The Dynamics of Power and Psychological Safety on Team Cohesion During Interprofessional Simulation-Based Education

Healthcare team functioning requires coordination and collaboration between multiple practitioners towards a common goal of delivering safe and quality patient care (Lemieux-Charles & McGuire, 2006). Communication patterns, leadership, mutual support, and situation monitoring are all processes of effective teams (Weaver et al, 2010). However, despite the growing focus on developing interprofessional teams, minimal focus is given to the contextual and cultural forces influencing healthcare team functioning. Negative relationships amongst providers can affect teams in clinical settings, which in turn can undermine patient safety (Carpenter, 1995). Sources of poor team cohesion can be rooted in unequal distributions of power and the inability to express oneself without fear (Leonard, Graham & Bonacum, 2004; Edmondson, 1999). The Interprofessional Critical Care Simulation (ICCS) experience at VCU is one program that aims to foster positive relationships by giving nursing and medical students an opportunity to work together in a simulated environment before they graduate. Each academic year, senior nursing students (~150) and fourth-year medical students (~170) participate in a series of three two-hour simulation workshops over a two-week period. Students are grouped into 48 interprofessional teams of approximately 6-7 members, and each team is assigned to one faculty facilitator for the series. Four faculty facilitators (two nurses and two physicians) conduct the workshops in the simulation centers in the School of Nursing or in the School of Medicine. During the 2015-16 academic year, we asked medical and nursing students to complete a self-reported paper survey measuring team cohesion (Jung & Sosik, 2002), perceived power distance (Yoo, Donthu & Lenartowicz, 2011), and psychological safety (Edmondson, 1999) at the end of the ICCS course. Each scale was validated in prior research, however power distance was tailored to measure perceptions of power on the team compared to the original measure regarding an individual’s beliefs regarding how power should be distributed. The mediation model was tested with 1000 bootstrapping samples and controlling for semester through SPSS Version 23 (Armonk, NY) Process Macro, model 4 (Hayes, 2013). After data cleaning efforts, 243 (76% response rate) post-surveys were included in analyses. There were 134 (55%) nursing students and 98 (40%) medical students in our sample. The majority of respondents were female (n=135; 56%) and identified as Caucasian (n=151; 62%). Our partial mediation, Rsq=0.30, F(2,227) = 47.94, p\u3c.001, revealed that as power distance increased 1.0 unit, psychological safety decreased 0.28 units, however as psychological safety increased 1.0 unit, team cohesion increased 0.40 units. In addition to this indirect relationship, the direct relationship illustrated that as power distance increased 1.0 unit, team cohesion decreased 0.19 units, total effect = -0.30 [-0.40, -0.20], indirect effect= -0.11 [-0.18, -0.05]. Facilitators of such interprofessional activities should shape team interactions so power is equally distributed amongst medical and nursing students, and support environments where students feel safe to speak up. Creating a safe space where learners clearly understand their roles and responsibilities on an interprofessional team will impact the affective nature of team dynamics. Future research can focus on the impact of facilitator leadership on team dynamics and influences of context and culture when transitioning to the clinical learning environment

Why Residents’ Perceptions of the Clinical Learning Environment Matter: Correlations between the ACGME Resident Survey, Perceived Organizational Support, and Psychological Safety

Purpose. To utilize two validated instruments to assess the cultural facets of the clinical learning environment in medical education and correlate findings with external program evaluation data. Identification of measurement tools could allow early intervention in graduate medical education to better facilitate work and learning processes. Method. During FY17, our institution surveyed residents across nineteen training programs on perceived organizational support and psychological safety to assess the clinical learning environment. These data were aggregated to the departmental level and correlated with nineteen residency program results on the FY17 ACGME Resident Survey. Results. Perceived organizational support correlated positively with domains of the ACGME Resident Survey: overall program evaluation score (r=.75, p\u3c.01), Faculty (r=.72, p\u3c.01), Evaluation (r=.73, p\u3c.01), Educational Content (r=.52, p=.02), and Resources (r=.55, p=.01). Psychological safety had a strong positive correlation with overall program evaluation score (r=.57, p=.01), Faculty (r=.50, p=.03), and Evaluation (r=.62, p\u3c.01). Neither internal assessment scale correlated with the Patient Safety/Teamwork domain of the ACGME Resident Survey. Conclusions. GME and health systems should actively monitor and improve aspects of the clinical learning environment through internal assessment including measurement on perceived organizational support and psychological safety. Based on our data, departments perceived to have greater support of their residents, where residents can speak up freely, are likely to show more positive ratings of programs on the ACGME Resident Survey. Programs should also identify and evaluate interventions to facilitate positive relationships between residents and their training programs, as well as foster environments that allow for speaking up without the fear of negative consequence

Real Voices, Real Questions, Real Engagement: VCU Speaker Series

You come here for something more than schooling. You come here for deep education and deep education is about learning how to die so that you learn how to live because when you examine certain assumptions that you have, certain presuppositions that you’re holding on to, when you let them go, that’s a form of death. And there’s no growth, there’s no development, there’s no maturation without learning how to die and giving up certain dogma, giving up certain doctrine. - Cornel West, Ph.D., VCU Siegel Center, Fall 2015 VCU is a large, public, urban research university situated in the middle of a capital city. Its faculty, staff, student body, alumni, and the surrounding community are remarkably diverse as are the academic offerings. It is, and should be viewed as, the intellectual and cultural engine of the region. Our project proposes the creation of a large-scale, high-profile speaker series designed to highlight emerging trends and provide students, faculty, staff, alumni and the Richmond community with a forum for conversation. The speaker series will cover topics that are critically engaging, have national relevance, and introduce ideas that propel the next generation of leaders. In addition to a large speaking engagement, the speaker series will also incorporate other activities to cultivate interactions and build relationships such as classroom lectures, book signings, and a dinner through the development office. The speaker series will host at least one speaker annually, with the addition of a second speaker as the event builds momentum. At least one of the lectures will occur at the beginning of the traditional academic semester, allowing for the greatest opportunity for participation across VCU and Richmond. Internal support from VCU students, faculty, staff, and colleges will ensure that the project is connected to the mission, vision, goals, and pursuits of VCU. A speaker series committee will help sustain and coordinate efforts across the university and community. Committee members will include stakeholders that require buy-in and cooperation for activities that complement the speaker series (e.g., other lectures, panel discussions, classroom activities). A survey will be used to gain insights into topics and speakers of interest. The committee will review the survey responses in order to make informed decisions during the planning process. The ongoing presence of hosting influential speakers will allow VCU to emerge into the national spotlight as thought-leaders. This speaker series will serve many purposes. First, the series will serve to inspire VCU students, faculty, staff, and the Richmond. Through frank and open conversations attendees will be exposed to new concepts and ideas. Second, the series will unite the diverse groups that make up VCU and the Richmond community. The lecture series will expose attendees to new ideas and open doors for possible opportunities for collaboration through classroom and community engagement activities related to the topics discussed. Third, the series will serve as a cultural conduit, solidly connecting the VCU and Richmond communities around engaging ideas of importance. Opening a new market-place of ideas will ensure that the students of VCU interact with new information in exciting and transformative ways

Incidence of Resident Mistreatment in the Learning Environment Across Three Institutions

Introduction: Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective of this study is to explore the prevalence of resident experiences with mistreatment. Methods: Residents at three academic institutions were surveyed using questions similar to the GQ in 2018. Quantitative data were analyzed based on frequency and Mann-Whitney U tests to detect gender differences. Results: Nine hundred ninety-six of 2682 residents (37.1%) responded to the survey. Thirty-nine percent of residents reported experiencing at least one incident of mistreatment. The highest reported incidents were public humiliation (23.7%) and subject to offensive sexist remarks/comments (16.0%). Female residents indicated experiencing significantly more incidents of: public embarrassment, public humiliation, offensive sexist remarks, lower evaluations based on gender, denied opportunities for training or rewards, and unwanted sexual advances. Faculty were the most frequent instigators of mistreatment (66.4%). Of trainees who reported experiencing mistreatment, less than one-quarter reported the behavior. Conclusion: Mistreatment in the academic learning environment is a concern in residency programs. There is increased frequency among female residents

Towards equitable learning environments for medical education : bias and the intersection of social identities

Context: Medical educators are increasingly paying attention to how bias creates inequities that affect learners across the medical education continuum. Such bias arises from learners' social identities. However, studies examining bias and social identities in medical education tend to focus on one identity at a time, even though multiple identities often interact to shape individuals' experiences. Methods: This article examines prior studies on bias and social identity in medical education, focusing on three social identities that commonly elicit bias: race, gender and profession. By applying the lens of intersectionality, we aimed to generate new insights into intergroup relations and identify strategies that may be employed to mitigate bias and inequities across all social identities. Results: Although different social identities can be more or less salient at different stages of medical training, they intersect and impact learners' experiences. Bias towards racial and gender identities affect learners' ability to reach different stages of medical education and influence the specialties they train in. Bias also makes it difficult for learners to develop their professional identities as they are not perceived as legitimate members of their professional groups, which influences interprofessional relations. To mitigate bias across all identities, three main sets of strategies can be adopted. These strategies include equipping individuals with skills to reflect upon their own and others' social identities; fostering in-group cohesion in ways that recognise intersecting social identities and challenges stereotypes through mentorship; and addressing intergroup boundaries through promotion of allyship, team reflexivity and conflict management. Conclusions: Examining how different social identities intersect and lead to bias and inequities in medical education provides insights into ways to address these problems. This article proposes a vision for how existing strategies to mitigate bias towards different social identities may be combined to embrace intersectionality and develop equitable learning environments for all.</p

Addressing unprofessional behaviors in the clinical learning environment: lessons from a multi-year virtual, intergenerational, interdisciplinary workshop

ABSTRACTIntroduction Optimizing the clinical learning environment (CLE) is a medical education priority nationwide.Materials and Methods We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions.Results Over two sessions (2021–2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants’ ability to recognize and respond to challenges in the CLE.Discussion Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants’ knowledge and commitment to improve the CLE