A Respectful Learning Environment: Avoiding Student Mistreatment

1
A Respectful Learning Environment Avoiding
Student Mistreatment

• G. Anne Cather, MD
• Associate Dean Student Services and Professional
  Devolvement
• March 2007

2
Objectives

• Discuss current national data on student
  mistreatment in medical school
• Review the WVU SoM AAMC GQ data on student
  mistreatment
• Analyze the SoM policy on Student Mistreatment
• Identify how faculty actions influence student's
  learning
• Explain generational differences in perceptions
  and actions
• Define methods to create a nurturing, respectful
  educational atmosphere for all

3
Historical Timeline

• 1988 AMA studied sexual harassment/exploitation
• AMA recommended to ACGME RRC to identify and
  eliminate instances of sexual harassment /or
  sexual exploitation in academic and clinical
  training programs
• Teacher-learner relationship should be based on
  mutual trust, respect/responsibility, carried out
  in a professional manner, in a safe learning
  environment, that places strong focus on
  education, high quality patient care ethical
  conduct

4
Historical Timeline

• 1990 the AAMC Graduating Questionnaire (GQ) has
  included questions on student mistreatment (every
  other yr)
• Originally asked 2 questions Sexual (30) and
  racial/ethnic (12) harassment or discrimination
• Consistent results ? mistreatment does occur
  (gender, ethnicity or sexual orientation often
  cited)
• Slurs, favoritism, poor evals, perceived
  hostility, ostracized/ignored, insensitivity,
  denied opportunities, malicious gossip

5
Historical Timeline

• 1999 LCME established a new standard on
  mistreatment each medical school
• Define develop standards of conduct
  (teacher-learner relationship)
• Develop widely promulgate written procedures to
  allow students to report violations without fear
  of retaliation
• Develop mechanisms for prompt handling of
  complaints
• Develop educational methods aimed at preventing
  student mistreatment

6
Medical School Procedure must have

• A non-threatening/easily accessible mechanism to
  submit and process reports or allegations
• A means to determine if further investigation is
  warranted
• Equitable methods to investigate adjudicate
  complaints
• Guaranteed rights of due process
• Appropriate protection of complainant and accused

7
Mistreatment

• Alleged, perceived or real incidents of
  inappropriate behavior or mistreatment of
  individuals
• Sexual harassment
• Discrimination or harassment based on race,
  religion, ethnicity, gender, sexual orientation,
  physical handicap, or age
• Humiliation, psychological or physical punishment
• Use of grading and other forms of assessment in a
  punitive manner

8
Mistreatment Why? What?

• Social and behavioral diversity of the students,
  faculty, residents staff the intensity of the
  interactions between them
• Intentional or unintentional occurrence results
  in
• disruption of the spirit of learning
• breach in the integrity and trust between teacher
  and learner

9
WVU SoM Student Mistreatment Policy

• Examples of mistreatment of students may include
  but are not limited to
• Harassment of a sexual nature
• Discrimination based on age, race, gender, faith,
  national or ethnic origin, disability, sexual
  orientation, and veteran status
• Exclusion from any usual and reasonably expected
  educational opportunities for any reason other
  than the students performance
• Any physical or verbal misconduct inflicting
  bodily injury or emotional harm
• Requirement to perform a menial task or tasks
  with the intent to humiliate

10
WVU SoM Student Mistreatment Policy Reporting
Procedure

• The individual considering making a report of
  mistreatment should first, if at all possible,
  attempt to resolve the matter directly with the
  alleged offender.
• Students may consult with an Associate/Assistant
  Dean for Student Services at any time for
  assistance.
• Such informal consultation will be confidential,
  unless precluded by safety of the student or
  University policy and procedure.
• Students have the right to report such incidents
  without fear of retribution or retaliation.

11
WVU SoM Student Mistreatment Policy Reporting
Procedure

• Should this not adequately resolve the situation
  a formal report may be filed in writing with an
  Associate/Assistant Dean (AD) for Student
  Services. Upon receipt of such a report the
  person receiving it may
• Review the situation and alleged violation with
  the accused, and the accused Department Chair,
  and if necessary then, call into session the
  Standards of Behavior Committee, to review the
  facts and make a recommendation for disciplinary
  action to the Dean of the School of Medicine.

12
Standards of Behavior Committee

• members appointed annually by the Dean
• consists of 2 BS 4 CS faculty (2 Mgtn 2
  Chas.) AVP for Social Justice HSC
• convenes solicits facts from the victim, the
  alleged perpetrator any key witnesses
• reports findings recommendations to the AD
  within 10 days of the meeting
• AD reviews forwards the findings to the Dean
  for action.

13
SoM Policy continued

• Retaliation against any member of the School
  community who comes forward in good faith with a
  complaint will not be tolerated. Such action will
  be cause for disciplinary action under this
  policy as a separate incident of mistreatment.
• A student alleging sexual harassment or unlawful
  discrimination will ordinarily be referred to the
  HSC Office for Social Justice.
• Phone numbers
• Student Services 293-2408
• Social Justice 293-1651

14
Early studies

• 10 schools, 581 returned surveys (59 response)
• 96.5 reported at least 1 perceived
  mistreatment/harassment
• Majority were psychological- publicly humiliated
  or belittled
• 55 sexual harassment
• 54 someone taking credit for their work
• Source Residents (85) Faculty (79)

West J Med. 1991 August 155(2) 140145.
15
Student Mistreatment Perception trends GQ 96
vs.99

• Reported denied opportunities due to gender
• 4.3?8.7
• Subject to racial/ethnically offensive remarks
• 3.8 ?7.2
• Believe lower evals were due to sexual
  orientation
• .4 ? .8
• Reported mistreatment incidents
• 27 ? 12 (Dean 17 ?4 Faculty 26 ?7)

Contemporary Issues in Medical Education
July/Aug 2000 Vol 3 No 4
16
AAMC 2003 GQ- 125 schools

• 1 form of medical student mistreatment
• public humiliation or belittling ?59.6 (gt1X)
• clinical hospital faculty or house staff most
  common source
• 12 subjected to racially/ethnically offensive
  remarks or names directed at them personally
  (gt1X)
• Fear of reprisal was the most common reason not
  to report an episode of mistreatment (47)
• Acts of severe abuse are much less common now
  than a decade ago

17
GQ 2000 2005
18
GQ 2000 2005
Often not want to pursue, just want it to stop
19
Consequence of mistreatment

• Wide ranging and well documented
• Headaches, memory loss, post-traumatic stress
• Workplace mistreatment
• ? worker productivity
• ? employee turnover
• Psychological mistreatment research in
  educational settings
• ? levels of self-esteem
• ? levels of stress

20
Negative Interactions with Faculty Graduate
Student Experiences

• 138 students Wayne State University looked at 4
  scales
• Negative Incidents
• Measure Coping with Harassment Scale
• Intention to Turnover Scale
• General Health Questionnaire

Jagatic Keashly, Conflict in Management Higher
Education Report Vol 1, No 3 Aug/Sept 2000
21
Mistreatment (WSU)

• Mistreatment behaviors reported students were
  primarily neglectful
• Little /no feedback
• No guidance
• No clearly defined goals, despite repeated
  requests
• Lack of concern for progress
• May be as damaging as more overtly hostile
  behaviors

22
Coping (WSU)

• Coping mechanisms are different based on the type
  of mistreatment.
• Talking to friends/family was the most frequent
  coping response for both minor and major
  incidents
• Otherwise coping responses differed for minor and
  major incidents
• Emotion focused coping (managing emotions
  internally vs. outward action about the problem)
  was used for minor negative incidents most often.
  
• Problem-focused coping (solving the problem
  directly) was used for major negative incidents.

23
MINOR

• Talk to friends and family about it
• Ignore it
• Tell the professor how I feel about the
  situation
• Assume there is some explanation for the behavior
  which I don't understand
• Try to forget the whole thing
• Tell myself it is not really important
• Talk to my advisor or another faculty member
  about it
• Treat it like a joke

• Talk to the chair of the department or the dean
  
• Arrange things so that I do not have to deal with
  the professor
• Assume the professor doesn't know any better
• Take someone with me if I have to see him or
  her
• Make a formal complaint
• Accept that it is part of being a student
• Seek legal advice or counsel
• Blame myself for what happened

24
MAJOR

• Talk to friends and family about it
• Talk to my advisor or another faculty member
  about it
• Talk to my advisor or another faculty member
  about it
• Make a formal complaint
• Tell the professor how I feel about the situation
  
• Seek legal advice or counsel
• Take someone with me if I have to see him or her
  

• Arrange things so that I do not have to deal with
  the professor
• Assume there is some explanation for the behavior
  which I don't understand
• Try to forget the whole thing
• Ignore it
• Tell myself it is not really important
• Treat it like a joke
• Assume the professor doesn't know any better
• Accept that it is part of being a student

25
Intention to Leave and General Health (WSU)

• The greater the frequency of mistreatment the
  stronger the intention to leave the program and
  the university in general
• Students' general health was negatively affected
  by mistreatment.

26
Gender Discrimination Sexual Harassment

• MS4s at 12 schools asked for written descriptions
  of personal experiences? 290 wrote 313
  descriptions perceived as discriminating or
  harassing
• 7 response categories educational inequalities
  stereotypical comments sexual overtures
  offensive, embarrassing, or sexually explicit
  comments inappropriate touching sexist remarks
  not classifiable

Witte, etal. Acad Med Vol 80, No7, July 2006
27
Gender Discrimination Sexual Harassment

• Educational inequalities most frequent more
  frequently reported by men (often OB-GYN)
• All other categories of experiences were more
  frequently reported by women
• Formal antiharassment policies should provide
  examples of unacceptable behavior based on
  examples

28
Gender Discrimination Sexual Harassment-
examples

• Educational inequalities differences in training
  environment between men and women
• Stereotypical comments women should be nurses
  rather than doctors a students gender would
  prevent him/her from doing well women arent as
  smart as men (pea sized brains, fluff in their
  heads)
• Sexual overtures request for dates, requests for
  sexual contact kiss a hand
• Offensive, embarrassing, sexually explicit
  comments usually sexually oriented joke or
  comments about genitalia

29
Gender Discrimination Sexual Harassment-
examples

• Inappropriate touching unwanted physical
  contact, often breasts or buttocks
• Sexist remarks refer to a female student as
  honey babe or girl good little girl

30
Mistreatment of university students most common
during medical studies

• Humiliation and contempt (40), negative or
  disparaging remarks (34), yelling and shouting
  (23), sexual harassment and other forms of
  gender-based mistreatment (17) and tasks
  assigned as punishment (13)
• Females more commonly reported mistreatment than
  males and were more disturbed by it.
• 51 females 46 males reported having
  experienced mistreatment from fellow students at
  least once
• 25 of the females 19 of the males reported
  contempt, humiliation derogatory remarks
  concerning the career chosen for students
  taking credit for someone else's work

Rautio, BMC Med Educ. 2005 5 36.
31
Student Treatment on Clerkships Based on Their
Specialty Interests

• MS4 students at 6 schools 75 response rate
• Mistreatment triggered by clinical interests 2X
  national rates for mistreatment triggered by race
  or sex
• Primary care students mistreatment lt focused
  specialty
• Common
• hearing deprecating comments about their
  interests
• being denied learning opportunities
• receiving lower evaluations
• being discouraged from pursing their interests
• needing to be evasive for self-protection
• some clerkships types of teachers were special
  problem sources.

Woolley, et.al. Teaching and Learning in Medicine
2006, Vol. 18, No. 3, Pages 237-243
32
Does exposure to Gender Discrimination Sexual
Harassment affect Specialty Choice?

• 14 public and private schools
• Students reported frequency of GD/SH assessed
  impact on choices (none, little, some, quite a
  bit, deciding factor)
• 83 men, 93 women experienced, observed or heard
  of at least 1 incident (personally 10 men, 27
  women)
• Women who reported experiences said GD/SH
  influenced their specialty choice (45 vs 16)
  and residency rankings (25 vs 11) than men
• Women experienced GD/SH most in general surgery,
  men in OBGYN
• Top 4 OBGYN, General Surgery, Emergency
  Medicine, Pediatrics

Stratton, et al, Acad MedVol 80, No 4, April 2005
33
Differences in Clinical Experiences Based on
Gender

• Family medicine clerkship, 451 MS3 students
• Majority of skills, no gender differences
• Women received more experience with 7/12 female-
  specific skills Men received more experience
  with 2/3 male-specific skills
• Women preceptors more likely to provide
  female-specific skills Men preceptors provided
  more experiences with procedures
• Highest level of exper. ?students in pairs and
  preceptor all of same gender. Lowest levels 1
  student and opposite gender preceptor.

Levy, et al, Acad Med Vol 77, No 12, Dec 2002
34
The Nexters 1980-2000

• Core Values optimism, civic duty, confidence,
  achievement, sociability, morality, diversity
• Trends child focus, technology, stress, busy,
  over-planned
• Assets collective action, optimism, tenacity,
  multitasking capabilities, technology savvy
• Liabilities need supervision structure,
  inexperienced (esp. with handling difficult
  people issues)

Generations at Work, Zemke et al, 2000
35
Nexters

• Veterans (1922-1943) good manners, smart
  critters, need to toughen up, they watch too much
  tv (with crude language violence)
• Boomers (1943-1960) cute, need, more discipline
  from their parents, can set the time on the VCR,
  need to learn to entertain themselves, they need
  too much attention, can they do my webpage for
  me?
• GenXers (1960-1980) another self-absorbed
  generation of spoiled brats

36
Nexters Messages to Motivateor How to Handle
with Care

• Youll be working with other bright, creative
  people
• You and your coworkers can help turn this
  company around. You can be a hero here.
• Budget plenty of time for orienting, Create a
  clear picture of the work environment. Learn
  about their personal goals.
• No preconceived notions about traditional gender
  roles they are gender benders
• Potential for conflicts between Nexters and
  GenXers- big gaps. Nexters will work well with
  mentors, especially more seasoned people.

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12 Steps to SUCCESS

• 7. Everyone needs to know the rules
• Everyone should be held to the same standards
• Have a fair adjudication process- someone will
  err
• View this as the appropriate culture. Be a
  leader. Spread the word.
• Develop ongoing educational programs that assume
  everyone wants to treat everyone with respect
• Provide for evaluation and continual improvement
  of ongoing programs

• Agree that treating others with respect is what
  its all about
• Legitimatize the issue by a statement from the
  Dean
• Review school GQ data qoyr
• Establish a committee to define abuse establish
  Standard of Conduct
• Focus on respect for the teacher and learner
  roles
• Think () how to treat others with respect rather
  than (-) punitive