creating safe learning environments dal...learning environment (le) is critical for optimal learning...
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CreatingandSupportingSafeClinicalLearningEnvironments:WhatcanIdo?
www.usask.ca
Drs.PrestonSmith,Dean&AnuragSaxena,AssociateDean,PGME,
LearningEnvironment:Whycare?
Learning Environment is an explicit accreditation standard
WhatmakesagoodclinicalTeacher?
§ Medical/Clinicalknowledge§ Clinicalandtechnicalskills/competence,clinicalreasoning
§ Positiverelationshipwithstudentsandpositivelearningenvironment
§ Communicationskills§ Enthusiasm
§ AcademicMedicine2008,Sutkin et.al
ComponentsoftheLearningEnvironment
Whatwouldyouthinkaresomecomponentsofasafelearningenvironment
SafeLearningEnvironment
LearningEnvironment§ Thelearningenvironmenthasbeendefinedaseverythingthatishappeningintheclassroomordepartmentorfacultyoruniversity
(Genn,2001,Roff andMcAleer,2001;Cinar,Cakmak &Uzunboylu 2009).
UnsafeLearningEnvironment§ Whatdoyouthinkaresomecharacteristicsofanunsafelearningenvironment?
§ Orwhatcouldgowrong?
ExcellentLearningEnvironment
§ Behavioral
§ Clinical
§ Physical
§ Learning
§ Program
§ Behavioral
a) Respectfulb) Collaborativec) Professionald) Learnerrolevaluede) Collegialf) Intimidationisnottoleratedg) Harassmentisnottoleratedh) Misogynyisnottoleratedi) Racial,ethnic,sexualorientationbiasisnottoleratedj) Freefromfacultyand/orstaffconflictk) Freefromfacultyand/orstaffpoliticsl) Speakingtruthtopowerisencouraged
§ Clinical
a) Competence/excellenceb) Varietyinlearningopportunities/venuesc) Patientsalignwithobjectivesd) Clinicalworkloadmanageablee) Patientsaresafef) Staffaresafeg) AppropriateSupervisionavailableh) Clinicalresponsibilityatthelevelofthelearneri) Clinicalenvironmentisadequatelystaffed
§ Physical
a) Personalphysicalsafetyb) Callroomsc) Computeraccessd) Libraryaccesse) Learningspaces(meetingrooms)f) Heatandairconditioningg) Nutritionavailableh) Accommodations(safeandcomfortable)i) Travelisminimumandsafe
§ Learning
a) Goodpimpingonlyb) Assessmentisfairc) Constructivefeedbackistimelyd) IPEvalued
§ Program
a) Leadershipiseffectiveb) Programevaluationisvaluedandimplementedc) Objectivesclearandobtainabled) Assessmentistransparentandfaire) Promotionistransparentandfairf) Learnersarerepresentedg) Selectionisfairandtransparenth) Remediationiswell-designedi) Excellentacademicprogrammingj) Researchsupportedandresourcedk) Administrationisadequatelyresourcedl) Residentoff-timerulesarerespectedm) Timetolearnn) Residentleadershipvaluedandsupported
SomeCommonDisruptiveBehaviours§ ByFaculty§ Rudeness§ Beingcondescendingordemeaning§ Passingjudgement§ Shaminglearners§ Boundaryviolationswithpatients,
familymembers,staff,orothercareproviders
§ Outburstofanger§ Creatingrigidorinflexiblebarriersto
requestsforguidanceorcooperation
§ ByLearners§ Negativecommentsaboutteam
members§ Refusaltolearnorcomply§ Notworkingcollaboratively§ Unmanagedinterpersonal
conflict§ Inappropriatejokesor
comments§ ProfaneLanguage
Disruptivebehaviourimpactsteamrelationshipsandqualityofhealthcaredelivery,andmayleadtoemulationofsuchbehaviour.
Exerciseonpossibleunderlyingrootcausesofdisruptivebehaviors§ Smallgroupwork(5min.)§ Largegroupdiscussion(5min.)
RootCauseAnalysisofDisruptiveBehaviour
§ Thereiscommonlyanunderlyingcausetodisruptivebehavior
§ Linkedtopersonalfactors,interactionsorworkingenvironment
§ IdentifyingWHAT,HOWandWHYcertainbehaviourhappenedhelpsdevelopcorrectivemeasuresandpreventreoccurrence
“Ifyoudon’tasktherightquestions,youdon’tgettherightanswers.Aquestionaskedintherightwayoftenpointstoitsownanswer.AskingquestionsistheABCofdiagnosis.Onlytheinquiringmindsolvesproblems.” – EdwardHodnett
CommonRootCauses
FrameworkforDiagnosisandIntervention
Document
Assess(&Accommodate???)
Resolve
FrameworkforaddressingdisruptiveworkplacebehaviorthatadverselyimpactstheLE
Document –> Assess –> Proportionate intervention-> Monitor
ExploringunderlyingrootcausesandInterventions
Addressingpersonalissues§Underlyingmentalhealthcondition
§ Assessments,ifneeded,(psychological,psychiatric,neurological,addiction)
§Stress(Financial,family,academicdemands)§DifficultiesmanagingResidency/Lifebalance§Littletonoexposureworkinginanemploymentsetting§Inexperienceworkingwithavarietyofhealthcareproviders
Addressingsystemissues§ Increasedclinical,research
academic,andadministrativeworkloads
§ Excessivedemandsinthecontextofscarceresources
§ Facultyshortages§ Insufficienteducationandtraining§ Unclearexpectationsandlackof
consequencesfordisruptivebehaviors
§ Lackofprocessorburdensomeadministrativeprocedures/under-reporting
Bemindfulofthecontext,systemandpersonalissuescontributingtodisruptivebehavior.
SupportforLearnersandFaculty
§ Counsellingprograms(WellnessOffice,Universityresources,externalphysiciansandconsultants)
§ Specificsupportsformanagingstresses,anger,work-lifebalance,etc.
§ Coaching/Mentoring§ Facilitation/Mediationofsituationswithhighconflict
CaseStudy:Harassment
§ CollegeofMedicineandHealthRegioncoordinateastrategy§ Consultedexperts:HumanRightsCommission
a) Firewallbetweenindividualandgroupissues
§ Independent,respectedfacultyleader&experiencedhospitalmediatorengaged
§ MetwithDivisionHeadandProgramDirectorseparately§ Deanmetwithresidentsseparately§ DeanandCEOmetwithunitandphysicians§ Metwithalliedhealthprofessionals§ All(moreorless)committedtosixmonthprocess
§ Monthlysurveyingresidents/regularmeetings§ Codeofconductdeveloped§ Twomandatoryeducationalsessions
§ Intimidationandharassment§ Physicalwellness
§ Mediatorengagedwithafew§ DeanandCEOregularlyupdated
CaseStudy:Harassmentcont’d
Keypoints§ Learningenvironment(LE)iscriticalforoptimallearningandsafework.
§ ThereisanoverlapbetweenworkplaceenvironmentandLEinresidencyduetotheprimarilyservice-learningfoundation.
§ DisruptivebehaviorsbyboththefacultyandthelearnersadverselyimpactLE.
§ Preventivestrategiesthroughcodesofconduct,ongoingeducationhaveabetterROI.
§ Addressingdisruptivebehaviorsrequirestimelyidentification,determinationofrootcauses,addressingbothsystem- andindividualissuesandrigorousmonitoring.
§ Keyresourcesandprocessesincludingalgorithmsareavailable.
FinalWord
§ Speaktruthtopower
§ Supportthosethatspeaktruthtopower
§ Thankyouforyourtimeandattention