Co-designing solutions with students

Co-designing solutions with students

The University of Western Australia’s medical school turned to the Medical Student Society to help them address the high levels of bullying and harassment reported by students on clinical placements

We ran a survey of student experiences in clinical placements in 2018, which showed that approximately 40 per cent of students had experienced bullying while on placement, and 10 per cent had experienced sexual harassment. Half of these students had not spoken to a student or staff member about the incident, and only 33 per cent said they knew what action to take if they were to experience bullying or harassment on placement.

We know that our medical school has always had good relations with its students and we have well-established channels to support them. So what we needed to do was to articulate those pathways as clearly as possible, and ensure that support was easily accessible for students on placement.

We met with our Medical Student Society to collaborate to produce a resource for students. A third-year student representative then began work developing the resource as a Scholarly Activity Service Learning project. The result was our publication “Bullying, discrimination and sexual harassment on clinical placements: a resource for UWA medical students”.

Here are some of the most useful features of our approach.

• Acknowledging and responding to reasons why students don’t report

The stress and work of making a complaint. The resource demystifies the process, so stress from uncertainty is reduced, and the responsibility and workload is transferred from the student to the medical school.

Concerns about confidentiality. The resource assures students that their identity will never be shared with anyone without their knowledge.

Not realising it was bullying at the time. The resource supports students who want to discuss their experiences with fellow students or academic staff, to help them to process their experiences better and help others identify bullying.

• Providing clear definitions of inappropriate behaviour

The resource defines bullying as a pattern of repeated unreasonable behaviour that is intimidating, humiliating, undermining or threatening. It may be subtle or overt. Examples include repeated hurtful remarks, and abuse such as making fun of a person’s work.

It also makes clear that bullying is not one-off abrupt comments, differences of opinion or fair, constructive criticism.

Discrimination is defined as treating a person with an identified attribute or personal characteristic less favourably than another person. Such characteristics include gender, age, race, religious belief, sexual orientation and cultural background. Examples include denying students learning opportunities due to their family or parental responsibilities.

Sexual harassment is defined as unwelcome sexual advances, requests for sexual favours or other unwelcome conduct of a sexual nature. It includes unnecessary touching and sexual blackmail involving threats, benefits or promises.

• Suggestions for what to do when you’re being grilled

Socratic instruction – a series of questions posed by the teacher for the students to answer – is commonly used in medicine. Unfortunately, many have experienced situations where a series of difficult and often intentionally unanswerable are asked. There is little evidence of the efficacy of this teaching method and growing evidence of potential harm, yet it remains commonplace in hospitals.

The resource states: “Every medical student will have had an experience where they will be asked a question that they don’t know the answer to. What happens when the questions keep coming? Is it teaching or is it bullying?”

The resource outlines ways of dealing with this situation in an assertive, positive way.

Is the resource proving valuable?

Culture change takes time and we have no overall evaluation yet; however, anecdotal evidence is encouraging.

“The outcome was that the student felt heard, their distress abated, and they were able to continue and perform well in that rotation.”

For instance, there was the case of a student in an operating theatre who was subjected to demeaning and bullying conduct from a consultant, to the extent that the student had to leave the theatre. The resource gave us a structure with which to deal with the complaint systematically and rapidly. The complaint was escalated to a clinical lead in the hospital, who addressed the matter with the consultant. Meanwhile the student was placed at a different clinical site for the remainder of their rotation and the academic support staff network provided support after the event.

The outcome was that the student felt heard, their distress abated, and they were able to continue and perform well in that rotation.

We are very proud of our resource and see it as an example of the success of projects that are co-designed with students. While it doesn’t change the behaviour of all who work in the clinical environment, we hope that it will raise awareness of the issue, empower students to respond to the issue and, over time, generate the change we wish to see, so that all our students are treated with respect and continue to treat others with respect once they are clinicians.

This story is part of a series: Turning the tide of bullying and harassment
in medical education and training