Abstract

The purpose of this statement is to communicate the University of Alabama at Birmingham Marnix E. Heersink School of Medicine’s commitment to a healthy learning environment that supports student learning and is free of mistreatment. It establishes that the medical school abides by the University of Alabama at Birmingham’s Equal Opportunity and Discriminatory Harassment Policy and follows the University’s procedures for addressing mistreatment. The Healthy Learning Environment and Learner Mistreatment Procedures outline the mechanisms for students to report mistreatment and the process by which the medical school addresses allegations of mistreatment. It describes the medical school’s responsibility to report on the status of the learning environment to students and other stakeholders to ensure transparency and accountability.

Reason for Statement and Procedures

This statement establishes expectations for a learning environment that supports student learning and is free of mistreatment. It also provides mechanisms by which students, residents, faculty, and staff can report concerns for mistreatment. This statement references university-level policies and procedures that meet the requirements set forth by the Liaison Committee for Medical Education (LCME) accreditation requirements as follows:

Element 3.5: Learning Environment/Professionalism
“A medical school ensures that the learning environment of its medical education program is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations. The medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards.”

3.6 Student Mistreatment
“A medical school develops effective written policies that define mistreatment, has effective mechanisms in place for a prompt response to any complaints, and supports educational activities aimed at preventing mistreatment. Mechanisms for reporting mistreatment are understood by medical students, including visiting medical students, and ensure that any violations can be registered and investigated without fear of retaliation.”

Scope

This statement applies to all preclinical and clinical medical students involved in UAB Heersink School of Medicine coursework (i.e., coursework on main and regional campuses and coursework in community practice). It also applies to all visiting students participating in electives (or other learning activities) on any of the medical school’s campuses.

Position On Maintaining a Healthy Learning Environment and Addressing Learner Mistreatment

The Heersink School of Medicine is committed to providing a safe, respectful, and healthy learning environment. The medical school does not tolerate harassment, discrimination, or retaliation. Appropriate professional behavior is expected from all learners, teachers, and support staff in every venue across all encounters.  This commitment extends to our regional campuses and other collaborative educational sites.  In line with this commitment, the medical school abides by all applicable policies including but not limited to UAB’s Equal Opportunity and Discriminatory Harassment Policy, UAB’s Duty to Report and Non-Retaliation Policy, UAB’s Title IX Policy, UAB’s Student Conduct Code, and the UAB Enterprise Code of Conduct. These policies contain multiple reporting options for students who believe that they are being discriminated against or harassed.

General Procedure

Defining Mistreatment

Mistreatment occurs when behavior shows disrespect for the dignity of others and interferes with the learning process.1

The following are the categories of student mistreatment assessed by the Association of American Medical Colleges (AAMC) in the Graduation Questionnaire

• publicly humiliating a student
• threatening a student with physical harm
• physically harming a student
• requiring a student to perform personal services
• subjecting a student to sexual advances
• asking a student to exchange sexual favors for grades or other rewards
• engaging in any negative behavior related to sex or gender, race or ethnicity, or sexual orientation.

The following are some examples of medical student mistreatment:

• Insults or unjustifiably harsh language in speaking to or about a person
• Verbally abusing, belittling, or humiliating a student
• Indicating that students are capable of a specific skill because of personal characteristics rather than training and readiness
• Indicating that students are not capable of a specific skill because of personal characteristics rather than training and readiness
• Using grades as punishment rather than as an objective evaluation of performance
• Intentionally singling out a student for arbitrary treatment that could be perceived as punitive
• Exclusion of a learner from any usual and reasonable expected educational opportunity for any reason other than as a reasonable response to that learner’s performance or merit
• Disparaging a student’s choice of residency, profession, or other career aspirations
• Assigning tasks for punishment rather than for objective evaluation of performance
• Pressuring students or trainees to exceed established restrictions on work hours
• Asking a student or trainee to lie or withhold the truth to a patient, colleague, or superior
• Exploitation of students in any manner (e.g. performing personal errands)
• Directing students to perform tasks that interfere with a student’s attendance at educational activities, (e.g., rounds, classes)
• Pressuring a student to perform medical procedures for which the student is insufficiently trained (i.e. putting a student in a role that compromises the care of patients or endangers the student)
• Threatening a lower or failing grade/evaluation to a student for inappropriate reasons
• Committing an act of physical abuse or violence of any kind (e.g., throwing objects, aggressive violation of personal space)
• Making comments of a sexual nature or any touching of a sexual nature
• Disregard for learner safety
• Other behaviors which are contrary to the spirit of learning and/or violate the trust between the teacher and learner.

The following actions are not mistreatment

• Direct constructive feedback about a student’s clinical performance or knowledge gaps and the need for improvement
• Expectations to prepare thoroughly, answer difficult questions, or manage demanding workloads commensurate with the student’s level of training
• Expectation to solve problems independently in controlled situations to build problem-solving skills and build confidence
• The healthcare team placing the needs of the patient above those of the student
• Emphasizing professional behavior and holding the student accountable for unprofessional behavior
• Working long hours and accommodating unpredictable schedule changes
• Asking students to perform tasks that advance a patient’s care.

Reporting Mistreatment

Medical students are encouraged to report any behavior that they perceive to be mistreatment. This includes behavior directed toward them as individuals, or toward other learners, teachers, residents, patients, or staff. The school provides several mechanisms for such reporting, including personal meetings (with course directors, the Associate or Assistant Deans for Students, or Medical Student Services team members on any campus), confidential or anonymous online reporting within the School of Medicine (i.e., ReportIt), and confidential or anonymous online reporting outside of the medical school (i.e., UAB Hotline, Title IX Office, and Employee Concerns-UAB Human Resources). End of clerkship evaluations include questions about observed or experienced mistreatment. This information is kept confidential, and information is only shared in aggregate to anonymize.

Students are introduced to the school’s position for a Healthy Learning Environment and Learner Mistreatment, the UAB Equal Opportunity and Discriminatory Harassment Policy, expectations for learner, faculty, and support staff professional behavior, and mechanisms available for reporting unprofessional behavior including mistreatment at the beginning of medical school. This statement, policies, expectations for professional behavior and the reporting mechanisms are covered in detail again prior to the start of clinical coursework during orientation to the clerkships. Students attest to reviewing the statement for Healthy Learning Environment and Learner Mistreatment during the mandatory annual student credentialing process.  Students are reminded of reporting mechanisms during orientation to each preclinical and clinical course, on the School of Medicine’s websites, and through digital signage in Volker Hall.

The medical school understands that confidentiality and anonymity of reporters are critical to ensuring that reporters feel empowered to report mistreatment. The medical school takes every step within the law to ensure confidentiality. The medical school abides by the UAB retaliation policy, which states that “retaliation against any individual who reports, in Good Faith, wrongful conduct or who participates in the investigation of wrongful conduct is prohibited.”

Instances of Student Mistreatment by faculty, staff, or residents.

Individual reports of student mistreatment are thoroughly investigated by the appropriate Heersink School of Medicine or UAB office(s). The process of responding to mistreatment is outlined in Figure 1. The reporter’s identity is kept anonymous throughout the process. The school’s plan to address the mistreatment event is shared with the student who helps guide timing of the plan’s implementation.

Figure 1. What Happens When a Student Reports Mistreatment by Faculty, Residents, or Staff?

Student Mistreatment of Other Students.

Professional behavior is expected of all medical students as defined in the Medical Student Code of Conduct and UAB’s Non-Academic Student Conduct Policy.  Reports of student mistreatment of other students are investigated and addressed by Medical Student Services and the appropriate UAB office(s). Interventions emphasize learner growth and personal accountability. Faculty members, staff, students, and other observers are strongly encouraged to report student mistreatment by other students to Medical Student Services or the UAB Community Standards and Student Accountability Office.

Monitoring and Accountability. The medical school monitors the health of the learning environment through a variety of assessment strategies including direct reports from students and other concerned individuals, reports from student advisory groups and the student senate, data from course/clerkship evaluations, ReportIT (reports and responses to reports), AAMC questionnaires, de-identified information provided by the  UAB Hotline, the Title IX Office, and the UAB Community Standards and Student Accountability Office. A summary of findings is provided annually to the Dean of the School of Medicine, the Continuous Quality Improvement Committee, the Senior Associate Dean for Medical Education, the School of Medicine Executive Committee, and the Health System leadership.  Each provides feedback for improving the Learning Environment. Improvement plans are implemented by Medical Student Services in collaboration with the university, UAB Hospital, UAB Health System, the UAB Office of Community Standards and Student Accountability, and other educational partners as needed.  The school also provides more frequent reports to clinical department chairs and regional campus deans to allow timely responses to mistreatment concerns identified in course evaluations.

History

Statement Created: July 01, 2021
Revised: 5/5/2025

University of Alabama at Birmingham Marnix E. Heersink School of Medicine policies and statements shall be reviewed periodically to determine whether revisions are appropriate to address the needs of the medical school community.

References

1. Dickstein, L.J., et al. Appropriate Treatment in Medicine: A Compendium on Medical Student Mistreatment.  A Project of the AAMC Group on Student Affairs, Spring, 2000.