Ad Hoc Committee to Review Teaching Exercises with Student Subjects
Purpose
To provide a process to review and approve proposals from faculty for teaching exercises that involve students as subjects.
Margie Hodges Shaw, JD, PhD, Chair
Assistant Professor
Division of Medical Humanities and Bioethics
Center for Ethics, Humanities and Palliative Care
University of Rochester Medical Center
601 Elmwood Avenue *Box 676
Rochester, NY 14642
Phone: (585) 275-0174 *Fax: (585) 276-0152
margie.shaw@urmc.rochester.edu
https://www.urmc.rochester.edu/medical-humanities.aspx
Procedure
- Course director submits to the committee chair a written description of the proposed teaching exercise, including:
- the purpose of the exercise
- the actual procedure
- the safety of the exercise including detailed CEL protocol specifying equipment, care, storage, maintenance, sterilization, and schedule for review of these factors
- the risks of the exercise
- the efficacy of the exercise
- number of student subjects
- how student subjects will be selected
- the written information that will be given to student subjects describing the exercise, the risks, side effects, contraindications for participation, opportunity to withdraw
Committee review will include consideration of the above factors as well as the voluntariness of student participation and the issues of privacy and confidentiality. When necessary, the committee will identify appropriate faculty or other consultation outside the committee’s expertise.
Requests for approval should be submitted to the Chair of the Ad Hoc Committee to Review Teaching Exercises with Student Subjects at least six weeks before the date of the teaching exercise.
A written authorization will be provided for approved requests with specifics regarding the annual report and deadline for submitting the report. in writing, and The annual report will include for each exercise the number of student participants, any deviations from the exercise as it was approved, any problems or student complaints that arose during the exercise, any anticipated changes in the exercise. An approved exercise will be renewed annually for two additional years. Any substantial modification in the exercise will require reapplication.
If a proposal cannot be approved as submitted, the committee will provide to the course director a written explanation of the reasons for the decision and recommendations for changes that would allow for approval of the exercise.
Decisions of the committee can be appealed to the Senior Associate Dean for Medical Student Education.
Avoiding the Appearance of Bias in Evaluations due to Prior Relationships
The Medical School expects both faculty and students to avoid situations where a previous relationship could bias evaluations, teaching or could create the appearance of bias. In case of doubt about such a situation, the student must contact his/her Advisory Dean and the faculty member must contact the Course Director. (An example would be a student working with a preceptor in a credit bearing course and/or required remediation that has a close relationship with the student’s family—the student and the faculty member must each report this to the course/clerkship director who would reassign the student).
The school views this issue as a matter of professionalism and all suspected violations of this policy will be reviewed by the Honor Board, the MSPRB and/or Department Chair.
Guidelines to Prevent the Mistreatment of Students
In compliance with AAMC on student mistreatment, the following procedures have been adopted to prevent the mistreatment of School of Medicine and Dentistry students.
AAMC Policy Statement
Reaffirming Institutional Standards of Behavior in the Learning Environment
The medical learning environment is expected to facilitate students' acquisition of the professional and collegial attitudes necessary for effective, caring and compassionate health care. The development and nurturing of these attitudes is enhanced and, indeed, based on the presence of mutual respect between teacher and learner. Characteristics of this respect is the expectation that all participants in the educational program assume their responsibilities in a manner that enriches the quality of the learning process.
While these goals are primary to a school's educational mission, it must be acknowledged that the social and behavioral diversity of students, faculty, residents, and staff, combined with the intensity of the interactions between them, will, from time to time, lead to alleged, perceived or real incidents of inappropriate behavior or mistreatment of individuals. Examples of mistreatment include sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, sexual orientation, physical handicap or age; humiliation, psychological or physical punishment and the use of grading and other forms of assessment in a punitive manner. The occurrence, either intentional or unintentional, of such incidents results in a disruption of the spirit of learning and a breach in the integrity and trust between teacher and learner.
Students should report all concerns to their Advisory Dean and to course and clerkship directors. Student concerns that, in the student’s view, are not satisfactorily addressed via this process will be reviewed by the Senior Associate Dean for Medical Student Education (SADMSE). The SADMSE will take the appropriate steps to resolve the problem(s) and advised the student about the action taken and the outcome of the review. See Reporting Violations for additional individuals available for assistance.
University of Rochester Teacher-Learner Policy
Modified from ACGME “Compact between Resident Physicians and Their Teachers”
To meet their educational goals and the medical school’s objectives, medical students must participate actively in the care of patients and must assume progressively more responsibility for that care as they advance through their training. In supervising medical students, faculty, residents and other students must ensure that medical students acquire the knowledge and skills while demonstrating the appropriate attitudes in each required and elective component of the curriculum. Throughout this process teachers and learners must adhere to the highest standards of quality and safety in the delivery of patient care services. Teachers are expected to nurture the values and behaviors that strengthen the doctor-patient relationship, demonstrate the Biopsychosocial approach and sustain the profession of medicine as an ethical enterprise.
All teachers must be committed to maintaining high standards of educational quality. A medical student’s educational needs should be the primary determinant of any assigned patient care services. Medical students must be mindful that they have responsibilities to their patients and these always take priority over purely educational considerations.
Medical students must learn in clinical settings epitomizing the highest standards of medical practice. Indeed, the primary obligations of institutions and individuals providing medical student education is the provision of high quality, safe patient care in a respectful and professional learning environment. Teachers accept an obligation to ensure high quality medical care in all learning environments.
Medical students are especially vulnerable and their well-being must be accorded the highest priority. Given the uncommon stresses inherent in fulfilling the demands of their education program, medical students must be allowed sufficient opportunities to meet personal and family obligations, to pursue recreational activities, and to obtain adequate rest. This is accomplished through the adherence to medical school policies on duty hours.
Obligations of Teachers
- As role models for our medical students, we will maintain the highest standards of care, respect the needs and expectations of patients, and embrace the contributions of all members of the healthcare team.
- We pledge our utmost effort to ensure that all components of the educational program for medical students are of high quality, including our own contributions as teachers.
- In fulfilling our responsibility to nurture both the intellectual and the personal development of medical students, we commit to fostering academic excellence, exemplary professionalism, cultural sensitivity, and a commitment to maintaining competence through life-long learning.
- We will demonstrate respect for all medical students, residents and faculty as individuals, without regard to gender, race, national origin, religion, disability or sexual orientation; and we will cultivate a culture of tolerance among the entire staff.
- We will do our utmost to ensure that medical students have opportunities to participate in patient care activities of sufficient variety and with sufficient frequency to achieve the competencies required by their chosen discipline.
- We will provide medical students with opportunities to exercise graded, progressive responsibility for the care of patients to meet the education program objectives. We will do our utmost to prepare and include medical students to function effectively as members of healthcare teams.
In fulfilling the essential responsibility we have to our patients, we will ensure that medical students receive appropriate supervision for all of the care they provide during their training.
We will evaluate each medical student’s performance on a regular basis, provide appropriate verbal and written feedback, and document our assessment.
Obligations of Medical Students
- We acknowledge the fundamental obligation of physicians—to place patients’ welfare uppermost; quality health care and patient safety will always be our prime objectives.
- We will put forth our utmost effort to acquire the knowledge, clinical skills, attitudes and behaviors required to fulfill all objectives of the educational program and to achieve the competencies deemed appropriate for each component of the medical school curriculum.
- We embrace the professional values of honesty, compassion, integrity, and dependability.
- We will adhere to the highest standards of the medical profession and pledge to conduct ourselves accordingly in all of our interactions. We will demonstrate respect for all patients and members of the health care team without regard to gender, race, national origin, religion, economic status, disability or sexual orientation.
- We learn most from being involved in the direct care of patients and from the guidance of residents and faculty and other members of the healthcare team. We understand the need for supervision of our work with patients.
- We accept our obligation to secure direct assistance from faculty or residents whenever we are confronted with situations or clinical decisions that exceed our confidence or skill to handle alone as outlined in the Medical Student Honor Code/ Patient & Student Safety.(Consultation: Students should seek consultation and supervision whenever their participation in the care of a patient may be inadequate because of lack of knowledge and/or experience.).
- We welcome candid and constructive feedback from faculty, residents, peers and members of the health care team who observe our performance, recognizing that objective assessments are indispensable guides to improving our skills.
- We also will provide candid and constructive feedback on the performance of our fellow students, of residents, and of faculty, recognizing the life-long obligation of physicians to participate in peer evaluation and quality improvement.
- We recognize the rapid pace of change in medical knowledge and the consequent need to prepare ourselves to maintain our expertise and competency throughout our professional lifetimes.
Medical school and university guidelines have been shared with the faculty, residents and students.
Concerns about violations of the Teacher-Learner policy or concerns about potential mistreatment should be directed to the designated ombudsperson. Students and teachers should contact the Senior Associate Dean for Medical Student Education (SADMSE) Dr. David R. Lambert in the Offices for Medical Education. Students should also notify their Advisory Dean. See the Reporting Violations chart for additional individuals that are available to assist.
The basic science course directors and clinical clerkship directors are also options for the initial contact. They are responsible for prevention of mistreatment of students in the courses and clerkships. The SADMSE will be the contact person for issues that occur in all electives.
Student concerns that are not satisfactorily addressed via the proposed course/clerkship grievance procedure will be reviewed by the Senior Associate Dean for Medical Student Education. If further action is warranted, the SADMSE will take the appropriate steps to resolve the problem(s).
University of Rochester Policies
Sexual Harassment
It is the University's aim to provide a setting which is characterized by respect for all and encouragement for the development of each individual's full potential. The University will not tolerate any behavior, including verbal or physical conduct, which constitutes sexual harassment and fully complies with all DOE/OCR Title IX guidelines when reviewing student complaints. All students, staff, and faculty are accountable for compliance with this policy; violations may lead to disciplinary action which, in sufficiently severe cases, may lead to separation from the University after appropriate due process. Certain forms of sexual harassment are also illegal under state and federal laws.
While the Medical School generally considers the wishes of the alleged victim in deciding when and how to respond to cases of sexual and other harassment, in instances when the perpetrator has threatened to harm and/or is felt to be a danger to the victim or the SMD community, the School retains the right (without approval of the victim) to take appropriate measures to protect the victim and the community.
Students who report incidents of alleged sexual harassment, will be given a copy of the SMD and Medical School policy on sexual harassment, as well as information on the University and Medical School ombudspersons.
As described in Section C, the Non Academic Standards, Policies and Procedures of the MSRCAP, student charges of the sexual harassment will be reviewed by the Medical Student Promotions and Review Board (MSPRB).
The University of Rochester Policy on Sexual Harassment - Adopted 1981
Sexual harassment ranges from sexual innuendo made at inappropriate times to coerced sexual relations. Sexual harassment is defined by the University to include unwelcome verbal and physical conduct of a sexual nature and may include, but is not limited to, the following types of behavior:
- sexually degrading words or gestures
- verbal sexual abuse or harassment
- offensive sexual graffiti, pictures or cartoons
- subtle pressure for sexual activity
- leering or ogling
- disparaging remarks to a person about his/her gender or clothing
- demands for sexual favors accompanied by implied or overt threats
- unnecessary touching, patting, pinching or brushing
- forced sexual contact including rape or date rape
Source: University of Rochester Sexual Harassment Brochure
The University is strengthening its ability to deter sexual misconduct and to aid members of the University community who are the victims of such assaults. The University offers programming aimed at helping students avoid being victims and intervene effectively for friends at vulnerable moments, and at deterring misconduct. The message is “Stop. Ask. Clarify.”
When sexual misconduct happens, please report it promptly. Help is available. Visit the web link for more information: www.rochester.edu/sexualmisconduct/. See the Reporting Violations chart for individuals that are available to assist.
University of Rochester Student Sexual Discrimination, Misconduct and Harassment Policy
To be in compliance with federal Title IX Sexual Harassment policy the U of R has established a uniform student review process for sexual discrimination, misconduct and harassment.
Complaints about sex discrimination engaged in by faculty or staff members are addressed through the procedures described in Human Resources Policy 106 www.rochester.edu/working/hr/policies/pdfpolicies/106.pdf.
Morgan Levy is Title IX Coordinator and Manager of University Student Services Coordination. The Title IX Coordinator oversees and provides leadership for the staff members who carry out investigations, compliance-related responsibilities and reporting. Any student, faculty or staff member, or applicant for admission for education who has concerns about sex discrimination or sexual assault or misconduct is encouraged to seek the assistance of the Title IX coordinator. You can reach Ms. Levy by contacting her at 585-275-7814 or Morgan.Levy@Rochester.edu.
If there are questions, concerns, or you need to discuss a problem, see the Reporting Violations chart for individuals that are available to assist:
How to Report Incidents of Mistreatment, Sexual Discrimination, Misconduct, Harassment and Acts of Intolerance and Discrimination
The medical school needs to be advised about all suspected violations of the Teacher-Learner policy as well as all incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination. Students are encouraged to report suspected violations to the designated contact person(s) indicated below. They should inform their Advisory Dean of the suspected violations either before or in conjunction with reporting to the designated contact person(s) indicated below. The chart below provides a quick reference with the contact people for reporting violations of the of the Teacher-Learner policy and incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination.
Students who report violations of the Teacher-Learner policy, incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination to the medical school will be advised about the follow-up and outcome of their reported incident.
Responding to Acts of Intolerance and Discrimination
The Committee on Inclusion and Diversity was created to serve as a mechanism to monitor acts of intolerance across the entire University and to insure a coordinated response.
The coordinator is University Intercessor, Lynnett Van Slyke located in the Provost’s Office, 24 Wallis Hall RC Box 270039, 585-275-9125. l.vanslyke@rochester.edu. Also see the Reporting Violations chart for additional resources.
How to Report Incidents of Mistreatment, Sexual Discrimination, Misconduct, Harassment and Acts of Intolerance and Discrimination
The medical school needs to be advised about all suspected violations of the Teacher-Learner policy as well as all incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination. Students are encouraged to report suspected violations to the designated contact person(s) indicated below. They should inform their Advisory Dean of the suspected violations either before or in conjunction with reporting to the designated contact person(s) indicated below. The Reporting Violations chart provides a quick reference with the contact people for reporting violations of the of the Teacher-Learner policy and incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination.
Students who report violations of the Teacher-Learner policy, incidents of mistreatment, sexual discrimination, misconduct, harassment and acts of intolerance and discrimination to the medical school will be advised about the follow-up and outcome of their reported incident.
Policy on Medical Student Work Hours during Clinical Years
To address the time commitment required of medical students during clinical rotations and taking into account the effects of fatigue and sleep deprivation on learning, clinical activities, student health and safety, the medical school has adapted the following policy.
- Duty hours must be limited to 80 hours per week averaged over a four-week period, inclusive of all in-house call and patient care activities.
- Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Students may remain on duty additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care.
- Students must be provided with one day in seven free from all educational and clinical responsibilities, averaged over a four-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical educational and administrative activities.
- Optimally, students should be provided with a 10 hour period after in-house call that they are free from all patient care activities.
Clinical clerkships will design student duties with these requirements and mind. Clinical course directors are responsible for monitoring and documenting student duty hours and for the education of their faculty, residents and other appropriate individuals to facilitate compliance with this policy. Students are required to comply with all monitoring requirements set forth by each specific clerkship.
Procedures to Avoid the Impact of Conflicts of Interest
The following policy and procedures have been implemented to avoid the impact of conflicts of interest. A faculty member or other institutional official will automatically recuse him/herself from any discussion or vote relating to a matter where there is a potential for or the existence of a conflict of interest and state publicly that there is a personal conflict.
The SMD policy and procedures to avoid the impact of conflicts of interest will be included on the agenda of all evaluation/disciplinary MSPRB, Appeals and Honor Board meetings. The voting members will be reminded that their eligibility to participate in a discussion or vote is a result of no known conflicts of interest. (Effective October 12, 2005, updated August 18, 2011)