APSF Develops Simulation Videos and Associated Facilitation Guides to Cultivate Discussion and Affect Change Around Workplace Violence

Jordan Francke, MD, MPH

A sobering study that found 46.8% of all academic anesthesiologists had at least a moderate intention to leave their institution within two years, with high rates of burnout and low rates of professional fulfillment being cited as primary reasons in an article published in JAMA in December 2023. In a session, “’OUCH! Did That Just Happen?’: Anesthesiology’s Workplace Violence Problem,” on Sunday, May 19, during the 2024 Annual Meeting, presented by IARS and SOCCA, moderator Emily Methangkool, MD, MPH, chair of Olive View-UCLA department of anesthesiology and associate professor of clinical anesthesiology at David Geffen School of Medicine, University of California, Los Angeles and trustee of the Anesthesia Patient Safety Foundation (APSF), explored with her panel of experts whether workplace violence may contribute to these sentiments.

Della M. Lin, MS, MD, an associate professor of anesthesiology at the John A. Burns School of Medicine in Hawai’i, director of the APSF’s Board of Trustees and American Society of Anesthesiologists (ASA) chair for the ad hoc committee on harassment, incivility and disrespect, played several audio clips of various healthcare professionals describing episodes of workplace violence they had either witnessed or been subjected to in their careers. She presented a 2022 Association of American Medical Colleges report that showed of all medical and surgical specialties surveyed, both men and women in anesthesiology reported the highest rates of sexual harassment (https://store.aamc.org/downloadable/download/sample/sample_id/524/). Data from the Stoelting Conference in 2021 demonstrated that 71.6% of perioperative professionals (e.g., surgeons, OR nurses, anesthesiologists) experienced nonphysical violence in the workplace, and 31% reported experiencing physical violence. Dr. Lin argued that workplace incivility (even just witnessing it) has significant impacts on physician wellbeing, and leads to worsening burnout and workplace dissatisfaction that can cloud clinical judgment and diagnostic acumen, and even lead to more frequent medical errors.

Alexander Hannenberg, MD, a senior research scientist and faculty member in the Safe Surgery Program of Araidne Labs in Boston, and a former president of ASA where he served as its first Chief Quality Officer, used his presentation to introduce to the audience the APSF’s new workplace violence curriculum that is available to anyone to use, free of charge, on the APSF website (https://www.apsf.org/videos/workplace-violence/). It contains three modules focusing on three challenging encounters that might occur in the anesthesia workplace: discrimination, incivility, and physical aggression. This resource will be invaluable particularly to programs lacking dedicated simulation centers and technologies – it requires only basic technology and therefore can be utilized within every anesthesia delivering center in the country.

Randolph H. Steadman, MD, MS, chair of the anesthesiology and critical care at Houston Methodist Hospital, concluded the session by demonstrating one of the example videos of a patient refusing to receive care from a surgeon of a particular ethnic background. Dr. Steadman said the group envisioned the venue of these media clips to be something as basic as a room with a TV or projector and several small tables. After watching each of the videos, a facilitator at each table is handed a guide to lead a debrief within the multidisciplinary team seated at their table. After small group discussions finish, all the tables can reconvene for a “large group summation” where the most important takeaways from each table are shared. Each simulated scenario also includes a “Take Two,” where the actors illustrate one possible reaction that the affected individuals could take. Dr. Steadman ended his presentation by screening the “Take Two” example of the discrimination in the workplace scenario. He stated that the possible reactions in the “Take Two” videos are intentionally meant to not necessarily resolve the conflict entirely in order to galvanize the viewers to continue discussing the scenarios and how they can be optimized after the session concludes.