Professional Misconduct in the Clinical Setting

PURPOSE 

The purpose of the policy on professional misconduct in the clinical setting is to specify the process for documenting unprofessional behavior by a student and the procedures for corrective measures in the clinical setting. 

OVERVIEW 

Professionalism is a core competency for UGHE medical students and is fundamental to the practice of medicine. Students are expected to demonstrate professional behavior in the classroom, in clinical settings, online, and outside the boundaries of courses and clerkships as members of the UGHE community. Professionalism comprises those attributes and behaviors that serve to maintain patient interests above physician self-interest. Professionalism should pervade all our activities in medicine and should include: 

  • A commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge. 
  • A commitment to sustain the interests and welfare of patients. 
  • A commitment to be responsive to the health needs of society.  

Professionalism lapses are managed with notification through Professional Misconduct Reporting Form and coaching as designed by the Clinical Division. Recurrent, persistent, or severe professionalism lapses, or failure of the student to engage in coaching and improvement plans may lead to adverse academic actions, up to and including dismissal from the School of Medicine. 

Examples of unprofessional behaviors that would warrant a professional misconduct reporting include but are not limited to:  

  1. avoiding or not accepting feedback,  
  2. inappropriate communication with the health care team,  
  3. inadequate medical record keeping,  
  4. not acting upon alarming patient symptoms,  
  5. physical/verbal abuse of a patient or caretaker,  
  6. prescribing medication without consulting the senior physician in charge,  
  7. tardiness or unexcused absences.  

PRINCIPLES 

  • Students must achieve the MBBS/MGHD competencies to advance through each phase of the curriculum and to graduate. 
  • Students need timely feedback about their professional behaviors and an opportunity to respond to feedback, learn, and grow. 
  • As early medical learners develop their professional identity, students may demonstrate lapses in professionalism that can be successfully addressed with feedback and coaching. The Clinical Division will support the students in meeting professionalism expectations. 
  • A Professional Misconduct Reporting Form indicates if a student needs additional help developing professionalism skills and behaviors. 
  • Professionalism lapses that lead to the submission of a Professional Misconduct Reporting Form and patterns of unprofessional behavior that fail to respond to feedback may lead to adverse academic actions, including failure of the relevant course/clerkship and/or referral to the relevant committee. 

PROCEDURE 

  1. A clerkship director, clerkship coordinator, or any supervising faculty who is concerned about a student’s professional behavior should first give feedback directly to the student, discuss approaches for improvement with the student, and develop an action plan in collaboration with the student. 
    a) The reporting faculty is encouraged to meet with a student who does not meet professionalism expectations as soon as concerns are raised and before the clerkship/rotation ends. 
    b) This meeting’s purpose is to share concerns about unprofessional behavior, discuss ways in which performance can be improved, thus allowing the student adequate opportunity to understand the issue and make appropriate changes. 
    c) Such feedback meetings, though strongly encouraged, are not required to submit a Professional Misconduct Reporting Form. 
  2. If attempts to engage the student in effective feedback dialogue and action planning about these issues are unsuccessful, the behavior is repeated, or the behavior is initially serious enough, then the faculty should complete a Professional Misconduct Reporting Form (PMR-Form). This should be filled in as close to the incident of concern as is practical.  
  3. The reporting faculty will meet with the student to review the PMR-Form. The student must sign and date the PMR-Form at this meeting, and add any additional information from their perspective if relevant. 
  4. The reporting faculty should then submit the completed PMR-Form to the Chair of Clinical Division.  
  5. The Chair of the Clinical Division will meet with the student to review the factors contributing to the professionalism lapse, explore and enact coaching strategies, and develop a plan with the student to address the issues, including forming strategies for professionalism learning and improvement. 
  6. Students may be given the provisional non-passing grade in the clerkship for failing to demonstrate professional behavior consistent with the UGHE MBBS/MGHD competencies required for graduation. 
  7. A Professionalism Committee, formed and chaired by the Chair of the Clinical Division, when appropriate, will review the PMR-Form to determine a course of action. 
  8. In reviewing the current PMR-Form, the Committee will also consider any prior PMR-Forms completed on the student.  If the professionalism lapse (1) is severe, (2) indicates current of future harm to patients, communities, colleagues, and/or the institution, and/or (3) demonstrates a lack of progress in achieving professionalism expectations following a coaching and improvement plan, then issues will be reported to the Dean of Academics for further disciplinary review. 
  9. Students who receive a PMR-Form but do not feel that its issuance was merited have a week from the issuance of the PMR-Form to either (a) ask for clarification from or review by the reporting faculty, who must respond to a student’s request for clarification or review, or (b) submit an appeal to the Chair of the Clinical Division. 

    a) If the issue is not resolved after this informal discussion or the student chooses not to ask for clarification or review from the reporting faculty, the student will have a week to submit an appeal to the Chair of the Clinical Division. This appeal will be reviewed by the Chair of the Clinical Division, who will determine whether its issuance should stand or be retracted.  
    b) Grievances (formal complaints) are not the same as disagreements. A student cannot grieve a Professional Misconduct Report merely because the student disagrees with its issuance.