Professionalism and Community Standards Policy

Rationale

The Brody School of Medicine (BSOM) highly values professionalism as a core competency in the practice of medicine. BSOM expects learners to demonstrate the highest level of professional and personal behavior, to conduct themselves honorably and responsibly, and to model and encourage professional behavior within the BSOM community. BSOM has a duty to support professional behavior and the development of a strong professional identity, and to educate and nurture students to ensure their professional development, performance, and success. BSOM also has a duty to identify unprofessional behavior, and, when necessary, to address unprofessional or inappropriate behavior.

Scope

This policy applies to the conduct of all learners within the BSOM undergraduate medical curriculum. The purpose of the policy is to provide mechanisms to (1) support and promote professional conduct; (2) ensure that unprofessional conduct is tracked and addressed; (3) provide a specific unified process to address and respond to unprofessional conduct; and (4) create a committee representative of the BSOM community to foster sound professional conduct. This policy operates in parallel to policies governing the year-appropriate Review and Promotion Committees; Review and Promotion Committees manage academic progression, while this policy manages student professional behavior. This policy also is informed by the following BSOM policies:

• BSOM Code of Student Conduct
• BSOM Code of Conduct
• BSOM Code of Professional Conduct
• ECU Student Conduct Process
• ECU Academic Integrity Policy

This policy is limited to professional conduct after matriculation at Brody School of Medicine.

Policy

All professionalism concerns should be reported to the Professionalism and Community Standards Committee (“the Committee”) through a professionalism concern process. The Committee is responsible for creating a single, unified longitudinal record of all professionalism issues brought to the Committee, whether those issues are resolved by informal one-on-one counseling, by a Review and Promotion Committee, by the Professional Conduct Committee, or by the Professionalism and Community Standards Committee.

The Committee is also charged with addressing any and all professionalism concerns which are brought before the Committee and which are not more appropriately referred to either the appropriate legal authority, BSOM Professional Conduct Committee, the ECU Student Conduct Board, the ECU Academic Integrity Board, or the year-appropriate Review and Promotion Committee. The Committee is charged with following all of the policies and procedures herein in order to resolve professionalism concerns. The Committee shall report annually to the executive Dean.

While this policy is intended to create a unified pathway for addressing professionalism concerns, nothing in this policy restricts anyone from filing a concern under BSOM’s Code of Student Conduct, ECU’s Code of Student Conduct, and/or ECU’s Academic Integrity Policy.

Definitions

For purposes of this policy, the following definitions shall apply:

BSOM Professional Conduct Committee – The committee appointed by the Dean to conduct hearings concerning violations of the BSOM Code of Student Conduct.

Office of Student Rights and Responsibilities (OSRR)—The Office on campus that administers the University-wide Student Conduct Process. OSRR also, in consultation with applicable faculty members, coordinates and follows the Academic Integrity process to address student academic integrity violations.

BSOM Professionalism and Community Standards Committee (“the Committee”) – A committee established by this policy to monitor and hear professional concerns and to implement this policy. The committee will consist of two basic sciences faculty members, a clinical faculty member, a clinical clerkship coordinator, a clinical clerkship director, and a medical student from each of the M2-M4 classes. Students serving on the committee shall recuse themselves and shall not be involved in any concern involving a student in their medical school class. Alternate committee members for each of these voting positions will also be designated. These members will attend each meeting as non-voting, resource members for committee deliberations. However, if a corresponding voting member is absent, the alternate will be empowered to vote in their stead.

Composition

Members of the committee shall meet the following qualifications:

1. Faculty Committee Members (4 voting, 4 alternate) – Although not required, preference will be given to those faculty members who are not responsible for assigning final grades in a course or clerkship (with the exception of the clinical course director member).
2. Student Committee Members (3 voting, 3 alternate) – Student committee members must be in good academic standing as defined by BSOM’s standard operating procedures.
3. Clinical Clerkship Coordinator Member (1 voting, 1 alternate) – The clinical clerkship coordinator member must be a current clinical clerkship coordinator.
4. Overall Committee Composition – In compliance with the University’s Notice of Nondiscrimination, members will be selected regardless of race, religion, color, national origin, religion, ethnicity, sex (including pregnancy and pregnancy related conditions), gender identity or expression, sexual orientation, age, political affiliation, veteran status (including relationship or association with a protected veteran; or active duty or National Guard service), genetic information, or disability.

If any committee member resigns or becomes ineligible to serve, the executive dean shall appoint a replacement member who meets the qualifications above as soon as practicable.

The assembled committee will elect a chair from the faculty members of the committee.The chair will set the agenda and lead each meeting. The chair will serve in this role until relinquished or their term expires. Furthermore, the chair will have the opportunity to vote only in the case of a tie.

Selection

Faculty/staff committee and alternate members shall be appointed by the executive dean to serve staggered three-year terms from the pool of faculty and staff who express interest in committee membership. In order to create these staggered terms, the initial class of faculty/staff members for the 2022-2023 term shall include one basic science faculty member and the clerkship coordinator member to be appointed to 2-year terms while all other faculty committee members will be appointed to 3-year terms.

All subsequent terms will be 3-year terms. Student committee and alternate members shall be appointed by the executive dean from a slate of interested students proposed by the Medical Student Council (MSC). For the initial 2022-2023 term, a student will be appointed from each of the M2, M3, and M4 classes. After the initial term, students will serve throughout their medical school career, with a new M2 member, and an alternate, being appointed each year.

Recusal

Committee members shall be recused from hearing and participating in the deliberations in the following scenarios:

1. No student committee member shall hear or participate in deliberations concerning students in their medical school class (i.e., the M2 student committee member shall not participate in cases involving an M2 student).
2. No committee member shall hear or participate in deliberations concerning any matter in which they were directly involved or about which they have direct knowledge.
3. No faculty committee member shall hear or participate in deliberations concerning cases arising in their own course or clerkship.
4. No committee member shall hear or participate in deliberations regarding a matter in which they have an actual or perceived conflict of interest and are unable to be objective. Conflicts may include close platonic, romantic, or familial relationships, financial relationships, or other facts giving rise to a conflict of interest.

Unprofessional Conduct

Conduct which violates the community standards of BSOM, including but not limited to the following:

General Behaviors

• Tardiness or unexcused absences to required learning events.
• Acts of dishonesty, including but not limited to cheating, plagiarism, or other forms of academic dishonesty.
• Lying or misrepresentation.
• Communicating in writing, via email, or in person in an unprofessional manner, including failing to timely respond to requests for information from BSOM faculty and staff.
• Verbal and/or physical abuse, threats, intimidation, harassment, coercion and/or other conduct which threatens or endangers the health or safety of any person.
• Excessive and distracting cell phone usage during small group meetings, clinical rounds, or other settings.
• Repeated failure to prepare for, engage in, or participate in clinical rounds, small group or problem-based learning (PBL) sessions, or other settings in which participation is integral to the educational experience.
• Disorderly, lewd or indecent conduct; or conduct or disruptive language directed toward and offensive to a member of or a visitor to the BSOM community
• Breach of peace; or aiding, abetting or procuring another person to breach the peace on BSOM premises or at functions sponsored by, or participated in by, the BSOM.
• Furnishing false information to any BSOM official, faculty member or office with intent to deceive.
• Forging, altering, or misusing any BSOM document, record, or instrument of identification.
• Submitting falsified ballots in an election of any BSOM recognized student organization or class election
• Disruption or obstruction of teaching, research, administration, disciplinary proceedings, or other BSOM activities.
• Posting of confidential faculty, staff, student or patient information on personal websites or blogs.
• Attempted or actual theft or receipt of stolen property and/or damage to property of the BSOM community or other personal or public property.
• Theft or other abuse of computer time, including but not limited to:
  • unauthorized entry into a file, to use, read or change the contents, or for any other purpose.
  • unauthorized transfer of a file.
  • unauthorized use of another individual’s identification and password.
  • use of computing facilities to interfere with the work of another student, faculty member or BSOM official.
  • use of computing facilities to send obscene or abusive messages.
  • use of computing facilities to interfere with normal operation of the BSOM computing system.
  • any other violation of the University Student and Employee Computer Use Regulation.
• Failure to comply with directions of BSOM Security, ECU Security personnel or law enforcement officers acting in performance of their duties.
• Unauthorized possession, duplication or use of keys to any BSOM premises or unauthorized entry to or use of BSOM premises.
• Violation of published BSOM and/or ECU policies, rules or regulations.
• Failing to:
  • Dress professionally by adhering to the BSOM dress code.
  • Maintain composure and professional demeanor, as appropriate.
  • Conduct themselves in a trustworthy manner.
  • Inform attending physicians/course directors/clerkship directors or others of anything that would interfere with the performance of their duties.
  • Complete responsibilities, whether clinical or academic, in a timely manner.
• Failing to comply with any other provision of BSOM’s Code of Student Conduct, Code of Conduct, or Code of Professional Conduct.

Clinical Behaviors

• With regard to patient care, refusing to admit errors in patient care, failing to seek guidance when needed in the performance of one’s clinical duties, and failing to adhere to the highest ethical standards.
• Being rude or disrespectful to patients, team members, and others.
• Being habitually tardy to classes, clerkships, rotations, or other mandatory activities.
• Engaging in unprofessional or inappropriate relationships with patients, as defined by the North Carolina Medical Board’s Position Statement 2.2.
• Showing lack of respect for patient confidentiality and privacy, particularly with regard to HIPAA-protected information.
• Failing to complete patient notes or other care-related responsibilities in a timely and thorough manner.

Regulated Behaviors

• Violation of any law or regulation, state or federal.
• Illegal use, possession, manufacture, sale, or distribution of narcotic or other controlled substances.
• Independently writing and signing a prescription for any medication without a medical license or without authorization.
• Illegal or unauthorized possession of firearms, explosives, other weapons, or dangerous chemicals on BSOM premises.

Professionalism Alert

A form submitted through the online concern system to report more minor concerns (e.g., tardy for mandatory session). These should be concerns that, in isolation, do not constitute a serious concern. However, the committee can detect when a pattern of these concerns arises, leading to a written warning after 4 alerts and a professionalism meeting after 7 alerts, and after every 4 additional alerts thereafter. Seven or more alerts in an academic year shall be be considered a professionalism concern.

Professionalism Concern

A form submitted through the online concern system to report either professionalism counseling completed or to report unprofessional conduct to be addressed by the committee. Professionalism concerns that reflect completed counseling are resolved professionalism concerns while professionalism concerns reported to the committee for resolution are unresolved professionalism concerns.

Professionalism Counseling

Counseling completed by a faculty member, course director, course coordinator, or administratorto address unprofessional conduct and to educate the learner with regard to ethical and professional standards.

Professionalism Meeting

A meeting between the learner and the Committee to address the professionalism concern and the circumstances surrounding it. Professionalism meetings will be held every two weeks, unless the Committee determines that a more urgent meeting is required.

Office of Student Affairs (OSA)

The Office of Student Affairs at BSOM is responsible for keeping records of professionalism concerns reported to the Committee. Professionalism concerns may also be referred to OSA for professionalism counseling. The Associate Dean(s) for Student Affairs sits on the Committee in an ex officio capacity.

Community Standards Review

Every professionalism concern submitted to the Committee shall be reviewed by the Committee and recorded. Resolved concerns will simply be acknowledged and recorded with email notice sent to the interested parties. Unresolved concerns shall be reviewed in accordance with the procedure defined in this policy and recorded.

Professionalism concerns are recorded only for the deliberations of the Committee – to track and address unprofessional conduct in a systematic way to improve student education on professionalism issues – and will not become part of the student’s permanent medical school record, unless the concern results in such a sanction being imposed through referral to a BSOM Professional Conduct Committee or to the University-wide student conduct process. These sanctions from other entities could lead to a comment in the student’s MSPE.

Student Supporter

Any learner coming before the Committee may be accompanied by a BSOM faculty member, staff member, or fellow student as a supporter. The student supporter may simply provide moral or emotional support or may participate in the discussion with the Committee. The student supporter may provide insight into the student, into the context of the concern, or into religious, cultural, social, or other factors which may have impacted the concern but might not otherwise have been apparent to the Committee.

Procedure

Overview

The procedures adopted by this policy are designed to accomplish three primary policy goals: (1) to address unprofessional conduct early, promptly, and effectively; (2) to provide a primary mechanism to monitor unprofessional conduct to promote early intervention; and (3) to educate students and improve their professional identity and professional interactions with others. To that end, it is the expectation of this policy that most initial professionalism concerns will be addressed and reported by observing faculty, course or clerkship directors, course coordinators, or other clinical personnel.

Professionalism Alerts Process

Prior to each meeting, professionalism alerts in the online reporting system will be reviewed by the committee chair, or other committee member as needed. When a student has 4 or more professionalism alerts for the academic year (M1: July to June; M2: July to March; M3: April to March; M4 April to commencement), they will receive written notice from the Committee. When a student has 7 or more professionalism alerts, this constitutes a professionalism concern, and the student will meet with the Committee. For every 4 professionalism alerts in an academic year following a meeting with the Committee, a student will meet again with the Committee for review. At any time, if the Committee has concerns regarding the details of a professionalism alert, they may ask a student to meet with the Committee.

Resolved Concern Process

When any faculty or staff member or BSOM committee addresses unprofessional conduct by conducting professionalism counseling or imposing any other requirement, that action shall be reported to the Committee by submitting a resolved concern form through the online concern system. At each meeting of the Committee, the resolved professionalism concern will be noted and recorded with email notice sent to the interested parties. No further action will be taken unless requested by the reporting entity.

Nothing in this policy should be construed as deterring or prohibiting any appropriate faculty or staff member or BSOM committee from promptly addressing professionalism concerns.

Unresolved Concern Process

Any person* or BSOM Committee who personally observes or receives credible evidence of the unprofessional conduct of a BSOM learner may file a professionalism concern with the Committee. When any person or committee identifies unprofessional conduct as defined by this policy and that conduct (1) has not been resolved by initial counseling or (2) is identified as too serious for professionalism counseling alone, an unresolved professionalism concern shall be filed through the online reporting system. Concerns filed by third parties, such as patients, nurses, or others shall also result in an unresolved professionalism concern.

1. The substance of the concern shall be communicated to the learner within one (1) calendar week of the concern. The learner then shall have one (1) calendar week from receipt of the concern to respond in writing and provide any additional information.
2. The concern shall be received and reviewed by the Committee at the next meeting following submission of the concern.
3. Based upon the information received, the Committee shall decide whether the concern shall be resolved by the Committee or referred to another entity for resolution. The Committee may determine the process (meeting, email, Teams meeting, etc.) by which this decision is made. In making this determination, the Committee shall be guided by the following considerations:
   1. Whether the conduct is repeated despite prior counseling.
   2. Whether the conduct has been previously sanctioned in any way.
   3. Whether the conduct involves violation of a law or regulations, such as HIPAA.
   4. Whether the conduct involves academic integrity which could have grade consequences.
   5. Whether the learner has more than 7 professionalism alerts or concerns (whether resolved or unresolved) filed with the Committee.
4. If the Committee determines that the matter should be more appropriately referred to another entity for resolution, the Committee will refer the matter and notify the learner. Any referral should be completed and communicated to the learner within one (1) calendar week of the Committee’s decision to refer.
5. If the Committee determines that the matter should be resolved by the Committee, the Committee shall schedule the student for a professionalism meeting at its next scheduled meeting contingent upon the learner’s availability, unless the Committee determines that the matter is sufficiently urgent that a special meeting is needed.
6. The professionalism meeting is intended to be informal and conversational in nature. The student shall have an opportunity to respond to the concern, to provide context for their actions, and to explain any mitigating factors. The learner may choose to be accompanied by a student supporter who may participate in the discussion.
   1. If the learner denies that the conduct occurred, the Committee must determine in private whether the conduct occurred, based upon a preponderance of the evidence.
   2. If the learner admits that the conduct occurred, the Committee and the learner will discuss the conduct in question and the professionalism ramifications of the conduct.
7. If the Committee determines that the conduct did not occur, the matter shall be resolved with no further action. The concern will be treated as a nullity.
8. The learner shall be informed of the Committee’s final resolution of their case within one (1) calendar week of the professionalism meeting.
9. All decisions of the Committee must be made by a majority vote of a quorum of the committee. A quorum consists of no less than five (5) committee members.
10. The deadlines addressed in this unresolved concern process may be extended by the Committee when there are extenuating circumstances.

* – Although “any person” as defined above may file a professionalism concern, it is anticipated that most concerns will be made by those interacting with students in academic or clinical settings, such as professors, coordinators, clinicians, nurses, students, other care team members, and staff.

Penalties/Consequences/Referrals

When the unprofessional conduct is admitted by the learner or found by the Committee, the learner will then have an opportunity to suggest and/or discuss an appropriate resolution. The Committee could consider at least the following resolutions and may choose to impose more than one based upon the facts of the case:

1. Referral to the Office of Student Affairs for professionalism counseling.
2. Required online professionalism training through modules or other online learning activities.
3. Assignment of a faculty professionalism mentor.
4. Assignment of a peer or resident professionalism mentor. Peer professionalism mentors may not be members of the student’s medical school class.
5. Assignment of a short paper on professionalism, particularly as it relates to the conduct in question.
6. Assignment to communication skills training.

More serious sanctions, such as suspension or dismissal from BSOM, would require that the entire matter be referred to the BSOM Professional Conduct Committee, OSRR, or other appropriate University Office.

Procedures for Implementation and Review

This policy will be reviewed and approved by the Executive Academic Committee (EAC) every three years.

This policy will be disseminated by the Office of Student Affairs to learnersand teaching faculty/administration during orientation each year.

Related Policies

• Assessment System: Assessment Creation and Implementation SOP
• Assessment System: Make-up Examinations SOP
• Assessment System: Foundational Phase Quiz Grading SOP
• Student Review and Promotion SOP
• Attendance Policy SOP
• USMLE Testing Policy SOP
• Academic Achievement Program SOP
• ECU Student Conduct Process
• ECU Academic Integrity Policy

Applicable Laws, Regulations & Standards

LCME Standard 3.5 (Professionalism)