SYLLABUSBlock 1: Foundations and Principles of

Medical Science I

MED 631Course Directors:

Academic Year 2017-2018Fall 2017

CONTENTS

WELCOME AND BLOCK RATIONALE...........................................................................................................................................1

BLOCK DESCRIPTION AND LEARNING OUTCOMES.....................................................................................................................2

Block Description...................................................................................................................................................................2

Student Learning Outcomes and Alignment...........................................................................................................................2

Knowledge For Practice Topics...............................................................................................................................................2

The Learning Experience in this Block....................................................................................................................................5

BLOCK FORMAT AND ASSIGNMENTS.........................................................................................................................................5

Attendance Expectation.........................................................................................................................................................5

Block Activities.......................................................................................................................................................................5

Lectures..............................................................................................................................................................................5

Clinical Correlates...............................................................................................................................................................2

Required Reading...............................................................................................................................................................2

Labs....................................................................................................................................................................................2

Case of the Week...............................................................................................................................................................2

Team Based Learning.........................................................................................................................................................2

Student Presentations........................................................................................................................................................3

Small Group Activities........................................................................................................................................................3

Additional Assignments......................................................................................................................................................3

Faculty Evaluation..................................................................................................................................................................3

ASSESSMENTS AND GRADING....................................................................................................................................................3

Assessments...........................................................................................................................................................................4

Self-Assessments................................................................................................................................................................4

Graded Assessments- Cumulative and Integrated Final Exams..........................................................................................4

Peer, Group, Faculty and Course Assessments...................................................................................................................4

Grading Criteria......................................................................................................................................................................4

LEARNING MATERIALS AND RESOURCES...................................................................................................................................6

POLICIES.....................................................................................................................................................................................6

Mandatory attendance..........................................................................................................................................................6

Late Work...............................................................................................................................................................................6

Absence..................................................................................................................................................................................7

Missed Tests...........................................................................................................................................................................7

Holidays..................................................................................................................................................................................7

Protocol for Remediation.......................................................................................................................................................8

Academic Success Services.....................................................................................................................................................8

PROFESSIONALISM GUIDELINES.................................................................................................................................................8

Code of Student Professionalism...........................................................................................................................................8

Honor Pledge......................................................................................................................................................................9

Professional Attire..................................................................................................................................................................9

Privacy and Confidentiality.....................................................................................................................................................9

Patient Care........................................................................................................................................................................... 9

Member of a Healthcare Team............................................................................................................................................10

Academic Dishonesty...........................................................................................................................................................10

Work Place UnProfessional Conduct....................................................................................................................................10

STATEMENT OF DISABILITY SERVICES......................................................................................................................................11

STATEMENT ON AUDIO AND VIDEO RECORDING....................................................................................................................11

STATEMENT ON A SAFE LEARNING ENVIRONMENT.................................................................................................................11

APPENDICES.............................................................................................................................................................................12

Appendix I MEDICAL EDUCATION PROGRAM OBJECTIVES..................................................................................................12

Appendix II MEDICAL STUDENT CLINICAL WORK POLICY....................................................................................................16

APPENDIX III MEDICAL STUDENT MISTREATMENT POLICY..................................................................................................17

WELCOME AND BLOCK RATIONALE

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Block Director:

NameUniversity of Nevada School of MedicineAddressPhone: email: Office Hours:

Block Director:

NameUniversity of Nevada, Reno School of MedicineAddressPhone: email: Office Hours:

BLOCK DESCRIPTION AND LEARNING OUTCOMES

BLOCK DESCRIPTION

STUDENT LEARNING OUTCOMES AND ALIGNMENTCourse Level Student Learning Outcomes

(Upon successful completion of this course, students will be able to …)MEPO

Alignment Assessment

A. Demonstrate proficiency in the basic principles of biology that are the foundation for genetics, protein biochemistry, molecular biology, cell structure and function, developmental biology, histology, anatomy.

1.1, 1.2,1.3

Exams TBLs (IRAT, GRAT, and

APPLICATIONS) Proctored small group laboratory

exercises and in class small group exercises

B. Demonstrate an introductory level of proficiency in the biological principles of laboratory medicine, diagnostic testing, imaging, pharmacology and pathology.

1.1, 1.2,1.3, 5.4

Exams Case of the Week responses

(reviewed and critiqued by clinicians and basic science faculty)

C. Demonstrate an introductory level of proficiency in the basic principles of human behavior and the ways these are applied in medical practice.

1.3, 1.5,2.6

Exams Proctored in class small group

exercises Case of the Week responses

D. Propose and apply a framework for making ethically appropriate judgments that put the patient first.

1.3, 2.7 Exams Proctored in class small group

exercises Case of the Week responses

E. Demonstrate an introductory level of proficiency in clinical problem solving with scientific reasoning, that integrates information from basic and clinical sciences.

1.1, 1.2,1.3, 1.6,4.8

Case of the Week responses

F. Demonstrate proficiency in howto critically read primary and secondary medical literature.

1.1, 1.2,1.6, 4.8,6.9

Student Presentations: Two Evidence based Medicine Exercises, group presentations and in class proctored discussion

G. Demonstrate proficiency in the use and interpretation of statistical methods in scientific and clinical research.

1.4 Exams

KNOWLEDGE FOR PRACTICE TOPICS

General Principles of Foundational Science

Biochemistry and molecular biology

Gene expression: DNA structure, replication, exchange, and epigenetics

imprinting,

X inactivation, DNA methylation Gene expression:

transcription

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Gene expression: translation, post-translational processing, modifications, and disposition of proteins (degradation), including

protein/glycoprotein synthesis,

intra-extracellular sorting,

processes/functions related to Golgi complex and rough endoplasmic reticulum

Structure and function of proteins and enzymes

enzyme kinetics competitive

inhibition noncompetitive

inhibition structural/regulatory

proteins Energy metabolism

(eg, ATP generation, transport chain)

Biology of cells Adaptive cell

responses and cellular homeostasis (eg, hypertrophy)

Mechanisms of injury and necrosis, including

pathologic processes (eg, liquefactive necrosis, free radical formation)

Apoptosis Cell cycle and cell

cycle regulation (eg, mitosis)

Mechanisms of dysregulation

cell biology of cancer (eg, role of p53, proto-oncogenes)

general principles of invasion and metastasis, including

cancer staging Cell/tissue structure,

regulation, and function, including:

cytoskeleton, organelles, glycolipids, channels, gap junctions, extracellular matrix, receptors Human development

and genetics Principles of pedigree

analysis inheritance patterns autosomal dominant autosomal recessive, X-linked, Maternal

(mitochondrial) Repeat expansion Genomic Imprinting Polygenic/

Multifactorial Linkage occurrence and

recurrence risk determination

Population genetics: Hardy-Weinberg law, founder effects, mutation-selection

equilibrium Principles of gene

therapy Genetic testing and

counseling Genetic mechanisms penetrance,

variable expressivity genetic heterogeneity allelic locus pleiotropy new mutations in dominant and X-

linked disorders germline mosaicism Delayed Age of onset Human Genome

Project Linkage analysis Pharmacodynamic

and pharmacokinetic processes: general principles

Pharmacokinetics: absorption, distribution, metabolism, excretion, dosage intervals Mechanisms of drug

action, structure-activity

relationships (eg, anticancer drugs)

Concentration and dose-effect relationships (eg, efficacy, potency),

types of agonists (eg, full, partial, inverse)

and antagonists and their actions

Individual factors altering pharmacokinetics and pharmacodynamics

age, gender, disease, tolerance, compliance, body weight,

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metabolic proficiency,

pharmacogenetics) vitamin A; vitamin B; vitamin B1, thiamine

(eg, Wernicke- Korsakoff syndrome, beriberi);

vitamin B3, niacin; vitamin B6,

pyridoxine; vitamin B9, folic

acid; vitamin B12,

cobalamins (pernicious anemia);

vitamin C (scurvy); vitamin D (rickets); vitamin E; vitamin K Biostatistics,

Epidemiology/Population Health, & Interpretation of the Medical Literature

Epidemiology/population health

Measures of disease frequency:

incidence/prevalence Measures of health

status: rates, crude and

adjusted; reproductive rates

(eg, maternal mortality, neonatal/infant/under-5 mortality); mortality, morbidity; standardization; life expectancy, health-adjusted life expectancy; population attributable risk (PAR), population

attributable risk percent (PAR%); risk factors

Survival analysis interpretation (eg, Kaplan-Meier curve)

Composite health status indicators, measures of population impact:

years of potential life lost;

quality-adjusted life years;

disability-adjusted life years;

standardized mortality ratio

Population pyramids and impact of demographic changes

Disease surveillance and outbreak investigation:

disease reporting; response to public

health advisory, health promotion;

recognition of clusters

Communicable disease transmission:

attack rate; herd immunity; reportable diseases Points of

intervention: primary, secondary; community level (eg,

cigarette taxes, soda taxes, smoke-free cities, buildings: restaurants, public buildings);

school policies; access, healthy food,

transportation, clean

air, safe environments

Study design, types and selection of studies (includes dependent/independent variables)

Descriptive studies (case report [one person]/case series [more than one])

Analytical studies: observational: community surveys; cross-sectional

(individuals); ecological

(populations); case control; retrospective and

prospective cohort Analytical studies: interventional: clinical trial

(randomized controlled trial;

double-blind; placebo-controlled; noninferiority/

equivalence trials); community

intervention Systematic reviews

and meta-analysis: potential uses; estimation of effect

sizes; heterogeneity; publication bias; forest plots, funnel

diagrams; risk of bias, bias risk

scale Obtaining and

describing samples: matching,

inclusion/exclusion criteria, selecting

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appropriate controls for studies, lack of controls, concealed allocation, randomization, stratification

Methods to handle noncompliance:

loss to follow-up; intention-to-treat

analysis Qualitative analysis Measures of

association Relative risk Odds ratio, hazard

ratio Other measures of

association: number needed to

treat/harm; absolute risk (AR),

absolute risk percent (AR%);

population attributable risk (PAR), population attributable risk percent (PAR%)

Distributions of data: measures of central

tendency; measures of

variability; regression to mean; normal distribution; nominal

measurement Correlation and

regression, uses and interpretation:

correlation coefficients;

multiple regression Principles of testing

and screening Properties of a

screening test:

validity, accuracy, reliability;

criteria for a screening test;

confirmatory testing; appropriateness; lead-time bias,

length bias; screening vs

diagnostic tests Sensitivity and

specificity; predictive value, positive and negative

ROC curves Probability: theory

(independence, product, addition rules);

decision trees; likelihood ratios

(application of Bayes theorem);

posttest, pretest Study interpretation,

drawing conclusions from data

Causation: hypothesis-

generating vs hypothesis-driven testing;

causal criteria, temporality, temporal sequence, dose-response relationship;

reverse causality Chance null hypothesis, Type

I error and alpha level (multiple comparisons, random error/chance)

sample size and Type II error, beta, power

selection and interpretation of basic tests of statistical significance:

chi-square; confidence intervals; p-values; t-test a priori vs. post hoc

analysis: subgroup analysis; error rate; affect types Interpretation of

graphs/tables and text

Bias, confounding, and threats to validity (includes methods to address)

selection, sampling bias

information bias: recall; ascertainment,

ecologic fallacy, lack of blinding;

loss to follow up confounding

variables, Hawthorne effect (includes methods to address)

other threats to validity (eg, placebo effect)

Internal vs. external validity:

generalizability (external validity);

efficacy vs effectiveness

Statistical vs. clinical significance;

clinical and surrogate outcome/end point

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Clinical decision making, interpretation and use of evidence-based data and recommendations:

Number needed to treat

application of study results to patient care and practice, including

patient preferences individualization of

risk profiles; risk/benefit analysis; synthesis of concepts

with real data

Research ethics Informed consent for

research CITI Training Privacy of patient

data (HIPAA) Roles of institutional

review boards (IRBs) Intervention

analysis: interim analysis; stopping analysis; safety monitoring Regulatory issues: drug development,

phases of approval; appropriateness of

placebo;

appropriateness of randomized clinical trial;

components of studies;

ethics; CITI training scheduling; off-label use Other issues related

to research ethics Role of Association

and society care guidelines

THE LEARNING EXPERIENCE IN THIS BLOCK

This course belongs to YOU. Your active participation will significantly enhance your personal learning experience and that of your classmates.

We value your feedback. Your suggestions will enable us to improve the rotation for future medical students.

BLOCK FORMAT AND ASSIGNMENTS

ATTENDANCE EXPECTATION

UNR Med academic faculty, community faculty, and engaged students expect attendance, punctual arrival, and participation in all educational activities. Regular and punctual attendance at all classes, essential for maximum academic achievement, is a major responsibility of UNR Med students. Failure to attend and contribute to the classroom environment significantly and demonstrably reduces the quality of the educational experience for everyone in the classroom. As a result, absences almost always impact quality performance.

BLOCK ACTIVITIES

LECTURES: You are responsible for learning all material that is covered in the lectures.

Attendance Recommended: Although attendance is not required, it is strongly encouraged. Each lecture includes a list of Learning Objectives or a Study Guide (available on WebCampus). Copies of the PowerPoint presentations are posted for most lectures prior to class. At the discretion of the individual instructors, lectures

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will be recorded using the Echo360 System located within the classroom and posted later in the day on WebCampus. NOTE: not all lectures will be available to be viewed outside of class. Lectures may NOT be recorded (audio or video) by individual students without prior approval from the OME and the Block Directors.

CLINICAL CORRELATES: You are responsible for learning all material that is covered in these lectures.

Attendance Required: Block I includes lectures that will be presented by Case of the Week facilitators. The Clinical Correlate Lectures are an important component of the Case presentations and attendance at these lectures is required. Each lecture will include Learning Objectives/Study Guides. Copies of the PowerPoint presentations will be posted for all lectures prior to class.

REQUIRED READING: You are responsible for learning all material that is covered in required reading.

All required reading assignments will include Learning Objectives/Study Guides. Required reading assignments will be posted on WebCampus. You are not responsible to learn material covered in recommended reading assignments that is NOT covered elsewhere (i.e. lecture or TBL).

LABS: You are required to attend and participate in all lab sessions.

Attendance Required: Block I includes five laboratory sessions. All Laboratory sessions will include Learning Objectives/Study Guides. NOTE: due to space limitations some labs will be offered multiple times in one week. You will be assigned to groups that are scheduled to meet during specific times. You are required to attend the lab during your assigned session.

CASE OF THE WEEK : You are required to attend/participate in all activities of the Case of the Week.

Attendance Required: Block I includes six Cases of the Week. The classroom activities include a 1-hour INTRODUCTION of the case (Mon or Tues) and a 1.5-2 hour WRAP UP of the case (Wed or Fri) by Physician Facilitators. In addition, there are 2-1 hr Small Group Sessions per week to work with your Team to solve the Case through a Progressive Disclosure Process (2-1 page Evening Reports are required to be submitted for each case). Times and small group meeting rooms have been reserved for these sessions (yellow). NOTE: in Block I you will also be required to attend 3-2 hour MENTORED Small Group Clinical Problem Solving sessions (in Weeks 2, 3, & 4) (yellow). These sessions are designed to provide guidance and strategies for small group learning and clinical problem solving, and clarify the expectations for the Evening Reports.

TEAM BASED LEARNING : You are required to attend/participate in all TBL sessions.

Attendance Required: Block I includes two TBL exercises. Each student is responsible for completing all assigned preparation work (i.e. assigned readings and practice problems) prior to the TBL session. Learning Objectives/Study Guides and assignments will be posted on WebCampus a week prior to the TBL. Failure to adequately prepare for these exercises will negatively impact your individual grade (IRAT score) and can also impact your Professionalism grade (this is a teamexercise). Your TBL grade will be calculated from your individual IRAT score and group scores (GRAT plus APPLICATION EXERCISE) for each TBL session. NOTE: The TBLs in Block I are for orientation. Overall scores for the TBLs will not factor into the Final Block grade.

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STUDENT PRESENTATIONS : You are required to make one oral presentation (small group) and to attend all other presentations.

Attendance Required: Block I includes twenty 15 minute student presentations on Common Genetic Diseases identified by the Association of Professors of Human and Medical Genetics. These are “classic” examples used to illustrate general principles of Clinical Genetics. You will work with your Team to create and present learning materials for your classmates covering these disorders (2 per Team, with 1/2 of the team working on each). A detailed template is provided on WebCampus to guide your preparations (Assignments). Class presentations are limited to 15 minutes total, and will include a short presentation of a hypothetical case. Due dates are distributed across the block to match the diseases to weekly content, and also to limit the number of presentations in a single day. Each team will be responsible for one “early” and one “late” presentation.

SMALL GROUP ACTIVITIES : You are required to attend and participate in all Small Group classroom activities.

ADDITIONAL ASSIGNMENTS : You are required to complete all additional assignments.

All required assignments will be posted on WebCampus in the Assignments folder (any assignments not posted on WebCampus are optional and will not count towards your final grade). Failure to complete any assignment at a passing level will result in a Final Grade of Incomplete until the task is accomplished or remediated to a passing level.

**More information on “How TBLs Work”, “How Cases Work”, “Small Group Assignments”, “Student Presentations”, “Required Reading”, and “Additional Assignments” can be found on WebCampus.

FACULTY EVALUATION

Evaluations of the faculty you have received instruction from will be sent to you via One45 a few days after the conclusion of that rotation. It is mandatory that you complete all the evaluations sent to you. Your feedback/suggestions/criticisms of the learning sessions are always taken into consideration. We have made specific changes based on previous feedback. Remember, feedback left on the One45 is not available to faculty members for a few weeks after the conclusion of the block. If you believe immediate action needs to take place, please contact the block director directly.

ASSESSMENTS AND GRADING

UNR Med requires that students must earn a grade of Pass or better in all blocks and demonstrate the appropriate level of professionalism to progress and to graduate. Students may be awarded a grade of Honors, High Pass, Pass, Fail, or Incomplete. The Policy for Final Grade Assignment stipulates that grades are awarded by the course directors.

It is understood that a student may disagree with the final grade assigned to him/her. The Grade Appeal Policy outlines the procedure for the appeal of a course grade for any portion of the medical education curriculum. All grade appeals are directed as presented in the UNR Grade Appeal Policy & Procedure.

ASSESSMENTS

SELF-ASSESSMENTS: You are required to complete all weekly self-assessments.

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Block I includes weekly formative (self) assessments. The first two will be administered in class (Mon morning) (magenta), while the remaining tests will be administered online (to be completed between 6 PM Fri and 12 am Mon or Tues). Questions for the self-assessments will be from Lectures, Cases, Labs, TBLs, Small Group Exercises, Required Reading, Assignments, and Student Presentations. The self-assessments are “closed book”. The purpose of these assessments is to monitor your progress in order to identify difficulties early and modify teaching and learning activities to ensure that you attain competency in all Block material. Although required, and graded, self-assessment scores will not count toward your Final Grade.

GRADED ASSESSMENTS- CUMULATIVE AND INTEGRATED FINAL EXAMS : You are required to complete and PASS all Graded assessments.Block I includes three summative (graded) exams (two Cumulative Exams in Weeks 5 & 9, and an Integrated Final in Week 9). These exams are 4 hrs in length and equal in weight (each is worth 1/3 of the Individual Grade). The cumulative exams cover: Weeks 1-4 (Exam 1) and Weeks 5-8 (Exam 2). The Final Exam will integrate content presented throughout the Block (Final). Questions for the exams will be from Lectures, Cases, Labs, TBLs, Small Group Exercises, Required Reading, Assignments, and Student Presentations and are “closed book”. All questions will be covered in Learning Objectives/ Study Guides. The purpose of these assessments is determine educational outcomes and to assign Final Grades.

EXAM REVIEW AND REQUESTS FOR CLARIFICATION1. Optional Exam Reviews will occur after each major exam. They will be held in the Year 1 classroom. The

purpose of an Exam Review is to increase student understanding of the topics being assessed.2. During this time it is expected and encouraged that the students will discuss the questions and answers

with each other. We have found that the peer-to-peer learning during these sessions is extremely effective! Please remember that we are asking for the BEST answer for the question among the given choices. There will often be more than one answer that is TRUE.

3. Block Faculty are also encouraged to attend these review sessions. Please take advantage of this and ask additional questions to them directly. You can also ask faculty for clarification of concepts via e-mail, although copying ANY part of the exam is strictly forbidden. You may schedule additional time to review specific questions if necessary.

4. If after consultation with fellow students there is still confusion on a question, please bring this to the attention of the Block Directors. We will respond to clarification requests by consultation with the teaching faculty who submitted the questions if necessary.

5. On occasion, exams have flawed questions, miss-keyed items, or other mistakes. When brought to the attention of the Block Directors, this situation will be remedied as appropriate.

PEER, GROUP, FACULTY AND COURSE ASSESSMENTS : You are required to complete all Peer, Group, Faculty, and Course assessments.Throughout the Block students will be required to complete different assessments. The manner and extent of your participation will be monitored by the faculty and can impact your final Professionalism grade in the Block.

GRADING CRITERIA

Graded Assessments: Students must receive a passing grade in ALL required components of the Block.

There are three primary assessment components for assigning Final Grades:1. Professionalism Grade (Pass/Fail) i. Peer Assessment Summary Reports ii. Professionalism Checklist2. Group Grades- (Pass/Fail) i. Two TBL scores- IRAT (50%) plus GRAT (25%) and Application Exercise (25%)

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ii. Six sets of case-based learning assignments (see Case Grading Rubric, WebCampus). iii. Four group oral presentations (Group Reports/Discussions and student presentations).3. Individual Grades- to pass the Block your average score must be 70% or higher i. Two cumulative Exams: Weeks 1-4 & Weeks 5-8 (33.3% each) ii. Integrated Final Exam: Weeks 1-8 (33.3%)

Final Individual Block Grades will be assigned based on the following formula and scale: FINAL GRADE = Average of 3 Exams (each exam equally weighted)

Honors (H) 92-100%High Pass (HP) 84-91%Pass (P) 70-83%Incomplete (I)*** <70% or failure of either of the other two graded components

***converts to Fail (F) if not successfully remediated (see Remediation Policy on WebCampus).

Honors outstanding performance which significantly exceeds basic competency levelsHigh Pass performance in which some basic competency levels have been exceeded.Pass acceptable performance in which all basic competencies have been met.Fail following remediation efforts, basic competencies have not been met.

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LEARNING MATERIALS AND RESOURCES

Please contact Mary Shultz (mshultz@med.unr.edu), Director of Savitt Medical Library, with any difficulties regarding availability of books, journals, or online materials, needed for your course. All referenced journals are available from Savitt and are on-line through Savitt.

Textbooks -- ANAT: Clinically Oriented Anatomy, by Moore and Dalley (Recommended) Atlas of Human Anatomy, by Netter (Recommended) Grant's Dissector, by Sauerland (Supplied)BCH: Principles of Medical Biochemistry 3rd edition, by Meisenberg and Simmons. (Required)CELL BIOL: Molecular Biology of the Cell, by Alberts (Required)DEV: Langman's Medical Embryology, by Sadler (Recommended)ETHICS: Resolving Ethical Dilemmas: A Guide For Clinicians, by Lo (Required)GEN: Medical Genetics, by Jorde, Carey, Bamshed, and White (Recommended)HB: The Behavioral Sciences and Health Care, by Sahler and Carr (Eds.) 3rd Edition Revised (Required)HISTO: Color Textbook of Histology, by Gartner & Hiatt (Recommended) Stedman's Medical Dictionary, by Gartner & Hiatt (Recommended) Digital Histology, by Pakurar & Bigbee (Recommended)MOL BIOL: Textbook of Biochemistry With Clinical Correlations, by Devlin (Recommended) Molecular Biology of the Cell, by Alberts (Recommended)PATH: Pathologic basis of disease, by Robbins, Kumar, & Cotran (Required) Basic skills in interpreting laboratory data, by Lee (Required)PHARM: The Pharmacologic Basis of Therapeutics, 12th Edition, 2012, by Goodman & Gilman (or the G&G Manual-a condensed version) (Recommended) Note: The Lang Series text by B. Katzung is also excellent. Both textbooks are available through Access Medicine and your UNR Net ID.Others:PHYSIOLOGY: either Medical Physiology, by Guyton & Hall or Medical Physiology, by Berne & Levy (Recommended)CLINICAL SKILLS: Mosby's Guide to Physical Examination, by Seidel, Ball, Dains et al., 7th Ed (Required)

POLICIES

General UNR Med policies are posted on the Office of Medical Education website: http://med.unr.edu/policy/medical-students

MANDATORY ATTENDANCE

Students must attend and actively participate in all scheduled activities as noted in their syllabus.

All students should attend required lectures, skills labs, and small group sessions.

Students must attend and complete all assessments.

LATE WORK

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ABSENCE

The learning sessions in this block are planned and scheduled in advanced and students are expected to be present every day except for illness or approved rare events (i.e. funeral of family member, childbirth, etc.). Students must discuss all absences from a required event (lecture, lab, exam, etc.) with the block director prior to the absence. Excused absences are at the block director’s discretion.

The following constitute excused absences: Serious illness of self or immediate family member Death of close family member or family issues Emergencies and accidents.

“Family issues” are serious or once in a lifetime issues. If you have a doubt about this, communication with the block director is key.

Students who are ill are encouraged to take appropriate time off and seek medical care. After three days, a medical note is required.

All other absences must be approved well in advance and are at the discretion of the block director. Students who are absent without notifying the block director are considered to have an unexcused absence and will receive an “evaluator concern” for professionalism and may possibly face other repercussions on the final grade, etc.

The policy for religious holidays can be found at: http://www.unr.edu/student-conduct/policies/university-policies-and-guidelines/religious-holiday-observation

For more information, please refer to our policy on absences from medical school: http://med.unr.edu/student-affairs/student-handbook/absences

MISSED TESTS

Students who show up late for or miss a scheduled block examination without an excused absence and prior arrangement with the block director will receive Fail for the block examination.

HOLIDAYS

State Holidays (As established by the Nevada Legislature): New Year's Day: January 1st Martin Luther King, Jr.'s Birthday: Third Monday in January Presidents' Day: Third Monday in February Memorial Day: Last Monday in May Independence Day: July 4th Labor Day: First Monday in September Nevada Day: Last Friday in October Veterans' Day: November 11th Thanksgiving Day: Fourth Thursday in November

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Family Day: Friday following the Fourth Thursday in November Christmas Day: December 25th

PROTOCOL FOR REMEDIATION

The first line of contact for academic concerns or professionalism issues is the block director or Dr. Howard.

Students falling below minimum standards or receiving a grade of "incomplete" will be required to begin a formal remediation program. Students will work with the block director to develop a specific remediation plan that includes activities and timelines. The plan may be submitted to the Office of Medical Education for review and then referred to the Student Promotion and Conduct Committee (SPCC) for approval. The student and the block director will present the remediation plan to the SPCC and additional follow-up will be determined by the complexity of the remediation plan.

Students who also have academic difficulties with other blocks will follow the Promotion guidelines of the School of Medicine.

ACADEMIC SUCCESS SERVICES

UNR Med provides support for all medical students through the Academic Learning Center.

One on one tutoring for all medical students is also offered through the UNR Med Academic Learning Center. Students requesting tutoring must make an appointment with the Learning Specialist to be assigned a tutor.

The Learning Specialist can also provide additional resource materials, and assistance with study strategies, time management skills and USMLE and NBME exam preparation. Please visit the following website for more information: http://med.unr.edu/student-affairs/academic-learning-center.

If you have any questions, please contact our Learning Specialist, Ranna Nash by email: rannan@med.unr.edu or telephone: (775) 682-8355.

PROFESSIONALISM GUIDELINES

CODE OF STUDENT PROFESSIONALISM

The Code of Student Professionalism policy is posted at http://med.unr.edu/policy/oaa-13-005. Students are expected to meet UNR Med standards of professional behavior as part of their professional development. This policy outlines the expectations and the consequences for lapses in professionalism. This policy observes all student due process rights including notifications and appeals. Students must meet UNR Med standards of professionalism to progress and graduate. These standards are in the following five domains:

1. Integrity2. Reliability and Responsibility3. Self-Awareness4. Team Building and Communication5. Patient Centered Care

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Student professionalism will be documented by faculty, staff and members of the health care team using the following:

Global Professionalism Assessment (GPA) http://med.unr.edu/Documents/unsom/ome/curriculum/one45_student_professionalism_form.pdf

Standard Clinical Evaluations

HONOR PLEDGEI will strive to maintain the highest standards of responsibility, integrity and professionalism during my education and throughout my professional career.I will neither receive nor give unauthorized assistance on examinations or assignments and I will approach my education with honesty and integrity.I will respect and support my classmates, colleagues and teachers at all times.I will strive to acknowledge my limitations, strive to learn from my mistakes and work to improve my skills to the benefit of my patients.I will strive to commit myself to a lifetime of learning and teaching both the art and science of medicine.I will strive to attend to all my patients with competence and compassion.I will maintain patient confidentiality and be tactful in my words and actions.I will honor the diversity of patients' experiences, cultures and beliefs.I will recognize the privileges afforded to me as a physician and a physician-in-training and promise not to abuse them.I will use my knowledge to improve the lives of others and never to harm.I make these promises solemnly, freely and upon my honor.

PROFESSIONAL ATTIRE

Your dress, hygiene, and behavior must be appropriate for your future profession as a physician.

PRIVACY AND CONFIDENTIALITY

It is expected that prior to starting clinical practice rotations, all students have signed off on the HIPAA Privacy and Confidentiality Policies. Remember, do not discuss patient information in public areas such as hallways, elevators, and cafeteria. You should carry any clinical records with patient identifiers only in a patient care setting, and no records with any patient identifiers should leave the hospital or ambulatory care setting under any circumstances. Do not use a cell phone, text message, or your personal email to communicate any information that may reveal a patient identity.

Patient Care infractions include falsifying or knowingly omitting pertinent information, lying regarding patient care, and/or conscious HIPAA violations. Students will be referred to the Student Promotion and Conduct Committee (SPCC). Disciplinary action up to and including dismissal may be recommended by the SPCC and presented to UNR Med Dean for approval. If SPCC approves continued active student status, the student will be placed on probation. A second infraction related to patient care will result in dismissal. The SPCC shall have the ability to override these guidelines.

PATIENT CARE

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Patient care infractions include falsifying or knowingly omitting pertinent information, lying regarding patient care, and/or conscious HIPPA violations: Students will be referred to SPCC. Disciplinary action up to and including dismissal may be recommended by the SPCC and presented for approval by the UNR Med Dean. If SPCC approves continued active student status, the student will be placed on probation. A second infraction related to patient care will result in dismissal. The Student Promotion and Conduct Committee shall have the ability to override these guidelines.

MEMBER OF A HEALTHCARE TEAM

A major goal of the learning experiences (ie: simulations, standardized patient encounters, etc.) in the first two years is to participate in patient care as a member of a healthcare team with many other healthcare professionals. Although as a student your main objective is your education, your contribution to the team is always appreciated. Patients, families and all members of the healthcare team should be treated as you would want to be treated. Courtesy and respect for everyone is expected.

ACADEMIC DISHONESTY

Please refer to statements in UNR Med Student Handbook regarding academic dishonesty.

In accordance with UNR policy, academic dishonesty is defined as cheating, plagiarism, or otherwise obtaining grades under false pretenses.

Plagiarism: defined as submitting the language, ideas, thoughts or work of another as one's own; or assisting in the act of plagiarism by allowing one's work to be used in this fashion. Cheating is defined as (1) obtaining or providing unauthorized information during an examination through verbal, visual or unauthorized use of books, notes, text and other materials; (2) obtaining or providing information concerning all or part of an examination prior to that examination; (3) taking an examination for another student, or arranging for another person to take an exam in one's place; (4) altering or changing test answers after submittal for grading, grades after grades have been awarded, or other academic records once these are official.

Also included under the heading of "cheating" is the submission of any work as your own that you did not create or perform. This includes, but is not limited to: homework assignments, written projects, and patient history or examination findings.

Cheating on any academic test will result in automatic failure of the course.

Students will be referred to SPCC. Disciplinary action up to and including dismissal may be recommended by the SPCC and presented for approval by the UNR Med Dean. If SPCC approves continued active student status, the student will be placed on probation. If the student is permitted to repeat the course, the highest grade he/she can receive is a Pass. A second infraction related to academic dishonesty will result in dismissal.

WORK PLACE UNPROFESSIONAL CONDUCT

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Unprofessional behaviors including but not limited sexual harassment, discrimination, or student abuse are not tolerated on the clerkship rotations. Students who experience such behavior should follow the guideline in the University of Nevada, Reno School of Medicine Code of Professional Conduct (https://med.unr.edu/policy/oaa-13-005).

STATEMENT OF DISABILITY SERVICES

During the admissions process, qualified candidates with disabilities will be considered without regard to their ability status by the UNR Med Admissions Committee in accordance with UNR Med’s Essential Functions Requirements. Appropriate accommodations to help the candidate successfully meet the requirements for graduation from UNR Med must be planned and discussed with the appropriate committees prior to matriculation. Disabilities occurring after matriculation will be dealt with on an individual basis by the Student Promotion and Conduct Committee (SPCC) in accordance with the Essential Functions Requirements to best meet the needs of the candidate and the school. Candidates must understand and accept their roles as health care providers within their communities.

UNR Med retains the right to review and approve or decline any or all requests for accommodation. If you have a disability that necessitates accommodation to meet UNR Med’s Essential Functions Requirements, then you must provide, at your own expense, appropriate documentation from a qualified professional describing the disability and setting forth any reasonable accommodations necessary to ensure that you are able to meet the Essential Functions.

https://med.unr.edu/admissions/applicants/additional-admissions-information/essential-functions

STATEMENT ON AUDIO AND VIDEO RECORDING

Surreptitious or covert video-taping of a class or unauthorized audio recording of a class is prohibited by law and by Board of Regents policy. A class may be videotaped or audio recorded only with the written permission of the instructor. To accommodate students with disabilities, some students are given permission to record class lectures and discussions. Therefore, students should understand that their comments during class may be recorded.

Simply stated, no one should be recorded without their express permission.

STATEMENT ON A SAFE LEARNING ENVIRONMENT

The University of Nevada, Reno is committed to providing a safe learning and work environment for all. If you believe you have experienced discrimination, sexual harassment, sexual assault, domestic/dating violence, or stalking, whether on or off campus, or need information related to immigration concerns, please contact the University’s Equal Opportunity & Title IX Office at 775-784-1547. Resources and interim measures are available to assist you. For more information, please visit: http://www.unr.edu/equal-opportunity-title-ix .”

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APPENDICES

APPENDIX I MEDICAL EDUCATION PROGRAM OBJECTIVES

University of Nevada, Reno School of Medicine

Medical Education Program Objectives

1 Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care

1.1. Demonstrate an investigatory and analytic approach to clinical situations

1.2. Apply established and emerging bio-physical scientific principles fundamental to health care for patients and populations

1.3. Apply established and emerging principles of clinical sciences to diagnostic and therapeutic decision-making, clinical problem-solving, and other aspects of evidence-based health care

1.4. Apply principles of epidemiological sciences to the identification of health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for patients and populations

1.5. Apply principles of social-behavioral sciences to provision of patient care, including assessment of the impact of psychosocial and cultural influences on health, disease, care seeking, care compliance, and barriers to and attitudes toward care

1.6. Contribute to the creation, dissemination, application, and translation of new health care knowledge and practices

2 Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals

2.1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

2.2. Communicate effectively with colleagues within one's profession or specialty, other health related agencies

2.3. Work effectively with others as a member or leader of a health care team or professional group

2.4. Act in a consultative role to other health professionals

2.5. Maintain comprehensive, timely, and legible medical records

2.6. Demonstrate sensitivity, honesty, and compassion in difficult conversations, including those about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics

2.7. Demonstrate insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions

3 Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles

3.1. Demonstrate compassion, integrity, and respect for others

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3.2. Demonstrate responsiveness to patient needs that supersedes self-interest

3.3. Demonstrate respect for patient privacy and autonomy

3.4. Demonstrate accountability to patients, society, and the profession

3.5. Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

3.6. Demonstrate a commitment to ethical principles pertaining to provision or withholding of care, confidentiality, informed consent, and business practices, including compliance with relevant laws, policies, and regulations

4 Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth

4.1. Develop the ability to use self-awareness of knowledge, skills, and emotional limitations to engage in appropriate help-seeking behaviors

4.2. Demonstrate healthy coping mechanisms to respond to stress

4.3. Manage conflict between personal and professional responsibilities

4.4. Practice flexibility and maturity in adjusting to change with the capacity to alter one's behavior

4.5. Demonstrate trustworthiness that makes colleagues feel secure when one is responsible for the care of patients

4.6. Provide leadership skills that enhance team functioning, the learning environment, and/or the health care delivery system

4.7. Demonstrate self-confidence that puts patients, families, and members of the health care team at ease

4.8. Recognize that ambiguity is part of clinical health care and respond by utilizing appropriate resources in dealing with uncertainty

5 Patient Care: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health

5.1. Perform all medical, diagnostic, and surgical procedures considered essential for the area of practice

5.2. Gather essential and accurate information about patients and their conditions through history-taking, physical examination, and the use of laboratory data, imaging, and other tests

5.3 Organize and prioritize responsibilities to provide care that is safe, effective, and efficient

5.4. Interpret laboratory data, imaging studies, and other tests required for the area of practice

5.5. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment

5.6. Develop and carry out patient management plans

5.7. Counsel and educate patients and their families to empower them to participate in their care and enable shared decision-making

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5.8. Provide appropriate referral of patients including ensuring continuity of care throughout transitions between providers or settings, and following up on patient progress and outcomes.

5.9. Provide health care services to patients, families, and communities aimed at preventing health problems or maintaining health

5.10. Provide appropriate role modeling

5.11. Perform supervisory responsibilities commensurate with one's roles, abilities, and qualification

6 Practice-Based Learning and Improvement: Demonstrate the ability to investigate and evaluate one's care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning

6.1. Identify strengths, deficiencies, and limits in one's knowledge and expertise

6.2. Set learning and improvement goals

6.3. Identify and perform learning activities that address one's gaps in knowledge, skills, and/or attitudes

6.4. Systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement

6.5. Incorporate feedback into daily practice

6.6. Locate, appraise, and assimilate evidence from scientific studies related to patients' health problems

6.7. Use information technology to optimize learning: Participate in the education of patients, families, students, trainees, peers, and other health professionals

6.8. Obtain and utilize information about individual patients, populations of patients, or communities from which patients are drawn to improve care

6.9. Continually identify, analyze, and implement new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes

7 lnterprofessional Collaboration: Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care

7.1. Work with other health professionals to establish and maintain a climate of mutual respect, dignity, diversity, ethical integrity, and trust

7.2. Use the knowledge of one's own role and the roles of other health professionals to appropriately assess and address the health care needs of the patients and populations served

7.3. Communicate with other health professionals in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual patients and populations

7.4. Participate in different team roles to establish, develop, and continuously enhance interprofessional teams to provide patient- and population-centered care that is safe, timely, efficient, effective, and equitable

8 Systems-Based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care

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8.1. Work effectively in various health care delivery settings and systems relevant to one's clinical specialty

8.2. Coordinate patient care within the health care system relevant to one's clinical specialty

8.3. Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care

8.4. Advocate for quality patient care and optimal patient care systems

8.5. Participate in identifying system errors and implementing potential systems solutions

8.6. Perform administrative and practice management responsibilities commensurate with one's role, abilities, and qualifications

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APPENDIX II MEDICAL STUDENT CLINICAL WORK POLICY

1. Purpose and BackgroundTo ensure the quality of the learning experience for the students at the University of Nevada, Reno School of Medicine (UNR Med), students should have sufficient time to pursue self-directed learning activities and to meet personal needs. Additionally, the clinical educational program involves the students in direct patient care activities. As such, a limitation on the number of hours a student may participate in clinical activities is necessary to create a proper learning environment, ensure patient safety and student wellness.

2. Revision History1. 3/4/09: Revision No. 1.0: New policy2. 7/1/13: Revision No. 2.0: Rev to reflect new work hours (Timothy Baker, M.D.)

3. Stakeholders1. Medical Students2. Residents3. Faculty4. Clerkship & Elective Staff

4. Policy1. It is the policy of the UNR MED to align our duty hours policy with the Accreditation Committee on Graduate Medical Education Common Program Requirements for resident duty hours for Postgraduate Year 1 (PGY-1) residents.2. Specifically, medical students, no matter their level of training shall:

1. Be limited to a maximum of 80 hours per week.2. Be limited to a maximum of 16 hours of continuous duty.3. Be permitted to take home call at the discretion of the Clerkship Director. During home call, if a student is called to come into the hospital, hours spent both in travel to and from the hospital as well as time spent in the hospital will count toward the duty hour limits.4. Be limited to a maximum of six overnight shifts in a row.5. Be provided with sufficient time for rest and personal activities between required educational/clinical activities. Optimally, this should be a 10-hour period of time, but must be a minimum of eight hours.6. Be provided a minimum of one day in seven free from all educational and clinical responsibilities. This may be averaged over a four-week period, but may not be spread between two distinct clerkships or rotations.7. Be excused from clinical rotations at 11 pm when participating in required daytime educational and clinical activities the following day.

5. Definitions1. Duty Hours: Refers to any time spent in the hospital, clinic or other patient care site in patient care, documentation of patient care, attending mandatory clerkship/elective and/or other University of Nevada, Reno School of Medicine activities. Duty hours do not include time spent studying, preparing, and/or reading. Time spent in transportation to and from clinical sites does not count toward duty hours unless it occurs during home call.2. 4-Week Average: Refers to a single rotation. Days off may not be averaged over multiple rotations.

6. Responsibilities & Procedures1. Clerkship Directors must inform students of the Medical Student Clinical Work Hours policy.2. Students may be required to track their clinical work hours at the direction of the Office of Medical Education and/or the Clerkship Directors.3. Students must inform the Associate Dean for Medical Education in Reno or the Associate Dean for Academic Affairs in Las Vegas immediately, and in writing, of any violations of this policy.

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4. The Office of Medical Education will inform the appropriate Clerkship Director of violations.5. Clerkship Directors will give quarterly reports to the Year 3-4 clerkship coordinators committee regarding violations of the work hours policy.

APPENDIX III MEDICAL STUDENT MISTREATMENT POLICY

1. Purpose and Background1. The University of Nevada School of Medicine (UNR MED) is committed to an environment of

mutual respect. All members of the medical school community are expected to maintain a positive learning environment in which students, faculty, staff and residents treat each other with respect. Members of the community, including institutional leaders, will not tolerate harassment, intimidation, exploitation and/or abuse.

2. This policy is intended to define inappropriate conduct in relationships with students. It also describes the mechanism through which medical students can report violations without fear of retaliation. This policy ensures access to educational programs that prohibit student mistreatment. For the purposes of this policy, community is defined as all sites where University of Nevada School of Medicine students receive training.

2. Revision History1. 5/14/14: Original (ASA)

3. Stakeholders1. Students2. Faculty3. Affiliated Institutional Staff4. Staff5. Residents

4. Policy1. Promoting a Positive Learning Environment: The University of Nevada School of Medicine

provides ongoing educational and developmental opportunities to promote a positive learning environment respectful of all individuals. The policy will be included in both student handbook and resident handbook, and will be posted on the medical school website. The topic will be addressed annually throughout the medical school.

1. Residents: The policy will be included in the resident handbook, and will be addressed at resident physician orientation sessions.

2. Faculty: The policy will be distributed electronically by the Dean to Faculty Council and to all faculty members. The policy will be a part of all new and renewed adjunct appointments, including clinical and volunteer faculty. View the New Hire Packet from HR. The electronic message will include resources for identification and prevention of mistreatment and abuse.

3. Affiliated Institutional Staff: The policy will be included in all new and renewed affiliation agreements with clinical sites. A letter will be sent from the Associate Dean for Student Affairs to the Chief Executive Officer at affiliated institutions requesting distribution of the policy to all staff interacting with medical school students. The Office of Admissions and Student Affairs will be available for presentations on the topic to various groups.

2. Examples of Mistreatment1. Mistreatment of students may occur in many forms and can seriously impair the

educational experience. Specific examples of mistreatment include, but are not limited to:

Yelling at and/or verbally berating a student in public or private Actions reasonably interpreted as demeaning or humiliating in public or private

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Assigning duties as a means of punishing students instead of for educational benefits

Unwarranted exclusion from learning opportunities Threats to fail, assign a lower grade or give a poor evaluation for non-academic

reasons Requesting that students complete personal chores or errands Unwelcome or inappropriate comments or discrimination related to a student's

physical appearance, age, gender, race, ethnicity or culture, sexual orientation, sexual identity, disability or marital status

Pushing, shoving, slapping, hitting, tripping, throwing objects or other forms of physical intimidation

Sexual harassment per the NSHE Administrative Code, Title 4, Chapter 8, Section 13, Subsection B

3. Retaliation1. Retaliation against students reporting mistreatment is regarded as a form of

mistreatment and will not be tolerated. Accusations that retaliation has occurred will be handled in the same manner as accusations concerning other forms of mistreatment.

4. Malicious Accusations1. A complainant or witness found to have been dishonest or malicious in making

allegations at any point during the investigation may be subject to disciplinary action.5. Campus Resources: The following campus resources may be helpful sources of information and

support in dealing with mistreatment or abuse issues: Office of Admissions and Student Affairs, School of Medicine

Cherie Singer - Reno (775) 682-8360 Jodi Shpargel - Reno (775) 682-8360

Main ASA Office - Reno (775) 784-6063 Ashley Sylvester - Las Vegas (702) 671-2393

Office of Medical Education, School of Medicine, Reno Amy McFarland (775) 784-4605

Office of Academic Affairs, School of Medicine, Las Vegas Gary Shen, M.D. (702) 671-2369

Office of Compliance, School of Medicine, Las Vegas J. A. Epperson (702) 968-4385

University of Nevada Reno Counseling Serv. (775) 784-4648 University of Nevada Las Vegas Counseling Serv. (702) 895-3627 Center for Student Cultural Diversity (775) 784-4936 Disability Resource Center (775) 784-6000 Office of Affirmative Action (775) 784-1547 Equal Opportunity & Title IX Off.-Denise Cordova (775) 682-6708

5. Definitions1. SPCC: Student Promotion and Conduct Committee.

6. Responsibilities & Procedures1. Procedure for Resolution

Informal Resolution: Students are encouraged to first utilize any of the informal mechanisms listed below, when possible:

Direct discussion between student and other person(s) Discussion with clerkship director, Associate Dean for Medical Education, Senior

Associate Dean for Academic Affairs or the Associate Dean for Student Affairs Discussion with either the assistant to the Associate Dean for Student Affairs

(Jodi Shpargel, jshpargel@med.unr.edu, (775) 682-8361) on the Reno campus or

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the Director of Student & Educational Affairs (Ashely Sylvester, asylvester@med.unr.edu, (702) 671-2393) on the Las Vegas campus

Utilize the resident and faculty evaluation process to document concerning behaviors

Sexual Harassment and/or Discrimination: All complaints related to sexual harassment and/or discrimination will not be subject to informal resolution and will be reported to the Associate Dean for Student Affairs who will then immediately refer the complaint to the Equal Opportunity and Title IX Office on the University of Nevada, Reno, campus.

Formal Resolution: When the informal mechanisms mentioned above do not lead to resolution of the incident or behavior, the following protocol will be followed:

If the incident involves an allegation of mistreatment by another student, the incident will be referred to the Associate Dean for Student Affairs for review and action.

If the incident involves an allegation of mistreatment by a resident, due process provisions in the Resident Handbook will be followed.

If the incident involves an allegation of mistreatment by a faculty or staff member, due process provisions in the NSHE Administrative Code pursuant to Title 2, Chapter 6 will be followed.

If the incident involves an allegation of student mistreatment by a staff member at an affiliated institution, the student and/or supervising faculty will refer the incident to the Associate Dean for Student Affairs.

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