When Patients Discriminate: A Trainee-Driven, Co-Created
Simulation Curriculum to Address Discrimination by Patients
The NYU Grossman School of Medicine project will design,
implement, and evaluate a program to address discrimination experienced by
trainees who are underrepresented in medicine or hold other minoritized
identities. The project will collect data and information on discriminatory
behavior experienced by residents across multiple specialties. Residents will
then be paired with faculty in their respective department to co-develop
objective structured clinical encounter (OSCE) cases across a variety of situations
for practical teaching and assessment of skills, such as supporting learners
through debriefing with their colleagues, addressing patients directly
regarding their behaviors, and escalating concerns about safety to faculty and
other leadership. The OSCE cases, as well as an affiliated discussion-based
workshop, will support housestaff in addressing incidents of discrimination in
ways that support learners, maintain a therapeutic patient-provider
relationship when possible, and build a community of trust and inclusion in the
clinical learning environment.
PI: Christian Torres, MD, Clinical Assistant
Professor of Medicine and Director of Diversity Training and Housestaff
UCSF School of Medicine
Peer Support Ambassadors: A Program to Advance a Supportive and Inclusive CLE
The UCSF project will formalize and centralize peer support across GME by creating a resident and fellow Peer Support Ambassador program, a leadership opportunity and training that will build on existing peer support curriculum and expand the training to include skills related to responding to racial trauma and advancing anti-oppression practice. Over the year, a cohort of 10 residents/fellows across specialties will be selected, trained, and funded through stipend support as a proof-of-concept pilot. As trusted peer leaders, PSAs will provide a mechanism to support trainees and promote an institutional culture and learning environment where trainees from all backgrounds can thrive.
PI: Larissa Thomas, MD, MPH, Professor of Clinical Medicine and Director of Wellbeing for Graduate Medical Education
University of Wisconsin School of Medicine
Simulation-Based Microaggressions Training for Residents and Faculty
The University of Wisconsin project will create a simulation-based course where resident trainees and their faculty supervisors can practice identifying and responding to microaggressions. The simulation will consist of multiple cases and scenarios developed in collaboration with learners and faculty and will consist of situations that pediatric residents commonly encounter and have reported difficulty in responding. In addition to the development of a required course for pediatric residents and their faculty supervisors to improve their skills in responding to microaggressions, the project will build capacity within the department through a train the trainer model and create a toolkit which can be exported to other departments and situations.
PIs: Emily Ruedinger, MD, MEd, Assistant Professor of Pediatrics and Associate Program Director of Pediatrics, and Sushant Srinivasan, MD, MHPE, Associate Professor of Pediatrics and Medical Director of the UW Clinical Simulation Program
Northwell Health Feinstein Institute for Medical Research
Simulation vs. RISE-UP: Microaggression Response Training in Emergency Medicine
The Zucker-Northwell North Shore/Long Island Jewish project will assess two different strategies for helping residents respond to microaggressions from patients and families in the clinical learning environment, while preserving a therapeutic alliance and upholding the ethical principles of beneficence, nonmaleficence, and patient autonomy. The project will compare the impact of a workshop series entitled Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE-UP) which has already met with positive feedback and encouraging results, with newly created simulation scenarios. The goal is to assess best practices in order to formulate a standardized, interactive curriculum which will teach residents the competencies and communication skills necessary for managing workplace microaggressions and mitigating their impact on learners and the clinical learning environment.
PIs: Sophia Gorgens, MD, Senior Resident, Department of Emergency Medicine and David Fernandez, MD, Senior Resident, Department of Emergency Medicine
University of Michigan
Improving the Culture of Safety Concerning Mistreatment: A Curriculum for Addressing Patient-Initiated Harassment, Discrimination and Microaggressions
The University of Michigan project will develop and further expand a novel curriculum for addressing patient-initiated harassment, discrimination, and microaggressions. The curriculum is delivered over 90-120 minutes, can be adapted to virtual or in person audiences, and consists of three parts: an overview of published literature, a framework for responding to mistreatment, and a skills practice session with a standardized patient. The goal is to provide trainees with the skills to prepare for, address, and debrief about patient-initiated mistreatment in real time.
PI: Nathan Houchens, MD, Associate Chief of Medicine of the VA Ann Arbor Healthcare System and Assistant Program Director of Internal Medicine
Yale School of Medicine
Clinical Learning Environment Optimizing Uptake Training (CLOUT)
The Yale project will bring the Chief Residents from five large clinical departments together to participate in a longitudinal curriculum to learn skills to de-escalate emotionally charged patient and family encounters and immediately respond to trainees who have been subjected to verbal abuse by patients. They will model and practice behaviors to promote personal resilience, psychological safety, and belonging by teaching both learners and faculty to identify best practices for appropriate debriefing and support. The curriculum will focus on 1) mitigating workplace stress due to patient verbal abuse, 2) addressing and responding to bias/mistreatment and harassment, as well as other factors that can contribute to a poor learning climate, and 3) creating communities of belonging and inclusion. Chief Residents will be paired with a faculty champion to provide mentorship, allyship, and buy-in, and to advance institutional memory and continuity.
PI: Dana Dunne, MD, MHS, Associate Professor of Medicine and Director of Educator Development for Graduate Medical Education
The Civility Champions Project
The Duke project will expand a pilot project conducted in the Department of Medicine in order to enroll a cohort of 50-75 participants from 5-7 clinical departments to be trained as Civility Champions. Civility Champions will receive training to increase their competence and comfort in providing restorative justice-based counseling to recipients of incivility as well as increase their ability to recognize workplace incivility, intervene as an upstander, and incorporate lessons learned in their teaching/leadership practice. In-person training for the Civility Champions will be conducted over six hours in small groups, using didactic and interactive activities, including small group discussions, case studies, and role-play. Each participating department will identify a Champion point person who will be given additional training in order to lead quarterly departmental debriefs of the Civility Champions themselves, with their time supported through departmental resources. The goal is to increase overall civility in the clinical learning environment.
PIs: Betty Staples, MD, Professor of Pediatrics and Associate Director of Graduate Medical Education and Jane Gagliardi, MD, MHS, Professor of Psychiatry and Behavioral Sciences, Professor of Medicine, and Program Director of Internal Medicine-Psychiatry Combined Training Program