Clinician safety and well-being are crucial components of excellence in health care. Unfortunately, clinicians’ feelings of physical and psychological safety and well-being are often undermined by their experiences of mistreatment, such as the “alarming rise in violent incidents in health care facilities” as well as patient-initiated discrimination and racism.
At the Josiah Macy Jr. Foundation, where we seek to advance health and health care for everyone by improving the education of the next generation of health care professionals, we are funding efforts to create safer, more inclusive, more nurturing clinical learning environments for health professions students, residents, and graduate students—most recently through the Catalyst Awards for Transformation in Graduate Medical Education. We know that patients benefit when health care professionals experience safety, support, and belonging.
Seven case studies describing initiatives in graduate medical education intended to achieve such an outcome are now available online at Academic Medicine [links are provided below]. These projects employed a variety of strategies and interventions, such as simulation experiences and peer mentoring, but all with the same goal of helping residents and fellows recognize and effectively respond to harmful bias, discrimination, microaggressions, and other forms of mistreatment in the clinical environment.
The project teams came together earlier this year at a Macy-sponsored convening to present their work, share best practices, and learn from one another. They subsequently produced their informative and thought-provoking case studies, which will be published in a December 2024 Academic Medicine supplement entitled Enhancing Clinical Learning Environments: Strategies to Foster Belonging in Graduate Medical Education, along with six commissioned papers.
Special thanks to my co-editors, David Blumenthal, MD, professor of public health and medicine at Harvard University, and Patricia Poitevien, MD, senior associate dean and associate professor at Brown University’s Warren Alpert Medical School, who guided the development of the supplement. Our Foreword and a set of commissioned papers are available for download ahead of print, as are the seven case studies linked below.
I am also pleased to report that representatives from four of the 2023 Catalyst Awards teams will be presenting “Simulation for Microaggressions Training” at the January 2025 International Meeting for Simulation in Health Care and that the community of practice we hoped to cultivate is thriving.
Facing dangerous working conditions is a problem for all those on the front lines of health care, particularly our nursing colleagues. We were eager to support the Hunt School of Nursing at Texas Tech University Health Sciences Center El Paso with a 2023 President’s Grant to help them develop, implement, and evaluate a training program that uses standardized patients to simulate encounters with potentially volatile patients. The simulation-based training allows nursing students to practice identifying and de-escalating patients’ aggression and learn how to manage potentially traumatizing situations before they become dangerous. Their outstanding program and leader, Dr. Ivonne Espinosa, were recently featured in an NPR report. We commend them and hope that they will continue to publicize their innovative curriculum, as the need for such training remains significant.
The Macy Foundation is deeply committed to supporting and broadly disseminating strategies that improve the well-being of everyone who learns and works in clinical learning environments. Projects such as these offer concrete strategies and solutions to ensure the physical and psychological safety that is fundamental in healing environments.
We hope you will enjoy reading more about how our seven 2023 Catalyst Awards recipients are accomplishing this important and timely goal:
Catalyst Award Case Studies, now available online at Academic Medicine:
- A pilot project is training more “Civility Champions” to provide restorative justice-based peer counseling to residents at Duke University School of Medicine.
- At NYU Grossman School of Medicine, objective structured clinical encounters are being used to teach residents how to address patients’ inappropriate behaviors.
- A resident-led research team at Northwell Health Feinstein Institute for Medical Research compared two approaches to helping residents to manage workplace aggression.
- A peer-support program for residents at the University of California, San Francisco School of Medicine now includes training in responding to racial trauma.
- At the University of Michigan Medical School, a curriculum featuring standardized patients is helping trainees address patient-initiated harassment, discrimination, and microaggressions.
- A simulation-based course at the University of Wisconsin School of Medicine is helping residents identify and respond to microaggressions.
- A longitudinal curriculum is helping learners at Yale School of Medicine de-escalate emotionally charged patient and family encounters.