Application

Effective 2026-27, these Guidelines apply to all students registered in the MD Program.

Introduction

Acquisition of professional competence is essential for physicianhood. These guidelines for the assessment of MD student professional standards 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.

The assessment strategy for professional competence in the MD Program includes diverse assessment data points, including the competency-based professionalism assessment form, attendance record, and critical incident reports. This guideline describes the processes for both Professionalism Check-Ins and the Student in Professionalism Difficulty Process. As part of programmatic assessment, there are additional overlapping areas that holistically integrate professionalism throughout training (for example, Portfolio, Clerkship rotations). 

The Professional Standards Curriculum Theme Lead is involved in developing the overarching assessment strategy for professional standards, aligned with the MD Program curriculum and in collaboration with Course/Curriculum Directors and the Director of Student Assessment. The Professionalism Remediation Lead provides individual-level support to learners with concerns identified in professional standards, including as described below.  As part of the program's quality improvement, the Professionalism Remediation Lead and the Professional Standards Curriculum Theme Lead work together to ensure the curriculum is informed by evolving student needs.

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 activity provides an opportunity for teachers to indicate both strengths and areas for improvement in professionalism, with the primary goal of providing formative feedback to support medical students' ability to effectively uphold professional standards and to develop professional competencies toward integral professional identity formation. The assessment strategy captures student performance over time and aims to identify any trends of concern in the professional standards domain across multiple courses or multiple learning contexts. Early identification allows for early supports and remediation, in support of sustainable and enriching careers as medical learners, then physicians in independent practice. 

The assessment of demonstrated professional behaviours form is organized according to six professionalism domains. Each domain includes criteria that reflect specific behaviours that characterize the respective domain. 

• Interactions with patients and essential care partners
• Reliability and responsibilities
• Growth and adaptability
• Relationships with colleagues
• Upholding student and professional codes of conduct
• Recognize and respond to ethical issues

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 

Satisfactory professionalism competency is required to receive credit in every course, and its assessment 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.

Through the four years of MD Program training, a student may be identified as not satisfactorily progressing as follows:

• On the first and second instances of a score of less than 3 on any combination of the professionalism domains included in the professionalism assessment, including two scores of less than 3 on the same form, a student professionalism check-in process will occur (see below for details).
• For three or more instances of a score of less than 3, including 3 or more scores of less than 3 on the same form, a student in professionalism difficulty review process will be initiated (see below for details).
• A critical incident report will initiate the student in professionalism difficulty review process (see below for details).
• When a student does not meet attendance requirements, a student in professionalism difficulty review process will be initiated.

The student in professionalism difficulty review process will be re-initiated 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 or continues to not meet expectations for attendance requirements.

Critical Incident Reports

Critical incident reports are intended to address situations in which a student has put a patient or someone else at significant risk and/or caused harm (physical, psychological, or emotional) because of their behaviour, or situations in which a student has engaged in conduct unbecoming of a physician-in-training. Critical incidents of unprofessional behaviours 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, misappropriating, 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 causes 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 appropriate Curriculum Director. Receipt of a notification that a critical incident has occurred will initiate the student in professionalism difficulty review process, which is described below. Critical incidents reported by members of the public who do not have access to the MD Program Critical Incident Report Form or the MD Program Event Disclosure Form will be reported to the Associate Dean of the MD Program.

A substantiated critical incident report 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. 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 assessment in the MD Program is the provision of formative feedback to support students toward readiness for residency and physicianhood. The assessment strategy for professional standards aims to integrate longitudinal assessment of essential professional competency throughout the MD Program training (years 1 through 4). This includes the ‘Professionalism Check-In' process as an opportunity for formative feedback when a concern regarding professional competence is identified. Lifelong learning and continuous improvement are an essential part of professional competence. 

The assessment strategy also enables the program to identify any trends of challenges in the professional standards domain, across multiple courses or multiple learning contexts.

The first and second instances of a score less than 3 on any combination of the six professionalism domains, including two scores less than 3 on the same form, will initiate the student professionalism check-in process. The check-in process is intended to ensure that students have the opportunity to discuss their performance in a safe and confidential environment, identify learning opportunities based on the comments provided via the professionalism assessment form, and be aware of the various supports available to them.

The check-in procedures are as follows:

1. The student is contacted in writing and required to meet with the course or component director for which a score of less than 3 was received. To support the early identification of challenges in the professional standards domain and/or to identify appropriate supports or resources for a student, the course/component director may consult with other faculty leads, as appropriate, on a need-to-know basis (e.g., the Director of Student Assessment and/or other curriculum leaders). The course director will also meet with the faculty involved in the assessment. 
2. The check-in process normally results in one of three outcomes:
   1. No 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 progress file.
   2. 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 progress file.
   3. The course/component director forwards the matter to the relevant Curriculum Director for further review. This action is taken only when 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 initiated 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
• When a student does not meet expectations for attendance requirements

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 where the course/component director considers the professionalism issue serious enough to warrant further review. Similarly, the Student Progress Committee may recommend the student for review in the professionalism difficulty process only when the professionalism issue is serious enough to warrant further review (for example, failure to appropriately respond/engage in efforts related to an existing remediation). 

Prior to the student meeting described below, the Curriculum Director may consult with other faculty leads, as appropriate, on a need-to-know basis (e.g., the Professionalism Remediation Lead, the Professional Standards Curriculum Theme Lead, the Director of Student Assessment, and/or other curriculum leaders). The student in professionalism difficulty review process may lead to formal 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 and required to meet with the relevant Curriculum Director to discuss the professionalism issues identified in the professionalism assessments and/or critical incident report. The student perspective as well as input from the course/component director and other curriculum leaders, as appropriate, will be considered during the meeting.
2. eviews 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 other curriculum leaders, as appropriate (i.e., the Professionalism Remediation Lead, Professional Standards Curriculum Theme Lead, Director of Student Assessment, Office of Learner Affairs), will determine next steps. The student’s record of professionalism (including their professionalism assessments, professionalism check-ins, attendance record, substantiated critical incident reports, focused professionalism learning plans, or previous remediations) and severity of the incidents (critical or otherwise) will inform next steps. The student’s input 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 Director, Undergraduate Learner Affairs or the Associate Dean, Learner Affairs, to explore 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 Professionalism Remediation Lead to develop a Focused Professionalism Learning Plan, including specific performance criteria that reflect the specific professionalism concern(s) and a time period for completion. The Curriculum Director(s) have ultimate responsibility for approval of the learning plan details and timelines, in consultation with the Professionalism Remediation Lead, the student, and, as relevant, course directors.
2. Following the time period specified for completion of the learning plan, the Professionalism Remediation 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 from the Professionalism Remediation Lead to the Curriculum Directors and the Foundations or the 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 /Clerkship directors determine that the student is making satisfactory progress in professionalism, the Curriculum Director(s) will inform the student that their learning plan has been successfully completed. A record of the learning plan, as submitted by the Professionalism Remediation Lead, including its successful completion, will be retained in the student progress file.
   2. If the Student Progress Committee/ Clerkship directors decide that the student is not progressing satisfactorily, a recommendation for professionalism remediation will typically be made (section C). 
   3. If the Focused Professionalism Learning Plan is for attendance and there are persistent attendance concerns, the student will be recommended for professionalism remediation (section C).
4. Students with an active Focused Professionalism Learning Plan (FPLP) will be considered to be in progress for the course in which the professionalism concern arose until such a time that the requirements of the FLP are met. Students on an FPLP are able to progress to the next course. Successful completion of the Focused Professionalism Learning Plan is a requirement for graduation. 
5. 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 written response to the Board of Examiners.

C. Professionalism Remediation

1. Professionalism remediation may be recommended by the Curriculum Directors or the Student Progress Committee 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 that they are not making satisfactory progress in professionalism and that a recommendation for professionalism remediation will be made to the Board of Examiners. The student must be fully informed of the process, including that they have an opportunity 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 provisional MedSIS course grade of “Unsatisfactory Progress” (for Foundations) or “Conditional” (for Clerkship) will be assigned.
4. The Professionalism Remediation Lead will meet with the student and, in collaboration with relevant portfolios (e.g., Course/Curriculum Directors, Director of Student Assessment, etc.), determine the appropriate remediation program, including performance criteria that reflect the professionalism concern(s) at issue and a 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 specified timeframe for completion of the professionalism remediation, the Professionalism Remediation Lead will review the student’s progress in consultation with relevant curriculum leaders. The outcome of this review will be a report provided by the Professionalism Remediation Lead to the Curriculum Directors and the Student Progress Committee.
6. The Foundations or Clerkship Directors and/or Student Progress Committee will review the student’s professionalism progress and decide whether the student is satisfactorily progressing in professionalism:
   1. If the Curriculum Directors/ Student Progress Committee determines that the student is making satisfactory progress in professionalism, the Curriculum Director will inform the student that their professionalism remediation has been successfully completed. A record of the remediation program, as submitted by the Professionalism Remediation Lead, including its successful completion, will be retained in the student progress file.
   2. If the Student Progress Committee/Curriculum Director determines that the student is not making satisfactory progress, 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. 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 that they are not making satisfactory progress 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 Professionalism Process Flowcharts.

Appendix A: Student Professionalism Process Flowcharts

Professionalism Guidelines FAQ

Date of original adoption: 7 December 2010

Date of last amendment: 21 July 2026