Approaches for Residents to Address Problematic Patient Behavior: Before, During, and After the Clinical Encounter

Shankar, Megha; Albert, Tyler J.; Yee, Nathan; Overland, Maryann Katherine

doi:10.4300/jgme-d-19-00075.1

Cited by 26 publications

(25 citation statements)

References 8 publications

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“…Well-facilitated team debriefing should be continued through allocated time and space where residents’ experiences can be acknowledged, validated, and addressed. 21 Bystander trainings on supporting targeted colleagues should also be encouraged given how frequently residents reported witnessing biased behavior.…”

Section: Discussionmentioning

confidence: 99%

Resident Physician Experiences With and Responses to Biased Patients

et al. 2020

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IMPORTANCE Biased patient behavior negatively impacts resident well-being. Data on the prevalence and frequency of these encounters are lacking and are needed to guide the creation of institutional trainings and policies to support trainees. OBJECTIVE To evaluate the frequency of resident experiences with and responses to a range of biased patient behaviors. DESIGN, SETTING, AND PARTICIPANTS A retrospective survey was sent via email to 331 secondand third-year internal medicine residents from 3 academic medical centers in California and North Carolina. First-year residents were excluded owing to their limited interactions with patients at the time of participant recruitment. Data were collected from August 21 to November 25, 2019. MAIN OUTCOMES AND MEASURES Descriptive statistics were used to report the frequency of experience of various types of biased patient behavior, residents' responses, the factors impeding residents' responses, and residents' experiences and beliefs regarding training and policies. RESULTS Overall, 232 of 331 residents (70%) participated; 116 (50%) were women; 116 of 247 (47%) were White (participants had the option of selecting >1 race/ethnicity); and 23 (10%) identified as lesbian, gay, bisexual, transgender, or queer. The frequency of resident-reported experience of types of biased patient behaviors varied. The most common behaviors-belittling comments and assumption of nonphysician status-were reported to be experienced 1 or more times per week by 14% of residents (32 of 231) and 17% of residents (38 of 230), respectively. Women, Black or Latinx, and Asian residents reported experiencing biased behavior more frequently. Forty-five percent of Black or Latinx residents (17 of 38) encountered instances of explicit epithets or rejection of care. All 70 Asian residents reported experiencing inquiries into their ethnic origins. Most women residents (110 of 115 [96%]) experienced role questioning behaviors, and 87% (100 of 115) experienced sexual harassment. The need to prioritize clinical care and a sense of futility in responding were the most common factors (cited by 34% of residents [76 of 227] and 25% of residents [56 of 227], respectively) significantly impeding responses to biased behaviors. Eighty-five percent of residents (191 of 226) never reported incidents to their institution. Eighty-nine percent of residents (206 of 232) identified training and policies as necessary or very necessary. CONCLUSIONS AND RELEVANCE This survey study suggests that biased patient behavior is experienced frequently by internal medicine residents. Non-White and women residents reported experiencing a disproportionate burden of these incidents. Residents' responses rarely included institutional involvement. Residency programs and health care systems should prioritize training and policies to address biased patient behavior and support affected residents.

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Section: Discussionmentioning

confidence: 99%

Resident Physician Experiences With and Responses to Biased Patients

et al. 2020

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“…1). 2,[4][5][6] We designed a fifty-minute workshop for internal medicine residents based on the MRT and informed by concurrent trainings at the associated medical school 3 with the following goals: identify microaggressions using case scenarios, describe the impact of microaggressions on provider wellbeing and learning environments, and practice response strategies through role plays. Case scenarios and role play prompts were developed using published qualitative research and resident-reported microaggressions.…”

Section: Methodsmentioning

confidence: 99%

“…There are growing calls to incorporate practical training on responding to microaggressions into medical education. [3][4][5] In this study, we describe a microaggression response toolkit (MRT) and workshop for residents, and their effects on perceived abilities to identify and respond to microaggressions.…”

Section: Introductionmentioning

confidence: 99%

“Let’s Talk About What Just Happened”: a Single-Site Survey Study of a Microaggression Response Workshop for Internal Medicine Residents

et al. 2021

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“…While our findings support the importance of improving healthcare systems, they are more congruent with recent scholarship on explicit personal tactics to mitigate gender‐based challenges. Researchers have suggested physicians use algorithmic responses to patient‐initiated sexual harassment, 35 advocate for those who experience harassment in real time, 36 and engage in dedicated practice responding to harassment 37,38 . Our results build on these studies by outlining strategies intended to navigate complex gender dynamics and role model approaches for learners.…”

Section: Discussionmentioning

confidence: 73%

“…Researchers have suggested physicians use algorithmic responses to patient-initiated sexual harassment, 35 advocate for those who experience harassment in real time, 36 and engage in dedicated practice responding to harassment. 37,38 Our results build on these studies by outlining strategies intended to navigate complex gender dynamics and role model approaches for learners. Interestingly, it was more common for attendings to discuss how they guide their learners and debrief after difficult situations than to discuss how they personally respond to gender-based harassment.…”

Section: Discussionmentioning

confidence: 78%

Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study

et al. 2020

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BACKGROUND: Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. OBJECTIVE: To explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate gender-based challenges in clinical environments. DESIGN: Multisite exploratory, qualitative study. SETTING: Inpatient general medicine teaching rounds in six geographically diverse US academic hospitals between April and August 2018. PARTICIPANTS: With use of a modified snowball sampling approach, female attendings and their learners were identified; six female attendings and their current (n = 24) and former (n = 17) learners agreed to participate. MEASUREMENTS: Perceptions of gender-based challenges in clinical teaching environments and strategies with which to respond to these challenges were evaluated through semistructured in-depth interviews, focus group discussions, and direct observations of rounds. Observations were documented using handwritten field notes. Interviews and focus groups were audio recorded and transcribed. All transcripts and field note data were analyzed using a content analysis approach. MAIN OUTCOMES: Attending experience levels ranged from 8 to 20 years (mean, 15.3 years). Attendings were diverse in terms of race/ethnicity. Strategic approaches to gender-based challenges clustered around three themes: female attendings (1) actively position themselves as physician team leaders, (2) consciously work to manage gender-based stereotypes and perceptions, and (3) intentionally identify and embrace their unique qualities. CONCLUSION: Female attendings manage their roles as women in medicine through specific strategies to both navigate complex gender dynamics and role model approaches for learners. Journal of Hospital Medicine 2020;15:XXX-XXX. © 2020 Society of Hospital Medicine

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Approaches for Residents to Address Problematic Patient Behavior: Before, During, and After the Clinical Encounter

Cited by 26 publications

References 8 publications

Resident Physician Experiences With and Responses to Biased Patients

Resident Physician Experiences With and Responses to Biased Patients

“Let’s Talk About What Just Happened”: a Single-Site Survey Study of a Microaggression Response Workshop for Internal Medicine Residents

Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study

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