Student Mistreatment and its Prevention

Rationale

The Brody School of Medicine (BSOM) is committed to providing an educational environment that is supportive and respectful of all members of the medical center community.

Standards of conduct in the learning environment which evoke mutual trust and understanding support the learning process. When all participants understand the standards of conduct between the teacher and student and when all participants are held accountable to these standards, an environment is established that enhances both learning and professional development. Inappropriate behaviors may cause the student to become cynical about the medical profession, interfere with the learning process, cause individuals to leave medical training, and promote an atmosphere in which abuse is accepted and perpetuated.

The BSOM acknowledges that the diversity of students, faculty, residents, and staff, combined with the intensity of the interactions between them may, from time to time, lead to alleged, perceived, or real incidents of mistreatment of individuals. Whether intentional or not, these incidents result in a disruption of the learning environment that BSOM strives to foster.

Scope

This standard operating procedure (SOP) applies to all incidents involving medical BSOM students in the learning environment resulting in mistreatment, whether real or perceived.

Definitions

BSOM: Brody School of Medicine

ECC: Executive Curriculum Committee. The ECC is charged with the overall oversight and control of the curriculum.

EAC: Executive Academic Committee. The EAC is charged with the management, monitoring, and oversight of all non-curricular elements of the undergraduate medical experience at the Brody School of Medicine from admission until graduation.

LEC: Learning Environment Committee. This committee consists of 6 faculty members (including one committee chair) appointed by the Executive Dean. This committee assists in monitoring de-identified reports of mistreatment and makes recommendations to address concerns identified both in individual reports and concerns consistently noted in settings in the learning environment. The LEC will assist in developing educational materials related to student mistreatment prevention. The LEC may invite other parties to their meetings to help identify strategies to foster a positive learning environment or address areas of mistreatment in particular settings.

LMS: Learning Management System. The computer program or programs used to store and access curricular materials.

Mistreatment: Policies, actions, or behaviors that treat a student in a threatening, intimidating, or otherwise inappropriate manner or which adversely affect the learning environment.

MRF: Mistreatment Reporting Form. This is the online form to report concerns of medical student mistreatment.

Ombuds: A person that serves as an impartial and confidential resource for learning about organizational policies. This person may lead people to the best resources/offices for issues, assist in dealing with difficult situations or people, and function as a third-party conflict manager when multiple people need help working through issues.

POSO: The Department for People Operations, Success and Opportunity. This department provides central human resources for East Carolina University.

SADAA: Senior Associate Dean for Academic Affairs.

Behaviors Not Considered Mistreatment

Examples include, but are not limited to the following:

• Setting high standards for conduct and achievement.
• Ensuring the safety and well-being of patients.
• Consistent and fair application of conduct and educational standards.
• Constructive critical interactions between the teacher and student.
• Asking questions in a public setting.

Behaviors Considered Mistreatment

Examples include, but are not limited to the following:

• Physical attacks, either threatened or actual. *
• Insulting or unjustifiably harsh verbal communication.
• Public embarrassment or humiliation.
• Requiring performance of personal services (e.g. shopping or babysitting).
• Basing a grade or evaluation on reasons other than those related to course/clinical/professional performance.
• Sexual harassment. *
• Intentional neglect or lack of communication related to course or clinical duties.
• Disregard for a student’s safety.
• Retaliation against a student who files a complaint.

*East Carolina University and ECU Health Medical Center policies, as well as criminal or civil law, may be applicable.

Students who believe they have been subjected to conduct prohibited under Title IX, including sexual assault, dating and domestic violence, stalking and sexual harassment, may report such misconduct or file a formal complaint with the East Carolina University Title IX Coordinator in The Department for People Operations, Success, and Opportunity (POSO). The Title IX Coordinator can be contacted by telephone, email, or in person during regular office hours: Building 283, Suite G-406, oeix@ecu.edu, (252) 328-6804 (office).

Reports of alleged violations of Title IX may be made during non-business hours at (252) 328-6804, oeix@ecu.edu, or through the Equal Opportunity and Title IX Concern & Complaint Form on the POSO website. For more information, please visit the Title IX Resources webpage.

Lastly, even if a student does not wish to file a formal complaint, any faculty or staff person with significant responsibility for student activities must complete the Anonymous Crime Reporting Form whenever they become aware of certain crimes, as required by the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act. The awareness can come from a direct report from a student, staff member, or a third party.

Responsibilities

Prevention and Distribution of SOP

BSOM is committed to preventing mistreatment of medical students and will address the issue of mistreatment through:

• Distribution of this SOP to medical students, residents, faculty, community preceptors, and administrators to facilitate reporting and tracking of incidents.
  • For medical students: This SOP will be displayed on the Academic Affairs Educational Policies and Standard Operating Procedures webpage in the Learning Environment and Professionalism section. Additionally, this SOP will be reviewed and explained at each year-specific orientation and included as a required reading in the Brody Visiting Student Learning Opportunities (VSLO) applicant form.
  • For faculty, residents, and fellows: The SADAA will share a copy of this SOP annually.
• Development of educational materials to address topics of fostering a positive learning environment, mistreatment, and related issues.
  • Inclusion as orientation material for new faculty.
  • Annual attestation is required upon completion of education modules.

Sharing of Mistreatment Data

The Office of Data Analysis and Strategy (ODAS) develops and maintains various reports and dashboards available to the SADAA, LEC, and general public. These reports contain de-identified data that allow tracking of reported incidents, monitoring trends, areas of concern, and improvements.

Information is distributed to the concerned groups and is subject to annual review by the SADAA. The annual report includes school-specific data from the AAMC Graduate Questionnaire (GQ) and aggregated data from reported incidents received through the internal reporting system. This information will be distributed to the Department Chairs and Graduate Medical Education Office, which will be responsible for sharing it with all faculty and staff who interact with students. The SADAA presents and discusses the annual report with the ECC and other groups as needed.

Education

The LEC will collaborate with the Offices of Faculty Affairs and Leadership Development, Office of Student Affairs, the Ombuds and other stakeholders as appropriate to develop educational materials and programs to foster a positive learning environment.

The BSOM website on appropriate treatment of medical students is one of the main sources of information and definitions on mistreatment, how to report it, examples, policies, and resources available to support the educational community at BSOM.

Procedures

Reporting Procedure

There are three main ways for reporting and resolution of incidents involving mistreatment (see Appendix A).

Direct Conversation and Resolution

When an alleged mistreatment incident occurs, the parties involved are encouraged but not required to resolve the matter directly.

• A student may contact the ombuds to initiate and support this process.
• Any of the individuals who are approached by a student for a direct conversation can provide support and help the student receive appropriate support services.
• Even in cases where a direct resolution is reached, any involved party is encouraged to report the incident through the Mistreatment Reporting Form (MRF) either anonymously or not.

MRF

A reporting form has been developed to ensure all medical students can report any concerns of mistreatment in a timely manner. Mistreatment Reporting Forms are available via a link on the LMS and Brody Office of Student Affairs website. In accordance with FERPA, all reports are considered part of the student record and protected under all applicable laws. The following steps are taken during the formal reporting process to reach resolution:

• The MRF allows for reporting with or without personally identifiable information about the reporter.
• Incidents reported via MRF are routed by the Director of ODAS directly to the SADAA unless the SADAA is identified as the source of mistreatment – any concerns regarding the SADAA are to be routed to the Executive Dean.
• When a mistreatment report is received, the SADAA contacts the LEC to arrange a meeting to review the reported incident(s). If a member(s) of the LEC is named in the report, the member(s) in question will not be invited to the meeting.
• Incidents are reported to LEC in an anonymous way to maintain confidentiality.
• When a reporter self-identifies, the SADAA can provide feedback to the reporter on resolution and/or recommendations.

Role of the SADAA

• The SADAA (or their designee) is responsible for monitoring new formal mistreatment reports at least weekly.
• If a given mistreatment report identifies a concern that legally must be communicated to the Title IX Coordinator, Clery Coordinator, law enforcement, or another authority, the SADAA (or Executive Dean) will report the incident as stipulated by Title IX and/or the Clery Act. Confidentiality will be maintained except as required by applicable laws and/or University policies.
• The SADAA works with the Director of ODAS to redact personal information that could compromise the identity of the reporter, or any individual(s) identified as the source of mistreatment prior to sharing a mistreatment report with the LEC.
• The SADAA will be responsible for communicating relevant recommendations of the LEC at an incident level or environmental trends to an identified authority (e.g. direct supervisor).

Role of the LEC

• Reviews redacted reports of mistreatment incidents as shared by the SADAA.
• Reviews mistreatment dashboard/report on a quarterly basis with the SADAA and ODAS Director to determine if patterns of behavior(s) in particular setting need to be addressed.
• Provides recommendations to the SADAA based on incidents discussed and data reviewed.

Resolution through Facilitation by the Ombuds

In some situations, reporting may be hindered by a variety of factors, including reluctance of the reporting individual to address the alleged offender, or intransigence of the alleged offender. A position of Ombuds has been established to help resolve such conflicts. The role of the Ombuds is to collect information concerning the mistreatment incident from appropriate sources and mediate between the parties with the intent of reconciling the matter to the satisfaction of both parties. This process is designed to preserve the confidentiality of all parties involved to the extent possible. Policy and law prohibit retaliation for reporting and/or participating as a witness regarding a potential violation of law and/or University policy. The Ombuds can be contacted via the MRF or email at BSOMOmbudsOffice@ecu.edu.

The following duties apply to the Ombuds:

• Any person may contact the Ombuds to seek assistance in resolving a conflict for any reason.
• The Ombuds is designated by ECU main campus and will not be an individual with medical student supervisory or administrative responsibilities at the BSOM.
• Incidents of mistreatment will be handled by the Ombuds according to ECU policy.
• The Ombuds will provide a redacted report biannually directly to the Executive Dean of the BSOM.

When a student wishes to report another student for mistreatment, the MRF reporting pathway will not be available. While the Direct Conversation and Resolution and Ombuds pathways remain, any student with concerns regarding another student are encouraged to contact the BSOM Office of Student Affairs or the ECU Office of Student Rights and Responsibilities (OSRR). The OSSR web page and reporting link are accessible at: Office of Student Rights and Responsibilities website.

Prevention of Mistreatment

Mistreatment prevention is the proactive process of fostering a positive learning environment where mutual respect and professionalism are prioritized. It involves educational and institutional initiatives, as well as collaborative efforts to identify and address behaviors that undermine a positive learning environment. Prevention requires proactive interventions including, but not limited to, ongoing training for faculty, staff, physicians, and students; and clear policies and communication to encourage a safe, supportive, and professional atmosphere.

The LEC and the SADDA will work with the offices that comprise Academic Affairs, OFALD, and any other pertinent parties (e.g. ECU Health) to provide the appropriate interventions.

Protection Against Retaliation

Those who are accused of mistreatment will be informed by the SADAA or Executive Dean that retaliation is regarded as a form of mistreatment and violation of the SOP. The accusation of retaliation will be handled with the same procedure as mistreatment.

False Accusation

Any complainant, respondent, or witness found to have been intentionally dishonest in the processes described in this SOP (e.g., the complainant making the allegation) may be subject to disciplinary action.

Procedures for Implementation and Review

This procedure is to be reviewed by the Executive Academic Committee every three years.

This procedure will be disseminated by the Offices of Student Affairs and Medical Education to students, teaching faculty, and administration.

Related Policies

• ECU Faculty Manual (Parts VIII and XII): ECU Faculty Manual.
  • Part VIII: Personnel Policies and Procedures for Faculty
  • Part XII: Faculty Appellate Provisions
• East Carolina University Student Conduct.
• Title IX Compliance and Resolution Regulation
• Student Conduct Process
• Regulation on Reports of Prohibited Interpersonal Violence and Related Misconduct

Applicable Laws, Regulations & Standards

LCME Standard 3, Element 6.

“A medical school develops effective written policies that define mistreatment, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing mistreatment. Mechanisms for reporting mistreatment are understood by medical students, including visiting medical students, and ensure that any violations can be registered and investigated without fear of retaliation.”

Appendix A

Mistreatment Reporting Mechanisms

Direct Conversation and Resolution

• Parties involved are encouraged to resolve the alleged mistreatment incident
• Learning Environment Committee (LEC) or others are unaware of the incident unless reported in Mistreatment Reporting Form (MRF) or the Ombuds
• No details shared quarterly on website, unless MRF submitted

Mistreatment Reporting Form (MRF)

• Reported incidents are identified by a case number and routed to SADAA
• Meeting with LEC arranged to review reported incidents
• Incidents shared with LEC anonymously
• If contact information is provided, SADAA can provide feedback on resolution to reporter
• Limited details shared quarterly on website

Facilitation by the Ombuds

• Submitted form sent to directly to Ombuds
• Ombuds to report annually to Dean
• No details shared quarterly on website unless associated with an MRF