ERASE-ing Patient Mistreatment of Trainees: Faculty Workshop

Abstract

Introduction: Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students). Methods: Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018. Results: Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it. Discussion: ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.

Tools for Responding to Patient-Initiated Verbal Sexual Harassment: A Workshop for Trainees and Faculty

“…16 Given the power that faculty and peers have to change or reinforce clinical culture norms, 9 the workshop also emphasizes the importance of bystander intervention. [9][10][11] After participating in the workshop, all physicians will have developed and rehearsed a script for responding in their own words to verbal harassment toward themselves and a trainee.…”

“…Previous authors in MedEdPORTAL have described curricula for faculty on responding to patient mistreatment of medical trainees; however, their work has focused on directly observed mistreatment. To our knowledge, there are only two modules 5 , 10 in MedEdPORTAL on addressing patient mistreatment of medical trainees. Like the ERASE curriculum of Wilkins and colleagues, 10 , 11 our module uses an interactive workshop to teach communication tools for responding to discriminatory comments made by patients.…”

A Policy Statement of the Society of General Internal Medicine on Tackling Racism in Medical Education: Reflections on the Past and a Call to Action for the Future

“…43,45 Despite recognition that is robust, dedicated faculty training is a prerequisite for effective curricular development and implementation, 4 faculty development efforts focused on anti-racist teaching, and dialoguing about race, racism, and white privilege are scarce. Some important work has been done with respect to interpersonal manifestations of racism, like supporting trainees in the face of microaggressions and mistreatment 45, 46 and acknowledging implicit bias. 47 Indeed, though curricula that focus on individual-level factors (implicit bias and microaggressions) may increase awareness of the negative experiences of URiM trainees and physicians, this "consciousness raising" 48 can create a false perception of change if the increased dialogue about interpersonal bias is not accompanied by efforts to identify and correct the systemic racist structures present within our institutions.…”

The “Difficult Learner” in anesthesiology: Challenges, pitfalls, and recommendations

“…During this meeting, it is important for the faculty to remain receptive to systemic or structural factors leading to the learner's lapse in professionalism, such as a suboptimal learning environment due to implicit bias and microaggression, or learner mistreatment by faculty or other healthcare professionals, or mistreatment from patients and families 37–39 . These structural factors may negatively affect the learners’ behaviors, especially when few are trained to manage the response and associated emotions 40 …”