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Resident Intimidation Seemal R. Desai, MD Vice-Chair, AMA-RFS Governing Council Honolulu, Hawaii Interim Meeting.

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Presentation on theme: "Resident Intimidation Seemal R. Desai, MD Vice-Chair, AMA-RFS Governing Council Honolulu, Hawaii Interim Meeting."— Presentation transcript:

1 Resident Intimidation Seemal R. Desai, MD Vice-Chair, AMA-RFS Governing Council Honolulu, Hawaii Interim Meeting

2 Introduction Overview of Intimidation AMA-RFS recognition of the issue History of graduate medical education Recent changes in GME Is intimidation an issue? Consequences of intimidation Proposed solutions

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

4 AMA-RFS Section within the AMA Approx. 25,000 resident and fellow members 76 State and specialty societies Annual and Interim Assemblies

5 AMA-RFS Member Connect Survey – 688 Residents and Fellows responded Identified four issues of importance Medical Liability Educational Loan Debt Uninsured Intimidation Over 75% of residents think it is important that the AMA address the issue of intimidation

6 Member Connect Survey Prevalence Resident members asked if they have experienced: Non-physical harm threatened Pressure to report work hours inaccurately Sexual Harassment Physical Harm Threatened 25% have had non-physical harm threatened 22% have been pressured to report inaccurate duty hours

7 Perpetrators

8 Member Connect Survey Reporting – 68% of residents believe they would know how to report intimidation 50% responded they would not be comfortable reporting intimidation to their residency program

9 Reporting

10 History of Graduate Medical Education 1914 – CMEH approved list of hospitals for internship 1923 – CMEH approved list for GME 1928 – Essentials of Approved Residencies and Fellowships – set standards 1953 – RRC was developed 1981 – LCGME became the ACGME Now 26 RRC’s, TYRC, IRC

11 Trend in Graduate Medical Education Standardization of Medical Education

12 Trend in Graduate Medical Education Standardization of Medical Education LearnersTeachers LearnersTeachers Learners Teachers

13 Trend in Graduate Medical Education Standardization of Medical Education LearnersTeachers LearnersTeachers Learners Teachers Educational Values

14 Trend in Graduate Medical Education Standardization of Medical Education LearnersTeachers LearnersTeachers Learners Teachers Generation Gap Conflict Educational Values

15 Sir William Osler Father of Medical Education Established the sleep-in residency program Residencies were open-ended and had a long tenure Residents led restricted and almost monastic lifestyle System spans the generations May now be obsolete

16 Generations Traditionalists Baby Boomers Generation X Generation Y

17 Generations Traditional or Silent Generation Term was title of Nov 5, 1951 cover of Time Raised during the post-war depression Faith in institutions, government, business, family, or church William Manchester commented: Withdrawn, cautious, unimaginative, indifferent Respect authority Subscribe to a top-down model of authority Included: Johnny Carson, Sandra Day O’Connor, Clint Eastwood, Neil Armstrong

18 Generations Baby Boomer Born during economic prosperity post WWII First generation that had advanced degrees Vietnam War Idealistic leaders that succeed by leading in the worst of times Political leaders today It 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.

19 Generations Generation X Term popularized by Coupland’s 1991 novel “Generation X…” described the loss of the icons of the baby boomer generation Jane Deverson – coined term in a text where she described this gen. “sleeps together before marriage, don’t believe in God, dislike the Queen, and don’t respect parents” Skeptical, raised during recession and downsizing More concerned with work-life balance than boomers Self driven, learners, skilled individuals

20 Generations Generation Y – Technology driven Tolerant of multiculturalism Customizing of everything Typically received positive affirmation from parents Expect the same affirmation by teachers Insist on a work-life balance

21 Why is there a problem now? More Intimidation or Less Tolerance? Sentinel Events ACGME Core Competencies 2003 Residency Work Hour Reforms Diversification of the workplace Is medicine the only industry affected? Military Corporate workplace

22 Institute for Safe Medication Practices Survey published in March, staff from different hospitals >80% felt mild intimidation 48% suffered strong verbal abuse 43% experienced threatening body language 4% physically abused

23 Consequences of Intimidation Patient Care Dishonesty Reporting Patient data Fear to act Congested communication Compromises in patient care Individual Relationship injuries Depression Fatigue Resignation or Transfer Perpetuation of cycle

24 Solutions Education Identification Enforcement

25 Education Education Goals Diversity Training Behavioral Training Generation Gap Training Forum Medical School Workshops/Seminars On-line curriculum

26 Identification Natural History of Reporting Fear of consequences Doubt of anonymity Whistleblower Monitoring mechanisms Exit interviews Ombudsman program Hotline for reporting intimidation

27 Enforcement Benign Enforcement Resident-Faculty Compact Faculty-Resident Compact Ombudsman Program Punitive Enforcement Requires identification of a systems problem Labor intensive

28 Summary 75% of AMA-RFS members rank intimidation as a top issues for residents Generation Gaps create conflict that lends itself to intimidation The consequences of intimidation are destructive to education and patient care Solutions to intimidation involve a multidirectional approach including: education, identification, and enforcement

29 Contact Information Seemal Desai, MD Vice-Chair, AMA-RFS Governing Council The University of Alabama Birmingham

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