Professionalism Form

THE LEARNING/WORK ENVIRONMENT SHOULD BE FREE OF MISTREATMENT, HARASSMENT, AND THREAT OF RETALIATION.


PROFESSIONALISM CONCERNS AND COMPLIMENTS NOT REGARDING CI MED STUDENTS
This form is for submitting professionalism concerns and compliments regarding CI MED students. All other professionalism concerns and compliments should be submitted to the sources below:
  • Concerns regarding CI MED staff should be directed to the Chief of Staff, Dr. Rosalind Garcia-Tosi.
  • Concerns regarding CI MED faculty (both clinical and non-clinical) should be directed to the Office of Faculty Affairs and Development, Dr. Deb Young.
  • Concerns regarding CI MED clinical non-faculty should be addressed through the Office of the Learning Environment, Dr. Mark Shima.

DEFINITION OF PROFESSIONALISM
Professional behavior is referenced in the work of the AAMC, including Patient-Centered care, Ethical conduct, Competence and skill, Accountability and Responsibility, Communication and Interpersonal skills, Continuous learning, Altruism, and Professional readiness. Additional information on CI-MED Student Professionalism can be found in APS-4 in the student handbook.
EXPECTATIONS
It is expected that Carle Illinois College of Medicine faculty, staff, students, and representatives will conduct themselves at all times in accordance with University conduct, policies, and guidelines - including the Student CodeUniversity Ethics, the Carle Standards of Conduct, and CI MED Professional Standards.
IN CASE OF IMMEDIATE RISK
Do not use this form to report events presenting an immediate threat. Reports submitted through this form will be reviewed within 2 business days. If there is an immediate risk to health or safety, please call 911 to connect with medical support or local law enforcement.
ANONYMOUS REPORTING
An individual may report an incident without disclosing their name, identifying the respondent, or requesting any action. Please note that choosing to make an anonymous report can significantly limit the ability of the college to respond. This information will be used for statistical purposes as well as for enhancing understanding of our college climate so that we may strengthen misconduct response and prevention efforts.

THE FOLLOWING FORM CAN BE USED TO REPORT PROBLEMATIC OR EXEMPLARY BEHAVIOR
Behavior(s) Reported Below
Behavior(s) Reported Below
Professional Ethic (Select all that apply)
Professional Ethic (Select all that apply)
Professional Relationships and Responsibilities (Select all that apply)
Professional Relationships and Responsibilities (Select all that apply)
Reliability and Responsibility (Select all that apply)
Reliability and Responsibility (Select all that apply)
Patient, Faculty, Resident, Administrative Staff, and Other Team Member Interactions (Select all that apply)
Patient, Faculty, Resident, Administrative Staff, and Other Team Member Interactions (Select all that apply)


This form will be sent to the Associate and Assistant Deans for Student Affairs. If that presents a conflict of interest, please contact the Executive Vice Dean of Carle Illinois College of Medicine.
NOTE: Only applications submitted through AMCAS will be accepted and reviewed.