clinical biennium quick start manual - Pritzker School of Medicine

Clinical BienniumQuick Start Manual2012

To Do List:Monthly• Schedule monthly “financial health” hour• Organize your student loans:• Resource: FIRST: http://www.aamc.org/programs/first/Quarterly• Schedule meeting with career advisor• Contact information in biennium handbook• Debrief about rotations, USMLE• Discuss career thoughts:• Bring your journal OR• Careers in Medicine clinical rotation evaluation (under exploring options):www.aamc.org/students/cim/DateSeptember 24, 2012January 2, 2013April 1, 2013Class MeetingAutumn Quarter beginsMS3 Class Meeting #1(BSLC - 1:00pm-6:00pm)Winter Quarter beginsMS3 Class Meeting #2(BSLC - 1:00pm-6:00pm)Spring Quarter beginsMS3 Class Meeting #3(BSLC - 1:00pm-8:00pm)

Table of ContentsForeword..................................................................................................................................................... 2Academic Schedule..................................................................................................................................... 3Professionalism at PritzkerGuiding Principles of Professionalism......................................................................................................... 6ResourcesImportant Numbers.................................................................................................................................. 10Frequently Asked Questions..................................................................................................................... 11VPN and Webapps.................................................................................................................................... 12Evaluation and Treatment for Bloodborne Pathogens Exposures............................................................. 14Needlestick/Exposure Procedure.............................................................................................................. 15Ombudsmen............................................................................................................................................. 16University of Chicago Police Department Security Services...................................................................... 17Transportation & Parking.......................................................................................................................... 20Map of Tunnel & Bridge between BSLC and the Hospital......................................................................... 28Policies and ProceduresPolicies and Procedures............................................................................................................................ 30The Learning Environment........................................................................................................................ 31Excerpt from 2011-12 Academic Standards Guidelines............................................................................ 32MISTREAT.................................................................................................................................................. 49Bias Response Team.................................................................................................................................. 50Professionalism Concern Reporting Process............................................................................................. 51Professionalism Concern Report............................................................................................................... 52Holiday Policy............................................................................................................................................ 54Duty Hours Policy...................................................................................................................................... 55Sandbox Access & Sign-Out Policy............................................................................................................ 56University of Chicago Medical Center PoliciesDress Code and Personal Appearance Policy............................................................................................ 58Scrub Policy............................................................................................................................................... 64HIPAA Privacy Rule.................................................................................................................................... 67Digital Millennium Copyright Act.............................................................................................................. 72Student Support ServicesStudent Support Services.......................................................................................................................... 74Pritzker School of Medicine Administration.............................................................................................. 75Student Health and Counseling Services.................................................................................................. 79Wellness.................................................................................................................................................... 88Career AdvisingCareer Advising at Pritzker........................................................................................................................ 94Career Advisor/Society Roster.................................................................................................................. 95Career Advisor Contact Information......................................................................................................... 97Careers in Medicine Website.................................................................................................................... 98Financial AidThird Year Financial Aid & You.................................................................................................................102References & Articles.........................................................................................................................104

ForewordDear Students,Welcome to the clinical years of medical school! The next two years are formative in many ways: they will be atime to gain experience and put into practice all you have learned thus far under the close supervision of theoutstanding faculty and residents of the University of Chicago. You will be part of a team composed of manydifferent professionals – residents, fellows, attending physicians, nurses, social workers, and countless others.You may, from time to time, find yourself in situations that will challenge you greatly – both intellectually andemotionally. As you move through your clerkships, you will undoubtedly discover that flexibility and opennessto new ideas are the keys to your success.Most importantly, you will have the opportunity to interact directly and meaningfully with our patients andtheir families. It is often true that our medical students are the members of the team who get to know thepatient best – not the disease but the person. The time you spend with your patients is one of the mostpotent therapeutic tools available to us as physicians. Never forget that our patients are at the center of whatwe do and that we owe them our very best every day.The information in this book serves as a reference when you have questions, need resources, or want toreflect on your clinical education.Congratulations on taking the next step in your medical training and thank you in advance for all that you willbe contributing to our patients and their care over the next two years.Sincerely yours,Holly J. Humphrey, MDProfessor of MedicineDean for Medical EducationJames Woodruff, MDAssociate Professor of MedicineAssociate Dean of StudentsOn Being A Student in the Medical Profession“…It was my first formal visit with a patient, and I was embarrassed. What would this barefoot farmhandthink of a young boy entering the exam room? But he was thrilled to see me. Later I realized that patients feltprivileged to be singled out in this fashion. Not only had they…seen the same big doctor whom the royaltycame to see, but now they got a bonus – me.”- Abraham Verghese, MDCutting For Stone, 20092

Academic ScheduleMS3 Academic Calendar2012-2013June 20-22, 2012June 25, 2012September 14, 2012September 24, 2012December 14, 2012January 2, 2013March 22, 2013April 1, 2013June 21, 2013Introduction to the Clinical BienniumThird-year clerkships beginSummer Quarter endsAutumn Quarter beginsMS3 Class Meeting #1 (BSLC - 1:00pm)Autumn Quarter endsWinter Quarter beginsMS3 Class Meeting #2 (BSLC - 1:00pm)Winter Quarter endsSpring Quarter beginsMS3 Class Meeting #3 (BSLC - 1:00pm)Spring Quarter endsClerkship Dates2012-2013Summer QuarterMedicine/Surgery 06/25/12 - 09/14/12Peds/Ob-Gyn 06/25/12 - 08/03/12 08/06/12 - 09/14/12Fam Med/Psych/Neuro 06/25/12 - 07/20/12 07/23/12 - 08/17/12 08/20/12 - 09/14/12Autumn QuarterMedicine/Surgery 09/24/12 - 12/14/12Peds/Ob-Gyn 09/24/12 - 11/02/12 11/05/12 - 12/14/12Fam Med/Psych/Neuro 09/24/12 - 10/19/12 10/22/12 - 11/16/12 11/19/12 - 12/14/12Winter QuarterMedicine/Surgery 01/02/13 - 03/22/13Peds/Ob-Gyn 01/02/13 - 02/08/13 02/11/13 - 03/22/13Fam Med/Psych/Neuro 01/02/13 - 01/25/13 01/28/13 - 02/22/13 02/25/13 - 03/22/13Spring QuarterMedicine/Surgery 04/01/13 - 06/21/13Peds/Ob-Gyn 04/01/13 - 05/10/13 05/13/13 - 06/21/13Fam Med/Psych/Neuro 04/01/13 - 04/26/13 04/29/13 - 05/24/13 05/28/13 - 06/21/133

Professionalism at Pritzker5

Guiding Principles of ProfessionalismIntroductionA mark of a great medical school is the ability to create an environment which nurturesfuture physicians who possess knowledge of the most advanced scientific fundamentals andwho demonstrate clinical competencies while behaving in ways that honor the profession ofmedicine. Helping students to achieve this level of professionalism is as important to a medicalschool as is its success in educating students in the biologic and clinical sciences.The following document outlines the fundamental attributes to which we ascribe as membersof the Pritzker School of Medicine community in our professional responsibilities, relationshipsand ethics.Professional ResponsibilitiesAs a medical student and future physician, I have chosen to pursue a profession which requirespersonal integrity, compassion, and a constant awareness of the commitment I have made tomyself, to my patients, and to the other members of the teams with whom I work. Exhibitingpersonal behaviors consistent with a respect for my chosen profession and having pride in mywork are central tenets of professionalism which I will strive to incorporate into my daily life. Todemonstrate my commitment to these responsibilities while enrolled at the Pritzker School ofMedicine, I will:1. Seek and accept feedback and constructive instruction from teachers, peers, residentsand faculty in order to continually improve my educational experience, knowledge, andclinical skills.2. Commit to the highest standards of competence both for myself and for those withwhom I work.3. Recognize the importance of life-long learning and commit to maintaining competencethroughout my medical career.4. Be mindful of my demeanor, language, and appearance in the classroom, in the presenceof patients, and in all health care settings.5. Be accountable to all members of the Pritzker community, including students, residents,faculty, and support staff.6. Admit to and assume responsibility for mistakes in a mature and honest manner anddevelop productive strategies for correcting them.7. Refrain from using illicit substances. Refrain from using alcohol, non-prescription orprescription drugs in a manner that may compromise my judgment or my ability tocontribute to safe and effective patient care.6

Guiding Principles of ProfessionalismProfessional EthicsCertain personal values and behaviors will be expected of me as a care-giver and as anambassador of the Pritzker School of Medicine. Through my behaviors, I will demonstrate acommitment to honoring and upholding the expectations of the medical profession, and, in sodoing, I will contribute to maintaining society’s trust in it. In particular, I will:1. Maintain the highest standards of academic and scholarly honesty throughout mymedical education, by behaving in a trustworthy manner.2. Recognize and function in a manner consistent with my role as a student on a team.3. Maintain a commitment to patient confidentiality, recognizing that patients will trust mewith sensitive information.4. Place my patients’ interests and well-being at the center of my educational andprofessional behavior and goals.5. Treat cadaveric and other scientific specimens with respect.6. Adhere to the standards of the profession as put forth by the American Board of InternalMedicine Physician Charter whose fundamental principles are social justice, patientautonomy, and the primacy of patient welfare.7. Learn about and avoid conflicts of interest as I carry out my responsibilities.8

Resources9

Important NumbersImportant NumbersJune 20, 2012Service Phone Email/WebsiteSafetyCampus Police (773) 702-8181 http://oca.uchicago.edu/safety/police/Dean-on-Call/Sexual Assault Dean-on-Call (773) 834-4357 http://deanoncall.uchicago.eduMedical Center Security (773) 702-8181 http://safety-security.uchicago.edu/medical/Umbrella Service (773) 702-8181 http://safety-security.uchicago.edu/police/resources.shtmlHealthNeedlestick Hotline (Page #9990) (773) 753-1880 http://medchiefs.bsd.uchicago.edu/administrative/needlestick.htmlStudent Health Service (773) 702-4156 http://healthcare.uchicago.edu/Appointments (773) 702-4156Urgent Care Nurse (773) 702-1915 http://healthcare.uchicago.edu/page/urgent-medical-careStudent Counseling Service (773) 702-9800 http://counseling.uchicago.edu/Urgent Care (773) 702-3625USHIP (773) 834-4543 http://studenthealth.uchicago.edu/page/insuranceDental Insurance (800) 323-1743 http://studenthealth.uchicago.edu/page/dental-coverageOmbudsmenAnne Hong, MD (773) 702-4585 ahong@medicine.bsd.uchicago.eduMichelle Josephson, MD (773) 702-2344 mjosephs@medicine.bsd.uchicago.eduJerome Klafta, MD (773) 702-9922 jklafta@dacc.uchicago.eduOffice of Student Affairs, Programs, and Multicultural AffairsJames Woodruff, MD (773) 795-1051 jwoodruf@medicine.bsd.uchicago.eduShalini Reddy, MD (773) 834-6762 sreddy@uchicago.eduElizabeth Kieff, MD (773) 702-4654 ekieff@bsd.uchicago.eduMonica Vela, MD (773) 702-4587 mvela@medicine.bsd.uchicago.eduRosita Ragin (773) 702-1617 rragin@uchicago.eduCareer AdvisorsCoggeshallMindy Schwartz, MD (773) 702-4591 mschwart@medicine.bsd.uchicago.eduBrian Callender, MD (773) 702-5207 bcallend@medicine.bsd.uchicago.eduDeLeePatricia Kurtz, MD (773) 702-4629 pkurtz@medicine.bsd.uchicago.eduTipu Puri, MD, PhD (773) 702-3630 tpuri@medicine.bsd.uchicago.eduHugginsShalini Reddy, MD (773) 834-6762 sreddy@uchicago.eduNanah Park, MD (773) 702-7656 npark@peds.bsd.uchicago.eduPhemisterJason Poston, MD (773) 702-7837 Jason.Poston@uchospitals.eduElizabeth Kieff, MD (773) 702-4654 ekieff@bsd.uchicago.eduPritzker School of MedicineAdmissions and Financial Aid (773) 702-1397pritzkeradmissions@bsd.uchicago.edupritzkerfa@bsd.uchicago.eduMedical School Education (Lori Orr) (773) 702-5306 lorr@bsd.uchicago.eduStudent Affairs and Programs (Kate Blythe) (773) 702-5944 kblythe@bsd.uchicago.eduMSTP Office (Marcus Clark, MD) (773) 834-3661 mclark@medicine.bsd.uchicago.eduMulticultural Affairs (Rosita Ragin) (773) 834-9146 rragin@bsd.uchicgo.eduPritzker Registrar (Maureen Okonski) (773) 702-3994 mokonski@bsd.uchicago.eduNorthshore University HealthSystemAssistant Dean (Ernest Wang, MD) (847) 570-2599 ewang@northshore.orgAssistant Vice President, Academic Affairs (Heather Winn) (847) 570-1086 hwinn@northshore.orgOtherAcademic Affairs (Donna Shannon) (847) 570-1478 academicaffairs@northshore.orgHIPAA Program Office (773) 834-9716 http://hipaa.bsd.uchicago.edu/University of Chicago Office for Civilityand Sexual Harassment (773) 834-4357 http://civility.uchicago.edu/bias.shtmlUniversity of Chicago Office of the Vice President forCampus Life and Dean of Students (773) 702-7770 http://dos.uchicago.edu/Please consider programming some of these numbers into your cell phone.10

Frequently Asked QuestionsQ: Who can I contact with EPIC related questions?A: Call CBIS at 773-702-3456.Q: Who can I contact regarding my Hospital Student Lounge Locker?A: Email Candi Gard your questions: cgard@bsd.uchicago.eduQ: What should I do if I lose my ID?A. Pritzker students should send an email to both Candi Gard (cgard@bsd.uchicago.edu)andKate Blythe (kblythe@bsd.uchicago.edu) with the subject line: Lost ID. You will receive anacknowledgement email, and a letter will be prepared for you to take to hospital security to have the IDreplaced. The letter should be ready to be picked up within a day or two.Q. If I need a Dean’s Letter stating that I am a student in good standing here, who do I need to see?A. Submit a request for a letter form available on the Pritzker website to Jill O’Brien (jobrien1@bsd.uchicago.edu)in BSLC 104S.Q. Where can I get a copy of my transcript?A. Requests for transcripts may be made directly through the Registrar’s websitehttp://registrar.uchicago.edu/students/transcripts.shtml.Q: I’m worried about how I’m doing in my courses and/or the USMLE exams, who can I turn to for help?A: Contact Dr. Halina Brukner, Associate Dean for Medical School Education(hbrukner@medicine.bsd.uchicago.edu).Q: Who do I contact regarding Epocrates access?A: Candi Gard (cgard@bsd.uchicago.edu)Q: Who do I contact regarding E*Value access?A: Jill O’Brien (jobrien1@bsd.uchicago.edu)Q. How do I get funding for off-site clerkship travel?A: If you drive your car to an off-site clinic for one of the required third-year clerkships, you are eligible for “PrivateCar Mileage” reimbursement. In order to be reimbursed for off-site clerkship travel, please:• Send an email to clerkshiptravel@bsd.uchicago.edu• Subject line: Clerkship Travel Reimbursement• Include the following information:o Nameo Student ID #o Addresso Zip Codeo Clerkshipo Locationo Dates of Rotationo List the dates that you drove with corresponding miles• for example: March 21, 2012 12 miles roundtripo We will contact you when your check is available for pick-up in Suite #10411

VPN and WebappsVPN - Connection GuidePlease note that the first time you use the VPN, you must have administrative rights on your computer or you willnot be able to download and install the software. Also, we recommend that you have the latest version of Java onyour computer before installing the VPN. You can find out if you have the latest version and download a new versionat www.java.com.Occasionally, Cisco AnyConnect VPN software will need to be updated. Check regularly for VPN updates at cvpn.uchicago.edu. If updates are available, you will be prompted to download and install the update. Updates willrequire Administrator privileges to install.Macintosh:Before using the VPN for the first time, we recommend you uninstall any old versions of the campus VPN beforeinstalling the new version. To uninstall the old version, follow the steps below:1. Open a terminal window (Applications > Utilities > Terminal).2. Run the following command: sudo /usr/local/bin/vpn_uninstall3. Enter your Mac OS X password.4. Answer “Yes” when are prompted to remove each item.5. Restart your machine.Once you’ve restarted your computer, resume the installation by following the steps below.1. Point your browser to http://cvpn.uchicago.edu.2. Log in with your CNetID and Password.3. The Cisco AnyConnect VPN Client should install on your computer. Note: A warning window may appear, if soselect Allow. Additionally, a window may appear that requires you to enter your Mac admin password; this isNOT the same as your CNet password - this password is unique to your Mac.4. When the install is complete you will see the Cisco AnyConnect icon anyconnect icon in your dock.5. o see details of the VPN connection, click the Cisco AnyConnect icon.6. To disconnect from the VPN, click the Cisco AnyConnect icon and select Disconnect in the Cisco AnyConnectVPN Client Window.Subsequent times that you use the VPN:1. Open your Mac’s Applications folder and double-click the Cisco AnyConnect Secure Mobility Client icon.2. Log in with your CNetID and Password.3. The Cisco AnyConnect icon will display in the dock when connected.Windows:Before using the VPN for the first time, we recommend you uninstall any old versions of the campus VPN beforeinstalling the new version. To uninstall the old version, follow the steps below:To do this, go to Start → Control Panel → Add/Remove Programs and Remove the “Cisco VPN Client.” After removingthe old version, you’ll be prompted to reboot your machine; after rebooting, you can run the new installer.Some older installations of the VPN Client may refuse to uninstall. If you run into one of these, this Uninstall utilityshould provide the kick-start you need.Once you’ve restarted your computer, resume the installation by following the steps below.1. Point your browser to http://cvpn.uchicago.edu. We highly recommend using Firefox rather than Explorer asyour browser.2. Log in with your CNetID and Password.3. The Cisco AnyConnect VPN Client should install on your computer. This may take a few moments. NOTE: ForWindows Vista and Windows 7 users, you may be asked to verify that you want to install the program from an“unknown publisher.” Select Yes or OK.4. When the install is complete, you will see the Cisco AnyConnect icon in your system tray (bottom right of yourscreen, by the clock).12

VPN and Webapps5. To see details of the VPN connection, right click the Cisco AnyConnect icon and select Open AnyConnect.6. To disconnect from the VPN, right click the Cisco AnyConnect icon and select Disconnect.Subsequent times that you use the VPN:1. Click Start > All Programs > Cisco AnyConnect VPN Client2. Login with your CNetID and Password.3. The Cisco AnyConnect icon will display in the system tray.After you have successfully VPN’ed, you can point your browser to https://webapps.uchospitals.edu and login to accessweb resources such as EPIC.Webapps Screenshot13

Evaluation and Treatment for Bloodborne Pathogens ExposuresEvaluation and Treatment for Bloodborne Pathogens ExposuresWhat are bloodborne pathogens?Bloodborne pathogens refer to viruses that can be transmitted through the blood or certain other bodyfluids. These include HIV, Hepatitis B virus, and Hepatitis C virus. Health care workers are exposed tothese pathogens through blood, mucous membrane, or skin exposures such as needle stick injuries,splashes, etc.What is a blood or body fluid exposure?A blood or body fluid exposure is defined as exposure to blood or other moist body fluids:with a contaminated sharp that pierces the skin (such as a scalpel or needle)exposure to eyes, mouth, other mucous membranesexposure to non-intact skinWhat should I do if I have an exposure?Needle sticks and cuts should be washed with soap and water.Splashes to the nose, mouth, or skin should be flushed with water.Eyes should be irrigated with clean water, saline or sterile irrigants.There is no scientific evidence to show that using antiseptics for wound care or squeezing the wound willreduce the transmission of HIV. The use of a caustic agent, such as bleach, is not recommended.How do I report an exposure?To report a blood or body fluid exposure, Alpha or numeric page the NEEDLE STICK HOT LINE at pager#9990. This pager is covered 24 hours per day. A UCOM clinician will return your page within 10minutes. You will need to provide the source patient's name, medical record number, hospital location,and phone number where you can be reached. The UCOM practitioner will initiate source patient testingand complete an initial assessment for HIV to determine whether post exposure prophylaxis for HIV iswarranted. Further evaluation and treatment will be given in UCOM. Employees must follow up withUCOM in person on the next business day.Do not talk with the source patient about testing for HIV and hepatitis virusesDo not draw the source patient's bloodDo not go to the Mitchell Emergency DepartmentUCH employees will also need to notify their supervisor that an exposure has occurred AND must reportthe exposure to Security at ext. 2-6262.For more information, go to our Bloodborne Pathogens Exposure Information Sheet (PDF).http://safety.uchicago.edu/pp/occhealth/pathogens.shtmlClick here for a printable pink pocket instruction card to carry or post in your department: "Procedure forpersonnel after exposure to blood or other potentially infectious material."Click here to review OSHA's information about Bloodborne Pathogens and Needlestick Prevention.Click here to review "Updated US Public Health Service Guidelines for Management of OccupationalExposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis"Click here to review "Updated US Public Health Service Guidelines for Management of OccupationalExposures to HIV and Recommendations for Postexposure Prophylaxis"14

Needlestick/Exposure ProcedureThe University of Chicago HospitalsPROCEDURE FOR PERSONNEL AFTER EXPOSURE TOBLOOD OR OTHER POTENTIALLY INFECTIOUS MATERIALOUCH!Now what doI do?Step 1. Clean/Decontaminate:Wash wounds and contaminatedskin with soap and water; rinsemouth, nose and eyes with wateror saline.Step 3. Inform your supervisor.Step 2. Page the needlestick hotline 188‐9990immediately for assessment and advice regardingtreatment. Pager 9990 is staffed by a UCOM clinicianand is available 24 hours a day.Do not talk with the source patient abouttesting for HIV and hepatitis virusesDo not draw the source patient’s bloodDo not go to the Mitchell ERStep 4. Follow instructions of UCOM Clinician.For exposures that occur during UCOM hours, provide the UCOM on‐callclinician with source patient information, then come directly to UCOM fortreatment.For exposures that occur after UCOM hours, provide the UCOM on‐callclinician with source patient information. If needed, a starter dose ofprophylactic medicine will be delivered to you.All employees with after‐hours exposures must come to UCOM on thenext working day (Mon‐Fri, 7:30 am – 4:00 pm)Off‐campus blood/body fluid exposure: Follow their protocol thencontact 773‐834‐4042 to report the exposureEffective July 1, 2004If you receive a bill for your needlestick, please drop it off toCandi Gard BSLC 104R cgard@bsd.uchicago.edu , orKate Blythe BSLC 104N kblythe@bsd.uchicago.edu15

OmbudsmenUNIVERSITY OF CHICAGO MEDICINE OMBUDSMENWho are the Ombudsmen?Anne Hong, MDDepartment of MedicineJerome Klafta, MDDepartment of Anesthesiaand Critical CareMichelle Josephson, MDDepartment of MedicineContact Information (in preferred order):Email: ahong@medicine.bsd.uchicago.eduTel: (773) 702-4585Pager: 9568Office: L-325Contact Information (in preferred order):Email: jklafta@dacc.uchicago.eduPager: 4931Tel: (773) 702-9922Office: G-419Contact Information (in preferred order):Email: mjosephs@medicine.bsd.uchicago.eduTel: (773) 702-2344Pager: 6406Office: S-509What is an Ombudsman?Every member of the University community makes a commitment to strive for personal and academicintegrity, to treat others with dignity and respect, and to honor the rights and property of others. From time totime, issues may arise that are not in keeping with our commitment to this goal. When this happens, it isimportant that you, as residents and students, know what resources are available to you.University of Chicago faculty members are appointed as Ombudsmen to serve as advocates and facilitators forstudents and residents at the University of Chicago. Ombudsmen are chosen because they are neutral, thirdparty physicians who are not otherwise involved with the academic promotion or evaluation of Pritzkerstudents or University of Chicago residents. All interactions with the Ombudsmen are confidential.Ombudsmen play an important role by providing a mechanism for medical students and residents to raise andresolve issues without fear of intimidation or retaliation.The Ombudsmen are available to serve as a confidential and private sounding board for students and residentsregarding their experiences at the University of Chicago. They will also investigate and resolve complaints ofmistreatment or other issues and abuses. These incidents may occur in the classroom, hospital setting or atschool-sponsored events, and may involve students, residents, staff, or faculty. The Ombudsmen will workwith each medical student or resident to explore options, suggest resources and call attention to the appropriatefaculty members and administrators.All discussions with Ombudsmen are confidential.16

University Police on campus: 123; Off Campus: 773-702-8181Chicago Police/Fire: 911Sign up for the C-Alert System: https://calert.uchicago.edu/This system will enable authorized University officials to reach members of the University communitythrough mechanisms other than regular University email and telephones. The new system can transmitshort notifications by email to any outside email address, by text message to a cell phone, or by voicemessage to an off-campus telephone. The information in the emergency notification system will be usedonly to contact you in case of emergency, a University closing, or some other event that requires rapid,wide-scale notification of the community. Use your CNet ID to sign up.UNIVERSITY OF CHICAGO SECURITY SERVICESWHISTLESTOPBlowing a whistle brings help when you need it. You can also get free whistles from the front deskin BSLC 104 or the hospital student lounge. The University of Chicago Police phone number is on thePritzker whistles.UMBRELLA COVERAGE (773) 702-8181.If you’re concerned about your safety as you walk in our patrol area, call us. We’ll send the first availablepatrol car to follow you to your destination.BICYCLE REGISTRATIONYou can register your bike with the UCPD by contacting the Community Services Division at 773.702.6008and we’ll give your bike a numbered identification sticker and put it on record with the Chicago PoliceDepartment.JUMPER CABLESCar won’t start? Call 773.702.8181, and an officer will bring you a battery jump box. (The officer cannotuse the squad car to jump your car, however.)LAPTOP STOP TAGSUniversity of Chicago Police Department Security ServicesA laminated bar code on your laptop computer will allow it to be traced if lost or stolen. Contact theUCPD Community Services Division at 773.702.6008 for more information.RAPE AGGRESSION DEFENSE SYSTEMS (R.A.D.)The R.A.D. System is a comprehensive course for women that begins with awareness, prevention, riskreduction and avoidance, while progressing to basic hands-on defense training.17

University of Chicago Police Department Security ServicesSafety Tips (From Common Sense: http://commonsense.uchicago.edu/)Whether you are at home or out and about, you need to stay alert. Here are a few simple tips that willhelp keep you safe.Keeping Safe While…Walking• Plan your way in advance. Choose well-traveled routes. Use discretion when talking or walkingwith strangers, even if they are offering you help or assistance. Always keep moving toward yourdestination. Walk with purpose.• When possible, try to travel with friends, whether it is daytime or evening. Just remember: There issafety in numbers.• Avoid deserted areas. Do not cut through parks, alleys, and vacant lots at night.• If you think you are being followed, cross the street, change direction, or go to a public place whereothers are present.• If a person confronts you and demands your money or possessions, give what is demanded andcreate a safe distance.• Keep alert. Don’t let a conversation on your cell phone or the use of headphones make you unawareof your surroundings.• Use caution when using automated teller machines (ATMs). Select one located in a busy, well-lightedarea. Plan ahead so you are not forced to find a machine in an unfamiliar part of town.Bicycling• Use a “horseshoe” lock to secure your bike to appropriate structures such as bike racks, signposts, oriron fences. Avoid chaining a bicycle to banisters or handrails; it is a safety hazard.• Register your bike with University Police; they will provide you with a numbered identification stickerand put it on record with the Chicago Police Department.Using Public Transportation• Avoid isolated bus or train stops and times when few other people are around• Keep your belongings on your lap if possible.Driving• Keep your car locked and use a steering wheel locking device or car alarm.• Keep purses and packages out of view.• If your car breaks down far from possible sources of help, raise the hood, then stay inside with thedoors locked. If someone offers to help, do not open your window or door or accept a ride; ask themto call the police or roadside assistance for you.18

University of Chicago Police Department Security ServicesAt Home• Lock your door, even if you are leaving just for a few minutes. Do not prop open doors, even for yourown or a friend’s convenience. When you leave, be sure to lock your windows as well.• Before you leave for a vacation, stop newspaper delivery, have a neighbor pick up your mail, and setyour telephone bell to the lowest volume.• Don’t admit strangers into your building or apartment. Use a peephole to confirm a visitor’s identitybefore opening the door. Don’t buzz a visitor into the building unless you are certain who it is.• Landlords are legally required to provide adequate hallway lighting and deadbolt locks on individualapartment doors. Window locks are required in some situations. Complain if these things are missingor inadequate. For further information, call the South East Chicago Commission at (773) 324-6926.Additional Safety Tips from the class of 2012• Use the buddy system - if you are on call with someone, walk with each other• AVOID dark alleys (ie- behind the BSLC), walk along the larger streets, even if it takes longer.• Keep your wallet in your white coat pocket. Don’t leave valuables in your backpacks in theworkrooms.• Carry only the bare minimum• Carpool• When you’re going to be in the OR, leave jewelry at home or in a safety deposit box.19

Transportation & ParkingPARKING OPTIONS FOR MEDICAL STUDENTShttp://safety-security.uchicago.edu/transportation/Parking Locations• 1155 E 60th St• Chapin Hall, 1313 E 60th St• Dorchester, 1427 E 60th St• Ellis Parking Structure, 5500 S Ellis• Faculty Apartments, 6027 S Ingleside• Judd, 58th and Kimbark• Kenwood, 6045 S Kenwood• Kimbark, 6022 S Kimbark Ave• Maryland, 57th and Maryland• Mott, 60th and Kimbark• New Grad, 60th and Kimbark• Pierce, 5514 S University• Wells, 6000 S Drexel AveFree Parking Location• Stony Island & 60th Street community lotParking Rates (as of September 1, 2011)• Dorchester, Chapin, Edelstone, Kenwood, Kimbark, Mott, NGR, 1155, Law School, FacultyApartments, and Wells- $80• Pierce, Judd, Maryland West, I-House, ATS, 5733, 5737 and Woodlawn- $80• Ellis Parking Structure- $80• Lexington Lot- $175LOCATIONS OF CAR-SHARING VEHICLESThe University and the Medical Center have car-sharing vehicles located at these parking lots:I-GO: www.igocars.org/locations• Pierce lot, 55th and Greenwood• Judd lot, east of the Booth School of Business, 5835 S. Kimbark• Chapin lot, 60th and KenwoodZipCar: www.zipcar.com/chicago/find-cars• International House, south of 58th on Dorchester• Pierce lot, 55th and Greenwood (3)• Judd lot, east of the Booth School of Business, 5835 S. Kimbark• Chapin lot, 60th and Kenwood• Lexington lot, south of 58th on University (2)• East of Comer Children’s Hospital, 58th and Drexel (2)• Kimbark lot, south of 60th on Kimbark (2)20

BUS TRACKERThe University of Chicago’s bus system has an online tracking application that delivers real-time locationinformation through a free iPhone app, smart phones, iPads or Internet-connected computers. Transitriders can now accurately predict when a bus will arrive at a specific stop.http://uchicago.transloc.com/UNIVERSITY OF CHICAGO MEDICAL CENTER SHUTTLE SERVICESThe following shuttle buses can help employees/students get to different points around the MedicalCenter campus, as well as to parking lots and CTA/METRA stops. For more information please call(773) 702-8969. UCMC shuttles are grey or white with large signs that say “University of Chicago MedicalCenter.”APOSTOLIC SHUTTLE (Free with U of C ID)Route: Between the Medical Center and the Apostolic Parking Lots on the corner of 63rd St. andKenwood. This shuttle operates Monday through Friday during daytime hours.DREXEL SHUTTLE (Free with U of C ID)Service from 5am–10am, M-F. Departs from 61st St. & Drexel Ave., every 10 minutes at :00, :10, :20, :30,:40, and :50 past the hour.FRIEND CENTER-METRA SHUTTLE (Free with U of C ID)Route: Between the Medical Center and the Friend Center on the corner of 55th St. and Cottage Grove.Operates Monday through Friday during daytime hours. This bus is particularly useful if you park on 55thStreet or rotate at the Friends center.LA RABIDA CHILDREN’S HOSPITAL SHUTTLE (Free with U of C ID)Route: Between La Rabida Children’s Hospital and the Medical Center. The shuttle departs from the mainentrance of La Rabida to the Medical Center’s Wyler Hospital entrance and the University of ChicagoComer Children’s Hospital. This shuttle service runs Monday through Friday, excluding holidays. Foradditional information, contact the Information Desk at La Rabida at (773) 753-8646.UCMC MIDWAY SHUTTLE (Free with U of C ID)• Route: Around the Medical Center and the University of Chicago campus. Operates Mondaythrough Friday during the day and night. Stops at many locations, including:• Drexel Parking Lots at 6043 S. Drexel• Woodlawn Parking Lot at the corner of 60th and Woodlawn• I/C METRA station at 57th Street• Friend Center at the corner of 55th & Cottage GroveTransportation & Parking• Employees who work late hours can also arrange for a Security Escort, who is available onan on-call basis. Call ext. 2-6262 to arrange for an escort. Those who commute via Union orNorthwestern train stations should take the CTA bus 192.21

DREXEL ROUTEDrexel AM & Apostolic AM RoutesEffective January 2011DREXEL ROUTEService from 5am–10am, M-F. Departs from61st St. & Drexel Ave., every 10 minutes at:00, :10, :20, :30, :40,:50 past hour.52nd StreetCottage Grove Ave.Drexel Ave.Ingelside Ave.Ellis Ave.APOSTOLIC ROUTEService from 5am–10am, M-F. Departs from63rd St. & Kenwood Ave., every 10 minutesat :00, :10, :20, :30, :40, :50 past hour.Greenwood Ave.University Ave.Woodlawn Ave.Kimbark Ave.Stops at 57th/59th St. Metra, 5:30am–6:30am, M-F.53rd StreetTransportation Information can be obtained from bus@uchicago.edu or calling 795-6108.After-hours transportation is available by calling 702-6262, 9pm–5am.Kenwood Ave.Buses on these routes stop at thefollowing locations:Blackstone Ave.Harper Ave.• Goldblatt Entrance52nd • Street Wyler Entrance• Bernard Mitchell Entrance• 58th/Drexel–Across from American School• Comer–Across from ER• 57th/Drexel-Knapp Center• 58th/Ellis-Bookstore (Apostolic Only)53rd StreetDorchester Ave.Lake Park Ave.Cornell Ave.South Hyde Park Boulevard54th Street54th Street54th StreetFRIENDCENTERMETRA55th Street55th StreetEllis Ave.56th StreetUniversity Ave.Kimbark Ave.Kenwood Ave.56th StreetLake Park Ave.REGENSTEINLIBRARYCottage Grove Ave.Maryland Ave.Drexel Ave.57th Street58th StreetUC MEDICAL CENTERREYNOLDS CLUBMAIN QUAD59th StreetUniversity Ave.Woodlawn Ave.57th Street58th StreetKimbark Ave.Dorchester Ave.Blackstone Ave.Harper Ave.METRANorth Midway Plaisance60th StreetSouth Midway Plaisance60th StreetSouth Stony Island Ave.61st Street61st StreetCottage Grove Ave.62nd StreetDrexel Ave.Ingelside Ave.Ellis Ave.Greenwood Ave.University Ave.Woodlawn Ave.62nd StreetKimbark Ave.Kenwood Ave.Dorchester Ave.KEYDrexel AM RouteApostolic AM Route63rd Street63rd Street63rd Street64th Street64th Street64th Street22

Friend Center — Metra RouteFRIEND CENTER-METRA ROUTEService to the Medical Center, Friend Centerand 57th St. Metra runs from 5:15am–9pm, M-F.Cottage Grove Ave.Departs from 59th St. & Drexel Hyde Park Ave., Boulevard every30 minutes at :00, :30 past hour. Departs fromthe Friend Center-Cottage Grove every 30minutes at :05, :35 past hour BY REQUESTONLY. Departs from the Friend Center-RonaldMcDonald House every 30 minutes 52nd at :10, Street :40past hour. Departs from 57th St. Metra every30 minutes at :20, :50 past hour.Drexel Ave.Ingelside Ave.Ellis Ave.Greenwood Ave.50th StreetBuses on the Friend Center-Metra Routestop at the following locations:• Goldblatt Entrance• Wyler Entrance• Bernard Mitchell Entrance• 58th/Drexel–Across from American School• Comer–Across from ER• 57th/Drexel-Knapp Center• Friend Ctr/Ronald McDonald House• 57th Street MetraKimbark Ave.Kenwood Ave.52nd StreetBlackstone Ave.Effective January 2011Transportation Information can be obtainedfrom bus@uchicago.edu or calling 795-6108.After-hours transportation is available METRA bycalling 702-6262, Hyde 9pm–5am. Park BoulevardHarper Ave.East End Ave.South Hyde Park Boulevard53rd Street53rd StreetRONALDMCDONALDHOUSEFRIENDCENTER54th Street55th StreetGreenwood Ave.University Ave.54th StreetWoodlawn Ave.Dorchester Ave.55th StreetBlackstone Ave.54th StreetLake Park Ave.Cornell Ave.56th StreetUniversity Ave.Kimbark Ave.Kenwood Ave.Lake Park Ave.Cottage Grove Ave.Maryland Ave.Drexel Ave.57th Street58th StreetUC MEDICAL CENTEREllis Ave.REGENSTEINLIBRARYREYNOLDS CLUBMAIN QUADUniversity Ave.Woodlawn Ave.57th Street58th StreetKimbark Ave.Dorchester Ave.Blackstone Ave.Harper Ave.METRA59th Street59th StreetNorth Midway PlaisanceEllis Ave.South Midway Plaisance60th Street60th StreetSouth Stony Island Ave.Cottage Grove Ave.62nd StreetDrexel Ave.Ingelside Ave.61st StreetGreenwood Ave.University Ave.Woodlawn Ave.62nd StreetKimbark Ave.Kenwood Ave.61st StreetDorchester Ave.63rd Street63rd Street23FRIEND CENTER METRA ROUTE

Evening Bus Service: Academic Year ScheduleEffective September 2011North and East Routes depart from the Regenstein Library. Central and South Routes depart from the Reynolds Club.Sept. 18–Dec. 10, 2011; Jan. 3–Mar. 17, 2012; Mar. 25–June 9, 2012.Monday-Thursday Service: buses depart every 10 minutes from 6pm–8pm at :00, :10, :20, :30, :40, :50 past the hour, and every 20 minutesfrom 8pm–2am at :00, :20, :40 past the hour. Friday Service: busesdepart every 10 minutes from 6pm–8pm at :00, :10, :20, :30, :40, :50past the hour. Buses depart every 20 minutes from 8pm–3am at :00,:20, :40 past the hour. Saturday Service: buses depart every 20 minutesfrom 6pm–3am at :00, :20, :40 past the hour. Sunday Service: busesdepart every 20 minutes from 6pm–2am at :00, :20, :40 past the hour.Dec. 11, 2011–Jan. 2, 2012; Mar. 18–Mar. 24, 2012; June 10–Sept. 15, 2012:buses depart every 20 minutes from 6pm–1am at :00, :20, :40 past thehour.Cottage Grove Ave.Drexel Ave.Hyde Park BoulevardIngelside Ave.Ellis Ave.52nd Street53rd StreetGreenwood Ave.50th StreetUniversity Ave.Woodlawn Ave.Kimbark Ave.Kenwood Ave.52nd Street53rd StreetDorchester Ave.Blackstone Ave.Hyde Park BoulevardHarper Ave.53rd StreetLake Park Ave.METRACornell Ave.South Hyde Park BoulevardMaryland Ave.54th StreetGreenwood Ave.55th Street54th StreetDorchester Ave.55th StreetBlackstone Ave.54th StreetMETRASouth Hyde Park BoulevardSouth Shore Drive56th Street56th StreetCottage Grove Ave.Maryland Ave.Drexel Ave.57th Street58th StreetREGENSTEINLIBRARYREYNOLDS CLUBMAIN QUADUniversity Ave.Kimbark Ave.57th Street58th StreetDorchester Ave.Blackstone Ave.Harper Ave.METRASouth Stony Island Ave.South Cornell Drive59th StreetCottage Grove Ave.North Midway PlaisanceSouth Midway PlaisanceWoodlawn Ave.Dorchester Ave.60th Street61st StreetDrexel Ave.Ingelside Ave.Ellis Ave.60th Street61st StreetKEYNorth RouteEast RouteCentral RouteSouth Route24SOUTH ROUTE CENTRAL ROUTE NORTH ROUTE EAST ROUTE

CTA Bus ServiceCTA #170: Service from 5:30am–10am; 3:30pm–7pm m-fCTA #171: Service from 7am–6pm m-f; weekends from 8am-6pmCTA #172: Service from 7am–6pm m-f; weekends from 8am-6pmCTA #192: Service from 6:30am–9am; 3pm–7pm m-fCheck for CTA schedules on transitchicago.com#170, #171, #172: Students, faculty, and staff of the University,including medical Center staff, ride free upon displaying aUniversity issued University of Chicago I.D., University of Chicagomedical Center I.D., or University of Chicago Laboratory SchoolI.D. #192: Ordinary CTA fares shall be paid by all riders includingUniversity and medical Center students, faculty, and staff.To access Hyde Park MeTrA Stations, the following CTA routescan be used:• 57th Street meTrA Station, use the CTA #170• 55th Street meTrA Station, use the CTA #171• 51st/east Hyde Park meTrA Station, use the CTA #172All OTher CusTOmersPay regular fares and can buy transfers to other CTA services.CTA Full FAres (exact fare required)• Cash fare: $2.25 full/$1.00 reduced• Transfers: Available to customers using Transit Cards, ChicagoCards, and Chicago Card Plus only.• Transit Card full/reduced (buy at CTA rail stations)$2.00 full/$.85 reduced—deducted on 1st ride,$.25 full/$.15 reduced—deducted on 2nd use within2 hours; free—3rd use within two hours.Pre-valued Transit Cards and select Passes can be purchased at twoUniv. of Chicago locations: the Identification and Privileges Officeand the Parking Office. Transit Cards and Passes are also sold atneighborhood Currency exchanges, Jewel, Dominick’s, select Cubfoods stores, and online at www.transitchicago.com.TrAnsiT inFOrmATiOn(312) 836-7000 daily, 5am to 1am TTY: (312) 836-4949CTA Website: transitchicago.comCTA Customer Assistance: 1-888-YOUr-CTA (968-7282)U. of Chicago Website: bus.uchicago.eduU. of Chicago email: bus@uchicago.eduKEY#170 AM Route#170 PM Route#171 Route#172 Route#192 Route#192 StopsDrexel Ave.Ingelside Ave.Hyde Park BoulevardEllis Ave.52nd StreetGreenwood Ave.50th StreetUniversity Ave.Woodlawn Ave.Kimbark Ave.Kenwood Ave.52nd StreetBlackstone Ave.Hyde Park BoulevardHarper Ave.Lake Park Ave.METRAMETRACornell Ave.East End Ave.Lake Shore Drive53rd Street53rd StreetCottage Grove Ave.Maryland Ave.Maryland Ave.Drexel Ave.54th StreetUC MEDICALCENTER55th Street57th Street58th Street59th StreetEllis Ave.Greenwood Ave.REGENSTEINLIBRARYREYNOLDS CLUBMAIN QUAD#192 AM StopUniversity Ave.54th StreetWoodlawn Ave.Kimbark Ave.56th Street57th Street58th StreetKimbark Ave.Kenwood Ave.#192 AM StopDorchester Ave.Dorchester Ave.55th StreetBlackstone Ave.Blackstone Ave.Harper Ave.54th Street56th StreetLake Park Ave.METRAMETRASouth Cornell DriveSouth Hyde Park BoulevardSouth Shore DriveNorth Midway PlaisanceSouth Midway PlaisanceLake Shore Drive60th Street60th Street61st StreetDrexel Ave.elside Ave.Ellis Ave.nwood Ave.iversity Ave.odlawn Ave.61st Streetimbark Ave.nwood Ave.chester Ave.25

Parking Combined RouteCottage Grove Ave.PARKING COMBINED ROUTE Hyde Park Boulevard(includes Drexel & Apostolic Lots)PM Route: Departs from 59th St. & Drexel Ave.,M-F. From 10am–3pm, service every 15 minutesat :00, :15, :30, :45 past hour. From 3pm–6pm,service every 10 minutes at :00, :10, 52nd :20, Street :30,:40, :50 past hour. From 6pm–9pm, serviceevery 20 minutes at :00, :20, :40 past hour.Drexel Ave.Ellis Ave.Greenwood Ave.50th StreetBuses on this route stop at thefollowing locations:• Goldblatt Entrance• Wyler Entrance• Bernard Mitchell Entrance• 58th/Drexel–Across from American School• Comer–Across from ER• 57th/Drexel-Knapp Center• 58th/Ellis-BookstoreKenwood Ave.52nd StreetBlackstone Ave.Effective January 2011METRAHyde Park BoulevardHarper Ave.Lake Park Ave.East End Ave.Transportation Information can be 53rd obtained Street from bus@uchicago.edu or calling 795-6108.After-hours transportation is available by calling 702-6262, 9pm–5am.53rd StreetFRIENDCENTERIngelside Ave.55th Street54th StreetEllis Ave.Greenwood Ave.56th StreetUniversity Ave.Woodlawn Ave.Kimbark Ave.Kenwood Ave.Dorchester Ave.Blackstone Ave.55th Street56th Street54th StreetLake Park Ave.METRACornell Ave.South Hyde Park BoulevardCottage Grove Ave.57th StreetMaryland Ave.Drexel Ave.REGENSTEINLIBRARY57th StreetREYNOLDS CLUB57th StreetMETRA58th StreetUC MEDICAL CENTERMAIN QUADUniversity Ave.Woodlawn Ave.59th StreetNorth Midway PlaisanceSouth Midway Plaisance60th StreetEllis Ave.58th StreetKimbark Ave.Dorchester Ave.Blackstone Ave.Harper Ave.South Stony Island Ave.60th Street61st Street61st StreetCottage Grove Ave.62nd StreetDrexel Ave.Ingelside Ave.Greenwood Ave.University Ave.Woodlawn Ave.62nd StreetKimbark Ave.Kenwood Ave.Dorchester Ave.63rd Street63rd Street64th Street63rd Street64th StreetSouth Stony Island Ave.26PARKING PM ROUTE

La Rabida Children’s Hospital Shuttle ScheduleEffective January 30, 2012The La Rabida Shuttle service provides passenger transportation to and from theUniversity of Chicago medical campus Monday through Friday, excludingholidays.The shuttle departs from the main entrance of La Rabida Children’s Hospital tothe University of Chicago campus; destinations are Wyler Hospital (5841 SouthMaryland Avenue) and Comer Hospital (5721 South Maryland Avenue).For additional information or a copy of the shuttle schedule, contact theLa Rabida Children’s Hospital Information Desk at (773) 753-8646.Departure from La Rabida's Main Departure from Wyler Hospital toEntranceComer Hospital7:30 a.m. 8 a.m.11:30 a.m. Noon2:30 p.m. 2:50 p.m.4:30 p.m. 5 p.m.27

Map of Tunnel & Bridge between BSLC and the HospitalHospital Student loungeJ083 doorS corridorJ corridorAb corridorDoors requiring swipeaccess with hospitaland/or UC IDGordon Center(GCIS)Doorwith yellowhaz-CummingsTunnel under Crerar andElevator N1Cummings & CrerarCafeGordon Center(GCIS) 3rd floorTake elevator N1down to mezzanine(M). The other elevatordoes not go to themezzanineBridge from GCIS toKnapp 3rd floorBSLC 3rd floorBridge from Knapp to BSLC 3rd28

Policies and Procedures

Policies and ProceduresThis section contains excerpts of policies of the medical school, University and medical center that areparticularly relevant to medical students in their clinical years. Please refer to the Academic StandardsGuidelines on the Pritzker website* and to the University of Chicago Student Manual which coversUniversity policies and regulations (studentmanual.uchicago.edu).1) The Learning Environment2) University of Chicago Pritzker School of Medicine Policies, excerpted from Academic StandardsGuidelinesa. Treatment of Studentsb. Unlawful Discrimination and Harassmentc. Sexual Harassmentd. Civil Behaviore. Disability Accommodation Protocolf. University Disciplinary Systemg. Disciplinary System of the Pritzker School of Medicineh. Mistreatment Reporting Resourcesi. Bias Response Teamj. Professionalism Concern Reportk. Holiday Policyl. Duty Hours Policym. Medical Student Sandbox Access and Sign-Out Policy3) Medical Center Policiesa. Dress Code and Personal Appearance Policyb. Scrub Policyc. HIPAA Privacy Ruled. Digital Millennium Copyright Act* http://pritzker.uchicago.edu/current/students/AcademicGuidelines.pdf30

The Learning EnvironmentThe Pritzker School of Medicine is committed to educating students in an environment that promotesthe development of appropriate professional attributes as defined by the Liaison Committee for MedicalEducation (LCME), the body that accredits medical schools. This section provides specific standardswhich address the teacher-learner relationship at Pritzker.While we hope that you will have the same positive experiences as the vast majority of Pritzker students,you will at times come across events that run counter to these standards. Pritzker takes violations ofthese standards seriously. Included in this section is information about who you can talk to if you thinkyou may have been mistreated. There is also a reference tool (MISTREAT) that covers some commonscenarios that occur on the wards and how you can assess whether you have experienced mistreatment.31

Excerpt from 2011-12 Academic Standards GuidelinesPolicy on Treatment of StudentsStatement of PolicyThe Pritzker School of Medicine at the University of Chicago is committed to maintaining an academicand clinical environment in which faculty, fellows, residents and students work together freely tofurther education and research and provide the highest level of patient care, whether in the classroom,the laboratory or the hospital and clinics. The School’s goal is to train physicians to meet high standardsof professionalism and practice in an environment where effective, humane and compassionate patientcare is demanded and expected. To this end, the School recognizes that each member of the medicalschool community should be accepted as an autonomous individual and treated civilly, without regardto his or her race, color, religion, sex, sexual orientation, sexual identity, national or ethnic origin, age,disability or any other class protected by law. Diversity in background, outlook and interest amongfaculty, fellows, residents, students and patients inherent in the practice of medicine, and appreciationand understanding of such diversity, is an important aspect of medical training. As part of that training,the School strives to inculcate values of professional and collegial attitudes and behaviors in interactionsamong members of the School community, and between these members and patients and their families.The School has appointed three faculty members to serve as ombudsmen to facilitate confidentialreporting of potential mistreatment and to raise awareness of appropriate standards of behavioramong the members of the medical school community.Dr. Anne Hong (pager 9568)Dr. Michelle Josephson (pager 6406)Dr. Jerome Klafta (pager 4931)Policy on Unlawful Discrimination and HarassmentIntroductionIn keeping with its long-standing traditions and policies, the School and the University of Chicago, inadmissions, access to programs, and educating and evaluating students, considers students on the basisof individual merit. The University does not discriminate on the basis of race, color, religion, sex, sexualorientation, gender identity, national or ethnic origin, age, disability, veteran status, genetic information,or other protected classes under the law. Such discrimination is unlawful.If a student believes that he/she has experienced such discrimination, he/she can consult with theUniversity’s Affirmative Action Officer. If the student files a formal complaint with the AffirmativeAction Officer, he/she will investigate the facts and report back to the student. See the Student Manualof University Policies and Regulations for details about this process. The student may also raise his/herconcerns with the Dean for Medical Education. Other available resources within the School to exploreconcerns about discriminatory treatment are the course director, the preceptor, the department chair orone of the Pritzker Ombudsmen. Often, the matter can be resolved through informal action, discussionand education.Rights of Students3237

Excerpt from 2011-12 Academic Standards GuidelinesUnlawful Discrimination and HarassmentThis policy is the basis for the University’s commitment to conform with the law in regard tonondiscrimination and maintaining a workplace free from sexual harassment and other unlawfulforms of harassment.Rights of StudentsDiscrimination based on factors irrelevant to admission, employment, or program participationviolates the University’s principles. In keeping with its long-standing traditions and policies, theUniversity of Chicago considers students, employees, applicants for admission or employment,and those seeking access to programs on the basis of individual merit. The University doesnot discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity,national or ethnic origin, age, disability, veteran status, or other protected classes under the law.Such discrimination is unlawful.Unlawful harassment based on one of the factors listed above is verbal or physical conduct thatis so severe or pervasive that it has the purpose or effect of unreasonably interfering with anindividual’s work performance or educational program participation, or that creates an intimidating,hostile, or offensive work or educational environment.A person’s subjective belief that behavior is offensive, intimidating or hostile does not makethat behavior unlawful harassment. The behavior must be objectively unreasonable. Expressionoccurring in an academic, educational or research context is considered as a special case and isbroadly protected by academic freedom. Such expression will not constitute unlawful harassmentunless (in addition to satisfying the above definition) it is targeted at a specific person orpersons, is abusive, and serves no bona fide academic purpose.Unlawful harassment includes same sex harassment and peer harassment among students, staffor faculty. Unlawful harassment by a faculty member, instructor, or teaching assistant of astudent over whom he or she has authority, or by a supervisor of a subordinate, is particularlyserious.Additional Characteristics of Sexual HarassmentSexual harassment deserves special mention. Sexual harassment encompasses a range of conduct,from sexual assault (a criminal act), to conduct such as unwanted touching or persistentunwelcome comments, e-mails, or pictures of an insulting or degrading sexual nature, whichmay constitute unlawful harassment, depending upon the specific circumstances and context inwhich the conduct occurs. For example, sexual advances, requests for sexual favors, or sexuallydirectedremarks or behavior constitute sexual harassment when (i) submission to or rejection ofsuch conduct is made, explicitly or implicitly, a basis for an academic or employment decision,or a term or condition of either; or (ii) such conduct directed against an individual persistsdespite its rejection.Romantic relationships that might be appropriate in other contexts may, within a university,create the appearance or fact of an abuse of power or of undue advantage. Moreover, even when3833

Excerpt from 2011-12 Academic Standards Guidelinesboth parties have consented at the outset to a romantic involvement, such consent does not precludea subsequent charge of sexual harassment against the instructor or supervisor. Because ofits relevance to sexual harassment, the University’s policy on consensual relations in cases whereone person has educational or supervisory authority over another is reproduced under sectionV, “Policy on Consensual Relations between Faculty and Students and between Supervisors andEmployees,”For more information, please visit http://studentmanual.uchicago.edu/university/index.shtmlExpectations of Civil BehaviorThe School expects civil behavior in an educational and clinical setting as set forth by the University inthe Student Manual of University Policies and Regulations. The statement in Student Manual of UniversityPolicies and Regulations notes the following:“At the University of Chicago, freedom of expression is vital to our shared goal of the pursuit ofknowledge, as is the right of all members of the community to explore new ideas and learn from oneanother. To preserve an environment of spirited and open debate, we should all have the opportunity tocontribute to intellectual exchanges and participate fully in the life of the University.”“The ideas of different members of the University community will frequently conflict, and we do notattempt to shield people from ideas that they may find unwelcome, disagreeable or even offensive. Noras a general rule does the University intervene to enforce social standards of civility. There are, however,some circumstances in which behavior so violates our community’s standards that formal Universityintervention may be appropriate. Acts of violence, explicit threats of violence directed at a particular individualthat compromise that individual’s safety or ability to function within the University setting, orother criminal acts, are direct affronts to the University’s values and warrant intervention by Universityofficials. Abusive conduct directed at a particular individual that compromises that individual’s abilityto function within the University setting and/or that persists after the individual has asked that it stopmay also warrant such intervention. Even if formal intervention is not appropriate in a particular situation,abusive or offensive behavior can nonetheless be inconsistent with the aspirations of the Universitycommunity, and various forms of informal assistance and counseling are available.”Consistent with this policy, the University of Chicago Pritzker School of Medicine regards all acts ofphysical harm, threats of physical harm, imposition of physical punishments and evaluation of studentson grounds other than those relevant and material to the course or clinical activity as violations of thesestandards. Abusive interactions between members of the School community are also matters of concern.Concerns about offensive or abusive conduct that cannot be reasonably resolved with the party involvedshould be discussed with the school’s Ombudsmen (Dr. Michelle Josephson or Dr. Jerome Klafta), anyPritzker Dean (see page v), the Director of Medical School Education, the course director, the preceptoror the department chair. Individuals listed at the University may also be contacted. These names arepublished annually in a brochure provided to the students by the University. Any of these individualscan discuss options with a student, offer guidance and support, and assist the student in attempting toresolve the matter informally. Every reasonable effort will be made to maintain confidentiality in suchdiscussions.Rights of StudentsIf informal resolution is unsuccessful or inappropriate, the Dean for Medical Education, AssociateDean for Medical School Education, Associate Dean of Students, or other University officials maydiscuss formal University procedures to address the situation with the student.3439

Excerpt from 2011-12 Academic Standards Guidelines• Conduct that has an impact on the academic evaluation of students may be subject to thegrievance procedures outlined below.• If the person whose conduct is the source of concern is a faculty member, fellow or resident, theSchool’s Dean for Medical Education, Associate Dean for Medical School Education, AssociateDean of Students can help the student file a complaint with the relevant department chair. Ifthe person about whom concerns are raised is a student, the Disciplinary Procedures governingstudents will apply.• If the person is a staff member, the School’s Dean for Medical Education, Associate Dean forMedical School Education, Associate Dean of Students or Director of Medical School Educationmay help a student file a complaint with University Human Resources Management.Rights of StudentsConduct by students that is in serious violation of these norms may result in formal disciplinary action,including dismissal.RetaliationRetaliation against any member of the School community who comes forward in good faith with acomplaint or concern is a serious violation of the School’s and the University’s standards of conductand professionalism and will not be tolerated. If a student believes he/she is being subjected to retaliationas a result of coming forward with a concern or a complaint, that student should immediatelyconsult with the School’s Dean for Medical Education, the particular department chair or the Deanof the Division of Biological Sciences.Education Regarding These PoliciesAn important aspect in assuring proper treatment of students in an academic and clinical environmentis education, both in particular cases of miscommunication or misunderstanding, but also more broadlyto the School community as a whole. Special efforts will be made to convey this policy and provokediscussion and awareness of its implementation and meaning to groups with significant contact with,or involvement with, the education of medical students, including faculty, fellows, residents, nursingpersonnel, and the Pritzker School of Medicine.Any questions regarding the interpretation or implementation of this policy should be directed to theSchool’s Dean for Medical Education or Associate Dean for Medical School Education.Disability Accommodation ProtocolTo ensure the intellectual richness of research and education, the University of Chicago seeks to providean environment conducive to learning, teaching, working, and conducting research that values thediversity of its community. The University strives to be supportive of the academic, personal and workrelated needs of each individual and is committed to facilitating the full participation of students with adisability in the life of the University.Section 504 of the Rehabilitation Act (Section 504) and the Americans with Disabilities Act (ADA)prohibit colleges and universities that receive federal funding from discriminating against qualifiedstudents with disabilities in educational programs and activities. A “qualified student with a disability”is a disabled student who, with or without reasonable accommodation (e.g., architectural access, communicationaids/services, or modifications to policies and practices) meets the University’s academicand technical standards required for admission or participation in the University’s educational programsor activities. The University is committed to complying with Section 504 and the ADA.4035

Excerpt from 2011-12 Academic Standards GuidelinesRequesting Reasonable AccommodationA student who wishes to request an academic modification or adjustment should contact the AssociateDean for Medical School Education or the Associate Dean of Students who will facilitate communicationwith the Director for Services for Students with Disabilities or the Director of Services for Studentsin the University to initiate the disability determination process. The process of determining eligibilityand considering what is a reasonable modification or adjustment is an interactive and collaborative process.Reasonable efforts are to be made both by the student requesting reasonable accommodation andthe representative of the Office of Campus and Student Life to complete the disability determinationprocess and the consideration of any reasonable academic modification or adjustment expeditiously.For more information, please visit http://studentmanual.uchicago.edu/university/Rights of Students3641

Excerpt from 2011-12 Academic Standards GuidelinesUniversity Disciplinary SystemPreambleDisciplinary SystemEach academic unit—the College, graduate divisions, professional schools, and the Graham School forGeneral Studies—has written procedures for student discipline to address violations of Universitypolicies and regulations and other breaches of the standards of behavior expected of University students.Those procedures may be obtained from the Office of the Dean of Students of the academic unit orfrom the Office of the Vice President/Dean of Students in the University. Procedures for undergraduateor graduate discipline follow the outline of the procedures described in the Student Manual of UniversityPolicies and Regulations, with variations that reflect the values and educational goals of the specificacademic unit.The University of Chicago is a community of scholars dedicated to research, academic excellence,and the pursuit and cultivation of learning. Every member of the University—student, faculty, andstaff —makes a commitment to strive for personal and academic integrity; to treat others with dignityand respect; to honor the rights and property of others; to take responsibility for individual and groupbehavior; and to act as a responsible citizen in a free academic community and in the larger society. Anystudent conduct, on or off campus, of individuals or groups, that threatens or violates this commitmentmay become a matter for action within the University’s system of student discipline.The intent of the student disciplinary systems is to ensure a fair and orderly proceeding on questions ofpossible student misconduct. A disciplinary proceeding enjoys neither the advantages nor the limitationsinherent in an adversarial proceeding of a court of law.The University’s disciplinary systems and the legal-judicial structures of the general society differ and aredistinct in principle. It may be taken as self-evident that students do not abdicate any of the rights thatare guaranteed to them by the civil society and that they are at all times free to claim and assertthose rights through the institutions, presumably judicial, of that society. At the same time, it isaffirmed that the University is a private enclave, dedicated to a purpose that imposes additional andspecial obligations while granting certain privileges to its members.Student misconduct may be simultaneously subject to external legal or administrative proceedings andthe University’s disciplinary system. Under those circumstances, the University’s disciplinary systemnormally will proceed notwithstanding the pendency of external processes, and University disciplinarycommittees are not bound by external findings, adjudications or processes.The University’s disciplinary procedures therefore should not be confused with the processes of law:the University’s regulations are applied to incidents that are not “cases,” the bodies that hear and disposeof incidents are not “courts,” individuals who may accompany a student in the course of a disciplinaryproceeding are not “counsel” advocating on behalf of the student and scrutinizing procedures forcompliance with “rules of evidence,” and requests for review of disciplinary decisions are not“appeals.” As a leading illustration of the sense of this statement, it should be understood that therelation of collegiality and trust that binds all members of the University community entails an obligationof truthfulness and candor on the part of everyone who participates in a disciplinary proceeding.An accused student must appear before a disciplinary committee and participate in a manner thathelps the committee reach a complete and fair understanding of the facts of the incident at issue.4237

Excerpt from 2011-12 Academic Standards GuidelinesArea Disciplinary System of the Pritzker School ofMedicineConduct involving possible violation of University policies and regulations and other breaches of standardsof behavior expected of a student in the Pritzker School of Medicine should be brought promptlyto the attention of the Dean/Associate Dean for Medical Education or through a Professional ConcernForm (see page 23). Such violation and breaches of standards include but are not limited to: plagiarism,cheating on examinations, falsifications of documents or records, theft, vandalism, violation of computingpolicies, violation of the alcohol and other drug policy, physical or verbal abuse which threatensor endangers the health or safety of others, sexual harassment, sexual assault or sexual abuse, violationof an administrative department’s regulations, failure to comply with directives of University officialsincluding the University Police, and violation of the terms of imposed disciplinary sanctions.Generally, the person bringing the allegation of misconduct by a student in the Pritzker School ofMedicine first will discuss the allegation with the Dean for Medical Education (or his or her designee 1 ).The Dean for Medical Education will ask the complainant to submit in writing the allegation as wellas any available documentation supporting the allegation. The complainant must maintain the strictconfidentiality of the allegation of misconduct. The Dean for Medical Education or his/her designeewill conduct an inquiry into the facts, which may include interviews with pertinent other people. If theDean for Medical Education thinks that the circumstances warrant it, the Dean for Medical Educationwill arrange for a meeting with the accused student as soon as practicable. In the meeting, the Deanfor Medical Education will inform the accused student of the alleged misconduct and will discuss theallegation. Based on the inquiry and in consultation with the Vice President/Dean of Students in theUniversity (or his or her designee), the Dean for Medical Education has the discretion and authority todismiss the complaint, to resolve the complaint informally with the parties, or to refer the complaintto the Dean of the Division of the Biological Sciences with a recommendation to convene a Divisionof the Biological Sciences Disciplinary Committee. Mediation and/or informal resolution are not appropriate,even on a voluntary basis, in matters involving allegations of sexual assault.If the Dean for Medical Education resolves an allegation of misconduct informally, the Dean for MedicalEducation may give the accused student an official warning and suspend specific student rights andprivileges for a designated period of time. A copy of the written notice warning the accused student thathe or she is violating or has violated University policies or regulations will be placed in the student’seducation record. If the Dean for Medical Education later finds that the student has engaged in additionalmisconduct, the Division of the Biological Sciences Disciplinary Committee may be informedof the earlier warning. If the Division of the Biological Sciences Disciplinary Committee is informed ofthe earlier warning, the Committee must consider it in determining further sanctions.If the Dean of the Division decides that a Division of the Biological Sciences Disciplinary Committeeis to be convened, the Dean for Medical Education will inform the accused student of the allegation,give the accused student a copy of the Pritzker School of Medicine disciplinary procedures and ask theaccused student to prepare a written response to the accusation. If there were witnesses to the allegedmisconduct, the Dean for Medical Education may ask pertinent witnesses to come before the disciplinarycommittee to answer questions and/or may ask witnesses to submit a written statement. Witnessesasked to submit a written statement will also be asked to sign a release to share their witness statementwith the accused student. Pending the Division of the Biological Sciences Disciplinary Committeeproceedings, the Dean for Medical Education may impose an interim suspension or any other interimmeasure to ensure the safety and well-being of others or to ensure the accused student’s own safety andDisciplinary System381 On occasion it may be necessary for another administrator to fulfill the responsibilities for the Dean of Students in the disciplinaryprocess.43

Excerpt from 2011-12 Academic Standards Guidelineswell-being. The Dean for Medical Education has the authority to inform the University Registrar not to releasethe academic record of the accused student pending the outcome of the disciplinary proceedings.Disciplinary SystemThe Dean of the Division of the Biological Sciences and Pritzker School of Medicine (or his or her designee)will appoint the members of the Division of the Biological Sciences Disciplinary Committee. All members ofthe Disciplinary Committee are expected to maintain independent judgment and open-mindedness about thealleged misconduct. The Disciplinary Committee consists minimally of three faculty members—one of whomshall also be a member of the Committee on Academic Promotions—two student members of the PritzkerSchool of Medicine, the Dean for Medical Education (or his/her designee), and a representative of the Officeof Campus and Student Life in the University. The latter two attend the Disciplinary Committee meeting in anon-voting, advisory capacity. If requested by the accused student, the student members may be replaced withtwo additional faculty members. The Disciplinary Committee will meet as soon as practicable.When a Division of the Biological Sciences Disciplinary Committee is convened, the accused student will beinformed in writing of the alleged misconduct and the date, time, and place of the Division of the BiologicalSciences Disciplinary Committee proceedings. The Division of Biological Sciences Disciplinary Committeemay convene prior to meeting with the accused student to discuss procedural matters. If a student has beenaccused of misconduct before, the Dean for Medical Education may inform the Disciplinary Committee ofthe previous accusation, other pertinent information related to the previous accusation, and of any disciplinaryaction. In advance of the meeting, the accused student will be provided with a copy of all the written materialfurnished to the Disciplinary Committee. The accused student may bring a person to the proceedings whoserole is limited to providing support to the accused student—not to serve as an active advocate or participantin the proceedings. The accused student should inform the Dean for Medical Education three to five businessdays before the Disciplinary Committee is to meet if a support person will be attending the proceedings. Ifthe person providing support is a lawyer, a representative of the University’s Office of Legal Counsel also willattend the proceedings. The Disciplinary Committee may ask or summon the complainant or others to appearbefore the Committee to answer questions of the Committee.The Division of the Biological Sciences Disciplinary Committee will seek to reach a complete and fair understandingof the facts of the incident at issue. The accused student will be asked to speak for himself or herselfbefore the Disciplinary Committee. If the proceedings involve multiple students accused of participation inthe same misconduct, the accused students will each be heard separately and not in the presence of the otheraccused students. During the proceedings, if the Disciplinary Committee hears other individuals, the accusedstudent may choose to be present when those individuals are heard. Only the Disciplinary Committee may askquestions of the accused student and others who appear before the Committee. If the accused student refusesto appear before the Disciplinary Committee, the Disciplinary Committee shall proceed without the accusedstudent.The Division of the Biological Sciences Disciplinary Committee proceedings generally follow this outline: Achair of the Committee is appointed by the Dean for Medical Education or his/her designee. The Dean forMedical Education or the chair of the Disciplinary Committee reminds all present that disciplinary proceedingsare distinctly different from the legal-judicial processes of the general society; that the relation of collegialityand trust that binds all members of the University community entails an obligation of candor on the partof anyone involved in a disciplinary proceeding; that disciplinary proceedings and their outcome are to remainconfidential The chair then restates the allegation into which the Disciplinary Committee is inquiring todetermine what may have happened and whether or not sanctions are to be imposed. The accused student maybe asked to make a statement in response to the allegation. Subsequently, committee members ask questions ofthe accused and others coming before the disciplinary committee and may conduct further inquiry. During theproceedings, if the Disciplinary Committee hears other individuals, the accused student may be present. At the4439

Excerpt from 2011-12 Academic Standards Guidelinescompletion of the inquiry, all present who are not members of the Division of the Biological Sciences DisciplinaryCommittee will be asked to leave while the Committee members deliberate on the allegation and inquiry,possible sanctions and implications of those sanctions, and come to a decision. The Disciplinary Committee decides,by majority vote and in consideration of all of the information before it, whether it is more likely than notthat the accused student’s conduct violated University policies and regulations or breached standards of behaviorexpected of University students. Disciplinary sanctions available to the Disciplinary Committee are set forth inthe following section, called Sanctions for Misconduct.When the Division of the Biological Sciences Disciplinary Committee reaches its decision, the Dean for MedicalEducation will inform the accused student as soon as practicable and will send a confirmation letter in whichboth the decision and the review process are delineated. The action of the Disciplinary Committee is reported tothe Office of Campus and Student Life in the University. Decisions of disciplinary suspension or expulsion willbe recorded on the student’s transcript and usually will read “Not permitted to register from [Date] to [Date].[Name and Title of the Dean of Students in the University], [Date].” In cases of expulsion the notation includes astatement “Must Reapply.” Other offices (e.g., Housing, University Registrar) are to be notified only if the actiontaken by the Division of the Biological Sciences Disciplinary Committee affects those offices, and then only theaction itself is transmitted.A written record will be kept by the office of the Dean for Medical Education as part of the student’s educationrecord with a copy furnished to the Office of Campus and Student Life in the University. This record shouldinclude all materials furnished to the Division of the Biological Sciences Disciplinary Committee, a copy of theconfirmation letter sent to the accused student, a statement of the main findings which were relevant to the finaloutcome of the disciplinary proceedings and to the sanctions imposed, as well as the considerations of the possibleimplications of the sanctions.If the Division of the Biological Sciences Disciplinary Committee imposes a sanction, the accused student mayhave the Disciplinary Committee’s decision reviewed. Review procedures are set forth in the section called ReviewProcess.Allegation of Misconduct by an IndividualIf the Dean for Medical Education decides that an Area Disciplinary Committee is to be convened, the AssociateDean of Students will ask the complainant to submit in writing the allegation as well as any available documentationsupporting the allegation. The Associate Dean of Students will inform the accused student of the allegation,give the accused student a copy of the academic unit’s disciplinary procedures and ask the accused student to preparea written response to the accusation. If there were witnesses to the alleged misconduct, the Associate Dean ofStudents may ask pertinent witnesses to come before the disciplinary committee to answer questions and/or mayask witnesses to submit a written statement. Witnesses asked to submit a written statement will also be asked tosign a release to share their witness statement with the accused student.The Dean for Medical Education, or his or her designee, will appoint the members of the Area Disciplinary Committee.All members of the Area Disciplinary Committee are expected to maintain independent judgment andopen-mindedness about the alleged misconduct. The Area Disciplinary Committee consists minimally of threefaculty members, one student, the Associate Dean of Students, or his or her designee, and a representative of theOffice of Campus and Student Life. The latter two attend the Area Disciplinary Committee meeting in a nonvoting,advisory capacity. The Area Disciplinary Committee may have as many as two student members. Threefaculty members, the Associate Dean of Students, or his or her designee, and a representative of the Office ofCampus and Student Life constitute a quorum. The Area Disciplinary Committee will meet as soon as practicable.Disciplinary SystemWhen an Area Disciplinary Committee is convened, the accused student will be informed in writing of the40 45

Excerpt from 2011-12 Academic Standards Guidelinesalleged misconduct and the date, time, and place of the Area Disciplinary Committee proceedings.The Area Disciplinary Committee may convene before meeting with the accused student to discussprocedural matters. If the accused student has been accused of misconduct before, the Dean of Studentsmay inform the Area Disciplinary Committee of the previous accusation, other pertinent informationrelated to the previous allegation, and of any disciplinary action. In advance of the meeting, the accusedstudent will be provided with a copy of all the written material furnished to the Area DisciplinaryCommittee.Disciplinary SystemThe accused student may bring a person to the proceedings whose role is limited to providing supportto the accused student - not to serve as an active advocate or participant in the proceedings. The accusedstudent should inform the Dean of Students three to five business days before the Area DisciplinaryCommittee is to meet if a support person will be attending the proceedings. If the person providingsupport is a lawyer, a representative of the University’s Office of Legal Counsel also will attend theproceedings. The Area Disciplinary Committee may ask or summon the complainant and others to appearbefore the Committee to answer questions of the Area Disciplinary Committee.The Area Disciplinary Committee will seek to reach a complete and fair understanding of the facts ofthe incident at issue. The student will be asked to speak for himself or herself before the Area DisciplinaryCommittee. If the proceedings involve multiple students accused of participation in the same misconduct,the accused students will each be heard separately and not in the presence of the other accusedstudents. During the proceedings, if the Area Disciplinary Committee hears other individuals, theaccused student may choose to be present when those individuals are heard. Only the Area DisciplinaryCommittee may ask questions of the accused student and others who appear before the Committee. Ifthe accused student refuses to appear before the Area Disciplinary Committee, the Area DisciplinaryCommittee shall proceed without the accused student.Area Disciplinary Committee proceedings generally follow this outline: The chair of the Area DisciplinaryCommittee reminds all present that disciplinary proceedings are distinctly different from the legaljudicialprocesses of the general society; that the relation of collegiality and trust that binds all membersof the University community entails an obligation of candor on the part of anyone involved in a disciplinaryproceeding; that disciplinary proceedings and their outcome are to remain confidential. Thechair then restates the allegation into which the Area Disciplinary Committee is inquiring to determinewhat may have happened and whether or not sanctions are to be imposed. The accused student maybe asked to make a statement in response to the allegation. Subsequently, committee members ask questionsof the accused and others coming before the disciplinary committee and may conduct further inquiry.During the proceedings, if the Area Disciplinary Committee hears other individuals, the accusedstudent may be present. At the completion of the inquiry, all present who are not members of the AreaDisciplinary Committee will be asked to leave while the Committee members deliberate on the allegationand inquiry, possible sanctions and implications of those sanctions, and come to a decision. TheArea Disciplinary Committee decides, by majority vote and in consideration of all of the informationbefore it, whether it is more likely than not that that the accused student’s conduct violated Universitypolicies and regulations or breached standards of behavior expected of University students. Disciplinarysanctions available to the Area Disciplinary Committee are set forth in the following section, calledSanctions for Misconduct.When the Area Disciplinary Committee reaches its decision, the Associate Dean of Students willinform the accused student as soon as practicable and will send a confirmation letter in which boththe decision and the review process are delineated. The action of the Area Disciplinary Committee isreported to the Office of Campus and Student Life. Decisions of disciplinary suspension or expulsion4641

Excerpt from 2011-12 Academic Standards Guidelineswill be recorded on the student’s transcript and usually will read “Not permitted to register from [Date]to [Date]. [Name and Title of the Dean of Students in the University], [Date]” In cases of expulsion thenotation includes a statement “Must Reapply.” Other offices (e.g., Housing, University Registrar) are tobe notified only if the action taken by the Area Disciplinary Committee affects those offices, and thenonly the action itself is transmitted. Where appropriate, and as permitted by law, the Dean of Studentsmay disclose allegations of misconduct and the outcomes of disciplinary proceedings to third-parties,including to external organizations.A written record will be kept by the Office of the Dean of Students as part of the student’s educationalrecord with a copy furnished to the Office of Campus and Student Life. This record should includeall materials furnished to the Area Disciplinary Committee, a copy of the confirmation letter sent tothe accused student, a statement of the main findings which were relevant to the final outcome of thedisciplinary proceedings and to the sanctions imposed, as well as the considerations of the possibleimplications of the sanctions.If the Area Disciplinary Committee imposes a sanction, the accused student may have the Area DisciplinaryCommittee’s decision reviewed. Review procedures are set forth in the section called ReviewProcess.Allegation of Sexual Harassment, Sexual Assault or a Sex OffenseInstances of sexual harassment, sexual assault and sex offenses fundamentally violate the University’sprinciples of community and the shared values and trust that bind its members. For purposes of theUniversity’s disciplinary systems, sexual harassment is that conduct prohibited by the University’s Policyon Unlawful Discrimination and Harassment; sexual assault is that conduct prohibited by the University’sSexual Assault Policy; and a sex offense includes rape, sodomy, sexual assault with an object, forciblefondling, incest and statutory rape (as defined by applicable federal law). This applies to incidentsinvolving accused individuals as well as accused groups.The University is committed to providing a prompt and thorough investigation of all complaints ofsexual harassment, sexual assault, or a sex offense notwithstanding any external investigative and legalprocesses. The University’s investigation thus may occur alongside, rather than in lieu of, an independentlaw enforcement investigation or civil action.If an Area Disciplinary Committee is convened for an allegation of sexual harassment, sexual assault,or a sex offense (whether made against an individual student or group), the Area Disciplinary Committeeprocedures will be invoked with the following modifications and clarifications. The Dean ofStudents and the Area Disciplinary Committee endeavor in all cases to initiate, proceed, and completean investigation as promptly and judiciously as feasible, and they will take special care to do so in a caseof sexual harassment, sexual assault or a sex offense. The Dean of Students will explain the disciplinaryprocedures to the accused student and a representative of the Office of Camps and Student Life willexplain these procedures to the complainant. These two administrators respectively will provide theaccused student and the complainant with periodic and timely updates.Disciplinary SystemAs expeditiously as feasible, the Area Disciplinary Committee will convene before the hearing to discussprocedural matters and to receive educational content on conducting a disciplinary proceeding for anallegation of sexual harassment, sexual assault or a sex offense. Area Disciplinary Committees otherthan the standing College Disciplinary Committee will be augmented by the faculty chair of the CollegeDisciplinary Committee or his or her designee who is outside the division or school of the com-4247

Excerpt from 2011-12 Academic Standards Guidelinesplainant and the accused. The student member of the Area Disciplinary Committee must be a graduateor professional school student who is from a different division or school than the complainant and theaccused. Two faculty members from the division or school of the accused and the chair of the CollegeDisciplinary Committee (or his or her designee) constitute a quorum.Disciplinary SystemTo accommodate concerns for the well-being of the complainant and /or the accused student, the Deanof Students may make appropriate arrangements enabling participation of the complainant without aface-to-face interaction with the accused student. If the person providing support for the accused and/or the complainant is a lawyer, a representative of the University’s Office of Legal Counsel also willattend the proceedings. During the hearing, if the Area Disciplinary Committee hears other individuals,both the accused student and the complainant may be present. The Area Disciplinary Committeewill apply a preponderance of evidence standard in deciding sexual harassment, sexual assault, and sexoffense cases. Namely, the Area Disciplinary Committee will decide whether, in consideration of all ofthe information before it, it is more likely than not that the alleged sexual harassment, sexual assault orsex offense occurred, or that the accused student breached standards of behavior expected of Universitystudents.In connection with the hearing, the complainant and the accused student will receive the same materials,subject to compliance with FERPA, which may require redaction of certain identifying information.The complainant will have the same opportunity as he accused student to bring a person to thedisciplinary hearing whose role is limited to providing support-not to function as an active participantin the hearing. If the person providing support is a lawyer, a representative of the University’s Officeof Legal Counsel also will attend the hearing. During the hearing, the Area Disciplinary Committeewill allow the complainant to be present when the accused student is heard. If an order of protectionor other injunction has been issued by a court, is in effect at the time of the hearing, and directs oneor both of the parties to have no contact with the other party, the complainant or the accused may bepresent in an accepted virtual means, i.e., telephone, video conferencing, etc.The complainant will be informed of the outcome of the proceedings concurrently with the accused.“Outcome” means whether the alleged conduct was found to have occurred but does not includeinformation about disciplinary sanctions. Both complainant and accused will be informed that theproceedings and the outcome must remain confidential and cannot be disclosed by anyone unlessdisclosure is authorized by law. However, the University may disclose information about the sanctionwhen it directly relates to the alleged victim, e.g., a no-contact directive is put in place, the duration ofa suspension, etc.The complainant and the accused both may request a review of the outcome within 15 days of beinginformed, in writing, of the decision. As with all requests for review, the only recognized grounds forreview are: (a) the prescribed procedures were not followed; (b) new and material information unavailableto the Area Disciplinary Committee bears significantly in the student’s favor.Allegation of Misconduct by a GroupIf an area Dean of Students receives a complaint alleging misconduct of a student group, the Area Disciplinaryprocedures will be invoked with the following clarifications and modifications. Misconduct ofa student as a member of a group may have consequences for the individual student, for the group, aswell as for the group leadership. Any member or members of a group and/or group leadership may alsobe held accountable for the misconduct if they were involved in the misconduct. Group members and/or leadership may also be held accountable if they:4843

Excerpt from 2011-12 Academic Standards Guidelinesditional misconduct, the Area Disciplinary Committee may be informed of the earlier warning and the circumstancesrelated to the warning. If the Area Disciplinary Committee is informed of the earlier warning, the AreaDisciplinary Committee must consider it in determining further sanctions.Disciplinary ProbationDisciplinary SystemThe Area Disciplinary Committee may place the accused student on disciplinary probation during which periodthe student continues to enjoy all the rights and privileges of a student except as the Area Disciplinary Committeemay specifically stipulate. If, during the period of disciplinary probation, an Area Disciplinary Committeefinds that the student has engaged in additional misconduct, the Area Disciplinary Committee will be informedof the student’s probationary status and the circumstances related to the student’s probationary status. The AreaDisciplinary Committee must consider the probation in determining further sanction.Loss of PrivilegesThe Area Disciplinary Committee may suspend specific student rights and privileges for a designated period oftime.Discretionary SanctionsThe Area Disciplinary Committee may assign the student specific academic work, community service for aspecific number of hours, or other appropriate discretionary assignments to be completed by a specific date, orimpose restitution or fines.Disciplinary SuspensionThe Area Disciplinary Committee may impose a disciplinary suspension, never exceeding nine quarters, duringwhich period the student is prohibited from exercising any rights and privileges of a student in the University.Unless the Area Disciplinary Committee specifically states otherwise in its decision, at the expiration of the periodof suspension, the student may resume active status as a student without any action on his or her part other thanwhat would be required of any student who has, for a comparable period, interrupted his or her residence in theUniversity for any other reason. However, a student under suspension who has been charged with another offensemay not resume active status as a student until final action has been taken on such charge by an Area DisciplinaryCommittee.Disciplinary ExpulsionThe Area Disciplinary Committee may expel a student. A student who has been expelled automatically forfeits allrights and privileges as a student in the University. Ordinarily, the University will not consider a re-application foreleven quarters following the date of expulsion.Revocation of the DegreeThe Area Disciplinary Committee may recommend revocation of the degree for misconduct that occurred beforethe degree was awarded.Further Disciplinary Policy InformationDisciplinary processes will proceed for anyone who has been matriculated at the University whether or not heor she is in residence and for anyone after graduation but only if the misconduct occurred before the degree wasawarded. A sanction given to a student not currently in residence takes the form of a condition imposed uponresumption of active status as a student. If a complaint against a student who has applied for graduation hasbeen brought to the attention of the Associate Dean of Students but an Area Disciplinary Committee has not yetbeen convened by graduation time, the Dean of Students has the discretion and authority to decide whether the5045

Excerpt from 2011-12 Academic Standards Guidelinesaccused student may receive the degree and/or participate in convocation. When an Area Disciplinary Committeehas been convened by the graduation date but the proceedings have not concluded, the accused student’sgraduation shall be postponed until the conclusion of the disciplinary proceedings including the completion of allsanctions.The University respects the privacy of student education records and the laws protecting that privacy. The Universityalso recognizes that participants in the area student disciplinary systems, namely complainant, accused(s), andmembers of the Area Disciplinary Committee, may benefit from broader access to information before, during,and after a hearing. Such broader access often streamlines the disciplinary process, fosters a more complete andfair understanding of the facts, and leads to more satisfying outcomes. To achieve a better process and outcome,area Deans of Students normally will ask accused students to authorize the release of their statement and, in someinstances, the disciplinary outcome to the complainant. Area Deans of Students may also, following consultationwith the Office of Campus and Student Life, request that accused students authorize release of additional documents,such as witness statements; it may, in such instances, be necessary for the area Deans of Students to redactcertain information. The area Deans of Students will also ask the complainant to sign a non-disclosure statement,requiring the complainant not to share the accused’s statement, additional documents, and/or the outcome of thedisciplinary hearing with others.If a student is accused of academic fraud and the regulations of external sponsors are involved as determined bythe Office of the Provost, the allegations are subject to the University’s policy on academic fraud. The inquirywill be conducted, in accordance with the external sponsor’s regulations governing scientific misconduct, by thedepartment chair or Academic Dean of the academic unit in which the academic fraud allegedly occurred in collaborationwith the Dean of Students of the academic area of the accused student. During this fact-finding phase,the accused student generally will continue to be registered as a student and enjoy all privileges pertaining to hisor her status as a student. If the inquiry determines that there is sufficient basis to continue the investigation,the University’s Standing Committee on Academic Fraud will be informed and the academic fraud investigationprocedures will be initiated. Allegations of academic fraud that involve dissertations of students who have receivedtheir degrees, or work published or submitted for publications also are subject to the University’s academic fraudprocedures. If the academic fraud inquiry concludes in the dismissal of the allegation, the academic unit maydecide that this alleged student misconduct should be heard by an Area Disciplinary Committee. All other allegationsof academic fraud by a student will be subject to the area disciplinary system.A student who has been suspended or expelled is also barred from all University property for the period ofthe suspension or expulsion, absent written permission from the Dean of Students. While employment by theUniversity is not an exclusive right or privilege of students, in cases in which employment is reserved for studentsor students are given preference in employment, the fact of suspension or expulsion may adversely affect status asan employee. Further, the University is entitled to take into account the grounds on which sanctions have beenimposed, as these may bear on qualifications for employment.Disciplinary SystemThe outcome of disciplinary proceedings for an allegation of a crime of violence or a non-forcible sex offense willbe disclosed to the alleged victim upon a written request from the victim or the next of kin if the alleged victim isdeceased as a result of the crime or offense.Under federal law, crimes of violence include arson; assault offenses (aggravated assault, simple assault, intimidation);burglary; non-criminal homicide (manslaughter by negligence); criminal homicide (murder and non-negligentmanslaughter); destruction, damage or vandalism of property; kidnapping/abduction; robbery; and forciblesex offenses. Forcible sex offenses are defined as any sexual act directed against another person forcibly or againstthat person’s will, or not forcibly or against the person’s will where the victim is incapable of giving consent.Forcible sex offenses include rape, sodomy, sexual assault with an object, and forcible fondling. Non-forcible sex4651

Excerpt from 2011-12 Academic Standards Guidelinesoffenses are incest and statutory rape.Maintaining the confidentiality of the disciplinary proceedings and their outcome is the responsibility of theaccused student, complainant and all others participating in or privy to those proceedings. Unless disclosure is authorizedby law, failure to respect the confidentiality of the proceedings and their outcome may result in disciplinaryaction. However, consistent with federal law, the University does not require alleged victims of sex offenses(forcible or non-forcible) to maintain the confidentiality of the outcome of the disciplinary proceeding regardingthose alleged offenses.The disciplinary procedures do not preclude the application of other policies.Review ProcessDisciplinary SystemIf a disciplined student wishes to request a review of the decision, the student must make that request in writingto the Office of Campus and Student Life not more than fifteen days following the issuance of the writtennotification of the decision of the Area Disciplinary Committee. The disciplined student must submit therequest for review and supporting material in writing. At the request of the disciplined student, the student maybe granted an additional fifteen days to prepare those materials. The only legitimate grounds for review are: (1)that prescribed procedures were not followed, and (2) that new and material information unavailable to the AreaDisciplinary Committee bears significantly in the student’s favor.A Review Board is constituted when a request for review is received by the Office of Campus and Student Life.The Review Board consists of the Vice President/Dean of Students in the University (or his or her designee), onemember of the faculty of the student’s academic area who serves as chair, and one student member of the student’sacademic area. The faculty and student members are both appointed by the Vice President/Dean of Studentsin the University and neither shall be a member of the Area Disciplinary Committee that rendered the decisionunder review. All members of the Review Board are expected to maintain independent judgment and openmindednessabout the decision under review. The Review Board, whose decision is final, does not conduct a newdisciplinary proceeding. Nor does the disciplined student, generally, appear before the Review Board, althoughthe Review Board reserves the right to ask the student to appear to clarify aspects of his or her request. TheReview Board, acting on the basis of the entire disciplinary record, may sustain or reduce the sanctions imposed ifit determines that prescribed procedures were not followed or, if satisfied that new and material information notavailable to the Area Disciplinary Committee might have resulted in a different decision, may require the AreaDisciplinary Committee to reconvene and consider the new information in the proceedings.Area Admission Review SystemsEach academic unit—the College, graduate divisions, professional schools, and the Graham School of GeneralStudies—has written procedures for addressing misconduct involving a student who has accepted admission butwho has not yet assumed the role of a student at the University. Those procedures may be obtained from the academicunit or from the Office of Campus and Student Life. The unit-specific procedures follow the outline of theprocedures described below, with variations that reflect the values and educational goals of the specific academicunit.Authority to defer or revoke admission before matriculation rests with the area Admission Review Committee,composed of the area senior admissions officer, the cognizant academic dean (or his or her designee), and a representativefrom Campus and Student Life. Admission may be deferred or revoked for fraud, misrepresentation,material omission of fact, dishonesty, violation of University standards in the application for admission, violationof University academic standards, or any other pre-matriculation misconduct.5247

Excerpt from 2011-12 Academic Standards GuidelinesGenerally, the person bringing the allegation of misconduct first will discuss the allegation with the senioradmissions officer of the academic area of the accused student (or his or her designee [*]). The complainant mustmaintain the strict confidentiality of the allegation of misconduct. The area senior admissions officer will notifythe admitted student of the alleged infraction and request a prompt written response to the allegation. Based onthe inquiry and in consultation with the Vice President for Campus and Student Life/Dean of Students in theUniversity (or his or her designee), the senior admissions officer has the discretion and authority to dismiss thecomplaint, resolve the complaint informally with the parties, or refer the complaint to the area Admission ReviewCommittee.If convened, the area Admission Review Committee will examine expeditiously the facts related to the allegationand the response. In its discretion, the area Admission Review Committee may seek additional informationfrom others with knowledge about the alleged misconduct and may ask the admitted student and/or others toanswer specific questions or meet with the committee. The area Admission Review Committee will determine theappropriate institutional action and/or discipline, including but not limited to withdrawal of admission, deferralof matriculation, public service, etc. Matriculation may be delayed so that the area Admission Review Committeemay complete its investigation and make a decision.The decision of the area Admission Review Committee is final and unreviewable within the University.Disciplinary System4853

MISTREATThe following is a quick reference sheet that can help you gauge whether common behaviors are consideredmistreatment of not. This tool is not intended to be a comprehensive list and represents some egregious behaviorsand some incidents that are shades of gray. The behaviors listed here have occurred at other institutions.We hope that you will never experience mistreatment but if you do, please don’t hesitate to talk with theOmbudsmen (reference page 16) or the University of Chicago Bias Response Team (reference page 50)Did the following occur? Mistreatment is not… Mistreatment is…MMalicious intentOn the first day of third year, the ward clerk saysto the student, “I can tell you guys are newbies,”then offers to help the students find a computerstation.A resident purposely gives student misinformationbefore rounds. Student overhears resident laughingabout “messing him over.”IIntimidation onpurposeA student working with the chairman of surgerysays he feels nervous about operating with himsince the chairman can “make or break” his career.Resident tells a student that they intend to makethem cry before the rotation is over.SSexual harassmentA male student asked not to go into a roombecause a female patient only wants a female toexamine her.A male attending tells a female student, “I can tellyou know how to grab it like you mean it” while sheis inserting an indwelling Foley catheter.TThreateningverbal or physicalbehaviorA student is yelled at to “get the XXX out ofthe way” by a nurse as a patient is about to beshocked during a codeAn attending grabs the student’s finger with aclamp in the OR tells the student they are an idiotafter they could not answer a “pimp” question.RRacism or otherdiscriminationAttending gives student feedback on how toimprove performance.A resident tells a Hispanic student that their“people” (assuming illegal immigrants) areresponsible for high healthcare costs.EExcessive orunrealisticexpectationsStudent asked to review an article and present iton round to the team.A resident tells a student that it is their job toperform rectal exams (necessary or not) on all thepatients admitted to the service.AAbusive favorsA student is asked to get coffee for themselves andfor the team prior to rounds since the resident didit yesterday. The team gives the student money.A student is asked to pick up an attending’s drycleaning.TTrading for gradesA resident tells a student that they can review andpresent a topic to the team as an opportunity toenhance their grade.A student is told that if they help a resident movethat they will get honors.49

Bias Response TeamBias Response Team (BRT)Origin• Every member of the Universitycommunity has the responsibility to fosteran environment of full acceptance,respect, openness and understanding.What It Is• A team ofA team of University Staff whichsupports and guides students affected bybias incidents.• Team Members are on call at 702-24272427:24 hours a day, 7 days a week.What To Expect• The BRT will document all incidents.• The BRT will help to inform educationalprogramming.civility.uchicago.educivility.uchicago.educivility.uchicago.educivility.uchicago.educivility.uchicago.edu50

Professionalism Concern Reporting ProcessFaculty or Pritzker Staff who notice a significant lapse in student professionalism may notify a FacultyDean, Course or Clerkship Director. The Faculty Dean, Course or Clerkship Director may choose toprovide the student with feedback on his or her behavior. However, if the breach is significant enoughthey may report the situation to the Associate Dean for Medical School Education who will determinewhether or not a should be completed.If the Professionalism Concern Reporting Form (PCR) is filed, the student will meet individually with theCourse or Clerkship Director to discuss the situation and the form is kept in the student’s file. If no otherprofessionalism issues occur throughout the student’s medical school career, the form is destroyed atgraduation. No record of the incident will be recorded in the student’s permanent file.If a student accumulates three PCR forms and/or the Associate Dean for Medical School Educationnotices a pattern of troubling behavior, or feels a single behavior is an egregious professionalism lapseshe will meet directly with the student. After meeting with the student the Dean will determine whetheror not to 1) Refer the students to the Committee on Promotions 2) Refer the students to the Universityof Chicago Disciplinary Committee and/or 3) include a record of the professionalism breach in thestudent’s Medical Student Performance Evaluation and permanent file.51

Professionalism Concern ReportPRITZKER SCHOOL OF MEDICINEMEDICAL STUDENT PROFESSIONALISM CONCERN REPORTDirections:Please complete all fields. Report will be submitted to the designated faculty dean and will be visible tothe student, the course/clerkship director or faculty dean completing the form.Student (Please print)Class / Activity / ClerkshipName of course, clerkship director or faculty deancompleting form (Please print)DateWhich of the following unprofessional behaviors has the student exhibited? Check all that apply.1) Professional Responsibilitiesa) Uses illicit substancesb) Uses alcohol, non-prescription drugs or prescription drugs in a manner that compromisesability to contribute to patient carec) Fails to accept and internalize criticism and feedbackd) Is unwilling to expand knowledge and competencee) Has inappropriate demeanor or appearance in the classroom or in the health care settingf) Fails to complete required tasks or requires constant reminders from staff/facultyg) Fails to notify appropriate staff in a timely manner of absencesh) Fails to accept responsibility for own errorsi) Consistently arrives late to commitmentsj) Repeatedly fails to respond to communications with staff, residents, faculty, or course/clerkship directors2) Professional Relationshipsa) Engages in inappropriate relationships with patientsb) Engages in inappropriate relationships with teachers, residents or faculty, therebydisrupting the learning environmentc) Acts disrespectfully toward othersd) Treats standardized patients disrespectfullye) Engages in disruptive behavior in class or with health care team3) Professional Ethica) Behaves in a dishonest mannerb) Misrepresents self, others, or members of the team to othersc) Breaches patient confidentialityd) Acts in disregard for patient welfare (e.g. willfully reports incomplete or inaccuratepatient information)e) Takes credit for the work of othersf) Misuses cadavers or other scientific specimens4) Violates official course or clerkship policy52

Professionalism Concern ReportOther:Describe in detail the incident which prompted the completion of this form (attach additional pages ifneeded).Describe previous feedback and remediation which took place prior to the completion of this form (attachadditional pages if needed).Date: _______________ Student commentsI acknowledge that I have reviewed this evaluation with the course/clerkship director or faculty dean andhave the following additional comments:Student SignatureDateDate: _______________ Additional Clerkship /Course Director/Faculty Dean NotesFaculty SignatureDateDate: _______________ Designated Faculty Dean’s Notes (if applicable)Designated Faculty Dean SignatureDate53

Holiday PolicyUniversity of Chicago, Pritzker School of MedicineClinical Curriculum Review CommitteeWorking Group on Student Duty HoursIntroductionIn the past, considerable variation has occurred regarding the granting of major holidays off to students. Due tothis variability, the Pritzker School of Medicine adopted a policy for holidays recognizing official university holidaysin July of 2004. Over a year of experience with this policy confirms that certain issues remain problematic.Specifically, given the limited clinical exposure of students to certain clerkships, and that the bulk of that exposureoccurs during intensive patient care periods when students are “on-call” or “post-call” with their respectiveresident and/or attending teams, a holiday can often compromise the learning experience for certain students. Inaddition, the original policy only referred to official university holidays, with no mention of time off for religiousholidays, or other national holidays that may be observed by students. Likewise, the original policy did notaccount for student requests for time off on non-holidays for personal/family reasons. Because of these reasons,the Curriculum Review Committee (CRC) Working Group on Student Duty Hours recommends the adoption of a“Flexible Holiday and Leave” policy to allow students greater flexibility with the requests that they make for timeoff, while preserving student clinical exposure during a rotation.The Flexible Holiday Policy includes the following:1. While students are participating in third year core clerkships, they are expected to participate in routineeducation or patient care activities whenever their assigned resident and/or attending team is on duty (i.e.on-call, post-call, etc.). The only standard exception to this is Thanksgiving Day when all students will havethe day off.2. Before the clerkship begins, students may make a request to their clerkship director that they are off on aspecific day for legitimate purpose (i.e. observing a national or religious holiday, personal/family conflict,etc.). These requests will be evaluated and processed by the clerkship director on a case by case basis.Please note that this holiday policy does not refer to 4 th year students on sub-internships who will be expected towork the schedule of an intern on their respective team. In addition, Christmas Day and New Year’s Day fall duringWinter Break and therefore automatically off.Questions or comments regarding this policy should be addressed to working group chair, Vineet Arora, MD, orrespective clerkship directors.54

Duty Hours PolicyDuty Hours for Medical StudentsUniversity of Chicago, Pritzker School of MedicineClinical Curriculum Review Committee2011 Working Group on Student Work HoursThe recent revision of the ACGME guidelines for work hours has led to a corresponding reevaluationof the work hours of medical students. Resident work hour restrictions wereimplemented to enhance patient safety under the theory that fatigued residents were hazardous intheir patient care responsibilities. Issues of work hours and fatigue are relevant to medical studenteducation, responsibilities and their personal health and safety for differing reasons.Medical student learning during the 3rd year comes from many sources, which include, but arenot limited to, clinical interactions with patients and the health care team, didactic sessions fromlecturers and preceptors, and individual reading. Moreover, in addition to clinical activities andduties that medical students may perform, students have the responsibility of taking exams,creating presentations, and engaging in self-directed learning. Thus, students must have adequatetime to integrate clinical knowledge through self-directed learning.In revising this policy, the 2011 Duty Hours Review task force recognizes that learning in theclinical environment is inherently unpredictable and learning may take place at suboptimal times.Because it is generally accepted that learning is most effective when students are not sleepdeprived, the following outlines duty hours for third and fourth year medical students at thePritzker School of MedicineTime spent by medical students engaged in clinical activities on a weekly basis must not exceedACGME specified weekly duty hour caps.Third Year Students:1) When 3rd year students are engaged in clinical work that involves call, students should bedismissed by midnight. In order for students to meet this 12 a.m. deadline, residents should notassign new patients to students after 10 pm. These deadlines are intended to give students enoughtime to finish write ups, discuss patients with their resident, read about their patients, and leaveremaining time for an adequate amount of sleep for the next day’s learning activities. Theserecommendations do not apply to:a. Students on shift assignmentsb. Surgical rotations (including gynecologic surgery) in which overnight call andparticipation in urgent or emergent situations are of educational value. In thesesettings, students should be dismissed after morning duties are completed.2) It is recommended that students have one day free of clinical responsibility per week, averagedover one month in order to study. Clerkship directors should stipulate the rules for theirindividual clerkship in their orientation material.● These days off may include any weekend days that are free of clinical activity (e.g.students on ambulatory rotations with weekends off will not receive additional week days●free of clinical duties.Students are expected to attend all required rotation specific non clinical activities(including but not limited to didactics, small group sessions and preceptor groups) even ifthat formal educational experience falls on a student’s day free of clinical duties.3) Specific daily work schedules will vary by clerkship, and are most appropriately determined bythe clerkship director.Fourth Year Students:The guidelines above do not apply to fourth year medical students. For 4 th year students on subinternships,ACGME duty hour guidelines are appropriate.Approved by EEC 7/6/1155

Sandbox Access & Sign-Out PolicyOver the past few years, there has been some confusion regarding third year medical student accessto the sign-out systems (i.e. Sandbox drive) that are used by the residents at the University of ChicagoMedical Center. It appeared that some students had access, while others did not. It is important tonote that the maintenance and updating of patient sign-outs is critical to ongoing patient care duringvulnerable periods of coverage by other residents. Because of this, it is very important that the residentsmaintain the sole responsibility of creating, editing, and updating the patient information contained onsign-out sheets. However, we do recognize there is a valuable learning opportunity in understandinghow the information on the sign-out is structured, in addition to providing summaries of other patientsthat are being followed by your team. Because of this, we have adopted the following plan, with inputfrom several medical students.Third-year medical students now have read-only access to the Sandbox drive where the sign-out sheetsare kept for respective services and teams. This read-only access will allow a student to view the signoutand print it out for use during their clerkships. However, we must stress that like all documentationof Protected Health Information (PHI), the sign-out is subject to the regulations governing patientprivacy and confidentiality put forth by the Health Insurance Portability and Accountability Act (HIPAA).Therefore, we request these sign-out sheets, if printed, are not shared with anyone other than thosephysicians on the care team caring for a particular patient, and are properly handled to ensure that thereis no breach in confidentiality.Upon the advancement to your fourth year, specifically during your sub-internships, you will be able tohave full access to the Sandbox drive in order to assume the responsibility of maintaining and updatingthe sign-out sheets for your patients.If you have any problems with accessing the sign-out system, please contact Lori Orr:lorr@bsd.uchicago.edu at the Pritzker School of Medicine and your request will be processed by amember of our staff.Sincerely,Vineet Arora, MD, MAAssistant Dean for Scholarship and Discovery56

University of ChicagoMedical Center Policies57

The University of Chicago Medical CenterPolicy and Procedure ManualTHE UNIVERSITY OF CHICAGO MEDICAL CENTERPersonnel Policy GuidelinesHuman Resources Section 602Page 1 of 6________________________________________________________________________Dress and Personal AppearancePolicyIt is important for all employees to project a professional image of the University ofChicago Medical Center (UCMC). To ensure that we consistently project this image topatients, visitors, and guests, UCMC maintains a dress code policy that applies to allpersonnel. Those employees who are required to wear scrubs or uniforms should alsorefer to the appropriate policy. Departmental policy may supersede asappropriate/reasonable for employees whose jobs do not require regular contact withpatients, visitors, and guests.________________________________________________________________________CommentsAt all times when employees are on UCMC premises, they are expected to wear anemployee photo-identification badge, identifying themselves as employees to the publicand to other UCMC personnel. As representatives of UCMC, employees are at all timesexpected to present a clean, neat, and professional appearance - i.e., this includes timeswhen entering and exiting UCMC premises as well as during working time. Employeesare expected to dress and groom themselves according to their position requirements andin accordance with appropriate professional standards. In jobs that involve personalinteractions with customers, patients, or visitors, a higher level of professionalism may berequired as relevant to projecting an appropriate and positive image of UCMC.Supervisors or department heads are responsible for establishing a reasonable dress codeappropriate to the job their employees perform within the framework of this policy. If asupervisor determines that an employee’s personal appearance is unacceptable, thatemployee may be asked to leave the workplace until properly dressed or groomed. If thesupervisor is not aligned with the employee’s department, that supervisor will notify themanagement of the employee’s department immediately. Under such circumstances, theemployee will not be compensated for his or her time away from work. Employeesshould consult their supervisor if they have questions as to what constitutes appropriatedress and appearance. Upon request and as appropriate, a reasonable accommodationmay be made to a person with a disability.58

Human Resources Section 602Page 2 of 6All employees are expected to accept and follow, as a condition of employment, thestandards in this policy. This is not an all-inclusive list and management reservesthe right to determine appropriateness based upon relevant circumstances.1. General Expectations:• Identification badges must be worn on the upper torso in a visible position withpicture side out at all times while on UCMC premises. (See Personnel PolicyGuidelines, HR Section 603.)• Uniform requirements: All employees will follow this policy unless thedepartment or care center specifies that a uniform should be worn. When thedepartment or care center requires uniforms, employees will be expected to wearthe complete uniform while on duty. Uniforms supplied by the department mustbe worn during working hours. Uniforms should fit properly, be complete, clean,and neat. Employees are responsible for the maintenance of their uniforms unlessotherwise provided under an applicable collective bargaining agreement. Sweatersmay be worn either under or over the uniform when needed for warmth. Forspecifics on scrubs, see Administrative Policy 06-12.• Patient gowns and/or isolation gowns may only be worn while directly involvedin the care of isolation patients, in rendering infant care, while in contact withbody secretions, or as required by the IDPH regulations to cover scrub uniforms.• Casual attire that may be appropriate for warm weather in a non-professionalsetting shall not be worn under any circumstances while on UCMC premises.This includes but is not limited to the following: tank tops, "muscle shirts," tubetops, halter-tops, mid-drifts, crop-tops, beachwear, inappropriately low-cutblouses or sundresses, no shorts, no inappropriately short skirts or dresses.• All dress must comply with Regulatory requirements (IDPH, OSHA, etc) andwith UCMC Safety and Infection Control Policies.• All dress must comply with UCMC Safety Policies where applicable.• All dress must be devoid of advertisements and slogans except for inconspicuousbrand name logos.2. FingernailsAll fingernails should be clean and well groomed and of a length that does not posepotential injury to patients or self or that will hinder the employee's ability to perform hisor her assigned job duties.59

Human Resources Section 602Page 3 of 6Special infection control and safety requirements for fingernails 1 apply to followinggroups of employees:• Employees who have direct contact with patients. These are employees who, aspart of their job duties, may touch patients, patient supplies and/or patient careequipment; including but not limited to the following: patient transporters,environmental service workers, physicians, registered nurses, licensed practicalnurses, nurse practitioners, nursing assistants, medical assistants, physicianassistants, patient care managers, case managers, patient service coordinators,patient service assistants, nursing unit secretaries, and inventory specialists.• Employees who handle sterile items used for invasive procedures.• Employees who are directly involved in the sterilization of surgical instruments.• Employees who are directly involved in the preparation or delivery of food.The above employees must comply with the following requirements forfingernails:‣ All fingernails must be clean.‣ Fingernails may not be longer than ¼ (one quarter) of an inch long.‣ Artificial fingernails may not be worn. This includes anything affixed to thenail other than plain nail polish, including but not limited to gel or acrylicoverlays and silk wraps.‣ Nail polish must not be chipped.3. Footwear RequirementsFor personnel working in non-clinical areas, the following standards apply:• Canvas or athletic type shoes are allowed; however, they must be clean and wellkept with the laces tied.1 Guideline for Hand Hygiene in Health-Care Settings. Recommendations of theHealthcare Infection Control Practices Advisory Committee and theHICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, 2002. Note: Compliancerequired by Joint Commission as part of the 2006 and 2007 National Patient SafetyGoals.60

Human Resources Section 602Page 4 of 6• Employees are expected to demonstrate appropriate judgment regarding socks,stockings or hosiery to project an image of business professionalism (e.g.,no tight-fitting “fishnet” stockings).• Open-toe and/or backless shoes projecting business professionalism may be wornduring warm weather.• All footwear is subject to the standard of what is appropriate and professional foran employee's assigned job responsibilities.For all personnel working in clinical areas where exposure to blood of bodilyfluids may occur, the following footwear requirements are in place 2 :• Shoes that protect the foot from exposure to blood or body fluids or that arecovered with a fluid resistant covering are required for all personnel working inclinical areas where exposure to blood or body fluids could occur.• Open toe shoes (e.g., sandals), shoes with open backs, and shoes with holes (e.g.,"Croc"-type) may not be worn in patient care areas. To comply with OSHArequirements, fluid resistant shoe coverings must be worn in clinical areas andmust be removed prior to leaving the location where exposure to blood or bodyfluids could occur (e.g., patient room, procedure room, operating room, etc.)Additional footwear restrictions may be established as appropriate for respectivepatient care areas and operating rooms.• Clinical personnel (e.g., nursing staff, medical/nursing assistants, and others) mustwear hosiery (either white or flesh tone) or socks under the uniform.4. Hygiene/Grooming/Fragrance /Jewelry• Consideration of co-workers, patients, and guests is expected and all employeesare to maintain appropriate cleanliness and hygiene habits at all times in theworkplace.• Perfume, cologne and after-shave should not be used in any clinical setting inconsideration of patients that may have allergies or sensitivities. In a non-clinicalsetting, the use of scented personal products should be moderate or avoidedaltogether. A non-clinical department may exercise the discretion to prohibit theuse of scented personal products out of consideration for employee allergies orsensitivities.2 Reference for Closed or covered shoes: OSHA Question and Answershttp://www.osha.gov/pls/edata/owae_data.osha_feedback?p_id=270871 : August 24, 200661

Human Resources Section 602Page 5 of 6• Hair is expected to be clean and neat. Hair should be worn in styles and colorsthat are appropriate for a professional business environment. Long hairstylesshould be worn with hair pulled back off the face and neck to avoid interferingwith job performance.• Mustaches and beards must be clean, well-trimmed, and neat, as appropriate for aprofessional business environment.• Jewelry should not be functionally restrictive, dangerous to job performance, orexcessive. Facial jewelry, (e.g., eyebrow rings, nose rings, lip rings, and tonguestuds), is not professionally appropriate and may not be worn during businesshours.5. "Business Casual Dress" will be permitted on Fridays, except during thespecified periods when casual days will be suspended. Business casual is defined asfollows:• Casual Shirts‣ Appropriate: All shirts with collars, including casual shirts, blouses, golf andpolo shirts. (T-shirts only appropriate if pre-approved for specific events.)‣ Inappropriate: T-shirts, shirts with inappropriate slogans, tank tops, "muscle"shirts, and "crop tops."• Casual Pants‣ Appropriate: Casual slacks and trousers without holes, frays, etc.‣ Inappropriate: Shorts, denim of any kind• Casual Footwear‣ Appropriate: Casual business shoe that is reflective of standards appropriatefor a professional business casual environment‣ Inappropriate: Casual sandals, "flip-flops," and other styles inappropriate fora professional business casual environment6. Religious Accommodations: Employees may engage in appropriate religiousexpression in the workplace as permitted by law. Religious expression in the workplacemay take the forms of certain types of dress or head covering, wearing of jewelry,discussion of religion, or the display of religious items in an employee's immediate workarea. If religious items are displayed in an employee's immediate work area, such itemsshould be placed in inconspicuous places to avoid potential offense to others who maynot share the same religious beliefs. Situations shall be addressed and evaluated on acase-by-case basis as necessary.7. Enforcement: UCMC management is responsible for support and implementation ofthis Dress and Personal Appearance Policy by:62

Human Resources Section 602Page 6 of 6• Personal example;• Incorporating this policy into departmental policy;• Reviewing and enforcing this and any department or care center policy withapplicants and employees;• Taking immediate corrective action if department or care center personnel reportto work in violation of this policy;• Progressing the corrective action process as appropriate to ensure compliance.Interpretation, Implementation, and Revision: The Chief Human Resources Officer isresponsible for the interpretation and revision of this policy. All UCMC employees areresponsible for compliance with this policy.Issued: January 1987, Dress and Personal AppearanceRevised: September, 1993, February, 1996, June, 1998, September 2001, August, 2002,April 2003, October 2004; May 2006, July 2006; January 2007; May 2007, June, 2007Reviewed: June 1998, August 2002, October 2004, October 2005EFFECTIVE DATE: April 2003, July 2006______________________________Darlene LewisVice President and Chief Human Resources Officer, UCMCHSRefer to Policy 00-04 Administrative Policy and Human Resources Section 201 EqualEmployment Opportunity /Affirmative Action63

Scrub PolicyPolicy: PC 106Issued: November 1994Revised: November 2007Reviewed: November 2007The University of Chicago Medical CenterPolicy and Procedure ManualSCRUB WEARPURPOSE:This policy defines which staff members and physicians are authorized to use hospital launderedscrub attire, which will be referred to as scrubs for this policy. Scrub attire is supplied whereindicated and/or required by CDC, the Joint Commission, or IDPH. Personal ProtectiveEquipment (PPE) is provided to all staff and physicians per OSHA standards. Scrub wear is notconsidered Personal Protective Equipment (PPE).POLICY:Scrub attire is furnished by Linen Services and is laundered off­site. Scrubs are provided foremployees working in the restricted areas defined below.PROCEDURES:1. Scrub attire is available though the auto­valet system or Linen Services in the event the autovaletsystem is down2. Scrub attire is not stored in staff lockers for use on the next shift.3. Scrub attire is not to be removed from UCMC property, taken or worn home. Scrubs are notto be worn off the Medical Center campus for any reason, including breaks and lunch. TheMedical Center campus is defined as the:Interiors of all buildings bounded by 58th Street (north), Ellis Avenue (east), 59th Street(south), and Maryland Avenue (west).Interior of the Duchossois Center for Advanced Medicine (DCAM) building bounded by 57thStreet (north), Maryland Avenue (east), 58th Street (south), and Cottage Grove Avenue (west)Interior of the Comer Children’s Hospital building bounded by 57th Street (north), 58th Street(south), Maryland Avenue (west), and Drexel Avenue (east)American School and the connecting walkwaysSky bridge and tunnels connecting the DCAM, parking facility, and Mitchell Hospital , andComer Children’s HospitalWalkways to and from the normal patient entrancesGoldblatt Pavilion walkway, from the entrance door up to and including the public sidewalk64Emergency room walkway, from the entrance door up to and including the public sidewalk andcircular drivewayPatient Care Policy 106 Scrub WearPage 1 of 3

Scrub PolicyThe University of Chicago Medical CenterPolicy and Procedure ManualDCAM walkway, from the entrance door up to and including public sidewalk and circulardriveComer walkway, from the entrance door up to and including the public sidewalk and circulardriveAll of the roadway and walkway over which persons normally travel walking from the parkinglot to the DCAM entrance, Comer Children’s Hospital entrance, and the Mitchell Hospitalentrance.4. Scrubs remain the property of UCMC. Employees who wear scrub attire withoutauthorization or remove it from UCMC property are subject to disciplinary action.5. Any staff member who gets blood or body fluids on their own clothing while on duty will beprovided the use of disposable scrub attire for the remainder of their shift. Linen services willprovide laundry of personal clothing when soiled by blood or body fluids. Clothing must bebrought to the linen manager or supervisor in a soiled linen bag.6. Parents of children and approved vendors shall be provided with either disposable scrubs orhospital scrubs when they are allowed or required to be in an area where scrub attire isrequired. Disposable scrubs may also be used for temporary access to restricted areasrequiring scrub attire. Coverall (Bunny) suits may only be used for temporary access to thehallways of restricted areas but may not be worn into any procedure room or O.R. suite.7. The color for hospital laundered UCMC scrub attire is misty green. Employees may not weartheir own (personal) misty green scrubs in any area of the hospital.8. Misty green scrubs must be covered when an employee is wearing misty green scrubs outsideof any restricted area. Acceptable covering of scrubs includes, the use of a reusable ordisposable lab coat long enough to cover from the shoulders to the knees with at least 3buttons fastened. Further, a gown that ties in the back may be worn.9. Scrub attire is furnished for the following restricted departments:DEPARTMENTOperating Rooms (GOR, DCAM, and Comer )Labor and DeliveryCardiac Cath Lab / EP LabInterventional RadiologySterile ProcessingGI ProceduresNICUPACUPatient Care Policy 106 Scrub WearCOMMENTSOnly when the employee is attending a deliveryin the labor and delivery OR suites.Provided to regularly assigned staff only.Page 2 of 365

Scrub PolicyAny employee with a full shift assignment inthe restricted area.The University of Chicago Medical CenterPolicy and Procedure Manual10. Within each department, some staff may need to wear scrub attire and others may not. This maybe due to the job or to the physical layout of the department. It is the responsibility of departmentmanagers to see that these specifics are written into each department’s own policy.11. Enforcement of the scrub policy is the responsibility of management. Managers of restrictedareas are responsible for ensuring employees are wearing clean hospital laundered scrubs andappropriate covering gowns. Managers of non­restricted areas are responsible to ensureemployees are not wearing misty green scrubs.12. Employees who fail to comply with this policy may be subject to discipline, up to andincluding termination.INTERPRETATION, IMPLEMENTATION AND REVISIONThe Linen Task Force (4­1226) is responsible for the interpretation, implementation and revisionof this policy after consultation with Infection Control.__________________________________Jamie O’Malley, RN, MSChief Nursing Officer__________________________________Harvey Golomb, MDChief Medical Officer___________________________David S. HefnerPresident___________________________J. Richard Thistlethwaite, MDMedical Staff PresidentPolicy: PC 106Issued: November 1994Revised: November 2007Reviewed: November 200766Patient Care Policy 106 Scrub WearPage 3 of 3

The University of Chicago Medical CenterOffice of Medical Center ComplianceSummary ofThe HIPAA Privacy RuleHIPAA Privacy RuleOVERVIEWThe Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 becameeffective on April 14, 2003. The federal government said that every employee working inhealthcare in any job must be taught about the Privacy Rule. The Privacy Rule tells us how weare to use and share health information about patients. A major goal of the Rule is to assurepatients that their health information will be protected.The Privacy Rule applies to all members of the workforce of The University of Chicago MedicalCenter (UCMC) and includes all physicians, residents, medical students and permanent as well astemporary staff. This summary is being given to you to help you understand the Rule and howimportant it is to the patients and the Medical Center.PROTECTED HEALTH INFORMATIONProtected Health information (“PHI”) is anything that might reveal something about the medicalor emotional condition of a patient. It is also information that might tell us who the patient is.Many different pieces of information can identify a patient or tell us something about theirmedical condition. Examples of things that might identify a patient or tell us something abouttheir condition include a social security number, driver’s license, state ID, fingerprints, name,address, and photographs, medical record number, labels, ID bands, and any reports or x­rays.USE AND DISCLOSUREAn organization like the UCMC can use and disclose or share patient information without apatient’s specific authorization if it is for treatment, payment, and healthcare operations.Treatment is anything we may do to care for the patient for example talking about or to thepatient, asking another doctor’s opinion, and sending the patient for tests or to therapy.Payment is sharing information in order to be paid for the services we have given to the patient.Health Care Operations covers any activity that might be done for or with the patient to helpthem get better such as setting up home care, arranging transportation, obtaining a wheelchair. Italso includes quality control, credentialing, and educating medical students, nurses, and otherallied health professionals.Sometimes we are required by law to disclose a patient’s health information to a governmentagency. Child abuse, communicable disease, and medical examiner reporting are a few examplesof disclosures to government agencies. It is important that we keep track of the places where wedisclose or send information about the patient. If the patient wants to know where we have sentinformation about them, we have to be able to provide a list. If the unit that you will be workingin makes these kinds of disclosures, your supervisor will train you on how to keep track of them.One way that we try to safeguard the privacy of our patients is by making sure that the personasking for any information about a patient has a right to get that information. So we must always671

HIPAA Privacy Rulemake certain we identify the caller or visitor as someone the patient wants us to speak to. At theUCMC we have a password system in place to protect our patients and their information. Youwill learn more about the password system from your supervisor.INCIDENTAL USE AND DISCLOSUREIt is very important that we try to limit the patient information that other people (like visitors)might hear while we are doing are jobs. We should speak in quieter voices when in public placesand never discuss a patient or their condition in the elevators or cafeteria. We should always pullcurtains in patient rooms, and ask visitors to step out while we finish our work or speak with thepatient. We should make sure our workspace is clean and does not have patient information lyingaround for others to see. All written information about patients that is no longer needed and isnot part of the medical record, like report sheets, notes, labels, and post­its, should be placed inthe shredding boxes and not thrown in the garbage.AUTHORIZATIONSFor anything outside of treatment, payment, or healthcare operations, we need to get the patient’sconsent to share their health information or we are risking the patient’s privacy. The law alsotells us to share only the information that is absolutely needed. Only the patient can ask for andget a copy of his own medical information.NOTICE OF PRIVACY PRACTICEThe law tells us that we must explain to our patients what we will do with the information aboutthem. Every patient has the right to know this. We give them the information in the Notice ofPrivacy Practice that is given to all of our patients when they come to the Medical Center. ThisNotice tells them they may: Inspect and get a copy of their medical record documentation Get a list of places and people who asked for and received information about them Be kept out of the hospital directoryFor patients who have complaints or want to ask questions about the Privacy Rule, they may callthe HIPAA Program Office at 773­834­9716.ENFORCEMENT AND PENALTIES FOR NON­COMPLIANCEThe Office for Civil Rights enforces the Privacy Rule.Civil penalties for not obeying the Privacy Rule are: $100 for each failure to comply $25,000 per year for multiple violations of the same requirementCriminal penalties for a person who knowingly violates HIPAA are as follows: $50,000 and a one year prison term $100,000 and up to 5 years in prison for wrongful conduct involving false pretenses $250,000 and up to 10 years in prison for wrongful conduct with intent to sell, transfer,or use individually identified health information personal gain or malicious harm.The manager of individual departments will provide more information about the Privacy Rule andUCMC policies.68The following page is a list of HIPAA tips on protecting our patients’ privacy, and confidentialityand security of their health information. In addition, please feel free to go to the HIPAA ProgramOffice website at http://HIPAA.bsd.uchicago.edu for additional information and resources.2

HIPAA Privacy RuleGUIDANCE January 2007 (updated March 2011)A to Z: HIPAA TIPS for PROTECTING PRIVACY AND SECURITYA. Contact Security Services if you see suspicious individuals in patient care or restricted areas.B. Wear your ID badge at all times.C. Discard documents containing patient information only in a shredding container.D. Discard floppy disks or CD-ROMs containing patient information only in shredding containersE. Use private areas to discuss PHI. Do not discuss patient information in cafeterias, elevators, or other publicplaces.F. Lower voices when having conversations concerning patients in non-private areas.G. Report any suspicious activity appearing on your computer to the IS Help Desk.H. Do not leave messages concerning a patient's condition or test results on answering machines. Do not leavemessages containing highly confidential patient information (i.e. mental health, substance abuse, HIV/AIDS,genetic testing, etc.) on answering machines.I. Do not open unknown email attachments or unrecognizable emails.J. Do not access protected health information unless it is necessary to perform your job duties, including that ofyour friends, family members, and colleagues.K. Use private areas to discuss patient information with patient, family, or visitors.L. Access only electronic information that you “need to know” to perform your job.M. Log-off your computer when away from your workstation.N. Turn computer monitors so they cannot be viewed by unauthorized persons.O. Verify caller’s identity or applicable code before releasing patient information by phone.P. Lock laptop computers and other portable devices in secure location when not in use.Q. Store passwords in secure areas - not accessible by others.R. Remove patient information from copy machines, fax machines, printers, or conference rooms.S. Obtain patient verbal permission before discussing information in front of family and friends.T. Do not share your computer user ID or password with anyone.U. Do not access the PHI of family members, friends, or other individuals for personal or other non-work relatedpurposes even if written or verbal authorization has been obtained.V. Medical records should not be taken away from the UC campus or off-site property.W. Clinic schedules, surgery schedules, and procedure schedules that contain PHI should not be left out in viewof others. When no longer needed, schedules should be placed in shredding bins, not regular trash cans.X. If you do not need PHI to do your job, do not seek it out.Y. If you overhear a conversation concerning a patient, keep it to yourself.Z. Report suspected privacy violations to the HIPAA Program Office by calling (773) 834-9716.http://hipaa.bsd.uchicago.edu Page 1For more information, please contact the HIPAA Program Office at 4-971669

4HIPAA Privacy RuleTHE UNIVERSITY OF CHICAGO MEDICAL CENTEROFFICE OF MEDICAL CENTER COMPLIANCEATTESTATION FOR HIPAA TRAININGCOMPLETION OF HIPAA OVERVIEWI ________________________________________have read the material about HIPAAthat was given to me. I understand the information about the Privacy Rule and howimportant it is to our patients at the University of Chicago Medical Center. I understanda copy of this signed document will be kept on file as proof that I have completed mytraining.Copy for your recordsSIGNATURE____________________________________________NAME (PRINT)___________________________________________DATE__________________________________________________70

HIPAA Privacy RuleHIPAA as it Applies to Medical Students who are PatientsGuidance June 2012A. HIPAA Regulations apply to medical care delivered to students. All care provided tostudents at the University of Chicago Medicine is covered by the Health Insurance Portabilityand Accountability Act of 1996. Thus all aspects of a student’s healthcare are consideredprotected by federal law. Members of the Pritzker Community (students, staff, faculty,leadership) are not entitled, by virtue of their relationships to the student, to access student healthcare information without explicit permission of the student/patient. This is true for all typesof information including but not restricted to the following: medical records, laboratory data,presence in the Emergency Department, admission to the hospital, and encounters in StudentHealth Service and Student Counseling Service. All members of the Pritzker Community mustdemonstrate respect for the medical privacy needs of our peers despite the educational context ofour curriculum (medical training).B. The Pritzker administration will remain unaware of a student’s medical emergenciesunless directly contacted by the student/patient or given advanced permission to be involved.Advanced permission may be given by completing a HIPAA Authorization through cMORE.Advanced permission means that the Pritzker Dean on Call will be notified in the event of amedical emergency and presentation to the UCM Emergency Department. Students who wish todirectly contact the University Dean on Call about their emergency should call 773-834-4357.71

Digital Millennium Copyright Act1. What does DMCA mean?FAQCopyright Infringement (DMCA) ViolationsThe DMCA is the Digital Millennium Copyright Act which is a United States copyright law. It criminalizesproduction and dissemination of technology, devices, or services that are used to circumvent measures that controlaccess to copyrighted works and criminalizes the act of circumventing an access control, even when there is noinfringement of copyright itself.2. What is a DMCA violation?A DMCA violation occurs when the University receives a report from an agent of the copyright holder that ainfringement has taken place. That is to say, that sharing of copyrighted materials such as, music, books, games,movies, or software applications has occurred over the University networks.3. How does the file sharing occur?File sharing most often occurs when using peer­to­peer (P2P) applications, such as BitTorrent, Gnutella, and AresWares.4. Are P2P applications preinstalled on new computers?No they are not preinstalled, but have to be downloaded from Internet or some other source.5. What happens when someone receives a DMCA violation notice?When a student or staff member is noted to be in violation they will be contacted by Network Security and have anopportunity to eradicate the activities without recourse from the University. If additional DMCA complaints arereceived and are dated after the original complaint date, these complaints will be considered as second offense, andwill invoke disciplinary actions from either the Dean of Students or Human Resource Management. However,legal action may be invoked by the copyright holders at any time.6. Are there other penalties?Yes, there have been other penalties. Violators have been aggressively sued by the copyright holders; theUniversity has penalized second­time offenders with a $1000 fine; and employees have been terminated.7. Does the University provide legal counsel when a subpoena is served?No, the University does not provide legal counsel. The Office of Legal Counsel acts as a conduit for delivering thepre­settlement letters, which are notices of intent to sue, from the agents of the copyright holder to the allegedviolator. If a valid subpoena, which seeks identifying information on the alleged violator, is received by theUniversity, the Office of Legal Counsel will provide such information as required by law.8. Can an alleged violator be sued?Yes. Several dozen members of the University community have received settlement letters from copyright holders,and lawsuits have commenced against a number of them.9. How do I avoid receiving a violation?Do not use peer­to­peer applications unless the use of the application is for University business and does notviolate copyright laws.72Document1

Student Support Services73

Student Support ServicesThis section contains information to help you navigate the third and fourth years of medical school.There are a number of individuals at the Pritzker School of Medicine who are available to assist you.Many of these individuals have no role in evaluating you; this is purposely done so that you have optionsto seek advice and counsel from those who do not evaluate you. We make every effort to avoid havingyou placed clinically with your career advisors. However, if you find that you have been assigned toyour advisor, please contact the clerkship director or Dr. Woodruff so we can work towards having youswitched to someone who is not your advisor.We have also provided information about campus and medical school resources to help you maintainphysical and mental health during your third year.74

Pritzker School of Medicine AdministrationPritzker School of MedicineAdministrationThe Administration of the Pritzker School of Medicine oversees the general workings of theschool, including the curriculum, admissions, financial aid and student life. In this section,we give you a “who’s who” of the Pritzker administration with a focus on the people you’ll beinteracting with most during your first year..Office of the DeanThe Office of the Dean oversees medical education for students inthe Pritzker School of Medicine and for all residents and fellows ingraduate medical education programs at the University of ChicagoMedical Center.Holly Humphrey, MD, Dean for Medical Educationpritzkerdean@bsd.uchicago.eduDepartment: MedicineCandace Tate, Executive Assistant to Dr. Humphreyadmin-team@bsd.uchicago.eduHolly Humphrey, MDDana Levinson, MPHGerard Mikols, MBA, Associate Dean for Medical Education Administrationgmikols@bsd.uchicago.eduDana Levinson, MPH, Assistant Dean for Medical Educationdlevinso@bsd.uchicago.eduKelly Smith, MPP, Director of Strategy and Planningksmith2@bsd.uchicago.eduGerard Mikols, MBAKelly Smith, MPPCandace TateLife at Pritzker – 2975

Pritzker School of Medicine AdministrationStudent Affairs and ProgramsThe Office for Student Life is dedicated to supporting the personaland professional development of all students at Pritzker by providingprograms and services geared toward the development of happy andwell-balanced physicians-in-training who will become competent,caring, and compassionate physicians.The Office for Student Life works in concert with many otherPritzker programs as well as faculty who oversee specific programs inglobal health and community service learning.James Woodruff, MDShalini Reddy, MDJames Woodruff, MD, Associate Dean of Studentsjwoodruf@medicine.bsd.uchicago.eduDepartment: MedicineKey contact for: career advising, Pritzker societies, dual degrees,student government, student organizations, and personal/professional needsShalini Reddy, MD, Director of Student Professional DevelopmentProgramssreddy@medicine.bsd.uchicago.eduDepartment: MedicineKey contact for: Pritzker societies and student organizationsElizabeth Kieff, MD, Director of Wellness Programsekieff@bsd.uchicago.eduDepartment: PsychiatryKey contact for: Health and well-being issues related to Pritzker,including concerns about relationships, children, studying, stress, etcKate Blythe, Director of Student Affairs and Student Programskblythe@bsd.uchicago.eduCandi Gard, Student Programs Administratorcgard@bsd.uchicago.eduValaria McClinton, Student Programs Administratorvmcclint@bsd.uchicago.eduElizabeth Kieff, MDCandi GardKate BlytheValaria McClintonHave a question but not sure who to contact?Try contacting Dr. James Woodruff (jwoodruf@medicine.bsd.uchicago.edu), Dr. ShaliniReddy (sreddy@medicine.bsd.uchicago.edu), Dr. Elizabeth Kieff (ekieff@bsd.uchicago.edu), or Dr. Monica Vela (mvela@medicine.bsd.uchicago.edu).Involved with many aspects of student life, these individuals are “point people” forPritzker. If they can’t answer your question, they can direct you to someone who can.7630 – Life at Pritzker

Multicultural AffairsThe Office of Multicultural Affairs works toensure a supportive academic environmentfor underrepresented minorities at our school.Among the nation’s highest ranked medicalschools, Pritzker has achieved one of the mostdiverse student bodies.Pritzker School of Medicine AdministrationMonica Vela, MD, Associate Dean ofMulticultural Affairsmvela@medicine.bsd.uchicago.eduDepartment: MedicineMonica Vela, MD Rosita Ragin Nikeela OliverRosita Ragin, Assistant Dean for Multicultural Affairsrragin@bsd.uchicago.eduNikeela Oliver, Secretary for Multicultural Affairsnoliver2@bsd.uchicago.eduAdmissions and Financial AidThe Office of Admissions and Financial Aid is involved with MDadmissions, yearly financial aid applications and awards, and financialliteracy education.Anthony Montag, MD, Associate Dean for Admissionsamontag@bsd.uchicago.eduDepartment: PathologySylvia Robertson, Assistant Dean for Admissions and Financial Aidsylvia@bsd.uchicago.eduCynthia Frierson, Director of Financial Aidcfrierson@bsd.uchicago.eduKey contact for: Questions about financial aidDarrell Nabers, Director of Admissions and Outreachdnabers@bsd.uchicago.eduKey contact for: Admissions volunteering, student interviewing,hosting applicants, outreach programming to student applicants, newstudent recruitmentCharles Todd, PhD, Associate Director of Admissions & Financial Aidctodd@bsd.uchicago.eduLee Brauer, Assistant Manager, Admissions and Financial Aidlbrauer@bsd.uchicago.eduMaria Hernandez, Coordinator for Admissions and Financial Aidmhernand@bsd.uchicago.eduJuana Villalpando, Coordinator for Admissions and Financial Aidjvillalp@bsd.uchicago.eduAnthony Montag, MDCynthia FriersonSylvia RobertsonDarrell NabersCharles Todd, PhDLee BrauerLife at Pritzker – 3177

Pritzker School of Medicine AdministrationMedical School EducationThe Office of Medical School Education develops the Pritzker curriculumto meet the changing needs of students and the medical profession. Thisoffice prepares the quarterly class schedule, conducts course and facultyevaluations, and uses evaluations to improve courses and clerkshipsthrough the Curriculum Review Committees.Halina Brukner, MD, Associate Dean for Medical School Educationhbrukner@medicine.bsd.uchicago.eduDepartment: MedicineLori Orr, Director of Medical School Educationlorr@bsd.uchicago.eduKey contact for: Questions about the curriculum or clerkship rotationsMaureen Okonski, Registrarmokonski@bsd.uchicago.eduKey contact for: issues relating to registrationJill O’Brien, Medical School Education Administratorjobrien1@bsd.uchicago.eduKey contact for: course schedules, NBME registrationHalina Brukner, MDMaureen OkonskiScholarship and DiscoveryScholarship and Discovery is one component of Pritzker’s curriculumin which students complete a mentored research project by the time ofgraduation. See the First Year Courses section for details and visit our Wikisite at https://sites.google.com/site/scholarshipdiscovery/home.Vineet Arora, MD, MAPP, Assistant Dean for Scholarship and Discoveryscholarshipanddiscovery@bsd.uchicago.eduDepartment: MedicineSujata Mehta, MA, Manager for Scholarship and Discoveryscholarshipanddiscovery@bsd.uchicago.eduPritzker Communications/WebsiteCaroline oversees the school’s internal and external communicationsincluding editing the Pritzker Pulse student newsletter and maintainingthe Pritzker website.Caroline Kraft, Marketing and Communications Manager / ResidencyAdvising Managerckraft@bsd.uchicago.eduKey contact for: Website content, Pritzker Pulse, letters ofrecommendation, advising, and residency applicationsJill O’BrienVineet Arora, MD,MAPPLori OrrSujata Mehta, MPPCaroline Kraft7832 – Life at Pritzker

Student Health and Counseling ServicesM E M OJune 1, 2012To:Fr:University of Chicago Pritzker Medical StudentsAlex Lickerman, MDVice President for Student Health and Counseling ServicesSubject: Student Health and Counseling ServicesWe believe student health is vital to student success. At the Student Health Service (SHS)--formerly known as the SCC (Student Care Center)--medical students have access to integratedand comprehensive services targeted at building and maintaining overall well-being. Ourmission is to provide these services in ways that are tailored to medical students’ needs andlifestyles.We are in the process of reshaping Student Health and Counseling Services (SHCS) to enhancestudent-centered care. Organizational changes are already underway, and we will be workingtowards enhancing and possibly relocating some of our facilities in the coming years. There willbe increased emphasis on health promotion and wellness programs oriented towards educatingstudents about important issues related to building and maintaining healthy lifestyles.In an effort to ensure that medical students have the option to see providers in the Student HealthService (SHS) who are not likely to interact with them as faculty, we have directed our staff toschedule you one of the following providers:Catherine Glunz, MDPeter Draper, MDSue Nankin, APNRebecca Pride, APNMari Sandoval, APNHelen Xenos, MDAlex Lickerman, MDThese providers are unlikely to interact with medical students academically.If you would like to schedule either a regular or urgent appointment with a provider who doesnot regularly teach at Pritzker School of Medicine please contact us at 773-702-4156 andidentify yourself as a medical student. If you encounter logistical difficulties in obtaining an79

Student Health and Counseling Servicesappointment please page the SHS Operations Manager at 188-9501 from any campus phone ordial 773-702-1000 and request pager 9501. Please only use this pager number if you are unableto make an appointment through the SHS Call Center.If you prefer to see a provider outside of the University of Chicago health care delivery systemand are enrolled in the Student Health Insurance Plan, please contact the Student InsuranceOffice at (773) 702-6817 to request a referral for the type of provider or specialist you wishto see. The Student Insurance Office is open Monday – Friday from 8 AM until 5 PM. TheStudent Insurance Office staff will complete your referral; however, we ask that you scheduleyour own appointments. If you are not enrolled in the Student Health Insurance Plan, pleasecontact the provider of your choice according to your insurance benefits.Appointments outside of the SHCS are fee-for-service. This means that you and/or yourinsurance will be responsible for all charges related to the visit and any associated testing. Pleaseunderstand that the Student Health Insurance Plan carries a deductible plus a co-insurancepayment for providers outside the SHCS. We strongly encourage you to check with the billingoffice for the provider you will be seeing for additional information regarding costs.Welcome to the University of Chicago Student Health and Counseling Services. For yourreference, below are a few important contact numbers:SHS – Student Health ServiceSCS –Student Counseling Service5839 S. Maryland Avenue – Suite R 100 5737 S. University(773) 702-4156 Appointments (773) 702-9800 Appointments(773) 702-1915 after-hours Nurse Advice Line (773) 702-3625 On-Call Staff(773) 702-6817 Billing & Insurance (after-hours emergency consultation)DCAM PharmacyStudent Health Insurance Plan Coordinator5758 S. Maryland – First Floor Administration Building(773) 834-7002 5801 S. Ellis Avenue – Rooms 231 and 232(773) 834-4543 (option #2)HPW - Health Promotion and Wellness(773) 702-8247Please do not hesitate to contact us whenever you need our services.Alex Lickerman, M.D.Assistant Vice President for Student Health and Counseling Services80

Student Health and Counseling ServicesSTUDENT HEALTH SERVICECURRENT HOURS: Monday-Thursday 8am-6pmWednesday/Friday 8am-5pmSaturday 8am -11am Urgent Care OnlySunday (Closed)-Contact nurse advice line 773-702-1915Physician and Nurse Practitioner Care:Student Health Service (SHS) physicians are staff members at the University of ChicagoHospitals (UCH) Medical Center. Students with chronic illnesses are encouraged to visit andestablish a relationship with a primary care provider soon after enrolling in the University.Students without ongoing medical conditions do not need to select a primary care provider.UCH is a teaching institution and occasionally medical residents assist in the SHS under theclose supervision of a SHS provider.The SHS physicians and nurse practitioners are here to not only help students with urgenthealth care needs (e.g. sprained ankle, strep throat, etc.), but also with care for chronicillness or routine general check-ups (e.g. annual physical, sexual/reproductive health care,chronic: respiratory, endocrine and cardiovascular issues, LGBTQ health, STI/HIV testing, etc.).Call (773) 702-4156 to schedule an appointment.Student Health Nurses:The Student Health Nurses are a resource for students and are available to review your healthconcerns/symptoms during SHS business hours. An SHS Nurse can help you determine whetheryou should come into the SHS for medical care. The SHS Nurse is also available to assist withprescription refills, facilitate referrals, and much more. Please call (773) 702-4156 to speakwith a nurse. There is a 24-48 hour turnaround time for prescription refills and referrals.SHARE: Sexuality, Health and Resources for Everyone:Services that are available through SHARE include routine health care and treatment ofgynecological problems. Nurse Practitioners offer annual pelvic exams including Pap smears,contraceptive services and emergency contraception, information on sexually transmittedinfections, lesbian health issues, and pregnancy testing, counseling, and referral. Sexuality andrelationship counseling is also provided. For evaluation of urgent problems, SHARE acute careappointments are available. Please call (773) 702-4156 to schedule an appointment. Note:Women who prefer a male provider for their gynecological services may request so during theappointment process.81

Student Health and Counseling ServicesAbnormal Pap smearsBreast disordersSexually transmitted diseasesAbsent or irregular menstrual cyclesPain: menstrual, intercourse, pelvicUrinary or vaginal infectionsGenital rashes and wartsUrgent Medical Care:If you have urgent/emergent medical situations after SHS business hours that cannot wait untilthe next business day, please call (773) 702-1915 for the Nurse Advice Line. The nurse adviceline is an outside service not affiliated with the University of Chicago. The nurse will provideadvice as needed.DCAM 3C:Phone Number: (773) 834-4630Hours: 8:30am-10:30am on SaturdaysLocation: Primary Care Group, Suite 3B in the UC Hospitals Duchossois Center for AdvancedMedicine, 5758 S. Maryland Ave. (Maryland and 58th St.)Laboratory and Vaccination Care:Students requiring mandatory vaccinations can make an appointment with the Student HealthNurse to fulfill the requirement.Students requiring vaccinations for travel must make an appointment, 4-6 weeks prior totravel, with a healthcare provider prior to receiving the proper vaccinations. Students shouldplan to receive travel vaccinations well in advance to their travel because certain vaccinesneed time to work. Immunizations are not covered under the Student Life Fee.Travel Immunization ClinicPharmacySports MedicineThe Sports Medicine Physician sees athletes and non-athletes to discuss sports and fitnessrelated injuries and also works with an athletic trainer for additional care.Nutrition ServicesPhysical TherapyPsychiatric and Psychological Care82

Univ e rsity o f Chica goStudent Health and Counseling ServicesStudent Counseling Service5737 S. University AvenueChicago, IL 60637(773) 702-9800counseling.uchicago.eduOur ServicesThe Student Counseling Service providesmental health care to University of Chicagostudents. Our services include:• Diagnostic assessment• Individual, couples and group short-term therapy• Medication management• Emergency services and crisis intervention• Academic skills counseling• Referral services for members of the Universityof Chicago Student Health Insurance PlanEmergencies• If you are in crisis during office hours andneed immediate assistance, call (773) 702-9800.• If you are in crisis during evening orweekend hours, call (773) 702-3625 andask to speak to the SCS staff memberon-call.Contact UsFor more information, or to make anappointment, call the SCS office:Phone: (773) 702-9800Hours: 8:00 a.m. - 4:45 p.m. weekdays*Feeling overwhelmed*Depression*Procrastination *Sexual orientation concerns *Relationship problems*Study skills*Alcohol and/or other drug misuse*Eating issues*Concerns about family & friends83

Student Health and Counseling ServicesStudent Health ServiceStudent Health Service physicians and nurse practitioners help studentsurgent health care needs and provide routine medical services. Themedicine physician works with certified athletic trainers and aspecialist to provide comprehensive care for musculoskeletal orthopedicinjuries.Student Health Service is an appointment-based service, sobefore you come in. Students can generally get an appointment24 hours for most medical care concerns and typically the same dayurgent care needs. If you are in need of routine care or CDCscreening tests, please remember to make your appointment inMany routine gynecological appointments are booked 6 weeks inso it is important to planMedical AdviceA resource available to students 24 hours a day tomedicalStudent Health Nurse773-702-4156Nurse Advice Line (after hours)773-702-1915EmergencyEmergency Room services are NOT COVERED under the StudentFee; ER services will be charged to students and/or their insurance. Ifyou are unsure whether you should go to the ER, call thenurse at (773) 702-4156 to determine if emergency treatmentnecessary. The Emergency Room is not appropriate for most earstomach flu, or soreIf you do go to the ER it is important that you tell the Emergencystaff you are a student, and that you take your insurance card anddent ID card with84

Student Health and Counseling ServicesStudent Counseling ServiceStudent Counseling staff includes social workers,and psychiatrists who are available to assist students with an arraymental health concerns: transition from home to school,relationship issues, depression, anxiety, substance misuse,disorders, and manyLet’s TalkLet’s Talk is athat providesaccess toconfidential,anonymous (ifwish)with counselorsStudentbut in aSCS location.appointmentFor details,counseling.uchicago.eduAppointments are made over the phone by calling (773) 702-9800.initial appointment is typically an intake assessment where thehas an opportunity to describe his/her chief concerns. Adetermines the Student Counseling services that can best him orher and provides referral to other resources asEmergencyDuring business hours, students may call (773) 702-9800 or walk in toStudent Counseling Service. After hours, students may call 702-3625to speak with the Student Counseling Staff Member-on-CallA cademic SkillsA ssessment ProgramASAP assists students whohaving academicincluding testprocrastination, studydeficits and other kindslearning concerns.ASAP meetings can beand ASAP workshops areSupport GroupsThroughout the year,groups are available on a rangetopics (eatingprocrastination, relationships,Call (773) 702-9800 toavailability, orcounseling.uchicago.edu85

Student Health and Counseling ServicesHealth Promotion and WellnessThe Health Promotion and Wellness team seeks to promote andstudents’ quality of life by assisting them in navigating lifestyle choicesbecome confident, competent, healthy, and resilient individuals withoverall sense of well-being. This involves balancing multiple factorsintellectual, social, occupational, physical, spiritual, financial, mental,environmental dimensions. Our Health Educators, inwith PeerHealth Educators (PHEs), offer information and resources on topicsregarding healthy lifestylesPeer HealthPHEs are studentscoordinate and eventsthe academicyear promote andfellow students onlifestyle choices.more about the PHEshow you can work thisactive groupwellness.uchicago.eduNutrition and healthy eating onUsing student health and counselingStressAlcohol risk assessment and behaviorTobacco and drugTimeRelationshipsand SleepSafer sex andErgonomics (preventing and reducing back, neck, shoulderRelaxationResources for Sexual Violence Prevention (RSVP)RSVP promotes healthy gender relations within theofChicago community. RSVP provides education andconversations about sexual violence and its preventionPeer Education workshops and awareness For details, goto rsvp.uchicago.edu86

Student Health and Counseling ServicesUniversity Student Health Insurance Plan (U-SHIP)The University requires all students to carry health insurance that covers,among other costs, hospitalization, specialty care, and outpatientdiagnostic and surgical procedures provided within the Chicago area.Each year, students are automatically enrolled in the University StudentHealth Insurance Plan (U-SHIP), administered by UnitedHealthcareStudentResources. Details about the U-SHIP plan can be found athttp://www.UHCSR.com/uchicago. To waive enrollment in U-SHIP, you mustprovide proof of comparable insurance by the end of the second week ofyour first quarter of enrollment. You can do this online athttp://studentinsurance.uchicago.edu.Students enrolled in U-SHIP receive their primary care at the on-campusSHCS Primary Care and Student Counseling Services. SHCS will coordinateyour care and make a referral, when necessary, to a specialist. Withouta referral from SHCS, you will be assessed a penalty of $50, except inemergency situations or if you are more than 50 miles from campus. If youare away from campus and you need health care, you can find a physicianwho is in the UnitedHealthcare StudentResources national network by goingto https://www.geoaccess.com/uhc/po.If you are enrolled in U-SHIP, your insurance coordinators are located oncampus. The On-Campus U-SHIP Coordinators (see Directory) are able toanswer questions about your covered health benefits and other topicsrelated to U-SHIP.Students not enrolled in U-SHIP also receive their primary care at theon-campus SHCS Services. However, medical services obtained that arenot covered by the mandatory Student Life Fee will be billed to you (thestudent) and/or your insurance plan.Pharmacy Discount for U-SHIP EnrolleesA special arrangement with the University of Chicago MedicalCenter’s DCAM Pharmacy enables students enrolled in the UniversityStudent Health Insurance Plan (U-SHIP) who take medicineschronically to receive 3 months of prescription for the price oftwo months co-pay.* This discount (available only at the DCAMpharmacy) also applies to oral contraceptives (birth control).* Certain exceptions apply.987

WellnessWELLNESS(as written by Erin Kirkham MD ‘10 with input from Elizabeth Kieff MD ‘03)The goal of wellness is to maintain a healthy mind, body, and life throughout medical training. Itseems pretty simple, and many of us already have individual strategies for coping with stress and stayinghealthy. But everyone will struggle at some point, so we felt it was appropriate to include some adviceand resources to help face the unique challenges of third year.Time. You are about to transition from making your own schedule to having little control over your time.Whereas once you could choose whether or not to attend a given lecture, now you are required to showup (on time!) every day. Your residents tell you when to be there in the morning and they tell you whento go home. So, the goal is to take back as much control as you can... Always carry something with youthat you can study (or eat) if you get a bit of down time during the day. If you have a few moments onyour way from Mitchell to DCAM to grab food or make a phone call or pick up a prescription from thepharmacy – DO IT! You will soon be living by the hospital’s schedule, which makes life difficult to plan.This requires you have to think a few steps ahead. If you need time off for any reason (a wedding, afuneral, an appointment) let the clerkship director and your residents know as soon as you can and theywill usually accommodate you. Resist the urge to try to be too hard-core. Remember, if your grandfatherdies, it is more than okay to go the funeral. Often, it’s not that you are asking for time away but howyou do it (whether you communicate well and offer to make it up) that can make all the difference.Finally, don’t let third year stop you from living. Even though it can be tough, make plans! Give yourselfsomething to look forward to, it can be a great motivator.Sleep. Make it a priority. I know, I know. Easier said than done. Sometimes it feels like there aren’tenough hours in the day to both sleep and study. Don’t get me wrong, you have to study. But burning themidnight oil on a regular basis is going to leave you exhausted during the day when you could be learninga lot (and impressing your attendings with your awesomeness!). Remember, while the exams areimportant, it is your clinical grades and evaluations that count the most. Don’t be afraid of the old adage:sleep when you can, eat when you can and yes... pee when you can. You can always catch a catnap inthe student lounge if you need it. Treat yourself to a pillow from home ‐ you can keep it in your lockerand sometimes that small comfort can make all the difference. Also, don’t make the mistake of trying tocompensate for no sleep night after night with too much caffeine or worse yet someone else’s Adderall.You’re likely to end up wired and irritable, which is no way to be when interacting with colleagues andpatients.Diet. Eating enough of the right kinds of food can be tough during third year. You will quickly get ABPburnout, so check out the DCAM cafeteria as well as the basement cafeteria. When those get old, youcan also always do a quick dash across the street to Cobb Hall. Keep a stash of snacks in your locker(granola bars, cliff bars, tuna fish, crackers, dried fruit, peanut butter and jelly). Utilize the fridge in thelounge. When you do have time to cook for yourself, make a big portion so that you will have leftovers.The Wellness website has links to some great recipes. In addition, www.sparkpeople.com is a freewebsite that allows you to easily track calories and workouts, plan meals, and includes a ton of resourcesfor staying healthy. Don’t forget that stress can be a trigger for unhealthy eating, under eating and overeating. If you start to get into trouble with food ‐ get help: Student Counseling Services is a good place tostart.Exercise. It is one of the best ways to relieve stress, but it is also one of the hardest things to fit intoa busy third year schedule. But it can be done! It is usually impossible to hit the gym in the morningbecause you are often already rounding with your team when it opens at 6:00 am. That leaves the88

Wellnessevening, when you are tired after a long day. The best advice comes from Nike: just do it. Don’t overthinkit. Don’t talk yourself out of it. You will never regret a workout afterward. Also, don’t forget that thereare ways to fit in some exercise while you are in the hospital: workout circuit in the lounge, takingthe stairs, running laps around the basement, speed walking (this won’t be optional when you are onsurgery) and even taking a stroll around campus.Relationships. Relationships can be both stress relievers and stress inducers. Take stock of therelationships that are stress‐inducing and do some work with those people before third year explainingto them what it means to be a third year medical student. In addition, identify the relationships that arestress relievers and block out time to spend on them. The constraints on your time can be really toughon a relationship. Schedule a weekly date night with your significant other. Schedule sex if you need to!Keep in touch with your friends. Send one‐line emails if that is all you have time to do. Oh, and don’tforget to call your parents to reassure them you are still alive! Most importantly, don’t forget that yourrelationships with one another are often the thing that will get you through the day. You are the oneswho best know what you are going through so don’t be afraid to ask for help (or a hug) when you needit and always, always resist the urge to tear each other down ‐ don’t be a gunner! ‐ there are plenty ofgood grades to go around.Stress. Often during third year you are stretched so thin that it can be a lot more difficult to deal withstressful events that happen in your life, whether in or outside the hospital. If you feel overwhelmed atany point and need to talk to someone, please access your resources. Feel free to contact a fourth yearthat you trust, or one of the fantastic people who are listed in this guide. Jim Woodruff, MD, the Deanof Students, is available to talk through any issues that you might have. Elizabeth will be having “AppleTalks” in the hospital student lounge on most Wednesdays from 12‐1, where you can stop by, eat anapple and chat about what ever comes up with her and your classmates. The Ombudsmen are impartial,confidential point people for difficult situations that may arise during medical school. Finally, StudentCounseling Services (SCS) is located on University Avenue between 57th and 58th. Calling to set up anappointment is easy (773.702.9800) and starts with an “intake appointment” which can then translateinto a therapy appointment, medication evaluation, study skills help or a referral. The records are keptseparately from the hospital and the services are “free” which is to say you already have paid for themwith your student life fee.Burnout. It will happen to everyone at various points during third year, and we all have to find waysto push through it. A very wise Pritzker grad once said, “Be where you are.” Keep this philosophy inmind as you approach each clerkship. You may be in the O.R. retracting for the seventh straight hourwith a limited view of what is happening deep in the abdominal cavity. You may be on your umpteenthmedicine call on a Saturday when it seems like everyone else is out living it up. No matter where you areor what you are doing, there is something you can learn and something you can contribute. Don’t getbogged down in the negativity floating around the hospital and try not to take it all too seriously. Don’tbe afraid to laugh ‐ it is after all the best medicine for you and for your patients.Finally, a note of reassurance (and hopefully, perspective). You don’t have to be AOA to match or to be afantastic physician. You can even be a surgeon without Honoring your surgery rotation – GASP! The sameholds true for all specialties. If you ask around, you will find that some of the best doctors you knowwere less than perfect students. It is more than ok to aim high – we know you’re going to do it anyway ‐but don’t forget to include staying happy and healthy among your ultimate goals.89

WellnessIt Just Takes A Moment…Below is an exercise I hope you will take the time to do (It can take as little as 10 minutes or aslong as you’d like). The basic idea is that if you take a moment to think through some of thepotential difficulties of the year, when things do get tough and you find yourself in “it” – you’llhave some words of wisdom and key resources to turn to that are tailored specifically to you,because, well – they have been written by you. We chose to put the exercise in the book so thatyou will know where it is BUT, you may want to rip it out and tape it to your refrigerator, mirroror bulletin board as a reminder of what is important and where to get help. Sometimes, it justtakes a moment to remember who you are beyond “third year student” and why you are doingthis sometimes amazing and sometimes incredibly hard third‐year‐thing.1) What am I most worried about for third year?Relationships:Career:Knowledge:Personal issues (sleep, stress, eating, spirituality, health, self‐medication):2) Who are 5 people I can depend on? (Don’t be afraid to write down their contactinformation here)1.2.3.4.5.90

Wellness3) What are the resources I can turn to?It Just Takes A Moment... (cont)4) When things are tough, what do I want to remember (anecdotes, advice, who to call,humor)?5) What/who is most inspiring to me?6) What are 5 things I like to do outside of medicine? (can I do any one of those now, today,this week?)1.2.3.4.5.7) What are 5 things I like MOST (or am most proud of) in myself?1.2.3.4.5.91

WellnessLow Fat Chewy Fruit & Oatmeal BarsIngredients:¾ cup firmly packed brown sugar½ cup granulated sugar1 8‐ounce container vanilla or plain low‐fat yogurt2 egg whites, lightly beaten2 Tbsp. vegetable oil2 Tbsp. skim milk2 tsp. vanilla1 ½ cups all‐purpose flour(can make with ¾ cup whole wheat flour and ¾ cup all‐purpose flour)1 tsp. baking soda1 tsp. ground cinnamon½ tsp. salt (optional)3 cups Quaker® Oats (quick or old fashioned, uncooked)1 cup diced dried mixed fruit, raisins, or dried cranberriesPreparation1.) Heat oven to 350°F. In large bowl, combine sugars, yogurt, egg whites, oil, milk, andvanilla; mix well. In medium bowl, combine flour, baking soda, cinnamon, and salt; mixwell. Add to yogurt mixture; mix well. Stir in oats and fruit.2.) Spread dough onto bottom of ungreased 13x9‐inch baking pan.3.) Bake 28 to 32 minutes or until light golden brown. Cool completely on wire rack. Cutinto bars. Store tightly covered.Yield2 dozen barsCommentsThis is a totally fool‐proof recipe and I made it every weekend during third year (I’m notkidding). I would carry at least two bars, in a zip lock bag, around with me every day so that incase I got really hungry, I would have them. Enjoy!92

Career Advising93

Career Advising at PritzkerWe have a robust career advising system at Pritzker that includes class-wide meetings, optionalworkshops and individual advising. Upon entrance to medical school (or re-entry into 3rd yearfor those who pursued a PhD), all students are divided into one of four societies named afterprominent University of Chicago luminaries: Lowell T. Coggeshall, Joseph Bolivar DeLee, CharlesB. Huggins and Dallas B. Phemister. The goals of the societies are to provide advising andmentoring of students and to foster community through formal and informal events.Each society is led by two faculty members and you have each been assigned one of theseeight advisors. Your advisor will be meeting with you during your third year and with increasingfrequency as you progress through the career selection and application process. Some of youmay have already met with your advisor during the past two years; if you haven’t, don’t worry!You should plan to meet with your advisors approximately quarterly during your third year todiscuss how you are doing with your clerkships. These meetings will also be an opportunity toreflect upon your experiences and to talk in general terms about what you enjoyed and whatyou struggled with. During the spring quarter, your meetings with your advisor will be morefocused towards narrowing down your specialty choices with a goal of making a final careerdecision towards the end of your third year/beginning of fourth year.As you go through your third year, “try on” each specialty to see if this is the right fit for you.The moleskin book you received as a gift at the clinical biennium was given for you to jot downyour thoughts about the clerkships as you go. It is sometimes helpful to think in dichotomies;the following anchors may be good starting points. You may find your interests fall somewherealong the spectrum and that these interests may change as the year goes on.Regardless of which specialty you ultimately choose, your third year will serve as an importantfoundation for the remainder of your career.94

Career Advisor/Society RosterFirst Last Society Career AdvisorMarie Adachi Huggins Nanah ParkChristine Anterasian Phemister Jason PostonDavid Arnolds Coggeshall Brian CallenderAnthony Aspesi Coggeshall Mindy SchwartzNdang Azang-Njaah DeLee Patty KurtzFiyinfolu Balogun Coggeshall Elizabeth KieffCarly Berg DeLee Patty KurtzSaba Berhie Huggins Shalini ReddyAnkit Bhatia DeLee Tipu PuriDavid Bluhm Huggins Nanah ParkAshley Brouillette Phemister Elizabeth KieffDaniel Budreau Phemister Jason PostonBrittany Butler Coggeshall Brian CallenderKristofer Chenard DeLee Tipu PuriChristopher Chesley Coggeshall Mindy SchwartzChristopher Choi Huggins Nanah ParkKimberly Clinite Phemister Elizabeth KieffOscar Coppes Huggins Shalini ReddyScott Deboer Phemister Jason PostonMichelle Desjardins Coggeshall Mindy SchwartzAdam Dickey Coggeshall Mindy SchwartzMargaret Distler Coggeshall Mindy SchwartzMichael Fenster DeLee Tipu PuriMichelle Fletcher Huggins Nanah ParkTyler Friedrich DeLee Patty KurtzJonathan Garneau Coggeshall Brian CallenderAdam Gasser Coggeshall Brian CallenderMichael Glista Huggins Shalini ReddyJeffery Goldstein DeLee Patty KurtzEmily Guhl Phemister Elizabeth KieffNina Gupta Coggeshall Mindy SchwartzXuan Han Huggins Nanah ParkDominic Harris Huggins Shalini ReddyTheodore Hart Phemister Elizabeth KieffKatherine Hekman Phemister Jason PostonTrent Hodgson Phemister Jason PostonVikrant Jagadeesan DeLee Patty KurtzRebecca Kaiser Coggeshall Mindy SchwartzJennifer Karlin Coggeshall Mindy SchwartzInyoung Kim Huggins Nanah ParkJeong Hwan Kim Huggins Shalini ReddyChristopher King Huggins Nanah ParkPaul Kukulski DeLee Patty KurtzRobert Kulwin Coggeshall Mindy SchwartzRupali Kumar Phemister Elizabeth KieffCassandra LaMar Phemister Elizabeth KieffCourtney Lawhn Heath Coggeshall Mindy SchwartzJohn Lim Coggeshall Brian CallenderChen-Yuan Lu DeLee Patty KurtzNicholas Ludmer DeLee Tipu PuriErica Mackenzie DeLee Patty Kurtz95

Career Advisor/Society RosterFirst Last Society Career AdvisorMolly Mcadow Huggins Shalini ReddyDonald Miles Phemister Jason PostonMelissa Mott Coggeshall Mindy SchwartzTeresa Murray Coggeshall Mindy SchwartzAshley Nassiri Huggins Shalini ReddyMelissa Naylor Huggins Nanah ParkEric Nickels Coggeshall Mindy SchwartzAkash Parekh Phemister Jason PostonCamille Petri DeLee Patty KurtzJessica Portillo Huggins Shalini ReddyLiese Pruitt Coggeshall Brian CallenderAsad Qadir Huggins Shalini ReddyErnika Quimby Coggeshall Brian CallenderEllen Rebman Phemister Elizabeth KieffSteven Reinhart Coggeshall Mindy SchwartzDaniel Reynolds DeLee Patty KurtzFady Riad Huggins Shalini ReddyKatie Richards Coggeshall Brian CallenderVanessa Rivas-Lopez Huggins Nanah ParkAlexander Ruby DeLee Tipu PuriKatarina Ruscic Coggeshall Brian CallenderNeha Sathe Phemister Elizabeth KieffAlan Schurle DeLee Tipu PuriAdam Schwertner Huggins Nanah ParkMadeleine Shapiro Phemister Jason PostonAlexander Sheppe Coggeshall Mindy SchwartzSandra Shi Phemister Jason PostonHannah Snyder Coggeshall Brian CallenderOluwafikunmi Sobowale DeLee Patty KurtzCarmela Socolovsky Coggeshall Brian CallenderJoseph Statz DeLee Tipu PuriKevin Stephens Jr. Huggins Nanah ParkMatthew Stutz Coggeshall Brian CallenderLisa Sun Huggins Nanah ParkSean Swearingen Huggins Shalini ReddyJasmine Taylor DeLee Tipu PuriJustin Tomal Phemister Elizabeth KieffAshley Vachon DeLee Tipu PuriAngela Viaene Huggins Nanah ParkDavid Voce Phemister Elizabeth KieffHannah Wenger Phemister Jason PostonNathaniel West Coggeshall Mindy SchwartzTess Wiskel DeLee Tipu PuriAshley Woods Huggins Nanah ParkPeter Wroe Phemister Elizabeth KieffLai Xue Huggins Shalini ReddyHelio Zapata Huggins Shalini ReddyXiwen Zheng Phemister Jason PostonAlbert Zhou Coggeshall Brian CallenderWenjing Zong Phemister Elizabeth Kieff96

Career Advisor Contact InformationNAME LOCATION E-MAIL PHONE PAGERCoggeshall SocietyDr. Mindy Schwartz CLI L-320 mschwart@medicine.bsd.uchicago.edu 702-4591 4906Dr. Brian Callender S 600J bcallend@medicine.bsd.uchicago.edu 702-5207 1205Contact Dr. Schwartz directly to make an appointment.DeLee SocietyDr. Patty Kurtz CLI L-350 pkurtz@medicine.bsd.uchicago.edu 702-4629 9569Dr. Tipu Puri AMB S505 tpuri@medicine.bsd.uchicago.edu 702-9939 5811Office Hours for Dr. Kurtz should be scheduled through Chalk.Contact Dr. Puri directly to make an appointment or through Chalk.Huggins SocietyDr. Shalini Reddy BSLC 104 H sreddy@uchicago.edu 834-5216 3505Dr. Nanah Park WP C120B npark@peds.bsd.uchicago.edu 702-7656 5461Office Hours for Dr. Reddy should be scheduled through Chalk.Contact Dr. Park directly to make an appointment.Phemister SocietyDr. Elizabeth Kieff BSLC 102 ekieff@bsd.uchicago.edu 702-4654 1137Dr. Jason Poston W661 jposton@medicine.bsd.uchicago.edu 702-7837 2482Office Hours for Drs. Kieff and Poston should be scheduled through Chalk.Pritzker Career Advising AdministrationCaroline Kraft BSLC 104-M ckraft@bsd.uchicago.edu 702-3333Kelly Smith BSLC 104-M ksmith2@bsd.uchicago.edu 702-4652Eileen Wayte AMB O-131 ewayte@bsd.uchicago.edu 834-375797

Careers in Medicine WebsiteAbout Careers in Medicine (CiM) www.aamc.org/careersinmedicineChoosing a medical specialty is one of the most significant decisions a medical student will make. So theAAMC created Careers in Medicine® (CiM), a career-planning program to help medical students• Identify career goals• Explore specialty and practice options• Choose a specialty• Select and apply to residency programs• Make good career decisions• Self-assessment tools• Career information on 112 specialties and subspecialties• Specialty description & personal characteristicso Training and residency informationo Salary & Workforce datao Links to over 1000 specialty organizations, journals & publications• Decision-making exercises• Specialty-choice and residency application information• Timelines to help you stay on track through this process98

Clinical Rotation EvaluationIn addition to beginning your practice of clinical medicine and learning the basics of being a physician, clinicalrotations are a great chance for you to try on different specialties and start figuring out which one might be a goodfit for you. As you complete each of your rotations, fill out and compare the evaluation questions below to assistyou in gathering your thoughts, feelings, and reflections on each specialty as a possible career choice for you.1. Name and Location of Clinical Rotation: __________________________________________________________________________________________________________________________2. What did I like most about this specialty? _______________________________________________________________________________________________________________________________________________________________________________________________________3. What did I like least about this specialty? _______________________________________________________________________________________________________________________________________________________________________________________________________4. Did this clinical rotation give me a good sense of what practice in this specialty would be like?□ Yes □ NoComments: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________5. Did my interests, values, skills, and/or personality “fit” with this specialty? If yes, in what waydid they “fit?” If no, why might they not be compatible?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. What are the possible practice settings for specialists in this field? Which of these settingsinterest me and do I know enough about them?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________© 2009 AAMC. May not be reproduced without permission. 199

7. What information do I still need to find out about this specialty?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________8. Has my perception of this specialty changed based on my clinical rotation experiences?□ Yes □ NoIf yes, how did it change? ____________________________________________________________________________________________________________________________________________________________________________________________________________________9. Did my clinical rotation experience influence the likelihood of choosing a career in thisspecialty? □ Yes □ NoIf yes, how did it influence me? _______________________________________________________________________________________________________________________________________________________________________________________________________________10. Right now, how interested am I in this specialty as a career option?1 2 3 4 5 6 7 8 9Not at all Neutral To a great degree11. Other comments or reflections about this rotation or specialty:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________© 2009 AAMC. May not be reproduced without permission. 2100

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Third Year Financial Aid & You• Be certain you have signed up for direct deposit at https://cmore.uchicago.edu/• The dates your funds should be disbursed in your direct deposit account are:June 13, 2012September 19, 2012December 26, 2012March 25, 2013• Pay your bills on time so you will protect your credit score. Check your accounts each month tobe certain there is no unauthorized activity. If you run into trouble with your credit score make anappointment to see Cynthia Frierson or Sylvia Robertson, sooner rather than later.• Save what you can so you will have funds to pay for your fourth year residency travel and relocationexpenses.• Stay away from expensive junk fund so you can stay healthy physically and financially.• Consult the FIRST website for information about all things financial for medical school students andresidents https://www.aamc.org/services/first• Contact us with any questions:Lee Brauer for processing issues at lbrauer@bsd.uchicago.eduCynthia Frierson for loan changes at cfrierson@bsd.uchicago.eduSylvia Robertson for emergency issues at sroberts@bsd.uchicago.edu• HAVE A WONDERFUL THIRD YEAR102

References & Articles103

COMMENTARYThe Art of PimpingAllan S. Detsky, MD, PhDTHE TERM “PIMPING” WAS POPULARIZED BY BRANCATI 1in 1989. As he defined it, pimping occurs whenan attending physician (the Pimper) poses a seriesof difficult questions to a resident or medical student(the Pimpee). Pimping usually occurs in settingssuch as “morning report” or “attending rounds,” in whichtrainees at various levels convene with a faculty member toreview patients currently under their care. Among surgeons,pimping may occur when students and residentsare a captive audience observing a patient undergoing anoperation. Brancati 1 described the origins of the term,which date back to 17th-century London. Koch’s seriesof “Pümpfrage” (pimp questions) were used on his roundsin the 19th century. The practice migrated to NorthAmerica in the 20th century and was documented byFlexner while observing Osler making rounds at JohnsHopkins. Brancati 1 outlined suggestions for attendingphysicians to further hone their pimping skills andmethods for students to defend themselves from it. Heposited that the art of pimping would disappear in thefuture with increased specialization and educationalreorganization. This Commentary revisits the art of pimping20 years later and provides an update for facultymembers and students alike on modern methods in thisimportant skill.Pimping is indeed alive and well within academic medicinefor several reasons. First, the basic structure of medicalteaching has not changed. Ross and Detsky 2 have describedthe teaching services at 2 academic hospitals on bothsides of the Canada/US border. Students and residents stillwork up patients and report to attending physicians as muchin 2009 as they did in the last half of the 20th century. Facultystill meet with small- to medium-sized groups of medicalstudents and residents and use interactive methods thatsomewhat resemble Socratic techniques. Second, the powerrelationship between teacher and student still exists and likelyalways will, because the teacher has more content knowledgeand is responsible for evaluating the students. Pimpingreinforces that power relationship because the teacherusually controls the questions. The teacher likely knows theanswers while the students may or may not. A historical exampleof the effect of this phenomenon was described byAusiello in a brief biography of Their. 3 When Their was chairof medicine at Yale, a resident once fainted from anxiety priorto a case presentation. This experience resulted in givingThier the nickname “Syncope Sam.” The third reason pimpinghas flourished is the explosive expansion of the knowledgebase in clinical medicine.Advice for Students (the Pimpees)Clinical teaching sessions often involve direct questioningof individual students in the presence of their peers. Thisdiffers from most examinations in which the student’sknowledge base is not on public display. In some cases,participants volunteer answers. More often, the facultymember selects 1 or more of the participants to respond. Ifthe first student cannot correctly answer, another studentis chosen, and so on until someone answers the questioncorrectly. If no one answers the question correctly, theattending does (assuming he or she knows the answer). Ifnot, a student is usually assigned to investigate the questionand report back the next day. Some students thrive ondisplaying their knowledge (or lack thereof) in public,others do not.For students, there are several techniques to protect againstbeing pimped (BOX).Conversely, some students actually prefer that theattending physician directs questions to them. Techniquesto achieve this goal include raising the hand oreyebrows, making eye contact, sitting upright, sittingdirectly in the sight line of the teacher, raising and flailingthe right arm, and if all else fails, blurting out theanswer without being asked. However, other participantsprobably will find these methods irritating. Students whofeel they are annoying their peers by displaying too muchknowledge should place themselves in a position in theroom where only the attending can see their face. Forthose who want the attending physician to ask about anattractive attribute of themselves, students are advised togive a visual clue (such as wearing an Oxford tie if theywere a Rhodes Scholar).Author Affiliations: Departments of Health Policy Management and Evaluation,and Medicine, University of Toronto; Department of Medicine, Mount Sinai Hospital,and University Health Network, Toronto, Ontario, Canada.Corresponding Author: Allan S. Detsky, MD, PhD, Mount Sinai Hospital,600 University Ave, Ste 427, Toronto, ON M5G 1X5, Canada (adetsky@mtsinai.on.ca).©2009 American Medical Association. All rights reserved. (Reprinted) JAMA, April 1, 2009—Vol 301, No. 13 1379104Downloaded from www.jama.com at Mercer Univ School of Medicine on September 21, 2009

COMMENTARYBox. Pimping Protection ProceduresAvoidanceDo not have visual contact with the teacher. There are severalvariations of this technique including (1) “eclipse” (make surethat another person’s head is always in the direct sight line betweenstudent and teacher); (2) “camouflage” (the student sitsvery still, hoping the attending does not notice him or her);and (3) “meditation” (the student lowers his or her head, leansslightly forward and puts the palms of the hands together).The MuffinThis technique is particularly useful for senior residents whoare fearful that the attending physician will embarrass them witha question they should be able to answer but cannot. The residentholds a large muffin in the dominant hand with the elbowflexed, and slowly makes motions with the elbow that movethe muffin toward and away from the mouth, somewhat likethe graphical lines representing the attitudes of focus groupmembers used by television networks while watching the recentpresidential debates (ie, closer to the mouth if the residentdoes not know the answer, further if he or she does). Ifthe resident feels that the teacher will call on him or her to answera question to which he or she cannot respond, the muffinshould be placed into the mouth. Most attendings will not askresidents or students to speak with their mouth full of food. Ifthe attending does, the resident should pretend to choke, thusavoiding all future questions.The Hostile ResponseIf a student is singled out to answer and is embarrassed becausehe or she cannot, the student should be sure to respondin a hostile fashion, both with the tone of voice and body language.Most teachers will refrain from asking that student questionsin the future. An answer that always works is “I don’tknow,” with a 1-second pause between each successively louderspoken word.The ListIf a list of answers is being compiled from several students (eg,what are the life-threatening causes of chest pain?) and the studentdoes not have one, the student should just repeat the responsegiven by a previous respondent and pretend he or shedid not hear it. This is particularly effective if the studentholds the patient list in front of him or her and looks likehe or she is preoccupied with patient care responsibilities.The student or resident can amplify the sympathy by constantlychecking his or her pager. (Who can blame anyonewho puts patients first?)Honorable SurrenderTell the teacher you are uncomfortable. Few students trythis, but sometimes the direct approach is best. Those whoare uncomfortable being put on the spot in public shouldjust say so. This can be done in the presence of the groupor in private after the teaching session.Pimp BackThe student or resident should find a knowledge area inwhich he or she has a comparative advantage over the teacherand turn the tables on him or her. In the era of increasedsubspecialization in which the teacher may not be familiarwith the patient presented, this is not as difficult as it sounds.However, pimpers usually do not like to be pimped so becareful.The Politician’s ApproachDo not answer the question that the attending asked but talkstraight to the audience (ie, ignore the pimper) by answeringa question you would have preferred being asked. Thisis even more effective if combined with pimping back (seeprevious procedure).Use PDA (personal digital assistant)Modern students have an advantage: instant electronicmobile devices that, if used properly, can provide theanswers in “real time.” Pimpers might avoid studentswith visible PDAs because they know these students canpimp back.Do Not Sulk/CryStudents who answer incorrectly should not become overlydiscouraged. Attendings rarely remember students who givewrong answers (especially to difficult questions); they oftenremember those who lose their composure.Advice for Attending Physicians,Faculty, Teachers, or (the Preferred Term)“Professors” (the Pimpers)There is proper etiquette that should be followed in teachingsessions that keep the good will of all participants.1. Respect educational order. Never ask a medical studentto respond to a question after a resident has answeredincorrectly. One way to avoid this faux pas: always start atthe bottom of the educational chain and move serially up alevel if no one at the first level has a correct answer (ie, thirdyearstudents before fourth-year students, before interns, beforeresidents). There is an important corollary for the juniorresidents and medical students: do not break ranks byshowing up the senior resident on the team (or the juniorresident or student’s next admission may be a very difficultpatient).2. Do not embarrass other attending physicians. Nevercall on other attending physicians who are present unlessyou are sure they know the answer. Conversely, if a topicarises for which others know more than you, ask them tomake comments so you do not embarrass yourself by sayingsomething wrong (and having them point it out).3. Look for the eclipser, camouflageur, meditator, ormuffin eater and use opportunities to comfortably drawthem into the conversation. These include asking them theeasiest possible questions so that they are less stressed. Use1380 JAMA, April 1, 2009—Vol 301, No. 13 (Reprinted) ©2009 American Medical Association. All rights reserved.Downloaded from www.jama.com at Mercer Univ School of Medicine on September 21, 2009105

COMMENTARYhumor to acknowledge that this form of teaching can beintimidating and state that your expectations are low (ie,the question is difficult and you do not expect any of themedical students to answer correctly).4. The public apology. If you say something wrong or embarrassa student, use the next opportunity to publicly apologize.A teacher apologizing to a student always goes overwell.5. Find an opportunity to provide praise, either in a publicfashion (eg, a round of applause for a student for an especiallygood presentation) or privately. A compliment fromthe attending physician can be very powerful for the studentor resident.Pimping in PerspectiveThis Commentary has refreshed some of the advice on pimpingbased on the author’s experiences in thousands of morningreports and attending rounds in general internal medicineover 26 years. How does this advice differ from thatoffered by Brancati? 1 For the student, it is similar in tonebut perhaps expands the arsenal of protective weapons. Forthe faculty member, it offers methods for mitigating the consequencesof defeat (or humiliation) for participants whenanswers are incorrect. Perhaps this means attending physicianshave “gone soft” in 20 years or simply have buriedtheir arrogance and become more interested in explaininghow they think.Students and teachers should recognize that the smallgroup interactive method of clinical teaching is aimed at impartingimportant knowledge in the right context and in amemorable fashion. Throughout history, pimping has beenviewed as a “sport” aimed at reinforcing the teacher’s positionof power. The unspoken truth is that these teachingmethods reinforce the pecking order from student to internto resident to staff. Everyone in the room wants to appearsmarter than their own level peers and as smart as thoseabove them, with the faculty seemingly “taking notes” allthe time.However, a more modern perspective is that the purposeof pimping is to increase retention of the key teaching pointsby being provocative. Most students recall these sessions verywell. It is important that students remember both the materialand the method, not just the method. For teachers,finding the right balance between humiliating the studentwho gives incorrect answers, and boring the audience bysimply providing the answers is a real skill. The lesson is tonot take pimping too seriously and remember that often morecan be learned from incorrect answers than from correct ones.Unlike Brancati, 1 this author has no fears that this art willdisappear but, like him, hopes that these tips will help itflourish.Additional Contributions: The author thanks Andrew Smaggus, MD, Eric Venos,and Michael Detsky, MD, for their comments on earlier drafts.REFERENCES1. Brancati FL. The art of pimping. JAMA. 1989;262(1):89-90.2. Ross JS, Detsky AS. Comparison of the US and Canadian health care systems:a tale of 2 Mount Sinai’s. JAMA. 2008;300(16):1934-1936.3. Ausiello DA. Introduction of Samuel O. Their, MD. J Clin Invest. 2008;118:3805-3810.106©2009 American Medical Association. All rights reserved. (Reprinted) JAMA, April 1, 2009—Vol 301, No. 13 1381

DRUGSMARTGet DRUG SMARTThings to consider in physician interactionswith pharmaceutical companies:inners and other gifts have been shown to create relationships andaffect clinical judgment in the prescribing of drugs.esearch is key to treatments for patients—use objective data (forexample, from PIER ® , the Cochrane Review ® , The Medical Letter ® ,UpToDate ® , PubMed ® , and journals) prior to prescribing.nderstand costs to patients and to society; not all treatments are worthwhileor necessary.ifts: The acceptance by a physician of individual gifts, hospitality, trips,and subsidies of all types that might diminish or appear to others todiminish the objectivity of their professional judgment is strongly discouraged.Evaluate any potential for influence on clinical judgment.elected information can be presented by drug representatives as an effectivemarketing tool; raw data and head-to-head comparisons are infrequentlyvolunteered or available. Critically evaluate information from all sources.onetary rewards (beyond reasonable compensation for time andexpenses) should be declined for participating in trials or recruitingpatients/subjects.lternatives such as generic drugs, other classes of drugs, and competingproducts should always be considered.estrict interaction with industry representatives to educational contactsand maintain boundaries.alk to peers and colleagues about potential bias in drug information andconflicts of interest.Physicians and the pharmaceutical industry have shared interests in advancing medical knowledgeand quality health care. Industry makes many positive contributions to those ends. But the primaryresponsibility of the physician is to promote the best interests of the patient. Interactions betweenphysicians and industry must maximize the good of the patient.107

ReferencesBlumenthal D. Doctors and drug companies. N Engl J Med 2004; 351:1885-1890.Coyle S. for the ACP-ASIM Ethics and Human Rights Committee. Physicianindustryrelations. Part 1: individual physicians. Ann Intern Med 2002;136:396-402.(For the recently approved Board of Regents position on gifts, please seewww.acponline.org/ethics/phys_inds.htm)Gelb D. The role of the pharmaceutical industry in neurologic education.Neurology 2005;64:E7-E10.McCormick B, Tomlinson G, Brill-Edwards P, Detsky A. Effect of restrictingcontact between pharmaceutical company representatives and internal medicineresidents on post training attitudes and behavior. JAMA 2001;286:1994-1999.Snyder L, Leffler C for the ACP Ethics and Human Rights Committee.Ethics Manual, Fifth Edition. Ann Intern Med 2005;142:560-582.Steinman MA, Shlipak MG, McPhee SJ. Of principles and pens: attitudes andpractices of medicine housestaff toward pharmaceutical industry promotions.Am J Med 2001;110:551-57.Wazana A, Granich A, Primeau F, Bhanji N, Jalbert M. Using the literature indeveloping McGill's guidelines for interactions between residents and thepharmaceutical industry. Acad Med 2004;79:1033-1040.DRUG SMART was developed by theAmerican College of PhysiciansCouncil of Associates. November 2006108

272Downloaded from qhc.bmjjournals.com on 2 August 2006ORIGINAL ARTICLERole of medical students in preventing patient harm andenhancing patient safetyS C Seiden, C Galvan, R Lamm...............................................................................................................................Qual Saf Health Care 2006;15:272–276. doi: 10.1136/qshc.2006.018044See end of article forauthors’ affiliations.......................Correspondence to:S C Seiden, University ofChicago, Department ofPediatrics, ComerChildren’s Hospital, 5721South Maryland Avenue,MC8016, Chicago,IL 60637, USA; seiden@uchicago.eduAccepted for publication6 May 2006.......................Background: Substantial efforts are focused on the high prevalence of patient harm due to medical errorsand the mechanisms to prevent them. The potential role of the medical student as a valuable member of theteam in preventing patient harm has, however, often been overlooked.Methods: Four cases are presented from two US academic health centers in which medical studentsprevented or were in a position to prevent patient harm from occurring. The authors directly participated ineach case.Results: The types of harm prevented included averting non-sterile conditions, missing medications,mitigating exposure to highly contagious patients, and respecting patients’ ‘‘do not resuscitate’’ requests.Conclusion: Medical students are often overlooked as valuable participants in ensuring patient safety.These cases show that medical students may be an untapped resource for medical error prevention.Medical students should be trained to recognize errors and to speak up when errors occur. Thosesupervising students should welcome and encourage students to actively communicate observed errors andnear misses and should work to eliminate all intimidation by medical hierarchy that can prevent studentsfrom being safety advocates.Deaths attributed to medical error are estimated to be thethird leading cause of death in the US, 1 resulting in48 000–98 000 deaths each year. 2 The literature onpreventing medical errors in general is rapidly evolving, butapplicability toward trainees has not been sufficientlyaddressed. Some attention has been paid to the role ofresident physicians in preventing errors 3–6 and to theimportance of teaching about patient safety in graduatemedical education. 7–9 However, there has been less attentionto the perception of errors by medical students and to the rolethey could have in error prevention. 10–18Medical students want to contribute to the healthcareteam, but their lack of clinical knowledge and inexperience(and corresponding lack of confidence), the fact that they arenot licensed providers, unwillingness or hesitancy to speakup (possibly routed in fear of negative evaluation or otherconsequences), and the medical hierarchy all discourage erroridentification and student communication of observed errors.As the cases in this paper illustrate, student contributions topatient safety therefore may be not initiated, ignored, oroverlooked. However, because medical errors are oftencaused from miscommunication and poor accessibility ofinformation, 19–21 medical students may be as adept atpreventing certain types of errors as other members of thehealthcare team. Because students usually follow fewerpatients than house staff, they can afford greater attentionto details that may frequently lead to medical errors (forexample, prescribed versus administered medications).Moreover, the inclusion of medical students in the care ofthe patient affords increased redundancy to catching medicalerrors and mitigating their consequences. 7Medical students do witness medical errors, with one studyreporting that 76% of medical students had observed amedical error. 17 Yet only about half of these students (whohad received formal training in patient safety) reported theerrors to a resident or attending, and only 7% reported usingan electronic error reporting system. These data, and thecases presented below, suggest that substantial culturalchanges are needed to make students proactive when theysee errors.This paper illustrates the powerful role medical studentscan play in preventing patient harm and introduces studentsas an untapped resource for error prevention. We present fourreal case histories in which one of the authors (then medicalstudents) prevented or could have prevented patient harm(table 1).CASESCase 1: Sterile technique in the operating room (OR)Case historyA third year medical student on her surgery rotation wasscrubbing on a wrist arthroscopy case. The student had seen twoprevious wrist arthroscopies performed by other surgeons. Theresident and student positioned the patient’s arm for sterilepreparation. After the arm was in position the attending,resident, and student left the OR to scrub. As the patient’s armwas being positioned into the traction apparatus the studentnoticed that skin on the arm of the Caucasian patient lacked theresidual yellow hue of the iodine based prep and concluded thatthe arm must not have been prepped sterilely. The studentassumed that the attending was aware of this. On previoussurgeries the student had noticed that the surgeons would oftendouble glove while prepping and setting up and then removetheir outer gloves. At one point in draping, the patient’sunprepped hand touched the attending’s arm above his outergloves. The student mentioned this to the attending but theattending did not respond.The student felt that the maxim in surgery was ‘‘medicalstudents should be seen and not heard’’ and therefore did notrepeat the warning. The student also still thought sterile prepwas forthcoming. After the patient’s arm was positioned, thestudent inquired if they should take off their outer gloves(which had been holding the patient’s unprepped arm). Theresident and attending, confused by the question, respondedthat the student could. As the attending prepared to makethe first incision on the unclean skin, the student quietly toldthe resident that the patient’s arm had not been prepped. Theresident replied that the arm had been prepped, but thennoticed the patient’s arm was still white. The patient’s armwww.qshc.com109

Downloaded from qhc.bmjjournals.com on 2 August 2006Role of medical students in patient safety 273Table 1Case examples of student involvement in prevention of medical errorNo Description of event Contributing factors or problems Role of medical student Lessons learned1 Non-sterile preppedlimb noticed beforeincisionPoor team communicationAssumptions of OR staffresponsibilitiesOR culture and hierarchy limitingcommunicationDaily variation of OR team membersObservations of procedures and deviationsfrom the norm prompted the student toquestion the omission of sterile techniqueDon’t assume anything; keep a suspecteye when things do not look correctErr on the side of caution, err in favor ofthe patientDon’t be afraid to speak up, even if youare wrongLearn proper sterile techniques2 Drugs ordered butnot administeredDrug order system requirestranscription from hand writtenorder to computer based MARNo formal practice of confirmingthat ordered drugs are administeredDrug administration was not confirmedStudents are in a position to follow thepractice of checking orders are carriedout and medications administered3 DNR order notfollowedNo system for alerting DNR ordersto teamStudent hesitant to communicateknowledge of DNR orderCommunicated DNR order to teamStudents encouraged to communicatewith team members when there arequestions about proper procedures4 Infection exposure Language barrierEmergency settingComplete history not takenStudent initiated translator consultObtained history suggestive of tuberculosisInitiated respiratory precautionsEffective communication is vital in patientsafetyWhen language barriers arise,translators must be used to ensure safepatient careOR, operating room; DNR, do not resuscitate; MAR, medication administration record.was re-draped, prepped, a sterile traction apparatus located,and the operation proceeded without incident.Error analysisThis near miss raises many important issues. As in manymedical errors, the etiology was one of poor communicationand follow through. The OR team failed to communicate whowas going to be responsible for prepping. The student’sperception of surgical hierarchy and the OR culture made itdifficult for the student to speak up when she first noticedthe unprepped arm. The student also felt more comfortabledisclosing the error to the resident instead of the attending (abehavior seen elsewhere 17 ).In this case the student prevented the medical error. Somestudents might have spoken up sooner; some may not havesaid anything at all. In addition, some luck was involved inmaking this case a near miss (the hue of the iodine basedprep on a light skinned patient).Lessons learnedThe Accreditation Council for Graduate Medical Education(ACGME) competencies for US resident education provide auseful framework for categorizing the lessons learned in thecases in this paper and illustrate how this construct can beapplied to undergraduate medical education. 22 Firstly, thecompetencies of patient centred care and professionalismsuggest that students should prioritize the safety of the patientahead of their own hesitancy to speak up. However, the studentalso needs sufficient medical knowledge to recognize that sterilepreparation is always performed for invasive procedures.Increased use of interdisciplinary team training (with emphasison talking to superiors) would enhance the practice-basedlearning and improvement opportunities, and aim to provide anincreased comfort level for any team member to speak up whenan error is recognized. 23The cornerstone of earlier detection of the near miss in thiscase rests upon interpersonal and communication skills.Students, as well as the entire healthcare team, should beencouraged to speak up in times of uncertainty regardingprocedures and patient safety. Unfortunately, the case aboveis not an isolated example of a failure to speak up. 18 24 Thepre-procedure ‘‘time out’’, which is now mandated by theJoint Commission on Accreditation of HealthcareOrganizations (JCAHO) immediately prior to beginninginvasive procedures, 25 creates a valuable opportunity forcommunication between members of the operative team. Ifthe team leader uses this ‘‘time out’’ not only for verificationof the patient’s name and anticipated procedure but also as aforum to remind all operative team members that they areexpected to speak up if they see any safety concerns, evenjunior or novice team members such as medical students maybe more likely to express concerns when they arise. Finally,systems based practice changes (such as standardization ofthe sterile prepping procedure) could provide anotherapproach to prevent this kind of near miss from recurring.Case 2: Drugs prescribed versus drugs administeredCase historyA student on her first third year clinical rotation was assignedto follow a 21 year old man with steroid treated ulcerativecolitis admitted for a planned total abdominal colectomy. Thepatient was doing well for the first three postoperative days,but on day 4 the student found while pre-rounding that thepatient had been vomiting since 3 am and appeared acutelyill. The team later questioned if the symptoms weresecondary to the patient’s recent change in diet from‘‘nothing by mouth’’ to clear liquids. A plain abdominalradiograph was ordered and showed apparent free air underthe diaphragm, indicating a possible postoperative perforation.Upon review of the patient’s chart the resident realizedthat the patient had not received the ordered postoperativefamotidine (Pepcid) during the first four postoperative days.The service’s practice was for selective histamine blockerssuch as famotidine to be prescribed after gastrointestinalsurgery to protect the gastrointestinal mucosa, relaxed fromanesthesia, from the potentially erosive effects of gastric acid.While famotidine was written in the postoperative orders, ithad never been transcribed to the computer based medicationadministration record (MAR).A subsequent gastrointestinal follow through study showedthat the patient had not perforated but probably had apostoperative ileus with the observed free air possibly residualfrom the surgery. He received a nasogastric tube and was finallystarted on famotidine. The patient quickly improved and wasdischarged home approximately 4 days later.110www.qshc.com

Downloaded from qhc.bmjjournals.com on 2 August 2006274 Seiden, Galvan, LammName: Mr.Patient MR: 1234567 **DAILY MAR CHECK***DOSE ADJUST FOR RENAL INSUFFICIENCYMed Date/Dose initiated Date/Dose D/C orDFamotidine2/16 20 mg PO BID2/162/17Figure 1Example of work round checklist to reduce medication errors.Error analysisThis case is a relatively benign example of the commonproblem of medication errors—that is, the failure to administerordered medications. This medical error could have beenprevented in many ways. For example, enhanced systemsbased practice such as the use of computerized physicianorder entry systems with standard order sets and decisionsupport may help prevent such errors (although they are notwithout flaws themselves 26 ).Lesson learnedIn this case only the resident noticed the missing medicationonce the patient became symptomatic. However, this errorcould have been prevented by the medical student if studentsperformed a daily check of their patients’ MAR to see that allmedications ordered for their patients are being administered.One suggestion is for students to add a table (fig 1) totheir daily work round sheet that includes check boxes fordrugs ordered, or to otherwise make it their practice to checkthe MAR daily. From a competencies perspective, it is alsohelpful for students’ medical knowledge to include commonmedication errors and drug interactions. Students could alsoeasily be trained to perform the increasingly used safety24 27 28practice of medication reconciliations, or to use errorprone drugs as ‘‘trigger tools’’ to prompt heightenedawareness for error. 29 Communication skills and professionalismwould come into play if the student detected an error.Case 3: Respecting the do not resuscitate (DNR) orderA third year student on his medicine rotation was following avery sick elderly patient with end stage Alzheimer’s diseaseand severely compromised activities of daily living who wasadmitted for percutaneous endoscopic gastrotomy tubeinsertion. The patient’s code status was ‘‘do not resuscitate’’(DNR). On the day of the procedure a cardiac arrest code wascalled in the post-anesthesia care unit (PACU). Upon arrivalin the PACU the resuscitation had been started by the PACUstaff, and the student’s senior resident began to lead thecode. The third year student whispered to a classmate thatthe patient was DNR but did not know what to do—thestudent did not know resuscitation efforts could be stoppedonce initiated. After several minutes the student realized thatthere was no harm in reminding the team of the DNR statusof the patient. After discussion, during which the codecontinued, resuscitation efforts were terminated and thepatient was pronounced dead.Error analysisIn spite of the ethical, legal, and individual value of DNRorders, the medical community lacks consistent mechanismsfor maintaining continuity of a patient’s code status and theyhave been overlooked in the past. 30 Wachter and Shojania 15reported the termination of resuscitation efforts because thewrong patient’s chart was pulled and, similarly, a junior staffmember was afraid to speak up (the patient’s nurse, just outof nursing school, correctly thought that the patient was fullcode). This case illustrates the confusion and diffusion ofauthority that can take place in resuscitations. 30Lesson learnedLike case 1, this case illustrates the troubling pattern of medicalstudents being afraid to speak up, suggesting greater need forincreased communication based competency training of allparties from student to faculty member. When medical studentspossess vital information it is essential that it is promptlycommunicated to the team. In addition, students’ medicalknowledge competency should include information on appropriateinitiation and termination of resuscitation efforts. Finally,in terms of patient centred care, emphasis should be placed onappropriate display and communication of patients’ individualresuscitation preferences.Case 4: Infection precautions complicated bylanguage barrierA third year student on his medicine rotation was called tothe Emergency Department (ED) to evaluate a Spanishspeaking patient with a presumed pneumonia. As the studenthad only moderate Spanish skills, he decided to request atranslator. The student found the patient’s symptomsincluded hemoptysis, night sweats, and weight loss, andthe patient had recently immigrated from Mexico where hermother had died of tuberculosis (TB). The student immediatelyobtained protective masks for the providers, the patient,and the patient’s husband. The student asked the EDattending whether TB was on her differential diagnosis forthis patient, to which the attending responded: ‘‘Yeah, Ithought about it’’. The attending did not comment about thepossible danger the patient posed to the other patients, thestudent, or the translator. Examination of the chest radiographrevealed markings consistent with TB. Several dayslater the patient’s sputum tested positive for acid-fast bacilli(diagnostic for TB). The patient was placed on appropriatetreatment and exposed staff were screened for PPD conversion.Error analysisThe error in this case is one of delaying treatment andexposing other patients and staff to a potentially infectiousdisease. This error probably occurred because of insufficienttriage evaluation of a patient with a cough and wascomplicated by the language barrier.Lesson learnedMedical students are repeatedly told in their training that thepatient’s history is their most powerful diagnostic tool. Aninability to communicate effectively, due to language barrieror otherwise, significantly diminishes the effectiveness ofpatient histories. Students, with their additional time, maymore readily seek the help of translators. In this case we cansee that this student’s perseverance led to the correctdiagnosis and correct treatment for the patient and alsoavoided further unnecessary exposure of hospital personnel.However, this case also illustrates the difficulty that studentsand other trainees may encounter when trying to conveyinformation or management suggestions to an unreceptivesuperior, and the need for competency in communication andpatient centred care. In this case the student pursued adiagnosis of TB that the attending had dismissed. In suchwww.qshc.com111

Downloaded from qhc.bmjjournals.com on 2 August 2006Role of medical students in patient safety 275situations, appropriate but sensitive confrontation with thegoal of providing safe patient care is imperative. In addition,students should note that systems changes could alsoimprove patient centred care and communication—forinstance, by automatically paging a translator when a non-English speaking patient arrives in triage.DISCUSSION AND RECOMMENDATIONSIn this paper we present several cases in which medicalstudents appropriately characterized a problematic situationand, in some cases, prevented a medical error and patientharm. Medical students are members of the healthcare teamwith sufficient knowledge and awareness to recognizemedical errors and add another layer to system defences.Moreover, because students follow fewer patients and canspend more time with each patient than residents, they canafford greater attention to detail. While students can andshould participate to their fullest ability to enhance patientsafety, it should be noted that students should never be seenas being the principal team member responsible for patientsafety, as they may often be required to leave patient careactivities for lectures, examinations, or to study. And there isalways the possibility that a student’s knowledge base will bedeficient to prevent a particularly complex error fromoccurring.This paper does not present examples in which studentsthemselves may cause errors (procedural or otherwise),another important subject that has received only limited15 31attention. Some recommendations—such as a patientsafety curriculum for undergraduate medical education,16 17 32–34 the use of interdisciplinary team training, 32–40and the use of simulation 34 41 42 —show promise as usefulinterventions to improve safety, but have been significantlydiscussed elsewhere. We offer below new recommendationscategorized by the ACGME resident based competencies 22 toincrease student awareness of medical errors and to empowerthem as team members who can contribute to patient safety.These recommendations are derived from the experiencesseen in the cases presented above. However, the smallnumber of cases examined may mean that the cases are notgeneralizable to all medical student experiences.N Improve students’ interpersonal, communication, and32 33 35–40professionalism skills.N Train students to practise patient centred care and to befamiliar with patient information that is essential tosafety.N Train students in elements of practice-based learning andimprovement as well as systems-based practice.N Provide students with appropriate medical knowledge forcommon causes of medical error.Recommendation 1: Improve students’ interpersonal,communication, and professionalism skillsProviding health care always involves accessing pertinentinformation and data. The number of sources and the largevolume of information that must be synthesized stack theodds that a clinician may at some point miss an importantpiece of data. Students should be trained and have practicalexperience in speaking up without hesitation when theypossess information that is critical to safe patient care. Thewrist arthroscopy and the DNR order cases indicate the needfor students to be vocal when they possess overlookedinformation and how hierarchy and unfamiliarity with rolesand responsibilities can hamper disclosure. Prefacing phrasessuch as ‘‘I’m probably mistaken, but…’’ or ‘‘this might be aridiculous question, however…’’ can deflect the confrontationalinteraction that might otherwise discourage a studentfrom questioning the action of his/her superior.Similarly, the medical staff hierarchy must becomereceptive to students raising patient safety-related questions.Students rarely spend a period longer than a month in anyone clinical setting, and thus may always have a tendency tofeel like an outsider. 18 Our experience and that of othersshows that students may feel hesitant and delay communicatinga known error because of their junior or outsiderstatus and the intimidation they feel from the medicalhierarchy. 34 40 In aviation, a hesitancy to question the captainled to 583 fatalities in the 1977 collision at Tenerife, CanaryIslands—the worst aviation accident in history. As a result ofthis accident, however, the training technique of crewresource management (CRM) was pioneered in an attemptto teach that concerns regarding safety can and must beconveyed by any team member. 15 Moreover, high reliabilityorganizations (such as aviation and nuclear power) teach usthe importance of having respect for an individual’s34 43expertise, regardless of their rank. In addition, becausepatient safety is such a new topic in the realm of medicalknowledge, all learners from medical student to attendingfaculty can be considered novices and should be equallyreceptive to questions and comments regarding safety. 43Making the medical staff more receptive to students raisingsafety questions requires challenging cultural changes thatwill not occur without consistent high level leadership,ongoing training in communication and teamwork, andaccountability for patient safety outcomes. 44 45 In this way themedical staff might see students as assets in trying to helpthe team reach patient safety goals. Finally, students shouldrecognize that appropriate competency in professionalismmeans the patient’s needs for safe patient care supersede anyself-interest that might cause hesitancy in bringing attentionto a potential error.Recommendation 2: Train students to practise patientcentred care and to be familiar with patientinformation that is essential to safetyStudents should be familiar with common and essential dataabout their patients such as medications (that they areordered and administered), allergies, code status, and otherinformation that might easily be overlooked. The second caseabove illustrates how an ordered drug may not actually beadministered. Also, when patients have a procedure orsurgery planned, students should assist the team incompleting verification of site, side, correct patient, andcorrect procedure.Recommendation 3: Train students in elements ofpractice-based learning and improvement as well assystems-based practiceStudents should report errors and near miss events toavailable reporting systems to enhance understanding oferrors. 17 46 47 While students sometimes report errors toresidents and faculty, event reporting tools are used muchless frequently. 17 Moreover, by reporting both errors and nearmiss events, students contribute to the knowledge base thatcan help prevent future errors and increase their ownawareness of error prevention.In addition, a demonstrated understanding and attentionto quality and patient safety should be part of medicalstudent competencies and corresponding evaluation. Formedical students especially, assessment drives behavior. 34 Ifstudents are expected to achieve competency in improvingquality and safety and are given methods to achieve thiscompetency, they will do so. For example, routine evaluationson clinical clerkships could include a question as to whetherthe student noticed, discussed, or otherwise contributed toareas of quality improvement or safety concerns. 22112www.qshc.com

Downloaded from qhc.bmjjournals.com on 2 August 2006276 Seiden, Galvan, LammRecommendation 4: Provide students withappropriate medical knowledge for common causes ofmedical errorIn the case series presented here, medical knowledge wasnecessary in sterile technique (case 1); postoperative perforationsafter gastrointestinal surgery and medication prophylaxis(case 2); ethical termination of resuscitation efforts(case 3); and recognition of contagious diseases such as TB(case 4). This is merely an anecdotal list of ways in whichmedical knowledge can be important to safety. While thenecessary knowledge for these cases might be imparted inany medical school curriculum (for example, in the surgeryclerkship or ethics course), specific emphasis on how this issafety related content should also be provided.Comprehensive literature on the epidemiology and etiologyof medical error should be matched to related content inmedical school curricula so that specific safety relatedmedical knowledge is developed. 48Incorporation of these recommendations can bolster thesafety in academic medical centers by using medical studentsas a previously untapped advocate for patient safety.ACKNOWLEDGEMENTSThe authors thank Julie Johnson, Paul Barach, Robert Wachter, JohnHickner, Steve Small, and David Stevens for review and suggestionsregarding this manuscript......................Authors’ affiliationsS C Seiden, The University of Chicago, Department of Pediatrics, ComerChildren’s Hospital, Chicago, IL, USAC Galvan, Northwestern University, Department of EmergencyMedicine, Chicago, IL, USAR Lamm, Harvard Affiliated Emergency Residency, Brigham andWomen’s and Massachusetts General Hospital, Boston, MA, USACompeting interests: none.REFERENCES1 Starfield B. Is US health really the best in the world? JAMA 2000;284:483–5.2 Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a saferhealth system. Washington, DC: Institute of Medicine, National AcademyPress, 2000.3 Volpp KG, Grande D. Residents’ suggestions for reducing errors in teachinghospitals. N Engl J Med 2003;348:851–5.4 Hobgood CD, Ma OJ, Swart GL. Emergency medicine resident errors:identification and educational utilization. Acad Emerg Med 2000;7:1317–20.5 Schenkel SM, Khare RK, Rosenthal MM, et al. Resident perceptions of medicalerrors in the emergency department. Acad Emerg Med 2003;10:1318–24.6 Wu AW, Folkman S, McPhee SJ, et al. Do house officers learn from theirmistakes? Qual Saf Health Care 2003;12:221–8.7 Joint Committee of the Group on Resident Affairs and Organization ofResident Representatives. Patient safety and graduate medical education,Association of American Medical Colleges, 2003.8 Hoff TJ, Pohl H, Bartfield J. Creating a learning environment to producecompetent residents: the roles of culture and context. Acad Med2004;79:532–9.9 Battles JB, Shea CE. A system of analyzing medical errors to improve GMEcurricula and programs. Acad Med 2001;76:125–33.10 Rosebraugh CJ, Tsong Y, Zhou F, et al. Improving the quality of adverse drugreaction reporting by 4th-year medical students. Pharmacoepidemiol Drug Saf2003;12:97–101.11 Lee SK, Cowie SE. MSJAMA: Medical students and remediation of error.JAMA 2001;286:1082–3.12 Rajendran PR. MSJAMA: Ethical issues involved in disclosing medical errors.JAMA 2001;286:1078.13 Fost N. MSJAMA: Ethical issues in whistleblowing. JAMA 2001;286:1079.14 Wusthoff CJ. MSJAMA: Medical mistakes and disclosure: the role of themedical student. JAMA 2001;286:1080–1.15 Wachter R, Shojania K. Internal bleeding: the truth behind Americàs terrifyingepidemic of medical mistakes, 1st ed. New York, NY: Rugged Land, 2004.16 Halbach JL, Sullivan LL. Teaching medical students about medical errors andpatient safety: evaluation of a required curriculum. Acad Med2005;80:600–6.17 Madigosky WS, Headrick LA, Nelson K, et al. Changing and sustainingmedical students’ knowledge, skills, and attitudes about patient safety andmedical fallibility. Acad Med 2006;81:94–101.18 AHRQ Web M&M. Low on the totem pole, 2005. Available at http://webmm.ahrq.gov/case.aspx?caseID = 110 (accessed 1 December 2005).19 Joint Commission on Accreditation of Healthcare Organizations (JCAHO).Sentinel event statistics, 2005. Available at http://www.jcaho.org/SentinelEvents/Statistics/ (accessed 10 March 2006).20 Lingard L, Reznick R, Espin S, et al. Team communications in the operatingroom: talk patterns, sites of tension, and implications for novices. Acad Med2002;77:232–7.21 Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidiouscontributor to medical mishaps. Acad Med 2004;79:186–94.22 Accreditation Council for Graduate Medical Education (ACGME). ACGMEoutcomes project: general competencies. Version 1.3, 1999. Available athttp://www.acgme.org/outcome/ (accessed 1 December 2005).23 Thomas EJ, Sexton JB, Helmreich RL. Discrepant attitudes about teamworkamong critical care nurses and physicians. Crit Care Med 2003;31:956–9.24 Pronovost P, Weast B, Schwarz M, et al. Medication reconciliation: apractical tool to reduce the risk of medication errors. J Crit Care2003;18:201–5.25 Joint Commission on Accreditation of Healthcare Organizations (JCAHO).Universal protocol for wrong site, wrong procedure and wrong personsurgery, 2003. Available at http://www.jointcommission.org/PatientSafety/UniversalProtocol/ (accessed 15 April 2006).26 Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician orderentry systems in facilitating medication errors. JAMA 2005;293:1197–203.27 Barnsteiner JH. Medication reconciliation: transfer of medication informationacross settings – keeping it free from error. Am J Nurs 2005;105(3Suppl):31–6.28 Joint Commission on Accreditation of Healthcare Organizations (JCAHO).Joint Commission 2006 National Patient Safety Goals. Available at http://www.jcaho.org/accredited+organizations/patient+safety/06_npsg_ie.pdf(accessed 15 August 2005).29 Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: a practicalmethodology for measuring medication related harm. Qual Saf Health Care2003;12:194–200.30 Lynn J, Goldstein NE. Advance care planning for fatal chronic illness:avoiding commonplace errors and unwarranted suffering. Ann Intern Med2003;138:812–8.31 Friend T. Medical mistakes happen when safeguards fail. USA Today 1 April,2003.32 Adams KA GG, Searcy CA. Development of a performance model of themedical education process. Technical Report commissioned by the Associationof American Medical Colleges. Washington, DC: American Institutes forResearch, 2001.33 Baker DP, Salas E, King H, et al. The role of teamwork in the professionaleducation of physicians: current status and assessment recommendations. JtComm J Qual Patient Saf 2005;31:185–202.34 Aron DC, Headrick LA. Educating physicians prepared to improve care andsafety is no accident: it requires a systematic approach. Qual Saf Health Care2002;11:168–73.35 Aggarwal R, Undre S, Moorthy K, et al. The simulated operating theatre:comprehensive training for surgical teams. Qual Saf Health Care2004;13(Suppl 1):i27–32.36 Flin R, Maran N. Identifying and training non-technical skills for teams in acutemedicine. Qual Saf Health Care 2004;13(Suppl 1):i80–4.37 Healey AN, Undre S, Vincent CA. Developing observational measures ofperformance in surgical teams. Qual Saf Health Care 2004;13(Suppl1):i33–40.38 Morey JC, Simon R, Jay GD, et al. Error reduction and performanceimprovement in the emergency department through formal teamwork training:evaluation results of the MedTeams project. Health Serv Res2002;37:1553–81.39 Thomas EJ, Sexton JB, Helmreich RL. Translating teamwork behaviours fromaviation to healthcare: development of behavioural markers for neonatalresuscitation. Qual Saf Health Care 2004;13(Suppl 1):i57–64.40 Pronovost PJ, Wu AW, Sexton JB. Acute decompensation after removing acentral line: practical approaches to increasing safety in the intensive careunit. Ann Intern Med 2004;140:1025–33.41 Gaba DM, Howard SK, Flanagan B, et al. Assessment of clinical performanceduring simulated crises using both technical and behavioral ratings.Anesthesiology 1998;89:8–18.42 Halamek LP, Kaegi DM, Gaba DM, et al. Time for a new paradigm inpediatric medical education: teaching neonatal resuscitation in a simulateddelivery room environment. Pediatrics 2000;106:E45.43 Stevens DP. Finding safety in medical education. Qual Saf Health Care2002;11:109–10.44 Colla JB, Bracken AC, Kinney LM, et al. Measuring patient safety climate: areview of surveys. Qual Saf Health Care 2005;14:364–6.45 Pronovost P, Sexton B. Assessing safety culture: guidelines andrecommendations. Qual Saf Health Care 2005;14:231–3.46 Kaplan H, Barach P. Incident reporting: science or protoscience? Ten yearslater. Qual Saf Health Care 2002;11:144–5.47 Runciman WB, Sellen A, Webb RK, et al. The Australian Incident MonitoringStudy. Errors, incidents and accidents in anaesthetic practice. AnaesthIntensive Care 1993;21:506–19.48 Weingart SN, Wilson RM, Gibberd RW, et al. Epidemiology of medical error.BMJ 2000;320:774–7.www.qshc.com113

Downloaded from qhc.bmjjournals.com on 30 August 2006114NEAR MISSES AND THEROLE OF HIERARCHY INEDUCATIONAL ANDRESEARCH SETTINGSTwo original papers and two commentariesin this issue of QSHC highlighthow system hierarchy inhibits identificationof risk in both educational andresearch settings. A report authored bythree medical students reminds thereader that because students and traineesare on the frontlines of patientcare, they frequently observe nearmisses that—if candidly addressed—could serve both to make patient caresafer but also to provide valuablelearning opportunities. The medicalhierarchy complicates the ability ofthese junior members of the careenterprise to assert their concerns.Addressing the complex issue of assertivenessin these hierarchies by juniorcolleagues deserves explicit attention byour teaching hospitals and systems. Asecond commentary suggests that nearmisses may be pervasive in clinicalresearch settings. The authors proposea formal near-miss reporting system forclinical research settings that maypromote both safer care and betterresearch. Just as students and juniordoctors are mindful of the inhibitoryhierarchies in teaching settings, the roleof hierarchy in clinical research settingsaffects all health professionals—nurses,pharmacists, and clerical personnel—who are in a position to discern a highrisk clinical environment.See p 272, 229, 228 and 271THE NEED FOR BETTERADVICE REGARDINGNON-PRESCRIPTIONMEDICATIONSMany recently reclassified Non-Prescription Medications (NPM, alsocalled ‘‘over-the-counter medications’’in North America) are of increasingpotency compared with earlier NPMmedicines. Hence the consequences ofinappropriate supply or use are potentiallymore serious. This UK studyobserved that pharmacists’ consultationsfor these medicines were frequently notguideline-compliant. The consequencesDavid P Stevens, Editorof inappropriate supply and use of NPMs are relatively unknown, but need to beexplored as medicine reclassification will result in greater volumes of potent medicinesbeing supplied from community pharmacies, and non-pharmacy retail outlets.See p 244TIME OF DAY AFFECTS ANAESTHESIA ADVERSE EVENTSA retrospective analysis of the effect of time of day on provider reported anaestheticadverse events shows an increased risk of adverse events for patients anesthetized atthe end of the work day compared to the beginning of the day. Although this mayresult from patient-related issues, medical care delivery factors such as case load,fatigue, and care transitions may also be influencing the rate of adverse events forcases that start in the late afternoon.See p 258IMPROVING COMFORT IN INTENSIVE CARE UNITSOne of the most complex settings in health care is the intensive care unit (ICU).Prevention and the relief of suffering easily can get caught in the web of complicatedtreatment, multidirectional communication, and individual preferences. This reportdescribes the use of an iterative process to develop a ‘‘bundle’’ of indicators forimprovement in the quality of palliative care in the ICU. The feasibility of the bundlewas successfully demonstrated by pilot testing in 19 ICUs. This work offersopportunities for further improvement in clinician-patient communication as well asother important components of palliative care in this setting.See p 264A VISIT TO THE QSHC HOMEPAGEThe QSHC homepage has had a facelift. We have been particularly interested inenhancing its function, for example, by pruning little-used functions and addingnew shortcuts. Dom Mitchell, Web Administrator for BMJ Journals, provides a walkthrough the functionality of the homepage. QSHC is committed to helping ourreaders make full use of this resource. As always, we are open to additionalsuggestions for its improvement.See p 226

Downloaded from qhc.bmjjournals.com on 3 August 2006COMMENTARIES 229......................Authors’ affiliationsH J Murff, R S Dittus, Division of GeneralInternal Medicine and Public Health,Vanderbilt University Medical Center and theDepartment of Veterans Affairs, TennesseeValley Healthcare System, GRECC, Nashville,TN, USACorrespondence to: Dr H J Murff, Departmentof Veterans Affairs, VA Tennessee ValleyHealthcare System, GRECC, 1310 24th AvenueSouth, Nashville, TN 37212-5381, USA;Harvey.murff@med.va.govCompeting interests: none.REFERENCES1 Cassel C, Stock MC, Wood AJ, et al. Report ofJohns Hopkins University External ReviewCommittee, 8 August, 2001.2 Steinbrook R. Improving protection forresearch subjects. N Engl J Med2002;346:1425–30.3 Burke JP. Infection control – a problemfor patient safety. N Engl J Med2003;348:651–6.4 Shaw R, Drever F, Hughes H, et al. Adverseevents and near miss reporting in the NHS. QualSaf Health Care 2005;14:279–83.5 Murff HJ, Byrne DW, Harris PA, et al. ‘‘Nearmiss’’reporting system development andimplications for human subjects protection. In:Henriksen K, Battles JB, Marks ES, Lewin DI, eds.Advances in patient safety:from research toimplementation. Volume 3. Implementation issues.AHRQ Publication No 05-0021-3. Rockville, MD:Agency for Healthcare Research and Quality(AHRQ), 2005.6 Murff HJ, Pichet JW, Byrne DW, et al. Researchparticipant safety and system factors in generalclinical research centers. IRB: Ethics and HumanResearch 2006 (in press).Hierarchies and patient safety.......................................................................................Hierarchies: the Berlin Wall of patientsafetyM M Walton...................................................................................To maximise patient safety considerations the medical hierarchyneeds to be balanced in favour of teaching and learning ratherthan the exercise of powerReporting and preventing adverseevents is the theme in two papersin this issue. In their commentary,Murff and Dittus 1 suggest that nursesand pharmacists could report medicationerrors and equipment failures duringclinical research, and Seiden et al 2identify a role for medical students inrecognising and preventing errors duringtheir clinical attachments.While I agree with their recommendationsfor improved reporting,enhanced communication and actingethically, I remain sceptical that changewill occur without significant examinationand understanding of the role ofhierarchies in our healthcare system.UNDERSTANDING WHERE WEHAVE COME FROMThe word ‘‘hierarchy’’, first found in1380 in the Oxford English Dictionary,referred to priests in relation to God.Today the term has broader applicationand refers to a group of individualsranked according to authority, capacity,or position. At the turn of the 20thcentury hospitals were organised intohierarchical structures with the medicalhierarchy at the pinnacle. 3 Typically,this involved ever increasing powerwith each rank subject to the authorityof the next level up. This arrangementhas endured despite increased complexityand costs and significantchanges in technology. Hospital patientpopulations, clinical pathways, andworkforce have radically changed overthe last three decades, yet the organisationalstructure for doctors remainssubstantially unchanged since the 19thcentury. 4 New areas (specialties andsubspecialties) have been accommodatedby adding to existing structures,creating departments and hierarchiesoften without reference to the needs ofpatients.Nineteenth century medical apprenticeswere legally bound to their surgeon(master) for 7 years, during which timethey worked as a servant in return forthe acquisition of skills to enable themto practice. 5 Surgeons had no more thantwo apprentices at any one time, thusallowing them an intimate knowledgeof their trainees. Today interns, residents,and registrars work with manyhealth professionals and seniors on aday to day basis and are required tounderstand and implement instructionsfrom doctors above them. Registrarswork for five or more consultants.They are expected to follow the usuallyunwritten rules of each of their ‘‘bosses’’and to take instructions. This results ininadequate communication, fragmentedsupervision, inadequate instructions,and more frequent suboptimal patientoutcomes. 6The medical hierarchy, a naturalderivative of the apprenticeship model,is today best characterised by the powerrelationship between a superior and asubordinate rather than the relationshipbetween teacher and learner. The goodingredients of the apprenticeshipmodel—mentoring, coordination, andconstant observation—only survive intemporary situations such as a teachingsession between a clinician and trainee.Instead, what has survived is theunhealthy obsequiousness shown by asubstantial portion of health professionals,medical students, and juniordoctors to senior clinicians.HOW THIS IMPACTS ON CAREERPROGRESSIONMedical students, interns, and residentsare low in the hospital and medicalhierarchies and remain dependent uponclinical supervisors for their instructionsand learning. Their progress up thehierarchy depends on favourable reportsfrom supervisors about their competence,performance, and professionaldevelopment. Maintaining a good relationshipwith those higher up the ladderunderstandably becomes a prime focus,often at the expense of other prioritiessuch as reporting on errors or on poorpatient care. Calling attention to asupervisor’s mistakes or potential mistakesmay have repercussions for thejunior. Medical students, interns, residentsand registrars tell me about theirfears (real or imagined) that disclosingmistakes—even reminding a seniorabout a protocol—may lead to anunfavourable report, decreased employmentopportunity, reduced chance ofaccess to training programs, or all three.The unequal power relationshipmeans that novices will be silent whenthey should speak up. This is notbecause we are training unethical orbad doctors. They do what they dobecause they have no option. Raising apotential problem or error with a senioror contradicting their decisions becomesstill more problematical if the clinicianpractices in the area of medicine whichinterests the junior.www.qshc.com115

Downloaded from qhc.bmjjournals.com on 3 August 2006230 COMMENTARIESSENIOR MEMBERS OF THEHIERARCHY RARELY REPORT ORTALK ABOUT ERRORIn addition to career fears, juniordoctors say they rarely see their seniorsreport or act on errors—their own orthose of others. 7 One explanation forthis may be that many clinicians are stillnot familiar with patient safety conceptsand do not have the knowledge andskills to practise safety principles.Perceived medicolegal fears and unwarrantedadministrative intrusions intopractice also inhibit error acknowledgement.8 But notwithstanding many of thecultural barriers, some clinicians areusing innovative teaching methodsdesigned to encourage individual assertiveness.One clinician I know conductsassertiveness training of the ward staffby intentionally making a prescribing ortreatment error and expecting the medicaland nursing staff to speak up whenhe does so. He tells them before theround that he will be deliberately makingan error, and that during the roundmembers of the team are to speak up toavoid him acting on the error.THE VOID IN UNDERSTANDINGERRORSAlthough a widely used and popularway of learning is the use of narrative, itis not the best way to learn about errors.The common use of the words ‘‘stuffup’’ or ‘‘screw up’’ to describe anadverse event suggests a lack of knowledgeabout errors and reinforces thepersonal circumstances and impact ofmistakes instead of a multifactorialanalysis. Narrative experiences are noteasily translated into professional discourseunless clinicians practise whatthey teach.During the preparation of a patientcase presentation to a medical wardmeeting by a team of medical, nursing,physiotherapy and occupational therapystudents participating in an interprofessionallearning project, the students toldme the patient had an adverse eventfrom a wrong medication order. As aresult the patient had been transferredto ICU for a few days before returning tothe ward. They wanted to know whetherthey should include this in their presentation.The medication error was areportable incident but, until the medicalstudent discussed it with the nurseunit manager, no report had been doneand no discussion had taken place withthe ward team. The students presentedthe case including the informationabout the medication error to the wardteam which, on this occasion, includedthe doctors. They used neutral languagefocusing on what happened and howthe patient was treated. They focused onthe patient and made no reference to‘‘who’’ was involved in the incident. Itwas obvious that the staff were not usedto such a comprehensive case discussion.I explained to the students duringthe debriefing that the language fordiscussing and learning from errors isstill underdeveloped, with many healthprofessionals unable to shift from the‘‘who did it’’ to ‘‘what happened’’. Icongratulated them on their presentation.CONCLUSIONMurff and Dittus 1 and Seiden et al 2emphasise that adverse events inresearch and clinical care can be minimisedwhen health providers (pharmacists,nurses and medical students)identify and report errors and potentialproblems. This will only happen whenthe positive attributes of the medicalhierarchy govern—such as leadership,promotion of shared team responsibilities,and respect for all members of thehealthcare team. From a patient’s perspective,why shouldn’t everyone caringfor them play such a role? We need tochange the framework for thinkingabout patient safety: to move away fromthe ‘‘discipline’’ hierarchy approach to apatient centred one in which the competenciesfor patient safety are designedfor everyone depending on their level ofresponsibility for patient care. Theauthors identified two key patient safetyactivities—namely, the need for appropriateassertiveness and honest andtimely reporting. These are importantcompetencies. Everyone—receptionists,cleaners, students, health professionalsworking under supervision, supervisorsand managers—should be able todemonstrate them. A ‘‘whole of system’’approach focuses on personal and teamresponsibilities, not hierarchies. Whenthe hierarchy is balanced in favour ofteaching and learning rather than theexercise of power, everyone will becomea resource.Qual Saf Health Care 2006;15:229–230.doi: 10.1136/qshc.2006.019240Correspondence to: AssociateProfessor M M Walton, Faculty of Medicine,University of Sydney, Sydney 2006, New SouthWales, Australia; mwalton@med.usyd.edu.auCompeting interests: none.REFERENCES1 Murff HJ, Dittus RS. Near misses and researchsubjects. Qual Saf Health Care 2006;15:228–9.2 Seiden SC, Galvan C, Lamm R. Role of medicalstudents in preventing harm and enhancingpatient safety. Qual Saf Health Care2006;15:272–6.3 Starr P. The social transformation of Americanmedicine. New York: Basic Books, 1982.4 Cassell EJ. Historical perspective of medicalresidency: 50 years of changes. JAMA1999;281:1231–3.5 Sinclair S. Making doctors: an institutionalapprenticeship. Oxford, UK: Berg, 1997.6 Feinstein AR. System, supervision, standards andthe epidemic of negligent medical errors. ArchIntern Med 1997;157:1285–9.7 Lawton R, Parker D. Barriers to incident reportingin a healthcare system. Qual Saf Health Care2002;11:15–8.8 Waring J. Beyond blame: cultural barriers tomedical reporting. Soc Sci Med2005;60:1927–35.116www.qshc.com

AHRQ WebM&M: Case & Commentary Print ViewPage 1 of 5PrintClose WindowSurgery/Anesthesia | December 2005 |Low on the Totem PoleSPOTLIGHT CASECommentary by Robert M. Wachter, MDCase Objectives• Understand the concept of authority gradient• List steps that can be taken to increase communication across an authority gradient• Consider the current culture of safety in your own institutionCase & Commentary: Part 1A fourth-year medical student on rotation in the pediatric intensive care unit (PICU) was invited to observethe operative repair of a congenital heart lesion in the pediatric cardiac surgery operating room (OR).When the student arrived in the OR, the patient was already intubated and anesthetized, and procedureswere under way to prep the patient for surgery. The student observed one of the team members insert aFoley catheter into the female patient. He was surprised to see that no efforts were made to perform“sterile prep” prior to insertion. However, being new to this setting and assuming different practices wereused in pediatric patients, the student dismissed the incident and did not mention it to anyone in the OR.In a previous issue of AHRQ WebM&M, a senior medical student thoughtfully discussed the pressuresstudents feel when they witness an error and struggle with the questions of whether and how to bring upthe issue [See related commentary]. Since I completed medical school soon after Watergate, I won’tattempt to remember how students feel when put in such a position. I will, however, use this case todiscuss the concept of authority gradients and how they relate to creating a culture of safety.Health care is remarkable for its interdependencies across personnel. Think of this PICU. There, highlytrained neonatologists and surgeons work side-by-side with, and are often dependent on, fellows,residents, and students. These medical personnel are exceptionally important to the care of patients. Butequally important, and often more important, is a virtual army of nurses, respiratory therapists, clinicalpharmacists, and clerks. These individuals play a vital role in ensuring the quality and safety of care; eachmay be the one to witness an error in the making, and each must share in the ever-changing flow ofinformation—everything from the patient’s creatinine level to the concerns of the patient’s family. It isdifficult to think of another workplace where such a diverse group of people work so closely together andare so dependent on each other to create positive outcomes.In all of this, the medical student occupies a particularly challenging position. Status in such workplacescomes because one is either an authority, in authority, or both. He is neither. In fact, the usual hierarchyin the medical workplace, with physicians at the top of the heap, is set on its head: within moments, thesavvy student recognizes that the ICU nurse has far more setting-specific knowledge than he, often morethan senior physicians. During my first day of internship, one of my colleagues taught me this lesson quitevividly. Admitting a complex patient with an acute myocardial infarction and heart failure, he failed tohttp://webmm.ahrq.gov/printview.aspx?caseID=1106/18/2007117

AHRQ WebM&M: Case & Commentary Print ViewPage 2 of 5prescribe a certain indicated medication to the patient. On rounds the next morning, the attending, asenior and highly revered teacher, gently asked him why he failed to begin the medicine. Bleary eyed, hemurmured, “Well, the nurse didn’t suggest it.” I admired his honesty.In witnessing a practice that he thought might be unsafe and not knowing what to do with his concerns,the student thus faces a predicament. Coupled with his feeling that his worries might be unfounded(maybe this procedure doesn’t require aseptic technique) is the massive authority gradient: he is about aslow on the totem pole as one can get in that ICU, and, unless this issue has been addressed proactively, heis unlikely to raise his concerns.How could this be done? It might be as simple as giving all students a primer on using the hospital’sincident reporting system or having the clerkship director or attending state at orientation, “You’re likely tosee some things during this rotation that you’re not sure about. Sometimes, you’ll wonder whether a givenpractice is in error or is putting the patient at risk. I want you to page me if you see such a thing, and we’lltalk it through. I know that’s hard—I remember what it felt like to be in your position, wondering whetheryou knew enough to be sure that what you were seeing was wrong, and what would happen if you raisedan alarm. But you’re in a unique position to catch things—you have the time to observe things that I don’t,and you bring a fresh set of eyes and ears. So please, let me know if you have any questions or concerns.”Note that, even if he is given a protocol for reporting errors and safety concerns but perceives that theculture is not supportive of such action, he is unlikely to come forward. As business consultants like to say,“Culture eats strategy for lunch.”Case & Commentary: Part 2The student followed the patient during her PICU course. On postoperative day 3, the student found thatthe patient had been febrile overnight and a urine culture had grown Pseudomonas aeruginosa. On rounds,the student presented this new data, including the account of the Foley placement in the OR. The patient’sFoley catheter was discontinued and appropriate antibiotic coverage provided. Subsequent urine cultureswere negative. After rounds, the student was approached by two attendings, separately. One remarkedthat the information about the catheter should not have been presented on rounds due to concerns thatpatients and family members might overhear. The second attending told the student this informationshould have been conveyed at the time of the incident. Neither attending commended the student forreporting the incident to the team. Shortly thereafter, the student submitted a report outlining the eventsin the OR to the institutional patient safety office.Sexton and colleagues surveyed operating room personnel, asking whether they perceived teamwork asbeing strong.(1) The results are shown in the Figure. Note that nearly 80% of attending surgeons, clearlyatop the authority chain, perceived teamwork to be strong, while only 10% of anesthesia residents, at thebottom, felt the same way (proving, as always, that one should virtually never ask the leader to assess thequality of teamwork). One can only assume that students’ perceptions would have been even worse.Perhaps more germane to the patient safety question, Sexton asked both surgeons and commercial airlinepilots whether they would want someone to question them if they thought they were doing somethingwrong. Virtually every pilot answered in the affirmative. A generation ago, aviation learned the lesson fromseveral horrible accidents that tragedy can often be averted when everyone feels comfortable raising their118http://webmm.ahrq.gov/printview.aspx?caseID=1106/18/2007

AHRQ WebM&M: Case & Commentary Print ViewPage 3 of 5concerns to the pilot, and the pilots welcome these questions.(2) Crew Resource Management (CRM)programs, implemented since the early 1980s, encourage this kind of cross talk, focusing in part onencouraging everyone to speak up if they have concerns. In the exercises, pilots learn that the messagesthat they send—spoken or unspoken—when someone does question their action indelibly cements theculture. If a pilot snaps, or even subconsciously assumes a disdainful facial expression, when a juniorcolleague raises a concern, the likelihood that similar concerns will be raised in the future plummets.Unfortunately, when Sexton asked surgeons the same question, nearly half said that they would not wanttheir coworkers to raise safety concerns during surgery.(1) The message to those lower on the authoritygradient (namely, everyone) is unmistakable: speak only at your own risk. This is certainly the messagethis student received from the first attending when he finally spoke up on rounds. Perhaps the secondattending meant to be supportive, but by failing to acknowledge the student’s position and predicament,she may have implied that the student had handled this poorly. The student’s actions could have beensimultaneously applauded and gently critiqued had the attending simply said, “I really appreciate youbringing this concern up. I know it’s really hard to do. In the future, if you see something like thathappening, please come right to me. It’s the only way we can keep our patients safe.”How can we establish a culture in which individuals feel comfortable breaching authority gradients to raisesafety concerns? First, there has to be a clear protocol for reporting: it does little good to establish cultureif the workers don’t understand the practical aspects of reporting. Second, evidence is accumulating thatspecific teamwork training, modeled on CRM, can help establish the desirable climate among the rank-andfileworkers.(3) My colleagues and I (physicians, nurses, and pharmacists) recently received a grant fromthe Gordon and Betty Moore Foundation to begin such a program at UCSF (along with Kaiser PermanenteHospital in San Francisco and El Camino Hospital), using actual commercial airline pilots to help conductthe training.Finally, an unmistakable message needs to be set by senior leadership about the necessity and moralimperative to “stop the presses” when someone witnesses a possible error or breach in a safety protocol.Because of the massive production pressure, health care workers feel uncomfortable raising an alarm whenthey merely suspect, but are not sure, that something is wrong. Rather than risking a false alarm and itsaccompanying stigma, they have learned to say, “Oh, it’s probably okay, ” and let it slide. We havedocumented one case in which this dynamic helped lead to a patient’s cardiac resuscitation being abortedin error (4), and another in which a patient received an invasive cardiac procedure intended for anotherpatient.(5)In fact, I have come to believe that this issue is at the core of an institution’s safety culture. There are anumber of superb, validated tools to measure the institutional culture of safety.(6-8) They provide a veryimportant snapshot across a number of dimensions, and I strongly encourage their use. My test, however,is much simpler.Consider the lowest person in the hierarchy of a hospital, perhaps a young ward clerk (it could just aseasily be a medical or nursing student). He or she witnesses something that seems wrong—perhaps the ORis calling for a patient but there is no consent in the chart. The patient’s surgeon is the chief of cardiac orneurosurgery, a highly respected and prominent surgeon. He is known to have a bit of a temper. In fact,he has been known to throw things in the OR, and let’s say he has good aim.The clerk knows that making herself 100% sure that the OR is calling for the right patient will take ahttp://webmm.ahrq.gov/printview.aspx?caseID=1106/18/2007119

AHRQ WebM&M: Case & Commentary Print ViewPage 4 of 5couple of telephone calls, and so might delay the start of the case by 10 minutes. She sees that the day’sOR schedule is jam-packed. But, even after weighing all that, her primary concern is for the patient’ssafety, and she decides to confirm that everything is right. And it is. It was just a paperwork snafu, andthe patient really was supposed to go to surgery. Ten minutes later, she releases the patient to thetransporter.So here is the question: what happens to the clerk? Do her colleagues snicker at her, whispering just outof earshot during coffee breaks, while the surgical residents cut her an “Oh, she’s the one” look on roundslater that day? Or does the hospital CEO (and the surgeon) take a moment to pat her on the back, makingit clear that gutsy acts like hers—stopping the presses when you’re not sure everything is right, ratherthan doing so only when you’re absolutely sure they are wrong—are precisely what must be done toensure patient safety?I recently posed this test to an audience of 1000 at the National Patient Safety Foundation’s annualconference in Orlando, asking how many worked in institutions that would pass my test. About five handswent up. We have a long way to go.The medical student in this case is to be commended for raising his concerns. Creating a culture in whichhe was comfortable doing so in real time—as the procedure was being carried out and his concernsmaterialized—is the hard work we face. This will take leadership, new training programs, and specificreporting protocols. Until we take up this work and find the resources to support it, we will lack a culture ofsafety, and patients will be harmed unnecessarily.Robert M. Wachter, MDProfessor and Associate Chairman, Dept. of MedicineUniversity of California, San FranciscoEditor, AHRQ WebM&M and Patient Safety NetworkFaculty Disclosure: Dr. Wachter has declared that neither he, nor any immediate member of his family,has a financial arrangement or other relationship with the manufacturers of any commercial productsdiscussed in this continuing medical education activity. In addition, his commentary does not includeinformation regarding investigational or off-label use of pharmaceutical products or medical devices.References1. Sexton J, Helmreich R, Thomas E. Error, stress and teamwork in medicine and aviation: cross sectionalsurveys. BMJ. 2000;320:745-749.[ go to PubMed ]2. Hamman WR. The complexity of team training: what we have learned from aviation and its applicationsto medicine. Qual Saf Health Care. 2004;13(suppl 1):i72-i79.[ go to PubMed ]3. Morey JC, Simon R, Jay GD, et al. Error reduction and performance improvement in the emergencydepartment through formal teamwork training: evaluation results of the MedTeams project. Health ServRes. 2002;37:1553-1581.[ go to PubMed ]120http://webmm.ahrq.gov/printview.aspx?caseID=1106/18/2007

AHRQ WebM&M: Case & Commentary Print ViewPage 5 of 54. Wachter RM, Shojania KG. Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of MedicalMistakes. New York, NY: Rugged Land; 2004:209-214.5. Chassin MR, Becher EC. The wrong patient. Ann Intern Med. 2002;136:826-833.[ go to PubMed ]6. Hospital Survey on Patient Culture. Rockville, MD: Agency for Healthcare Research and Quality; April2005.Available at: http://www.ahrq.gov/qual/hospculture.7. Sexton JB, Thomas EJ. The Safety Climate Survey: psychometric and benchmarking properties.Technical Report 03-03. The University of Texas Center of Excellence for Patient Safety Research andPractice.Available at: http://www.uth.tmc.edu/schools/med/imed/patient_safety/Safety%20Climate-EWR.pdf8. Singer SJ, Gaba DM, Geppert JJ, Sinaiko AD, Howard SK, Park KC. The culture of safety: results of anorganization-wide survey in 15 California hospitals. Qual Saf Health Care. 2003;12:112-118.[ go to PubMed ]FigureFigure. Teamwork Level Rated as “High” (1)http://webmm.ahrq.gov/printview.aspx?caseID=1106/18/2007121

IndexANAcademic Schedule 3Needlestick/Exposure Procedure 15BOBias Response Team 30, 49, 50Ombudsmen 16, 49, 89CPDCareer Advising 93, 94Career Advising at Pritzker 94Career Advisor Contact Information 97Career Advisor/Society Roster 95, 96Careers in Medicine Website 98Digital Millennium Copyright Act 72Dress Code and Personal Appearance Policy 30Duty Hours Policy 30, 55RPolicies and Procedures 29, 30Pritzker School of Medicine Administration 75, 76, 77,78Professionalism at Pritzker 5Professionalism Concern Report 30, 52, 53Professionalism Concern Reporting Process 51References & Articles 103Resources 9, 30ESEvaluation and Treatment for Bloodborne PathogensExposures 14Excerpt from 2011-12 Academic Standards Guidelines32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46,47, 48Sandbox Access & Sign-Out Policy 56Scrub Policy 30, 64, 65, 66Student Health and Counseling Services 79, 80, 81, 82,83, 84, 85, 86, 87Student Support Services 73, 74FTFinancial Aid 101, 102Foreword 2Frequently Asked Questions 11The Learning Environment 30, 31To Do List: 2Transportation & Parking 20, 21GUHIMGuiding Principles of Professionalism 6, 7, 8HIPAA Privacy Rule 30, 67, 68, 69, 70, 71Holiday Policy 30, 54Important Numbers 10Map of Tunnel & Bridge between BSLC and the Hospital28MISTREAT 31, 49VWUniversity of ChicagoMedical Center Policies 57University of Chicago Police Department SecurityServices 17, 18, 19VPN and Webapps 12, 13Wellness 80, 88, 89, 90, 91, 92122