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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.
+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
+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
+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