The missing orientation

Last Thursday and Friday were my first days at my new job as a resident doctor in the psychiatry post-graduate training program at Queen’s University. As you might expect, these were spent in orientation sessions. Here’s the agenda for the hospital-wide orientation:

Nothing is too surprising here. In fact, if anything, I’m surprised by how much on the agenda was duplicated information from required online modules we had to complete in advance, or stuff easily found on hospital websites we’ve already been directed to. It made for a packed but disengaged day.

But, this is a blog post about what I think is missing from our orientation — both the hospital-wide one and the Psychiatry program orientation the following day (which was also similarly procedural).

In neither was there very much discussion about the culture of the organisation. Neither as it is now nor what it aspires to be. At the entrances in the Kingston hospitals there are often little hand sanitizer stations with signs that say something like, “We clean our hands when we enter the hospital.” I’ve always thought it was an endearing (and yeah, perhaps also clumsy) message that tries to convey the norms of this institution. There was very little of that kind of thing in our orientation. There wasn’t nothing — there was a recapitulation of policies around privacy in record keeping, zero-tolerance for snooping, and reporting on adverse events. All good stuff, of course but I wonder if more could be done to set the right tone and set the expectations on how to work together to create a just and safe culture for employees and patients.

There was nothing, for instance, about how we are expected to speak to junior doctors and medical students as colleagues, and same also for allied staff; or, that we are expected to use person-first language; or, how to intervene when we witness harassment or burnout; or, that the teaching culture is one of encouragement and not shame-based (i.e. no “malignant pimping“); or, a reflection on the place of dark humour in medicine; or, the norms around de-escalation and use of restraints. These are probably not new topics for any incoming resident, but I worry our orientation missed out on the opportunity to explicitly set the record straight about what is expected in this institution.

Also, more than just set norms, I wonder if this was also a missed opportunity to do some actual training in how to enact these norms. As an example, if I remember my CAMH employee orientation correctly, it spanned two days and included exercises on power and privilege, communication and de-escalation techniques. Additionally, as a recent Harvard Business Review article points out, the usual sexual harassment training and policies don’t work, but specific intervention training does. So, why not teach that to incoming residents?

All in all, the orientation days were not as engaging as I think they could have been, and that’s sad to me because there is so much work to be done to improve hospital culture.