Comment on Student Professionalism (CSP) Form

Please click here to complete a Comment on Student Professionalism Form

The Comment on Student Professionalism Form (Formerly known as the Professional Behavior Observation Form) is designed to look for patterns that will impair the student’s ability to function effectively as a physician. A form may be submitted to the Office of Medical Education by anyone who witnesses inappropriate or concerning behavior by a student. The faculty member submitting the form may deal with the concern and just report the interaction, or may request that the faculty member meet with the student about the incident. They can determine the level of necessary intervention which can range from a conversation with the student, to referral to Honor Council, medical (psychiatric) referral, or to the Associate Dean of Student Affairs or Vice Dean of UPSOM for serious issues.

Such incidents, if minor and if there are no recurrences, are kept in the student’s file until graduation, at which time the file is destroyed. Unless these issues rise to the level requiring disciplinary action, they do not become part of a student’s permanent record. This form exists to track patterns of behavior without putting a student in jeopardy of “labeling.”

UPSOM has identified professional attributes that we consider to be a core part of the educational program. These attributes are excerpted below:

Honesty, integrity, and self-awareness, being able to recognize, admit and remediate mistakes or lack of knowledge or skill (9.5, 23-1, 23-2, 28-5) *

Respect, integrity, compassion and empathy (9-5, 23-2)

Respect for others as demonstrated through punctuality, dependability, completion of assigned tasks, and professional appearance (20-1, 23-3)

Leadership and accountability (24-2, 24-3)

Provide culturally competent care (15-4, 20-3, 20-5)

Respect for patient privacy (21-4)

Conduct research activity with integrity (26-1)

Collaborate effectively with others and share responsibility and credit appropriately (23-4, 24-2)

Manage conflicts with others in a collegial manner (23-5)

Conduct one’s self within appropriate boundaries in relationships with co-workers, patients and industry (20-1, 23-6)

* Numbers refer to UPSOM Educational Objectives where an attribute is cited