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Professionalism/Environment of Learning Program

Tulane University School of Medicine
Environment of Learning
Process for Ensuring Professional Conduct of Learners and Educators

The Tulane University School of Medicine (SOM) is committed to creating and maintaining a positive environment for its faculty and learners. This environment is one that is respectful of one another and holds accountable, those that do not uphold the tenets of professional workplace behavior. Exemplary behavior by individuals who are exceptional role models for professionalism will be acknowledged.

This program is designed to provide an environment that is professional, respectful, inclusive, and intellectually stimulating and to create a positive learning and work environment where each individual can have an expectation of professionalism from members of the community. This program allows for individuals to report concerns. Most important is early intervention to prevent concerning behavior from escalating.

The School of Medicine program includes a reporting/tracking system for concerns about the environment of learning and workplace. Incidents are reported by a variety of mechanisms, documented in the system, and recorded in a confidential database. Each report will be investigated following the method of the Professionalism Pyramid for Graduated Interventions (first developed at the Vanderbilt School of Medicine.)

A team of three senior faculty will be appointed to review each report as they are received. The role of this team, called the TRIO, is to triage and ensure each concern is thoroughly and properly addressed using the Professionalism Pyramid method as well as to ensure follow up. A senior administrator in the school will be assigned to provide logistical support to the TRIO and manage the database. Incoming reports will be reviewed each business day. The TRIO will also oversee the Professionalism Committee, made up of appointed faculty, trained to be peer awareness intervention counselors. The program is managed as a component of the Dean’s office.  Make a Report Form

For students, any breach that falls under the purview of the Honor Board should be referred to the Honor Board directly. This procedure is outlined in the April 1999 revision of the Honor Code, available on the Student Affairs website. Such breaches include cheating, stealing, impairing another student’s ability to learn, or acting in a deceitful manner.

For breaches in professional behavior outside of those considered by the Honor Board will be addressed using the method of the Professionalism Pyramid for Graduated Interventions: It issue will first be referred to the Director of Students Support and Wellness for initial informal intervention. If a pattern of behavior emerges, the student would then be refered to the senior associate dean for Admissions and Student Affairs, who will speak directly with the parties involved and reviewing evidence. If further problems arise, the issue will be brought to the Student Professionalism and Promotion Committee for discussion and potential intervention or disciplinary action. (For more detailed information, please see the Student Handbook)

Reporting of Exceptional Behavior: How to Report
Exemplary treatment of a learner or any member of the learning environment, either experienced or witnessed, can be reported by the same School of Medicine reporting system available to all students, residents and faculty.  Make a Report Form.

Reporting of Inappropriate Behavior: How to Report

For students, residents or faculty:
Perceived inappropriate treatment of a learner or any member of the learning environment, either experienced or witnessed, should be reported by using one or more of the following methods:< /p>

  1. In writing through the School of Medicine anonymous reporting system made available to all students, residents and faculty Make a Report Form.  If the incident involves perceived harassment or discrimination, the reporter should select the correct link which will go directly to the Office of Institutional Equity(OIE) as it is required by law to do. Any report that comes to the TRIO, if deemed to include harassment or discrimination, the TRIO is required by law to forward to the OIE.

For students only:
In addition to the methods listed above, the students also have the opportunity to report perceived inappropriate treatment by reporting:

  1. Verbally or in writing to the course or clerkship director of the learner’s course. The course/clerkship director is then required to report the student’s concern to the Professionalism Program Administrator for entering into the database and forwarding to the TRIO to initiate the review process.
     
  2. In the mandatory end‐of‐course and clerkship evaluations.
    All student evaluations are reviewed by the Director of the Office of Medical Education. If a concern is identified in the evaluation, the Director will then forward the concern to the Professionalism Program Administrator to initiate the process. The students have the option to delay the report review for two months to protect any potential retaliation reflected in their grade.

Confidentiality of Reports
If requested, all reports, by any method, will be kept anonymous and confidential. Anonymous reports will also be investigated to the extent that specific information is provided. However, full disclosure of the persons involved and the behaviors witnessed can lead to more effective action to correct the problem. Therefore, full reporting of incidents of inappropriate behavior is strongly encouraged to include all the individuals involved.

For students, the identity of learners reporting inappropriate treatment can often be protected by delaying action on the report until the learner is no longer vulnerable. Each of the reporting mechanisms described above allows the learner to request a delayed action on the report.

The establishment of a safe environment is a quality improvement initiative and therefore, all reporting is legally non-discoverable.

The School and the University will keep confidential all records of complaints and investigations to the extent permitted by law. To reiterate, behaviors that violate Title IX of the 1972 Education Amendments to the Higher Education Act, which include discrimination or harassment based on sex or gender, must be reported by any University official so that they can be promptly acted upon in order to be compliant with Federal Law.

If a report suggests discrimination, the school is also required to notify the University’s Office of Institutional Equity and an investigation by that office will also be initiated.

Behaviors that pose an immediate danger to others (e.g. violence or threats of physical violence, illegal drug use by caregivers in the clinical setting, deliberate violation of patient safety procedures) or are illegal (e.g. stealing narcotics, falsifying patient records) must also result in immediate reporting so that preventative action can be taken.

Protection of Rights of those Reporting Inappropriate Treatment
The success of this Professionalism/Environment of Learning Program in safe‐guarding the learning environment depends on the timely reporting of incidents of inappropriate treatment. In all cases, retaliation, or the encouragement of another to retaliate, against the person making such a report or the learner involved is strictly prohibited and if found to exist, will become included in the focus of an investigation and sanctions.

Protection of the Rights of those Accused of Inappropriate Treatment
Intentional false or malicious reports of inappropriate treatment by learners will not be tolerated and will be handled as a disciplinary matter in the learner’s program. All reports of inappropriate treatment will be handled confidentially, with the exceptions noted above, and in a manner that affords the accused due process.

Investigation of Reports of Inappropriate Behavior
Per the Professionalism Pyramid, all reports of inappropriate behaviors will initially be triaged by the TRIO* for an initial determination of merit. All reports that directly affect a student will be made available to Student Affairs and Academic Affairs leadership. If requested by the individual reporting, the timing of an investigation can be adjusted to protect them. We encourage all reports to be as detailed as possible to allow for a complete review. Processes for review and follow up will vary depending upon the situation and are summarized as follow:

  1. Reports made by Student Learners in the School of Medicine about:
    1. A resident mistreatment of a student
      The TRIO will determine the level of offense and proceed by the defined pyramid algorithm for intervention. The TRIO will assign to an awareness intervention counselor and the report may be escalated following the pyramid algorithm. They may also notify the appropriate Residency Program Director. If indicated, the DIO will be notified of the complaint. A resolution report is expected to be returned to the TRIO and Program Administrator within 7 business days of notification.
       
    2. A faculty mistreatment of a student
      The TRIO will determine the level of offense and proceed by the defined pyramid algorithm for intervention. The TRIO will assign to an awareness intervention counselor. If not the first offense, the report may be escalated following the pyramid algorithm and they may also notify the appropriate Chair and if needed the Dean. A resolution report is expected to be returned to the TRIO and Program Administrator within 7 business days of notification.
       
    3. Other members of the environment (RN’s, technicians, etc) mistreatment of a student
      The TRIO will review the report and determine best course of action. It may be required to notify the hospitals Chief Medical Officer, Human Resources, or appropriate unit at that facility. A resolution report from the hospital designee, is expected to be returned to the TRIO within 7 business days of notification.
       
    4. *Student mistreatment of another student
      In this case only, the Program Administrator will provide the report to the Director of Student Support and Wellness (not to the TRIO.) The Director will conduct the review and provide intervention (if indicated) bringing in appropriate persons when indicated. These reports will not be included in the database. The students also have the option to directly write or speak to the Director of Student Support and Wellness.

      Of note, this system is NOT meant for residents and faculty to report unprofessional behavior of the students which is an option on their end of course/clerkship evaluations.

  2. Reports made by Resident Learners in the School of medicine about:
    1. Resident mistreatment of another resident
      The TRIO will determine the level of offense and proceed by the defined pyramind algorithm for intervention. The TRIO will assign to an awareness intervention counselor and the report may be escalated following the pyramid algorithm. They may also notify the appropriate Residency Program Director. If indicated, the DIO will be notified of the complaint. A resolution report is expected to be returned to the TRIO and Program Administrator within 7 business days of notification.
       
    2. Faculty mistreatment of either a student or resident
      The TRIO will determine the level of offense and proceed by the defined pyramind algorithm for intervention. If the first offense, the TRIO will assign to an awareness intervention counselor. If not the first offense, the report may be escalated following the pyramid algorithm and they may also notify the appropriate Chair and if needed the Dean. A resolution report is expected to be returned to the TRIO and Program Administrator within 7 business days of notification.
  3. Reports made by other faculty or anonymously about a faculty member
    The TRIO will determine the level of offense and proceed by the defined pyramid algorithm for intervention. If the first offense, the TRIO will assign to an awareness intervention counselor. If not the first offense, the report may be escalated following the pyramid algorithm including possibly to the appropriate chair or the dean. A resolution report is expected to be returned to the TRIO and Program administrator within 7 business days of notification.

Resolution of Reports
In all cases, a report will first be made back to the Professionalism TRIO or documented by the Director of Student Support. The person who reported the inappropriate treatment, if identified, will be notified that action has been taken on his/her report by the program administrator. Specific details of any action may not generally be revealed.

Reporting and Assessment of the Environment of Learning
On a quarterly basis, the TRIO will review the results of the previous quarter and analyze the data for trends. In addition, a overall, de-identified summary will be published for all learners and faculty on a quarterly basis, and this will be published on the Professionalism/Environment of Learning Program website. A timely review will allow for early intervention for those individuals with recurrent issues. The tracking will include at least a rolling 36 month trend.

The “10 Owls” Society
Exemplary behavior is essential for the growth of a more accountable, professional environment. Therefore, those residents and faculty who have received exceptional reports will be recognized by the Dean and inducted into the 10 Owls Society, once the individual receives 10 reports.

Process for Addressing Reports of Unprofessional Behavior by Faculty
Tulane School of Medicine has adopted the Professionalism Pyramid for Graduated Interventions for addressing report of unprofessional behavior by faculty. This workflow has been approved by the Executive Faculty of the School of Medicine.