Enhancing an Experience-Based Patient-Initiated Mistreatment Training

Problem: Mistreatment of health care workers and learners by patients and their families is prevalent at all levels of training. This mistreatment has negative consequences and disproportionately affects women and historically marginalized and excluded groups.

Approach: The authors designed and piloted a preliminary practice-based curriculum consisting of a discussion of literature, a framework for responding to mistreatment in the moment, and interactive simulated mistreatment encounters with trained patient actors. Feedback was generally positive, but participants consistently requested greater diversity in the representation of mistreatment. Using funds from the Josiah Macy Jr. Foundation Catalyst Award for Transformation in Graduate Medical Education, the authors expanded and improved the curriculum to meet the needs of a diverse population of learners. Effectiveness of the curriculum was measured using pre- and post-curriculum surveys.

Outcomes: The curriculum was delivered over multiple sessions from January 2022 to March 2024 with grant-funded interventions starting in January 2024. Participants included medical students, house officers, and faculty, and 678 participants completed pre-curriculum surveys. Upon implementation of grant-funded interventions, post-curriculum surveys showed improvements in respondents' self-reported plan to use skills demonstrated in the session (4.76 to 4.85, P = .006) and plan to address mistreatment with their teams moving forward (4.75 to 4.81, P = .045).

Next steps: All health care workers and learners deserve to feel safe, respected, and welcome in their work and in training. The foundation of this curriculum will support expansion to meet the needs of all patient-facing health care workers and learners at the pilot institution and beyond.