Part B: Narrative Data and Tables

Section III.  Medical Students
Part B: Narrative Data and Tables

MS-1.  Students preparing to study medicine should acquire a broad education, including the humanities and social sciences.

Ordinarily, four years of undergraduate education are necessary to prepare for entrance into medical school; however, special programs (e.g., combined baccalaureate-M.D. programs) may allow this to be reduced. General education that includes the social sciences, history, arts, and languages is increasingly important for the development of physician competencies outside of the scientific knowledge domain.

MS-2. Premedical course requirements should be restricted to those deemed essential preparation for completing the medical school curriculum.

a. List all college courses or subjects required for admission.

Bachelor’s degree from an accredited institution.

College biology with laboratory, one year, (8 semester hours)

General college chemistry with laboratory, one year (8 semester hours)

            Organic chemistry, one semester and

            Organic chemistry or biochemistry, one semester

Humanities, social and behavioral sciences, (24 hours)

Calculus or statistics, one year (6-8 semester hours)

General college physics with laboratory, one year (8 semester hours)

b. Identify any courses, especially those outside of the fields of mathematics, physical sciences, and life sciences, which are recommended but not required for admission to medical school.

Computer literacy

MS-3. The faculty of each school must develop criteria and procedures for the selection of students that are readily available to potential applicants and to their collegiate advisors.

Briefly describe the process of medical student selection, beginning with receipt of the application forms and proceeding through screening/interview procedures, tender of acceptance offer, and matriculation. Cite the criteria for selection and indicate how they are published and disseminated.

An application is reviewed by a Screening Committee member, once Hopkins receives the applicant’s AMCAS (American Medical College Application Service) verified application, the Johns Hopkins University School of Medicine secondary application, and the required letters of recommendation. The committee member reviews the activities, honors, awards, academic record, test scores and recommendations using guidelines established by the Committee on Admission which focus on the applicant’s experiences, letters of recommendations, coursework, grades, and test scores.  If the screener feels the applicant warrants an interview, he/she will select the individual for one.  Those applicants not selected to interview are notified that they have not been selected to interview.  Students not selected to interview are placed in a ‘hold’ status, which does not generally change.

Students selected to interview are notified via e-mail and telephone.  Written confirmation and details of the interview are mailed to the applicant.  The applicants come to the medical campus for a day of interviews with one faculty and a student committee member.  They also have lunch with faculty members and are given tours of the medical campus by student guides who are not members of the Admissions Committee. While waiting for their interviews, applicants are encouraged to interact in a group setting with each other and student members of the Admissions Committee.  Regional interviews are conducted for applicants living some distance from Baltimore.

Upon completion of the interview, all Committee on Admission members receive copies of the candidate’s application and are asked to submit a preliminary vote for each candidate.  The vote score is used as a guideline to rank the applicants in order of discussion.  Each applicant is discussed at the meeting by the faculty and student interviewer.  A second vote by faculty only is then rendered.

Applicants admitted by the Committee on Admission receive a congratulatory phone call from the Assistant Dean of Admission, followed by a written acceptance letter and statement of intent.  All admitted students are invited to a Second Look Weekend program later in the spring.

Candidates discussed for admissions but not admitted are notified that they have been placed on the Alternate List and will be reviewed again later in the admission process. A normalized priority score based on the original COA vote serves as a guideline for selection of applicants from the Alternate list.

Criteria for selection written by our institution appear in the MSAR (Medical School Admissions Requirements) published by the AAMC for potential applicants. The information appears as follows:

"Selection Factors

In addition to proven academic competence, previous achievements and activities help the Committee on Admission to evaluate applicant's suitability for medicine. Students who have unusual talents, strong humanistic qualities, demonstrated leadership, and creative abilities are sought. There are no residence requirements for U.S. citizens, and applications are invited from candidates in all sections of the country."

MS-4. The final responsibility for selecting students to be admitted for medical study must reside with a duly constituted faculty committee.

Persons or groups external to the medical school may assist in the evaluation of applicants but should not have decision-making authority.

MS-5. Each medical school must have a pool of applicants sufficiently large and possessing national level qualifications to fill its entering class.

The size of the entering class and of the medical student body as a whole should be determined not only by the number of qualified applicants, but also the adequacy of critical resources:

- Finances.
- Size of the faculty and the variety of academic fields they represent.
- Library and information systems resources.
- Number and size of classrooms, student laboratories, and clinical training sites.
- Patient numbers and variety.
- Student services.
- Instructional equipment.
- Space for the faculty.

Class size considerations should also include:

- The need to share resources to educate graduate students or other students within the university.
- The size and variety of programs of graduate medical education.
- Responsibilities for continuing education, patient care, and research.

a. Number of students enrolled in each academic year of the medical curriculum. 

b. If appropriate, provide similar tables of enrollment by year for the following categories:  (1) medical students in a decelerated curriculum, (2) students in a combined baccalaureate-M.D. program, and (3) students in each joint degree program (e.g., M.D.-Ph.D.).

1) Not offered
2) Not offered
3) Students in Combined MD-PhD program as of 2004-05:

"An addtional 41 students are on LOA from the medical school while completing PhD."

c.  If students in combined baccalaureate-M.D. programs or joint degree programs are not drawn from the same pool as regular medical students, briefly describe the size and characteristics of the applicant pools for each such program.

MS-6. Medical schools must select students who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become effective physicians.

Briefly describe the methods used to document and evaluate non-academic personal or professional attributes of medical school applicants.  If a standard form is used for interviewing candidates, supply a copy of the form and describe how it is used.

See also Part A, items (a.) and (b.) in this section of the database.

The following information is provided to Admissions Committee members and describes the methods used to assess and report on the various attributes of applicants as they are considered for acceptance to the Medical School. 

INTERVIEW GUIDELINES

     The medical school interview has a dual purpose of assessing and recruiting prospective students to Johns Hopkins. It enables the Admissions Committee to become better acquainted with applicants, to learn more about their academic talents and personal qualities. The interview also gives applicants an opportunity to visit Johns Hopkins, perhaps for the first time. The impressions made during the interview may later influence admitted applicants to select Johns Hopkins over other schools.

     The conduct of the interview should not be restricted in terms of style, specific questions to ask, or spontaneous dialogue between the interviewer and applicant. However, there are certain elements that constitute an effective interview report that will provide useful information to the Admissions Committee.

     The interview report should be a concise assessment of the applicant ’s suitability for attending Johns Hopkins. The interviewer should avoid restating information clearly seen on application forms. Comments should focus on areas which are not apparent on the application. Knowing more about the depth of academic achievements such as research, independent studies, honors projects, etc., are helpful to the Committee. Questions concerning extracurricular activities can help determine the applicant’s degree of commitment and how he/she and others may have benefited from the experience. It is useful to know about the special qualities that an applicant may have with respect to his/her leadership, commitment to, creativity, and other significant features. If special awards or honors are indicated it would be helpful to know more about the nature of the honor. Based on what can be ascertained from letters of recommendation is the award or honor commonly granted to students, or it is truly recognition of distinguished achievement.

     The interview report should discuss evidence of humanistic qualities such as compassion, warmth, empathy, and the applicant’s ability to relate to people from diverse backgrounds. The assessment of communication skills will enable the Committee to know if the applicant is articulate, comfortable in the interview setting, able to demonstrate clarity of thought in response to questions, exhibit appropriate animation, and non-verbal expression.

     Interviewers should present both the strengths and weaknesses of the applicant. The written comments should be a dispassionate report of observations made during the interview. A summary statement is helpful; however, strongly stated superlative comments concerning the desirability of an applicant should be limited to only those candidates who are truly exceptional and stand apart from other candidates.

Committee members should not interview applicants with whom they are acquainted. If a Committee member has a potential conflict of interest, it should be brought to the attention of Jim Weiss (the Associate Dean for Admissions) or Paul White (the Assistant Dean for Admissions and Financial Aid). Appropriate means will be determined for providing objective information about the applicant, and consider if it is best for the Committee member to abstain from discussion, voting or both.

     It is helpful to Committee members to know something about the quality of the academic programs for applicants who have attended lesser known colleges. Interviewers who are not familiar with the college attended by an applicant are encouraged to get information about the college from the Admissions Office before dictating the interview report. Also, interviewers should be aware that some schools package their students better than other schools, which is not necessarily a reflection of the quality of the applicant or the institution attended.

     The most effective way of determining questions to be asked of an applicant is to review the application before conducting the interview. File review will enable the interviewer to structure the interview around specific questions related to the applicant’s academic work, extracurricular activities and experience. In order for the applicant to feel that the interviewer is well-prepared for the interview, it is advisable to avoid looking in the file after the interview has started.

     During the discussion of applicants at Admissions Committee meetings, the interviewer is expected to provide an assessment of each applicant’s strengths and weaknesses. Therefore, it would be inappropriate to tell an applicant during the interview that you will serve as his or her advocate at Committee meetings.

     Every effort should be made to make the applicant comfortable in the interview setting. If the interview starts in a welcoming and friendly manner the applicant is likely to be relaxed and easy to engage in conversation. Allow a few minutes at the end of the interview for applicants to ask questions about Johns Hopkins. Applicants may also be referred to Paul White for information about the curriculum, financial aid, or other kinds of information.

SUGGESTED FORMAT:

1. Personal History

2. Academic History and Awards

3. Activities, Humanism and Leadership

4. Letters of Recommendation

5. The Interview

6. Summary and Conclusions

MS-7. The selection of individual students must not be influenced by any political or financial factors.

a. Briefly describe the size and composition of the admissions committee, how members are chosen, and how long they serve.  Who makes the final decision about admissions? Describe the circumstances surrounding any committee decisions or recommendations that have been overruled or rejected since the last full accreditation survey.

The Committee on Admission (COA) is comprised of 36 faculty members and 14 Fourth Year students. The COA is divided into two even groups of 25. The Associate Dean for Admissions, in consultation with the department chairs, selects a diverse group of faculty to serve for an indefinite period on the Committee; Members on the average serve 5 years (range 1-10 years).   The Fourth Year students are nominated and then elected by their classmates for a one-year term on the Committee.

Candidates interviewed for admission then receive a preliminary vote by all members of the COA and are then discussed by their faculty and student interviewer at the committee meeting. After each candidate’s discussion, the faculty members of the COA vote upon him or her again. At the conclusion of the discussions, a recommendation is made by as to the number of offers of acceptance and then voted upon by the faculty. The faculty has final decision regarding offers of admissions and their decisions have never been overruled or rejected.

The Committee on Admission accepts applications not only from applicants for the M.D. program but from those who are interested in a combined M.D.-Ph.D. degree. Provided with the Johns Hopkins application for the M.D. program is a supplemental form, which should be completed by those applicants for the combined degree. Under the section “Graduate Programs” in the school catalogue, those departments that offer study leading to a Ph.D. degree are listed. When the application for the M.D. program as well as the “Application Supplement for Admission to the Combined M.D.-Ph.D. Study” are received along with all necessary letters of recommendation, it is reviewed by the Committee on Admissions (represented by the Associate and Assistant Dean for Admissions), members of the M.D.-Ph.D. Committee, and by the appropriate graduate department. The Associate or Assistant Dean of Adminssions or their designate routinely interviews M.D.-Ph.D. candidates.

We do not have a combined M.D.-M.P.H. program, although several students from each class eventually pursue such a degree through the Johns Hopkins Bloomberg School of Public Health.  Admissions to the M.P.H. degree program are handled by the Admissions Office at the School of Public Health. 

MS-8. Each medical school should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students.

The standard requires that each school’ student body exhibit diversity in the dimensions noted.  The extent of diversity needed will depend on the school’s missions, goals, and educational objectives, expectations of the community in which it operates, and its implied or explicit social contract at the local, state, and national levels.

a. Complete the following table showing the racial and ethnic background for first-year and for all enrolled medical students.

*This and other Hispanic ethnic categories may be of any race

**Includes Cuban, other Hispanics, and combinations of these categories

b. Include copies of any policies, mission statements, or institutional goals that specifically address the gender, racial, cultural, or economic diversity of the student body.

Refer to SOM catalog, page 61. “Notice of Nondiscriminatory Policy as to Students”

http://www.hopkinsmedicine.org/som/Academics/catalog/MCAT3b_03.pdf

Refer to SOM catalog: http://www.hopkinsmedicine.org/admissions/minstudents.html

c. Describe any programs designed to facilitate the achievement of student diversity goals (e.g., pipeline programs, targeted recruiting efforts), and any specific admissions practices supporting achievement of the school’s diversity goals. 

Please see attachment, “MS-8-c.”

We do not have a separate screening, interview, or selection process for minority candidates for admission. However, as the attached document indicates, additional efforts are taken to ensure that we enroll a diverse class of students.

See also Part A, items (d.) and (e.) in this section of the database.

MS-9. Each school must develop and publish technical standards for admission of handicapped applicants, in accordance with legal requirements.

Provide a copy of any technical standards that have been developed for the admission of handicapped applicants.

Refer to SOM Catalog, pages 21-22:

School of Medicine Technical Standards for Admission

Applicants to the Johns Hopkins University School of Medicine are considered without regard to disability, but with expectation that they can complete satisfactorily all parts of the curriculum within the prescribed four year period.  The School does not offer a decelerated curriculum. In addition to certain academic standards, candidates for the M.D. degree must have abilities and skills in observation, communication, motor function, quantification, abstraction, integration, conceptualization and interpersonal relationships and behavior.  Some disabilities in certain of these areas may be overcome technologically, but candidates for the medical degree must be able to perform in a reasonably independent manner without the use of trained assistants.  The candidate must have sufficient motor function to elicit information from patients by palpation, auscultation, percussion, and other diagnostic maneuvers.  The candidate must be able to execute motor movements reasonably required to provide general care in emergency treatments to patients.  Such actions require coordination of both gross and fine motor muscular movement, equilibrium and functional use of the sense of touch and vision.  Those desiring additional information should contact the Admission’s Office.

MS-10.  The institution’s catalog or equivalent informational materials must describe the requirements for the M.D. and all associated joint degree programs, provide the most recent academic calendar for each curricular option, and describe all required courses and clerkships offered by the school.

A medical school’s publications, advertising, and student recruitment should present a balanced and accurate representation of the mission and objectives of the program.

MS-11. The catalog or informational materials must also enumerate the school’s criteria for selecting students, and describe the admissions process.

Provide a copy of the current medical school bulletin or catalog.  If there is no longer a print version of the catalog, indicate the web site URL for the corresponding material, and include a printed copy of the relevant web pages in the Appendix.

The School of Medicine catalog is available at: http://www.hopkinsmedicine.org/som/Academics/catalog.html.

The School of Medicine academic calendar is available at: http://www.hopkinsmedicine.org/som/Academics/calendar.html

MS-12. Institutional resources to accommodate the requirements of any visiting and transfer students must not significantly diminish the resources available to existing enrolled students.

Complete the following table for each of the past three academic years:

MS-13. Transfer students must demonstrate achievements in premedical education and medical school comparable to those of students in the class that they join.

MS-14. Prior coursework taken by students who are accepted for transfer or admission to advanced standing must be compatible with the program to be entered.

a. Describe the process of selecting students for admission to advanced standing or transfer.

We do not have a transfer admission process

a. Describe the process of selecting students for admission to advanced standing or transfer.

We do not have a transfer admission process because we rarely admit transfer students.

b. If any transfer or advanced standing students were admitted for the current academic year, complete the following table:

N/A—We have not had transfers into these classes. 

MS-15. Transfer students should not be accepted into the final year of the program except under rare circumstances.

If the school has admitted one or more transfer students to the final year of the program during any of the past three academic years, describe the circumstances.

Not applicable. 

MS-16. The school should verify the credentials of visiting students, formally register and maintain a complete roster of such students, approve their assignments, and provide evaluations to their parent schools.

Registration of visiting students allows the school accepting them to establish  protocols or requirements  for health records, immunizations, exposure to infectious agents or environmental hazards, insurance, and liability protection comparable to those of their own enrolled students.

MS-17. Students visiting from other schools for clinical clerkships and electives must possess qualifications equivalent to students they will join in these experiences.

a. How do you verify credentials and grant approval for students from other schools to take clerkships or electives at your institution?

Visiting Student Policy (excerpted from http://www.hopkinsmedicine.org/som/Audience/visitors.html)

The School of Medicine policies concerning acceptance of visiting medical students for clinical and research electives.

1. Clinical Electives: A limited number of clinical electives are available to medical students who are attending either LCME approved schools (U.S. and Canadian medical schools) or schools with which we have a formal affiliation. *
2. Research Elective: Research experiences are offered on a space available basis to U.S. and international trained medical students who submit appropriate application materials to the Registrar's Office. Acceptance decisions are made by the preceptor.
3. Basic Clerkships: Visiting students are not accepted for required basic clerkships.

Application Process: Application should be made by the visiting student to the Registrar of the School of Medicine. A transcript and letter of recommendation is required. Completed applications are forwarded to the department in which the student wishes to work. The registrar will notify the student of action taken and arrange for housing, visa, etc.

* Foreign Medical School Exchange Programs

b. Who is responsible for maintaining an accurate, current roster of visiting students? Describe the information included in the roster, and how it is used.

          The Registrar maintains the roster of visiting students.  Information in contained in the roster includes the students’ names, SSN’s, dates of their electives, the department/division in which the elective will be taken, the title of the elective, the preceptor, school of origin, fees charged, and dates of registration.  The information is used to track registration, to locate students while at JHUSOM, to track grade collection, and to perform statistics on visiting students. 

MS-18. The system of academic advising for students must integrate the efforts of faculty members, course directors, and student affairs officers with the school’s counseling and tutorial services.

There should be formal mechanisms for student mentoring and advocacy. The roles of various participants in the advisory system should be defined and disseminated to students.  For example, the role of the associate dean for student affairs in student advocacy and/or student discipline should be made clear.

a. Describe your academic advisory system for medical students.  Describe any programs designed to assist potentially high-risk entering students in adapting to the demands of medical school.

     Academic advising at Johns Hopkins relies upon the combined efforts of the faculty, the Student Assistance Program, and the Office of Student Affairs.  Faculty members who work directly with students in small groups, tutorials, and clinical rotations are expected to provide concurrent feedback to students about their performance and offer suggestions for improvement.  They communicate with course directors about students whom they view to be struggling.  Course directors carefully monitor students’ progress and make themselves available to meet with students who perceive they are having difficulties with their academic work.  Course directors will also arrange meetings with students who have marginal performance and are responsible for arranging tutoring.  This occurs predominantly during the pre-clinical years and is paid for with funds from the Office of the Vice Dean for Education.    

   The Associate and Assistant Deans for Student Affairs are notified by course directors about students having academic difficulty.  These deans also routinely review grades received in pre-clinical and required clinical coursework.  If a student is identified as having academic difficulty, one of the deans will meet with the student and offer assistance through established programs—tutoring, counseling, or study skills training through the Student Assistance Program.  The deans will also refer students to the Office of Equal Opportunity and Affirmative Action to discuss possible evaluation for potential learning disabilities.  However, students may directly contact this office and do not need a referral from the Office of Student Affairs.    

  Academic advising in the sense of curricular advising is done through individual faculty and the Office of Student Affairs.   Individual faculty are available to provide advice about different coursework.  The deans in the Office of Student Affairs also routinely meet with students to discuss the structure of individual curricula and counsel students about how to meet graduation requirements.  They also assist students with curricular conflicts and provide advice about extramural clinical and research experiences.       

b. Complete the following table for the most recently concluded academic year:

 c.  What percentage of students who experience academic difficulty (repetition of all or part of the year, move to a decelerated curriculum, leave of absence due to academic problems) typically continue to do so after remediative action has been taken? Summarize the most common reasons for academic difficulty.

We do not offer a decelerated curriculum and there have been no students who have taken a leave of absence due to academic problems in the last several years.  Some students have had to repeat all or part of an academic year.  Approximately 50% of those students continue to experience some difficulty in the pre-clinical curriculum.  A significant majority of those students perform satisfactorily during their clinical rotations, although many may have difficulty on standardized tests such as the NBME Shelf Examinations.  Students who have experienced these difficulties are monitored closely by the Office of Student Affairs and are discussed at the Student Promotions Committee.  There, course directors are made aware of the students’ past difficulties and attempt to arrange close monitoring and mentorship (e.g. meet with students to discuss progress, assign students to faculty known as truly outstanding teachers, etc.).
 

     The most common reasons for academic difficulty fall into three main categories:  personal illness, family/social problems, and learning disabilities.  In the first category, psychiatric illness, especially affective disorder, predominates.  Students suspected of suffering from such illnesses are referred to Student Mental Health directly or through the Student Assistance Program.  Other students face difficulties because of unexpected family issues such as illness, death, or financial reversals.  These students are counseled and offered support from appropriate sources (Office of Student Affairs, the Student Assistance Program, Financial Aid).  Finally, there is a growing recognition of the prevalence of learning disabilities among students in higher education.  Often, these students have been able to achieve significant academic success due to innate intelligence, despite their disability.  However, the rigors of the medical school curriculum can “unmask” a long-standing disability.  Students suspected of suffering from such disabilities are referred to the Office for Equal Opportunity and Affirmative Action and accommodations are made based upon recommendations following appropriate testing.  

 d. Estimate the percentage of an entering class that typically graduates in four years, and the overall graduation rate for that class.

The data for the four-year rate of graduation reflects a large combined M.D./Ph.D. program. 

See also Part A, item (f.) in this section of the database

MS-19. There must be a system to assist students in career choice and application to residency programs, and to guide students in choosing elective courses.

a. Describe your system for career and residency counseling, including intramural and extramural elective choices.  Note the roles or titles (e.g., student affairs dean, departmental faculty advisor) of anyone responsible for formal approval of elective courses.

            Formal and informal systems provide information to students to assist in their career choice as well as application to residency.   Our formal systems include the following:

1.  Faculty advisor—These individuals each assigned to a small number of students each year provide invaluable information about career opportunities.  In addition to sharing their own knowledge, the faculty advisors aid students in contacting other members of the faculty to provide additional, and perhaps more detailed, information. 

2.  Associate and Assistant Deans of Student Affairs—The deans in the Student Affairs Office communicate with medical students throughout their studies with regard to curricular and other choices that would help them decide on a given career.  Although typically focused on specialty choice, such advice also explores options for students who will not seek post-graduate residency training but may undertake research or other directions. 

            The Deans meet with medical students during the winter of their 3^rd year to discuss the process of residency application and ultimate matching into programs.  Starting early in the summer following the 3^rd year, the Deans meet with all students individually to discuss their plans for residency.  The students’ interests and vocations, the strengths and weaknesses of their application, the competitiveness of their specialty choice, and other factors that might influence application and matching strategy are all covered.  The students are also encouraged to contact Departmental Residency Advisors and individually-identified mentors (see below) in their chosen field for additional information.

3.  Departmental Residency Advisors are identified in all specialties and serve as resources for students seeking information about a given field in general as well as specifics about application to programs.  A list of these advisors is provided to students in winter of their 3^rd year. 

            Informal systems also exist as students identify mentors from early on in their education here from whom they receive information about different specialties.  Students also rely on upperclassmen and recent graduates for information about the application process as well as details about specific programs that they have visited or in which they have matched. 

            Students receive approval for electives at other institutions other than our own and our affiliates from Curricular Consultants in the department at Hopkins which corresponds to the one in which the extramural study is to be undertaken.  If the proposed experience does not fall within the realm of an equivalent department here at Hopkins, the student receives approval from the Associate Dean for Student Affairs who reviews the objectives and curricular content with the student.  Students desiring to study at other institutions must make final arrangements through the Office of the Registrar of The Johns Hopkins University School of Medicine.  

b. List the principal components of your system of evaluation that are employed in construction of the formal Medical Student Performance Evaluation (“dean’s letter”).

            The Medical Student Performance Evaluation (MSPE) or Dean’s Letter draws upon various sources of information in order to communicate an assessment of the applicants’ strengths and weaknesses.  The students’ medical school applications are reviewed for information about previous experiences and accomplishments.  A meticulous review of the students’ academic performance since matriculation is undertaken, including review of the transcript and reading of all written comments provided as part of students’ evaluations in the preclinical and clinical years.  In addition, the Dean responsible for the letter meets with the applicant for at least one hour to discuss their experiences and clarify information (such as the actual responsibilities or experiences of a listed extra-curricular activity).  The letter itself briefly introduces the applicant and highlights noteworthy accomplishments prior to matriculation.  Any disciplinary actions taken against the students are included.  Their performance in the preclinical years is discussed briefly along with a description of any academic difficulties the students had during that time.  A more extensive section reviews their performance on subsequent clinical rotations and excerpts are taken from all written evaluations received from such course work.  Descriptions of research experiences as well as objective information about productivity such as publications or presentations at refereed meetings are also included.  Important contributions to the academic or surrounding community are highlighted.   A histogram is sent out with the transcript which shows the distribution of grades received in the clinical clerkships by fourth year students to allow relative comparison of applicants by program directors.  Students are given the opportunity to view their Dean’s Letters prior to dissemination to correct any factual inaccuracies.   

c. Indicate who prepares the MSPE and attach two or three representative examples for recent graduates (obliterating names).

            The Associate and two Assistant Deans for Student Affairs are responsible for composing the Dean’s Letters.  Every effort is made to provide consistency in terms of the kind of information communicated by each individual letter writer.  When possible, one dean is responsible for writing all letters for applicants in a given specialty to enhance that consistency.   

MS-20. If students are permitted to take electives at other institutions, there should be a system centralized in the dean’s office to review students’ proposed extramural programs prior to approval and to ensure the return of a performance appraisal by the host program.

How are extramural electives screened prior to allowing students to enroll?  Describe your system of collecting performance appraisals for students taking electives outside your institution.

See SOM policy, page 20, SOM catalog:

Electives:

Approval may be granted for elective study at institutions other than The Johns Hopkins University. In such instances, the student must obtain approval from the Curricular Consultant of the department at Hopkins which corresponds to the one in which extramural study is undertaken.  One of the required 31/2 elective quarters may be taken at another non-affiliated medical institution. Students desiring to study at other institutions must make final arrangements through the Office of the Registrar of the The Johns Hopkins University School of Medicine.

The Registrar maintains enrollment information on all extramural electives.  At the end of the extramural rotation, an evaluation form is sent to the supervising faculty member at the extramural site.  This parallels a similar process for intramural electives.   

MS-21.

The process of applying for residency programs should not disrupt the general medical education of the students.

Students should not be exempted from any required educational experiences or assessment exercises in order to pursue other activities intended to enhance their likelihood of obtaining a desired residency position.

MS-22. Letters of reference or other credentials should not be provided until the fall of the student’s final year.

a. How does the school handle potential scheduling conflicts in required academic activities (e.g., fourth-year courses or selectives, examinations) and residency interviews?

     Students have always been responsible for meeting requirements to pass their coursework, including attendance.  However, in the past, there was some variation in how course directors handled time away for residency interviews.  The following policy was adopted by the Educational Policy Committee in December 2004 to address this issue

POLICY REGARDING ABSENCES FROM REQUIRED CLERKSHIPS
FOR RESIDENCY INTERVIEWS

The School of Medicine recognizes the primacy of the Basic Clerkships as critical components of medical students’ education.  Our curriculum affords significant flexibility in the scheduling of these clerkships, with several fourth year students taking these courses each year.  The realities of residency interviewing can have an impact on the experience of students during the fall and early winter months.  
            To minimize this impact, curricular scheduling is discussed with students well in advance of their fourth year to encourage students not to schedule clerkships during the months when they will most likely have the bulk of their interviews.  However, given the limited number of clerkship spots and the extended interviewing season in some specialties, some fourth years end up taking these courses during this time.  

            The following policy is to address the amount of time that such students can miss from their Basic Clerkships for residency interviews.  The goal is to ensure that students obtain sufficient experience in each of the basic disciplines to meet the objectives of the Hopkins curriculum. 

1.         On 6-9 week clerkships, students will be allowed to miss 3 full days of responsibilities as excused absences for interviews. 

2.         On 4-4.5 week clerkships, students will be allowed to miss 2 full days of responsibilities as excused absences for interviews. 

3.         Students must inform course directors of any such absences in advance of the beginning of the clerkship when possible.  If students do not contact the course director in advance of any absences, they will be considered unexcused and will impact on the student’s final grade. 

4.         All students who miss more than the allowed days above will be required to develop a plan for remediation of missed days with the clerkship director.  Such remediation is a necessary requirement for successful graduation from the M.D. curriculum.  

b.  What is the earliest date for the release or provision of letters of reference or other documents supporting applications to residency programs? 

Letters of reference in support of students’ residency applications are received in the Office of Student Affairs and are uploaded to the ERAS system in the fall of the fourth year. Transcripts for these students are uploaded to the system no earlier than October 1^st and can be updated until the end of the month.  Dean’s Letters (MSPE’s) are finalized in mid- to late-October and are uploaded to ERAS at that time. 

For students applying through the Central Application Service of the San Francisco Match, transcripts and Dean’s Letters are mailed via express delivery to arrive on November 1.  

Students as a group are informed of the above during the third year of medical school when they meet with the Student Affairs Deans to discuss the application process. The information is reinforced during further individual meetings with the Deans to discuss their Dean’s letters and application strategy in the summer between third and fourth year

MS-23. A medical school must provide students with effective financial aid and debt management counseling.

In providing financial aid services and debt management counseling, schools should pay close attention and alert students to the impact of non-educational debt on their cumulative indebtedness.

a. Provide the name, title and date of appointment for the financial aid director.  To whom does the financial aid director report?

Paul T. White, Assistant Dean for Admissions and Director of Financial Aid (appointed to the latter position in February 2002).  Mr. White reports to Dr. David Nichols, Vice Dean for Education, regarding financial aid matters. (See organizational chart, IS-11a.4).

b. Where do medical students go to obtain financial aid services? How do they obtain such services during clinical rotations? What other student groups (e.g., allied health students, graduate students) are served by the financial aid office?  How many staff members are available specifically to assist medical students?

The medical school students come to the Office of Financial Aid, located at 733 N. Broadway, Room 137, Baltimore, MD 21205. In addition to office visits, we send students information via their individual e-mail accounts or in some cases, through the class-wide e-mail accounts. They may access this information regardless of whether or not they are in Baltimore. The Office of Financial Aid also assists graduate students needing information, and occasionally house staff who may have questions. There are four members of the Financial Aid staff available to meet with medical students.

c. Summarize the financial aid counseling and services provided to medical students. Does the financial aid office have sufficient personnel, space, equipment, and other resources to carry out its responsibilities to the medical school? If not, please explain.

Excerpt from Student Website:

The Johns Hopkins University School  of Medicine Office of Financial Aid
The financial aid program at The Johns Hopkins University School of Medicine, is designed to help students secure sufficient financial resources to attend our medical school.

In order to be eligible for financial aid at Hopkins, as well as Title IV, Title VII and University Scholarships/Loans, students must be U.S. citizens, U.S. nationals, U.S. permanent residents or hold an I-94 form with one of the following designations: refugee, asylum granted, indefinite or humanitarian parole, Cuban Haitian entrant, status pending.

Medical students who are not considered in the above categories, do not qualify for Federal Programs or Hopkins Scholarship/Loan funds. These Medical students are required to deposit four years of tuition and living expenses into an escrow account with the university.

Financial Aid at Hopkins is need-based. Medical students are considered federally independent for Title VI programs however, in order to be considered for institutional funds and Title VII funds, parental information is required to determine eligibility .

Required documents for applying for Financial Aid:

1. Complete the Free Application for Federal Student Aid (include student and parent information) School code: E00235
2. Complete the Need Access application software
   (online website www.accessgroup.org) Fee charged.
3. Submit copies of Student and Parent (s) Federal Income Tax forms for the current year, along with ALL SCHEDULES and W2 forms.

The Financial Aid Office offers a full range of services throughout the academic year, including notifying students about various scholarship opportunities and making them aware of current issues in student financial aid.

Staffing, equipment and resources are adequate to meet needs.  

d. Describe the system for counseling students about debt management.

The Office of Financial Aid provides financial counseling to all entering students as required by the U.S. Department of Education. As part of our counseling we annually provide our students with a report which summarizes their debt prior to medical school as well as whatever debt they may have incurred while in medical school. Furthermore, the report includes their loan’s estimated interest rate and their estimated repayment based on the standard repayment schedule. In addition, we offer counseling regarding their need to manage their debt levels and to avoid taking on what is commonly referred to as elective debt (such as reliance on credit cards to acquire purchases). We direct our students to the Association of American Medical College’s financial management publication, Monetary Decisions for Medical Doctors, known as MD2. This publication is available to our students online at http://www.aamc.org/students/financing/md2. 

During the Spring of Year Four, we meet with the entire graduating class to review their loan summary reports covering their pre-medical and medical school years. As part of our exit counseling, we routinely invite the director of financial aid services for the AAMC to give our students an overview of a number of topics, including debt management during the residency years, loan consolidation, economic hardship, and deferments. The Department of Education requires exit counseling.

In addition, the Student Assistance Program offers financial planning workshops to medical and graduate students.  These workshops cover debt management, financial management, 403(b) plans, dollar cost averaging, and investment fundamentals. 

See also Part A, item (i.) in this section of the database.

MS-24.  Schools should develop financial aid resources that minimize total student indebtedness.

a. Complete the following table[1] for students presently enrolled in medical school:

b. Complete the following table for all students enrolled in the current year and for all enrolled students in each of the preceding two academic years:

See also Part A, item (h.) in this section of the database.

[1] Report information that is substantiated by applications processed by the school.  Include National Medical Fellowships, National Health Service Corps, Armed Forces Health Professions, Medical Scientist Training Program, State-funded awards, Federal Stafford Student Loans, Health Professions Student Loans, Primary Care Loans, Health Education Assistance Loans, Alternative Loan Program, and institutional loans and scholarships.

[2] Include tuition and fees, books and supplies, typical living expenses, and any other expenses covered in the financial aid budget.

MS-25. Institutions must have clear and equitable policies for the refund of tuition, fees, and other allowable payments.

Describe your policy for refund of tuition payments to students who withdraw or are dismissed from enrollment.

           The following is an excerpt taken from the SOM catalog and can be found at the URL address as follows: http://www.hopkinsmedicine.org/som/Academics/Catalog/MCAT3c_03.pdf

          “Full Time Students
           Full time students are billed on a semester basis.  A total refund of tuition payments will be made for a full time student withdrawing before completion of four weeks of a semester.  Students withdrawing after completion of four weeks will receive a pro-rated refund up to 60 percent calculated from day one of the semester.  Students withdrawing after completion of 60 percent of a semester will receive no refund of tuition.

           The date of withdrawal will be calculated from the date the student’s written statement of withdrawal is submitted to the Office of the Associate Dean for Student Affairs.  Exceptions to this policy must be approved by the Vice Dean for Academic Affairs.

MS-26. Each school must have an effective system of personal counseling for its students that includes a program to promote the well-being of students and facilitate their adjustment to the physical and emotional demands of medical school.

a. Describe the system for personal counseling of students and comment on its accessibility, confidentiality, and effectiveness.

b. Briefly summarize any programs designed to facilitate students’ adjustment to the physical and emotional demands of medical school.

The system of personal counseling for students that promotes the well-being of students and facilitates their adjustment to the physical and emotional demands of medical school consists of the Student Assistance Program (SAP) and Student Mental Health (SMH).  SAP and SMH services address the concerns of students, their academic advisors and supervisors, and faculty.  These concerns include student issues such as school, work, personal, and family challenges.  School/work issues may include concerns associated with advancement to more responsible professional positions, sexual harassment, interpersonal difficulties and any problems which interfere with student performance, productivity, well-being, and satisfaction.  Personal and family challenges may include matters of emotional health such as stress, family problems, grief, depression, anxiety, addiction, or chronic illness.

Student Mental Health Program (SMH)

Medical students can be self-referred to SMH ; they do not need to access either system through other health care providers.  SMH patients may be seen either in the hospital or a nearby, private location.

Medical students complete an evaluation with a student mental health psychiatrist, who is a faculty member of the department of psychiatry.  After the consultation visits with the psychiatrist and student mental health therapist are completed, the psychiatrist develops a treatment plan collaboratively with the student.  If ongoing care is decided upon, the student may be referred to the Student Assistance Program, the Student Mental Health therapist (who may work in concert with the student mental health psychiatrist), a Student Mental Health psychiatrist or a psychiatrist/therapist in the community or the department of psychiatry.  The SMH insurance pays 50% of the fees for treatment (and if the student is seen in student mental health, they get eight free visits per calendar year).

SMH offers brief, supportive, cognitive therapy, psychodynamic therapy and psychoanalysis, along with psychopharmacology.   The particular service rendered depends on the needs of the individual student.

SMH Accessibility

SMH patients may be seen either in the hospital or at the 550 Building, located at 550 North Broadway in Suite 403, which is an easily accessible and confidential location.  This site is adjacent to the medical student dormitory, Reed Hall, and across the street from the Johns Hopkins Hospital.  In addition, medical students may be seen at the FASAP/SAP offices at Eastern High School, 1101 East 33^rd Street, Baltimore, MD 21218. 

SMH Confidentiality

SMH services are private and confidential, in agreement with the Department of  Psychiatry and with state law and University policies.  The SMH staff will adhere to strict policies of confidentiality for all participants in the programs consistent with relevant state and Federal Regulations, including HIPAA and those regulations covering confidentiality of alcohol and drug abuse records. Information will be provided to outside parties only with the written permission of the student with the exception of limited information to supervisors or others when necessary for the benefit or protection of the student, University, families, patients, or student colleagues. Students must consent to the policies governing these limited disclosures in order to use the services of SMH. Students using the SMH will be informed of these limits on confidentiality and the nature of the program at the start of services. Participation in SMH will not affect future employment or career advancement. Participation will not protect an individual from disciplinary action. SMH records are maintained in a location separate and distinct from the student records and psychiatric records for seven (7) years as required by law.

SMH Effectiveness

SMH conducts surveys of its patients’ satisfaction.  If the student consents, a survey asking the student to rate the effectiveness of student mental health services, as well as any specific comments is mailed two months after they were evaluated.  If specific concerns are raised, they are addressed with the student with the student’s approval.  More general concerns are addressed anonymously with administration.  The overwhelming majority of students have found SMH services helpful in past surveys.  In addition, quality assurance is ensured through extensive supervision, case conferences and anonymous departmental reviews.

Student Assistance Program (SAP)

The SAP model is assessment, referral and brief treatment. The program takes a compassionate approach recognizing that some students may need more than six sessions, may not make a successful transition to an outside referral source, or may need on-going monitoring by the program. Clinical services included in the SAP are:

1. Identification and assessment of personal problems.
2. Referral to appropriate and accessible services and resources.
3. Brief mental health interventions utilizing a short-term treatment model of up to five sessions, as clinically indicated.
4. Follow-up services to ensure access to services and resources
5. Ongoing and focused group activities are offered to address some of the main difficulties faced by medical and graduate students.  The goals of these activities are to decrease student stress, develop more adaptive coping styles, increase student resiliency and address problematic thinking and behavior patterns that could lead to the development of psychiatric conditions or impair performance, the achievement of career goals or interpersonal effectiveness.
6. Consultation with Associate Deans for Student Affairs and appropriate Promotions Committees

The SAP is directed by Kathleen Beauchesne, PhD, MBA, MSW, LCSW-C.  Everett Siegel, MD, Assistant Professor in Psychiatry is the Medical Director.  Michael Heitt, PsyD. serves as the Associate Director of the SAP, and Deborah Hillard, PsyD. is the SAP clinician.  To ensure a broad range of clinical services and personnel, SAP services are also provided by FASAP clinicians, including licensed clinical psychologists, licensed clinical social workers, and licensed professional counselors.

The FASAP Director, Medical Director and Associate Director and the SOM Vice Dean for Education and Associate Dean of Student Affairs are responsible for the planning and on-going program management for SAP.  The program administrative activities include but are not limited to the review of the memo of understanding, an operational plan, a publicity plan and other activities associated with program development.  On-going program management activities may include clinical supervision, record review, data collection and reports, quality assurance, and other activities as indicated

SAP Accessibility

SAP services are easily accessible and centrally located at the 550 Building, located at 550 North Broadway in Suite 403 and 507.  This site is adjacent to the medical student dormitory, Reed Hall, and across the street from the Johns Hopkins Hospital.  In addition, medical students may be seen at the FASAP/SAP offices at Eastern High School, 1101 East 33^rd Street, Baltimore, MD 21218.  For more information or to schedule an appointment, call 410/955-1220 or 443/997-3800

SAP and SMH Accessibility:  24 Hour Crisis Response--ProtoCall Services

Both SAP and SMH use ProtoCall Services, Inc., which provides pre-intake clinical screening, telephone assessment, telephone crisis stabilization, triage, and referral, as well as the mobilization of medically necessary resources or on-call staff for FASAP, SAP and SMH during the day, when clinical staff may not be available, and after-hours.

All services are provided from within the ProtoCall call center by Master’s-level Mental Health Professionals who meet strict academic and professional requirements.  These clinicians are nationally recognized as among the best in telephone crisis intervention, assessment, and triage.

ProtoCall staff use a solution-focused approach that allows the clinician to focus on the positive aspects of the situation or on solutions, rather than focusing on the problem.  An assumption in solution-focused approaches is that the client has the necessary resources to find solutions to crises.

When faced with callers in crisis, ProtoCall counselors assess for dangerousness or need to mobilize emergency resources and then begin to build a rapport with the caller.  ProtoCall clinicians can often stabilize callers over the phone by first listening for successes, strengths, or ideas that are an exception to the current situation.  The counselor expands the intervention to include the accepted solution and then advances the idea that this different and successful solution may resolve the current situation.

The goal of ProtoCall staff is not to become the caller’s therapist or to interfere in the therapeutic process, but rather to provide callers with a response that manages risk, is user friendly, and is customer-service focused. 

If a crisis situation cannot be managed by ProtoCall, the FASAP/SAP Associate Director and Security are notified as well as the local law enforcement authorities.  ProtoCall follows the notification policies outlined by FASAP/SAP/SMH in such situations.

SAP Confidentiality

SAP services are private and confidential, in accordance with state law and University policies.  The SAP staff will adhere to strict policies of confidentiality for all participants in the programs consistent with relevant state and Federal Regulations, including HIPAA and those regulations covering confidentiality of alcohol and drug abuse records. Information will be provided to outside parties only with the written permission of the student with the exception of limited information to supervisors or others when necessary for the benefit or protection of the student, University, families, patients, or student colleagues. Students must consent to the policies governing these limited disclosures in order to use the services of SAP. Students using the SAP will be informed of these limits on confidentiality and the nature of the program at the start of services. Participation in the SAP will not affect future employment or career advancement.

Participation will not protect an individual from disciplinary action. SAP records are maintained in a location separate and distinct from the student records for seven (7) years as required by law.

SAP Programs to Facilitate Adjustment to Medical School

Ongoing and focused group activities are offered by SAP to address some of the difficulties faced by medical and graduate students.  Student awareness off the services provided by the SAP is achieved through program presentations, presentations at orientations, student groups, faculty groups, flyers and brochures of an educational and promotional nature. Information about the program is maintained on the FASAP website with links to student pages.  The SAP has written articles, worked with groups and offered the following activities since February 2003.  Over 1,200 medical and graduate students have attended SAP events since its inception.

SAP Effectiveness

The SAP asks students to complete client satisfaction surveys following individual appointments and evaluation forms at each event.  Evaluation forms are also completed by students following SAP events.  Utilization data is collected and disbursed via quarterly reports through the FASAP/SAP Management Committee meetings, SAP Advisory Committee meetings and through the SAP Outcomes meetings. The Client Satisfaction data, evaluation and utilization data is reported as part of the FASAP/SAP Annual Reports. 

The SAP Advisory Committee serves as an essential group in monitoring SAP effectiveness. The SAP/SOM Advisory Committee meets in February and September of each year.  The members consists of medical and graduate students, who are nominated by the Medical Students Society and the Graduate Student Association, those individuals with direct responsibility for medical and graduate students, including the Associate Dean of Medical Students, the Associate Dean of Graduate Students, the Registrar, and other representatives nominated by Dean Nichols in consultation with Dr. Ford.  FASAP and SAP personnel staff the committee.

The SAP Advisory Committee

• Reviews the pattern of services and programs offered by the SAP,
• Provides guidance to the SAP staff about the concerns of students, their academic advisors and supervisors, and faculty,
•  Renders recommendations to the SAP staff,
• Helps educate students, faculty and staff about the nature of services, needs and issues confronting the students,
• Provides support to the SAP staff,
• Assists in the evaluation of the efficacy of SAP service

The effectiveness of the SAP is also monitored through quarterly meetings with representatives of FASAP and the SOM, or as mutually determined by the parties, to review the SAP.  In addition, a SOM representative attends the quarterly FASAP Management Committee meeting.

Drug Testing and Other Health Services

Drug testing and other necessary health services, including non-SAP psychiatric, psychological, and mental health services, are provided through the Student Health Program (SHP) Medical Coverage or a student's other independent health care provider.  The University Health Center provides for-cause drug and alcohol testing, as well as follow-up random monitoring for drug or alcohol use.  These costs are covered by individual student health insurance policies.

Eligibility

All registered Johns Hopkins University School of Medicine students and their immediate family members are eligible for SAP services, and there is no cost for utilizing SAP services. 

The students also coordinate the Big-Sib/Little-Sib Program which pairs a second-year student with a newly matriculated first-year.  Advice about the medical school and life in Baltimore is shared. This kind of peer support has been very helpful to many students as part of their adjustment. 

MS-27.  Medical students must have access to preventive and therapeutic health services.

Describe the system for providing preventive and therapeutic health services, including location(s) of health care sites, hours of operation, services provided, and how costs of the services are covered.

University Health Service, (UHS): Appointments and Information:
410-955-3250 (M-F 8am-4:30pm)
Carnegie Building Rm. 136
After-hours physician on-call:
Medical /surgical: 410.955-4331
Psychiatric: 410.955.5964

University Health Services Benefits Office:
Blalock 144 (M-F) 8:30am-5:00pm)
Contact: 410.955-3872

Student Health Program (SHP):
Contact: 888.400.0091 or 410.424.4485
(M-F 8am-5pm)
Student Assistance Program:
410.955.1220
550 Building, Rm. 507
Student Mental Health Services:
410.955.1892
550 Building, Rm.403

University Health Service, (UHS):
1. offers comprehensive ambulatory medical services
2. staffed by Board Certified Internist Faculty and Fellows
3. Offers routine gynecological care
4. 24-hour physician on-call services
5. Nurse triaging for walk-in  patients with urgent problems
6. sub-specialty referrals
7. Health Entrance Screenings for Medical students and House officers

SERVICES COVERED:
UHS Billing and Benefits Office covers adult medical care, (all office visits to the primary care center are at no cost to the student.)  Other services are gynecological care, obstetrical care, adult mental health
(thru the Student Mental Health Service), pediatric care of covered dependants, adult immunizations (except travel immunizations), and HIV testing is covered.
Students get one free routine eye exam and one covered gynecological preventive exam per calendar year.

See response to MS 26 regarding the system for the provision of preventive and therapeutic mental health services. 
 
Locations
SMH Locations
SMH patients may be seen either in the hospital or at the 550 Building, located at 550 North Broadway in Suite 403, which is an easily accessible and confidential location.  This site is adjacent to the medical student dormitory, Reed Hall, and across the street from the Johns Hopkins Hospital.  In addition, medical students may be seen at the FASAP/SAP offices at Eastern High School, 1101 East 33rd Street, Baltimore, MD 21218.

SAP Locations
SAP services are easily accessible and centrally located at the 550 Building, located at 550 North Broadway in Suite 403 and 507.  This site is adjacent to the medical student dormitory, Reed Hall, and across the street from the Johns Hopkins Hospital.  In addition, medical students may be seen at the FASAP/SAP offices at Eastern High School, 1101 East 33rd Street, Baltimore, MD 21218.  For more information or to schedule an appointment, call 410/955-1220 or 443/997-3800.

Hours of Operation
SAP Hours of Operation
SAP Services are available from 8:30 to 5:00 Monday through Friday. Some meetings may occur earlier in the morning or in the evening depending on the student’s needs and the clinician’s schedule. After hours services are available through ProtoCall, the SAP 24/7 on-call telephone crisis counseling service.

SMH Hours of Operation
SMH Services are available from 8 to 5, Monday through Friday.  Some evaluation and therapy meetings may occur earlier in the morning or in the evening depending on the student’s needs and the provider’s schedule.  After hours services are available through ProtoCall, the SAP 24/7 on-call telephone crisis counseling service.

Costs of Services
SMH Costs
The services of the SMH are provided through an agreement between the School of Medicine and the Department of Psychiatry.  Student insurance pays 50% of the fees for treatment (and if the student is seen in student mental health, they get eight free visits per calendar year).

SAP Costs
The total costs of services to be provided are $54,106 for FY05.   These costs are paid by the School of Medicine.

MS-27-A.  The health professionals who provide psychiatric/psychological counseling or other sensitive health services to medical students must have no involvement in the academic evaluation or promotion of the students receiving those services.

Describe the mechanisms that allow students to obtain assistance for sensitive health care, psychiatric, or psychological problems (such as substance abuse, sexually transmitted diseases, etc.), with confidence that the providers of such services will not be in a position at some present or future time to evaluate the student’s academic performance or take part in decisions regarding the student’s advancement.

Students obtain their physical health care through the University Health Service.  Clinicians who see students there are not in roles of evaluating students or contributing to decisions regarding their advancement through the curriculum.  At times students are referred (or elect to seek healthcare) from specialists on the faculty who are, at times, in positions of evaluating students.  In the rare circumstances where a faculty member would be asked to evaluate a student whom they have treated, the faculty member will recuse him/herself from this position and defer evaluation to other members of the faculty.  If the treating physician is a course director, another member of the department will review the student’s performance and grade calculation for that course prior to submission to the Registrar’s Office.

            The clinicians working in Student Mental Health, with the exception of the Director, are not in positions of evaluating students’ academic performance.  In the rare instance in which the Director will have performed a psychiatric evaluation on a student rotating through the department, he will recuse himself from evaluating the student’s performance in the course. 

            Students may also undergo psychological evaluation and receive treatment through the Student Assistance Program.  The clinicians there are never in positions of evaluating students’ academic performance. 

 MS-28. Health insurance must be available to all students and their dependents, and all students must have access to disability insurance.

a. Is health insurance available for all students and their dependents? If yes, briefly describe the scope of benefits and premium costs.  Who pays the premium?  If health insurance is not offered, what provisions are made to provide health care for students?

            All students are required to enroll in the Student Health Plan administered by the Johns Hopkins Employee Health Program.  The insurance has a $1M maximum benefit for most services except chemical dependency which has a $250K limit.  The plan has an 80% prescription benefit.  Premiums are the responsibility of the student.  Current fees are as follows:

            Individual coverage                   $145/month
            Two party coverage                  $323/month
            Family coverage                       $403/month.

b. Is disability insurance available to students?  If yes, describe how students are informed of its availability.

           The SOM provides a disability policy and a $100K term life insurance policy to at no cost to the students.  The disability policy pays $1000/month during years 1 and 2 and $1500/month during years 3 and 4. 

           Students are informed of all benefits and requirements for health insurance each year during open enrollment periods.  Requirements are also addressed in information sent to applicants by the Admissions Office and in the SOM catalogue. 

http://www.hopkinsmedicine.org/som/Academics/Catalog/MCAT3c_03.pdf

MS-29. Medical schools should follow accepted guidelines in determining appropriate immunizations for medical students.

Medical schools in the U.S. should follow guidelines issued by the Centers for Disease Control and Prevention, along with those of relevant state agencies.  Canadian schools should follow guidelines of the Laboratory Center for Disease Control and relevant provincial agencies.

Briefly describe your student immunization policies and procedures.

At orientation:

All medical students are required to present acceptable documentation
of immunity status or submit to testing of immunity status for measles, mumps, rubella, chickenpox, Hepatitis B and tuberculosis. (through PPD or chest radiographs)

Tetanus/diphtheria immunizations are updated

An intermediate strength PPD will be placed and read provided there are no contraindications

For those whose tuberculin skin test is found to be positive, a chest x-ray is done to rule
out tuberculosis.The medical student is then given an appointment at University Health Service to be assessed by a physician and possible start of INH therapy, where appropriate.  INH therapy is administered per CDC guidelines.

For those individuals with a previous history of positive tuberculin skin tests, the report of a chest x-ray taken after findings of positive PPD which indicates NO evidence of active TB must be provided. Thereafter, a repeat chest x-ray is done very five years in the absence of symptoms of tuberculosis.

Viral titers are drawn for:  Rubeola, Rubella, Mumps, Chickenpox, and Hepatitis B antibody. If viral titers are negative, immunizations are offered at not cost to the student at University Health Service.

If Hepatitis B antibody status is negative, the series of 3 vaccines or booster shot is offered at Occupational Health Service (410.955.6211). Titers will be drawn through Occupational Health Service after completion of the Hepatitis B series. Students will have up to one month to get the titers drawn at no cost to them. If not done within the designated time frame, the student will incur the cost of the test.

Hepatitis B antibody tests will not be drawn from those students with documentation of immunity confirmed by the series of 3 injections of the Hepatitis B vaccine.

MS-30. Schools must have policies addressing student exposure to infectious and environmental hazards.

The policies should  include 1) education of students about methods of prevention; 2) the procedures for care and treatment after exposure, including definition of financial responsibility; and 3) the effects of infectious and environmental disease or disability on student learning activities.  All registered students (including visiting students) need to be informed of these policies before undertaking educational activities that would place them at risk.

a. Describe institutional policies regarding student exposure to infectious and environmental hazards, including the following:

- education of students about methods of prevention

- procedures for care and treatment after exposure, including definition of financial responsibility

- effects of infectious and/or environmental disease or disability on student educational activities

b. Briefly summarize any protocols students must follow regarding exposure to contaminated body fluids, infectious disease screening and follow-up, hepatitis-B vaccination, and HIV testing.

c. In the course of their education, when do students learn how to avoid or prevent exposure to infectious diseases, especially from contaminated body fluids? When and how are they taught the procedures to follow in case of exposure (e.g., a needlestick injury)?

Students  receive training in Universal Precautions and Phlebotomy/IV Therapy Techniques as part of the second year course in Clinical Skills.  A training certificate is issued to each student certifying their program of instruction.  This certificate becomes part of the student record housed in the Registrar’s Office.

The needlestick exposure policy is discussed at the orientation session when students learn about the University Health Services.  In addition, all students are provided on an annual basis a wallet-size card with instructions and a phone number to call in the event of an exposure.  The phone line is available 24 hours a day/7 days a week.  The policy is also addressed in the University Health brochure which is updated annually and distributed each year during registration.

 ( Please see attachment "Appendix Document, 30c, "University Health Services Student Brochure") and card (Appendix Document, 30c-2, “Needlestick Exposure Card”.) 

MS-31. In the admissions process and throughout medical school, there should be no discrimination on the basis of gender, sexual orientation, age, race, creed, or national origin.

Describe any circumstances where medical school applicants or students may receive differential consideration on the basis of gender, sexual orientation, age, race, creed, or national origin.

While we do not assign points or weights to any applicants, Johns Hopkins is committed to the enrollment and education of individuals from all groups.  The medical school values having a diverse student population and has an excellent record of enrolling students traditionally underrepresented in medicine. Our well-publicized non-discrimination policy clearly outlines the University’s policies across all divisions regarding these issues. 

Our well-publicized non-discrmination policy clearly outlines the University's policies across all divisions regarding these issues.

MS-32. Each medical school must define and publicize the standards of conduct for the teacher-learner relationship, and develop written policies for addressing violations of those standards.

The standards of conduct need not be unique to the school but may originate from other sources such as the parent university.  Mechanisms for reporting violations of these standards -- such as incidents of harassment or abuse -- should assure that they can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, and support educational activities aimed at preventing inappropriate behavior.

a. Supply a copy of any formal statement of the standards of conduct expected in the teacher-learner relationship.  Describe how students, residents, and faculty are informed about the policy

See Appendix document, MS-32.a.

Faculty are informed of the Teacher –Learner Conduct Policy at the annual New Faculty Orientation with other faculty policies; the policy is also linked from the faculty policy section of the SOM website (http://www.hopkinsmedicine.org/som/faculty/policies/index.html).

The Education Policy Committee approved the Teacher –Learner Conduct Policy and charges course and clerkship directors to inform all faculty, residents and graduate students engaged in the teaching and evaluation of students in their respective courses to disseminate the policy guidelines.

The policy is also published on the Graduate Medical Education website (http://www.hopkinsmedicine.org/som/gme/GME_Policies/index.html), and program directors are reminded to disseminate this policy at resident orientation sessions.

Lastly the policy is available to students at the Student Affairs website, (http://www.hopkinsmedicine.org/som/students/policies/relationships.html)

and reviewed with incoming students at orientation..

b. Provide a copy (or web site URL) of any formal or informal policies and procedures for handling allegations of student mistreatment, including avenues for reporting such incidents and mechanisms for investigating them. What evidence is there to indicate that the effectiveness of such policies?

See Faculty Policy, “Grievance Procedures for Faculty, Fellows and Student Body,” at

http://www.hopkinsmedicine.org/faculty_staff/policies/facultypolicies/grievance.html

c. Describe educational programs provided by the school or other university officials to avoid or prevent student mistreatment.

The Self Study Subcommittee recognizes that the SOM has not developed educational programs for faculty and/or students to address the teacher-learner conduct policy.  As a result, a task force working with the Vice Dean for Faculty, Associate Dean for Student Affairs, Graduate Medical Education Council, Medical School Council representatives and legal counsel, was organized to develop an educational approach to address to this deficiency. 

MS-33. The medical school must publicize to all faculty and students its standards and procedures for the evaluation, advancement, and graduation of its students and for disciplinary action.

Attach a copy of, or web site URL for, the school’s standards and procedures for the evaluation, advancement, and graduation of students, and the procedures for disciplinary action.  How are these standards and procedures publicized to faculty members and students?

          This information is readily available to students and faculty in the Academic Catalog on pages 23-25 and can be found online at the URL address below. 

http://www.hopkinsmedicine.org/som/Academics/Catalog/MCAT%202b_03.pdf

            A full description of disciplinary procedures available to students and faculty through the Office of Students Affairs, and on the SOM website (http://www.hopkinsmedicine.org/som/students/policies/discipline.html), is as follows:

THE JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE

PROCEDURES RELATING TO STUDENT DISCIPLINE

The following procedures will govern complaints regarding the conduct of a student enrolled in the School of Medicine.

1. A student’s record within the School of Medicine will contain documentation reflecting conduct during the period of enrollment.
   
   
2. A student will have access to his School record, including those documents, if any, reflecting conduct, in accordance with the standards set forth in the Family Educational Rights to Privacy Act and applicable University policy.  The University’s policy on access to and release of student records is published annually and a copy may be obtained from the Office of the Registrar of the School of Medicine.
   
   
3. A student will have access to his School record, including those documents, if any, reflecting conduct, in accordance with the standards set forth in the Family Educational Rights to Privacy Act and applicable University policy.  The University’s policy on access to and release of student records is published annually and a copy may be obtained from the Office of the Registrar of the School of Medicine. 
   
   
4. Where a matter involving student conduct cannot be resolved to the satisfaction of the Associate Dean for Student Affairs, or where the gravity of the acts with which the student is charged appears to warrant further attention, the Dean of the Medical Faculty will appoint an ad hoc committee of the Advisory Board of the Medical Faculty to hear the charge of misconduct.  The Committee may include such other persons, for example, student peers, as may be deemed appropriate.  Each person appointed to the ad hoc committee shall be free of bias or personal interest in the matter.  The Dean, Vice Dean, Associate Dean and Registrar shall be non-voting ex-officio members of the ad hoc committee.  The Dean, Vice Dean, or an Associate Dean shall preside at meetings of the ad hoc committee and may vote when the ad hoc committee is equally divided on a question.
   
   
5. A student charged with misconduct will be given written notice of the charges and of the date and time of the Committee hearing.  Prior to the hearing an accused student shall be given access to all documentary evidence to be presented against him.  An accused student may request an opportunity to consult with the Dean, Vice Dean, or an Associate Dean prior to a hearing.
   
   
6. A student may be accompanied to the hearing by a faculty member or student advisor.  Representation of the accused student or the accusing party at the hearing by attorneys will not be permitted.
   
   
7. In the course of the hearing, a student will be given the opportunity to present evidence and witnesses in his behalf, to question all witnesses, and to make statements to the Committee.
   
   
8. Members of the ad hoc committee may ask questions of the student charged and of witnesses appearing before the Committee.
   
   
9. A hearing before the ad hoc committee will be closed and persons other than Deans appearing as witnesses will be asked to absent themselves before and after their testimony.  Parents of the accused student will be permitted to accompany a student throughout the hearing, and, if they should to do so, to make a statement.
   
   
10. A hearing shall be recorded by the deliberations of the ad hoc committee shall not be recorded.  Following the hearing, the accused student shall be permitted to listen to the recording upon request, but all copies of the recording shall remain in the School’s possession.
    
    
11. All parties, witnesses, and representatives shall be excused at the conclusion of the hearing and the ad hoc committee shall deliberate privately.  The Committee shall make findings as to the truth or falsity of the charges against the student and, where necessary, shall submit to the Dean a recommendation of a penalty.
    
    
12. The options for disciplinary action, should the Committee decide that the student’s behavior warrants discipline, will include, but will not necessarily be limited to the following:
    
    

    1.Reprimand without probation or suspension.
    

    2.Probation for a specified time period or until explicit* conditions are met.  Review and final decisions to be administrative.
    

    3. Suspension for a specified time period or until explicit* conditions are met.  Review to be administrative.
    

    4.Suspension for a specified time or until explicit* conditions are met.  Review by the ad hoc committee of the Advisory Board.
    

    5.Unconditional Expulsion.
    

                *Explicit conditions are to be unambiguous and as objective as the conditions allow.

    
    
13. A student may appeal an adverse decision to the Dean of the School of Medicine, or, in the absence of the Dean, appeal may be made to the Vice Dean or an Associate Dean.  A student may appeal an adverse decision of the Dean, Vice Dean, or Associate Dean to the Provost of the University.
    
    
14. A student may attend classes pending the proceedings before the ad hoc committee unless the student is judged by the Dean, Vice Dean, or Associate Dean to be a danger to himself or others.  A student must seek the permission of the Dean, Vice Dean, or Associate Dean in order to continue the educational program pending appeal from the recommendations of the ad hoc committee.

Attach a copy of, or web site URL for, the school’s standards and procedures for the evaluation, advancement, and graduation of students, and the procedures for disciplinary action.  How are these standards and procedures publicized to faculty members and students?

MS-34. There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, or dismissal.

Summarize the due process protections in place when taking an adverse academic action involving a medical student, including appeal opportunities.

For due process protections involving disciplinary matters, please refer to the response to MS-33. 

With regard to due process protections in place when facing adverse academic action, please refer to URL address listed in MS-33. 
http://www.hopkinsmedicine.org/som/Academics/Catalog/MCAT%202b_03.pdf

     During years one and two, students must pass every course in order to be promoted. In either the first or second year, dismissal is automatic if a student receives two failing grades, one failing and one unsatisfactory grade, or unexcused incompletes in two or more courses.

     A student may repeat only one year of the first two years of the curriculum. During the repeat year dismissal is automatic if the student receives one failing grade or two unsatisfactory grades.

     During the clinical years, one failing grade in required clerkships/courses will result in automatic dismissal. Unsatisfactory performance in two courses will result in dismissal at the discretion of the Promotions Committee. A single Unsatisfactory grade in a required clerkship/course must be remediated. Remediation must be attempted at the earliest time that scheduling permits.A student dismissed for academic reasons may submit a written petition for readmission to the appropriate Committee on Student Promotion setting forth an explanation for the student’s deficient performance, any extenuating circumstances, and any other information relevant to the student’s deficient performance, any extenuating circumstances, and any other information relevant to the student’s fitness to continue the academic program.
     The student additionally may request the opportunity to appear personally before the Committee on Student Promotion.
     In accordance with the high standard of ethical conduct required of a physician, students are expected to refrain from acts of dishonesty which impair the academic integrity of the University. Students whose behavior appears to be unbefitting a physician will be reviewed by an ad hoc committee of the Advisory Board of the Medical Faculty, and such other persons as may be deemed appropriate. The ad hoc committee will be appointed by the Dean, or in the Dean’s absence, the Vice Dean for Academic Affairs. This committee will decide on the student’s status within the school. Students reviewed under such circumstances will have the opportunity to meet with the ad hoc committee in person prior to a decision. A student whose status is affected by a decision of the ad hoc committee will be afforded an opportunity to appeal to the Dean and, thereafter, to the Provost of the University. A complete description of procedures to be followed in disciplinary matters is available in the Student Affairs Office.


MS-35.  Student records must be confidential and available only to members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by laws concerning confidentiality.

Describe the general content of the student record files. Where are student records maintained?  Who, other than the student, is authorized to examine or review such records?            

Student records are maintained by the SOM Registrar in a secure area which is always manned by office personnel during business hours and locked after hours.  The record contains admission information, course comments and evaluations, a permanent record card (which contains grade information and actions of the Student Promotions Committees) and a transcript.  The file also contains copies of all certifications completed by the Registrar as well as copies of all correspondence generated from and to the student.

            The files are available to the Students Affairs and Admissions Deans.             Students are permitted to review their records and have access to all materials except that which they have waived their right to see (primarily admissions documents).  All such materials are clearly marked.

MS-36. Students must be allowed to review and challenge their records.

a. Describe the procedure students must follow in order to review or challenge their records.

Students may at any time review their records in the Registrar’s Office.  Challenges to grades listed on the permanent record card are initially referred to the course director.  Students may also discuss concerns about grades received with the Student Affairs Deans.

b. Does each required course and clerkship provide students with an opportunity to review their performance, and if necessary appeal an examination or course grade? 

A new grade appeals policy was adopted in February 2005 and is as follows:

"Every course allows a student to review his/her performance.

Appeals of examination grades are made to the course director.  Appeals of final grades are made according to the following policy:"

GRADE APPEALS POLICY

The components of evaluation in a course or clerkship should be transparent to the student and discussed at the start of the student’s experience.  Grades are generated by the course/clerkship director.  Should there be a disagreement about a grade in a course or clerkship, the student is to follow the guidelines below for grade appeals. 

1.         The first stage of a grade appeals process will be a meeting between the student and the course director.  The course director may also request any faculty preceptors involved in evaluating the student be present for this meeting.  At that time, the student will have an opportunity to voice his/her concern(s) about the grade which he/she received.  The course director will have the chance to review the criteria by which the final grade is determined and will be expected to answer any questions the student has.  The course director may elect to obtain additional information based upon what the student has said and would ultimately decide to maintain the original grade or submit an amended grade to the Registrar. 

2.         If dissatisfied with the results of the above, the student may appeal to the appropriate Promotions Committee (First and Second Year or Third and Fourth Year) by contacting the Office of the Vice Dean for Education.   The Committee will be chaired by the Vice Dean who will vote only in the case of a tie.  The Associate Dean/Registrar, the Associate Dean for Student Affairs, and the Assistant Dean for Minority Affairs will be non-voting ex-officio members.  The student will be asked to provide information regarding the grounds for the grade appeal and will be given an opportunity to address the Committee if they so desire.  The course director involved will not be allowed a vote in the matter and will be excused for the period of debate and voting after being given a chance to address the Committee.  After consideration, the Committee will advise the Vice Dean for Education of any changes merited.  Two standards will be employed by the Committee in evaluating the appeal which could lead to a recommended amendment:

a.  if the grade is not found to reflect valid and consistent academic performance standards or criteria, or the considered academic judgment of the course director;

b.  if the grade is found to be based upon impermissible criteria beyond performance, achievement, and effort such as gender, race, age, or other factors as delineated in the policy on Teacher Learner Relationships.

 3.         The student may appeal an adverse decision to the Dean of the Medical School by notifying him/her in writing within 7 days of the decision.  The Dean’s review will be limited to review of procedural integrity and his/her decision will be final.

MS-37.  Schools should assure that students have adequate study space, lounge areas, and personal lockers or other secure storage facilities.

a. Describe the quantity, quality, and accessibility of student study space, lounge, and relaxation areas.  Do medical students share such space or facilities with other student groups? 

A)
       The main lounge and relaxation space, used mostly by 1^st and 2^nd year students, is a student lounge in the basement of the Pre-Clinical Teaching Building (PCTB). This area is newly renovated with comfortable seating, cable television and a small kitchen with microwave ovens for student use. It is a rather modest space considering this is the only official lounge for all medical students. Graduate students may also use this space. 
       Students on clinical rotations have access to the Doctor’s Lounge and for women, the Elizabeth Garrett lounge, inside the hospital and share this space with faculty and staff. A student-only branch of the Academic Computing Center is located on the 4^th floor of the hospital (Blalock 4 ) and contains  8 workstations, 1 laserjet printer, both Ethernet and wireless Internet access. There are two computers located in the Doctor’s Lounge. All lounges are accessible 24/7 with cardkey access.
      Official study spaces for students include the Welch Library, with limited hours of accessibility, and the IRC Computer lab at PCTB, open 24 hours. Neither of these areas have enough seating or tables to accommodate all four classes of medical students. The Welch Library is actively reviewing extending hours to accommodate student study needs.
      The IRC has reliable computer access, however there are not enough computers for the number of users during busy times and it is not a quiet area for study. Thus, students often use alternate areas of study such as the School of Public Health, newly renovated with a coffee shop, and classrooms/labs at PCTB, which are locked after hours. All study spaces are shared with other graduate students. There is a lack of study space in the hospital for students on clinical rotations. The institution is committed to building a new education building as a long-term solution.

b. Summarize the storage facilities for students’ personal possessions and valuables (e.g., microscopes, computing equipment), both at the main or home campus and at clinical teaching sites.

B)    First year students are assigned two half lockers, one in the basement of PCTB,the other on the 3^rd floor. These are most commonly used for storage of personal belongings during anatomy lab, located on the 2^nd floor, so there is a slight inconvenience in locker location since students have to travel from their locker to the labs. Full, rather than half lockers, would be desirable, allowing increased space for personal belongings.
      Second year students are assigned one half locker in the basement, near small group lab rooms. These are appropriate in location and sufficient for storage.
      Both first and second year students are provided with convenient lockers in the lab rooms for microscope storage directly at their seat.
      Third and fourth year students are assigned half lockers in the Doctor’s Lounge, sufficient for storage of personal belongings.