Championing Civility in the Clinical Learning Environment: Evaluation of a Novel Training Program

Sharon L Shofer; Jane P Gagliardi; Stephanie Bryant; Apurva M Khedagi; Dinushika Mohottige; Ada Gregory; Aimee K Zaas; Tracy Truong; Betty B Staples

doi:10.1097/ACM.0000000000005866

Championing Civility in the Clinical Learning Environment: Evaluation of a Novel Training Program

Acad Med. 2024 Sep 6. doi: 10.1097/ACM.0000000000005866. Online ahead of print.

Authors

Sharon L Shofer¹, Jane P Gagliardi², Stephanie Bryant³, Apurva M Khedagi⁴, Dinushika Mohottige⁵, Ada Gregory⁶, Aimee K Zaas⁷, Tracy Truong⁸, Betty B Staples⁹

Affiliations

¹ S.L. Shofer is assistant professor, practice of medical education, Office of Graduate Medical Education, Duke University Health System, Durham, North Carolina; ORCID: https://orcid.org/0009-0006-7764-9918.
² J.P. Gagliardi is professor of psychiatry and behavioral sciences, professor of medicine, and associate dean for learning environment and well-being, Duke University School of Medicine, Durham, North Carolina; ORCID: https://orcid.org/0000-0003-4667-6607.
³ S. Bryant is a registered dietitian and clinical research coordinator, Department of Pediatrics, Duke Center for Childhood Obesity Research, Duke University, Durham, North Carolina.
⁴ A.M. Khedagi is a cardiology fellow, Department of Medicine, University of California San Diego, La Jolla, California.
⁵ D. Mohottige is assistant professor, Institute for Health Equity Research and Barbara T. Murphy Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York; ORCID: https://orcid.org/0000-0001-5099-4910.
⁶ A. Gregory is associate director, Kenan Institute for Ethics, Duke University, Durham, North Carolina.
⁷ A.K. Zaas is professor, Department of Medicine, Duke University School of Medicine, and director, Internal Medicine Residency Program, Duke University Health System, Durham, North Carolina; ORCID: https://orcid.org/0000-0003-2718-915X.
⁸ T. Truong is a senior biostatistician, Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina; ORCID: https://orcid.org/0000-0001-5923-4037.
⁹ B.B. Staples is professor, Department of Pediatrics, and associate director of graduate medical education, Duke University School of Medicine and Duke University Health System, Durham, North Carolina; ORCID: https://orcid.org/0009-0004-0417-6510.

PMID: 39240790
DOI: 10.1097/ACM.0000000000005866

Abstract

Problem: Incivility in the health care workplace is increasing and negatively impacts everyone in the environment, including health care team members and the patients and families they serve. This study examined the efficacy and impact of Civility Champions (CCs), a novel training program for a multidisciplinary cohort of faculty and graduate medical education (GME) trainees based in principles of trauma-informed care, nonviolent communication, and restorative practices.

Approach: Participants were 39 faculty and GME trainees representing 6 departments in a major academic medical center. The concurrent, mixed-methods study employed the Kirkpatrick New World Model as a framework for the creation of the evaluation tools as well as to analyze and report the results of the study. Quantitative and qualitative data analysis examined participants' reactions, perceived learning, workplace use of the skills following training, and initial indicators of whether the program is on track to meet its goals.

Outcomes: Participants found CCs training to be valuable (84.6% agree or strongly agree that training was relevant and would recommend it to others). Post-training, CCs felt an increased sense of confidence and commitment using the skills and knowledge learned as indicated by a positive average change score (P < .05) on all measures. At the 6-month survey, 70% of CCs had employed the skills. Results on the implementation of the CCs program found that key success factors include improving program visibility, providing opportunities for skill refreshment, and fostering a supportive community.

Next steps: This study expanded a novel training program to multidisciplinary departments and provided early evaluation of the efficacy of the training in the health care workplace. CCs training showed significant measurable benefit using both quantitative and qualitative measures. Future iterations will include training interdisciplinary cohorts and will attempt to assess the program's impact on institutional culture.