Although the goal for medical students at schools across the United States is to contribute to the greater good, countless issues can arise over the course of a medical student's journey that can upend what is in many instances a lifelong goal. When such issues arise, a medical student may find him or herself being asked to appear the medical school's promotions committee.
What Does a Promotions Committee Do?
As any medical student and his or her parent understand, acceptance to medical school is highly competitive. Applicants may also spend a great deal of time and financial resources securing admission to a medical school. Once admitted, medical school can be very expensive.
Medical school itself can be a high-stakes race. It is fortunate, however, that medical students are better positioned to complete medical school than other professional schools, and the vast majority of medical students who experience course or clerkship failures go on to successfully complete their undergraduate medical education.
When medical students do experience course failure or other issues in medical school – academic, disciplinary, or otherwise – they may find themselves in front of a medical student promotions committee, also known as an academic progress committee, or simply, the promotions committee. Although appearing before a promotions committee does not always carry the stigma of potential remedial or punitive action, because of the importance of decisions made by promotions committees, medical students must approach any appearance with the necessary regard.
How Concerned Should I Be If I Have to Appear Before My Promotions Committee?
Given these circumstances, dismissal from medical school can have a severe emotional, financial and professional impact on the lives of medical students, and no medical student and his or her parents should allow a student to appear before a school's promotions committee without taking the necessary precautions and steps as everything is at stake.
Promotions committees exist at every allopathic medical school accredited by the Liaison Committee on Medical Education (LCME) and every osteopathic medical school accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association.
The LCME, the accrediting body for educational programs at schools of medicine in the United States and Canada, currently accredits 134 United States medical schools, which includes 4 in Puerto Rico (as well as 17 others in Canada). There are 38 osteopathic medical schools accredited in the United States. 3 Caribbean medical schools are accredited.
Medical schools are obligated to have in place a process by which representatives of the institution determine the progression of students through the medical education program.
Why Do I Have to Appear Before My Promotions Committee?
Promotions committees are generally tasked with promoting medical students from one year to the next and with dismissing students from the medical education program. One concern, however, is that, for example, schools that graduate medical doctors (M.D.'s), are not provided any specific guidance regarding how such committees should be structured, who should participate, or the criteria by which decisions about students should be made.
For such high-stakes decisions, medical schools can be severely lacking in terms of how their promotions committees are composed, how decision-making is structured, and how decisions impacting medical students are made in practice. In addition, most medical schools either do not promulgate or do not reasonably release detailed information about the composition of their promotions committees, and due to Family Educational Rights and Privacy Act (FERPA) regulations, no information about actual promotions committee decisions is publically available.
At many medical schools, the promotions committee is charged with the responsibility of reviewing student performance and enforcing academic and behavioral standards. Students who face course or clinical struggles, who have taken a leave of absence (LOA), who face professionalism concerns or potential disciplinary issues, can and will be called before their medical school's promotions committee.
Promotions committees are not always harbingers of doom, however. For students who have successfully completed their medical school requirements, the promotions committee will recommend those students' graduation.
Common Examples of Why Medical Students Have to Appear Before their School's Promotions Committee
Although generally more mature and often with professional and life experience to guide their judgment, a medical student's best laid plans can go awry, and just as every medical student's journey is unique, the reasons why a medical student may have to appear before his or her promotions committee can vary greatly. That being said, there are common themes as to why a medical student may be subject to remediation, discipline, or dismissal. Some involve academic and professionalism concerns of a more general nature, and others involve alleged conduct that can at times be quasi-criminal or even criminal in nature:
- Professionalism concerns or unprofessional behavior, which can include a single egregious incident, or a pattern of concern
- Academic misconduct or dishonesty or a violation of the medical school's academic integrity policies
- Disciplinary charges or behavioral charges in violation of the school's code of conduct and/or state or federal law
- Violations of a medical school's Title IX sexual misconduct policy; such violations vary, and can include any kind of sexual misconduct, from sexual harassment in the school setting up to and including sexual assault or non-consensual sex
- Falling below and/or marginally above the medical school's passing requirements in coursework, summative assessments, clinical rotations, etc.
- Failing additional attempts on NBME subject exams
- To return to active status after a leave of absence (LOA) for academic or health reasons, or concerns with leave of absences generally
Is the Decision of a Promotions Committee Final?
Different medical school will have different policies and procedures for how such concerns will be addressed, but most medical schools can have a progression of decisions involving a student subject to potential action by the medical school before such a decision is finalized, be it remedial, disciplinary, or other action that can impact a student. Regardless of how initial decisions are made, at most medical schools, the Dean will have final authority over any decisions made by lower committees, hearing panels, and so forth.
Can I Appeal the Decision of a Medical School Promotions Committee?
It depends on your particular medical school's polices and procedures, but in most instances, a student can appeal the decision of the promotions committee. That being said, an appeal does not generally allow a complete review of the initial decision,
For example, a school may have an academic progress committee that makes an initial finding and decision regarding a student. If the student has grounds to appeal such a decision, the student can appeal the matter to what is sometimes known as an academic review committee. Often such an appeal is not a “de novo” review of the matter, meaning that the hearing body presiding over the appeal will not reconsider the case in full, but rather, will only address limited grounds to determine if there were any issues that led to the lower hearing body's decision. For example, an appeal may only consider if the lower decision was arbitrary, capricious, or made in bad faith.
Because of what is at stake in such decision, even at schools where a progression of decisions is possible, it is critical that a medical student who faces any kind of action by his or her medical school take the necessary precautions and steps in advance of any initial decision to be made by the school so that such a decision is based on all available favorable information and evidence to support the student's cause.
Who Sits on a Promotions Committee?
Another potential issue is the composition of promotions committees. Some schools use a combination of faculty members, administrators, and even other medical students. When medical students serve in such a capacity, the students selected must often show evidence of a strong academic record and high personal behavior standards. Even with this being the case, should medical students make what can be life-altering decisions regarding another medical student? There are arguable pros and cons to students sitting on such committees, but such a question must be asked in a fundamental sense.
The composition can also vary depending on at which stage of the process the matter is being addressed. In terms of best practices, hearing board or panel members should not only sign confidentiality agreements that comply with the Family Educational Rights and Privacy Act ("FERPA") regulations, members should receive training on their obligations under FERPA. Although something as seemingly basic as a promotions committee member being obligated to not share a medical student's personal information – academic, health, or otherwise – failures in this regard are a concern that regrettably arises more often than one may anticipate in such matters.
Will a Promotions Committee Make a Fair Decision?
A related concern is the competence of the parties who serve on promotions committees as on-the-job experience with promotions committee work is inadequate preparation for members making such high-stakes decisions.
Studies have indicated that, in some instances, 85% of those who served on promotions committees received no training to prepare them for their role. The remaining 15% who reported that they received training indicated that it primarily involved overviews on institutional policy and committee procedures.
Study participants expressed concern with:
- Insufficient training regarding the applicable medical school's policies and standards;
- Insufficient information regarding the applicable school's medical education curriculum and grading and how a student who appears before the promotions committee should be viewed in of the school's requirements;
- Insufficient training on legal issues that may arise during the course a promotions committee's review of a matter / concern, and prospective deliberations involving such matters / concerns – specific areas of concern included: disability law (for example, how the American Disabilities Act can affect a medical student's journey); Title IX sexual harassment and sexual misconduct issues; issues involving the Family Educational Rights and Privacy Act (FERPA); Title VI discrimination issues; and the institutional resources available to medical students.
Because the decisions that promotions committees make can have a profound impact that can literally affect a medical student for the rest of his or her life, promotions committee members believed that they lacked case examples, with information about common scenarios and what was decided and why such decisions were made.
Promotions committee members believed such examples would be useful to help guide current decisions as past cases could provide members with information about the potential impact of their decisions, and about the ultimate success (or lack thereof) of the students considered by the committee in the past.
What Will the Promotions Consider in Making Its Decision?
In order to understand the relative influence of common medical student characteristics and circumstances on promotions committee member decision making, a list of 18 basic student characteristics and circumstances about which committees would reasonably be informed follows below.
Promotions committee members at medical schools across the United States were asked how influential each would be to their decision making. Responses were recorded on a four-point scale from “Not at all influential” to “Highly influential”.
Promotions committee members indicated that the most influential medical student characteristics and circumstances were the “nature of the lapse in professionalism,” “total number of lapses in professionalism,” “total number of academic failures,” “poor clinical skill acquisition,” and “level of reliability." The least influential characteristics/circumstances were “amount of financial debt,” “academic background/preparation for medical school,” and “amount of time the student has until graduation.”
The 18 characteristics and circumstances are listed below in order of most influential to least influential:
- Nature of the lapse of professionalism
- Total number of lapses of professionalism
- Total number of academic failures
- Poor clinical skill acquisition
- Level of reliability
- Willingness to seek help
- Level of insight into the medical student's problem
- Work ethic
- Existence of severe mental illness
- Existence of an appropriate remediation option
- Poor standardized exam performance
- Existence of physical health problems
- Existence of documented learning disability
- Existence of mild mental illness
- Existence of physical disability
- Amount of time the medical student has until graduation
- Academic background / preparation for medical school
- Amount of financial debt
Should My Case Be Going Before the Promotions Committee in the First Place?
Related to the concern that promotions committee members can have difficulty in making what they believe to be appropriate decisions, there is sufficient evidence that, prior to a promotions committee even being a consideration, medical school faculty have difficulty with accurately evaluating underperforming students, and that this difficulty influences faculty decisions about the submission of failing grades. Because failing grades are often the first step towards a medical student's eventual appearance before a promotions committee for decisions which can include potential dismissal, it is a major concern that medical school faculty are unable to adequately gauge and address a student's academic struggles before the student fails and a promotions committee is warranted.
The seriousness of the issue is more pronounced because there is also evidence that medical student behaviors related to withdrawal or dismissal, which include academic struggles and dishonest or unprofessional behavior, are consistent over time. As such, with proper training for applicable faculty, medical schools can avoid the more drastic measures that are used to address student concerns after those concerns reach the point of arguable no return.
If medical schools properly address student concerns early on, then having to appear before a promotions committee to face remedial or punitive action would be unnecessary. Regrettably, medical schools are not as proactive as one would hope in trying to address and resolve student concerns before it is too late.
Fundamental Concerns with Promotions Committees
On the one hand, it is good that promotions committee members take their role seriously – understanding that the decisions they can make can literally make or break a medical student's hopes and goals. On the other hand, the fact that members believe they are lacking across multiple areas of policy, procedure, and law should make it clear that the current climate of medical school promotions committees needs to be fundamentally addressed and improved.
Despite members making such high stakes decisions, regrettably, medical students and their parents at times do not realize the potential implications of any meeting or hearings with a medical school, and as a result, go into such meetings and hearings not as prepared as both possible and necessary.
What Should I Do If I Have to Appear Before My Promotions Committee?
The good news is that an attorney experienced in helping medical students and protecting student's rights can help a student subject to potential adverse consequences navigate the process and prepare as best as possible in an effort to avoid an unfavorable outcome which can impact a medical student both in the short and long term as medical school itself can be negatively impacted and also prospective residency and employment opportunities.
Even with the most rigorous medical school admissions processes in place, there will always be medical students who experience academic failures or exhibit professionalism concerns or unprofessional behaviors, and medical schools must have in place mechanisms to address those issues. Some in medical school may regard this process as “natural selection” in the sense of the heard being thinned, but to a medical student who has worked his or her entire life to become a doctor, such a narrow view is not only unacceptable, but is also not cognizant of the potential reasons why a student may have to face the promotions committee in the first place, and as importantly: 1) whether there were failures on the school's part to address and mitigate concerns prior to the promotions committee's involvement becoming necessary; and 2) whether the promotions committee itself is properly composed and trained so as to be able to make the right decision when it is necessary for the promotions committee to be involved.
Fair and unbiased promotions committee decisions do not require blind application of policy across all medical student cases in order to uphold medical school standards. Instead, consistent reference to stated medical school values and priorities, provided to members as part of a comprehensive training program would allow promotions committees to achieve a flexible and fair approach to students in a manner appropriate to the medical community. Until such best practices are instituted at medical schools across the United States, medical students and their parents must not face promotions alone.
Helping Medical Students Nationwide
It is not uncommon for medical school promotions committees to fail to understand or recognize a student's interests and rights. Because of the fundamental concerns associated with promotions committees and also what is at stake, medical students need to take action to protect their rights, ensure due process, and appeal unfavorable results.
Attorney Joseph D. Lento has a firm understanding of the role promotions committee play in making or breaking a medical student's hopes and goals, and he has helped countless students at medical schools across the United States address and resolve such concerns.