Available online 10 April 2024

Author links open overlay panel, , , , , , , AbstractProblem

Workplace mistreatment is a contributor to resident burnout; understanding and intervening against mistreatment is one key tool in mitigating burnout. While ACGME survey data alerts programs to general mistreatment trends, those data are not detailed enough to inform local interventions. Our team designed and implemented a Challenging Interactions Reporting Tool (CIRT) to characterize the experiences of our trainees at a granular level and to inform targeted interventions for improvement.

Approach

Our CIRT was offered to 158 residents in August 2020 via REDCap. Residents submit electronic reports that are reviewed weekly by program leaders who develop action plans for each report. Reporters can identify themselves or can choose to remain anonymous. When “hot spots” for mistreatment are identified in our hospital, we implement a targeted systems-level intervention.

Outcomes

Residents filed 275 reports between August 2020 and December 2022. Reports represented all training environments and involved all interprofessional members of clinical teams. Residents reported awareness of, use of, and satisfaction with the tool.

Next Steps

Our program created the CIRT as a tool to inform local interventions for improving the safety of our clinical learning environment. We continue to disseminate our tool across our hospital’s GME programs and are now measuring the impact of our interventions.

Section snippetsPROBLEM

Challenging interactions are common in medicine and range from unprofessional behaviors to overt discrimination. For trainees, some of these challenging interactions may be an important opportunity for skill-building and discomfort tolerance (i.e. delivering serious news to a family or navigating a disagreement in recommendations with a consultant) whereas others may cross the line into mistreatment, as defined by the American Medical Association as “either intentional or unintentional,

Setting and Participants

We developed our challenging interaction reporting tool (CIRT) for the 158 pediatric residents in our large, urban, freestanding children’s hospital. Our pediatrics training program includes post-graduate year (PGY) trainees from PGY 1 through 4; trainees in the PGY 4 year are in combined programs such as Child Neurology, Internal Medicine and Pediatrics, or Genetics and Metabolism. Our clinical learning environment spans three outpatient primary care clinics, several inpatient units, and the

Submitted Reports

From August 2020 to December 2022, 275 reports were filed using the CIRT by residents of all training years (PGY-1: 42%, n=109; PGY-2: 26%, n=67; PGY-3 30%, n=77; PGY-4 3%, n=8). Reports included all training environments and involved all members of the interprofessional care team as sources of challenging interactions including: nurses (26%, n=71), attending physicians (25%, n=69), co-residents (15%, n=42), advanced-practice providers (14%, n=38), fellows(12%, n=34), social workers and case

DISCUSSION

Using a trauma-informed approach,15 we developed and implemented a reporting tool for residents to report instances of challenging interactions in the workplace. After a year of implementation, residents were aware of the tool and those who had filed a report were satisfied with the outcome. We found challenging interactions occurred in all training environments and with all members of the health care team. Obtaining more granular data on the challenging interactions and dividing them into

CONCLUSIONS

We created a Challenging Interactions Reporting Tool for pediatric residents using a trauma–informed approach to gain a deeper understanding of challenging interactions, including mistreatment, within the clinical learning environment. Program leaders can use this information to develop targeted interventions to help mitigate workplace mistreatment and create psychologically safe and inclusive clinical learning environments.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

Thank you to our fellow Program Directors, Drs. Jeanine Ronan, Nicole Washington, George Dalembert, Beth Rezet, and Lindsay Albenberg as well as to our Associate Designated Institutional Officers Drs. Don Boyer, Leslie Kersun, Jessica Fowler, and Mackenzie Frost for their collaboration. Special thanks to Sophia Tan and Donna Divito who helped with project management and analysis. We also thank our Department Chair and Physician-in-Chief, Dr. Joseph St. Geme III, Designated Institutional

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