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2. Promote diversity and wellbeing

7. Practice ethically

This page focuses on the boundaries between acceptable and unacceptable consensual romantic relationships and sexual harassment, in a supervision setting.

 

Charter elements featured

2. Promote diversity and wellbeing

#5   show concern for others

#6   respect age, gender, values, culture & beliefs

#8   support others if you witness disrespectful behaviour

7. Practice ethically

#26 communicate transparently, acknowledge, and apologise for, mistakes

#27 maintain privacy and confidentiality, appropriately

Romantic relationships between adult co-workers occur in many workplaces however it essential that understand and manage the boundaries between appropriate and inappropriate behaviour.

Broadly speaking we can classify these into three behaviour groups:

1.       Non-consensual sexual advances – sexual harassment

2.       Inappropriate consensual romantic relationships where conflict of interest exists (E.g. students and supervisees)

3.       Consensual romantic relationships

Non-consensual sexual advances – sexual harassment

The following hypothetical scenario depicts a senior doctor approach a junior doctor in an unwitnessed setting.

The feedback deals with the issue of autonomy versus consultation, which are addressed in the following charter elements:

3. Ensure patients and staff are safe

#10  Clarify when unclear or concerned about advice

#11 Practice within role and consult appropriately

4. Collaborate to create an open, safe and empowering learning environment

#13  Clarify roles, priorities and expectations, regarding communication and consultation.

#14  Show initiative, promote independence and offer support

 

Giving feedback  and advice on these elements is often challenging. However, compared with the first scenario, the supervisor is arguably more effective on this occasion, because refers to a specific incident, as an example and respectfully explores this. Here he demonstrates the charter elements: 

6. Achieve effective feedback

#22 be objective and measured in one's appraisals

#24 initiate open respectful conversation to explore poor performance, when relevant

 

Further, he uses that example to provide specific corrective advice that the JMO should first check with his team's registrar before making non-routine clinical decisions. This is a partial demonstration of charter element:

#25 convert feedback to effective improvement goals

Whilst the JMO was understandably confused in the first scenario, in this scenario the JMO is unnecessarily defensive of his decision to discontinue the IV fluids, focussing on clinical criteria rather than being receptive to the supervisor's main message, regarding consultation. He refutes the supervisor's advice to consult, as unworkable, rather than exploring solutions. In this sense he does not achieve charter element:

#23 be receptive to constructive feedback

Some tips for receiving feedback are shown here.

The following videos deal with the supervisor's endeavour to coach the JMO to achieve better practice.

Scene 1c video (with permission HETI)

In this scene, the supervisor calmly persists in providing corrective advice to the unreceptive JMO but may well be thinking "WTF?" Here he demonstrates respect for the JMO with charter elements:

1. Demonstrate respect

#2   interact politely and acknowledge others' effort and contribution

#4   remain composed when frustrated or stressed

 

However, he is not getting anywhere with this repetitive advice. Jenny Rudolph, from the Centre for Medical Simulation (Rudolph, 2006), would suggest the supervisor instead ask himself  "WTF?" ie "What's The Frame?". By that she means

"instead of focusing primarily on correcting actions, it is often crucial to diagnose trainees' 'frames'-- the thought processes that drive their actions. We offer an efficient three-step algorithm for providing this 'frame-based' feedback:

(1) describe how the trainee is doing according to the instructor;

(2) diagnose the trainee's immediate learning needs using inquiry to elicit their frame; and

(3) direct instruction to those needs.  

This is a great strategy to achieve charter elements #22 and #23

6. Achieve effective feedback

#22 be objective and measured in one's appraisals

#24 initiate open respectful conversation to explore poor performance, when relevant

This can be delivered as a three step "I" statement we suggested earlier when trying to avoid or resolve conflict (see discussion about roster in orientation video) in which you state the issue you are concerned about, why it concerns you and ask the other person more about it to understand their needs. For example, the supervisor might say:

1. You just said that consulting with your team before making decisions will impact on your autonomy

2. I am concerned that your desire for autonomy may compromise your judgment about when to consult and that this may lead to negative feedback from other teams or even harm to patients, in the future

3. How is autonomy more valuable than consultation?

On this occasion, the JMO would reveal his real need which is to make a good impression by showing he has initiative (and hence advance his career). It is only by doing this that the JMO achieves element #19

5. Monitor and manage JMOs' work environment

#19  Raise concerns (and encourage others to do the same) if any aspect of one's work impacts negatively on productivity, wellbeing, or career progression.

The supervisor will be empathetic and will be better able to motivate the JMO to change his practice, if he understands this need. This is explored in the next video.

Scenario 1d video (with permission HETI)

The supervisor and JMO are communicating effectively here. The focus of the conversation has shifted from addressing the JMOs behaviours to addressing his needs. The JMO articulates these needs to the supervisor who finds a useful solution in the form of the ISBAR communication tool. This is a partial demonstration of charter element #25 - convert feedback to effective improvement goals, an example of which is demonstrated in SMART goals.

A comprehensive guide to managing formal feedback interviews is presented here.