4.01 Responsibilities of Teachers and Learners

Responsibilities of Teachers 

Clinical Supervision of Medical Students

Resident, Fellow and Graduate Teaching Assistant as Teacher Policy

Responsibilities of Learners

Course Directors’ Expectations of Students 

The teacher-learner relationship confers rights and responsibilities on both parties. Behaving in a way that embodies the ideal teacher-learner relationship creates a culture of mutual respect, minimizes the likelihood of student mistreatment and optimizes the educational experience.

Responsibilities of Teachers

  • Treat learners fairly, respectfully, and without bias related to their age, race, gender, sexual orientation, disability, religion or national origin.
  • Distinguish between the Socratic method, in which insightful questions are a stimulus to learning and discovery, and overly aggressive questioning, in which detailed questions are repeatedly presented with the end point of belittlement or humiliation of the learner.
  • Give learners timely, constructive and accurate feedback and opportunities for remediation, and submit grades and evaluations within 4 weeks and no later than 6 weeks of the end of a course or clerkship.
  • Be prepared and on time for all activities.
  • Ensure proper supervision of medical students during required clinical activities.
  • Provide learners with current material and information and appropriate educational activities.
  • Disclose familial relationships to avoid conflicts of interest (See Section 4.20Faculty-Student/Patient Familial/Intimate Relationships and Recusal Requirements)

Clinical Supervision of Medical Students

PURPOSE
To ensure the safety of patients and learners and a supportive environment for student learning and growth in the clinical setting.
 
OVERVIEW
In keeping with the combined duties to patient care/safety and education of students in the practice of medicine, and in keeping with accreditation requirements (LCME 9.2 Faculty Appointments, and 9.3 Clinical Supervision of Medical Students), this policy describes the requirements to meet the standard of appropriate supervision in the clinical environment.
Harvard Medical School values the role of learners in the provision of excellent clinical care. To ensure patient care/safety and accomplishment of the goals and objectives of the medical education program, the faculty have determined the educational principle of graded responsibility to maximally support learners in their development of clinical expertise. We believe that appropriate supervision is also critical to performing assessments of the learner and providing meaningful feedback.
 
POLICY
HMS students must be appropriately supervised when participating in required or elective clinical activities at all clinical training sites.
1. Medical students may not provide care in an unsupervised fashion.
2. Supervisors must either hold an HMS faculty appointment or be supervised in their teaching and assessment role by an individual who has an HMS faculty appointment and may include physicians, residents, fellows, and other licensed health professional faculty supervising an activity within their scope of expertise or practice.
3. Students may be supervised at one of two broad levels as determined by the supervisor:
a. Direct observation: the supervisor is present with the student and the patient;
b. Immediately available indirect supervision: the supervisor, while not in the presence of the student and/or patient, is immediately available to the learner and/or at the site of care to provide direct supervision.
4. Determination of appropriate level of supervision is the responsibility of the supervisor, based on many factors, including:
a. Level of training of the student;
b. Previous experience and skill of the student with the clinical activity and setting;
c. Familiarity of the supervisor with the abilities of the student;
d. Acuity of activity and level of risk to patient.
5. Students may not perform procedures without direct supervision.
 
PROCEDURE
1. The supervisor reviews and independently verifies all student findings, assessments, and care plans and documents this review.
2. The faculty supervisor ensures that any non-physicians who are engaged in clinical teaching for supervising any student are acting within their scope of practice.
3. The clerkship or course director is responsible for communicating policies and procedures related to supervision to HMS faculty, residents, fellows and students participating in their curriculum, and for monitoring compliance with the policies and procedures.
4. Students can report concerns regarding adequate and appropriate supervision of what they may deem a violation of this policy through a variety of channels: direct reporting to a clerkship or course director; documenting concerns in course or clerkship evaluations at the end of the course or clerkship or in established reporting mechanisms monitoring the learning environment, including the anonymous ALERT system.
 

Resident, Fellow and Graduate Teaching Assistant as Teacher Policy

 
OVERVIEW
Residents and clinical and research fellows (fellows) play an important instructional role in the clinical education of Harvard medical students. In order to fulfill that responsibility, residents and fellows need to be familiar with the competencies, program and learning objectives expected of medical students enrolled in core clinical clerkships, subinternships and advanced clinical electives. Residents and fellows should be formally oriented to their roles as teachers and provided will resources to enhance their teaching and assessment skills.
 
Graduate teaching assistants (TA) also play an important instructional role in the preclerkship HST program and in some Post-PCE (Principal Clinical Experience) Advanced Integrated Science Courses (AISCs). In order to fulfill these teaching responsibilities, TAs should be familiar with the HMS competencies and program and learning objectives expected of medical students. Graduate TAs should be formally oriented to their roles as teachers and provided with resources to enhance their teaching and assessment skills.
 
PRINCIPLES
At HMS, we recognize and value the crucial role residents, fellows and graduate teaching assistants play in the teaching and education of medical students. We believe in the importance of providing excellent training for these trainees in support of their roles as teachers and evaluators of HMS students.
 
POLICY
1. All incoming residents and fellows are required to attend Graduate Medical Education New Resident and Fellow Orientation at their sites, which includes an orientation to their roles and responsibilities as teachers. All graduate TAs are required to attend a yearly teaching seminar, which includes an orientation to their roles and responsibilities as teachers.
a. Attendance is collected by each affiliate’s Office of GME or the MD program (for graduate TAs teaching in HMS-based courses) and will be centrally monitored by the MD Program’s Office of Educational Quality Improvement (OEQI).
b. Orientation covers the following topics:
i. HMS MD Program Objectives and associated competencies required for the MD Degree
ii. HMS Student Mistreatment, Attendance & Work Hour Policies
iii. HMS Policy on Faculty-Student/Patient Familial/Intimate Relationships and Recusal Requirements, which specifies that providers of health and psychiatric/psychological services to a medical student, family members of students, or anyone involved in an intimate relationship with a student must have no involvement in the academic assessment of or in decisions made about the promotion of that student.
iv. HMS/HU Blood-borne Pathogen Exposure Protocol for HMS & HSDM Students (for Residents and Fellows)
c. If a resident or fellow is unable to attend Orientation, an alternative orientation experience is arranged.
2. Residents and fellows who teach medical students receive a copy of their respective Clerkship’s Learning Objectives and Required Clinical Experiences and the Professional Attributes expected of medical students. Graduate TAs receive a copy of course objectives.
3. Residents and fellows who evaluate or assess medical students participate in faculty development sessions on the HMS Assessment System, including EPAs (Entrustable Professional Activities) and need to attest on an annual basis that they have reviewed and acknowledge receipt of HMS’s Program Objectives and Competencies required for the MD Degree and respective Clerkship Objectives.
4. The MD Program’s Office of Educational Quality Improvement (OEQI) and Academy and the GME Offices of the affiliates offer faculty development programming to help faculty, residents, fellows and post-doctoral instructors improve their teaching and evaluation skills. For required components, attendance is monitored centrally by HMS as well as the GME Offices of the affiliates.
5. Clinical departments offer additional teaching development workshops to residents and fellows, including topics such as creating a positive learning environment; setting expectations for learners; giving effective feedback; precepting in the clinic setting; leading teams; and facilitating small groups. Model curricula for Residents and Fellows as Teachers have been developed by the Office of Educational Quality Improvement/Director of Faculty Development for dissemination to the residency and fellowship programs.
 

Responsibilities of Learners

Once a student is formally admitted to Harvard Medical School (HMS), our responsibility is to ensure that our graduates meet certain standards of professional conduct and responsibility. These standards include reliability, honesty and integrity, responsibility in professional relationships, responsibility in relationships with patients and families, responsibility in relationships with others, including members of the Harvard community, and responsibility related to personal health issues and substance abuse.

Achieving these standards is a developmental process that takes place over the 4 (or more) years of medical student status. The School is committed to providing structured opportunities for students to reflect uponand learn fromlapses in compliance with these standards.

Students will be evaluated repeatedly on the basis of these standards, examples of which include the following:

Reliability

  • Can be depended upon to do his/her duty as defined by course and clerkship objectives;
  • Completes tasks she/he was assigned or agreed to perform;
  • Attends, is prepared, and participates in a timely fashion in all scheduled activities, including classes/lectures, tutorials, labs, clinics, rounds, etc.;
  • Complies with administrative/regulatory requirements of HMS and affiliated institutions.

Honesty and Integrity

  • Is honest and ethical with regard to assignments, examinations, research activities, and patient care;
  • Acknowledges mistakes, reflects upon them, learns from them, and takes active and effective steps to correct them;
  • Adheres to ethical and legal standards of conduct.

Responsibility in Professional Relationships

  • Knows and acts in accordance with his/her own cognitive, physical and emotional limitations;
  • Takes steps to act on constructive criticism;
  • Handles stress appropriately;
  • Is considerate and respectful of colleagues, sustaining collegiality faithfully;
  • Listens to and maintains effective communication with colleagues;
  • In written, voice, email and other electronic communications, including blogs and social media sites, as well as in published writing, reflects thoughtfully and treats fellow students and faculty with mutual respect and understanding;
  • Uses professional judgment and respectful language when providing feedback in student surveys about courses and teachers;
  • Uses appropriate language and tact in all professional situations;
  • Does not make inappropriate demands on colleagues;
  • Does not discriminate on the basis of race, color, gender, sexual orientation, religion, age, national origin, ethnic background, political beliefs, veteran status, disability status or any other improper basis;
  • Shows appropriate judgment in responding to unethical, unprofessional, or dangerous behavior on the part of others;
  • Comports himself/herself professionally at all times.

Responsibility in Relationships with Patients and Families

  • Knows and acts in accordance with his/her own cognitive, physical and emotional limitations;
  • Is considerate, conscientious and respectful toward a patient’s and family’s physical needs and emotional concerns;
  • Listens to and maintains effective communication with patients and families;
  • Uses appropriate language and tact in all professional situations;
  • Keeps accurate medical records;
  • Maintains patient confidentiality where and when required and in written, voice, email and other electronic communications, including blogs and social media sites, as well as in published writing;
  • Does not discriminate on the basis of race, color, gender, sexual orientation, religion, age, national origin, ethnic background, political beliefs, veteran status, disability status or any other improper basis;
  • Is appropriately groomed in all professional situations;
  • Maintains appropriate boundaries in the doctor/patient relationship;
  • Comports himself/herself professionally at all times.

Responsibility in Relationships with Others, including Members of the Harvard Community

  • Abides by all expectations for conduct set forth in the HMS Student Handbook.

Responsibility Related to Personal Health Issues and Substance Abuse

  • Shows appropriate judgment in seeking evaluation and assistance if, as a result of injury, illness, emotional difficulties or substance abuse, a student’s ability to meet academic or clinical responsibilities becomes impaired or potentially impaired;
  • Is aware that substance abuse is not compatible with professional conduct;
  • Is aware that the use of any substance in the settings of patient care and research activity is not compatible with professional conduct.

Course Directors’ Expectations of Students 

In an effort to encourage a positive learning atmosphere of respect and good will among students and course instructors, HMS course directors have developed the following expectations:

  • Attend required activities
    • Notify course director if you are unable to attend a required activity.
  • Be on time to sessions
    • Be in your seat and ready to go by the time the class starts.
  • Show courtesy to speakers and patients in amphitheater sessions
    • Quiet down when the session starts without needing to be asked.
    • If you are late, enter the back; do not walk in front of the speaker.
  • Come prepared for class sessions
    • Complete all assigned readings, problem sets, case reviews prior to the session (whether lecture, tutorial, mini-case, laboratory, case-based collaborative learning session (CBCL) or focused exercise) at which they will be discussed.
  • Participate actively in sessions; give your classmates an opportunity to participate
  • Use electronic devices appropriately
    • Laptops and tablets are acceptable for accessing course materials during sessions, except during patient clinics.
    • Sending email, accessing social media, surfing the web for non-course-related purposes are not acceptable.
  • Choose appropriate resources for course study and exam preparation
    • Resources that are approved by course directors are posted on Canvas or MyCourses.
    • It is not acceptable to use old exams, study guides or tutorial materials handed down by students in previous year’s classes without permission of course director.
    • It is not acceptable to distribute exams, study guides or tutorial materials to students in classes behind you without permission of course director.

Updated 3/11/19