University of California San Francisco
UCSF School of Medicine UCSF Medical Center

Physicianship Policy

Updated On
December 12, 2023

Purpose

To specify the process for documenting unprofessional behavior by a student.

Overview

Professionalism is a core competency for UCSF medical students and is fundamental to the practice of medicine. Students are expected to demonstrate professional behavior in the classroom, in clinical settings, online, and outside the boundaries of courses and clerkships as members of the UCSF community.  

Professionalism lapses are managed with notification through the Physicianship Evaluation Form and coaching as designed by education leadership. Recurrent, persistent, or severe professionalism lapses, or failure of the student to engage in coaching and improvement plans may lead to adverse academic actions, up to and including dismissal from the School of Medicine.

Examples of unprofessional behaviors that would warrant a Physicianship Evaluation Form include but are not limited to: avoiding or not accepting feedback, inappropriate communication including via social media, tardiness or unexcused absences, cheating, or plagiarism.

It is important to acknowledge the ways that bias and norms rooted in white supremacy culture can impact the assessment of the professionalism domain (i.e., endorsing a narrow view of professional behavior that elevates some individuals over others based on a lack of cultural humility in the definition of professionalism). It is the UCSF SOM’s aspiration to reduce and ideally to eliminate the impact of bias on learners by setting out clear and transparent guidance regarding professionalism expectations, and by ensuring that assessment of professionalism lapses includes systematic efforts to bring equity and anti-oppression lenses to professionalism standards and assessments. 

Related LCME Standards

3.5 Learning Environment (Professionalism)

Principles

  • The curriculum supports each student’s development into a physician who demonstrates the professional behaviors expected within the profession. 
  • Students must achieve the MD Competency Milestones to advance through each phase of the curriculum and to graduate.
  • Students need timely feedback about their professional behaviors and an opportunity to respond to feedback, learn, and grow.
  • As early medical learners developing their professional identity, students may demonstrate lapses in professionalism that can be successfully addressed with feedback and coaching. The Associate Dean for Students will provide support to the student in meeting competency expectations for professionalism.
  • A Physicianship Evaluation Form indicates that a student needs additional help developing professionalism skills and behaviors.
  • Professionalism lapses that lead to the submission of a Physicianship Evaluation Form and patterns of unprofessional behavior that fail to respond to feedback may lead to adverse academic actions, including failure of the relevant course/clerkship and/or referral to the Committee on Academic Standards.
  • The School of Medicine is required by the AAMC to report persistent, recurrent or serious unprofessional behavior on the Medical Student Performance Evaluation, along with information about the student’s response to educational interventions. 

Policy

  1. A course/clerkship director or associate dean (“Reporting Faculty”) who is concerned about a student's professional behavior should first give feedback directly to the student, discuss approaches for improvement with the student, and develop an action plan in collaboration with the student.
  2. If attempts to engage the student in effective feedback dialogue and action planning about these issues are unsuccessful, the behavior is repeated, or the behavior is initially serious enough, then the Reporting Faculty may complete a Physicianship Evaluation Form and will meet with the student to review the form and discuss feedback with the student. The Physicianship Evaluation Form should be filed as close to the incident of concern as is practical.
  3. The completed form will be submitted to the Associate Dean for Students, who will meet with the student to review the issues and explore strategies for professionalism learning and improvement.
  4. Students may be given the provisional non-passing grade of E in a course or clerkship for failing to demonstrate professional behavior consistent with the UCSF MD competencies required for a physician.
  5. A physicianship subcommittee of the Committee on Academic Progress (CAP) will review every Physicianship Evaluation Form to determine a course of action. In reviewing the current Physicianship Evaluation Form, the subcommittee will also consider any prior Physicianship Evaluation Forms. If the professionalism lapse (1) is severe, (2) indicates current of future harm to patients, communities, colleagues, and/or the institution, and/or (3) demonstrates a lack of progress in achieving professionalism expectations following a coaching and improvement plan, then the following consequence is warranted:
    • These issues will be reported in the Medical Student Performance Evaluation (MSPE). The School will notify residency program directors about Physicianship Evaluation Forms that meet the above criteria but are received after submission of the MSPE. The student will be placed on academic probation and referred to the Committee on Academic Standards.
  6. Students who receive a Physicianship Evaluation Form but do not feel that its issuance was merited can ask for clarification or review from the Reporting Faculty.
    • If the issue is not resolved after this informal discussion or the student chooses not to ask for clarification or review from the Reporting Faculty, the student will have four weeks to submit an appeal to the Associate Dean for Students. This appeal will be reviewed by the Physicianship Appeal Committee, who will determine whether its issuance should stand or be retracted. 
    • Grievances (formal complaints) are not the same as disagreements. A student cannot grieve a Physicianship Evaluation Form merely because the student disagrees with its issuance.
    • The student cannot further appeal the Physicianship Evaluation Form unless: (1) the student feels that it was based on discrimination (for example, that bias or wrongdoing by a faculty member has occurred), -or- (2) the student feels there was an infringement of the student’s academic freedom. An example of possible infringement of academic freedom is when a student alleges that the Physicianship Evaluation Form was submitted by a faculty member based upon the student's expression of opinions or academic positions that differed from that of the faculty member's opinions or positions. An example might be where a student wrote an opinion piece in the student paper with which the faculty member expressed disagreement.
    • A student with a grievance of an alleged act of discrimination as expressed through a Physicianship Evaluation form may contact the Office for Diversity and Outreach for further information.

Procedure

  1. A course/clerkship director or associate dean (Reporting Faculty) who is concerned about a student's behavior should give and discuss feedback directly with the student and make suggestions for improvement.
    1. The Reporting Faculty is encouraged to meet with a student who does not meet professionalism expectations as soon as concerns are raised and prior to the end of the course/clerkship or program.
    2. The purpose of this meeting is to share concerns about unprofessional behavior, discuss ways in which performance can be improved, thus allowing the student adequate opportunity to understand the issue and to make appropriate changes.
    3. Such feedback meetings, though strongly encouraged, are not required in order to submit a Physicianship Evaluation Form.
  2. If the behavior is repeated or is initially serious enough, then a Physicianship Evaluation Form will be completed by a Reporting Faculty.
  3. The Reporting Faculty who issues the Physicianship Evaluation Form will send the completed form to the student.
  4. The Reporting Faculty should meet with the student to review the form.
  5. To document this process, the student can sign and date the form and may respond by providing additional information.
  6. The faculty member who completed the form will submit it to the Associate Dean for Students.
  7. The Associate Dean for Students generally meets with the student to review the factors contributing to the professionalism lapse, explore and enact coaching strategies, and develop a plan with the student to address the issues.
  8. Students who receive a Physicianship Evaluation Form but do not feel that its issuance was merited have four weeks from the issuance of the Physicianship Evaluation Form to either (a) ask for clarification from or review by the Reporting Faculty, who must respond to a student’s request for clarification or review, or (b) submit an appeal to the Associate Dean of Students. If a request for clarification or review does not resolve the issue, the student has four weeks starting from their receipt of the Reporting Faculty’s substantive response to the student’s request to submit an appeal to the Associate Dean for Students.
  9. Upon the Associate Dean for Students’ receipt of a student’s appeal of the issuance of a Physicianship Evalution Form, the Associate Dean for Curriculum or Assessment will be assigned to manage the appeal. This appeal will be reviewed by the Physicianship Appeal Committee, who will determine whether its issuance should stand or be retracted. The committee will return the final decision to the Associate Dean for Students to communicate the committee decision to the student.

Accountable Dean or Director: Associate Dean for Competency Assessment and Professional Standards

Approval Date and Governing Body: May 21, 2019, CCEP 
Updated: December 12, 2023