EAA066 Student Mistreatment

Policy Number: EAA066
Policy Title: Student Mistreatment

A. Policy

UTRGV SOM has zero tolerance for student mistreatment. UTRGV SOM is committed to maintaining an environment where there is mutual respect between students, teachers, peers, patients, and all members of the education and health care teams.

To maintain an optimal learning environment, it is incumbent upon all members of the SOM community to report instances of student mistreatment.

Instances of alleged mistreatment will be investigated, and appropriate measures will be taken to stop the mistreatment.

Retaliation against reporters of mistreatment will not be tolerated.

B. Definitions and Examples

The Association of American Medical Colleges defines mistreatment as behavior that shows disrespect for the dignity of others and unreasonably interferes with the learning process. It can take many forms, and includes any behavior that humiliates, degrades, demeans, intimidates, or threatens an individual or a group. To violate this policy, the behavior should be such that a reasonable person would find that it creates inhospitable working or learning conditions.

Mistreatment can be further defined but is not limited to the following domains:

Mistreatment Domains
Domain	Definition
Physical mistreatment	Any behavior that involves physical harm, threat of physical harm or imposition of physical punishment.
Abusive expression	Includes spoken, written, visual, or nonverbal actions directed at another person that are outside the range of commonly accepted expressions of disagreement, disapproval, or critique in an academic culture and professional setting that respects free expression.
Power abuse	Includes any abuse of authority or inappropriate actions, threats or retaliation in the exercise of authority, supervision, or guidance. This includes using learner evaluation, grades and potential letters of recommendation as quid pro quo for behaviors.
Psychological cruelty	Any malicious behavior that results in psychological pain and suffering.
Sexual harassment	Sexual harassment is defined as unwelcome sexual advances, unwelcome requests for sexual favors, and other verbal, nonverbal, or physical conduct of a sexual nature when a person's submission to such conduct is implicitly or explicitly made the basis for employment decisions, academic evaluation, grades or advancement, or other decisions affecting participation in a University program (quid pro quo), or when such conduct creates a hostile learning or working environment.
Discrimination	Any prejudicial treatment on the basis of race, color, national origin, religion, sex, gender, gender expression, gender identity, gender transition status, pregnancy, physical or mental disability, medical condition (cancer-related or genetic characteristics), genetic information (including family medical history), ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services, including protected veterans.

Examples of mistreatment:

Mistreatment Examples
	Not Mistreatment	Mistreatment
Physical mistreatment	A surgeon tells the student not to take the retractor from them unless they ask the student to retract.	Scrub tech hits the student's arm with a clamp as they are trying to sew because they did not like how the student bumped the Mayo stand.
Abusive expression	The student is yelled at to "get out of the way" by a member of the code team as a patient is about to be shocked during resuscitation.	A resident yells at the student for "always getting in the way."
	An operating room nurse tells the student that they contaminated their gown and instructs them to rescrub.	A resident makes fun of the student calling them "incompetent" because they do not know how to insert a Foley catheter.
	An attending gives the student feedback on how to improve their performance and it makes the student feel bad because they feel criticized and not appreciated for their efforts.	An attending speaks to the student in public or private in a meant to humiliate. "Did you even go to college?" "How did your pass your other rotations?"
Power abuse	The student is in the operating room for the first time and feels timid because they do not know where to stand and what to do.	An attending tells the student not to scrub in on any cases, and says to the other members of the team, "Students always contaminate the field."
	The student who, after being given clear expectations at the beginning of their obstetrics and gynecology rotation, is asked to leave the operating room because they did not introduce themselves to the patient, read about the patient or prepare for the case.	A resident tells a student that it is their job to write all of the consult notes and progress notes for all patients on the service.
	The student stays in the outpatient clinic late because there are patients that still have not been seen and labs to be followed up on.	The student is expected to work over 80 hours a week, and it is communicated to them that this will be the way to earn an Honors grade on the rotation.
	The student is asked to run down to central supplies to get the necessary equipment to perform a bedside paracentesis.	The student is asked to pick up an attending's dry cleaning or dinner for the chief resident.
	A resident tells a student that they would like them to review and present a topic to the team as a way to demonstrate their knowledge base and oral presentation skills.	The student is threatened with a failing or lower grade if they do not help the resident write notes.
	The student is assigned duties to help the team provide patient care that do not seem educational to the student ("scut"), including calling an outside hospital to obtain microbiology reports.	The student is assigned duties as punishment rather than learning.
	On the first day of third year, a resident says to the students on rotation, "You must be the newbies on service," then offers to help the students find a computer station.	Students on the team are all given nicknames by the chief resident that are demeaning and culturally inappropriate.
Psychological cruelty	The student's question is not answered because the attending is concentrating on a critical portion of the procedure.	The student's questions are repeatedly ignored by the attending when other learners' questions are answered.
	The student had to eat lunch alone because the rest of the team was busy with other duties	The entire team eats lunch together every day but it is made clear that the student is not invited and is laughed at or ignored when they enter the room.
	The student working with a department chair says he feels nervous about rounding with him/her since they can "make or break" their career.	Resident tells a student that it is their goal to make them cry before the rotation is over.
	A resident incorrectly tells the student the patient's CXR is normal and when the student reports the result on rounds the attending, who knows otherwise, gets upset at the student.	A resident purposely gives a student misinformation before rounds. Student then overhears the resident laughing with another resident about messing him over.
Sexual harassment	A male student is asked not to go into a room because a female patient only wants a female to examine her.	The student is subjected to offensive sexist remarks or name calling while on call with the team.
	A student is asked by the resident on the team to attend a farewell party at a local bar for the interns leaving the service.	A student is asked by a resident to go out after hours to a bar "so they can discuss the student's progress on the clerkship"
Discrimination	The student is asked to see a specific patient in clinic because they speak their language.	The student is subjected to racist or ethnically offensive remarks or names about themselves or others, including patients.
	The student is asked to wear a white coat in clinic and make sure their attire meets professional standards.	The student is subjected to derogatory remarks about their or another's sexual orientation.

C. Who Should Report

The maintenance of an Optimal Learning Environment is incumbent on all of us engaged in teaching, research, and mentoring the next generation of physicians. Mistreatment of any kind undermines the professional and collegial environment in which we learn and practice medicine. Mistreatment directly affects the well-being of teachers and learners, and in a clinical setting may also affect patient safety and treatment outcomes. Anyone who is a victim of mistreatment, a witness to another's mistreatment, or the recipient of a report or outcry about mistreatment, should report the concern.

D. Reporting Options

To be dealt with judiciously and equitably, mistreatment must be reported in a timely and respectful manner. Anonymous reports are permitted. However, your decision to remain anonymous may greatly limit UTRGV's ability to stop the alleged conduct, collect evidence, or take action against parties accused of violating this policy. You should make reports as soon as you become aware of the mistreatment or misconduct.

You may make reports of suspected mistreatment in any of the following ways:

To report overt threats, call UT Police: (956) 882-4911 or 911
To report mistreatment or unprofessional behavior in an academic or clinical setting:
1. Talk with a faculty member, chief resident, attending physician, Program Director, Department Chair, or Module Director; or
2. Report to a dean - Assistant Dean/Pre-clerkship, Assistant Dean/Clerkship, Assistant Dean for Student Affairs, Associate Dean for Educational Affairs, or Associate Dean for Student Affairs; or
3. Go online and make a mistreatment report via Vaqueros Report It
  https://www.utrgv.edu/reportit
To report mistreatment by staff personnel, contact the direct supervisor or the Office of Human Resources
https://www.utrgv.edu/hr
(956) 296-1516
To report sexual harassment, sexual misconduct, sexual violence, or discrimination, report to the Office of Institutional Equity and Diversity (Title IX /AA/EO Coordinator).
https://www.utrgv.edu/equity/
(956) 665-3851
Faculty, employees in the Office of Student Affairs, and University Police are obligated to refer reports of sexual misconduct to the Title IX Coordinator. Students may discuss an incident with a counselor in the Counseling Center, a health care provider in Student Health Services, the clergyperson of the student's choice, an individual who works or volunteers in the Office of Victim Advocacy and Violence Prevention, or an off-campus resource (i.e. rape crisis center, doctor, psychologist, etc.) without concern that the incident will be reported to the Title IX Coordinator.

UTRGV provides support for students who are victims of sexual misconduct through the Office of Victim Advocacy and Violence Prevention (OVAVP):
https://www.utrgv.edu/ovavp/
(956) 665-8287
If in doubt - whether to report a concern, or to whom to make a report - call the Dean on Call: (956) 296-2502 or submit a report via:
https://www.utrgv.edu/som/student-affairs/student-mistreatment-learning-environment/index.htm

E. Response and Follow-up

The Office of Student Affairs (OSA) maintains contact with the University offices which investigate reports of mistreatment. As reports are investigated and adjudicated, OSA presents the nature of the reports and the outcomes of the investigations to the Optimal Learning Environment Committee (OLEC) in a de-identified manner and in compliance with state and federal law. OLEC determines whether further action is needed, such as policy change or additional professional development, and reports its recommendations to the Dean and other appropriate SOM officials.

OSA also communicates back to the reporter(s) of mistreatment incidents. Within the constraints of the rules of confidentiality linked to the procedures for investigation and adjudication of these investigations, OSA informs the reporters of the disposition of the incident, if not otherwise communicated.

Retaliation against a reporter, witness or victim of mistreatment is not tolerated. UTRGV maintains a zero tolerance policy (ADM 04-301) toward retaliation:
https://www.utrgv.edu/hop/policies/adm-04-301.pdf

Appendix A:

SOP for Handling of Mistreatment Concerns

Mistreatment includes words or actions which disparage, belittle, humiliate, or disrespect a person, or pose an imminent or actual threat to a person's health or safety.

Mistreatment can be reported in a variety of ways, and any channel of reporting should be encouraged and accepted.
There are 3 channels students use to report mistreatment:

o To the Office of Student Affairs (in person, by e-mailing
MDStudentAffairs@utrgv.edu, or by calling the Dean on Call at 956-296-2502).
o By answering affirmatively to questions about experiencing mistreatment on the end of module or end of clerkship evaluation.
o On-line via the mistreatment portal on the SOM webpage:
(https://cm.maxient.com/reportingform.php?UnivofTexasPanAmerican&layout_i d=19) or via Vaqueros Report It on the UTRGV webpage
(https://www.utrgv.edu/reportit)

Regardless of the source of the report or the channel through which an event is reported, the person receiving a mistreatment report must contact the Associate Dean for Student Affairs. If the report comes in after office hours and seems urgent, the recipient of the report should call the Dean on Call (956) 296-2503.

For an imminent threat to safety, students should call University Police (956) 882-4911or 911.

The Associate Dean for Student Affairs (or designee) refers mistreatment reports in the following manner:

• Mistreatment by faculty or resident: to the Associate Dean for Faculty Affairs (956)296-1430), Associate Dean for Graduate Medical Education (956)296-1423, or the Department Chair.

• Sexual misconduct or discrimination:
o Office of Institutional Equity and Diversity (Title IX) (956)665-2103
o Office of Advocacy and Violence Prevention - for immediate and long-term support for a victim of sexual misconduct or interpersonal violence (956)665-8287

• Mistreatment by a patient in a clinical setting:
o Attending physician
o Clerkship Director

• Mistreatment by a UTRGV employee (non-faculty):
o Human Resources: Edinburg (956) 665-2451, Brownsville (956)882-8205, Harlingen (956) 778-0762

• Mistreatment by a student:
o Associate Dean for Student Affairs (956) 296-1414

The Associate Dean for Student Affairs will compile mistreatment reports and their disposition. As these compilations are completed, the Associate Dean for Student Affairs will present them to the Optimal Learning Environment Committee (OLEC). OLEC will make recommendations and forward to the appropriate committee or office for further disposition.

Appendix B:

Sources

Association of American Medical Colleges:

Power and Privilege Definitions
https://www.aamc.org/system/files/2019-08/power-privilege-definitions.pdf

Sexual and Gender Harassment Resources
https://www.aamc.org/what-we-do/mission-areas/diversity-inclusion/harassment

Navigating the Hidden Curriculum in Medical School
https://www.aamc.org/news-insights/navigating-hidden-curriculum-medical-school

David Geffen School of Medicine, UCLA - Medical Student Mistreatment Policy
https://medschool.ucla.edu/current-15-mistreatment

Harvard Medical School - Student Mistreatment Policy and Procedures
https://medstudenthandbook.hms.harvard.edu/716-discrimination-harassment-and-student-mistreatment

UT System: Cultivating Learning and Safe Environments
https://utsystem.edu/sites/default/files/sites/clase/files/clase-health-aqgreqate.pdf

UT Health Science Center San Antonio - Student Mistreatment Policy
http://catalog.uthscsa.edu/generalinformation/institutionalpolicies/studentmistreatmentpolicy/

UTRGV School of Medicine - Medical Student Standards of Conduct (EAA016)
/2020-2021/SOM-Medical-Student-Handbook/SOM-POLICIES/EAA016-Medical-Student-Standards-of-Conduct-Policy

UTRGV School of Medicine - Prohibition of Retaliation (EAA060)
/2020-2021/SOM-Medical-Student-Handbook/SOM-POLICIES/EAA060-Prohibition-of-Retaliation

UTRGV Policy Number: ADM 03-300: Sexual Misconduct
https://www.utrgv.edu/hop/policies/adm-03-300.pdf

Related SOM Policies

Medical Student Standards of Conduct - EAA016

Prohibition of Retaliation - EAA060

Optimal Learning Environment - EAA078

Compact Between Teachers and Learners - EAA078

Related UTRGV Policies

UTRGV Policy Number: ADM 03-100: Non-Discrimination and Complaint Procedure

UTRGV Policy Number: ADM 03-200: Accommodations for Individuals with Disabilities

UTRGV Policy Number: ADM 03-300: Sexual Misconduct

UTRGV Policy Number: ADM 03-400: Consensual Relationships

UTRGV Policy Number: ADM 04-301: Non-Retaliation

Dates Reviewed or Amended

Reviewed and endorsed by OLEC: May 3, 2022

Reviewed and endorsed by CCAC: May 11, 2022

Next review: Spring 2023

Approved by the Faculty Assembly on December 04, 2019.

Approved by the Deans Advisory Council on November 22, 2019.

Approved by the Dean/Chief Academic Officer on November 22, 2019.

Sources: