MEDICAL PROFESSIONALISM 

MEDICAL STUDENT RESPONSIBILITIES

STUDENT CODE OF PROFESSIONALISM

DISCIPLINARY PROCEDURES OF THE HONOR COUNCIL HEARING BOARD OF THE SCHOOL OF MEDICINE

GUIDELINES ON PROFESSIONAL CONDUCT IN THE TEACHER-LEARNER RELATIONSHIP

MEDICAL STUDENT RESPONSIBILITIES
STUDENT CODE OF PROFESSIONALISM
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE

(Recommendations & Guidelines from Students, Organization of Student Representatives OSR/AAMC) )

A student shall be dedicated to providing competent medical service with compassion and respect for human dignity. In all instances, the student must maintain the dignity of the person, including respect for the patient's modesty and privacy.

1. NONDISCRIMINATION

It is unethical for a student to refuse to participate in the care of a person based on race, religion, ethnicity, socioeconomic status, gender, age, or sexual preference. It is also unethical to refuse to participate in the care of a patient solely because of medical risk, or perceived risk, to the student. It is not, however, unethical for the pregnant student to refuse to participate in activities that pose a significant risk to her fetus.

2. CONFIDENTIALITY

The patient's right to the confidentiality of his or her medical record is a fundamental tenet of medical care. The discussion of problems or diagnoses of a patient by professional staff/medical students in public violates patient confidentiality and is unethical. Under no circumstances can any medical record be removed from the institution, nor is photocopying of the record permitted. For presentations or rounds, students are permitted to extract information but not copy wholesale parts of the chart.

3. PROFESSIONAL DEMEANOR

The student should be thoughtful and professional when interacting with patients and their families. Inappropriate behavior includes the use of offensive language, gestures, or remarks with sexual overtones. Students should maintain a neat and clean appearance, and dress in attire that is generally accepted as professional by the patient population served. Under pressure of fatigue, professional stress or personal problems, students should strive to maintain composure. The student should seek supportive services when appropriate.

4. MISREPRESENTATION

A student should accurately represent herself or himself to patients and others on the medical team. Students should never introduce themselves as "Doctor" as this is clearly a misrepresentation of the student's position, knowledge, and authority.

5. HONESTY

Students are expected to demonstrate honesty and integrity in all aspects of their education and in their interactions with patients, staff, faculty, and colleagues. They may not cheat, plagiarize, or assist others in the commission of these acts. The student must assure the accuracy and completeness of his or her part of 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 not knowingly mislead others or promote himself or herself at the patient's expense. The student is bound to know, understand, and preserve professional ethics and has a duty to report any breach of these ethics by other students or health care providers through the appropriate channels. The student should understand the protocol of these channels.

6. CONSULTATION

Students should seek consultation and supervision whenever their care of patient may be inadequate because of lack of knowledge and/or experience.

7. CONFLICT OF INTERESTS

When a conflict of interest arises, the welfare of the patient must at all times be paramount. A student may challenge or refuse to comply with a directive if its implementation would be antithetical to his or her own ethical principles, when such action does not compromise patient welfare. Gifts, hospitality, or subsidies offered by medical equipment, pharmaceutical or other manufacturers or distributors should not be accepted if acceptance would influence the objectivity of clinical judgment. Students interactions with commercial interests should conform to the American Medical Association (AMA) guidelines.

8. SEXUAL MISCONDUCT

The student will not engage in romantic, sexual, or other nonprofessional relationships with a patient, even at the apparent request of a patient, while the student is involved with the patient's care. The student is not expected to tolerate inappropriate sexual behavior on the part of other medical personnel or patients.

9. IMPAIRMENT

The student will not use alcohol or drugs in a manner that could compromise patient care. It is the responsibility of every student to protect the public from an impaired colleague and to assist a colleague whose capability is impaired because of ill health. The student is 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.

10. CRITICISM OF COLLEAGUES

It is unethical and harmful for a student to disparage without good evidence the professional

competence, knowledge, qualifications, or services of a colleague to a review (judicial) body, staff, students or a patient. It is also unethical to imply in word, gesture, or deed that a patient has been poorly managed or mistreated by a colleague without tangible evidence. Professional relations among all members of the medical community should be marked with civility. Thus, scholarly contributions should be acknowledged, slanderous comments and acts should be avoided, and each person should recognize and facilitate the contributions of others to the community. The medical student will deal with professional, staff, and peer members of the health team in a cooperative and considerate manner.

11. RESEARCH

The basic principle underlying all research is honesty. Scientists have a responsibility to provide research results of high quality; to gather facts meticulously, to keep impeccable records of work done; to interpret results realistically, not forcing them into preconceived molds or models; and to report new knowledge through appropriate channels. Co-authors of research reports must be well-enough acquainted with the work of their coworkers that they can personally vouch for the integrity of the study and validity of the findings, and must have been active in the research itself. Plagiarism is unethical. To consciously incorporate the words of others, either verbatim or through paraphrasing, without appropriate acknowledgment is unacceptable in scientific literature.

12. EVALUATION

Students should seek feedback and actively participate in the process of evaluating their teachers (faculty as well as house staff). Students are expected to respond to constructive criticism by appropriate modification of their behavior. When evaluating faculty performance, students are obliged to provide prompt, constructive comments. Evaluations may not include disparaging remarks, offensive language, or personal attacks, and should maintain the same considerate, professional tone expected of faculty when they evaluate student performance.

13. TEACHING

The very title "Doctor" -- from the Latin docere, "to teach" -- implies a responsibility to share knowledge and information with colleagues and patients. It is incumbent upon those entering this profession to teach what they know of the science, art, and ethics of medicine. It includes communicating clearly with and teaching patients so that they are properly prepared to participate in their own care and in the maintenance of their health. The following are not specific responsibilities of students; they are physicians' responsibilities, although students are frequently asked to take these on.

14. DISCLOSURE

In general, full disclosure is a fundamental ethical requirement. The patient must be well informed to make health care decisions and work intelligently in partnership with the medical team. Information that the patient needs for decision making should be presented in terms the patient can understand. If the patient is unable to comprehend, for some reason, there should be full disclosure to the patient's authorized representatives.

15. INFORMED CONSENT

Students are to understand the importance of the obligation to obtain informed consent from patients, but are not responsible for obtaining such consent. It is the physician's responsibility to ensure that the patient, or his/her surrogate, be appropriately informed as to the nature of the patient's medical condition, the objectives of proposed treatment alternatives, and risks involved. The physician's presentation should be understandable and unbiased. The patient's or surrogate's concurrence must be obtained without coercion.

 

STUDENT CODE OF PROFESSIONALISM
 
I. PREAMBLE

As students of the University of Pittsburgh School of Medicine, we recognize that personal and professional integrity are vital both to the practice of medicine and to the conduct of our daily lives. We also understand that personal and professional issues may challenge our integrity at various times throughout our careers. To help confront these challenges, we have created the Student Code of Professionalism that makes explicit the values of this community and our responsibilities within it. These core values are simple: trust, integrity and respect. We accept the responsibility of upholding the standards and ideals of the Code of Professionalism, which seeks to support and reflect our respect for each other and for our patients.

In order to maintain an atmosphere of trust, integrity and respect, we must be willing to face situations which may be uncomfortable. Part of our training must be to learn to confront those who violate our principles and compromise the integrity of our community. Even if difficult, we must embrace this responsibility, or be ourselves in violation of the Code of Professionalism because of our failure to act.

We realize that as part of the community of the School of Medicine, our actions affect those around us and influence the quality of this institution. We understand that membership in this community is contingent upon our commitment to the Code of Professionalism and its principles of professional behavior and academic integrity. We illustrate this by signing the Code of Professionalism pledge card.

II. GENERAL PRINCIPLES OF PROFESSIONAL CONDUCT

Our professional relationships should be based on mutual respect and concern. We must strive to maintain, to the greatest degree possible, an atmosphere of intellectual openness, honesty, and sincerity, recognizing that differences will exist. Everyone we encounter, whether that person be a fellow student, faculty member, staff, or patient must be treated with the same level of respect regardless of belief, practices, or identity. We must consider how our words and actions affect both our patients and peers.

The spirit of cooperation is integral to the medical profession and the foundation of our educational experience. We must promote an atmosphere of cooperation that reflects our core values in the classroom and on the wards in order to optimize both our collective learning and the delivery of patient care. As medical professionals in training, we must strive to uphold the highest standards of the medical profession. These standards of behavior are articulated in the statement of the Organization of Student Representatives (AAMC), which is published in the University of Pittsburgh medical student handbook. These include but are not limited to student responsibilities in the areas of honesty, cooperative and respectful collegial relationships, non-discrimination, confidentiality, appropriate consultation and representation, proper sexual conduct, recognition and appropriate handling of issues of impairment, research integrity, and avoidance of conflicts of interest.

 

III. GENERAL PRINCIPLES  OF ACADEMIC INTEGRITY

As medical students of the University of Pittsburgh, we are responsible for proper conduct and integrity in all of our scholastic work. We have the obligation to uphold the ethical standards of the medical profession in carrying out our academic assignments. Any violation of the principles listed below would compromise the fairness of the educational process and would erode the level of trust necessary to support our community. We are therefore honor-bound to uphold the following self-imposed principles:

1. We will not give, receive or obtain unauthorized assistance during an examination. This includes, but is not limited to copying from the exam of another student, allowing another student to copy from one’s exam and reading a copy of the exam prior to the date of the exam without the consent of the instructor.

2. If we take an exam early, we shall not share the form, content, or degree of difficulty of the exam with any medical student. Similarly, if we take an exam late, we shall not receive information on the form, content, or the degree of difficulty of the exam. This is also true for exams that are re-used, as so designated by the course director.

3. We shall not falsify, misrepresent, or misuse data, reports, clinical records or research findings.

4. We shall properly cite sources and not present work for evaluation which is not our own unless properly cited as such.

5. We shall not destroy or conceal any educational materials meant for use by others.

6. We shall address any witnessed violation of the principles of academic integrity.

The faculty has the obligation of providing an environment conducive to independent work during an examination. As a measure of trust, examinations will not be monitored by the faculty except in order to answer questions or to give authorized aid. During each examination, we may be asked to sign the following pledge as a reminder of the commitment we made upon matriculation: "I have neither given nor received aid during this examination."

IV. RESPONSIBILITIES REGARDING VIOLATIONS OF THE CODE OF PROFESSIONALISM

If we violate the principles of the Student Code of Professionalism, we must report ourselves to an Honor Council member (as defined in Section V), course or clerkship director, or dean and conscientiously attempt to rectify the situation.

If we witness any violation of the general principles of professional conduct or academic integrity, we have an obligation to address the situation. We may initiate dialogue with the offending party in order to resolve the conflict and restore mutual respect. If we are uncomfortable or uncertain whether or not to initiate dialogue, or if this dialogue fails, we should contact an Honor Council member, Course or Clerkship Director, or Dean and ask for help. Together with these individuals, we will resolve issues at the lowest level possible, with the emphasis on mediation wherever possible. We understand, however, that certain actions may warrant a formal hearing by the Honor Council Hearing Board and that we are obligated to cooperate in the investigation or disposition of such allegations. 

V. THE HONOR COUNCIL

The Honor Council is composed of nine students, (two elected from each of the four classes within the School of Medicine and one from the MD/PhD program) and three faculty members. The faculty members will be nominated by the student members of the Honor Council and appointed by the Dean. They will serve for three years on a rotating basis and may be reappointed. The selection will take place within one month after the first year Student Honor Council members are elected. The names and phone numbers of the student and faculty members of the Student Honor Council, will be posted in the student lounge and printed in the student directory.

Responsibilities of the student Honor Council members include:

1. To effectively model and communicate the principles of the Code of Professionalism

2. To foster an environment in accordance with the Code of Professionalism.

3. To serve as a resource, when requested, to help address individual Code of Professionalism concerns in an informal and confidential manner.

4. To participate in disciplinary procedures of the Honor Council Hearing Board.

5. To maintain confidentiality.

 

VI. INFORMAL RESOLUTION OF A CODE OF PROFESSIONALISM VIOLATION

Any student or faculty member is encouraged to bring any concern regarding his/her own actions or the actions of another student to an Honor Council member, faculty member (including but not limited to course and clerkship directors) or Dean.

Resolution utilizing outside help. Any of these individuals may provide support, counseling and information about appropriate options for informal or formal resolution of the issue. In addition, they can often help to sort out whether the concern brought forward represents a serious breach of academic integrity or professional conduct or falls into a gray area that is less clear cut. Students are assured that all such discussion will be held in confidence unless there is a potential of immediate harm to the student or to others. If the complaint brought forward is deemed to be a significant breach of the Code of Student Professionalism, it is expected that the complainant, with the support of the Honor Council members, faculty or Dean, will cooperate in pursuing the matter. If the complainant so chooses, and if appropriate, the individual consulted may aid in the process of arriving at an informal resolution. This may be attempted directly with the accused or with the aid of other Honor Council faculty or students (a maximum of 2 student members may be involved in a particular incident). Alternatively and where appropriate the complaint may be referred for a formal hearing. (See the Disciplinary Procedure of the Honor Council Integrity Hearing Board of the School of Medicine.)

Informal Resolution. Any Honor Council member(s), Course or Clerkship Director or Dean may attempt to reach an informal resolution, which would be acceptable to both parties. Measures which could be taken and recommendations which could be considered include the following:

1. Mediation or facilitated discussion between the confronting and confronted parties.

2. Letter to the community to expand awareness or to clarify misunderstandings.

3. Town Meeting or open forum to discuss issues which may concern the community as a whole.

4. Invitation of speakers to discuss social and/or academic concerns.

5. Communication with faculty or administration to raise awareness of potential problems.

6. Referral to School of Medicine resources (course director, clerkship director, Dean of Student Affairs, Office of Faculty Affairs, Director of Minority Programs, SHARP Committee, etc).

7. Referral to University of Pittsburgh resources (Office of Affirmative Action, Sexual Assault Services, Campus Police, etc).

8. Referral to a formal disciplinary process.

Records

The Honor Council will elect a secretary from among its members to keep a record of its proceedings. No names, times, dates, locations, or other information which may reveal the identity of the parties involved may be specified in these records. Upon the resolution or termination of the complaint, the secretary will summarize these records into a brief written abstract. The abstracts will be kept solely by an appointed faculty member of the Honor Council and used only to assist the Honor Council by providing guidance and establishing precedent for resolution of future conflicts. In the event that the faculty curator’s term on the Honor Council ends, the abstracts will be transferred to an active member.

VII. REFERRAL TO FORMAL DISCIPLINARY PROCEDURES

If informal resolution is unsuccessful or inappropriate, then referral to a formal disciplinary procedure may be deemed necessary. Violations of the Student Code of Professionalism of the Medical School may be referred to the Honor Council Hearing Board. Certain violations of the Student Code of Professionalism of the Medical School that also violate the University Code of Conduct may alternatively be referred to the University Judicial Board for adjudication. Violations of the University Sexual Harassment Policy may alternatively be referred to the Office of Affirmative Action. The referral process is described in the respective policies of the University of Pittsburgh or the Medical School.

VIII. ADMISSIONS CONCERNS

The Honor Council Chairperson is responsible for providing the Office of Admissions with the latest version of the Student Code of Professionalism for distribution to all candidates presenting for an interview at the School of Medicine.

DISCIPLINARY PROCEDURES OF THE HONOR COUNCIL HEARING BOARD OF THE SCHOOL OF MEDICINE

I. Initiation of Disciplinary Proceedings and Determination to Proceed Further

Disciplinary proceedings may be initiated only by formal complaint made to the Dean for Student Affairs. Any student, faculty member, administrative officer, or staff of the School of Medicine may initiate disciplinary proceedings by complaint, within 90 days of the incident. The Dean for Student Affairs will require a complaint to be put in writing and signed before proceeding further. Any formal complaint reported to a member of the Honor Council or to another Dean will then be transmitted to the Dean for Student Affairs.

Upon receipt of a formal complaint, and following such investigation and consultation as deemed appropriate, the Dean for Student Affairs determines whether further proceedings are warranted. If it is determined that they are not, the Dean for Student Affairs notifies the person making the complaint of the determination and proceeds no further. If it is determined that further proceedings are warranted, the Dean then arranges for written charges to be provided to the student who has been accused of the infraction.

II. Formal Statement of Charges

The formal statement of charges must set forth the nature, time, and place of the violation charged. It is to be promptly presented to the person charged within ten working days after receipt of the written complaint, in such a manner that guarantees receipt. The statement of the charge is to be accompanied by a written notification of a date, time, and place for a conference with the Dean for Student Affairs. The date for the conference should be at least three, but not more than ten, working days after the initial provision of the written, formal statement to the person charged. The formal charge will be accompanied by the following statements of the rights of the accused:

1. The accused shall have adequate time to prepare his or her case.

2. The accused is permitted but shall not be required to take any examinations between the time he or she is charged and five days after the final decision is delivered to the student.

3. During the hearing, the accused shall have the right to the advice and full assistance of a member of the University community (who may not be an attorney or a law student). Participation of extramural legal counsel is not permitted at the School level.

4. The accused shall be presumed innocent until proven guilty by clear and convincing evidence presented to the Dean for Student Affairs or to the Honor Council Hearing Board.

5. The accused shall have the right to call a reasonable number of witnesses. The accused, or his or her advocate from within the University, shall be allowed to question and cross examine witnesses and shall have a fair opportunity to present his or her defense.

6. The accused shall not be restrained in any manner from the full exercise of his or her rights of appeal.

In order to expedite disposition of a matter, any person charged may, in writing, waive any of the minimum periods required to elapse between notice and the holding of any hearing provided in this section. Official University vacations, holidays, or weekends will not be counted as part of the time limit specified for dealing with any case.

III. Procedures for Conference with the Dean for Student Affairs for Disposition of the Violation

The accused is given the following options:

1. Admit to the violation as charged and submit to the imposition of sanctions determined by the Dean, , and as may be agreed upon by both the student and accusing party or,

2. Have the charge referred for disposition to the full Honor Council Hearing Board.

The choice shall be recorded in writing with the signatures of the accused and the Associate Dean for Student Affairs

IV.  Procedure for Administrative Disposition of Admitted Violation 

When the accused elects to admit to the charges, the Dean for Student Affairs shall proceed with the conference, in an attempt to reach an informal resolution. The accused shall be given the opportunity, within reasonable bounds, to present evidence in mitigation or extenuation of the violation admitted. Upon request, the accused may continue the conference over a reasonable time and allow others to testify for this purpose. Normally, the person bringing the complaint or a representative of the involved department in the School of Medicine will attend this conference. In all cases, the conduct of any investigation will be confidential and a breach of confidence will be considered a Code of Professionalism violation. Within five working days following the conference, the Dean for Student Affairs will prepare a written report , including recommendation for sanction, which may have been agreed upon in writing by both the student and person bringing the complaint. A copy of this report will be sent to the accused. The report will be kept by the Dean for Student Affairs in a confidential file separate from the official academic file and will be destroyed when the student graduates or permanently terminates registration.

The dean's office may provide such information identifying an individual student for the following uses:

1. To an instructor who is involved with a student integrity violation at the initial stage and who wishes to use this previous record in determining whether a resolution between the instructor and the student or an academic integrity hearing board may be most appropriate;

2. To a college or school Academic Integrity Hearing Board after a decision of guilt or innocence has been made in a case, but before a sanction has been recommended.

If a mutually acceptable agreement cannot be reached, the matter will be referred to the full Honor Council Hearing Board for disposition.

When the accused denies the allegations (i.e. pleads innocent) or is not willing to accept the determined sanction, then the Dean for Student Affairs will forthwith terminate the conference and refer the matter to the Student Solicitor for presentation to the full Honor Council in accordance with the procedures described below. Referral consists of transmittal of a copy of the formal charge plus any items relevant to the case and deemed appropriate by the Dean for Student Affairs. The Student Solicitor thereupon prepares and presents a charge to the full Honor Council Hearing Board.

V. Organization and Function of the Honor Council Hearing Board and its Officers 

The full Honor Council Hearing Board is composed of the nine students of the Honor Council (two elected from each of the four classes within the School of Medicine and one from the MD/PhD program) and four faculty members, nominated by the Honor Council and appointed by the Dean of the Medical School and rotated on a staggered basis. The Board will elect a student chairperson, secretary and student solicitor. The function of the Board is to hear all charges of violation and to make a finding regarding innocence or guilt, and to recommend sanctions in the case of those found guilty of a violation.

The Student Solicitor, with help from the person filing the charges, prepares the case against the accused. From the time of reviewing a charge until final disposition of the case by the Board , the Student Solicitor shall not discuss the case with other members of the Board . The Secretary of the Board shall keep a record of all proceedings of the Board. Assistance for this will be provided by the Office of Student Affairs. The Dean for Student Affairs will be responsible for assisting the Board in its operation but will not be a direct participant in the hearing.

VI. Hearing Procedures Before the Full Honor Council Hearing Board 

1. Scheduling the Hearing

Promptly upon receipt of a charge from the Dean for Student Affairs, the Student Solicitor will notify the Secretary of the Board. The Secretary then promptly confers with the involved parties in order to ascertain the earliest agreeable date for the hearing, taking into account the time required for adequate preparation, and makes arrangements. The Office of Student Affairs will send a written notice of the arrangements to the members of the Board, the Student Solicitor, and the accused. Notice to the accused will be served by in-hand delivery or, if that is not possible, by registered mail. The hearing date will be at least three, but not more than ten, working days from the date of in-hand delivery or mailing of the notice to the accused. The accused may, on his or her own initiative, waive the three day limit.

2. When Accused Appears

If the accused presents is at the hearing personally, or is represented by a campus representative who has written authorization to appear for the defendant, the hearing shall proceed as follows:

a. The Chairperson reads the statement of charge and asks the accused, or his or her representative, whether he or she admits or denies the substance of the charge.

b. When the accused, or his or her representative, admits the substance of the charge, the student may then make any statement he or she desires in mitigation or extenuation. A reasonable number of witnesses may be called in substantiation of this statement. Members of the Board may ask questions of each witness. A reasonable number of witnesses, whose comments may have bearing on the sanction, may be called to substantiate the extenuating circumstances. In executive session, the Board shall then consider and determine the sanctions, if any, to be recommended to the Dean of the Medical School.

c. When the accused, or his or her personal representative, denies the substance of the charge, the Board proceeds to hear evidence as to the matter in dispute. This will normally occur in the following order:

Evidence in support of the charge is presented under direction of the Student Solicitor;

Evidence in support of the accused is presented under direction of the person charged, or his or her representative;

Witnesses may be summoned and cross examined by the Board , the Student Solicitor, and the accused, and/or his or her representative.

Closing oral arguments may then be made by the Student Solicitor followed by the accused, or his or her representative.

In executive session and in absence of the Student Solicitor, the Hearing Board will then determine whether a violation has occurred and what sanction, if any, should be recommended to the Dean of the Medical School..

3. When the Accused Does Not Appear

If the accused does not appear personally at the hearing, or is not represented by an authorized representative, the fact that the accused has been duly notified shall be verified (VI.1). If it is determined that he or she has not, the hearing is adjourned and the procedures revert to setting and notification of a rescheduled hearing. If it is determined that due notice was given, the hearing proceeds as follows: The Student Solicitor reads the statement of charge and presents witnesses and other evidence in support of the charge; The Student Solicitor makes a closing statement; In executive session and in absence of the Student Solicitor, the Board determines whether a violation has occurred and what sanction, if any, should be recommended to the Dean.

4. General Rules of Procedure and Rights Secured to The Accused

a. General Conduct of Hearing. The Chairperson of the Hearing Board presides and makes all rulings with respect to questions of practice and procedure. Control is maintained by recognition of the participation of members of the Council and others in the hearing.

b. Quorum for Hearing and Voting Privileges. Six members of the Board constitute a quorum. The six members include at least two faculty member and exclude any student member(s) who may have been involved in the initial consideration of the charges. All members of the Hearing Board, with the exception of the Student Solicitor, have full voting privileges when deciding a case.

c. Evidence. No attempt shall be made to apply technical legal rules of evidence. In general, any evidence, whether oral testimony or documentary, which is considered by the Chairperson to be relevant to the charge or defense should be received. The Chairperson may exclude frivolous, repetitive or merely cumulative testimony. Reasonable limits may be imposed on the number of material witnesses and the amount of cumulative evidence that may be introduced. Hearsay evidence (testimony by a witness regarding what a person not present at the hearing has stated) should be received and evaluated with caution, since no opportunity exists to question the absent person.

d. Burden and Standard of Proof. Number of Hearing Board Members Required to Determine Violation. The Board members have a responsibility to assure that the evidence presented is clear and convincing to vote for a finding in support of the charges. Members may not consider evidence not presented in the hearing itself. When the accused denies the charge, three quarters of the Board members hearing the matter must concur on a guilty finding.

e. Option of a Closed or Open Hearing. If the person charged requests an open hearing, which is open to all members of the Medical School community, it shall be granted. The Chair will have the right to exclude persons when required for orderly conduct of the hearing. Otherwise all hearings are closed to the University community.

f. Right to Question Witnesses. The Board, the Student Solicitor, and the accused, or his or her representative, shall have the right within bounds of general relevance, to question witnesses who testify at the hearing.

g. Right to Assistance. The accused has the right to be advised, assisted, or represented at the hearing, by an individual from the University community (excepting an attorney or law student) who may take an active part in the proceedings.

h. Provision of Record for Review. The Secretary of the Board shall prepare a written summary of the proceedings at all hearings. A tape recording of the hearing will be made. These will be given to the Dean for Student Affairs, who will store them.

i. Number of Hearing Board Members Required to Recommend Particular Sanctions. In order to recommend the sanction of indefinite or definite suspension, two thirds of the members of the Board sitting on the particular hearing must concur in its imposition. Other sanctions may be recommended by a simple majority.

5. Notice of Action of the full Hearing Board

The Hearing Board may inform the person charged orally of its disposition of the charge following its determination, or it may defer giving any notice for a period not to exceed two working days after formal closing of the hearing. The Secretary of the Council shall, not later than five days after formal closing of the hearing, give to the accused, the person bringing the charge, and the Dean of the School of Medicine a written Notice of Finding and Recommendation. This shall include, if violation was not admitted, an entry: "Violation as Charged-Found" or "Violation as Charged-Not Found", and in any case where a sanction is recommended, an entry: "Sanction Recommended" (specified with clarity).

6. Failure by the full Hearing Board to Convene or to Make a Timely Determination in Referred Case

Failure of the Board to dispose of the matter in a duly referred case within 30 calendar days after its formal referral by the Dean for Student Affairs to the Student Solicitor shall result in direct referral of the matter to the Dean of the School of Medicine, for administrative disposition. If the alleged violation is not then admitted in conference, the Dean may proceed to hear the case himself, make a determination of violation or non-violation, and impose sanctions as provided in Section G.

VII. Sanctions for Violations

When a violation of the Honor Code is found by the Hearing Board, the matter is referred to the Dean of the School of Medicine for final disposition . The range of permissible sanctions for disciplinary action, whether imposed by administrative action or recommended by Hearing Board action includes but is not limited to:

1. Lesser Sanctions

Although suspension for a definite or an indefinite time will usually be the sanction imposed for willful violation of the Honor Code, lesser penalties may be imposed because of extenuating or mitigating circumstances, or if the Hearing Board finds that a more appropriate penalty applies better to the circumstance.

2. Suspension for a Definite Time

Exclusion from classes and other activities with forfeiture of academic credit, as set forth in the notice of suspension, for a definite time beginning immediately. Sanction for cheating shall ordinarily include a recommended failure in the course involved with authorized withdrawal in other concurrent courses, regardless of the time in the school year when the offense is committed. If the suspension is for more than one term, the suspension shall begin immediately and shall be served in consecutive terms.

3. Indefinite Suspension

Termination of student's status, subject only to formal readmission, with no right to petition for readmission before the expiration of a calendar year from the date of suspension.

4. Placement of letter with Finding of Violation as Charged

Ordinarily, if the finding of violation as charged is made, the finding and sanctions will be included in the formal academic file. Any findings in the permanent file shall be included in any future report(s) concerning the student, unless specified otherwise by the Board. Alternatively, the Board could recommend that the findings and sanction be included in an impermanent file, which is maintained by the Associate Dean for Student Affairs (see D.)

In any case, the Promotions Committee may consider the results of any findings of violation of the Code of Professionalism and imposition of sanctions by the Honor Council Hearing Board in assessing the suitability of a student to be a physician.

VIII. Custody of Disciplinary Records Separate from Academic Records 

The placement of any statement of violation as charged, along with any sanctions imposed, is outlined in VII.4. Otherwise, all records pertaining to disciplinary proceedings in which a student is charged with a violation will be maintained separately from the academic record. The Dean for Student Affairs shall be the sole custodian for all records involving disciplinary proceedings. To this end, all records made or considered by the Honor Council Hearing Board in disciplinary proceedings before them shall be transmitted immediately upon completion of the proceedings to the Dean for Student Affairs.

IX. Review and Appeal 

The accused or accuser may appeal within five days of the date of a decision letter an adjudication, or a determination that the charges are not subject to adjudication, to the Provost, who may seek the advice of the University Review Board. Information about how to proceed may be obtained from the Office of the Provost. The student may appeal also to the University Review Board, whose recommendation shall be made to the Provost. The action of the Provost, taken with or without the advice of the University Review Board, shall constitute an exhaustion of all required institutional remedies.

Approved by the Executive Committee on April 9, 2002

GUIDELINES ON PROFESSIONAL CONDUCT IN THE TEACHER-LEARNER RELATIONSHIP

I. PREAMBLE

The University of Pittsburgh School of Medicine is committed to the principle that the educational relationship should be one of mutual respect between teacher and learner. Because the school trains individuals who are entrusted with the lives and well being of others, we have a unique responsibility to assure that students learn as members of a community of scholars in an environment that is conducive to learning.

Maintaining such an environment requires that the faculty, administration, residents, fellows, nursing staff, and students treat each other with the respect due colleagues. All teachers should realize that students depend on them for evaluations and references, which can advance or impede their career development. They must take care to judiciously exercise this power and to maintain fairness of treatment avoiding exploitation or the perception of mistreatment and exploitation. The quality and worth of a University of Pittsburgh School of Medicine education rest not only in the excellence of the content and the skills that are taught, but also in the example provided to students of humane physicians and scientists who respect their professional colleagues at all career levels, their patients, and one another.

II. RESPONSIBILITIES OF TEACHERS AND LEARNERS

The teacher-learner relationship confers rights and responsibilities on both parties. Behaving in a way that embodies the ideal teacher-learner relationship fosters mutual respect, minimizes the likelihood of learner mistreatment, and optimizes the educational experience. Learners are defined as individuals participating in undergraduate or graduate medical education, i.e., a medical student, a resident, or a fellow.

A. Responsibilities of Teachers

1. Treat learners fairly, respectfully, and without bias related to their age, race, gender, sexual orientation, disability, religion, or national origin.

2. Distinguish between the Socratic method, where insightful questions are a stimulus to learning and discovery, and overly aggressive questioning, where detailed questions are repeatedly presented with the end point of belittlement or humiliation of the learner.

3. Give learners timely, constructive, and accurate feedback and opportunities for remediation.

4. Be prepared and on time for all activities.

5. Provide learners with current material and information and appropriate educational activities.

B. Responsibilities of Learners

Be courteous and respectful of others regardless of their age, race, gender, sexual orientation, disability, religion, national origin, or role in your education.

A medical student should act in accordance with the University of Pittsburgh School of Medicine Student Honor Code.

The residents and fellows should act in accordance with the dictates contained in the Graduate Medical Education Directory: Institutional and Program Requirements sections.

Be aware of the medical condition and current therapy of patients.

Put patients’ welfare ahead of educational needs.

Know limitations and ask for help when needed.

Maintain patient confidentiality.

View feedback as an opportunity to improve knowledge and performance skills.

III. DESCRIPTION OF INAPPROPRIATE BEHAVIOR

Inappropriate behaviors are those that are not respectful or professional in a teacher-learner relationship. Determining whether a given behavior is inappropriate involves a subjective assessment of the intentions of the performer and the perception of the recipient. Clearly inappropriate behaviors include, but are not limited to:

Unwanted physical contact (such as touching, hitting, slapping, kicking, pushing) or the threat of the same;

Sexual harassment (see the University of Pittsburgh Policy 07-06-04, Sexual Harassment);

Discrimination based on age, race, gender, sexual orientation, disability, religion, or national origin;

Requiring learners to perform personal chores (e.g., running errands or babysitting);

Verbal harassment, including humiliation or belittlement in public or privately;

Use of grading and other forms of assessment in a punitive or self-serving manner.

IV. WHAT TO DO IF YOU BELIEVE INAPPROPRIATE BEHAVIOR OR MISTREATMENT HAS OCCURRED

While we believe that the principles articulated above are generally practiced and respected by the members of our diverse community of scholars throughout the School of Medicine, we recognize that there may be occasions when perceived or real incidents of unprofessional behavior directed toward learners occur. When this occurs, the School of Medicine is committed to establishing the facts through a fair process, which respects the rights and confidentiality, to the extent possible, of the involved parties:

Any individual who has concerns about unprofessional behavior on the part of a medical student may speak with the course or clerkship director, the Associate Dean for Student Affairs, or any member of the Honor Council to discuss options as described in the Student Honor Code policy.

Any individual who has concerns about unprofessional behavior on the part of a resident, fellow, or faculty member may speak to the course or clerkship director, the program director, the department chairman and/or the Assistant Dean of Graduate Medical Education.

Learners who have a concern about unprofessional behavior on the part of residents, faculty, or other clinical staff are strongly encouraged to come forward and report perceived mistreatment. The procedures below are in place to assure that such reports may be made without fear of retaliation or reprisal for doing so.

Exchanges of information, whether verbal or written, will be handled in a confidential manner. However, at any level, there may be situations that limit the ability for confidentiality, such as those involving potential harm to a student or others, including sexual assault.

A complaint should be reported as soon as possible but not more than twelve months after the alleged incident.

V. PROCEDURES FOR LEARNERS TO FOLLOW

Several avenues are open to the learner who experiences an incident of inappropriate behavior and mistreatment.

A. MEDICAL STUDENTS

1. Informal Pathway

a. Talking Directly with the Individual

The student may consider speaking directly with the person. If the behavior stems from a misunderstanding or a need for increased sensitivity, the person will often respond positively and stop. Open communication may clarify any misunderstanding or issue(s) and lead to a successful, informal resolution.

b. Counseling and Guidance

Students who wish to discuss an incident of mistreatment or inappropriate behavior have the option of going to the appropriate course or clerkship director, the Associate Dean for Student Affairs, the Assistant Dean of Student Affairs and Minority Programs, or any member of the Honor Council or SHARP (Student Health Advocacy Resource Program) Committee. This contact may help the student clarify the incident, gain further perspective, and/or identify options and action steps.

All involved parties must agree upon all informal resolutions. A written record of the resolution may be filed with the Associate Dean for Student Affairs at the discretion of the parties. If informal resolution is not successful or appropriate, a student may choose to refer the complaint to the School of Medicine for resolution. In this case, the student refers the complaint in writing to the Senior Associate Dean.

2. Formal Pathway

a. University Procedures for Discrimination and Sexual Harassment

The University of Pittsburgh maintains guidelines and prescribed procedures for investigating incidents of alleged discrimination or sexual harassment. These procedures are published annually in the University of Pittsburgh Handbook for all students and on the University of Pittsburgh Web site. Students who experience discrimination or sexual harassment are encouraged to consult these guidelines and to follow the procedures developed by the University for these situations.

b. Referral to the School of Medicine for Resolution

Following initial informal review and inquiry, if it is determined that the complaint is not appropriate for informal channels, at the discretion of the Senior Associate Dean, an ad hoc committee may be appointed composed of faculty and peers of the accused to hold a hearing. At least one student member of the Honor Council will sit as a full voting member of the Committee for consideration of the particular incident. The accused will be notified in writing of the complaint. A copy of the notification will be sent to the Department Chair of the accused (for faculty) and/or the Program Director (for residents). Both parties will be invited to attend the hearing. Students may also request that a special student advocate of their choosing attend the Committee during the hearing of the incident. Such advocates must be members of the University community with the exception of faculty of the College of Law or students of the same. The ad hoc Committee is focused on the academic goals listed in Section I above and, as such, precludes the involvement of legal counsel by any party.

c. Procedure for Formal Resolution for Medical Students

The ad hoc Committee will meet to review the facts of the complaint and will receive written or oral testimony. The accused may attend the hearing and will be offered the opportunity to rebut the complaint. The Chair of the ad hoc Committee will submit a written report of the Committee’s recommendations to the Senior Associate Dean. The Senior Associate Dean may accept the recommendations or not and his final decision will then be communicated in writing to both the accused and the student. Incidents involving nurses or ancillary staff will be referred to the appropriate supervisor.

The Senior Associate Dean will maintain records of the proceedings. The period between the receipt of a complaint, resolution, and action will occur within 30 business days.

B. RESIDENTS AND FELLOWS

Informal Pathway

a. Talking Directly with the Individual

The resident/fellow may consider speaking directly with the person. If the behavior stems from misunderstanding or need for increased sensitivity, the person will often respond positively and stop. Open communication may clarify any misunderstanding or issue(s) and lead to a successful, informal resolution.

b. Counseling and Guidance

Residents and fellows have the option of going to the rotation director, program director, chairman, or the Resident and Fellow Assistance Program. Should resolution not be successful or appropriate at this level, a resident/fellow may choose to refer the complaint, in writing, to the Assistant Dean of Graduate Medical Education.

Formal Pathway

a. University Procedures for Discrimination and Sexual Harassment

The University of Pittsburgh maintains guidelines and prescribed procedures for investigating incidents of alleged discrimination or sexual harassment. These procedures are published annually in the UHCP Resident and Fellows Integrated Orientation Manual. This document is maintained on the GME web site. Residents or fellows, who experience discrimination or sexual harassment are encouraged to consult these guidelines and to follow the procedures developed by the University and used by UHCP for these situations.

Referral to the Assistant Dean of Graduate Medical Education (GME) for Resolution

The Assistant Dean of GME will receive all written complaints that are not resolved utilizing the channels above at the department level or through the Resident and Fellows Assistance Program. At the discretion of the Assistant Dean, an ad hoc committee of the UHCP GME Committee may be appointed. This committee should be composed of faculty and resident members from uninvolved departments or divisions. The ad hoc committee may call on the program director of the department or division involved as well as others who may have information to present regarding the complaint.

c. Procedure for Formal Resolution for Residents/Fellows

The ad hoc committee will meet to review the facts of the complaint and may receive written or oral testimony. The accused may attend the hearing and will be offered the opportunity to rebut the complaint. The Chair of the ad hoc Committee will submit a written report of the Committee’s recommendations to the Assistant Dean of GME. The Assistant Dean may accept the recommendations or not and his final decision will then be communicated in writing to both the accused and the resident/fellow.

Incidents involving nurses or ancillary staff will be referred to the appropriate supervisor. The Senior Associate Vice Chancellor will be notified in writing of any disciplinary action taken. The Assistant Dean will maintain records of the proceedings within the GME Office Archives. The period between the receipt of a complaint, resolution, and action will occur within 30 business days.

VI. APPEALS PROCESS

If the accused is a faculty member who wishes to appeal the decision of the ad hoc committee, or the disciplinary action of the supervisor, a written appeal must be submitted to the Dean, School of Medicine/Senior Vice Chancellor for the Health Sciences, within ten (10) business days of receipt of the decision or the disciplinary action. The action of the Dean/Senior Vice Chancellor shall be the final remedy available in this appeal process.

If the accused is a resident physician, a written appeal must be submitted to the Dean of the School of Medicine or designate within ten (10) business days of receipt of the final decision.

If the accused is a medical student, the appeal will follow that outlined in the Honor Council Hearing Board document.

VII. RETALIATION

Retaliation against any member of the school community, who comes forward with a complaint or concern, is prohibited. If an individual believes that he or she is being subjected to retaliation as a result of coming forward with a concern or a complaint, he or she should refer the matter to the Dean of the School of Medicine or designate.

Conditionally approved by the Executive Committee - January 8, 2002.

 

 
 

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