All Australian audiology students and interns surveyed in a La Trobe University study experienced negative acts during clinical placement, with nearly a third of those who answered questions about bullying claiming they were bullied.
The study was the first to investigate the incidence of negative acts and bullying of audiology students and interns in clinical settings.
“The emotional toll was substantial, manifesting in symptoms of depression, self-doubt, sleeplessness, and a substantial percentage expressed intentions to quit their clinical placement or the profession due to these negative experiences,” said the study lead, Dr Bojana Šarkić, a senior lecturer in audiology at La Trobe University.
“Our findings highlight a critical gap: policies designed to protect and support students are either insufficient or poorly implemented. The psychological and professional repercussions for these future healthcare professionals cannot be underestimated.”
Disturbing behaviour
Some of the more disturbing behaviours they faced included threats of violence, regularly being shouted at, experiencing excessive teasing, hostile reactions, offensive remarks, racial slurs, intimidation, sexual harassment, questions, advances and jokes, and being given hints to quit.
Results of the online survey of 52 respondents (70.6% who were audiology interns and 29.4% who were audiology students on clinical placement) were published in The International Journal of Work-Integrated Learning volume 26, 2025.
Participants were recruited from Audiology Australia membership, the La Trobe University Master of Clinical Audiology program and via a LinkedIn post advertising the study. They were first- and second-year students and graduate interns from 2020 and 2021. About 80% were female and a similar percentage were aged in their 20s.
Clinical settings ranged from rehabilitative and diagnostic private practice to hospitals, community health and other settings, and included metropolitan, rural and remote workplaces.
The online survey was distributed from August 2021 to January 2022.
Findings included:
- All 52 participants were exposed to at least one negative act during their placement and/or clinical internship year categorised as work learning-related bullying, person-related bullying, physically intimidating bullying, ethnic harassment or sexual harassment.
- 43 answered questions about bullying and nearly a third (12/43 or 27.9%) self-reported having experienced bullying on placement. They reported consequences secondary to bullying including self-doubt, loss of confidence, feelings of inadequacy, humiliation or embarrassment, inability to relax, fear/anxiety, sleeplessness, negative effects on personal relationships, isolation, and depression.
- The most reported negative acts occurring weekly/daily were error reminders (19%), excessive monitoring (19%), ridicule (14%), persistent criticism (12%), and withholding information (12%).
- The least frequently reported negative acts occurring weekly/daily were threats of violence (2%), punished with work (2%), racial jokes, slurs or remarks (2%), physical contact (2%) and sexual jokes (2%). A small subset who spoke a language other than English at home were subjected to racist remarks or jokes to some degree.
- 7% reported weekly or daily excessive teasing, hostile reactions, and offensive remarks, 5% were shouted at daily or weekly and a further 16% experienced shouting now and then or monthly.
- About 2% experienced weekly or daily derogatory comments or intimidation, 5% were asked sexual questions weekly or daily and 5% faced sexual advances and sexual jokes now and then or monthly.
- About 19% were given hints to quit now and then or monthly including 5% who received daily or weekly hints.
- Perpetrators of bullying acts tended to be in positions of power, leaving those bullied feeling vulnerable and disempowered. The most common perpetrators were clinical staff (9/12) 75%, administrative staff (25%), patients (16.7%) and other students (16.7%).
- Two thirds of interns and half of students bullied on placement said they considered quitting.
- Many were unaware of bullying and harassment policies at university or on placement and had not received information or training about anti-bullying policies or reporting procedures.
“Given that the most reported negative acts in the study were more psychological in nature, such as social exclusion and unmanageable workload, this may explain why a smaller proportion of participants classified their experience as bullying, despite all still reporting having encountered at least one negative act,” the study authors said.
Warrants concern
They said the actual prevalence of bullying may be higher than suggested due to the absence of a universally accepted definition of bullying, “although one-third is already a significant proportion that warrants concern”.
“It is important to recognise that some behaviours reported by students as negative interactions may be subject to interpretation,” they added. “For instance, what a student perceives as “excessive monitoring” might be viewed by a supervisor as appropriate oversight to ensure patient safety and proper training.
“Similarly, “unmanageable workloads” and “tasks above level” might be interpreted differently depending on individual perspectives and expectations.
“Supervisors might assign challenging tasks to foster growth and competency, whereas students may feel overwhelmed due to a lack of experience or confidence,” they said.
Balance constructive feedback
“Error reminders” were a necessary part of the learning process, provided they were delivered constructively and with intent to educate, researchers said.
“The key difference lies in the manner and context in which these reminders are given,” they wrote. “Constructive feedback is essential for professional development, but it must be balanced with support and encouragement to avoid being perceived as punitive or overly critical.”
Findings underscored the need for training programs to equip supervisors with skills in delivering constructive feedback and managing expectations, the authors said.
The study also highlighted deficiencies in implementation of workplace policies to create psychologically safe spaces for those new to the profession and emphasised the need for measures to address the issue.
To graduate in Australia all audiology students must accrue a minimum of 250 clinical practicum, or placement, hours under the supervision of a clinically registered audiologist.
Most universities rely on the goodwill of external providers to provide these placements, and student experience can vary widely depending on the experience of the supervisor, the authors said.
“Clinical supervisors are required to provide constructive, and corrective, feedback as part of their role, however, as a power imbalance exists between student and clinical supervisor, it is not uncommon for the potential for students to experience negative behaviours during placement,” they wrote.
Previous studies had reported high prevalence rates of negative interactions, such as bullying, among nursing students, interns, and other allied healthcare professionals.
Co-authors were Adjunct Senior Research Fellow and audiologist Dr Andrea Simpson, head of orthoptics Dr Konstandina Koklanis, and orthoptics course coordinator Associate Professor Meri Vukicevic.
They also collaborated on a study in orthoptic students and graduates on clinical placement, published in the British and Irish Orthoptic Journal, which found similar results.
“It’s time we broaden the conversation and take meaningful action to ensure clinical placements across all health disciplines, large or small, are safe, supportive, and nurturing environments for students and interns,” Dr Šarkić said.
“Let’s raise awareness, drive change, and protect the wellbeing and future of our allied health professionals.”
Limitations of the audiology study included its sample size of 52 participants with only 12 of these reporting bullying. This limited statistical meaningfulness of the data and generalisability of findings to the broader profession, the authors said.
Reliance on self-reported data through a questionnaire was also susceptible to response biases and underestimation or overestimation of prevalence and psychological impacts of negative experiences in the profession.
“These findings suggest that a greater awareness of the student and internship experience is required by universities, placement providers, and overarching professional bodies,” the authors concluded.
“Further attention and development of anti-bullying training programs for students, audiologists and auxiliary clinical team members is needed to prevent this issue.”
The audiology survey was adapted from the Clinical Workplace Learning Negative Acts Questionnaire, which is among the most widely used and rigorously tested instrument for assessing workplace bullying through a behavioural experience method.
