Should We Enter the Room? Protecting Trainees from Patients During Adverse Patient Encounters: A Residency Education Subcommittee-sponsored Workshop

Certain patient behaviors towards trainees such as mistreatment or patient illness factors may cause trainees on consultation-liaison (CL) services to feel degraded, anxious, or fearful and can adversely impact education. There is no clear guidance in the literature on how to navigate these scenarios. This workshop will present scenarios that require timely response by CL attendings during patient encounters, provide strategies on how to support trainees in continued interactions with patients, suggest a process for determining whether a resident should remain involved in direct patient care, and discuss approaches for maintaining patient engagement when a trainee is removed from direct-patient interactions.






10 minutes: Dr. Mallika Lavakumar will introduce the speakers and moderate the discussion. She will also provide an overview of adverse patient encounters and their impact on quality of training, trainee wellness, and career choices.






20 minutes: Dr. Rubi Vaughn will present on instances when patients refuse to work with trainees due to the trainee’s race, ethnicity or religion. These encounters raise complex ethical, legal and clinical challenges that can have an adverse impact on the patient, the trainee, and other involved clinicians. She will highlight the tension between legal protection afforded to trainees and the virtue of self-sacrifice so commonly taught as part of the patient-physician contract.






20 minutes: Dr. Sarah Slocum will discuss the need for attendings to take an active stance and respond promptly when patients verbally attack trainees. She will review existing curricula on aggression towards trainees and discuss the concept of shared decision-making as it applies to decisions within CL team members.






20 minutes: Dr. James Rustad will describe the helplessness and feelings of captivity that entitled patients evoke in trainees. He will emphasize the need for close supervision, identification of psychodynamic mechanisms at play, and attending modeling of limit setting to support trainees in their development as physicians.




20 minutes: Dr. Samuel Greenstein will discuss the dilemmas of trainees' repeated exposure to patients with COVID-19. He will highlight the power differential inherent within a CL team, and delineate protection conferred to various stages of physician-learner. He will recommend strategies to maintain resident engagement when residents are not directly involved with patients.




The workshop is relevant to trainees and teachers of CL psychiatry and is designed to reexamine traditional principles of medical professionalism, teach interpersonal skills, and support the CL community in its efforts to achieve a safe, resilient, and inclusive workforce.




References:




Wilkins KM, Goldenberg MN, Cyrus KD. ERASE-ing Patient Mistreatment of Trainees: Faculty Workshop. MedEdPORTAL. 2019 Dec 27;15:10865.




Salari N, Khazie H, Hosseinian FA et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Hum Resour Health. 2020 Dec 17;18(1):100.