2.02 Attendance

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. 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.

Pathways Preclerkship

HST Preclerkship

Principal Clinical Experience (PCE)

Elective Clinical Clerkship

Required Subinternship

Advanced Integrated Science Courses (AISCS) and Essentials of the Profession II

Required Clinical Capstone Course 

 

PRECLERKSHIP PHASE

Pathways Preclerkship

The Pathways MD curriculum is designed to promote active engagement of each student in all components of the curriculum with the following goals:

  • To develop a sense of professionalism
  • To promote collegiality
  • To engage students in teaching one another
  • To give students experience working in teams in which different backgrounds and expertise are represented.

Meeting these goals requires each student to be present and an active participant.

A central tenet of the HMS attendance policy is that students provide the faculty with timely and valid notifications for absences from any curricular activities. The faculty rely on a student’s honesty and integrity when presenting a compelling reason for an absence from a required activity; honesty and integrity are core values for doctors and dentists. Multiple absences not only impair individual learning, but also impact group learning which is vital to the success of the Pathways curriculum.

The integrated curriculum of the Pathways MD program is designed to promote an engaging, collegial interchange of ideas among students and faculty in all sessions, including large group formats such as lectures. It is the expectation that students will arrive to class on time, as well as attend and participate in all sessions unless an absence has been requested as outlined below. In formats that involve collaborative work, participation will be assessed and comprises an important element in the satisfactory demonstration of competence. Because the patient must be the center of all health care activities, attendance is particularly important in all sessions that involve patients, including large-and small-group formats. In addition, students are expected to attend all sessions that specifically involve written or oral examinations. A student who arrives late will not ordinarily be allowed additional time on an examination.

On the part of the School, the attendance policy will be evenly and fairly applied to all students. The official academic calendar is posted online.

Pathways Preclerkship Absence Policy

A planned absence from a Pathways preclerkship course or course session must be reported a minimum of two weeks in advance. The student will notify faculty and administrators, as outlined below, by submitting the Course Absence Notification Form with the date of the session(s) to be missed, the affected course(s), and the reason for the absence.

When it is not feasible to provide advance notice (illness, family emergency), the course director (site director for Practice of Medicine), society advisor and society coordinator must be informed as soon as possible, ideally on the day of the absence. In the case of illness requiring a student to stay home, the student should email the society coordinator as well as involved faculty, including clinic and hospital preceptors, on the morning of the absence, in addition to filling out the Course Absence Notification Form.

Absence forms will be collected and monitored centrally. Notification of all absences will be sent to the society as well as to the course director and appropriate course faculty.

It is strongly encouraged that members of a student’s small group and relevant course faculty also be informed of a planned absence given the impact on group dynamics. Planned absences of more than one day must be registered and discussed in advance with both the society advisory dean and the course director to ensure that the student is aware of the ramifications of an extended absence.

More than FIVE absences over the course of the preclerkship curriculum, as well as ANY unreported absence will trigger an in-person meeting with the society advisory dean and referral to the Council of Academic Societies. Such cases may be referred to the Promotion and Review Board (PRB).

If a student is absent, he or she is expected to learn the material. It is not the course faculty’s responsibility to arrange for make-up of missed content or sessions.

Required Attendance

Absence on the day of a course quiz or examination or other assessment activity or during Professional Development Weeks (PDWs), except in the case of a religious observation, illness, family or personal emergency, is not allowed, as credit will not be given for missed evaluation activities. Please see the examination policy in Section 2.03.

Patient-related Sessions

Absence during a patient-related session (e.g. patient clinic, Practice of Medicine clinical session) is highly discouraged and will be closely monitored. The tenets of professionalism set a higher bar for individual absence when a patient is involved in the educational activity. In addition, during patient-related sessions, we emphasize the importance of timely arrival, professional dress, and avoidance of cell phone use. Similar to sessions in the learning studio, an absence from a patient session must be reported in advance except when emergency situations do not allow for this.

Religious observance

Religious obligations are a valid reason for an absence. 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 complete the Course Absence Notification Form. See also Section 2.03, Grading and Examinations.

Scheduled Conferences and Student Associations

Students may be absent to attend a scientific conference or meeting for the purposes of presentation of a paper or other academic work or poster. Absences should be limited to the day of the presentation and reasonable associated travel time, i.e., the absence may not include the entire conference. Similarly, many student organizations host national meetings of interest to HMS students; absence should be limited to one day and reasonable associated travel time. These absences will be counted toward the five-day annual maximum.

Remote Participation Policy

In very special circumstances, remote participation in class sessions (via Skype, WebEx, FaceTime, etc.) may be considered to help students keep up with content when they are unable to attend class. This option is only applicable if the course director, society faculty, learning studio educators and tablemates agree. In the event that all parties agree, remote participation arrangements are the responsibility of the student who will be absent and not the Office of Curriculum Services or course faculty.

Additional factors to be considered

Under no circumstances will an absence relieve a student of meeting all of the academic requirements of the course; if the absence request conflicts with a session or sessions that cannot be otherwise made up or completed, the student should be aware that the absence may or will affect the grade given in the course.

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:

  1. Grades may be affected.
  2. Students who accumulate more than five absences during an academic year will be reported to the Council of Academic Societies and may be referred to the Promotion and Review Board (PRB).
  3. Failure to report any absence from any course or clerkship session will be referred to the PRB.
  4. The PRB will review attendance policy noncompliance to determine whether such unprofessional behavior warrants official censure in the student’s academic record.
  5. Summative comments in the evaluations of preclerkship courses may include excessive/unreported absences or tardiness.

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.

 

HST Preclerkship

HST educational programs train physicians, scientists and engineers to have a deep understanding of the analytical and molecular basis of medicine by integrating engineering, science and technology into medicine and biomedical research. Implicit in the HST educational experience is a high-quality, expertly-managed course-based curriculum that includes clinical training as well as a broad range of enrichment opportunities. In particular, HST students complement their classroom and laboratory exposure to the cutting edge of modern biomedical, physical and engineering sciences by participation in research in leading laboratories at MIT and at Harvard, HMS and the affiliated institutions. Active participation in all learning modalities is considered integral to an HST education. Nevertheless, HST fully realizes that it is sometimes difficult for a student to balance these competing and potentially mutually-exclusive commitments.

 

HST Preclerkship Absence Policy

HST believes that, within these guiding principles and philosophies, its reciprocal faculty-student educational “contract,” culture of respect, and unique range of objectives and opportunities necessitate a broad, context-based absence policy. Class attendance and participation are expected as a cornerstone of the HST curriculum and out of obligation to fellow students. Course directors and other faculty also have a responsibility to organize in-class time efficiently and effectively and to maximize learning and value to the students. Although HST courses include a diverse group of students with a broad range of career objectives, approaches to learning and programmatic requirements, all students benefit equivalently from the rigorous HST educational approach.

Thus, it is reasonable that all students in HST courses (including both HST MD and graduate students, as well as non-HST students) uniformly be expected to attend class sessions to the greatest extent possible. In this regard, students are explicitly NOT allowed to extend vacations beyond the periods specified in the academic calendar, or to miss academic exercises for frivolous reasons. Occasional absences from class, however, can occur for:

  1. attendance at a national or international research conference at which the student presents his/her work; attendance at the student’s qualifying doctoral examination; or the need to use critical, difficult-to-schedule equipment, etc.;
  2. a highly significant personal event, such as attendance at a sibling’s wedding;
  3. observance of religious holidays;
  4. illness or family emergency.

In all circumstances except illness or family emergency, it is the obligation of the student to notify the preclerkship course director in advance of the absence. If the absence is outside of the above-stated guidelines, permission MUST be obtained in advance from the course director. This allows a quantifiable means to verify adequate attendance to ensure that graduating students have achieved a level of competency as measured by performance on tests, and have shown a commitment to professional responsibility with participation in the entire educational experience that is defined by the curriculum.

Failure to accurately notate absences will be grounds for disciplinary action by the HMS Promotion and Review Board (PRB). Excessive absences may require repeating coursework. Course directors are encouraged to reiterate and clarify this policy during the first session of class and include it in writing in the course materials.

Implementation of this policy in a manner that serves the best interests of students, faculty and others (including patients) requires understanding and flexibility by and communication among all parties. While commitment to all aspects of the HST curriculum is generally expected, attendance at classes is only one measure of a student’s commitment. Students are therefore encouraged to seek the advice of their research supervisors, academic advisors, and course directors to schedule research, classes, and clinical training in such a way that they do not conflict with each other. Should a situation arise that might affect fulfillment of some of the student’s obligations (e.g., course attendance) or the student’s course of study, it is the student’s responsibility to consult with his/her academic advisor and/or course directors to find a solution that guarantees the student’s professional development. Consultation on issues related to attendance or absences and arbitration of disputes will be done by the London Society Advisory Dean and Associate Director at HMS.

Religious observance

Religious obligations are a valid reason for an absence. 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. It is the obligation of the student to notify the preclerkship course director in advance of the absence. See also Section 2.03, Grading and Examinations.

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.

 

PCE PHASE

Pathways and HST: Principal Clinical Experience and Core Clerkships

Students completing their PCE are physicians in training who should meet the highest standards of professional conduct and responsibility. Given the nature of clinical training and the important role of students on the healthcare team, it is expected that students will attend all clerkship and longitudinal activities during the PCE; absences are detrimental to the educational experience and should only occur under special circumstances. However, HMS is committed to student health and well-being, and it is understood that situations arise that may require absence from a clerkship or PCE session. We expect that our students will exert utmost professionalism when working with their clerkship and PCE leaders to coordinate absences. With the exception of the following three scenarios, all requests for planned absences should be made at least four weeks in advance of the affected clerkship and no less than four weeks prior to the event, as detailed below using the PCE Course Absence Notification Form

1. Emergent or Acute Life Events: Unexpected circumstances, such as acute illness, a family emergency, or other emergent life events may arise during the PCE. If an emergent situation arises, the student should notify the clerkship site director, clerkship coordinator, preceptor and supervising resident and attending physician on the student’s clinical care team as soon as possible. It is imperative that others have knowledge of such absences. In the case of some acute, contagious illnesses (e.g., Flu or Norovirus), students may be asked to stay at home and be cleared by Occupational Health before returning to clerkship duties.

2. Health or Academic Issues: It is expected and permissible for students to be excused from PCE/core clerkship duties to see a health care practitioner for any reason (e.g., general or mental health). There may also be times when students need to be excused/absent from the PCE to attend advising or counseling meetings that pertain to their professional, personal or academic life (e.g., attending appointments in the Office of Learning Resources and Support). Under these circumstances, students should communicate in a timely and effective manner as soon as possible prior to the absence with the PCE Director, Clerkship Site Director, and team. Students who need to see a health care provider regularly during the PCE should work with their Clerkship Site Directors to identify the best possible times to make these appointments.

3. Religious Obligations: Religious obligations are a valid reason for absence. 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 discretion in judging the importance of a particular holiday and in requesting travel days around such holidays. As religious obligations are known well in advance, students should communicate their observances and request to have these days off at the start of their PCE year by discussing them with their Society Advisory Dean and PCE Director.

Students who request absences from clerkships or PCE sessions for any reason that is not included in the above scenarios must first discuss these requests with their Society Advisory Dean and then obtain approval from both their PCE Director and the affected Clerkship Site Director, ideally 4 weeks in advance of the clerkship and no less than 4 weeks prior to the event. This includes absences for events such as weddings, required legal activity (e.g., jury duty), or presentations at scientific conferences. It is generally only allowable to miss clerkship activities for scientific conferences if presenting an oral, podium presentation, rather than a poster. If an excused absence is granted, students are expected to make travel arrangements to/from the meeting that are as expeditious as possible.

Requests for brief absences from the PCE and core clerkship for scenarios other than those noted above, such as meeting with a research team or interviewing for a scholarship, are not usually granted because of the detrimental effect of absences on the clerkship educational experience and, consequently, potentially on evaluations. It is the strong recommendation of clerkship site directors that such meetings be planned during free-time provided during the clerkship or after the end of the clinical workday, as this will afford the best chance of successful scheduling without clerkship disruption.

Making Up Time Due to Absences

Since clinical learning is experiential and integrated, it cannot be adequately made up in pieces; frequent and/or prolonged absence may pose a barrier to learning (i.e., home study does not replace the experience of providing care for patients). Consequently, when a student misses a significant amount of time in a clerkship, as outlined below, the student will be expected to make up time missed and will not be able to pass the clerkship unless additional clerkship time is scheduled. The Clerkship Site Director and the student will work together to identify an ideal time to make up time missed, either during or after the clerkship. It is important to note that students should not always expect that alternate arrangements can be made for requested absences, and that permitting such compensatory activity is at the discretion of the clerkship site director:

Medicine/Surgery—12-Week Rotation: Greater than three missed days

Obstetrics & Gynecology/Pediatrics—6-Week Rotation: Greater than two missed days

Neurology/Psychiatry/Radiology—4-Week Rotation: Greater than one missed day

Primary Care Clerkship (PCC) – Greater than two missed sessions

More than FIVE absences over the course of the PCE year, as well as ANY unreported absence will trigger an in-person meeting with the Society Advisory Dean and referral to the Council of Academic Societies. Such cases may be subsequently referred to the Promotion and Review Board (PRB) [See Sections 4.02 and 4.03].

Consequences of Noncompliance with PCE Attendance Policy

Students who fail to comply with the School’s attendance policy face a number of serious consequences. These include the following:

  1. Evaluations may be affected.
  2. Students who accumulate more than five absences during an academic year will be reported to the Council of Academic Societies and may be referred to the Promotion and Review Board (PRB).
  3. Failure to report any absence from any course or clerkship session will be referred to the PRB.
  4. The PRB will review attendance policy noncompliance to determine whether such unprofessional behavior warrants official censure in the student’s academic record.
  5. Summative comments in the evaluations of clinical courses may include excessive/unreported absences or tardiness.

 

POST-PCE PHASE

Pathways and HST: Elective Clinical Clerkship Absence Policy

The clinical components of the curriculum 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 site director.

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 Advisory Dean and relevant clerkship or course faculty. The Society Advisory Dean must be informed of all absences, including cases of acute illness.

 

Pathways and HST: Required Subinternship Absence Policy

In the core (required) subinternship in Medicine or Pediatrics, senior medical students function as “intern equivalents.” Given the level of responsibility students assume in this clinical setting, other than religious observance, no planned absences (including travel to professional conferences) are allowed during these core clerkships. If a student anticipates a need for time off, the subinternship should be scheduled during a different block, pending availability. 

 

Pathways Advanced Integrated Science Courses (AISCs) and Essentials of the Profession II Absence Policy

 

AISCs and Essentials of the Profession II are full-time courses that require student engagement in regularly scheduled activities in the classroom, and in clinical or other experiential settings.

If a student is absent, he or she is expected to keep up with the material covered in missed sessions. For any absence, students should contact the course directors to ask if specific make-up activities are required, in addition to following the procedures described below.

Planned absence: A planned absence from a course must be reported a minimum of two weeks in advance. The student will notify faculty and administrators by submitting the Course Absence Notification Form with the date of the session to be missed, the affected course, and the reason for the absence. The number of planned absences should not exceed one day during any individual  course, with the exception of residency interviews (see below).

Residency interviews: Students are expected to make all reasonable good-faith efforts to avoid scheduling interviews at any time that would conflict with a course activity. If conflicts are unavoidable, up to two absences may be taken specifically for residency interviews, and the reason should be indicated on the Course Absence Notification Form. This is in addition to the one planned absence described in the previous paragraph, which may be used either for a residency interview or for another purpose. If a student has questions or concerns about scheduling interviews, he or she should consult the society advisor.

Illness or family emergency: When it is not feasible to provide advance notice (illness, family emergency), the course directors, society advisor and society coordinator must be informed as soon as possible, ideally on or before the day of the absence. In the case of illness requiring a student to stay home, the student should email the society coordinator as well as involved faculty, including clinic and hospital preceptors, on the morning of the absence, in addition to filling out the Course Absence Notification Form.

Religious observance: Religious obligations are a valid reason for absence. 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 discretion in judging the importance of a particular holiday and in requesting travel days around such holidays. As religious obligations are known in advance, students should request to have these days off well before the start of a course.

Absence Notification Forms will be collected and monitored centrally. Notification of all absences will be sent to the society as well as the course directors and appropriate course faculty.

An in-person meeting with the society advisory dean will be required if, during an individual course, the student exceeds ONE absence for purposes other than residency interviews; or exceeds one absence for any purpose plus TWO additional absences for residency interviews; or for ANY unreported absence. Such cases may also be referred to the Council of Academic Societies and the Promotion and Review Board (PRB). Please reference the Pathways Preclerkship Absence Policy for further information about potential consequences of noncompliance.

 

 

Pathways and HST: Required Clinical Capstone Course Absence Policy

 

In the core (required) Clinical Capstone course, senior medical students function as “intern equivalents.” Given the level of responsibility students assume in this clinical setting, other than religious observance, no planned absences (including travel to professional conferences) are allowed during these core clerkships. If a student anticipates a need for time off, the Clinical Capstone course should be scheduled during a different block, pending availability. In addition, students should consider the timing of residency interviews for the specialty to which they are applying when scheduling the Clinical Capstone course to avoid interview conflicts during the Clinical Capstone.

 

Consequences of Noncompliance with Elective Clinical Clerkship and Required Subinternship Attendance Policy

 

Students who fail to comply with the School’s attendance policy face a number of serious consequences. These include the following

1.   Grades may be affected.

2.   Students who accumulate more than five absences during an academic year will be reported to the Council of Academic Societies and may be referred to the Promotion and Review Board (PRB).

3.   Failure to report any absence from any course or clerkship session will be referred to the PRB.

4.   The PRB will review attendance policy noncompliance to determine whether such unprofessional behavior warrants official censure in the student’s academic record.

5.   Summative comments in the evaluations of clinical elective or subinternship courses may include excessive/unreported absences or tardiness.

Religious observance

Religious obligations are a valid reason for an absence. 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. See also Section 2.03, Grading and Examinations.

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.

Updated 1/8/18