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Bullying culture: Valuing the teacher-student relationship

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13 NZMJ 30 October 2015, Vol 128 No 1424
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
EDITORIAL
Bullying culture: Valuing the
teacher-student relationship
Elizabeth Berryman
The New Zealand Medical Students’
Association (NZMSA) is calling on all
clinical teachers and students to take
a new approach to teacher-student relation-
ships in the light of medical students report-
ing high levels of bullying when on clinical
placements. The NZMSA 2015 survey found
that 54% of students reported being bullied.
Other New Zealand and international stud-
ies have shown similar results.1-3 Such high
levels have been received with disbelief by
some of the medical profession, and some
have doubted whether what was being cap-
tured was indeed bullying.4 This indicates
the need to clearly dene what is appro-
priate behaviour, and what is not.5 NZMSA
believes that if both parties place a higher
value on the teacher-student relationship, a
bullying culture could not exist.
The NZMSA survey
In August this year, the NZMSA conducted
a nationwide survey of fourth, fth and
sixth year medical students studying in
New Zealand. The survey found that 54%
of students had experienced what they
perceived as bullying when on clinical
placements and 76% had witnessed another
student being bullied. The 772 responses
were from a pool of 1,536 NZMSA clinical
students. The survey allowed students
to anecdotally share their experiences
of bullying if they wished. Many of these
experiences were signicant, with teachers
blatantly crossing professional bound-
aries and breaching codes of ethics and
workplace health and safety policies.4,6,7
However, students commonly reported
more subtle forms of bullying, such as
isolation, rudeness, inappropriate humour,
humiliation and intimidation, which holds
the same negative outcomes.1,8
Students’ experiences
The results show that a large proportion
of students are encountering what they
perceive as bullying, and we know that this
behaviour has negative impacts on students
learning and wellbeing.3,7 It tells us that
we are not creating a safe environment
for students, we are not fostering positive
teacher-student relationships, and we
are not placing a high value on the teach-
er-student relationship, even though it is
one of the main factors known to contribute
to ‘good learning’.9,10
The statistics capture the extent of the
problem, but the stories shared by the
students illustrate it better. Here are a few
of them.
Racism
A staff member refuses to learn the
names of his Asian students, despite
the students wearing name badges and
having names that are easy to pronounce.
Instead, he refers to them as “Bob” or “Bill”,
regardless of whether they are male or
female. Three students from different years
told this story:
“He would refer to me in third
person in theatre...such as saying,
‘It’s Bill’s fault—she keeps making
mistakes.’”
“It made me feel annoyed and
that I was in some way inferior
to the other student I was paired
with (a European male) whom the
consultant addressed by his proper
name and didn’t make jokes about.
I knew I had to take it because that
was the price of passing.”
“If you don’t pull hard enough
[assisting in theatre], I’ll send you
back to Hong Kong.”
14 NZMJ 30 October 2015, Vol 128 No 1424
ISSN 1175-8716 © NZMA
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EDITORIAL
Sexual harassment
“The registrar said a few of the team
were going for drinks after work on
Friday and he asked if I would like to
join them. I agreed, but when I got
to the bar it was just him. I asked
where the others were and he said
they had all pulled out last minute.
He then proceeded to buy me an
alcoholic drink and pressured me to
have more. I kept making excuses
to leave but was told, ‘I will tell the
consultant you haven’t been good
on this clinical run if you don’t have
another drink with me.’ I made an
escape, but the rest of the run he
would make inappropriate sexual
jokes out of earshot of others and say
things like, ‘You won’t get very far
in a career in medicine if you don’t
know how to have a bit of ‘fun.’”
Intimidation
“I was grilled by consultants
constantly from day one; on ward
rounds, in clinic, in front of patients
and other staff. I was questioned
intensely and embarrassed by not
being able to verbalise the answer
adequately. The style of questioning
was not friendly and sounded like
an interrogation. I can remember
one ward round vividly: one of my
discharged patients from a few
weeks ago came in overnight and I
was told to present him to everyone
on the team at the patient’s bedside
during ward round. I did not have
his notes on me and I couldn’t
remember much about him. I
tried presenting but I fumbled
and couldn’t quite get it right. The
consultant then started interro-
gating me about the condition that
the patient had come in with, ring
question after question; eventually
I just had a blank. I stood there for
what seemed like several minutes
not doing anything. The worst thing
was when the consultant said, ‘this
patient must not have made a big
impression on you then?’ My heart
sank. I felt as though whatever
shred of condence I had left was
destroyed and I felt like I let down
the patient. The embarrassment
in front of the entire team and the
patient made me want to leave and
cry. I went to the patient after and
apologised. He said not to worry,
but he seemed quite concerned
about the events that occurred.”
Differing expectations
We all agree that we should not tolerate
blatant bullying of the kind exemplied in
the racism and sexual harassment examples
above.11 However, what about the more
commonly reported perceived bullying of
isolation, rudeness, inappropriate humour,
humiliation and the kind of intimidation
described by the last student? Do we all agree
that these kinds of behaviours are no longer
acceptable in the clinical learning envi-
ronment? We believe that the survey results
indicate that students and teachers have
differing expectations of what is acceptable.12
This produces an uneasy tension between
teachers and students, and erodes the teach-
er-student relationship.10 If this difference is
not dealt with, it will continue.
Valuing the
teacher-student
relationship
Of course, many factors affect the
teacher-student relationship, including
wider system pressures, and we cannot
possibly cover them all in this article, but
we acknowledge the impact these.13,14 The
apprenticeship model of clinical medical
education means that the relationship
between the teacher and the student is
pivotal, so we will focus on this.10 It is
personal interaction that determines the
quality of a relationship, and like all good
relationships we need to dedicate time
and effort into developing it and value its
importance to see improvement.10 We will
focus on three key things we can do right
now to place value on the teacher-student
relationship.
Firstly, we should acknowledge that each
relationship is unique. Every teacher and
every student is different, and each rela-
tionship requires a different set of skills.12
Educating both students and teachers
in how to deal with these differences is
important. Currently, there is very little
15 NZMJ 30 October 2015, Vol 128 No 1424
ISSN 1175-8716 © NZMA
www.nzma.org.nz/journal
EDITORIAL
training provided for clinical teaching staff,
and students are not taught how to be an
effective clinical student.8 We have work-
shops for ‘dealing with dicult patients’,
but we have nothing for dealing with
‘dicult team dynamics’.
Secondly, as with the doctor-patient rela-
tionship, there is a clear power difference
between teacher and student. The hierar-
chical structure of the system increases
the power disparities.13 Compounding the
issue is what the literature describes as
the ‘hidden curriculum’, in which teachers
unconsciously try to teach students about
‘real-life medical culture’.9 An article by
Haidet & Stein states that sometimes this
hidden curriculum includes premises
such as a:
“demand for ‘right’ answers
(avoidance of uncertainty); intim-
idation, public shaming, and
humiliation (doctors must be
perfect); the treatment of students
as objects to be ‘lled up’ with
knowledge and facts (outcome is
more important than process);
unhealthy competition (medicine
takes priority over everything else),
and deference to experts, regardless
of their teaching abilities (hierarchy
is necessary) p. S17.”10
Teachers must acknowledge this power
difference and this unconscious hidden
curriculum, and try to reduce its impact so
that accurate and constructive feedback,
both teacher-to-student and student-to-
teacher, can be given.13 Simple things, like
learning students’ names, giving student’s
opportunities to ask questions, saying ‘Good
Morning’ directly to students or acknowl-
edging them with a smile around the
hospital, are a start.
Some teachers are already adapting these
kinds of practices:
Allowing feedback from students:
“I had some trepidations going into
my nal attachment for the year in
light of the recent NZMSA showcase
on bullying, however two days into
the attachment our surgeon said the
following to me and my classmate:
‘I know that my style of teaching
can be quite abrupt and blunt and
I will push you both hard. I’ve
found this to be an effective way for
students to learn. However if this
is too much, or if you think that
it crosses a line, then I want you
both to feel comfortable in letting
me know that and I will adjust my
approach accordingly.’ The doctor
then went on to ask if we were
happy to continue with this style of
teaching and we both agreed that we
were, but that we would like another
opportunity to give feedback midway
through the attachment.”
Developing the relationship
“She [doctor] greeted us with a
warm welcome and big smile on our
rst day. She took us on a tour of the
ward and introduced us to all the
staff and made sure they knew who
we were. We then went to a small
room and she asked us questions
about what schools we went to, what
we did before medicine, and what we
wanted to learn from this placement.
She told us a bit about herself, her
hobbies and her children. It felt like a
safe place to discuss what we needed
to do on the placement and to ask
questions. This took 30 minutes.
During the attachment she was
quite strict and sometimes asked us
dicult questions on the spot, but it
was okay ‘cos we knew her and that
she wasn’t going to think we were
idiots for getting it wrong.”
Thirdly, students must take responsibility
for their own learning.12 If we don’t under-
stand something, or we don’t like something
a teacher is doing, we have to raise it with
the teacher. We must show our teachers
that we recognise it is an enormous priv-
ilege to be involved in clinical practice, and
that we appreciate the generosity of the
many teachers who go above and beyond
to help us to learn, despite many other
pressures, but that we must take initiative
ourselves to make the most of learning
opportunities.15 We must also learn to ask
what is expected of us in each new rela-
tionship and how to give constructive
feedback to our teachers about how we
individually learn.
16 NZMJ 30 October 2015, Vol 128 No 1424
ISSN 1175-8716 © NZMA
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EDITORIAL
Conclusion
The blatant bullying needs to stop, that
we all agree on. But the survey results show
that less obvious behaviour is having just as
much negative impact on students, and it is
because of differing expectations. Teachers
and students need to agree on what is
acceptable behaviour in the teacher-student
relationship, then work on developing it. A
medical taskforce workgroup has been set
up to form recommendations for change,
but it starts now with each and every
interaction we have. We need all parties to
discuss openly and honestly with each other
how we can do things better.
A new approach is needed to the teach-
er-student relationship. We call on all
teachers and students to value and respect
the relationship as much as we do the
patient-doctor relationship.10 We cannot
change the culture overnight, but with this
renewed approach the teacher-student
relationship in time can develop into a rela-
tionship of trust, communication, improved
learning and positive outcomes.
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Fitzjohn J, Palmer CL,
Mulder RT. The impact
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R, Le Fevre J, Perry A.
Bullying and harassment
of trainees: An unspoken
emergency? Emergency
Medicine Australasia.
2015;27(5):464-7.
3. Scott J, Blanshard C,
Child S. Workplace
bullying of junior doctors:
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naire survey. The New
Zealand Medical Journal
(Online). 2008;121(1282).
4. Tran V. Dealing with bully-
ing and harassment: a
practical guide for Austral-
asian emergency medicine
trainees. Emergency
Medicine Australasia.
2015;27(5):473-7.
5. Wearn A, Wilson H,
Hawken SJ, Child S,
Mitchell CJ. In search
of professionalism:
implications for medical
education. NZ Med J.
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6. New Zealand Medical
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ation; 2002 [cited 2002];
Available from: http://
www.nzma.org.nz/about/
ethics/codeofethics.pdf
7. Ministry of Business,
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8. Du J, Sathanathan J,
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Competing interests: Nil
Author information:
Elizabeth Berryman (4th year Medical Student), President 2015, New Zealand Medical
Students’ Association
Corresponding author:
Elizabeth Berryman (4th year Medical Student), President 2015, New Zealand Medical
Students’ Association
president@nzmsa.org.nz
URL:
www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2015/vol-128-no-1424-30-
october-2015/6705
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EDITORIAL
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... The small group has an important function in undergraduate medical education and is now widely accepted as a powerful, appropriate teaching method (Cooke et al., 2010). While the teacher of the small group can have numerous more specific learning aims, three broad goals are acknowledged as vital to the development of medical students' quality future practice: 1) Helping students develop and apply knowledge, thinking and understanding (Cooke et al., 2010;Golding, 2011;Wilson & Cunningham, 2013) 2) Cultivating students' values for professional practice (Cooke et al., 2010;Golding, 2011;Wilson & Cunningham, 2013) 3) Protecting students from mistreatment (Berryman, 2015;Plaut, 1993;Plaut & Baker, 2011) In this paper, we explain how a group of medical teachers raised and addressed a research question about effective teacher-student relationship in small group teaching. We do this to help teachers conceptualise their teacher-student relationship and, ultimately, be guided to create groups allowing these three important educational goals to be achieved. ...
... These processes are essential for generating discussion and sharing thinking and ideas as a prelude to the learning that ideally follows (Biggs & Tang, 2011). Because relationship can be a profound influence on these processes, as well as the achievement of learning goals, creating the "right" teacher-student relationship in this unique context is vital (Berryman, 2015;Harland, 2012;Vygotsky, 1978). According to some (e.g., Harden & Laidlaw, 2016;Palmer, 2007), the power of the "right" relationship can be such that it becomes more important than a teacher's pedagogic skill, knowledge or understanding of a topic. ...
... • students can occupy a vulnerable position in small groups and in education more generally (Berryman, 2015). Any experience of bullying can have a detrimental effect on the learner, but some (e.g., younger students) may also have not yet developed the resilience to deal with it (Crampton et al., 2015;Curtis et al., 2007) • any act of enculturation into practice can influence the "kind of doctor" a student becomes (Cruess et al., 2014;Larkin & Mello, 2010); therefore, how students learn about interpersonal and professional relationships via small group experiences is important to their developing practice • student bullying is a significant, ongoing worldwide concern and takes many forms, including academic neglect (Fnais et al., 2014). ...
... Degrading experiences such as bullying or harassment at work have been shown to be associated with suicidal thoughts [9]. The New Zealand Medical Students' Association (NZMSA) surveyed their members in 2015 and reported that 54% had experienced bullying or sexual harassment while on clinical placement [10]. It has been suggested that sometimes accusations of bullying can be linked to situations that are an inevitable part of training [7]. ...
... The next page of the Particip8 app was a list of experiences that the student possibly could have experienced during the day. These experiences were chosen from the "NZMSA 2015 Bullying and Harassment Survey" and commonly experienced situations of clinical medical students [10]. Screenshots from the Partcip8 app are presented in Figure 2. ...
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Background: Well-being in medical students has become an area of concern, with a number of studies reporting high rates of clinical depression, anxiety, burnout, and suicidal ideation in this population. Objective: The aim of this study was to increase awareness of well-being in medical students by using a smartphone app. The primary objective of this study was to determine the validity and feasibility of the Particip8 app for student self-reflected well-being data collection. Methods: Undergraduate medical students of the Dunedin School of Medicine were recruited into the study. They were asked to self-reflect daily on their well-being and to note what experiences they had encountered during that day. Qualitative data were also collected both before and after the study in the form of focus groups and "free-text" email surveys. All participants consented for the data collected to be anonymously reported to the medical faculty. Results: A total of 29 participants (69%, 20/29 female; 31%, 9/29 male; aged 21-30 years) were enrolled, with overall median compliance of 71% at the study day level. The self-reflected well-being scores were associated with both positive and negative experiences described by the participants, with most negative experiences associated with around 20% lower well-being scores for that day; the largest effect being "receiving feedback that was not constructive or helpful," and the most positive experiences associated with around 20% higher scores for that day. Conclusions: The study of daily data collection via the Particip8 app was found to be feasible, and the self-reflected well-being scores showed validity against participant's reflections of experiences during that day.
... Evidence suggests any student can suffer bullying in the clinical workplace, and at the hands of any staff member [5][6][7]. However, senior staff are reported to be the most likely perpetrators, and students of minority ethnicity, gender or sexuality are likely to fare worse [2]. ...
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Background: Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research. Methods: We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes. Results: The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious. Conclusions: Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).
... The commonest reported bullying acts have been found to be verbal and physical harassment, gender and racial discrimination and, importantly, several forms of academic harassment [3][4][5]. While any student can suffer bullying, at the hands of any staff member [6][7][8], students of minority ethnicity, or sexuality, and of the female gender 1 are likely to experience it more [4]. A bullying perpetrator can be any staff member, but have been found to most likely be senior staff members [3,4]. ...
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Background: Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity. Methods: CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight- week cycles, one in 2016 & another in 2017. CAPLE’s primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers’ reflective journals and a paper survey about staff experiences of the 2017 intervention. Results: We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change. Conclusions: This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour. Keywords: Bullying, Mistreatment, Intervention, Clinical environment, Engagement, Staff development
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Background Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity. Methods CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight- week cycles, one in 2016 & another in 2017. CAPLE’s primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers’ reflective journals and a paper survey about staff experiences of the 2017 intervention. Results We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change. Conclusions This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour.
... Focusing on anatomy education, medical students often feel intimidated by their mentors (Berryman, 2015). Furthermore, the subject is loaded with details, which make students feel inadequate and stressed around assessment time (Winter et al., 2017). ...
... We conceptualise our findings as a subset of broader issues of student engagement and as a subset of the literature about student stress [24][25][26], caused by challenges in the preclinical learning environment, such as time, workload, grades and academic performance [11][12][13][14][15]. Although the fears we addressed for our students were not (to our knowledge) caused by inappropriate behaviour from the teachers, we also know that both the preclinical and clinical learning environments can be a source of fear due to bullying-type behaviours [27,28]. As such, our findings are related to the literature about and helpful to those wanting mitigate student bullying. ...
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Background One aim of medical education is to cultivate student thinking, and specific methods have been developed, implemented, and evaluated for doing this. However, doing so is not as straightforward as simply employing these methods. Methods In a wider year-long participatory action research study about developing student thinking, we interviewed, observed, and video-recorded six medical teacher-participants. Participants also filled out reflective journals and regularly discussed practices as a group. ResultsWe found that teaching methods customarily used to develop student thinking (e.g. reflective thinking, clinical reasoning) sometimes failed. This failure was because students experienced fear as a result of such methods, such as fear of looking stupid in a discussion. Our teacher-participants went on to develop very specific methods for identifying and mitigating fears and better cultivating students’ thinking. They (1) got to know students and understand what they were afraid of, (2) mitigated student fear by talking regularly and ‘normalising’ fear in learning for them, (3) modified teaching methods to make students feel less scared and (4) demonstrated ‘care’ for their students, a value which could increase students’ confidence and help them mitigate fears for themselves. Recommendations and SummaryWe suggest teachers to (1) create opportunities to learn about their students, (2) regularly discuss with their students how fear can be normal in learning, (3) adjust teaching methods to mitigate fear and (4) care and show their care for their students. We also suggest that medical teachers could benefit from staff development about the phenomenon of potential student fear and recommend the pursuit of a better understanding of how ‘caring’ might be identified, nurtured in teachers and usefully expressed in practice.
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Still rife and must be tackled R ecent changes in undergraduate medical education have been rapid and profound. Faced with the explosion of knowledge, ongoing technological advances, patients' changing expectations, the recognition of health inequalities worldwide, and better understanding of educational theory, medical educators have striven to provide undergraduate programmes that equip students with basic knowledge, skills, and attitudes that recognise their immediate progression into independent practice and their need to develop skills as lifelong learners. What remains familiar at the core of medical education is exposure to patients with their multifaceted problems and the experience of health care at the point of delivery. Sadly, clinical practice also exposes medical students to some of the best recognised yet least easily solved problems in medical education: bullying and harassment. A study by Frank and colleagues in this week's BMJ reports the experiences of US medical students of this important but uncomfortable issue that needs to be tackled.1 Bullying …
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Calls for organizational culture change are audible in many health care discourses today, including those focused on medical education, patient safety, service quality, and translational research. In spite of many efforts, traditional "top-down" approaches to changing culture and relational patterns in organizations often disappoint. In an effort to better align our informal curriculum with our formal competency-based curriculum, Indiana University School of Medicine (IUSM) initiated a school-wide culture change project using an alternative, participatory approach that built on the interests, strengths, and values of IUSM individuals and microsystems. Employing a strategy of "emergent design," we began by gathering and presenting stories of IUSM's culture at its best to foster mindfulness of positive relational patterns already present in the IUSM environment. We then tracked and supported new initiatives stimulated by dissemination of the stories. The vision of a new IUSM culture combined with the initial narrative intervention have prompted significant unanticipated shifts in ordinary activities and behavior, including a redesigned admissions process, new relational practices at faculty meetings, student-initiated publications, and modifications of major administrative projects such as department chair performance reviews and mission-based management. Students' satisfaction with their educational experience rose sharply from historical patterns, and reflective narratives describe significant changes in the work and learning environment. This case study of emergent change in a medical school's informal curriculum illustrates the efficacy of novel approaches to organizational development. Large-scale change can be promoted with an emergent, non-prescriptive strategy, an appreciative perspective, and focused and sustained attention to everyday relational patterns.
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This is the seventh article in an education series, discussing some of the 'hot topics' in teaching and learning in medicine. Historically, 'professionalism' was defined by the social structures of medicine, but has moved on to represent the expected behaviours and attributes of practitioners. Well publicised cases of professional misconduct, the rise of medical ethics as a discipline, and the move to a more patient-centred approach have driven the profile of professionalism into mainstream medical education. While there are many definitions of medical professionalism, there is a growing degree of consensus around what it encompasses; the way we manage tasks, our interactions with others, and looking after ourselves. The literature indicates that professionalism can be taught, learnt and applied; that attributes and behaviours can be identified; and that assessment is best approached using a range of methods over time. For learners, one of the critical factors in developing professionalism is the modelling by senior members of the profession as students move from peripheral observers to legitimate participants. Medical programmes in New Zealand are engaging with this literature in developing current curricula.
Article
To discover the level of interest in a surgical career amongst junior doctors and trainee interns in the Auckland region. Secondary aims are to identify the factors that influence career choice as well as the timing of career choice. An anonymous and structured questionnaire was distributed to all trainee interns and junior doctors in their first to fifth postgraduate years in the Auckland region. Questions were based on basic demographics, level of training, career preference and factors from previous experiences in surgery that may have influenced their career choice. Total of 87 replies with 36% expressed interest in surgery whereas 64% were interested in non-surgical specialties. Top three factors influencing career choice were similar in both groups: Lifestyle, career ambitions and family. Personal interest, practical hands-on and positive previous experiences were the top reasons why junior doctors chose surgery. Poor lifestyle, lacking of interest, limited future part-time work and previous negative experiences were the top reasons why junior doctors did not choose surgery. A significantly (p<0.05) larger number of junior doctors in the surgical group had positive previous experiences on their surgical runs, with their consultants and registrars compared with the non-surgical group. Those interested in surgery decided on their careers earlier. Career aspirations of New Zealand junior doctors were similar to findings reported overseas. To promote surgery amongst junior doctors and medical students, attention should be paid to the key factors which may influence career choice. By improving working conditions and have better surgical education with good mentoring, team atmosphere and opportunities for early exposure will hopefully allow better recruitment and training of future surgeons.
Article
Workplace bullying is a growing concern amongst health professionals. Our aim was to explore the frequency, nature, and extent of workplace bullying in an Auckland Hospital (Auckland, New Zealand). A cross-sectional questionnaire survey of house officers and registrars at a tertiary hospital was conducted. There was an overall response rate of 33% (123/373). 50% of responders reported experiencing at least one episode of bullying behaviour. The largest source of workplace bullying was consultants and nurses in equal frequency. The most common bullying behaviour was unjustified criticism. Only 18% of respondents had made a formal complaint. Workplace bullying is a significant issue with junior doctors. We recommend education about unacceptable behaviours and the development of improved complaint processes.
Article
Relationship-Centered Care acknowledges the central importance of relationships in medical care. In a similar fashion, relationships hold a central position in medical education, and are critical for achieving favorable learning outcomes. However, there is little empirical work in the medical literature that explores the development and meaning of relationships in medical education. In this essay, we explore the growing body of work on the culture of medical school, often termed the "hidden curriculum." We suggest that relationships are a critical mediating factor in the hidden curriculum. We explore evidence from the educational literature with respect to the student-teacher relationship, and the relevance that these studies hold for medical education. We conclude with suggestions for future research on student-teacher relationships in medical education settings.
Article
In addition to the intentional teaching of knowledge and skills by surgeons to their trainees and protégés is the unintended, often unrealized transmission of implicit beliefs, attitudes, and behaviors through a process called the hidden curriculum. The hidden curriculum is a function of implicit values held by the institution as a whole, and the individual surgical educators and allied health professionals working in the trainee's learning environment. It has been argued the hidden curriculum plays a central role in the development of professionalism, but it may also play an important role in inadvertently deterring good candidates from considering orthopaedic surgery as a career. We review the importance of attending to the messages we transmit to our trainees, protégés, and junior colleagues as we strive to develop professional competency and recruit the best into the field.
Innovation and Employment: Health and Safety in Employment Act
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Ministry of Business, Innovation and Employment: Health and Safety in Employment Act 1992, (1992).