Professionalism Report Forms

Purpose of Professionalism Report Forms

To enable UNR Med to respond promptly to any reports of mistreatment or unprofessional behavior and to also recognize exemplary behavior to ensure:

all members of the Medical Doctor and Physician Assistant Studies Programs maintain professional standards in the learning environment in accordance with the Student Mistreatment Policy.
all members of the Graduate Medical Education Program maintain professional standards in accordance with the Resident Professionalism Policy.
all members of the Speech Pathology and Audiology (SPA) program maintain professional standards in the learning environment. SPA students may also utilize services offered through the University.
all members of the faculty and employees maintain professional standards in accordance with the UNR Med Professionalism Statement, which are outside of the learning environment.

Please select the appropriate process:

Please DO NOT use this form for:

Master’s and doctoral students in biomedical sciences should utilize services offered by the University of Nevada, Reno Graduate School. Should a report be filed through one of the mechanisms above, UNR Med will route to the graduate school.
Complaints of unlawful discrimination or harassment. These complaints should be filed as soon as possible with the Center for Civil Rights and Equal Access. Contact information: eotix@unr.edu, 775-784-1547, or the Center for Civil Rights and Equal Access. office in the UNR Continuing Education Building, Room 206.
Concerns regarding barriers to the implementation of approved ADA accommodations or the need to request accommodations. These concerns should be filed as soon as possible with:
- Students: UNR Disability Resource Center, William N. Pennington Student Achievement Center, Room 230, 775-784-6000
- Employees: UNR Human Resources, ADAservices@unr.edu 775-784-6082, 70 Artemisia Way.
Emergencies
In an emergency, please call 911. This form is NOT for reporting emergencies and should only be used for professionalism or mistreatment reporting.

MD and PA Learning Environment Report Form

Anonymity and Confidentiality

As a part of efforts to ensure you feel comfortable reporting professionalism lapses or mistreatment, Learning Environment Report Forms are anonymous unless the reporter includes his or her name; if that is the case, they are confidential. All possible measures will be used to protect the reporter from being identified, unless the reporter indicates this is not desired (for example, if a form is reporting exemplary professional behavior). Anonymous reports may not contain sufficient information to address the concern. Complete confidentiality cannot be guaranteed due to NSHE code and state and federal laws.

Purpose of the Learning Environment Report Form and Student Affairs and Personnel Committee

The Learning Environment Report Form provides a mechanism for students, residents, fellows, faculty and staff to report issues of professionalism in the learning environment to the Student Affairs and Personnel Committee. The Student Affairs and Personnel Committee is composed of the associate dean for student affairs, associate dean for curricular affairs, senior associate dean for undergraduate academic affairs, and the associate dean for graduate medical education. This committee meets and reviews every report which is submitted and forwards the report to the appropriate office to address the report. PA concerns are routed by the committee to Brian Lauf, DMSc, PA-C, director, physician assistant studies program. The Student Affairs and Personnel Committee confirms the concern was addressed.

If your report involves an individual on this committee, please select the option below to route the report to Dr. Timothy Baker.

Please check here to route to Dr. Baker:

Retaliation

We strive to ensure that everyone at UNR Med feels comfortable reporting professionalism lapses and student mistreatment. Please know that by filling out this form, your grade or evaluation will not be affected. Retaliation is prohibited and can be reported through this process.

False Accusations

Making an accusation which is intentionally false or is made with reckless disregard for the truth is prohibited and may be subject to discipline.

What Happens After a Report

After you submit your report, you will receive a report number. This number can be used to check the status of your report here , even if you submitted anonymously. In addition, if you include your name and email address in your submission, you will receive an email once steps have been taken to address this concern.

Safety

If you feel unsafe in your current learning environment, you may leave and then contact the Associate Dean, Student Affairs or the Director, Physician Assistant Studies Program

Your Contact Information

If you do not wish to disclose your name, please leave these items blank

Name

Email Address

Your Role

Are you reporting on behalf of someone else?

Incident

I wish to report:

Date of Incident

This incident took place in:

Please type in the name of the person(s) who is the focus of this submission. (Do not include those who happen to be nearby, but did not display exemplary or lapse in professional behavior).

Name of the Person

Person's Role

Add Person

Description of Incident

Please describe in the box below the circumstances and behavior that took place in the learning environment as well as the following: the position or role of individual(s) involved, your relationship to them, and the location where the behavior occurred.