A Call to Action: Students Establish a Culture of Bystander Intervention Early in Medical Training.

Abstract

To the Editor: Discrimination, harassment, unrecognized biases, and mistreatment are all forces that negatively influence health care work environments and outcomes. As the United States confronts social inequity nationwide, it is imperative that providers and leaders in medicine are keenly aware of how biases shape our profession and overall health care climate. An effective health care culture must uphold values, maintain accountability, and work to reduce barriers that prevent transparency, communication, advocacy, and growth. It is critical that all health care professionals are empowered with skills to intervene when mistreatment occurs and to lead teams to prevent and recognize mistreatment. However, little time is dedicated to such needs. We created a novel 4-session, student-led, prevention-focused, small group Culture Change in Medicine curriculum as an action-based advocacy project targeted at immediate cultural change at our institution. Sessions are near peer-led where senior medical students facilitate small groups of junior students. Four sessions total are completed by all medical students at key transition points of training: Session 1: Bystander Intervention, Preclerkship Session 2: Response to Discrimination and Bias, Transition to Clerkship Session 3: Advocacy, Postclerkship Session 4: Leadership in Action, Senior Practicum Peer leaders facilitate case-based discussions and deliberate possible interventional or protective strategies for victims or bystanders, empowering students with tools to prevent or address mistreatment. Peer educators undergo faculty development training sessions via live webinars and receive educator guides, facilitator tips, and supplemental resources. A faculty advisor oversees the content development and execution of the training. To date, 2 classes of medical students completed sessions of this training, resulting in 510 person-hours of instruction. Feedback submitted through 97 anonymous postsession surveys is largely positive. Eighty-five students (87%) reported that the curriculum had important topics to cover during medical school and 92 students (95%) reported that their peer educators were knowledgeable on the topics delivered in the curriculum. Near peer leaders promoted buy-in and motivation from students, allowing for broader and more honest conversations about these sensitive topics, and provided a stronger sense of security and confidentiality without the presence of authority figures (faculty/staff). Next steps include widening participation to other key groups such as clinical faculty, graduate medical education programs, and other health professions learners and faculty. We hope that our work can also translate to other institutions and provide a foundation for further dialogue and improvement in medical training culture, building new skills to confront the societal norms that lead to bias, discrimination, and mistreatment. Acknowledgments: The authors thank the leadership of the Uniformed Services University School of Medicine for supporting student leadership in this endeavor. Additionally, this curriculum would not be possible without the time investment, professionalism, and passion of the many student peer educators. Finally, the authors thank Military Primary Care Research Network staff for their ongoing assistance in the development of curricular evaluation methods.