Skip to main content


This page provides an introduction to the RCOG/RCM undermining toolkit, an initiative to address the challenge of undermining, bullying and harassment in maternity and gynaecology services.


Undermining and bullying behaviour has long been recognised as a problem for trainees in obstetrics and gynaecology (O&G). In 2013, the RCOG and RCM published a joint statement about tackling undermining, which included an agreement to produce an accessible joint learning resource to support maternity and gynaecology services in tackling these difficult issues. For more information, please visit the main improving workplace behaviours page

The 2013 Illing report gives a comprehensive review of the literature on the occurrence, causes, consequences, prevention and management of bullying and harassing behaviours in the NHS and has been a key reference for the authors. The executive summary is short and is recommended reading.

Michael West’s work reveals the importance of good team work for patient outcomes: if there is persistent undermining, bullying or harassment within a team or unit, the chances of highly effective team performance are diminished, with a negative impact on the care of women.

In 2014 the GMC undertook a review to tackle undermining and bullying in medical education and training involving 6 departments of Obstetrics and Gynaecology. The GMC report outlines the key factors contributing to positive workplace behaviour and a supportive training environment, these are: 

  • Valuing doctors in training
  • Departmental cohesion and leadership
  • Workload and stress for doctors in training and consultants
  • Communication with doctors in training and recognising undermining and bullying
  • The need for effective senior leadership.

The report and learning from these visits makes essential reading for all those wishing to address the issues of undermining and bullying and further complements the contents of this toolkit.

Undermining in maternity and gynaecology services

There is limited published evidence about why this poor behaviour is more prevalent within maternity and gynaecology services, but it is suggested that:

  • Empathetic professionals (trainees in O&G have high empathy scores compared with other specialties) are working in high-stress environments (labour wards and theatre) with a blame culture which is more prevalent than in other specialties
  • Variable clinical supervision, exacerbated by gaps in service provision (a lack of both appropriately trained doctors and midwives to maintain the service), can further increase stress and lead to more inappropriate behaviour
  • Changes in working patterns have affected staff relationships and communication
  • Midwives have an independent practitioner role compared with nurses and can bypass more junior trainees, who perceive they are being undermined
  • In some departments the needs and priorities of doctors in training are not well understood and staff within these environments don’t always realise the impact of certain comments and behaviours on trainees.

Accordingly, there is a need for action to eliminate inappropriate workplace behaviours: such behaviour should not be tolerated, and steps should be taken to remove or reduce its occurrence across healthcare systems and wider society.

There is some limited evidence from the GMC survey and other data that the focus on undermining behavior and our effort to address the issues is starting to have some impact on the experience of trainees and staff working in our services.

There is a change in reporting which may indicate a reduction in incidence but also an improvement in the number of issues that have been addressed and resolved. This is encouraging, but there is much work that still needs to be done.

This toolkit suggests interventions that can be taken at a variety of levels:


We are keen to continue to develop the undermining toolkit. If you have any additional good practice examples and resources that you think would be useful, please email Sakinah Takeram at

Elsewhere on the site

Resources and support for trainees
Further resources to support specialty trainees in O&G
Resources and support for trainers
Resources to help trainers deliver the specialty training programme in O&G