6.4: Procedures for Addressing Performance, Professionalism and Technical Standards Concerns
The CP3 will periodically review the record of all students; in addition, it can place any student on its agenda for discussion and action if there is a concern about their performance or progress in fulfilling academic, professionalism or technical standards.
The CP3 can take any action it deems appropriate in its discretion under the facts and circumstances presented to address any concerns about academic, professional or technical standards issues, including (but not limited to):
- Requiring a student to correct a marginal pass or a failing grade in a specified manner and/or by a specified date.
- Placing a student on academic probation with a prescribed and restricted curriculum (including the discontinuation of activities such as extracurricular activities, RA-ships and TA-ships, laboratory research, community service, etc.) for a time period specified by the CP3.
- Requiring a student to take USMLE Step 1 or Step 2 CK at a specified time, requiring a passing score on such an exam, and/or restricting access to any clerkship until they have either taken or received an overall passing score.
- Placing the student’s enrollment on administrative hold for one or more quarters.
- Requiring a remedial curriculum, or that the student be referred for an assessment.
- Dismissing the student from Stanford University School of Medicine MD program under circumstances deemed by the CP3 to warrant such action
Procedures regarding academic deficiencies:
As a general proposition, students will be notified in advance if they are to appear on the agenda of the CP3.
Students who appear on the CP3 agenda in regard to an academic deficiency will be accorded the following rights:
- To ask for and receive from an Advising Dean a written explanation as to why they are receiving attention by the CP3.
- To have an opportunity to discuss their academic progress and/or deficiencies with an Advising Dean and to participate in formulating for presentation to the CP3 a proposal for a remedial program (where appropriate).
- To have an opportunity to submit a written statement to the CP3.
- In any case involving dismissal from Stanford University School of Medicine MD program, to be invited to appear in person at the scheduled CP3 meeting during the presentation of their case prior to the closed deliberation of the committee. NOTE: Students appearing before the CP3 may have a qualified advocate of their choice accompany them to the meeting; advocates may be either the student’s academic advisor or another faculty member of Stanford University School of Medicine. An attorney is not a qualified advocate.
- Under ordinary circumstances, to receive a written report within 10 working days after the CP3 meeting detailing the committee action taken. The time frame may be extended for good cause at the discretion of the CP3 chair.
- To have an opportunity to discuss the CP3 action and report with an Advising Dean and to submit a written request to the CP3 chair that the action be reconsidered. The request must be based on compelling new information not available at the time the action was taken, not on a complaint expressing dissatisfaction with the outcome or with an underlying University or Stanford University School of Medicine policy of general application. Such a request should be submitted within 14 working days of receipt of the report, but the time frame may be extended for good cause at the discretion of the CP3 chair.
- To have the opportunity to file a formal grievance, as outlined in the Stanford University Bulletin (Student Academic Grievance Procedure). Grievances appealing a CP3 action are filed with the Dean of the School of Medicine.
Procedures regarding professionalism concerns:
- In general:
- The faculty of Stanford University School of Medicine endorses students as suitable to practice medicine based on maintenance of continuous satisfactory performance in the areas of meeting academic, professional, and technical standards.
- The CP3 may address minor professionalism concerns at its discretion and as it sees fit, such as by referral to a student’s academic advisor or completion of a program of remediation.
- As to serious professionalism concerns, such concerns will be addressed under a three step process as presented below.
- NOTE: Alleged violations of Stanford’s student conduct codes (including the Honor Code and the Fundamental Standard) are adjudicated by a different University process. That conduct, however, may also raise concerns regarding professionalism requiring review under this process.
The Three-Step Process
Step 1: Personal Communication
A faculty member (including any of the Advising Deans) or any other individual should communicate a possible substantive deficiency in professionalism of a medical student to the Senior Associate Dean for Medical Education. The Senior Associate Dean will then inform the CP3. This should be done as soon as practicable after the professionalism deficiency is identified.
The Senior Associate Dean (or his or her delegate) should give the student a copy of these guidelines and arrange a meeting with the student and, as appropriate, the individual identifying the deficiency and/or any of the Advising Deans. If the alleged deficiency can be explained or corrected in a mutually satisfactory manner, the matter need go no further. The Senior Associate Dean should then communicate his or her conclusions or actions to the CP3.
To facilitate identification of students who may have professionalism deficiencies, student services personnel will maintain impermanent files separately from students’ permanent files as a repository for such concerns. If a serious professionalism concern is communicated to a student, a memorandum regarding the conversation should be sent to the student and a copy placed in the student’s impermanent file. By having a central repository for such information, students whose performance repeatedly provokes professionalism concerns can be identified. The impermanent file should also contain records on formal or informal hearings, and/or CP3 considerations of students regarding professionalism. Except as disclosure is necessary under this process, access to impermanent files will in general be restricted to those Stanford administrative personnel with a need to know (such as the Advising Deans and the CP3) and the student. As a general proposition, the contents of any such impermanent file are to be destroyed within one year after the student graduates.
Step 2: CP3 Informal Hearing
If the student, the identifier of the deficiency, the CP3, or the Senior Associate Dean is not satisfied with the result of the personal communication described above, the CP3 will hold an informal private hearing upon being notified of that dissatisfaction. The informal CP3 hearing will involve the student, a quorum of the CP3, the student’s Advising Dean, a student-chosen advocate (who must be a faculty member of Stanford University School of Medicine ), and any other individual (e.g., the faculty member identifying the deficiency) whom the chair of the CP3 thinks pertinent to discuss the matter. The purpose of the informal private hearing will be to permit the student and any other involved individuals to present their versions of the alleged deficiency and work out, if possible, a mutually satisfactory remedy.
The chair of the CP3 will communicate in writing the results of the hearing to the student and the Senior Associate Dean within ten working days of the meeting. At the discretion of the Senior Associate Dean, the written communication or other summary of any mutually satisfactory remedy may also be placed in the student’s permanent file. If there is no mutually satisfactory remedy, the written communication and any other records of the informal hearing will be placed in the student’s impermanent file.
Step 3: Formal Hearing
If the matter cannot be satisfactorily resolved at the CP3 informal hearing, or if the student or the Senior Associate Dean is not satisfied with the outcome of the hearing, or if there is a breakdown of (or failure to timely complete or adhere to) the mutually agreed-upon remedy, the CP3 chair will call a formal hearing.
A formal hearing is intended to provide an opportunity for the parties to present their positions in a process with the authority to decide on a remedy and/or an outcome, including dismissal from the Stanford University School of Medicine MD program. The Executive Committee of the School of Medicine Faculty Senate shall appoint, to hear the matter, an ad hoc Committee on Suitability for the Practice of Medicine. The Committee on Suitability will be composed of four members of the full-time faculty and one member of the adjunct clinical faculty. Each member of the Committee on Suitability must attend the formal hearing. The Committee on Suitability will hear the matter and make findings and recommendations to the Senate Executive Committee. Decisions of both committees will be made by majority vote.
The chair of the Committee on Suitability for the Practice of Medicine will conduct the formal hearing using the general procedural guidelines outlined below:
- The student will be informed in writing of the alleged deficiency to be considered, of the situation upon which the concern is based, and of the scheduled date of formal hearing (which shall be at least 10 days after the date of this written statement). The written statement will also include a copy of this process and any special rules and procedures to be followed in the hearing. The student may request a reasonable extension of the hearing, if necessary, to prepare their position.
- The student will be allowed to inspect their medical school education record to which they would be entitled under Stanford’s policy on the Privacy of Student Records, including material in such files concerning the alleged deficiency.
- No person who has first-hand information concerning this matter, who presents evidence at the hearing, or who otherwise is involved in this process may serve on the Committee on Suitability. A replacement, when necessary, will be appointed by the Senate Executive Committee.
- The student will be permitted to have a qualified advocate accompany them at the hearing, but that advocate may not participate directly in the hearing. The advocate must be a member of the Stanford University School of Medicine faculty; an attorney is not a qualified advocate. The student shall notify the chair of the Committee on Suitability at least five days prior to the hearing of the identity of any advocate.
- The student has a right to be present during the presentation of evidence supporting the alleged deficiency, to question any witness who presents evidence at the hearing, and to offer evidence or argument at the hearing to rebut that evidence. The student will be given a reasonable opportunity to present their version of the situation, and may present relevant evidence and witnesses on their behalf.
- The presentation of evidence and arguments will be recorded by a court reporter.
- Unless the student asks for an open hearing, the data and discussions of the hearing will be kept confidential, and no record will be placed in the student’s permanent file unless the charge of deficiency is substantiated.
- The findings and recommendations resulting from the formal hearing should be based upon the evidence presented at the hearing and on the contents of any pertinent Stanford University School of Medicine student records and files
After the hearing, the Committee on Suitability for the Practice of Medicine will convey its findings and recommendations in writing to the Senate Executive Committee in a timely manner. The Senate Executive Committee will consider the findings and recommendations and issue a final decision in writing to the student in a timely manner. The Senate Executive Committee will also inform the CP3 chair and the Senior Associate Dean of Medical Education of the final decision.
The student may appeal the decision of the Senate Executive Committee to the Dean of Stanford University School of Medicine as a formal written grievance under (and within the time limits of) the Stanford University Student Academic Grievance Procedure.
Procedures regarding technical standards concerns:
If concerns arise as to a medical student’s continuing ability to fulfill the technical standards of Stanford University School of Medicine, the CP3 will appoint an ad hoc committee to review the matter and advise the CP3.
updated August 2021