This was a cross-sectional, observational study carried out over 2 months (June-July 2012). Undergraduate medical students studying in a Medical school in Navi Mumbai, India were included in the study. Permission from Institutional Ethics Committee was obtained prior to the conduct of this study. The procedures followed were in accordance with the Ethical standards of the committee on human experimentation and with the Helsinki Declaration of 1975 that was revised in 2000.

Four hundred undergraduate students studying in the medical school were invited to participate in the survey. Sample size was calculated based upon the following formula:

N = (Z1-α/2)² * P(1-P) / d2 where, N = sample size, Z1-α/2 = confidence interval = 1.96, P = estimated prevalence from previous studies =0.52, and d= desired precision (margin of error)=0.05.

After obtaining informed consent, the socio-demographic, personal details, medical/psychological history and history of substance abuse were recorded in a self-designed case record form. They were administered Illinois Bully Scale to detect the prevalence and various aspects of bullying in the past 30 day. Illinois Bully Scale is a validated and reliable scale [9]. The items of the scale consist of 3 subscales; bullying, fighting and victimization. Undergraduate medical students were asked to respond on a Likert scale of 5 point values as follows: Never = 0, 1 or 2 times = 1, 3 or 4 times = 2, 5 or 6 times = 3, 7 or more times = 4. Subscale scores were computed by summing the respective items of the subscale [9]. Higher scores in individual subscales indicated more bully perpetration, victimization and fighting behaviour. Participants not willing for consent, for participation and incomplete returned forms were excluded from analysis.

Data from the completed forms was analysed statistically using the Statistical Package for the Social Sciences (SPSS) version-17 software. Normality of data was assessed. Mann-Whitney U Test and Kruskal-Wallis test for the non-parametric data was used. Probability ‘p-value of less than 0.05 considered as statistically significant.

Of the 400 case report forms that were distributed, 17 did not give consent. A total of 383 students completed the forms which were then analysed (response rate 95.75%). Out of these, 98.69% reported to having indulged in or faced peer-based bullying. Regarding prevalence of types of bullying, physical bullying was found to be 63.97%, while verbal bullying was seen in 97.39%, and 88.77% reported feeling victimized [Table/Fig-1].

Verbal bullying was found to be the more common form in both males and females. Physical bullying as well as verbal bullying scores were found to be higher and of significantly (p<0.05) greater severity in males as compared in comparison to females [Table/Fig-2].

There was a statistically significant (p=0.034) difference in the physical bullying scores among groups of medical school year [Table/Fig-3]. The physical bullying scores in students studying in third year medical school were higher and statistically significant in comparison to first (p=0.003), second (p=0.044) and fourth (p=0.024) year students [Table/Fig-4].

Physical bullying scores were higher and statistically significant in participants who reported alcohol consumption (p=0.001) and cigarette smoking (p<0.001) in comparison to those who did not [Table/Fig-5,6].

There was no significant difference (p>0.05) in the association found between victimization scores and factors like gender, year of medical schooling, alcohol consumption and cigarette smoking [Table/Fig-12 and 3,5,6].

The preliminary finding of the study suggests high prevalence of peer-based bullying and victimization among medical school students in tertiary care medical school in Navi Mumbai.

Studies have shown that medical students perceive bullying to be common and pervasive in the medical profession [5,10–14]. Prevalence of bullying in our study was found to be higher than studies from the UK but somewhat similar to the rates found in Scandinavian countries like Finland [4,5]. Studies have reported that verbal bullying in the form of verbal abuse, undue pressure to produce work and persistent unjustified criticism are the most frequently reported form of bullying experienced by medical professionals [4,7,15]. In our study too, verbal bullying was found to be the more common form of bullying in both males and females.

In our study, as compared to females, males had a significantly higher severity of both verbal and physical bullying. This finding was similar to those reported by Ahmer et al., and Uhari et al., where they also found differences in gender to be significantly related to bullying where males were found to outnumber females [5,16].

Study by Owoaje et al., observed that victims of bullying may go on to harass others when they themselves become seniors, as they may feel the need to avenge themselves, thus continuing the cycle of abuse [10]. This could be a probable explanation for the behaviour of the third year medical students in this study, for indulging more in physical bullying than the students of other years.

In our study consumption of alcohol and cigarettes was found to be significantly associated with physical bullying. These results are similar to the findings of other studies who reported an established connection between bullying and smoking and drinking in youngsters. They observed that substances like alcohol might induce violence by causing cognitive disruption e.g. misunderstood communication and disinhibiting behaviours [6,17,18].

The sense of victimization is a complex issue related to negative identification, sociological and psychological environment and personality of the person [14]. In our study though more number of females reported feeling victimized, there were no significant associations found between victimization and factors like gender, year of medical schooling, alcohol/cigarette use, language, native place or religion.

The strength of this article is that it is a one of the first studies conducted in undergraduate medical students in an Indian scenario addressing the issues of bullying/victimization using a validated scale. Although this study provides useful information on the prevalence of bullying/victimization in undergraduate medical students, it has certain limitations. Assessment was done using a self-reported subjective scale and hence judgment may differ amongst the respondents, and a reporting bias could be present. Furthermore, the cross-sectional design of the study could have resulted in recall bias. The report is from a single medical school therefore the results are limited and cannot be generalized for all the undergraduate medical students in India.

Peer-based bullying and victimization was found to be highly prevalent amongst undergraduate medical students. Though the report is from a single medical school, it would be imprudent to turn a blind eye to these findings. Fostering of a bully-free work environment is the need of the hour. This can be done by having: (a) sensitization and feedback from staff/students regarding anti-bullying policies; (b) committee established in each institution to ensure proper implementation of these policies; (c) appropriate measures like counselling to provide help to those who report bullying during their medical studies. This article provides preliminary information for future research in an area which has hitherto received little attention in India.