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October 26, 2021 | Author: Dr. Susan Moffatt-Bruce

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October is National Bullying Prevention Month, which is timely as bullying and violence against health care workers is on the rise.

Last month, I saw a headline from AP News: “Health workers once saluted as heroes now get threats.” It detailed the wave of hostility, intimidations and violence that many health care workers are experiencing from individuals who are upset over COVID rules designed to keep everyone safe.

The article was about American health care workers but we know this happens in Canada, too. Just last week, The Globe and Mail spotlighted this same issue. And while the pandemic has intensified this abuse, the problem has sadly been happening for years.

Researchers Margaret Keith and James Brophy recently brought attention to this fact in their book Code White (2021). Detailing stories from more than 100 health care workers, the book is a disheartening exposé on the systems-based issues in Canada that serve to perpetuate indifference and acceptance of these incidences as “just part of the job.”

But this shouldn’t be part of anyone’s job.

How we are using our voice and influence to stand against bullying

The Royal College has always been a strong advocate of positive workplaces. Physicians and all health care workers should be free from mistreatment in all of its forms wherever they train, learn and practise.

This month, the Royal College issued a joint statement with the Canadian Medical Forum to denounce the repeated bullying, attacks and protests outside of numerous health care settings.

Beyond this statement, we are using the levers we have available to affect change. For example, our accreditation process ensures that resident training programs that fail to ensure the psychological and physical safety of their learners will face reprimands and remedial action.

Launched in 2019, our new system of accreditation for residency education (CanERA) puts more explicit emphasis on positive and safe learning environments. It looks at indicators like having effective resident wellness policies and supports. This includes having an effective process for the identification, reporting and follow-up of resident mistreatment (e.g. unprofessional behaviour involving intimidation, harassment and/or abuse). Moreover, a new annually administered survey will enable residents to share their input throughout the accreditation cycle — not just once every eight years during an accreditation review.

In addition, through our work with CanRAC (a consortium of the three accrediting colleges in Canada) we are integrating an anti-racism lens into medical education, research and clinical care. CanRAC is collaborating with physicians with lived experience, who are leading expert working groups on such topics as addressing anti-Black racism and Indigenous health. Our shared commitment to support self-determination will influence the health and medical education systems to address the inequities and discriminations that racialized and historically underrepresented populations continue to face. Together with the College of Family Physicians of Canada and the Collège des médecins du Québec, we will explore how accreditation standards and processes can most appropriately and effectively define, evaluate and implement clear expectations for anti-racism and cultural safety in postgraduate medical education.

If you are facing work-related bullying, help is nearby

For those of you who may be personally experiencing work-related bullying or harassment, please know you are not alone in your struggle. While it may be difficult, I encourage you to seek support. Perhaps from a trusted friend or mentor. There are also online supports available. The Canadian Medical Association has done an exemplary job being a voice for physician wellness. I encourage everyone to check out their resources like the newly released Pandemic Wellness Toolkit, which includes a link to a wellness support line. I would also like to remind you that the Royal College has an online learning module to help with recognizing and managing disruptive behaviour in the clinical environment.

This is not the end of the story, far from it

Just like a chronic disease, treating the system will take ongoing medical attention. Organizations, institutions, workers and learners will all have to join together to ensure learning and work environments truly support physician wellness and resilience — not just in word, but in practice.

As we move forward, I welcome your feedback on how the Royal College can further support professional and ethical conduct related to our work in accreditation, curriculum/learning or other strategic priorities.

Please reach out any time: ceo@royalcollege.ca

With gratitude,

Susan

Susan D. Moffatt-Bruce, MD, FRCSC, PhD, MBA, FACS
Chief Executive Officer

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Jonathan Slater | October 27, 2021

As a medical student and as a resident in the 1980s verbal abuse and intimidation embedded in the learning environment. For example, I remember being a clinical clerk left alone on a weekend to care for a palliative patient, mixing chemo without instruction or safety equipment, with the attending physician refusing to answer calls for advice, and then being berated for making the calls the following Monday. This sort of thing carried on through my final year of residency. As a practicing clinician and physician leader there were other forms of bullying to be dealt with. What are the concrete steps that the Royal College is putting into place to improve our workplace environment and psychological safety? There are standards, such as this one: https://mentalhealthcommission.ca/national-standard/ (you may have to cut and paste into browser). Are you endorsing any such standards and incorporating them into residency standards?

Dr. Susan Moffatt-Bruce | November 18, 2021

Hello Jonathan, I am so sorry to hear about your experiences with verbal abuse and intimidation during your medical training (and beyond). It is our great hope that we have made improvements since then — and these efforts are ongoing — to help ensure that residents are even more protected from unsafe learning environments. At this time, we have an opportunity within our accreditation work. While the Royal College has not specifically endorsed the standard you reference from the Mental Health Commission of Canada, we have embedded support for the psychological health and safety (and wellness) of residents in our institution and program standards. It would then be up to individual schools and programs to implement the materials from the MHCC as we do not mandate how an institution or program upholds these Royal College standards; rather, that they abide by them. If you would like more details, please reach out to communications@royalcollege.ca and they can appropriately direct any follow-up questions. Kind regards, Susan

Thomas Baitz | October 27, 2021

I am sure that lawyers would not take the abuse that they individually would experience, parallel to what individual physicians and nurses have to live with. Please publish the LAWS under which immediate police support and criminal harassment charges can be brought against individuals harassing us. I would call it systemic harassment of healthcare workers - no systemic protection is given to us. Oh yes, be polite, smile, etc. while we are human beings and require as much personal support ss anyone else. The College gives us nice words but no protection whatsoever. It is a systemic disease just as much as racism is. Thomas Baitz

Royal College Communications | November 18, 2021

Hi Dr. Baitz, Health care professionals are advised to consult with their workplace or centre’s security team, the police and/or legal counsel if they feel they have been harassed, threatened or otherwise put at risk. Regrettably, the Royal College is not in a position to investigate or respond to specific incidents of harassment.