Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. 97, No. 12 / December 2022 1780 Innovation Report Please see the end of this article for information about the authors. Correspondence should be addressed to Sylvia Botros- Brey, Long School of Medicine, 7703 Floyd Curl Dr., MC 7845, San Antonio, TX 78229; telephone: (773) 484-8981; email: botrosbrey@uthscsa.edu. Acad Med. 2022;97:1780–1785. First published online June 1, 2022 doi: 10.1097/ACM.0000000000004759 Copyright © 2022 by the Association of American Medical Colleges Supplemental digital content for this article is available at http://links.lww.com/ACADMED/B283, http://links.lww.com/ACADMED/B284, and http:// links.lww.com/ACADMED/B285. Addressing Peer-to-Peer Resident Mistreatment Through the Use of Forum Theatre: A Pilot Intervention Sylvia Botros-Brey, MD, MSCI, Adriana Dyurich, PhD, LPC, Alixandria Pfeiffer, DO, Roberto Prestigiacomo, MFA, Hanzhang Wang, MD, MPH, Sarah M. Page-Ramsey, MD, Joseph W. Basler, MD, PhD, and Ruth Berggren, MD, MACP Abstract Problem Residents may experience mistreatment by faculty, peers, nurses, or patients. While faculty are reportedly the primary contributors to mistreatment, residents can also be offenders, which merits study. Forum theatre (FT) is an experiential learning modality requiring a peer group to develop problem-solving strategies. FT was piloted to address mistreatment among residents. The objective was to determine whether FT was feasible, acceptable to resident learners, and could lead to self-reported changes in perceptions or behaviors, providing program directors a focused option to address professionalism as a competency. Approach This initiative was conducted from September 2019 through February 2021 in obstetrics–gynecology and urology residencies at UT Health San Antonio and consisted of 3 phases: a focus group to identify mistreatment experienced by residents, resident volunteers to create and act out the FT scenario, and enactment of the FT scenario during didactic time. Residents completed anonymous retrospective pre- and postsurveys, as well as at 6–8 months after, to assess knowledge, attitudes, and self-reported and observed behaviors. Wilcoxon rank- sum tests and 2-sample t tests for proportions were used to compare variables between groups. Outcomes The FT was completed successfully in both departments during didactic time. Twenty-six residents participated, 24 (92%) responded. Most respondents (23, 96%) would recommend FT to colleagues for teaching professionalism. Behavior changes were reported by 15 (63%) participants after the program. After 6–8 months, self-reported mistreatment behaviors had decreased, including “making fun of others” (15 (63%) to 10 (38%), P = .04) and sending “disparaging texts” (13 (54%) to 7 (27%), P =.02). Next Steps The use of FT during regularly scheduled didactic times was feasible and well received among residents. The evaluation demonstrated sustained self-reported behavior changes. Plans are ongoing to expand this approach to other medical specialties and professions institutionally. Problem Mistreatment in medical education remains ongoing and challenging. Te Association of American Medical Colleges defnes mistreatment as intentional or unintentional behavior showing disrespect for the dignity of others that unreasonably interferes with the learning process. 1 Reports consistently demonstrate that residents experience mistreatment from multiple sources. 2 While faculty are reportedly primary contributors to resident mistreatment, residents are ofenders up to 28% of the time. 2–4 Residents can choose to propagate or mitigate mistreatment; fast pace of clinical duties, extensive training expectations, and minimal time for guided refection may pose challenges for intentional behavior change. Furthermore, mistreatment topics are not easily addressed during residency although they are part of Accreditation Council for Graduate Medical Education (ACGME) competencies. 5 Most programs rely on faculty role modeling for professionalism training, which is ofen confounded by a hidden curriculum, wherein mistreatment results directly from observed faculty behaviors. 6 Witnessed unprofessional faculty behavior has been identifed as the greatest challenge to teaching professionalism; lack of mentorship, debriefng, or guided refection further contributes to suboptimal professionalism outcomes. 5 To our knowledge, few studies have addressed resident mistreatment while considering resident contributions. 7 Fewer still evaluate interventions to interrupt mistreatment propagation. 7 Forum theatre (FT) is an experiential learning modality based on Boal’s “Teatre of the Oppressed,” which requires peer groups to develop problem-solving strategies. 8 FT catalyzes change using guided refection to address complex professionalism challenges based on realistic confict scenarios. Learners become participating spect-actors who watch, respond, and step into the play, exploring potential solutions. Troughout, a facilitator debriefs with participants and solidifes key messages. FT combines experiential and observational learning with refective practice and peer group consensus building. FT has been used in medical schools to address racism, professionalism, and cultural humility topics. 9 Our literature search did not identify studies using this modality within residency programs. We piloted FT at UT Health San Antonio to evaluate if its use to address mistreatment among residents was feasible, acceptable to resident learners, and could lead to self-reported changes in perceptions or behaviors, thereby ofering program Downloaded from http://journals.lww.com/academicmedicine by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4X Mi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 01/15/2024