Original Article

CME Article: Supporting Trainees by Addressing Inappropriate Behaviors by Patients

Authors: Karla E. Williams, MD, Monica L. Baskin, PhD, Amanda L. Brito, MD, Sejong Bae, PhD, Lisa L. Willett, MD, MACM

Abstract

Objectives: Physicians in training may be particularly vulnerable to the negative effects of discrimination and inappropriate behaviors by patients. We sought to determine the frequency of inappropriate behaviors by patients toward Internal Medicine (IM) residents, residents’ confidence to manage the behaviors, and differences among demographic characteristics, including race, sex, and level of clinical experience.

Methods: We developed a curricular session to equip IM residents and faculty to respond to discrimination or inappropriate behaviors by patients. Before the session, we surveyed residents about their experiences with macroaggressions, microaggressions, and other inappropriate behaviors using a 16-question survey instrument. We used descriptive statistics to summarize the participants’ characteristics and the χ2 or Fisher exact test for comparison between groups.

Results: Eighty-two percent (27 of 33) of residents who attended the workshop completed the survey. We found that the majority of residents experienced patient macro- and microaggressions. More than 50% had a personal experience or witnessed experience with a macroaggression related to race (56%) or gender (59%). Seventy percent of residents personally experienced a microaggression by a patient. Women and residents of color are more likely to experience these types of encounters, which become more common in residents with higher postgraduate year level. Confidence in how to appropriately respond to such encounters is low.

Conclusions: Our study highlights that macro- and microaggressions by patients toward IM residents are common. Curricula are needed to equip trainees with tools to appropriately respond during such encounters.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Association of American Medical Colleges. Diversity and inclusion. https://www.aamc.org/initiatives/diversity. Updated 2019. Accessed February 10, 2019.
2. Accreditation Council for Graduate Medical Education. AGCME common program requirements (post-doctoral education program). https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRPost-Doctoral2018.pdf. Published June 10, 2018. Accessed July 19, 2019.
3. Association of American Medical Colleges. Unconscious bias resources for health professionals. https://www.aamc.org/initiatives/diversity/322996/lablearningonunconsciousbias.html. Accessed February 10, 2019.
4. The Joint Commission. Quick safety issue 23: implicit bias in health care. https://www.jointcommission.org/resources/news-and-multimedia/newsletters/newsletters/quick-safety/quick-safety-issue-23-implicit-bias-in-health-care. Published April 2016. Accessed November 25, 2020.
5. Project Implicit. https://implicit.harvard.edu/implicit/index.jsp. Published 2011. Accessed December 12, 2019.
6. University of Alabama at Birmingham. The Common Thread: find yourself in everyone. https://www.uab.edu/thecommonthread/. Published 2019. Accessed January 19, 2019.
7. Montenegro RE. A piece of my mind: my name is not “Interpreter.”  JAMA 2016;315:2071-2072.
8. Sue DW. Microaggressions in Everyday Life, Race, Gender, and Sexual Orientation. New York:Wiley;2010.
9. Sehgal P. Racial microaggressions: the everyday assault. https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2016/10/racial-microaggressions-the-everyday-assault. Published October 2016. Accessed January 19, 2019.
10. Tedeschi B. 6 in 10 doctors report abusive remarks from patients, and many get little help coping with the wounds. https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors. Published October 2017. Accessed December 12, 2018.
11. Williams JC, Rohrbaugh RM. Confronting racial violence: resident, unit, and institutional responses. Acad Med 2019;94:1084–1088.
12. Sue DW, Alsaidi S, Awad MN, et al. Disarming racial microaggressions: microintervention strategies for targets, white allies, and bystanders. Am Psychol 2019;74:128–142.
13. Wheeler M, De Bourmont S, Paul-Emile K, et al. Physician and trainee experiences with patient bias. JAMA Intern Med 2019;179:1678–1685.
14. Recupero PR, Heru AM, Price M, et al. Sexual harassment in medical education: liability and protection. Acad Med 2004;79:817–824.
15. Witte FM, Stratton TD, Nora LM. Stories from the field: students’ descriptions of gender discrimination and sexual harassment during medical school. Acad Med 2006;81:648–654.
16. Brady JM. The racist patient—revisited. J Perianesth Nurs 2014;29:239–241.
17. Jain SH. The racist patient. Ann Intern Med 2013;158:632.
18. Paul-Emile K, Smith AK, Lo B, et al. Dealing with racist patients. N Engl J Med 2016;374:708–711.