OME: Global Assessment of Medical Student Professionalism

Evaluated By:*

First Name

Last Name

Student:*

First Name

Last Name

Dates: (start date to end date)*

:

Have you discussed your concerns about the student's behaviors with them?*

Yes No

This student has exhibited one or more of the following behaviors that need improvement to meet the standards of professionalism, as defined by the University of Nevada, Reno School of Medicine Code of Student Professionalism.

Please write a short description of the observed behavior(s) of the student you are reporting about:*

This student needs further education or assistance with the following:

Integrity

Behaving in an ethical and dependable manner Adhering to the UNR Med Student Honor Code Acting in a manner to be deemed worthy of trust

Reliability and Responsibility

Completing tasks in a timely manner Arriving on time for scheduled activities Notifying faculty Attending all mandatory classes and activities for full duration Adequately preparing for educational activities Responding promptly (within 48 hours) to faculty and administration requests when contacted personally or electronically Knowing the contents of the syllabus published for each course

Self-Awareness

Accepting constructive feedback and modifying behavior accordingly Maintaining professionalism in interpersonal relationships Maintaining composure during difficult interactions Identifying and modifying personal biases that may affect professional interactions Recognizing limitations and seeking help

Team Building and Communication

Checking and responding to UNR Med email within 48 hours Demonstrating respect and sensitivity in all communication and interactions with fellow students Demonstrating sensitivity to patients Accepting and providing constructive and supportive feedback Managing conflicts in a collegial manner

Patient Centered Care

Demonstrating compassion Maintain patient confidentiality Acknowledge limits of knowledge in patient care settings

Comments and Suggestions for Change:

Your Signature:*

[clear]

All forms are submitted to Neda Etezadi-Amoli, M.D., Associate Dean, Academic Affairs and Janet Corral Ph.D., Associate Dean, Medical Education.

University of Nevada, Reno School of Medicine Global Assessment of Medical Student Professionalism