Yale Psychiatry Grand Rounds: February 26, 2021

February 26, 2021

"The Office of Academic Professionalism and Development: Fostering a Shared Vision of Professionalism at the Yale School of Medicine"

Linda Mayes, MD, Arnold Gesell Professor of Child Psychiatry, Pediatrics and Psychology, Yale Child Study Center; Chair, Yale Child Study Center; and Andrea Terrillion, JD, Director, Professionalism and Leadership Development, Yale School of Medicine Office of Academic Professionalism and Development

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00:00And welcome to grand rounds.
00:02I'm Cindy Crusoe.
00:03Deputy Chair for Diversity equity,
00:05inclusion in the Department of Psychiatry
00:07and today's grand rounds will focus
00:10on professionalism and one important
00:12aspect of this talk will describe
00:14a reporting mechanism for harmful
00:16behavior in the School of Medicine,
00:18and I just want to stress that that
00:22is a necessary but insufficient
00:23part of the work that we continue
00:25to do around professionalism.
00:28An addressing harmful behavior.
00:29So I really want to.
00:32Encourage us to tipping in those
00:34terms and the work that we really
00:36need to do to continue to build
00:39community and trust within our
00:41community so our presenters today
00:43are Doctor Linda Mays who is the
00:46Arnold Gesell professor of Child,
00:48psychiatry,
00:48Pediatrics and psychology at
00:50the Yale Child Study Center.
00:52She's also chair of the Yale Child
00:54Study Center and director of the
00:56Office of Academic Professionalism
00:58and Development at Yale School of
01:01Medicine and also joining us is.
01:03Andrea Terrell on who is the director
01:05of professionalism and Leadership
01:06Development here in the Office of
01:09Professionalism and Development.
01:10So thank you all so much for being here.
01:13I really appreciate your time and
01:15I'm going to turn it over to you all.
01:19Cindy, thank you so much and it's
01:22really lovely to be with everyone.
01:24Andrea and I have been going around
01:26the medical school and speaking to
01:28many groups and we're just grateful
01:30for the opportunity to tell you what
01:33we're trying to think about in terms of
01:35professionalism and leadership in what
01:37is now becoming VOA PD or the Office of
01:41Academic Professionalism and Development.
01:43What we'll do is bring you into
01:45some of the activities of the office
01:48and what we're trying to grow.
01:50One of the things that it's been most
01:52gratifying about are going around in these
01:55meetings is actually hearing for everyone.
01:57Hearing your suggestions,
01:58hearing the things that are on your mind
02:01that you would like to see changed.
02:03And that helps us then know the directions
02:06and refine the directions that we're going.
02:09Let me just before we go
02:10to the first slide slide,
02:12let me just give a very brief
02:14history of this office.
02:16When Dean Brown joined are now a
02:18year and one month ago to to become
02:21Dean of the School of Medicine.
02:24Nancy brought with her her experience
02:26at Vanderbilt an A great sensibility
02:29about how we bring professionalism.
02:32Into our culture,
02:33but also how we we work to change
02:36that culture and we work to be very
02:39clear about how professionalism
02:41and leadership are coming together.
02:44We also brought together the Office
02:46of Faculty Affairs and what was
02:48previously the Special Advisor to the
02:51Dean office around this broader definition.
02:53In this broader perspective,
02:55on faculty and the development
02:57of faculty in all aspects,
02:59not just their academic careers,
03:01but in their development as a professional.
03:04So our area of the Office of the LAPD,
03:07Andrea, if you can go to the next line.
03:11Or are we? Can I move the slides?
03:16So here are the areas that we focus on
03:19in the professionalism side of oh APD.
03:22Most importantly,
03:23we're focusing on fostering a shared
03:25community vision of professionalism.
03:27What is it to be a professional in
03:31an academic medical environment?
03:33And why we say a shared community
03:36vision is exactly that.
03:37It needs to be shared among us,
03:40but that professionalism is
03:41a responsibility of everyone.
03:43Once we have this community vision,
03:45once we have a shared sense of
03:47values then we all are responsible
03:50for creating a professional culture.
03:53And for upholding that culture.
03:55And for actually mentoring on new
03:57members to our community in that culture.
04:00So the first bullet is very much about a
04:03culture change in the School of Medicine,
04:05and when we get to talking just in
04:07the next slide about our values,
04:09you'll see more of that.
04:12But within that culture change
04:14is also serving as a resource for
04:17individuals who are experiencing
04:19unprofessional behavior from their
04:21colleagues in various settings.
04:23And we want to be a place where
04:25in the people feel that they can
04:27trust that there is a resource.
04:29If they can come to.
04:32That that those responses will be timely.
04:34They will be thoughtful,
04:36will respect confidentiality so that
04:37we are beginning to service that
04:40resource for individuals and apart
04:42then of that is the third bullet.
04:44Is to create very clear processes
04:47and mechanisms for reporting.
04:49For addressing.
04:50Resolving professionalism,
04:51concerns and then following up
04:53on whether how we address them,
04:56how we resolve them has been effective
04:59so bullets two and three really go
05:02together and we'll talk a lot about that.
05:05But on the other side.
05:08As we need to build capacity and what
05:10I mean by the other side is not just
05:14addressing when behavior is problematic,
05:16but how do we actually promote
05:19positive professionalism?
05:20How do we promote people developing
05:22in this identity as professionals
05:24and develop a capacity among all
05:26of us on how to how to address and
05:30facilitate faculty professionalism
05:31so embedded in the fourth bullet
05:34is not only increasing capacity by
05:36training leaders across the school?
05:38And how to recognize and address
05:41professionalism concerns,
05:42but also how to facilitate professionalism
05:45development in their department's?
05:48And in the final bullet,
05:50we believe that leadership,
05:51development and professionalism
05:53development go hand in hand.
05:55That there are sets of skills that
05:57one can learn and learn and practice
05:59and develop across the lifespan of
06:02being a faculty member that promote
06:04professional development that promote
06:06professionalism and to that end we're
06:09developing a number of leadership
06:11development workshops and having a
06:13cadre of coaches to support the faculty.
06:16Andrea,
06:17could we go to the next slide?
06:21So defining professionalism,
06:22I'm going to actually turn to my
06:25colleague Andrea Trillion to start that.
06:27Andrea our first task. As you could
06:29imagine, is to try to do some level setting
06:32in terms of what does professionalism mean.
06:34And of course every time you try
06:37to define professionalism you end
06:39up with a list of don'ts, right?
06:41It's always like I, I don't know what it is,
06:44but I know what. It's not that
06:46just seemed to come much easier.
06:49So we try to really start.
06:51With what do we have that exist that is
06:54existing that can help us anger anger?
06:56Our definition of professionalism
06:58here at the School of Medicine.
07:01We looked at some other organizations
07:03and their kind of definitions.
07:06Love the Mayo Clinic definition.
07:08Here's some literature in
07:10terms of academic definition,
07:12but we started with what we have
07:16throughout the University and
07:18throughout the School of Medicine
07:20and what we did is really again,
07:23look at all of the values, standards,
07:26policies that we have that really
07:29set the standard for our behaviors.
07:32Um and really.
07:34Co late that and and consolidate it into
07:38one spot because as you can imagine,
07:42these are all iaccessible somewhere on some
07:45website somewhere in some communication,
07:47but they're never really in one place,
07:51so the first thing we did on our website,
07:55which is our primary at this point,
07:58centralized point or hub for communication,
08:00is really centralized.
08:02All of these policies and standards.
08:05And there's really,
08:06you know,
08:07we put ourselves in the shoes of
08:09someone who is experiencing behavior
08:10or had witnessed something and that
08:12could be someone who was again
08:15directly experiencing behavior.
08:16Or perhaps a mentor or a faculty
08:19leader where someone came to them
08:20with a with an issue or a problem.
08:23And they're like I don't know,
08:25you know, I I don't think it's right,
08:28but but you know,
08:29how can I again level set my
08:31reaction to kind of the School of
08:33Medicine's standards on these things?
08:35And what we did is for that person
08:38who's kind of struggling. Is this OK?
08:41Is this not OK? Is it me right?
08:44What standard should I apply?
08:46We consolidate all of that information
08:49foundational to all of this is,
08:51of course the core values of
08:54the School of Medicine.
08:55And I'm going to turn it over to Linda
08:58to kind of review that because she was
09:01part of the committee that originally
09:03generated these these core values.
09:06As well as core values for twenty
09:0921st century leaders at the School of
09:12Medicine and she can give you a little
09:15history about how those work.
09:17Thank you Andrea. So in late 2018,
09:19Dean Alcorn brought together 3
09:21climate committees, one on Wellness,
09:24one on engagement and one on leadership.
09:27And then the leadership Committee
09:29was charged with defining what
09:32leadership looks like in the 21st
09:34century in the School of Medicine.
09:37The committee.
09:38Elected after much discussion and much many,
09:41many interviews elected not to focus on
09:45skills themselves but to focus on what
09:49are values that actually drive behavior.
09:52And that's very important that all
09:53of these values that you see here
09:56are the values that underlie the
09:58behaviors that on the positive
09:59side of professionalism and on the
10:01lapsing side of professionalism.
10:04I'll go into each component of the circle,
10:07but to make two points about
10:09this being a circle,
10:10it's very intentional that it's not just
10:13a conservation of space in a graphic,
10:15it's intentional in the sense that
10:17it wants that we want to emphasize
10:19that there's not a hierarchy to
10:21these values in traditional medical,
10:24medical, academic world,
10:25you might see excellence and
10:27science and discovery at the top,
10:29and then other things following.
10:30We want to emphasize here that all of these.
10:34Grown and equal value and that they re late.
10:36Then the second point by the circle
10:39is that they relate to one another.
10:42But you cannot have innovation
10:45and scholarship.
10:46Without focusing on building an
10:48engaged and productive community.
10:50And without having people feel that
10:53they are included in the mission
10:55and having diverse points of view.
10:57You can't sustain an innovative scholarship
11:01without thinking of generativity.
11:04Of the generation coming after you and
11:07the world that you will make for them.
11:10You can't do that without again building
11:12an engaged and productive community so
11:14they all interrelate with one another,
11:17and then we want to call out
11:19the value of integrity,
11:21reflection and communication.
11:23'cause it might sound like that communication
11:26in particular is simply a skill,
11:29but the capacity to think about
11:31the group that you're leading.
11:34The group, whether it's a lab group,
11:36whether it's a section,
11:37whether it's a Department,
11:39whether it's the school,
11:40the capacity to think about,
11:42what they need, where they are.
11:44How to best to communicate and
11:46listen and communication is both
11:48talking and listening to their needs.
11:50Is is a skill, but it's also a value.
11:54That you value the time that it takes
11:57an you value understanding the other,
11:59whether that other is an individual
12:02or a group.
12:03And reflections is also always
12:05the cultivating, yes.
12:07A skill on how to reflect on
12:10the outcomes of 1's actions.
12:12But it's also a value that you value.
12:16The constant learning that goes
12:18with that reflection.
12:19So that's what these values are
12:22and they drive the leadership
12:24skills that we want to emphasize,
12:27and they drive the.
12:29Also the professionalism behaviors that
12:32we want to encourage and facilitate.
12:35These values have been adopted
12:36as the School of Medicine values,
12:39so not just for leadership,
12:40but as the values for the School
12:43of Medicine. And so Dan will go
12:45back to everything on the other.
12:47The grey side of the slide and I'll
12:50turn back to Andrea.
12:51So with respect to the other policies
12:53and standards we we site and where
12:56we're calling people's attention to
12:58the Yale standards of faculty conduct
13:00applied to all faculty members,
13:02and it really outlines roles and
13:04responsibilities as it relates to.
13:06Faculties obligations as scholars,
13:08educators and members of the Yelp
13:11community with respect to other
13:13policies and codes of conduct,
13:15we have cited the policy
13:18prohibiting discrimination,
13:19harassment and sexual misconduct.
13:21All of the the the standards with respect
13:24to the the responsible conduct of research.
13:27We have addressed the clinical
13:28as well because through the Yale
13:30Medicine practice standards
13:32and professionalism Charter,
13:33there are specific standards with
13:35respect to the clinical practice
13:37at the School of Medicine.
13:39The Yale Standards of Business
13:41Conduct applied to every member of
13:43the Yale Community and deal with
13:45things like and we all see them and
13:48sign off on them when we onboard but.
13:51You know they're not there again,
13:54they're not in front of us every day,
13:57but they they deal with things like
14:00treating people with respect, honesty,
14:02and integrity in our dealings.
14:04Conflict of interest, conflict of commitment.
14:09Honesty, financial integrity,
14:10those types of things and then
14:12we have the the campus Workplace
14:15violence prevention policy,
14:16which again talk specifically about
14:18behaviors and the privacy and
14:21security of health information of
14:23course talks about or deals with all
14:26of our duties as it relates to the
14:29privacy of health information so.
14:31All of these really help us define
14:35and get a picture of what?
14:38Professionalism means at the School
14:40of Medicine and again as you can see
14:43from the responsible conduct of research,
14:45academic and research integrity is
14:47part of the scope of our office.
14:51Again,
14:51just a way for us as we continue
14:54to evolve an an again.
14:56This is an iterative process until
14:58we're able to kind of come up with
15:01or arrive at a pithy list of of
15:0310 pillars of professionalism.
15:05These are at least the things that
15:07we continue to flesh out so that we
15:10all have a mutual understanding in
15:12terms of how we're supposed to conduct
15:15ourselves and treat one another.
15:19So should we go to the
15:21next slide show under this is sure
15:24this is all the example of all that's.
15:27This is an example of the Don't list,
15:30which we have an we communicate,
15:32but as you can as you can imagine,
15:35it's impossible to have something
15:36that's 100% inclusive but just
15:38gives people a little sense of the
15:41types of things that we in in the
15:43scope and continuum of behaviors
15:45that could be considered to breach
15:47the professionalism standards.
15:52And we have now a central portal.
15:54But before I describe the portal,
15:56I want to to make one more general frame.
16:01We have a portal for reporting concerns
16:03and we're spending a fair amount of time
16:06right now talking about reporting concerns.
16:09The overall goal though,
16:10as I said earlier of this office,
16:13is to change the culture.
16:15And to change the culture
16:17so that professionalism,
16:19actually so that professionalism,
16:20concerns go down and that we're
16:22celebrating exemplary examples
16:24of professionalism everyday.
16:25So we're also working on the positive
16:28prevention development side of things,
16:30because we don't want just to
16:33be a portal for all bad things,
16:35but we do have a central for Portal Now.
16:39One portal, one route,
16:41an if you go on the OH APD website,
16:45you'll see this very bright red button.
16:48And it's on various places on
16:49the website where you can click.
16:51And report a concern.
16:53We will, as will describe,
16:54will help them find the appropriate
16:57routes for addressing that concern.
16:59But then, if you choose,
17:01you can call and you'll reach Andrea
17:03or me or our other colleague,
17:06Jessica Wyland.
17:06We have a web and email that's
17:10viewed only by the three of us,
17:12so that's another route as well as
17:15this professionalism anonymous.
17:16Or you can name reporting Andrea,
17:18do you want to add to this
17:21just in terms of that these
17:23reporting mechanisms of course,
17:25do not anyway interfere with anyone directly
17:28addressing a concern that they might have.
17:30You know, this is for individuals who
17:33maybe aren't comfortable doing that,
17:35or perhaps they've tried to get
17:37behaviors addressed in the past and.
17:40It just had.
17:41They haven't just gotten any traction
17:43or the behavior has persisted,
17:45but nothing prohibits someone
17:46who's comfortable from doing that.
17:48The other thing is I do
17:51with respect to reporting,
17:52our office is a resource,
17:54not just to folks who feel that they
17:56feel that they are being the subject
17:59of of unprofessional baby behavior,
18:01but also individuals who may see
18:03things right or may be struggling with
18:06something because maybe Amenti has
18:08reported something to do something.
18:10To them,
18:10and they don't quite know what to do with it,
18:13so again,
18:14there's that this is a way for you
18:16just to reach us so that we can
18:18provide that consultation and help.
18:20So it's just a way to make us
18:22iaccessible or the office iaccessible
18:24if someone doesn't know her name.
18:27And Ann has not dealt with us before.
18:29It's really a way for people
18:31just to access the office.
18:35And the other point to add to this is as
18:37Doctor Christo mentioned in the beginning,
18:40that we are we have created
18:43this way of reporting concerns.
18:45But we're also trying to do this on a
18:47central level and really asking that
18:50this that people report when they need
18:52to report will consult you individually.
18:55But if you need to report
18:57that you report Centralny.
18:59On for this reason.
19:01We're trying to standardize responses.
19:04We're trying to standardize procedures.
19:07But we also and I know that this will
19:10sound like on the negative side of things.
19:13But but we also want to be sure
19:16that we can early on see when people
19:19are starting to have trouble.
19:21In the past five,
19:22one concern might go to one office,
19:25another concern or a similar concern
19:27that might go to another office,
19:29and there was a very not
19:32coordinated response,
19:32so it would be very possible for
19:35someone to be having having some
19:37challenges that were different offices
19:39were addressing but never knew,
19:41never knew the full story.
19:43Never knew that this person,
19:45for example,
19:46was doing quite well until two months ago,
19:49when all of a sudden three different
19:52things happened.
19:53So that's another.
19:54That's another purpose of having
19:56a single portal is so that we
19:58can coordinate information.
20:00We can have a much more early
20:02response early detection,
20:03and for those small number of people
20:06that are having difficulties over
20:07longer periods of time that we can
20:10identify those much earlier and
20:12before their impact on a number,
20:14any number of our missions is more profound.
20:17Would you add Andrea?
20:19Yeah,
20:19I think
20:20that's that. Those are great points.
20:23But say so. One of the things we really
20:27want to address with everyone is.
20:31Is essentially what can you expect
20:32after you when you report a concern,
20:34because I think one of the big.
20:37I think hurdles sometimes is that
20:39people feel and this could be someone,
20:41again a mentor leader who
20:43comes to us with a listen.
20:45This is what I'm seeing or this is what
20:47I've heard or someone who's actually
20:49being the subject of certain types
20:51of behavior that are unprofessional.
20:53There's a fear of losing control,
20:55you know, like you give it to this office,
20:58you bring it to this office and
21:00then they're off with it on an
21:02institutional basis and you really
21:03feel like losing control.
21:05And that's really scary.
21:06'cause it's hard enough to bring concerns.
21:08Forward, so how do we deal with that?
21:12That fear,
21:12and I think one of the things we
21:15we stress in all communications,
21:18our website and and presentations
21:20such as these and when dealing
21:22with folks who bring issues forward
21:24is we really consider ourselves
21:26consultants in the first instance.
21:29So anybody who reports a concern,
21:31we,
21:31we sit and we talk about how can
21:34we address that unprofessional
21:36behavior or the circumstances, right?
21:38That prompted the report and really do
21:41so in a way that they are comfortable
21:44with in terms of their confidentiality
21:46and all these other types of things.
21:50So it's not like a report, and then we go.
21:53It really is a conversation now.
21:55We can only do that if we know
21:58who's bringing the report forward,
22:00and we do.
22:01There is a mechanism for anonymous reporting,
22:04but to the extent someone has,
22:06someone identifies with the
22:07complaint or contact us directly.
22:09We that's part of our initial
22:12conversation with them,
22:13so we can problem solve and use our
22:15creativity to address behaviors.
22:17But again, protect confidentiality
22:19or at least address those issues.
22:21And again,
22:22navigate the problem while
22:24observing any parameters that
22:25they might be comfortable with.
22:27Fact finding.
22:28In many instances a it may be warranted
22:31for us to actually do additional
22:33factfinding when we get a concern
22:36raised to our office, and we do that.
22:39And we do that.
22:40In the form of fact finding specific
22:43concerns or conducting confidential
22:45climate assessments of work units.
22:48Engagement, an referral.
22:50We engage.
22:50Depending on the nature of the concern,
22:53the role of the person who
22:56has brought things forward,
22:57or the person who's involved.
22:59We collaborate heavily with
23:01Darren Latimer's office.
23:02You know the deputy Dean of Diversity,
23:04inclusion, and our Chief diversity Officer.
23:07If a postdoc is involved,
23:09we would talk to the the Office
23:12of Postdoctoral Affairs,
23:13an if a staff member is involved
23:15in all of this,
23:17we would collaborate with
23:19human resources as well.
23:20Again,
23:21it's about evaluating and
23:22addressing the concern in.
23:24It's not about turf,
23:25it's just about kind of.
23:27How can we most effectively deal
23:29with the issue?
23:30That's that's in front of us and we speak.
23:33I mean, we communicate regularly with
23:35with Dean Lattimore on a number of issues,
23:38and that gets to the last point,
23:40which is sometimes we're not the best.
23:43We we are not the most.
23:45We are not the most appropriate
23:47office to deal with an issue,
23:49so something they came.
23:51Come to us, but it's more
23:53appropriately handled by Title Nine,
23:55quarter eight coordinator,
23:56or a Title 9 office rather than our office.
24:00Same thing in referring things to
24:02deal at a more or the Office of
24:05Institutional Equity and Access.
24:07So again,
24:08there's a lot of partnership interaction,
24:10engagement with our professionalism
24:12partners because no one concern
24:14is the same and everything has
24:16nuance and specificity to it,
24:18so we're working very cooperatively
24:20with one another.
24:25To the next 100
24:26confidentiality and no retaliation.
24:28Again, very, very. As you can imagine,
24:31top of mind concerns for anybody
24:33who interacts with our office,
24:35and we have addressed the issue of
24:38confidentiality and no retaliation explicitly
24:40on our website and provided details on that.
24:43Again, for people who are who are wondering,
24:47right? Should I do this?
24:49Should I should I should I trust this office?
24:52Should I reach out to them with
24:55respect to confidentiality?
24:57All issues,
24:57all issues that are brought to our office
25:00are treated with the utmost discretion.
25:03We have detailed conversations about
25:05the parameters and preferences of the
25:07individual with respect to confidentiality
25:09and the request for absolute
25:11confidentiality may impact resolution,
25:13but it doesn't mean we can't do anything.
25:16You know that that we that we
25:18can't come come up with some way
25:21to protect that confidentiality of
25:23the individual who reported it and
25:26do something to address behaviors?
25:28And that's our job, right?
25:30That's where our creativity and our
25:32skills come in, and we do again.
25:34Have detailed conversations with
25:36folks who brought concerns forward.
25:38I will tell you when we follow.
25:40When I fell off,
25:41I'll follow up with people after
25:43they brought a concern forward.
25:45I will say listen,
25:47it was addressed an the parameters
25:49that we decided upon that that we
25:51agreed to with respect to your
25:53confidentiality were preserved.
25:54So again,
25:55just to keep make sure people
25:57understand they don't lose total.
25:59Control and that their confidentiality
26:01concerns are are respected with
26:04respect to retaliation.
26:05Retaliation is prohibited against
26:07individuals who in good Faith report
26:10alleged violations of Yelp policy
26:12or law or provide information in
26:14connection with the investigation
26:16of these matters.
26:17This is the policy of the University.
26:21It is specifically articulated
26:22and displayed on our website.
26:25We talked to people about this
26:27when they bring concerns forward.
26:30By the same token, we also speak to,
26:33you know,
26:34someone who's who's were where
26:35professionalism concern has been
26:37raised about their behavior.
26:39When we speak to them, we do.
26:41We know, we educate.
26:43We talked to them about the
26:45prohibition and we also kind of
26:47educate about things that come natural,
26:50particularly things though.
26:51That come that would come natural
26:54to folks who are in.
26:56In do the type of work that you do,
26:59your fixers, you know you fix things,
27:01and you know the natural instinct
27:03of many if not most,
27:05is to literally say you know this thing.
27:07Was this this issue?
27:08What they talked to me about this issue,
27:11you know? did I offend you?
27:13They start to ask about it.
27:15If they start apologizing to everybody
27:17and one of the things is that's a
27:20natural instinct 'cause most people
27:22do not want to offend people and
27:24don't want to make people uncomfortable.
27:26But again,
27:27educating that that natural instinct,
27:28right that natural kind of path
27:30in many ways just serves to make
27:32people uncomfortable and it could
27:34be perceived as retaliation.
27:36So that's again part of our education,
27:38as when we talk to folks about these issues.
27:41'cause again your,
27:42your brain automatically goes to
27:44oh goodness, who reported this?
27:46And did I offend them and you want to fix it?
27:50And we have to explain kind of why that's
27:52not that why that's not allowed and how
27:55it's in everybody's interest not to do that.
27:58But just to kind of take the feedback
28:01and adjust your behavior and the final
28:04thing is that if in fact individuals
28:06believe that they have been the subject
28:10to retaliation because they spoke
28:12to our office or any office in the
28:15University of someone brought a Title 9
28:18complaint were or went to the Diversity
28:21Office with a claim about diversity,
28:23inclusion or discrimination.
28:26That they need.
28:27They can come to us or back to the
28:30original office and report that an and
28:32one of the things that I think it's very
28:35important to know about retaliation.
28:37Prohibition is that the initial problem
28:40may be quite small in discrete right?
28:42The concern that was brought forward
28:44may be quite discreet and not serious.
28:46But if in fact it is determined
28:49that retaliation has a curd that
28:52then that discreet.
28:53Smaller problem becomes a much bigger
28:55problem because that is something that
28:57we cannot have because people have to.
28:59If we're going to have a decent culture,
29:02we have to have a culture of safety and
29:04that people can bring forth concerns.
29:06And if we don't have that and people
29:09can hear about concerns without
29:10retaliating 'cause we don't have that
29:13we just don't have a shot, right?
29:15So we have to really take a hard
29:17line against that.
29:22Did you have anything to add to
29:23that? No, I think that's well stated.
29:25Do we? Should we go to the next slide?
29:29So our overarching goal of this office
29:32is is Andrea has also said is education.
29:36We want actually overtime we
29:39want to educate people about.
29:41The standards of professionalism
29:44about how to respond.
29:47Um, about the various ways
29:48that we can be helpful as well,
29:51and then also as much as we
29:53can to remedy those breaches.
29:55We try and we are.
29:57This is actually very important to us,
30:00to be intervening in a very timely way.
30:03So we monitor the website daily
30:05several times a day we're monitoring
30:08the reported concern and so we will
30:11respond in a timely way and do our
30:13best to be not only responsive quickly,
30:16but responsive, thoughtfully,
30:17and listening to the individual
30:19needs in the individual colors.
30:21If you will, of any concern.
30:24Everything is different.
30:25Every concern is different.
30:27There's just not a list that we can make
30:30and then say for concern a steps 1,
30:33two, and three occur.
30:34We take into account these drivers,
30:36the character of the behavior,
30:38the seriousness of it.
30:40Is it a first time occurrence?
30:43Watts the context as it occurs
30:45in the context of tremendous
30:46stressors and that individuals life.
30:49What are all the things that really
30:52determined Anna go into that behavior?
30:55And is it reccuring?
30:57How often is it a Kurd but also is
31:00it recurring and is it recurring
31:02over a short period of time or
31:05a long period of time?
31:07Those are the various things
31:08that we need to take into account
31:11in what makes this this work?
31:13Have an individual flavor as
31:15well as the need to be
31:17creative. Andrea, please add.
31:18I would just say that when you look at the
31:22research in this area that has been done,
31:24you know the research shows that 75 to.
31:2780% of professionals in an academic medical
31:31academic Medical Center environment self
31:33correct within a few awareness conversations.
31:37So I think we I mean that
31:40kind of enters into our work.
31:44You know, having the conversation when the
31:48incident is isolated when the incident has,
31:51you know is smaller if you
31:55will or less significant.
31:57And I'm not I'm separating serious,
32:00serious misconduct here,
32:01but behaviors that are are
32:02breaches of professionalism,
32:04but and but like add up, right?
32:07An and tend to negatively
32:09impact the culture most.
32:10Again a very high percentage of folks the
32:14research shows will self correct with some,
32:16with with with, with in a few awareness I
32:19mean three or less awareness conversations.
32:22And I just think that that I
32:25think is really driving our work.
32:28And that if things are brought up and they
32:31are addressed that most most of these
32:34behaviors will in fact stop and cease,
32:37and an that's a very I think,
32:39powerful statistic that motivates
32:41us every day as we do our work.
32:48And then we're also developing.
32:50As we said earlier, we're developing
32:52because we think of leadership and
32:55professionalism is hand in hand.
32:57And we actually want to change the
33:00culture and we want to give people skills
33:04early on to address not only to address,
33:07professionalism, lapses,
33:08but skills about having
33:10difficult conversations about
33:11engaging communities and groups.
33:13So we're developing leadership
33:15education opportunities for
33:16faculty at all ranks and roles.
33:19We already have a set of customized
33:22workshops that are on the on our website.
33:26That Department scan request.
33:27And we will come and do those for you.
33:31And then we'll have some open
33:33enrollment workshops that are
33:34starting in the spring of 2021.
33:37Very specific leadership
33:38development programs justice.
33:39Earlier this year we launched a
33:42leadership development program for
33:44new section Chiefs and program leads
33:46and that will then become a twice
33:49a year offering for anyone that
33:51assumes those new leadership roles.
33:54In that program includes didactic sessions,
33:57but also includes peer peer support,
34:00pure coaching over an extended
34:02period of time.
34:04One of the nice things about we've
34:06discovered in our first round about
34:08the program is that you bring section
34:11Chiefs together from different
34:12departments and they start to both hero.
34:15You're dealing with the same thing
34:17I'm dealing with and they begin to
34:20learn how to share skills and learn
34:22to be supportive of one another.
34:24So you also,
34:25we're also creating a condray if you will,
34:28of leaders that can help each other see
34:31different ideals with each other and
34:33will be offering the second group of this.
34:36Program later this spring.
34:39The emerging leaders in the advanced
34:41Emerging Leaders Program is one
34:43that's been going on for awhile
34:45in collaboration Yo medicine,
34:46in collaboration with the
34:48School of Management.
34:49But the important difference now is that
34:51the program has not doubled in size,
34:53so it was 40 and it's now 80.
34:57And working together with
34:58Paul Taherian yo medicine.
35:00We're creating channels where people
35:02can actually apply as well as be
35:04nominated by their chair and working very
35:07closely with the School of Management.
35:09Again around the values and how
35:11we how we teach leadership skills
35:13that will support the values.
35:15The final area that we're
35:17actively developing right now.
35:19And then there's others that if
35:21you invite us back in a year,
35:24this list will grow.
35:25But we're creating a cadre of coaches.
35:28That are both external to Yale as well
35:31as internal coaches and can provide
35:33developmental coaching that is for again,
35:36such as new section Chiefs who
35:38need to learn some very specific
35:40skills as well as coaching that
35:42addresses when there has been a
35:45professionalism concern and there is
35:47clearly a need to learn something
35:49different and you and you way of
35:52approaching whatever the circumstances,
35:53we will connect those individuals with
35:56this group of coaches an will pair them.
35:59Pair them up really based on
36:04individual individual compatibility.
36:06Our office then creates a set
36:08of goals for the
36:10coaching that then the coach and
36:12the Coachee can adapt and revised.
36:15But we do create those goals,
36:17especially when the coaching has been
36:20asked for mandated as a part of a
36:24intervention for professionalism concern.
36:26Actively growing this cohort.
36:27So in a year from now we will have more
36:30and we're growing it out at different
36:32levels of coaching support as well Andrea,
36:35would you add just I just
36:37want to stress that when we talk
36:40about leadership development,
36:41but I think at times people
36:42automatically go to people who
36:44have some sort of leadership title.
36:46And as we interpret it again with respect
36:49to the education for all faculty.
36:51Thanks and rolls, it is about again how
36:54to have that difficult conversation.
36:57How to receive that difficult conversation,
37:00communication, building alignments.
37:01You may have a very very small team
37:05and you know how do you deal with
37:08even interacting with a 2 trainees,
37:11Anna Nana support staff,
37:13member of the support staff.
37:15So again I just think that we're
37:19interpreting leadership development in
37:20its broadest and most generous sense.
37:23And our intent is to get those
37:26programs to just about everyone who
37:29again needs some soft skills training.
37:32And an you know,
37:33those those types of skills that really
37:36again prep them for leadership roles,
37:38but also help them in their their
37:40day-to-day in the role they're currently in.
37:44And so I would add that there's two things
37:47that I hope we both hope that you can hear.
37:50One is that we think of leadership
37:52as a developmental progression,
37:54not as just simply assuming a job or
37:56moving up moving up the hierarchy.
37:59We think of leadership is something
38:01that can be learned as a set of skills
38:04and a set of skills that you can use.
38:07If you're running your lab of
38:10three or your Department of 500.
38:12So we really think of leadership,
38:14not is just moving up the hierarchy,
38:16but skills.
38:17The other piece that that is really important
38:20that I hope you're starting to hear,
38:23is that it goes back to the
38:25addressing of concerns is that
38:27we don't just address concerns.
38:29And then that's it.
38:31We're very much continuing to be
38:33involved and following up with both
38:35the individual that brought the
38:37concern as well as the individual
38:39about whom the concern was brought.
38:41Because we believe that it's
38:43important to follow up to be sure that
38:46interventions have had an impact,
38:48but also it's a developmental developmental
38:51idea that people can learn and change.
38:54And we want to help to track that Andrea.
39:01So do you want to go on this one?
39:05This this just kind of shows the role of
39:08the office and providing consultation
39:11support for chairs and section Chiefs just
39:15again developing a strategy to address
39:19and remediate unprofessional behavior.
39:21Supporting directly or indirectly
39:24very necessary conversations.
39:27And sometimes those can be difficult
39:29regardless of what what role you're in.
39:32An again our offices role in
39:35supporting those conversations,
39:36again either being present, ANAN,
39:39participating in the conversation,
39:41or assisting the cherished section chief
39:43with having that behind the scenes
39:46again factfinding conducting climate
39:48assessments to assess work environments,
39:50and those again are confidential
39:53thematic overviews of an environment
39:55that provides the leader with a sense
39:58of how people are experiencing.
40:00The unit and their colleagues an.
40:03Again, it provides fruitful information
40:05for how we can make recommendations
40:08about adjustments,
40:09things that can be done additional supports
40:12that can really change that environment.
40:15Conducting 360 feedback reviews
40:17of individual faculty members,
40:19and again providing check and
40:21follow up in coaching support to
40:24individual faculty members.
40:25Units Department's What we do
40:28as well is again the vetted.
40:31An executive that vetted and matched
40:33executive and leadership coaches.
40:35We do Oriente them to the School of
40:38Medicine values and then we do follow
40:41up in corrective coaching engagements
40:43just to ensure that it's not OK.
40:45You have a coach go go fix it
40:48and no one ever says OK.
40:51Is it time to stop or is this actually
40:54happening that if in fact the the Department
40:57and then individual is engaged in coaching?
41:00Let's make sure it's the right
41:03one for that person.
41:04You know,
41:05let's make sure that that it's a
41:07good fit and that it is an active,
41:10engaged,
41:10and productive engagement.
41:14And that is it. So I think I can still be
41:17very glad to take questions. In fact, the
41:19questions are what we actually really want.
41:22'cause we would really like to discuss.
41:24I do see that there's already one question.
41:26Cindy, did you want to monitor
41:28them or do you want me to
41:30do that? Go ahead, we can.
41:32We can both tag team here.
41:34Go ahead. Alright sounds great. Thanks.
41:35So the question is who conducts the
41:38fact finding and what options for
41:40representation will the person who is
41:42the subject of the fact finding half?
41:44And the consequences?
41:45So the fact finding as Andrea
41:48and I can do this together,
41:50the fact finding is conducted by us, Andrea,
41:53Me or Jessica while in in our office.
41:56But we also, if needed, as we said,
41:59will reach out to other offices to help.
42:02We're always working very closely
42:04with both the person that brought the
42:06complaint as well as the person about
42:08whom the complaint has been made.
42:10And and I don't know what the
42:12person who asked the question.
42:14What you mean by representation.
42:16But certainly if the individual
42:18wants to have a friend or colleague
42:21with them when we speak with them,
42:23that's that's fine and always allow Andre.
42:26Do you want to add to that?
42:29No, I think that covers it.
42:32And the potential consequences go.
42:36I know it would be actually probably much
42:39more reassuring if we could have behavior
42:42a consequence B behavior C consequences D,
42:45But the consequences actually can range from,
42:48as you've heard, vacanza conversation
42:50that with the individual and
42:52talking about why did this happen,
42:54their perspective on how it happened
42:57and how they might change to all the
43:00way that certain things are more serious
43:03as the other part of your question.
43:06Implies about employment or promotional
43:10concerns. The consequences are decided
43:14in collaboration with the Dean.
43:18Well, First off the.
43:19Even the process that I'm about
43:22to describe is.
43:23Determined by the severity of the incident.
43:25So if it's a first time event,
43:28we've had a conversation,
43:29we're not necessarily going to invoke
43:32Dean and chair and everyone around that.
43:34If it's much more serious than the
43:37consequences might be reviewed by the Dean,
43:39the section chief, or the chair.
43:42And and then we will,
43:44depending on the severity of the incident,
43:46we will need to get the general
43:49counsel involved.
43:49Andrea, please add.
43:51Again, I think it's it's very very
43:54specific in terms of the nature
43:56of the the nature of the conduct.
43:58Most don't rise to that high level
44:00unless there's again a very specific
44:03and destructive pattern or very
44:04serious incident of misconduct.
44:06It's it's really conversation
44:07and then that that is,
44:09we have found that just when you look
44:12at again at the research in this area,
44:15but also for us, that is,
44:17most issues are resolved
44:18through that approach.
44:19If they're not, or if it's serious, then.
44:22You know it.
44:23It has to be escalated and we do.
44:30Other questions. We be glad that yes, power.
44:36And you're muted.
44:37How are you got it, thanks.
44:40I'm glad to see this taking off
44:42I I just recently. Reviewed
44:44decision that Judge Arterton
44:46wrote on a motion to dismiss last
44:49week about a case from the anesthesia
44:53Department against Yale and Yale,
44:55New Haven Hospital. And I mean this
44:58occurred a couple of years ago and I
45:02think shows the need for this kind of
45:05thing. One of the things that
45:08disconcerted me a little bit about.
45:11Um? The filing was that Yale New
45:17Haven Hospital tried to argue.
45:20That they were not an educational
45:23institution under Title 9.
45:25That offended me a little bit. I thought
45:29that seemed inappropriate.
45:32Well, how are the Rays actually?
45:35He raised an important point.
45:38So we've been talking a lot about
45:40the Yale School of Medicine,
45:42and this office sits in the
45:45Yale School of Medicine.
45:47Leo New Haven Health System
45:48is a different system,
45:49which is the point you're actually
45:51raising and hence they can make
45:53that argument whether whether
45:54we accept that argument or not,
45:56they can make it because
45:58they are a different system.
46:01That having been said,
46:02one of the things that we're actually
46:04working very closely on now it's
46:07coordinating these efforts with Yale.
46:08New Haven health system that cause,
46:11for example,
46:12an event might happen in the operating room.
46:16And that same faculty member might have had
46:19another event in a clinic of Yale Medicine.
46:22And heretofore,
46:23those would have been two separate events.
46:26Um?
46:27Either party might not have
46:29known about the other.
46:31And most importantly.
46:32When you take those two together,
46:35it might be more of a symptom,
46:38an indication that that faculty
46:40member was beginning to struggle.
46:43And that a different level of
46:45intervention was really needed because
46:46they were beginning to struggle.
46:48It was starting to filter across
46:50all of their work environments.
46:52So that's the other reason for bringing
46:54the really working really closely
46:55with the old New Haven health system,
46:58and we've already done several joint
47:00efforts with the health system.
47:03And we're working working
47:04through the process of having
47:06coordinated information coming,
47:07so they are L solutions.
47:09That is the health systems if
47:11you will report a concern.
47:13But and we're working now to
47:15be able to share that.
47:17That information is shared with
47:19us in a highly confidential way
47:22and clearly very protected so that
47:24we can start to think about these
47:26temperature checks if you will
47:28about the health of the faculty.
47:30So coordinating with the health system is.
47:33Is critical,
47:34it's not just on the multiple other
47:36levels that trying to bring together
47:38the school in the health system,
47:40but certainly on this this
47:42level really important, Andrea.
47:45No, I think that's I think you've really
47:47detailed the way we're attempting to
47:49really reach out and coordinate those.
47:51The again, the information,
47:53which I think is really important.
47:56Sure. Comment on the specific training
48:00for supervisors and supporting
48:01trainees who may be facing problems.
48:04Sometimes happens that senior faculty in a
48:06well meaning manner encourage more junior
48:09folks to be restrained or not rock the boat.
48:12Maybe a reflection of their past experiences,
48:14but it can have a significant
48:16impact on whether the June.
48:18Yes, absolutely. If I,
48:20if I understand the gist of your question,
48:22I think that under that is is the culture
48:25change that we're trying to bring about.
48:28So that but it takes awhile.
48:30It takes awhile for historical.
48:32The events of the past to begin
48:34to fade in people's memories.
48:37And the more recent events where
48:39things have been addressed and been
48:41addressed timely to come forward, but.
48:44One of the things that we're trying to do,
48:47and we'd be grateful for any input
48:49in the very act of going around and
48:52having these kinds of discussions,
48:54is we're trying to actually help
48:55people to start to realize how they
48:58can support individuals coming forward.
49:00Now you can talk about coming forward.
49:02It's not just the last ditch effort,
49:04but it's actually an effort to get
49:06help to talk to, get some consultation,
49:09and that there will be.
49:10There will be a response.
49:12At the least, the response will be to listen.
49:16I meant to listen thoughtfully,
49:18but that there will be a response.
49:20Andrea.
49:22I do, I think that again,
49:24just outreach to the office to get
49:26some advice on how to deal with
49:29things or how we might be able to
49:31address the behavior well again,
49:33protecting the persons confidentiality.
49:35I think it. I think it's I just
49:37think it's one of those things where
49:40it's worth the outreach you know.
49:42Again, as you say, at a minimum,
49:45you'll just have someone to listen,
49:47maybe get some some advice
49:48for how to navigate,
49:50and then there may be something we can.
49:53Actually do about the behavior.
49:54We can go through suggestions and
49:56just problem solve around it.
49:59Either both of us have even
50:02will not even make sense.
50:04Both of us have offered we've
50:06we've helped helped a junior person
50:09have a difficult conversation.
50:11We've either join the conversation
50:13or given them some pointers and
50:16then followed up with them.
50:18It becomes a becomes an administrative
50:22supportive relationship. Uh.
50:27I don't.
50:31Oh, I see. Sorry, sorry Cindy.
50:33I read the question that was
50:34sent just to you, sorry.
50:37And we were saying that I think
50:39folks may be sending things
50:40directly to you, which is fine
50:42that we just we aren't able to see
50:44them. So OK, got it, got it.
50:48Then it's important that I do read the
50:50questions because I can't see anything,
50:52so thank you. I'm no help.
50:59Other questions. Or suggestions for
51:03what you'd like to see us do more on or?
51:17I will say that we've been quite busy.
51:21And so. Just to say that I don't
51:27think either of us actually
51:28interpret that as a bad thing.
51:30We actually interpret it as a good thing
51:33that the word is starting to get out.
51:35And people are starting to use
51:37the office and we're starting to
51:39see things at an earlier level,
51:41which I do think is a very good sign.
51:44'cause I think we can be very helpful then.
51:47So encourage encourage people
51:49to come forward.
51:53You're muted, I'm sure. Is
51:55there is one question and it
51:57has to do with kind of what
51:59will be the metrics of success.
52:01Will there be data reporting
52:02such as the number of times the
52:04office has been involved that
52:06number of times things have been
52:07raised to the general counsel's
52:09office, etc. Yeah, thanks Frank.
52:11So absolutely so.
52:12We are planning just like you get a Title
52:159 I believe Title 9 reports quarterly.
52:17Right now we are planning on reporting
52:20annually at a pretty high level.
52:22Obviously not want I don't want to make
52:25people nervous about confidentiality,
52:27so we'll be reporting at a high
52:30level of a number of concerns.
52:33We have more general categories so
52:36that we can act in those categories.
52:39Haven't thought about actually reporting
52:42when we escalated to the general
52:45counsel Becausw I would be a little
52:49worried about since that happens.
52:51The important thing to save is
52:53just like in scientific misconduct,
52:56which is pretty rare.
52:57I mean actual, proven,
52:59documented scientific misconduct
53:01is pretty rare.
53:02Really really severe professionalism
53:04issues are also pretty rare.
53:07And I know everyone sitting in this
53:09room probably remembers or is thinking
53:12about once they've heard about, but.
53:16Truly, really severe ones are rare,
53:18so I'd be slightly worried about the
53:21more detail we give about the process.
53:24Given the rarity that we might
53:27compromise confidentiality,
53:28but we certainly will be doing that.
53:31And since we started this really in earnest,
53:34just about.
53:364-5 months ago will be reporting
53:38out in another 5-6 months and then
53:41that will be on an annual basis.
53:43And if we discover that people want
53:45it twice a year, then we will.
53:48We will do that. Would you add 100?
53:52So
53:53that I think that you know,
53:55I can see a scenario perhaps
53:57where we report again the number
53:59of cases case type if you will.
54:02However, we categorize them and
54:04then just kind of interventions
54:06if you will to show people that
54:08we do positive things as well,
54:10not necessarily general counsels office.
54:12But you know coaching engagements,
54:14you know those types of things,
54:16just to show the activities of the office,
54:19I think might be a good thing and and again,
54:22wouldn't necessarily.
54:23Involved when we we,
54:25we engage general counsel's office,
54:27but just kind of the things that we're
54:29doing to that are being implemented
54:32to address behaviors but also just
54:34improve the environment generally just
54:36to show the activities of the office.
54:41So these are really very important
54:43question that's been directed to me,
54:45that is that there obviously
54:47there are persons that engage in
54:49bullying and harassing behavior.
54:51There are. Regretful part of life,
54:56but that their faculty may be concerned.
55:00About how they give feedback
55:03to a trainee or fellow. Um,
55:07and that they might get reported based on.
55:11How they give that feedback or might
55:14be accused of bullying or harassing.
55:16I think it's an important
55:18question on pawn 2 levels.
55:21One is that it speaks to.
55:24It speaks to culture.
55:27And what we're trying to create
55:29is not a culture of fear.
55:31It's not a culture of seeking out bad NIS.
55:38Although I know that we're focusing
55:40a lot on reporting concerns.
55:42We're really trying to create a
55:45culture supporting one another
55:48and everybody rising generativity.
55:51So, so that's the more philosophical
55:53point to this question,
55:55but the other practical point.
55:58Is another activity that and
56:00when we talk about how to have
56:02difficult conversations,
56:03that kind of skill or the skill
56:06about how to give feedback,
56:08that's a skill in training that we can
56:10offer faculty that we can offer individuals.
56:13There are ways to give really challenging
56:16and really difficult feedback that
56:18it actually becomes an experience
56:20where everybody can learn from.
56:21We won't necessarily immediately
56:23take away everyones fear about that.
56:25I understand that,
56:26but if we can give enough.
56:28Enough skill and enough training and have
56:31enough examples where it worked well.
56:33I think that's that's that's the antidote.
56:36If you will,
56:37on Drew.
56:40I just I guess I would
56:42just emphasize that yes,
56:44someone could report something
56:45that again it was a difficult
56:47conversation information.
56:48They did not want to hear.
56:51The reality is, how was the what
56:53was the the the spirit and tone and
56:56tenor of that conversation right?
56:58So I think that the issue is just
57:00exploring that the tenor and the tone
57:02an just trying to figure out what
57:05happened and and it could be that
57:07honestly we need to go back to the
57:09person who reported the concern and
57:11again ask them kind of what was upsetting.
57:14Was it the the way in which the
57:17message was delivered or was it
57:19the message and those are two
57:21different things in many ways so.
57:23Again, a lot of a lot of this
57:25is just building awareness,
57:27and if in fact something was
57:29experienced in a way that was not
57:32intended or reasonably did not occur,
57:34then we address that.
57:35But we have to.
57:37We have to give the person who who feels
57:39that that they experience something
57:41that was that was insulting or bullying
57:44or harassing or whatever it might be.
57:47We have to give them some portal someplace to
57:50go to report that so that we can help them.
57:53Again,
57:54feel heard an address.
57:55Any concerns that they have.
58:00And one of the IT will take time.
58:03But one of the most perhaps important
58:06messages that we want to try to get out.
58:09There is one of trust that people can
58:11trust in the process and trust in the
58:14trust in our efforts to be helpful.
58:17And we know that it will take time.
58:25Linda, I don't know if you
58:27have any other questions about
58:28one more minute. I don't know if you
58:29had anything else that came through.
58:32Well, let's see. I don't
58:36think so. Not that I can see.
58:41Great, well thank you so much for being here.
58:44We really appreciate it.
58:45We definitely want to
58:46have you back next year,
58:48see how things are going and what
58:51more that we might contribute to.
58:53Developing a culture of trust and
58:56commitment to more professional behavior.
58:57So again, thank you so much for being here.
59:01Thank you, Roger. Thank
59:02you for having us. Bye.