STFM Statements

Society of Teachers of Family Medicine Opposes Texas Legislation That Undermines the Physician-Patient Relationship and Restricts Training

September 2021—The Society of Teachers of Family Medicine is deeply concerned about the consequences of the Texas state law Senate Bill 8, which took effect September 1, 2021. These consequences include the effective banning of certain medical communication between a physician and patient, restricting clinical training of the full scope of women’s health care, encouraging rewards for citizens to file claims about suspicions of legal procedures and inspiring the replication of these laws in other states.

Interferes with Physician-Patient Relationship
STFM strongly opposes any laws and regulations that interfere in the confidential relationship between a patient and their physician. Patients must be able to depend on their physicians’ training, expertise and use of medical evidence to help them make critical decisions about their personal health. Physicians and health care professionals must be able to practice medicine freely and without threat of punishment, harassment, or retribution.

Restricts Residency Education
We are opposed to restrictions on our physicians and educators to teach and provide clinical training for the full scope of family medicine to our residents. Our opposition is consistent with our advocacy policy that Congress and/or federal agencies should not legislate or mandate restrictions on the educational content of training programs. Any such restrictions limit and/or adversely affect our educational mission. We reaffirm the right of each trainee to choose certain aspects of their training consistent with their belief systems. This policy informs our Board’s position on the Texas legislation.

Restricts Access to Health Care 
This Texas law goes against our policies and beliefs in the value of having appropriate numbers of health care personnel to meet the health care needs of the population and to provide access to health care for all individuals. Abortion is part of full spectrum women's health care and physicians can use their own judgement as to whether to provide it.

Rewards Vigilante Behavior
Senate Bill 8 allows for a bounty that encourages citizens to file a cause of action, whether frivolous or provable, against physicians, other health care professionals, and anyone who ‘aids or abets’ an act of providing full spectrum health care. This raises concerns about access to health care for women and the wellbeing and safety of the physicians and health care professionals who provide care for them.

Precedent Setting
If permitted to proceed, this law will be precedent-setting and could normalize vigilante interference in the patient-physician relationship in other complex, controversial medical or ethical situations. Legislating the communication between patient and physician is not something we can allow to happen.

Patients and their physicians should be the ones to make medical decisions together about what care is best for them. This law obstructs that ability. We strongly urge the courts to act swiftly to strike down this law and any similar legislation.

The STFM Board of Directors, represents more than 5,000 family medicine educators, including physicians, researchers, behavioral health professionals, pharmacists, nurses, physician assistants, residents, medical students, and others involved in family medicine education, with a mission to advance family medicine to improve health through a community of teachers and scholars.

STFM Statement Against Discrimination 

STFM opposes all discrimination in any form, including but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin.

STFM Statement on Affirmative Action

The United States Supreme Court’s decision to overturn the use of race-conscious college admissions reverses four decades of progress toward greater representation in educational institutions. Despite this ruling, the Society of Teachers of Family Medicine (STFM) remains steadfast in its commitment to diversity, equity, and inclusion and will continue to develop antiracism initiatives, including curricula, programs, and partnerships. Diversity in the primary care workforce eliminates health disparities, drives scientific innovation, and improves health, especially for historically marginalized populations. In order for future physicians to practice cultural humility, their peers, faculty, and staff must reflect the diversity of the populations they serve. 

approved by the Board of Directors May 2023

Ethics & Conduct Policy

1. Purpose and Objectives

The mission of the Society of Teachers of Family Medicine (“STFM”) is to advance family medicine to improve health through a community of teachers and scholars. To further this mission, the overarching purpose of this Ethics & Conduct Policy (the “Policy”) is to advance excellence of STFM and the broader discipline of family medicine (the “discipline”) and maximize the participation of all members and staff in a welcoming, safe, and intellectually engaging environment for interaction and the exchange of ideas.

2. Persons and Entities covered by the Policy

All STFM members, staff, and participants involved in an official STFM activity agree to comply with this Ethics and Conduct Policy. “All participants” includes, but is not limited to members, officers, directors, attendees, guests, presenters, speakers, contractors, exhibitors, sponsors, authors, reviewers, editors, and volunteers (collectively referred to herein as “STFM Affiliates”. 

This Ethics and Conduct Policy applies to all official STFM activities, which include but are not limited to:

• • Any meeting or call, whether in-person or online, whose purpose is to conduct or discuss matters related to STFM business, activities, publications, awards, or initiatives.
  • Any element of an STFM conference or workshop, such as plenary sessions, educational sessions, tours, receptions, business meetings, networking sessions.
  • Any component of the publication review process associated with an STFM-sponsored journal, such as the editorial and review tasks for handling a submission and the responses from the authors. 
  • Any communications that are hosted by STFM. 
  • Any STFM sponsored professional development activity or certification activity. 
  • Any STFM sponsored social activity.
  • Any non-STFM activity, where the person is acting as a representative of STFM.

At STFM’s discretion, this Policy also applies to conduct of an STFM Affiliate in any professional activity or capacity, even when not engaged in an STFM-associated activity, if that conduct may adversely affect their or others’ ability to perform or participate in any STFM-associated activity. An example would be a conviction for a criminal act.

All STFM Affiliates are required to read and abide by this Policy and may be required to submit signed acknowledgement statements agreeing to the terms and conditions of this Policy. Failure to timely submit a required acknowledgement statement when requested is a violation of this Policy. However, failure to complete such a statement does not diminish application of this Policy to that STFM Affiliate.

Community Standards of Conduct
To advance the STFM mission and priorities, STFM adopts the following standards of conduct for all STFM Affiliates while representing or performing any roles or duties on behalf of STFM, and participating or engaging in any STFM-related activities or events (“Community Standards”):

• • Respectful, professional, and inclusive conduct and treatment of all those engaged or contemplating engagement in the STFM community, as well as others in the discipline.
  • Not practicing racial, sexual, and other intersecting forms of bias, harassment, and discrimination (eg, based on gender, ethnicity, nationality, religion, sexual orientation, identity and expression, disability, etc.).
  • Not retaliating against any person(s) who raises a conduct concern or who assist in any way to investigate or resolve it.
  • Support for the ability of individuals to participate in the robust and open exchange of scientific ideas and encouraging multiple perspectives, popular or not, to be voiced by a diversity of individuals.
  • Honesty in the conduct and attribution of your work in the discipline.
  • Public disclosure of relevant conflicts of interest in your work in the discipline.

To be an STFM leader and for the privilege of being recognized as an STFM Affiliate in good standing, all Affiliates must practice ethical, professional, and inclusive conduct and fulfill these Community Standards and other requirements of this Policy. 

Failure to satisfy these Community Standards by an STFM Affiliate, or any other ethical or conduct requirements set forth herein, is a violation of this Policy.

3. Reporting Conduct Concerns

STFM provides the following ways to raise conduct concerns within the scope of this policy:

a). Informal Complaints
Informal conduct concerns may be reported by reaching out to any STFM staff member, officer, or member of STFM’s Board of Directors (the “Board”). The information needed for a formal complaint is generally helpful for STFM to act on an informal concern; however, an informal complaint may be raised verbally as well as in writing. An informal approach is more likely when the person raising the concern is not seeking a formal process to resolve the concern. Still, taking this approach does not preclude a formal resolution. An informal approach may also be pursued when an individual seeks to explore resolution options before deciding to identify those involved or whether to file a formal complaint.

b). Formal Complaints 
Filing a formal complaint may be done by submitting the complaint in writing to the STFM Executive Director/CEO or the STFM President. A formal complaint is equally suitable when the person filing it seeks a formal resolution process or an informal resolution approach.

Generally, a formal complaint should include the following information:

• • Name of the accused(s) and contact information and affiliation with STFM, if known.
  • If the conduct concern(s) involves a target(s), the name of the identified target(s) and their contact information, if known.
  • Name and contact information of the person raising the concern and how they became aware of the concern.
  • Names of any witnesses or others with pertinent information, and contact information, if known.
  • Description of the conduct concern, with the date, approximate time, location/setting/activity, and all known relevant facts and circumstances.
  • Any relevant documents that are available to the person filing the complaint.
  • Other information that might help STFM understand the full nature of the conduct concern.
  • Any request for confidentiality per Section 5 below.

SUBMIT A FORMAL COMPLAINT HERE 

4. Confidentiality

Any person who raises or reports a conduct concern, witnesses the conduct concern, is the identified target(s), or is the accused may request confidentiality of their identity or of others most directly involved. Whenever a request for confidentiality is made, STFM will take all reasonable steps to do so. In taking such steps, STFM and those individuals designated to investigate and resolve the reported conduct concern will also emphasize this Policy’s prohibition against retaliation. 

All STFM Affiliates are required to respect confidentiality of the identities of each individual most directly involved in a conduct concern while it is being reviewed and resolved. Failure to do so is a violation of this Policy. 

Notwithstanding the above, STFM may not maintain confidentiality if, in its sole judgment and discretion, safety or law requires otherwise. For instance, if an accused is determined to have violated this Policy, STFM may exercise its discretion to make that disclosure. 

5. Investigation of Conduct Concerns or Complaints

Submission of a conduct concern by informal or formal complaint is generally required to initiate this process. However, STFM and/or its assigned Decision-makers will initiate a review or investigation on its own initiative when it has reason to believe there is a conduct concern under this Policy. 

STFM will review all reported conduct concerns for further investigation within the scope of this Policy. However, STFM will not proceed with an investigation if STFM’s initial review determines there is no credible question regarding concerning conduct, or available information is inadequate to make that assessment or to pursue a resolution.

Credible conduct concerns and complaints will be subject to investigation and resolution by individuals appointed by the STFM presidential triad (president elect, president and immediate past president of STFM) and executive director/CEO as Factfinders and Decision-makers. These individuals will engage with persons reporting conduct concerns, identified targets, and the accused about the conduct at issue. They will also conduct the review and/or any investigation that may be needed for resolution. 

The roles and responsibilities of Factfinders and Decision-makers are as follows:

• • Factfinders. Factfinders are authorized by the Board to receive, initially review, and take any other necessary short-term action to respond to a conduct concern provided by formal or informal means. They are also authorized to conduct a full investigation of facts relating to a reported conduct concern when the Decision-makers determine that an informal resolution does not suffice. Factfinders will make recommendations to the Decision-makers regarding the suitability of an informal resolution and may make other recommendations. Factfinders may be STFM employees, STFM board members, STFM members, or outside legal counsel retained by STFM.

• • Decision-makers. Decision-makers may also be the Factfinders. Decision-makers may be STFM employees, STFM board members, STFM members, or outside legal counsel retained by STFM. The Decision-makers are authorized by STFM to:
    • Determine whether to rely on a third-party investigation for fact finding. 
    • Require additional fact-finding by the factfinder(s) to supplement the initial investigation.
    • Engage any identified target and the accused and possibly engage other individuals most directly involved, to determine a resolution.
    • Apply the criteria specified to determine the sufficiency of an informal resolution; and modify the terms of an informal resolution or determine that a formal resolution is needed.
    • Determine whether a violation of this Policy has occurred in a formal resolution process, and decide what consequences to impose if a violation has occurred; and
    • Request and accept, modify, or reject recommendations from the Factfinder.

Factfinders and Decision-makers assigned to address a particular conduct concern are required to be free of conflicts that would interfere with their performance of their responsibilities. When the Decision-maker or Factfinder acts under any provision of this Policy, he or she is exercising STFM’s discretion

6. Resolution of Conduct Concerns or Complaints

1. Informal Resolution
An “Informal Resolution” focuses on community building, not punishment. The primary goals of an Informal Resolution are to identify why a conduct concern arose, enhance understanding of community standards, repair relationships, and ensure that recurrence of the concern is unlikely.
An Informal Resolution is sufficient to resolve conduct concerns where the Decision-maker determines, and any identified target and the accused agree, that it is unnecessary to determine the Policy has been violated. An Informal Resolution may be appropriate under the following circumstances:

• • • The dominant need is to explain that certain conduct was harmful, how to avoid recurrence of such conduct, repair relationships, and, where implicated, restore safety and inclusion.
    • The offensive conduct is not a recurring issue or the accused has displayed an authentic commitment to avoid repetition of the cause of the concern, and
    • Safety and inclusion can be restored without the need for further action.

2. Formal Resolution
If the Decision-makers determine that an informal resolution is insufficient to resolve the conduct concern, a formal resolution process will be pursued. However, a formal resolution will not be initiated or continued if the Decision-makers determine there is an inadequate basis to pursue any resolution (eg, no credible question of a violation or unavailability of needed individuals or information). The Decision-makers may forego the formal resolution process if, at any time after commencing the Formal Resolution process, an informal resolution is deemed sufficient. 

1) Stages
The following stages generally apply in any formal resolution process, except where the Decision-maker determines an informal resolution is appropriate:

• • Factfinding. The Factfinder finds the relevant facts and documents them, gathering any documents and notes of any communications supporting the facts. Before finalizing the documentation of facts, the Factfinder engages with any target and the accused to inform them of the nature of the conduct concern, to confirm that it is within the scope of this Policy, and to gain their perspectives.
  • Supplemental factfinding. The Factfinder provides the documented facts and supporting documents to the Decision-makers. The Decision-makers may request the Factfinder to conduct supplementary factfinding. The Factfinder will resubmit any supplementary information as requested by the Decision-makers.
  • Notice and response period. Once all the facts are gathered, the Factfinder and Decision-makers will notify the accused, the target(s), and those who reported the conduct concern. Any identified target and the accused have a 14-day period to access the factual record and respond in writing, providing the Decision-makers with any additional facts or circumstances they believe should inform the final determination and any consequences.
  • Final determination. The Decision-makers review any submission received. Upon expiration of that 14-day period, whether responses are submitted or not, the Decision-makers make a final determination and, if a violation is found, imposes consequences.
  • Notification. The Decision-makers provide written notice to the accused, any identified target, and any other individual who reported the concern of the Decision-makers’ final determination.

ii). Timing
The goal for timing to complete the Formal Resolution process is 90 to 120 days from the submission of the conduct concern to the final determination. However, the Decision-makers may extend the period for good cause, such as limited availability of individuals most directly involved, difficulty of obtaining relevant facts, complexity of the issues, or limited resource capacity. 

iii) Appeal Process
Should a participant accused of breaking the policy wish to appeal a decision within 30 days after it is made, they may make an appeal to the STFM Executive Committee who is required to review the appeal within an additional 60 days. Grounds for appeal include a claim of procedural error, substantive or significant new evidence, or evidence of bias in the fact-finding and decision process. The Executive Committee may uphold, reject, or adjust the findings or ask for further investigation. 

7. Short-Term Actions

When required under the circumstances, the Factfinders or Decision-makers may take short-term actions, and may periodically adjust or end any short-term actions, when the Decision-makers determine such actions are in the best interests of STFM, pending a final decision resolving the conduct concern. Short-term actions are generally taken around the same time as, or within a few days or weeks of, a conduct concern being raised, depending on the facts and circumstances. These may include, but are not limited to:

a). Inappropriate Language:
Participants who demonstrate inappropriate behavior as defined by the Ethics and Conduct Policy will be asked to stop and are expected to comply immediately. An example might be an individual who submits inappropriate comments on the STFM All Member Forum.

b). Safety Measures

• • Initial safety measures. The Factfinder may require temporary separation of any individuals, temporarily exclude an accused or other individual from participating in some or all STFM-associated activities or take other temporary action to address concerns about safety of individuals or safety or protection of property.
  • Decision-makers oversight. The Factfinder will follow up with the Decision-makers promptly to determine the ultimate safety measure in writing.
  • Notice of ultimate safety measures. Before implementing ultimate safety measures, the Decision-maker will notify the accused, any identified target, and any other then-known person who would be uniquely subject to a restriction under (or need protection of) the ultimate safety measures. 

8. Enforcement and Consequences

a). Potential Consequences
A violation of this Policy may result in one or more of the following consequences following an Informal or Formal Resolution:

• • Restorative or community-building practice (which may be pursued to address conduct concerns even without a determination of a violation of the policy)
  • Private or public reprimand or statement
  • Revocation or denial of membership privileges; suspension of membership and associated privileges*
  • Permanent expulsion from STFM (for egregious misconduct in severity or frequency)
  • Removal or suspension from a volunteer position*
  • Removal or suspension from engagement with specific staff or members*
  • Removal or suspension from a leadership position whether employed or volunteer*
  • Suspension or permanent prohibition from attending or making presentations at STFM meetings or specific events at STFM meetings*
  • Disciplinary action, up to and including suspension or termination of employment for STFM employees*

*Suspension may be imposed by a Factfinder or Decision-makers on an interim basis as a short-term safety measure applying the criteria and process in this document.

b). Considerations and Proportionality
The consequences imposed will be proportional to the severity of the violation, and the corresponding harm caused or threatened to individuals, STFM, the discipline, or society-at-large. Considerations to determine severity of the harm include, but are not limited to:

• • The nature of the violation 
  • Whether the violation is repetitive or the frequency of the violation, and
  • Whether the violations implicate safety interests
    
    

SUBMIT A FORMAL COMPLAINT HERE