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GWU School of Medicine and Health Sciences
Student Mistreatment Policy and Procedures
Please note: The Mistreatment Officer
is Dr. Jeffrey Akman.
Policy's Principles
The George Washington University School of Medicine and Health Sciences
(the "School") is committed to maintaining a positive environment
for study and training, in which individuals are judged solely on relevant
factors such as ability and performance, and can pursue their educational
and professional activities in an atmosphere that is humane, respectful
and safe. The School's mission statement provides that the Medical School
"will achieve our mission through our commitment to the following
principles: altruism, collaboration, compassion, innovation, integrity,
respect and service excellence". Medical student mistreatment is
destructive of these fundamental principles and will not be tolerated
in the Medical School community.
Policy's Objectives
This policy and related procedures are intended to inform members of
the Medical School community what constitutes medical student mistreatment
and what members can do should they encounter or observe it. In addition,
the policy and related procedures are intended to: (i) prohibit medical
student mistreatment by any employee of the University, Hospital or Medical
Faculty Associates ("MFA") including faculty members (pre-clinical
and clinical), clerkship directors, attending physicians, fellows, residents,
nurses and other staff, and classmates in the Medical School community;
(ii) encourage identification of medical student mistreatment before it
becomes severe or pervasive; (iii) identify accessible persons to whom
medical student mistreatment may be reported; (iv) require persons (whether
faculty, staff or student) in supervisory or evaluative roles to report
medical student mistreatment complaints to appropriate officials; (v)
prohibit retaliation against persons who bring medical student mistreatment
complaints; (vi) assure confidentiality to the full extent consistent
with the need to resolve the matter appropriately; (vii) assure that allegations
will be promptly, thoroughly, and impartially addressed; and (viii) provide
for appropriate corrective action.
The ultimate goal is to prevent medical student mistreatment through
education and the continuing development of a sense of community. But
if medical student mistreatment occurs, the School will respond firmly
and fairly. As befits an academic community, the School's approach is
to consider problems within an informal framework when appropriate, but
to make formal procedures available for use when necessary.
What constitutes medical student mistreatment
The School has defined mistreatment as behavior that shows disrespect
for medical students and unreasonably interferes with their respective
learning process. Such behavior may be verbal (swearing, humiliation),
emotional (neglect, a hostile environment), and physical (threats, physical
harm). When assessing behavior that might represent mistreatment, students
are expected to consider the conditions, circumstances, and environment
surrounding such behavior. Medical student training is a rigorous process
where the welfare of the patient is the primary focus that, in turn, may
appropriately impact behavior in the training setting.
Examples of mistreatment include but are not limited
to:
- harmful, injurious, or offensive conduct
- verbal attacks
- insults or unjustifiably harsh language in speaking to or about a
person
- public belittling or humiliation
- physical attacks (e.g., hitting, slapping or kicking a person)
- requiring performance of personal services (e.g., shopping, baby
sitting)
- intentional neglect or lack of communication (e.g., neglect, in a
rotation, of students with interests in a different field of medicine)
- disregard for student safety
- denigrating comments about a student's field of choice
- assigning tasks for punishment rather than for objective evaluation
of performance (inappropriate scutwork)
- exclusion of a student from any usual and reasonable expected educational
opportunity for any reason other than as a reasonable response to that
student's performance or merit
- other behaviors which are contrary to the spirit of learning and/or
violate the trust between the teacher and learner.
Violation of this policy may lead to disciplinary action, up to and including
expulsion or termination.
It is expected that when there is a need to weigh the right of an individual's
freedom of expression against another's rights, the balance will be struck
after a careful review of all relevant information and will be consistent
with the School's commitment to free inquiry and free expression.
Other mistreatment behaviors such as sexual harassment, discrimination
based on race, religion, ethnicity, sex, age, disability, and sexual orientation
will ordinarily not be covered under this policy and instead will be covered
by already existing GW University policies and procedures. However, the
VPHA has the authority to determine (on a case by case basis) whether
or not an alleged form of mistreatment would be more appropriately covered
under this policy. When a medical student is alleged to have engaged in
medical student mistreatment, the Assistant Dean for Curricular and Student
Affairs will determine whether such cases shall be handled under this
policy or the medical school policy on professional comportment.
Prevention; dissemination of information
The School is committed to preventing and remedying mistreatment of medical
students. To that end, this policy and related procedures will be disseminated
among the School's community. In addition, the School will periodically
sponsor programs to inform medical students, residents, fellows, faculty,
administrators, nursing and other staff about medical student mistreatment
and its resulting problems; advise members of the School community of
their rights and responsibilities under this policy and related procedures;
and train personnel in the administration of the policy and procedures.
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Methods of communicating to specific groups include but
are not limited to the following:
To medical students
- inclusion of a section on medical student mistreatment in the Regulations
for M.D. Candidates,
- inclusion as an agenda topic for MSI, MSII, and MSIII orientation,
- inclusion of a reference to the topic in the guidelines/description
of each pre-clinical course and clinical rotation,
- education of the medical student body through class meetings with
student members of the medical student mistreatment committee.
To faculty, residents, fellows
- Annual transmittal, by the Dean, of a copy of the policy and procedures
to department chairs, course directors, clerkship and program directors
on site and at affiliated institutions, with instructions to distribute
and explain the policy and procedures to faculty participating in the
teaching and training of medical students,
- inclusion as an agenda topic for chief resident/resident/ fellow
orientations.
To nurses and other clinical staff
- Annual transmittal, by the Dean, of a copy of the policy and procedures
to nurse executives on site and at affiliated institutions with instructions
to distribute and explain the policy and procedures to all staff involved
in the training of or otherwise interacting with medical students.
Consensual relationships
Relationships that are welcomed by both parties do not entail mistreatment,
and are beyond the scope of this policy. Whether a relationship is in
fact welcomed will be gauged according to the circumstances; special risks
are involved when one party –- whether a faculty member, staff member
or student -- is in a position to evaluate or exercise authority over
the other. Members of the School community are cautioned that consensual
relationships can in some circumstances entail abuse of authority, conflict
of interest, or other adverse consequences that may be addressed in accordance
with pertinent University policy and practice.
What to do
Three procedural avenues of redress are available to medical students
who believe that mistreatment has occurred -- consultation, informal resolution,
and formal complaint. Often, concerns can be resolved through consultation
or informally resolved. If the matter is not satisfactorily resolved through
the consultation or informal resolution procedure, then the person who
made the allegation of mistreatment (whether a medical student or otherwise)
or the person against whom the allegation was made may initiate a formal
complaint.
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Consultation
A medical student who believes she/he has been mistreated may discuss
the matter with the person who has engaged in the behavior or with his/her
department chair, the clerkship director, the residency director, the
Assistant Dean for Curricular and Student Affairs, the relevant staff
supervisor, or the Grievance Officer assigned to cases of medical student
mistreatment who shall be consulted when appropriate by any of the foregoing
persons. The Grievance Officer will provide a copy of the medical student
mistreatment policy and procedures, respond to questions about them, assist
in developing strategies to deal with the matter and work in accordance
with the procedure set forth in Appendix A.
Informal resolution procedure
An informal resolution procedure, which is initiated in the same manner
as a consultation, entails an investigation by the Grievance Officer of
the charges in accordance with Appendix B.
Formal complaint procedure
The formal complaint procedure is available when the informal resolution
procedure fails to resolve satisfactorily the allegation of mistreatment.
The person who made the allegation of mistreatment (the "Complainant"),
the person against whom the allegation was made (the "Respondent")
or a responsible School official may initiate a formal complaint.
A formal complaint is initiated by submitting to the Grievance Officer
a signed, written request to proceed with a formal complaint. The request
is due within 15 business days after the person receives from the responsible
School official a statement of the disposition of the informal resolution
procedure. The Grievance Officer will inform the requesting party of the
process that will be followed and provide a copy of the applicable procedure.
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Outcomes
If the informal resolution procedure or formal complaint procedure results
in a determination that mistreatment occurred, the findings and recommendations
shall be referred to the appropriate University, Hospital or MFA official
for imposition of corrective action, including sanctions that the official
is authorized to impose. A range of relevant considerations may be taken
into account in determining the extent of sanctions, such as the severity
of the offense, the effect of the offense on the victim and on the University
community, and the offender's record of service and past offenses. Sanctions
may include, but are not limited to, oral or written warning, termination
of privileges to train/interact with/evaluate medical students, probation,
suspension, expulsion, or termination of employment; provided that a respondent
may not be dismissed except in accordance with the procedural safeguards
for faculty, residents, staff, and students set forth in the relevant
documents. The appropriate University, Hospital or MFA official may impose
interim corrective action at any time, if doing so reasonably appears
required to protect a medical student.
Redress of disciplinary action
Nothing in this policy or these procedures shall be deemed to revoke
any right that any member of the University community may have to seek
redress of a disciplinary action, such as a faculty member's right to
maintain a grievance under the Faculty Code.
Confidentiality
The Grievance Officer and other investigators and decision-makers will
strive to maintain confidentiality to the full extent appropriate, consistent
with the need to resolve the matter effectively and fairly. The parties,
persons interviewed in the investigation, persons notified of the investigation,
and persons involved in the proceedings will be advised of the need for
discretion and confidentiality. Inappropriate breaches of confidentiality
may result in disciplinary action.
Retaliation
Retaliation against a person who reports, complains of, or provides information
in a mistreatment investigation or proceeding is prohibited. Alleged retaliation
will be subject to investigation and may result in disciplinary action
up to and including termination or expulsion.
False claims
A person who knowingly makes false allegations of mistreatment, or who
knowingly provides false information in a mistreatment investigation or
proceeding, will be subject to disciplinary action (and, in the case of
students, consistent with the Honor Code).
Time limits
The School aims to administer this policy and these procedures in an
equitable and timely manner. Persons making allegations of mistreatment
are encouraged to come forward without undue delay.
Interpretation of policy
The Office of the Vice President and General Counsel is available to
provide advice on questions regarding interpretation of this policy and
these procedures.
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Appendix A: Consultation Procedure
- The consultation consists of one or more meetings between the Grievance
Officer or his or her designee ("the Officer") and the person
who requests the consultation.
- The Officer will provide a copy of the medical student mistreatment
policy and procedures to the person requesting consultation and respond
to questions about them. The Officer may discuss the situation with
the person, assist in developing strategies to deal with the matter,
determine (and notify such person) that no further action is necessary,
or initiate the informal resolution procedure under Appendix
B.
- The Officer will prepare a record of the consultation, which will
be maintained only in his or her office. Such record (i) will be maintained
by the Officer for a ten year period (and thereafter may be discarded),
and (ii) will not be made a part of an individual's personnel, departmental
or other employment related records. If the person accused of mistreatment
is identified by name or can be identified by the nature of the incident
then that person alleged of mistreatment will be notified (by the Officer)
of the allegation and the complainant's name(s) will also be disclosed.
Such individual shall have an opportunity to review the record of the
allegation, and submit a written response which will be maintained by
the Officer. The record will be treated confidentially to the full extent
possible consistent with fairness and the University's need to take
preventive and corrective action.
- When the Officer has reason to believe that criminal conduct may have
occurred or that action is necessary to protect the health or safety
of any individual, the University, Hospital, or MFA may take appropriate
actions consistent with its policies to refer the matter to appropriate
authorities. Under these circumstances, it may not be possible to maintain
complete confidentiality with regard to the matter.
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Appendix B: Informal Resolution
Procedure
- A person who requests consultation (the "Person") may pursue
an informal resolution.
- The Officer will ask the Person to provide a factual account of the
alleged mistreatment and to sign a statement to such effect. The Officer
may assist the Person in preparing a signed statement.
- The Officer will inform the person accused of mistreatment ("the
Respondent") of the allegation in sufficient detail to enable the
Respondent to make an informed response.
- The Officer will (i) investigate the alleged mistreatment as promptly
as circumstances permit, (ii) afford the Respondent a reasonable opportunity
to respond to the allegation, (iii) advise the parties and persons interviewed
or notified about the alleged mistreatment of the need for discretion
and confidentiality.
- Upon initiating an investigation, the Officer may inform University,
Hospital or MFA officials who would be charged with recommending corrective
and disciplinary action ("Responsible Officials") of the fact
that an informal resolution procedure is under way.
- Upon concluding the investigation, the Officer will report his or
her findings on the matter to the Responsible Official, and may include
a recommendation as to what action, if any, should be taken. Corrective
or disciplinary action shall be imposed by the Responsible Official,
in his or her discretion, consistent with his or her authority.
- If the Officer is unable to resolve the matter informally, the Responsible
Official shall determine, based on the report obtained from the Officer,
whether or not to impose corrective or disciplinary action. Any corrective
or disciplinary action imposed by the Responsible Official shall be
in his or her discretion, consistent with his or her authority.
- A Responsible Official will notify the parties of the disposition
of the informal resolution procedure to the extent consistent with University
policies, appropriate considerations of privacy and confidentiality,
fairness, and applicable law.
- If dissatisfied with the disposition of the informal resolution procedure,
the Person who alleged the mistreatment, the Respondent, or a Responsible
Official may initiate the formal complaint procedure.
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Appendix C: Formal Complaint Procedure
-- Special Panels
A. Initiation of special panel procedure
- The party requesting to proceed with a formal complaint must file
a written request to such effect with the Officer. The request must
be filed within 15 business days after receipt of information from a
Responsible Official of the disposition of the informal resolution procedure
(See Appendix B). The written request
for a formal hearing (the "Complaint") must state why the
disposition of the matter should be modified or overturned, and may
include a statement of the relief requested.
- The Officer will send a copy of the Complaint to the responding party
and the Vice President for Health Affairs (or designee).
- An aim of the special panel process is to complete, if feasible, the
formal complaint procedure within 45 business days of the Officer's
receipt of the formal complaint request.
B. Establishment of special panels
- A Complaint filed under Appendix C will be heard by a five-member
panel selected by lot by the Vice President for Health Affairs, as described
in Section C below. Panelists will be selected from a pool of 15, six
of whom are faculty members appointed by the Vice President for Health
Affairs, six of whom are students appointed by the Assistant Dean for
Student Affairs and three of whom are staff members appointed by the
Associate Vice President for Human Resources.
- Each appointee to the pool ordinarily will serve a two-year term.
The appointing official should stagger the appointments so that, if
feasible, the terms of not more than five of his or her appointees expire
in any year.
- An appointee to the pool may be removed and replaced at any time,
at the discretion of the appointing official. The appointing official
should promptly fill vacancies in the pool according to the procedure
in Section B.1 above.
C. Selection of panel
- Within five business days of receiving the Complaint, pursuant to
Section A.2, above, the Vice President for Health Affairs (or designee)
will select by lot the five-member panel from the pool. Two of the panel
members will be drawn from the same status group as the Respondent,
two panel members will be drawn from the same status group as the Complainant
and one panel member will be drawn from among the pool members in the
remaining status group. No member of a faculty member's department may
serve on the special panel. Within the five-day period, the Vice President
for Health Affairs (or designee) will notify the Officer of the names
of the special panel members.
- The Officer will notify the parties of the panelist names. Within
three business days of receipt of the notice, either party may submit
to the Vice President for Health Affairs a written objection to designation
of any panel member. The objection must clearly state the reasons for
the objection. The Vice President for Health Affairs may, at his or
her discretion, replace a challenged panelist with another member of
the pool from the same status group.
- A designated panelist who at any time has or may reasonably be perceived
as having a conflict of interest or is otherwise unable to serve on
a special panel shall recuse him or herself, and notify the Vice President
for Health Affairs of the recusal. For sound reasons, which shall be
disclosed to the parties and panel members, the Vice President for Health
Affairs in his or her discretion, may replace a panel member. The successor
panel member shall be selected by lot by the Vice President for Health
Affairs from among pool members of the replaced panel member's status
group.
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D. Scheduling the hearing
- Within five business days after their appointment, special panel members
will select a chairperson. The special panel will set a hearing date
and time. The hearing will be held within a reasonable time, normally
within 20 business days after the special panel is appointed. Panel
members may not communicate with either party outside the presence of
the other party.
- The special panel chairperson will notify the parties of the hearing
date, time, and location at least seven business days before the hearing.
Within two business days after receiving notice of the hearing, a party
with a scheduling conflict may submit to the chairperson a request for
postponement. The chairperson, after consulting the special panel members,
has discretion to reschedule the hearing. All parties will be notified
as soon as feasible if the hearing is rescheduled.
- If a party does not appear for the hearing within 30 minutes after
the scheduled time, the special panel will decide whether to reschedule
the hearing or proceed.
E. Conduct of hearing
- The special panel chairperson will preside at the hearing and decide
procedural issues. Only persons participating in the proceeding may
be present during the hearing except as otherwise provided in these
procedures. The hearing will be conducted in the following sequence:
(a) Preliminary matters. The chairperson will introduce the parties,
their counsel or advisors, and the special panel members; review the
order of proceedings; explain procedures that govern use of the tape
recorder; and present a brief summary of the Complaint.
(b) Opening statements. The party who requested the hearing may
make an opening statement. The responding party may then make an opening
statement. Each opening statement shall not exceed 15 minutes.
(c) Presentation of Complaint. The party who requested the hearing
may present to the panel testimony, witnesses, documents or other evidence.
Following the testimony of the party who requested the hearing, and
of each witness, the responding party may ask questions.
(d) Response to Complaint. The party who responded to the Complaint
may present testimony, witnesses, documents or other evidence to the
panel. Following the testimony of the responding party, and of each
witness, the party who requested the hearing may ask questions.
(e) Closing statements. The party who requested the hearing may
make a closing statement. The responding party may then make a closing
statement. Each closing statement shall not exceed 15 minutes.
- Special panel members may ask questions of parties or witnesses at
any time during the hearing.
- The hearing will not be conducted according to strict rules of evidence.
However, the special panel chairperson may limit or exclude irrelevant
or repetitive testimony, and may otherwise rule on what evidence may
be offered.
- When the hearing cannot be completed in one session, the special
panel chairperson may continue the hearing to a later date and time.
- The hearing will be recorded on audiocassette. Either party may obtain
a copy of the recording at reasonable cost, on written request.
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F. Witnesses
- Each party (and the panel) may ask witnesses to testify at the hearing,
but no person may be compelled to testify. However, each party shall
have a right to know prior to the hearing the contents of and the names
of the authors of any written statements that may be introduced against
him or her, and to rebut unfavorable inferences that might be drawn
from such statements.
- At least three business days before the hearing, each party must
provide the chairperson and the other party a list of witnesses he or
she intends to present at the hearing.
- The special panel may request that additional witnesses appear. The
Officer will, if feasible, arrange for the appearance of these witnesses.
- Each party is responsible for notifying its witnesses of the hearing
date, time, and location. A hearing will not necessarily be postponed
because a witness fails to appear.
- All witnesses will be excluded from the hearing before and after
their testimony. A witness may be recalled at the discretion of the
special panel chairperson.
- A University, Hospital or MFA employee must obtain permission from
his or her supervisor to be absent from work to appear at a hearing.
Employees will be paid while appearing at a hearing during working hours,
but not for other time spent on the Complaint during or outside working
hours.
- A student must obtain permission from his or her professor to be
absent from class to appear at a hearing.
- Supervisors and professors should be aware of the importance of hearings
and not unreasonably withhold permission to appear at a hearing. If
an employee or student needs assistance in obtaining permission to appear
at a hearing, he or she should contact the Officer.
G. Advisors
- Each party may be accompanied by not more than two advisors, who may
be University, Hospital or MFA employees or other persons the party
selects.
- Except as contemplated by Section 3 below, no advisor may speak on
behalf of the party, make an opening or closing statement, present testimony
or examine witnesses. The advisor's role is limited to assisting the
party to prepare for the hearing and providing the party private advice
during the hearing.
- Notwithstanding the preceding paragraph, in the event that a faculty
member shall be involved in a hearing and such person has active representation,
the other party involved in the hearing will also be allowed active
representation. In that event each party shall be permitted to select
an advisor, who throughout the proceeding may (but shall not be required
to) speak on behalf of the party, make opening and closing statements,
and examine witnesses.
- A Complainant or Respondent who plans to be accompanied by an attorney
or other advisor at the hearing must notify the chairperson and the
other party at least five business days before the hearing.
- The special panel may request or the University may provide an advisor
to be present at any hearing to advise the special panel.
- The University may have an observer present at any hearing.
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H. Decision after hearing
- After the hearing, the special panel will meet in closed session to
review the hearing and make a decision on the Complaint, consistent
with the substantial weight of the evidence. The decision must be approved
by a majority of the special panel members.
- The special panel report of its decision must be in writing and set
forth findings of fact, conclusions, and, where appropriate, recommendations
for corrective or disciplinary action.
- The special panel will submit the report of its decision to the Vice
President for Health Affairs within ten business days after the hearing
ends.
- If the special panel concludes that medical student mistreatment
occurred, the Vice President for Health Affairs will forward a copy
of the special panel report to an official responsible for implementing
corrective or disciplinary action. After reviewing the special panel
report, a Responsible Official will decide whether to impose corrective
or disciplinary action, consistent with that official's authority. A
Responsible Official will notify the parties of the disposition, to
the extent consistent with University policies, appropriate considerations
of privacy and confidentiality, and applicable law. A Responsible Official
may, in his or her discretion, send a copy of the special panel report
to the parties (at their home addresses of record, by courier, overnight
mail or certified mail, return receipt requested). The report sent to
the parties may omit portions, to maintain consistency with University
policies regarding confidentiality.
I. Review of special panel decision
- A party dissatisfied with a special panel decision may submit a request
for review to the Vice President for Health Affairs, who will transmit
the request to the senior official responsible for oversight of the
status groups to which the parties belong.
- The request for review must be in writing and set forth reasons why
the special panel decision should be modified or overturned. The review
must be based on the hearing record and may not present new evidence
or testimony.
- The request for review must be submitted within 15 business days
of the party's receipt of the special panel decision. If the request
is not received by then, the special panel decision will be the final
University decision on the Complaint.
- The senior official(s) will strive to issue a final decision on the
review within 20 business days following submission of the request for
review. The decision of the senior official(s) shall be the final decision
on the Complaint within the University.
- When the special panel decision is final, or when the final decision
on a review is issued, the VPHA will provide a copy of it to the Responsible
Official for implementing corrective or disciplinary action. Any corrective
or disciplinary action taken by the Responsible Official shall be within
discretion, and consistent with the authority of the Responsible Official.
A range of relevant considerations should be taken into account in determining
the extent of sanctions, such as the severity of the offense, the effect
of the offense on the victim and on the University community, the consequences
of the sanction to the Respondent, and the offender's record of service
and past offenses. Respondent will be promptly notified of the outcome.
- A Responsible Official may, in his or her discretion, send a copy
of the final decision to the parties (at their home addresses of record,
by courier, overnight mail or certified mail, return receipt requested).
The copy sent to the parties may omit portions, to maintain consistency
with University policies regarding confidentiality
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Approved by the Medical Center Faculty Senate
February 6, 2002
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