Being a professional is one of the key attributes of being a physician. In order to assist students in their development as future professionals, the program provides abundant instruction and feedback, both formal and informal, about professionalism. Information about the program’s formal professionalism instruction is summarized in this Calendar under the Ethics & Professionalism theme. This section focuses on the assessment of students’ professional behaviour as well as how critical professionalism incidents are defined and addressed.
The MD Program’s Guidelines for the Assessment of 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, which is summarized below.
Professionalism incidents that require immediate action are addressed through critical incident reports, also summarized below.
Suspected breaches of academic integrity are addressed in accordance with the MD Program’s Academic Integrity Guidelines, which are informed by the University of Toronto’s Code of Behaviour on Academic Matters.
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. 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 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:
- 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 (which is described in more detail 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.
As stated in the MD Program’s Guidelines for the Assessment of Student Professionalism, 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. 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.
- 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, which will trigger a student in professionalism difficulty review process. The student in professionalism difficulty review process may result in a focused professionalism learning plan. It may also 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.
- A critical incident report will trigger a student in professionalism difficulty review process. Critical incidents can be reported as part of a competency-based assessment or by any teacher, University staff member, or hospital staff member using the MD Program’s Critical Incident Report Form. Further information about critical incidents is provided below.
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.
Procedural details regarding the student professionalism check-in process and student in professionalism difficulty review process are provided in the MD Program’s Guidelines for the Assessment of Student Professionalism.
Critical Incident Reports
Critical incident reports are intended to address situations where a student has put a patient or someone else at significant risk because of their behaviour, or situations in which a student has engaged in conduct unbecoming of a physician in training. Critical incidents of unprofessional behaviour include 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
(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, University staff member, or hospital staff member using the MD Program’s Critical Incident Report Form. The person reporting a critical incident will be required to identify the area(s) of concern, the source(s) of information, provide details of the incident, and provide any relevant documentation. Critical incident reports are forwarded to the Foundations Director or Clerkship Director, as appropriate. Receipt of a critical incident report will trigger the student in professionalism difficulty review process.
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.
The MD Program’s Protocol for MD Students to Report Mistreatment and Other Kinds of Unprofessional Behaviour describes the principles and procedures for peer-to-peer critical incident reports.