Accelerating a long-term effort to create the most positive learning environment possible, the University of Miami Miller School of Medicine will conduct a survey of all students, residents and faculty this month to identify role models – the faculty who should be widely praised – and faculty members who will benefit from constructive and directed feedback.
This first-ever use of the PULSE 360 survey to have learners evaluate faculty is a critical step in the Miller School’s response to concerns expressed by the Liaison Committee on Medical Education in its reaccreditation of the school. The LCME granted the Miller School full accreditation last year but placed the medical education program on “warning,” finding its performance unsatisfactory in six areas, including student mistreatment.
“The whole place doesn’t work if there’s not respect between the faculty and the learners at any level,” said Laurence B. Gardner, M.D., executive dean for education and policy. “If you go even further it’s the whole ethos of our behavior toward each other. So it includes staff and patients, because in any environment where there’s a lack of respect and mistreatment of learners, there’s not likely to be optimal respect and treatment for anyone.”
Along with the survey, which resulted from several years of work to address the issue of learner mistreatment, the school has reiterated its zero tolerance policy that all faculty must review and sign.
“We are strongly committed to addressing and eliminating student mistreatment,” said Edward Abraham, M.D., executive vice president for health affairs, CEO of UHealth, and dean of the Miller School. “A task force of faculty, students and residents has provided data and recommendations on how to continue improving the overall learning environment. We will have zero tolerance for any form of mistreatment of our learners.”
Alex J. Mechaber, M.D., senior associate dean for undergraduate medical education and the Bernard J. Fogel Chair in Medical Education, said, “We have spent a lot of effort on increasing awareness and education plans and now we are identifying mistreatment in various areas and making sure we have more robust systems in place for students and residents to feel comfortable reporting it.”
Among the systems adopted for reporting medical student concerns about treatment is the University-wide ’CaneWatch system. In both ’CaneWatch and the PULSE (Physician Universal Leadership Skills Education) survey, everything is anonymous, and there is extensive follow-up.
“This will only work if we recognize and reward the great behaviors, and if we take steps to significantly improve the poor behaviors,” Gardner said. “We will publicize the positive results, and celebrate the strong advocates of the optimal learning environment.”
For those teachers whose performance could benefit from interventions focused on communication, professionalism and teaching skills, there will be a feedback session, and then more coaching if needed until improvement is noted in the survey, which will be repeated every six months.
The survey description says behaviors to be identified may include “verbal abuse, gender or sexually inappropriate remarks, prejudiced comments, discriminatory behavior, sarcasm, intentional embarrassment, condescension, unprofessional criticism and other inappropriate behaviors.”
The Association of American Medical Colleges includes these incidents and behaviors in its definition of student mistreatment: The learner is threatened with physical harm, required to perform personal services, subjected to unwanted sexual advances, denied opportunities for training/rewards based on gender, race or ethnicity, or received lower evaluations/grades solely because of race, ethnicity or sexual orientation.
The Miller School has submitted a detailed action plan to the LCME in response to its findings during the reaccreditation process. An LCME team will be back in Miami in October 2018 to review the improvements and the results of graduation questionnaires, and to talk with faculty and students.
This aggressive response is a top priority for the Miller School. “On the last graduation questionnaire, the number of our students saying that they had either personally experienced or witnessed mistreatment was above the national average,” Gardner said. “That’s not acceptable to us.
“And it’s a very high priority of the accreditation agency that this concern be addressed at every medical school.”