Mistreatment includes any behavior that is harmful or offensive to an individual student and interferes with the student’s learning. This may include public embarrassment or humiliation; threat of or actual physical harm; sexual harassment or assault; discrimination or harassment based on race, color, religion, ethnicity or national origin, sex, gender identity or expression, sexual orientation, disability, age, or personal beliefs; psychological punishment; and the use of grading and other forms of assessment in a punitive, harassing, or discriminatory manner.

Microaggressions “...are brief, commonplace slights/insults that can be verbal, behavioral or environmental. They are often automatic and unintentional and trigger a sense of subordination based on a social identity (e.g. race, gender, sexual orientation, religion, disability). Microaggressions typically perpetuate a worldview of White supremacy and superiority. They can be overt (using racist language to refer to a racialized group) or implicit (being surprised by someone’s career ambitions or academic success). Microaggressions can impact student well-being and lead to worse health outcomes.”

Student-centered negative impacts of mistreatment have been well-documented throughout the medical education literature within both the preclinical and clinical spaces. Most importantly, learner mistreatment is associated with a range of distressing mental health effects including: alcohol dependence, depression, suicidal thoughts, PTSD, burnout and decreased self-confidence (Cook et al. p. 749, Gan and Snell p. 608). In addition, mistreatment is associated with adverse career-related problems including regret for choosing medicine as a career, increasing thoughts of leaving medical school, and decreased career satisfaction (Cook et al. p. 749, Gan and Snell p. 608).

While not discretely measured by the AAMC GQ, at AMS, we encourage reporting of microaggressions to enable response, student support and tracking. Thus, microaggressions are reportable within our internal student mistreatment reporting system, known as the Learning Environment Survey. Microaggressions are defined as “subtle snubs, slights, and insults directed towards minorities, as well as to women and other historically stigmatized groups, that implicitly communicate or at least engender hostility” (Torres et al. p. 869). Microaggressions have been associated with: depression, lower self-esteem, anxiety, trauma responses, alcohol dependence and other chronic health problems. As Torres et al. stated, “microaggressions extract a psychological and physical toll on those who experience them, with a societal price of harming the already fragile pipeline of women and minority physicians in academia” (2019, p. 870).

Cook, Alyssa F., et al. “The Prevalence of Medical Student Mistreatment and Its Association With Burnout.” Academic Medicine, vol. 89, no. 5, 2014, pp. 749-754.Gan, Runye, and Linda Snell. “When the Learning Environment is Suboptimal: Exploring Medical Students' Perceptions of "Mistreatment."” Academic Medicine, vol. 89, no. 4, 2014, pp. 608-617.Torres, Madeline B., et al. “Recognizing and Reacting to Microaggressions in Medicine and Surgery.” JAMA Surgery, vol. 154, no. 9, 2019, pp. 868-872.

Every Learning Environment Survey that is submitted is confidential unless the report requires mandated reporting (such as an issue related to Title IX). Confidential means that students have submitted a Learning Environment Survey with their names and that their names and/or identifying details are not shared beyond the Assistant Dean of Student Affairs, Learning Environment and the Associate Dean of Student Affairs. We strongly encourage students to provide their name so that they can be supported, understand options for intervention and also receive follow-up once an intervention has been made. Students also have the option to submit Learning Environment Surveys anonymously–without providing their name–but this significantly limits our ability to provide support to students and respond in a robust manner.

After submission, the Assistant Dean of Student Affairs, Learning Environment (ADSA-LE) and Associate Dean of Student Affairs receive a notification that a Survey has been filed via email. Within 72 business hours, either Dean (most often the ADSA-LE) will reach out to the student to provide support and discuss potential next steps. Please know that students are never required or expected to meet as we recognize that discussing mistreatment and/or microaggressions can be very challenging.

A reporting student decides when or if they would like the ADSA-LE to address the concern with the respondent at several time intervals (e.g. immediately, if another report is filed about the same individual, after grades are posted, at the end of the year, after graduation, etc.) On a monthly basis, the Executive Committee of the Committee on the Learning Environment (E-COLE) meets and discusses each case in an anonymous fashion to ensure that the response to student mistreatment and/or microaggressions has been/is appropriate and in line with institutional policies.

The Associate Dean of Student Affairs and ADSA-LE monitor for egregious incidents that need to be addressed by the E-COLE immediately and for any sexual or gender-based harassment or violence that need to be forwarded to the Title IX office.

After a learning environment concern is addressed with a respondent, the student will be notified.

Typically, incidents of student mistreatment and/or microaggressions are addressed in a tiered manner. A respondent who is reported to have mistreated or microaggressed for a first time will be contacted by the ADSA-LE to discuss the incident, be provided with feedback and supported to identify educational opportunities to prevent future incidents from occurring. A second report engenders a meeting for focused feedback and contacting the individual’s supervisor for a more formal performance improvement plan. A third report and/or any episode of mistreatment and/or microaggressions felt to be egregious are addressed by an ad hoc E-COLE meeting, involve the notification of a respondent’s supervisor and consideration for the appropriateness of a faculty appointment, if applicable.

The following a non-exhaustive list of potential outcomes:

• Student determines no action should be taken unless another report is filed about an individual

• The Assistant Dean of Student Affairs, Learning Environment meets with a respondent (the person who was reported to have mistreated the student) for focused feedback and reflection

• A person’s direct supervisor is informed of the behavior with the request for the development of a performance improvement plan (e.g. Department Chair, Nursing Supervisor, Program Director, etc.)

• The Executive Committee of the Committee of the Learning Environment determines the respondent should not hold a faculty appointment

• A Department-level or faculty-level intervention (e.g. programming, newsletter, training, etc) is held or mandated