Students pursuing the MD degree at Harvard Medical School (HMS) are physicians in training who must meet standards of professional conduct and responsibility (see Section 4.01) to develop into effective physicians. As a professional school, HMS requires attendance and active participation in all components of the curriculum, as defined by course and clerkship directors. Active participation in the School’s course and clerkship activities indicates the student’s understanding and mastery of professional responsibilities. The granting of the MD degree attests to the fact that the student has demonstrated a commitment to his/her professional responsibilities through participation in all aspects of the curriculum as defined by the faculty. When it is necessary for students to be absent from a required MD program activity, students must approach such absences with the same standard of professional responsibility required of practicing physicians; professional responsibility extends to one’s patients and members of one’s team. See Section 4.01, Responsibilities of Teachers and Learners.
The Pathways MD curriculum is designed to promote active engagement of each student in all components of the curriculum with the following goals for students: to develop a sense of professionalism, to promote collegiality, to engage students in teaching one another, and to give students experience working in teams where different backgrounds and expertise are represented. Meeting these goals requires each student to be present and actively engaged; consequently, attendance is required at all sessions of each course.
A central tenet of the HMS attendance policy is that students provide the faculty with timely and valid requests and/or notifications for absences from any curricular activities. The faculty relies on a student’s honesty in presenting a compelling reason for an absence from a required activity to be the core principle underlying professional communication regarding such absences; integrity is a core value for doctors. Faculty will likewise apply the attendance policy without preconceived judgment or assumptions in a way that is both fair and consistent, but which also considers a student’s individual situation. When a student does not attend a required session or course activity and has not provided, in advance, an appropriate request for permission for or explanation of the absence, as described below, the student is in violation of the standards of conduct required for students at HMS.
Attendance at and participation in learning activities in all four years of the curriculum, whether classroom or clinical, is considered critical for the professional development of the physician. Consequently, the attendance policies will apply throughout the 4-year curriculum.
The integrated curriculum of the Pathways MD program in the foundational preclerkship phase and in the integrated advanced science/clinical courses post-clerkships is designed to promote an engaging, collegial interchange of ideas among students and faculty in all sessions, including large group formats such as lectures. Students are required to attend all sessions and to participate. In some formats that involve collaborative work, participation will be assessed and comprises an important element in the satisfactory demonstration of competence. Attendance may be taken at any and all sessions. Because the patient must be the center of all health care activities, attendance will be assessed at all sessions that involve patients, including large-and small-group formats. In addition, students shall attend, on time, all sessions that specifically involve written or oral examinations. A student who arrives late will not ordinarily be allowed additional time on an examination.
The clinical components of the curriculum, including all clinical experiences during the preclerkship phase of the MD program, core clinical clerkships and subinternships, and clinical electives, mandate the full-time commitment of the student in all patient-care and didactic activities. The student’s presence during all patient care activities - on the clinical floors of the hospital, in clinics, in physician offices, and in diagnostic settings, is critical to the learning experience because it provides opportunities to observe and to participate in acute medical management decisions. Students are required to attend all lectures, rounds, case presentations, conferences, clinics, on-call periods, and other experiences as designated by the clerkship, Practice of Medicine or ICM director.
Planned absences for religious observance, family emergencies, presentations at scientific conferences, or required legal activity (e.g., jury duty) should be discussed (in advance whenever feasible) with the Society Master and relevant course faculty. The Society Master must be informed of all absences, including cases of acute illness. An explanation of the criteria for consideration of absences from courses and clerkships is outlined below.
Absences are categorized as Category 1, Category 2, or Category 3 based on the criteria outlined below. Regardless of the category of the absence, the student must notify his/her Society Master, the director of the course(s) or clerkship in which the student is enrolled at the time of the absence, and, if applicable, the PCE director, in advance whenever he/she will be absent from any required course or clerkship activity. The Society Master will determine which Category will be recorded for the absence using the criteria in this policy and will notify the student and course/clerkship director of the decision. For purposes of this policy, the unit of measure for an absence is a class session for classroom courses (i.e., preclerkship courses and non-clinical electives) and a day for clinical activities (core and elective clerkships, Practice of Medicine, Patient-Doctor II, ICM).
Category 1 Absences
Medical and family emergencies outside a student’s control may justify a Category 1 Absence. These include medical emergencies or acute illness and follow-up care, family emergencies, and sudden changes in life circumstances.
Religious obligations are a valid reason for a Category 1 Absence from a class or clerkship activity. Massachusetts state law provides that a student in an educational institution who is unable, because of his/her religious obligation, to attend a class, participate in an examination, or meet a study or work requirement shall be provided with the opportunity to make up this work (see Section 7.01, Harvard University Policy Regarding Religious Holidays). Students should use careful discretion in judging the importance of a particular holiday and in requesting travel days around such holidays. The student must inform his/her course or clerkship director (as well as other relevant individuals as outlined above for unexpected events) and Society Master at least one week in advance when he/she must be absent for a religious obligation. Extended time off beyond the timeframe of the official religious holiday will not be considered a Category 1 Absence. See also Section 2.03, Grading and Examinations.
Category 2 Absences
Category 2 Absences typically include absences for special events (e.g., weddings, graduations, family gatherings) or reasons other than those enumerated above in Category 1. This Category is designed to recognize the importance of family events even as students assume professional responsibility, but with some reasonable limits to be recognized. Students who accumulate more than three Category 2 Absences during an academic year will be referred to the HMS Promotion and Review Board (PRB) to review the rationale for this number of Category 2 absences. Because of the high importance placed on attendance at all required course and clerkship sessions, Category 2 Absence requests should be submitted judiciously. The ultimate decision about a Category 2 absence rests with the PCE director during the PCE and with the Society Master during all other components of the curriculum.
Scheduled Conferences. Leadership in medicine is founded on a solid knowledge of the science of medicine. To that end, building the foundation of medical knowledge and clinical skills must be the priority for medical students. While leadership in extracurricular and extramural activities is encouraged, such opportunities must not occur at the expense of a student’s required coursework and attendance responsibilities. The threshold for a Category 2 absence to participate in or present at a conference should be higher during the preclerkship and PCE components of the MD program. Participation in or presentation in any format at a conference is best deferred to the post-PCE component of the MD program. Students considering submission of an abstract or paper for presentation at a conference should not do so before getting permission from the Society Master or the PCE director, if the event occurs during the PCE.
a. Individual students may request permission to attend a scientific conference or meeting for the purposes of presentation of a paper or other academic work or poster as first author. A Category 2 Absence is ordinarily limited to the day of the presentation and reasonable associated travel time, i.e., the absence will not include the entire conference.
b. Student Associations: Many student organizations host national meetings of interest to HMS students; these organizations include the following:
- Organization of Student Representatives of the Association of American Medical Colleges (AAMC)
- American Medical Student Association (AMSA)
- American Medical Women's Association (AMWA)
- Student National Medical Association (SNMA)
- American Student Dental Association (ASDA)
- Asian Student Association
- Hispanic Student Association
Individual students who wish to attend a conference must follow the policy below:
- Ordinarily, only elected officers, students seeking or holding leadership positions in the organization hosting the conference, or presenters may qualify for a Category 2 Absence from a course or clerkship in order to attend a conference.
- The ultimate decision about a Category 2 Absence for scheduled conferences rests with the Academic Society or the PCE director, if occurring during the PCE, and is based on the student’s academic record to date, attendance record to date, and the course/clerkship director’s estimation of the importance of the specific course/clerkship session(s) that would be missed.
- Students may not qualify for a Category 2 Absence from an examination in order to attend a professional conference (See Section 2.03, Examination Policy).
Additional factors to be considered include:
- A student must make certain he/she has financial resources for all anticipated conference and travel expenses before committing to any travel.
- After completing the steps outlined above, the student may make arrangements for the conference (purchase tickets, secure accommodations, pay conference registration fees, etc.). No student should make any purchases until he/she has received permission from the Society Master or the PCE director during the PCE to miss class, clerkship or PCE time to attend the conference.
Under no circumstances will an Absence, either Category 1 or Category 2, relieve a student of meeting all of the academic requirements of the course or clerkship; if the Category 2 Absence request conflicts with a session or sessions that cannot be otherwise made up or completed, the student will be advised that the absence may or will affect the grade received in the course or clerkship.
Category 3 Absences
Category 3 refers to unreported absences and those that do not follow the policy above. A zero tolerance policy exists for unreported absences throughout the curriculum. Failure to request and confirm an absence from any required course or clerkship – didactic or clinical – (even if the reason would have been in Category 1 or 2 if requested in advance) will be considered a Category 3 absence constituting a failure of professional responsibility and will be referred to the PRB.
Depending on the situation, the PRB may place students on Monitored Academic Status (MAS) or Academic Probation for 3 or more Category 2 Absences or for any Category 3 Absences. See Section 4.03, Policies and Procedures on Student Rights and Responsibilities.
Vacation periods are published in the academic calendars for courses and clerkships (Section 2.01). Students are not allowed to begin vacations before the published vacation start date or extend vacations beyond the published vacation end date.
Required subinternship: In the core (required) subinternship in Medicine or Pediatrics senior medical students function as "intern equivalents" under the supervision of a senior resident. Given the level of responsibility students assume in this clinical setting, no Category 2 Absences or travel to professional conferences are allowed during this core clerkship. If a student anticipates a need for time off during the final year of medical school, the subinternship should be scheduled during a different block, pending availability. Students should consider the timing of residency interviews for the specialty to which they are applying when scheduling the subinternship to avoid interview conflicts during the subinternship.
Consequences of Noncompliance with Attendance Policy
Students who fail to comply with the School’s attendance policy face a number of serious consequences. These include the following:
- Grades may be affected.
- A Category 2 or Category 3 Absence from a required subinternship will result in a failure and require that the subinternship be repeated.
- Students who accumulate more than three Category 2 Absences during an academic year or who fail to report any absence from any course or clerkship session (Category 3 Absences) will be referred to the HMS Promotion and Review Board.
- The PRB will review attendance noncompliance to determine whether such unprofessional behavior warrants official censure in the student’s academic record and Medical Student Performance Evaluation (MSPE, or Dean’s Letter).
- Summative comments in the evaluations of preclerkship and clinical courses and non-clinical electives may include descriptions of Category 2 Absences and/or Category 3 (Unreported) Absences or tardiness. Such comments will be included in the MSPE.
Any student who does not attend their scheduled classes or clerkships for a period of 30 days without approval and has not been placed on an official leave of absence (LOA), absent extenuating circumstances, will be considered absent without leave and withdrawn from Harvard Medical School. See Section 2.09, Leaves of Absence.
Last updated on 6/15/15