Interpersonal Violence/Bullying Situations at the University: Academic Daily Life Clippings among Students from Undergraduate Health Programs

43 (1 Supl. 1) : 537-546; 2019 I Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil. Interpersonal Violence/Bullying Situations at the University: Academic Daily Life Clippings among Students from Undergraduate Health Programs Situações de Violência Interpessoal/Bullying na Universidade: Recortes do Cotidiano Acadêmico de Estudantes da Área da Saúde


INTRODUCTION
The word "bullying" comes from the English term bully, which means: tough guy, bossy, goon 1 . This is a subject that has occupied a large space in the media and generated concern in the educational context. It is possible to identify several initiatives of society to understand it and reduce its negative impact on the school institution, including the University. Due to the characteristics of the phenomenon, it is important to approach it from the point of view of violence.
Violence has been seen as a major and growing public health problem worldwide, with serious individual and social consequences, particularly for young individuals, who appear in statistics as the ones who most often die and most often kill 2 . More than considering violence as multicausal, it is necessary to look at it from the perspective of complexity, considering the subject = context interpenetration. Thus, if on the one hand poverty and exclusion of rights can lead to the exhaustion of strategies to deal with adversity, leading to violence, on the other hand, it is a serious mistake to think that violence is only present among the poor. Every day we have lessons from reality that show us situations in which interpersonal violence occurs at different levels of the social pyramid³. Examples can be found in road traffic relationships, in the construction of the teacher-student relationship, and in the student-student relationship, such as in the University admission period, with the so-called hazing.
In the context of interpersonal violence, bullying emerges as an important phenomenon. Bullying comprises all forms of aggressive, intentional and repeated attitudes, in an insistent and disturbing manner, which occur without obvious motivation and covertly, being adopted by one or more students against another or others, within an unequal power relationship. This phenomenon subtly manifests itself as jokes, nicknames, teasing, mockery and physical aggression [2][3][4] .
The literature about bullying in the context of elementary and high school education shows that its targets generally lack the resources, status, or ability to stop the harmful acts. They are usually unsociable, insecure, and have trouble adjusting to coexistence and group participation. They have a different physical aspect from the standards imposed by their peers, 539 Maria Paula Panúncio-Pinto et al.
https://doi.org/ 10.159010. /1981 and their low self-esteem is aggravated by the adults' critical interventions or indifference regarding their suffering. They have few friends, are passive, quiet and do not effectively respond to the acts of aggression they suffer 2-4-5 .
The practice of bullying is related to psychological and / or behavioral disorders that can often cause significant damage to the victims' quality of life and daily activities. Situations such as school phobia, social phobia, generalized anxiety disorder, depression, anorexia and bulimia have been reported, and there are even reports of suicide and homicide among children and adolescents 6 .
Perpetrators and witnesses may also suffer the consequences: those who practice bullying are very likely to maintain aggressive practices throughout their lives, may adopt antisocial behaviors and those who witness it, in turn, are troubled by the climate created in the environment and the fear of being the next target, which also leads to a decline in their educational and social development. Constant exposure to bullying, either directly or indirectly, implies the assimilation of this fact, by those involved, as something normal 2-4-7 .
In the context of university education, such situations of peer violence are also a matter of concern, not only because of the climate of insecurity they create and the possible situations of academic inadaptation and failure, but also the health costs for those involved 8 .
In fact, the University has been called to rethink its responsibility for the integral education of its students and the commitment to disseminate values aimed at improving the human condition 9 . More than that, the University has been challenged with providing technical education of excellence, while an ethical and political education that expresses its commitment to equity is also expected 10 .
The concern about the university environment and the student, in this perspective of integrality, has increased the interest in understanding their daily life and the aspects related to their adaptation to the university, academic success / failure; stress and mental health factors, among others 11-12-13-14-15-16 .
It is possible that interpersonal violence in the context of university education is one of the aspects associated with academic failure, school dropout and adjustment difficulties and, thus, its understanding is important, aiming at this view for the integral formation, human values and equity.
Considering that IPV can extend beyond the university admission period and interfere with students' adjustment and performance, increasing the understanding of students' and faculty perceptions of IPV / bullying can provide elements for coping with difficulties that college students have to face during their undergraduate journey. This article presents the results of an exploratory study conducted over two years in a Higher Education Institution (HEI) that has 07 undergraduate courses in the health area. The study aimed at identifying the perception of teachers and students about the presence of interpersonal violence (bullying) in the context of undergraduate school and its most frequent forms.

METHOD
This is a descriptive and exploratory study, with a predominantly qualitative approach with some quantitative procedures, which conducted a general survey on the recognition of the presence of IPV / bullying among undergraduate students in the Unit. The exploratory character led to the construction of a semi-structured questionnaire, also consisting of open-ended questions. The study was approved by the Research Ethics Committee of Hospital das Clínicas and Faculdade de Medicina de Ribeirão Preto (Process HCRP 8663-2014).
This research was carried out in an HEI with 07 courses in the health area -Biomedical Sciences, Physical Therapy, Speech Therapy, Biomedical Informatics, Medicine, Nutrition and Metabolism, Occupational Therapy, and the study population comprised the students and teachers. At the time of data collection, the Unit had 319 teachers and approximately 1,400 students.
Data were obtained through a semi-structured electronic questionnaire, sent together with the Free and Informed Consent (FIC) form through e-mail to all teachers and students of the Unit, using Google docs technology. This tool consists in the creation of a site containing the research documents, which are sent by electronic mail through a link that can be accessed by the subject, adequately completed and subsequently accessed by the researcher on the same site. The form and questionnaire were sent three times, every thirty days, at two moments (1 st Semester of 2015; 1 st Semester of 2016) emphasizing that each subject could only participate once in the research.
In qualitative terms, content analysis was used as a strategy to identify empirical categories for open-ended questions of the questionnaire 17 . The thematic content analysis allows the identification of categories through the manifest content in a deductive approach. The manifest content is identified through the use of keywords for the reading /search, which may start with categories predetermined by the research objective or by the hypotheses and may allow the inclusion of new perspectives from the analyzed material [18][19] . This qualitative research strategy allowed the identification of the types / categories of interpersonal violence, as reported by students and teachers. In quantitative terms, the frequency of occur- rence of these categories was obtained, as well as the answers to the closed questions (yes / no), which were quantified by the frequency of their occurrence.

RESULTS
The study included 137 students and 32 teachers. Among the students, 78 were females (56%), 25 males (17%) and 38 (27%) did not answer this question. The participants' age ranged from 17 to 35 years, with 89 students aged 17 to 25 (65%), 34 students aged 26 to 30 (25%) and 14 students aged 31 to 35 (10%). As for the undergraduate course, 25 were from Speech Therapy (18%), 24 from Physical Therapy (17%), 23 from Occupational Therapy (16%), 17 from Medicine (13%), 16 from Nutrition and Metabolism (12%), 09 from Biomedical Sciences (7%), 09 from Biomedical Informatics (7%) and 14 students did not answer this question (10%). For 86 students (63%) IVP / bullying is present in the undergraduate course. About the witnessed situations, seven categories emerged from the answers, which are shown in Chart 1, together with their frequencies and some discursive clippings that compose them. They are: interpersonal violence / bullying in the senior-freshman relationship, interpersonal violence / bullying due to personal characteristics, interpersonal violence / bullying due to sexual orientation / gender, violence in teacher-student relationship, interpersonal violence / bullying due to academic performance, interpersonal violence / bullying due to social class and interpersonal / bullying violence due to ethnicity.
Among the teachers, 20 were females (63%) and 12 males (37%), aged between 39 and 64 years old; 20 (63%) identified the presence of IPV / bullying, and three categories related to the reported situations of violence emerged, being common to three of the seven categories that emerged among students. The categories, their frequency of occurrence and some of the discursive clippings that constitute the categories can be seen in Table 2. They are: interpersonal violence / bullying due to personal characteristics, violence in the teacher-student relationship and interpersonal violence / bullying in the senior-freshman relationship.

DISCUSSION
Interpersonal violence / bullying is a complex social phenomenon of which definition needs a consensus. Despite this lack of consensus in terms of definition, there are certain common elements that allow us to list characteristics that define peer violence at school: (1) it consists of a type of violent behavior; (2) it involves a broad spectrum of negative actions of a physical, psychological or social nature, developed over a prolonged period of time and which are harmful to the person to whom they are directed; (3) it is intentional in nature, that is, the perpetrator is aware of the harm caused to the victim; (4) it is generally accepted that the victims are not responsible for (causing) the actions directed against them and (5) the abuse may be perpetrated by an individual or group and the target of violence may be one or more individuals, but overall, the victim is one single person 20 . To some extent, these elements are present in the situations reported by the discursive clippings that constitute the categories described in this study.
One of the most important characteristics of bullying is the "systematic abuse of power" 21 . This condition of bullying characterization is present in the categories that emerged among both students and teachers. In situations involving violence in the student-teacher relationship and violence in the senior-freshman relationship, power is clearly positioned, either by a real (teacher-student) or imagined (senior-freshman) hierarchy.
The other two most frequent categories, derived from situations reported by students and teachers (IPV / bullying due to personal characteristics) or only by students (IPV / bullying due to sexual orientation / gender, IPV / bullying due to academic performance; IPV / bullying due to social class and IPV / bullying due to ethnicity) also refer to abuse of power. The abuse of power originates from the asymmetry between the victim and the perpetrator, which may be due to the fact that the victim belongs to a minority, i.e., physically or psychologically weaker 22  "... an excellent student was teased due to her above-average participation in that class ..." "Annotations in the roll call of pejorative nicknames by two or three student names" "Student (s) verbalizing characteristics of others -e.g. height, weight, clothing ,using a derogatory tone " "Isolation of a student who has a physical disability" Violence in teacher-student relationship 09 "… I learned about aggressive and degrading forms of mockery made by medical teachers through the students' narratives…" "… I witnessed students "crying", "distressed", " inattentive" and referring to the attitudes of some teachers in the classroom, that got to the point of affecting their confidence and self-esteem…" "… A teacher… humiliates internship students for not knowing the answers…" "jokes" ... bullying between teachers and students, especially due to situations of excess power / pseudo-power." Interpersonal violence / bullying in senior-freshman relationship 04 "... requirement to wear "Totems" (cap, bandana, splint) without flexibility while maintaining the tradition ... verbal threats of social penalties.
"... incidents during freshman reception week ..." "When I followed the registration of new students, I witnessed some situations such as shouting and offense (softly characterized as "jokes")." "I feel that humiliating situations (such as "get me a beer") keep happening at the parties involving freshman students" "Freshman who are forced to wear the yellow cap even outside the Campus premises." traditionally reported in the context of elementary and high school: students who do not correspond to the physical, intellectual, communication standard (too tall, too thin, too shy) suffer some kind of violence / discrimination (nicknames, jokes, mocking comments) that can be considered bullying, as they are repeated over time 23 .
Using the descriptor "university violence" there is a large number of publications in English, studies that refer to sexual violence, especially against women 24-25-26 . Likewise, there are studies on dating violence among university students, still focusing on the topic of violence against women 27-28-29 . There is also an extensive literature that deals with violence in the senior-freshman relationship, in situations involving the socalled university "hazing" practices (praxe in Portugal; trote in Brazil) 30-31-32-33-34-35 . There are some studies in Brazil related to violence against women in the university environment 36-38-39-40 and a growing number of publications in recent years about violence in the senior-freshman relationship 39-40-41-42-43 .
Sexual violence against women in the university context is a frequent object of scientific research and affirmative policies in many US, European and Latin American universities 44 . However, within the IPV/bullying category due to sexual orientation/gender, there were no discursive references to sexual violence. Discursive clippings refer to 'chauvinistic', sexist jokes and intolerance towards the Lesbian, Gay, Bisexual, Transvestite, Transsexual and Transgender (LGBT) population.
Regarding violence in the senior-freshman relationship, it is possible to see a growing concern to identify, understand and avoid these violent situations in recent studies 23-30-31-32-33-34-39 . Although this is not a study on "hazing", studies about violence in the senior-freshman relationship may provide insights into the understanding of peer violence in academic daily life, since the type of violence that begins in the reception period for new students can continue to occur throughout the academic journey, extrapolating the freshman arrival period, and intersecting with the issues of gender, ethnicity and social class, topics of the other categories that emerged during this investigation. It is possible to think that if, as freshmen, the students accepted the "jokes" to become part of the group 23 , they should continue to accept it for the same reason throughout their undergraduate journey. It is also worth considering that many students entering university bring with them a history of emotional vulnerabilities, and being bullied can cause significant suffering, often requiring psychological support to deal with this reality.
Hazing, as a rite of passage to university life, is not always classified as violent and oppressive. However, situations that have gained visibility in recent years point to the embarrassment and violence that may be present in university hazing 543 Maria Paula Panúncio-Pinto et al.
https://doi.org/10.1590/1981-5271v43suplemento1-20190060.ING [45][46] . This makes it a problem for managers and the university community to face. Hazing, (trote, praxe) refers to situations that occur in a group where the exercise of power and control of older members over newcomers prevails during the initiation period, when the freshmen are asked to perform certain tasks, which may vary from jokes without major consequences, to situations in which the exercise of the seniors' power and authority over freshmen leads to activities that cause embarrassment and discomfort, involving violence, humiliation, coercion for alcohol consumption and use of other drugs, which can endanger the freshman's physical and mental integrity 21-31-32 .
The tradition present in the hazing activities, and the naturalization of violence as a joke, make students who "survived" it repeat it in the following year as a sophomore/junior/senior, arguing that receiving the hazing was good for their integration into the new environment  . This creates an institutional culture that reinforces a tradition that is neither healthy nor constructive.
Studies on the freshman reception period indicate that more than half of higher education students went through some kind of hazing practice 23-33-39-41 . The freshmen's adherence to hazing places it as a natural event in the context of university education. However, abuses frequently occur, often leading to extreme situations of physical and emotional damage to freshmen, negatively affecting their adjustment and adaptation to this new phase of life.
When students are approached directly to express their perception of hazing, close values are obtained for positive (joy, integration, acceptance) and negative (indignation, humiliation, fear) perceptions [35][36][37] . Some studies show a significant association between negative hazing assessment and gender -women rate hazing negatively more often than men, and between negative assessment and age / course periodolder / more advanced students rate it more positively than younger students / those coursing early cycles [45][46] .
In studies published in Brazil about IPV between seniors and freshmen, mostly involving medical schools, the word "hazing" is presented with a negative connotation of abuse, a hierarchical relationship that, rather than intended to welcome, aims to humiliate, coerce, embarrass  The official HEI agenda does not use the word "hazing" for any of its activities during the freshman reception period.
Situations of violence that occurred in the universities of the state of São Paulo have gained visibility in the media and gave origin to the Parliamentary Commission of Inquiry (CPI) on "Violations of Human Rights in the São Paulo state Colleges/Universities". The CPI's final report describes violence of all kinds, practiced in the university context involving hazing, parties and academic daily life 47 .
The situations reported in the context of the CPI of the São Paulo state Universities give rise to an interface between the three main categories identified in this study: violence against women (sexual harassment, sexual violence, gender-based discrimination) is present in situations involving freshman reception and hazing, but it is also present in academic daily life in general. That is similar to the violence motivated by personal characteristics, which can be very evident at the time of admission to the University and continue throughout the undergraduate years.
The acts of discrimination motivated by personal appearance, social class, ethnicity, or academic performance point to the fact that victims, such as the findings of studies about bullying in elementary and high school 1-5-6-7 , are people who do not fit the dominant pattern 21 . That is, prejudice against "people who are different" would be the main motivator of the phenomenon  .
Reports of hazing involving abuse and violence that often hit the means of communication during the start of a new school year led to the prohibition of hazing according to specific laws in some Brazilian states. Since 2015 hazing is prohibited in all public schools in the state of São Paulo, at any level of education 49 .
In the University of São Paulo, hazing has been prohibited since 1999 by Ordinance GR3154/99 50 . This same ordinance states that violent practices are prohibited not only within the geographic boundaries of campuses, but wherever people are gathered on behalf of the University, broadening the concept of "university environment", as well as the responsibility of the university community regarding events that occur in frat-houses, on the streets at the so-called "tolls"(where freshmen collect money for the seniors) and in other spaces where students circulate.
Despite the legislation that prohibits hazing, its extinction does not seem possible, as it involves traditions of HEIs of great symbolic value and seen as undisputed. Universities are highly hierarchical environments that generate different forms of IPV: violence is present in the relationships between teachers and students, preceptors and students, teachers and preceptors 41 , offering students a model of interpersonal relationship based on violence. In a study about abuses suffered by students in medical schools, teachers and preceptors were identified as aggressors: verbal abuse, humiliation, insults, facilitating elements of hierarchization, competition and fragility of interpersonal relationships 23 . This hierarchy, so strongly defined at the University, leads to the promotion of symbols and rituals that favor the reproduction of violence 35 between seniors and freshmen, teachers and students, students and students, in any level of education. It is important to point out that the discussion of the results found in this study used the terms "interpersonal violence" and "bullying" as synonyms. The use of the word bullying has been established in studies on the occurrence of peer violence in the context of elementary and high school, among children and adolescents. It is possible to assume here that peer violence at any level of education can be termed "bullying" and, in fact, studies of IPV at the University use the term, 1-3-8-12-23-40-42 mainly because it is based on an imagined power relationship between equals. This would not apply to the teacher-student relationship, since the hierarchy in this case is as real as in the relationships of interpersonal violence in the workplace.
Therefore, it is essential that attitudes be taken to take care of interpersonal relationships in the context of university education, aiming at guaranteeing the students their emotional stability, their adaptation and adjustment to the undergraduate years, as well as their ethical and political formation, to act in society with responsibility for the guarantee of human rights.
An excerpt from a student's speech illustrates and synthesizes the feelings of those who are affected by different forms of violence throughout academic life: "I thought the university environment was a tolerant, pluralistic one, and it is the opposite of that".
Finally, it is necessary to consider the number of participants in relation to the study population. Approximately 1,400 students from the seven undergraduate courses offered by the Unit were invited to answer the form that was sent via Google Docs to the classes' institutional email. A total of 137 students answered the invitation, accepting to participate in the study (9.8% of the population). Similarly, 320 teachers were invited to participate through the same method, and 32 participated (10%). Poor adherence can be attributed to several reasons: the habit of not using the institutional email, little interest in the IPV / bullying topic or subjects related to undergraduate teaching. However, as this is an exploratory approach, although it can be argued that the sample size does not allow generalizations, the repetition of the topics that constituted the categories indicates the types of situations present in the context of undergraduate school, according to the perspective of students and teachers who agreed to participate. The topics that point to the types of violence can be taken as a starting point for further investigations.

FINAL CONSIDERATIONS
The results of this exploratory study allow us to conclude that the students and teachers who participated in this study recognize the presence of IPV / bullying in the daily life of undergraduate school, and peer violence in the senior-freshman relationship is the one most commonly identified. The violence in the teacher-student relationship also emerged as a category for students and teachers, albeit with a more discrete frequency.
Asymmetrical power relations may extend beyond the period of freshman reception, and violence, naturalized as a "joke", becomes invisible: when the abuse of the other becomes funny, the need for reflection on the education being offered at the University becomes evident. Which values should characterize university education?
The results of this study become a matter of concern by showing that intolerance and disrespect for differences are present, with such concrete examples, in the daily life of a HEI.
Therefore, it is essential that attitudes be taken to take care of interpersonal relationships in the context of university education, in order to guarantee the students their adaptation and adjustment to undergraduate school, their ethical and political training to act in society to guarantee human rights and equity.