Boston University School of Medicine Policy on the Appropriate Treatment of Medical Students (ATM) in the Educational Setting
Boston University School of Medicine strives to provide an educational environment that supports rational discourse, diversity of views, and open inquiry and expression between teachers and medical students. To achieve the School’s goals of excellence in education, patient care, community service and research, frank feedback to students and constructive criticism regarding student performance are necessary. All participants in the School’s educational programs also must recognize and respect the dignity and the diverse backgrounds, personalities, and needs of individual medical students. There may be instances, however, when medical students and others with whom medical students interact in the course of their education encounter situations and incidents that are stressful, difficult to negotiate or may be perceived as inappropriate or even abusive.
To this end, the Liaison Committee on Medical Education (LCME) developed a standard to offer guidelines to medical schools regarding appropriate treatment of students in the educational setting, as follows:
LCME Standard on Medical Student Abuse:
Each medical school or its parent university should define the standards of conduct in the teacher-learner relationship. Schools should develop and widely promulgate written procedures that allow medical students to report violations of these standards–such as incidents of harassment or abuse–without fear of retaliation. The procedures also should specify mechanisms for the prompt handling of such complaints, and for the educational methods aimed at preventing student mistreatment.
To address the LCME guideline, Boston University School of Medicine has established a committee, the Appropriate Treatment in Medicine (ATM) Committee, and a Policy on the Appropriate Treatment of Medical Students in the Educational Setting. This document describes both the ATM Committee and this policy, which the Committee is charged with implementing.
Inappropriate treatment of medical students is damaging to educational relationships and academic progress. Examples of inappropriate treatment include*, but are not limited to:
- Berating comments, humiliation, or intimidation;
- Intellectual bullying;
- Deliberate and repeated exclusion from reasonable learning opportunities;
- Requests or expectations to perform personal services;
- Grades used for punishment rather than for objective evaluation of performance;
- Assignment of tasks or chores as a means of punishment; and
- Physical punishment or physical threats.
Incidents of abuse or harassment based on race, color, religion, sex, age, national origin, physical or mental disability, sexual orientation, genetic information, military service, or because of marital, parental, or veteran status are subject to federal law, state law, and separate University policies, and are thus not addressed by this policy statement. If it appears that an incident or situation may involve discrimination, medical students are encouraged to report the incident under the applicable discrimination policy. The University’s policies and procedures for handling complaints of discrimination are published in university bulletins and websites, and also are available in the Office of Student Affairs.
* Not included is constructive feedback regarding performance that may be critical. Constructive feedback about performance is crucial to students’ educational progress and professional development. Some feedback may be critical or even discouraging, but not, per se, inappropriate.
II. Goal of the ATM Policy
The goal of the ATM policy is to support an educational environment for medical students in which teaching and learning, evaluation, and feedback occur in a candid, constructive, and appropriate manner. The ATM Policy is written to address behaviors and actions of all individuals involved in the education of medical students, including faculty, house officers, other medical students, and staff. It is hoped that this Policy will provide guidance that will help avoid behavior toward medical students that unreasonably interferes with their learning and/or physical or emotional well-being. This policy statement describes the structure and function of the ATM Committee, establishes procedures and processes to investigate complaints of inappropriate treatment of medical students, and offers guidance regarding the development of educational programs for the cultivation of an environment free of inappropriate treatment of medical students.
III. Charge of the Committee
The ATM Committee is charged to: (1) cultivate a civil and respectful learning environment at Boston University School of Medicine; (2) address incidents or patterns of inappropriate treatment of medical students; (3) review reports by medical students and others regarding perceptions of abuse; (4) identify patterns or trends in such reports and forward such information to appropriate parties, (5) receive and address medical student complaints about inappropriate behavior, and (6) use the information garnered from student submitted comments and from other sources for campus-wide educational efforts around the issue of appropriate treatment of medical students.
IV. Procedures for the Investigation of Complaints of Inappropriate Treatment
Medical students are encouraged to address behaviors they encounter in the educational setting that make them uncomfortable or that compromise their learning. Students who believe they have been subject to inappropriate treatment and seek a remedy to the situation should be able to make non-capricious, good faith allegations without fear of retribution.
Allegations of Unlawful Discrimination: Complaints of abuse or harassment based on race, color, religion, sex, age, national origin, physical or mental disability, sexual orientation, genetic information, military service, or because of marital, parental, or veteran status are subject to federal law, state law, and separate University policies. Such complaints are not within the jurisdiction of the ATM Committee and are not addressed by this policy statement. The ATM Committee Chair will refer all incidents of this nature to the appropriate University official(s) under existing University policies and procedures.
Students are encouraged to attempt to resolve difficult situations directly with the party(ies) involved. Students who wish to address issues on their own may seek informal guidance from a trusted faculty mentor or from a dean. Students may choose to keep the identity of the offending individual confidential from a faculty mentor or dean without compromising their efforts to seek guidance.
Students who feel that addressing the situation on their own is not feasible may choose to report the matter to the ATM Committee according to the options outlined below. It should be noted that neither anonymous complaints nor named complaints against unnamed individuals can result in a formal investigation by the ATM Committee but may be used to inform the general educational efforts of the Committee. The identities of both the student lodging the complaint and the accused must be revealed to the Committee before a formal investigation can proceed.
- Anonymous communication about a general situation or unnamed individual: The ATM Committee may receive anonymous reports that do not accuse a specific individual but that contain general allegations of inappropriate treatment or descriptions of situations during which inappropriate treatment is alleged to have occurred. These reports may identify educational or other campus settings or courses in which a problem was noted. The ATM Committee, at its discretion, may accept such reports for review even if filed anonymously. Such reports, however, can be used only to inform the general educational efforts of the ATM Committee.
- Anonymous communication about an identified or identifiable individual: The ATM Committee may receive anonymous reports that allege inappropriate behavior on the part of an identified or identifiable individual. The ATM Committee, at its discretion, may accept such reports for review even if filed anonymously. The ATM Committee Chair will review the allegations and will normally make an attempt to contact those in the particular educational setting, including the identifiable individual who is the subject of the complaint, who may be able to shed light on the matter and address it constructively, if warranted. The Committee Chair will monitor information received and the results, and report back to the ATM Committee.
- Named complaint about a general situation or unnamed individual: The ATM Committee may receive named reports from students that do not accuse a specific individual but that contain allegations of inappropriate treatment or descriptions of situations during which inappropriate treatment is alleged to have occurred. These reports may identify educational or other campus settings or courses in which a problem was noted. The ATM Committee Chair will review the allegations and will normally make an attempt to contact individuals who may be able to shed light on the matter and address it constructively, if warranted. The Committee Chair will monitor the information received and report back to the ATM Committee in a timely manner. The Committee Chair also will communicate the results to the medical student who lodged the complaint. At this point, the matter will be considered closed unless brought again before the Committee by the same or a different student.
- Named complaint about an identified or identifiable individual: Upon referral or receipt of a signed complaint from a medical student alleging that he/she has been subjected to inappropriate treatment by an identified or identifiable individual, or describing a specific situation in which allegedly inappropriate treatment is observed to have occurred, the ATM Committee will accept the complaint and proceed to investigate the allegation. The Committee Chair or designee will normally make an initial effort to investigate and resolve the matter directly through discussion with the involved persons, including the accused individual(s). The Committee Chair may refer the matter to an appropriate department chair or supervisor for further review and attempted resolution. The ATM Committee Chair will monitor the progress of the referral.
Complaints against identifiable individual(s) will be handled with care to preserve the confidentiality of both the accuser and the accused individuals to the maximum extent consistent with the goals of investigating and resolving the complaint. The medical student complainant has a right in the early stage of the investigation to request anonymity to those outside the ATM Committee. If the investigation reaches a stage at which it cannot move forward without a guarantee of the student’s anonymity, the student has the right to determine whether he/she would like to move forward without a guarantee of anonymity. Should the student wish to remain anonymous, the ATM Committee will attempt to work with the individual(s) against whom complaints have been made, but will not be able to submit a final report with recommendations to the Dean.
If the situation appears to be resolved as a result of the initial efforts by the ATM Committee Chair, the Chair will communicate the results to the medical student who lodged the complaint, and the investigation will be considered closed unless brought again before the Committee by the student. If, however, a satisfactory resolution is not achieved, the ATM Committee will proceed with further investigation of the complaint and attempts at a more formal resolution. Such requests must be in writing and must specify the medical student’s allegations in detail. The ATM Committee will then conduct a formal investigation. The ATM Committee Chair may designate a subcommittee to conduct the investigation and report its findings to the ATM Committee. Prior to commencement of a formal investigation, the ATM Committee will notify the University’s Office of the General Counsel and seek advice regarding legal aspects of the investigation.
Such investigation will include an opportunity for the individual(s) against whom the complaint is made to:
- Receive a notice from the ATM Committee Chair detailing the allegations and identifying the complainant;
- Meet with the investigating committee and present evidence in his/her defense; and
- Be accompanied by an advisor of his/her choice at such meeting.
The investigating subcommittee will report to the full ATM Committee and assist the ATM Committee Chair in preparing a report to the Dean. A draft of the report will be provided to the accused individual(s) and to the complainant for written comment. Written comments must be submitted to the ATM Committee Chair within ten business days of the receipt of the draft report.
The ATM Committee will thereafter submit a final written report of findings and recommendations to the Dean of the School of Medicine, with a confidential copy to the medical student and to the accused individual(s). The report will state findings and, if warranted, a recommendation for action.
Recommendations for action to be taken by the Dean or other appropriate institutional authority may include:
- Dismissal of the complaint as non-meritorious;
- Approval of steps that have been negotiated by the ATM Committee and agreed upon by the relevant parties;
- A requirement that the accused individual or his/her department take remedial action that may include an apology to the student, the reconsideration of a negative evaluation of the student’s performance, or other remedial steps;
- Formal admonition or reprimand of an accused individual;
- Consideration of more serious employment action up to and including suspension or dismissal of an accused individual.
If an accused individual is an employee of Boston Medical Center, the Dean will discuss the matter with the Hospital President and they will take such actions as each deems appropriate within the scope of their respective authorities.
The Dean may accept, modify, or reject the report, or request that the ATM Committee conduct further review or investigation.
V. Methods of Reporting Concerns or Complaints of Inappropriate Behavior
There are five methods by which students can report concerns or file complaints regarding inappropriate behavior:
- The student can complete and submit a written Comment Form, available in the reception area of the Office of Student Affairs. The Comment Form should be as detailed as possible, including the name and contact information of the student completing the form.
- The student can submit a signed letter of complaint to any member of the ATM Committee in person or by postal mail or fax.
- The student can send an email to any member of the ATM Committee. Only emails sent from students’ BU email accounts can be accepted without a personal signature.
- The student can submit a complaint through the ATM website. The ATM website contains a link to an on-line Comment Form.
- The student can meet in-person with any member of the ATM Committee and follow up the meeting with a written affidavit.
VI. Reports and Communications from the ATM Committee
The ATM Committee will produce the following written products:
- A brochure for medical students outlining general areas of awareness and progress, the ATM Committee’s charge and membership, and how (and for what) to approach the ATM Committee or one of its members. This brochure will be distributed to all medical students at the beginning of each academic year, will be available in the Office of Student Affairs, and will be posted on the ATM website.
- A web page on the Office of Student Affairs website publicized to medical students, house staff, faculty, staff, and other interested parties. The on-line Comment Form will be housed on this web page.
- An annual report to the Dean outlining issues, listing accomplishments, and summarizing investigated cases and their status or resolution.
- A training module to be included in first- and third-year medical student orientations.
VII. ATM Educational Initiatives
The School of Medicine will promote the development, implementation, and evaluation of educational programs for its faculty, post-graduate trainees, medical students, and staff that are designed to cultivate a civil and respectful environment and to prevent incidents or patterns of inappropriate treatment of medical students.
VIII. ATM Website
An ATM website will be developed and maintained. The ATM website will house an introduction to the ATM initiative, a description of the ATM Committee and its members including e-mail links for each member, a link to the ATM Policy, a link to the Boston University policy on sexual harassment, a link to the Office of Equal Opportunity, which is charged with administering all University policies related to discrimination and harassment, and a link to the on-line Comment Form. The Office of Student Affairs, in collaboration with the ATM Committee Chair and the ATM Committee membership will maintain the ATM website.
IX. ATM Committee Composition
Please refer to Article 5, Section G4 of the Boston University School of Medicine Bylaws.
X. Selection of Committee Members:
XI. Frequency and Records of Committee Meetings
This Committee will meet quarterly, at a regularly scheduled time. Special meetings of the ATM Committee may be held at the call of the Chair, as necessary. Attendance of five (5) or more Committee members will constitute a quorum. Minutes of the meetings of the ATM Committee will be recorded by the Office of Student Affairs staff member present, will be reviewed and approved by the Committee. Supporting documents from formal investigations will be retained in the Dean’s Office in a locked cabinet for a period of five (5) years after final determination of the case in question. Electronic copies of minutes and other documentation will be stored on the BUSM server with password access limited to the Committee Chair, the OSA staff member who is staff to the Committee, and the Dean and Provost of the Medical School.