Tools for Creating a Respectful Learning Environment

General advice

Following these tips and guidelines can help you and those around you to develop a respectful learning environment.

1. Do not make jokes about students’, patients’ or anyone’s gender, race ethnicity, age or sexual orientation.

2. Model respectful relationships with peers, trainees and nurses.

3. Remember gratitude

  • Educators: Remember to value your students/residents and thank them for their hard work.
  • Students: Set a good example in the workplace by showing gratitude to your faculty/residents and staff and thanking them for their hard work.

4. Communicating expectations

  • Educators: Communicate clear expectations for students to reduce misunderstandings.
  • Students: Clarify expectations for student’s role on the service to reduce misunderstandings.

5. Performing personal services

  • Educators: Do not ask students to run errands/pick up food, coffee, etc.
  • Students: If asked to run errands/pick up food, coffee, etc., respond in a way that helps others know that you are very interested in the educational opportunities and would prefer to stay in the clinical area and not miss out on these educational opportunities.

6. Paperwork in clinical settings

  • Educators: Communicate with students the expectation, importance and the expected amount of paperwork that students will encounter in the clinical setting.
  • Students: Understand that paperwork is a part of medicine and is integral to the care and management of your patients.

7. Awareness of stressful situations

  • Educators: Develop increased self-awareness of stress level. When stress level increases, take measures to actively reduce it.
  • Students: Develop an awareness of the educator’s stress level. When the stress level increases, take measures to actively reduce it or wait quietly and patiently to let the educator handle the situation.

8. Perception of offensive behavior

  • Educators: Reflect on interactions with students/residents to appreciate how they may have perceived something.
  • Students: Reflect on interactions with residents/attendings/nurses to appreciate how they may have perceived something. When things are quiet/conducive to discussion, bring up the situation and clarify what the different perceptions might have been.

9. The Golden Rule

  • Educators: Remember what it was like as a medical student and think about how you would have liked to be treated.
  • Students: Remember your experiences as a medical student and think about how you will conduct yourself in an exemplary fashion as a resident and attending in the future.

10. Assess the clinical environment for hot spots and think creatively for solutions that would avoid these.

11. If a student or resident reports that they are being mistreated by a nurse or patient, listen and ask questions to better understand the issues, and try to help the student/resident respond appropriately.

Scripts for educators and students

Consider using these scripted phrases and responses to avoid mistreatment and miscommunication.

Educators

  • During critical care situations
    “Please stand to the side for the time being as I am concerned that this patient is very unstable. We can talk about the teaching points after the patient has been stabilized.”
  • During a teaching lesson or clinical situation
    “Please hold your questions until we have sufficient time to give them the attention that they deserve.”
  • When a student doesn’t know the answer
    “I understand that you may not know the answers to my questions. Don’t feel badly about that. I ask them to better understand your knowledge base so that I can teach at a level that will best serve you.”
  • Apologizing
    “I am sorry about this misunderstanding. I may not have communicated clearly.”
    “I am sorry if what I said was offensive to you. I didn’t intend for it to be so harsh, but once I said it, I realized that it would have been better to say the same thing this way…”

Students

  • When asked to run an errand
    “I find the clinical experience to be so interesting and important. I would prefer not to miss any of it in order to pick up coffee.”
  • To avoid being left without a role when a patient is deteriorating
    “During this month, when a patient becomes unstable, in what way can I participate?”
  • To help with communication when a patient is deteriorating suggest the following at the beginning of the month/week/day
    “It would be helpful to have a phrase that denotes that a patient is unstable so that those present are aware of this, but the patient and family are not alarmed. Perhaps something like ‘let’s all pay attention now’. ”
  • When there has been an erroneous assumption or statement
    “I am sorry about this misunderstanding. I may not have understood you clearly.” Then discuss it openly.
  • When something offensive has been said
    “I think I understand the meaning that you intended, however, it might be offensive to others because of the ambiguity. Did you mean… (Restate comment without offensive portion)?”
  • In response to someone yelling
    “I can hear you well, there is no need to raise your voice.”
  • In response to profanity or inappropriate comment
    “I would prefer if you use professional terminology so that I can learn the best way to handle this difficult situation.”

Responding to perceived offensive behaviors

When you are concerned about a situation, think about discussing it with another member of the team. Often a colleague can help develop the best approach to the situation.

  • Educators: Generally, students and residents would like to learn how to respond to these situations themselves, rather than have faculty “rescue” them from the situation.
  • Students: Generally, educators would like the opportunity to understand your perception in order to clear up a misunderstanding at the time or in close proximity to it. It often worsens if it is allowed to fester.

We encourage you to address issues of mistreatment that arise (with nurses, patients, other students, trainees and faculty) in real-­‐time in order to create a respectful workplace.

However, the Associate Dean for Student Affairs would then like to hear about issues of mistreatment as well.


Content adapted from guidelines originally established by Stanford School of Medicine. Revised August 1, 2016.