An Innovative Curriculum to Empower Trainees and Faculty to Address Patient-Initiated Identity-Based Misconduct in the Clinical Learning Environment.

Abstract

Introduction: Training residents and attending physicians on effective communication strategies to manage biased patient and visitor comments is lacking. The I-RESPOND toolkit curriculum provides strategies for addressing identity-based misconduct in the clinical setting.

Methods: Resident physicians and faculty in 12 departments at a single academic center participated in the workshop between June 2021 and February 2022. The workshop consisted of interactive didactics, an introduction to the I-RESPOND toolkit, and opportunities to practice communication strategies with formative feedback. Retrospective pre/postworkshop survey instruments and a follow-up survey were used to evaluate the workshop and subsequent experiences.

Results: Sixty-six (32%) of 204 participants (including residents and attendings) completed the workshop evaluations, with 15 workshops facilitated. Both groups of participants were significantly more confident in their ability to respond to identity-based misconduct after participation. The retrospective pre/postworkshop analysis of their perceived change in confidence in addressing the workshop educational objectives showed a significant increase in median confidence score from pre- to postworkshop (p < .001). On the follow-up survey, participants' mean ± SD rating (disaggregated sample, 50 participants) for the likelihood of using at least one strategy in the next 2 months was 4.2 ± 1.01 (on a 5-point scale; 1 = Very unlikely, 5 = Very likely), with 9 (32%) of 28 participants indicating they had intervened in the moment to address the behavior.

Discussion: This curriculum increased awareness of the impact of patient-initiated misconduct and helped inform institutional policies related to the management of disruptive discriminatory behavior from patients and visitors.