Medical Student Mistreatment Policy

Definitions

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 defined, but is not limited to the following domains:

Physical Mistreatment

Definition: Any behavior that involves physical harm, threat of physical harm or imposition of physical punishment.

Example:

• Not Mistreatment: A surgeon tells the student not to take the retractor from them unless they ask the student to retract.
• Mistreatment: 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

Definition: 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.

Examples: 

• Not Mistreatment: 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.
• Mistreatment: A resident yells at the student for “always getting in the way.”

• Not Mistreatment: An operating room nurse tells the student that they contaminated their gown, and instructs them to rescrub.
• Mistreatment: A resident makes fun of the student calling them “incompetent” because they do not know how to insert a Foley catheter.

• Not Mistreatment: 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.
• Mistreatment: An attending speaks to the student in public or private in a way with intention to humiliate, “Did you even go to college?” “How did you pass your other rotations?”

Power Abuse

Definition: 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.

Examples:

• Not Mistreatment: 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.
• Mistreatment: 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.”
   
• Not Mistreatment: 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.
• Mistreatment: 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.
   
• Not Mistreatment: 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.
• Mistreatment: 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.
   
• Not Mistreatment: The student is asked to run down to central supplies to get the necessary equipment to perform a bedside paracentesis.
• Mistreatment: The student is asked to pick up an attending’s dry cleaning or dinner for the chief resident.
   
• Not Mistreatment: 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.
• Mistreatment: The student is threatened with a failing or lower grade if they do not help the resident write notes.
   
• Not Mistreatment: 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.
• Mistreatment: The student is assigned duties as punishment rather than education.
   
• Not Mistreatment: On the first day of third year, a resident says to the student on rotation, “You must be the newbies on service,” then offers to help the students find a computer station.
• Mistreatment: Students on the team are all given nicknames by the chief resident that are demeaning and culturally inappropriate.

Psychologic Cruelty

Definition: Any malicious behavior that results in psychological pain and suffering.

Examples: 

• Not Mistreatment: The student’s question is not answered because the attending is concentrating on a critical portion of the procedure. 
• Mistreatment: The student’s questions are repeatedly ignored by the attending when other learners’ questions are answered.
   
• Not Mistreatment: The student had to eat lunch alone because the rest of the team was busy with other duties.
• Mistreatment: 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.
   
• Not Mistreatment: The student working with a department chair says he feels nervous about rounding with him/her since they can "make or break" their career.
• Mistreatment: Resident tells a student that it is their goal to make them cry before the rotation is over.
   
• Not Mistreatment: 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 angry at the student.
• Mistreatment: A resident purposely gives a student misinformation before rounds. Student then overhears the resident laughing with another resident about messing him over.

Sexual Harassment

Definition: 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 working environment.

Examples 

• Not Mistreatment: A male student is asked not to go into a room because a female patient only wants a female to examine her.
• Mistreatment: The student is subjected to offensive sexist remarks or name calling while on call with the team.
   
• Not Mistreatment: 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.
• Mistreatment: 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

Definition: 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:

• Not Mistreatment: The student is asked to see a specific patient in the clinic because they speak their language.
• Mistreatment: The student is subjected to racist or ethnically offensive remarks or names about themselves or others, including patients.
   
• Not Mistreatment: The student is asked to wear a white coat in the clinic and make sure their attire meets professional standards.
• Mistreatment: The student is subjected to racist or ethnically offensive remarks or names about themselves or others, including patients.

Reporting Options

Concern about potential violations of the DGSOM Policy on Medical Student Mistreatment may be handled by communication with various individuals, and students are strongly encouraged to formally report infractions. Options include, but are not limited to the following:

• Conversation (by the student or others) with any or all of the following:
  • Individual(s) involved
  • Others such as the chief resident, attending physician, and/or clerkship/site director or course chair
  • Dean’s Office (Assistant Dean, Associate Dean, SAO, or leadership of Drew, PRIME or MSTP)
• Mistreatment Incident Reporting Form
• DGSOM Course and Faculty Evaluations 
• UCLA Equity, Diversity and Inclusion Office 
• UCLA Title IX Office 

Please note that University employees are mandated reporters and are required to inform the appropriate offices if they become aware that a student may have experienced conduct prohibited by the UC Sexual Violence and Sexual Harassment Policy or by the UC Nondiscrimination Policy Statement.

Students should also be aware of confidential resources available to them including:

• Office of the Ombuds
• Behavioral Wellness Center (BWC)
• Counseling and Psychological Services (CAPS)
• CARE Advocates 

DGSOM Response and Mechanisms for Investigating Reports of Mistreatment

When a report is made (via online form or from another body) the Committee on Learning Environment Oversight (CLEO) receives the report and responds within 72 business hours. Members on the Committee include:

• Chair (from below)
• Co-Chair (from below)
• 2 Medical Students – Professionalism Representatives
• 1 Chief Resident
• 2 Faculty Members (surgical + non surgical preferred)
• Assistant Dean of Equity, Diversity, Inclusion
• Assistant Dean for Student Affairs
• Assistant Dean for the Clinical Curriculum
• GME Designated Institutional Official or designee
• CLEO Staff Administrator

Potential Ad Hoc Members:

• Site Director at an Affiliate Site
• Director of Behavioral Wellness Center and Faculty Wellness Program
• Staff Member
• Legal Counsel

When there is a report of a concern of mistreatment, it is brought to the Chair and Co-Chair of CLEO in a confidential fashion. The subsequent triaging will depend on the nature of the issue, the acuity, etc. The Chair and Co-chair will make an immediate determination regarding acuity and avenue of reporting. Title IX and DPO reports will be referred with in 72 business hours of notification. All reports are reviewed at CLEO's regular scheduled meetings. 

Learn More about CLEO