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Professionalism/Environment of Learning Program

 

Scope:

A comprehensive program for both facilitating a professional environment and providing a system to collect and track all reports to ensure accountability and follow-through.

Purpose:

The Tulane University School of Medicine (SOM) is committed to creating and maintaining a positive and respectful environment for its faculty, learners and staff by holding accountable those who do not follow the tenets of professional workplace behavior. The SOM Guiding Principles outline our prioritized core values and link them to behavioral expectations. Each year, all members of our community will acknowledge receipt of these principles. An emphasis has been placed on recognizing those individuals with exemplary behavior and who are role models for professionalism.

The Professionalism/Environment of Learning Program (PELP) is designed to facilitate the creation and maintenance of an environment that is professional, respectful, inclusive, and intellectually stimulating. The PELP allows individuals to both recognize exemplary behavior as well as submit concerns about all aspects of the learning environment.

The program receives all concerns, which can be submitted through a variety of mechanisms, and documents and records them in a confidential database. Each report is reviewed and managed following established algorithms, approved by the PELP Advisory Board. An essential assumption is that all members of our community do not intend harm, rather may need education and awareness of the impact of their actions. Thus, early intervention is key to prevent continued or escalated unprofessional behavior.

Goals:

1.    Facilitate a professional learning and work environment based on our Guiding Principles that is inclusive of all.
2.    Provide consistent educational opportunities for all members of our community.
3.    Provide a clear and transparent process for reviewing and resolving all submissions.
4.    Provide a fair system to ensure accountability of all members of our community.
5.    Build and maintain trust by making available all relevant data and metrics to ensure the integrity of the program.
6.    Ensure confidentiality and minimize fear of retaliation.
7.    Provide oversight to ensure resources are provided to units with recurrent concerns.

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. 

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)

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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 utilizing the Kudos Form link.

The “10 Owls” Society

Exemplary behavior is essential for the growth of a more accountable, professional environment. Therefore, those who have received 10 or more exceptional reports will be recognized by the Dean and inducted into the 10 Owls Society.

Reporting of Concerning 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 one or more of the following methods:

  1. In writing utilizing the Professionalism Concern Form. If the incident involves perceived harassment or discrimination, the reporter should select the Tulane University Campus Reporting Form link to send the report directly to the Title IX Coordinator and/or the Office of Institutional Equity (OIE) as required by federal law. Reports submitted to the Professionalism Program that are deemed to include harassment or discrimination will be forwarded to OIE.

For students only:
In addition to the methods listed above, students have the opportunity to report perceived concerning behavior by reporting:

  1. Verbally or in writing to the course or clerkship director of the learner’s course. The PELP encourages students to report concerns directly. However, after discussing concerns with students, course/clerkship directors are encouraged to submit a Professionalism Concern Form. This will allow for entering of the concern into the tracking database and initiation of the review process.
     
  2. In the end‐of‐course and clerkship evaluations. All student evaluations include a link to the Professionalism Program reporting form so that students may report concerns directly to initiate the review process. Students have the option to delay the review of the report to eliminate concerns regarding potential retaliation being reflected in their grade for the course or clerkship.
Confidentiality of Reports

If requested, all reports received will be kept anonymous and confidential. Anonymous reports will be reviewed to the extent that specific information is provided. Please note that full disclosure of the persons involved and the behaviors witnessed can lead to more effective action to correct the problem. Therefore, reporting the names of all individuals involved is strongly encouraged.

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 delayed action on the report.  Please note, however, that time delays in addressing an incident may lessen the impact of the intervention.

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 includes discrimination or harassment based on sex or gender, must be reported by any University official so they can be promptly acted upon in compliance with federal law.

If a report suggests discrimination, the School is required to notify the University’s Office of Institutional Equity so that an investigation may 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 action can be taken.

Protection of Rights of those Reporting Concerning Behavior

The success of PELP 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 will be considered a breach of professionalism and will be addressed accordingly.

Protection of the Rights of those Reported for Concerning Behavior

Intentional false or malicious reports of concerning behaviors will not be tolerated and will be handled as a disciplinary matter in the learner’s program. All reports of concerning behavior will be handled confidentially, with the exceptions noted above, and in a manner that affords due process.

Review of Reports of Concerning Behavior

All reports of  will be triaged by the TRIO* for an initial determination of merit. All reports directly affecting a student will be made available to the administrative leadership of the Offices of Student Affairs and Academic Affairs. If requested by the individual reporting, the timing of a review can be adjusted or delayed 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 using the established professionalism remediation protocol for intervention. The report will be sent to the Program Director of the resident’s/fellow’s program and will be addressed according to the department or program's policy. The Chair of the GMEC Professionalism Subcommittee, the DIO, and the relevant Clerkship Director will also be notified of the complaint. A resolution report is expected to be returned by the Program Director to the TRIO and Program Administrator.
    2. A faculty mistreatment of a student
      The TRIO will determine the level of offense and proceed by using the established professionalism remediation protocol for intervention. The TRIO will assign the report to a peer messenger. If not the first offense, the report may be escalated following the pyramid algorithm, and the TRIO 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.
    3. Other members of the environment (RN’s, technicians, etc) mistreatment of a student
      The TRIO will review the report and determine the best course of action, which may include notifying the hospital's Chief Medical Officer, Human Resources office, or appropriate unit at that facility. A resolution report from the hospital designee is expected to be returned to the TRIO and Program Administrator.
    4. *Student mistreatment of another student
      In this case only, the Program Administrator will provide the report to the Associate Dean for Student Affairs, administrative leadership of the Office of Academic Affairs, and if requested, the Director of Student Support and Wellness. The Associate Dean of Student Affairs and/or Director of Student Support and Wellness (if requested) will conduct the review and provide intervention (if indicated), bringing in appropriate persons as needed. At the discretion of the Professionalism Committee, other department leadership may be notified as well. A resolution report is expected to be returned by the Associate Dean for Student Affairs to the TRIO and Program Administrator.

      Of note, this system is NOT meant for residents and faculty to report unprofessional behavior of students, which is an option on the end-of-course and -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 using the established professionalism remediation protocol for intervention. The report will be sent to the Program Director of the resident’s/fellow’s program and will be addressed according to the department or program's policy. The Chair of the GMEC Professionalism Subcommittee and the DIO will also be notified of the complaint. A resolution report is expected to be returned by the Program Director to the TRIO and Program Administrator.
    2. Other members of the environment (RN’s, technicians, etc.) mistreatment of a resident
      The TRIO will review the report and determine the best course of action, which may include notifying the hospital’s Chief Medical Officer, Human Resources office, or appropriate unit at that facility. A resolution report from the hospital designee is expected to be returned to the TRIO and Program Administrator.
    3. Faculty mistreatment of either a student or resident
      The TRIO will determine the level of offense and proceed by using the established professionalism remediation protocol for intervention. The TRIO will assign the report to a peer messenger. If not the first offense, the report may be escalated following the pyramid algorithm. The TRIO 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.
    4. Any individual’s concern about a residency or fellowship program
      The TRIO will determine the level of offense and proceed by using the established professionalism remediation protocol for intervention. The report will be sent to the Department Chair, Chair of the GMEC Professionalism Subcommittee, and the DIO. A resolution report is expected to be returned to the TRIO and Program Administrator.
  3. Reports made by other faculty or anonymously about a faculty member
    The TRIO will determine the level of offense and proceed by using the established professionalism remediation protocol for intervention. The TRIO will assign to a peer messenger. If not the first offense, the report may be escalated following the pyramid algorithm and the TRIO 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.
     
  4. Reports made about the Dean of the School of Medicine or other senior SOM administrators
    The TRIO will determine the level of offense and proceed using the established professionalism remediation protocol for intervention. The TRIO will assign professionalism concerns reported about the Dean or other senior administrators to a member(s) of the SOM Executive Faculty, the University Provost/Senior Vice President for Academic Affairs, or the President of the University.  A resolution report is expected to be returned to the TRIO and Program Administrator.
Resolution of Reports

In all cases, a report will first be made back to the Professionalism TRIO. The person who reported the inappropriate treatment, if identified, will be notified that action has been taken on his/her report. 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 posted 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 a rolling 36-month trend.

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.