Pre-clerkship Phase Attendance Policy

Policy Statement: Medical students are expected to attend and participate in all assigned pre-clerkship phase activities. Attendance and participation are considered elements of medical student professionalism, and personal and professional development, as outlined in the PLFSOM Educational Program Goals and Objectives (specifically, objective 5.6 - “Demonstrate honesty in all professional and academic interactions”, objective 5.7 - “Meet professional and academic commitments and obligations”, and goal 8 - “Demonstrate the qualities required to sustain lifelong personal and professional growth”). Internal as well as published studies strongly indicate that attendance and participation correlate with academic success in medical school. As such, the school monitors and encourages medical student attendance and participation in all pre-clerkship phase curricular activities, and sets specific expectations for attendance and participation for all activities designated as “required” (including all graded activities).

1. Reason for Policy: This policy defines the expectations for pre-clerkship phase student attendance and participation in support of the school’s educational goals and objectives and, more generally, in support of student academic success.
2. Who Should Read this Policy: All students, all members of the PLFSOM Committee on Student Grading and Promotion (GPC), all pre-clerkship phase course directors, the PLFSOM Associate and Assistant Deans for Student Affairs (plus all Office of Student Affairs staff that interact with students in regards to attendance and/or conduct), the PLFSOM Associate and Assistant Deans for Medical Education, all pre-clerkship course coordinators.
3. Resources: This policy is primarily applied and supported by the PLFSOM Office of Student Affairs. This policy is administratively maintained (reviewed, revised, and disseminated) by the PLFSOM Committee on Curriculum and Educational Policy (CEPC).
4. Definitions:
   • Assigned activity: Any educational program administrative or curricular activity assigned to a student (as disseminated via the school’s curriculum and learning management systems or in emails sent to the students via their official TTUHSC accounts)
   • Required activity: Any educational program administrative or curricular activity for which attendance is required (as disseminated via the school’s curriculum and learning management systems or in e-mails sent to the students via their official TTUHSC accounts)
   • Graded activity: Any graded activity that substantively contributes to the student’s fulfillment of the overlying course objectives and to the student’s final grade. All graded activities are considered required, but not all graded activities constitute critical summative assessments (see overlying course or requirement syllabi)
   • Critical summative assessment: Critical summative assessments are graded activities involving performance standards that are obligatory to passing the overlying course or requirement. They are specified in the overlying course or requirement syllabus and disseminated via the school’s curriculum and learning management systems or in e-mails sent to the students via their official TTUHSC accounts
   • Attendance: Timely presence in and attention to an assigned activity (may be monitored, and may be recorded and assessed for required activities)
   • Tardy attendance: Late arrival to an assigned activity (defined as arriving within 10 minutes after the scheduled start time for an assigned activity). For some time-sensitive assigned activities (such as OSCEs), tardy admittance to an assigned activity may not be allowed, and under these circumstances the student will be counted as absent (consult course or requirement syllabi)
   • Absence: Non-attendance or arrival more than 10 minutes after the scheduled start time for an assigned activity. Absences are recorded at the course level by the required activity. However, excused absences (planned or unplanned) may involve entire days, including multiple required activities, and those days shall be accounted for as one absence under Section IX, regardless of the number of required activities missed. An excused absence requiring only part of a day, as determined by the Associate Dean for Student Affairs or their designee, shall be accounted for as one absence under Section IX, regardless of the number of required activities missed during the excused absence. For unexcused absences, each required activity missed shall be accounted for as one absence under Section IX
   • Planned absence: An absence anticipated and pre-approved by a student due to special circumstances consistent with Section 6.VI below
   • Unplanned absence: An absence unanticipated by the student and for which pre-approval is not possible - consistent with Section 6.VII below
   • Unexcused absence: An absence inconsistent with the criteria for excused absence, planned or unplanned, per Sections 6.VI and 6.VII below
5. The Policy:
   • General expectation of attendance and participation: Consistent on-time attendance and participation demonstrate respect for the educational environment and are essential ways for the school to monitor student progress in multiple competencies. Being on time and prepared to participate fully are essential to the effective work of learning teams. When it is necessary for students to be absent from a required activity, students must approach such absences with the same standard of professional responsibility required of practicing physicians. All absences from pre-clerkship phase required activities, whether planned or unplanned (see Sections 6.VI and 6.VII below), are expected to be reported to the PLFSOM Office of Student Affairs, and to be excused according to the criteria outlined below.
   • Relation of absences to professionalism: Unexcused absences from pre-clerkship phase required activities constitute a professionalism concern and are thus grounds for referral of the student to the GPC for review according to the criteria outlined below (see also the PLFSOM Policy on Grading, Promotion, and Academic Standing) - see also Section 6.VIII, below). Excessive absenteeism, as specified in Section 6.IX below, may constitute a professionalism concern and/or other academic concern(s) related to fulfillment of educational program objectives and/or fitness for continued participation in the educational program.
   • Absences, and academic responsibility: Under no circumstances does an absence, or tardiness, relieve a student of meeting all assigned academic requirements. Regardless of the cause or status of an absence, students are responsible for the content, work, and academic performance standards associated with all missed activities. Students are also expected to meet any participation requirements and, for group/team-based activities, to equitably contribute to their group’s learning (even in relation to missed activities). See section XII (Responsibility for make-up work).
   • General school and faculty responsibilities related to this policy: The school and its faculty are accountable for:
     1. Notifying students of their assigned activities via the school’s curriculum management systems or by the student’s official TTUHSC e-mail account
     2. Monitoring attendance for all required activities
     3. Notifying students of attendance concerns
     4. Establishing clear expectations for students regarding the timely completion of graded activities, critical summative assessments, and the scheduling of make-up activities/assessments when indicated as outlined below
     5. Acting fairly and in good faith under this policy
   • General student responsibilities related to this policy:
     Students are accountable for:
     1. Maintaining awareness of course policies related to attendance and participation. It is the student’s professional responsibility to review the absence policy and specific attendance requirements for all assigned courses and activities
     2. Accurately managing their schedules to ensure on-time preparation, attendance, and participation in assigned activities
     3. Accurately confirming their attendance as and when required (misrepresentations of attendance, for oneself or others, is considered a professionalism concern for which a student may be referred to the GPC for academic review)
     4. Communicating professionally about absences according to the systems established and disseminated by the Office of Student Affairs
     5. All absences involving required activities (including all graded activities and all critical summative assessments) should be reported via the plfabsence@ttuhsc.edu system (or alternative system, when indicated and disseminated by the Office of Student Affairs) regardless of whether the student presumes the absence will be excused or not seeking the school’s assistance if personal circumstances interfere with their on- time attendance and participation
     6. Accepting that faculty and school decisions under this policy shall be based on the specific relevant circumstances. Because of this, decisions rendered in any specific situation shall not be considered as establishing generally applicable precedents
   • Planned absences: A planned absence from a pre-clerkship phase required activity must be reported a minimum of two weeks in advance (unless deemed unavoidable by the Associate Dean for Student Affairs, non-compliance shall result in the absences being counted as unplanned). The student will notify the Office of Student Affairs via the plfabsence@ttuhsc.edu e-mail system (or alternative system, when indicated and disseminated by the Office of Student Affairs). Planned absences must be pre-approved by the Associate Dean for Student Affairs or their designee. Requests should be based on compelling circumstances such as:
     1. Routine/non-acute medical and dental appointments
     2. Discretionary legal proceedings/consultations or other appointments for necessary professional services
     3. Essential personal/family events (weddings, graduations, etc.)
     4. Religious obligation/observance
     5. Scheduled conference presentations/unique programs/school-requested tasks
     6. Requests deemed insufficient or excessive shall be denied - subject only to appeal to the Dean (or the Dean’s designee) within 5 business days of the student’s notification of the denial. Appeals must be submitted in writing or via the student’s TTUHSC e-mail account and copied to the Associate Dean for Student Affairs.
     7. Student appeals of a denied absence request should include a detailed explanation of the request and of the basis for the appeal. If a student’s absence request conflicts with a required activity that cannot be otherwise made-up or completed, the absence may adversely affect the student’s grade or other performance assessments in the activity and its overlying course or requirement.
   • Unplanned absences: Unplanned absences should be reported to the PLFSOM Office of Student Affairs via the plfabsence@ttuhsc.edu system (or alternative system, when indicated and disseminated by the Office of Student Affairs) as soon as the circumstances reasonably allow (typically within 24 hours). In situations not involving critical summative assessments (as designated by the overlying course or requirement syllabus), the criteria for excused unplanned absences include:
     1. Acute illness (documentation of a directly related physician encounter is required for absences of three or more days)
     2. Participation in legal proceedings (with documentation)
     3. Serious illness or death of a family member (documentation may be required for multiple absences or absences of three or more days)
     4. Observance of a religious holy day/obligation (documentation may be required for multiple absences or absences longer than one day)
     5. Other personal or family emergency (with documentation)

In situations involving critical summative assessments (as designated by the overlying course or requirement syllabus), the above criteria still apply, but documentation is required in all cases (specifically including documentation of a directly related physician visit on the day of or before the absence).

• Unexcused absences: All absences should be reported via the plfabsence@ttuhsc.edu system (or alternative system, when indicated and disseminated by the Office of Student Affairs) regardless of whether the student presumes the absence will be excused or not. As per Sections 1 and 6.I above, unexcused absences from pre-clerkship phase required activities constitute a professionalism concern and are thus grounds for referral of the student to the GPC according to the criteria outlined below (see also the PLFSOM Policy on Grading, Promotion, and Academic Standing). Referral of a student to the GPC based on unexcused absences shall be made by the Associate Dean for Student Affairs (or their designee). Unexcused absence from a required activity may result in reduced or no credit for the activity depending on the overlying course or requirement policy and the student’s performance on any associated make-up assignments, if allowed. Alternatively, students may lose points toward their final grade due to unexcused absences as outlined in the individual course syllabi. A single unexcused absence from a critical summative assessment may result in referral of a student to the GPC based on a professionalism concern. Referral of a student to the GPC based on an unexcused absence from a critical summative assessment shall be at the discretion of the Associate Dean for Student Affairs (or their designee).
• Total absences regardless of cause: For the reasons outlined in Section 6.I above, there is a general expectation of consistent attendance and participation in assigned activities regardless of the potential cause(s) of any particular absence or combination of absences (see definition of absence in Section 5 above). As such, any student with 5 or more absences during any pre- clerkship semester, regardless of cause, shall be required to meet in person with the Associate Dean of Student Affairs (or their designee) to: 1. Review this policy; 2. Review the nature (types and pattern) of the student’s absences; 3. Discuss any related corrective measures, assistance, or support services the student may need to consider; and 4. Explore options for mitigating the adverse academic consequences of their absenteeism. In addition, any student with 10 or more absences during any pre-clerkship phase semester, regardless of cause, shall be referred by the Associate Dean for Student Affairs to the GPC for review of the student’s fulfillment of educational program objectives and academic fitness for continued participation in the educational program.
• Missed graded activities and critical summative assessments:
  1. Missed graded activities and critical summative assessments due to planned absences: In requesting approval for a planned absence under Section VI above, it is the student’s responsibility to review their assigned activities during the proposed absence, and to list in their request any graded activities and critical summative assessments they will miss (failure to declare a graded activity and/or critical summative assessment may result in no credit, and no make-up opportunity, for the activity/assessment). Requests for planned absences may be denied solely on the basis of their interference with the student’s timely participation in assigned graded activities and/or critical summative assessments. For an approved planned absence involving missed graded activities and/or critical summative assessments, it is the student’s responsibility to contact the relevant course or requirement director to arrange for a make-up activity or assessment. Make-up activities or assessments shall, whenever possible, be scheduled at the discretion of the course director within 2 business days immediately before or 5 work days immediately after the approved absence. As also noted under Section VI above, some required activities, including some graded activities, cannot be made-up or completed as intended (usually due to the team-based or experiential nature of the activity), and under these circumstances the absence may adversely affect the student’s grade or other performance assessments in the activity and its overlying course or requirement.
  2. Missed graded activities and critical summative assessments due to unplanned absences: For an unplanned absence involving missed graded activities and/or critical summative assessments, it is the student’s responsibility to contact the relevant course or requirement director as soon as possible, and no later than 24 hours after returning, to arrange for a make-up activity or assessment. Make-up activities or assessments shall, whenever possible, be scheduled at the discretion of the course director within 5 business days immediately after the student’s return. As also noted under Section VI above, some required activities, including some graded activities, cannot be made-up or completed as intended (usually due to the team-based or experiential nature of the activity), and under these circumstances the absence may adversely affect the student’s grade or other performance assessments in the activity and its overlying course or requirement.
  3. Missed graded activities and critical summative assessments due to unexcused absences: Missed graded activities or critical summative assessments due to unexcused absence will result in no credit for the activities or assessments (the student is then subject to the remediation policies of the overlying course or requirement).
• Tardiness: Repetitive tardiness is disruptive and constitutes a professionalism concern that may be cited in student assessments and reported to the Associate Dean for Student Affairs as a potential basis for individual counseling, and for processing in the context of other academic concerns as may arise. A student who accumulates five episodes of tardiness involving required activities in any semester is required to meet with the Associate Dean for Student Affairs (or their designee) for individual counseling (consistent with Section 6.IX above). Persistent repetitive tardiness, despite individual counseling by the Associate Dean for Student Affairs (or their designee), may result in referral of a student to the GPC based on a professionalism concern, and this is required for any student accumulating ten or more episodes of tardiness involving required activities in any semester. Referral of a student to the GPC based on repetitive tardiness shall be made by the Associate Dean for Student Affairs (or their designee). Tardiness involving a critical summative assessment may result in reduced time allowed for completion of the assessment (students may be denied compensatory time), exclusion from the exam (and associated loss of credit for the exam), and/or diversion to an alternative testing location/station.
• Responsibility for make-up work: To meet the objectives of any missed activity, students should review relevant learning materials, participate in any linked formative assessments, practice quizzes, or posted discussion questions, and consult with their classmates regarding the specific content covered in the activity. For missed required activities, regardless of cause, a students should contact the course director to determine if make-up work is required. Course directors (or their designees) may issue alternative assignments for students to complete when they are absent from a required activity, regardless of whether the absence is excused or unexcused. Make-up work may be required even in situations where the student will not receive credit for a missed required activity based on the overlying course or requirement policy. Students must complete required make-up work by the faculty-assigned deadline, without reminders from the activity/course staff or faculty.
• Responsibility for the additional costs related to absences and tardiness: In particular situations, unexcused absence from, or tardy attendance of, a required activity may result in a student being responsible for the additional costs incurred in making-up the activity (for example, the unbudgeted cost of providing a previously unplanned standardized patient).