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Wilkins KM, Goldenberg MN, Cyrus KD, Hyacinth M, Conroy ML. Addressing Mistreatment by Patients in Geriatric Subspecialties: A New Framework. Am J Geriatr Psychiatry 2022; 30:78-86. [PMID: 34053835 DOI: 10.1016/j.jagp.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Mistreatment by patients is unfortunately common in clinical medicine, including geriatric subspecialties. Despite the prevalence of this problem, there are few standardized approaches for addressing it at both interpersonal and institutional levels. The "ERASE" framework is a novel, practical approach for addressing mistreatment by patients. "ERASE" includes Expecting and preparing for mistreatment by patients, Recognizing mistreatment, Addressing mistreatment in real time, Supporting members of the healthcare team who have been mistreated, and Establishing a positive institutional culture. The framework may prove particularly helpful and applicable to providers specializing in geriatrics and can be used by administrators, educators, and all members of the healthcare team to promote safe, dignified clinical care and learning environments.
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Affiliation(s)
- Kirsten M Wilkins
- Yale School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT.
| | | | - Kali D Cyrus
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marilise Hyacinth
- Yale School of Medicine, New Haven, CT; Middlesex Health, Middletown, CT
| | - Michelle L Conroy
- Yale School of Medicine, New Haven, CT; VA Connecticut Healthcare System, West Haven, CT
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Abstract
The incorporation of actors as standardized patients (SPs) to help students achieve learning goals across a range of topics has become widespread in medical education. SPs are integrated into formative and summative objective structured clinical examinations by medical educators and by licensing boards for assessment of competence. While SPs are useful for assessment of dynamic skills, they also have significant utility as an engaging instructional method. Few tools in teaching allow for the breadth of instruction, practice, and assessment offered by workshops involving SPs. A simulated encounter with an SP may be a trainee's only opportunity to experience working through a particular clinical scenario in an environment that carries no risk of significant harm. Thus, there is immense potential for educational innovation with SPs. The following Twelve Tips piece provides suggestions for harnessing this potential based on available literature and educational experiences of the authors.
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Affiliation(s)
- Jaideep S Talwalkar
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Kali D Cyrus
- American Psychiatric Association, Washington, DC, USA
| | - Auguste H Fortin
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Abstract
INTRODUCTION Mistreatment of physicians by patients is a long-standing phenomenon that has garnered increased attention recently. Medical students and residents also experience mistreatment, and many supervising physicians do not know how to recognize it or respond appropriately. Little guidance exists as to how faculty should best address these situations. We developed, taught, and evaluated a stepwise approach to help faculty physicians manage patient mistreatment of trainees (residents and students). METHODS Our approach is summarized by the acronym ERASE: (1) Expect that mistreatment will occur. (2) Recognize episodes of mistreatment. (3) Address the situation in real time. (4) Support the learner after the event. (5) Establish/encourage a positive culture. We designed an interactive, case-based educator development session to teach ERASE and surveyed participants before and after to evaluate the session. Sixty-nine participants attended one of four workshops between November 2017 and January 2018. RESULTS Nearly 80% of attendees reported having received no prior training in managing mistreatment of trainees by patients. Participants noted significant changes in their confidence in recognizing and responding to episodes of mistreatment after the session compared with just prior to it. DISCUSSION ERASE fills an important void in medical education by introducing a novel, easy-to-understand approach that faculty can employ to manage mistreatment of trainees. We have continued to disseminate this model to faculty and residents in various departments around our medical center and at national conferences. This resource will allow educators to disseminate the ERASE model at their home institutions.
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Affiliation(s)
- Kirsten M. Wilkins
- Associate Professor, Department of Psychiatry, Yale University School of Medicine
| | | | - Kali D. Cyrus
- Assistant Professor, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Affiliation(s)
- Jessica A Gold
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Carol A Bernstein
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Kali D Cyrus
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Elizabeth Fitelson
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Alicia Lieberman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
| | - Christina Mangurian
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis (Gold); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York (Bernstein); Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cyrus); Department of Psychiatry, Columbia University, New York (Fitelson); Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco (Lieberman, Mangurian)
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Goldenberg MN, Cyrus KD, Wilkins KM. ERASE: a New Framework for Faculty to Manage Patient Mistreatment of Trainees. Acad Psychiatry 2019; 43:396-399. [PMID: 30523539 DOI: 10.1007/s40596-018-1011-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 11/29/2018] [Indexed: 05/06/2023]
Affiliation(s)
| | - Kali D Cyrus
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
In this thoughtful article, medical educators in various stages of their careers (resident, mid-career clinician-educators, medical school deans) reflect upon increasing reports of harassment and mistreatment of trainees by patients. In addition to providing a general overview of the limited literature on this topic, the authors describe their own experience collecting information on trainee mistreatment by patients at their institution. They explore the universal difficulty that educators face regarding how to best address this mistreatment and support both faculty and trainees. Given the current sociopolitical climate, there has never been a more urgent need to critically examine this issue. The authors call on the greater medical education community to join them in these important conversations.
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Affiliation(s)
- Kali D Cyrus
- a Department of Psychiatry Director of the Standardized Patient Program , Yale School of Medicine, The Teaching & Learning Center (TLC) , New Haven , CT , USA
| | | | - Jessica L Illuzzi
- c Vidone Birthing Center, St. Raphael Campus, Yale School of Medicine , New Haven , CT , USA
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