creating safe learning environments dal...learning environment (le) is critical for optimal learning...

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