Office of Professional Affairs aims to evolve learning environment

In the high-stress, high stakes world of medicine it has never been more crucial to ensure people have a positive working and learning environment. 

The way we respect people in the workplace, and in education is changing. Expectations for acceptable behaviour are increasing, and accountability is more important than ever. 

In December 2022, the Faculty of Medicine at Dalhousie announced a new Office of Professional Affairs (OPA). Their goal—to create and maintain a healthy and safe learning environment in the medical school. 

Led by the newly appointed assistant deans of professional affairs, Drs. Ian Epstein (Dalhousie Medicine Nova Scotia) and Samantha Gray (Dalhousie Medicine New Brunswick), the OPA is one of the first of its kind in Canadian medical schools.

“I’m really glad we’re one of the early adopters,” says Dr. Epstein. “Society is starting to really grapple with some of the institutionalized issues that impact people’s experience day-to-day in their lives, and then get amplified in the demanding atmosphere of medical practice.”

The issues Dr. Epstein refers to, are not new. They have been addressed in various ways for decades, and the plan to launch the OPA has been crystallizing for several years. More than two years ago, Dr. Andrew Warren, then assistant dean of postgraduate medical education, and Dr. Carolyn Thompson, assistant dean of resident affairs, started a learning environment task force, recognizing the need for a formal way to address these issues. The medical school’s serving and engaging society portfolio is also focused on achieving greater social accountability. With the OPA, the Faculty of Medicine is taking things a step further.  

“We can’t continue to practice and teach the way we did 20 years ago,” says Dr. Gray. “We are committed to taking the steps necessary to ensure that people have a positive working environment both at the medical school and in the hospital, so that they can learn better, and ultimately be better physicians. Our patients deserve that, and so do our learners.”

A positive learning environment

Drs. Epstein and Gray, who both have a background in education, note the decision to create this office was not reactive, but a natural next step in ensuring not only the education of students and residents in a positive environment, but also faculty. 

“It’s an evolution, not a revolution,” says Dr. Epstein, recalling advice from a former colleague. “It’s a logical evolution of us as a species that we start to deal with these things within medicine, and it’s a logical evolution of us as a profession that we start to deal with harassment, sexism, racism, intimidation, being miserable at work—we just have to.”

The new office is focused on addressing reports of learner mistreatment, and the promotion of professionalism through education and outreach activities. Drs. Epstein and Gray are physically located on their respective campuses, but operate under one office. They work together in process development and the growth of the office, ensuring faculty development and the change in the culture of medicine is consistent across the medical school. They each address the day-to-day inquiries based on where the issues arise. 

Dr. Epstein is clear this is not a situation where there will be a ‘one-size-fits-all’ solution. 

“Some of these complaints may be extraordinarily site specific, while others are going to be cross-provincial and cross-campus and affect everybody. Those issues will have more complexity and require significant collaboration between the two campuses.”

The OPA will also collaborate with human resources, legal, serving and engaging society, and other stakeholders. They will work closely with continuing professional development and medical education to develop a catalog of content and subject matter experts where they can direct interested parties. 

The Office of Professional Affairs is more than just a support for faculty and students—it is a support for the profession of medicine, something Dr. Katherine Stringer, head of the Department of Family Medicine, knows is critical as physicians and learners navigate the complexities of the environments and individuals with whom they interact. 

“Our Dal learners and teachers are building and adapting their clinical learning environments on a daily basis in communities across the Maritimes,” she says. “Such dedication, often under stressful clinical conditions, requires acknowledgement and support.  The Office of Professional Affairs is a very welcome resource in this process as we try to understand the varied experiences, provide appropriate support and create the best possible learning environments for all.”     

A few months in, Drs. Gray and Epstein are starting to see more complaints and inquiries come across their desks, something they see as a good sign. Complaints are expected to go up substantially in the first two or three years, as people become comfortable bringing their concerns forward. 

“It’s not a failure to see complaints go up significantly at first,” says Dr. Epstein. “But 20 years from now, a real marker of success is to see complaints way down because we have changed the culture and dealt with so many complaints successfully that we’re no longer needed. That’s my dream of success.”

Spirit of collaboration

So, what can faculty and learners expect when they contact the OPA?

“Every issue that is brought to us will be treated seriously and confidentially,” says Dr. Gray. “We may not always get the outcome that they were expecting, but we certainly take any concerns seriously.”

Dr. Epstein emphasizes that working with the OPA is not a punitive process.

“This is not about policing the medical school. This new office has been developed in the spirit of collaboration, and our goal is to make the working and learning environment better for people, and to do that in a friendly, safe and confidential way.”

In the past, a barrier for many people was not wanting to make a formal complaint. With the new office, that formality is gone. Drs. Gray and Epstein will make a record of any issues brought forward, but in many cases, this is simply for their own files. 

“Let’s lower the barrier, and people can just talk,” says Dr. Epstein. “We’re happy taking complaints through multiple channels—it’s doesn’t have to be a formal report. Feel free to come forward and talk to us, pick up the phone, or send us an email.”

Building trust

The new assistant deans know a change in culture is not going to happen overnight. 

“It's going to take time, months, even years to really make a change in the way we handle professionalism and see a change in the learning environment, and the culture around reporting,” says Dr. Epstein. “It's going to take time to build the office and build trust.”

Slowly but surely, the pair are working to develop better processes and make improvements that long-term, will create that very environment where they’re no longer needed. 

But for now, both Dr. Epstein and Dr. Gray are available to those in the Faculty of Medicine wishing to discuss issues of professionalism. Want to get in touch? Contact DalMedOPA@dal.ca. Individuals with concerns can also access the Confidence Line, the Faculty of Medicine Office of Professional Affairs Safe Reporting platform. This safe, secure, and easily accessible site is found at dalhousiemedicine.confidenceline.com.