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Friday, September 6, 2019

Walking on Eggshells With Trainees in the Clinical Learning Environment—Avoiding the Eggshells Is Not the Answer.

Gold MA, Rosenthal SL, Wainberg ML.
JAMA Pediatr. 
Published online August 05, 2019.
doi:10.1001/jamapediatrics.2019.2501

Here is an excerpt:

Every trainee inevitably will encounter material or experiences that create discomfort. These situations are necessary for growth and faculty should be able to have the freedom in those situations to challenge the trainee’s assumptions.5 However, faculty have expressed concern that in the effort to manage the imbalance of power and protect trainees from the potential of abuse and harassment, we have labeled difficult conversations and discomfort as maltreatment. When faculty feel that the academic institution sides with trainees without considering the faculty member’s perspective and actions, they may feel as if their reputation and hard work as an educator has been challenged or ruined. For example, if a trainee reports a faculty member for creating a “sexually hostile” environment because the faculty has requested that the trainee take explicit sexual histories of adolescents, it may result in the faculty avoiding this type of difficult conversation and lead to a lack of skill development in trainees. Another unintended consequence is that trainees will not gain skills in having difficult conversations with their faculty, and without feedback they may not grow in their clinical expertise. As our workforce becomes increasingly diverse and we care for a range of populations, the likelihood of misunderstandings and the need to talk about sensitive topics and have difficult conversations increases.

There are several ways to create an environment that fosters the ability for trainees and faculty to walk across eggshells without fear. It is important to continue medical school training regarding unconscious bias, cultural sensitivity, and communication skills. This should include helping trainees not only apply these skills with each other and with their patients but also with their faculty. Trainees are likely to have as many unconscious biases toward their faculty as their faculty have toward them. For example, one study found that at one institution, female medical school faculty were given significantly lower teaching evaluations by third-year medical students in all clerkship rotations compared with male medical school faculty. Pediatrics showed the second largest difference, with surgery having the greatest difference.

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