Suitability for the Practice of Medicine

BACKGROUND AND OVERSIGHT
 
Granting of the M.D. degree signifies that the holder is a physician prepared to enter postgraduate education for the practice of Medicine and to care for patients. 
 
Medical students who fail to maintain appropriate professional behavior and/or adequate academic performance will be subject to review, potential disciplinary action where relevant, and possible dismissal from the College of Physicians and Surgeons (P&S).
 
Professionalism is a key determinant of a physician’s ability to provide safe, high quality care to patients, and protecting the safety of patients is the overriding concern of the Faculty of Medicine at P&S.
 
At P&S, the Fundamentals Faculty Committee and Clinical Faculty Committee oversee the progress of students through the curriculum. These Committees are charged with determining a medical student’s suitability for the practice of Medicine.
 
DOMAINS OF PROFESSIONALISM
 
To grant the M.D. degree, the Faculty of the College of Physicians & Surgeons must be assured that students demonstrate ability in the general competencies of a physician. We reference specific professionalism sub-competencies drawn from the AAMC Physician Competency Reference Set, along with annotations specific to P&S below each sub-competency:
 
Demonstrate compassion, integrity, and respect for others [P1]
  • Students must treat others with fairness and respect, work collaboratively, and help fellow students whenever appropriate in their shared pursuit of learning and optimal patient care.
  • Students must assure the accuracy and completeness of their contributions to the medical record and must make a good-faith effort to provide the best possible patient care.
  • Students must be willing to admit errors and must not purposefully mislead others.
  • Students are bound to know, understand, and preserve professional ethics and have a duty to report any breach of these ethics by other students or health care providers through the appropriate channels.
  • Students must not cheat, plagiarize, use unauthorized materials, misrepresent their work, falsify data, or assist others in the commission of these acts.
  • Students must not copy notes in the medical record, copy notes from house staff or faculty, paraphrase an author’s ideas, or work without proper citation.
Demonstrate respect for patient privacy and autonomy [P3]
  • Students must protect the security of confidential, sensitive, and protected patient information (digital and paper-based).
  • Students must only access patient Electronic Medical Records and other Protected Health Information (PHI) for patients they are following, cross covering, or have directly encountered with their team as part of their clinical clerkships, electives, and selectives. They are permitted continued access after the patient is discharged from the hospital, transferred to another service or when the student rotates off service, as part of the student’s medical education at P&S.
  • Students must be knowledgeable about and abide by HIPAA policies and utilize only Columbia University email systems for patient and Columbia matters. They must not auto-forward Columbia University email to Gmail and other unapproved email systems. Students must encrypt portable devices, e.g. laptops and USB drives, etc., used to store patient or individual research data, and encrypt data files with Protected Health Information if stored on a portable device that is not encrypted.
  • Students must not take photos or videos of patients except for purposes of documentation in the medical record, and then, only with prior written consent of the respective institution, and when possible, of the patient. Such images must not leave CUMC on a student’s electronic device and may not be transmitted in any way other than from one approved email system to another approved email system and only to those caring for the patient.
  • Students must not post images or other patient information on social networking sites, the internet, or anywhere else.
Demonstrate accountability to patients, society, and the profession [P4]
  • Students must abstain from using any substance in a manner that could compromise patient care. They must never use alcohol or drugs in public wearing clothing or ID that identifies them as student physicians.
  • Students must protect the public from an impaired colleague and assist a colleague whose capability is impaired because of ill health. Students are thus obligated to report persons of the health care team whose behavior exhibits impairment or lack of professional conduct or competence or who engage in fraud or deception. Such reports must conform to established institutional policies.
  • Students must be punctual, reliable, and conscientious in fulfilling their professional duties, including attendance at required lectures, small groups, and at examinations, timely completion of assignments, and fulfillment of all parts of all clinical courses.
  • Students must maintain a neat and clean appearance with dress and attire that is accepted as professional.
  • Students must not use offensive language, gestures, or remarks with sexual overtones.
  • Students must abstain from romantic involvement with patients or their family members while serving on a patient’s medical team, and abstain from romantic involvement with residents and faculty in positions of authority while serving in a student role. Sexual misconduct including sexual harassment and sexual assault are unacceptable behaviors and are reported to the Columbia University Title IX office.
  • Students must strive to maintain composure under pressure of fatigue, professional stress, or personal problems.
  • Students must seek supportive services when appropriate.
  • Students must always be supervised in the clinical environment and seek additional supervision if they find themselves inadequately supervised because of lack of knowledge and/or insufficient experience. Students are expected to recognize when they need additional consultation and supervision in the clinical setting and seek it accordingly.
  • Students must seek feedback and actively participate in the process of evaluating their teachers (faculty as well as house staff). Students are expected to respond to feedback by appropriate modification of their behavior. When evaluating faculty performance, students are obliged to provide prompt, constructive comments. Evaluations should maintain the same considerate, professional tone expected of faculty when they evaluate student performance.
  • Students authoring research reports must be well-enough acquainted with the work of any co-workers that they can vouch for the integrity of the study and validity of the findings and must have been active in the research itself.
  • While in public, students represent the medical profession, Columbia University and the College of Physicians and Surgeons and are expected to comport themselves responsibly.
Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation [P5]
  • Students must not refuse to participate in the care of a patient based on the patient’s race, religion, ethnicity, socioeconomic status, gender, age, marital status, sexual orientation, or gender identity.
  • Students must not refuse to participate in the care of a patient solely because of medical risk, or perceived risk to the student. Students retain the right of “conscience exemption” from performance of or participation in procedures or practices that violate their core moral, ethical, and/or religious beliefs. Patient care assignments for students with medical conditions placing them at undue risk will be addressed in an individualized manner.
Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations [P6]
  • Students must abide by all P&S and Columbia University policies and procedures, as well as all Hospital policies where they are assigned, and be familiar with the policies. Students must obey all local, State and Federal laws at all times.
Violations of these standards are considered to be very serious breaches of professional conduct.
 
DOCUMENTATION OF CONCERNS ABOUT PROFESSIONALISM
 
Faculty and staff who observe a student behave in a way that raises concerns about professionalism are expected to address the behavior by doing one or both of the following, depending upon the nature of the behavior and what would be most helpful to the student, within one month:
  • Provide verbal or written feedback to the student with specific suggestions for improvement
  • Complete a “Professionalism Concern Report,” review it with the student in person and submit it to the Senior Associate Dean of Student Affairs.
Examples of areas of concern that would prompt the completion of a “Professionalism Concern Report” if they are observed as an enduring pattern include, but are not limited to:
  • Failure to complete assignments on time
  • Failure to complete required evaluations and surveys
  • Excessive tardiness
  • Lack of response to official communications
Examples of uncommon but serious areas of concern that would prompt the completion of a “Professionalism Concern Report” if they are observed even in isolation include, but are not limited to:
  • Unexcused absence
  • Mistreatment of others
  • Dishonest practice
  • Violation of patient privacy
  • Failure to complete required hospital credentialing procedures
  • Failure to complete USMLE exam(s) by the required deadlines
Students receiving one or more “Professionalism Concern Reports” will meet with the Senior Associate Dean for Student Affairs to review the reported lapse in professionalism and discuss strategies for addressing the reported lapse and preventing future lapses.
 
Students may contest a Professionalism Concern Report by:
  • Discussion with the reporting faculty member, who may choose to retract the report within the academic semester of its filing
  • Review with the Senior Associate Dean for Student Affairs, who may choose to affirm or retract the report after consultation with both parties
Professionalism Concern Reports will be disclosed in the Medical Student Performance Evaluation at the discretion of the Senior Associate Dean for Student Affairs as guided by the following standards:
  • Isolated concerns that are not deemed egregious may not be reported
  • Isolated concerns in the Fundamentals Curriculum that are not deemed egregrious will be reported only if there are additional concerns reported in the Clinical Curriculum
  • Concerns in the Clinical Curriculum that are not deemed egregious will be reported only if there are two or more such concern reports submitted
ADMINISTRATIVE EVALUATION
 
The Office of the Dean of the Faculty of Medicine, acting either on behalf of a Faculty Committee or on its own behalf may request, at any time, an administrative evaluation of a P&S student by a consulting psychiatrist or other mental health professional chosen by P&S. This evaluation serves to address academic, personal, and/or behavioral concerns that may have been brought to the attention of the Dean’s Office. A failure to comply with a request for an administrative evaluation may affect a student’s academic status within P&S. The content of the evaluation is confidential and is not available to the student. The recommendations are shared by the evaluator with the Senior Associate Dean of Student Affairs and discussed by both with the student. Summary information is shared by the Senior Associate Dean of Student Affairs with faculty and/or administration as deemed appropriate.
 
Approved by the Curriculum and Education Policy Committee 7/25/14