UMMS Student Handbook 2012/13
SECTION TWO: Honor Code, Technical Standards & Professionalism
2012/13 UMass Medical School Student Handbook: first posted date: 08/27/12.
* Revisions approved after this date will be noted in RED.
The UMass Honor Code's commitment to professionalism is described in both the Honor Code itself and in Technical Standard Five (Behavioral and Social Attributes, (http://www.umassmed.edu/studentaffairs/handbook.aspx).
As a community of scholars and future physicians, the code carries with it a responsibility to mutually assure the integrity of the community. This reflects the obligation of licensed physicians to maintain the ethics of the profession (http://www.mass.gov/eohhs/provider/licensing/occupational/physicans/mandated-reporting/).
It is expected that each student will make a personal commitment to abide by the UMass Honor Code, which includes both self-monitoring and reporting violations.
The Honor Code applies to students at the School of Medicine and is enforced by an Honor Board. All students who are enrolled in a degree-granting program from the school of medicine will be held to the Honor Code until they receive their final degree(s). The Honor Board consists of faculty and students (chosen by their peers), with a Chair named by the Dean. Violations include actions that fall into behavioral, academic, legal and safety categories.
Consequences of all violations include self-assessment and remediation; some violations may require course repeat, service work or dismissal. Categories of violations are tiered and cumulative (such that repetitive violations, even of a lower tier, lead to increased consequences).
Please see full Honor Code policy at: http://www.umassmed.edu/uploadedFiles/HONOR%20BOARD%20DOCUMENT%208.6.13.pdf
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UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL TECHNICAL STANDARDS FOR MEDICAL SCHOOL ADMISSION, CONTINUATION AND GRADUATION
INTRODUCTIONThe mission of the University of Massachusetts School of Medicine is to graduate skilled and effective physicians. It is the responsibility of the faculty to select applicants from among residents of the Commonwealth who are best qualified to complete the required training and most likely to become the best possible physicians. Applicants are selected for admission to the school based not only on their scholastic achievement and ability, but also on their intellectual, physical and emotional capacities to meet the requirements of the school's curriculum and of a successful career in medicine. The faculty of the University of Massachusetts School of Medicine recognizes that academic competency is essential for success in medical school. Such things as intellectual curiosity, undergraduate grades, and the MCAT examination help to demonstrate academic competency. The Admissions Committee is instructed to exercise its judgment on behalf of the faculty in selecting the entering class. The committee is asked to consider not only academic ability but also character, integrity, extracurricular achievement, commitment to service, ability to contribute to the advancement of medical knowledge and biomedical research, the likelihood of providing primary care in the Commonwealth, serving the health care needs of our underserved communities, and overall suitability for the medical profession based upon information in the application, letters of recommendation, and personal interviews.
The Liaison Committee on Medical Education, which accredits the medical school, requires that the curriculum provide a general professional education, enabling each student to pursue graduate training in a variety of disciplines. Also, one of the missions of University of Massachusetts School of Medicine is to graduate a significant number of generalist physicians. This requires the development of broad knowledge, skills, and behaviors, enabling ongoing self-directed learning, further training, and delivery of competent medical care. The faculty of the University of Massachusetts School of Medicine believes that such a broad based and patient oriented curriculum is best suited for future generalists, specialists, and physician investigators. The basic sciences curriculum includes anatomy, biochemistry, histology, pathology, pharmacology, and physiology and is designed to establish a core of knowledge necessary for clinical training. The clinical curriculum begins early in the first year and includes diverse experiences in primary care, family medicine, and ambulatory patient care. The third and fourth year include in-depth experiences in primary care, family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, surgery, diagnostic imaging, pathology, emergency medicine, geriatrics, and rehabilitation medicine in ambulatory and in-patient settings. These experiences provide a broad basis for the practice of medicine, regardless of the future choice of specialty. Each student is required by the faculty to successfully complete each required course and clinical rotation to graduate.
The following technical standards specify those attributes the faculty considers necessary for completing medical school training, enabling each graduate to subsequently enter residency and clinical practice. These standards describe the essential functions students must demonstrate in order to fulfill the requirements of a general medical education, and thus, are pre-requisites for entrance, continuation, promotion, retention, and graduation from medical school.
The University of Massachusetts School of Medicine will consider for admission any applicant who meets its residency requirement, academic criteria, and demonstrates the ability to perform or to learn to perform the skills listed in this document, with or without reasonable accommodations consistent with the Americans with Disabilities Act. Any applicant with questions about these technical requirements is advised to discuss the issue with the ADA Student Coordinator prior to the interview process.
Certain chronic or recurrent illnesses that interfere with patient care or safety are not compatible with medical practice or training. Any student who is a carrier of a blood borne pathogen [including but not limited to Hepatitis B virus, Hepatitis C virus, and Human Immunodeficiency virus (HIV)] will not be permitted to perform some invasive procedures. This will restrict the student’s ability to perform fully in some clinical clerkships and to meet the requirements of some specialties; therefore, the student will possibly be prohibited from future training and practicing in those fields. Read the Addendum and Policy Statement on Blood-Borne Pathogens appended to this document. Other conditions that may lead to a high likelihood of debilitating student illness should also be carefully considered before committing to a clinical career. Deficiencies in knowledge base, judgment, integrity, character, or professional attitude or demeanor, which may jeopardize patient care, may be grounds for immediate removal from the clinical situation, course/rotation failure and possible dismissal.
A student must possess aptitude, abilities, and skills in five areas:
1) observation; 2) communication; 3) sensory and motor coordination and function; 4) conceptualization, integration and quantitation; and 5) behavioral and social skills, abilities and aptitude. These are described in detail below. Students must be able to independently perform the described functions.
Students must be able to observe demonstrations and conduct experiments in the basic sciences, including, but not limited to: anatomic dissection of preserved tissues and cadavers, physiologic and pharmacologic demonstrations in animals, microbiologic cultures, microscopic studies of microorganisms and animal and human tissues in normal and pathologic states. A student must be able to observe patients accurately at a reasonable distance and close at hand, noting non-verbal as well as verbal signals. Specific observational requirements include, but are not limited to the following abilities: detecting and identifying significant changes in colors of fluids, skin, culture media, and dipstick tests; perceiving with acuity and accurately discriminating findings on x-rays and other imaging tests; efficiently reading written and illustrated material; observing intracellular details through a microscope; observing demonstrations in the classroom, including projected slides, films, videos and overheads; observing and differentiating changes in body movement; observing anatomic structures; discriminating numbers and patterns associated with diagnostic instruments and tests, such as sphygmomanometers and electrocardiograms, and using instruments competently, such as the otoscope, ophthalmoscope, microscope, and stethoscope.
Students must be able to relate effectively and sensitively with patients of all genders; as well as all ages, races, life-styles, sexual orientations, and cultural backgrounds, and be able to convey a sense of compassion and empathy. A student must be able to communicate clearly with and observe patients in order to elicit information, accurately describe changes in mood, activity, and posture; and be able to perceive verbal as well as nonverbal communications. Communication includes not only speech but also reading and writing. Medical education presents exceptional challenges in the volume and breadth of required reading and the necessity to impart information to others. Students must be able to communicate quickly, effectively and efficiently in oral and written English with all members of the health care team. Specific requirements include but are not limited to the following abilities: communicating rapidly and clearly with the medical team on rounds; eliciting a thorough history from patients; and communicating complex findings in appropriate terms to patients and to various members of the health care team (fellow students, physicians, nurses, nurses’ aides, therapists, social workers, and others). Students must learn to recognize and promptly respond to emotional communications such as sadness, worry, agitation, and lack of comprehension of physician communication. Each student must be able to read and to record observations and plans legibly, efficiently and accurately in documents such as the patient record and the electronic record. Students must be able to prepare and communicate concise but complete summaries of individual encounters, including hospitalizations. Students must be able to complete forms according to directions in a complete and timely fashion. Students must be computer literate and able to access patient records and medical information with facility.
3. SENSORY AND MOTOR COORDINATION OR FUNCTION
Students must be able and willing to perform with acuity, accuracy, and facility, a complete physical examination on any patient of all genders, utilizing palpation, auscultation, percussion, and other diagnostic maneuvers. In general, this requires sufficient ability to observe with acuity and to process accurately: visual, auditory, exteroceptive (smell, touch, pain and temperature) and proprioceptive (position, pressure, movement, stereognosis, and vibratory) phenomena, as well as the ability to manipulate with precision, at a fine level of movement, patients, and medical instruments and equipment. Methods of surgical instruction include practice on living or preserved animal tissues. A student must be able and willing to provide general care and emergency treatment to any patient of all genders in a timely manner. Furthermore, a student must be able to respond promptly to medical emergencies within the hospital, and must not hinder the ability of co-workers to provide prompt care. Examples of such emergency treatment reasonably required of physicians include arriving quickly when called and initiating cardiopulmonary resuscitation, administering intravenous medication, applying pressure to stop bleeding, opening obstructed airways, suturing wounds, and performing basic obstetrical maneuvers. Cardiopulmonary resuscitation may require moving an adult patient, repeatedly and rapidly applying considerable chest pressure, delivering an adequate volume of artificial respiration, and calling for help. A student must be able to learn to perform basic laboratory tests, e.g., urinalysis, completed blood count, and diagnostic and therapeutic procedures, e.g., phlebotomy, arterial blood gas drawings, lumbar puncture, arthrocentesis. Students must be able to measure angles and diameters of various body structures using tape measure and goniometer, measure blood pressure and pulse, and interpret graphs describing biologic relationships. Clinical rotations in ambulatory care settings require the ability to transport oneself to a variety of ambulatory settings in a timely manner, and inpatient rounds require prolonged and rapid movement.
4. INTELLECTUAL-CONCEPTUAL, INTEGRATIVE AND QUANTITATIVE ABILITIES
These abilities include measurement, calculation, reasoning, analysis, judgment, and synthesis. The student must also be able to recognize letters and numbers quickly and accurately. Clinical reasoning and problem solving are critical skills demanded of physicians requiring all of these intellectual abilities, and they must be performed quickly, especially in emergency situations. Moreover, the effective physician often must deal with several tasks or problems simultaneously ("multi-tasking"). Students must be able to identify significant findings from history, physical examination, and laboratory data, provide a reasoned explanation for likely diagnoses, construct a reasoned and cost-effective diagnostic plan, and prescribe medications and therapy, recalling and retaining information in an efficient and timely manner. Students must be able to identify and communicate the limits of their knowledge to others when appropriate. The ability to incorporate new information from peers, teachers, and the medical literature in formulating diagnoses and plans is essential. Good judgment in patient assessment, diagnostic and therapeutic planning is essential.
5. BEHAVIORAL AND SOCIAL ATTRIBUTES
Empathy, integrity, honesty, concern for others, good interpersonal skills, interest and motivation are all personal qualities that are necessary for any physician. Students must be able in all clinical and academic settings to fully utilize their intellectual abilities, to exercise good judgment, to promptly complete all responsibilities attendant to the diagnosis and care of patients. They must be able and willing to develop mature, sensitive, professional and effective relationships with patients of all genders, ages, races, life-styles, sexual orientations, and cultural background, as well as with their families, with other health care providers, and with all members of the learning and working community. At times this requires the ability to be aware of and appropriately react to one's own immediate emotional responses: e.g., students must maintain a professional demeanor, and be able to function at a high level in the face of personal fatigue, dissatisfied patients and their families, and tired colleagues. Students must be able to develop professional relationships with patients and their families, providing comfort and reassurance when appropriate while protecting patient confidentiality. Students must be able to maintain professional conduct when interacting with patients and the families of patients suffering from catastrophic illness, trauma, and death. Students must possess adequate endurance to tolerate physically taxing workloads and to function effectively under stress. All students must be able and willing to work on any day of the week and on any day of the year when called upon to serve in scheduled clinical activities or learning opportunities. All students are at times required to work for extended periods, occasionally with rotating and overnight shifts. Students must be able to adapt to changing environments, to display flexibility and to learn to function in the face of uncertainties inherent in the clinical problems of many patients. Students are expected to accept appropriate suggestions and criticism and, when necessary, to respond by modifying their behavior.
Adopted by the University of Massachusetts Medical School Admissions Committee on Dec. 12, 1990;First revision September 15, 1993;Second revision July 30, 1999;Third revision April 5, 2001;Fourth revision July 9, 2009.
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The Faculty and Student Body of the University of Massachusetts Medical School regard the following as guidelines for professional conduct. These areas are derived from the school’s Technical Standards (see Student Handbook). We are proud that the vast majority of our students exemplify these behaviors naturally. All members of the UMass Medical School community are expected to act professionally in the school, hospital and in the community with or in front of patients, families, members of the health care team, and others in the professional environment (school, hospital, clinic, office) including members of the faculty and administration, other students, standardized patients, and staff.
Displaying honesty and integrity
Maintaining a professional demeanor
- Consistently displays ethical behavior.
- Does not misrepresent or falsify information and/or actions e.g. does not cheat.
- Takes credit only for own work/contributions and impartially gives credit to others for their work.
Showing respect for patient’s dignity and rights
- Treats peers, faculty, staff, and patients with respect in individual settings; e.g. not arrogant or insolent.
- Treats peers, faculty, staff and patients with respect in lecture and conference settings; e.g. turning cell phone and pager to vibrate, refraining from disturbing others via text messaging, talking, activities not related to class, etc.
- Maintains professional demeanor even when stressed; e.g. not verbally hostile, abusive, dismissive or inappropriately angry with peers, faculty, staff or patients.
- Never expresses anger physically.
- Abides by professionally accepted boundaries for interpersonal relationships; e.g. never uses his or her position for personal gain or to engage in romantic or sexual relationships with patients or members of their families.
- Conforms to policies governing behavior; e.g. confidentiality, sexual harassment, consensual amorous relationships, hazing, use of alcohol, and any other existing policy of the medical school or clinical system.
- Appearance, dress, professional behavior follow generally accepted professional norms.
- Makes appropriate attempts to establish rapport with patients or families.
- Shows sensitivity to the patients’ or families’ feelings, needs, wishes, and diversity.
- Demonstrates appropriate empathy.
- Shows respect for patient autonomy.
- Maintains confidentiality of patient information.
Responding to supervision
- Correctly estimates own abilities or knowledge.
- Recognizes own limits; appropriately seeks help, eg from peers, faculty, tutoring services.
Interacting with other members of the team
- Accepts and incorporates reasonable feedback in a non-resistant and non-defensive manner.
- Accepts responsibility for own errors.
- Demonstrating dependability and appropriate initiative.
- Completes tasks in a timely fashion without needing reminders; e.g. papers, reports, examinations, appointments, patient notes, patient care tasks.
- Assists and facilitates learning among peers.
- Appropriately available for professional responsibilities; e.g. attends required classes and activities, is available when on clinical service, responds to e-mail and pager.
- Takes on appropriate responsibilities willingly; e.g. not resistant or defensive.
- Takes on appropriate patient care activities; e.g. does not “turf” patients or responsibilities.
( REV 1/30/07 from policy approved by the Education Policy Committee 11/2001)
- Shows sensitivity to the needs, feelings, wishes of team members; e.g. lab, small groups, projects, other members of the health care team.
- Relates and cooperates well with members of the team.
- Communicates with other members of the team in a timely manner.
Process for Use of Professionalism Incidents Reports
Professional behavior is expected of both learners and teachers with or in front of patients, members of the health care team, and others in the professional environment (school, hospital, clinic, office) such as faculty members, standardized patients, staff, and administration members. Items on the “essentials of professional behavior” document state the areas felt by the faculty to be guidelines for professional behavior. These areas are derived from the Medical School’s Technical Standards and from our Clerkship Evaluation form. Professionalism incident reports may be filed to report praise for incidents of unusually meritorious behavior or to report concerns. The intent of the “concern” report is to give the student formative feedback of concerns about professional behavior before that behavior becomes part of a grade or a sanction by one of the Academic Evaluation Boards.
Either “praise” and “concern” reports may be filed only by the relevant course/ clerkship coordinator, Senior Associate Dean for Educational Affairs, Assistant or Associate Deans in the offices of Undergraduate Medical Education or Student Affairs, or Vice Provost in the Office of School Services.
- The report will consist of a narrative statement describing the incident and the school’s “professionalism” document with the relevant areas checked off or otherwise indicated.
- While it is often helpful to receive personal praise, a face-to-face meeting between the student and the person filing a praise report does not need to be held. The student will be sent a copy of all praise reports.
- All praise reports WILL be placed in the student’s permanent file and may be mentioned in the MSPE (Dean’s Letter).
- Faculty or other concerned personnel are encouraged to discuss their concern directly with the involved student before going to one of the above individuals to report an episode. The decision of whether or not to file a concern report at that point will be at the discretion of the relevant course/ clerkship coordinator, Senior Associate Dean for Educational Affairs, Assistant or Associate Deans in the offices of Undergraduate Medical Education or Student Affairs, or Vice Provost in the Office of School Services.
- It is normally expected that before filing a report, a face-to-face meeting between the student and the person filing the report will be held. In the sole discretion of the person filing the report, other involved persons may be asked to attend. If a face to face meeting is not feasible, an explanation of the reason/s and ways in which the student was contacted must be included. At times, this process of discussion and fact-finding may result in the decision not to file a report.
- The report will consist of a narrative statement describing the incident and the school’s “professionalism” document with the relevant areas checked off or otherwise indicated. Optionally, the student may also file a commentary which could include a different side of the story, report of extenuating circumstances and/ or discussion of remediation.
- The report needs to be filed in a timely manner (usually within 3 months of any episode occurring).
- Any initial filed report will be discussed by the person filing the report, the Associate Dean for Student Affairs and the Chair of the Basic or Clinical Science Academic Evaluation Board to determine whether:
a.) The report should be filed and student monitored with no action taken unless a second report is received.
b.) The initial report should be presented to the appropriate Academic Evaluation Board.
c.) A Technical Standards Committee (“Honor Board”) needs to be convened to hear and investigate the case (such as where the issue involves an allegation of
misrepresenting or falsifying information).
d.) Some other course of action is appropriate. Any second or subsequent report will automatically be presented to the appropriate Academic Evaluation Board.
- The Office of Student Affairs will be responsible for determining whether a previous report has been filed.
- If a decision is made that an initial report should be filed with no formal action taken unless a second report is received, the report will NOT be placed in the student’s permanent file. It will be retained in a separate file until the student graduates. - If no further reports are received, the report will be destroyed when the student graduates or leaves the school. No mention of a report in this category will be made in the MSPE (Dean’s Letter) or on the transcript.
- If a report is brought up for discussion at the appropriate Academic Evaluation Board, that Board will proceed as under current policy. If the behavior is part of a pattern, some remediation may be required. Under current policy, the Board has the ability to recommend a variety of actions including no action/ monitoring, remediation, and other sanction up to and including dismissal. Any recommendation which will delay the student's progress must be approved by the Progress Board unless accepted by the student on a voluntary basis. The Academic Evaluation Board will also determine whether there will be any mention of the episode/s in the MSPE.
- If a Technical Standards Committee (“Honor Board”) is convened, that Board will proceed under current policy.
- Appeals will go through the current Appeals process for recommendations from the Academic Evaluation Board.
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