Scenario: A cardiologist is activated for percutaneous intervention of a STEMI right before daycare opens. Rushing to the hospital with their six-year old in tow, the cardiologist asks the second-year Doctoring student if they could please watch their child at the nurse's station during the catheterization and the student agrees immediately. Within an hour, the case is over and patient is doing well. The physician thanks the student profusely and buys the student coffee at Au Bon Pain.

Impact: In this case, the student missed out on an hour to complete their required Doctoring session and an opportunity to observe a cardiac catheterization.

Outcome: The student tells another medical student about being asked to watch the child and the second medical student files a Learning Environment Form on their behalf. The Assistant Dean of Student Affairs, Learning Environment (ADSA-LE) reaches out to both the reporting student and the affected student. After discussing the case, the student and ADSA-LE agree that the student was asked to perform a personal service. Because this was the first time the cardiologist was ever reported to have a potential mistreatment report, the ADSA-LE invites the faculty member to discuss the event. By nearly all accounts, the cardiologist is an outstanding teacher and they express understanding that students shouldn't be asked to perform childcare, even during an emergency. The cardiologist and ADSA-LE agree it was an exceptionally rare circumstance and is very unlikely to occur again. The cardiologist will bring up the case during their next faculty meeting to discuss contingency plans.

Takeaways:

• Performing childcare during time a student is expected to be learning is considered student mistreatment

• While in an emergency, the priority must always be patient safety, medical students should not be tasked with childcare

• Faculty members are not expected to be perfect and meetings with the ADSA-LE are not designed to be punitive

Scenario: It is a busy long call on the internal medicine service. After rounds, the attending asks the new medical student on the team to run to the cafeteria to buy the team (including the student) bagels and OJ. The attending gives the student their credit card. This attending is known for keeping their team well fed. Last week, the attending asked the senior resident do to the same thing for the team but the medical student wasn't aware of this.

Impact: The student (and the team!) appreciated the food. Being new to the wards, the student was eager to help the team by placing orders (to be co-signed), updating their patients and their families and contacting CVS for med recs. The student reached out to the ADSA-LE via the Learning Environment Survey about the scenario.

Outcome: Next week, the student and the ADSA-LE met and discussed the case. After reflection, the student and ADSA-LE agreed that mistreatment did not occur. The student notes they were still able to complete their tasks in a timely manner despite picking up food (that was paid for by the attending). The student also notes that the attending asked the junior resident to pick up food for the team during the next long call.

Takeaways:

• It's not unreasonable to ask students to pick up food (within the hospital campus) that is paid for and available for all team members

• Rotate whom you ask to pick up food for the team and make that known: "Every few weeks I try to buy lunch for the team and will try to rotate who picks it up."

• We encourage students to report any concerns about potential mistreatment and/or microaggressions in the learning environment and recognize that not all reported concerns will constitute mistreatment and/or microaggressions

• Keep feeding your residents and students

Scenario: A third year medical student on an interventional radiology elective is asked by the interventional fellow to pull 5-10 papers from PubMed for a research proposal the fellow is putting together. The student is not otherwise involved in the project.

Impact: The student did not feel comfortable saying no to the fellow and spent several hours looking up papers and printing them. The student missed time in the IR suite and felt uncomfortable around the fellow for the rest of the rotation. The student filed a Learning Environment Survey regarding possible mistreatment.

Outcome: The report was reviewed by the Assistant Dean of Student Affairs, Learning Environment (ADSA-LE). After meeting with the student, it was clear that the student was asked to perform a personal service for the fellow and this met the definition of student mistreatment. The student asked that the fellow not be contacted until after grades for the rotation were posted. On review of the Learning Environment Survey database, the fellow was found to have mistreated another student approximately a year prior. Following the AMS Mistreatment Policy, the ADSA-LE reached out to the fellow for feedback and notified the fellowship director.

Takeaways:

• "Personal services" includes asking students to do work on a research project that they are otherwise not involved in

• Asking students to look up research papers for a patient presentation, student-led chalk talk or research project they are involved in would be very reasonable

• Typically, unless a mistreatment concern is egregious, a second report of an individual mistreating a student engenders a meeting for feedback and notification of the person's supervisor (i.e. Chair, Program Director, Fellowship Director, Dean, etc)