As a resident physician in ophthalmology, Lauren Hock, MD, sees patients of all ages and backgrounds. And she’s experienced all sorts of behavior from patients who see her—some friendly, some unpleasant, and some that can only be described as outright harassment.
Hock is not alone. Statistics show many residents will experience patient-initiated identity-based harassment at some point during their specialty training, yet many are reluctant to address it.
Identity-based harassment refers to negative behavior that targets an individual based on (but not limited to) race, ethnicity, gender, sexuality, citizenship, socioeconomic status, disability, or other demographic categories. Such behavior can vary—from verbal slights to non-verbal gestures to open hostility and sometimes physical violence.
For medical trainees, it can affect their learning, productivity, commitment, and physical and emotional well-being.
Hock used her own experiences, as well as prior research, to lay the groundwork for a project that received funding through an Innovation Grant from the American Medical Association (AMA).
With her ophthalmology colleagues—as well as Patrick Barlow, PhD, assistant professor of internal medicine and a consultant with the Carver College of Medicine Office of Consultation and Research in Medical Education—Hock developed, taught, and evaluated a workshop to prepare residents and faculty to respond to patient- and visitor-initiated verbal sexual harassment toward themselves and others. Residents and faculty across multiple departments participated in the workshop.
“My goal in initiating this project was for every trainee to feel prepared to recognize and address identity-based harassment in the moment, if they feel safe to do so,” says Hock. “A key to this is incorporating response rehearsal training into graduate medical education.”
Training the trainers
As part of an expanded education project to address not only verbal sexual harassment but any harassment based on an individual’s identity, Kanya Ferguson, MD, is working to deploy this training workshop to reach as many residents as possible.
“We want residents to feel empowered to respond to these situations in an effective way that still maintains the physician/patient relationship and strengthens it in the end,” says Ferguson, clinical associate professor in dermatology and director of diversity, equity, and inclusion in the Office of Graduate Medical Education (GME).
Ferguson has partnered with more than a dozen faculty volunteers from a wide array of specialties. During “train the trainers” sessions in early May, these facilitators prepared to present the workshop and carry this message to residents and faculty.
“We had open conversations and practiced how to present this information in an interactive and engaging way,” she says. “The sessions served as the springboard to help us distribute our final workshop widely throughout the institution.”
Hock appreciates the mix of volunteers who stepped forward as trainers.
“Department-wide discussions involving senior faculty are essential to creating a culture of openness, support, and willingness to address these issues,” she says.
Collaboration is also key to the program’s success, and the Carver College of Medicine Office of Diversity, Equity, and Inclusion (DEI) is playing an instrumental role in supporting the workshop.
“We’ve been able to provide input about issues we’ve found helpful during our own presentations and from the UI Health Care Black Community Listening Sessions,” Nicole Del Castillo, MD, MPH, director of the college’s DEI office.
Looking to the future
While the AMA grant funds training through 2021, the need for education will continue.
“Our goal is to make this a sustainable educational initiative within the institution,” says Del Castillo. “Our hope is to expand this beyond our students/trainees to our faculty and staff.”
Ferguson says data will drive the structure and scope of future education.
“We have a number of evaluative tools we’re going to use, not only from the residents who attend the session, but later through focus groups and general climate surveys, as well,” she says. “We’ll evaluate where we’re successful, evaluate where we have room to grow, and then make modifications for the future.”
In the end, the goal is clear.
“We want to make sure that we’re creating an inclusive and welcoming environment for everyone,” says Del Castillo. “We want to make sure we’re constantly thinking about ways to promote diversity, equity, and inclusion.”