Professional ConductExpectations and Responsibilities for

Residents

Office of Graduate Medical Education

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.

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.

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

2012 Graduation Questionnaire DataMistreatment 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

Yes 61.4 47.1No 38.6 52.9

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

Clerkship faculty (clinical setting)

Resident/Intern

Nurse

Student

Clerkship faculty (classroom)

Administrator

Other institutional personnel

Pre-clerkship faculty

0 10 20 30 40 50

All Schools (n=12,195)

U of U (n=88)

Percent who personally experienced mistreatment

University of Utah Medical Student and National Figures 2012 Graduation Questionnaire

Publically humiliated

Lower evals - gender

Req'd to perform personal services

Subj. to offensive race/ethnic remarks

Threatened with physical harm

Subj. to unwanted sexual advances

Denied training - sexual orientation

Asked to exchange sexual favors for grades

0 10 20 30 40 50

All Schools (n~12,170)

U of U (n=88)

Percent who personally experienced

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…

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

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

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

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

Level III Unprofessional Behavior

Examples may include:• Physical violence or abuse directed at

someone• Level I or II behaviors that persist after

intervention

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.

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.

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.

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.

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.

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

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

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

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