Academic Regulations

Policies, statements and guidelines relevant to the MD Program and that apply to all University of Toronto medical students are available below.

These Academic Regulations are organized into five categories.  A keyword search is available. Students, faculty and staff are responsible for being aware of the relevant policies if and when a situation arises that requires familiarity with their content.

 

Titles with the following notations indicate documents from external sources. Links to websites hosting the policy documents are provided, along with short descriptive text:

* indicates a policy of the Governing Council of the University of Toronto
^ indicates a policy of the Temerty Faculty of Medicine
indicates a policy of an agency external to the University of Toronto

Academic Integrity

Code of behaviour on academic matters *

Code of behaviour on academic matters *

Students are responsible for being aware of all aspects of the University of Toronto's Code of Behaviour on Academic Matters, including understanding what constitutes a breach of academic integrity.

Please note that possession of an unauthorized aid on your person during an assessment is a breach of academic integrity, with the potential for academic penalties. This includes cell phones or other electronic devices, even if they are turned off.  Given that it is generally impossible to determine if a device has been used inappropriately when found in a student’s possession at the time of an assessment, action will always be taken when this occurs.

Further information and resources, including perils and pitfalls, strategies, and consequences, are available on the University’s academic integrity webpage

MD Program Academic Integrity Guidelines

MD Program Academic Integrity Guidelines

The MD Program’s academic integrity guidelines are informed by the University of Toronto’s Code of Behaviour on Academic Matters. Suspected breaches of academic integrity by MD students are addressed in accordance with the flow chart below.

Please note that the College of Physicians and Surgeons of Ontario (CPSO) and/or other provincial/territorial physician regulating bodies as well as the Canadian Resident Matching Service (CaRMS) have reporting requirements with respect to academic integrity, particularly in cases where a suspected breach of academic honesty during medical school has undergone a University-level investigation, inquiry  or proceeding (i.e. by a University Tribunal, as set out in the University of Toronto’s Code of Behaviour on Academic Matters).

MD Program Academic Integrity Guidelines PDF

* In this context, meeting with the student on a “without prejudice” basis means that nothing the student says in the meeting with the Course Director (or designate) may be used as evidence against the student should the matter go to a University Tribunal hearing. The Course Director’s account of the meeting can, however, be used to facilitate resolution at the level of the Curriculum Director or Associate Dean.

** In this context, meeting with the student on a “with prejudice” basis means that anything the student says in the meeting with the Curriculum Director or Associate Dean may be used as evidence against the student should the matter go to a University Tribunal hearing.

According to the Code of Behaviour on Academic Matters, “Where a proctor or invigilator, who is not a faculty member, has reason to believe that an academic offence has been committed by a student at an examination or test, the proctor or invigilator shall so inform the student's dean or department chair [relevant Course Director or Curriculum Director, as appropriate, for the MD Program], as the case may be, who shall proceed as if he or she were an instructor [Course Director], by analogy to the other provisions of this section.” [C.i.(a) Divisional Procedures, 14]

“In the case of alleged offences not covered by the procedures above and not involving the submission of academic work, such as those concerning forgery or uttering, and in cases involving cancellation, recall or suspension of a degree, diploma or certificate, the procedure shall be regulated by analogy to the other procedures set out in this section.” [C.i.(a) Divisional Procedures, 15]

 


Date of original adoption: 20 June 2017
Date of last review: 20 June 2017

Academic Standards and Promotion

Standards for grading and promotion of MD students – Foundations (Years 1 and 2)

Standards for grading and promotion of MD students – Foundations (Years 1 and 2)

Introduction

These Standards serve as an adjunct to the University Assessment and Grading Practices Policy and describe the practices of the MD program with regard to determining student grading and promotion in Foundations (Years 1 and 2). They are complemented by the MD Program’s Academic difficulty procedural guidelines and Student professionalism guidelines.

Standards

  1. Authority of the Board of Examiners: All final decisions related to a MD student’s standing and promotion are made by the Board of Examiners, a standing committee of the Council of the Temerty Faculty of Medicine. To inform these decisions, the Board of Examiners receives recommendations from the Student Progress Committee and/or Faculty Lead, Ethics & Professionalism.
  2. Individual assessment marks and course grades:
    1. Individual assessment marks: Marks for individual assessments are not subject to any formal approval, but rather serve as the basis for decisions about overall course standing. Individual assessment marks do not appear on transcripts or other documentation provided by the MD Program to external individuals or organizations.
    2. Provisional (unofficial) course grades: Course grades communicated through MedSIS or other means constitute an unofficial record; they are reserved exclusively for internal use and do not appear on transcripts or other documentation provided to external individuals or organizations. Provisional course grades in MedSIS are subsequently forwarded to the Board of Examiners to confirm academic standing (see Sections 7 and 8.) The program may calculate numerical grades for the purpose of informing the adjudication of academic awards.
    3. Official course grades: Upon approval of the Board of Examiners, course grades are made available to students in the Accessible Campus Online Resource Network (ACORN), which is the official record and is used by the University to generate official transcripts. MD program course grades are transcripted as “Credit (CR)”, “No Credit (NC)”, “In Progress (IPR)” or “Incomplete (INC)”.
  3. Standards of achievement on each type of assessment, other than professionalism: Each course in the Foundations Curriculum is composed of components and longitudinal themes. It is the responsibility of each Foundations course committee, in consultation with the relevant component directors and theme leads as well as the Student Assessment and Standards Committee (SASC), to define satisfactory completion of each type of assessment required during their course. This section does not apply to the assessment of professionalism, which is addressed in the MD Program’s Student professionalism guidelines. Specifically:
    1. Assessment methods: Course committees are responsible, in consultation with the relevant component directors and theme leads, for establishing the assessment methods to be used in the course. These assessment methods are subject to periodic review by the Student Assessment and Standards Committee (SASC) and/or Evaluation Committee. Changes to assessment methods must be brought to the attention of the Foundations Director, in accordance with the MD Program’s Guidelines and protocol for making curricular changes.
    2. Definition of “satisfactory progress”: For every marked assessment in a course, course committees are responsible, in consultation with the relevant component directors and theme leads, for defining the numerical and/or completion threshold for satisfactory progress on that assessment and for establishing assessment methods to measure achievement of that threshold. Course committees are also responsible, in consultation with the relevant component directors and theme leads, for identifying any mandatory non-marked learning activities that are required for successful completion of the course. Both marked and non-marked assessments on which a satisfactory progress is achieved will be recorded as “Satisfactory Progress”.
    3. Communication to students: Course committees are responsible for articulating all assessment methods for their course, including the standards of achievement for the course as a whole (see Section 6), in a course outline provided to students no later than the first day of the course. Any changes to the assessment methods after they have been made know to students must take place in accordance with the University Assessment and Grading Practices Policy.
  4. Definition and application of Focused Learning Plans: Students who have not satisfactorily achieved the threshold standard for any course assessment and are required to formulate a Focused Learning Plan, as described in the Academic difficulty procedural guidelines, will be assigned a provisional MedSIS course grade of “Partial Progress”. If the Focused Learning Plan is satisfactorily completed, the student’s provisional MedSIS course grade will be changed from “Partial Progress” to “Satisfactory Progress”. In the event that the Focused Learning Plan has not been satisfactorily completed, see Section 8.b below.
  5. Professionalism: Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is required to progress from one year level to the next and to graduate from the program. Assessment of professionalism takes place through competency-based professionalism assessments. Professionalism incidents that require immediate action are addressed through critical incident reports. The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.
  6. Standards of achievement in a course as a whole: In order to received credit for a course, students must:
    1. satisfactorily complete all marked assessments for each of the components and longitudinal themes that constitute the course, AND
    2. perform satisfactorily on any non-marked learning activities in that course, including but not limited to professionalism and logging of clinical experiences in courses where this is relevant.
  7. Definition of provisional course grades in MedSIS: Provisional course grades differ in some respects from the final grades awarded by the Board of Examiners. Specifically:
    1. Satisfactory Progress is used to denote that all requirements in the course are being met. Credit for the course will be recommended to the Board of Examiners at the end of the academic year pending satisfactory completion of all course assessments, including those for all longitudinal components and themes that constitute a course, and barring the availability of new information that calls into question the student’s successful performance in the course, as described in Section 8.
    2. Partial Progress is used to denote that a student has not yet demonstrated satisfactory progress in one or more longitudinal components and themes that constitute a course, and has been required to formulate a Focused Learning Plan. Upon achievement of satisfactory progress on their Focused Learning Plan, the student’s provisional course grade in MedSIS will be changed from Partial Progress to Satisfactory Progress. Partial Progress is an interim, internal notation that does not appear on official documentation.
    3. Unsatisfactory Progress is used to denote that a student has not been successful in completing the course due to any of the reasons in Section 6 and/or if formal remediation or probation has been assigned by the Board of Examiners. For students placed on remediation or probation, a grade of No Credit (NC) will be assigned to the course attempt(s) requiring remediation/probation, regardless of the outcome of the remediation/probation on the subsequent attempt(s). Following remediation or probation, the final course grade recommendation to the Board of Examiners for the subsequent attempt will depend on the student’s history of academic difficulty, as described in Section 8. Unsatisfactory Progress is an interim, internal notation that does not appear on official documentation.
    4. CR (Credit) is used to denote that all requirements in the course have been met. This is the grade that will be recommended to the Board of Examiners at the end of the academic year, barring the availability of new information that calls into question the student’s successful performance in the course, as described in Section 8.
    5. NC (No Credit) is used to denote that a student has not been successful in completing the course due to any of the reasons in Section 6. The recommendation to the Board of Examiners will depend on the student’s history of academic difficulty, as described in Section 8.
    6. INC (Incomplete) is used to denote that a student has not completed/submitted certain requirements of the course (marked or non-marked assessments), as arranged with the appropriate curriculum leader(s). Upon completion of the assessments, a provisional MedSIS course grade and final grade recommendation will be determined. 
  8. Principles governing recommendations to the Board of Examiners: The Student Progress Committee and Faculty Lead, Ethics & Professionalism will be guided by the following principles in making their recommendations to the Board of Examiners:
    1. Successful completion of a course: A grade of “Credit (CR)” in a course will be recommended to the Board of Examiners if a student:
      1. has satisfactorily completed all marked assessments for each of the components and longitudinal themes that constitute the course, AND
      2. has performed satisfactorily on any non-marked learning activities in that course, including but not limited to professionalism and logging of clinical experiences in courses where this is relevant.
    2. Remediation: A program of formal remediation will normally be recommended to the Board of Examiners if a student:
      1. has not satisfactorily completed all marked assessments for each of the components and longitudinal themes that constitute the course, OR
      2. has not performed satisfactorily on any non-marked learning activities of the course, including but not limited to professionalism and logging of clinical experiences in courses where this is relevant, OR
      3. has not demonstrated satisfactory progress on their Focused Learning Plan, as described in Section 4.

      In cases where a program of formal remediation is approved by the Board of Examiners, the student will receive a final grade of No Credit (NCR) in course(s) requiring remediation, regardless of the outcome of the remediation on the subsequent attempt(s). The student’s promotion to the next year or level of medical training will also be delayed.

      A program of formal remediation will normally require the student to re-register in the same level of the program and repeat relevant courses when they are next offered the following year. At the discretion of the Student Progress Committee, a recommendation may be made for a student to repeat all of the courses in the academic year.

      If the remedial program is successfully completed, the student will be assigned credit for the subsequent course attempt(s), subject to the approval of the Board. 

      If the remedial program is not successfully completed, probation will normally be recommended to the Board of Examiners. See 8.c below for more details regarding probation.

      In cases where a program of formal remediation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

    3. Probation: Probation will normally be recommended to the Board of Examiners if a student has not successfully completed remediation, as defined above.

      In cases where probation is approved by the Board of Examiners, the student will receive a final grade of No Credit (NCR) in relevant course(s) with unsuccessful remediation. The student’s promotion to the next year or level of medical training will be delayed.

      To clear probation, the student must re-register in the same level of the program and successfully repeat relevant course(s) when they are next offered the following academic year. At the discretion of the Foundations Directors and the Student Progress Committee, a recommendation may be made for a student to repeat all of the courses in the academic year in question or only the course(s) in which they experienced academic difficulty.

      When the student clears probation, the student will be assigned credit for the repeat course attempt(s), subject to the approval of the Board, and be placed in Good Standing.

      If probation is not successfully completed, failure in the repeated course(s) and dismissal from the program will normally be recommended to the Board of Examiners. See 8.d below for more details regarding dismissal.

      Probation may also be recommended to the Board of Examiners if a student receives 2 partial progress grades after the initial attempt in the same academic year. If the student’s academic performance and outcomes were impacted by discrete, time-limited, and extenuating circumstances, the Board of Examiners may not place the student on probation.

      In cases where probation is approved by the Board of Examiners, the student may retain a final grade of Credit (CR) for the first course if successfully reassessed. The student will receive a final grade of No Credit (NCR) for the second course and their promotion to the next year or level of medical training will be delayed. 

      To clear probation, the student must re-register in the same level of the program and successfully repeat the second course when they are next offered the following academic year. At the discretion of the Student Progress Committee, a recommendation may be made for a student to repeat all of the courses in the academic year.

      When the student clears probation, the student will be assigned credit for the repeat course attempt, subject to the approval of the Board, and be placed in Good Standing.

      If probation is not successfully completed, failure in the repeated course and dismissal from the program will normally be recommended to the Board of Examiners. See 8.d below for more details regarding dismissal.

      In cases where probation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.
       

    4. Dismissal: Dismissal from the program will normally be recommended to the Board of Examiners if a student has not successfully cleared probation.

      In cases where dismissal from the program or probation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

    5. Promotion: Each course in the Foundations Curriculum is considered a developmental milestone in the achievement of those competencies necessary to progress to the next level of medical training. Recommendations regarding promotion to the next stage of training will be made at the end of each academic year. Promotion from one year to the next will be recommended to the Board of Examiners if a student has achieved “Credit” in all courses, including successful completion of longitudinal components and themes, by the end of the academic year.
    6. Graduation: Graduation at the next Convocation of the MD program will be recommended to the Board of Examiners if a student has been deemed to have successfully achieved credit for every program course and requirement, including the specified amount of approved and assessed elective time.
  9. Deviations from normal practice: Where the word “normally” is used in relation to recommendations to the Board of Examiners, the Student Progress Committee and Faculty Lead, Ethics & Professionalism may choose to deviate from the recommendation that is indicated in these Standards. In such cases, a rationale must be provided to the Board of Examiners for the deviation, and the Board of Examiners will take both the recommendation and the rationale under consideration.
  10. Appeals: Students may appeal to decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Temerty Faculty of Medicine.

Date of original adoption: 12 July 2016 

Date of last amendment: 20 June 2023

Standards for grading and promotion of MD students – Clerkship (Years 3 and 4)

Standards for grading and promotion of MD students – Clerkship (Years 3 and 4)

Introduction

These Standards serve as an adjunct to the University Assessment and Grading Practices Policy and describe the practices of the MD program with regard to determining student grading and promotion in Clerkship (Years 3 and 4) and also apply to students registered in the MD Extended Clerkship. They are complemented by the MD Program’s Academic difficulty procedural guidelines and Student professionalism guidelines.

Standards

  1. Authority of the Board of Examiners: All decisions related to a MD student’s grading and promotion are ultimately made by the Board of Examiners, a standing committee of the Council of the Temerty Faculty of Medicine. To inform these decisions, the Board of Examiners receives recommendations from the Clerkship Director (or designate) and/or and Faculty Lead, Ethics & Professionalism.
  2. Individual assessment marks and course grades:
    1. Individual assessment marks: Marks for individual assessments are not subject to any formal approval, but rather serve as the basis for decisions about overall course standing. Individual assessment marks do not appear on transcripts or other documentation provided by the MD Program to external individuals or organizations.
    2. Provisional (unofficial) course grades: Course grades communicated through MedSIS or other means constitute an unofficial record; they are reserved exclusively for internal use and do not appear on transcripts or other documentation provided to external individuals or organizations. Provisional course grades are subsequently recommended to the Board of Examiners (see Sections 7 and 8).
    3. Official course grades: Upon approval of the Board of Examiners, course grades are made available to students in the Accessible Campus Online Resource Network (ACORN), which is the official record and is used by the University to generate official transcripts. MD program course grades are transcripted as “Credit (CR)”, “No Credit (NC)”, “In Progress” (IPR) or “Incomplete” (INC).
  3. Standards of achievement on each type of assessment, other than professionalism: It is the responsibility of each Clerkship course committee, in consultation with the relevant theme leads as well as the Student Assessment and Standards Committee (SASC), to define satisfactory completion of each type of assessment required during their course, in accordance with guidelines articulated below. (This section does not apply to the assessment of professionalism, which is addressed in the MD Program’s Student professionalism guidelines.) Specifically:
    1. Assessment methods: Course committees are responsible for establishing the assessment methods to be used in the course. These assessment methods are subject to periodic review by the Student Assessment and Standards Committee (SASC) and/or Program Evaluation Committee. Changes to assessment methods must be brought to the attention of the Clerkship Director, in accordance with the MD Program’s Guidelines for making curricular changes.
    2. Standards of achievement on assessments - Definition of definition of satisfactory performance or “pass”: For mastery exams and oral exams in all Clerkship courses, this threshold is 60%. For other marked assessments (excluding final clinical evaluations), this threshold is normally 60%, as determined by the course committee. For the clerkship OSCE, the numeric threshold is set according to the borderline regression method. Assessments on which a “pass” is achieved will be recorded as “CR” (“Credit”). Assessments on which unsatisfactory performance, or a “fail” is achieved will be recorded as “NC” (“No Credit”).
    3. Definition of “satisfactory completion” for final clinical evaluations: An overall assessment of “meets expectations” or above on each final clinical evaluation in a course is required to achieve “satisfactory completion” of the clinical evaluation for that course. An overall assessment below “meets expectations” on any final clinical evaluation in a course is considered unsatisfactory performance or a “fail”. The overall assessment of final clinical evaluations requires a holistic judgement and does not represent an average of individual assessments.
    4. Definition of an “incomplete” mandatory non-marked learning activity: Course committees are also responsible for identifying any mandatory non-marked learning activities (e.g. required encounters and procedures in the core clinical clerkship courses) that are required for successful completion of the course. Incomplete non-marked learning activities will be recorded as “INC” (“Incomplete”).
    5. Definition of successful completion of the Clerkship OSCE: The standard for successful completion of the  Clerkship OSCE is determined by the MD Program using a borderline regression method. The Clerkship OSCE is sequential in nature. A student who does not achieve standard on the first Clerkship OSCE attempt will be required to successfully complete a supplementary OSCE prior to promotion to Year 4 (see section 7.e). The supplementary OSCE expectations will be communicated to the student. If the supplementary OSCE is satisfactory, according to the standard set by the borderline regression method, the student will be assigned credit (CR) for the Clerkship OSCE. If the supplementary OSCE attempt is unsuccessful, a recommendation to the Board of Examiners will normally be made for NC in the course.
    6. Communication to students: Course committees are responsible for articulating the assessment methods and standards of achievement for their course in a course outline provided to students no later than the first day of the course. Any changes to the assessment methods after they have been made known to students must take place in accordance with the University Assessment and Grading Practices Policy.
  4. Professionalism: Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is required to graduate from the program. Assessment of professionalism takes place through competency-based professionalism assessments. Professionalism incidents that require immediate action are addressed through critical incident reports. The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.
  5. Standards of achievement in a course as a whole:
    1. Determination of achievement: It is the responsibility of each course committee to define satisfactory completion of their course as a whole. Specifically:
      1. Additional expectations for marked assessments: For each Clerkship rotation, there is a requirement to achieve 60% on each mastery exam and oral exam, as applicable to the specific rotation.
      2. Clinical evaluations: An overall assessment of “meets expectations” or above on each final clinical evaluation in a course is required to achieve “satisfactory completion” of the clinical evaluation for that course.
      3. Mandatory non-marked learning activities: By their nature, mandatory non-marked learning activities are required in order to complete the course.
      4. Professionalism: See Section 5 above.
  6. Definition of provisional course grades in MedSIS: Provisional course grades differ in some respects from the final grades awarded by the Board of Examiners. Specifically:
    1. CR (Credit) is used to denote that all requirements in the course have been met. This is the grade that will be recommended to the Board of Examiners, barring the availability of new information that calls into question the student’s successful performance in the course, as described in Section 8.
    2. NC (No Credit) is used to denote that a student has not been successful in completing the course due to any of the reasons in Section 6a. The recommendation to the Board of Examiners will depend on the student’s history of academic difficulty, as described in Section 8. If formal remediation is assigned by the Board of Examiners, an interim notation of NGA will be assigned to the course (see below). If probation is successfully completed, a grade of No Credit (NC) will be assigned to the course attempts requiring probation, regardless of the outcome of the probation on the subsequent attempts; the student will be assigned credit for the subsequent course attempts, subject to the approval of the Board.
    3. NGA (No Grade Available) is used to denote that a student has been assigned formal remediation that is pending completion. If remediation is successfully completed, the student will be assigned credit for the courses requiring remediation, subject to the approval of the Board.
  7. Principles governing recommendations to the Board of Examiners: The Clerkship Directors (or designate) and Faculty Lead, Ethics & Professionalism will be guided by the following principles in making their recommendations to the Board of Examiners:
    1. Successful completion of a course: A grade of “Credit (CR)” in a course will be recommended to the Board of Examiners if a student:
      1. has achieved 60% on each written mastery exam and oral exam required for the course, AND
      2. has achieved an overall assessment of “meets expectations” or above on each final clinical evaluation required for the course, AND
      3. has satisfactorily completed, as determined by the course, any marked assessments required for the course in addition to mastery exams and oral exams, AND
      4. has performed satisfactorily on any non-marked learning activities in that course, including but not limited to professionalism, logging of clinical experiences and completion of required number of Entrustable Professional Activities (EPAs), in courses where this is relevant.
    2. Remediation: A program of formal remediation will normally be recommended to the Board of Examiners if a student:
      1. has not achieved at least 60% on each written mastery exam and oral exam required for the course, OR
      2. has not achieved an overall assessment of “meets expectations” or above on each final clinical evaluation required for the course, OR
      3. has not performed satisfactorily on any non-marked learning activities of the course, including but not limited to logging of clinical experiences or completion of required number of Entrustable Professional Activities (EPAs), in courses where this is relevant, by the time of the Board’s meeting.

      In cases where a program of formal remediation is approved by the Board of Examiners, the student will receive an interim grade of No Grade Available (NGA) and be required to repeat failed course components within the same academic year (or immediately after).

      If the remedial program is successfully completed, the student will be assigned credit for the subsequent course attempt(s), subject to the approval of the Board.

      If the remedial program is not successfully completed, failure in the course and probation will normally be recommended to the Board of Examiners.

      In cases where a program of formal remediation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners. 

    3. Probation: Probation will normally be recommended to the Board of Examiners if a student has:
      1. not successfully completed remediation previously imposed by the Board of Examiners, OR
      2. not achieved credit on the first attempt in two or more courses (totaling at least 12 weeks in curriculum, or equivalent) in the same level of the program, as confirmed by the Board of Examiners.

      In cases where probation is approved by the Board of Examiners, the student will receive a final grade of No Credit (NCR) in relevant course(s) with unsuccessful remediation, regardless of the outcome of the probation on the subsequent attempts. The student’s promotion to the next year or level of medical training will be delayed.

      To clear probation, the student must re-register in the same level of the program and successfully repeat relevant courses when they are next offered the following term or academic year. At the discretion of the Clerkship Directors and/or course director(s), a recommendation may be made for a student to repeat all of the courses in the academic year in question or only the course(s) in which they experienced academic difficulty.

      When the student clears probation, the student will be assigned credit for the repeat course attempt(s), subject to the approval of the Board, and be placed in Good Standing.

      If probation is not successfully completed, failure in the repeated course(s) and dismissal from the program will normally be recommended to the Board of Examiners.

      Probation may also be recommended to the Board of Examiners if a student fails April and August Clerkship OSCEs after the initial attempt.

      In cases where probation is approved by the Board of Examiners, the student will receive an interim grade of No Grade Available (NGA) to denote that the course is pending completion. To clear probation, the student must successfully re-assess in Clerkship OSCEs.

      When the student clears probation, the student will be assigned credit for the Clerkship OSCEs course, subject to the approval of the Board, and be placed in Good Standing.

      If probation is not successfully completed, failure in the Clerkship OSCE course and dismissal from the program may be recommended to the Board of Examiners.

      In cases where probation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

    4. Dismissal: Dismissal from the program will normally be recommended to the Board of Examiners if a student has not successfully completed probation.

      In cases where dismissal from the program is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

    5. Promotion: Promotion from Year 3 to Year 4 will be recommended to the Board of Examiners if a student has achieved “Credit” in all Year 3 courses. Recommendations regarding promotion from Year 3 to Year 4 will be made no later than 60 days after the end of the Year 3 academic year. The timing of recommendations for promotion will be informed by applicant timelines for the first iteration of the residency match process. Students who have not been promoted from Year 3 to Year 4 may not be allowed to enrol in or complete Year 4 course or program requirements.
    6. Graduation: Graduation at the next Convocation of the MD program will be recommended to the Board of Examiners if a student has been deemed to have successfully achieved credit for every program course and requirement, including the specified amount of approved and assessed elective time. Graduation from the MD Program also requires successful completion of the Clerkship OSCE, in accordance with the standard for successful completion determined by the Program.
  8. Deviations from normal practice: Where the word “normally” is used in relation to recommendations to the Board of Examiners, the Clerkship Director, individual course directors, and Faculty Lead, Ethics & Professionalism may choose to deviate from the recommendation that is indicated in these Standards. In such cases, a rationale must be provided to the Board of Examiners for the deviation, and the Board of Examiners will take both the recommendation and the rationale under consideration.
  9. Appeals: Students may appeal to decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Temerty Faculty of Medicine.

Date of original adoption: 10 February 2012 

Date of last amendment: 20 June 2023

Guidelines for the assessment of MD students in academic difficulty – Foundations (Years 1 and 2)

Guidelines for the assessment of MD students in academic difficulty – Foundations (Years 1 and 2)

1. Introduction

“Academic difficulty” is a comprehensive term used to refer to all students who are identified as demonstrating less than satisfactory progress in the MD Program. These Guidelines are intended to support and ensure student achievement of course objectives and program competencies, with the ultimate goal being promotion through and graduation from the MD Program. For the purpose of these Guidelines, less than satisfactory progress in a course may be recorded as either “Partial Progress” or “Unsatisfactory Progress”, in accordance with the MD Program’s Standards for grading and promotion.

2. Mechanisms for identifying partial progress and unsatisfactory progress

There are two formal mechanisms for identifying Partial Progress and Unsatisfactory Progress in Years 1 and 2 of the MD Program, as follows:

  1. Based on marked assessments and non-marked learning activities: Each Foundations course includes a series of multipoint assessments. Each assessment includes a threshold standard that defines satisfactory progress. In order to receive credit for a course, a student must satisfactorily complete all marked assessments for all of the components and longitudinal themes that constitute the course, and must perform satisfactorily on all non-marked learning activities for that course. The threshold standards for each type of assessment in a course are provided in the course outline. A student who does not achieve the threshold standard for an assessment type or the course as a whole will be identified as being in academic difficulty. Procedures to address partial and unsatisfactory progress based on assessment results (excluding professionalism assessments) are provided in Section 3.
  2. Based on professionalism assessments and critical incident reports: Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is required to progress from one year level to the next and to graduate from the program. Assessment of professionalism takes place through competency-based professionalism assessments. Professionalism incidents that require immediate action are addressed through critical incident reports. The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.

In addition to the formal mechanisms for identifying Partial Progress and Unsatisfactory Progress outlined above, the program is committed to the early, informal identification of students whose progression is not optimal. These informal mechanisms may include assessment-related observations by tutors, including Academy Scholars, as well as conversations between students and tutors, Academy Scholars and/or administrative staff. The purpose of early, informal identification is to ensure that such students have the opportunity to discuss their performance with the appropriate curriculum leader(s) and/or administrative staff in a safe and confidential environment, and that they are aware of the various supports available to them.

3. Procedures to address partial and unsatisfactory progress based on assessment results

(excluding professionalism assessments and critical incident reports)

Note: With respect to the following procedures to address partial and unsatisfactory progress based on assessment results, references to “Foundations Director” and “Director of Student Assessment” should be read to include “or delegate, as determined by the program”. Recommendations to the Board of the Examiners from the Student Progress Committee will be made to the Board on the committee’s behalf by the Foundations Director and/or Director of Student Assessment delegate, as determined by the program.

In the event that the Student Progress Committee decides that a student is not satisfactorily progressing given their performance on a Focused Learning Plan or formal program of remediation:

  1. Student Meeting

    Following the initial identification of Partial Progress based on assessment results (excluding professionalism assessments and critical incident reports), a Student Meeting will be held, as follows:

    1. The student will meet with the Foundations Director or delegate, as determined by the program.
    2. The student will be informed orally and/or in writing that they have not been satisfactorily progressing, that the Board of Examiners may be informed of this fact, and that their performance may be discussed at a meeting of the Board of Examiners.
    3. The student may be required to meet with the Associate Dean, Learner Affairs or delegate for the purpose of exploring health-related or personal reasons for their less than satisfactory progress and potential supports needed.
    4. The Foundations Director will consult, as necessary, with other curriculum leaders to determine next steps, including the identification of any additional learning activities, assessments and/or academic supports that are appropriate to the situation, as well as the time period for completion and review of next steps.
    5. The student will be informed of next steps, which will be included in a Focused Learning Plan, as described in 3.b.
  2. Focused Learning Plan (“Partial Progress”)

    Following the Student Meeting and determination of next steps:

    1. The student will, with guidance, formulate a Focused Learning Plan to reflect the identified next steps, including the time period for completion and review.
    2. The Foundations Director will review and either approve or not approve the student’s Focused Learning Plan. To facilitate this review, the Foundations Director may consult with other curriculum leaders.
      1. If the student’s updated Focused Learning Plan is approved, the Foundations Director will inform the student and the Focused Learning Plan will be entered in the student’s Learner Chart by the Director of Student Assessment or delegate, as determined by the program.
      2. If the student’s Focused Learning Plan is not approved, the Foundations Director will inform the student, and a meeting with the student will take place to discuss next steps. Based on feedback from the Foundations Director, the student will update their Focused Learning Plan, which will be reviewed and either approved or not approved by the Foundations Director.
    3. After the time period specified in the Focused Learning Plan, the Foundations Director will review the student’s progress, which may include consultation other appropriate curriculum leaders. The outcome of this review will be a progress update submitted by the Foundations Director to the Student Progress Committee.
    4. The Student Progress Committee will review the student’s progress, including consideration of the student’s Focused Learning Plan, and decide whether the student is satisfactorily progressing.
      1. If the Student Progress Committee decides that the student is satisfactorily progressing, the student will be informed by the Foundations Director and/or Director of Student Assessment that their Focused Learning Plan has been successfully completed and that they are satisfactorily progressing.
      2. If the Student Progress Committee decides that the student is not satisfactorily progressing, a formal remediation process will be initiated, as described in 3.c.
    5. In cases where a program of formal remediation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.
  3. Remediation or Probation (“Unsatisfactory Progress”)
    1. The student will be required to meet with the Foundations Director or delegate, as determined by the program.
    2. The student will be informed both orally and in writing by the Foundations Director that they are not satisfactorily progressing according to the terms of their Focused Learning Plan or formal program of remediation, that the Board of Examiners will be informed of this fact, and that their performance will be discussed at a meeting of the Board of Examiners. Students will also be informed of the consequences of not successfully completing the required remediation or probation requirements, as set out in the MD Program’s Standards for grading and promotion. The student must be fully informed of their rights, including their right to provide a written submission to the Board of Examiners in the event that their performance is being reviewed by the Board.
    3. The student may be required to meet with the Associate Dean, Learner Affairs or delegate for the purpose of exploring health-related or personal reasons for their unsatisfactory progress and potential supports needed.
    4. The Foundations Director, in consultation with other curriculum leaders, and subject to the approval of the Board of Examiners, is responsible for the design and content of a formal program of remediation or probation requirements. A program of formal remediation or probation requirements may include the repetition of one or more courses when they are next offered the following year, which may require a delay in promotion to the next year or level of medical training. The Foundations Director will recommend to the Board of Examiners the level of performance expected in supplemental assessments. Specific performance criteria that may differ from those normally used in a course or for a component may be required for successful completion of remedial work or probation requirements. The timing and duration of the remediation or probation will be dependent on the specific course(s)/component(s) in question.
    5. Following the specified time period for completion, the Student Progress Committee will review the student’s progress and decide if the student has successfully completed the formal program of remediation or probation requirements.
      1. If the Student Progress Committee decides that the student has successfully completed the formal program of remediation or probation requirements, the Student Progress Committee will recommend to the Board of Examiners that the student be granted Credit for the course, in accordance with the MD Program’s Standards for grading and promotion.
      2. If the Student Progress Committee decides that the student has not successfully completed the formal program of remediation or probation requirements, the recommendation to the Board of Examiners from the Student Progress Committee will be governed by the MD Program’s Standards for grading and promotion. In such cases, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.
    6. The Board of Examiners will make the final determination regarding successful completion of the remediation or probation requirements. Students may appeal to decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Faculty of Medicine.

Procedures to address unsatisfactory progress based on professionalism assessments and critical incident reports

The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.

 


Date of original adoption: 12 July 2016
Date of last amendment: 12 July 2016, 20 June 2017, 11 June 2019, 07 July 2020

Guidelines for the assessment of MD students in academic difficulty – Clerkship (Years 3 and 4)

Guidelines for the assessment of MD students in academic difficulty – Clerkship (Years 3 and 4)

1. Introduction

“Academic difficulty” is a comprehensive term used to refer to all students who are identified as demonstrating performance below expectations in the MD Program. These Guidelines are intended to support and ensure student achievement of course objectives and program competencies, with the ultimate goal being promotion through and graduation from the MD Program.

2. Mechanisms for identifying performance below expectations

There are two formal mechanisms for identifying performance below expectations in Years 3 and 4 of the MD Program, as follows:

  1. Based on marked assessments, final clinical evaluations, and/or non-marked learning activities: In order to achieve credit in a Clerkship course, rotation or OSCE, a student must achieve the minimum grade and other performance requirements, as defined by the course or Program and in accordance with in the MD Program’s Standards for grading and promotion. A student who does not achieve the grade and/or performance requirements for an assessment or the course as a whole will be identified as being in academic difficulty. Procedures to address unsatisfactory progress provided in Section 3.
  2. Based on professionalism assessments and critical incident reports: Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is required to graduate from the program. Assessment of professionalism takes place through competency-based professionalism assessments. Professionalism incidents that require immediate action are addressed through critical incident reports. The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guidelines.

3. Procedures to address performance below expectations in clerkship

(excluding professionalism assessments and critical incident reports)

Unsatisfactory performance based on marked assessments, final clinical evaluations, non-marked learning activities,  or on a program of formal remediation (Remediation and Probation procedures)

Following the identification of unsatisfactory performance based on marked assessments, final clinical evaluations, non-marked learning activities, and/ or on a program of formal remediation:

  1. The student will be required to meet with the Year 3 or Year 4 Clerkship Director or delegate, as determined by the program.
  2. The student will be informed both orally and in writing by the Year 3 or Year 4 Clerkship Director that their performance is below expectations, that the Board of Examiners will be informed of this fact, and that their performance will be discussed at a meeting of the Board of Examiners. Students will also be informed of the consequences of not successfully completing the required remediation or probation requirements, as set out in the MD Program’s Standards for grading and promotion. The student must be fully informed of their rights, including their right to provide a written submission to the Board of Examiners in the event that their performance is being reviewed by the Board.
  3. The student may be required to meet with the Associate Dean, Learner Affairs or delegate for the purpose of exploring health-related or personal reasons for their unsatisfactory progress and potential supports needed.
  4. Subject to the approval of the Board of Examiners, the course director is responsible, in consultation with the appropriate curriculum leaders, for the design and content of the remedial work or probation requirements, including the level of performance expected of the student to demonstrate that they have met the standard for successful completion of the course. Specific performance criteria that may differ from those normally used in a course may be required for successful completion of remedial work or probation requirements. The timing and duration of the remediation or probation will be dependent on the specific course in question and will be determined by the course director in consultation with the student, course committee, and Year 3 or Year 4 Clerkship Director. A program of formal remediation or probation may include the repetition of one or more courses when they are next offered the following year, which may require a delay in promotion to the next year or level of medical training or graduation from the program.
  5. Following the specified time period for completion, the course director will review the student’s progress and decide, in consultation with the Year 3 or Year 4 Clerkship Director, if the student has successfully completed the formal program of remediation or probation requirements.
    1. If the course director decides that the student has successfully completed the formal program of remediation or probation requirements, a recommendation will be made to the Board of Examiners, in accordance with the MD Program’s Standards for grading and promotion. If remediation is successfully completed, the student will be assigned credit for the courses requiring remediation, subject to the approval of the Board. If probation is successfully completed, a grade of No Credit (NC) will be assigned to the course attempts requiring probation, regardless of the outcome of the probation on the subsequent attempts; the student will be assigned credit for the subsequent course attempts, subject to the approval of the Board.
    2. If the course director decides that the student has not successfully completed the formal program of remediation or probation requirements, the recommendation to the Board of Examiners will be governed by the MD Program’s Standards for grading and promotion. In such cases, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.
  6. The Board of Examiners will make the final determination regarding successful completion of the remediation or probation requirements. Students may appeal decisions made by the Board of Examiners to the Appeals Committee, which is a standing committee of the Council of the Faculty of Medicine.

4.  Procedures to address performance below expectations based on professionalism assessments and critical incident reports

The MD Program’s professionalism standards of achievement and procedures to address unsatisfactory progress with respect to professionalism are described in the Student professionalism guideline.

 


Date of original adoption: 7 December 2010
Date of last amendment: 12 July 2022

Regulations for student attendance and guidelines for absences from mandatory activities (MD Program)

Regulations for student attendance and guidelines for absences from mandatory activities (MD Program)

A high rate of attendance is key to the success of medical students, given the competency-based, experiential nature of medical training and the central role played by highly interactive small-group modes of instruction at the University of Toronto. However, there are instances which may necessitate medical students requiring time away from the MD Program, as defined below. These regulations and guidelines permit and support absences from mandatory learning activities in order for students to seek needed health care services.

These regulations and guidelines describe reasons for health-related and other types of absences that are normally acceptable and corresponding procedures that are intended to:

  • be clear, user friendly and implementable with available resources
  • minimize disruption to student learning and patient care
  • enable consistent and equitable decision-making
  • maintain the educational integrity of the MD Program’s goals, objectives and competencies
  • facilitate the early identification, in a safe and confidential manner, of students who may require support
  • ensure students are empowered to succeed in their progress through the program

Absences from mandatory learning activities fall into two categories:

  1. unplanned absences (absences that arise due to unforeseen and often emergent circumstances)
  2. planned absences (absences that arise due to known or anticipated circumstances)

Changes to rotation call schedules are not considered planned absences. Students who would like to request a change to their call schedule should contact the relevant Clerkship course director and Clerkship course administrator.

A prolonged absence or series of absences that affects the ability of a student to complete a course or curricular component within its normal timeframe or a reasonably extended timeframe (as defined by the relevant curriculum leaders) may be more effectively addressed and supported by a Leave of Absence (LOA), defined as an official, temporary withdrawal from studies. Further details regarding LOAs are included in the program’s Regulations and guidelines for leaves of absence from the MD Program.

Submission of a U of T Verification of Illness (VOI) Form is required for health-related absences from assessments or for health-related absences of more than two consecutive days of mandatory learning sessions. The completed U of T VOI form must be submitted normally no more than five business days after the last day of the unplanned absence. Depending upon the type or duration of the absence, or the number of prior absences, students may be required to submit other supporting documentation.

For both planned and unplanned absences:

  • Course and Component Directors (or their delegates) are responsible for determining if deferred/make-up work or assessment is required, and communicating next steps to the student.
  • Students are responsible for covering material and knowing the content from any missed sessions and, if applicable, completing any deferred/make-up work or assessments.

Please note that the following are considered unprofessional behaviour that may be reflected in a student’s professionalism assessment:

  • Failure to attend a mandatory learning activity for an urgent/emergent reason (unplanned absence) without providing notification within a reasonable timeframe
  • Failure to attend a mandatory learning activity for a reason that was known or anticipated, or can reasonably be expected to have been known or anticipated, but for which a planned absence request was not submitted
  • Disregarding the decision of an MD Program leader regarding a planned absence request

Mandatory Learning Activities

Foundations (Years 1 and 2)

Clerkship (Years 3 and 4)

  • All scheduled assessments and their corresponding activities

(as indicated in MedSIS)

  • All small group tutorials and workshops, including but not limited to Case-based Learning (CBL), Clinical Skills, Health in Community, Ethics & Professionalism, Health Science Research (HSR), and Portfolio
  • All service-learning community visits
  • All Family Medicine Longitudinal Experience (FMLE) sessions
  • All Interprofessional Education (IPE) sessions
  • All Anatomy sessions
  • Some lectures, especially those that involve themes or guest panels
  • All clinical activities
  • All learning sessions, including clerkship seminars, core Interprofessional Education (IPE) sessions, Portfolio sessions, and local (site-specific) teaching sessions

Unplanned Absences

Unplanned absences are absences that arise due to unforeseen and often emergent circumstances, including for:

  • Illness/injury/personal crisis
  • Family emergency
  • Funeral/memorial service
  • Travel/transportation emergencies (e.g., accidents, subway breakdowns)

Notification Procedures (Unplanned Absences)

Students are responsible for using the MD Program’s unplanned absence notification form to submit notification of an unplanned absence as soon as possible after attending to the immediate needs arising from the situation.

In the event that the student believes that an extended absence of three or more days may be required, this should be conveyed in the notification, and will normally require submission of supporting documentation after the immediate needs arising from the situation have been attended to. If the matter is sensitive, the student may elect to first consult with the Associate Dean, Learner Affairs or a counsellor in the Office of Learner Affairs to determine appropriate notification procedures.

Please see Appendix A for an Unplanned Absence Notification Procedures Flowchart.

Planned Absences

Planned absences are absences that arise due to known or anticipated circumstances and require prior approval by the Course or Component Director. Students should not assume that approval will be granted for planned absences and are strongly advised not to commit to any plans before receiving confirmation of approval from the Course or Component Director(s) (or delegate).

Notification Procedures (Planned Absences)

Students are responsible for using the MD Program’s planned absence request form to submit planned absence requests in a timely manner, as follows:

  • For planned personal day absences in Foundations and Clerkship, at least two weeks' notice are required prior to the start date of the missed activity(ies)
  • For Clerkship clinical rotations, at least 30 days prior to the start date of the rotation in which the missed activity(ies) are scheduled to take place.
  • For all other Clerkship courses and all Foundations courses, at least 30 days prior to the activity(ies) to be missed.

Planned Personal Day Absences

Students in years 1, 2, and 4 of the MD Program are allotted 3 planed personal day absences per academic year. Students in year 3 of the MD Program are allotted 4 planned personal day absences per academic year. The following limitations apply:

'Blackout periods refers to periods in which a planned personal absence day cannot be requested.

  • No more than 1 Personal Day can be taken per Foundations course
    • Blackout periods: Assessment dates (includes MEs, progress test, HSR presentations, ICE:CS observed assessments, OSCE, and any dates where a student must reassess)
  • No more than 1 Personal Day can be taken per Clerkship rotation in Year 3 or per elective/selective in Year 4
    • Blackout periods: ME, OSCE dates, during a course of two weeks or less in duration, on days marked for course orientation, scheduled call days, and centralized teaching days (TED, TTR Campus Weeks, Portfolio sessions)
  • Personal Day absences cannot be combined with any other planned absence types (e.g., conferences)

If the planned absence request is approved, the student is responsible for informing the immediate education supervisors of the activities they will be absent from. If the matter is sensitive, the student may elect to first consult with the Associate Dean, Learner Affairs or a counsellor in the Office of Learner Affairs to determine appropriate notification procedures.

Please see Appendix B for a Planned Absence Request Procedures Flowchart.

Information and Decision-making Guidelines (Planned Absences)

In general, the following factors will be taken into consideration regarding planned absence requests:

  • Reason for the absence
  • Duration and type of learning activities to be missed, including their relative importance or uniqueness in the curriculum
  • Student’s academic record, including professionalism
  • Student’s attendance record/absence history

For more details regarding common reasons for planned absences, including corresponding information requirements and typical decision outcomes, see Table 1 (Foundations) and Table 2 (Clerkship) below.

Planned absence requests for reasons other than those included in Table 1 and Table 2 will be considered on a case-by-case basis, but will normally not be approved.

Absence Monitoring (Check-in Meetings)

The MD Program is committed to monitoring absences from mandatory learning activities in order to help ensure that the program is able to provide an accurate assessment of a student’s progress through the program and that students are well positioned and supported to succeed in achieving course learning objectives and program competencies. A check-in meeting may be required of a student who has a recurrent or problematic absence history, typically defined as (but not limited to) the following:

  • eight or more full day equivalent unplanned and/or planned absences in an academic year,
  • two or more unplanned and/or planned absences on days on which assessments are scheduled in an academic year, or
  • two or more deferred assessments in an academic year.

In such cases, the Assistant Registrar, Registration & Student Success will review the student's absence history, where appropriate, to determine next steps, including if a check-in meeting is warranted.

If warranted, the student will be invited to a check-in meeting with the Assistant Registrar, Registration & Student Success, which is intended to:

  • provide students an opportunity to discuss their absences in a safe and confidential environment,
  • help ensure they are aware of the various supports available to them, and
  • determine if the student is able to complete a course or curricular component within its normal timeframe or a reasonably extended timeframe (as determined by the relevant curriculum leaders).

The MD Program’s Regulations and guidelines for leaves of absence from the MD Program will help inform next steps in cases where a student is unable to complete a course or curricular component within its normal timeframe or a reasonably extended timeframe and may benefit from a LOA.

 

Tables and Appendices

 


Date of original adoption: 20 September 2011
Date of last amendment: 20 June 2023

Regulations and guidelines for leaves of absence from the MD Program

Regulations and guidelines for leaves of absence from the MD Program

Definition

A leave of absence from the MD Program constitutes an official, temporary withdrawal from studies, and is recorded on the student’s transcript.

There are two types of leave: (1) for personal reasons and (2) for academic enrichment.

Personal leaves of absence

Requests for personal leaves of absence are considered on a case-by-case basis by the Director, Undergraduate Learner Affairs, Office of Learner Affairs (OLA), possibly in consultation with other MD Program leaders. Full disclosure of the reasons for the request is expected, and supporting documentation will be required.

Personal leaves of absence will normally be granted for a maximum of one full academic year at a time.

Leaves of absence for academic enrichment

Leaves of absence to pursue academic programming that complements the MD Program may be granted to students with an excellent academic record, normally with no identified weaknesses.

Leaves of absence for academic enrichment will normally be granted for a maximum of two full academic years.

Students who are considering an application for leave of absence for academic enrichment must meet with the Director, Undergraduate Learner Affairs to discuss academic and career implications. They must also discuss with the Registrar matters relating to financial aid, tuition and registration.

Students must submit an application for a leave of absence for academic enrichment to the Associate Dean, MD Program no later than February 1 of the calendar year they wish their leave to begin. As part of their application, students must include a clearly set-out plan and articulated objectives for the proposed leave, including how it complements the MD Program, as well as plans for re-entry into the MD Program.

If the requested leave of absence for academic enrichment is granted, the Associate Dean, MD Program will provide a Letter of Approval which summarizes the conditions under which the leave was granted and the expected re-entry date. This letter will be copied to the student’s record, the Foundations or Clerkship Director (as appropriate), and the relevant Academy Director.

Re-entry into the MD Program following a leave of absence

Students who are granted a leave are not registered as medical students for the duration of the leave. When they re-enter the program, they will be subject to the current fee schedule.

Credit is retained for all courses that had been fully completed prior to the leave. Students returning from a leave are generally subject to the current curriculum, although certain modifications may be made to reflect any major curricular changes introduced during their absence.

Students who are on leave, whether for personal reasons or academic enrichment, are expected to contact the Director, Undergraduate Learner Affairs and Registrar at least two months before their intended return to the MD Program so that preparations for their re-entry can commence.

Students returning from a leave of absence may also be required to participate in supplemental clinical skills training to ensure their academic success and the well-being of patients.

 


Date of original adoption: 20 September 2011
Date of last amendment: 14 July 2016

Required clinical experiences in the core clerkship rotations - responsibilities of students, faculty, and MD Program curriculum leaders

Required clinical experiences in the core clerkship rotations - responsibilities of students, faculty, and MD Program curriculum leaders

A. Principles

  1. Educational value

    The logging of clinical procedures and encounters in core clerkship rotations has important educational value for students, teachers, and course directors

    1. Students benefit from logging because it allows them to confirm that they have in fact encountered all of the core problems and performed all of the core procedures that the program has deemed essential for completion of the MD degree.
    2. Every participant in the clerkship education process benefits from logging because it allows the program to confirm that all clinical sites provide equivalent experiences and that all students meet the minimum expectations with regard to patients seen and procedures performed
  2. Real patients

    The MD Program emphasizes the importance of student interaction with real patients to help support achievement and assessment of the program’s key and enabling competencies. For this reason, the required encounters and procedures lists are designed to be achievable exclusively through experiences with real patients. However, simulated experiences may be permitted in some cases to remedy gaps, as described below

  3. Course component

    Logging of clinical encounters and procedures is a mandatory, Credit/Non-credit component of every core clerkship rotation that is greater than or equal to one week in length. A student will not receive credit in a course until such time as the list is completed

  4. Academic integrity

    The principle of academic integrity applies to logging just as it applies to all other course components. Therefore, any falsification of data will be considered a a breach of academic integrity, subject to disciplinary action according to University and MD Program policies and procedures

B. Description of the course lists of required encounters and procedures

Every core clerkship course maintains and publishes a list of required encounters and procedures. These lists are reviewed annually by each course and updated as required, with central oversight by the Clerkship Director. Updates must be reviewed/approved by the Clerkship Committee and Curriculum Committee

The lists are publicized on the course websites on Elentra and on the Case Logs tab on MedSIS. At the start of each rotation, students are expected to familiarize themselves with the list of required encounters and procedures for that course, including the required number of each encounter and procedure and the level of student involvement required, as described below.

  1. Encounters

    Encounters are defined as meaningful involvement in a patient’s care. For example, taking a history, performing relevant physical examination manoeuvres, and taking part in discussion of investigation and management are considered encounters

  2. Procedures

    Procedures have a pre-specified level of minimum involvement that must be achieved in order to be logged. These expectations are clearly articulated as part of the list of required procedures. The levels are

    1. The student observed the procedure
    2. The student performed the procedure with assistance or assisted someone else
    3. The student performed the procedure independently
  3. Number

    In most but not all cases, only one encounter or procedure per item listed is required. Students are not expected to log every patient, but must meet the requirements for logging (including quantity) specified by each course

  4. Settings

    The expected setting for each procedure and encounter is generally implicit, given that the lists are course-based and courses typically have specific settings. In cases where more specificity is required, it is included in the name of the procedure or encounter. Where context specificity is not important, encounters/ procedures are annotated on the case logs list as achievable in more than one course (e.g. Well care of the newborn in Pediatrics or Family Medicine

C. Process for reporting and review

  1. Mid-rotation

    As part of the formal interim feedback conversation, it is mandatory for students to review their Case Logs Student Activity Report with their preceptor/site-supervisor, except in the case of courses with a duration of one week or less. (Courses of one week or less are deemed too short to require mid-rotation meetings.) It is a student’s responsibility to present the report to their preceptor/site supervisor

    Students are expected to have a dialogue with their preceptor/supervisor regarding the report. This portion of the mid-rotation feedback conversation has two main purposes

    • To discuss the key learning points of the experiences that have been logged by the students to date
    • To establish a plan for subsequent clinical experiences to remedy any gaps in order to complete all the required encounters and procedures by the end of the rotation. This is documented on the Interim Feedback Form
  2. End-of-rotation

    The Course Director reviews each student’s record to ensure all encounters/procedures have been completed, and assigns a grade of Credit/No credit.

  3. Incomplete requirements

    As stated above in A. Principles, the expectation is that the required clinical encounters and procedures are preferentially experienced through interaction with real patients. Some encounters and procedures will be identified in each course as “Must be real” because they are critical common patient encounters that cannot be adequately replaced by simulation. Even for other required encounters and procedures, simulations should only be used to remedy gaps, such as when a given experience with a real patient is unavailable (e.g., in the case of seasonal illness or certain less common presentations)

    In the event of an incomplete Case Logs Activity Report, students will be required to work with the course director expeditiously to make an action plan, with follow-up from the course director, to remedy any remaining gaps. In some cases, an encounter/procedure may be achieved on a future rotation and left blank until achieved. Upon completion of a Case Logs Activity Report, Credit for the component will be awarded. Note: All gaps in all courses must be completed within six weeks of the end of the Year 3 clerkship in order for all clerkship courses to be considered complete with credit earned

  4. Central monitoring

    The Clerkship Director will monitor overall completion rates in every course at regular intervals to identify any trends of concern requiring action

    Individual students who are persistently unable to complete the required lists in multiple courses may be considered to exhibit academic difficulty, in which case the appropriate interventions will be applied, in accordance with the Guidelines for the assessment of MD students in academic difficulty – Clerkship


Date of original adoption: 12 September 2011 

Date of last amendment: 09 July 2019

Student Assessment

Assessment and grading practices policy *

Assessment and grading practices policy *

The University’s Assessment and Grading Practices Policy sets out the principles and key elements that should characterize the assessment and grading of student work in for‐credit programming at the University of Toronto.

Full details are available from the University of Toronto Governing Council page for this policy.

MD Program Assessment Rules and Regulations

MD Program Assessment Rules and Regulations

Note: This MD Program Assessment Rules and Regulations policy document includes information previously included in the following two policy documents: MD Program Examination and Mastery Exercise Rules and Regulations and MD Program Standards for Student Review and Challenge of Examination and Assessment Outcomes.

Contents
This document is comprised of the following sections:

  1. General regulations on taking assessments as scheduled
  2. Rules for the conduct of written assessments
  3. Rules for the conduct of OSCEs
  4. Calculation re-check of an assessment or course
  5. Re-mark of a written assessment
  6. Access to completed assessments

A. General regulations on taking assessments as scheduled

Students are required to be present at the assessment room for in person invigilation or virtually for electronically proctored assessments as scheduled. However, illness or personal circumstances may interfere with a student’s ability to adequately prepare for or complete an assessment as scheduled. In these circumstances, students should contact the appropriate course director as soon as the problem becomes apparent. In the case of an absence from an assessment due to illness, students should obtain a completed U of T Verification of Illness (VOI) Form. Further details about how to submit notification and any required supporting documentation for an unplanned absence can be found on the MD program’s school absences webpage. It is the responsibility of the relevant course and/or curriculum director to determine whether the circumstances warrant a deferral.

Students who cannot complete an assessment as scheduled due to a religious obligation should submit a planned absence request in accordance with the procedures and deadlines included in the MD Program Regulations for student attendance and guidelines for absences from mandatory activities. According to those Regulations, religious observance planned absence requests from assessments are normally approved, while other types of planned absence requests from assessment are normally not approved.

Retroactive Accessibility Accommodations:

If a learner receives approval for a formal accessibility accommodation from Accessibility Services after 
failing an assessment (either due to the discovery or diagnosis of an existing disability of which the 
learner was previously unaware, or due to delay in the process beyond the student’s control), the 
learner may be granted approval to reattempt the assessment with the approved accommodation in 
place. The following factors may be considered when determining if retroactive accommodation is 
warranted:

  1. timeliness of the request (e.g., when did the student know about the disability, how much time has passed between making the request, and the duration of approved accommodation) 
  2. nature of the accommodation requested; 
  3. supporting documentation provided; 
  4. amount of course work completed; 
  5. the learner’s academic record.

If a learner chooses not to use an approved formal accessibility accommodation, a reattempt of the 
assessment with the accommodation retroactively applied will not be granted.
 

B. Rules for the conduct of written assessments

  1. Arrive on time: For assessments completed through in person invigilation at designated locations and electronically proctored (e-proctored), students must be present at the assessment and download the assessment at least fifteen (15) minutes before the scheduled start time of the assessment. Students may be directed to be present earlier than fifteen (15) minutes for some assessments.
  2. Late arrival procedures: For in person invigilated assessments completed at designated locations, students who arrive late will be permitted to enter the room and complete the assessment, but will not be allowed additional time. Students who are ten (10) or more minutes late for a Foundations mastery exercise will be directed to a separate back-up room to complete the exercise. Students who are late for a Clerkship mastery exercise will complete the mastery exercise in the assessment room. Students who are repeatedly late are responsible for contacting the Foundations or Clerkship Director to discuss their circumstances. For e-proctored assessments, students who attempt to log into the assessment late and find that their assessment download has been deleted will not be allowed additional time. In such instances, students will need to contact the administrator who will provide them with a new assessment download for the remaining duration of the assessment.  
  3. What to bring to assessments completed through in person invigilation at designated locations: Students should bring photo identification (T-card) and are required to display it at the request of the invigilator/examiner. For computer-based assessments, students are responsible for bringing their own device (computer or tablet). For paper-based assessments, students are responsible for bringing their own pens and pencils. Students are responsible for bringing a watch to monitor the time throughout the assessment, which must be placed on their desk during the assessment. Students are not permitted to use cell phones or smart watches as timekeeping devices during an assessment.
  4. Scent- and nut-free area: For assessments completed through in person invigilation at designated locations, students should refrain from wearing scent (i.e. perfume, cologne) and from bringing food items containing nuts or traces of nuts to the assessment. Students who arrive wearing scent may not be permitted into the assessment location. Students who arrive with a food item that contains nuts or traces of nuts will not be permitted to bring it into the assessment location.
  5. What not to bring to the assessment desk/table: No materials or aids should be brought to the assessment desk/table unless explicitly authorized by the program/invigilator/examiner. This includes but is not limited to paper and pen for notetaking, cell phones, textbooks, electronic earphones and headphones, and other devices (e.g., iPad, tablet, smart watch) which are strictly prohibited. For e-proctored assessments, the use of non-electronic ear plugs to cancel noise are permitted.  If using such ear plugs, the student must show them to the camera one at time before inserting them into their ears at the start of the assessment. For assessments completed through in person invigilation, bags and books are to be deposited in areas designated by the invigilator/examiner and are not to be taken to the assessment desk/table. For e-proctored assessments, the assessment desk/table must be free of any unauthorized materials or aids for the duration of the assessment. All electronic devices are to be turned off and must remain in the designated area or away from the desk/table for e-proctored assessments. Under the terms of the University of Toronto Code of Behaviour on Academic Matters, possession by a student of unauthorized materials/aids during their assessment is a breach of academic integrity, with the potential for academic penalty. This includes cell phones, smart watches or other electronic devices, even if they are turned off. The University is not responsible for personal property left at the assessment location.
  6. Assigned seating for assessments completed through in person invigilation at designated locations: The invigilator/examiner has the authority to assign seats to students in the assessment room. No person will be allowed in an assessment room during an assessment except the students completing the assessment and those supervising the assessment.
  7. Behaviour during assessments: No materials or aids should be used during any assessment unless explicitly authorized by the program/invigilator/examiner. This includes but is not limited to paper and pen for notetaking, cell phones, textbooks, electronic earphones and headphones, and other devices (e.g., iPad, tablet, smart watch) which are strictly prohibited. For e-proctored assessments, the use of non-electronic ear plugs to cancel noise are permitted.  If using such ear plugs, the student must show them to the camera one at time before inserting them into their ears at the start of the assessment. Students who use or view any unauthorized materials or aids while their assessment is in progress, who assist or obtain assistance from other candidates or from any unauthorized source, or who communicate with one another in any manner whatsoever during the assessment are liable for academic penalties under the terms of the University of Toronto Code of Behaviour on Academic Matters.
  8. Irregularities/errors/ambiguities in assessment materials: Irregularities/errors/ambiguities relating to wording, spelling, punctuation, numbers or notations will normally be referred to the course director in writing within 24 hours of the assessment.
  9. Leaving the room during the assessment: For assessments completed through in person invigilation at designated locations, students may leave the assessment room no earlier than thirty (30) minutes after the start of the assessment, and under supervision. Candidates shall remain seated at their desks during the final ten (10) minutes of each assessment, even if they have completed the assessment. For e-proctored assessments, students are encouraged to use the washroom before the assessment. A short washroom break may be unavoidable and is thus allowed. The videos will be flagged for review when this occurs.
  10. At the conclusion of assessments: At the conclusion of an assessment, all writing shall cease. For paper-based assessments, the invigilator/examiner may seize the papers of students who fail to observe this requirement. For computer-based assessments, the invigilator/examiner will make a note of students who fail to observe this requirement. Failure to observe this requirement may result in a penalty imposed under the terms of the University of Toronto Code of Behaviour on Academic Matters. For computer-based in person invigilated assessments, students may leave the assessment room only after an invigilator/examiner has ensured that the assessment has been uploaded.
  11. After the assessment: For assessments completed through in person invigilation at designated locations, assessment books and other material issued for the assessment shall not be removed from the assessment room except by authority of the invigilator/examiner. For all assessments, the sharing of assessment questions in any format or by any means is considered a breach of academic integrity under the terms of the University of Toronto Code of Behaviour on Academic Matters.

C. Rules for the conduct of OSCEs

  1. Arrive on time: Students must normally arrive at the in person examination site or virtual site at least thirty (30) minutes before the scheduled starting time of the examination. Students may be directed to arrive earlier than thirty (30) minutes for some examinations.
  2. Late arrival procedures: It is at the discretion of the examiner whether a student who arrives late will be allowed to participate in the examination and whether additional time beyond the scheduled examination time will be allowed.
  3. What to bring to the in person examination: Students should bring photo identification, lab coat, stethoscope, watch with a second hand, clipboard, and pens and pencils. Failure to do so may prevent the student from completing the examination. If additional equipment is required, this will be communicated to students before the OSCE.
  4. What to bring to the virtual examination: Students should bring photo identification, blank paper, and a pen or pencil. Students should wear proper attire (e.g. business casual attire). 
  5. Scent- and nut-free area: At the in person examination site, students should refrain from wearing scent (i.e. perfume, cologne) and from bringing food items containing nuts or traces of nuts to the examination. Students who arrive wearing scent may not be permitted into the examination location. Students who arrive with a food item that contains nuts or traces of nuts will not be permitted to bring it into the examination location.
  6. What not to bring to the in person examination: No materials or aids should be brought to the examination location unless explicitly authorized by the examiner. Bags and books are to be deposited in areas designated by the examiner. All electronic devices are to be turned off and must remain in the designated area. Under the terms of the University of Toronto Code of Behaviour on Academic Matters, possession by a student of unauthorized materials/aids during their assessment is a breach of academic integrity, with the potential for academic penalty. This includes cell phones or other electronic devices, even if they are turned off. The University is not responsible for personal property left at the examination location.
  7. What not to bring to the virtual examination: No additional electronic devices aside from the device being used to access the virtual platform. Electronic note taking or the recording of the examination is strictly prohibited. 
  8. Behaviour during the examination: Each student will proceed through the sequence of stations as assigned by the examiner. Students are responsible for ensuring that all information is written legibly for in person examinations.
  9. Professionalism: Where standardized patients are used in the course of an examination, students will extend the same respect and professional courtesy as that which is appropriate for any clinical interaction. Students shall not otherwise engage in behaviour that is disruptive to the examination process. Characterization of behaviour as disruptive and expulsion of a disruptive student from the examination site will be at the discretion of the examiner. Students are expected to behave in compliance with and are subject to penalties under the terms of the MD Program Guidelines for the Assessment of Student Professionalism
  10. Conflict of interest: In cases where there is a conflict of interest (including a conflict of clinical and educational roles) during an examination, either the student or examiner may stop the station and notify staff immediately. The student will be reassigned to a different examiner/standardized patient when time allows.
  11. Irregularities: If a student feels that their performance has been compromised as a result of an irregularity in the conduct of the examination, they must report the irregularity to the examiner prior to leaving the examination site.
  12. During and after the examination period: Students shall not discuss any part of the examination with another student for the duration of the exam period. The administration period of the examination includes all sessions of the examination that are conducted for separate groups of candidates and that may occur on separate days. No portion of the examination shall be retained by a student after the conclusion of the examination unless explicitly authorized by the examiner. Students are expected to behave in compliance with and are subject to penalties under the terms of the University of Toronto Code of Behaviour on Academic Matters.
  13. During virtual examinations: Students must ensure that their video remains on and that their audio is unmuted. Students are not permitted to record the examination or use virtual backgrounds.

D. Calculation re-check of an assessment or course

If a student is concerned that the calculation of a mark or grade for an assessment or course was incorrect, they may request a calculation re-check, which will focus solely on the addition of marks or grades within an assessment or course. Such requests must be submitted in writing to the relevant course director, copied to the Student Progress Analyst (md.progress@utoronto.ca) for Foundations courses or course administrator for Clerkship courses, no later than five business days after a mark or grade for an assessment or course was made available to the student. If possible, the student should indicate the location of the possible miscalculation.

The course director will ensure that a calculation re-check is completed and the outcome communicated to the student in a timely manner, normally within two weeks from receipt of the written request. Completion of the re-check may take longer depending upon the availability of relevant faculty members and administrative staff.

A calculation re-check may result in a raised mark, lowered mark, or no change. By requesting a calculation re-check, a student agrees to accept the outcome of the re-check. Appeals to the outcome of a calculation re-check are governed by the Faculty of Medicine Appeal Guidelines, including acceptable grounds for appeals.

E. Re-mark of a written assessment

The option to request a re-mark applies only to written assessments that include short answer questions (SAQs) and/or other narrative components. Multiple choice questions (MCQs) and Clinical Decision Making items (CDMs) are not eligible for re-mark requests. A high standard of psychometric performance is upheld for items included in written assessments and each course director undertakes a systematic post-test analysis of the performance of each item, which identifies any problematic questions.

A student may request a re-mark for a written assessment with a SAQ/narrative component (not MCQ or CDM) that they believe has been incorrectly marked in its substance. In the event that a student needs to view their completed assessment in order to determine the location and nature of the suspected substantive mis-mark and provide an informed statement in support of a re-mark request, they may request to view the completed assessment. Section F includes information regarding access to past and completed assessments.

  • Re-mark request procedures:
    • Students must submit in writing a re-mark request to the relevant course director (copied to the course administrator) no later than four weeks after the assessment mark has been made available to the student.
    • The request must identify the written assessment and portion(s) of the written assessment that the student would like re-remarked.
    • The request must include a statement in support of the re-mark. This statement should demonstrate that the answers provided in the assessment are substantially correct by citing specific instances of disagreement, supported by documentary evidence from course materials. The student must do more than simply assert that they disagree with the marking or that they deserve more marks.
  • Re-mark rules and regulations:
    • The course director will ensure that the assessment is re-marked, normally by the individual initially responsible for marking, the individual who has academic oversight of the marking of the assessment in question, or a course-specific assessment subcommittee.
    • The re-mark will be informed by the statement of support provided by the student. It will also be re-marked in a manner consistent with the rest of the class and, if applicable, the assessment rubric.
    • The course director will ensure that the outcome of the re-mark is communicated to the student, normally within four weeks from receipt of the re-mark request. Completion of the re-mark may take longer depending upon the availability of relevant faculty members.
    • A re-mark may result in a raised mark, lowered mark, or no change. By requesting a re-mark, a student agrees to accept the outcome of the re-mark.
    • Appeals to the outcome of a re-mark are governed by the Faculty of Medicine Appeal Guidelines, including acceptable grounds for appeals articulated in those guidelines.
    • If, as a result of a re-mark, an answer key, scoring system, or other aspect of an assessment are found to require alteration, all affected students will be promptly notified, as appropriate.

F. Access to completed assessments

Access to all MD Program assessments is restricted, meaning that medical students may not request or obtain copies of completed assessments. The following procedures, rules and regulations for viewing completed written assessments are intended to maintain the integrity of the MD Program’s question banks.

Medical students may request a supervised viewing of a written assessment that they have completed in order to determine the location and nature of a suspected mis-mark and provide an informed statement in support of a request for a re-mark.

  • Procedures to request a supervised viewing of a completed written assessment:
    • Students must submit in writing a request to the relevant course director (copied to the course administrator) no later than two weeks after the assessment mark has been made available to the student. The timing of the viewing will be informed by adherence the rules articulated below.
  • Viewing rule and regulations:
    1. The viewing will take place in a location determined by the course director or delegate.
    2. The viewing must be supervised by the course director or delegate.
    3. The student will bring their signed photo identification and provide it to the supervisor, if requested.
    4. If a student is reviewing multiple written assessments, they must be reviewed one at a time.
    5. The viewing of a single written assessment will not exceed 30 minutes.
    6. The student may not be accompanied by anyone else during the viewing.
    7. All belongings must be placed at the side of the room or under the table. Nothing, including writing/notetaking implements or cell phones, is allowed on the viewing table.
    8. Students may not consult books or notes, nor take notes or photographs, during the viewing.
    9. Answer keys and/or marking rubrics will not be provided to the student.
    10. The course director or delegate is under no obligation to provide feedback to the student during or in response to the viewing, except in the context of a request for a re-mark.

 


Date of original adoption: August 2011
Date of last amendment: 12 September 2023

Standards for formative and narrative assessment and feedback

Standards for formative and narrative assessment and feedback

Preamble

These standards apply to all required learning experiences, defined as required and transcripted courses and clerkship rotations.

The Foundations Director and Clerkship Director are responsible for ensuring that processes are in place to enable and support the provision and monitoring of formative and narrative assessment and feedback in accordance with the following standards.

Standards for formative assessment and feedback

These standards are informed by and should be implemented in accordance with the expectations and requirements of CACMS accreditation element 9.7, Timely Formative Assessment and Feedback.

Formative assessment and feedback provided to students should be grounded in the objectives of the required learning experience in order assist students in achieving those objectives.

  • In all required learning experiences of four weeks or longer, every student must receive formal formative feedback by at least the mid-point of the learning experience.
  • Clerkship clinical rotations with distinct sub-rotations should preferably provide mid-rotation feedback at the mid-point of each sub-rotation, but may instead provide this feedback at the mid-point of the rotation as a whole.
  • For required learning experiences of less than four weeks, students should where possible be provided with timely formative feedback or alternate means by which a student can assess their progress in the experience.
  • For half- or year-long required learning experiences, every student must receive formal formative feedback approximately every six weeks.

Standards for narrative feedback

These standards are informed by and should be implemented in accordance with the expectations and requirements of CACMS accreditation element 9.5, Narrative Feedback.

For all required learning experiences, a narrative description of a medical student’s performance, including his or her non-cognitive achievement, should be included as an assessment component whenever teacher-student interaction permits this form of assessment.

 


Date of original adoption: 15 November 2011
Date of last amendment: 11 December 2018

Standards for timely completion of student assessment and release of marks

Standards for timely completion of student assessment and release of marks

These standards are informed by and should be implemented in accordance with the expectations and requirements of CACMS accreditation element 9.8, Fair and Timely Summative Assessment.

These standards apply to all required learning experiences, defined as required and transcripted courses and clerkship rotations.

For all required learning experiences, each student component assessment (evaluation forms, examination results, etc.) must be released to the students within six weeks of the assessment completion of the activity to be assessed. Earlier release is encouraged. Individual adherence to this deadline is to be monitored by the course director. Regardless of whether the course director elects to delegate this task to an administrative assistant, the overall responsibility for compliance remains with the course director.

The final grade in each course is to be recorded within the appropriate student information system(s), as determined by the MD Program, and must be made available to students no later than six weeks following the end of the required learning experience. Earlier release is encouraged. In exceptional circumstances, an individual student’s assessments and/or final course grade may be delayed; in this situation, the student must be notified of the reasons for delay. Under no circumstances should the release of assessments or grades to an entire class or group of students be delayed beyond the timeframes named above.

Students should be advised of sub-standard performance as soon as this information is available, in advance of the deadlines noted above where possible.

Teachers or course directors who persistently fail to meet the six-week assessment and/or final grade deadline will be brought to the attention of their Department Chair and/or the Associate Dean, MD Program by the Foundations Director, Clerkship Director, and/or MD Program Office of Evaluations and Assessments.

Note: The Christmas/New Year holiday period when the University of Toronto is closed does not count towards the six week timeline for the release of assessments and final course grades describe above.

 


Date of original adoption: 19 April 2011
Date of last amendment: 12 March 2019

Temerty Faculty of Medicine Appeals Guidelines ^

Temerty Faculty of Medicine Appeals Guidelines ^

The Temerty Faculty of Medicine Appeals Committee procedures and guidelines for appeals are contained within the Guidelines for Procedure of that body.

MSPR Guidelines

MSPR Guidelines

Introduction

A Medical Student Performance Record (MSPR) is produced for each University of Toronto (U of T) medical student in support of the Canadian Residency Matching Service (CaRMS) application requirements.

The U of T MSPR components are summarized below. These components are informed by and consistent with a MSPR template endorsed by the Association of Faculties of Medicine of Canada. Explanatory notes are provided to ensure clarity and transparency about specific components, where necessary. Information regarding the U of T MD Program curriculum will be made available on the MSPR via hyperlinks.  

Also included below are MSPR production and dissemination guidelines. The use of MD Program student academic records for the purposes of MSPR production and dissemination is governed by and consistent with University of Toronto Guidelines Concerning Access to Official Student Academic Records and MD Program Access to Student Academic Records. By acting in accordance with those Guidelines, the MD Program supports and is in compliance with appropriate access to, and privacy of, official student academic records consistent with the Freedom of Information and Protection of Privacy Act (FIPPA).

MSPR Components

The U of T MSPR is comprised of the following components:

1. Identifying Information

  • Student Name
  • University of Toronto Student Number
  • Date of Issuance
  • Academic year in which student enrolled in Year 3 of the MD Program

2. Academic History

  • Date of first registration in the MD Program
  • Time to complete program (Example: leaves, extensions or repeated years)
    • This sub-section is intended to enable medical schools to contextualize extensions, leaves, gaps or breaks due to unsatisfactory academic performance as well as those that are non-academic in nature. The identification of “repeated years” due to unsatisfactory academic performance is governed by the MD Program’s Standards for Grading and Promotion. Privacy of students’ personal information, including with respect to non-academic extensions or leaves due to illness or injury is protected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) and Personal Health Information Protection Act (PHIPA).
  • Information on prior, current or expected enrollment or graduation in dual, joint or conjoint degree programs
    • Only dual, joint or conjoint degree programs formally associated with the U of T MD Program in accordance with the U of T Quality Assurance Framework will be identified in this sub-section. Information about academic programs pursed in addition to the MD Program that are not formally associated with the MD Program will be reflected the student’s transcript.
  • Description of any repeated courses
    • This sub-section is intended to enable medical schools to provide context, including supportive commentary, in cases where a repeated course is indicated on the student’s transcript. The identification of “repeated courses” is governed by the MD Program’s Standards for Grading and Promotion.
  • Description of any academic misconduct in medical school that the student has been found guilty of that is currently part of their academic record

3. Academic Progress

  • Professional Performance

    This section will indicate if a student’s professionalism performance in the MD Program “meets expectations” or “does not meet expectations”, in accordance with the MD Program Student Professionalism Guidelines. For the purposes of the MSPR, students who have successfully completed a Focused Professionalism Learning Plan or Professionalism Remediation have met the program’s professionalism expectations.

  • Preclinical Curriculum
    • This section will indicate if the student has successfully complete the MD Program’s Foundations curriculum. It will not include grades or other performance indicators for each Foundations course as that information is provided on student transcripts.
  • Clerkship Courses
    • Student performance for each clerkship course will be represented on the MSPR by Credit/No Credit along with narrative comments from the “strengths” section of the student’s final clinical assessment forms. Further details regarding the inclusion of narrative comments on the MSPR are included below under MSPR Production and Dissemination Guidelines.
  • Electives
    • Student performance for each elective completed by the time the MSPR is produced will be represented on the MSPR by Credit/No Credit along with narrative comments from the “strengths” section of the student’s final clinical assessment forms. Further details regarding the inclusion of narrative comments on the MSPR are included below under MSPR Production and Dissemination Guidelines.

MSPR Production and Dissemination Guidelines

MSPRs are normally produced and disseminated in the Fall term of students’ Year 4 in the MD Program. Specific production and dissemination processes and dates are determined by Enrolment Services – Undergraduate Medical Education (UME), informed by applicant timelines for the first iteration of the Canadian residency match process.

Student academic records are the source of information for production of the MSPR. These student academic records include information contained in University transcripts, in electronically stored records such as final clinical assessment forms, and in the "official student academic record'' as maintained within UME Enrolment Services in the Temerty Faculty of Medicine.

Narrative Comments

Narrative comments for clerkship courses and completed electives will be drawn solely from the “strengths” section of students’ final clinical assessment forms. Narrative comments on the MSPR will not include comments from interim feedback forms or from any source other than final clinical assessment forms.

With the exception of corrections to grammar or spelling, the comments drawn from the “strengths” section of students’ final clinical assessment forms will be included verbatim on the MSPR. As part of the final clinical assessment form for MD Program courses, the “strengths” comments will not edited, adapted or expanded upon to advantage their use in the MSPR.

Consent, including presumed consent, by students for inclusion on the MSPR of narrative comments from the “strengths” section of clinical assessment forms is provided as follows:

  • Following completion of each clerkship course and elective, students will receive notification to review their clinical assessment form, including narrative comments, to confirm that the clinical assessment form accurately reflects their performance.
  • Students will have two weeks from the date of notification to indicate their agreement or disagreement.
  • If a student agrees with the clinical assessment form, or does not reply to the notification within two weeks, they will have provided consent to include on the MSPR comments from the “strengths” section of the evaluation form(s) for the course or elective in question.
  • If a student disagrees that their clinical assessment form accurately reflects their performance in the course, they will meet with the course director and/or Clerkship Director to discuss their concerns, including any comments from the “strengths” section of the form that the student believes are not factual and accurate. This is not an opportunity to advocate for the addition of comments; the comments on final clinical evaluation forms are based on preceptors’ workplace-based observations throughout the rotation or elective. Following such discussion, the course director and/or Clerkship director will determine if the comments on the clinical assessment form are factual and accurate. Comments on the evaluation form that are deemed by the course director and/or Clerkship Director to be factual and accurate will not be changed on or removed from the evaluation form, and will be included on the student’s MSPR, as outlined above. There is no further route to appeal with respect to inclusion of narrative comments on a student’s MSPR.

For courses in which a student has completed remediation, the narrative comments from the “strengths” section of original clinical evaluation form will be included on the MSPR.

For repeated courses, in which the initial course attempt appears on the student’s transcript as No Credit (NC), the narrative comments from the “strengths” section of both the initial course attempt and repeated attempt(s) will be included on the MSPR.

 


Date of original adoption: 13 April 2021

Policy on scheduling of classes and examinations and other accommodations for religious observances *

Policy on scheduling of classes and examinations and other accommodations for religious observances *

The University of Toronto welcomes and includes students, staff and faculty from a broadly diverse range of communities and backgrounds. The University community comprises one of the most diverse campus populations anywhere. Students, staff and faculty have a wide range of backgrounds, cultural traditions and spiritual beliefs. With reference to the University’s commitment to human rights as articulated in the Statement on Human Rights and in accordance with the accommodation principles of the Ontario Human Rights Code, the Policy on Scheduling of Classes and Examinations and Other Accommodations for Religious Observances is concerned with accommodations for students with respect to observances of religious holy days.

Policy on the student evaluation of teaching in courses *

Policy on the student evaluation of teaching in courses *

The purpose of the Policy on the Student Evaluation of Teaching in Courses is to outline the principles and parameters that guide the evaluation of courses at the University of Toronto. The specifics of how the course evaluation process will be structured and administered in particular contexts will be outlined in the Provostial Guidelines for the Student Evaluation of Teaching in Courses. The Provostial Guidelines and the course evaluation policy, in addition to divisional guidelines on course evaluation, form an institutional framework for the evaluation of courses.

Guidelines for teacher and course evaluations

Guidelines for teacher and course evaluations

Overview 

The MD Program relies on various sources of information to provide feedback on the quality of the program as a whole, on individual components including courses, and on individual teachers. This feedback enables evidence-based, continuous quality improvement of the program and student experience. It is also a core element of a faculty member’s teaching dossier, which is used for promotion and related purposes. One of the chief sources of such feedback is data obtained from students via teacher assessments and course evaluations.

Curriculum leaders should work with student course representatives to ensure that the importance of timely evaluation completion is well understood. Course directors should communicate their evaluation expectations to students at the beginning of the course and at subsequent points as necessary. 

Principles 

  1. One of the most powerful and effective tools used to assess the quality and effectiveness of the MD Program curriculum and its teachers is constructive student feedback.
  2. Students in the MD Program are in training to enter a profession that relies to a considerable extent on collegial critique for self-improvement. Giving effective feedback and responding to feedback are competencies essential for effective self-regulation.  
  3. The MD Program endeavours to educate medical students in a manner that fosters the development of competencies essential for effective self-regulation.  
  4. Students are essential partners in the education program and should contribute to the planning and implementation of a reasonable, required program of course evaluation and teacher assessment.
  5. The time required to complete assessments of teachers and evaluation of courses should be minimized by ensuring:
    1. That the process of completion of forms be as easy as possible, including:
      1. That the forms be concise and only include essential information.
      2. That whenever possible, dedicated time be set aside during school hours for students to complete course evaluations and teacher assessments.
      3. That the forms be available for completion on a variety of technological platforms.
    2. That the number of students required to complete the forms be determined with regard to statistical principles. 
    3. That reminders to complete any forms be limited to no more than once per week.

Expectations

  1. In light of the preceding principles, students are to evaluate all activities, faculty teaching events and faculty/residents interactions where they have substantial contact. The minimum number of clinical teacher assessments should be no less than three. In courses where there is substantial contact with residents it is also expected that students will complete no less than three resident assessments. Students are also expected to complete all end of course evaluations.
  2. Students are expected to complete all evaluations forms upon receipt of the request and will receive reminders every two weeks. Evaluations forms must be submitted prior to a cut-off of 15 days from the time of receipt of the original request. The cut-off date is intended to ensure that feedback data remains valid, is not unduly influenced by recall bias, and is available in a timely manner to facilitate quality improvement activities.
  3. Completion of course evaluation and teacher assessment forms will be monitored by the central MD Program administration. Clerkship students who have not completed the end of course evaluation will not have electronic access to assessments completed on MedSIS pertaining to their own performance until they have submitted the required evaluations in that course. If a student does not meet this requirement (completing end of course evaluation) they may still access their own assessment by scheduling a meeting with the course director at which time they should be prepared to discuss why they have not completed their evaluations as requested.
  4. If students encounter a technical difficulty that hinders the completion of an evaluation form, it is their responsibility to bring this problem to the attention of the course administrator, course director, or technical staff in a timely manner.

Standards for the timely release of teacher assessment scores and feedback

The MD Program places great value on the commitment of the many teachers who contribute to the education of our students. In recognition of their efforts, student assessment of teacher effectiveness scores and other formal feedback will be made available to teachers within two months of the end of the course (in Foundations) and within two months of the end of the academic year (in Clerkship). The MD Program will facilitate the provision of each teacher’s student assessment of teacher effectiveness scores to the relevant University Department Chair(s).

Teacher assessment data will, however, only be released when a minimum of three assessments have been received for a given teacher for each learning activity in order to protect the confidentiality of the students who provided the feedback.

Courses that run for a prolonged period of time (particularly the entire length of the academic year) and courses with multiple rotations are encouraged to share interim or informal feedback earlier when this can be done without compromising student anonymity.

Failure to meet the two-month deadline will be brought to the attention of the Foundations Director or Clerkship Director as appropriate, and if necessary the Associate Dean, MD Program and/or the relevant Department Chair.

Standards for the use of teacher assessment scores and feedback

Student assessment of teacher effectiveness scores and other evaluation feedback about individual teachers must not be disclosed to those outside of the MD Program, nor to individuals within the MD Program, who do not have the authority to access that data. The only exceptions are when the disclosure is required by official MD Program business, by University policy, or by law.

Letters of reference or external award nominations written by MD Program leaders for teachers must not contain student assessment of teacher effectiveness scores or student comments retrieved from evaluation forms without the specific consent of the teacher.

Individuals aware of inappropriate disclosure of teacher assessment information outside of the MD Program should inform the Associate Dean, MD Program as soon as possible.

Teacher assessment appeals process

MD Program teachers have the right to request an appeal of their teacher assessments. Included below are guidelines for appeal requests and the adjudication appeal requests, including the reporting process.

Appellant Responsibilities:

  1. Appeal requests are to be directed to the attention of the Evaluation Scientist, Office of Assessment and Evaluation, MD Program by email (md.oae@utoronto.ca) and copied to the appellant’s Clinical Chief and Departmental Chair/Divisional Head, and the Course Director.
  2. Appeal requests must be submitted no more than one year after the release of the assessments in question.
  3. Notices of such requests are to provide a rationale for such request.

Process & Reporting:

  1. Teacher assessment records are compiled by the Office of Assessment and Evaluation for review by an ad hoc three member Appeals Committee, which is chaired by a Senior Educator appointed by the Associate Dean, MD Program and includes both a faculty and student representative. This committee convenes as required.
  2. Reviews are limited to appeal requests submitted by the deadline indicated above, and which pertain to teaching within the immediately preceding academic year unless more than one year of data was required in order to reach an aggregate of three assessments. 
  3. If successful, the outcome of the appeal will include the elimination of the assessment in question.
  4. All outcomes are considered final and are reported to the appellant and copied to the appellants’ respective Clinical Chief and Departmental Chair /Divisional Head as either supported or denied.
  5. Students will not normally be notified when an appeal is made, nor will they be notified regarding the outcome of the appeal.
  6. A summary of all appeals and their outcomes will be provided to the Associate Dean, MD Program.

Standards & Guiding Principles:

In order to ensure uniformity and fairness, the committee relies on standards in its adjudication process that may include:

  1. Face validity:
    1. A presentation of reasonably refuting evidence.
    2. Undue influence of a statistically atypical assessment(s).
    3. Whether an evaluation(s) is (are) program or teacher oriented.
    4. Obvious transposition of scale ratings.
  2. For assessments in question, additional considerations may include:
    1. Whether there is evidence supporting apparent retribution by a student.
    2. Whether or not a student(s) has (have) substantiated their ratings in narrative form.
    3. Whether the degree of contact between teacher and student is reasonable for purposes of rendering an assessment of teaching effectiveness.

In circumstances where arguments for and against upholding an appeal are balanced, the resolution will be to favour the appellant.

System error teacher assessment appeals process

Instances may arise where a Course or Component Director identifies that a teacher received a low or incorrect assessment as a result of a system error beyond the teachers control.  Examples of a system error include receiving low ratings as a result of miskey issues (ratings do not correspond with comments), or being assessed for the incorrect teaching activity. Included below are guidelines for appeal requests and the adjudication of appeal requests, including the reporting process.

Course or Component Director Appellant Responsibilities:

  1. The Course or Component Director who has identified the low or incorrect assessment will formally notify the Office of Assessment and Evaluation (md.oae@utoronto.ca). There is no need to copy in the Clinical Chief and Departmental Chair/Divisional Head for the teacher in question.
  2. Appeals requests must be submitted no more than one year after the release of the assessment in question.
  3. The submission should include: i) the name of the teacher who received the low assessment, ii) the name and date of the session, and iii) a description of the system error.

 

Process & Reporting:

  1. Teacher assessment records related to the teacher who has received the low or incorrect assessment are compiled by the Office of Assessment and Evaluation. The records are analyzed alongside the submitted material by the Office of Assessment and Evaluation Program Evaluation Director, Senior Analyst, and Manager, to verify that the low or incorrect assessment resulted from a system error.
  2. If the outcome of the appeal is determined to be a system error, the assessment in question will be eliminated. 
  3. All outcomes are considered final and are reported to the Course or Component Director who submitted the appeal and the teacher whose performance will be revised. 
  4. Students will not normally be notified when the appeal is made, nor will they be notified regarding the appeal's outcome. 
  5. A summary of the appeal case and the submitted documentation will be kept as part of the Office of Assessment and Evaluation records. Data from system error appeals will be analyzed regularly to identify areas that could be refined. 

 


Date of original adoption: 13 August 2013
Date of last amendment: 31 January 2022

Student Conduct and Professionalism

Code of student conduct *

Code of student conduct *

The University of Toronto's Governing Council has approved the Code of Student Conduct, which includes details on the purpose of the Code, possible offences addressed by the Code, procedures for addressing violations, possible sanctions to be imposed, and the maintenance of records of non-academic disciplinary proceedings.

All MD Program students, faculty, and staff are expected to be familiar with the Code of Student Conduct, and to consult the Governing Council website as needed.

Standards of professional practice behaviour for all health professional students *

Standards of professional practice behaviour for all health professional students *

Health professional students engage in a variety of activities with patients/clients under supervision and as part of their academic programs. During this training, the University, training sites, and society more generally expect our health professional students to adhere to appropriate standards of behaviour and ethical values. All health profession students accept that their profession demands integrity, exemplary behaviour, dedication to the search for truth, and service to humanity in the pursuit of their education and the exercise of their profession.

The Standards of Professional Practice Behaviour for all Health Professional Students express professional practice and ethical performance expected of students registered in undergraduate, graduate and postgraduate programs, courses, or training in the Temerty Faculty of Medicine.

Guidelines for students working part-time as health professionals #

Guidelines for students working part-time as health professionals #

The Council of Ontario Faculties of Medicine (COFM) Guidelines for Students Working Part-time as Health Professionals were created to advise learners who wish to undertake a clinical rotation in a patient care environment they may presently or previously be employed as a health care provider

Ontario Schools of Medicine undergraduate medical education programs enroll medical students who have registration and/or previous employment in other areas of health care. To support financial obligations as students, undergraduate medical learners may seek temporary or seasonal employment in their registered health professional roles. These roles may overlap with learning in clinical environments. This guideline will direct decision making for a select group of students involved in clinical learning at a health care facility where they are/have been employed (full or part time) as a health care worker.

Guidelines for appropriate use of internet, electronic networking and other media ^

Guidelines for appropriate use of internet, electronic networking and other media ^

The Guidelines for Appropriate Use of the Internet, Electronic Networking and Other Media apply to all medical trainees registered at the Temerty Faculty of Medicine at the University of Toronto, including undergraduate and postgraduate students, fellows, clinical research fellows, or equivalent. Use of the Internet includes posting on blogs, instant messaging [IM], social networking sites, e-mail, posting to public media sites, mailing lists and video-sites.

Guidelines for the Assessment of Student Professionalism

Guidelines for the Assessment of Student Professionalism

Application

Effective 2017-18, these Guidelines apply to all students registered in the MD Program.

Overview

Being a professional is one of the key attributes of being a physician. These guidelines for the assessment of MD student professionalism are informed by the University of Toronto’s Standards of Professional Practice Behaviour for all Health Professional Students and the MD Program’s competency framework.

Assessment of student professionalism takes place through competency-based professionalism assessments and critical incident reports, as described below.

Suspected breaches of academic integrity are investigated and addressed in accordance with the MD Program’s Academic Integrity Guidelines.

Competency-based Professionalism Assessments

In selected teaching and learning settings where teachers are in a position to make meaningful observations about students’ professional behaviour, including small group settings and clinical learning environments, supervising teachers complete competency-based student professionalism assessment forms. This assessment exercise provides an opportunity for teachers to indicate both strengths and areas for improvement with respect to professionalism, with a primary goal being the provision of formative feedback to support medical students' professional identity formation through the development of their professional competencies. It also allows the program to monitor whether individual students are exhibiting a pattern of unprofessional behaviour, possibly across multiple courses or multiple learning contexts.

The Faculty Lead, Ethics and Professionalism plays a dual role with respect to these guidelines. They play a leadership role in ensuring that the processes to support the assessment of student professionalism and
processes to support students who are identified as being in professionalism difficulty are clearly articulated, fair, and informed by Temerty Medicine’s commitment to the principles and practices of equity, diversity, inclusion, Indigeneity, and accessibility (EDIIA). The Faculty Lead, Ethics and Professionalism also plays a consultative role with respect to medical students who have been identified as being in professionalism difficulty. This consultative role includes active participation in the development and assessment of focused professionalism learning plans and professionalism remediation plans. 

The professionalism assessment form is organized according to six professionalism domains. Each domain includes criteria that reflect specific behaviours that characterize the respective domain, as follows:

  • Altruism
    • Demonstrates sensitivity to patients’ and others’ needs, including taking time to comfort the sick patient
    • Listens with empathy to others
    • Prioritizes patients’ interests appropriately
    • Balances group learning with his/her own
  • Duty: Reliability and Responsibility
    • Fulfills obligations in a timely manner, including transfer of responsibility for patient care
    • Informs supervisor/colleagues when tasks are incomplete, mistakes or medical errors are made, or when faced with a conflict of interest
    • Provides appropriate reasons for lateness or absence in a timely fashion
    • Prepared for academic and clinical encounters
    • Actively participates in discussions
    • Fulfills call duties
    • Timely completion of MD Program and hospital registration requirements
  • Excellence: Self-improvement and Adaptability
    • Accepts and provides constructive feedback
    • Incorporates feedback to make changes in behaviour
    • Recognizes own limits and seeks appropriate help
    • Prioritizes rounds, seminars and other learning events appropriately
  • Respect for Others: Relationships with Students, Faculty and Staff
    • Maintains appropriate boundaries in work and educational settings
    • Establishes rapport with team members
    • Dresses in an appropriate manner (context specific)
    • Respects donated tissue; cadavers
    • Relates well to patients, colleagues, team members, laboratory staff, service, and administrative staff
  • Honour and Integrity: Upholding Student and Professional Codes of Conduct
    • Accurately represents qualifications
    • Uses appropriate language in discussions about cases and with or about patients and colleagues
    • Behaves honestly
    • Resolves conflicts in a manner that respects the dignity of those involved
    • Maintains appropriate boundaries with patients
    • Respects confidentiality
    • Uses social media appropriately
    • Respects diversity of race, gender, religion, sexual orientation, age, disability, intelligence and socio-economic status
  • Recognize and Respond to Ethical Issues in Practice
    • Recognizes ethical issues and dilemmas in case vignettes and in practice
    • Examines personal values in relation to challenges in educational and clinical settings
    • Applies ethical reasoning skills to case situations
    • Acts appropriately with respect to complex ethical issues
    • Understands options to respond to unprofessional and unethical behaviours of others

Teachers are asked to rank students from 1 to 5, with 5 being the highest score, for each of the six professionalism domains. The assessment of each domain is based on the criteria applicable to the student’s learning activity. Teachers have the option of indicating if they were not in a position to assess one or more of the professionalism domains. Teachers are required to provide comments regarding any scores of 1 or 2, including those that are based on a critical incident (details regarding critical incident reports provided below).

Professionalism Standards of Achievement

Satisfactory professionalism competency is a requirement to achieve credit in every course, and assessment of professionalism competency is included in every course. Satisfactory professionalism competency is also required to progress from one year level to the next and to graduate from the program, in accordance with the MD Program’s Standards for Grading and Promotion for Foundations and Clerkship.

A student may be identified as not satisfactorily progressing as follows:

  • One or two scores of less than 3 on any combination of the six professionalism domains, including two scores of less than 3 on the same form, will trigger a student professionalism check-in process (see below for details).
  • Three or more scores of less than 3 on any combination of the six professionalism domains, including 3 or more scores of less than 3 on the same form, will trigger a student in professionalism difficulty review process (see below for details).
  • A critical incident report will trigger the student in professionalism difficulty review process (see below for details).

The student in professionalism difficulty review process will be re-triggered in cases where a student who has successfully completed (or is in the process of completing) a focused professionalism learning plan or program of professionalism remediation subsequently receives a score of less than 3 on one of the six professionalism domains.

Critical Incident Reports

Critical incident reports are intended to address situations where a student has put a patient or someone else at significant risk and/or caused harm (physical, psychological, emotional) because of their behaviour. Critical incidents of unprofessional behaviour include, but are not limited to, the following:

  • Failure to keep proper medical records
  • Falsification of medical records
  • Breach of confidentiality
  • Failure to acknowledge and manage appropriately a conflict of interest
  • Being disrespectful to patients and others
  • Failure to be available while responsible for contributing to patient care
  • Failure to provide transfer of responsibility for patient care
  • Providing treatment without appropriate supervision or authorization
  • Referring to oneself as, or holding oneself to be, more professionally qualified than one is
  • Being under the influence of alcohol or recreational drugs while participating in patient care
  • Failure to respect the rights of patients and others, including contravention of the Ontario Human Rights Code
  • Assaulting a patient or others, including any act that could be construed as mental or physical abuse
  • Sexual abuse of a patient, as defined by the Province of Ontario Regulated Health Professions Act
  • Stealing or misappropriating or misusing drugs, equipment, or other property
  • Violation of the Criminal Code
  • Any other conduct unbecoming of a physician in training that puts a patient or someone else at significant risk and/or casues harm (physical, psychological, emotional)

Please note that “patients and others” includes patients, families, staff, peers and others.

Critical incidents can be reported as part of a competency-based assessment, or by any teacher, medical student or other learner, University staff member, or hospital staff member using the MD Program’s Critical Incident Report Form or MD Program Event Disclosure Form. Completed critical incident report forms should be forwarded to the Foundations Director, Clerkship Director or Associate Dean, Learner Affairs. Receipt of a notification that a critical incident has occurred will initiate the student in professionalism difficulty review process, which is described below.

A substantiated critical incident report may to lead to a program of remediation, which the student would be required to report to the College of Physicians and Surgeons of Ontario (CPSO) and/or other provincial/territorial physician regulating bodies, as appropriate. A substantiated critical incident can also lead to failure to achieve credit in one or more courses, failure of a year, suspension, or dismissal from the program.

Student Professionalism Check-in Process

A primary goal of professionalism assessments is the provision of formative feedback to support medical 
students’ professional identify formation through the development of their professionalism competencies. 
These professionalism assessments also enable the program to monitor whether individual students are 
exhibiting a pattern of unprofessional behaviour, possibly across multiple courses or multiple learning contexts.

One or two scores of less than 3 on any combination of the six professionalism domains, including two scores of less than 3 on the same form, will trigger the student professionalism check-in process. The check-in process is intended to ensure that students have the opportunity to discuss their performance, including consideration of comments provided on the professionalism assessment form, in a safe and confidential environment, and that they are aware of the various supports available to them.

The check-in procedures are as follows:

  1. The student is contacted in writing by and required to meet with the course or component director of the course or component in which the score of less than 3 was received. In order to support the early identification of potential patterns of unprofessional behaviour and/or to identify appropriate supports or resources for a student who may be experiencing professionalism difficulty, the course/component director may consult with the Faculty Lead, Ethics and Professionalism; Foundations Directors; Clerkship Directors; and/or other curriculum leaders prior to or following the check-in.
  2. The check-in process normally results in one of three outcomes:
  1. No voluntary professionalism activities and/or supports are suggested by the course/component director. A record of the discussion is created by the course/component Director, reviewed by the student, and retained in the student file.
  2. Voluntary professionalism activities and/or supports are suggested by the course/component director. A record of the discussion is created by the course/component director, reviewed by the student, and retained in the student file.
  3. The course/component director forwards the matter to the relevant curriculum (Foundations or Clerkship) director for further review. This action is taken only in exceptional circumstances, where the course/component director considers the professionalism issue serious enough to warrant further review. A record of the discussion is created by the course/component director, reviewed by the student, and forwarded to the relevant curriculum director. The student will meet with the curriculum director in accordance with the student in professionalism difficulty review process, described below.

See Appendix A for a check-in process flow chart.

Student in Professionalism Difficulty Review Process

The student in professionalism difficulty review process will be triggered if a student receives:

  • Three or more scores of less than 3 on any combination of the six professionalism assessment domains, including 3 or more scores of less than 3 on the same form
  • A critical incident report

A course or component director may decide to initiate the student in professionalism difficulty review process as the outcome of a check-in meeting. This action is taken only in exceptional circumstances, where the course/component director considers the professionalism issue serious enough to warrant further review.

Prior to the Student Meeting described below, the curriculum director may consult with the Faculty Lead, 
Ethics and Professionalism, to discuss whether or not there are any potential underlying complexities. If 
potential underlying complexities are identified prior to the student meeting or at any point during the student in professionalism difficulty review process described below, the Faculty Lead, Ethics and Professionalism may strike an ad hoc consultation panel to inform next steps, including the identification of appropriate resources or supports. With the goal of enabling a fair and equitable process, the reasons for striking an ad hoc consultation panel include but are not limited to student mental health, accessibility needs, or potential power asymmetries, particularly for students from equity-deserving groups. Only those who need to be involved should be invited to participate on an ad hoc consultation panel, and all panel members shall maintain confidentiality to the extent possible.

The student in professionalism review process may lead to a program of remediation, which the student would be required to report to the College of Physicians and Surgeons of Ontario (CPSO) and/or other provincial/territorial physician regulating bodies, as appropriate. The review can also lead to failure to achieve credit in one or more courses, failure of a year, or dismissal from the program, in accordance with the MD Program’s Standards for Grading and Promotion for Foundations and Clerkship.

The student in professionalism difficulty review procedures are as follows:

A. Student Meeting

  1. The student is contacted in writing by and required to meet with the relevant curriculum director (i.e. Foundations Director or Clerkship Director), or delegate, to discuss the professionalism issues identified in the professionalism assessments and/or critical incident report. The student viewpoint as well as input from the course/component director and other curriculum leaders, as appropriate, will be considered during the meeting.
  2. Reviews that involve a critical incident report will normally result in one of three outcomes:
    1. The critical incident is not substantiated by the curriculum director, in which case no further action is required.
    2. The critical incident is not substantiated as a critical incident but is substantiated as a low professionalism score, in which case the curriculum director will facilitate the submission of a non-course based professionalism assessment form
    3. The critical incident is substantiated by the curriculum director, in which case the review process proceeds.
  3. The curriculum director, in consultation with the Faculty Lead, Ethics & Professionalism and other curriculum leaders, as appropriate, will determine next steps. The student’s record of professionalism (including their professionalism assessments, substantiated critical incidents reports, and previous programs of professionalism remediation) and severity of the incidents (critical or otherwise) will inform next steps. The student’s perspective and other background information will also be taken into account. Next steps will involve one of four outcomes:
    1. No further action required
    2. Focused Professionalism Learning Plan (See section B below)
    3. Professionalism Remediation (See section C below)
    4. Academic sanctions (See section D below)
  4. The student may be required to meet with the Associate Dean, Learner Affairs or delegate for the purpose of exploring health-related or personal reasons for their unsatisfactory progress and potential supports needed.

B. Focused Professionalism Learning Plan

  1. The student will meet with the Faculty Lead, Ethics & Professionalism to develop a Focused Professionalism Learning Plan, including specific performance criteria that reflect the specific professionalism concern(s) at issue and time period for completion. The Faculty Lead has ultimate responsibility for approval of the learning plan details and timelines, in consultation with the student.
  2. Following the time period specified for completion of the learning plan, the Faculty Lead will review the student’s progress. The review may include consultation with relevant curriculum leaders. The outcome of this review will be a report provided by the Faculty Lead to the Foundations or Clerkship student progress committee.
  3. The Foundations or Clerkship student progress committee will review the student’s professionalism progress and decide whether the student is satisfactorily progressing in professionalism:
    1. If the student progress committee decides that the student is satisfactorily progressing in professionalism, the student will be informed by the Faculty Lead that their learning plan has been successfully completed. A record of the learning plan, including its successful completion, will be retained in the student file.
    2. If the student progress committee decides that the student is not satisfactorily progressing, a recommendation for professionalism remediation will normally be recommended, as described in section C below. 
  4. In cases where professionalism remediation is recommended to the Board of Examiners, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

C. Professionalism Remediation

  1. Professionalism remediation may be recommended following unsuccessful completion of a Focused Professionalism Learning Plan or as an immediate outcome of the student meeting.
  2. The student will be informed in writing by the relevant curriculum director or delegate that they are not satisfactorily progressing in professionalism, and that a recommendation for professionalism remediation will be made to the Board of Examiners. The student must be fully informed of their rights, including their right to provide a written submission to the Board of Examiners.
  3. If the recommendation for formal professionalism remediation is approved by the Board of Examiners, a provincial MedSIS course grade of “Unsatisfactory Progress” (for Foundations) or “Conditional” (for Clerkship) will be assigned.
  4. The Faculty Lead, Ethics & Professionalism will meet with the student and determine the appropriate program of remediation, including specific performance criteria that reflect the specific professionalism concern(s) at issue and time period for completion. Remediation may include repetition of a course(s), a year, and/or suspension from the program. Students will also be informed of the consequences of not successfully completing the required remediation, including in relation to the MD Program’s Standards for grading and promotion.
  5. Following the time period specified for completion of the professionalism remediation, the Faculty Lead will review the student’s progress. The review may include consultation with relevant curriculum leaders. The outcome of this review will be a report provided by the Faculty Lead to the Foundations or Clerkship student progress committee.
  6. The Foundations or Clerkship student progress committee will review the student’s professionalism progress and decide whether the student is satisfactorily progressing in professionalism:
    1. If the student progress committee decides that the student is satisfactorily progressing in professionalism, the student will be informed by the Faculty Lead that their professionalism remediation has been successfully completed. A record of the program of remediation, including its successful completion, will be retained in the student file.
    2. If the student progress committee decides that the student is not satisfactorily progressing, a recommendation will be forwarded to the Board of Examiners. This recommendation will normally include academic sanctions, in accordance with the MD Program’s Standards for Grading and Promotion for Foundations and Clerkship. In such cases, the student should be provided with timely notice of the recommendation, disclosure of the evidence on which the recommendation is based (i.e. the reasons for the recommendation), and an opportunity to provide a response to the Board of Examiners.

D. Academic Sanctions

  1. Academic sanctions are normally recommended following unsuccessful completion of a program of professionalism remediation, in accordance with the MD Program’s Standards for Grading and Promotion for Foundations and Clerkship. In exceptional circumstances, the outcome of a student meeting involving a substantiated critical incident report may be the immediate recommendation for academic sanctions. Academic sanctions may include failure to achieve credit in one or more courses, being placed on probation (with specified performance requirements and consequences for not successfully completing those requirements), failure of a year, suspension, or dismissal from the program.
  2. The student will be informed in writing by the relevant curriculum director or delegate that they are not satisfactorily progressing in professionalism, and that a recommendation for academic sanctions will be made to the Board of Examiners. The student must be fully informed of their rights, including their right to provide a written submission to the Board of Examiners.

 

See Appendix A for a student in professionalism difficulty process flow chart.

Appendix A: MD Program Student Professionalism Check-in Process PDF


Date of original adoption: 7 December 2010

Date of last amendment: 23 May 2023

Guidelines and procedures for physical examination of students by peers and tutors

Guidelines and procedures for physical examination of students by peers and tutors

Purpose

The purpose of this document is to provide a student-centred approach to consent for physical examination of students by peers and tutors that is respectful of students’ privacy and to provide a clear procedure for negotiating adverse events

Scope

This document applies to all students and faculty involved in the teaching and learning of clinical skills in the MD Program curriculum. In this document, the term “peers” refers to MD Program students

Guideline

  1. Examining peers is part of the Foundations Curriculum clinical skills training in the MD Program
  2. Students and tutors may examine head, neck, and limbs typically exposed with T-shirts and shorts. Abdomen and chest (anterior and posterior) exposed by removal of top layer of clothing may only be examined with students’ explicit consent and in accordance with appropriate draping procedures as found in the “Examination of the Patient” section in week 12 of ICE Clinical Skills syllabus
  3. Students and tutors will not be expected to examine breasts, the genitals or rectal area
  4. Students must obtain verbal consent from peers to be examined before each instance of physical examination. Any concerns regarding consenting to peer exam in general should be discussed with the Clinical Skills Director, Foundations Director or Associate Dean, Learner Affairs at the beginning of the academic year
  5. Students may withdraw verbal consent to be examined at any time. Students are not required to disclose their reasons for withdrawing consent
  6. Students may decline to give consent to be examined by tutors and peers. Students are not required to disclose their reasons for refusing consent
  7. Students who refuse or withdraw consent for any component of the physical exam may discuss this decision with either their tutor, Clinical Skills Director, Foundations Director or Associate Dean, Learner Affairs.   All parties will handle this discussion sensitively and confidentially
  8. Students may opt to pre-select partners from within the group with whom they are comfortable
  9. Tutors must not coerce students into consenting to be examined. They should only invite students to volunteer for demonstration purposes who have previously given consent. Any instances of perceived coercion or discomfort should be discussed with the Foundations Director and/or Associate Dean, Learner Affairs. Tutors will have access to ongoing faculty development opportunities to ensure they have clear, ongoing understanding of these guidelines
  10. Tutors shall not take a refusal into account when considering the student’s academic performance
  11. In the event that peer participation for physical examination is not possible within the student’s group, other avenues to ensure that student learning is not compromised will be implemented (i.e. combining groups, use of standardized patients, etc)
  12. In the event of discovery of a suspicious finding, inappropriate behaviour, or a breach in confidentiality, tutors and students will follow the adverse event procedures outlined below

Adverse Events Procedure

A. Discovery of a suspicious finding

During physical examination of students by peers and tutors it is possible that a new suspicious finding may be discovered, for example, discovery of a mass, a heart murmur, or elevated blood pressure. The goal is to enable the student to obtain timely medical attention

The following steps will be taken

  1. The examining student confidentially informs the examined student of the suspicious finding
  2. The examining student determines whether the student is already aware of the suspicious finding
  3. Both students confidentially inform their tutor
  4. The tutor asks permission to perform the same physical examination
  5. If the tutor confirms the suspicious finding, the tutor recommends that the student seeks medical advice
  6. The tutor reminds both students of the duty of the examining student to maintain confidentiality regarding the incident

B. Inappropriate behaviour

Inappropriate behaviour, such as inappropriate use of medical equipment, offensive language, or physical abuse may occur during physical examination of students by peers and tutors. Tutors may directly witness inappropriate behaviour or be alerted to it by a student. The consequence for inappropriate behaviour will vary and will be determined on a case-by-case basis

The following steps will be taken

  1. The tutor speaks to the student(s) behaving inappropriately
  2. The tutor informs the student that their behaviour is inappropriate and may be a breach of University or Faculty policy or standard
  3. For serious breaches of behaviour, the tutor contacts the course director regarding the incident
  4. The course director checks applicable policies and standards regarding the incident and takes required actions
  5. If a student has potentially been harmed by the inappropriate behavior, the tutor ensures that he or she seeks appropriate care (i.e. counseling)

C. Breach in confidentiality

Confidential information about a student may be revealed during history taking or physical examination. For example, students may reveal a history of medical issues, or physical examination may reveal surgical scars. It is possible in these situations that a breach in confidentiality may occur despite students being taught about the importance of confidentiality

NOTE: Some students may willingly provide specific consent to have their physical findings used for the instruction of others, which would not breach confidentiality

The following steps will be taken in the case of a breach in confidentiality

  1. The tutor takes the student(s) who breached confidentiality aside to speak with them
  2. The tutor informs the student(s) that sharing confidential information without consent is unacceptable and a breach of standards
  3. The tutor contacts the local site coordinator and course director regarding the incident
  4. The course director checks applicable policies and standards regarding the incident and takes required actions
  5. The tutor ensures the student whose confidentiality has been breached is informed and, if required, seeks appropriate care (i.e. counseling)

 


Date of original adoption: 12 April 2016
Date of last amendment: 12 March 2019

University-Mandated Leave of Absence Policy *

University-Mandated Leave of Absence Policy *

The University is committed to providing students with the opportunity to pursue their educational goals. It is also committed to maintaining a safe environment for study and work. Pursuant to the University's commitment to providing supports and accommodations for students and its obligation under the Ontario Human Rights Code, the University provides accommodative resources through a number of services, each involving specialized attention by experienced and qualified staff to the specific needs of students.

In certain circumstances, the potential application of the Code of Student Conduct will not be suitable, since it entails a disciplinary approach. Similarly, it may not be consistent with the duty to accommodate to merely let the student confront significant negative academic consequences in these situations. The University-Mandated Leave of Absence Policy, therefore, sets out additional options to better reflect the needs and the situation of the student.

Wellness and Learning Environment

Learner Mistreatment Guideline^

Learner Mistreatment Guideline^

Important: This Protocol is NOT for emergency use.

Students concerned about impending harm to themselves or others should call 911 or seek immediate assistance from onsite security or other authorities. Students should make a subsequent disclosure/report as described in this Protocol, only after safety is ensured.

The Temerty Faculty of Medicine's Learner Mistreatment Guideline is a revision to preceding program or departmental level guidelines on mistreatment, unprofessional behaviours, discrimination, harassment, or other concerning behaviours towards learners. 

This revision replaces the MD Program Student Mistreatment Protocol (approved in March 2020), and the PGME Guidelines for Managing Disclosures of Learner Mistreatment (approved January 2021), and any pre-existing guidelines within the Physician Assistant, Medical Radiation, or clinical Rehabilitation Sciences Programs. These Guidelines have been written with consideration of other foundational policies and procedures within Temerty Medicine, University of Toronto, Ontario Human Rights Code, as well as accreditation requirements of affected programs as of Fall 2023.

Statement on prohibited discrimination and discriminatory harassment *

Statement on prohibited discrimination and discriminatory harassment *

The University aspires to achieve an environment free of prohibited discrimination and harassment and to ensure respect for the core values of freedom of speech, academic freedom and freedom of research. The purpose of the Statement on Prohibited Discrimination and Discriminatory Harassment is to promote a greater awareness of the rights and responsibilities entailed by these aspirations and to describe the manner in which the University deals with prohibited physical and verbal harassment (apart from harassment based on sex or on sexual orientation, which are dealt with in Policy and Procedures: Sexual Harassment).

The approach taken in the Statement is to reiterate the University's commitment to the rights of freedom from prohibited discrimination and harassment and to the rights of freedom of expression and inquiry, to recognize that the task of implementing and respecting those values within the unique environment of the University is a delicate one that precludes the use of blunt instruments, and to describe the responsibilities of various members of the University community and the institutional arrangements available to fulfill the commitment to a working and learning environment free from prohibited discrimination and harassment.

Policy on sexual violence and sexual harassment *

Policy on sexual violence and sexual harassment *

The Governing Council's Policy on Sexual Violence and Sexual Harassment applies to all Members of the University Community. All Members of the University Community will be offered appropriate support with respect to issues of Sexual Violence, regardless of their role in the University or the role of the person against whom an allegation is made. A companion guide is available to provide more information about this Policy to students.

Sexual Harassment Complaints involving Faculty and Students of the University of Toronto arising in Independent Research Institutions, Health Care Institutions and Teaching Agencies ^

Sexual Harassment Complaints involving Faculty and Students of the University of Toronto arising in Independent Research Institutions, Health Care Institutions and Teaching Agencies ^

The University of Toronto, independent Research Institutions, Health Care Institutions and Teaching Agencies in which University faculty members, students (including trainees) and staff may work and study, have their own separate policies and procedures covering sexual violence, including sexual harassment or assault.  The Sexual Violence and Sexual Harassment Complaints involving Faculty Members and Students of the University of Toronto arising in Independent Research Institutions, Health Care Institutions and Teaching Agencies protocol does not change or replace those policies.  Instead, it provides a process for deciding, in a particular case involving members of the University community working in an independent Research Institution, Health Care Institution or Teaching Agency, which institution will take responsibility for the case and, therefore, which procedure should be followed.  It also provides for the relevant institution to keep the other informed to the extent appropriate to enable each institution to meet its own obligations to faculty members, employees, and students or otherwise at law. In some cases the responsibility for dealing with a case will most appropriately be shared by the University and the relevant independent Research Institution, Health Care Institution or Teaching Agency.

Guidelines regarding infectious diseases and occupational health for applicants to and learners of the Temerty Faculty of Medicine academic programs ^

Guidelines regarding infectious diseases and occupational health for applicants to and learners of the Temerty Faculty of Medicine academic programs ^

The Guidelines Regarding Infectious Diseases and Occupational Health for Applicants to and Learners of the Faculty of Medicine Academic Programs are intended to minimize the risk and impact of infectious diseases that may pose a threat to learners and those with whom they may come into contact. The document is intended to address educational requirements on methods of prevention, to outline procedures for care and treatment after exposure, and to outline the effects of infectious and environmental disease or disability on learning activities. 

Respiratory Protection Policy ("Mask Fit") and Procedures for University of Toronto Faculty of Medicine Undergraduate Students ^

Respiratory Protection Policy ("Mask Fit") and Procedures for University of Toronto Faculty of Medicine Undergraduate Students ^

The Respiratory Protection Policy and Procedures for University of Toronto Faculty of Medicine Undergraduate Students describes the "Mask Fit Policy" for MD students and procedures to follow should a trainee be exposed to an airborne infectious agent.

Protocol for incidents of medical student workplace injury and exposure to infectious disease in clinical settings

Protocol for incidents of medical student workplace injury and exposure to infectious disease in clinical settings

Overview

The University of Toronto MD Program is committed to promoting medical student safety and to facilitating appropriate support for students who become injured or potentially exposed to infectious disease in the course of their studies or training. The clinical sites affiliated with the University of Toronto are likewise committed to risk reduction among medical students and to the timely and effective management of incidents of medical student injury or potential exposure that occur on their premises. The Academy anchor hospitals play a special role in providing follow-up care to students of that Academy who incur such an injury or potential exposure at another site. Together, the MD Program, the Academies, and all the clinical affiliates ensure that medical students receive the assistance they require in the aftermath of an injury or potential exposure to infectious disease.

This Protocol defines the roles and responsibilities of every party involved in the handling of incidents of injury and potential exposure, and is comprised of the following parts:

Part A: Financial Responsibility

Part B: Administrative Responsibilities

Part C: Detailed Protocol

  1. Responsibilities of students
  2. Responsibilities of supervising physicians
  3. Responsibilities of health professionals who provide initial care
  4. Responsibilities of follow-up health care providers
  5. Responsibilities of Academy Directors
  6. Responsibilities of U of T WSIB Administrator
  7. Responsibilities of Associate Dean, Learner Affairs

Appendix 1: Protocol Flowchart

Part A: Financial Responsibility

Medical students are eligible for Workplace Safety Insurance Board (WSIB) coverage of claims while on unpaid placements required by their program of study. Private insurance is provided should the unpaid placement required by the MD Program take place within a site that is not covered by WSIB. The Ministry of Advanced Education and Skills Development (MAESD) ensures that students on work placements receive WSIB for placement sites that have WSIB coverage and private insurance for sites that are not covered by WSIB for injuries or disease incurred while fulfilling the requirements of their placement. WSIB insurance does not cover any self-initiated observership, informal shadowing or other clinical activities outside of the MD Program that are not eligible for the MAESD coverage.

In addition, all medical students at the University of Toronto are strongly encouraged to purchase disability insurance in every year of the MD Program. Through this insurance, costs that are incurred due to incidents that occur during activities other than required clinical training may be covered. Furthermore, private disability insurance may in some cases provide additional and/or broader financial support for incidents that are also covered by the WSIB. Students are encouraged to educate themselves about their disability insurance options to determine the plan and provider that best meet their needs.

All costs stemming from injury or exposure to infectious disease that are not borne by the WSIB or private insurance shall be borne by the student.

Part B: Administrative Responsibilities

A claim to the Workplace Safety and Insurance Board (WSIB) or private insurer should be made in all cases in which post-exposure prophylaxis (PEP) has been initiated or whenever other costs are incurred by the site of initial treatment, the site of follow-up treatment, and/or the student, following an incident that occurred in the course of required clinical training.

A claim may also be warranted in other situations where medical treatment or modified duties are required. The WSIB Administrator at the University of Toronto can provide advice if there is uncertainty as to whether to proceed with paperwork.

Please note that Ministry of Advanced Education and Skills Development (MAESD) may incur a fine for claims submitted to the WSIB later than three business days after the incident. Timeliness is therefore essential.

The responsibility to complete documentation in support of a claim rests with a variety of parties. The student’s Academy Director is responsible for liaising with all parties to ensure timely completion of the documentation and to facilitate communication among the parties as necessary.

For clarity, the following documentation is typically required from each party:

  • The student:
    1. After receiving treatment and ensuring an appropriate incident report form or equivalent (as per Section c(1)) has been completed, the student should inform his/her Academy Director of the incident.
    2. Documentation may be requested directly by the WSIB after the claim (if any) has been submitted by the University of Toronto WSIB Administrator; there is not generally any documentation for the student to complete beforehand.
  • Faculty Registrar:
    1. Written confirmation that the student’s injury or exposure occurred during the course of a legitimate, unpaid placement that represented part of the student’s academic program.
    2. A copy of the affected student’s signed Student Declaration of Understanding regarding WSIB and private insurance coverage through the MAESD.
    3. A copy of the MAESD Letter of Authorization to Represent Employer, with the top portion completed by the Registrar on behalf of the University.
  • Representative at the site of the incident:

    (Note: If an incident occurs at an Academy hospital, the Academy Director may act as the representative of the hospital for the purposes of incident documentation, if this is deemed appropriate by the hospital leadership.)

    1. The bottom half of the MAESD Letter of Authorization to Represent Employer obtained from the Faculty Registrar (see above).
    2. For sites with WSIB coverage: a U of T Accident Report Form, if none was completed at the time of the incident. The University will make this form available to all affiliated sites.
    3. For sites without WSIB coverage: an private insurer Accident Report Form. The University will make this form available to all affiliated sites.
  • Occupational Health staff or other representative at the site(s) of treatment:
    1. All records related to the incident and the treatment provided to the student.
  • WSIB Administrator at the University of Toronto
    1. Consolidated submission.

Part C: Detailed Protocol

a. Responsibilities of STUDENTS who are injured or potentially exposed to infectious disease in a clinical setting

i.    Immediately following the incident, the student is expected to:

  1. Inform his/her supervising physician or other teacher of the incident to ensure that patient care can be transferred as appropriate.
  2. Request that steps be taken to seek consent from the patient to draw a sample, in the case of potential exposure to infectious disease (e.g. a needle-stick injury).
  3. Seek immediate treatment (within a maximum of two hours) from one of the following:
    1. The Occupational Health Unit or site-specific equivalent if one is present where the incident occurred, and it is during office hours. (Students should be informed of this at the commencement of each rotation. In some cases, this will be defined as the Emergency Department.)
    2. The site’s off-hours substitute for the Occupational Health Unit or equivalent if the incident occurred outside of office hours.
    3. The local Emergency Department if the incident occurred somewhere in the community.
  4. Inform the health care provider who attends to the incident of his/her status as a medical student at the University of Toronto. If the incident has occurred in a hospital setting, the student should present his/her identification badge.
  5. Request that a workplace incident report be filled. If the incident has occurred in the community and care is sought at a local Emergency Department where a workplace incident report may not be available, an alternative document indicating the nature of the incident and the medical treatment that was administered should be completed
  6. Obtain a copy of all incident reports and other paperwork.

ii.    subsequent to receiving initial treatment, the student is expected to:

  1. Report any incident of injury or exposure to his/her Academy Director as soon as possible, regardless of where the incident took place.
  2. Follow the course of treatment prescribed by the site of initial care, if any.
  3. Obtain follow-up care and/or support, as arranged by Academy Director.
  4. Follow the course of treatment (if any) prescribed by the designated treatment site’s Occupational Health Unit.
  5. Comply in a timely manner with any requests to fill out paperwork related to the incident from the Academy Director, the Occupational Health Unit, the U of T WSIB Administrator, the WSIB or private insurer, the MAESD, or others.
  6. If necessary, make appropriate arrangements with course directors, the Foundations/ Clerkship Director, and/or the Associate Dean, Learner Affairs for accommodations, absences, or other matters arising from the incident.

iii.   In the event that treatment is unsuccessful and the student contracts an infectious disease, he/she is expected to:

  1. Share this information confidentially with either his/her Academy Director or the Associate Dean, Learner Affairs, who will arrange for the Expert Panel on Infection Control to convene. The Panel will determine what measures must be enacted to safeguard patients’ well-being, in accordance with the Faculty of Medicine Guidelines regarding infectious diseases and occupational health for applicants to and learners of the faculty of medicine academic programs. Information on the student’s status and health will be shared strictly on a need-to-know basis.

b. Responsibilities of SUPERVISING PHYSICIANS or other teachers when a student under their supervision is injured or potentially exposed to infectious disease in a clinical setting.

Immediately following the incident, the supervising physician is expected to:

  1. Assist the student in accessing immediate care as necessary. The site-specific workplace injury protocol should be applied.
  2. Facilitate the obtaining of consent for samples to be drawn from the patient, in cases of potential exposure to infectious disease.
  3. If the student is unable to speak for himself/herself:
    1. Describe the incident to the health professionals who provide initial care to the student.
    2. Inform the health professionals who provide initial care to the student that he/she is a medical student from the University of Toronto.
    3. Contact at least one of the student’s Academy Director, course director, or site director to inform them of the incident.

c. Responsibilities of HEALTH PROFESSIONALS WHO PROVIDE IMMEDIATE TREATMENT to medical students who experience an injury or potential exposure to infectious disease

The health professionals who provide immediate treatment to a medical student who has experienced an injury or potential exposure to infectious disease are expected to:

  1. Complete AT LEAST one of:
    1. A local institutional incident report form
    2. The U of T Accident Report Form for students
    3. The Physician’s First Report (“Form 8”)
    4. An alternative record of the incident and the treatment administered, only if the other documents named above are not available
  2. Provide a copy of all such forms and other documentation to the student.
  3. If the immediate treatment is provided at the site of the incident, and that site is an affiliate of the University of Toronto
    1. Report the incident to the Academy Director (if applicable) or other senior official of the hospital with designated oversight of undergraduate medical trainees.
  4. If arrangements are made for follow‐up care to be provided elsewhere:
    1. Provide the service or consultant designated for follow‐up care with sufficient details regarding the student’s initial treatment and also, in the case of a potential exposure to infectious disease, non‐identifying information regarding the health status and risk factors of the patient or other individual(s) involved in the incident.
  5. Instruct staff to provide a copy of all incident records to the University of Toronto WSIB Administrator and/or the student’s Academy Director if requested in support of an insurance claim.

d. Responsibilities of the FOLLOW-UP HEALTH CARE PROVIDER

The Academy Director will ensure that the student is connected with appropriate follow‐up care. The health care provider designated to provide that care is expected to:

  1. Liaise with the providers of initial care, if different, to ensure that information relevant to the case is appropriately shared. Relevant information includes details of the student’s initial treatment, in the case of a potential exposure to infectious disease, non-identifying information regarding the health status and risk factors of the patient or other individual(s) involved in the incident.
  2. Contact the student to update him/her on the need for follow-up.
  3. Initiate and/or continue whatever treatment is deemed to be necessary.
  4. Complete any paperwork requested by the Academy Director, the Vice-President Education, the U of T WSIB Administrator, or others, in keeping with the Affiliation Agreement and the WSIB Agreement between the hospital and the University.

e. Responsibilities of ACADEMY DIRECTORS, in the event of a student in their Academy incurring an injury or potential exposure to infectious disease in a clinical setting.

In order to ensure immediate responsiveness to student injury or potential exposure to infectious disease, every Academy Director is responsible for maintaining an up-to-date, site-specific protocol for handling various types of such incident, as appropriate for their Academy. This protocol must include a means by which students can be readily referred for timely follow-up care with an appropriate clinician.

i.    Upon being notified that a student of the Academy has been injured or potentially exposed to infectious disease, the Academy Director is expected to:

  1. Make contact with the student to assess his/her needs.
  2. If relevant, confirm with the student that the appropriate health care provider for follow-up care and administration of the case have been arranged.
  3. If relevant, and if the student indicates that follow-up care and administration of the case have not been arranged, liaise with the Academy base hospital’s Occupational Health Unit or other appropriate service to ensure that this is done.
  4. Liaise with the Associate Dean, Learner Affairs to advise him/her of any additional support required for the student arising from the incident (e.g., counselling, special accommodations, advocacy, etc.)
  5. Ensure that all required paperwork is completed and submitted by liaising with the appropriate parties, including Occupational Health Units and the U of T WSIB Administrator, as required. (See Part B of this Protocol for details.)
  6. Follow-up with the student periodically to ensure that he/she receives a response regarding the claim (if applicable), to offer assistance with additional paperwork that may be required, and to verify that his/her needs arising from the incident have been met.

ii.    In the event that treatment is unsuccessful and the student informs the Academy Director that he/she has contracted an infectious disease, the Academy Director is expected to:

  1. Meet with the student to assess his/her needs.
  2. Contact the Associate Dean, Learner Affairs, who will inform the Chair of the Expert Panel on Infection Control. Information on the student’s status and health will be shared strictly on a need-to-know basis.

iii.   To ensure that the University and Hospital comply with expectations regarding tracking and analysis of incidents of medical student injury, the Academy Director is expected to:

  1. Maintain a complete record of every incident of injury or potential exposure to infectious disease involving a medical student from their Academy, with details minimally including:
    1. the type of incident
    2. the site of the incident
    3. the student’s immediate supervisor on the rotation at the time of the incident
    4. the activity in which the student was engaged at the time of the incident
    5. the follow-up that was received
    6. the documents that were submitted and to whom
    7. the student’s level of study and the course
  2. Report incidents as they arise through the regular Academy Directors’ Committee meetings.
  3. Propose recommendations as warranted to reduce the number or severity of incidents, or to improve the response that students receive.

f. Responsibilities of the WSIB ADMINISTRATOR at the University of Toronto, with respect to incidents of medical student injury or potential exposure to infectious disease

i.    Upon being notified that a medical student has been injured or potentially exposed to infectious disease, the WSIB administrator is expected to:

  1. Confirm the required documentation with the Academy Director.
  2. Review the documentation that is submitted regarding the incident.
  3. Follow-up with the relevant individuals regarding any additional paperwork that is required.
  4. Submit the completed documentation to either the WSIB or private insurer as appropriate.
  5. Inform the Academy Director and the student that the claim has been submitted.

ii.    To ensure that the University complies with expectations regarding tracking and analysis of incidents of medical student injury, the WSIB Administrator is expected to:

  1. Maintain a complete record of every incident involving a medical student that is reported to the WSIB administrative office at the University of Toronto, with details minimally including:
    1. the type of incident
    2. the site of the incident (the Academy hospital, other hospital, non-hospital)
    3. the date and details of the claim
    4. the recipient of the claim (WSIB or private insurer)
  2. Provide data for an annual student injury and exposure report to the Associate Dean, Learner Affairs.
  3. Perform other tracking functions as required by the University, legislation, etc.

g. Responsibilities of the Associate Dean, Learner Affairs

i.    If contacted by an Academy Director or a student himself/herself regarding an injury or potential exposure to infectious disease, the Associate Dean, Learner Affairs is expected to:

  1. Meet with the student to determine if there are any gaps in their required or desired follow-up (medical, administrative, or well-being-related).
  2. Advocate for the student if appropriate follow-up is not forthcoming in a reasonable timeframe.
  3. Follow-up with the student periodically regarding the status of the claim and any newly arising support they require.
  4. Liaise with the Academy Directors, other MD Program leaders, and/or others to develop solutions to problems arising from the incident. Consideration will be given to the protection of student personal health information and issues potentially pertaining to patient safety, informed by the Personal Health Information Protection Act and Freedom of Information and Protection of Privacy Act.

ii.   In the event that treatment is unsuccessful and the student or the student’s Academy Director informs the Associate Dean, Learner Affairs that he/she has contracted an infectious disease, the Associate Dean is expected to:

  1. Meet with the student to assess his/her needs.
  2. Contact the Chair of the Expert Panel on Infection Control. The Chair will determine whether the Panel should convene. If so, the Panel will determine what measures must be enacted to safeguard patients’ well-being, as per the Faculty of Medicine Guidelines regarding infectious diseases and occupational health for applicants to and learners of the faculty of medicine academic programs. Information on the student’s status and health will shared strictly on a need-to-know basis.

 

Appendix 1: Protocol Flowchart

 


Date of original adoption: 22 September 2011
Date of last amendment: 09 July 2019

Medical student health and safety supplemental guidelines - personal safety and occupational hazards

Medical student health and safety supplemental guidelines - personal safety and occupational hazards

1. PURPOSE

These Guidelines supplements existing documents that articulate personal, occupational, and environmental health and safety guidelines and protocols that apply to medical students, including:

These Guidelines addresses personal safety and occupational hazards related to working in the health care environment. Specifically, these Guidelines promotes a safe environment that minimizes the risk of injury or harm at all University of Toronto affiliated teaching sites, provides a protocol to report unsafe or hazardous training conditions, and a mechanism to take corrective action. It identifies the roles and responsibilities that the Academies, clinical sites, and clinical clerkship, and students play in supporting a safe working environment.

These Guidelines are informed by the University of Toronto Health and Safety Policy as well as accreditation Element 5.7 Security, Student Safety, and Disaster Preparedness.

2. PREAMBLE

In the course of their training, medical students may be exposed to risk of personal injury or hazardous agents. The University, its affiliated teaching sites, including hospitals, laboratories and community clinical settings, and medical students are jointly responsible for supporting a culture promoting health and safety and preventing injury and incidents. Although medical students are not employees, when students work in the health care environment, hospital occupational health and safety training, regulations and protection programs are extended to them. Accidents, incidents and environmental exposures occurring during training will be reported and administered according to the reporting policies and procedures of the University, hospital or clinical teaching location.

3. SCOPE

These Guidelines pertain to the following items under the categories:

Personal Safety including:

  • Access to secure lockers and call rooms
  • Safe travel between call facilities and clinical service location, and to private vehicle or public transportation
  • Safety while working in isolated or remote situations including visiting patients in their homes or after hours
  • Protection from workplace violence and harassment
  • Protection of student’s personal information

Occupational Hazards including:

  • Hazardous workplace materials as named in the Occupational Health and Safety Act
  • Radiation safety, chemical spills, and environmental exposures
  • Infectious diseases that are communicable by contact, needle stick or respiratory mechanisms

4. PERSONAL SAFETY

Responsibility of the Academies, Clinical Sites and Clinical Clerkships:

  • Academies, clinical sites, and clinical clerkships share in the responsibility that students are adequately oriented to personal safety risks and policies prior to starting on clinical services.
  • Medical students are entitled to secure and private call rooms.
  • Medical students are entitled to personal safety programs normally available to hospital staff that promote safe travel between workplace and private vehicles or public transportation.
  • Clinical clerkships and clinical sites should train students in their ability to assess personal safety risks specific to each rotation or clinical setting.
  • Where safety risks exist, students are not expected to see a patient in hospital, clinic or at home, during regular or after hours, without the presence of a supervisor and security personnel (as required).
  • Clinical sites must endeavour to safeguard trainees’ personal information, other than identifying them by name when communicating with patients, staff and families.
  • Medical students should obtain training on prevention, management, and reporting of workplace violence, harassment and intimidation.

Responsibility of Students:

  • Students must use all necessary personal protective equipment, precautions and safeguards, including back up from supervisors, when engaging in clinical and/or educational experiences.
  • Students must exercise judgment and be aware of alternate options when exposing themselves to workplace risks or during travel to and from the clinical site (i.e., driving a personal vehicle when fatigued).
  • Students must use caution when offering personal information to patients, families or staff.
  • Students must promptly report any safety concerns (e.g. risk of personal safety, fatigue, etc.) to their supervisor.
  • Students must participate in training in the prevention and management of workplace violence, intimidation and harassment.

Reporting Protocol and Procedure for Managing Breaches of Personal Safety:

  • Students who feel their personal safety or security is threatened should remove themselves immediately from the situation in a professional manner and seek urgent assistance from their supervisor, the institution’s security services, call “Code White”, or 911 where applicable.
  • Students identifying a personal safety or security breach must report it to their immediate supervisor, or to the Academy Director/ Medical Education Lead, to allow a resolution of the issue at a local level, and to comply with the site reporting requirements. Students should follow the relevant protocols for the management of workplace violence, intimidation and harassment. Student confidentiality will be maintained in reporting whenever possible.
  • The Learner Mistreatment Guideline articulates procedures for University of Toronto medical students to disclose/report incidents of student discrimination, harassment, mistreatment and other incidents of unprofessionalism that they have experienced or witnessed.
  • Students in community-based practices or other non-institutional settings should discuss issues or concerns with the supervising faculty member or community-based coordinator or bring any safety concerns to the attention of their Academy Director, Clerkship Course Director, Clerkship Director or Associate Dean, Learner Affairs.
  • If the safety issue raised is not resolved at the local level, it must be reported to the Associate Dean, Learner Affairs, who will investigate and may re-direct the issue to the relevant hospital medical education office and/or University office for resolution.
  • Pending investigation and resolution of identified concerns: The Clerkship Director and/or Associate Dean, Learner Affairs have the authority to remove students from clinical placements if a risk is seen to be unacceptable.
  • As necessary and appropriate, the Associate Dean, Learner Affairs will bring personal safety issues to the Associate Dean, MD Program; Academy Director; and hospital office responsible for safety and security and may involve relevant University Offices for resolution or further consultation.
  • The Associate Dean, Learner Affairs may at any time investigate and act upon health and safety systems issues that come to her/his attention by any means, including internal reviews, student/faculty/staff reporting, or police/security intervention. Consideration will be given to the protection of student personal health information and issues potentially pertaining to patient safety, informed by the Personal Health Information Protection Act and Freedom of Information and Protection of Privacy Act.

5. OCCUPATIONAL HAZARDS

Academies, clinical sites, and clinical clerkships share in the responsibility that students are adequately oriented to workplace hazards and safety policies prior to starting on clinical services.

Responsibilities of the Academies, Clinical Clerkships and Clinical Site:

  • The Academies, clinical clerkships and clinical sites must ensure medical students are appropriately oriented to current best practices for workplace safety guidelines.
  • Training will be provided in WHMIS (Workplace Hazardous Materials Information System).
  • Clerkships must have guidelines to address exposures specific to each training site (e.g. radiation safety, hazardous materials), communicate these to medical students at site-specific orientation sessions, and assess trainees for appropriate understanding prior to involvement in activities which may involve potential exposure to hazardous materials.
  • Clinical sites must provide the necessary equipment to ensure medical student safety with respect to environmental or infectious exposure.

Responsibilities of the Student:

  • Students must participate in required safety sessions as determined by the Academy, clerkship or clinical training site.
  • Students must complete WHMIS training before working in clinical settings.
  • Students must follow all of the occupational health and safety policies and procedures of the training site including, but not limited to, the appropriate use of personal protective equipment.
  • Students must agree to report unsafe training conditions as per the protocol outlined below and in accordance with clinical site policies.
  • Students in breach of the occupational health policies of their training site are subject to the procedures by that site consistent with the requirements of the Occupational Health and Safety Act. If attempts to resolve the situation by internal protocols are not successful, it may be brought to the attention of the training site Academy Director/Medical Education Lead.

Reporting Protocol for Workplace Hazard Exposure or Incident

A. During daytime hours while working at an affiliated hospital or site associated with an affiliated hospital:

  1. The student should follow post exposure protocols and must go immediately to the Employee/Occupational Health Office of the institution if there are personal health risks associated with the exposure.
  2. The student must complete the incident report form as required by the institution’s protocol.
  3. The student must report the incident to his/her immediate supervisor.

B. During evenings or weekends or at a training site with no Occupational Health Office:

  1. The student must follow immediate post exposure protocols and if there are personal health risks associated with the exposure, go immediately to the nearest emergency room and identify him/herself as medical student at the University of Toronto and request to be seen on an urgent basis.
  2. The student must report to the available supervisor, comply with the institution’s protocol for completion of appropriate incident report.

 

COFM Blood borne pathogen policy #

COFM Blood borne pathogen policy #

The Council of Ontario Faculties of Medicine (COFM) Blood Borne Viruses Policy sets out guidelines and recommendations around blood borne diseases for all Ontario medical students who participate in clinical activities. This includes participating in the care of patients with communicable diseases, and procedures for learners who have communicable diseases and are training in a clinical setting.

COFM Immunization policy #

COFM Immunization policy #

The Council of Ontario Faculties of Medicine (COFM) Immunization Policy applies to all medical learners (undergraduate medical students and postgraduate residents and fellows) attending an Ontario medical school and performing clinical activities in Ontario. Undergraduate medical learners who do not comply with the immunization policy may be excluded from clinical activities. Residents who do not comply with the immunization policy may be delayed in starting or continuing training. Ontario medical learners doing international clinical placements will require an additional assessment. A travel medicine consultation should take place at least eight weeks before their placement. Additional immunizations may be necessary depending on the location of their placement.

Policy on Crisis and Routine Emergency Preparedness and Response *

Policy on Crisis and Routine Emergency Preparedness and Response *

Crisis and routine emergency situations on the University of Toronto’s three campuses are governed by the Policy on Crisis and Routine Emergency Preparedness and Response. In addition to the Policy, there exist internal and external policies and statutes that define the University's roles and responsibilities in a crisis or routine emergency situation. 

Student Clinical Placements in an Emergency Situation: Guidelines for Clinical Sites (HUEC) ^

Student Clinical Placements in an Emergency Situation: Guidelines for Clinical Sites (HUEC) ^

The Guidelines for Clinical Sites on Student Placements in an Emergency Situation is a Health-sciences wide document to assist clinical sites with decision making relative to learners and related issues in an emergency event.

Standards for call duty and student workload in the Clerkship

Standards for call duty and student workload in the Clerkship

Maximum on-call frequency:

  • The maximum on-call frequency in all clinical clerkship courses is one night in four averaged across the entire rotation duration.
  • Clerks cannot be scheduled for two weekends (which includes Fridays) in a row within any block rotation or throughout the entirety of a longitudinal integrated clerkship.
  • Clerks may be scheduled for call duty on the last Saturday of a block, including overnight call duty finishing on the Sunday morning.
  • Clerks must not be scheduled for call duty the evening before an examination or on the last day of a six- or eight-week block (usually a Sunday), nor on the Fridays before (a) the December holiday period (Year 3), (b) the CaRMS interview period (Year 4), (c) the March Break (Year 3), (d) the extended weekend break in June (Year 3), and (e) the last rotation of the academic session (Year 3).

Maximum consecutive hours on-call: After being available for service in-hospital for twenty-four consecutive hours, clerks must be relieved of all service and educational duties until the commencement of the next working day, after ensuring adequate handover of patient care responsibilities. Such handover shall not exceed two hours, for a total of twenty-six consecutive hours in the hospital.

On-call activities that are not overnight in-house call: There are two settings where students are on call, but not overnight in the hospital.

  • Some rotations include an on-call requirement that extends into the evening but is not overnight, and students are expected to be back to work the following day. In these cases, the on-call period must end by 11:00 pm. From time to time, as a result of clinical duties, a student may need to stay later than 11:00 p.m., to complete a clinical task, to complete handover, etc. If a clerk on such a rotation is required to stay on-call beyond midnight, then the on-call shift is converted to in-hospital call. If this occurs, after ensuring adequate handover of patient care responsibilities s/he must be relieved of all service and educational duties until the commencement of the next working day. Such handover shall not exceed  two hours.
  • Some rotations include a home-call requirement. Such call will be considered 'converted' to in-hospital call if a clerk commences work in the hospital between the hours of midnight and 6:00 am or if a clerk works in the hospital or other clinical care setting for at least 4 consecutive hours of which one hour extends beyond midnight. If a home call is converted to in-hospital call, then, after ensuring adequate handover of patient care responsibilities the following morning, the clerk must be relieved of all service and educational duties until the commencement of the next working day. Such handover shall not exceed two hours.

Students shall not be asked or expected to exceed the limits specified above under any circumstances.

Mandatory educational activities on days following on-call shifts: If a course or the Clerkship as a whole has designated certain educational activities as mandatory, then students must be relieved of their duties at midnight of the preceding day. Alternatively, such mandatory educational activities can be scheduled first-thing in the morning to enable post-call students to attend within their twenty-six hour limit.

Students do not work on weekends if not on-call: If a student is not on call or on shift, he/she shall not work on a weekend day.

Daily workload limit apart from being on-call: Across the duration of a rotation, the average number of hours per day that a student spends in total in required clinical and didactic experiences shall not exceed 12, excluding  days on which the student is on-call or post-call.

On-call limits when pregnant: A medical student who is pregnant will not be required to participate in on-call duty after 27 weeks’ gestation, unless agreed to otherwise by the medical student.

Responsibility to monitor adherence with these standards: It is the responsibility of every site director for each clerkship course to actively monitor adherence to all aspects of this standard and to intervene immediately if any are breached.

Procedure for possible breaches: Concerns from students, teachers, or administrative staff members regarding breaches of the standard should be brought to the attention of the site director in the first instance. If the response is unsatisfactory or if a pattern of breaches emerges, the matter should next be raised with the course director for review and possible redress. If continued non-compliance occurs at one or multiple sites after the course director has intervened, the issue should be reported to the Clerkship Director and relevant University Department Chair for immediate response.

 


Date of original adoption: 17 May 2011
Date of last amendment: 31 October 2017

Standards for time spent in required learning activities in the Foundations Curriculum

Standards for time spent in required learning activities in the Foundations Curriculum

Standards

The Foundations curriculum runs throughout the first two years of the MD Program. The program respects the importance of enabling students to achieve an appropriate balance between their academic responsibilities, independent learning time, and personal lives. To this end, the following standards have been adopted:

  • The maximum per week number of scheduled in-class teaching hours (lectures, seminars, laboratory sessions, and small-group learning activities) is 28.
  • The maximum per week number of required self-directed learning activity hours (such as for completion of online modules, a four hour Enriching Educational Experience, etc.) to be completed outside of scheduled class time is 10.

A week is defined as Monday through Friday, excluding holidays. There are no scheduled in-class activities on Saturdays and Sundays.

In addition, across each entire year of the Foundations Curriculum there will be a maximum of 30 hours of mandatory but flexibly scheduled curriculum experiences. Mandatory but flexibly scheduled curriculum experiences include the Family Medicine Longitudinal Experience (FMLE), Interprofessional Education (IPE) curriculum, Enriching Educational Experiences (EEE), etc.

Each week of the Foundations Curriculum has a full day that is unscheduled, available for self-learning as well as special activities such as clinical skill development.

Moreover:

  • The maximum number of scheduled in-class teaching hours in a day shall be seven, and this maximum shall be attained no more than two days per week. On all other days, the maximum number of scheduled teaching hours shall be six.
  • There must be no more than three hours of lectures scheduled consecutively.
  • There should be no more than four hours of lectures in a day.
  • In circumstances where the curricular framework requires additional lecture time, a maximum of four consecutive hours of lecture or six hours of lectures in one day may be permitted only with prior approval from the Foundations Director. Extra consideration should be given on such occasions to employing engaging and interactive large-group formats.

Exceptions to these standards can be made for unusual circumstances (e.g., to recover a session that was cancelled on short notice due to University closure, unforeseen lecturer unavailability, etc.), but strict adherence is otherwise expected.

Monitoring and Reporting

Course directors, insofar as they are responsible for designing and implementing their courses, hold primary responsibility for ensuring compliance with these standards. Course directors of courses that run synchronously are expected to work collaboratively to ensure that total scheduled teaching hours do not exceed the limits specified above. Concerns from students, teachers, or administrative staff members regarding breaches of these standards should be brought to the attention of the course director in the first instance. If the response is unsatisfactory or if a pattern of breaches emerges, the matter should be raised with the Foundations Director for review and redress.

 


Date of original adoption: 14 July 2016

Statement on access to preventive, diagnostic, and therapeutic health services for medical students

Statement on access to preventive, diagnostic, and therapeutic health services for medical students

All residents of Ontario are entitled to free health services under the provincial health plan, and students at the University of Toronto have access to a number of options to seek medical care.

Students of all University of Toronto programs on the St. George Campus are entitled to receive regular care through the University Health Service in the Koffler Student Centre (http://healthservice.utoronto.ca/main.htm). Students on the UTM Campus are entitled to receive regular care through the Health & Counselling Centre in the South Building (http://www.utm.utoronto.ca/health). The clinics on both campuses are generally open during normal business hours throughout the year. Students should book an appointment in advance, although a limited number of same-day appointments are also accepted.

Furthermore, students in the MD Program are able to access confidential mental health services from the professional counsellors on staff at the Office of Learner Affairs. Service is provided by appointment and on a drop-in basis, with flexible hours to accommodate medical students’ schedules.

In addition, students can register with a family doctor in the local community. Information on family medicine practices accepting medical students is maintained online by the Office of Learner Affairs; this information is reviewed quarterly.

For urgent care, students may access any walk-in or after-hours clinics in the vicinity of both core and elective teaching sites, or they can visit the emergency department of any of the nearby hospitals. Information on after-hours clinics and emergency departments close to the campus is maintained on the websites for both the St. George Campus and UTM health services (see above).

To locate all levels of care across the Province of Ontario, students are advised to refer to the Ministry’s search tool at the Health Care Options website: http://www.health.gov.on.ca/en/.

For immediate advice from a registered nurse, students can also call the provincial Telehealth Ontario hotline at 1- 866-797-0000, which operates 24 hours a day, every day of the year.

Accessing health care and workplace injury flowcharts are provided on the MD Program’s website: http://www.md.utoronto.ca/workplace-injury-and-health-care-access.

In case of emergency, students should always call 911.

 


Date of original adoption: 17 May 2011
Date of last amendment: 25 August 2016

 

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