FACILITATOR GUIDE August 14-18, 2017 - Orientation Professional Development Groups Class of 2021
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Orientation
Professional Development Groups
Class of 2021
August 14-18, 2017
FACILITATOR GUIDE
1Table of Contents
**Please note! If you select a link within this document, it will take you to that location within the
document. To return to where you were, hit Shift and F5 at the same time.
Table of Contents.............................................................................................................................. 2
Professional Development Session Goals ........................................................................................ 3
Week at a Glance Orientation Schedule ........................................................................................... 6
PD Group Assignments and Room Locations ................................................................................... 7
Session I – Monday, August 14, 2017 ............................................................................................ 11
Instructions for the PD Group Code of Conduct Representatives ................................................... 15
Session II – Tuesday, August 15, 2017 .......................................................................................... 16
Related Policies: .................................................................................................................. 20
Session III – Thursday August 17, 2017 ......................................................................................... 23
Related Policies to Case I: ................................................................................................... 24
Related Policies to Case II: .................................................................................................. 29
PD Facilitator Instructions for the White Coat Ceremony ................................................................ 31
2Professional Development Session Goals
PD Group Facilitators:
Thank you for your interest and willingness to assist the members of the Class of 2021 with making
the transition to the profession of medicine. We are all familiar with the many new, exciting and
challenging situations related to professionalism that beginning medical students face. With the
Advisory Dean Program, (see https://admissionsstage.urmc-
sh.rochester.edu/oee/mdorientation/resources.html for details) the students have access to a safe
place where they can explore, for the duration of their tenure at Rochester, issues related to
professionalism and professional development. However, as students prepare to receive their white
coats on Friday, our hope is to introduce them, via the PD small groups, to some of the broad ethical
concepts, behavioral expectations and topics they will be exposed to in pursuit of their careers in
medicine.
Professional Development (PD) Group Room Assignments:
The room assignments for the PD groups are listed on pages 7-10 of this Facilitator Guide.
Class of 2021 Code of Conduct
During the week of orientation, one representative from each of the PD Groups will work on
developing a Class of 2021 Code of Conduct that will be taken as a part of Friday’s White Coat
Ceremony.
A. On Monday, elect and/or select your group’s code development representative. E-mail Jane
Risolo @ jane_risolo@urmc.rochester.edu with student name and your PD group number ASAP.
On Tuesday, solicit ideas from your group on important components that should be included in
the Class of 2021 Code of Conduct.
B. Give students time to reflect and share why they view the suggested components as important
(note: ask someone to record the ideas on the board)
C. Ask the students to rank their top three items for referral to the Class of 2021 Code Development
group.
NOTE: the Code Development group will meet Wednesday, 4:30 - 6:00 p.m. and Thursday 2:30 –
3:45 p.m. Please complete the code by 3:45; Student Services needs to add the code to the
White Coat Program for Friday’s ceremony.
IMPORTANT – INSTRUCT CODE REPRESENTATIVES TO FIND THEIR INSTRUCTIONS ON THE
WEBSITE UNDER RESOURCES/PROFESSIONAL DEVELOPMENT/STUDENTS.
3Each of the four Advisory Dean Groups has been divided into three small PD groups (see pages 7-10
for the group assignments). If you observe student behavior that is concerning (overly shy, reticent,
rude or insensitive to others, etc.) or may lead to performance difficulty in the PBL’s or Double Helix
Curriculum (dominating the conversation, inflexibility, disinterested, etc.) please contact the
appropriate Advisory Dean ASAP.
In an attempt to avoid redundancy in the curriculum, the topics incorporated in the orientation PD
group cases will not be repeated in other parts of the curriculum. Consequently, it is necessary for
each group to get through all of the cases.
MEDICAL STUDENT HONOR CODE
A Medical Student Honor Code was implemented for the Class of 2008 and forward. The Honor Code
exists in conjunction with other University, School of Medicine and Dentistry, and regulatory policies.
The Honor Code is not in lieu of, nor does it replace or supersede existing University School of
Medicine and Dentistry, and/or regulatory policies and procedures. In addition, the Medical Student
Promotions and Review Board (MSPRB) retains the right to review professionalism, behavioral and
other student cases directly, (independent of the Honor Code process) where health and safety
concerns exist and in instances, determined by the MSPRB, to be egregious violations of the Medical
School’s professionalism standards. Students, by entering the University of Rochester, agree to
follow the terms of the Honor Code.
The full honor code can be found in the student handbook found on the Offices for Medical Education
web site:
https://www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/student-
handbook.pdf
A Week-at-a-Glance Orientation Schedule has been included on page 6 of the guide. Listed below
are the times the PD facilitators will work with the students.
• Monday, August 14, 9:45 a.m. – 11:45 a.m.
• Tuesday, August 15, 8:00 a.m. – 10:00 a.m.
• Thursday, August 17, 8:00 a.m. – 9:30 a.m.
• Friday, August 18, 9:30 – 11:00 a.m.
White Coat Ceremony U of R Interfaith Chapel – River Campus
NOTE: Group pictures will be taken after the White Coat Ceremony (11:00 a.m.) and a luncheon will
be held in the Flaum Atrium from 11:00 – 12:45 P.M. We hope that you will be able to attend the
luncheon following the ceremony. You will be provided a lunch ticket by Diane Frank, Director of
Student Services.
NOTE: THERE WILL NOT BE ANY RESERVED PARKING AVAILABLE ON THE RIVER CAMPUS
FOR THE WHITE COAT CEREMONY. Parking stickers will be provided for non-Medical Center
4facilitators who need parking for the MRB parking lot (paid lot adjacent to the MRB @ 415 Elmwood
Avenue) from 8:30 a.m. - 1:00 p.m.
If you have questions or concerns about the facilitator guide, the cases for the PD groups, please do
not hesitate to contact:
David R. Lambert, M.D. – Senior Associate Dean for Medical Student Education
Phone: 275-4537
E-Mail: David_Lambert@urmc.rochester.edu
Jane Risolo, Assistant to David Lambert
Phone: 275-5910
E-Mail: jane_risolo@urmc.rochester.edu
Thanks again for your contribution to Orientation and the professional development of the
Class of 2021.
5Week at a Glance Orientation Schedule
University of Rochester School of Medicine & Dentistry
Orientation Schedule
August 14 - 18, 2017
Monday – August 14, 2017
Time: Event: Location:
8:00 – 8:30 am Continental Breakfast Flaum Atrium
8:30 – 9:00 am Welcome to the University of Rochester Case Method Room
9:00 – 9:30 am Rochester and the Double Helix Curriculum Case Method Room
9:30 – 9:45 am Break
9:45 – 11:45 am Professional Development Groups See individual schedules for location
11:45 – 12:00 pm Pick Up Lunch Forbes Mezzanine
12:00 – 2:00 pm Meet with Advisory Deans See individual schedules for location
2:00 – 2:15 pm Break
2:15 – 4:30pm Compliance Groups I & II – UHS & Fitness Center Class of ’62 & Fitness Center
2:00 – 4:30 pm Compliance Groups III & IV – free time
2:00 – 4:30 pm Open Hours for IT & iPad Orientation Help Miner Library IT Computing Center
Tuesday – August 15, 2017
Time: Event: Location:
8:00 – 10:00 am Professional Development Groups See individual schedules for location
10:00 – 10:15 am Break
10:15 – 11:45 am Identity in a New Community Flaum Atrium
11:45 – 12:00 pm Pick Up Lunch Forbes Mezzanine
12:00 – 1:00pm Intro to Honor Board and Honor Code Case Method Room
1:00 – 1:15 pm Break
1:15 – 2:45 pm Introduction to Academic and Personal Support Services Case Method Room
2:45 – 3:00 pm Break
3:00 – 5:00 pm Compliance Groups III & IV – UHS & Fitness Center Class of ’62 & Fitness Center
2:45 – 5:00 pm Compliance Groups I & II – free time
2:45 – 5:00 pm Open Hours for IT & iPad Orientation Help Miner Library IT Computing Center
Wednesday – August 16, 2017
Time: Event: Location:
8:00 – 9:15 am University Counseling Center/Stress Management Workshop Case Method Room
9:15 – 9:45 am Break/Escorted to Saunders Research Building
9:30 -11:15 am Academic IT Resources Saunders Research Building 1301 - 1307
11:15 – 11:30 am Walk to Genesee Valley Park
11:30 – 1:00 pm Lunch & Activity Set up GVP – Roundhouse Shelter
1:00 – 4:00 pm Community Engagement Project GVP
4:30 – 6:00 pm Small Group Code Development – Code Development Reps ONLY 2-8405
Thursday – August 17, 2017
Time: Event: Location:
8:00 – 9:30 am Professional Development Groups See individual schedules for location
9:30 – 9:45 am Break
Course Evaluation and A Student Perspective: The Double Helix
Curriculum (DHC) and time management in the DHC; Introduction to
Mastering Medical Information Course, Introduction to Problem-Based
9:45 – 11:00 am Learning Case Method Room
11:00 – 12:30 pm Break and pick up lunch – eat on your own Forbes Mezzanine
12:30 – 2:30 pm Introduction to the PBL Small Groups and PBL Tutorial See individual schedules for location
2:30 – 3:45 pm Final Small Group Code Development – Code Development Reps ONLY 2-8529
2:30 – 3:45 pm Free Time
Friday – August 18, 2017
Time: Event: Location:
8:30 – 9:15 am White Coat Ceremony Rehearsal Interfaith Chapel (River Campus)
9:30 – 11:00 am White Coat Ceremony Interfaith Chapel
11:00 – 11:30 am Class Photo River Campus
11:00 – 12:45 pm Lunch/Reception (Ticket Required) Flaum Atrium
1:00– 3:15 pm Biopsychosocial Integration Conference (Students Only) Case Method Room
1:15– 3:00 pm Information Session for Family & Friends Class of ’62 (G-9425)
3:00 – 4:00 pm Reception for Family & Friends Flaum Atrium
3:15 – 3:45 pm Completion of Matriculation and Orientation Questionnaires Case Method Room
3:45 – 5:00 pm Free Time 6PD Group Assignments and Room Locations
University of Rochester School of Medicine and Dentistry
Advisory Dean and Professional Development Groups
Class of 2021
Please note final student assignments may change due to changes in the matriculating class.
David Kaufman, MD, Advisory Dean
Email: David_Kaufman@urmc.rochester.edu
Phone: (585) 275-4537
Office: Medical Education, Box 601 (Room G.7644)
Facilitators Location PD Group Last Name First name
Gina Cuyler, MD Ahern Nicholas
Samuel Carrell All sessions: Azogini Chiamaka
Barry Michaela
PBL 1-8405 Bennett John
1 Buswell Mary
Chow Jessica
Crofton Kathryn
Dhimal Totadri
Sportiello Michael
David R. Lambert, MD Amaravathi Anusha
Caitlin Burzynski All sessions: Battaglia Jennifer
Bittner David
PBL 1-8425 Caglayan Cihan
2
Chumbley Lyndon
Custer Matthew
Dillen Jonathan
Przysinda Emily
Jason Mendler, MD Benassai Michelle
Dhristie Bhagat All sessions: Buda Alexandra
Calderon Thais
PBL 1-8435 Cotsalas Deanna
3
Dean Owen
Ezran Camille
Finkelstein Alan
Salama Noah
7University of Rochester School of Medicine and Dentistry
Advisory Dean and Professional Development Groups
Class of 2021
Please note final student assignments may change due to changes in the matriculating class.
Laurence Guttmacher, MD, Advisory Dean
Email: Laurence_guttmacher@urmc.rochester.edu
Phone: (585) 275-4537
Office: Medical Education, Box 601 (Room G.7644)
Facilitators Location PD Group Last Name First Name
Marc Libman, MD Fennell Margaret
Elizabeth Saionz All sessions: Geiger Joshua
Gomez Julia
Hwang Jason
PBL 1-8445 4 Johnson Thomas
Jones Shaunpaul
Kong Daniel
Koruga Alexander
Lee Gayin
Flavia Nobay, MD (Monday) Fiscella Blythe
Erin Denney-Koelsch, MD All sessions: Girten Alec
Rohith Palli Gurditta Kunali
Hernandez Cesar
PBL 1-8455 5
Iyengar Mahima
Johnson Tylia
Kenney Howard
Kothari Shiva
Cynthia Christy, MD Gershteyn Anna
Stacey Isidro All sessions: Godbout Jennifer
Haft Michael
Haxton Miriam
PBL 2-8405 6
Homeier Daniel
Jay Catherine
Johnson Trent
Lawton David
8University of Rochester School of Medicine and Dentistry
Advisory Dean and Professional Development Groups
Class of 2021
Please note final student assignments may change due to changes in the matriculating class.
Elizabeth (Betsy) Naumburg, MD, Advisory Dean
Email: Elizabeth_naumburg@urmc.rochester.edu
Phone: (585) 275-4537
Office: Medical Education, Box 601 (Room G.7644)
Facilitators Location PD Group Last Name First Name
David E. Burns, MD Li Kevin
Jenny Jean All sessions: Liu Michelle
Lynch Olivia
Maxwell Nicholas
PBL 2-8425 7 Mehta Varun
Meyer Jessica
Miller Renee
Najera Chance
Nie Yunbo
Ryan Bodkin, MD Mancho Amundam
Courtney Royal All sessions: McCutchan Keith
Mei Tiffany
Mezue Malcolm
PBL 2-8435 Motyl Claire
8
Negron Tianna
Phan Amy
Powell Stephen
Prong Michelle
James Haley, MD Lundgren Jerold
Vienna Tran All sessions: Mathews Eric
McGann Kevin
Meng Steven
PBL 2-8445 9
Mikami Sage
Munjal Havisha
Ng Grace
Porter Randall
Rojas Betsy
9University of Rochester School of Medicine and Dentistry
Advisory Dean and Professional Development Groups
Class of 2021
Please note final student assignments may change due to changes in the matriculating class.
Cheryl Kodjo, MD, Advisory Dean
Email: Cheryl_kodjo@urmc.rochester.edu
Phone: (585) 275-4537
Office: Medical Education, Box 601 (Room G.7644)
Facilitators Location PD Group Last Name First Name
Jennifer Pascoe, MD Rana Neel
Daniel Underberg All sessions: Robinson Casey
Scott Stuart
Shetty Anisha
PBL 2-8455 10 Stettnichs Kaitlyn
Wang Maxwell
Wirth Korry
Yull Rachel
Zhao Yu
Julie Pasternack, MD Reinhardt Benjamin
Howard Lam All sessions: Rizk Nina
Rodi Julia
Saizan Autumn
PBL 2-8527 11 Sebastian Armand
Sholtis Connor
Tay David
Whyte Racquel
Yu Veronica
Jason Rotoli, MD Rodriguez Alejandra
Haley Martin All sessions: Saxena Shireen
Shaw Reid
Silva Hannah
PBL 2-8529 12 Thornton Taylor
Winbush Angelina
Wood Daniel
Zambrano Dennis
Zhang Anne
10Session I – Monday, August 14, 2017
9:45 a.m. – 11:45 a.m.
I. Take attendance - note absent students…if a student present is not assigned to your group,
direct student to correct group/room. If anyone is missing, please e-mail
jane_risolo@urmc.rochester.edu ASAP so that we can get the person in the right place.
II. Introductions
III. “Get Acquainted Exercise” – Have the students take five minutes to identify three (3) things
they can share with the PD group that help to identify who they are as people. Have the full group
discuss insights learned and how their diverse life experiences have and may influence their
personal and career goals and vision in medicine.
IV. Elect/select the Code Development representative after cases
“Get Acquainted Exercise”
Share three things that help to identify who you are as a person.
CASE I - “A Routine Visit”
Mr. S is a 61-year-old factory worker who has not seen a doctor for 30 years. In recent months,
however, he had developed some discomfort in his legs when he would climb hills and he has had
worsening erectile dysfunction for the past year. His wife convinced him that he needed a “physical,”
and she arranged an appointment with her doctor, Dr. A. Dr. A is a recent graduate of the family
medicine residency program here.
Dr. A spent nearly an hour getting to know Mr. S. Her inquiries were directed not only at the specific
problems that brought him to her, but were designed to get to know him as a person. She performed
a thorough physical examination. Additionally, she submitted samples of his blood, urine and stool
for testing. At the end of the visit she shared impressions of the probable cause of his complaints,
explaining the options for learning more about and dealing with the problem, and providing
reassurance when appropriate.
11Discussion Questions
1. Describe the feelings and emotions Mr. S and Dr. A likely experienced during the encounter.
Suggestions: Embarrassment, nervousness, caution, uncertainty
2. What underlies his willingness to expose intimacies to this stranger?
Suggestions: Evidence of respect, commitment to listen and understand his worldview and
concern for his well-being
3. What is the nature of the unwritten contract that existed between these two? What obligations
upon the doctor are implied by the contract?
Suggestions: Candor, nonjudgmental approach, the patient’s best interests
4. What attributes of a physician’s behavior are necessary in order to assure preservation of this
contract with society?
Suggestions: Effective communication, empathy and competent care
Author: J. Franklin Richeson, M.D. Monday
ISSUES THAT CONTRIBUTE TO MEDICAL STUDENTS’ ANXIETY/STRESS
(20 Minutes)
Case Themes: Obligation/responsibility to colleague and boundaries about being a friend's doctor,
colleague or friend.
Case II – “I’m okay…is he okay?”
It is the beginning of the third month of medical school. Although you had some worries about
starting medical school, it has gone well so far. You are excited about the Human Structure and
Function course, which started last month. Plus, people in the class are friendly and your living
situation seems to be working out okay. However, you are somewhat concerned about your
roommate Adam. He is a native of North Dakota and this is his first time living away from home. You
notice that he has started to have frequent headaches for which he is taking a fair amount of
ibuprofen. He describes having some stomach pain, but he attributes that to the medication. You are
worried about his sleep pattern. He stays awake even after the two of you have studied until late
each day. Adam has also started to miss the class parties and social events. You share your
concerns with another classmate, who says that she is very concerned about Adam.
Discussion Questions
1. Should these students be concerned about Adam's behavior or complaints?
Suggestions: Yes, personal wellness, academic progress, patient safety risks
122. Discuss all the possible explanations for Adam's behavior and complaints that you can think of
and which are the most concerning.
Suggestions: Anxiety, stress, health, substance misuse
3. What responsibility do you have as a colleague to Adam? What actions, if any should you take?
What options do you have for helping Adam?
Suggestions: Expectation to talk with peers about concerning behavior; recommend a meeting
with Advisory Dean, University Counseling Center (UCC)/ University Health Service (UHS)
Author: Tana A. Grady-Weliky, M.D.
Updated: February 2004 by Elizabeth Naumburg, M.D. Monday
If the group appears to have the comfort level, ask the students to share issues or concerns they
have regarding beginning medical school. If not share some of the items from the list below to get the
conversation stimulated. NOTE: If students appear to be reluctant to share, it helps to have the
facilitators share appropriate personal examples.
Goal: To help students to be comfortable sharing concerns, to help them to see that their concerns
are not necessarily unique and to remind them that there are SMD resources to help them to address
their concerns. (Direct them to the Support Services for URSMD Students document under
Resources/Student Support Services Tab on the Orientation Website.)
ISSUES THAT CONTRIBUTE TO MEDICAL STUDENTS’ ANXIETY/STRESS
1. Getting acclimatized to Rochester
2. Conflict in the family or with significant others related to moving away to attend medical school. Dealing
with high expectations of families and others for your medical career.
3. Homesickness
4. Partner separation
5. Concerns about the ability to do the work
6. Ability to still be at the “top” of the class
7. Concerns about whether they really merit being in medical school
8. Introvert vs. extrovert
9. Concerns about the socialization process to medical school
10. Being offered admission from the waiting list and ability to compete with non-wait list matriculants
11. First generation to pursue higher education
12. First in the family to pursue a career in medicine
13. Being from a family of high achievers
14. Ability to secure a “competitive” residency
15. Concerns about ability to finance a medical education
16. Having an ADA eligible disability and needing accommodations that require extra time for
examinations/sequestered location for examinations (the concerns are generally linked to how they are
viewed by faculty and peers).
1317. Unresolved feelings regarding sexual identity, sexual assault and/or abuse
18. Family (or personal) issues related to substance use/abuse
19. Confronting the death of a loved one and having to deal with death and dying.
Author: Brenda D. Lee, M.Ed.
Case Themes: Confidentiality, Professionalism, Peer relationships
Case III – I Love the Brain
Mary is very interested in neurosurgery. During Human Structure and Function, she takes the
lead on the dissections of the head and brain. After completing the dissection that exposed
the cadaver’s brain she takes out her iPhone and asks Lionel to take her picture hugging the
cadaver with her face positioned close to the exposed brain.
Later that day, Mary posts the picture on her Facebook page with a caption “I Love the
Brain!!!”
Discussion Questions
1. Does this represent a breach of ethics for Mary and/or Lionel?
Suggestions: Breach of ethics for both
2. How might the other HSF small group members present respond?
Suggestions: Remind Mary and/or Lionel about the suspected breach of ethics;
encourage to discuss desire to take the photo with course director, refer to Ask Jane
Ethics Consultation service, suggest follow-up with Advisory Dean, URMC Privacy
Officer or Honor Board representative
3. Is there a reporting obligation for SMD students who see the Facebook posting?
Suggestions: Yes, in the absence of concern for personal safety, discuss concern with
student first, then alert AD and/or Honor Board representative.
4. Why do anatomy students sometimes engage in this sort of macabre humor?
Suggestions: Way to channel anxiety, personal insecurity, not aware of ethical
boundaries,
HSF course policy: absolutely no photos or video in the anatomy labs.
Author: Brenda D. Lee, M.Ed. Monday
14PREPARING FOR THE CLASS OF 2021 CODE OF CONDUCT
IMPORTANT – Instruct the Code Development student representatives to find their instructions on
the website under Resources/Professional Development/Students. For your
information, they are also listed below.
Instructions for the PD Group Code of Conduct Representatives
Class of 2021 Code of Conduct - Professional Development Group Representatives
During this week of orientation, one representative from each of the PD Groups will work on a
committee to develop a Class of 2021 Code of Conduct. The Code will be recited as a part of the
Friday’s White Coat Ceremony.
• Each PD group will elect/select a code development representative during the Monday PD
group meeting.
o Please e-mail Jane Risolo @ jane_risolo@urmc.rochester.edu with the selected
student representative name and their PD group number ASAP but no later than
by end of day.
• During the Tuesday PD group meetings, the facilitators will solicit ideas from each group on
important standards/components that should be included in the Class of 2021 Code of
Conduct. Each group will be asked to select three items and rank them for referral to the
group developing the Class of 2021 Code.
o Give students time to reflect and share why they view the suggested components as
important (note: ask someone to record the ideas on the board)
The Code Development representatives will meet twice to finalize the Code. Dean Laurence
Guttmacher will be available as the facilitator.
Listed below are the specifics regarding the code development meetings:
• Wednesday – August 16th, 4:30 – 6:00 p.m. (light snacks served)
PBL Room 2-8405
• Thursday – August, 17th, 2:30 – 3:45 p.m.
PBL Room 2-8529
The code development representatives will have time during the Thursday 8:00 a.m. PD group
meetings to provide updates on the recommendations from the Wednesday meeting as well as to
solicit additional input from their PD groups for the final code development session on Thursday.
IMPORTANT INFORMATION
• Please remember to review the recommendations from Wednesday’s planning meeting with
your PD group on Thursday AM.
15Session II – Tuesday, August 15, 2017
8:00 a.m. – 10:00 a.m.
INTRODUCTION TO PROFESSIONALISM AND CODE OF CONDUCT
Case Themes: Representing oneself, entitling the medical student, integrity and the student role and
the power differential with faculty
Case I – “I’m not a doctor, but I play one on television”
You are a first year student engaged in the Primary Care Clerkship (PCC) during the second
semester. Having thought about the issue and having decided that misrepresentation to
patients is a real mistake, you consciously and consistently introduce yourself to patients as
“Lucy Rodriguez, first year medical student.” In the normal course of affairs, you see
patients first, present your findings to your preceptor, and then the two of you see the patient
together. When you go into the room with your preceptor to see the first patient, you are
surprised to hear Dr. Green say “Dr. Rodriguez told me about your sore throat.” You are
uncomfortable, but say nothing, thinking it was a slip. You go to see the second patient and
the same thing happens.
Discussion Questions
1. Is it ever acceptable to use the term “doctor” when referring to a medical student?
Explain why or why not.
Suggestions: Never acceptable, misleading to patient
2. What, if any, adverse consequences present themselves in the choice to call a
medical student “doctor”?
Suggestions: Misleading to patient, adverse impact on patient trust
3. What assumptions are made by the patient and/or medical student and/or preceptor
when the title “doctor” is used in the introduction of the medical student?
Suggestions: Misleading about level of training
4. What should you do in this situation?
Suggestions: Provide accurate title/status with diplomacy, if unsure how to respond
contact course director and/or Advisory Dean
Author: Laurence Guttmacher, M.D. Tuesday
16Case Themes: Professional boundaries (in the setting of changing technologies), representing
oneself, exploration of the doctor-patient relationship (including family members of the patient)
Case II – I Can Set You Up, Right?
You are finishing up the second semester of your first year of medical school, including your
Primary Care Clerkship (PCC) rotation with a Family Medicine doctor in a rural town 30
minutes from Rochester. You have really enjoyed getting to know her patients. Although you
are eager for the summer off, you are also sad to see your time in this office come to an end.
On your last day you are excited to see that Mr. W is coming in at 4 p.m. He is a jovial 90-
year-old man with end-stage renal disease and congestive heart failure. Lately, he has been
in the office almost every week because his symptoms have been poorly controlled at home.
You saw him last week with your preceptor at Highland Hospital where he had been admitted
for shortness of breath. Mr. W is usually accompanied by his grandson Jake, who has his
Health Care Proxy. Jake makes sure that Mr. W takes his medications, eats regular meals
and tries to check on him daily. You enjoy talking to Jake and think his dedication to his
grandfather is admirable, especially for a single male in his late-20’s who has a bustling law
practice.
After knocking on the door of Exam Room #1 and entering, Mr. W and Jake enthusiastically
greet you. In addition to asking how Mr. W has been feeling and discussing his health status,
you mention today is your last day in the office. You tell them that you have enjoyed getting
to know them and that you appreciate all they have taught you.
“Don’t go!” Mr. W exclaims “I’ve been thinking you and Jake would make a terrific couple!
Now that you won’t be taking care of me, I can set you up, right? That way I’d have my own
personal physician in the family!”
Jake blushes, but then suggests you become Facebook friends. He writes his name down
on a piece of paper and says he’ll send you a request later that day. “At least this way, I can
keep granddad in the loop. He’ll want to know what kind of doctor you decide to become.”
By the time you get home from clinic, the friend request is sitting in your Inbox.
Discussion Questions:
1. Are family members included in the doctor-patient relationship? We talk about how it’s
unacceptable to date/be romantically involved with a patient, but does this transfer to
family members? Does the prohibition against dating extend to former patients?
2. Discuss the difficulties of inevitable short-term relationships with patients as a medical
student.
3. What are the professionalism issues surrounding Facebook? Is it appropriate to be
“Friends” with patients? What about colleagues and other hospital or clinic staff?
4. What should you do in this situation?
Suggestions: Consult Ask Jane Question 9
http://intraqa.urmc-sh.rochester.edu/students/ask-jane/index.asp
17For more information regarding Ask Jane Consult Service see page 30 of Facilitator Guide
Author: Amy Potter, MD Class of 2011 Tuesday
Case Theme: Confidentiality, professionalism, peer accountability
Case III – Kicking Back and Relaxing
Eight members of the Class of 2016 decide to have an end of the academic year celebration at
a popular restaurant, the Next Door Grill. After ordering drinks and food, the conversation
focuses on Joe’s recent PCC experience. “I really connected with one of my patients named
Jamie. Jamie is a 28 year teacher in the city of Rochester who loves his students and his job.
He has been having major challenges with fatigue, complaints of loss of balance and
struggling with coordination. While he has always enjoyed great success with multitasking, he
now has difficulty with reasoning and sustaining his attention span. While we still need to see
the test results, it looks like he has multiple sclerosis.
The students continue to share interesting and challenging cases. When ordering a third
round of drinks, Mary indicated that she is going to stop at two drinks because she will be
seeing patients at URWell in an hour.
The next day a concerned citizen calls the medical school privacy officer to report what he
thinks is a HIPAA violation. “I was at the Next Door Grill last night sitting in a booth next to
what I think were medical students (because four of them had short white jackets with a URMC
patch) who were discussing patients. I am so upset, because one of the patients described as
“Jamie,” sounds like my colleague. I do not remember all their names but I remember Rosie,
who wore a white coat and spandex, Joe and Kyle.
18Discussion Questions:
Awareness of Surroundings When Discussing Patients
1. Are there concerns regarding these students and their behavior?
2. Are there issues associated with wearing white coats to a bar?
3. What are the concerns and professionalism standards associated with discussing
patients outside of clinical/academic settings?
Alcohol Consumption and Patient Contact
4. Does it matter if the patient contact occurs in a voluntary setting vs. in lectures or small
groups?
5. Does it matter if there are standardized vs. real patients?
Professional Attire
6. What expectations are there for professional behavior and attire? What are appropriate
guidelines for attire in patient settings and for wearing the white coat?
7. Is there reason to be concerned about classmates who consume three or four rounds of
drinks?
8. Do you have a responsibility to discuss the appropriateness of the behavior with your
classmates?
9. Do you have a responsibility to report this behavior? If so, where and how?
10. How should the school respond to this matter?
Author: Brenda D. Lee, M.Ed. Tuesday
Facilitator Notes
Kicking Back and Relaxing
• Wearing white coats to a bar
• Consuming alcohol when one has patient care responsibilities
• Image and judgment patients have when detecting alcohol or impaired decision-making from a
provider.
• The difference between graduate school and professional school.
• Students are expected to comply with the professionalism standards at all times, including non-
school related matters.
• Requirements for licensed physicians to report professionalism concerns among peers
• Medical School’s Honor Code and the obligation to report violations
• Committee on Physician Health (CPH) a resource for reporting and helping medical students
with substance abuse concerns. See the policy below for responding to student impairment.
Opportunity to discuss the new professionalism expectations
Appearance and forms of dress
19Please share examples of inappropriate attire and unacceptable dress – short skirts and
dresses, plunging necklines, midriffs showing, sandals, jeans even if it’s with a tie!, spaghetti
straps, etc.) Students should know, it’s not that they are condemned now to being fashion
less, but they are expected to be more conservative. Remind students about a related dress
expectation for the White Coat ceremony, because there will be patient interaction at the first
integration conference on Friday.
(Source: Former PCC Course Director Kathy Markakis, MD)
Options for exploring difficult and challenging patient encounters
• Preceptor
• Advisory Dean and AD meetings
• University Counseling Center (UCC)
Author: Brenda D. Lee, M.Ed. Tuesday
Related Policies:
IMPAIRED MEDICAL STUDENT POLICY
I. GENERAL POLICY
A student must not use alcohol or drugs in a manner that could compromise patient care.
Additionally, it is the responsibility of every student to protect the public from an impaired colleague
and to reach out to a colleague whose capability is impaired because of ill health. A student is
impaired if substance abuse, illness or disability prevent the student from adequately or meaningfully
participating in the medical school program. Every student is obligated to report persons of the health
care team whose behavior exhibits impairment, lack of professional conduct or competence. Such
reports must conform to established institutional policies as described here and in the Medical
Student Handbook.
II. ENFORCEMENT OF POLICY
A. Referral
A student whose performance is believed to be impaired by substance abuse or suspected substance
abuse will be referred by his/her advisory dean or the Medical School Professional Review Board
(MSPRB) to the Committee on Physicians’ Health of the Medical Society of the State of New York
(CPH) for diagnosis, monitoring and treatment. CPH will report to the MSPRB a student’s failure to
seek treatment subsequent to the MSPRB referral; a student’s unsuccessful treatment; and/or
relapse in treatment of substance abuse. The MSPRB Chair may suspend the academic or clinical
activities of any such student during the diagnosis or treatment phase if the student is judged by
him/her to be a danger to self or to others. A student’s failure to seek treatment, failure to be
successfully treated, or relapse will be grounds for dismissal or other disciplinary actions by MSPRB.
B. Action by MSPRB and CPH
1. Upon receipt of a report regarding a student with a possible impairment, the MSPRB or its
designee will further investigate the report. After assessing the concern, MSPRB will report to
CPH a student whose performance is believed to be impaired because of substance abuse. CPH
will attempt to assess whether a substance abuse problem exists, and, if it does, whether
performance as a student has been impaired.
202. Students who have been referred to by MSPRB and who refuse to undergo an evaluation will be
referred by the NYS CPH to MSPRB for further action by the MSPRB. The MSPRB need not be
bound by confidentiality and may take administrative action (e.g., suspension or dismissal)
against a student who does not cooperate with evaluation.
3. If MSPRB believes that a student may have a substance abuse problem, but impaired
performance has not occurred, MSPRB will recommend to the student that he/she obtain
treatment. The student may refuse treatment without being subject to disciplinary action unless
his/her performance becomes impaired.
4. If CPH reports to MSPRB its determination that a student does not have an impairment, the
report will be placed in a sealed envelope marked confidential in the student’s file. Only the
Senior Associate Dean for Medical Student Education, the Advisory Dean and the MSPRB
may access the file. The MSPRB shall have the authority to make determinations related to
the information.
C. Treatment and Monitoring by CPH
1. If the performance of a student has been impaired by substance abuse, treatment by CPH
therapists will be recommended. The cost of the CPH treatment and services will be paid by
the student. No disciplinary action will be taken so long as the student accepts, complies with,
and successfully undergoes treatment. It is the practice of the CPH to utilize blood or urine
tests to monitor treatment. Successful abstention will be documented by CPH monitoring blood
or urine drug levels as long as the CPH physician deems it necessary. In instances where
patient welfare or safety is in jeopardy or the student refuses to undergo treatment, MSPRB
will be notified by CPH and MSPRB will take appropriate action.
2. Relapse will be dealt with by resumption of treatment. If patient welfare is not jeopardized and
the student responds to resumed treatment, no disciplinary action will be taken.
3. If the period of necessary treatment and/or monitoring extends beyond graduation, the New
York State CPH will notify the CPH of the State of the student's residency and request that
treatment and/or monitoring continue in that State.
III. REPORTING
Students should contact the Honor Board or their Advisory Dean to report concerns regarding an
impaired University of Rochester medical student. Advisory Deans are encouraged to bring
impairment concerns that emerge from individual relationships with students to the MSPRB to relieve
the burden of sole responsibility. The Honor Board or the Advisory Dean will then contact the
MSPRB. Students may self-report their impairment problem by contacting CPH directly at the hotline
number (1-800-338-1833). To report a member of the healthcare team who is suspected of
impairment, students should contact their Advisory Dean or the appropriate Clerkship Director.
IV. IMPAIRMENT UNRELATED TO DRUGS OR ALCOHOL
When a student’s performance is affected due to a suspected impairment unrelated to drugs or
alcohol, the MSPRB shall have the right to mandate that the student undergo a medical or psychiatric
evaluation for the purpose of providing recommendations to the MSPRB relative to the student’s
ability to meet program requirements and to provide safe and effective patient care. The School, at
its option, may use University Health Service (UHS) and/or the University Counseling Center (UCC)
evaluators to perform the evaluations and for treatment and monitoring when conflicts of interest can
be avoided.
When a student has been assessed as having impairment, UHS and/or UCC may be designated by
MSPRB to monitor the student’s treatment and progress. The student will pay all costs associated
21with the treatment. The UHS/UCC professional who has been designated as the student’s treatment
monitor will be a liaison between the student’s provider and the MSPRB. The MSPRB will not
request specific information regarding the student’s diagnosis or the contributing factors. The
MSPRB will require UHS/UCC/CPH and/or another designated student monitor treatment to provide
an opinion as to whether a student will be able to return to the program and what limitations the
student will have. The MSPRB shall have the right to determine whether the student can perform in
accordance with the program requirements.
There will be a mechanism for the systematic sharing of information with the MSPRB so long as the
student remains in treatment.
V. AMENDMENT
The school reserves the right to amend this policy at any time.
22Session III – Thursday August 17, 2017
8:00 – 9:30 a.m.
PROFESSIONALISM AND THE DOUBLE HELIX CURRICULUM
1. Update from the Code Development Representative
2. Review the instructions for the White Coat Ceremony
Please emphasize:
Need for appropriate attire for both the White Coat Ceremony and the first Biopsychosocial
Integration Conference
The need to be on time for the rehearsal at 8:30 am at the Interfaith Chapel on the River
Campus
Guests will not be seated at the chapel until the rehearsal ends approximately 9:15 am
The tickets for the luncheon will be in the student’s white coat. Everyone must have a
ticket for lunch, they cannot be served without one.
Do NOT bring book bags, purses or other personal items to the White Coat Ceremony. There
are no storage facilities at the Interfaith Chapel.
3. Case Discussions
• Case I – “Take Notes For Me”
• Case II – “We Still Need To Learn All This Material”
23Session III: Thursday, August 17, 2017
8:00 - 9:30 a.m.
PROFESSIONALISM AND THE DOUBLE HELIX CURRICULUM
Case Themes: Confidentiality, professionalism, peer relationships
Case l – Take Notes for Me
Abdullah anticipates missing the SCOPE integration conference on Thursday and asks Colin
to take notes for him. Colin decides to use his iPad to videotape the conference. The
conference focuses on understanding the patient’s emotions and worldview when making
difficult health decisions. Dr. Jar has invited one of her patients to participate in the session
to discuss the emotions and choices she made to terminate her pregnancy.
Colin sends the conference video link to Abdullah. While sitting with several of his friends,
Abdullah opens the video link on his iPad and shows the conference recording to his friends
who are not medical students. One of his friends recognizes the patient and listens to the
segment where the patient discusses the termination of her pregnancy and states “now I
understand why she seemed so out of it during her senior year…”
Discussion Questions
1. When is it ok to discuss patient encounters with family, friends and/or other medical
students not involved with the care of the patient?
2. Does this represent a breach of confidentiality by Abdullah and/or Colin?
3. How should the breach of confidentiality be handled?
4. What are the anticipated consequences of the breach of confidentiality?
5. Would the recording of the integration conference be an issue if there was not a
patient present?
Author: Brenda D. Lee, M.Ed. Thursday
Related Policies to Case I:
SMD HIPAA Privacy Officer Responses to Questions
When is it ok to discuss patient encounters with family, friends and/or other medical students
not involved with the care of the patient?
With the authorization of the patient or when there is no identifiable information, not even unique
circumstances or diagnosis that might tend to identify the patient. See HIPAA Policy 0P23.2
Involvement in Care https://sites.mc.rochester.edu/departments/hipaa/hipaa-policy-manual/ for details
regarding providers discussing care with others. As far as medical students discussing a patient
among themselves, this should be done only as part of an educational or patient care experience in a
secure setting by those directly involved in that experience. This is certainly more stringent than my
or other practices. I encourage students to talk about PCC experiences in Dean’s lunches, even with
24other students and myself who were not directly involved. We routinely go over confidentiality and it
would be a terrible educational loss if they cannot talk with colleagues and supervisors who were not
“directly involved”.
Does this represent a breach of confidentiality by Abdullah and/or Colin?
Yes, by both students. The patient’s protected health information has been disclosed without her
authorization, in violation of the HIPAA Privacy Rule. In addition, Dr. Tree has been recorded without
her authorization. See HIPAA Policy 0P31 Breach of Unsecured Protected Health Information
http://intranet.urmc-sh.rochester.edu/policy/hipaa/Privacy/P31.pdf
How should the breach of confidentiality be handled?
The Privacy Officer for SMD should be notified immediately. The Privacy Officer will perform a risk
assessment to determine the potential risk of harm to the patient (financial, reputational or other) and
based on this, whether the patient must be notified of the breach. Given the sensitive nature of the
PHI disclosed, the fact that it was disclosed to multiple individuals, at least one of whom knew the
patient, and that it was sent electronically, it would be considered a sufficiently significant risk of
reputational harm to require written notification to the patient. The law also requires that any such
notification be reported via the federal Office of Civil Rights web site.
The Information Systems Division (ISD) Help Desk should also be contacted to assist with permanent
deletion of the video from the portable electronic devices of the students to prevent further use or
disclosure.
Dr. Tree should be notified, both as a courtesy in regard to her inclusion in the video and because
she may be able to perform a role in providing reassurance to the patient that all appropriate steps
are being taken to address the breach.
What are the anticipated consequences of the breach of confidentiality?
Sanctions for the students would be determined by the Privacy Officer in collaboration with the Dean.
HIPAA Policy 0P5 http://intranet.urmc-sh.rochester.edu/policy/hipaa/Privacy/P5.pdf provides for a
spectrum of possible sanctions that range anywhere from re-education of the student or workforce
member, counseling or oral warning to written warning, suspension or termination from employment
or program. Remediation may be required. Examples include making a presentation to peers,
preparing written training materials and sending a letter of apology to the individuals whose privacy
was breached.
Another consequence may be that Dr. Tree will be unwilling to participate in the future or word may
spread among students, who would not be willing to participate as patients in future educational
sessions.
*When is it permissible to audio and videotape lectures and sessions with patients?
Attendance Requirements (see page 29 of the facilitator guide)
25*USE OF VIDEO, AUDIO AND RECORDING EQUIPMENT IN EDUCATIONAL SETTINGS
All audio and video equipment will be operated only from the Control Room which will be locked at all
times unless a member of the Center for Experiential Learning (CEL) is present in the room. CEL-IT
staff are the specialists with primary responsibility for this facility.
• The live feed from the Control Room will be off at all times except when the system is being
used for an announced educational purpose. In all cases, students will be informed in advance
when any session is being recorded. Except when these pre-announced classes or
assessment exercises are videotaped, the live feed from the Control Room will always be off
(e.g., during all Advisory Dean lunches, during all other classes, off-hours times when students
study in the PBL rooms, etc.)
• During times when professional staff needs to set up or test the equipment, notices will be
posted on all PBL room doors. Recording equipment maintenance work will not be scheduled
during potentially sensitive times such as Advisory Dean lunches or ICM physical exam
sessions.
• Students will not only be informed in advance by CEL and Course Directors about any PBL or
clinical exercise that will be recorded, but will also be informed as to whether the use is for
their own formative development (e.g., access will be provided to them to monitor their own
progress), for a formal assessment (e.g., an OSCE exercise in which a recording might
become part of their student record and subject to all the confidentiality of any other part of
their educational record), for a faculty development exercise (e.g., so PBL tutors can watch
themselves and develop skills in small group facilitation), or any combination of these or any
other purpose.
• Any concerns about violation of confidentiality should be addressed immediately to Dr. David
Lambert, the Senior Associate Dean for Medical Student Education.
VIDEO, AUDIO AND RECORDING EQUIPMENT IN OTHER EDUCATIONAL SETTINGS
Personal audio or video/digital recording equipment cannot be used by students in educational
settings, except as provided below. Educational settings include but are not limited to lectures;
problem based learning sessions, small group learning activities, laboratory experiences, and clinical
clerkship or elective activities. Additionally, students cannot audio or video/digital record meetings or
conversations with course/clerkship directors, administrative support staff, nor medical school
personnel.
An exception to the above policy exists for any medical student who has requested permission to
record educational sessions as an accommodation for a disability, and has been approved to do so
by the medical school’s disability access coordinator. The process for requesting accommodations
can be found in the student handbook under Assistance for Individuals with Disabilities. As with all
approved accommodations, the disability access coordinator will notify the relevant course/clerkship
directors when recording approval has been granted as an accommodation. Students will not also be
required to obtain individual instructor permission within each course or clerkship. Notwithstanding
the above, due to federal privacy laws, students with accommodations cannot record individual
patient encounters in clerkship settings without additional approval of the medical center privacy
officer, who may consult with the medical school’s disability access coordinator. The privacy officer’s
approval will be sought by the medical school to avoid undue burden to the student. In instances
26where a patient case is discussed or a patient is present in the educational setting (e.g. lecture, small
group), any recorded information is treated as Protected Health Information and is under the same
restrictions as outlined in or implied by the Health Insurance Portability and Accountability Act
(HIPAA) and medical school/hospital policies. Students must not share such content with anyone.
Students must delete/destroy such content once they have completed all required assessments in
that course/clerkship. The medical school will endeavor to remind students who have approved
accommodations of these obligations but a failure to remind does not excuse non-compliance.
(Effective December 7, 2010, revised November 3, 2015, revised March 3, 2016)
Also: SMH Policy 9.2.5 Photographing, Filming or Recording of Patients http://intranet.urmc-
sh.rochester.edu/Policy/SMHPolicies/section09/9-2-5.pdf describes in detail the requirement that
written consent be obtained prior to recording or filming any identifiable image of a patient taken for
internal organizational uses such as education of the workforce or quality assurance activities.
*See SMD Policies
Case Themes: Knowing when to ask for help, Honor Code expectations and violations and peer
accountability
Case II – “We Still Need To Learn All This Material”
In spite of stellar undergraduate credentials, Bob is uncertain if he has made the right decision to
matriculate at URSMD. He is the first person in the family to complete college. Although his family
generally supports his decision to attend medical school, his parents feel he should have accepted
an offer of admission to an institution closer to home.
Since Bob had lived at home during college, he was interested in attending medical school in
another city. He also wanted to lessen his family’s dependence on him. Although his parents have
some familiarity with English, they have relied on him to handle all of their business transactions.
This situation had become increasingly burdensome for Bob. His father is unemployed and on
disability after sustaining a severe back injury during a motor vehicle accident. Bob is their only
child, and they have had to make sacrifices for him to have a better quality of life.
Given all of his family responsibilities and his father’s accident, he has not been able to concentrate
on his work; he becomes increasingly anxious and is unable to sleep at night. Although he is aware
of the free counseling available to medical students through the University Counseling Center
(UCC), he is concerned that residency programs will learn he had counseling. He did not attend a
PBL session, and several ICM small group discussions. He missed Advisory Dean lunch and has
not responded to e-mails from his Advisory Dean. The day before the HSF final, he decides to visit
the course director, Dr. Philbin, to request additional time to prepare for the exam. On his way to Dr.
Philbin’s office, he notices that the door of the anatomy lab with the exam specimens is open. He
enters in hopes of finding Dr. Philbin. No one was in the lab so Bob uses his cell phone to take
photos of the specimens. After exiting the lab he remembers his backpack is on the lab table. He
uses his ID to release the swipe lock, retrieves his backpack and leaves.
Later that afternoon, he gets together with classmates Kathy and Lee to study. He downloads the
exam pictures on a computer in the PBL room and offers to e-mail copies of the pictures to them.
Kathy reviews the pictures, but declines the offer to have the pictures e-mailed to her. Lee refuses
27to look at the pictures citing that to do so would be contrary to his ethical values. Bob is taken
aback by their reactions to the pictures and states “we still need to learn all of this material; the
pictures simply help us to focus our review for the exam.”
Lee feels conflicted about the access to the photos and decides to leave an anonymous message
on Dr. Philbin’s voice mail that he “suspects” a fellow classmate has had access to the information
on the final.
The next day, Dr. Philbin informs the class about the anonymous alert regarding suspected
cheating. He strongly advises students with information to contact him. Bob contacts Lee and Kathy
and says, “don’t worry, I’ll take care of things, this will all go away.” Kathy and Lee are now afraid
and decide to remain silent. To aid with the investigation, Dr. Philbin requests a history of the ID
swipe access to the lab rooms.
Discussion Questions
1. Ask for general reactions.
2. What is your reaction to Lee’s anonymous message on Dr. Philbin’s voice mail that he
“suspects” a fellow classmate has had access to the information on the final. Has he
complied with the Honor Code?
3. Do Lee and Kathy have obligations to confront and report Bob?
4. Who is in violation of the Honor Code? Bob, Kathy, or Lee? All three students?
5. What constitutes an Honor Code violation? How and when to contact the Honor Board?
If additional time permits, discuss the following:
6. In college, class attendance is often optional, so long as one passes the examinations. Is
the same true in medical school? What about small group sessions? What about patient
centered exercises?
7. What resources were available to help Bob avoid this situation?
Facilitator Notes:
Visits to University Counseling Center (UCC) are confidential and information about students’ visits
will not be released to anyone at the University, including the Student Affairs Office/Advisory Dean.
Authors: Brenda D. Lee, M.Ed, Abiola Dele-Michael, M.D.
Alicia Jacob-Zysman. M.D. Thursday
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