+

The Surgical Clerkship Educational Environment

Jim Lau, MD FACS STANFORD SCHOOL OF MEDICINE

STANFORD SURGERY

+What is the Surgical Educational

Environment

n High stress questioning and answering environment that is usually done in public n On the wards during rounds n Formal teaching rounds n Tumor board n M&M n Operating Room

n What is the problem? n The perception of mistreatment of medical

students higher in procedure based specialties.

+Video One – The Wards

+Discussion

n Impression n Overall n Which parts are equivocal n What parts were mistreatment n Is neglect a problem

n What can be done to improve this situation n If you were the student n If you were a bystander

n Parting shots

+Video two – The OR

+Discussion

n Impression n Overall n Which parts are equivocal n Why is this ok

n What can be done to improve this situation n You n The resident n The attending

n Parting shots

Incidence of personal and witnessed mistreatment 2013

�  Students reported personally experiencing any of the mistreatment behaviors (excluding “publicly embarrassed”) during medical school:

◦  At least ONCE �  51.6% of Stanford students (33 out of 64) �  42.1% of students nationally

�  Students reported personally witnessing any of the mistreatment behaviors (excluding “publicly embarrassed”) during medical school:

◦  At least ONCE �  21.9% of Stanford students (14 out of 64) �  23.1% of students nationally

7

21.9% 23.1%

0

20

40

60

80

100

Stanford U (n=64) All Schools (n=13,146)

Personally witnessed mistreatment of another student

51.6% 42.1%

0

20

40

60

80

100

Stanford U (n=64) All Schools (n=13,146)

Personally experienced mistreatment

+Sources of Publicly Humiliated

+Sources of Other Than

+Did You Report the Mistreatment

+Types of Mistreatment?

n Types of mistreatment n Physical n Verbal ¢ n Sexual Harassment n Ethnic n Power ¢

n Mistreatment Ombudsman for the serious offenses – rare n Physical, sexual, and ethnic

n Majority of mistreatment – are verbal and power n Education of the surgical educational environment n Faculty and residents

+Educational Strategy to Combat

Mistreatment in Surgery Clerkship n  Address three group

n  Faculty

n  Residents

n  Medical Students

n  Medical Students n  Module on the surgical educational environment

n  First Week - Trigger videos – guided discussion

n  Last Week – Clerkship and Environmental Debrief

n  Faculty and Residents n  Grand Rounds

n  Division Meetings

n  Faculty Development

n  Resident Core Course

+You are powerful!

n Tools at your disposal

n REFLECTION

n DISCUSSION

n Peers

n Residents

n Attendings

n EMPOWERMENT

n ACTION

+Reporting

n Clerkship Director

n Overall Clerkship Lead

n Discuss with me if you feel comfortable n Will do what you want me to do. Be specific. n I am a surgeon.. I like to take care of the problem n Discreet (if you want) n NO WORRIES REGARDING FEAR OF REPRISAL

n Dr. Rebecca Smith-Coggins n Respectful Educator and Student Mistreatment Committee

n Please…Anyone.

n Just don’t let it fester

+n  Mary Hawn

n  Goodman Surgical Simulation Center n  Tom Krummel n  Ralph Greco n  Dana Lin

n  Cara Liebert, Laura Mazer, Edward Shipper, and Vivian de Ruijter

n  Sylvia Bereknyei n  Kate McGurk and Jennifer Tran

n  Stanford School of Medicine

n  Charles Prober n  Rebecca Smith-Coggins n  Elizabeth Stuart n  Neil Gesundheit n  Clarence Braddock

n  Kelley Skeff n  Cynthia Irvine n  Pree Basaviah

n  Clerkship n  Karen Cockerill

Acknowledgements �  Surgery Residency

•  Marc Melcher

•  Natalie Kirilcuk

•  Anita Hagan

•  Patricia Raines

•  JoAnn Smithson �  MHPE

•  Ilene Harris

•  Laura Hirshfield

•  Matthew Lineberry

•  Classes of 2012, 13, 14 �  CISL

•  David Gaba

•  Sandi Feaster

•  Lexi Buchanan

•  The entire CISL Team �  Pedro Tanaka �  Sarah Williams �  Diane H. Steinberg �  The Surgery Faculty �  THE SURGERY RESIDENTS �  THE MEDICAL STUDENTS

+ Questions?