Section 7: Professionalism

Professionalism

Code of Professional Conduct and Professional responsibility

The Board of Regents of the Nevada System of Higher Education (NSHE) permits professional schools to establish written policies, procedures, and sanctions for discipline of their students that may be used in lieu of the policies, procedures and sanctions of the NSHE Code, Title 2, Chapter 10, subject to prior review by the office of General Counsel and approval by the President of UNLV. In accordance with the authorization granted in the Code, the UNLV School of Medicine sets forth the following written policies, procedures, and sanctions for the discipline of its students.

Professionalism is the basis of medicine's contract with society and is essential to maintaining the trust and support of the public. Personal behaviors have the potential to positively and negatively reflect on the UNLV School of Medicine and on the medical profession.

  1. The UNLV School of Medicine has adopted the Fundamental Principles outlined by the American Board of Internal Medicine's 2002 Physician Charter in which a commitment to:
    1. Primacy of patient welfare
    2. Patient autonomy
    3. Social justice
  2. The Professional Responsibilities inherent in implementing The Physician Charter include:
    1. Commitment to professional competence
    2. Commitment to honesty with patients and colleagues
    3. Commitment to patient confidentiality
    4. Commitment to maintaining appropriate relations with patients
    5. Commitment to improving the quality of care
    6. Commitment to improving access to care
    7. Commitment to a just distribution of finite resources
    8. Commitment to scientific knowledge
    9. Commitment to maintaining trust by managing conflicts of interest
    10. Commitment to professional responsibilities
  3. Additional responsibilities include:
    1. Practicing behavior that reflects the honor, responsibility, and service commitment of members of the medical profession
    2. Treating colleagues, coworkers, staff and faculty with respect and dignity
    3. Avoiding the use of obscene, derogatory or profane language or gestures at all times

UNLV School of Medicine students are required to comport with the Code of Professional Conduct and Professional responsibility. Students are also expected to adhere to the UNLV Student Conduct Code and the UNLV Student Academic Misconduct Policy. UNLV School of Medicine shall retain primary jurisdiction with respect to the Code of Professional Conduct and Professional Responsibility violations by its students, but reserves the right to refer a student to the UNLV Student Conduct process if extenuating circumstances require it.

Respectful Learning Environment Policy

Relationships between Teachers and Students

Students and teachers should recognize the special nature of the teacher-learner relationship, which is in part defined by role modeling, mentorship and supervision. Students and teachers should strive to develop their relationship to one characterized by mutual trust, acceptance and confidence. There is a power differential as teachers often evaluate student performance and the results of evaluations may impact a student's future. Students also evaluate the quality of their teachers and to an extent, may impact the teachers' career.

Both should recognize the potential for conflict of interest and respect appropriate boundaries. Actions that give the appearance of violating boundaries should be avoided. These include, but are not limited to:

  1. Romantic involvement
  2. Business relationships
  3. Faculty or students accepting services or personal favors from each other (e.g., babysitting, work in the office)
  4. Accepting substantial gifts
  5. Special treatment of a student, including gifts, meals, entertainment or social contacts that differ from the usual teacher-learner relationship with other students.
  6. Social media: It is recommended that faculty postpone connecting on social media sites until the student is no longer in the class or under supervision of the faculty member. Students should refrain from requesting social media contact from anyone who supervises or evaluates them during courses or rotations.

The UNLV School of Medicine promotes learning and working environments where all members of the Health Sciences Center community interact in a mutually respectful fashion where personal dignity, cultural awareness and civility are maintained. UNLV School of Medicine strives to foster an environment that promotes learning through positive and courteous interactions between teachers and learners. This is an environment free of harassment, intimidation, exploitation, and abuse.

Teacher-Learner Expectations

UNLV School of Medicine values professional behaviors and attitudes, including altruism, integrity, respect for others and a commitment to excellence. Learning is best fostered in an environment of mutual respect between teachers and learners. In the context of medical education, the term teacher is used broadly to include peers, resident physicians, full-time and volunteer faculty, clinical preceptors, nurses, ancillary support staff as well as others from whom students learn.

Principles include these:

Duty: Teachers have a duty not only to facilitate the acquisition of knowledge and skills required to deliver the standard of care but also to instill the values and attitudes required for preserving the medical professions social contract with its patients.

Integrity: Learning environments that are conducive to conveying professional values are based on integrity. Students learn professionalism by observing and emulating role models who epitomize professional values and attitudes.

Respect: Respect for every individual is fundamental to the ethic of medicine. Mutual respect is essential for nurturing that ethic. Teachers have a special obligation to ensure students are always treated respectfully.

Responsibilities of Teachers and Learners:
Teachers should:
  1. Treat students fairly and respectfully.
  2. Maintain high professional standards in all interactions.
  3. Be prepared and on time.
  4. Provide relevant and timely information.
  5. Provide explicit learning and behavioral expectations early in the course of instruction.
  6. Provide timely, focused, accurate and constructive feedback on a regular basis and thoughtful and timely evaluations at the end of instruction.
  7. Display honesty, integrity and compassion.
  8. Practice insightful questioning, stimulate self-discovery and avoid questioning which may be perceived as humiliating, degrading or punitive.
  9. Solicit feedback from students regarding their perception of the educational experience.
  10. Encourage students who experience mistreatment or who witness unprofessional behavior to report the facts immediately.
Students should:
  1. Be courteous of teachers and fellow students.
  2. Be prepared and on time.
  3. Be active, engaged and curious learners.
  4. Demonstrate professional behavior in all settings.
  5. Recognize that not all learning stems from formal and structured activity.
  6. Recognize their responsibility to establish learning objectives.
  7. Recognize their responsibility to participate as an active learner.
  8. Demonstrate a commitment to life-long learning.
  9. Recognize personal limitations and seek assistance as needed.
  10. Display honesty, integrity and compassion.
  11. Recognize the privileges and responsibilities that come from the opportunity to work with patients.
  12. Recognize the duty to place patient welfare above their own.
  13. Recognize and respect patient privacy.
  14. Solicit feedback on their performance.
  15. Recognize that criticism is not synonymous with abuse.

Policy and Process to Address Medical Student Mistreatment

Purpose

The purpose of this policy is to define inappropriate conduct in the teacher-learner relationship and to provide a mechanism and procedures to allow medical students and residents to report violations without fear of retaliation. In addition, the policy aims to ensure educational programs aimed at preventing student mistreatment are provided to the entire community on a regular basis. The community is defined as all sites where UNLV School of Medicine medical students and residents receive training.

Definitions/Examples

Mistreatment of students can occur in a variety of ways and may impair learning. Types of abuse include verbal, power, ethnic, physical, and sexual harassment. Examples of mistreatment of students include, but are not limited to instances or a single egregious instance of public humiliation or belittlement, criticism or other actions that reasonably can be interpreted as demeaning or humiliating, unwarranted exclusion from reasonable learning opportunities, unwelcome sexual comments, jokes, innuendos, or taunting remarks about one's body, attire, age, gender, ethnicity, sexual orientation, or marital status, intentional physical contact such as pushing, shoving, slapping, hitting, tripping, throwing objects at, or aggressive violation of personal space.

Administrative Responsibility

The Senior Associate Dean for Student Affairs and Admissions is responsible for oversight of appropriate treatment of students and will monitor trends in departments, as well as by individual residents and faculty. Trends may be reported to the appropriate department chairs (or designee) and/or to the associate deans so issues can be investigated and decisions about what action is appropriate can be determined.

Ongoing Education to Promote a Positive Learning Environment and Discourage Mistreatment and Abuse

UNLV School of Medicine provides ongoing education to its community on promotion of a positive learning environment respectful of all individuals. This policy is included in the UNLV School of Medicine Student Handbook and posted on the UNLV School of Medicine website; the topic will be addressed at orientations at matriculation and at the beginning of the third year. The policy will be reviewed by the Curriculum Committee, the Graduate Medical Education office and UNLV School of Medicine faculty on a regular basis and modified as necessary. The Dean will send a letter annually to all faculty (including volunteer faculty) reinforcing the school's statement on supporting an abuse-free environment, of the trainee mistreatment policy, and resources for resolution.

Reporting Violations of the Code of Conduct and Professional Responsibility

All members of the UNLV School of Medicine are bound by the responsibility to report violations of the Code of Conduct and Professional Responsibility, and/or instances of student mistreatment. Student mistreatment is a violation of the Code of Professional Conduct and Professional Responsibility. The process of reporting a violation of the Code is as follows:

  1. The complaint must be in writing and dated.
  2. To the extent possible, the complaint must contain the date, time, location and name of person(s) involved in the potential violation.
  3. The complaint must describe the incident in as much detail as possible
  4. The complaint should include the name(s) of any individual who may have witnessed the potential violation.

Through multiple avenues, a complaint or allegation about behaviors of a faculty member or resident in violation of professionalism codes of conduct or behaving in a manner inconsistent with the UNLV School of Medicine statement supporting a respectful learning environment, can be made to one or more of the following individuals.

  1. Senior Associate Dean for Student Affairs and Admissions
  2. Course or block directors
  3. Clerkship directors
  4. Anonymous submission to Senior Associate Dean for Admissions and Student Affairs

Informal resolution may be pursued through any of these individuals, based on an assessment of the complaint and/or the wishes of the student. Informal resolution may be achieved by direct discussion and/or mediation with the alleged offender by the student along with the individual contacted above.

Students or faculty can also submit mistreatment reports online.

Mistreatment Incident Report Form
  • Date of Incident:
  • Location of Incident:
  • Detailed description of Incident:
  • Name(s) and positions of person(s) involved*(required).
  • Witnesses, if any, to the incident:
  • Student Response to the incident:
  • Has this incident been previously reported?
  • Electronic Signature/ or option to select anonymous submission
  • First Name:
  • Last Name:
  • Email:
  • Phone number:
  • Other facts relevant to the report:
  • Course/Rotation/Elective (optional):
  • Course/Rotation/Elective Site (optional):
Sexual Harassment or discrimination

UNLV School of Medicine is committed to a harassment-free campus. Offensive remarks or behavior, which are sexual or discriminatory in nature, may be sexual harassment or discrimination. Complete information regarding Sexual Harassment or Discrimination reporting, investigation and the appeal process are located in the Student Handbook, Section 9.

The Office of Student Affairs also can assist students in contacting the right resources.

Procedure for investigating and resolving allegations of violations of the Code of Professional Conduct and Professional Responsibility

If a learner has exhausted the possibility of resolving a situation of abuse or mistreatment using informal mechanisms, he/she, in conjunction with one of the individuals listed above, will contact the Senior Associate Dean for Student Affairs and Admissions and provide a written description of the circumstances leading to the complaint. The complainant is encouraged to be willing to be identified to the person. However there are circumstances when the complainant may prefer anonymous reporting. Anonymous reporting is allowed and will be the choice of the complainant. Every effort will be made to investigate and address the mistreatment, but anonymous reporting may limit the actions, which can be taken during the investigation and to resolve the mistreatment.

Ad Hoc Professionalism Committee

Upon receipt of a formal complaint, the Senior Associate Dean for Student Affairs and Admissions will convene the Ad Hoc Professionalism Committee. The purpose of the Ad Hoc Professionalism Committee is to provide consultation and recommendations to address violations of professionalism, including student mistreatment, and to be advisory to the Vice Dean for Academic Affairs & Education. The Ad Hoc Professionalism Committee chair will conduct an investigation of the written complaint.

Membership

Senior faculty will serve on the Ad Hoc Professionalism Committee, but none who are implicated in the complaint will be called to serve. The Senior Associate Dean for Student Affairs and Admissions will select the chair and the chair will select other members. The Ad Hoc Professionalism Committee will convene within 10 working days after the Senior Associate Dean for Student Affairs and Admissions receives the complaint and will interview the complainant, inform the accused about the substance of the complaint, interview the accused, and any other persons who might have insight into the situation, such as witnesses. Because the Ad Hoc Professionalism Committee is advisory to the Vice Dean for Academic Affairs of the UNLV School of Medicine and has no status as a disciplinary committee within the University, legal counsel will not be permitted to appear before the Committee and the accused or any witnesses have the right to refuse to appear without prejudice against their case. As part of its investigation, the Ad Hoc Professionalism Committee will evaluate all available materials.

Scope of Authority

The Ad Hoc Professionalism Committees authority will be to determine, by majority vote, two courses of action:

  1. There is no significant basis to conclude that mistreatment occurred.
  2. There is a significant basis to conclude that abuse did occur or that mistreatment or abuse probably did occur. The Ad Hoc Professionalism Committee will forward the findings to the Vice Dean for Academic Affairs.

The Vice Dean for Academic Affairs of the School of Medicine will review the Committee's findings and make a decision on corrective action to take. He/she may meet with both the complainant and the accused prior to rendering a decision. The Vice Dean for Academic Affairs will inform the parties of the decision within 10 working days after receiving the recommendations of the ad hoc professionalism Committee.The Vice Dean for Academic Affairs will work with the appropriate department chair, section head, dean, or hospital administrator to ensure that corrective action is taken. In the case of faculty, this corrective action may include referral of the matter to the appropriate ad hoc committee for formal investigation and remediation. If the accused is a staff member, human resources will be consulted regarding the appropriate procedures to be followed. If the accused is a resident, the Senior Associate Dean for Graduate Medical Education will be consulted regarding appropriate procedures. The Vice Dean for Academic Affairs will inform the Ad Hoc Professionalism Committee of the final disposition of these complaints.

None of the procedures detailed above are intended to deprive the complainant or the accused of their rights to seek remedies through general University procedures.

Right to Appeal

Students may request a review and appeal of the Vice Dean for Academic Affairs decisions following the school's policy for appeal and due process for the School of Medicine, as outlined in the Student Handbook, Section 7.

Anonymity/Confidentiality

The Ad Hoc Professionalism Committee will keep proceedings in confidence. The Committee will report findings only to the Vice Dean for Academic Affairs. Written material will be kept in confidential files maintained by the Office of Student Affairs. At the end of the academic year, the Senior Associate Dean for Student Affairs and Admissions, in collaboration with the Ad Hoc Professionalism Committee Chair, will submit an annual report to the Medical Student Progress Committee, and the Curriculum Committee and the Dean of the UNLV School of Medicine.

Retaliation

Retaliation against those reporting mistreatment is regarded as a form of mistreatment and will not be tolerated. Accusations that retaliation has occurred will be handled in the same manner as accusations concerning other forms of mistreatment.

Academic Integrity Policy

Academic misconduct is considered a violation of the UNLV School of Medicine Code of Professional Conduct and Professional Responsibility.

Academic misconduct includes, but is not limited to:

  1. Cheating: Fraud or deceptive practices which provide or attempt to provide an individual of advantage in written, oral, technical or laboratory evaluations.
  2. Plagiarism: Using the words or ideas of another, and claiming them as ones own, whether intentional or unintentional.
  3. Signing in or requesting another student to sign in for required activities when the individual is not present.

Misrepresentation:

  1. Providing information known to be false on written or verbally transmitted presentations, patient records, transcripts, university documents or personal qualifications.
  2. Falsely signing another student's or faculty's name to any document
  3. Alteration of patient records, transcripts or university documents.
  4. Any misrepresentation by which a student gains or attempts to gain an unfair advantage from the university, faculty, students or staff.

Wrongful procurement of goods, services or information:

  1. Stealing, destroying or damaging university property and/or the property of other students or faculty, including laboratory projects, clinical instruments, study materials or supplies
  2. Unauthorized use of online resources.

Mistreatment of Patients: This may include, but is not limited to knowingly missing assigned clinic sessions or providing treatment of patients outside of scheduled sessions and without appropriate supervision.

Unlawful Conduct: Students are representatives of the UNLV School of Medicine at all times and personal and public behaviors reflect on the school as well as the profession of medicine. The commissions of any felony, gross misdemeanor or misdemeanor (excluding misdemeanor traffic violations) represent unlawful conduct. All students are obligated to disclose any felony, gross misdemeanor or misdemeanor, arrests and convictions, to the Senior Associate Dean for Student Affairs and Admissions.

UNLV School of Medicine shall retain primary jurisdiction with respect to allegations or academic misconduct by its students but reserves the right to refer a student to the UNLV Academic Misconduct process if extenuating circumstances require it.

Criminal Background Checks

Applicants:

Applicants must meet the legal standards to be licensed to practice medicine in the State of Nevada. Students must acknowledge and provide written explanation of any misdemeanor or felony offense or disciplinary action taken against them prior to matriculation. As a condition of final acceptance to the UNLV School of Medicine students must provide the results of a criminal background check through the AMCAS Certiphi process. Applicants who receive a conditional acceptance to the UNLV School of Medicine are required to authorize the background check as soon as they receive notification of the conditional acceptance. Failure to disclose prior or new offenses can lead to rescinding an offer of admission, disciplinary action or dismissal.

Payment and cost of applicant background checks: The UNLV School of Medicine will not pay or reimburse expenses related to background checks for accepted applicants. Students are required to pay for the costs of the background checks.

Medical Students:

UNLV School of Medicine has made every effort to minimize the number of times a student is required to undergo a background check. However, the medical school, on behalf of some hospitals and outpatient clinics may require students to submit to additional background checks and/or a fingerprint-based background check. Students are required to submit to these additional requirements to obtain clearance to be permitted to complete required educational rotations and experiences in that facility or at that institution. Students who do not submit to fingerprinting or who fail to meet the background check requirements for institutions or facilities may be unable to fulfill academic requirements and may be dismissed from the UNLV School of Medicine.

Payment and cost of student background checks: The UNLV School of Medicine will not pay or reimburse expenses related to background checks for medical students.

Medical students must continue to meet the legal standards to be licensed to practice medicine in the State of Nevada. Should a student be arrested or convicted of any misdemeanor or felony offense while in medical school, he/she agrees to notify the Senior Associate Dean for Student Affairs and Admissions within seven days as to the nature of the incident. Failure to disclose prior or new offenses can lead to disciplinary action or dismissal.

Drug Testing

Medical students may be screened for drug use when transitioning to, or working in a patient care environments, and/or as required by clinical partners of the UNLV School of Medicine.

Medical students may also be administered a drug test when a supervising faculty member or staff, after consultation with designated campus drug and alcohol specialists, concludes that it is likely the student has engaged in the inappropriate use of controlled or prescription substances, including overuse of alcohol. This conclusion may be based upon observed behavior or physical symptoms, including that the student appears to be under the influence of alcohol or drugs; a pattern of abnormal or erratic behavior; information provided by credible sources regarding the students use of mind-altering substances; or evidence the student tampered with a previously administered drug test. All medical students tested due to this provision shall be removed from patient care and clinical services pending the results and review of further testing.

Testing Process:

When testing is required to be administered as a condition of clinical placement, the UNLV School of Medicine will use Certiphi. Those testing procedures will be communicated to students prior to the Transition to Clerkships course. Medical students will be responsible for the costs of drug testing to meeting clinical placement requirements.

When testing is required due to a concern about the inappropriate use of a controlled or prescription substance, including the overuse of alcohol, a local physician testing and diversion program process will be used. The School of Medicine will be responsible for the costs of drug testing due to a concern about inappropriate use.

Results: A report will be sent to the Senior Associate Dean for Student Affairs and Admissions. The Office of Admissions and Student Affairs will maintain a record that students have complied with testing requirements. These records are not part of the student's permanent file and will be destroyed upon the student's graduation from medical school. Only negative test reports will be shared with clinical affiliates. If a student receives a positive result, it will be forwarded to the Senior Associate Dean for Student Affairs and Admissions and the Medical Student Progress Committee for further review and action.

School Action: The Medical Student Progress Committee may require the student to appear for further review of the positive result, discussion, and recommendations to ensure patient safety and student health and wellness.

Return to Medical School: Students will be required to complete a Medical Clearance and a Fitness to Participate in the Academic and Clinical Program of Studies Evaluation prior to returning to the curriculum.

Guidelines for Dress and Deportment

Physicians need to present themselves in a manner that complements ability and demonstrates trustworthiness, sensitivity, compassion, integrity and professionalism. The following guidelines regarding dress and deportment are provided to give structure and guidance to students beginning the process of development as a medical professional. These guidelines are not intended to dictate student dress nor suppress individual expression or personal preference. These guidelines reflect patient expectations and comfort in their professional interactions with medical students and physicians.

  1. Students are expected to be clean, well groomed, and dressed in a manner consistent to their responsibilities.
  2. Professional Dress: Professional dress is expected in all interactions with patients and standardized patients, as well as in evaluations conducted in the Clinical Education and Assessment Center.
  3. Casual Clothing: Clean, comfortable clothing permitting participation in appropriate non-patient care activities, and not involving faculty or students from other professional institutions or settings, in which medical students are guests.
  4. Scrub clothing: Scrubs may be worn in appropriate settings (i.e., anatomy lab, lounge, and student study spaces). Scrub suits may not be worn in the lecture hall or small-group learning classrooms unless otherwise specified.
  5. White Coat: UNLV School of Medicine provided white coats should be worn in all settings in which patients simulated or otherwise, are encountered. White coats should be clean and pressed at all times.
  6. Identification Badge: An identification badge consists of the student's ID with name and school logo. It must be easily visible at all times. Name badges must be worn above the waist and must not be altered or defaced in any way. Patients and their families must be able to identify first and last names by looking at the name badge.
  7. Accessories / Jewelry: Minimal jewelry or accessories is encouraged. Students should be mindful of jewelry, which may come into contact with patients in the clinical setting (rings, bracelets, necklaces). Jewelry should be worn in a manner that does not interfere with patient care or personal and patient safety. Jewelry expressing political preference or social policy is not permitted.
  8. Ear piercings: Ear piercings are acceptable but other visible body piercing is discouraged.
  9. Tattoos and body art: Tattoos and body art should be covered to the extent possible when working with patients and staff.
  10. Hats and head coverings: Hats and head coverings are generally not permitted unless required. Exceptions may be made for religious or health-related reasons.
  11. Grooming: Students are expected to be clean, well groomed and dressed in a manner appropriate to their responsibilities.
  12. Scented products: The use of scented products is discouraged in consideration of patients, their families, and co-workerssensitivities or allergies.
  13. Hair: Hair must be controlled in such a manner as to prevent it from touching patients or requiring frequent repositioning.
  14. Facial Hair: Facial hair should be neatly groomed.

Student Representation on School of Medicine Committees and Class Leadership

Medical students are important members of several UNLV School of Medicine committees. These include the:

  • Curriculum Committee (second and fourth-year students)
  • Medical Student Admissions Committee (second and fourth-year students)
  • Medical Student Progress Committee (second and fourth-year students)

Medical student representatives and leaders are held to the same conduct and professional standards at all times while representing medical students. This includes the importance of maintaining confidentiality regarding all issues discussed and decisions made as part of the work of the medical school committee. Student representatives will complete required training, including FERPA, as well as completing non-disclosure and confidentiality training, which will include signed agreements.

Additionally, there are numerous student organizations as well as affinity groups promoting the understanding of various medical specialties, student interests, and opportunities available for students.

Class elections will be held each year where students will choose their representatives to University Committees as well as representatives to the Association of American Medical Colleges Organization of Student Representatives (OSR). Students also will select leadership for other student groups. Complete information on class elections and offers positions is found in Section 5: Governance.