UNIVERSITIES must give healthcare students more opportunities to practise handling difficult and potentially volatile interactions to bridge the gap between classroom learning and real-world clinical settings, says Universiti Malaya (UM) Faculty of Medicine Clinical Skills Unit head Assoc Prof Dr Noorjahan Haneem Md Hashim.
She said classroom teaching is often structured, while real encounters could involve patients and families who are frightened, distressed, frustrated, grieving or angry, often under time pressure and in challenging environments.
“One gap is between knowing the principles of good communication and being able to apply them in real, sometimes difficult situations.
“What needs strengthening is not only what we teach, but how we design the learning opportunities,” she said.
According to the World Health Organization (WHO), between 8% and 38% of healthcare workers worldwide experience physical violence at some point in their careers, with many more exposed to verbal aggression.
In Malaysia alone, the Health Ministry reported that cases of violence against healthcare workers rose sharply from 167 in 2017 to 442 in 2018, reaching a five-year high of 494 in 2019, before declining to 321 in 2020 and 260 in 2021 during the Covid-19 pandemic.
Dr Noorjahan Haneem, who is also an associate professor in UM’s Faculty of Medicine Department of Anaesthesiology, said training should account for factors such as the environment, workload, language and differing expectations, noting that generations, cultures and different groups within the healthcare system may have different expectations of communication, decision-making and the role of healthcare professionals.
“Training should help students recognise these differences and adapt appropriately, rather than assuming that one approach will work for everyone,” she said.
She added that recognising and responding to potentially volatile situations (see infographic) is important because early recognition could allow intervention before a situation escalates.
However, healthcare workers should not be expected to handle violence alone.
“They need to know not only how to communicate and de-escalate, but also when to disengage, call for assistance and activate the appropriate institutional response,” she said.
“The objective is not to teach healthcare workers to tolerate aggression but to help them recognise risk, respond appropriately and protect themselves, their colleagues, other patients and, where possible, the distressed patient or family member as well.”
She said students need both technical and non-technical skills, including understanding institutional procedures, knowing how to summon help, use emergency alert systems, maintain personal safety, disengage when necessary and report incidents.
“Safety is both an individual skill and a team and organisational responsibility,” she said.
