight bodies • Form dedicated groups such as ombuds offices or antibullying committees to investigate allegations independently Peer support programs • Implement structured peer support systems that connect individuals with those who have faced similar experiences• Continue to foster a culture of community and resilience The Importance of Bystanders and Upstanders Bystanders play a critical role in disrupting harmful behaviors and protecting bullied individuals. A bystander observes bullying without intervening, whereas an upstander takes action to support the individual and address harmful behavior.9 Although direct confrontation is an option, it is not required. Upstanders may validate experiences in real time, document concerning interactions to leadership, or use distraction to redirect attention. Particularly impactful is countering disrespectful behavior during meetings by reinforcing and crediting the targeted individual’s ideas and inviting respectful dialogue (Table S1, SDC,https://links.lww.com/AA/F753). Although these actions seem small, they can profoundly affect the individual by affirming their professional identity and signaling value to the broader team. In contrast, bystanders, especially those in positions of power, undermine trust and contribute to moral injury when they fail to intervene or acknowledge harmful behaviors. Justice and Accountability Documenting incidents of bullying is essential, should formal complaints become necessary. Records, including emails, meeting summaries, or personal accounts with dates, locations, and witnesses, can strengthen future reports. Many bullies are repeat offenders, although such behavior is rarely reflected in credentialing or references. Formal investigation ensures that such conduct is documented in the academic record. Legal action may become necessary in some cases but is often avoided because of fear of retaliation, reputational harm, or threats to future employment. Cultivating Emotional Resilience Resilience is the ability to adapt and maintain well-being, professional identity, and purpose in the face of challenges.10 In the context of academic bullying, it is not a trite coping mechanism, but a skill set necessary for self-preservation. Although institutions must address accountability and systemic solutions, emotional resilience can help individuals protect their values, identity, and sense of self.10 Strategies to cultivate resilience are not prescriptive nor a panacea for the moral injury caused by bullying. Individuals may demonstrate incredible resilience, but resilience alone cannot mitigate the harms of a toxic work environment. Rather, these approaches may help preserve identity and self-worth. Although prioritizing healthy habits and fulfilling activities outside work might ameliorate moral injury, bullying often disrupts these routines. Building strong social connections can reduce isolation and provide supportive validation. Reexamining personal and professional values (ie, through a Values Exercise: https://www.think2perform.com/values/) can help set boundaries and guide decision making. Professional mental health support is also essential, but concerns around medical licensure often deter physicians from seeking care. Resources from the Dr Lorna Breen Hero’s Foundation, a nonprofit that advocates for physician mental health, can help clarify these licensing policies (https://drlornabreen.org/). CONCLUSIONS Academic bullying and moral injury are pervasive, structural issues embedded within academic medicine. Left unaddressed, these behaviors undermine professional integrity, compromise patient care, and force talented individuals out of the field. Although resilience and collective community are needed to overcome such adversity, meaningful change must begin with institutional and individual accountability. We can begin to create a more inclusive academic culture by identifying the detrimental consequences of academic bullying, creating policies for safely reporting bullying behavior, supporting those affected, and refusing to accept that enduring abuse is a prerequisite for academic advancement.
Paul et al. (2026) studied this question.