A student physician shall be dedicated to providing competent medical service with compassion and respect for human dignity. In all instances the student physician must maintain the dignity of the person including respect for the patient’s modesty and privacy.
It is unethical for a student physician to refuse to participate in the care of a person based on race, religion, ethnicity, socioeconomic status, gender, age, or sexual preference of the patient. It is also unethical to refuse to participate in the care of a patient solely because of medical risk, or perceived risk, to the student. It is not, however, unethical for the pregnant female student to refuse to participate in activities that pose a significant risk to her fetus.
The patient’s right to the confidentiality of his or her medical records is a fundamental tenet of medical care and of the law. The discussion of problems or diagnoses of an identified patient by professional staff/medical students in public violates patient confidentiality and is unethical. Under no circumstances can any medical record be removed from the institution, nor is photocopying of the record permitted. For presentations or rounds students are permitted to extract information but not copy wholesale parts of the chart.
The student physician is expected to be thoughtful and professional when interacting with patients and their families. Inappropriate behavior includes the use of offensive language, gestures, or remarks with sexual overtones.
Students should maintain a neat and clean appearance and dress in attire that is generally accepted as professional by the patient population served.
Under pressure of fatigue, professional stress, or personal problems students should strive to maintain composure. The student should be encouraged to seek supportive services when appropriate.
A student physician should accurately represent himself/herself to patients and others on the medical team. A student should never introduce himself/herself as “Doctor” as this is clearly a misrepresentation of the student’s position, knowledge and authority.
In general, full disclosure is a fundamental ethical requirement. The patient must be well informed to make health care decisions and work intelligently in partnership with the medical team. Information that the patient needs for decision making should be presented in terms the patient can understand. If the patient is unable to comprehend, for some reason, there should be full disclosure to the patient’s authorized representative.
Student physicians are to understand the importance of the obligation to obtain informed consent from patients but are not responsible for obtaining such consent. It is the physician’s responsibility to ensure that the patient or his/her surrogate be appropriately informed as to the nature of the patient’s medical condition, the objectives of proposed treatments, treatment alternatives, and risks involved. The physician’s presentation should be understandable and unbiased. The patient’s or surrogate’s concurrence must be obtained without coercion.
Student physicians are expected to demonstrate honesty and integrity in all aspects of their interactions with patients and staff, in particular, in assuring accuracy and completeness of their part of the medical record. It is important that the student be willing to admit errors and not knowingly mislead others or promote himself/herself at the patient’s expense.
Student physicians should seek consultation and supervision whenever their care of a patient may be inadequate because of lack of knowledge and/or experience.
When a conflict of interest arises the moral principle is clear – the welfare of the patient must at all times be paramount. A student physician may challenge or refuse to comply with a directive whose implementation would be antithetical to his or her ethical principles.
Gifts, hospitality, or subsidies offered by medical equipment, pharmaceutical or other manufacturers or distributors should not be accepted if acceptance would influence the objectivity of clinical judgment.
The student physician will not engage in romantic, sexual, or other nonprofessional relationships with a patient, even at the apparent request of a patient, while the student is involved with the patient’s care. The student physician is not expected to tolerate inappropriate sexual behavior on the part of a patient or other medical personnel.
The student physician will not use alcohol or drugs that could compromise patient care. It is the responsibility of every student to protect the public from an impaired colleague and to assist a colleague whose capability is impaired because of ill health. The student is obligated to report persons of the health care team whose behavior exhibits impairment or lack of professional conduct or competence, or who engage in fraud or deception.
It is unethical and harmful for a student physician to disparage without good evidence the professional competence, knowledge, qualifications, or services of a colleague to a review (judicial) body or patient. It is also unethical to imply by word, gesture, or deed that a patient has been poorly managed or mistreated by a colleague without good evidence.
Professional relations among all members of the medical community should be marked with civility. Thus, scholarly contributions should be acknowledged, slanderous comments and acts should be expunged, and each person should recognize and facilitate the contributions of other to the community.
The medical student will deal with professional, staff, and peer members of the health team in a considerate manner and with a spirit of cooperation.
The basic principle underlying all research is honesty. Scientists have a responsibility to provide research results of high quality; to gather facts meticulously, to keep impeccable records of work done; to interpret results realistically, not forcing them into preconceived molds or models; and to report new knowledge through appropriate channels. Coauthors of research reports must be well enough acquainted with the work of their coworkers that they can personally vouch for the integrity of the study and validity of the findings, and must have been active in the research itself.
Plagiarism is unethical. To consciously incorporate the words of others, either verbatim or through paraphrasing, without appropriate acknowledgement is unacceptable in scientific literature.
Students should seek feedback and actively participate in the process of evaluating their teachers (faculty as well as housestaff). Students are expected to respond to constructive criticism by appropriate modification of their behavior.
The very title “Doctor” – from the Latin docere, “to teach” – implies a responsibility to share knowledge and information with colleagues and patients. It is incumbent upon those entering this profession to teach what they know of the science, art, and ethics of medicine. It includes communicating clearly with and teaching patients so that they are properly prepared to participate in their own care and in the maintenance of their health.
(Academic Year 2012/2013)
USF Health and the affiliated clinical sites will provide students with access to their employee health services if exposures to infectious diseases occur.
To minimize exposure risks, the following principles are to be followed:
1. Practice Standard (Universal) Precautions
2. Consider all patients as potentially infectious
USF’s Health Administration/Infectious Disease Center has developed protocols, which summarize the steps to follow if you are exposed to an infectious disease. While each clinical site has its own specific procedures, protocols are outlined below as a reference for you.
Resource persons available to assist you:
- The Infectious Disease Division Office at Tampa General Hospital (844-4174)
- Health Administration Office – USF Medical School, Room 4146 (974-3163 or 974-5171)
- Infectious Control/Employee Health Practitioners at affiliated hospitals (refer to orange exposure cards for specific practitioners)
A. Exposure is defined as: Airborne contact with a person who has a sputum smear positive for acid fast bacilli (AFB) and/or a positive sputum culture for mycobacterium tuberculosis (MTB).
B. Confirm exposure with your instructor or supervisor and fill out an incident report.
C. Report to the clinical site’s Employee Health or USF Health Administration for an evaluation if you feel you have had an exposure to tuberculosis.
D. You will be given a baseline PPD if you have not had a TB skin test within the past three months, or a chest x-ray if you have a history of a positive PPD.
E. You will be given a second PPD or chest x-ray twelve weeks after the tuberculosis exposure to determine if you acquired a tuberculosis infection due to this exposure. There will be no charge for the tuberculin skin tests or chest x-rays.
F. If your post-exposure PPD or chest x-ray is positive, you will be advised to report to your personal healthcare provider, Health Administration or the Hillsborough County TB Clinic for an evaluation and prophylaxis therapy.
A. Exposure is defined as: Intensive, direct contact such as pulmonary resuscitation (mouth to mouth); and/or prolonged, direct care for four or more hours within an enclosed area.
B. Confirm exposure with your instructor or supervisor and fill out an incident report.
C. Report to the clinical site’s Employee Health or USF Health Administration for an evaluation of the exposure as soon as possible (preferably within 48 hours).
D. If appropriate, you will be prescribed prophylactic therapy (Rifampin 600mg bid for two days).
A. Exposure is defined as: Close contact with a person who is incubating or has varicella lesions that are not dried up and crusted over.
B. Persons with a negative history of chicken pox or a negative varicella titer who are exposed to chicken pox or shingles must report to Employee Health/USF Health administration for evaluation.
C. A varicella (chicken pox) titer will be drawn on the exposed person. Persons with a negative varicella titer will not be allowed in patient contact areas from day 10 through day 21 post-exposure.
D. The varicella vaccine (two doses, four to eight weeks apart) will be offered to persons with a negative varicella titer.
Students concerned about exposures to other infectious diseases (i.e. pertussis, measles, rubella, and viruses) should call USF Health Administration at 974-3163 or 974-5171.
- A parenteral (needlestick/sharp) exposure to blood, tissues, or infectious body fluids;
- Mucous membrane (eyes, nose, mouth) exposure to blood, tissues, or infectious body fluids;
- Non-intact skin (chapped, abraded, weeping, dermatitis, open lesions) exposure to blood, tissues, or infectious body fluids.
- Blood/blood products
- Semen/vaginal secretions
- Amniotic fluid
- Cerebrospinal fluid
- Pleural fluid
- Peritoneal fluid
- Pericardial fluid
- Synovial fluid
- Concentrated Virus
- Any body fluid visibly contaminated with blood
- Nasal secretions/sputum
- Saliva (except in settings where the likelihood of blood contamination is high)
- Perform immediate physical removal of the blood/body fluid;
- Report the exposure to his/her instructor/supervisor immediately;
- Initiate an incident report;
- Report to the clinical site’s Employee health or USF Health Administration within two hours of the exposure;
- Bring the following information on the source patient, if available: name, medical record number, patient ID number, diagnosis and room number;
- If you are uncertain where to report if Employee Health/USF Health Administration is closed, call the Infectious Disease Fellow on call for guidance (974-2201).
- Provide first aid treatment as necessary;
- Investigate the source patient and order HIV and hepatitis tests as necessary;
- Draw baseline HIV, HCV and HBsAB on the student. Follow-up tests at 3 months, 6 months and 12 months will be offered;
- Code names will be used for laboratory testing;
- Students requiring prophylaxis for the exposure will receive it at no cost.
- Hepatitis B – 1:4 chance (assuming the source of the exposure is HBsAg positive, especially HBeAg positive, and the healthcare worker is HBsAb negative)
- Hepatitis C – 1:30 to 1:1000 chance
- HIV – 1:300 chance
- 194 HIV seroconversions in healthcare workers reported to the CDC
- 57 = definite occupationally acquired; 139 = possibly occupationally acquired
- Needle size – larger gauge more risky than smaller gauge
- Needle type – hollow bore more risky than solid suture needle
- Needle with syringe of fluid – more risky than needle alone
- Deep puncture with fluid injection > deep puncture without fluid > superficial puncture > superficial scratch with bleeding > mucous membrane exposure > nonintact skin exposure > aerosol of blood
- Large volumes or prolonged contact with blood is associated with mucous membrane and nonintact skin exposure.
- Aerosolizing of blood has not been associated with the acquisition of any BBP.
- Blood is the most risky fluid
- Bloody body fluids are more risky than body fluids without blood
– the greater the inoculums, the greater the risk
- Amount of circulating virus is highest when source patient has advanced AIDS and/or is experiencing acute antiretroviral syndrome.
- Almost all seroconversions have occurred when source was symptomatic or had AIDS.
- Double gloving more protective than single gloves
- Gloves may decrease exposure volume by 50%
- Physical removal of blood/bloody body fluid from exposed site by squeezing,
- scrubbing, irrigation, flushing.
- Bleach (1:10 dilution) only agent that kills Hepatitis B in the environment
- Bleach, chlorhexidine, povidone-iodine – all equally effective in killing HIV in the environment.
A. Use of personal protective equipment
1. Wear gloves to decrease inoculums from sharps injury
2. Wear gowns, faceshields, gloves to decrease extent of mucous membrane or skin exposure
B. Elimination of risky practices
1. Do not recap needles
2. Do not overfill sharps containers
3. Do not attempt invasive skills without training and/or supervision
4. Consider all patients as potentially infectious – practice Standard (Universal) Precautions
John T. Sinnott, MD
Linda Lennerth, RN, MSN
USF Health Administration
Infectious Disease Center
Academic Year 2012/2013
Students must immediately report changes in local address, phone number, or cell phone number to the Morsani College of Medicine Registrar’s Office by one of the following methods:
1. Complete a Change of Address Form and submit to the MCOM Registrar’s Office or visit the Registrar in MDC 1007.
2. E-mail updated information to Marrissa Cook (email@example.com).
The USF Health Campus Security office is located in MDC 1023. Their telephone number is 813-974-2417.
If no one is present the phone will automatically revert to the University Police at 813-974-2628.
The safety of students is a primary concern of the Morsani COM. The educational process involves long hours, many spent alone studying or working in the laboratory, and students must take extra precautions on and off campus. USF police suggest the following preventive measures:
- Avoid isolated sites
- Have access to other people or a phone
- Call the police department (974-2417) when working or studying on campus after hours so the area can be patrolled
- Secure doors behind you
- Don’t walk to the parking lot alone at night, call SAFE (974-7233) on campus for a Safe Team Escort
A Security Officer is on duty at USF Health on a 24-hour basis. Officers frequently check ID cards so be sure to carry your student ID card with you when at USF Health after normal business hours.
If you have a true emergency call 911.
If you are calling from a cell phone you most likely will get another police department first. You must tell them this is an emergency on USF property and you are calling from a cell phone. The emergency system cannot identify cell phones as easily. You should be prepared to give your name and precise location. You should also state if you feel threatened.
Sexual assault is a criminal violation subject to prosecution by the State Attorney’s Office. All sexual assault allegations reported to the USF police are referred to the State Attorney’s Office which then makes the decision whether to prosecute.
All vehicles parked on USF Campus (including Moffitt Hospital) are required to display a parking permit. Student permits can be purchased from the USF Parking Services. The cost for an annual Commuter Student Permit will be $174 plus tax for the 2012/2013 academic year.
The Non-resident Student Permit allows you to park in any lot/garage designated “S” (Non-resident Student). Lot 32 on USF Hawthorn Drive is the closest lot to the medical school with over 450 spaces available on a first-come, first0serve basis. Lot 33T on USF Health Drive has over 100 “S” spaces available on a first0come, first-serve basis. Overflow student parking is accommodated in Lot 19 on USF Hawthorn Drive by the Moffitt Child Care Center, and in the Laurel Garage on USF Laurel Drive next to the Morsani Health Center and is serviced by the Bull Runner B route.
Students are required to park off-site at the Hyde Park lot located at the corner of South Hyde Park Avenue and Brorein Street. TGH vehicle hangtags are required on the lot and can be picked up for free in the Parking office located on the first floor of the parking garage. Note: In order to get the hangtag, students must show a TGH ID, which is issued through the Resident Physician Services Office (GME) on the 4th floor of the West Pavilion. Office hours are Monday – Friday, 7:30 am - 2:30 pm.
The Hyde Park lot will be open from 5:00 am – 9:00 pm Monday – Friday and a shuttle bus will run between the parking lot and TGH every 15 minutes. Security will be stationed at the lot during operating hours. Please contact the parking office at 813-844-2277 for parking information on hours after 9:00 pm.
There are four shuttle drop-off/pick-up locations across TGH campus: At the garage high top; at the sea wall behind the energy center; at the Rehabilitation building, and at the bottom of the Emergency Department ramp. After 10:00pm the shuttle will begin using the West Pavilion (main entrance) for all pick-ups.
Students arriving/departing TGH outside the Hyde Park hours of operation are allowed to park in the visitors section of the parking garage. To exit the visitors garage, present your TGH student ID and Hyde Park hangtag at the exit booth.
Students may park in the visitors section of the garage on weekends for free; to exit, you must present your TGH student ID and Hyde Park hangtag at the exit booth.
Call rooms are intended for the use of medical residents. This privilege has been extended to medical students and a specific hallway has been assigned as such. Please do not abuse this privilege and follow the rules listed below:
1. Call Rooms are for in-house overnight call only – You may sign up for a room on the calendar posted monthly on the door. There are no assigned rooms for specialties. The number of rooms is limited and many contain bunk beds. Please be considerate of your fellow students when signing up for and using a room. Keys are available in the GME office during business hours.
2. Please take all personal possessions with you if leaving TGH, otherwise you need to use the lockers provided. Locks are available on a check-out basis in the GME/Housestaff office. There is a wall of lockers available to check out on a month-to-month basis and must be renewed monthly or they will be reassigned. Rooms will not be cleaned if overnight bags or clothing are on the bed. Please assist us by placing your bags against the wall opposite the bed.
3. Do not leave garbage on the floor, bed or desk; it is not the housekeeper’s job to pick up after you. We are fortunate to have a regular housekeeper in this area. On the days he/she is off please be aware that you may need to change the bed linens for that day. Clean linen is delivered daily and stored in the linen room in the Housestaff area. Blankets are limited so please be considerate when taking number of them off the cart. For emergency needs the GME office stocks toothbrushes, toothpaste, mouthwash and deodorant.
4. Dirty scrubs and towels need to be put in the laundry hamper, this includes in the shower facilities.
5. Food is not allowed in rooms. If you do bring something up please dispose of it properly. All trays brought up from the cafeteria need to be returned, not left in the kitchen area.
6. Please lock your call room door…this is for your own protection. If you do leave personal items in the room we will not be responsible for loss if the door is open.
7. When leaving a room, if you are not returning, please leave the door ajar to indicate cleaning is necessary.
8. The Computer Room is for everyone’s use, please be considerate when printing. The printers often run slowly and we need to avoid excessive print jobs. Paper is provided by the Housestaff office as well as replacement ink cartridges.
9. If you have a problem, let us know at 844-7412.