Resident/Student Mistreatment Reporting Form

Mistreatment, as defined in the Penn State College of Medicine Student Handbook, arises when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. This could include behaviors performed by faculty, nurses, residents/interns, other institution employees, staff or other students.

If you prefer an anonymous method of reporting, be assured that the complaint will receive the same attention as one with identifiers completed. If you identify yourself in the report, your name is confidential and is used only to contact you for further details and next steps. Your name is not provided in any communication with the individual(s) you are reporting.

If you are not comfortable with reporting, you can still request a confidential meeting with Dr. Byler to discuss your concerns by emailing dbyler@pennstatehealth.psu.edu.

Should this complaint be viewed as in violation of Title IX or involve criminal activity, immediate action is required. Due to the severity of this type of complaint, preservation or your anonymity cannot be guaranteed in these specific circumstances.

For this next section, please be as specific and explicit as possible. This helps ensure that the incident of mistreatment is handled appropriately.

You may skip any questions.

Our priority is to ensure your submitted report receives immediate attention. If you provided your contact information, a member of the investigative team may contact you directly.

If you feel speaking confidentially about this incident would be beneficial, we encourage you to contact a counselor or a College of Medicine Ombudsperson.

Humiliated and/or chastised	Neglected/Left out of communications
Subjected to sexist remarks	Mistreatment based on sex or gender
Subjected to ethnically or religiously offensive remarks	Object of ethnically or religiously offensive remarks
Subjected to vulgar language	Made to complete personal services (such as buying coffee or running errands unrelated to defined work tasks)
Sexual mistreatment (including remarks or advances)	Threatened with physical harm
Subjected to physical harm

Administrator (Department, College or Hospital)	Attending
Faculty member	Fellow/Resident/Post-doc
Course Director	Nurse (including Nurse Practitioner, CNA, etc.)
Medical Student	Graduate Student
Nursing Student	Physician Assistant Students
Member of Care Coordination Team (Social Worker, Respiratory Therapist, etc.)	Other