we will use our cell phones„ž-for-mistreat… · ontario school of medicine. learning objectives...
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We will use our cell phones
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What do you want to learn in
the Prescription for
Mistreatment workshop?
Northern Constellations May 3, 2019
Dr. Catherine Cervin
Dr. Jason Shack
Dr. Katie Anderson
Kristen Wright
Kate Beatty
℞ for Mistreatment: Enhancing safe learning environments across NOSM
Disclosure of Affiliations, Financial
Support, and Mitigating Bias
Speakers: Dr. Catherine Cervin, Dr. Jason Shack, Dr. Katie Anderson, Kristen Wright, Kate Beatty
Affiliations:
The workshop speakers have no commercial affiliations.
Financial Support:
This workshop has received no financial or in-kind support.
Mitigating Potential Bias:
All speakers have learning and/or work relationships with the Northern Ontario School of Medicine.
Learning Objectives
1. Describe the characteristics of a psychologically safe
work environment and its link to quality education and
patient care in northern Ontario.
2. Analyze and debate definitions of learner mistreatment
3. Formulate practical strategies to implement healthier
learning and work environments in their own setting.
Agenda
• Introduction
• Icebreaker
• WHY we need healthy, respectful, safe learning/work environments
• What mistreatment is and is not
• Discussion of mini cases (table discussions)
• Identifying good practices for healthier learning and work environments
• Next steps for NOSM
We will use our cell phones
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ICEBREAKER
Take one minute to write down 3 –4
points about how you felt when:
1. You were a member of a collegial
respectful team.2. You were on a team in which you
observed mistreatment of a team
member or you felt mistreated
yourself.
3. Find a partner and discuss key
points about healthy and unhealthy
work/learning environments
Discussion
What is the impact for individuals and teams
when feeling safe?
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Our Phase Two
Faculty Comments
It is my absolute pleasure to have them. I look forward to meeting the next group of students.
This ‘Teaching —Learning Programme‘ is very much a two way street. I am learning ALOT also. We are hugely enjoying being a part of the NOSM Teaching
Faculty.
Thank you for your note Peter. NOSM and it’s students have added tremendous value
to our town, and to my practice. I enjoy their
presence, and wish I had more to offer them.
What are you and your community doing to
promote a healthy, safe and respectful culture?
High performing teams
Students eager to come to community
Engaged self directed learners
Faculty feel rewarded,
excited
Collegial energetic learners and faculty
Positive rewarding learning
environment
Faculty Support - Teaching skills- Feedback - Wellbeing
Superb learner* experience in community
*NOSM and Visiting
Electives
Successful recruitment to the
community
Learner Support - Good teaching feedback Wellbeing
Psychological
Safety
Patient
Safety
NOSM’s Core Values – Respect &
Inclusiveness
NOSM’s faculty, staff, and learners seek to learn and listen to one another
respectfully and communicate openly. NOSM’s staff, faculty, and learners
treat others and their ideas in a manner that conveys respect as
differences are discussed, fosters an open academic debate, and which
respects academic freedom.
NOSM fosters inclusiveness by supporting an environment which
embraces differences in staff, faculty and learners and respectfully creates
value from the differences of all members of the NOSM community, in
order to leverage talent and foster both individual and organizational
excellence.
CHANGE - Across the Country
CMA - March 12, 2019
$1.6 million announced to fund pan-provincial physician
wellness initiative
“For the past few years we’ve been addressing
the issue of physician wellness by putting our
fingers in the dike, jumping around where people
identify a need. Everyone wants to address
physician wellness, so the demand has increased
exponentially.” - Dr. Jane Lemaire, University of Alberta
Who is responsible for the work,
research and learning
environment?
ALL of us
Administrators
Faculty
Residents/ Fellows
Nurses
Clinical personnel
Other Staff
Students
WHY are we talking about a Prescription
for Mistreatment?
Mistreatment of medical students
AFMC GQ (2018): Percent of respondents who indicated they personally experienced mistreatment behaviours
Most common behavior experienced occasionally (2-4x)
Publicly humiliated (21.8%)
Sexist remarks/names (13.2%)
Count Percent
Yes 1107 59.4
No 758 40.6
Respondents: 1865
NOSM ISA 2019 Results
Definition of Mistreatment
NOSM
Mistreatment is any instance of bullying,
discrimination, harassment, humiliation,
intimidation, inappropriate or unethical
behaviour experienced or witnessed by a learner
that negatively affects their learning, research and/or
work environment.
What is learner mistreatment?
Public Humiliation
Threatening physical harm
Physical Harm (hitting, slapping, kicking)
Requiring performance of personal services (shopping,
babysitting)
Offensive sexist remarks/names
Denial of rewards or training opportunities based on
gender/ race, ethnicity/ sexual orientation
Impact of Mistreatment
Burnout
Depression
Stress and worry
PTSD symptoms
Problematic drinking
Decreased self-confidence
Unhappiness
Disrupted personal relationships
Psychosocial Impaired patient care
Attrition
Lower career satisfaction
Cynical attitude
Medical errors
Regret choosing medicine
Influences specialty
choice
Professional
Cook et al., 2014; Frank et al., 2006; Keashly, Hunter, & Harvey et al., 1997;
Maida et al., 2003; Oser et al., 2014; Wolf et al., 1991
Who mistreats?
Maintaining a positive learning environment is a
responsibility that ALL of us share
At Your Table Discussion
Scenarios
We will present some case scenarios
Based on what we have discussed so far, at each table
please discuss the scenario and consider if it is:
Definitely mistreatment
May or may not be mistreatment depending upon
what conditions?
Not mistreatment
Think about if there are others in the scenario, what
could they have done?
Let’s discuss this case scenario in
the clinical learning environment…
Think it over
Is this mistreatment?
Definitely mistreatment
May or may not be mistreatment
Not mistreatment
What factors made you decide this?
Is there anything others could have done in this scenario?
Think it over
Is this mistreatment?
Definitely mistreatment
May or may not be mistreatment depending upon what conditions?
Not mistreatment
What factors made you decide this?
Is there anything others could have done in this scenario?
High expectations is not mistreatment
Asking a student to review the literature and give a
presentation is within professional expectations.
However, if it is punitive in nature, if the same student
is asked to do this many times (different from the other
students), if the tone and demeanor of the supervising
residents was not respectful, it will be considered
mistreatment.
Think it over
Is this mistreatment?
Definitely mistreatment
May or may not be mistreatment
Not mistreatment
What factors made you decide this?
Is there anything the resident could have done in this scenario?
Denigrating remarks
It is normal for the care-givers to feel connected to their patients; however
that does not excuse inappropriate language or denigrating comments.
This is definitely mistreatment.
What is currently in the works at
NOSM?
Revised Harassment and Discrimination Policy
Learner Mistreatment Procedure
Learner Advocates
“NOSM Well” app
Centralized place for all mistreatment,
harassment and discrimination concerns and
complaints
The journey continues....We need your feedback
Thank you for being part of this workshop