3.13: Respectful Environment and Mistreatment Policy

The School of Medicine standards of conduct for the teacher-learner relationship reads as follows:

I.      Standards

A.    Stanford School of Medicine is committed to providing a work and educational environment that is conducive to teaching and learning, research, the practice of medicine and patient care.  This includes a shared commitment among all members of the School of Medicine community to respect each person’s worth and dignity, and to contribute to a positive learning environment where medical students are enabled and encouraged to excel.  Given their roles in the educational process and their inherently unequal positions vis a vis students, all instructional personnel (including faculty, residents, and other members of the healthcare team) are to treat students with courtesy, civility and respect and with an awareness of the potential impact of their behavior on such students’ professional futures.

B.     Conduct inconsistent with this policy can occur in a variety of forms and may seriously impair learning.  In particular, instructional personnel are expected to create an environment in which feedback regarding their performance can be given openly by students without concern for reprisal, and which is free of exploitation, harassment, impermissible discriminatory treatment, humiliation, or other mistreatment or abuse of medical students.  Examples of conduct inconsistent with these standards might include:

  • Sexual harassment
  • Physical or verbal abuse
  • Assigning duties as punishment rather than education
  • Requiring a student to perform personal services (such as shopping or babysitting)
  • Unwarranted exclusion from reasonable learning or professional opportunities
  • Evaluation or grading on inappropriate criteria (or threatening to do so)
  • Harassment or discrimination on the basis of sex, race, age, color, disability, religion, sexual orientation, gender identity, national or ethnic origin, or any other characteristic protected by applicable law

C.     Note: The expectations stated in this policy primarily relate to the standards of conduct for instructional personnel.  For their part, medical students are expected to adhere to similar standards of respectful and professional behavior, including (but not limited to) the standards of conduct for students set forth in the MD Program Handbook and Policy Manual and website.

II. Guidelines for Application

A.    These standards of conduct are applicable to all School of Medicine instructional personnel (including faculty, residents, teaching assistants and other members of the healthcare team) in their interactions with Stanford medical students—whether on or off campus and whether in formal educational (such as clinical or classroom) or in social settings.

B.     In general, a determination of whether specific conduct is inconsistent with this policy will depend on a case-by-case analysis of the particular facts and circumstances, and the use of a “reasonable medical student” standard.

C.     Students subjected to abuse, discrimination, mistreatment or harassment have a right to seek timely and effective remediation with the full support of the School of Medicine and Stanford University.  In addition, retaliation and/or reprisals against an individual who in good faith reports or provides information in an investigation about conduct that may violate this policy is prohibited.

D.    Conduct inconsistent with this policy may consist in repeated actions or may even arise from a single incident if sufficiently egregious.

E.     In the review of conduct under this policy, other Stanford University and School of Medicine policies and procedures (such as Stanford’s Prohibited Sexual Conduct Policy) may become relevant.

III.  The Respectful Environment and Mistreatment Committee

The Respectful Environment and Mistreatment Committee is a standing committee to carry out the purposes and procedures set forth in this policy.

A. The committee meets monthly, and on an ad hoc basis if it is deemed necessary by the Chair.

B. The committee is chaired by the Associate Dean for Medical Student Life Advising, who is hereafter referred to as the Chair.

C. The composition of the committee includes the following as members:

  • The Chair
  • One or more students (clinical and preclinical)
  • A student selected by SUMMA (Stanford University Minority Medical Alliance)
  • A student selected by SNMA (Student National Medical Association)
  • An Academic Advising Dean
  • The Director of Graduate Medical Education (or designee)
  • The Assistant Dean for Clerkship Education
  • The Assistant Dean for Preclerkship Education
  • The Director of Educators for CARE
  • A Residency Training Program Director
  • A faculty or staff member with specific knowledge and sensitivity to racial issues and instances of bias.
  • A faculty or staff member with specific knowledge and sensitivity to LGBTQ+ issues and instances of bias.
  • A faculty or staff member with specific knowledge and sensitivity to ability issues and instances of bias.
  • A Resident
  • The Chair of the Physician Wellbeing Committee

D.    The REMC will keep such confidential records of its proceedings as are appropriate to support its purposes of education and concern resolution.

IV. Procedures

The following procedures for handling incidents of potential violations of the Standards of Conduct for the Teacher-Learner Relationship place a strong emphasis on resolving complaints informally.  The procedures include advising and mediation.  It is important to note that the procedures do not preempt other formal or informal channels available within the University.  It is recommended that students should -- as a first step-- contact the Chair of the Respectful Environment and Mistreatment Committee to review the various options that are available (on a confidential basis as that status is granted to the Associate Dean for Medical Student Life Advising).  The Chair is empowered to explore with the student a plan of action that may include some or all of the steps described below. Alternatively, there are three anonymous avenues to report a concern: 1)Medhub; 2)SAFE report, and 3) on an end of Course or end of Clerkship evaluation.

A.    Informal: Concern about potential violations may be handled by communication with various individuals, including but not limited to the following:

  1. Direct discussions (by the student or others) with the alleged offender.
  2. Conversation (by the student or others) with individuals such as the chief resident, attending physician, clerkship director, and/or Educator-4- Care (E4C) faculty.
  3. The Chair may present the concern to all or a portion of the committee, and to such third parties that the Chair deems appropriate for seeking an informal resolution.
  4. The Chair may enlist one of the trained Mistreatment Coaches to educate the person who is the source of the concern.
  5. The Chair also may in his/her discretion refer the matter to an alternate available University process or office, such as an existing grievance process or the Sexual Harassment Policy Office or the Director of the Diversity and Access Office.
  6. Direct conversation by the student with confidential resources including but not limited to the Ombuds, Counseling and Psychological Services, and the Deans of Religious Life.

Informal solutions to address the problem may be recommended and/or pursued such as (but not limited to) systems changes or educational interventions.  The Chair will be available throughout the process to discuss with the student the status of the matter, including any potential resolution.

B.     Formal: If no resolution is reached and the student wishes to proceed with a more formal grievance or complaint process, the Chair may refer the student to other existing processes or may (in an appropriate case) accept from the student a written grievance or complaint to use the procedure described below.

  1. The student should set forth in writing the substance of the grievance or complaint, the grounds for it and the evidence on which it is based, and the efforts taken to date to resolve the matter.  It is at this stage that the matter becomes a formal grievance or complaint.
  2. The grievance or complaint document should be submitted to the Chair.  A grievance should be filed in a timely fashion, i.e., normally within thirty days of the end of the academic quarter in which the action that is the subject of the grievance or complaint occurred.  A delay in filing may be grounds for rejection of that grievance or complaint.
  3. The Chair will review the grievance or complaint and (if it reflects an appropriate use of the process) will then promptly (within 7 days) transmit the grievance or complaint to the Senior Associate Dean for Medical Education (SADME) for handling.
  4. The SADME shall promptly initiate a review, which should normally be completed within sixty days.  The SADME may attempt to resolve the matter informally and may refer the matter (or any part of it) to a grievance officer or other designee, who will evaluate and/or address the matter as the SADME directs.  The SADME may also, in appropriate cases, remand the matter to the appropriate administrator (including to the administrative level at which the grievance or complaint arose) for further consideration.
  5. In undertaking this review, the SADME (or their designee) may request a response to the issues raised in the grievance or complaint from any individuals believed to have information the reviewer considers relevant, including faculty, staff and students.
  6. The SADME (or their designee) shall issue their decision in writing and take steps to initiate such corrective action as is called for (if any).  Conduct meriting discipline shall be brought to the attention of the appropriate disciplinary process.
  7. Appeal
    1. If the student is dissatisfied with the disposition by the SADME (or their designee), they may appeal to the Dean of the School of Medicine.  The appeal should be filed in writing with the Dean within ten days of the issuance of the decision by the SADME (or their designee); a delay in filing the appeal may be ground for rejection of that appeal.
    2. The Dean may attempt to resolve the matter informally and may refer the matter (or any part of it) to a grievance appeal officer or other designee, who will review the matter at the Dean’s direction.  The Dean also may remand the matter to the appropriate administrator (including to the administrative level at which the grievance arose) for further consideration.
    3. The Dean should normally complete his or her review of the appeal and issue his or her decision in writing within forty-five days.  That decision is final.  It is not subject to further review by any other University process.

V.  General Provisions

A.    Time Guidelines: The time frames set forth herein are guidelines.  They may be extended by the Chair, the SADME or the Dean, as applicable, in his or her discretion for good cause (including for reasons relating to breaks in the academic calendar).

B.     Advisers: A student initiating or participating in a grievance or complaint under this procedure may be accompanied by an adviser in any discussion with the Chair, the SADME, the Dean, or their designees (such as a grievance or grievance appeal officer); such adviser must be a current Stanford faculty, staff member or student.

C.     Ombuds: Students should be aware that the University Ombuds and the School of Medicine Ombuds are available to discuss and advise on any matters of University concern and frequently help to expedite resolution of such matters.  Although it has no decision-making authority, the Ombuds’ Office has wide powers of inquiry.

D.    Sexual Harassment and Disability related issues: For further information and resources concerning sexual harassment, students should refer to the web page of the Sexual Harassment/Assault Response & Education-Title IX Office. For further information and resources concerning disabilities and accessible education, students should refer to the web page of the Office of Accessible Education and/or the Diversity and Access Office.

E.     No retaliation: Stanford University prohibits retaliation or reprisals against individuals based on their pursuit in good faith of a grievance or complaint under this procedure, or their participation in good faith in the grievance or complaint process.

F.      Standards for Review: If the grievance or complaint involves a decision that is being challenged, the review by the SADME, as well as the review by the Dean on appeal, usually will be limited to the following considerations:

  1. Were the proper facts and criteria brought to bear on the decision?  Were improper or extraneous facts or criteria brought to bear that substantially affected the decision to the detriment of the grievant?
  2. Were there any procedural irregularities that substantially affected the outcome of the matter to the detriment of the grievant?
  3. Given the proper facts, criteria, and procedures, was the decision one which a person in the position of the decision maker might reasonably have made?

VI. Education

The Stanford School of Medicine will provide ongoing education to promote a positive learning environment and discourage violations of the standards of conduct for the teacher-learner relationship.  Such education serves several purposes.  First, it promotes an environment of respect for each person’s worth and dignity.  Second, it informs students that there are procedures available for them to register concerns of educator conduct violations, which can be investigated and addressed without fear of retaliation.  Third, it informs instructional personnel of the School of Medicine’s standards of conduct and procedures for responding to allegations of violations of these standards. Educational sessions on this topic will be introduced during the pre-clerkship curriculum and readdressed early in the clinical curriculum.  Educational sessions on this topic will also be presented to educational personnel including but not limited to at forums such as resident orientation, department meetings, and staff meetings.  The materials and methods for providing this education will be the responsibility of the Respectful Environment and Mistreatment Committee.

updated August 2023