Learning Environment Standards, Procedures and Policy

Standards for the Learning Environment

The College of Physicians and Surgeons bears special responsibility to assure that its students learn in an environment that fosters mutual respect, civil behavior and the values of professionalism, ethics and humanism.  The standards and procedures for the P&S Learning Environment have been adopted by the P&S Curriculum and Education Policy Committee, and are discussed with students during orientation and transition to the Major Clinical Year.

P&S recognizes that the quality of the learning environment, including interactions among faculty, residents, nurses staff, and students, impacts student learning and satisfaction.  Learning in the context of patient care, including life and death situations where patient needs come first, can present special challenges in ensuring a positive learning environment. P&S has prepared a guide for faculty and residents with tips on how to handle these challenges: Tools for Fostering a Positive Learning Environment.

The monitoring mechanisms and procedures to address suboptimal learning environments are described below. P&S is pleased that in end of course/clerkship and end of year surveys, students mostly express satisfaction with their educational experiences at P&S, including positive stories about their compassionate, intellectually challenging and caring treatment from faculty, residents, nurses, and staff. 

The standards for behavior by P&S students are delineated in Suitability for the Practice of Medicine and the P&S Student Honor Code.

Under the leadership of senior students, P&S has developed a guide for students with tips on how they can contribute to a positive learning environment in patient care settings and how to get the most of our their training in such settings: Tools for Students for a Positive Learning Environment in the Clinical Setting.

Monitoring the Learning Environment

P&S has developed ongoing mechanisms to monitor and enhance the learning environment in all education settings including the classroom, laboratory, hospital and clinic by:

  • Soliciting reports from students of exemplary learning environments to celebrate and learn from them
  • Developing a culture in which students feel safe reporting mistreatment events if they occur, so they can be addressed and avoided in the future
  • Identifying environments students perceive as hostile to learning so they can improve
  • Appointing a senior faculty learning environment advisor in each CUMC department to work with course directors, affiliate deans, and the senior associate dean for student affairs to address and follow up on any learning environment issues.

Classification of Suboptimal Learning Environments

At times students describe being treated in ways that are unacceptable and inconsistent with the P&S Learning Environment Policy, as described in the table below.  P&S differentiates between three types of unacceptable behavior and asks students to report them separately: mistreatment, creating a hostile learning environment and unsafe patient care practices. The following table assists in distinguishing these behaviors. It includes links to video vignettes illustrating such behaviors. These videos were provided by Stanford University with the understanding that they are not to be copied or downloaded for distribution:

Behavior

Explanation, examples

Video Illustration
 (Do not download or copy.)

Mistreatment

(directed at a medical student)

· Public humiliation (Note: Public embarrassment is not considered mistreatment by AAMC)

· Threat of or actual physical harm (eg. hitting, kicking, slapping)

· Being subjected to unwanted sexual advances (Note: See *Reporting Sexual Misconduct below for Title IX policies.) 

· Being subjected to offensive sexist, racist, ethnic remarks or those based on sexual orientation (directed at the student)

· Receiving lower grades or evaluations based on gender, race or sexual orientation.

· Being required to provide personal service (eg. shopping or babysitting)

Video illustrating mistreatment

Creating a hostile learning environment

· Witnessing disparaging speech and/or nonverbal communication about an individual other than a medical student, including humor that belittles, humiliates or demeans an individual or a group

· Witnessing shouting, displays of temper

· Witnessing behaviors contributing to a culture of negativity, rudeness or intimidation

· Repeatedly being ignored by those in a teaching role

Video illustrating creating a hostile learning environment

Unsafe patient care practices

· Witnessing near misses or errors resulting in injury

· Witnessing inappropriate behavior directed at residents, nurses or other healthcare providers which affect the quality of patient care

 

In contrast with the categories above, an illustration of an acceptable learning environment in which students are expected to answer questions about their patients and their diseases, and expected to give clear and organized presentations is found here, entitled 'business as usual'.

Reporting Mistreatment or Hostile Learning Environment:

  • P&S encourages students to report mistreatment or hostile learning environment in end of course evaluations https://cumc.co1.qualtrics.com/SE/?SID=SV_38Zh0vdTRzM3ZJz or at any other time.  The Center for Education Research and Evaluation tracks reports of mistreatment and hostile learning environment, maintaining anonymity of the student.  The deans for student affairs and curriculum, and the vice dean for education, regularly review these reports and monitor follow-up actions within the departments where the events occurred. To preserve anonymity to the fullest extent possible reports are ‘quarantined’ until after course directors have submitted grades (in the case of Fundamentals courses and MCY clerkships) or after students have matched (in the case of electives).
  • The senior learning environment advisor, working with the senior associate dean for student affairs, the course director and if relevant, the affiliate dean, addresses reports of mistreatment and hostile learning environment and responds to these reports in a relevant and constructive manner.  Department chairs will recieve a quarterly report summarizing their department's activity, including positive and negative learning environment. 
  • The confidential resources for students to discuss mistreatment in the learning environment are:
    • Director of the Center for Student Wellness
    • University Ombudsperson
  • Other resources to discuss the learning environment include:
    • Dean of Student Affairs
    • Dean of Diversity and Multicultural Affairs
    • Advisory Dean
    • Clerkship FCM Senior Student Advisor

Reporting Sexual Misconduct

* Title IX federal regulations require that any allegation of sexual discrimination, harassment, gender-based or sexual misconduct reported to a faculty member or administrator must be reported to and investigated by the Title IX Office at the university, which for Columbia is at the Morningside campus. The policies are described at http://ps.columbia.edu/education/honor-code-policies/college-university-policies/discrimination-harassment-gender-based-sex.  Staff in the Title IX and the Equal Opportunity and Affirmative Action offices are trained to investigate these allegations and determine responsibility.  The only staff who are able to maintain confidentiality regarding these allegations and thus not required to report to the Title IX and EOAA Offices are Student Health and Student Mental Health professionals, Center for Student Wellness staff, the University Ombuds Officer, University Clergy, and staff in the Columbia Sexual Violence Response Office. These policies are further described in orientation for first year students and transition to the Major Clinical Year.

Reporting Unsafe Patient Care

At NewYork-Presbyterian we follow these steps:

1.     Go to the KEEPSAFE log in page (you will need to be connected to the NYP or CUMC network).

2.    On the upper right, click on NYP Network,

3.    Choose Application Account (instead of NYP).

4.    An anonymous button will appear below the login boxes that you can use to begin a report. 

The reporting mechanism at affiliate hospitals should be available at orientation to the hospital.

Following Up on Student Reports (other than sexual misconduct)

The name of the student reporting remains anonymous at each step.  The senior associate dean for student affairs reviews each report to confirm that it meets the criteria for mistreatment or hostile learning environment and instructs the Center for Education Research and Evaluation (CERE) to log the report in a tracking database.  After the quarantine period ends, CERE forwards the report to the departmental senior learning environment advisor and clerkship or elective director to conduct appropriate follow up. 

· For first-time cases, follow up typically involves discussing the report directly with the individual reported and exploring prevention of the inappropriate behavior.

· For repeat cases, follow up may include departmental leadership or the dean’s office and may result in removal from the privilege of teaching medical students.

In all cases, the senior learning environment advisor submits to the senior associate dean for student affairs a written follow up report, which CERE also logs in the tracking database.

Committee on the P&S Learning Environment

The Committee on the P&S Learning Environment is a standing committee comprised of senior learning environment advisors from each CUMC clinical department and the senior associate dean of student affairs.  It meets annually to discuss the current status of the various learning environments, mistreatment and hostile learning environment trends and address issues.  If a student who has reported mistreatment (other than sexual misconduct, which is handled by the CU Title IX Office) is not satisfied with the response from the senior learning environment advisor and requests a formal inquiry, a subcommittee of the Committee on the P&S Learning Environment will meet to hear the request and render a decision.  The Committee will conduct its inquiry with fairness and respect for the confidentiality of all parties.