A model of influences on the clinical learning environment: the case for change at one U.S. medical school.
BACKGROUND
The learning environment within a school of medicine influences medical students' values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists.


METHODS
We designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment. We provide a description of our program and early outcomes.


RESULTS
The program has enhanced student awareness of what constitutes mistreatment and how to report it. Faculty members are also aware of the formal processes and procedures for review of such incidents. Our proposed model of influences on the learning environment and the clinical workforce informs the quality of trainee education and safety of patient care. Institutional leadership and culture play a prominent role in this model. Our integrated institutional response to learning environment concerns is offered as a strategy to improve policy awareness, reporting and management of student mistreatment concerns.


CONCLUSIONS
Our WE SMILE program was developed to enhance education and awareness of what constitutes mistreatment and to provide multiple pathways for student reporting, with clear responsibilities for review, adjudication and enforcement. The program is demonstrating several signs of early success and is offered as a strategy for other schools to adopt or adapt. We have recognized a delicate balance between preserving student anonymity and informing them of specific actions taken. Providing students and other stakeholders with clear evidence of institutional response and accountability remains a key challenge. Multiple methods of reporting have been advantageous in eliciting information on learning environment infringements. These routes and types of reporting have enhanced our understanding of student perceptions and the specific contexts in which mistreatment occurs, allowing for targeted interventions. A common platform across the healthcare professions to report and review concerns has afforded us opportunities to deal with interprofessional issues in a respectful and trustworthy manner. We offer a model of learning environment influences with leadership and institutional culture at the helm, as a way to frame a comprehensive perspective on this challenging and complex concern.
Department of Pathology, Stony Brook University School of Medicine, Stony Brook, NY, 11794-8691, USA. Howard.fleit@stonybrookmedicine.edu.
Howard B
HB
Fleit
Stony Brook University School of Medicine, Stony Brook, USA.
Richard J
RJ
Iuli
Department of Pediatrics, Division Chief, Developmental and Behavioral Pediatrics, Stony Brook Children's Hospital, Stony Brook University School of Medicine, Stony Brook, USA.
Janet E
JE
Fischel
Department of Family, Preventive and Population Health, Stony Brook University School of Medicine, Stony Brook, USA.
Wei-Hsin
WH
Lu
Donoho Academy of Clinical and Educational Scholars, Stony Brook University School of Medicine, Stony Brook, NY, USA.
Latha
L
Chandran
D004504:Education, Medical, Undergraduate / Q000592:standards*; D005180:Faculty, Medical / Q000941:ethics* / Q000592:standards*; D000071277:Harassment, Non-Sexual / Q000706:statistics & numerical data; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D007858:Learning; D020380:Needs Assessment; D028743:Professional Misconduct / Q000706:statistics & numerical data*; D016730:Program Development; D036301:Qualitative Research; D012577:Schools, Medical; D013315:Stress, Psychological; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D014481:United States; D035642:Whistleblowing
Clinical learning environment; Institutional leadership; Medical student mistreatment; Patient safety; Professionalism