Resident Intimidation

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Resident Intimidation. Seemal R. Desai, MD Vice-Chair, AMA-RFS Governing Council Honolulu, Hawaii Interim Meeting. Introduction. Overview of Intimidation AMA-RFS recognition of the issue History of graduate medical education Recent changes in GME Is intimidation an issue? - PowerPoint PPT Presentation

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  • Resident IntimidationSeemal R. Desai, MDVice-Chair, AMA-RFS Governing CouncilHonolulu, HawaiiInterim Meeting

  • IntroductionOverview of IntimidationAMA-RFS recognition of the issueHistory of graduate medical educationRecent changes in GMEIs intimidation an issue?Consequences of intimidationProposed solutions

  • IntimidationDefinition -- attempt to frighten by acting in a dominating manor with the goal of making people do what the intimidator wants.Behavioral trait present in everyoneBehavioral theorists suggest it is seen in children as a consequence of being intimidated by others

  • AMA-RFSSection within the AMA

    Approx. 25,000 resident and fellow members

    76 State and specialty societies

    Annual and Interim Assemblies

  • AMA-RFSMember Connect Survey 688 Residents and Fellows respondedIdentified four issues of importanceMedical LiabilityEducational Loan DebtUninsuredIntimidationOver 75% of residents think it is important that the AMA address the issue of intimidation

  • Member Connect SurveyPrevalenceResident members asked if they have experienced:Non-physical harm threatenedPressure to report work hours inaccuratelySexual HarassmentPhysical Harm Threatened25% have had non-physical harm threatened22% have been pressured to report inaccurate duty hours

  • Perpetrators

  • Member Connect SurveyReporting 68% of residents believe they would know how to report intimidation50% responded they would not be comfortable reporting intimidation to their residency program

  • Reporting

  • History of Graduate Medical Education1914 CMEH approved list of hospitals for internship1923 CMEH approved list for GME1928 Essentials of Approved Residencies and Fellowships set standards1953 RRC was developed1981 LCGME became the ACGMENow 26 RRCs, TYRC, IRC

  • Trend in Graduate Medical EducationStandardization of Medical Education

  • Trend in Graduate Medical Education19142006Standardization of Medical EducationLearnersTeachersLearnersTeachersLearnersTeachers

  • Trend in Graduate Medical Education19142006Standardization of Medical EducationLearnersTeachersLearnersTeachersLearnersTeachersEducational Values

  • Trend in Graduate Medical Education19142006Standardization of Medical EducationLearnersTeachersLearnersTeachersLearnersTeachersGeneration Gap ConflictEducational Values

  • Sir William OslerFather of Medical EducationEstablished the sleep-in residency programResidencies were open-ended and had a long tenureResidents led restricted and almost monastic lifestyleSystem spans the generationsMay now be obsolete

  • GenerationsTraditionalistsBaby BoomersGeneration XGeneration Y

  • GenerationsTraditional or Silent Generation 1925-1945Term was title of Nov 5, 1951 cover of TimeRaised during the post-war depressionFaith in institutions, government, business, family, or churchWilliam Manchester commented: Withdrawn, cautious, unimaginative, indifferentRespect authoritySubscribe to a top-down model of authorityIncluded: Johnny Carson, Sandra Day OConnor, Clint Eastwood, Neil Armstrong

  • GenerationsBaby Boomer 1946-1964Born during economic prosperity post WWIIFirst generation that had advanced degreesVietnam WarIdealistic leaders that succeed by leading in the worst of timesPolitical leaders todayIt is estimated that the Boom Generation will hold a plurality in Congress until 2015, the White House until 2021, and will have a majority in the Supreme Court from 2010 to 2030.

  • GenerationsGeneration X 1961-1981Term popularized by Couplands 1991 novel Generation X described the loss of the icons of the baby boomer generationJane Deverson coined term in a text where she described this gen. sleeps together before marriage, dont believe in God, dislike the Queen, and dont respect parentsSkeptical, raised during recession and downsizingMore concerned with work-life balance than boomersSelf driven, learners, skilled individuals

  • GenerationsGeneration Y 1977-2003Technology drivenTolerant of multiculturalismCustomizing of everythingTypically received positive affirmation from parentsExpect the same affirmation by teachersInsist on a work-life balance

  • Why is there a problem now?More Intimidation or Less Tolerance?Sentinel EventsACGME Core Competencies2003 Residency Work Hour ReformsDiversification of the workplaceIs medicine the only industry affected?MilitaryCorporate workplace

  • Institute for Safe Medication PracticesSurvey published in March, 20042095 staff from different hospitals>80% felt mild intimidation48% suffered strong verbal abuse43% experienced threatening body language4% physically abused

  • Consequences of IntimidationPatient Care DishonestyReportingPatient dataFear to actCongested communicationCompromises in patient careIndividualRelationship injuriesDepressionFatigueResignation or TransferPerpetuation of cycle

  • SolutionsEducationIdentificationEnforcement

  • EducationEducation GoalsDiversity TrainingBehavioral TrainingGeneration Gap TrainingForumMedical SchoolWorkshops/SeminarsOn-line curriculum

  • IdentificationNatural History of ReportingFear of consequencesDoubt of anonymityWhistleblowerMonitoring mechanismsExit interviewsOmbudsman programHotline for reporting intimidation

  • EnforcementBenign EnforcementResident-Faculty CompactFaculty-Resident CompactOmbudsman ProgramPunitive EnforcementRequires identification of a systems problemLabor intensive

  • Summary75% of AMA-RFS members rank intimidation as a top issues for residentsGeneration Gaps create conflict that lends itself to intimidationThe consequences of intimidation are destructive to education and patient careSolutions to intimidation involve a multidirectional approach including: education, identification, and enforcement

  • Contact InformationSeemal Desai, MDVice-Chair, AMA-RFS Governing CouncilThe University of Alabama Birminghamseemald@yahoo.com

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