Prescribing Restorative Justice for Education in the Health Professions
The Rx for RJ Project is intended to introduce restorative practices in medical school education as a way to address learner mistreatment and provide a community-building response to improve the learning environment. Restorative practices foster ethical development and interpersonal communication skills consistent with medical ethics and professional standards for lifelong success in medicine.
“Hospital behaviors that may have been tolerated in the past are clearly viewed differently now, and can no longer be accepted in the future. Any form of mistreatment negatively affects the culture and climate of medical schools and teaching hospitals.” (Acosta and Cunningham 2014)
Over the past fifty years, numerous reports have described the medical school learning environment as abusive and stressful for students. In the past, abuses were considered “unavoidable” and necessary hardships that students must overcome so that they may become an effective medical professional (Kassebaum and Cutler, 1998). More recent research, however, has demonstrated that an abusive learning environment may have long term consequences for medical professionals that can negatively impact academic performance, competency, professionalism, and health (Dyrbye et al., 2005). Current students believe that abuses, while uncommon, are still occurring and manifested through the use of insensitive language by attendants and residents, unequal distribution of classroom resources, and unfair or unclear academic expectations. Faculty confirm that students might feel mistreated, but that oftentimes these feelings come about because of miscommunication or because there are too few spaces where educators and students could share in collaborative dialogue. Although some policies and procedures have empowered students to better hold faculty and residents accountable for misconduct, it does not yet provide an effective means to bridge hierarchical differences between educators and learners. New forums of interaction can be developed so that a more positive learning environment can be co-created by faculty, residents, and students. These spaces for interaction can be developed through the introduction of restorative justice practices.
Restorative justice (RJ) is a global social movement which focuses on seeking educational and reparative solutions to crime, misconduct, and conflict. In higher education, RJ is a collaborative decision-making process that includes harmed parties and those who caused harm. Though facilitated dialogue, these stakeholders specify the harm and seek ways to repair it and rebuild community trust. Restorative practices have been demonstrated to be effective in a variety of settings including criminal justice (Strang and Sherman 2007), K-12 Schools (Thorsborne 2015), and universities (Karp and Sacks 2014).
Jay Behel, PhD (Project Coordinator), is Associate Dean of Student Affairs at Rush Medical College where he directs student professional development and wellness initiatives and supports processes for community-building and addressing student mistreatment. He also is a clinical psychologist and director of Geriatric & Rehabilitation Psychology at Rush University Medical Center and is the education director for the LGBTQ Health Committee at Rush. Dr. Behel completed his undergraduate education at Vanderbilt University with majors in English and psychology. He received his Ph.D. in clinical psychology from Auburn University and then completed a residency and fellowship at Rush. Dr. Behel has published and presented extensively on a range of topics including adjustment to disability, physician communication and, more recently, several aspects of medical education.
David A. Acosta, MD, is the Chief Diversity and Inclusion Officer for the Association of American Medical Colleges, providing strategic vision and leadership for the AAMC’s diversity and inclusion activities across the medical education community, and leads the association’s Diversity Policy and Programs unit. A physician of family medicine, Dr. Acosta joined the AAMC from the University of California (UC), Davis School of Medicine where he served as senior associate dean for equity, diversity, and inclusion and associate vice chancellor for diversity and inclusion and chief diversity officer for UC Davis Health System. He previously served as the inaugural chief diversity officer at the University of Washington (UW) School of Medicine, where he established a rural health fellowship program for Tacoma Family Medicine, a residency program affiliated with the UW Department of Family Medicine. Dr. Acosta received his bachelor’s degree in biology from Loyola University and earned his medical degree from the University of California, Irvine, School of Medicine. He completed his residency training at Community Hospital of Sonoma County in Santa Rosa, Calif., and a faculty development fellowship at the UW Department of Family Medicine.
Briana Barocas, Ph.D., is the Director of Research of New York University’s Center on Violence and Recovery and a Research Associate Professor at the Silver School of Social Work. Her research interests in trauma, resiliency, and recovery have led to research on first responders, individuals and families affected by domestic violence, and survivors of 9/11. Additional research interests include gender relations and the world of work. Her research has been supported by the National Institute of Justice, the National Science Foundation, the Department of Homeland Security, and the Department of Defense. She has over 10 years of research experience in the specific field of restorative justice applications to domestic violence practice. Her earlier research on work-family issues and current work on the response to and recovery from violence and trauma have strengthened her commitment to developing and researching programs and services that better the lives of individuals, families, and communities. She holds a PhD in Social Policy and Policy Analysis from Columbia University, an MS in Gender Studies from the London School of Economics and Political Science, and a BS in Human Development and Family Studies from Cornell University.
David R. Karp is Professor of Sociology at Skidmore College in Saratoga Springs, New York. His scholarship focuses on restorative justice in community and campus settings and on prison programs preparing inmates for return to the community. He was the recipient of the 2010 Donald D. Gehring Award from the Association for Student Conduct Administration for his work on campus restorative justice. David has published more than 100 academic papers and six books, including The Little Book of Restorative Justice for Colleges and Universities (2013) and Restorative Justice on the College Campus (2004). David is the Principal Investigator of a multi-campus research project on student conduct practices called the STARR Project (Student Accountability and Restorative Research Project). He is also a volunteer mediator and a restorative justice facilitator and trainer. David received a B.A. in Peace and Conflict Studies from the University of California at Berkeley, and a Ph.D. in Sociology from the University of Washington.
Adrienne Lawson-Thompson serves as the Director of Institutional Culture/Climate and Community Engagement with the Office for Equity, Diversity & Inclusion at UC Davis Health System in Sacramento, California. Her primary responsibilities at the health system includes working with Senior Leadership in the Schools of Medicine, Nursing, Physicians Practice Board, UC Davis Medical Center and Medical Education on climate needs assessment and reporting; professional leadership development for faculty, staff, students; continuous diversity improvement; and community engagement. Adrienne has a doctorate in Educational Leadership & Policy Studies. Her research interest is broad in scope, which includes culture and climate change in organizations, transformational leadership, restorative justice practices, diverse faculty, staff retention and recruitment.
Holly Northam (RN, RM) is a Senior Lecturer at the University of Canberra. Holly has extensive clinical experience in critical care including and organ and tissue donation practice. Holly’s PhD, ‘Hope for a peaceful death and organ donation’ explored bereaved families experiences of organ donation decision-making. Holly is a 2006 Churchill Fellow and a Director on the Boards of Donor Families Australia and Sharelife Australia. Holly convenes and teaches at postgraduate and undergraduate level and supervises HDR students. Holly’s research interests include end of life care, restorative practices in health care, cultural sensitivity in health care, international nurse student’s experiences, adult resiliency, and donor –recipient communication.
Acosta, David and David R. Karp. 2017. "Restorative Justice as the Rx for Mistreatment in Academic Medicine: Applications to Consider for Learners, Faculty and Staff.”Academic Medicine 93: 354-356. doi: 10.1097/ACM.0000000000002037
Acosta, David and Paul G. Cunningham. 2014. "Restorative Justice to Resolve Learner and Differential Mistreatment."Wing of Zock.