Learning Environment Standards, Procedures, and Policy
The Columbia University Vagelos College of Physicians and Surgeons (P&S) 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 (PDF).
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.
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 (PDF).
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 Columbia University Medical Center (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 below. P&S differentiates among 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 videos have 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.
Mistreatment Directed at a Medical Student
Watch a video that explains and shows examples of mistreatment, as follows:
- Public humiliation (Note: Public embarrassment is not considered mistreatment by the Association of American Medical Colleges.)
- Threat of or actual physical harm (e.g., hitting, kicking, slapping).
- Being subjected to unwanted sexual advances (Note: See *Reporting Sexual Misconduct below for Title IX policies.)
- Being subjected to offensive remarks related to gender, race, ethnicity, or sexual orientation (directed at a student).
- Receiving lower grades or evaluations based on gender, race or sexual orientation.
- Being required to provide personal service (e.g., shopping or babysitting).
Creating a Hostile Learning Environment
Watch a video that explains and shows examples of a hostile learning environment, as follows:
- 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 and displays of temper.
- Witnessing behaviors contributing to a culture of negativity, rudeness, or intimidation.
- Repeatedly being ignored by those in a teaching role.
Unsafe Patient Care Practices
The following are examples of unsafe patient care practices, as follows:
- Witnessing near misses or errors resulting in injury.
- Witnessing inappropriate behavior directed at residents, nurses, or other healthcare providers that affects 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 on our learning environment video content webpage, 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 or at any other time using this Qualtrics online survey form. The Center for Education Research and Evaluation (CERE) tracks reports of mistreatment and hostile learning environment, maintaining the 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 Major Clinical Year 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 receive 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. Read more about sexual respect initiatives at Columbia.
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:
- Go to the KEEPSAFE login page. You will need to be connected to the NewYork-Presbyterian (NYP) or CUMC network.
- On the upper right, click on NYP Network,
- Choose "application account" (instead of NYP).
- 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 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 Columbia University 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.