Throughout medical school, medical students learn in a variety of environments such as classrooms, small groups, clinical skills workshops, clinical simulation centers, hospitals, and clinics. Medical students also encounter a wide variant of teachers including preclinical and clinical faculty, community preceptors, residents, fellows, nursing staff, and fellow classmates. All learning environments should be physically and psychologically safe and should promote a student’s learning. It is imperative that all interactions and assessments of learners, regardless of the environment, be fair, impartial, objective, and unbiased. Should a learner encounter a situation that does not meet these criteria, they should have access to recourse without fear of retaliation.
Among the four missions of the CUSOM is the education of future physicians. Our students have gone through a rigorous selection process and represent a group of highly skilled and academically well-prepared students. The CUSOM holds in high regard professional
behaviors and attitudes, including altruism, integrity, respect for others and a commitment to excellence. All members of the medical school community, including students, faculty, residents, fellows, staff, and administrators are held to high standards
in these areas.
Effective learning is best fostered in an environment of mutual respect between teachers and learners. In the context of medical education, the term “teacher” is used broadly to include peers, resident physicians, full-time and volunteer faculty members, clinical preceptors, nurses and ancillary support staff, as well as others from whom students learn. Students and teachers share the challenge of learning and teaching not only the art and science of medicine, but also the acquisition of behaviors and values that characterize the ideal physician.
This Agreement serves both as a pledge and a reminder to teachers and students that their conduct in fulfilling their mutual obligations is the medium through which the profession perpetuates its ethical values. Failure to uphold the principles of the
teacher learner agreement may result in referral to the Office of Professional Education (Faculty), the Student Professional Committee or the Student Promotions Committee (Students).
Duty: Medical educators have a duty not only to convey the knowledge and skills required for delivering the profession's standard of care but also to model the values and attitudes required for preserving the medical profession’s social contract with its patients.
Integrity: Learning environments that are conducive to conveying professional values must be based on integrity. Students and residents learn professionalism by observing and emulating role models who epitomize authentic professional values, attitudes and, especially, behaviors.
Respect: Respect for every individual is fundamental to the ethic of medicine. Mutual respect between students, as novice members of the profession, and their teachers, as experienced and esteemed professionals, is essential for nurturing that ethic. Given the inherently hierarchical nature of the teacher-learner relationship, teachers have a special obligation to ensure that students and residents are always treated respectfully.
1.1.3 Relationships between Students and Teachers
Students and teachers should recognize the special nature of the teacher-learner relationship, which is, in part, defined by professional role modeling, mentorship and supervision. There is a power differential, as expressed by the fact that teachers often evaluate student performance and the results of their evaluations may affect the student's future. Conversely, students evaluate the quality of their teachers and this can, to a lesser degree, affect the teacher’s career.
Because of the special nature of this relationship, students and teachers should strive to develop a relationship that is characterized by mutual trust, acceptance, and confidence. They both have an obligation to respect and maintain appropriate boundaries. Students and teachers must avoid any and all behaviors that conceivably could lead to the perception of a boundaries violation; avoiding boundary violations is crucial to a proper teacher-student relationship. There are similar boundaries between students and patients that exist because of the nature of this special and trusting relationship. Boundary violations or actions that may give the appearance of a boundary violation should routinely be avoided. A partial list includes:
Health providers who provide health services, including psychiatric/psychological counseling, to a medical student or their primary family members will not be involved in the academic assessment or promotion of the medical student receiving those services. When students or their primary family members choose their health care providers from physicians who are on the faculty, they have the potential to be in a conflict-of-interest situation, where their provider is also evaluating their academic or clinical performance. Faculty members are not allowed to complete an evaluation for any students for whom they provide or have provided medical care including their primary family members. Conflicts arise between a faculty’s role as the student's physician and their role as an evaluator of the student's performance. Faculty must notify students as soon as they recognize the conflict. Students likewise must notify a faculty member if they are assigned to a physician for evaluation who is providing or has provided medical care for them or their primary family members in the past. The student must also notify the course director who will find an alternative clinical site or provide an alternative faculty member for evaluation. Students may consult the Office of Student Life for a list of physicians who do not teach students.
1.2 Mistreatment Policy
1.2.1 Standards of Behavior and the Definition of Mistreatment
The CUSOM has a responsibility to provide an environment conducive to effective learning and compassionate, high quality patient care by creating an atmosphere of mutual respect and collegiality among faculty, residents, students, and staff.
The CUSOM is committed to creating a learning, research and clinical care environment that is supportive, that promotes learner well-being and that is free from ridicule, exploitation, intimidation, sexual or other forms of harassment, physical harm and threats of physical harm. To that end, the CUSOM will not tolerate the mistreatment of students, nor will it tolerate retaliation against any learner because they reported, in good faith, a violation of the school’s professionalism standards. The CUSOM shall also:
Definition of Mistreatment
The American Association of Medical Colleges states, “Mistreatment, either intentional or unintentional, occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process.” Examples of mistreatment include: public belittlement or humiliation; verbal abuse (e.g., speaking to or about a person in an intimidating or bullying manner); physical harm or the threat of physical harm; requests to perform personal services; being subject to offensive sexist remarks, or being subjected to unwanted sexual advances (verbal or physical); retaliation or threats of retaliation against students; discrimination or harassment based on race, religion, ethnicity, sex, age, or sexual orientation; and the use of grading or other forms of assessment in a punitive or discriminatory manner.
Suboptimal Learning Environment
Although it is not mistreatment, a suboptimal work or learning environment can interfere with learning, compromise patient care, marginalize students and cause significant distress among students. Student feedback about suboptimal learning environments should be given to course directors, to the Assistant Deans of Medical Education as appropriate or reported in your course or clerkship evaluation.
1.2.2 Procedures for Reporting Faculty and Staff Unprofessional Behavior
If a student feels that they have witnessed unprofessional behavior in the learning or clinical environment, the student should contact the Office of Faculty Relations. The Office can serve as an advocate for fair and equitable treatment for medical students and can facilitate confidential and safe reporting of unprofessional behavior. For further information, go to the Office of Faculty Relations.
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