The following section presents principles of professional behavior relevant to medical students. Students should take this opportunity to review the Honor Code that they signed when they started medical school as well as the competencies of Professional Behavior listed in the Outcome Objectives of the MD Program in Section 2. Achieving these competencies will affect your clinical grades and MSPE. In addition, the administration and faculty of have approved the principles expressed below. We expect these principles to be positive examples that define professional behavior and provide guidelines for the growth and behavior of medical students. Students who violate any of these principles can be subject to disciplinary action including dismissal from has adopted the following from “Recommendations and Guidelines for Students” from the Organization of Student Representatives of the Association of American Medical Colleges.
Students are expected to demonstrate dedication to acquiring knowledge, skills, both cognitive and non-cognitive, and attitudes necessary to provide competent medical care. Students are expected to be responsible for their medical education and take an active role in the planning of their medical education. 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.
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.
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.
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.
Despite fatigue, professional stress or personal problems, students should strive to maintain composure. The student should seek supportive services when appropriate.
Misrepresentation:
A student should accurately represent herself or himself to patients and others on the medical team. Students must never introduce themselves as “Doctor” as this is clearly a misrepresentation of the student’s position, knowledge and authority.
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.
Consultation:
Students should seek consultation and supervision whenever their care of a patient may be inadequate because of lack of knowledge and/or experience.
Conflict of Interests:
When a conflict of interest arises the welfare of the patient must at all times are 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. Student interactions with Commercial interests should conform to the American Medical Association (AMA) guidelines.
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. 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.
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.
Criticism of Colleagues:
It is unethical and harmful for a student to disparage without good evidence the professional competence, knowledge, qualification or services of a colleague to a review (judicial) body, staff, students or a patient. It is also unethical to imply by word, gesture or deed that a patient has been poorly managed or mistreated by a colleague without tangible evidence.
The medical student will deal with professional, staff and peer members of the health team in a cooperative and considerate manner
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 co-workers 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 acknowledgement is unacceptable in scientific literature.
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.
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.
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 representative.
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.
Medical students who fail to maintain the highest degree of personal and professional integrity or whose behavior is not in keeping with achieving both cognitive and non-cognitive skills will be subject to review, disciplinary action and possible dismissal from the College of Physicians and Surgeons.
Violations of these standards are considered to be very serious breaches of professional conduct. Examples of such violations include substance abuse, harassment of patients, faculty, staff or other students, breach of patient confidentiality, falsification of records, unexcused absence, refusal to participate in the care of a patient, and abuse of civil law, hospital rules and University rules governing conduct. Examples of abuse of civil law include sexual harassment, assault, or any other unprofessional behavior.
Students must obey all civil laws at all times. Behavior both inside and outside the institution will be held to the same high standards.
Students shall be punctual, reliable and conscientious in fulfilling their professional duties, including attendance at lectures, examinations and all parts of all clinical clerkships.
GUIDELINES FOR STUDENTS DURING PATIENT ENCOUNTERS
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Patients Rights |
Students’ Code of Conduct |
Behavioral Examples |
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The patient has a right to know who the provider of care is. |
The student should dress professionally, wear a name tag (specifying name and medical student) and introduce him/herself. |
Unless told otherwise, the patient will assume the provider is a physician. |
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The patient has the right to be addressed by his or her name. |
The student should address the adult patient by the surname, the child by the first name. The student may also address adult patients by Ms. or Sir. |
Do not use patronizing titles, e.g., grandpa, mom, dear, cutie, etc. |
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The patient has a right to know what to expect during the interview and to refuse to answer questions. |
The student should preface questions about sensitive issues. |
e.g., "I need to ask you certain questions about..." |
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The patient has the right to be interviewed and examined in a comfortable, professional environment. |
The student should appear respectful and empathic. |
Put patient at ease. Watch your body language: sit down, appear relaxed and talk to patient at eye level. Avoid threatening behaviors such as hovering or staring. Avoid casual touching, e.g., hands on back or shoulder of patient. |
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The patient has a right to know what to expect during the physical examination and to refuse to be examined. |
It should be explained to the patient what part of the body will be examined (before undressing). |
No peeking techniques, e.g., pulling up bra to examine heart . No surprises. Always warn: “I will now examine your groin area for lymph nodes.” |
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The patient has a right to modesty. |
The patient should be given a gown and privacy to undress. |
Do not undress or help undress patient, regardless of age. |
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The patient has a right to a Chaperoned examination. |
All exams must be chaperoned. |
e.g., “Do you want your mother or relative in the room while I examine you?” Be particularly careful when examining children and teenagers. |