Policy 174: Policy on Attendance and Absence for Students in the Doctor of Medicine (MD) Program

1.  Purpose 

The Toronto Metropolitan University (the “University”) School of Medicine’s MD program is designed to promote learning through a competency-based approach in which curriculum objectives and content are reinforced across the program’s four years via an ascending level of complexity. To achieve the learning outcomes of the MD program for progression, students in the MD program must attend all assessments and actively contribute in all required learning experiences.

This policy outlines the principles and governance for attendance at and absences from required learning experiences and assessments for all students across all Phases in the MD program.The program has periods of vacation built into the curriculum in each of the three Phases as indicated in the Student Handbook. Outside of this period, any absence requests must follow the process outlined in this policy.

2.  Application and Scope

This policy applies to all:

• students enrolled in the MD program at the University;
• required learning experiences and assessments as defined by the MD program; 
• absences from MD program studies and activities that are of a short-term duration, normally no more than two (2) consecutive weeks;
• students enrolled in the MD program at TMU with academic accommodations whose absence is not related to their academic accommodation.

This policy does not apply to students who are:

• absent from MD program studies for longer than two (2) consecutive curricular weeks. Please refer to the School of Medicine Policy on Leave of Absence for Students in the Doctor of Medicine (MD) Program. 
• seeking academic accommodation for temporary or permanent disabilities that have a longer-term impact on their academic functioning (e.g., long term medical or conditions, learning disabilities, sensory impairments, acquired brain injuries, attention deficit/hyperactivity disorder, mental health or mobility issues). Please refer to Policy 159: Academic Accommodation of Students with Disabilities and consult with TMU’s Academic Accommodation Support.
• seeking academic accommodation for religious, Aboriginal and/or spiritual observance. Please refer to Policy 150: Accommodation of Student Religious, Aboriginal and Spiritual Observance and/or consult with TMU’s Human Rights Office. 

3.  Definitions

3.1  Academic Accommodation

A planned variation or modification in the way a student with a disability receives course curriculum and materials, participates in course and non-course degree requirements, and is evaluated and assessed, in order to acquire and demonstrate the essential academic requirements needed to successfully meet the learning objectives of a course or program. Policy 159: Academic Accommodation of Students with Disabilities. 

3.2  Academic Consideration

The general name given to a number of Alternative Assessments or Arrangements that may be made in response to students who are granted a planned or unplanned absence.

3.3  Alternative Assessments

Assessments that are replacement academic evaluations of student achievement, that are prepared and/or approved by a faculty member in response to a student with demonstrated extenuating circumstances which resulted in missing or non-completion of an assessment.

3.4  Assessment

An academic evaluation of student achievement via a holistic review to reach the required level of program competencies up to graduation, endorsed by the Undergraduate Medical Education (UGME) Program Council and necessary for progression in the MD program (e.g., an Objective Structured Clinical Examination, or OSCE); a progress testing session or a formative assessment session; a simulation testing session; a project review or presentation.

3.5  Academic Challenges

A designation of the UGME Competence Committee given to students who are found, via a holistic review of academic progress, of not meeting curriculum program outcomes or demonstrating a pattern of academic performance, based on established program metrics, that does not align with the required outcomes in a program learning experience(s).

3.6  Learner Affairs Unit (LAU)

The School of Medicine Learner Affairs Unit.

3.7  Lapse of Professionalism

Conduct or behaviour - in isolation or as part of a pattern - that falls short of the professional conduct standards as defined by the relevant School of Medicine and University policies and other elements outlined in this policy.

3.8  Learning Plan

A formalized plan of study developed and agreed to by the relevant faculty member(s) in consultation with the student which outlines what must be achieved and may also allow the student to continue in their program of study. It defines the maximum and/or minimum number of courses that can be taken, assigns specific courses and required outcomes, and recommends academic support and seminars.

3.9  Mandatory Session

A required component of a course or program of study, including but not limited to curriculum learning sessions and required assessments.

3.10  Phase

A distinct time period in the four-year UGME curriculum: Phase 1 means Foundations Phase, September Year 1 through March Year 2; Phase 2 means Clinical and Community Immersion Phase, April Year 2 through August Year 3; and Phase 3 means Professionalization Phase, September Year 4 through April Year 4.

3.11  Planned Absence

A foreseen time away from a Mandatory Session in MD program studies that requires notification by the student and prior approval by the program.

3.12  Remediation 

A process of addressing and correcting deficiencies in a student’s knowledge, skills or understanding of the course material, professional achievements and/or performance. This process, overseen by a designated faculty member, contains a learning plan that attempts to understand root causes (to prevent recurrence); ensure program requirements can be achieved; has a defined timeline and milestones; and offers additional support as needed.

3.13  Unplanned Absence

An unforeseen time away from a Mandatory Session in MD program studies that requires formal notification by the student or others to the program.

3.14  UGME

Undergraduate medical education.

3.15  UGME Competence Committee

The body that works in collaboration with the UGME Program Council on the governance of the program and works to support students to ensure that they are graduation-eligible.

4.  Principles

4.1  The values described in the Senate Policy Framework are applicable and fundamental to this policy.

4.2   The MD program is committed to supporting student health and wellbeing to help them achieve program outcomes.

4.3   Attendance and active engagement in learning are required for students to meet defined objectives in each Phase of the MD program and to progress to graduation.

4.4   Students must act ethically, honestly and in accordance with academic responsibility and integrity when notifying the MD program about Unplanned Absences and requesting Planned Absences.

4.5   As noted in Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program, professionalism is required to progress in all MD program courses. A student’s non-adherence to this policy may be addressed as a Lapse of Professionalism and may have an impact on progression.

4.6   The MD program is committed to the safety of all those whom MD program students learn from and work or interact with. It is understood that this may also impact attendance.

5.   Requirements

5.1   Attendance Requirements

5.1.1   MD program students are expected to attend and actively contribute in all Mandatory Sessions in all three Phases of the MD program. For a list of these sessions in each Phase, see Procedures Section 1.0.

5.1.2  Meeting expectations around attendance is a professional responsibility of every student. Where students do not meet Section 5.1.1 above, their review will be addressed by the Associate Dean UGME or their designate who will consider:

5.1.2.1   the course impacted by their absence

5.1.2.2   information from the LAU

5.1.2.3   previous specialized learning plans and/or support by the UGME Student Progress Subcommittee, and where appropriate, in accordance with Senate Policy 159: Academic Accommodation of Students with Disabilities

5.1.2.4   Lapses of Professionalism, as outlined in Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program

Actions may include remediation for a single session or a review for follow-up by the UGME Student Progress Subcommittee, the UGME Competence Committee and/or the LAU. 

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5.1.3  Students not meeting expectations for attendance will be reviewed by the Associate Dean UGME and the UGME Competence Committee. After reviews, there may be a request by the UGME Competence Committee for a plan and monitoring by the UGME Student Progress Subcommittee. This may require Learning Plans, Remediation, and/or a request the student meet with an official of the LAU for an assessment of health, wellness, learning and/or support. The UGME Student Progress Subcommittee, UGME Competence Committee or LAU may address this as a Lapse of Professionalism and/or not meeting academic standards. To support the student in their career, recommendations to the UGME Competence Committee may result in action inclusive of but not restricted to: a repeat of a course or required learning experience, delay in progression between Phases or to graduation, and/or action under Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program, or other action that is appropriate in the circumstances.

5.1.4  Attention to time management is a core component of medical professionalism. Students are expected to attend ALL Mandatory Sessions on time. Late attendance at Mandatory Sessions will be tracked centrally and addressed. Students who demonstrate a pattern of repetitive or pervasive tardiness will be reviewed for action by the Associate Dean UGME, or their designate, who will request a review by the LAU to explore underlying reasons for the concern and to support student well-being. This may be followed by a recommendation to the UGME Competence Committee to consider a Learning Plan, Remediation, or other recommendations that are appropriate in the circumstances for review by the UGME Student Progress Subcommittee.

5.1.5  Faculty or assigned proxies will record and report attendance and timeliness in all Mandatory Sessions during Phases 1, 2 and 3 of the program.

5.2   Absence Requests

5.2.1  It is the responsibility of the student to notify the relevant program representative official in writing, and submit relevant documentation, where required, if they will be absent for any reason, and, except in the case of an urgent Unplanned Absence, this should occur prior to the onset of the absence.

5.2.2  Students who face a sudden or progressive change in their health that leaves them in a situation that could negatively impact the health and/or wellness of patients, families, colleagues, instructors and peers will take an immediate leave and contact the LAU to plan next steps. If students are unsure about whether their health circumstances may negatively impact others, they must contact the LAU.

5.2.3  Students must ensure that a Planned Absence is approved by the relevant program representative official prior to the scheduled date of the absence. This plan is final and cannot be extended except in cases of travel or other issues outside the student’s control.

5.2.4  Students are learning in a program that is based on a competency-based education model. Therefore, missed sessions may need a remedial or special learning plan, an alternative assessment, or a temporary leave from studies. A special learning plan may be anything from a written submission to the course lead or scheduled time with formal face-to-face remediation that includes supportive teaching and experiential learning time. All such sessions will be monitored for attendance by the UGME Office.

5.2.5  Students with approved absences for ongoing medical care are requested to submit documentation of compliance to the LAU. The LAU will inform the MD program the student is compliant with a plan supported by the LAU.

5.3  Assessment of Absence Requests 

5.3.1   Approval of a Planned Absence will be considered based on the following:

• whether the absence request adheres to the categories and timelines outlined in Section 3.1 of the Procedures that accompany this Policy;
• the student’s academic record, past pattern of requests and missed or incomplete course requirements;
• how the request impacts a mandatory assessment;
• whether the student is in good academic standing and has not been designated by the UGME Competence Committee as having Academic Challenges;
• any professionalism issues;
• whether the missed session(s) can be re-taught or remediated; 
• the impact of the request on the learning outcomes for peers (e.g., group presentation or simulation); and
• other factors that may be relevant in the circumstances.

5.3.2   Unplanned Absences will be:

• assessed and addressed by the program with Academic Consideration, Remediation, and/or with a formal Learning Plan where possible and necessary;
• addressed by the program with a referral to TMU’s Academic Accommodation Support services, where there is a reasonable basis to believe that the student’s unplanned absences are disability-related.
• tracked and requests sent to the LAU for intervention if they are excessive compared to program metrics;

5.3.3   Absence requests will be evaluated in a fair, timely and consistent manner. Decisions on student absence will be documented through written communication. 

6.   Academic and Professional Integrity

6.1   Academic Misconduct and Lapses in Professionalism

This policy must not be used to gain academic advantage or benefit, including, without limitation, by:

• submitting false, altered, forged or falsified documents to support an absence request;
• making false claims for such consideration to delay or avoid academic requirements; or
• falsifying representation for attendance at sessions (virtual or in person), including signing in fraudulently for peers.

Such cases will be cited for academic misconduct and treated as a Lapse in Professionalism. They will be subject to the processes and consequences as outlined in TMU’s Senate Policy 60: Academic Integrity, Procedures: Academic Integrity, Senate Policy 61: Student Code of Non-academic, Procedures: Student Code of Non-academic Conduct, and Senate Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program.

7.   Privacy and Confidentiality

7.1   Respect of Student Privacy

Students’ personal information will be collected, used, and disclosed in accordance with University policies and applicable legislation.

7.2  Documentation

All documentation received regarding attendance and absences requests will be collected, maintained, and disposed of in accordance with the University’s records management, records retention schedule, privacy and information classification policies, procedures and standards.

7.3  Communication on this Policy 

All communication by the MD program to students on this policy will be via email using the University’s server.

8.  Appeals

Students who believe a decision relating to absences and tardiness has negatively impacted a course grade(s) or standing can appeal based on grounds outlined in Senate Policy 168: Grade and Standing Appeals. Students should follow the procedures outlined in this policy.

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Related Policies/Procedures

Policy 60: Academic Integrity

Policy 61: Student Code of Non-academic Conduct

Policy 150: Accommodation of Student Religious, Aboriginal and Spiritual Observance

Policy 159: Accommodation of Students with Disabilities

Policy 168: Policy on Grading and Standing Appeals

Policy 175: Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program

Procedures: Academic Integrity

School of Medicine Policy on Communicable Disease Prevention in the Doctor of Medicine (MD) Program

 

Procedures: Policy 174: Policy on Attendance and Absence for Students in the Doctor of Medicine (MD) Program

1.  Mandatory Sessions

Mandatory Sessions in each of the three curriculum Phases of the MD program are outlined below. Attendance may be taken at other learning sessions, such as large group sessions with active learning pedagogy, during Phases 1, 2, and 3.

1.1   Phase 1 Mandatory Sessions 

In Phase 1, students are expected to attend and actively contribute in all:

• small group learning sessions
• anatomy laboratory sessions
• learning sessions with standardized patients and low and high fidelity simulation tools
• team-based and seminar learning sessions
• project learning sessions
• experiential learning sessions with community agencies and/or in primary and acute care clinics
• curriculum sessions in all courses
• sessions with academic coaches
• interprofessional education (IPE) learning sessions
• additional sessions communicated by the program as being mandatory
• assessments

1.2   Phase 2 Mandatory Sessions

1.2.1  Students are required to attend all required clinical, academic and community learning sessions scheduled across Phase 2. This includes all:

• scheduled office, hospital ward or clinical learning
• project, small group or active large group sessions 
• interprofessional, community and home patient care experiences
• on-call required patient care and learning as mandated by the program and course
• specialty office and community clinics as assigned during the Family Medicine Longitudinal Integrated Clerkship Module
• in the Acute Care module and the Community Care modules (this includes all sessions scheduled and communicated by the Phase 2 Committee led by the Chair of UGME Phase 2) 
• when in the Community Care Module of Phase 2 (this includes all required clinical learning experiences with patients and community affiliates)
• all community agency learning
• all sessions in LEAP weeks
• all Selective and Elective clinical learning

1.2.2   Students are expected to attend 90% of required learning Phase 2 sessions. Students who miss more than 10% of a defined learning experience in Clerkship will be reviewed by the Phase 2 Committee who will reach a decision recommended to the UMGE Competence Committee. This may result in action from the UGME Student Progress Subcommittee in discussion with program leads in Phase 2 and the Phase 2 chair to create a learning plan that may be enacted in Phase 3, to allow the student to demonstrate the relevant competency-based goals.

1.2.3   Assessments for a module, block or a course, including formative assessments and any assessment linked with reaching a program competency stage or Entrustable Professional Activity milestone in a Phase require mandatory attendance for progression.

1.2.4   LEAP week sessions are core learning. Students must attend all LEAP week sessions in person unless they are granted an absence for illness or a similar cause by the Phase 2 Chair, the LAU or the UGME Office.

1.3.  Phase 3 Mandatory Sessions

1.3.1   Phase 3 learning has been created in the curriculum to support successful transition to Postgraduate Medical Education learning. Students are expected to attend sessions across this Phase. Failure to do so may result in a remedial learning plan being created by the UGME Competence Committee and a deferral in graduation until the next academic year or fall of Year 4.

1.3.2   Students are required to attend across Phase 3:

• 90% of approved self-directed learning in the Electives block
• all small group sessions for the longitudinal courses
• all required learning sessions to support demonstrating Entrustable Professional Activities at the residency level
• all required sessions for the final block of self-directed advanced learning
• all assessments
• all project and team sessions
• all coaching sessions
• all simulation sessions to educate on or assess Entrustable Professional Activities competency
• any remedial sessions or processes to reach graduation competency

2. Allowable Reasons for Absence 

2.1    Planned Absence 

The reasons for a Planned Absence include but are not limited to the following:

• to attend a scheduled medical or dental appointment that, with travel, may occupy up to a half day
• to participate in an official committee, process, review, provincial or national student government meeting if the student is on the leadership team, or an operational or strategic initiative of the University, School or program
• to attend a medical or MD program aligned science or social science conference or workshop as a non-presenter or presenter
• to participate in varsity, provincial/national/international arts, political, advocacy, leadership, community advancement or sporting events
• to attend a major family events including but not limited to celebrations (i.e. weddings, anniversaries) or culturally important activities

Planned Absences require approval by the appropriate MD program official, who will take into account the reasons for the absence request and particular circumstances in determining the number of allowable days. For the details, see Section 3.1

2.2   Unplanned Absence 

2.2.1  The program acknowledges that unforeseen and emergent circumstances arise that may preclude the student from attending Mandatory Sessions.

If such circumstances arise or can reasonably be foreseen, students must discuss with the program and LAU how best to deal with such circumstances, including Unplanned Absences from educational sessions. 

2.2.2  The reasons for an Unplanned Absence include but are not limited to the following:

• an illness/injury that is personal or arising from and with a family crisis
• a family emergency
• a funeral/memorial service
• a travel/transportation emergency

Students must notify the program concerning Unplanned Absences. For the details, see Section 3.2.

2.2.3  In the interests of the safety of all individuals involved in the MD program's clinical and educational experiences, the program will consider accommodating or granting academic consideration, as per processes outlined in this policy, students whose Unplanned Absence is due to a personal health issue that results from an infection and/or exposure to an environmental hazard that impacts patient safety and/or the health of others. 

2.2.4  The processes outlined in this policy will take into consideration that Unplanned Absences may have consequences and create added responsibility as it relates to meeting the outcomes necessary for the student’s medical education.

2.2.5  Given that all courses will continue during a student’s Unplanned Absence, the volume of material, the number of clinical skills sessions missed, and other relevant circumstances, will be considered in the plan for return studies to after an Unplanned Absence. 

3.  Notification of Absences

To notify the LAU and the MD program of an Unplanned Absence, the student must submit the School of Medicine’s online absence notification form (if at all possible). This form requires declaring the absence category (whether it is a Planned Absence or Unplanned Absence), the absence start and end date, duration, required learning experience affected (if applicable), mandatory activities missed, whether a scheduled assessment will be missed, and documentation, if required. 

In the event of a sudden severe health issue, a notice to the LAU or UGME Office may be made by a colleague or family member by email.

3.1   Planned Absence

For Planned Absences, notification using the online absence notification form must occur at least thirty (30) days prior to give the LAU or UGME Office time to ascertain whether approval is warranted. Failure to meet this timeline will result in a dismissal of the request without appeal.

Decisions by the LAU and UGME Office regarding Planned Absence requests are made subject to the following, with approval conditional on the rationale and documentation where necessary:

• A request to attend a conference or workshop as a non-presenter or presenter is normally approved for a maximum of three (3) days and one (1) absence per academic year. Exceptions are possible on written request. Documentation in the form of proof of acceptance or invitation is required.
• Students who have a second presentation in one academic year for a different research or scholarly work may request an absence and consideration will be given by the Associate Dean UGME.
• A request to participate in a major family celebration or a varsity, provincial, national or international arts, political, advocacy, leadership, community advancement or sporting event is normally approved. Documentation in the form of a personal testimonial is required from the student which will be expunged from the student record after graduation.
• A request for a health or dental care appointment is almost always approved. Documentation is not required. 

Remediation for Planned Absences will be determined by the MD program and communicated to the student and the LAU in written form.

NOTE: A Planned Absence will not be approved for:

• family or personal vacations;
• travel after holidays (unless weather impacts travel); or
• entertainment events.

3.2   Unplanned Absence 

For Unplanned Absences, the online absence notification form must be submitted as soon as possible and no more than five (5) business days after the last day of the Unplanned Absence. The University’s Student Health Certificate must also be submitted for health-related absences of more than two (2) consecutive days as per the TMU processes. In certain cases, the LAU and MD program may ask for further documentation before allowing a return to studies. 

Students who have had an Unplanned Absence and cannot communicate with the LAU or MD program due to health issues may have a family or designated contact person communicate their absence with the LAU.

The LAU will inform the MD program in writing if a student requires a prolonged leave of absence. Students who have a brief Unplanned Absence due to an acute illness or life event will notify the LAU and MD program and a decision on remediation (if any) will be made.

Students returning from a prolonged LOA, will require a formal document from a recognized health professional that is the most responsible professional for their care. This note must attest to the student being able to assume the level of learning in the MD program and required responsibilities to demonstrate the Phase outcomes.

During Phase 2 and 3 learning, the LAU will inform the MD program of an Unplanned Absence and the UGME Office will notify clinical site leaders. Students who are off suddenly due to illnesses that impact patient safety should advise their affiliate’s clinical care learning team or supervisor by email to allow for patient care needs being met.

Remediation for Unplanned Absences will be determined by the MD program and communicated to the student and the LAU in writing via email.

Failure to provide notification of absences is a Lapse of Professionalism with consequences as outlined in Policy 175:Standards of Professional Conduct for Students in the Doctor of Medicine (MD) Program.

4.   Tracking of Absences

4.1   Definition of a Recurrent Absence History 

A student may have a recurrent absence history, typically defined as any one of the following:

• ten (10) or more full days equivalent Unplanned and/or Planned Absences in an academic year, two (2) or more Unplanned and/or Planned Absences on days on which assessments are scheduled in an academic year
• two (2) or more deferred assessments in an academic year
• other actions cited by the LAU or UGME program as concerning
• year on year pattern of absences
• a pattern of non-approved absences

4.2   Meeting with the Student 

In such cases, the Associate Dean UGME or their designate and Phase Lead or their designate, will review the student's absence history and, where appropriate, determine next steps, which include a meeting with the student with an official of the LAU present.

The purpose of such a meeting is to:

• provide the student with an opportunity to discuss their absences and root causes in a safe environment
• ensure the student is aware of the various TMU and LAU/Program/School supports available to them
• determine if the student is able to complete a course or curricular component or present academic year within its normal timeframe or under a Learning Plan within an extended timeframe

The student must meet with the Associate Dean UGME and Phase Lead, in the presence of a leader from the LAU, to discuss a revised learning plan or temporary leave from studies. Students are expected to meet the requirements of the remediation plan and time offered for such unless circumstances arise that lead to a request for an extension.

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5.  Tracking of Tardiness

5.1   Definition of a Problematic Tardiness History 

Absences and lateness will be recorded and held internally by the Phase/Program and reviewed by the UGME Competence Committee in order to track student absences. Absences do not appear on the student’s transcript.

A student may have a recurrent or problematic history of tardiness, typically defined as:

• five (5) or more Mandatory Sessions in an academic year in which they have been officially recorded as being late; or
• two (2) or more assessments in an academic year in which they have been officially recorded as submitting or being late.

5.2   Meeting with the Student 

In such cases, the Associate Dean UGME and Phase Chair will review the student's history of tardiness and, where appropriate, determine next steps, which includes deciding whether a meeting with the student is warranted with the LAU present. The purpose of such a meeting is to:

• provide students an opportunity to discuss their history of tardiness in a safe and confidential environment;
• help ensure they are aware of the various supports available to them.
• understand the root cause and support the student addressing this early in their career

The Associate Dean UGME and Phase Chair will review the student’s history of tardiness and, where appropriate, determine next steps.