What is the learning environment?

Among the four missions of the medical school 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 school holds in high regard professional conduct and 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 for Faculty Relations (Faculty), the Student Professionalism Committee or the Student Promotions Committee (Students).

1.1.1 Guiding Principles 

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 ethics 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. 

1.1.2 Responsibilities of Teachers and Students

Teachers Must:	Students Must:
Duty Maintain high professional standards in all interactions with patients, students, colleagues, and staff.  Provide relevant and timely information. Provide explicit learning and behavioral expectations early in a course.  Provide timely, focused, accurate and constructive feedback on a regular basis.  Practice insightful (Socratic) questioning, which stimulates learning and self-discovery and avoid overly aggressive questioning which may be perceived as hurtful, humiliating, degrading or punitive.  Be familiar with the Student Honor Council process and the Student Professionalism Committee process and the role that faculty and students play in each (see sections 1.3.1 and 1.3.2).  Provide thoughtful and timely evaluations at the end of a course.  Disclose to students, during lectures, seminars and mentored research activities, the existence of any financial ties or conflicts-of-interest that are related to the material being taught.  Be familiar with the responsibilities of the Teacher-Learner Agreement and utilize appropriate mechanisms to encourage students who experience mistreatment or who witness unprofessional conduct or behavior to report the facts immediately (see section 1.2.2 for options) and to treat all such reports as confidential. Integrity Display honesty, integrity, and compassion.  Solicit feedback from students regarding their perception of their educational experiences and personal interactions. Respect Treat students and colleagues fairly, respectfully, and without bias, in accordance with federal and state laws protecting against discrimination based on age, race, ethnicity, gender, sexual orientation, religion, political affiliation, disability, national origin, and other protected characteristics. Be prepared and on time.  In all educational, research, and clinical care settings, individuals, including those from lower socioeconomic backgrounds, those who are disadvantaged, uninsured, or non-English-speaking, must be welcomed and treated with respect. Recognize and respect patients' rights to privacy.	Duty  Be active, enthusiastic, curious learners who work to enhance a positive learning environment.  Demonstrate professional behavior in all settings.  Recognize that not all learning stems from formal and structured activities.  Recognize their responsibility to develop personal learning goals and to participate as active learners.  Demonstrate a commitment to life-long learning, a practice that is essential to the profession of medicine.  Recognize the privileges and responsibilities that derive from the opportunity to work with patients in clinical settings. Recognize the duty to place patient welfare above their own.  Recognize and respect patients' rights to privacy.  Provide teachers and the School of Medicine with constructive feedback that can be used to improve the educational experience.  Be familiar with the responsibilities of the Teacher-Learner Agreement and utilize appropriate mechanisms to report exemplary professionalism and professionalism lapses (see section 1.2.2 for options). Integrity Recognize personal limitations and seek help whenever it is needed.  Display honesty, integrity, and compassion; these attributes include the responsibility for upholding the School of Medicine Honor Council Principles (see section 1.3.2).  Solicit feedback on their performance and recognize that criticism is not synonymous with “abuse.”  Respect Treat teachers and fellow students fairly, respectfully, and without bias, in accordance with federal and state laws protecting against discrimination based on age, race, ethnicity, gender, sexual orientation, religion, political affiliation, disability, national origin, and other protected characteristics. Be prepared and on time.  In all educational, research, and clinical care settings, individuals, including those from lower socioeconomic backgrounds, those who are disadvantaged, uninsured, or non-English-speaking, must be welcomed and treated with respect. Recognize and respect patients' rights to privacy.

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 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: 

1. Romantic involvements. 
   
2. Business relationships, other than those that might emerge from joint educational projects. 
   
3. Faculty or students accepting services or personal favors from each other (e.g., babysitting, house sitting, pet care, work in the office). 
   
4. Accepting substantial gifts. 
   
5. Special treatment of a student, including gifts, meals, entertainment, or social contacts (this includes social media), which differs substantially from the usual teacher-learner relationship with other students. 

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. See Educational Conflict of Interest Policy. 

1.2 Mistreatment Policy

1.2.1     Standards of Behavior and the Definition of Mistreatment

The medical school 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.

We are 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 school 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 school shall also:

• Provide mechanisms and procedures by which learners may safely report mistreatment against them or others.
• Provide information to students about what will happen to their reports of mistreatment; and
• Use data from these reports to educate faculty, residents, professional staff, and others about what constitutes mistreatment, with the goal of reinforcing a culture of respect.

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.

• To make an online report, go to Report an incident of professional excellence or unprofessional behavior
• If a student feels that they have witnessed or been subject to sexual misconduct, or discrimination or harassment based on a protected characteristic; the student should contact the University’s Office of Equity. Policies and procedures can be located here: University Policies and Procedures

Contact by phone: 1-888-CU-TITLE

Contact by email at [email protected]