Duality of Interest: Health Provider and Education Roles for Faculty Supervising Students

Purpose

To provide expectations and requirements regarding the potential duality of interests concerning the education and health care of UCSF medical students.

Overview

Faculty physicians, fellows, residents, and other non-faculty instructors & supervisors as well as clinical staff in academic medical centers serve major roles in both teaching and clinical care. From time to time, medical students, by virtue of illness or learning difficulties, may need to seek advice, assessment, and/or clinical care from faculty who teach in the medical school. When a student seeks care from a faculty member in the institution in which the student is enrolled, a duality of interest may be created. This policy is established to address the potential duality of interests that arise in these circumstances, in the interests of:

Maintaining the rights of the student to confidentiality with treating providers.
Avoiding the potential that assignments, assessments, grading, and progress could be impacted by a faculty member’s knowledge of a student’s illness or disability status.
Minimizing concerns about favoritism related to special relationships between a faculty and a student.
Ensuring compliance with LCME standards, specifically standard 12.5: Non-Involvement of Providers of Student Health Services in Student Assessment/Location of Student Health Records (Appendix A)

Definitions:

Duality of Interest	A situation in which an individual has multiple responsibilities which may result in conflicts of interest, real or perceived.
May	Allowable in all circumstances; at times with limitations
Must not	Prohibited from engaging in the activity
Should not	It is preferred that the individual not engage in this activity; however, circumstances may occur in which the individual may engage in this activity
Familial or intimate relationships	Close family relationships (first and second-degree relatives, including those by marriage) and social relationships (close family friends.) Please also refer to the UC policy APM-015 that prohibits romantic and sexual relationships between faculty and students.

Related LCME Standards

12.5: Non-Involvement of Providers of Student Health Services in Students Assessment/Location of Student Health Records

Principles

The physician has a primacy of duty to their patient and is professionally obligated to act in the best interests of their patient.
The student has the right to strict confidentiality of their health and medical conditions, inclusive of both physical and mental health or learning disability.

The student may waive their right to confidentiality if the student believes it is in their best interest.
Further, limits to strict confidentiality may be necessary to ensure patient safety.

Faculty and staff are responsible for approaching and working with each student without bias and without favoritism.
Faculty and students must recognize that the appearance of a duality of interest may interfere with the learning environment for both the involved student as well as the student’s peers and must be considered regardless of whether a conflict of interest is truly present.

Policy

UCSF Faculty and Staff Providing or who Have Provided Clinical Care Services for a Student

Must not serve in any academic (small group, clinical, or research) supervisory or mentoring role for that student. They specifically must not supervise the student in the clinical setting, provide an academic assessment of the student, participate in assigning grades for that student or participate in making decisions about academic advancement or lack thereof for that student. In the event that no other faculty member is available to supervise a relevant clinical experience that a student requests, the Associate Dean for Students must review the circumstances and may provide a limited waiver to this policy.
May function as a large group classroom teacher for that student at any time, and may function as a small group teacher for that student as long as they do not participate in assessment or grading activities and may provide general support for classroom-based learning experiences for that student that requires their expertise.
Must not provide written or verbal statements regarding their involvement in the student’s care or the nature of the student’s condition to the School of Medicine administration or other bodies unless specifically requested by the student under their care and after the appropriate consent has been provided. Exceptions to the requirement of consent include the presence of life-threatening physical or mental conditions or other legally covered limits of confidentiality.
The School of Medicine Medical Student Well-Being Program staff may, for continuity purposes, continue to care for a student after university limits on number of visits for that student has been reached. They may not serve in any academic, supervisory, mentoring or assessment role for a student who is are has been under their care.

UCSF Faculty who have participated in supervision, assessment, grading, and academic advancement decisions for a student:

Must not solicit that student as a patient in their clinical practice.
May accept a student request for medical care with the understanding that they will adhere to the directives in section A.
Faculty may not provide medical advice or care to their students while they are supervising that student.

UCSF Faculty and Staff with Familial or Intimate Relationships with an Enrolled Student

Must not serve in any academic supervisory role for that student. They must not supervise the student in the clinical setting, lead small group sessions involving the student, provide an academic assessment of the student, participate in assigning grades for that student or participate in making decisions about academic advancement or lack thereof for that student.
May serve in a mentoring capacity for situations that do not formally contribute to decisions about academic progress.

Policy Limitations

This policy is not intended to prevent the timely intervention by a qualified clinician in case of a medical emergency (e.g., cardiopulmonary arrest, suicidality, homicidality). Once the student has been stabilized or transferred to the appropriate care site, the faculty member with a duality of interest should relinquish care.

In the event a faculty-student relationship specifically or not specifically described in this policy presents a conflict of interest, it is the expectation that the faculty member takes responsibility for managing the relationship based on the best interest of the student patient. Consultation regarding potential or actual conflicts of interest may be sought from the Associate Dean for Students or Medical Student Well-Being. Please also refer to the UC policy APM-015 that prohibits romantic and sexual relationships between faculty and students.

In the case of disagreement about the application of any elements of this policy, the default arbiter will be the Associate Dean for Students. Waivers of this policy require consultation and approval of the Associate Dean for Students.

Procedure

Procedures in alignment with the UCSF School of Medicine Policy on Duality of Interests Between Faculty, Staff and Students

This policy will be posted with other UCSF School of Medicine policies on the UCSF School of Medicine Medical Student Education Guidelines and Policies.
In the event that a faculty member realizes that they have been assigned a role with an individual student that is prohibited by their current or prior clinical or familial/intimate relationship with that student, the course or clerkship director should be notified and reassignment requested. The reason given for the reassignment is duality of interest; neither the specific duality of interest situation nor the specific student should be specifically identified.
Faculty will be required to attest via a question on the assessment form that they have not provided clinical care to a student before they complete an assessment on that student. They will be directed not to complete the assessment if they have provided care.
Students attest to understanding this policy during orientation and prior to starting their clerkships.*
If a student realizes they have been assigned a role with an individual faculty member that is prohibited by a current or prior clinical or familial/intimate relationship with that faculty member, the student should notify the course or clerkship director and ask to be reassigned. The reason given for the reassignment is duality of interest; the nature of the specific duality of interest situation need not be identified.
Since under FERPA, the Associate Dean for Students has been identified as a need to know administrator in the School of Medicine and should be notified of any serious concerns about students by faculty or staff working with those students in an educational or mentoring role. HIPAA privacy regulations are not relevant to faculty-staff supervisory,educational, or mentoring relationships.
- Faculty or staff members who, in the course of their assigned teaching responsibilities, identify a student in need of urgent or emergent care for mental health, substance abuse, or physical illness should refer the student to the nearest Emergency Department and notify the Associate Dean for Students immediately or as soon as is reasonably possible. They should inform the student that they will be notifying the Associate Dean for Students.
- Faculty or staff members who become aware of a student through indirect communications that a student is or may be experiencing an urgent or emergent problem as specified above should notify the Associate Dean of Students. They should inform the student that they will be notifying the Associate Dean for Students.
- Faculty who through their mentoring or advising roles become aware of student mental or physical health conditions that may be anticipated to significantly impact student performance in a course or clerkship should consult with the Associate Dean of Students. They should inform the student that they will be notifying the Associate Dean for Students.
- Faculty or staff members identifying a risk to patient safety associated with a student’s physical or mental illness, should temporarily and discretely reassign the student and immediately notify the Associate Dean of Students. They should inform the student that they will be notifying the Associate Dean for Students.
Any unique situations needing clarification should be referred to the Associate Dean of Students.

*For the 2018-19 academic year, this attestation occurred for incoming and current students in October 2018.

Accountable Dean: Associate Dean of Students

Related Policies:

This policy is replacing the Providers of Sensitive Care policy.

Approval Date and Governing Body: August 1, 2017, CCEP

Last updated: October 16, 2018