# Navigating patient bias and mistreatment: a cross-sectional study of a workshop and coaching series for internal medicine residents

## TL;DR

A workshop and coaching series helped medical residents feel more confident in handling patient mistreatment, improving their psychological safety and trust.

## Contribution

The program combines skill-building workshops and coaching to empower residents and faculty in addressing patient mistreatment.

## Key findings

- Residents reported increased confidence in responding to verbal mistreatment after the intervention.
- Willingness of upstanders to act against witnessed mistreatment significantly improved post-intervention.
- The program's approach is novel in integrating skill-building with coaching for both residents and faculty.

## Abstract

Physicians are often challenged with navigating patient bias and mistreatment, contributing to burnout and decreasing psychological safety and trust. We sought to determine the effectiveness of a resident workshop series supported by faculty coaches on the ability to navigate mistreatment by patients.

We implemented an educational program and coaching series in our internal medicine (IM) residency program at an academic teaching hospital. The participants included 48 PGY2 and PGY3 IM residents and 10 faculty coaches. We created a large-group four-part workshop series for residents over a 10-month period, a small-group faculty coaching skills development series, and small-group resident coaching sessions by faculty. Residents were surveyed before and after the intervention evaluating instances of and response to mistreatment from patients.

Forty-eight PGY2 and PGY3 IM residents (100% of each class) completed the curriculum, 42 (87.5%) of whom completed the presurvey and 33 (68.8%) of whom completed the postsurvey. At baseline, 34/42 residents (81.0%) reported experiencing and 39/42 (92.9%) witnessed some form of verbal mistreatment. The postsurvey results demonstrated increased confidence in responding to mistreatment, with a response of “Often” for direct verbal comments increasing from 14.7% preworkshop to 30.0% postworkshop (p < 0.0001 for trend). They also reported an increase in the willingness of upstanders engaging against mistreatment when witnessed, with the “Maybe” category changing from 28.2% to 11.8% and the “Always” category changing from 23.1% to 41.2% (p = 0.0023 for trend).

Our intervention increased confidence in responding to mistreatment experienced by residents. The program, incorporating skill-building along with coaching, is a novel approach to empowering both residents and faculty to address various forms of patient mistreatment. The ability to effectively navigate mistreatment may positively impact psychological safety and build trust.