Response to Learner Concerns About Content and Delivery of Educational Activities

Purpose

To outline the UCSF School of Medicine’s policy for responding to student or faculty reports about oppressive language and content in educational experiences within the School. This policy focuses on the curricular response and is complemented by existing procedures and policies for student support.

Overview

UCSF is committed to presenting lectures and learning activities that are evidence-based, designed and delivered by UCSF faculty/teachers with expertise in many fields and selected to support students in advancing the knowledge and critical thinking skills that are essential for their development as UCSF physicians. 

To advance learning and promote new knowledge and understanding within and beyond the institution, medical schools at academic centers invite discussions of issues that challenge current knowledge and expand the boundaries of learners and educators alike. It is the role of academia to identify, acknowledge, and explore controversies and problems within our existing evidence base in order to promote constructive and generative impact. 

UCSF is firmly committed to pursuing an anti-oppression framework in all mission areas. This work requires acknowledging and exploring:

  • the history of racism and all forms of structural oppression in medicine and biomedical science, as well as at UCSF
  • the impact of societal/structural racism and oppression on health and health care for populations that have historically been disadvantaged, minoritized or marginalized by our profession; 
  • the controversies and gaps in our scientific (biomedical, social, epidemiologic, systems, educational) paradigms related to but not limited to the role of race, ethnicity, gender, gender identity, sexual orientation, socioeconomic status, access to healthcare, and ability status as well as structural racism/oppression in health, illness, and healthcare.

Our goal is to educate the anti-oppressive healthcare and academic workforce that our diverse communities need. We recognize that there is variability in anti-oppressive competency within our academic community and we are committed to defining expected competencies for all members of our community and working to help them grow and develop in those competencies.  

As educators and healthcare professionals, we recognize that all of us bring unconscious bias to this work. This bias means that even those fully committed to advancing anti-oppressive work in education, healthcare and science will not be perfect in their adoption and application of contemporary and evolving anti-oppressive concepts and language. As with the patient safety movement, we recognize that successfully moving our community towards an anti-oppressive practice requires a strategy that supports everyone in their growth and improvement while protecting individuals and communities from discrimination. 

We also value the hard work of critically evaluating ideas, concepts, and information in a way that encourages and facilitates the participation of all. This work can occasionally be emotionally charged, and it can be difficult to distinguish disagreements about concepts from deviations from inclusive practices. It is important that we have a systematic and clearly identified way of addressing situations that negatively impact a person’s sense of value to the community or ability to contribute to the work of critical evaluation mentioned above. Using the framework of Sigal Ben-Porath, this means we value dignitary safety as we engage in challenges to intellectual safety.

It is critical that our response to concerns prioritizes an anti-oppressive lens, sustains intellectual debate on controversial topics and new ideas, fosters growth, demonstrates respect for the personal integrity of everyone, and moves the profession of medicine in all of its mission areas toward a more just, equitable and inclusive environment. 

Definitions of Key Categories Related to Concerns about Adherence to Anti-racist and Anti-oppressive Best Practices

Lapse: Microaggressions, commentary or language that can reasonably be interpreted as unintentional or ill-informed and nonetheless reinforces negative societal stereotypes of a person or group of persons or uses outdated descriptors that do not optimally convey current understanding of anti-oppressive strategies.

Critical event: Discriminatory commentary or language that can reasonably be interpreted as an intentional and specific attack on the personal integrity and dignity of a person. Anti-oppressive critical events typically result in reporting to the Office of Prevention of Harassment and Discrimination because they are egregious, pervasive or persistent manifestations of discrimination and/or harassment.

Event of uncertain character: A concern raised for which there is uncertainty or disagreement about whether the report 

  • is appropriately categorized as a lapse or a critical event; or 
  • represents a deviation from inclusive practices or a disagreement with evidence-based concepts. 

Definitions of Additional Key Terms Related to This Policy

Dignitary Safety: Protection of the dignity of all members of the community (students, faculty, staff) so that they can engage fully in the intellectual challenge needed to foster growth. Threats to dignitary safety may arise from lapses or events. 

Challenges to intellectual safety:  The appropriate and intended introduction of new ideas, paradigm shifts, and controversies to challenge existing mindsets as an essential tool to foster the intellectual curiosity and critical thinking that 21st-century physicians need. Discussions about the interpretation of and conclusions drawn from data about race, ethnicity, ancestry, or racism are not in and of themselves oppressive, though they may involve both uncertainty and discomfort.

Curricular Inclusivity Committee: Standing committee members convened by Associate Dean for Curriculum to evaluate and review an event of uncertain Impact and recommend an appropriate institutional approach.

Related LCME Standards

3.5 Learning Environment (Professionalism)

3.6 Student Mistreatment 

Principles

  • Anti-oppression
  • Growth Mindset
  • Proportionate and just response to critical events and lapses
  • Intellectual Challenge with Dignitary Safety to foster intellectual and emotional resilience
  • Continuous Educational Quality Improvement and Professional Development
  • Inquiry

Policy

Reporting concerns

  1. Anyone raising concerns for themselves or on behalf of others about an educational activity is expected to have witnessed the activity or viewed the online content in its context and should document the specific issues that merit filing the concern.  
  2. Response to an event that raises concerns about curriculum inclusivity includes at least one of these three interventions: responding to the negative impact of the event on a student or group of students; correcting inaccuracies or adding information about ongoing academic disagreement for the entire class, if needed; and responding to the need to improve the curriculum and/or promote faculty development for those who teach in the curriculum. Interventions in a specific situation are determined collaboratively with affected stakeholders.
    • Students who have been mistreated or personally impacted by an event should either reach out to the course director, submit the concern through the SAFE mechanism, or contact the Associate Dean for Students (ADS) directly. This will result in an urgent response to impacted students if they request a response.  The ADS will also then notify the AD Curriculum.
    • Students who may not been personally impacted by an event but believe the curriculum needs improvement should submit a report through the Bridges Real-time Feedback form in their own words, using core principle of respectful feedback, with a good faith assessment of whether this meets the definition of a lapse (e.g. unintentional stereotyping or outdated language and paradigms), critical event (e.g. intentional attack on a group of persons), or an event of uncertain impact (e.g. unclear if event represents a critical event, lapse or  intellectual challenge).
      • Individual students should not feel burdened to get a certain number of colleagues to express their opinion in order to effect changes. We as a community respect and recognize the validity of each individual’s experience of the curriculum and neither student support nor curricular improvement mechanisms depend on volume of comments.
      • Conversations to discuss and explore concerns among students are encouraged. Students should be respectful of different perspectives and the need for time and space for reflection. 

Actions based on the Level of Concern
Independent of the level of concern (below), any conveyance of curricular information that is factually incorrect or action that is not consistent with medical/clinical best practices (as determined through Bridges curricular governance processes) will merit a communication to the class to correct inaccuracies. 

Anyone who has a concern about the content or delivery of an educational activity will make a good faith effort to analyze the level of concern using the following taxonomy:

  1. Lapses call for education and feedback, with subsequent engagement of the continuous educational improvement and curricular governance process. The categorization of an issue as a lapse does not negate or minimize the negative impact it had on students. Students personally impacted and who desire urgent support are encouraged to report this issue as an anti-oppressive lapse through the SAFE form for review by the Associate Dean for Students.
    • Course directors and facilitators who recognize or receive feedback about a lapse through the Bridges Real Time Feedback Form (BRTF) will communicate corrected information to the class based on their understanding of the context and significance of the lapse in one of several ways: during a lecture/educational session; in a question-and-answer period; or on the class forum.
    • In the event of a report of a lapse that is controversial (e.g., that may reflect a difference of opinion based on evidence), the course director will refer the issue to the Curricular Inclusivity Committee for review and notify the class that a report has been received and is under review.
    • Course directors will provide the involved instructor with the feedback about the reported lapse, including recommendations for improvement and will inform the students who raised the concern (if they self-identified) that follow-up has taken place. In select cases, some course instructors may follow up with students directly as well.
  2. Critical Events are grounds for urgent educational and administrative action.
    • Course directors and session facilitators are expected to take immediate action to address the discriminatory comment.
    • Students should document the substance of the event in the Bridges Real-Time Feedback Form (BRTF) and/or contact the instructor and the course director.
    • Course directors are required to respond to the student if the student self-identifies and to report the incident to the associate deans for curriculum and students within 1 business day of recognition of the event.
    • The deans will issue an acknowledgement and plan for action in response to the event as soon as possible and no later than one week after the educational event via an email to the class.
    • Deans or faculty will report the event to the Office for Prevention and Harassment Discrimination (OPHD) as mandatory reporters.
  3. Events of uncertain character are events for which there is disagreement among reporting students or between supporting students and course/clerkship directors about whether the event represents a lapse, a critical event or a difference of opinion on an evidence based concept; these disagreements will be referred to a multi-stakeholder committee to decide on appropriate action.
    • The School of Medicine will establish a standing Curricular Inclusivity Committee comprised of faculty, students and deans charged to review reports of curricular inclusivity lapses that are either controversial or of uncertain significance. The committee can request consultation from subject matter experts or from other individuals with added insight into the issue under discussion.
    • The Associate Dean for Curriculum will convene the committee to review the event and recommend the appropriate institutional approach(es)
    • The Associate Dean for Curriculum will notify the medical school community that the committee has been convened to review the event
    • Follow up will be given to the medical school community by the medical education administration at the conclusion of the process
    • Further details of the process are under Procedures section A below

Curricular Accountability

  1. The associate deans for curriculum and students will present a semi-annual report to curricular governance committees and to the student body or their representatives on the frequency and response to reports of anti-oppressive lapses and critical events.
  2. The Office for Prevention of Harassment and Discrimination is responsible for deciding when to initiate and how to communicate outcomes of investigations. 

Procedure

Full Implementation procedures about the policy will be developed and finalized after the policy is finalized. 

Under policy #3, the second bullet above, if there is an event of uncertain impact, the Associate Dean for Curriculum will convene the Curricular Inclusivity committee to review the event and recommend an appropriate institutional approach.

  1. Committee Composition
    • Associate Dean for Curriculum or designee (consultative role) 
    • An additional education dean not originally involved in the event
    • The director of the Anti-Oppressive Curriculum
    • An Anti-Oppressive Curriculum liaison
    • Two students from outside the class involved
    • Two faculty members not involved in the original event
    • Any other subject matter expert deemed to be useful to the process by the committee
  2. Function
    • The committee will meet as soon as is reasonably possible to address the event in a timely fashion
    • The committee will issue recommendations for the appropriate institutional approach(es) to the event
    • The committee’s recommendations will be advisory to the Vice Dean for Education, who will then report to the broader medical school community
  3. Faculty will be notified if their educational activity is being reviewed by the Curricular Inclusivity Committee.
  4. Pending the determination of the Curricular Inclusivity Committee, the faculty instructors will be referred to relevant faculty development programs or the Anti-Oppression Curriculum Component Leads to improve educational activity.
  5. Center for Faculty Educators will develop faculty development workshops in concordance with feedback from this reporting process. CFE will review the results of the AOC process annually and adjust workshops accordingly.
  6. Policy will be highlighted and distributed annually to all faculty educators and students will be included in student attestation policy process.
  7. Education about the definitions in this policy will be incorporated into Differences Matter Orientation for incoming MS1 students and ARCH Weeks for existing students.

Accountable Dean or Director: Associate Dean for Curriculum 
Related Policies: