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University of Illinois Urbana-Champaign
University of Illinois at Urbana-Champaign
Carle Illinois College of Medicine
Mistreatment Form
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THE LEARNING/WORK ENVIRONMENT SHOULD BE FREE OF MISTREATMENT, HARASSMENT, AND THREAT OF RETALIATION.
DEFINITION OF MISTREATMENT
The Association of American Medical Colleges (AAMC) defines mistreatment as behavior that shows disrespect for the dignity of others and unreasonably interferes with the learning process. This behavior can be intentional or unintentional and includes examples such as sexual harassment, discrimination, humiliation, psychological punishment, physical abuse, and using evaluations punitively.
EXPECTATIONS
It is expected that Carle Illinois College of Medicine faculty, staff, students, and representatives will conduct themselves at all times in accordance with University conduct, policies, and guidelines - including the
Student Code
,
University Ethics
, the
Carle Standards of Conduct
, and
CI MED Professional Standards
.
MANDATORY REPORTING
Be advised that the recipients of this report are Mandatory Reporters.
If you are reporting an incident that is protected under Title IX (e.g. domestic violence, sexual violence, gender discrimination, etc.), we are required to report the incident to the UIUC Title IX office. We encourage you to also report the situation to the UIUC Title IX office via
https://wecare.illinois.edu
.
IN CASE OF IMMEDIATE RISK
Do not use this form to report events presenting an immediate threat. Reports submitted through this form will be reviewed within 2 business days.
If there is an immediate risk to health or safety, call 911
to connect with medical support or local law enforcement.
ANONYMOUS REPORTING
An individual may report an incident without disclosing their name, identifying the respondent, or requesting any action.
Please note that choosing to make an anonymous report can significantly limit the ability of the college to respond.
This information will be used for statistical purposes as well as for enhancing understanding of our college climate so that we may strengthen mistreatment response and prevention efforts.
Mistreatment or Professionalism
Mistreatment or Professionalism
Mistreatment
Professionalism
Submission Date
THE FOLLOWING FORM CAN BE USED TO REPORT PROBLEMATIC BEHAVIOR:
Your Full Name (optional)
Your Email Address (optional)
Date(s) of Mistreatment Incident
Behavior(s) Reported Below
Behavior(s) Reported Below
Mistreatment (Personally Experienced)
Mistreatment (Witnessed)
Duty Hours Violation
Unsafe Environment
Inappropriate Clinical Expectations
Concern
Compliments
Name of Respondent
Location of Incident
Mistreatment Behavior (
Select all that apply)
Mistreatment Behavior (
Select all that apply)
Publicly humiliated
Threatened with physical harm
Physically harmed (e.g., hit, slapped, kicked)
Required to perform personal services (e.g., shopping, babysitting)
Subjected to unwanted sexual advances
Asked to exchange sexual favors for grades or other rewards
Denied opportunities for training or rewards based on gender
Subjected to offensive sexist remarks/names
Received lower evaluations or grades solely because of gender rather than performance
Denied opportunities for training or rewards based on race or ethnicity
Subjected to racially or ethnically offensive remarks/names
Received lower evaluations or grades solely because of race or ethnicity rather than performance
Denied opportunities for training or rewards based on sexual orientation
Subjected to offensive remarks/names related to sexual orientation
Received lower evaluations or grades solely because of sexual orientation rather than performance
Subjected to negative or offensive behavior(s) based on personal beliefs or personal characteristics other than gender, race/ethnicity, or sexual orientiation
Use this section to detail the behavior(s) or pattern of behavior(s) you are reporting, the impact to yourself and others, and describe the environment in which the behavior(s) took place.
Reporting Mistreatment in Clinical Setting
Course/Clerkship Where Incident Occurred
Location of Incident
Describe the situation with sufficient detail to allow corrective measures.
Related Attachment
This form will be sent to the Director of the Learning Environment and the Ombudsperson. If that presents a conflict of interest, please contact the Executive Vice Dean of Carle Illinois College of Medicine.
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NOTE: Only applications submitted through AMCAS will be accepted and reviewed.