Professional Expectations in Medical Education

A College draft policy setting out expectations for physicians involved in medical education and training explicitly addresses the need to protect and support medical students and trainees should they encounter violence, harassment and discrimination in the learning environment. The draft reflects concerns heard from organizations and individuals who participated in an earlier consultation.

“Physicians must not engage in intimidation, violence and discrimination and must take reasonable steps to stop these practices if they see them occurring in the learning environment,” states the Professional Responsibilities in Medical Education policy draft.

Although a number of medical schools have policies on these issues, the working group that developed the policy draft thought it was important for the College to make a statement on these issues.

“Predatory or violent behaviour is unacceptable anywhere, but it is particularly problematic in a learning environment where medical students and trainees model the behaviour of their teachers,” said Dr. Brenda Copps, CPSO President and a member of the policy working group.  

“Students and trainees often gain knowledge and develop attitudes about professionalism through role modeling so MRPs and supervisors have a duty to lead by example,” she said.  

Dr. Copps noted that the College’s Inquiries, Complaints and Reports Committee has seen instances of inappropriate conduct by supervisors towards residents/medical students. The inappropriate conduct has included harassment (including sexual), intimidation, and discrimination.

The Professional Association of Residents of Ontario was just one of the respondents in the policy’s preliminary consultation who asked for more explicit references to intimidation and harassment. They stated they were concerned that our current policies did not address issues in which students who are treated unprofessionally.

Students and trainees often gain knowledge and develop attitudes about professionalism through role modeling

The current policies — Professional Responsibilities in Undergraduate Medical Education and Professional Responsibilities in Postgraduate Medical Education — are combined into the new draft.

The draft also requires those physicians involved in administration at medical schools or health-care institutions that train physicians contribute to providing a safe and supportive environment that allows medical students and/or trainees to make a report if they feel their MRP or supervisor is behaving unprofessionally.

A Canadian survey of recent medical graduates indicated that while many students identified experiencing or witnessing mistreatment during their training, actual reporting rates are very low as the students were worried that speaking up about bad behaviour will have consequences on their professional success.

Other Things to Know about the Proposed Policy

• Addresses the need to be available to assist trainees and medical students when not directly supervising;
• Prohibits MRPs and/or supervisors from entering into sexual relationships with medical students and/or trainees while directly or indirectly responsible for mentoring, teaching, or supervising;
• Prohibits MRPs and/or supervisors from entering into relationships with medical students and/or trainees that could present a risk of conflict of interest, bias, or coercion (such as a business relationship) while directly or indirectly responsible for mentoring, teaching, supervising or evaluating the medical student and/or trainee;
• Requires that express consent be obtained when medical students or trainees observe care;
• Requires express consent be obtained when medical students participate in care;
• Requires MRPs and or supervisors to use professional judgment to determine whether consent is necessary for trainee participation in patient care.