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Creating and Supporting Safe Clinical Learning Environments: What can I do? www.usask.ca Drs. Preston Smith, Dean & Anurag Saxena, Associate Dean, PGME,

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Page 1: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

CreatingandSupportingSafeClinicalLearningEnvironments:WhatcanIdo?

www.usask.ca

Drs.PrestonSmith,Dean&AnuragSaxena,AssociateDean,PGME,

Page 2: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

LearningEnvironment:Whycare?

Learning Environment is an explicit accreditation standard

Page 3: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

WhatmakesagoodclinicalTeacher?

Page 4: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Medical/Clinicalknowledge§ Clinicalandtechnicalskills/competence,clinicalreasoning

§ Positiverelationshipwithstudentsandpositivelearningenvironment

§ Communicationskills§ Enthusiasm

§ AcademicMedicine2008,Sutkin et.al

Page 5: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

ComponentsoftheLearningEnvironment

Whatwouldyouthinkaresomecomponentsofasafelearningenvironment

Page 6: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

SafeLearningEnvironment

Page 7: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

LearningEnvironment§ Thelearningenvironmenthasbeendefinedaseverythingthatishappeningintheclassroomordepartmentorfacultyoruniversity

(Genn,2001,Roff andMcAleer,2001;Cinar,Cakmak &Uzunboylu 2009).

Page 8: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

UnsafeLearningEnvironment§ Whatdoyouthinkaresomecharacteristicsofanunsafelearningenvironment?

§ Orwhatcouldgowrong?

Page 9: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

ExcellentLearningEnvironment

§ Behavioral

§ Clinical

§ Physical

§ Learning

§ Program

Page 10: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Behavioral

a) Respectfulb) Collaborativec) Professionald) Learnerrolevaluede) Collegialf) Intimidationisnottoleratedg) Harassmentisnottoleratedh) Misogynyisnottoleratedi) Racial,ethnic,sexualorientationbiasisnottoleratedj) Freefromfacultyand/orstaffconflictk) Freefromfacultyand/orstaffpoliticsl) Speakingtruthtopowerisencouraged

Page 11: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Clinical

a) Competence/excellenceb) Varietyinlearningopportunities/venuesc) Patientsalignwithobjectivesd) Clinicalworkloadmanageablee) Patientsaresafef) Staffaresafeg) AppropriateSupervisionavailableh) Clinicalresponsibilityatthelevelofthelearneri) Clinicalenvironmentisadequatelystaffed

Page 12: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Physical

a) Personalphysicalsafetyb) Callroomsc) Computeraccessd) Libraryaccesse) Learningspaces(meetingrooms)f) Heatandairconditioningg) Nutritionavailableh) Accommodations(safeandcomfortable)i) Travelisminimumandsafe

Page 13: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Learning

a) Goodpimpingonlyb) Assessmentisfairc) Constructivefeedbackistimelyd) IPEvalued

Page 14: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Program

a) Leadershipiseffectiveb) Programevaluationisvaluedandimplementedc) Objectivesclearandobtainabled) Assessmentistransparentandfaire) Promotionistransparentandfairf) Learnersarerepresentedg) Selectionisfairandtransparenth) Remediationiswell-designedi) Excellentacademicprogrammingj) Researchsupportedandresourcedk) Administrationisadequatelyresourcedl) Residentoff-timerulesarerespectedm) Timetolearnn) Residentleadershipvaluedandsupported

Page 15: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

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.

Page 16: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

Exerciseonpossibleunderlyingrootcausesofdisruptivebehaviors§ Smallgroupwork(5min.)§ Largegroupdiscussion(5min.)

Page 17: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

RootCauseAnalysisofDisruptiveBehaviour

§ Thereiscommonlyanunderlyingcausetodisruptivebehavior

§ Linkedtopersonalfactors,interactionsorworkingenvironment

§ IdentifyingWHAT,HOWandWHYcertainbehaviourhappenedhelpsdevelopcorrectivemeasuresandpreventreoccurrence

“Ifyoudon’tasktherightquestions,youdon’tgettherightanswers.Aquestionaskedintherightwayoftenpointstoitsownanswer.AskingquestionsistheABCofdiagnosis.Onlytheinquiringmindsolvesproblems.” – EdwardHodnett

Page 18: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

CommonRootCauses

Page 19: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

FrameworkforDiagnosisandIntervention

Document

Assess(&Accommodate???)

Resolve

Page 20: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

FrameworkforaddressingdisruptiveworkplacebehaviorthatadverselyimpactstheLE

Document –> Assess –> Proportionate intervention-> Monitor

Page 21: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

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.

Page 22: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

SupportforLearnersandFaculty

§ Counsellingprograms(WellnessOffice,Universityresources,externalphysiciansandconsultants)

§ Specificsupportsformanagingstresses,anger,work-lifebalance,etc.

§ Coaching/Mentoring§ Facilitation/Mediationofsituationswithhighconflict

Page 23: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

CaseStudy:Harassment

§ CollegeofMedicineandHealthRegioncoordinateastrategy§ Consultedexperts:HumanRightsCommission

a) Firewallbetweenindividualandgroupissues

§ Independent,respectedfacultyleader&experiencedhospitalmediatorengaged

§ MetwithDivisionHeadandProgramDirectorseparately§ Deanmetwithresidentsseparately§ DeanandCEOmetwithunitandphysicians§ Metwithalliedhealthprofessionals§ All(moreorless)committedtosixmonthprocess

Page 24: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Monthlysurveyingresidents/regularmeetings§ Codeofconductdeveloped§ Twomandatoryeducationalsessions

§ Intimidationandharassment§ Physicalwellness

§ Mediatorengagedwithafew§ DeanandCEOregularlyupdated

CaseStudy:Harassmentcont’d

Page 25: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

Keypoints§ Learningenvironment(LE)iscriticalforoptimallearningandsafework.

§ ThereisanoverlapbetweenworkplaceenvironmentandLEinresidencyduetotheprimarilyservice-learningfoundation.

§ DisruptivebehaviorsbyboththefacultyandthelearnersadverselyimpactLE.

§ Preventivestrategiesthroughcodesofconduct,ongoingeducationhaveabetterROI.

§ Addressingdisruptivebehaviorsrequirestimelyidentification,determinationofrootcauses,addressingbothsystem- andindividualissuesandrigorousmonitoring.

§ Keyresourcesandprocessesincludingalgorithmsareavailable.

Page 26: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency
Page 27: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

FinalWord

§ Speaktruthtopower

§ Supportthosethatspeaktruthtopower

Page 28: Creating Safe Learning Environments Dal...Learning environment (LE) is critical for optimal learning and safe work. There is an overlap between workplace environment and LE in residency

§ Thankyouforyourtimeandattention


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