The Faculty of Medicine reserves the right to dismiss or to deny admission, registration, readmission, or graduation to any student who in the judgment of the Faculty of Medicine is determined to be unsuited for the study or practice of Medicine.
A student charged with a disciplinary infraction subject to “Dean’s Discipline” is entitled to notice of the charges, an opportunity to be heard and an opportunity to appeal a disciplinary decision to the Dean of the College of Physicians and Surgeons*.
Ordinarily, a disciplinary proceeding begins with a written communication from the Office of the Dean of Students requiring the student to attend a disciplinary hearing to respond to a specified charge. (In rare cases, the proceeding may begin with an oral communication requiring the presence of the student at a hearing.) The hearing is held before the Senior Associate Dean for Student Affairs and two other members of the Faculty of the College of Physicians and Surgeons, appointed by the Dean of the College of Physicians and Surgeons. The hearing is a fact-finding, not an adversarial courtroom-type, proceeding; the student need not be present to hear other witnesses and there is no formal cross examination of witnesses or objecting to evidence. In addition, although students are always free to consult an attorney, they may not have an attorney present during a disciplinary hearing or at any appeal.
The student is informed of the evidence that led to the charges against him or her and asked to respond. The student may offer his or her own evidence. This includes the student’s own appearance at the hearing and may include the appearance by others (witnesses) on his or her behalf and any written submission or relevant documents the student may wish to submit.
After the Office of the Dean of Students has heard the student and others and considered all the evidence, it reaches a determination and notifies the student in writing of that decision. If the student is found to have committed a disciplinary infraction, the penalty can include censure, probation, suspension and dismissal.
The student has the right to appeal a decision that results from a disciplinary hearing to the Dean of the College of Physicians and Surgeons and Executive Committee of the Faculty Council. The appeal must be made in writing within seven days of the time he or she is notified of the decision, and it must clearly state the grounds for appeal. Such appeal should be sent to the Dean at P&S 2-401.
Normally, on such an appeal, the Dean of the College of Physicians and Surgeons relies solely upon the written record and does not conduct a new factual investigation. Moreover, the Dean focuses upon whether, in the Dean’s view, the decision made and the discipline imposed are reasonable under all of the circumstances of the case. There is no further appeal within the University.
*The University-wide Rules of University Conduct govern conduct incident to demonstrations, rallies and picketing and may displace “Dean’s Discipline” in cases of serious violations.
The federal government has issued regulations that provide for confidentiality in the handling of protected health information. These regulations govern how patient information is managed by everyone in the health care field, including hospitals, billing offices, clinical research laboratories, and anyone else who might have access to this confidential material, including students. The regulations govern behavior in the hospital, in clinics, in physicians’ offices, and clinical and research laboratories.
An education program is in place for all Columbia physicians, students and staff to bring the University into compliance with the new regulations. Students must comply with these regulations.
As members of the Columbia community all must comply with the University’s computer and network use policy. Copying, storing, displaying or distributing copyrighted material using University systems or networks without the express permission of the copyright owner, except as otherwise allowed under the copyright law, is prohibited. Under the Federal Digital Millenium Copyright Act of 1998, infringements of copyright by a user can result in termination of the user’s access to University systems and networks.
Bandwidth consumption that file sharing programs exert draws on the Columbia University Medical Center network. The network’s goal is to serve the needs of the hospital, research and teaching. One of the major systems used by the hospital is WebCIS (Web-based clinical information system). It is a sophisticated clinical repository browser with capabilities to store and display information from a multitude of departments. This program plays an integral role in the delivery of excellent health care. An increase in network congestion inevitably results in a delay in the delivery of patient care.
This frustration is also felt by the research and teaching departments. They depend on an unhindered network connectivity to conduct everything from scientific data searches to the running of video conferencing. Not only is one compromising the security of their own computer as well as increasing the vulnerability of the university network to hackers, but the act of file sharing copyrighted material from unauthorized sources is unethical and against the law. Breach of Columbia University policy will result in immediate disconnection of the I.P. of the offending party. A second such offense may result in termination of matriculation.
Each third year student is assigned an individual confidential access code permitting access to clinical data, as well as library resources and administrative information, from work stations throughout the hospital and medical school.
Third year students have complete, although audited, access to all clinical data. Students’ ability to access this confidential information is a privilege granted to them in order to provide good patient care in the least intrusive, most effective manner. Utilization of this privilege to access this information for any other reason is a breach of ethical conduct and is illegal.
This is true of all patient information whether or not the patient has a special relationship to the institution, as often indicated on computer screens, and regardless of the source of the patient information, e.g., charts, x-rays, lab data, computer prints, etc.
There is a specific computer screen which appears when an individual attempts to access information of an individual who has a special relationship to the institution. That screen must be overridden to continue in the quest of information. If an individual overrides that screen without the need to know, they have breached the privilege granted them.
When a student is provided with an access code for the patient information system, they sign a legal document that states they will use this information only to provide patient care and in the context of the need to know. Any attempt to access patient information without the need to know will be dealt with severely, including termination of matriculation at the College of Physicians and Surgeons.
A pregnant medical student should perform all normal duties during her clinical rotations with the following provisions:
Medical Sales Representatives are defined as vendors’ representatives who promote pharmaceutical products or medical supplies or equipment, often referred to as “pharmaceutical detail people”. To do business with New York-Presbyterian Hospital MSR’s must register with the Purchasing Department located at 333 East 38th Street.
As students will encounter patients from diverse groups, their personal appearance becomes an important part in establishing rapport with each patient. Therefore, the therapeutic alliance must be secured before initial verbal interaction has occurred. Student/physicians should place the patient’s needs first even if this necessitates curtailing some aspects of one’s individual expression.
The principle, “first do no harm,” is the basis for control of scrub suit use. As blue scrub suits are worn near patients, they must never be the vehicle of infection for a patient. The only way to assure infection is not carried to patients is to restrict use of blue scrub suits to contiguous areas of direct patient care, i.e., in hospital patient care units.
Blue scrub suits are therefore permitted only in these direct patient care areas.
All student I.D. badges must carry the term “Medical Student” in prominent letters, and the badge must be worn in a visible site.
Attendings and residents must introduce the student to a patient as a medical student (e.g., “This is John Doe, your medical student”), and the student is to introduce himself or herself similarly.
The Faculty of the College of Physicians and Surgeons has reaffirmed that all students take care of all patients and that providing care is in the normal course of their education.
The Faculty upholds the principle that no physician or physician-to-be, can refuse to treat, or participate in the treatment of a patient with any special disease. Refusal to participate in the treatment of a patient with a special disease will invariably lead to an administrative review of the possible reasons (and there will be few) for refusal and is likely to lead to termination of the student’s matriculation at the College of Physicians and Surgeons. All students must observe all existing guidelines for precautions to be observed in the care of patients.
Limiting required duty hours does not imply that medical students must cease providing essential patient care services at arbitrary cut-off times. Priority must always be given to patient safety and well-being and to avoiding transferring patient care responsibilities to others at inappropriate times in the continuum of care (e.g., during an operative procedure, in the midst of a rapidly evolving clinical event). A tired medical student who is intimately familiar with a sick patient is often better able to provide quality care than is a fully rested medical student who is unfamiliar with the details of the case.
Taken from:AAMC Policy Guidance on Graduate Medical Education- Assuring Quality Patient Care and Quality Education and adapted for medical students.
The following policies and procedures governing faculty and staff conduct in the teacher-learner relationship have been adopted by the Executive Committee of the Faculty Council in accordance with the new accreditation requirement of the Liaison Committee on Accreditation of Medical Education. They are in three parts: (I) Standards for Conduct in the Teacher-Learner Relationship; (II) Procedures for Reporting and Investigating Violations; and (III) Requirements for Dissemination and Education.
As a medical school which trains women and men who will be entrusted with the lives and well being of others, P&S is aware that it bears a special responsibility to assure that it’s students learn in an environment that fosters mutual respect and the values of professionalism, ethics and humanism in the practice of medicine. An environment conducive to learning requires that faculty, students and administrative and support staff treat each other with civility. The members of the faculty, however, bear special responsibility to assure that students are treated fairly and with respect in all settings where students are educated: the classroom, the laboratory, on patient rounds, at the bedside, in the operating room. Whether they wish to or not, faculty are the individuals on whom students model their own behavior. In addition, they often hold the key to students’ career advancement through their control of student evaluations and references.
Special care must be taken by faculty not to abuse the authority they exercise in the educational setting, to treat all students fairly, and to avoid exploiting or appearing to exploit their students. The quality and worth of a Columbia medical education rests not only in the excellence of the content and the skills that are taught, but in the examples provided of humane and ethical physicians and scientists who respect their colleagues in health care delivery, patients and one another. There is no place in the College of Physicians and Surgeons for incivility, verbal or physical abuse, exploitation or mistreatment of students or one another. Personal humiliation and the use of psychological or physical punishment are unacceptable as teaching methods.
Increasingly, the CUMC community is a diverse body of faculty, students and staff, and it is the expectation of the College that everyone will carry out their responsibilities in a manner that is professional and respectful of this diversity. This expectation extends also to residents, nurses and other health professionals in the medical center who because of their roles in the delivery of health care participate in the process of educating future physicians.
The following are examples of behaviors that P&S considers unacceptable:
Students are also expected to be respectful of one another and of the faculty, staff and support staff that they encounter in the classroom and the clinical setting.
The following procedures apply to students enrolled in the MD program or in the MD/PhD program during their MD years. Students enrolled in other Schools and programs should refer to their Office of Student Affairs for information and direction. Students enrolled in the biomedical PhD program through the Graduate School of Arts and Sciences should follow the procedures established by that School which are available through the Office of Graduate Student Affairs.
P&S believes that the standards of appropriate conduct in the educational setting are generally respected and practiced throughout the Columbia University Medical Center and the College of Physicians and Surgeons. P&S recognizes, however, that there are occasions when the intensity and pace of study and work, and the differing expectations that members of it’s pluralistic, diverse community bring to their work and study, may lead to perceived or to real incidents of inappropriate behavior on the part of faculty towards students. When this happens, P&S is committed to establishing the facts through a fair process which respects the rights and confidentiality of the involved parties. This process will be the responsibility of a faculty Committee on Civility in the Learning Environment which will be chaired by a faculty member appointed by the Vice-President/Dean.
Students who wish to come forward and report inappropriate behavior on the part of a faculty or staff member may do so without fear of retaliation or reprisal, and with the assurance that complete confidentiality will be maintained unless the situation is such that there is a potential of immediate harm to the student or others.
In reporting such violations there are a number of avenues that students can follow.
Discriminatory Behavior, Sexual or Physical Harassment:Students who experience behavior they believe to be discriminatory, or who are the subjects of sexual or physical harassment should consult the University guidelines and procedures established for handling these complaints and contact the University offices designated to work with students on these issues. These guidelines and procedures are published annually in FACETS, the University’s Student Handbook, and can also be found on the Provost’s website. Students who wish to report other incidents of inappropriate behavior may do so to the Dean of Students; the Dean of Diversity and Minority Affairs; the Director of the Center for Student Wellness; the University Ombudsperson; a Special Advocate (see below) or to the Chair of the Committee on Civility in the Learning Environment.
The Committee will conduct its inquiry with fairness and with respect for the confidentiality of all parties. Its findings will be presented in the form of a written report to the student, the faculty member and the Dean who may refer it to the Executive Committee of the Faculty Council. Recommendations for appropriate action may be made consistent with Columbia University Policies and Statutes.
The Committee on Civility in the Learning Environment will also advise the Vice-President/Dean on any measures that, in their judgment, need to be taken to reinforce the standards of conduct.
P&S realizes that it is not enough to simply articulate a policy. That policy must be widely circulated to students, faculty and staff and reaffirmed and reinforced through continuing and continuous education in a number of venues.
All medical students will receive a copy of the Standard and Procedures upon registering and it will be discussed during orientation, class meetings and in the monthly meetings of student representatives with the Dean. The Standard and Procedures will be prominently posted, together with the names of the special advocates, on the websites and bulletin boards where students receive their information.
Each course director, clerkship director and residency director will be responsible for seeing that the Standard and Procedures are made known to their teaching faculty and to all students at the start of each course, clerkship or rotation. Chairmen and Directors will be responsible for seeing that the policy and procedures are known to their faculty and discussed at departmental/center meetings and that it is discussed at all orientations of ward attendings and house staff.
The Committee on Civility in the Learning Environment will be responsible for recommending to the Vice-President/Dean further steps to foster an environment conducive to learning. The Special Advocates will meet as a group periodically with the Vice-President/Dean to assess their experiences (with no discussion of specific cases) with a view to seeing whether any patterns or problems have emerged that may need to be addressed on a school-wide basis.
The School will continue to develop and foster educational programs as needed and as experience under this policy dictate.
Either the student or the faculty member may appeal the decision of the Dean to the Provost. Findings of fact, remedies granted the student and penalties imposed on the faculty member are all subject to appeal. A written appeal must be submitted to the Provost within 15 working days of the date of the letter informing them of the Dean’s decision.
Normally the Provost takes no longer than 30 working days to evaluate an appeal. The Provost usually confines his or her review to the written record but reserves the right to collect information in any manner that will help to make his or her decision on the appeal.
The Provost will inform both the student and the faculty member of his or her decision in writing. If the Provost decides that the faculty member should be dismissed for cause, the case is subject to further review according to the procedures in Section 75 of the University Statutes, as noted above. Otherwise, the decision of the Provost is final and not subject to further appeal.
| Patients’ Rights | Students’ Code of Conduct | Behavioral Examples |
|---|---|---|
| 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. |
| 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. |
| 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…” |
| 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. |
| 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 or Tanner staging. No surprises. Always warn: “I will now examine your groin area for lymph nodes.” |
| 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. |
| The patient has a right to a chaperoned examination. No female medical student may examine a male patient alone. No male medical student may examine a female patient alone. | All pelvic exams must be chaperoned. For all other examinations the patient should be asked if they would like someone else in the room. | e.g., “Do you want your mother or relative in the room while I examine you?” Be particularly careful when examining children and teenagers. |