Friday, April 30, 2021

Stand by me (Musings on ongoing bullying in healthcare)

Stayed tuned for updates, which are sure to occur.

The idea for the blog was stimulated by news of a celebrated, experienced UK nurse who faced being stuck off after in 2017 she saved a woman's life who was hemorrhaging after losing her baby with a blood transfusion in an ambulance. (Further Reading) But, through no fault if hers, the required prescription for a blood transfusion had not been taken onto the ambulance with the patient. The nurse claims she has been the victim of bullying by senior NHS managers after she saved the life of the woman. She was unable to return to work at the trust's insistence for ten months, and resigned after she lost a disciplinary hearing. She had to find work outside the trust and is now practising elsewhere.

She was a finalist for 2020 Florence Nightingale Nurse of the Year after raising 
£100,000 to buy iPads for Covid patients isolated from loved ones. Four years later the Nursing and Midwifery Council concluded the nurse undoubtedly acted in the best interests of the patient and has 'no case to answer'. In some ways this case reminds me of the Bawa-Garba case in UK where a pediatric trainee was convicted of gross negligence manslaughter. (Further Reading)

In addition to this case, harassment and bullying of medical students has been in the news in several nations for a few years. And in my province of Alberta, Canada, in 2016 a noose was hung outside a Black Dr's operating room in Grande Prairie. It was reported almost immediately to hospital administrators by startled bystanders. Yet, according to multiple doctors who wrote complaints, nothing was done to discipline the perpetrator, a white surgeon whom colleagues say still held leadership positions after the incident. (Further Reading)

The blog's title derives from a 1961 song by Ben E. King featured in the 1986 move of the same name.

The University of Alberta where I once taught has explicit, well defined Employment Equity and Human Rights Definitions and policies on bullying and discrimination. Yet I'm certain both still exist. The guidelines are followed by all faculties, including the Faculty of Medicine & Dentistry. (Further Reading) It covers pretty much every kind of discrimination, whether direct or indirect: any act or omission based on race, religious beliefs, colour, gender, physical disability, mental disability, marital status, age, ancestry, place of origin, family status, source of income, sexual orientation or political belief, when that act or omission results in loss of or limit on opportunities to work or to fully participate in campus life or offends the dignity of the person.

As a patient I've seen bullying by a Dr. against a trainee and at scientific conventions. As a patient the male Dr. presumably wanted the female trainee (intern or resident) to suffer abuse as a rite of passage that would toughen her up. Few likely report it as the Dr. is all powerful and they fear being judged as troublemakers that could affect their career progression.

At Canadian transfusion medicine conferences I've also witnessed bullying, again by a male Dr. (a 'biggie') against a female Dr. who had presented and was taking comments from the audience. She held her own but his comments were dismissive and abusive and it likely cost her much stress. I wondered why at the time and since and, frankly, suspect he'd not have done that to a male colleague in the same way.

As always, comments are most welcome. Would appreciate hearing about discrimination or bullying you've experienced or witnessed, You can do so by name or anonymously.

Chose this song because we all need to stand by colleagues in any field when they experience bullying, discrimination, harassment of any kind. Sad to report as items in Further Reading report, the incidence of bullying in medicine remains quite high.

  • Stand By Me (Ben E. King with stars and clips from the film)
Nurse who faced being struck off after she saved a woman's life with a blood transfusion has been cleared by an official inquiry (20 Apr. 2021) | Related:
Employment Tribunal of Leona Harris (18 Oct. 2019) | The complaint of unfair dismissal is not well-founded and is dismissed.

University of Alberta: Employment Equity and Human Rights Definitions

Taylor-Robinson SD, De Sousa Lopes PA, Zdravkov J, Harrison R. A. Personal perspective: is bullying still a problem in medicine? Adv Med Educ Pract. 2021 Feb 10;12:141-5. (Free full text)

Bullying in the workplace (1 Sept. 2020, CMA)  | What bullying in health care looks like, why it persists and how to eliminate it from the culture of medicine.

Medicine's bigotry and bullying problem
(Oped in Canada's Macleans magazine, 8 July 2020)

Colenbrander L, Causer L, Haire B. 'If you can't make it, you're not tough enough to do medicine': a qualitative study of Sydney-based medical students' experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020 Mar 24;20(1):86. (Free full text)

Australia: Culture of bullying, harassment and discrimination in medicine still widespread, survey suggests (9 Feb. 2020)

The Bawa-Garba case should usher in a fairer culture in healthcare (9 May 2019)

Thursday, April 01, 2021

Simply the best (Musing on healthcare educators during COVID-19)

I've meant to write this blog for awhile. I'm privileged to look after the mailing lists for University of Alberta's Medical Laboratory Science. As such, even though I no longer teach in the division, I get all messages to students and staff plus more. The blog will focus on medical laboratory education but I suspect it rings true for other health professionals. Had help with ideas for the blog from a former student of mine, who I won't identify at this time.

The blog's title is based on a ditty written by Holly Knight and Mike Chapman, but best known by Tina Turner's recording of it.

Where to start. I'll need to speak in generalities because it differs depending on the prevalence of COVID-19 in educators' areas. Sample list of key adaptations heath profession educators had to make:
1. Managing the chaos of ever-changing information. Suspect most people know how hard this is as regulations and policies regularly change as new evidence becomes available. Good example is the changing advice on the AstraZeneca COVID-19 vaccine as research and real world evidence become available.

2. Online learning. This was a major transition, involving putting course material online. Much harder for instructors who didn't use Powerpoints regularly, instead had in-class activities. 
Not all students enjoy online learning as much as face-to-face interaction with classmates and instructors, nor do the assignments, required pre-reading, etc. That's true for in person classes too but worse with online learning. Plus it's much easier to be distracted when text messages arrive as today's students pretty much have their cell phones on at all times.

Online learning also put much stress on university, community college, and technical institute IT departments.

3. In introductory courses, depending on when the pandemic was declared, students had a different laboratory experience than in prior years when all routine labs and a final exam were performed before entering the clinical year. Similarly, for other pre-clinical experiences such as phlebotomy visits to outpatient labs, etc.

Ultimately, some in-person introductory lab courses resumed, but required many adaptations in student labs. Examples: Fewer students in each lab space (e.g., one lab becomes two), shower curtains erected for students facing each other on the same bench, between labs sanitizing high touch areas (door knobs, bench areas, reagent bottles).

4. In the clinical year, depending on when the pandemic was declared, students were pulled from the sites until safety precautions could be put in place. This required re-scheduling.

5. Depending on how many institutions, healthcare organizations are involved, processes and procedures could differ, requiring educators to meet the needs of each.

To me all healthcare educators deserve a loud round of applause for how they've had to adapt during the COVID-19 pandemic to constantly changing regulations and policies. In some ways I'm glad I retired decades ago as I would have found this difficult even then.

Chose this song because to me healthcare educators have been simply the best during COVID-19 pandemic. To me they're heroes similar to those on the frontlines.
As always, comments are most welcome (you can do so anonymously or by name below) and  there are some.