The death of a doctor named Aulia Risma , who was studying for the Specialist Doctor Education Program (PPDS), has reopened the dark veil of education that occurs in the medical community.

Moreover, what happened to Aulia Risma is not the first time it has happened. In 2020 , a PPDS student also ended his life with strong suspicions of bullying .

In fact, Indonesia is still experiencing a shortage of doctors , especially specialist doctors, in various regions outside Java.

The existence of bullying practices is an irony in the midst of the shortage of doctors. This shows that there is something wrong with the education system, especially the PPDS education system, and emphasizes the importance of a humanist approach in the education of specialist doctors.

The effects of seniority and systems

Specialist medical schools have a high prevalence of bullying , not only in Indonesia but also throughout the world . In fact, a study in Sweden showed that in addition to bullying , female PPDS students also often experience sexual violence . This means that they have the potential to experience at least two traumatic events during their studies.

According to data from the Ministry of Health (Kemenkes), there have been more than a thousand complaints of bullying or alleged bullying with around 30% of the reports verified as bullying cases . Referring to the data, bullying practices are common.

Bullying practices are seen from how junior students often receive insults and curses from seniors, even for personal orders, such as picking up laundry from the laundry, picking up senior children from school, and paying vehicle taxes . In addition, there are also practices that lead to physical and mental violence , and also extortion against PPDS students.

This bullying that leads to extortion creates another financial burden for students, outside of the official fees set by educational institutions. If this burden is not met, it will impact the continuity of PPDS students’ studies.

In addition to having to finance the personal needs of seniors and consultants (specialist doctors or subspecialists), PPDS students also face heavy study pressure and workloads so that they can also experience bullying caused by the system.

For example, they have to work as much as 80 hours per week without pay because they perform tasks related to the duties and functions of a doctor such as a coder , porter, etc.

Humanistic education as a solution

Research shows that the practice of humanistic education in medical education has an impact on the quality of future medical and health jobs. This is because humanistic education emphasizes compassion, sensitivity, sensitivity and dialogue when dealing with patients.

Bullying that occurs in the medical education environment, especially PPDS, is very contrary to the meaning and purpose of education. This is because bullying not only affects the victim—who has the potential to experience a decline in physical and mental health —but also reduces the quality of service and patient safety.

Involve all parties

Many studies have been published on bullying in medical education environments and efforts to address it. Studies in 2019 and 2022 revealed that bullying in medical education is a violation of basic medical ethics and a violation of human rights, thus requiring institutional policy intervention.

Currently, the police have begun investigating the Aulia Risma bullying case. While waiting for the results of the investigation , for example, the government should move quickly to conduct a thorough investigation at the medical faculty and the hospital that is the organizer of the education. This is to ensure zero bullying in medical education in Indonesia.

So far, the Minister of Health’s Instruction Number HK.02.01/MENKES/1512/2023 concerning the prevention and handling of bullying against students in teaching hospitals within the Ministry of Health, has not provided a deterrent effect on perpetrators of bullying, especially in PPDS.

The government also needs to form a special anti- bullying task force in the medical education environment. This task force consists of various elements, not only from within the university, hospitals, the Ministry of Health, the Ministry of Education, Culture, Research, and Technology (Kemendikbudristek), the police, but also several independent experts, such as psychologists, sociologists, and legal experts.

This task force is tasked with identifying signs of bullying , accompanying victims, and campaigning for anti- bullying movements that are integrated into the learning curriculum, both formal and informal (extracurricular activities).

As an initial step, campuses can optimize the Sexual Violence Prevention and Handling Task Force (PPKS) to be the vanguard in preventing various acts of violence that occur on campus, including bullying.

This bullying prevention solution also needs to involve the National Human Rights Commission (Komnas HAM) because bullying has robbed human rights. One of them is by using social media as an alternative to the bullying complaint post in the medical education environment. Because, it is possible that bullying victims feel unsafe or uncomfortable to report through the Ministry of Health post .

From a personal perspective, PPDS participants need moral support from family and close friends to reveal the bullying cases they experience, for example through popular podcast channels . Family and close friends play a role in accompanying PPDS participants who are victims of bullying so that they do not feel alone in facing this problem.

No less important, eliminating bullying requires a commitment from every leader, educator, employee, and student in the PPDS environment to work together to break the chain of bullying that has been deeply rooted for decades.

One thing that must be eliminated is the claim that bullying is part of mental development . This view perpetuates the dominance of seniority influence (power) or in Gramsci’s language called hegemony , namely how bullying in PPDS is produced and reproduced by leading resident doctors as juniors to act according to the wishes of seniors—as if without coercion or violence.

In fact, the hegemony of mental development like this harms humanity and will only produce doctors with a feudalistic mentality .

It is time for every leader, both in educational environments and hospitals, educators, employees, and students in the PPDS environment to realize, acknowledge, and improve their education system, so that it becomes more humanistic and treats doctors humanely.

Author Bios: Anggi Afriansyah is a Researcher, Angga Sisca Rahadian is also a Researcher and Mercy of Saleh is a Researcher all at the National Research and Innovation Agency (BRIN)