Agenda and Meeting Materials - UConn School of Medicine ...

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Appendix of Terms PIRT = Professionalism Incident Report Triage PRB = Professional Review Board AAC = Academic Affairs Committee CHIPS = Confidential Help and Information for Professional Students
APPENDIX E: University of Connecticut School of Medicine Professionalism Incident Report Type of Report (circle one) PRAISE CONCERN Subject of Report (Student Name): Date of Report: Person Submitting Form Date/Time of Incident (include title and/or role): (time period if longitudinal observations): Action Requested (circle one) For File Only Referral to Professional Incident Report Triage (PIRT) I. Statement summarizing the behavior being praised or raising concern: II. Describe in detail the incident(s) which prompted the completion of this form (attach additional pages if needed). III. Describe previous feedback and remediation which took place prior to the completion of this form (attach additional pages if needed) if applicable. IV. Summary of attempts to resolve this current issue and report of outcome, if any. [NOTE: The following to be completed by a Member of Professionalism Incident Report Committee] Student Subject of report: I have read this description and discussed it with the individual who filed the report, and/or a representative of the Professionalism Committee. Signature: ____________________________________ Date: ___________________ Student signature on this form is intended only to verify that the student has reviewed the form with the individual who filed the report, and/or a representative of the Professionalism Committee. Student Comments: Professionalism Incident Report Committee Member: I have reviewed this evaluation. Signature: ____________________________________ Date: ___________________ PIRT Member Comments:
Page 1 and 2: Approval of the minutes • Februar
Page 3 and 4: • The C to P or F to P would be a
Page 5 and 6: Faculty Council (Storrs). • Admis
Page 7 and 8: Student does not appeal AAC agrees
Page 9 and 10: 5.G. Student Appeals Students may a
Page 11 and 12: 1. The student must be able to pres
Page 13 and 14: VI. Rules Concerning Appeals Upon r
Page 15 and 16: Table of Contents I. Curriculum Gov
Page 17 and 18: How Do You Use CHIPS? What is the C
Page 19 and 20: Appendix D: University of Connectic
Page 21 and 22: identify him/herself in case furthe
Page 23 and 24: The PRB shall consist of 5 voting m
Page 25: will also be responsible for inform
Page 29 and 30: Appendix F: University of Connectic
Page 31 and 32: Professionalism Task Force Updates
Page 33: Committee on Community and Continui

Agenda and Meeting Materials - UConn School of Medicine ...

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