Violence Prevention and Mitigation Procedure

• To ensure safe, respectful, and violence‑free clinical and academic environments for UGME learners;
• To prevent, identify, respond to, and learn from incidents of verbal abuse, threats, harassment, intimidation, and physical violence; and
• To define clear roles, protections, and reporting/response pathways consistent with SHA’s Culture of Safety and College of Medicine safety expectations.

This policy covers all learning settings (inpatient/outpatient clinical areas, community sites, simulation, classrooms, online learning, call rooms, transit between sites, home visits) and all times (scheduled activities, after hours, on‑call). It applies to any SHA‑affiliated activity where students encounter patients, families, or members of the public.

Saskatchewan Health Authority (SHA) refers to the single health region of the province of Saskatchewan. It is a health authority providing the following direct and contracted health services to the people of Saskatchewan:

• Primary, secondary, tertiary, and quaternary care
• Home and community care
• Mental health services
• Population and preventive health and addiction services

Supervisor refers to the licensed physician who is most responsible for the supervision of a medical student in a particular practice or service.

Physical Safety against violence includes the protection of learners from physical harm, threats of harm, or unsafe conditions resulting from violent or aggressive behavior in any UGME learning environment.

Violence: Any incident in which a person is abused, threatened, or assaulted during their participation in learning/clinical work, including verbal abuse, intimidation, harassment, bullying, and physical assault. SHA Culture of Safety.

Verbal Abuse: Insults, derogatory comments, shouted invective, threats, or persistent hostile remarks that cause psychological harm or create a hostile environment.

Aggressive Patient/Visitor: Individuals who exhibit behaviors that present a risk of harm (verbal or physical) to students.

Students: Prioritize personal safety, remove themselves from unsafe situations when able, seek immediate assistance, and report incidents.

Preceptors/Faculty/Residents: Provide immediate support, ensure the area is safe, facilitate medical attention if needed, and assist in reporting via College and SHA channels.

Year Chair, Rotation Directors & Site Coordinators: Ensure local orientation on violence prevention and site security; implement risk‑mitigation for known high‑risk settings; ensure no academic penalty for students who step away from unsafe situations.

UGME Office: Maintain policy, provide orientation, monitor compliance, coordinate support, oversee data/quality improvement, and escalate systemic issues to College leadership and SHA partners.

SHA Unit/Facility Leadership & Security: Provide safe physical spaces, security responses, and organizational follow‑up consistent with the Culture of Safety Policy.

The UGME program does not tolerate violence (including verbal abuse, intimidation, threats, bullying, harassment, sexual and gender‑based violence) toward or by students. Safety is a shared responsibility of the UGME team, medical students, SHA, and affiliated sites.

The College and SHA commit to a just Culture. Students are encouraged and supported to report concerns and incidents without fear of reprisal.

A. Immediate Response

• Ensure safety first: Leave the area if needed; call Security or 911 for imminent risk.
• Notify the most responsible preceptor/faculty or the charge nurse/unit leader promptly.
• Medical care: Obtain first aid/health care as required (Emergency Department/Occupational Health).
• Preserve information: Write a brief factual account (who/what/when/where), retain the names of any witnesses. Avoid deleting relevant messages.

B. Reporting Pathways

Students may choose one or more of the following; reporting in good faith is protected:

• College/UGME Reporting:
  • Report to Clerkship/Course Director, appropriate year chair, UGME OSA
  • College safety reporting channel to enable academic protections, placement adjustments, and follow‑
• SHA Safety Reporting (for incidents at SHA sites): Submit via the SHA safety reporting system
• University of Saskatchewan Harassment/Violence Prevention: Students can report an incident under university policies addressing violence, discrimination, and harassment.
• Police when criminal conduct is suspected (assault, credible threats), seek guidance from the office of Student Affairs.

C. Supports for Students

Students will not face academic repercussions for declining or withdrawing from activities that place them at unacceptable risk of harm; alternative learning will be arranged.

Any retaliation against a student who raises a concern or reports about an incident is prohibited.

Students are encouraged to work with UGME program and Office of Student Affairs to explore academic accommodations after incidents (e.g., schedule changes, site reassignment)

Access to OSA for counseling/wellness services; facilitated access to University of Saskatchewan support.

D. Prevention & Risk Mitigation

Program level orientation: Violence prevention and reporting procedures are provided at the start of the Pre-clerkship and Clerkship.

Learner Stage	Area	Content / Activity	Timing	Delivery Method	Completion / Verification
Pre-Clerkship (Y1–Y2)	Violence Prevention & Response	Foundational violence prevention and response training (SinMS I)  The objectives for the session:  1. Describe strategies to optimize personal safety during patient encounters.  2. Identify behavioral warning signs that suggest a patient may become violent.  3. Describe strategies to de-escalate a potentially volatile situation.  4. Identify response options including types of crisis intervention, evasion techniques, and restraint options.	Fall term (typically October)	Scheduled formal session	Attendance recorded
Pre-Clerkship (Y1–Y2)	Safety Policies & Resources	Student safety, emergency management	Orientation	Orientation materials, websites, signage	Completion recorded
Clerkship (Y3)	Violence Prevention	Workplace Assessment of Violence Education (WAVE)	Year 3 Orientation	Online module	Completion recorded

Buddy/Presence rules: Students are not to see potentially violent patients alone; ensure an available supervisor/co‑worker is present

After‑hours: Access to Safe walk/security escorts to vehicles or between buildings. USAFE

Clerkship site: Local emergency numbers, panic alarm locations, and security call procedures should be reviewed on Day 1 of the rotation site.

Clinical Experiences in the Community completed in non-SHA community-based organizations in Saskatoon and Regina: Medicine and Society

These learning environments may involve variable levels of structure, unpredictability, and exposure to individuals experiencing distress or crisis. Violence prevention within CLE is therefore addressed through orientation, supervision, relationship-based placement design, and clear escalation pathways.

D.1. Placement Vetting

Community-based organizations approved for CLE placements must:

• Be established community-based organizations
• Work with equity deserving groups
• Deliver programming addressing social determinants of health
• Be able to orient and supervise learners
• Disclose any conflicts of interest

Most CLE placements are longstanding partnerships with the UGME. New organizations are added selectively and reviewed prior to learner placement.

Program-Level Orientation: All learners participating in CLE must complete:

• The overall CLE module orientation
• A Year 1 session introducing work with community members, including expectations for professionalism, boundaries, and respectful engagement

D.2. Site-Specific Orientation

Each placement facilitator must provide a site-specific orientation, typically during the first hour of the 9-hour placement, with additional time dedicated where required by the organization.

Site-specific orientation must include:

• An introduction to the organization, population served, and programs
• Review of organizational protocols related to safety, escalation, and incident reporting
• Clarification of learner scope, boundaries, and expected activities
• Identification of supervisory contacts during the placement
• Guidance on how to respond to and report safety concerns or threatening situations

While not all organizations have formal violence prevention content, facilitators are expected to orient learners to local safety practices relevant to the setting.

D.3. Supervision and Oversight

• Learners will be supervised by the placement facilitator or a designated staff member within the organization.
•  
• Supervision may be delegated depending on agreed upon activities, but responsibility for learner oversight remains with the organization.
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• The supervision model must be appropriate to:
• The learner’s level of training
• The nature of activities
• The level of interaction with community members

Learners must not be placed in situations requiring them to independently manage:

• Aggressive or escalating behavior
• Safety incidents
• High-risk interactions beyond their training or role

Learners must:

• Participate in all required orientations
• Adhere to organizational protocols and professional standards
• Maintain respectful, trauma informed interactions
• Report safety concerns, threats, or incidents promptly
• Remove themselves from situations they reasonably perceive as unsafe and notify their placement facilitator and academic contact

Learners will not be penalized academically for raising safety concerns or declining participation in unsafe activities.

D. 4. Incident Response and Reporting

Immediate Response: If a violent or threatening incident occurs:

• Learners should prioritize personal safety
• Follow the organization’s internal safety procedures
• Notify the supervising staff immediately

All incidents or near misses must be reported to the placement facilitator and the module director Dr. Olukayode Olutunfese oao168@usask.ca or Course Chair Dr Juan-Nicolás Peña-Sánchez juan.nicolas.ps@usask.ca or Office of Student Affairs (med.studentaffairs@usask.ca) and Director Academics in accordance with the Violence Prevention Policy. Director Academics will review incidents to ensure learner support, identify any required changes to placement activities and determine whether placement continuation is appropriate.

E. Formal Response, Follow-up & Learning

• Triage & investigation by the appropriate body (unit manager/SHA safety, UGME leadership), with timely feedback to the student on actions taken where permissible.
• Remedial actions will be discussed with the leadership at the site where the violence has occurred.
• Data & quality improvement: UGME will aggregate de‑identified incident themes quarterly to prevent recurrence and improve learning environment safety.

Owner: Director Academics

Review cycle: Every two years or sooner following significant incidents or policy changes in the related policies

• University of Saskatchewan Violence prevention Policy
• College of Medicine Safety and security
• SHA Culture of Safety Policy
• SHA Violence Prevention and Mitigation Plan
• WorkSafe Saskatchewan

• If you feel unsafe:

  • Leave → Call Security/911

  • Get help from preceptor/charge nurse/ facilitator

• Care: First aid/Occupational Health.

• Report (choose any or all):

  • UGME: Rotation Coordinator, Rotation Director, Year chair or Admin support at the learning site.

  • Office of Student affairs: studentaffairs@usask.ca

  • Incident report UGME

  • SHA safety report

• Support: studentaffairs@usask.ca