Learning Environment Standards, Procedures, and Policy

 

Overview/Rationale

At VP&S, we recognize that a healthy learning environment is essential to promote excellence in learning, patient care, and safety. In accordance with the CUIMC CARES values and the VP&S Honor Code, all members of the CUIMC community are committed to a learning environment that fosters professionalism, belonging, humanism, and ethical practice. We strongly endorse the importance of both psychological and physical dimensions of learning environments, including personal wellness, interactions and social relations with others, organizational practices and policies, and the physical and virtual spaces in which our students learn. 

Accreditation Standards

  • LCME 3.5 Learning Environment/Professionalism
  • LCME 3.6 Student Mistreatment

Stakeholders

Medical Students, Staff and Faculty

Monitoring the Learning Environment

VP&S has developed ongoing mechanisms to monitor and enhance the learning environment in all education settings including the classroom, laboratory, hospital, and clinic. These efforts aim to both address challenges and celebrate positive examples by: 

  • Soliciting reports from students of exemplary learning environments  

  • Developing a culture in which students feel safe reporting mistreatment events if they occur 

  • Identifying environments students perceive as hostile  

  • Appointing a senior faculty learning environment advisor in each Columbia University Irving Medical Center (CUIMC) department to work with course directors, affiliate deans, and the associate dean for student affairs, support & services  

Classification of Suboptimal Learning Environments 

Sometimes, students are treated in ways that are unacceptable and inconsistent with the VP&S Learning Environment Policy, as described below. VP&S distinguishes between four types of unacceptable behavior and requests that students report them separately: mistreatment, creating a hostile learning environment, unsafe patient care practices, and bias.   

Mistreatment Directed at a Medical Student 

Examples of mistreatment include: 

  • 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 language interpreting). 

Creating a Hostile Learning Environment 

Examples of a hostile learning environment include: 

  • 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 inappropriate behavior directed towards patients, including withholding of information or failure to disclose an error 

  • Witnessing inappropriate behavior directed at residents, nurses, or other healthcare providers that affects the quality of patient care. 

 

Reporting Mistreatment, Hostile Learning Environment, or Bias 

  • VP&S encourages students to report mistreatment, hostile learning environments, and bias 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, hostile learning environment, and bias, maintaining the anonymity of the student.  

  • Department chairs will receive a quarterly report summarizing their department's activity, including positive and negative learning environment. 

  • Other confidential resources for students to report and discuss mistreatment in the learning environment include: 

  • Director of Well-Being and Health Promotion 

  • University ombudsperson 

Other resources to discuss the learning environment include: 

  • Associate Dean for Student Affairs, Support & Services/ Associate Dean for Medical School Professionalism in the Learning Environment 

  • Associate Dean for Diversity, Inclusion and Belonging 

  • Advisory dean 

  • Clerkship FCM senior student advisor 

  • FCM Coach 

All issues and concerns can also be reported to Columbia University Life: Report a Concern | University Life (columbia.edu) 

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: 

  • 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. 

At Columbia Doctors: 

At affiliate hospitals:  

  • Will be provided at orientation to the hospital. 

Following Up on Student Reports (Other Than Sexual Misconduct) 

In cases of mistreatment and hostile learning environments 

  • To preserve anonymity to the fullest extent possible, reports are ‘quarantined’ until after course directors have submitted grades (for Fundamentals courses and Major Clinical Year clerkships) or until after students have matched (for electives).  

  • The Associate Dean for Student Affairs, Support & Services reviews each report to confirm that it meets the criteria for mistreatment or hostile learning environments and instructs CERE to log the report in a tracking database. Report a Concern | University Life (columbia.edu) Reports of mistreatment and hostile learning environments are addressed by the senior learning environment advisor, in collaboration with the associate dean for student affairs, support & services, the course director, and if relevant, the affiliate dean. Responses to reports may target individualized and or systemic remedies as appropriate.  

  • The deans for student affairs and curriculum, the vice dean for education, and student representatives, and as appropriate representatives for the CUIMC Office of Professionalism regularly review reports and monitor follow-up actions within the departments where the events occurred.  

  • 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 Associate Dean for Student Affairs, Support & Services a written follow-up report, which CERE also logs in the tracking database. 

In cases of bias 

  • The The deans for student affairs and curriculum, the vice dean for education, and student representatives, and as appropriate representatives for the CUIMC Office of Professionalism reviews each report to confirm that it meets the criteria for bias and instructs CERE to log the report in a tracking database. Reports can then if appropriate be addressed by the dean of curriculum and/or the director of equity and justice in curricular affairs, who discuss reports with involved course/clerkship directors. 

Committee on the VP&S Learning Environment 

The Committee on the VP&S Learning Environment is a standing committee comprised of senior learning environment advisors from each CUIMC clinical department, and the Associate Dean for Student Affairs, Support & Services/ Associate Dean for Medical School Professionalism in the Learning Environment. The committee meets regularly to review the current status of VP&S learning environments; discuss trends in mistreatment, hostile learning environments, and bias; and address emerging issues. If a student who has reported mistreatment, excluding 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 VP&S Learning Environment will convene to hear the request and render a decision. The committee will ensure that the inquiry review is conducted with fairness and respect for the confidentiality of all parties involved.