Today, we're going to end on a discussion about unprofessionalism in the workplace, and we're going to have four great talks. Three great talks and one really bad one, but we'll enjoy these. The first is going to be on gender harassment by Dr. Vaz Zavaleta, microaggressions by Dr. Tracy Jaffe, professionalism transgressions by myself, and then trainee professionalism and wellness by Dr. Stephen Harris. I'm really grateful for this really awesome panel that has agreed to join us. So without much further ado, I'll give you Dr. Vaz Zavaleta. They're going to talk about gender harassment. I was asked to give this talk by one of my mentors, and of course, I said yes. But I can only speak from my perspective. I'm a trans-identified, non-binary radiologist who advocates for gender-expansive diversity, equity and inclusion. So I'd like to take a moment to talk about intersectionality, intersectionality as it relates to gender and race in radiology, and the lack of attention to this critical concept is best addressed by one of our health equity and DEI colleagues, Dr. Dan Chande. I'm just going to quote a couple of sentences from his commentary here that are really impactful. It's incredibly difficult to have a nuanced conversation about gender and racial diversity as it has been co-opted and exploited to become one of the most divisive issues in our society. However, it's imperative to confront implicit biases and our shortcomings, blind spots, if we hope to address them. When creating structures to support and address diversity, equity and inclusion at the organizational and patient level, it's important to consider intersectionality and recognize that while one may never find someone who has faced discrimination along every access, our goal should be to cultivate leaders who are aware and will remain cognizant of the multidimensional nature of diversity and how nuances like language can affect inclusion. Our ACR Workforce Survey is published regularly. The most recent one does not collect racial demographics, though it does capture binary gender and age. As we strive to improve our efforts in regards to diversity, it's important that we're able to understand specific obstacles of women of color as well as gender-diverse non-binary representation. So in 2018, the National Academies of Science, Engineering, and Medicine published Sexual of Women, Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. This report advocates and supports the need to create diverse, inclusive, and respectful environments in higher education across fields of study. As I was preparing for this talk, I realized that the terms sexual harassment, gender harassment, gender discrimination are used throughout the literature. The NASEM report defines sexual harassment as an umbrella term inclusive of gender harassment, unwanted sexual attention, and sexual coercion. Gender harassment or gender discrimination, as it sometimes might be called, is defined as verbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one's gender. I also would like to say that because this report did not detail sex assigned at birth and gender identity in the demographics, it presumes a binary cisgender demographic. From my point of reference, this is a limited demographic and an antiquated demographic, although not an irrelevant demographic, one from which to build on. So in 2022, also the National Academies of Science, Engineering, and Medicine published Measuring Sex and Gender Identity and Sexual Orientation, detailing the importance for robust, accurate data collection in terms of gender identity. So shortly thereafter, JAMA Network published a report to look at the reporting policies of sex and gender in preeminent biomedical journals. I refer you to my talk earlier this week on Cultivating Best Practices for Sex and Gender Collection and Use in Radiology. So although this is—we're going back to the sexual harassment report by the NASEM, and although this report and subsequent reports I will review are limited by binary cisgender demographic, we'll continue because, as I mentioned, this is important data from which to build on. So let's jump right into this data, results of this report. The survey was given to 11,000 undergraduate students with about 3,000 responses, 4,000 graduate professional law students with about 1,600 responses, 889 medical and graduate students with about 411 responses. And what's very noticeable here is that when comparing female medical students to female graduate not-in-medicine and undergraduate students, 50 percent of female medical students have experienced some sort of sexual harassment. This bar graph evaluates faculty and staff sexual harassment on students. The graph shows that female medical students report significantly more gender harassment than other students, both in non-science engineering and math and science engineering and math. Interestingly, the male medical students also report more gender harassment than the rest of the students, but the difference is not to the degree of difference it is for the female medical students. Across the board, female students face more experiences of sexual harassment than their male counterparts. This report published in JACR in 2020 surveyed the literature reports that these gender harassment statistics are unfortunately supported by general surveys of experienced mistreatment in the medical student graduate questionnaires. The AAMC graduate questionnaires from 2018 to 2021 have similar percentages of students, ranging from 39 to 40 percent over those years, who have experienced public humiliation, derogatory remarks and discrimination based on gender, race, sexual orientation or other personal traits or beliefs. And over the past three decades, the prevalence of sexual harassment among women radiology faculty ranges from 30 to 52 percent in cross-sectional surveys. So let's look quickly at a few studies over the years. 1995 ACR survey of radiologists that is based on the, again, based on the binary woman and men demographic and does not address intersectionality, shows that in the past two years around this survey, 35 percent of trainees and 48 percent of attendings experienced some sort of sex discrimination. 39 percent of trainees and 41 percent of attendings experienced some sort of unwanted sexual attention. If we fast forward two decades to 2016, this survey looks at 1,569 radiologists were polled between September and October of 2016. They only had a 25 percent response rate. This included 400 respondents. Of the 400 respondents, 10 percent had suffered sexual harassment. And in those 10 percent, 24.4 percent of the female group and 4.4 of the male group had suffered sexual harassment. 29 percent had witnessed sexual harassment. We have to not think that we improved from 40 percent to 10 percent in two decades, but because we had such a low response rate, it's not clear if we can say that the rate of sexual harassment is decreasing. So this paper concludes that the low numbers for reporting sexual harassment in the radiology workforce may stem from the notion that reporting might have a negative outcome and be ineffectual. There may be a culture belief that women should tolerate such practices. In 2018, a survey sent out to women in IR showed 22 percent of women experienced sexual harassment during training. 47 percent of women reported experiencing sexual harassment in practice. Only 18 percent of women who reported being victims of sexual harassment had reported these experiences. In 2022, an anonymous questionnaire-based cross-sectional study conducted by the AUR-affiliated 2019 to 2020 Task Force was published, where they looked at 575 anonymous responses from 3,265 social media group members at a response rate of about 17.6 percent. Of these, 375 participants completed the whole study. In this case, the demographic gender was used with values female or prefer not to answer missing. So the results of the survey show that 85 percent of females have experienced gender discrimination, where gender discrimination refers to gender-based behaviors, policies, and actions that adversely affect the workplace setting by leading to disparate treatment or creation of an intimidating environment. 33 percent of females have experienced sexual harassment, where sexual harassment refers to behaviors characterized by the making of unwelcome and inappropriate sexual remarks or physical advances in workplace or other professional situation. There are not enough examples of gender discrimination and sexual harassment in radiology. This thoughtful, comprehensive, and well-written report includes narratives of harassment. I've just included one here, which is so important for us no matter what our role in the department, because this lack of knowledge can limit radiologists' ability to relate to this topic, acknowledge its importance and impact, and take actions toward improvement. The narratives provide a relatable example of gender discrimination and sexual harassment in radiology. They may spark discussions that raise awareness among the radiologists and hopefully will result in much-needed interventions geared towards improvement. So there's clearly a lot of work to be done in this area. As we move forward, improving the culture of radiology and making radiology a more inclusive space, let's return to the concept of moving gender beyond the binary. I encourage you to read this paper by Dr. Tomlinson and colleagues. So as my colleague Dan Chande says, while our ACR Workforce Survey is published regularly, we still don't collect race, and we still capture only binary gender. It's important that we're able to understand specific obstacles of women of color, as well as gender-diverse non-binary representation. And just to review, the NASCM reported on measuring sex and gender identity and sexual orientation details states, let's strive for robust, accurate data collection in terms of gender identity. Models like JAMA and Nature are requiring the robust metrics of gender and sex data collection as detailed by this report. In fact, Dr. Jack C., radiation oncologist at Emory and colleagues, did just that. Existing research had been limited by a lack of comprehensive validated measures, low response rates and narrow samples, as well as comparisons limited to the binary gender categories of male or female assigned at birth. So they published this paper. This survey's goal was to assess organizational climate, sexual harassment, and cyber incivility. Faculty members who received NIH Career Development Awards from 2006 to 2009 and who are still in academics were polled. There was a 64 percent response rate, 830 respondents. So the question was, do experiences that reflect the culture of academic medicine, including sexual harassment, cyber incivility, and positive or negative perceptions of climate differ by gender, race, and ethnicity, and lesbian, gay, bisexual, transgender, queer status, and are these factors associated with faculty mental health? So gender, including the binary categories of male or female assigned at birth, which is cisgender, non-binary, or did not identify gender are collected. Race and ethnicity, Asian, underrepresented in medicine, defined as race and ethnicity other than Asian or non-Hispanic, white and white, and LGBTQ plus status versus cisgender heterosexual demographics were collected. There were concerning rates of sexual harassment, cyber incivility, and negative perceptions of climate, which were experienced that were associated with poor mental health. The key findings of the current study included observations that women were more likely than men to indicate experiencing gender harassment and unwanted sexual attention. Women rate both general and diversity climate as worse than men. Women report certain terms of incivility and sexist comments and harassment when using social media professionally, suggesting that although women's representation in medicine has improved, their experiences still reflect marginalization that requires attention. Mental health was lower for women, and this difference appeared partly explained by differences in the measured cultural experiences. Men also frequently reported unwanted experiences. The lack of interactions between measures of cultural experiences and gender in the modes for mental health suggests that these experiences also have consequences. I like this conclusion here that's in the paper. I won't read it because of time, but I encourage you to look up this paper in JAMA and reference it. So gender harassment is hardly benign simply because it's not sexually predatory. Countless studies have documented effects of gender harassment on physical, psychological, and professional well-being, including job satisfaction, commitment, absenteeism, tardiness, burnout performance, and turnover. One common finding is that harassment rates are highest in fields that are dominated by men, numerically, structurally, or culturally, that this has important implications. Institutions that recruit and promote more women and appoint more women to leadership positions may see a reduction in sexual harassment. So I'd like to list the key points from this 2020 report looking at sexual harassment in conclusion. The prevalence of sexual harassment among women in medicine remains high. Survey research in radiology also demonstrates high rates of self-reported discrimination and harassment. Individuals with multiple social minority identities endure multiple concurrent disadvantages when subject to sexual harassment. Bystanders have agency to impact situations as they unfold. Although individual changes in behavior can be impactful, ultimately wholesale cultural transformation is key to preventing sexual harassment. Leaders in radiology, like leaders everywhere, must make clear that harassing behaviors will not be tolerated and that those who have committed harassment will be held accountable. Again, you can see this paper for the recommendations from the National Academies of Science, Engineering, and Medicine. Thank you. Thank you. And Dr. Tracy Jaffe will follow. And I am going to talk about microaggressions, which is a complicated topic because sometimes it's hard to decide what is a microaggression and what's a macroaggression. If you look at the definition for microaggression, it's something said or done that communicates something negative. And here's where I think there's a change. In stigmatized or culturally marginalized groups, I'm going to erase that and just say towards anyone, I think that we would all agree that any of these comments that make people feel bad are the wrong way to go. So I had a couple options for this talk. I could straight up give you a definitions talk on microaggression. I could talk about my own experiences, either as a witness or as a mistake maker, as an aggressor, or as a recipient. And I decided for the purposes of this talk to talk about it as a recipient because I'm going to have an opportunity to intervene. So here's what happened last week, and it's now actually two weeks ago, but let me tell you the story. So I was walking by the CT scanners, which are near my office, and I heard them call a stroke code. And because I'm a busy body, I lingered to make sure that everything was going okay. I'm the vice chair for clinical affairs, and I just, I'm nosy. So I stayed. Stroke came running in, and it was led by a neuro resident. This resident was also accompanied by a group of nurses. And we also had a bunch of CT techs and radiology nurses there, as well as a radiology resident. So the stroke code resident turns to me, and I'm wearing scrubs, no jacket. My ID turns out, I don't tuck my scrub top in, so my ID is under my scrub top. And he turns to me and says, you, go get me more information about the patient. All right? So I go to the computer. I'm good at following commands. My husband would disagree, but in this setting, I'm pretty good in the work situation. I go to the computer, find out the patient has a contrast allergy. So go back into the room. We've done the non-con head CT, and it becomes clear that we're going to do a contrasted study. So while the stroke resident is faced away from me, I let him know that the patient has a contrast allergy, no past medical history contributing to the symptoms. And I say it aloud, and also ask, would you be okay if I gave some Benadryl, 25 milligrams of Benadryl and some Solumendrol before we inject contrast? And the stroke resident didn't respond to me. So I looked around the room, and I audibly said, how many times do you have to say something in the middle of a stroke code to get someone to acknowledge that you've said something? And one of the nurses across the room said four times. So I realized I had three more times that I was going to have to make my point. So I leaned into the gantry, and the stroke resident is leaning in, talking to the patient, and he's taking care of the patient. And I said, okay, I just want you to know that the patient has a contrast allergy. May I give a dose of Benadryl and Solumendrol so we can keep going? And the resident says, okay, but doesn't turn around to speak, doesn't make eye contact, doesn't turn around. So I just want to stop the story and just tell you that in this moment, we're caring for the patient. I don't really care what happens next as far as how I feel. Solumendrol, Benadryl on board, patient does well, turns out coincidentally on the very top or the very bottom of the CTA, we find PE, which had nothing to do with the patient's stroke-like symptoms. But, you know, we saved the day because now we've committed the patient to long-term anticoagulation. But as the premeds were going in, I stopped the stroke resident and said, hi, I realized that I didn't get your name. And he said, oh, I'm David. And I said, oh, I'm Tracy Jaffe. And I'm one of the vice chairs and the attending in radiology standing here. And his jaw dropped, and the behavior changed entirely. Again, I'm going to pause and say that I didn't like how he was reacting and interacting with anyone in the room. This wasn't about me. This was about using a split second to make a point. I could also tell that the radiology nurses and residents were looking at me and techs were looking at me and wondering why I hadn't intervened earlier. And I thought in this moment, I had a subtle lesson that I could teach him. I wasn't going to embarrass him. I wasn't going to report him. But I wanted him to know that in a group of a whole bunch of people, we could just exchange names. Here's the part of the talk with the definitions. I will just, this is that slide where I showed you anyone. If you're a microaggressions expert, you can split them up into microassaults, microinsults, and microinvalidations. I think that it's very hard for us to distinguish between them because they happen every day all the time. Assault, I'm going to go through these slides because I don't think you need me to define these. I think at this point, what I would tell you is that my story didn't fit any of these categories particularly nicely, but touches on all of them a little bit in a way. I would tell you that in this case, the stroke resident was treating me differently than I expected him to. I don't know what I was expecting. What did I, what was it that he assumed about me? Did he notice that I was a 5'4 female and a cisgender female and I have freckles and I was wearing scrubs and a mask? So what did he get from that? Did he get that I wasn't a physician, that I might have been one of the nurses or technologists in the room? Did he get that I might have been not an attending, that I was a co-level on his level and therefore could tell me what to do or, and this is the one that sticks in my mind, did he think that I wasn't a doctor because I was a radiologist? So did he think that I didn't have any input in this moment of caring? And I don't know the answer. Others have asked me why I waited so long and why I didn't embarrass him or why I didn't dress him down in the moment. And I think that this for me is the take home point about microaggressions. There are things you can do in the moment and then there are things you can talk about later and in the moment, I wanted to make sure we were taking care of the patient. I wanted to find a time where I had his full attention to just clarify what we were doing and I wanted to act like my mother and father taught me. I wanted to act the way I wanted to be treated. I didn't want to embarrass him. I didn't want this to be a big deal. I just wanted him to know my name and when I put that I was the attending, I think that re-centered the conversation. Okay, here's a list of things you can do when you catch your breath. It's a lot of things. I would tell you that some of these for a lot of us are going to feel a little aggressive and are going to feel like require a conversation with a cup of coffee. And I didn't have that time or that ability in that moment. I'll tell you that what I did there in that moment was I separated what was going on from how I felt. I guess I challenged the stereotype because I unveiled that I was the attending. I guess I pretended that I didn't understand because I just skipped over it and just said I don't know your name. And I also let the resident know that I was also a physician and typically it's good behavior to introduce yourself. And so I reminded him of the rules. I wanted to do this because my feelings were not important during the code, but I was able to get my point across with very few words and I got the effect I wanted. I told you I've been a microaggressor and I wanted you to see this slide because I want you to know that we've all done it and here's some things I remind myself of. I want to always own up to it when I've recognized a mistake I've made. I want to apologize. I want to think about the language I use every day in that moment and every day. And I want to take the opportunity to be a role model, at least in the academic environment. So hopefully this little nugget of microaggression is a story that you'll take with you and then unfortunately I would guess recognize it most days as you practice medicine. So thank you for giving me the time to share that story with you. And now you get to hear about professionalism, transgressions. My name is Vikas Kulani. I want to start by saying I hold no special wisdom on this. I'm just sharing some experiences that I've had in my job. And hopefully this is of use to you. When we're talking about unprofessionalism, what kind of things are we talking about? Incivility, discrimination, non-team behavior, bullying, harassment, sexual harassment. The list of bad behaviors is out there. We've all experienced them. And to Dr. Jaffe's point, we've also been on the dishing end of this. And so we all have to think about this carefully. The cost of this behavior is immense. I'm not going to read you the list, but just look at the kinds of words that pop up, decreased work effort, decreased quality of work, worrying, avoiding, performance declining, et cetera. So this is a very costly problem. And it has been said that managers and executives spend about one sixth of their time dealing with this problem of incivility at the workplace. So what can we do about this? Number one, and this point was made in the previous talk as well, that we need to model the behavior we want to see. You got to heal yourself. And none of us is perfect. And the cheapest thing you can do to improve the climate in your department is to say sorry when you mess up. Because that sets a tone amongst the interactions that are expected all around you. And all of us are leaders in some space or another. And so this is very, very important. The second is that we need to hire for decency first. And this is something that's on those people who are hiring. It's very tempting to look at long CVs and figure out what someone is qualified for. But at the end of the day, if you hire for decency first, you're setting a tone in the department. And that will allow more people to succeed than just the person you're hiring. Now, in order to do that, vetting that behavior is super important. And making some discrete calls about what is going on in that person's background is really important because, again, you don't want to introduce bad behavior into a working environment that may be succeeding. The flip side of this is that we need to be honest to each other about these calls. And I think that it's been talked about that the thin blue line, the thin white line also exists, this white coat line that we talk about. We are not honest enough about some of these things. And then it becomes that you're passing off problems from one place to another. Now, if a person is leaving, discussing that problem does not have to be that you're killing their career. It can be a constructive, like this is what it will take for this individual to succeed at your institution. And that, I think, is a much more constructive way of passing on that information. Another part is to state expectations very clearly within the department. And this becomes very, very important in setting, again, the tone that you want. And onboarding is an opportunity to do this. And we actually, at Michigan, have made an onboarding course that we're gonna talk about and we're gonna try to publish on at some point. But we basically have a revolving 12-month course now where you discuss with people the various things that a faculty member may be required to do over the course of their lives. That also allows you to talk about professionalism subtly in almost every one of those sessions. Another part that I am very, really particular about is that oftentimes bad behavior gets so much attention it takes away attention from the people in the department who are doing great things. And I think it is really important within a department to reserve the oxygen for good behavior. What is going on that is great in the department, talk about that more often than talking about the negative. And that will change, I think, the tenor of discussions within the department. What you get attention for is really important. Now, some of this work is driven by evidence. There's an organization, the Center for Positive Organizations in our business school at University of Michigan. They examine top 1% of organizations around the country. These include businesses and other groups. And what they have found and published extensively on is that these organizations tend to derive excellence by recognizing and fostering individual and collective strengths, resources, and potential. So positive leadership is something that they really sort of promote in this organization. And what do these high-quality interactions look like? Well, they are short-term interactions that involve respect, reciprocity, and trust. They can be very brief and they improve workplace performance for a number of reasons. And you can read these studies. I won't go into the detail, but they even claim that they improve physical health. Now, we joined the CPO and we implemented an initial experiment where we did it in breast imaging. And in 2021, we implemented this in the middle of the pandemic, so that makes it complicated to study. Nevertheless, a survey was administered in 2021 and 2023 and very high response rates. And we performed path analyses. And what we found is that by implementing this positive organizational behavior work, we got improved perceptions of leadership, workplace climate, engagement, reduction, and burnout to a very high P value, or very low, I suppose, and a reduction in intent to leave also at P equals less than 0.05. There are many limitations of these studies, and I can go over this with you, but we are now experimenting with this also in interventional radiology. So this is something that has been empirical in our department. But what if someone is indeed behaving badly? What do we do about it? And this is what you don't do, right? I mean, what we often do about it is just stick our head in the sand, and this is just the worst thing you can do because, and this is from an Australian protest, by the way, this picture. But that, I think, just sets up the problem to come back to you in a bigger, badder form. And we also tend to justify bad behavior because every person's on a gray scale. They have many good qualities. So they're an excellent clinician, they take care of their patients, they really care about their patients, they do it because they expect perfection, excellent researcher, they bring in lots of money, they work incredibly hard, they're super fun in other settings, do it when they're stressed, joking around, yada, yada, yada. We've heard all of this, right? And this gray scale does not excuse what the bad behavior is. And we have to be able to separate this out and deal with the problem at hand. And we either stand for something or we're standing for nothing in that situation. So another part of this is that non-traditional models of leadership are very, very important. I have had two associate chairs and one of my very senior vice chairs who took a very long time in their early careers to raise their kids, came back, they don't have the CVs that someone who may have not taken those breaks, but boy, were they amazing leaders in helping me set a tone in my department that I wanted. The titration of responses is very important, that you don't jump from zero to 100, but you titrate up how you're going to talk to this person. I often, when I hear about it, will have someone I trust go talk to the person so it's not the chair right away, that I will save the chair's discussion for a point where the situation has become a lot more serious. And so thinking about what are the steps you're going to take is very important. And a couple of systems that have been developed around this, the PARS and the CORS systems, they were developed at Vanderbilt, they've come to Michigan as well, we're using them. And these are systematic interventions that you do in people who have repeated transgressions. Early intervention is super important because if you rescue somebody from behaviors that are going to be self-destructive later in their career, you're saving their career. So early on, if you can intervene, that's really a super help to that person. These cup of coffee conversations that are talked about also in PARS, CORS, where someone who's trained in this kind of thing can go and talk to a person and say, hey, you had this problem, or I'm sure you didn't mean to do this, but this is how it might have come across. These are kinds of discussions that can be had in private, they can be documented, you can write an email to yourself, but these really help rescue a person from a pattern that could become really problematic. And ideally, you get the person to partner in the improvement in the behavior that you want, you know, and you can almost get them to suggest their own intervention, their own changes that they're after. I have found that annual reviews are super big opportunities for improvement, and this is critical in being able to tell people that, hey, we have such and such expectations. In our department, we also have a policy that I set that you're not eligible for an annual bonus if you have professionalism issues that are documented. And so this sets an expectation that this is gonna affect you eventually, and we have pathways for dealing with that, how they can appeal it and so on, but it sets a tone. And documentation, as I said, bystander training is very important, how to get people to intervene when they don't know how to intervene, and I have had experiences in my own life where I wish I had done something when I witnessed something, and I didn't know what to do, and I think this is very important as well. One of my colleagues, who's a very senior-level leader in our department, she says to me that non-renewal is a tool that chairs don't use often enough, and this has really stuck to me. Now, you don't wanna use this willy-nilly, but if some transgressions are so severe that they're hurting the tone of your department, then it comes a time where maybe that person is not suited for that department, and that also allows them to go to a different place and start over and maybe think about it differently. So this is a tool, I don't use it lightly, but it is there in case you do need to use it, and what it does do is that it also, people who are on that spectrum notice that, and they clean up their behavior. I wanna end by acknowledging two people that have really helped me with this work, Amy Young and Kim Garver, who really brought in the positive business organization stuff from, that's Dr. Young, and then Kim Garver was my first associate chair for department life and culture, and she really helped me set this tone for the department. I also wanna thank Dr. Jess Robbins, who was the original organizer of this session, who really wanted me to talk about this stuff. So with that, I thank you, and I give you Dr. Stephen Harris. I'm Steve Harris, I'm an abdominal imager at Vanderbilt, and also the associate program director for the diagnostic program that's there as well. I think you'll see some common themes from the last presentation, but we didn't work on that together, but some of these are, I'm gonna point out a few things that are specific for trainees, especially for those of you who might not have roles and leadership within the residency program, but it's really still important to know some of these and how you can be an effective teacher and advocate for your trainees. So a trainee is 30 minutes late. So why do you think they're late? So we're talking about wellness and professionalism. There's not a lot of information here, but obviously either one can be the situation. What you think is the reason that they're late might be based on your own implicit biases, it might be based on recent experience, and it's very broad what those two could be, but then you find out that it's the third time they've been late. Now you have more information, you're more concerned, maybe you're the program director being called, maybe you're calling the program director, but it's a very important thing to do, and then during the phone conversation, you also happen to mention that they're also been rude to the staff too. So you have these concerns, and to be honest, a lot of times this might be when you call the program director the first time that they've heard of this. It's a lot of information at once. You're trying to support the residents, you're trying to support the fellow, and it's really important that you kind of address these issues early. So the first question is when we talk about trainee wellness and professionalism, why is there a separate session for this? Isn't it just the same thing as others? I'm gonna try to highlight some of these differences and suggest some tips so that everyone can be ready to support trainees, their wellness, and when they encounter professional discretions. How can you be prepared? And then what can you do? So these are all important things that we can address for trainee wellness and professionalism. So in terms of cultivating wellness and identifying, mediating professionalism, the first is to build community. That's really broadly speaking, but meant to be so. Community within your department, within your residency or fellowship, that's a really important part to have the trainees feel supported, but also set expectations, as you will see. Providing feedback and documentation. Knowing your resources and procedures might not be something that you think about off the bat, but it's really important to be able to support the trainees and then finally to be proactive is a very important step. So what's a trainee? Well, some people kind of think of them as medical students just kind of a little bit advanced, but that's definitely not the case. An attending or maybe your fellows are basically attendings. Is that true? Well, not exactly if they're working as trainees. Trainees have a very special position within that. And that means that there's a lot of steps that go along to it that are unique to trainees. So you have GME involved, you have a DIO and you have ACGME. So they have, while the expectations of professionalism might be the same when there are distractions, how those are dealt with might be very different than other groups. And so it's important to realize those differences and how that might impact you, either if you're involved in education or if you're just in kind of involved with the department, how those discretions might be addressed differently. So be honest, when we think about the challenges of working with trainees and identifying professionalism, how much time do you really spend with the trainees? Has that changed? Do you have, are you partially remote? Do you have attendings that are fully remote? Are you able to really spend a lot of time with them? Do you really spend enough time to know, how they are performing in the professional setting? And then how well do you really know them? Maybe not just their names, but what's really going on in terms of whether they might have concerns about wellness and wellbeing. When we think about wellness, there's obviously all these categories. If you're a trainee, what is the important ones to you? What causes you the most stress? If you're not a trainee anymore, when you were a trainee, what were those? They're probably different than they are for you now. And it's important to recognize that the components of wellness can be different depending on different stages. So trainees wanna be a part of the community. How do we know that? Well, we're in the middle of interview season right now, and I can assure you that's the main thing that our applicants ask about. What are you doing to build community? What's it like being there? How do you support it? How do your residents interact with each other and the faculty? And so that's what they're telling us is really important to them. And definitely professional disruptions can, and wellbeing concerns can certainly coexist. As an attending or a leader in your education department, how do you, the number one thing is to grow and develop your team. That can be forming relationships, not just with the residents, but with other faculty, the nurses, the technologists, the administrative staff to really have your eyes and ears kind of on the ground. So if there are concerns, you identify them early. You're someone that's gonna be trusted, that they can contact if there's anything so that we can kind of be proactive and identify any issues early on. We set expectations as was kind of discussed before. I think it's even more important with our trainees who might be with us maybe only for a year or a couple of years. You can say, well, they're just gonna be here a short time, but if we don't set expectations early then, then bad habits can develop and the culture of your training program or department can be dramatically affected if we're not crystal clear about what our expectations are for our trainees. And then providing feedback is a key part of it. If we observe things that need to be reported, but we don't say anything, some maybe that the first resident or fellow that we identified, maybe that had happened a lot. It just hadn't ever been reported. It hadn't ever gotten to the program director's ear to hear about. There wouldn't be any intervention and maybe you're the person that can be the first person to raise that concern. And that's very important. And then the final part, as we mentioned before too, is documentation. I think sometimes you think about documentation as kind of like lining up the evidence against someone, but I've seen other sides of it too. You can say, well, this trainee's never at conference where if you kind of look at the numbers, maybe their conference attendance is just the same as other trainees, or maybe you have an incident where they say, oh, well, there was this incident six months ago and the first time it comes up is at a CCC meeting or something like that, where the details are kind of lost. It's ambiguous when you kind of ask the resident about it. It was so long ago, it's unclear. And so documentation is a really important part in fairness to the trainee in terms of getting the most accurate information. And so that's the fairest way to treat our trainees. Knowing your resources, and I'll add probably a more important part of that is knowing your limitations. Institutions have great resources that you're probably not familiar with. In fact, your trainees might have access to resources that not even you as faculty have. They might have access to scheduling doctor's appointments or other kinds of resources that are special for trainees. And if you're not aware of those, when you encounter a trainee with a wellbeing concern, you might not even know how to address that or where to direct them. Knowing, being familiar with these resources, including work, personal, career, and family life for let's say childcare or otherwise can really, if you're the individual who can kind of direct them towards those, you can really gain a lot of their trust and become someone that's looked at as someone who's really advocating for the trainees. And you kind of build that trust and community. Knowing your procedures is something that your institution probably has a document that might be a house staff manual that might be pretty short, a couple of pages. But when we look at trainees, they're kind of governed by a very different system. So they have different steps that involve coaching or corrective action. They might have things like individualized learning plans or improvement plans or performance plans. And certainly if you're involved in a training program or a part of a CCC, or even as a general faculty member or someone working with trainees, it's really important to be familiar with at least what these are and what the options are. Because that's a very different system than dealing with either a medical student or an attending. These are very defined tracks that your trainees might be on and to be in familiar with those can be very helpful. So I'll kind of end with this. This is the just culture model which your trainees are probably very familiar with and you might as be as well since it's from the ABR study guide. Most of or many of the, you know, discretions that are come up are often at this ask risk behavior. So the important thing I'll point out here is that the recommended approach is coaching. Coaching is something that isn't just kind of a one-time intervention. It can start with certainly the cup of coffee conversation, but it's oftentimes more longitudinal. It's getting to know the trainee more to be able to have them kind of identify where they can improve and what is really causing them pain or a method of kind of dealing with this. And so that can't happen if you aren't proactive. Our residents and fellows are here for a short time. And so it's imperative to kind of identify any professionalism issues early and to be proactive, not to kind of put our head in the sand here, but really engage in this coaching because that can be the part that really, as we've heard, kind of really can really change their career in a really positive way. All right, so going back to this side of cultivating wellness and identifying and remediating professionalism, we want to build community. That's what our trainees are looking for. And that's what makes it kind of a fun place to work. I expect that many of us are at where we are because of the trainees and to be able to work with them. And so that can be a really positive thing, providing feedback and documenting it, knowing your resources and procedures. If you kind of go from here, it can be one thing to kind of look for and familiarize yourself with, being proactive. And then the final part is that kind of all feeds back. Dealing with professionalism issues in a professional manner can build trust. And then that in turn builds community and trust in you, your department, and your kind of general environment. So thanks so much.

workplace unprofessionalism

gender harassment

microaggressions

medical settings

academic settings

intersectionality

organizational culture

trainee wellness