Standard Operating Procedures

Standard Operating Procedures

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  • Scheduling of Non-Human Simulation Activities

    1. An online request form must be filled out listing the following information:

    • Human or Non-Human Simulation
    • School Affiliation (SOM, SON, SHP, GME, etc)
    • Activity Sponsorship 
    • Course Name and Number
    • Preferred Activity Dates
    • Up to 3 Alternative Activity Dates
    • Required Scheduled Times
    • Course Director & Affiliated Instructors Names
    • Course Director's Contact Information
    • Rooms Required for the Activity
    • Type of Activity Being Conducted
    • Activity Required for Graduation or Advancement
    • New or Established Activity 
    • Number of Learners
    • Group Sizes (if applicable)
    • Type and Number of Simulators/Equipment Required for the Activity
    • Requirements for Assistance with Operating Simulators 
    • Supply List/Completed Template (Disposable and Non-Disposable)
    • Room Set Up Requirements
    • 3 Course Objectives
    • Does a Written Case Already Exist (and what is its name) or Need to be Created
    • Option to Upload Existing Case
    • Details for Recording the Activity
    • Option to Upload Scoring/Grading Rubric
    • Monitoring Room Requirements
    • Option to Upload Further Related Documentation

    1. Requests must be made by the published deadlines found at the top of the request page.
    2. All requests will be reviewed by the Assistant Director of Simulation (or his/her designees) for appropriateness, educational impact, availability of resources, etc.
    3. At the discretion of the Assistant Director of Simulation, requests may be reviewed by designated Faculty Liaisons, or by the HEC Internal Advisory Board.
    4. After review, requests will either be approved, provisionally approved, held pending request for more information or rejected. If a request if rejected, coaching will be offered to help develop the scenario to meet simulation standards.
    5. Rejected requests can be appealed to the Faculty Liaison group (composed of SMEs from all the schools at UTMB).
    6. Provisionally approved requests (primarily new activities) would then proceed through the full development phase utilizing the instructor(s), HEC technical staff, relevant SMEs and, if necessary, experts in simulation-based educational principles. These would then be resubmitted for final approval.
    7. Once an activity is approved, it will be placed on the B-Line calendar, room(s) will be reserved, relevant resources will be reserved and/or ordered/purchased, and the primary contact person will be notified of the final date and time.
    8. If a conflict should arise between 2 or more events trying to utilize the same rooms/resources, the request will be reviewed and conflicts resolved based upon the following factors:

      • Summative vs formative
      • Requirements for graduation/advancement
      • Flexibility of one or more courses
      • Established vs new event
      • Educational impact of the activities
      • Adaptability of one or more courses to utilize other rooms/resources

    9. Cancellation of a course must be submitted 5 business days prior to the scheduled date with the exception of extenuating circumstances or unanticipated reason for cancelling.
  • Scheduling Human (Standardized Patient) Activities

    All Human (Standardized Patient) activities must be requested, approved, managed and scheduled through the Health Education Center.   

    1. An online request form must be filled out listing the following information:

      • Human or Non-Human Simulation
      • School Affiliation (SOM, SON, SHP, GME, etc)
      • Activity Sponsorship 
      • Course Name and Number
      • Preferred Activity Dates
      • Up to 3 Alternative Activity Dates
      • Required Scheduled Times
      • Course Director & Affiliated Instructors Names
      • Course Director's Contact Information
      • Rooms Required for the Activity
      • Type of Activity Being Conducted
      • Activity Required for Graduation or Advancement
      • New or Established Activity 
      • Number of Learners
      • Group Sizes (if applicable)
      • Supply List (Disposable and Non-Disposable)
      • Room Set Up Requirements
      • 3 Course Objectives
      • Does a Written Case Already Exist (and what is its name) or Need to be Created
      • Option to Upload Existing Case
      • Number of SPs Required for the Activity
      • Details for Recording the Activity
      • Option to Upload Scoring/Grading Rubric
      • Monitoring Room Requirements
      • Length of time per SPs encounter
      • Proctoring Requirements 
      • Option to Upload Further Related Documentation
      • Does an SP Checklist Already Exist or Does it Need to be Created
      • Does a Door Sign Already Exist or Does it Need to be Created
      • Will a Post-Encounter Station be Required for this Activity (established scenarios only)

    2. Requests must be made by the published deadlines found at the top of the request page.
    3. All requests will be reviewed by the Assistant Director of Simulation (or his/her designees) for appropriateness, educational impact, availability of resources, etc.
    4. If approved, SP availability, requirement for SP training, etc. will be assessed prior to setting a final date in the B-Line calendar.
    5. The HEC Standardized Patient (SP) Center maintains the right to reserve (block) the day before and after an activity to allow for appropriate set-up and take-down. To ensure quality service is provided and to allow for finalization of data collected, the SP Center also maintains the right to reserve (block) multiple days after hosting an examination. For exams with a duration of 5 or more days, up to 10 working days may be reserved by the SP Center. 
    6. At that point, the primary contact will be notified of the final date(s) and time(s) for the course.
    7. At the discretion of the Assistant Director of Simulation, requests may be reviewed by Faculty Liaisons, or by the HEC Internal Advisory Board.
    8. After review, requests will either be approved, provisionally approved, held pending request for more information or rejected. If a request if rejected, coaching will be offered to help develop the scenario to meet simulation standards.
    9. Rejected requests can be appealed to the Faculty Liaison group (composed of SMEs from all the schools at UTMB).
    10. If a conflict should arise between 2 or more events trying to utilize the same rooms/resources, the request will be reviewed and conflicts resolved based upon the following factors:

      • Summative vs formative
      • Requirements for graduation/advancement
      • Flexibility of one or more courses
      • Established vs new event
      • Educational impact of the activities
      • Adaptability of one or more courses to utilize other rooms/resources.
    11. Cancellation of a course must be submitted 8 weeks prior to the scheduled date with the exception of extenuating circumstances or unanticipated reason for cancelling.
  • Standards for Simulation-based Education

    The HEC embraces the Society for Simulation in Healthcare’s (SSH) simulation standards (www.ssih.org). The HEC also holds institutional memberships with the International Nursing Association for Clinical Simulation in Learning (INACSL) and the Association of Standardized Patient Educators (ASPE).

    For non-human simulation activities, the HEC recommends utilizing the Healthcare Simulation Standards of Best Practice. This resource can be accessed using the following link: https://www.inacsl.org/healthcare-simulation-standards

    For human simulation activities the HEC recommends utilizing ASPE’s Standards of Best Practice. This resource can be accessed using the following link: https://www.aspeducators.org/standards-of-best-practice

    Interprofessional simulation activities should follow the appropriate guidelines listed above, in conjunction with the Core Competencies for Interprofessional Collaborative Practice published by the Interprofessional Education Collaborative (IPEC). Further information on IPEC can be located on the following website: https://www.ipecollaborative.org/

    The HEC recommends that all simulations are consistent with current evidence-based clinical practice and guidelines.

  • Established Scenarios

    All scenarios will need to be approved by the HEC prior to being scheduled on B-Line. Established scenarios will undergo an expedited review based on the HEC’s experience with the particular scenario. Each scenario will be reviewed by the HEC regarding educational objectives, logistics, equipment needs and scheduling. The HEC may request further information or clarification prior to approval and scheduling. Once approved a confirmation will be e-mailed to the contact person of the activity/scenario. A reminder will be e-mailed to the contact person of the activity/scenario five (5) business days prior to the scheduled date of the educational session. If it is an established activity that has not been conducted in the HEC, optimally each scenario will be piloted prior to the scheduled date to ensure effective performance of the scenario.

    All educational material and supply requirements for non-human simulation activities must be submitted at the time of making the scheduling request. Any request to make changes to the session should be received no later than five (5) business days prior to the session date. Instructors and learners may be asked to complete an evaluation after the simulation event.

    For human simulation activities, requests must be submitted, no later than 3 months before the scheduled date with established cases and/or checklists being confirmed and approved no later than 2 months prior the scheduled activity. If new materials are being created for an established activity, guidelines for new scenarios/cases need to be followed. Please note, once recruitment for an activity has started, changes to the activity are not permitted.

  • Development of New Scenarios/Cases

    For non-human simulation activities, the HEC recommends utilizing the Healthcare Simulation Standards of Best Practice: Simulation. This resource can be accessed using the following link: https://www.inacsl.org/healthcare-simulation-standards

    For human simulation activities the HEC recommends utilizing ASPE’s Standards of Best Practice. This resource can be accessed using the following link: https://www.aspeducators.org/standards-of-best-practice

    The HEC must receive the completed scenario/case templates before it is to be implemented (please refer to the timelines listed below). Piloting of scenarios should be completed before the scheduled activity date. The cases/scenarios should follow current clinical standards of care. There should be a process for pre-briefing and debriefing.

    For Human simulation activities, new case development requests must be submitted, no later than 6 months before the scheduled date with finalized cases and related materials (checklists, doors signs, etc.) being received no later than 2 months prior the scheduled activity. Please see the chart below which outlines the process for new script action items. For established cases that are being modified or new checklists being created, requests must be submitted no later than 3 months before the scheduled date and the finalized versions no later than 2 months prior to the scheduled activity. Please note, once recruitment for an activity has started, changes to the activity are not permitted. 

    NEW CASE ACTION ITEMS & DEADLINES

    1Case author(s) uses HEC template to develop the new script and case related materials (door sign & checklist)
    2Case author(s) submits all case materials (script, door sign, checklist, etc.) to HEC staff for review
     Submission deadline: 6 months prior to the activity
    3HEC staff returns case materials to author(s) for review
    4Case author(s) and HEC staff meet to review and edit the case materials
    5Trainer(s) reviews case materials
    6Case author(s) and/or HEC staff address trainer’s questions/comments
    7Case is piloted.
     Case author(s), HEC staff, and trainer(s) attend the pilot activity.
    8Finalize the all case documents
     Finalization deadline: 2 months prior to the activity
    9Utilize the case materials in an activity
    10Edit script (based on observations and feedback from SPs, trainers, HEC staff, faculty, & students)

     

    For Non-Human simulation activities, new scenario development requests must be submitted, no later than 3 months before the scheduled date with new scenario and related materials (charts, orders, etc) being received no later than 1 months prior the scheduled activity.

    After making a scheduling request for development of a new scenario/case, you will be asked to meet with HEC staff to discuss the development process and you will be provided with guidance for completing the script/scenario template. If you have any questions about the process or wish to discuss new scenario/case development, please contact one of the Asst. Directors of Simulation: Kristen Kahrig, kmkahrig@utmb.edu (Non-human Simulation) or Darlene Self, pdself@utmb.edu (Human Simulation)

    The structure of the case/scenario should encompass pertinent patient history, equipment, supplies, and necessary case information. Some recommendations include, but are not limited to:

    1. Case Title
    2. Goals and Objectives
    3. Patient Chief Complaint
    4. Patient Information (name, age, gender, weight, height)
    5. Case Presentation (information given to the participant prior to the beginning of the case)
    6. Vital Signs
    7. Past Medical History
    8. Medications
    9. Allergies
    10. Events (actions taken by the participant)
    11. Result of Event (decrease in B/P, increase in HR etc.)
    12. Staff Needed
    13. Equipment/props needed (all resources to be used by the scenario)
    14. Simulator type (if appropriate)
    15. Environment

  • Pre-brief and Debrief

    Pre-brief

    The role of the pre-brief is to clearly delineate learning objectives and expectations for the learners participating in an educational activity. The Health Education Center’s policies regarding confidentiality and professional behavior should be made available to all learners, including explicit instruction that all equipment belonging to the Health Education Center must physically remain in the center. Any logistical information and orientation for learners may also be relayed as part of the pre-briefing. The pre-briefing is to be conducted in a psychologically safe context. Learners may be asked to suspend disbelief during simulated activities to assist with achieving the highest level of fidelity for the simulation. Any pre-course preparation required of the learners should be distributed to all learners within a reasonable time frame, to be determined by the course instructor, prior to the scheduled educational activity.

    Debrief

    The instructors/facilitators are expected to conduct a formalized debriefing after each educational activity. A specific time allotment should be reserved for debriefing as part of every educational activity. The debriefing may take place at any time following the primary learning activity. The role of the debriefing is to guide learners to derive meaning from the simulated learning opportunity. The Health Education Center understands that debriefing methods vary, thus it does not endorse a specific style of debriefing; however, debriefing should be used to assist in reinforcing the learning objectives of the educational activity. The debriefing should include a formative assessment of the learners and is to be conducted in a psychologically safe context. Debriefing may also include an assessment of the instructors or efficacy of the education activity. Audiovisual technology and playback may be used as part of the debriefing process.

  • Faculty Guidelines

    Faculty are expected to prepare adequately for their scheduled events. This includes the following:

    1. Establish the learning objectives and how they will be assessed.
    2. Arrive a minimum of 15 minutes before scheduled activity and behave in a professional manner. If the activity involves PBLs, faculty must arrive at least 30 minutes early to pre-brief with PBLs to ensure understanding of activity expectations.
    3. Conduct a Pre-Brief as per the HEC's simulation standards.
    4. Prepare and engage students for activities.
    5. Provide supervision and a structured debrief for learners.
    6. Adhere to HEC standards for simulated learning activities.
    7. Bring sign-in sheets and copies of the scenarios/case for personal use if required.
    8. Understand scenarios will be evaluated by the HEC, Faculty Content Experts, and learners for educational impact.

    Please note, if PBLs (paid by letter staff) are requested for an activity, the HEC will provide copies of the scenarios/cases for the PBLs.

  • Dress Code

    The Appearance and Dress policies cover all HEC Simulation areas. The goal of the dress code is to maintain a professional demeanor in preparation for interactions in skills and simulation activities.  Violations may result in removal of the learner from the HEC.

    While in the Simulation Center, learners must adhere to appearance and dress requirements consistent with those in a clinical setting with actual patients, as well as requirements related to a learning and testing environment. These requirements include:

    • The learner’s ID badge/UTMB ID must be worn in a visible location unless otherwise instructed by HEC staff.
    • Clothing must be clean, fit properly, and be appropriate for a professional encounter.
    • Students must be dressed in compliance with specific School/Program requirements, for example white coats and/or scrubs.
    • Closed-toe shoes must be worn.
    • Undergarments which are appropriate to the article(s) of clothing worn, are required.
    • Fingernails must be groomed in accordance with IHOP - 03.01.06 - tips of the nails may not extend past the end of the fingers. The nail surface must be smooth. Artificial nails/wraps or acrylic overlays are not permitted. Nail polish may not be chipped or cracked.
    • Hair must be restrained so as to not contact a patient during an encounter.
    • The body must be free of potentially offensive odor, including perfume, cologne or natural body odor.
    • Jewelry must be modest and present no safety risk or interfere with simulation activities.
    • Attachments to clothing such as lapel pins should be limited in number and are restricted to those received in one’s official UTMB capacity.
    • Unless provided as part of a simulation exercise, no hats or hair covers may be worn except for religious or medical reasons.
  • Code of Conduct

    In accordance with UTMB IHOP Policy 07.01.03 ~ Student Conduct and Discipline

    Honor Pledge: On my honor, as a member of the UTMB community, I pledge to act with integrity, compassion and respect in all my academic and professional endeavors.

    1. All users of the HEC must act in a manner that is professional, collaborative, supportive, non-intimidating, and mutually respectful and does not disturb academic activities.  
    2.  All users of the HEC must abide by the legal and professional standards of practice and codes of ethics that guide one's discipline.
    3. No user shall infringe upon the privacy, rights, privileges, health, or safety of others.
    4. All users of the HEC, including learners, instructors, and standardized patients are expected to be punctual for sessions, organized and prepared for simulation-based experiences.
    5. The course instructor has the right to remove any participant from the center. HEC staff have the right to remove anyone (e.g., instructors, students, etc.) from the facility.
    6. All faculty, staff and students must be oriented to the center prior to using the equipment.
    7. All HEC users must wear their UTMB/ID badge in accordance with the HEC dress code.
    8. No eating or drinking is allowed at any time in the simulation areas.
    9. No pens, markers, are allowed in the simulator rooms.
    10. Use of the HEC simulation computers is restricted to assigned simulation activities and not for personal use.
    11. Equipment is not to be used for any purpose other than specified; anyone who fails to comply with this request will be asked to leave the center.
    12. Assets are not to be removed from the HEC without approval from leadership.
    13. Any equipment malfunction or abuse must be reported to HEC staff immediately.
    14. Adherence to the dress code is expected. 
    15. Do not remove the simulator from the bed unless instructed to do so.
    16. Lockers are available for short term use for placement of personal items (book bags, phones, coats, etc.). The lockers allow input of a personal code to lock and unlock. Belongings should be removed from the lockers immediately following the scheduled event.
    17. All electronics including cell phones, PDA’s, cameras, camera phones, and video recorders are prohibited during simulation activities. Recording and/or sharing of simulation information is forbidden.
    18. Unauthorized photography is not permitted at the HEC. Anyone requiring photos for a presentation or poster must follow established guidelines for photography and video recording.
    19. Permission for the use of screen shots or video clips from session recording utilizing the B-Line system for purposes other than debriefing following the session (such as presentation or poster) must be obtained from the Vice President of Interprofessional Education and the Health Education Center.
  • Confidentiality and Privacy

    The HEC Interprofessional Simulation Center abides by the UTMB Institutional Handbook of Operating Procedures regarding confidentiality and privacy. The HEC also abides by the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) wherever applicable.

    Each simulation activity in the HEC has the possibility of being recorded. In order to preserve the integrity of the scenarios used for learning activities and to provide an equitable learning experience for each student, all persons using the HEC will be required to sign a confidentiality agreement. Students are expected to uphold all requirements of the Health Insurance Portability and Accountability Act (HIPAA) and any other federal or state laws requiring confidentiality. Individuals violating this agreement should be reported to responsible faculty.

    The HEC has the ability to record and display a variety of media. Cameras, microphones, and control rooms are located on every floor and in the cargo elevator. The recording equipment should not be used unless proper training has been provided. All recordings will be backed and stored per UTMB policy. Recordings can be used for educational purposes and debriefing opportunities with the appropriate faculty, staff and students as well as for research purposes. The confidentiality agreement signed by students protects privacy and discourages inappropriate discussion of recorded contents or student’s performance in the simulation scenarios. Any viewing or publication outside of the classroom, such as posting on YouTube, is forbidden and will result in disciplinary action. Students and faculty should conduct themselves professionally in accordance with the HEC's code of conduct. 

  • Photography and Video

    All learners and instructors will be required to sign an image consent form, and will be made aware of the video recording policy as stated below. If recordings are to be used for research purposes, related consent forms will be given to the participants and stored as per approved IRB protocol. 

    A signed copy of the image consent form must be on file in order for a learner or an instructor to participate in simulation activities in the HEC. A copy must also be on file prior to an instructor being assigned login and password access to the B-Line system, which allows the viewing of recorded sessions.

    The B-line system allows the HEC to assign and restrict access to sessions for review or debriefing to only those instructors/faculty involved in the specific session. Instructors cannot view sessions recorded by other groups. Learners are not provided password access to the system, unless a specific request is made by the session faculty member. The HEC retains B-line recorded session for 7 years from the date of training.

  • Safety

    The following policies from the UTMB Institutional Handbook of Operating Procedures Section 8 Health, Safety and Security; written to provide a safe work and learning environment, will be adhered to by all entering the Health Education Center.

    Environmental Policy Statement

    Workplace Violence

    In addition, the following are applicable to all entering the Health Education Center, including faculty, students, and employees of the center.

    Emergency contact information for all entering the HEC must be accessible to faculty, course facilitators, supervisors, or tour guides.

  • Conflict Resolution

    This section will outline guidance for resolving concerns and/or conflicts related to the UTMB Health Education Center (HEC). The HEC leadership and SOM, SON, SHP, SPPH and GSBS leadership is responsive to concerns/conflicts that arise in the HEC related to function of the facility and interactions between staff, students and faculty members involved in HEC operations. This guidance provides a consistent plan for HEC users to voice concerns or resolve conflicts related to HEC simulation space, personnel or equipment.

    This sections aims to:

    • Provide the opportunity to resolve a conflict or complaint quickly, fairly and without reprisal.
    • Improve communication and understanding between staff, students and faculty members involved in HEC operations.
    • Ensure confidence in leadership decisions by providing a mechanism whereby these decisions can be objectively reviewed.
    • Support a positive work environment by identifying individuals responsible for preventing and resolving conflicts and complaints.
    • Identify organizational policies and procedures which need to be clarified or modified regarding HEC operations.

    The HEC is a core facility utilized by faculty, staff and learners from all 5 UTMB Schools (SOM, SON, SHP, SPPH and GSBS), UT Health Systems and external users. The HEC organizational chart identifies key positions that may be involved in conflict resolution.

    Provost of UTMB or his/her designee
    VP of IPE & HEC or his/her designee
    Assistant VP, HEC & Simulation or his/her designee
    Assistant Director(s) of Simulation or his/her designee
    Associate Director of Business or his/her designee 

    Associated IHOP Policies

    IHOP 05.03.14 Faculty Ombudsperson
    IHOP 05.03.08 Faculty Grievance
    IHOP 07.01.13 Student General Grievance Policy
    IHOP 06.05.06 Code of Ethics UTMB Employees

    Conflict Resolution and Complaint Process for Conflicts or Concerns
     

    Informal conflict resolution, UTMB Students
    UTMB students who experience a conflict or who have a complaint in relation to the HEC should first attempt to discuss the matter with their course director. Student concerns/conflicts will be managed by the course director. In some situations, this may be difficult or inappropriate. In these cases, the student may request a meeting with the dean of student affairs in the appropriate school (SOM, SON, SHP, SPPH or GSBS) to discuss the problem. If the student is not satisfied with the informal resolution of their concern or problem, they may prepare a written complaint with supporting details of the conflict situation or complaint and submit this to their course director and/or their dean of student affairs.

    Formal conflict resolution and complaint process, UTMB Students
    If the student is not satisfied with the informal resolution of their concern or problem, they may prepare a written complaint with supporting details of the conflict situation or complaint and submit this to their course director and the appropriate dean of student affairs (SOM, SON, SHP, SPPH or GSBS).

    Within five (5) working days of receiving the conflict resolution request or complaint, the course director will complete the investigation and prepare a written response. The dean of student affairs will forward a copy of the response along with a request that the student sign and date the copy to confirm he or she has received the reply and agrees or disagrees with the course director’s plan of action.

    Informal conflict resolution, HEC Employees
    HEC employees who experience a work-related conflict or who have a complaint should first attempt to discuss the matter with their supervisor. In some situations, this may be difficult or inappropriate. In these cases, the employee may request a meeting with the Assistant VP HEC & Simulation to discuss the problem.

    Formal conflict resolution and complaint process, HEC Employees
    If the employee is not satisfied with the informal resolution of their concern or problem, they may prepare a written complaint with supporting details of the conflict situation or complaint and submit this to their supervisor.

    The supervisor will investigate the merits of the conflict resolution request or complaint. The supervisor may consult with the Assistant VP HEC & Simulation, HEC Assistant Director(s) of Simulation, HEC Associate Director of Business or UTMB Human Resources representative, if necessary.
     
    Within five (5) working days of receiving the conflict resolution request or complaint, the supervisor will complete the investigation and prepare a written response. The supervisor will forward a copy of the response along with a request that the employee sign and date the copy to confirm he or she has received the reply and agrees or disagrees with the supervisor’s plan of action.

    Informal conflict resolution and complaint process, HEC Faculty Liaisons
    UTMB faculty functioning as Faculty Liaisons or leaders of HEC working groups who experience a work-related conflict or who have a complaint should first attempt to discuss the matter with the Assistant VP HEC & Simulation. In some situations, this may be difficult or inappropriate. In these cases, the employee may request a meeting with the VP of IPE & HEC to discuss the problem.

    Formal conflict resolution and complaint process, HEC Faculty Liaisons
    If the HEC Faculty Liaison is not satisfied with the informal resolution of their concern or problem, they may prepare a written complaint with supporting details of the conflict situation or complaint and submit this to the Assistant VP HEC & Simulation.

    The Assistant VP HEC & Simulation will investigate the merits of the conflict resolution request or complaint. The Assistant VP HEC & Simulation will consult with the HEC Assistant Director(s) of Simulation, HEC Associate Director of Business, VP of IPE & HEC or UTMB Human Resources representative, if necessary.
     
    Within five (5) working days of receiving the conflict resolution request or complaint, the Assistant VP HEC & Simulation will complete the investigation and prepare a written response. The Operations Director will forward a copy of the response along with a request that the faculty member sign and date the copy to confirm he or she has received the reply and agrees or disagrees with the plan of action.

    Conflicts or Concerns between Faculty and HEC Leadership
    If the Faculty is not satisfied with the informal resolution of their concern or problem, they may prepare a written complaint with supporting details of the conflict situation or complaint and submit this to the Provost or President of UTMB or his/her designee. The decision and recommendations made by the President of UTMB or his/her designee and all decisions will be final.