Harassment in the Field of Medicine: Cultural Barriers to Psychological Safety

The Art of Speaking Up: Supporting a Culture of Safety in the OR

Considering the high-risk, stressful, and fast-paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up-an interaction between perioperative team members to address a concern-requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking-up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole-team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted.

A new framework for Australian specialty colleges and other healthcare leaders to address bullying, discrimination, and harassment that involves doctors

Bullying, discrimination, and harassment (BDH) within healthcare teams is a global issue that risks healthcare worker wellbeing, patient safety, public health, and industry reputations. Collectively, fragmented regulation, weak detection and correction processes, conflicts of interest, and fear of retribution for complainants create an environment that enables perpetrators. Specialty training Colleges and other stakeholders can collaborate to address this issue more effectively. This paper examines Australian processes and proposes that the existing disparate mechanisms should be replaced with a national BDH framework that is supported by an independent investigation body. The authors seek to stimulate discussion to reform practice in Australia and in other countries with similar health systems.

Influence of a sexism and sexual harassment prevention course on medical students' perceptions of and responses to problematic situations

BACKGROUND

Issues of sexism and sexual harassment within the medical field are widespread. The aim of his study was to describe the influence of a training course on the prevention of sexism and sexual harassment on medical students' perceptions and responses to problematic situations in the workplace.

METHODS

We performed a secondary analysis of the transcripts of 16 medical students' interviews. The data were initially gathered as part of an external evaluation of the course. We decided to further explore these with a focus on potential changes about sexism and sexual harassment awareness induced by the course. Data were analyzed using qualitative thematic analysis.

RESULTS

Most medical students were aware of the existence of sexism and sexual harassment in the medical environment before the course but were not always able to delineate what could be considered as such or not. The course allowed them to broaden their ability to identify problematic situations, that were somewhat "trivialized" before, and to set a lower cut-off when judging what constitutes sexism or sexual harassment. It also provided them with tools on how to react when confronted to these situations, as well as resources to seek help. However, students stressed the importance of such courses also being offered to medical staff higher up in the hierarchy, as they are the ones in a position of power.

CONCLUSIONS

The course helped students to better identify and react to sexism and sexual harassment. However, given students' lack of power within the hierarchy, efforts to prevent sexism and sexual harassment must be undertaken at an institutional level to allow for change in the system as a whole.

Validation of the Generalized Workplace Harassment Questionnaire for Use with Medical Students

The Generalized Workplace Harassment Questionnaire (GWHQ) has not been validated among medical students whilst they are on clinical placements. Therefore, this study aims to validate its use when applied to this cohort. A sample of 205 medical students in their clinical training phase completed the GWHQ. To examine the validity of the proposed factor structure of the validated 25-item GWHQ, which was reduced to from the original 29-item set, a confirmatory factor analysis was conducted. Model fit was appraised by evaluating the comparative fit index (CFI), the root mean square error of approximation (RMSEA), and the standardized root mean squared residual (SRMR). Spearman's rho correlation coefficients were applied to correlations between factors. With the exclusion of Item 19, the resulting fit was improved. In the revised model for a 24-item GWHQ, CFI = 0.995, RMSEA = 0.047, and SRMR = 0.115. Overall, the fit met the criteria for two fit indices and was thus deemed to be acceptable. Factor loadings ranged from 0.49 to 0.96. The Spearman's rho correlation coefficient between Verbal and Covert Hostility was high, although all correlations with Physical Hostility were weak. In conclusion, the amended 24-item version of the GWHQ is a valid instrument for appraising instances of harassment or hostility within clinical placements attended by medical students in New Zealand.

Moving the Field Forward: Using Self-Determination Theory to Transform the Learning Environment in Medical Education

Issue: The learning environment (LE) is known to be the main determinant of physician distress, yet most wellness interventions continue to focus on the learner. Additionally, few wellness interventions that focus on the LE have derived from well-established theory. These limitations represent major barriers in our progress toward improving the LE and supporting medical learner wellness in an evidence-based, humanistic, and scalable way. Evidence: To remedy the situation, I highlight a cross-section of promising experimental research in self-determination theory (SDT) and its potential applications in medical education. Implications: I propose that we incorporate SDT-based faculty development workshops to improve leaders' awareness and motivating style with learners. These interventions are known to improve the LE and thus learners' engagement, performance, and wellness. SDT-trained personnel would be needed to train medical faculty, including about the reciprocal benefits of being autonomy-supportive.

[Mistreatment of Paraguayan medical residents in 2022: a multicenter study]

Introducción

los residentes de postgrado tienden a sufrir maltratos durante sus prácticas hospitalarias y estos comportamientos abusivos no deben considerarse normales. El objetivo fue describir la frecuencia y las características del maltrato en residentes de medicina del Paraguay en 2022.

Metodología

se aplicó un diseño observacional de corte transversal. Se incluyó a los residentes de hospitales del Paraguay que aceptaban completar una encuesta online difundida por las redes sociales. Se utilizó un cuestionario de 23 preguntas que evalúa el maltrato psicológico, físico, académico y sexual. Adicionalmente se solicitó datos demográficos, académicos y aspectos relacionados a la denuncia del maltrato.

Resultados

el cuestionario fue llenado por 348 residentes. La edad media fue 28 ± 3 años y hubo predomino del sexo femenino (63,2%). Participaron residentes de 32 hospitales, la mayoría era de 1° año (50,3%) y de especialidades clínicas (60,6%). Acorde al cuestionario, 339 residentes (97,4%) refirieron algún grado de maltrato. Relacionando las especialidades con el maltrato, el mismo fue mayor en las quirúrgicas: RR 1,4 IC 95% 1,0-1,9 (p 0,01). Los principales responsables del maltrato fueron los residentes superiores (55,2%) y los jefes de salas (31,8%). La denuncia fue realizada por 8% de los afectados. El principal motivo para no denunciar fue el temor a que realizarla le traería problemas (67,8%).

Conclusiones

el maltrato fue referido por 97,4% de los residentes, siendo mayor en las especialidades quirúrgicas. Urge aplicar medidas preventivas para evitar este tipo de abusos durante la residencia.

Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine

Importance

The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).

Objective

To evaluate academic medical culture, faculty mental health, and their relationship.

Design, Setting, and Participants

A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health.

Exposures

Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status.

Main Outcomes and Measures

Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health.

Results

Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis.

Conclusions and Relevance

High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.