Question 20

College answer

Not available.

Discussion

A few points:

• Mentorship, as mentioned several times in this stem, implies a specific relationship with the trainee, which may or may not have meaning for CICM. Consider that CICM do not have a specific definition of mentorship in the training program, and are unlikely to be putting a lot of weight behind that wording; but at the same time this is a "scheduled mentoring meeting", implying that some kind of structure is behind this.
• That this is happening "in your department" changes the context somewhat, as it implies that you have a working relationship with both the complainant and the bully.

a)

Initial response to the complainant

• First, thank them for their openness. To bring up a matter like this requires some substantial courage and is often painful. 
• Reassure them of confidentiality. 
• Assure them that it will be taken seriously.
• Ask them to describe the situation to you.
• Ask them what they would want to happen, ideally (for example, an apology). 
• Explain that, though the process can remain confidential and their complaint can remain anonymous, their complaint is serious and needs to be escalated, as they have a right to workplace conditions that do not pose a risk to their mental health.

Establish, from the available information:

• Is the behaviour bullying, discrimination, harassment? A relationship between trainee and supervisor is never without feedback, and some of this feedback can be very critical. 
• How severe is the behaviour? Does the situation warrant an immediate step to minimise harm? This may take the shape of sending the staff member home, and organising a reliever.
• What further information is required to have a better understanding of the situation? For example, it may be valuable to discuss the reported events with other staff who might have observed them. It would also be important to determine who would be the best person to gather that information.
• Is this something that can be resolved at the level of the medical team, or does it need to be escalated?
• Is this serious enough that an investigation is required? An investigation may be required if:
  • The complaint describes events occurring over a long period of time
  • Multiple coworkers are involved
  • The alleged behaviours are in dispute
  • Senior managers are involved in the bullying
  • It is ongoing, and previous efforts to resolve it have failed.

Discuss options and plan:

• Explain to the trainee that the employer has a responsibility to ensure a safe workplace
• Discuss goals (eg. the goal may be for the behaviour to cease)
• Provide information about the complaint process
• Emphasise confidentiality
• Organise a follow up appointment

b)

Advantages of escalating a complaint

• The complaint may result in a positive change.
• Others who may be victimised by the same person may notice a difference in their treatment
• The institution as a whole benefits from a culture of accountability, where calling out bad behaviour is an acceptable and expected norm
• It may be psychologically beneficial for the trainee, as it is a positive step
• It prevents the normalisation of a toxic workplace culture

Disadvantages of escalating a complaint

• The complaint may not result in the desired change. Escalating a complaint to a person or body who are not in a position to make positive changes could not be expected to yield the desired result.
• Statistically, most such complaints lead to an unsatisfactory end.  Llewellyn et al (2018) reported that, of those junior doctors who took action against bullying, "most reported ineffective or personally harmful outcomes".
• The complaint may have definite negative consequences for the complainant and their supporters.  These negative consequences may be difficult to quantify and prove, but are clearly seen, as in the experiences of female surgical trainees.
• Loss of trust: if the complainant insists that the discussion remains private, and the complaint is still escalated, they may feel betrayed and will not engage with the process in the future. If the trainee feels that the process is getting out of their control and is having unintended consequences for them, they may not raise this issue in the future.
• The complaint may result in more bullying, particularly if the perpetrator develops the impression of invulnerability or imputiny (eg. as the result of an impotent complaints process).