Teacher Conduct and Professionalism

All relevant Temerty Faculty of Medicine policies and procedures apply to appointed faculty members teaching in the MD Program. The following policies and guidelines are of particular interest to MD Program teachers and administrators.

The Temerty Faculty of Medicine Office of Clinical & Faculty Affairs maintains a list of Faculty Resources, including policies and procedures not listed below. All faculty members affiliated with the MD Program should familiarize themselves with the policies and procedures listed at http://temertymedicine.utoronto.ca/clinical-faculty-resources

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 Faculty Council of the Temerty Faculty of Medicine
# indicates a policy of an agency external to the University of Toronto

CMA Code of Ethics and Professionalism #

The CMA Code of Ethics and Professionalism articulates the ethical and professional commitments and responsibilities of the medical profession. It is founded on and affirms the core values and commitments of the profession and outlines responsibilities related to contemporary medical practice.

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Guidelines for ethics and professionalism in healthcare professional clinical training and teaching ^

The Guidelines for Ethics and Professionalism in Healthcare Professional Clinical Training and Teaching provides guidance for all healthcare professional trainees and the clinical faculty or supervising clinicians in determining their rights and responsibilities when participating in clinical education.

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Policy on official correspondence with students *

The Governing Council's Policy on Official Correspondence with Students provides guidance on the appropriate mechanisms for official correspondence with students, as well as the rights and responsibilities of students, faculty, staff, and the University of Toronto regarding sending and retrieval of official correspondence.

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Procedure for conflicts of clinical and educational roles in the MD Program

1. Preamble

Many teachers in the Temerty Faculty of Medicine are also practising clinicians, creating the potential for the following conflict of professional roles to arise:

  • A teacher may be assigned to supervise (i.e. teach or assess) a medical student previously cared for or currently being seen as a patient.
  • A teacher may be asked to provide care to a current or former student.

Both kinds of situations must be carefully managed, particularly if the care is of a sensitive nature or if the care is provided in the context of an ongoing clinical relationship. Included below are guidelines and procedures intended to address both kinds of situations summarized above.

Guidelines with respect to the separation of MD Program leadership roles from other decision-making positions (e.g. Resident Selection Committee; MD Program Board of Examiners, unless ex officio) are included in the MD Program’s Access to student academic records.
 

2. Guidelines and procedures with respect teachers assigned to supervise a medical student previously cared for or currently being seen as a patient

If a medical student comes under the supervision of a teacher who is currently treating or has previously treated that student for a sensitive health concern, or who is their primary care physician or specialist consultant for ongoing regular care, a conflict of professional roles between the teacher’s clinical and educational responsibilities arises. In this context, “supervision” is defined to include any small group didactic teaching or teaching of clerks in a clinical setting, but does not include large group lectures. “Sensitive health concerns” include but are not limited to mental health conditions and conditions that are sexual in nature; the threshold for sensitivity is recognized to be an individual decision, which should fully consider reasonable expectations of the patient.

In situations where there is a conflict of professional roles between the teacher’s clinical and educational responsibilities, as defined above, the teacher must not participate in the assessment of the student in question, either directly or indirectly (e.g., by providing feedback to the site director of a clinical rotation). It is also preferable that the student be scheduled for alternative supervision, if possible, without disrupting the educational experience of the student in question and other students in the course, and without drawing any unnecessary attention to either the student or teacher.

Both the teacher and the student are individually responsible for reporting the potential conflict of professional roles to the appropriate MD Program leader of their choosing, which include the course director; the student’s Academy Director; the Foundations or Clerkship Director; and/or the Associate Dean, Learner Affairs. After being contacted by either the student or teacher, the MD Program leader will make arrangements to remove the student from the teacher’s supervision or at a minimum to ensure that assessment is conducted exclusively by other faculty members with no input from that teacher.

Students who make a report shall disclose that the conflict pertains to the teacher’s clinical role, but shall not be required to disclose the nature of the health care they received. Teachers who make a report need disclose only that a conflict of interest has arisen without making explicit that it pertains to their clinical role; this provision has been included in recognition of physician teachers’ primary responsibility to uphold patient confidentiality.

If it is the student who reports the conflict, the teacher in question will not be informed of the reason for the change unless it proves necessary, and only after consent is provided by the student. If it is the teacher who reports the conflict, the student will be informed of institutional policies around conflicts of interest and the reason for the transfer of supervision.

If additional faculty or staff need to be involved in order to transfer the student to another supervisor, explanations are to be provided to them on a need-to-know basis only, with the minimum amount of information required.

Procedures with respect to OSCEs and other oral assessments

If cases where there is a conflict of clinical and educational roles during an OSCE or other oral 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.

Special provisions with respect to curriculum leaders

In this context, curriculum leaders include course and component directors, theme leads, and the Foundations Director and Clerkship Director. When the faculty member in question is considered a curriculum leader, it will generally not be possible to remove that individual entirely from the oversight and involvement of a student who is a former or current patient. Instead, it is expected that the curriculum leader report their potential conflict of professional roles to the Vice Dean, MD Program as soon as they become aware that a former or current patient is enrolled in a course under their jurisdiction.

Upon such notification, the Vice Dean, MD Program will take measures to ensure that any “extra attention” that may subsequently need to be paid to the student in question (e.g., for academic difficulty or professionalism concerns) is handled by a suitable alternate. The curriculum leader in conflict may be involved only insofar as this is deemed necessary to ensure consistent treatment of all students. The involvement of the alternate will be duly documented. It is not required that the student be advised that an alternate has been put in place unless their performance or behaviour necessitates “extra attention” as defined above; nevertheless, depending on the circumstances, the Vice Dean may, at his/her discretion, notify the student of the arrangement from the outset.
 

3. Guidelines and procedures with respect teachers asked to provide care to a current or former student

If a student is supervised, tutored, or mentored in a formal or informal capacity by a teacher, then an educational relationship is established. Consequently, a conflict of professional roles would arise if a teacher accepted a request to provide health care services or clinical advice to such students during the period of the educational relationship. If a student requests such advice or assistance, he or she should be advised to seek care from their family physician or other appropriate health care provider (except in cases of an emergent/urgent nature).

Alternatively, if a teacher wishes to accept the request to provide care to a student, the teacher must inform the appropriate MD Program leader of their choosing prior to commencing care Appropriate MD Program leaders include: the course director; the student’s Academy Director; the Foundations Directors or Clerkship Directors; and/or the Associate Dean, Learner Affairs. The provisions and procedure in Section 2 above will then apply.

Teachers should never encourage students to confide personal health-related concerns to them. Rather, students may be referred to the Associate Dean, Learner Affairs or their Academy Director for assistance in accessing appropriate resources.

With regard to the provision of medical services or advice after the educational relationship has come to an end, teachers are strongly urged to exercise caution and familiarize themselves with the relevant professional regulations; they should also bear in mind the possibility that the educational relationship may be renewed at a later date.

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Procedure for the disclosure of potential commercial or professional conflicts of interest by MD Program teachers

As clinicians and researchers, teachers in the MD Program may have a potential conflict of interest, financial or otherwise, in relation to content they may discuss in the context of teaching. As examples, teachers may have an interest related to a commercial product, a research finding, a company, or special interest group.

Procedure

All teachers in the MD Program must disclose any actual, perceived, or potential conflicts of interest.

  1. This includes:
    • those delivering content in large group lectures and small group learning activities, such as symposia, seminars, and tutorials.
    • those preparing or determining content such as course directors, planners, and members of curriculum committees.
       
  2. Teachers of large group lectures are expected to declare any conflicts of interest during the annual teacher recruitment process. Course directors will take steps to ensure that declared conflicts are properly managed in compliance with the Faculty of Medicine Relationships with Industry and the Educational Environment in Undergraduate and Postgraduate Medical Education, the University of Toronto Policy on Conflict of Interest – Academic Staff, the University of Toronto Statement on Conflict of Interest and Conflict of Commitment, and any other relevant documents.
     
  3. For large group lectures, teachers must use the conflict of interest slide template developed by the MD Program, and must verbally present any disclosure at the beginning of each session.
     
  4. Potential conflicts of interest pertinent to course directors or planners must be declared in the overall course description.
     
  5. In less formal settings such as small group learning activities, clinical teaching at the bedside, in the operating room or procedure room, or in ambulatory settings, it is not practical to disclose potential conflicts at the outset of every encounter. However, teachers should be mindful of situations in which the impartiality of their statements could be questioned and disclose any potential conflict of interest in such cases to the students under their supervision.
     
  6. For advice on how to approach these situations, teachers are encouraged to speak with the course director(s) of the courses in which they participate.

This procedure is consistent with the standards articulated in the Faculty of Medicine Relationships with Industry and the Educational Environment in Undergraduate and Postgraduate Medical Education, but also recognizes the potential for non-industry-related conflicts of interest.

It is the responsibility of course directors or other faculty members who coordinate teacher recruitment (e.g. week managers or site directors) to make this procedure known to all teachers.

Education

The MD Program is committed to providing students with education regarding conflict of interest principles and procedures.

Reporting

  1. Students who are concerned that an actual, perceived, or potential conflict of interest has not been properly disclosed or managed in accordance with these procedures have the option to contact the relevant course director.
     
  2. The course director is responsible for discussing these concerns with the relevant student(s) and teacher(s), and consulting with other individuals as needed to determine if any corrective steps are required. The outcome of these discussions and consultations will be communicated by the course director to the relevant student(s) and teacher(s). The course director will maintain a confidential record of these discussions and consultations, which will be reported in summary format to the Foundations Director or Clerkship Director, as appropriate, and Vice Dean, MD Program.
     
  3. If for any reason the student does not feel comfortable contacting the course director, then the student has the option of contacting the Foundations Director or Clerkship Director, as appropriate, or Curriculum Director, who will be responsible for following the procedures described above.
     
  4. Should the matter not be resolved to the satisfaction of any of the parties involved, the issue will be forwarded to the Vice Dean, MD Program, who will be responsible for discussing the concerns with the relevant student(s) and teacher(s), and consulting with other individuals as needed to determine if any corrective steps are required. The outcome of these discussions and consultations will be communicated by the Vice Dean, MD Program to the relevant student(s) and teacher(s). The Vice Dean, MD Program will maintain a confidential record of these discussions and consultations, which will be reported in summary format to the course director and Foundations Director or Clerkship Director, as appropriate.

 

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Professional responsibilities in medical education #

The College of Physicians and Surgeons of Ontario's (CPSO) Professional Responsibilities in Medical Education sets out expectations for the professional conduct of physicians practising in Ontario in both undergraduate and post-graduate education. Together with the Practice Guide and relevant legislation and case law, they will be used by the College and its Committees when considering physician practice or conduct.

Additional information, general advice, and/or best practices can be found in companion resources, such as Advice to the Profession documents.

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Relations with industry and the educational environment in undergraduate and postgraduate medical education ^

Temerty Medicine's Relations with Industry and the Educational Environment in Undergraduate and Postgraduate Medical Education sets out standards that will provide best practices to ensure that relationships between the Faculty, and its academic units and members, and business entities ("industry") will be appropriate and transparent. The standards and measures for disclosure are intended to guide the conduct of faculty members and learners by managing potential conflicts to ensure an environment that protects the integrity and reputation of individuals and institutions

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Standards of professional behaviour for medical clinical faculty ^

Temerty Medicine's Standards of Professional Behaviour for Medical Clinical Faculty describes the professional and ethical expectations of Clinical Faculty.

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Statement on conflict of interest and conflict of commitment *

The Governing Council's Statement on Conflict of Interest and Conflict of Commitment affirms the commitment of the University of Toronto to the identification and management of real and perceived conflicts of interest and conflicts of commitment within a framework defined by the University’s academic mission and its fundamental values.

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