1. Professional Conduct Expectations and Responsibilities for Residents Office of Graduate Medical Education

2. Purpose  Recognize that mistreatment is a serious problem nationally and at the University of Utah.  Recognize that mistreatment is unprofessional behavior.  Recognize if you are mistreating students.  Know alternative professional behaviors.

3. Mistreatment Definition Mistreatment, either intentional or unintentional, occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. Examples include: sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, or sexual orientation; humiliation, psychological or physical punishment; and the use of grading and other forms of assessment in a punitive manner.

4. Professional Conduct Policy Promotes behaviors and attitudes of mutual respect Encourages resolving concerns directly with person engaging in alleged unprofessional behavior Pertains to faculty and residents Defines three levels of unprofessional behavior Defines three levels of response to unprofessional behavior

5. 2012 Graduation Questionnaire Data Mistreatment Reported by University of Utah graduating medical students, 2012 Percent of medical students who indicated they personally experienced any of the listed behaviors [Mistreatment]. U of U (n=88) All US Schools (n=12,195 Yes61.447.1 No38.652.9

6. 2012 University of Utah and National Graduation Questionnaire – Who Mistreats Medical Students?

7. University of Utah Medical Student and National Figures 2012 Graduation Questionnaire

8. Representative comments from medical students who reported mistreatment xxx did not ask questions to teach [but]rather to belittle students…. [no] attempt to make sure clinicians are in clinic when you're scheduled …one attending who did not take time to teach…or even acknowledge that students were present I don't mind being pimped, but feeling humiliated after questioning is very heartbreaking and disappointing…

9. Level I Unprofessional Behavior Examples may include: Passive disruptive behavior (e.g. ignoring) Active disruptive behavior such as: -Verbal outbursts -Abusive comments directed at-large

10. Responses to Level I Unprofessional Behavior Examples may include: Written commitment not to repeat the behavior Notification of the Chief resident, Program Director or Department Chair/Division Chief Developing an action and follow-up plan/ monitoring

11. Level II Unprofessional Behavior Examples may include: Yelling, swearing, cursing; threatening, humiliating; inappropriate comments (sexual or other) directed at a person or persons Physical violence or abuse directed at an object (includes throwing objects in anger or frustration) Discrimination or retaliation

12. Responses to Level II Unprofessional Behavior Examples may include: Written commitment not to repeat the behavior Written notification of a remediation plan to the resident, copy to Department Chair/Division Chief Notification of appropriate dean Mandatory follow-up Record of the incident is kept

13. Level III Unprofessional Behavior Examples may include: Physical violence or abuse directed at someone Level I or II behaviors that persist after intervention

14. Responses to Level III Unprofessional Behavior All of the level II steps plus: Notification of the Professional Conduct Committee who will recommend actions to the Dean.

15. Why are you making me complete this module? I don’t mistreat medical students.  We expect our residents and fellows to be caring, compassionate people who are highly motivated to be good teachers.  Resident supervisors of medical students are cited as the major source of medical student mistreatment.  The University of Utah has a problem with mistreatment of medical students.  It is possible to mistreat students without realizing it.  It is our expectation that you are professional in your demeanor and that you model professional behavior.  There is shared accountability for professional behavior toward medical students.

16. Why are you making me complete this module? (cont’d) I don’t mistreat medical students. You may:  Feel that mistreatment is a normal part of learning.  Have a role model you have seen mistreat students.  Have been inappropriate when you are tired, under time pressure.  Think you are preparing students for what they will face in their own residencies.  Have seen resident peers, more senior residents or faculty turn a blind eye to mistreatment.

17. What can you do when a student’s performance is not up to expectations?  Talk with or watch faculty you admire and either see what they do or ask their advice.  Learn your triggers and teach yourself to pause when your buttons are pushed.  Apologize sincerely in public if you slip.  Correct students in a professional manner.  Give constructive criticism to address clinical performance issues.

18. Any advice?  Constructive criticism is helpful and expected. Mistreatment is unprofessional and wrong. Don’t confuse the two!  Humor does not always translate across cultures. Your sense of humor might be seen as belittling. Be sensitive.  Teaching points should be concrete and behavioral (“Try to present only important points when presenting a case,” NOT “Utah students are so slow compared to XXXX students.”)  Have good will, apologize if you screw up, don’t be defensive, and remember your own positive experiences as a student.

19. University of Utah School of Medicine Initiatives to Eliminate Mistreatment Zero tolerance tolerance policy for mistreatment Faculty Code of Conduct Process to identify mistreatment. Students complete: Debriefing Sessions End of Unit/Course/Clerkship/Rotation evaluations Residents complete: ACGME annual survey Office of Graduate Medical Education annual resident survey Process for identifying safe reporting venues Process for setting and then modeling professional behavior

20. How/Where to Report Mistreatment (by anyone, to anyone) Students: Communicate directly with the resident (or other person) who is engaging in mistreatment Contact the relevant Chief Resident Contact a relevant faculty member Contact any of the School of Medicine deans

21. How/Where to Report Mistreatment (by anyone, to anyone) Residents: Communicate directly with the mistreater Contact the Chief Resident Contact a relevant faculty member Contact the mistreater’s Program Director Contact the mistreater’s Division Chief or Department Chair Contact the GME Director

22. How/Where to Report Mistreatment (by anyone, to anyone) Faculty who witness mistreatment: Communicate directly with the mistreater Contact mistreater’s Chief Resident Contact mistreater’s Program Director Contact mistreater’s Division Chief or Department Chair