College of Medicine Professionalism Policy

Purpose

The State University of New York, Downstate Health Sciences University is committed to ensuring that its learning and scholarly environment is conducive to the ongoing development of explicit and appropriate professional behaviors in its students, faculty, administrators and staff at all locations. With regard to medical student education, Standard 3, Element 3.5 of the Liaison Committee on Medical Education (LCME) Standards for Accreditation of Medical Education Programs, provides that the medical school and its clinical affiliates share the responsibility for periodic evaluation of the learning environment in order to identify positive and negative influences on the maintenance of professional standards, develop and conduct appropriate strategies to enhance positive and mitigate negative influences, and identify and promptly correct violations of professional standards. Similarly, the Accreditation Council for Graduate Medical Education (ACGME, Institutional Requirements III.B.6) provides that medical schools are responsible for ensuring that the training environment for all residents and fellows is conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, residents, fellows, faculty, administrators and staff at all locations.

Preamble

Downstate Health Sciences University College of Medicine is a community marked by exceptional personal and professional integrity that embodies the foundational tenets of our institution — values-driven culture, leadership, and education. It is our system of principles that continue to spur excellence and pride in the work we do every day. We commit to the highest standards of ethical behavior and exemplary performance in education, research, and patient care.

Our students, trainees, faculty, administrators and staff strive each day to create an environment conducive to the education of ourselves and our community. We will continually demonstrate kindness, empathy and compassion for our peers, our colleagues, and our patients in the care we provide, the research we conduct, and the education we deliver. In regard to patient care, we firmly believe in the primacy of patient and family welfare and deep respect for patient autonomy. We support the principles of health equity and social justice, which include the equitable distribution of health care resources. We will adhere to universal principles of research ethics when designing, conducting, performing, evaluating, and reporting our research. We will respectfully express our beliefs and opinions and be sensitive to the diversity of our community, which is one of our great strengths.

Regardless of where we are, or whom we are with, we will conduct ourselves in a manner of utmost honesty and integrity as we treat, learn, teach, conduct research, and communicate. We will strive to achieve this every day and if we briefly falter, we will acknowledge our error, apologize where appropriate, and resume what we have accepted as professional behavior befitting a leading academic medical center.

The same professionalism principles and policies that apply to students, trainees, faculty, administrators and staff in person apply to them online. Social media are public forums, irrespective of privacy, security and intended audience. Each member of the Downstate Health Sciences University College of Medicine community who participates in social media, should do so in a manner consistent with the College’s professional standards.

Policy

This policy is intended to highlight important professional qualities that our campus values in all its members, including our medical students. Physician knowledge and expertise must be accompanied by a moral code of conduct toward his/her/their patients and other members of the health care team, including students, faculty, residents and other health care professionals. Physicians and medical students are expected to model and to adhere to the professional standards of his/her/their licensing board or the medical community, as applicable, and to the standards of SUNY Downstate Health Sciences University, including standards specific to the College of Medicine. Faculty, students, administrators and staff are expected to engage in ethical and professional conduct in all university activities.

Professionalism encompasses a number of virtues expressed in the following attitudes:

Excellence: a desire to maintain a standard of knowledge and competence that exceeds ordinary expectations, and includes a commitment to lifelong learning. Some examples of behaviors that exhibit excellence include:

1. Contributing to an atmosphere of learning;
2. Putting forth effort which goes beyond what is needed solely to achieve a grade in a course;
3. Not exhibiting anti-intellectual attitudes and behaviors; and
4. Assuring that all decisions are made based on adequate knowledge.

Altruism: readiness to place the interests of others above one’s own. Some behaviors exhibiting altruism include:

1. Sacrificing one’s own time and energy for the sake of others’ needs;
2. Accepting inconvenience to meet the needs of one’s patients or fellow students;
3. Accommodating patients’ and families’ special needs for comfort and help;
4. Volunteering one’s skills and expertise for the welfare of the community; and
5. Understanding the principles of health equity and social justice and how the principles apply to care of the patients and their families

Compassion: empathy combined with a desire to correct the cause of the problem. Some examples of compassion in a clinical context include:

1. Recognizing the needs of a patient and their families without being specifically told;
2. Appreciating the patients’ and families’ special needs for comfort and help; and
3. Doing all that you can to meet the needs of the patient and families.

Duty: preparedness to behave conscientiously or reliably and responsibly with respect to rules and schedules. Some behaviors which exhibit a sense of duty include:

1. Being available and responsive when “on call”:
2. Reporting on time;
3. Completing paperwork and assigned tasks;
4. Fulfilling responsibilities, including both clinical duties and any assigned teaching responsibilities; and
5. Following appropriate public health recommendations regarding infection control and environmental hazards

Accountability: accepting responsibility for one’s behavior toward patients, colleagues, students, faculty, residents, the profession, and the public. Some examples of accountability include:

1. Accepting constructive feedback and incorporating it to make changes in behavior;
2. Recognizing limitations and seeking help;
3. Not working in an impaired state; and
4. Protecting patient confidentiality.

Honor and Integrity: “honor” is the consistent regard for the highest standards of behavior and “integrity” is the refusal to violate the code of professionalism. Possessing honor and integrity implies being fair, being truthful, keeping one’s word, meeting commitments and being straightforward. In addition to personally upholding these standards, physicians, faculty, students, administrators and staff are obligated to encourage professionalism on the part of one’s colleagues and report lapses in professional conduct on the part of others. Honesty and integrity in research, patient care, educational programs and community engagement hold the highest priority. Some examples of lack of honor and integrity include:

1. Cheating, plagiarism, forgery, and sabotage;
2. Falsification of documents such as laboratory records, patient histories or records;
3. Misrepresentation of circumstances, procedures, participants, and/or results of research; and
4. Misrepresentation of training or credentials to patients, staff and external agencies, or on residency/employment applications.

Respect: readiness to treat others — including patients, residents, colleagues, staff and faculty — with consideration for their rights and interests. For example:

1. Establishing and maintaining appropriate boundaries in work and learning situations;
2. Respecting all groups;
3. Recognizing and responding to personal bias;
4. Dressing in an appropriate manner;
5. Using professional language and being mindful of the environment;
6. Resolving conflicts in a manner that respects the dignity of every person involved;
7. Demonstrating personal commitment to honoring the choices and rights of other persons, especially regarding their medical care; and
8. Listening to other members of the health care team and taking their opinions into account.

The College of Medicine utilizes a variety of tools to evaluate the learning environment in order to identify positive and negative influences on the development of medical students’ professional behaviors, especially in the clinical setting, including, but not limited to:

• Incident reports from students, residents, faculty and staff
• Student evaluations of rotations, faculty and sites (Course/Faculty Assessment)
• Resident departmental faculty evaluations
• Student responses to internal surveys (weekly surveys, end of unit surveys, clerkship surveys) and to external surveys such as the AAMC Graduate Questionnaire
• Resident responses to internal GME surveys (via New Innovations) and external surveys such as ACGME Resident Survey
• Faculty responses to internal surveys and to external surveys such as ACGME Faculty Survey
• Results of site visits by external assessors including ACGME, CLER, NYSDOH, CMS, etc.
• Results of internal special reviews (conducted by the GMEC PMC subcommittee)
• Reports of surveys requested by individual participating sites such as Pres-Ganey
• Reports of quality improvement and safety analyses
• Reports from site visits to participating sites and clinical learning settings conducted internally by the Education leadership, GMEC and its subcommittees conducted routinely and those conducted on an ad hoc basis to investigate concerns and complaints

Violations of the professionalism standards described above are referred to the appropriate institutional committee or administrative body for investigation, evaluation and resolution. For medical students, alleged violations are referred to the Academic Progress Committee for review and further action. For residents and fellows, alleged violations are referred to the Designated Institutional Official and GMEC as well as to the resident’s/fellow’s employer Human Resources Department. For faculty, alleged violations are referred to the Office of the Dean of the College of Medicine as well as the faculty member’s employer Human Resources Department. For other staff, alleged violations are referred to the Human Resources Department. Incidents of mistreatment are handled in accordance with the College of Medicine’s Policy on Student Mistreatment.

References/Related Policies

• SUNY Downstate Health Sciences University, College of Medicine: Policy on Student Mistreatment.
• SUNY Downstate Health Sciences University, College of Medicine: GME Policy on Professional Misconduct
• SUNY Downstate Health Sciences University, College of Medicine: Policies of the Faculty and Professional Staff
• SUNY Downstate Health Sciences University, Research Compliance — Responsible Conduct of Research