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Y3CC Professionalism Subcommittee

Report with Recommendations to the Year 3 Curriculum Committee

April 28, 2003

The Year 3 Professionalism Subcommittee was formed in September 2002 to study and make recommendations to the Year 3 Curriculum Committee regarding the teaching and assessment of Professionalism in the third year curriculum.   The subcommittee consisted of Phillip Davis (chair), Amber Barnhart, Erica Nelson, Christine Todd, Jamie Fulfer, and Linda Morrison (staff). The charge to the subcommittee was to answer the following questions:

• Should Professionalism be taught in the clerkships?  If so, what content would be appropriate and/or reasonable?
• How should the issue be taught and how should the clerkships share responsibility for teaching about it?
• How should students be evaluated?  Having content knowledge about professionalism and being able to identify behavior that is not professional and/or personally demonstrating appropriate professional behavior?
• Should the clerkships be consistent in the manner of assessing student knowledge and demonstration of professionalism?

The Committee met regularly, first reviewing relevant literature (Appendix A), then discussing program strengths, issues, problems, gaps and needs. A review of the Professionalism curriculum across the four years of the medical school was developed to determine the comprehensiveness of the program and to identify any gaps (Appendix B).  The school’s Honor Code was reviewed to see what Professionalism concepts were already included. 

SIUSOM Definition of Professionalism

Medicine as a profession demands the highest level of competence with regard to knowledge, skills, attitudes and behavior in the care of patients, in the generation and dissemination of knowledge, and in all interactions with peers, other health professionals, staff, patients, and families.  The essence of Medicine is embodied in the concept of Professionalism, which requires the physician to serve the interests of the patient above his or her self-interest, and to ascribe to the concepts of altruism, accountability, excellence, duty, service, honor, integrity, and respect for others.  The current SIU School of Medicine Honor Code is consistent with these concepts of medical professionalism.  See Appendix C for the full Honor Code, annotated by the Year 3 Professionalism Subcommittee with behavioral objectives for students. 

The following issues were identified and discussed by the subcommittee: 

• Formal Curriculum:  The School of Medicine has an extensive and integrated formal curriculum on Professionalism already in place, beginning in the first year and continuing through the fourth year. Additional teaching sessions are not needed, although reiteration and repetition of Professionalism content in other courses and venues might be helpful.  Opportunities for students to discuss and reflect on these issues in the course of their regular daily activities could be sought out. 
• Student understanding of Medical Professionalism seems somewhat trivialized and superficial. Although inappropriate behaviors need to be corrected, the focus of our expectations needs to encompass the larger perspective needed for the long term practice of Medicine. 
• Culture clash:  Although the efforts have been made to better integrate clinical education and experiences into the curriculum of the first two years, the culture or environment in which the students operate in Year 1 and Year 2 is very different from that of the medical professional, in which they do not become immersed until Year 3. Problems occur when the two cultures (academic and professional) clash.  The reference group is different, with different patterns of social behavior and a different standard of behavior.  The result is that expectations for students are not as clear nor as consistent as we would like them to be.
• High professional standards must be expected by and of all medical school personnel:  faculty, residents, nurses, administrators and staff, as well as of medical students.  The best intentions of the formal curriculum can be undermined quickly and effectively by the modeling of poor professional behaviors, particularly when the lapse is on the part of faculty, the quintessential role models for students. Because Professionalism is a behavior, not an attribute, students may occasionally encounter examples of poor professionalism.  Students should strive to learn from encounters of both excellent and poor professional behavior with the ultimate goal of achieving the highest level of professionalism of which they are capable. 
• Problem behaviors include:  unexcused absences; tardiness; lack of preparedness; poor interpersonal interactions with patients, standardized patients, peers, staff, nurses, residents, attending physicians, and faculty; rudeness; oppositional behaviors; and poor treatment of personnel.  Some of these behaviors only become problems when a pattern of behavior has developed (such as tardiness or lack of preparedness). Others (such as poor interactions or treatment of patients and others) are problematic even upon a single instance.  These behaviors are seen throughout the four years.
• Inappropriate behaviors are more often noticed by residents, nurses, staff, and other students, than by faculty.  A structure is needed to collect feedback from these groups for use in evaluating performance.
• There is a tendency to overlook or forgive inappropriate professional behavior in students who do well academically. This, too, happens across all four years.  There continue to be occasions when faculty do not hold students accountable to stated expectations for behavior, activities or completion of course work.  As an institution, we need to be more demanding of ourselves to uphold our standards and less tolerant of inappropriate behavior on the part of students. 
• Peer assessment skills are taught and utilized primarily in Years 1 and 2, and with the exception of the Internal Medicine clerkship, are not used thereafter. To date, students have had difficulty developing the necessary skill level to provide constructive comments for their peers. Issues identified included the effectiveness of student training, the effectiveness and consistency of faculty guidance and modeling, misplaced concern about giving offense, fear of retribution, and lack of motivation. Additional guidance and practice in the art of giving and receiving feedback would be beneficial for students and faculty. In addition to using peer assessment for information/insight on the students reported about, we should evaluate students on the art and practice of giving constructive feedback.
• Departmental student evaluation meetings have been useful for frank discussions about student performance in all areas (clinical performance, knowledge/clinical reasoning, and non-cognitive behaviors).
• Documentation of inappropriate student behaviors is not as widespread as it should be. Although faculty may provide verbal reports of inappropriate behaviors, there seems to be reluctance on the part of many faculty to put negative comments in writing.  This reluctance appears to stem from concerns that the behavior may be an isolated incident, that students may challenge their written reports, and/or that they don’t want to negatively impact a student’s future. 
• Student privacy issues have been well-protected, perhaps to the detriment of progress on efforts to hold students accountable for their behavior and/or to correct patterns of behavior.
• A systematic procedure to track the development of professional behavior in students over time, could help provide students with insight into their behavior and help them develop into the type of medical professionals that bring credit to the school, on a more timely basis.   The focus should be positive and formative, with clear and reasonable expectations. The system should incorporate mechanisms that:
• document behaviors across clerkships so that patterns of behavior can be identified, yet do not prejudice faculty unnecessarily,
• allow students to demonstrate improvement,
• enable the requirement of appropriate remediation and other actions needed to protect the integrity of the School and the Profession, and
• recognize students for exemplary behavior.
• Should Professionalism be taught in the clerkships?  If so, what content would be appropriate and/or reasonable?  How should the issue be taught and how should the clerkships share responsibility for teaching about it?
  • Formal teaching about Professionalism at SIU School of Medicine is quite extensive and integrated across all four years of the curriculum, with a two-week course on Doctor-Patient Relationship in Year 3 as well as integrated modules within many of the clerkships. The Year 3 Professionalism curriculum is delivered using small group discussions, standardized patients, and written exercises that encourage students to reflect on the meaning of the concepts and issues taught (see Appendix B).  Subcommittee consensus was that formal teaching (introduction of new material) was adequate, although opportunities for reiterative reflection and discussion of value conflicts and other more difficult Professionalism topics should be encouraged. Informal teaching via modeling and mentoring is a critical component of any professionalism curriculum and efforts should be made to ensure that all faculty (basic science and clinical), residents and staff are cognizant that they are responsible for demonstrating professionalism in their interactions with students, patients and peers.
• How should students be evaluated?  Having content knowledge about professionalism and being able to identify behavior that is not professional and/or personally demonstrating appropriate professional behavior?
  • Student’s growth as professionals is evaluated during clerkships via mentor, faculty, and resident reports as well as on standardized patient assessments.  This is noted on the Final Clerkship Evaluation Form, both in Section 3 (Non-cognitive Behaviors--rating and comments) and in the narrative Summary Statement of Overall Academic Performance. Performance-based assessments (with standardized patients) are used in all clerkships and provide a measure for patient-related professionalism, within a clinical reasoning context.  These are appropriate, but our evaluation of Professionalism could be improved.  Cognitive awareness of Professionalism expectations is not sufficient; student behaviors must reflect an understanding and acceptance of these concepts.  Further case development could focus on the inclusion of additional or targeted professionalism concepts.  Improvement could be made in the consistency between numerical ratings and comments on the Final Clerkship Evaluation Form. Collecting evaluative data from nurses and other staff could provide a more well-rounded picture of a student’s professionalism.  Peer and self-assessment, both critically important skills for medical professionals, are rarely used in the clerkships, but could be.  In Internal Medicine, students rate their colleagues on professional behaviors and comment on their strengths and weaknesses. The assessments are anonymous, confidential and are used in preparing the final clerkship evaluation form. Comments typically concern interpersonal skills, respect for others, and promptness. 
• Should the clerkships be consistent in the manner of assessing student knowledge and demonstration of professionalism?
  • Consistency across clerkships in assessing student knowledge and professional behaviors would model some of the very attitudes and behaviors we as a medical school are advocating. This should certainly be the goal towards which the Year 3 Curriculum Committee is working.
• Recommendations:
  • Revise the Final Clerkship Evaluation Form to conform as closely as possible to the ACGME Core Competencies, to facilitate evaluation across the continuum of medical education and to underscore the importance of these behaviors in medical education.
  • Consider re-conceptualizing the marginal rating as an unsatisfactory, rather than a satisfactory rating.
  • Develop and implement a multi-layered system for the evaluation of Professionalism standardized across all clerkships that includes the following components:
    • Student self-evaluation,
    • Anonymous and constructive peer evaluation,
    • 360 degree evaluations to include input from nurses, residents, staff, and faculty for a more well rounded collection of professionalism data,
    • Performance assessments with identified professionalism components,
    • Periodic feedback to students on their professional development,
    • A system for recognition of exceptional performance, and
    • A tracking system for continuity across clerkships (see Appendix D)
  • Develop and provide faculty development opportunities (using internal resources and external consultants) to help faculty fulfill their responsibilities regarding the development and evaluation of student professionalism in the clerkship year, regarding (among other things):
    • Setting, communicating and upholding expectations for students,
    • providing constructive feedback, and
    • writing clear, non-contradictory and useful evaluations of performance. 
  • Stimulate discussion among clerkship directors and clerkship faculty on the meaning and implication of the Final Clerkship Evaluation Form ratings of marginal and meets expectations in non-cognitive behavior, with the goal of increasing the accuracy of these ratings and their consistency with the narrative comments provided by the clerkship director.

 APPENDICES:

A: List of References

B. Four Year Professionalism Curriculum at SIU-SOM

C. Annotated Definition of Professionalism/Honor Code

D. Recommended Model for Professionalism Tracking System for Year 3

APPENDIX A

Y3 Professionalism Subcommittee Reference List

• Arnold EL, Blank LL, Race KEH, and Cipparrone N “Can Professionalism Be Measured? The Development of a Scale for Use in the Medical Environment” Academic Medicine 1998; 73:10:1119-1121

• Arnold, Louise “Assessing Professional Behavior:  Yesterday, Today, and Tomorrow” Academic Medicine 2002; 77:6:502-514

• Arnold, Robert M “Assessing Competence in Clinical Ethics:  Are We Measuring the Right Behaviors?” Journal of General Internal Medicine 1993; 8:52-54

• Cohen, Jordan J. “Measuring Professionalism:  Listening to Our Students” Academic Medicine 1999; 74:9:1010

• Coulehan J and Williams PC “Vanquishing Virtue: The Impact of Medical Education” Academic Medicine 2001; 76:6:598-605

• Fehser, Jennifer “Teaching Professionalism: A Student’s Perspective” The Mount Sinai Journal of Medicine 2002; 69:6:412-414

• Gibson DD, Linson Coldwell L, and Kiewit SF  “Creating a Culture of Professionalism: An Integrated Approach” Academic Medicine 2000; 75:5:509-510

• Ginsburg S, Regehr G, Hatala R, McNaughton N, Frohna A, Hodges B, Lingard L and Stern D “Context, Conflict and Resolution: A New Conceptual Framework for Evaluation Professionalism” Academic Medicine 2000; 75:10:S6-S11

• Hafferty, Frederic W.  “In Search of a Lost Cord:  Professionalism and Medical Education’s Hidden Curriculum” Educating for Professionalism Creating a Culture of Humanism in Medical Education 11-34

• Hafferty, Frederic W.  “What Medical Students Know about Professionalism” The Mount Sinai Journal of Medicine 2002; 69:6:385-397

• Ludmerer, Kenneth M. “Instilling Professionalism in Medical Education” JAMA 1999; 282:9: 881-882

• Misch, Donald A  “Evaluating Physicians’ Professionalism and Humanism: The Case for Humanism “Connoisseurs”” Academic Medicine 2002; 77:6:489-495

• Nierman, David M.  “Professionalism and the Teaching of Clinical Medicine: Perspectives of Teachers and Students” The Mount Sinai Journal of Medicine 2002; 69:6:410-411

• Papadakis MA, Loeser H, and Healy K  “Early Detection and Evaluation of Professionalism Deficiencies in Medical Students:  One School’s Approach” Academic Medicine 2001; 76:11:1100-1106

• Papadakis MA, Osborn EHS, Cooke M, Healy K and the University of California, San Francisco School of Medicine Clinical Clerkships Operation Committee “A Strategy for the Detection and Evaluation of Unprofessional Behavior in Medical Students” Academic Medicine 1999; 74:9:980-990

• Phelan S, Obenshain S and Galey W  “Evaluation of the Noncognitive Professional Traits of Medical Students” Academic Medicine 1993; 68:10:799-803

• Prislin MD, Lie D, Shapiro J, Boker J, and Radecki S “Using Standardized Patients to Assess Medical Students Professionalism” Academic Medicine 2001; 76:10:S90-S92

• “Professionalism Project:  Draft Summary of Section/Regional Discussions” Group on education Affairs 2001

• Reiser, Stanley J. “The Moral Order of the Medical School” Educating for Professionalism Creating a Culture of Humanism in Medical Education 3-10

• Robins LS, Braddock CH, and Fryer-Edwards KA “Using the American Board of Internal Medicine’s “Elements of Professionalism” for Undergraduate Ethics Education” Academic Medicine 2002; 77:6:523-531

• Rubenstein, Arthur “Summary Remarks:  The Implications of Professionalism for Medical Education” The Mount Sinai Journal of Medicine 2002; 69:6:415-417

• Siegler, Mark. “Training Doctors for Professionalism: Some Lessons from Teaching Clinical Medical Ethics” The Mount Sinai Journal of Medicine 2002; 69:6:404-409

• Sox, Harold C. “Medical Professionalism in the New Millennium:  A Physician Charter” Annals of Internal Medicine 2002; 136:3:243-246

• Stern, David T.  “Practicing What We Preach? An Analysis of the Curriculum of Values in Medical Education” The American Journal of Medicine 1998; 104:569-575

• Swick HM, Szenas P, Danoff D and Whitcomb ME “Teaching Professionalism in Undergraduate Medical Education” American Medical Association 1999; 282:9:830-832

• Swick HM “Toward a Normative Definition of Medical Professionalism” Academic Medicine 2000, 75:6:612-616

• Wear D and Castellani B  “The Development of Professionalism: Curriculum Matters” Academic Medicine 2000; 75:6:602-610

APPENDIX B

Teaching Professionalism Across the Curriculum

Southern Illinois University School of Medicine

In addition to the sessions delineated below, there are several Empathy Sessions (topic-based small group discussions) scheduled during each year of the curriculum, but attendance is voluntary. This list includes topics only, not method of delivery.

• Year 1:  Orientation
  • White Coat Ceremony and Address
  • Confidentiality and Professionalism
  • Professional Responsibility and Diversity Day
  • Patient/Physician Responsibility (first unit)
  • Peer Assessment
  • HIPAA (Health information, portability and accountability act)
• Year 2: Orientation
  • Honor Code and student professionalism workshop
  • Professional dress and conduct (SIU P&S guidelines)
  • Confidentiality workshop
  • Medical error (informed consent, system, national, and research error) workshop
  • Elements of a Good Doctor
  • PAUSE: patient care and communication
  • Peer assessment
  • HIPAA (Health information, portability and accountability act)
• Year 2: Professional Attitude and Conduct Sessions
  • Geriatric patients, including grief and special communication needs
  • Adolescent patients including special communication needs
  • Medical Error (national/local, and prescription issues) and Informed Consent
  • Prevention and risk (including drug abuse, depression, suicide, spousal abuse and other unhealthy behaviors)
  • Suicide Sensitivity Groups
• Year 3:  The Physician-Patient Relationship Course
  • Historical Perspectives on the MD/Patient Relationship
  • Ethical Perspectives on the Physician-Patient Relationship
  • Legal Perspectives on the Physician-Patient Relationship
  • Standard of Care – Legal Rights and Responsibilities
  • Informed Consent in the Physician-Patient Relationship
  • Confidentiality and Privacy – Ethical and Legal Considerations
  • Communication in the Physician-Patient Relationship
  • Issues of Bias in the Physician-Patient Relationship
  • Legal, Ethical, and Psychosocial Aspects of Withholding/Withdrawing Treatment
  • Withholding/Withdrawing Treatment
  • Palliative Care-Clinical Decision Making
  • Palliative Care-Hospice Considerations
  • Assisted Death-Legal and Ethical Issues
  • Organ Donation
  • The Impaired Physician-Patient Relationship
• Year 3:  Medical Humanities Integrated Modules in Clerkships
  • Sexuality in the MD/Patient Relationship (OB/GYN)
  • Legal Aspects of Abortion (OB/GYN)
  • Women’s Health & Health Policy (OB/GYN)
  • Child Abuse and Neglect (Pediatrics)
  • Pediatrics and Health Policy (Pediatrics)
  • The Dying or Grieving Child (Pediatrics)
  • Psychiatry and Law (Psychiatry)
  • Medicine and Religion (Psychiatry)
  • Psychiatry and Health Policy (Psychiatry)
  • Surgical Ethics (Surgery)
• Year 4:  Society, Law and Health Care Course
  • Overview of the Judicial Process
  • The Physician as Expert Witness
  • Forensic Medicine – Medical-Legal Investigation
  • The Physician as Expert Witness – Regulating the Medical Expert
  • Mock Trial
  • Introduction to the United States Health Care System – A Policy Overview
  • The United States Health Care System – A Comparative Overview
  • Fundamentals of Health Economics
  • Financing Health Care
  • Managed Care – Physician and Hospital Services
  • Clinical Decision Making and Quality of Care – Contemporary Challenges
  • Quality of Care – Professional Responsibilities – Peer Review
  • Access to Health Care – EMTALA
  • Mental Health Care – Cost, Quality, Access
  • Health Care Access and Availability for Vulnerable Populations
  • The Health Care System – Focused Perspectives on Health Policy
• Year 4:  Preparing for Teaching Role in Residency
  • Providing Feedback
  • Lecture and presentation skills (medical and lay audiences)
  • PAUSE: patient care and communication
  • Peer Assessment

APPENDIX C

Southern Illinois University School of Medicine

Honor Code

Annotated with behavioral examples April 28, 2003

Students of Southern Illinois University School of Medicine are accepted into the School of Medicine after due consideration and evaluation and are expected to understand and accept the responsibilities of their profession.  Recognizing that all persons have their own beliefs and values, the Faculty explicitly state their belief that medicine as a profession demands the highest level of competence with regard to knowledge, skills, attitudes and behavior in the care of patients and/or in the generation and dissemination of knowledge. The essence of medicine is embodied in the concept of professionalism.

Professionalism requires the physician to serve the interests of the patient above his or her self-interest. Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity and respect for others.

Altruism is the essence of professionalism.  The best interest of patients, not self-interest is the rule.

• Contributes to the profession; is active in school, community, state, and national projects or organizations.
• Offers to help team members who are busy.
• Expresses interest in providing extra follow-up care for patients, even beyond that expected by the clerkship.
• Seeks to achieve balance in own personal and professional activities for self, peers, and family; does not mislabel, misprioritize or rationalize dysfunctional behaviors.

Accountability is required at many levels -- individual patients, society and the profession. Physicians are accountable to their patients for fulfilling the implied contract governing the patient/physician relationship.  They are also accountable to society for addressing the health needs of the public and to their profession for adhering to medicine’s time-honored ethical precepts.

• Demonstrates awareness of own limitations and weaknesses, and identifies areas for improvement.
• Seeks help, advice, and consultation when appropriate; uses advice given to improve behaviors.
• Takes care of personal appearance and hygiene, and presents self in a professional manner (i.e., dress, demeanor, behaviors).
• Informs others (students, staff, faculty) in advance when not available to fulfill responsibilities and arranges for suitable replacement or additional activities.
• Routinely arrives in a timely manner; handles conflicting responsibilities appropriately with proper notification and consultation.
• Is accountable for deadlines; completes assignments and responsibilities on time.
• Answers notes, letters, pages, e-mail, and phone calls in a timely manner.

Excellence entails a conscientious effort to exceed ordinary expectations and to make a commitment to life-long learning.  Commitment to excellence is an acknowledged goal for all physicians.

• Works to master techniques and technologies of learning.
• Assesses oneself accurately to identify areas for further learning or self-improvement.
• Takes advantage of learning opportunities, voluntary as well as required.
• Shows initiative and self-motivation; sets direction and goals for oneself.
• Seeks out and uses criticism constructively to improve one’s own knowledge, skills, attitudes, and behaviors.
• Assists others (students, patients, faculty) to further their study and learning.

Duty is the free acceptance of a commitment to service.  This commitment entails being available and responsive when “on-call”, accepting inconvenience to meet the needs of one’s patients, enduring unavoidable risks to oneself when a patient’s welfare is at stake, advocating the best possible care regardless of ability to pay, seeking active roles in professional organizations, and volunteering one’s skills and expertise for the welfare of the community.

• Recognizes and reports errors and inappropriate behavior by peers to said peers and to appropriate faculty/staff as needed.
• Takes responsibility for an appropriate share of the work of the team, performing it carefully and well.
• Helps build and maintain an environment that facilitates and promotes professionalism among students, staff, and faculty.
• Maintains confidentiality of assessment materials; does not cheat or plagiarize the work of others.

Honor and integrity are the consistent regard for the highest standards of behaviors and the refusal to violate one’s personal and professional codes.  Honor and integrity imply being fair, being truthful, keeping one’s word, meeting commitments, and being straight-forward. They also require recognition of the possibility of conflict of interest and avoidance of relationships that allow personal gain to supersede the best interests of the patient.

• Is forthcoming with information; does not withhold and/or use information for personal power.
• Admits errors; doesn’t attempt to pass blame or attribute personal responsibility to others.
• Deals with confidential information discreetly and appropriately.
• Does not misuse resources (e.g., school computers, patient’s food, doctors’ lounge).

Respect for others (patients and their families, other physicians and professional colleagues such as medical school faculty and staff, nurses, medical students, residents, and subspecialty fellows) is the essence of humanism, and humanism is both central to professionalism, and fundamental to enhancing collegiality among physicians.

• Treats patients as individuals, taking into account lifestyle, beliefs, personal idiosyncrasies, and support systems; communicates bad news with sincerity and compassion.
• Demonstrates respect for other students in words and behaviors, does not misuse or misrepresent other students in order to be recognized or promote one’s own self-interest.
• Demonstrates respect for institutional staff and representatives; requests assistance or information politely and expresses appreciation for help received.
• Demonstrates respect for faculty; does not read, play games, or talk during lectures or seminars.
• Asks questions respectfully; expresses opinions without insulting or discounting the work or opinions of others.
• Respects patient rights and dignity; shows respect for patient’s privacy needs; knocks on doors before entering, introduces oneself, and drapes patients appropriately.
• Demonstrates tolerance towards and acceptance of different cultures, races, genders, personal orientations, religions, attitudes and beliefs.
• Does not disrupt small group sessions through inappropriate behaviors or words; comes prepared, participates constructively in all expected group activities and evaluations; turns pagers/cell phones to vibrate mode for duration of group session.
• Cooperates with other group members in organizing, participating, and collaborating to ensure that group goals and objectives are met.
• Does not encourage or provide disruptive leadership (e.g., organizing pranks, inappropriately confronting authority figures).

The process of becoming a physician is long, arduous, and often overwhelming.  During its course, some students may be tempted to compromise standards.  Certain events may lead students to perform at less than their best. We must not accept such behavior in ourselves or our colleagues, as it may lead to compromises in patient care.

The same personal integrity that promotes honesty should also promote reporting any infraction of the School of Medicine Honor Code.  Students are encouraged to take concerns, conditions or situations that may lead to violation of the School of Medicine Honor Code to the Student Advisory Committee.

A student who violates the School of Medicine Honor Code may be subject to dismissal or to lesser disciplinary actions as the facts of the situation warrant.

Explicit components of the SIU School of Medicine Honor Code include the following:

1. Students, as well as faculty and all other members of the SIU community, recognize the right of all individuals, including one’s peers, to be treated in a respectful manner, without regard to race, age, gender, disability, national origin, religion, or sexual orientation. Unacceptable behavior includes (but is not limited to) racial, sexist or religious slurs, racial or sexual harassment, physical violence, or threats of violence, or suppression of rights and intellectual freedom in any way.
2. All property, both intellectual and physical, must be respected and never plagiarized, defaced, or treated in a disrespectful manner. Property refers to cadavers, other instructional materials, any school or personal property and any written or electronically stored material other than a student’s own.
3. Any form of cheating is a violation of the trust placed in future physicians and a serious infraction of the School of Medicine Honor Code. Each examination must represent the student’s own efforts. Except as directly and specifically authorized by a faculty member, no student shall be permitted, at any time prior to, during, or following an examination, to give to or receive from any other person, information relating directly or indirectly to an examination; nor shall any student be permitted to communicate in any manner whatsoever, with another person regarding such examination. The term “examination” is defined to include but not be limited to any test, evaluation, or other form of academic or nonacademic performance assessment.  Likewise, plagiarism, forgery, falsification of records, and/or tampering with examination material are prohibited.
4. The SIU Student Conduct Code will be followed, except when portions of the above School of Medicine Honor Code express a higher degree of responsibility.

Examples adapted from: Embedding Professionalism in Medical Education.  Report from an Invitational Conference by the AAMC and the NBME, May 2002.

APPENDIX D

Recommended Model for Professionalism Tracking
System for Year 3

The Year 3 Professionalism Subcommittee recommends the adoption of a system or procedure that will enable us to track student performance in the area of Non-cognitive Behaviors or Professionalism across clerkships. The goal of this system is two fold. First, it allows the school to document and track a student’s professional development during the 3^rd and 4^th years of medical school when rapid changeover of environments and evaluators can mask the severity or degree of poor professional behavior.  Second, it allows clerkship directors the opportunity to structure educational experiences for students in their clerkship who have deficiencies in their professional behavior in hopes of successful remediation. 

All clerkship directors would be alert to students who are identified as having deficiencies in professionalism. A student’s behavior might come to light through poor marks in the area of non-cognitive behaviors on faculty evaluations, poor peer evaluations, or verbal reports of concern received by the clerkship director about a student interaction.  If merited, the clerkship director would fill out a form (to be developed) outlining the concerns that would be discussed with the student and then sent to a designated faculty/administrator who would be appointed by the Dean to function as the Year 3 Professionalism Mentor/Dean.

The Year 3 Professionalism Mentor/Dean, after receipt of a form, would be responsible for meeting with the student, discussing the issues specific to professionalism, and assigning appropriate follow-up, which might include counseling, frequent feedback sessions with faculty or close monitoring of professional behavior.  If a student receives two of these clerkship director generated forms, their file would be forwarded to the Student Progress Committee for discussion and the presence of the noted professional deficiencies would be included in their Dean’s Letter. Receiving three or more of these forms would merit further discussion at the SPC level, with the possibility of dismissal for reasons of Professionalism. Clerkship director reports of unprofessional behavior would be neither linked to or limited by a student’s pass/fail standing within the clerkship. Therefore, it would be possible for a student to pass all clerkships but have their progress through medical school impeded by the SPC on the grounds of poor professional behavior alone.  

Clerkship directors would be notified by the Y3 Professionalism Mentor/Dean regarding any incoming clerkship students who have professionalism deficiencies, to enable them to design and structure the student’s clerkship experience to help remediate noted deficiencies. This might involve assignment to specific attendings, specific subspecialty clinics or ward work, and/or frequent feedback sessions. The identity of students with professionalism deficiencies in prior clerkships will be known only to clerkship directors, with the expectation that this information remain confidential so as not to prejudice new faculty-student interactions.

The Y3 Professionalism Mentor/Dean would follow identified students throughout the year and document student progress or lack of progress. The Y3 Professionalism Subcommittee strongly believes that the Y3 Professionalism Mentor/Dean should be a physician in a centralized administrative position without a conflict of interest that would interfere with his/her ability to address this sensitive and important issue with students. The Y3 Professionalism Mentor/Dean’s centralized location elevates a complaint beyond a specific department (or faculty) and provides a more objective context.  Having the Y3 Professionalism Mentor/Dean attached to the Dean’s office also underscores the commitment of the School of Medicine to the concepts of Professionalism and our intent to take infractions of these concepts seriously.  It is anticipated that with the implementation of a procedure in which documented professionalism deficiencies are fairly and appropriately acted upon by the School, faculty will be more willing to be complete and forthright in their documentation of student behavior.  It is further anticipated that as long as the process is fair and reasonable, students will also support it.