What is the learning environment?

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 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 PATH Office (Faculty/GME),  Medical 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

Category	Teachers Must	Students Must
Duty	Maintain high professional standards in all interactions. Provide relevant, timely information. Provide explicit learning and behavioral expectations early in a course. Provide timely, focused, accurate, and constructive feedback. Use insightful questioning without being aggressive or humiliating. Know Honor Council and Student Professionalism Committee processes. Provide thoughtful, timely evaluations. Disclose financial ties or conflicts of interest. Guide students in reporting mistreatment confidentially.	Be active, enthusiastic, curious learners. Demonstrate professional behavior in all settings. Recognize informal and formal learning. Set personal learning goals and engage actively. Commit to life-long learning. Acknowledge responsibilities of working with patients. Place patient welfare first. Respect patient privacy. Provide constructive feedback to faculty and the institution. Know the Teacher-Learner Agreement and report professionalism lapses or strengths.
Integrity	Display honesty, integrity, and compassion. Seek feedback from students about teaching and interactions.	Recognize personal limitations and seek help. Display honesty, integrity, and compassion; uphold Honor Council Principles. Seek feedback and understand criticism is not abuse.
Respect	Treat students and colleagues fairly, respectfully, and without bias. Be prepared and on time. Welcome and treat respectfully individuals of all backgrounds in all settings. Respect patient privacy rights.	Treat teachers and peers fairly, respectfully, and without bias. Be prepared and on time. Welcome and treat respectfully individuals of all backgrounds in all settings. Respect patient privacy rights.

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 boundary 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: 

• Romantic involvement. 
• Business relationships, other than those that might emerge from joint educational projects. 
• Faculty or students accepting services or personal favors from each other (e.g., babysitting, house sitting, pet care, work in the office). 
• Accepting substantial gifts. 
• 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 (OSL) for a list of physicians who do not teach students. Educational Conflict of Interest

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:

• 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. To make an online report, go to Report an incident of unprofessional behavior/conduct or learner mistreatment.
• 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
  • Contact by phone 1-888-CU-TITLE
  • Contact by email at [email protected]
  • To make an online report, click on the  Submit a Report or Request  button
• Office of Equity Policies and procedures can be located here: University Policies and Procedures