Section VI: Medical Student Standards of Behavior

Medical students acquire skills and knowledge not only for their own benefit but also for the benefit of another party – their patients. The duty to act in the best interest of the patient is the fundamental ethical principle of our medical profession. This duty dictates certain standards of professional behavior for medical students (and doctors) which include but are not limited to:

Honesty. Cheating on examinations, falsifying applications or data on medical records and other forms of intellectual dishonesty are wrong not only because such behavior violates intrinsic academic integrity, but also because such behavior may be deleterious to patients.

Professionalism.  As future physicians responsible for the well-being of patients, medical students are held to very high standards of professional behavior.  The professional behavior expected of medical students includes, but is not limited to, fulfilling all academic and extra-curricular commitments, responding to communications from AMS faculty and staff in a timely manner, notifying the appropriate personnel about anticipated absences within a reasonable time frame, adhering to clinical schedules in a punctual and responsible manner, and using appropriate and constructive language in written communications and evaluations of courses, clerkships, and faculty presenters. 

Health. Specific illnesses that impair performance include, but are not limited to, active drug and/or alcohol addiction, severe depression and other psychiatric illnesses and, occasionally, physical illnesses. It is not permissible for students to interact with patients while impaired by these conditions. It is the policy of the medical school to encourage recognition of illness which leads to impairment in medical students and to support treatment so that those students may continue their education successfully and without stigma.

Boundary violations with patients. It is never appropriate to have a sexual relationship with a current patient. Knowledge acquired during the doctor patient relationship should never be used for any purpose other than therapeutic. A romantic relationship based on this information is always inappropriate. (Relationships with other students, staff and faculty are not addressed in this policy, but are addressed by University policies.)

Criminal activities. These include but are not limited to, selling or dealing drugs, child abuse, possession of child pornography and sexual activities resulting in legal designation as a registered sex offender. Such behavior is incompatible with medical professionalism.

Social networking. The medical school strongly advises students to exercise caution when using social networking tools such as Facebook, Twitter, You Tube, blogs, etc. These tools, while useful for interaction around social causes or political movements, can also create professional and ethical dilemmas regarding relationships with patients, patient confidentiality and patient trust in care providers. Additionally, they contribute to a blurring of the line between professional contexts, in which you represent Brown and the medical profession generally, and other more personal interactions. AMS students must be cognizant of the “social contract” between physicians and the public that holds medical professionals to high standards of behavior.

Specifically, students are prohibited from sharing personal expressions, in the form of text, photos or video, that:

  1. Violate patient confidentiality;
  2. Violate the doctor-patient relationship;
  3. Depict illegal activities.

Students are strongly discouraged from sharing personal expressions in the form of text, photos or video that could impair a student’s ability to form a therapeutic relationship with patients or to have a professional relationship with medical colleagues and supervisors. In short, the administration of AMS expects students, like physicians, to maintain a high level of professionalism in their non-medical public life.

There is an ethical imperative to report medical students and physicians who are in violation of these standards. Reports about students may be made to the Associate Dean for Medical Education. Reports about suspected health issues may be made to the Student Health Council rather than the administration. Anonymous reports will not be accepted but the anonymity of the reporter will be guaranteed. There will be no adverse consequences for the reporter for reports submitted in good faith, whether or not the suspicions are validated. Reports about faculty or other physicians should be directed to preceptors, residents, clerkship supervisors, hospital administrators, the Associate Dean for Medical Education or the Physician Health Committee of the RI Medical Society.

In cases where medical students violate the above standards of behavior, the Associate Dean for Medical Education may request that the Medical Committee on Academic Standing (MCAS) review pertinent information and meet with the student in order to determine an appropriate course of action. The MCAS has the authority to place a student on fellowship status or leave of absence when the student’s behavior raises questions as to whether or not the student should be in contact with patients. If the MCAS renders such a decision, the student may appeal the decision to the Dean of Medicine and Biological Sciences (using the procedure described in Section IV).

The Academic Code

Alpert medical students are expected to adhere to Brown University’s Academic Code, which may be found at: www.Brown.edu/Administration/Dean_of_the_College/academic_code/code.html. The following information is excerpted from the university’s Academic Code. Under usual circumstances, these policies will be applied to medical students. In some cases (e.g., parental notification), policies intended for undergraduate students may not be appropriate for medical students.

Academic achievement is ordinarily evaluated on the basis of work that a student produces independently. A student who obtains credit for work, words, or ideas which are not the products of his or her own effort is dishonest. Such dishonesty undermines the integrity of academic standards of the University. Infringement of the Academic Code entails penalties ranging from reprimand to suspension, dismissal or expulsion from the University.

Brown students are expected to tell the truth. Misrepresentation of facts, significant omissions or falsifications in any connection with the academic process, including, but not limited to, Change of Course permits; the academic transcript; or applications for graduate training or employment, testing, written work including theses or dissertations, or enrolling/participating in a course or academic exercise under the identity of another individual at Brown or elsewhere, are violations of the Code. Brown reserves the right to address issues of academic dishonesty or misrepresentation by former students respecting their academic work at Brown. This policy also applies to alumni, insofar as it relates to Brown transcripts and other records of work at Brown.

Misunderstanding the Code will not be accepted as an excuse for dishonest work. If a student is in doubt on some points as they affect work in a particular course or as they may be interpreted in practice, he or she should consult the instructor in the course or one of the academic Deans in his or her appropriate division, so as to avoid the serious charge of academic dishonesty.

All cases of suspected academic dishonesty will be screened by a Designated Representative of the Dean of the College, in consultation with concerned faculty and witnesses if needed. The Designated Representative will make a decision as to whether a case requires a formal hearing. Such decisions are not considered final or binding and may be changed on the basis of new information or a shift in judgment.

If, after screening, the Dean’s representative decides that a formal hearing is warranted, he or she shall, as soon as possible, notify the accused student in writing of specific charges of dishonesty, the nature of the evidence which would be presented against him or her, the time and place of the hearing, and the range of penalties which may be imposed if academic dishonesty is found.

The accused student will be permitted to have an advisor who should give the student advice on matters of preparation for the hearing, hearing procedures, and possible outcomes. The Designated Representative of the College will provide each accused student with a list of persons from within the university community (faculty or staff) who may be willing to serve as an advisor. The accused student should be informed that he or she has the right to dispute the evidence against him or her and the right to present evidence and witnesses of his or her own to support his or her case, to examine any witnesses against him or her, and to avoid self-incrimination by declining to answer questions or declining to participate in the proceedings in whole or in part. However, the fact that the accused student declines to participate does not affect the validity of these deliberations, nor does it affect the authority of the University or its representatives to impose penalties if dishonesty is found. The advisor is not permitted to attend the hearing except as a possible witness.

Hearings, deliberations, and decisions on penalties, culpability, or innocence shall be made by a Standing Committee, consisting of a Dean from the accused student’s college/school (but not the Designated Representative of the College), plus two faculty members, one the chair and one to be chosen from a standing pool of eight, provided however that in the case of a medical student found in violation of the Academic Code by the Standing Committee, the matter shall be referred to the medical school for an assessment of a penalty to the offender. Faculty members on the Standing Committee on the Academic Code should serve staggered terms of four years, with two being elected through the Faculty’s regular procedures every year on a rotating basis. Faculty members eligible to serve on the Academic Code Standing Committee shall include all voting members of the Faculty and all Emeritus faculty. In the event that two faculty members are not available at the scheduled time for the Standing Committee hearing, the place of one or more of the faculty members may be filled by an academic Dean. No person serving as a student’s advisor can also serve as a member of the Academic Code Standing Committee for that hearing. This Committee's procedures are administrative in nature and concern internal University affairs; accordingly, the deliberations of the Standing Committee are not subject to formal rules of civil procedure or evidence. The meetings/hearings need not be open to the public, the student does not have a right to legal counsel at the meetings/hearings, nor shall legal counsel be part of the appeal process.

If an undergraduate student or graduate student is determined to be in violation by the Standing Committee, a penalty shall be assessed to the offender by the Standing Committee and that decision will be conveyed to the student in a letter from the Committee. The student will be informed in the letter that he or she has the right to appeal any decisions to the Dean of the College (in the case of an undergraduate student) or the Dean of the Graduate School (in the case of a graduate student).

If a medical student is determined to be in violation by the Standing Committee, a penalty shall be assessed by the MCAS. The hearing materials before the Standing Committee will be forwarded to the MCAS for consideration. The Chair of the Standing Committee shall participate as a non-voting member of the MCAS. The MCAS shall afford the student the opportunity to appear before the MCAS in order to speak and respond to questioning. The MCAS may also invite other individuals to appear for the purpose of providing information to the Committee. The student may be accompanied by a Brown University faculty or staff advisor, but may not be accompanied by an attorney. The student shall be informed of the penalty assessed in a letter by the MCAS. The student will be informed in the letter that he or she has the right to appeal any decisions to the Dean of Medicine and Biological Sciences.

The appeal must be in writing and include all materials the appellant considers relevant, including a narrative clearly outlining the grounds of appeal. Appeals will normally be considered only when new information which was not reasonably available at the time of the hearing becomes available or when an allegation of substantial procedural error on the University, the Standing Committee, or the MCAS is made. The decision of the appropriate Dean in response to this appeal will prevail whether or not the student found in violation has participated in deliberations and hearings, but non-participation after proper notice will not be grounds for overturning a decision, nor will it be grounds for a rehearing. The appellant has five working days in which to appeal the Standing Committee’s and/or the MCAS' decision; the five-day period for an appeal to the Dean will begin to run on the first working day following receipt of the letter from the Standing Committee (in the case of undergraduate and graduate students) or the MCAS (in the case of medical students). Cases that arise after the suspected offender has graduated shall be handled in the same way as cases involving current students, except that the time intervals for notification shall be extended to allow for response from an accused person who is not on campus.

When the Standing Committee determines that the accused did not commit a violation, materials considered in the case, except the original exam or other work, shall be destroyed, and no record of the accusation or the investigation shall appear in the student’s file. If the judgment is “insufficient evidence to determine a violation,” no record of the charge or investigation will remain in the student’s folder, but some will be kept in the confidential files of the Standing Committee.

A University official or officer alleging a violation of the Code will be sent copies of all written notices mentioned in these procedures, and has the right to appeal to the appropriate Dean, in writing including all materials he or she considers relevant, within five business days of being informed of the final dispositive action by either the Standing Committee or the MCAS.

Penalties & Sanctions

The Standing Committee and MCAS are authorized to respectively recommend and enact any penalty or sanction they judge to be appropriate. The following are the most common penalties/sanctions:

I. Reprimand

In some cases in which a first offense has been judged to merit a minor penalty/sanction, the student will be allowed to repeat the exercise or complete an alternative assignment, as determined jointly by the instructor of the course and the Dean’s representative. A letter of reprimand will be written to the student. A copy of the letter will be placed in the student’s academic folder. In exceptional cases, the Standing Committee may vote to remove the letter of reprimand from a student’s folder after a specified time pending good behavior. Responsibility for evaluation of the student’s work in the course continues to belong to the instructor of the course. The following will normally accompany a reprimand:

  1. Permanent record entry in the student’s internal academic folder.
  2. Parental notification.
  3. If the student later requests an institutional letter of support, it will be provided but may refer to the incident.
II. Loss of credit in the exercise

For most offenses the least severe penalty/sanction will be loss of credit in the exercise. The student may be required to repeat the exercise or complete an alternative assignment, although credit will not be given. The student will be allowed to continue in the course. The following will normally accompany this penalty/sanction:

  1. Permanent record entry in the student’s internal academic folder.
  2. Parental notification.
  3. If the student later requests an institutional letter of support, it will be provided but may refer to the incident.
III. Directed No Credit in the course

When the offense is sufficiently serious to merit failure in the course, the student will be withdrawn from the course immediately following adjudication. The following will normally accompany this penalty/sanction:

  1. Permanent record entry in the student’s internal academic folder.
  2. Parental notification.
  3. Transcript notation of No Credit in the course and of violation of the Academic Code.
  4. Withholding of an institutional letter of support, or discussion of the offense in the letter. (If the offense occurs after such a letter has already been written, the letter may be withdrawn or supplemented, with appropriate explanation.)
IV. Suspension

A serious offense may result in the student’s suspension from the University for a period of one semester or longer. The following will normally accompany suspension:

  1. Permanent record entry in the student’s internal academic folder. 
  2. Parental notification.
  3. Withholding of an institutional letter of support or discussion of the offense in the letter. (If the offense occurs after such a letter has already been written, the letter may be withdrawn or supplemented, with appropriate explanation.)
  4. Transcript notation of Suspension, Directed No Credit in the course, and violation of the Academic Code.
V. Dismissal

A student who has been dismissed must earn readmission, by work and/or study away from Brown for at least six months and usually a year or more. The following will normally accompany dismissal:

  1. Permanent record entry in the student’s internal academic folder. 
  2. Parental notification.
  3. Withholding of an institutional letter of support or discussion of the offense in the letter. (If the offense occurs after such a letter has already been written, the letter may be withdrawn or supplemented, with appropriate explanation.)
  4. Transcript notation of Dismissal, Directed No Credit in the course, and violation of the Academic Code.
VI. Expulsion

A very serious offense or multiple offenses may warrant permanent expulsion from the University. The following will normally accompany expulsion:

  1. Permanent record entry in the student’s internal academic folder.
  2. Parental notification.
  3. Withholding of an institutional letter of support or discussion of the offense in the letter. (If the offense occurs after such a letter has already been written, the letter may be withdrawn by the University, with appropriate explanation.)
  4. Transcript notation of Expulsion, Directed No Credit in the course(s), and violation(s) of the Academic Code.
VII. Revocation of Degree

An offense that is discovered after the awarding of a degree may warrant the revocation of that degree. The following will normally accompany revocation:

  1. Permanent record entry in the student’s internal academic folder.
  2. Parental notification.
  3. The withdrawal of any institutional letters of support.
  4. Notification of concerned faculty, including the chair of the student’s department of concentration and thesis advisor, if any.
  5. Notification of external parties who had been informed of the original awarding of the degree.
  6. Directed no credit in any course or rotation for which the student is registered at the time of the violation.
  7. Transcript notification that the degree was revoked for violation of the Academic Code.