The Office for a Respectful Learning Environment has provided this list of specific strategies and things to say – and not to say – to help faculty ensure a good experience by students and simultaneously avoid perceptions of mistreatment.
These suggested scripts were not written to offend faculty who are talented teachers, but rather to offer tools to help faculty navigate the complex area of student mistreatment where even well-intentioned efforts are sometimes misinterpreted.
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Suggested Faculty Scripts
As much as possible, make your expectations predictable for your trainees.
Review the One-Minute Learner, a list of six strategies to structure your early interactions with new students.
- Discuss goals (yours for the students, the students for themselves, today’s goals, overall clerkship goals)
- Getting going: When should the students start seeing patients, which patients should they see (or not see)?
- How much and how long: What should the students do in the room, how much time should they spend alone with the patient, what should they focus on? Try to be specific about what they should do, learn or review.
- How and when should the student present? Tell them the structure and format of your expected presentation. If you are going to offer feedback in front of other students, offer something like: “Feedback works best when it is immediate, so let’s all feel comfortable giving each other constructive feedback during rounds in front of the group. I include myself – please give me feedback when you feel I could improve on something.”
- EMR interactions: Name specific aspects of charting you are hoping they will master. “Please look up and tell me what you feel are the most relevant lab values for these five patients.”
- Questions: Make the times students should ask questions predictable. For example, “At the end of rounds, we will go back through the patients with the resident and you can ask your questions.”
- Consider setting the stage for students to bring you any concerns in real time by saying something like:
“I am here to help you have a great experience in (name of clerkship/rotation). We want to meet the expectations for this rotation and prepare you for your career in medicine, regardless of your specialty choice. If you have concerns about the rotation, student expectations, learning environment or how best to improve, I’d be happy to meet with you or direct you to the appropriate person. The best way to reach me is…”
Giving critical feedback in front of other people can be challenging, and complaints from students who felt humiliated when given feedback publicly are common.
Set the stage for your teaching by saying something like this:
“I am going to be asking all of you questions on rounds, not to test or trick you, but to assess your knowledge level. Please try not to be insulted by easy or difficult questions. ‘I don’t know’ is a perfectly appropriate answer.”
“I am going to be asking everyone questions. I am not trying to embarrass you, or anyone. Knowing the edges of your knowledge helps me match my teaching to your knowledge level.”
“If I give you a list of specific things to read up on during the clerkship in front of other people, it isn’t to humiliate you, it’s to round out your knowledge of our specialty and I do this commonly. Expect me to give assignments. Sometimes I’ll follow up and ask you to tell me what you learned, and other times I won’t. If I ask you to read on something and tell us about it the next day, don’t wait for me to remember to ask you about it. Sometimes I may get distracted and forget. Feel free to initiate a discussion about the best time is to present your topic.”
“This patient is unstable. I’m going to give them my full attention. We will address teaching points once the patient is stable.”
“I’m going to ask you to stand out of the way; you can watch from here but please do not move to that part of the room for your protection and the protection of the patient.”
“I’m sorry I can’t address your questions at this moment. We will get to them later when I have the time to give them the attention they deserve.”
It can be tempting to say, “I can’t stand that those guys from XXX always doing YYY!” Instead, try to model a collegial approach. For example:
“I had thought the team would follow our consult recommendations to do X, but they did Y instead. I’m sure there’s a good reason. Let’s call them to get more information so we’re all on the same page.”
If something happens and you inadvertently snap at a student, or raise your voice, consider a simple apology:
“I am sorry I raised my voice. Practicing medicine can be very challenging sometimes. I wasn’t upset with you, I was just worried about xyz.”
“I realize I was harsh when I said xyz. I apologize and I shouldn’t have said it that way.”
If you are concerned about a student who appears to be disengaged or withdrawn:
“You seemed a little quiet/distracted/upset today on rounds. Is everything OK?”
Negative comments about other Specialties or other broad groups of health professionals
Many of us are proud of our specialties. At times, the practice patterns of other units, specialties or teams may frustrate us. That said, be especially careful about making any broad negative general statements about others such as, “why would anyone be an X? Those guys XYZ.” Or, “This drives me crazy, the nurses here always XYZ.”
Instead: If you hear another person disparaging a specialty, consider saying something like this:
“We all take a lot of pride in our specialties. Comments or jokes like that can really hit a nerve with people who care a lot about what they do. You might want to reconsider making comments like that in the future.”
Comments or jokes regarding diverse populations such as those concerning Race, Ethnicity, Religion, Gender, Gender Identity and Sexual Orientation
Many mistreatment complaints concern faculty who thought they were making a joke or an innocent observation.
Be especially careful about comments about any aspect of diversity, including race, ethnicity, gender or gender identity, religion or sexual orientation. Many of these also create legal liability. For your benefit and for the benefit of others, you should avoid making disparaging comments or jokes based on another person’s aspect of diversity.
Instead: Inquire. If you think knowing more about a student’s aspects of diversity could help you to improve the learning environment, consider something like: “I know you mentioned that you will not be here Saturday so you can observe the Sabbath. Would it be OK with you if I asked you to tell me a little more about your scheduling needs so that we can work together to develop a schedule that maximizes your learning without interfering with your other obligations?”
Unless it is about unprofessional appearance, any aspect of your student’s appearance
Seeming compliments can be experienced as diminishing. Our medical students are constantly evaluating their potential to become successful physicians. Comments about their appearance, attractiveness or other irrelevant characteristics can feel demeaning to learners.
Distributing opportunities based on the gender of your medical students
Medical students want to participate in real clinical medicine. Try to equally distribute opportunities to your learners. Especially avoid giving males or females different opportunities.
Speaking Ill of Residents
Medical students carefully observe how attending physicians treat their residents and fellows.