Reporting Racism
The purpose of this feedback form is to report instances of racism that you see or experience from the classroom to the wards. Our goal is to collect this information to understand main areas/systems of racism that are impacting our UCSD community so that we can strategically advocate for change.

Tell us your stories and experiences at UC San Diego Health to help us better understand the state of racial justice at our institution. This form IS NOT intended to be a form of "anonymous reporting." The deans closely monitor anonymous reporting at the school of medicine and strive to swiftly and appropriately respond to any all reports, which span racism, sexism, homophobia, and other forms of abuse and harassment. In contrast, this form specifically deals with instances of racism, is ONLY monitored by students. Any reported instances of extreme abuse or harassment (which will be determined on an ad hoc basis by site administrators) will be relayed to the UC San Diego administration to ensure student and staff safety.

Some examples of what you report
1.) Racist incidents that you want to share so that we have an understanding of racists events at our school
2.) Racist incidents that you would like us to follow up on with the goal of making systematic change at our school
3.) If you witnessed a racist event (that you would like us to follow up, or would just like us to be aware of)

If you decide that you do not want us to follow up with your submission, we will still use this information when summarizing reports quantitatively to admin, but will not disclose any identifying information.

Some examples: Use of race based medicine in lecture (i.e race as a risk factor, no explanation for racial disparities, using race in the one line, etc.), racist comments (overt or insidious), etc.

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For reference: definition of mistreatment per medical student advising handbook
Mutual respect between students and other healthcare professionals may be expressed in many ways but all interactions should include honesty, fairness, and evenhanded treatment. Behaviors that are inherently destructive to the teacher-learner relationship or the learning environment are prohibited. Students are adult learners and, as such, deserve the respect one would give to colleagues. Examples of abusive treatment of students include but are not limited to the following:
- Public berating and humiliation
- Intellectual “bullying”
- Deliberately and repeatedly excluding students from reasonable learning opportunities
- Asking students to carry out personal chores or tasks to cull favor or to avoid explicit or implicit criticism
- Destructive criticism
- Physical punishment or physical threats (e.g., hitting, slapping, pushing, kicking, the threat of physical punishment or intentionally or negligently placing another at risk of physical harm)
- Sexual harassment (e.g., physical or verbal advances, discomforting humor, soliciting sexual favors in exchange for grades or opportunities)
- Discrimination based on student’s race, religion, ethnicity, sex, age, sexual orientation, gender identity, or physical or mental disabilities
- Grading used to punish a student rather than to evaluate objective performance
- Assigning tasks for punishment rather than to evaluate objective performance
- Intentional neglect or intentional lack of communication
Level that racism was observed or experienced *
Required
In what setting did this incident occur? *
Required
Describe racist incident/experience with as much detail as you feel comfortable *
Do you have any suggestions or thoughts about how you would have liked to situation you described to be addressed? *
How would you like us to proceed based on your submission? *
Required
If you'd like for us to follow up with you directly about this, please provide your contact information. This is by no means required! We understand the importance of confidentiality.
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