Attendance and Absence – Pre-clerkship

The purpose of this policy is to provide clear and consistent expectations for students, staff and faculty related to student attendance in the pre-clerkship portion of the MD program.

Other related documents are the Student Leadership Absence Policy, Clerkship Attendance and Absence Policy, and Procedure for Procedure for Session Attendance Across Sites/Campuses.

Active participation by medical students in learning opportunities is critical to their formation, education, and training. Sustained and deep engagement, which requires regular and punctual attendance, is expected of all students in all of their classes (lectures, laboratories, seminars, tutorials, small groups and clinical sessions).

The College of Medicine recognizes that students have varied learning needs and can make choices about their approach to learning . That being said, for many components of the program, the College of Medicine relies heavily upon faculty with clinical obligations, their patients and other patient volunteers. Absenteeism and lack of punctuality by students place an unwelcome strain on the goodwill of all concerned. Often a significant degree of accommodation by physicians and their patients has occurred to make these educational experiences possible. Replicating these experiences to accommodate student absences is extremely difficult. Acceptance of responsibility for attendance and participation in patient care is part of the student’s professional education and responsibility. Appropriate attendance and punctuality are indicative of the student’s understanding of, and adherence to, expectations of professional behaviour.  Students who neglect their academic responsibilities may be excluded from final examinations and it may be addressed through the Procedures for Concerns with Medical Student Professional Behaviour.

It has been the College’s experience that, for some students, chronic non-attendance often results in academic and/or professional difficulty. Students also end up feeling disengaged and separated from their class cohort, which can further affect academic success because of a lack of peer support. The College reserves the right to mandate attendance by those students who are in academic or professional difficulty. Such circumstances would be clearly documented and provided in writing to the student.

Pre-Clerkship: The first and second years of the University of Saskatchewan Undergraduate Medical Education Program (UGME) are termed “pre-clerkship”. During this program phase, medical students participate in large and small group learning activities as well as clinical learning activities in health care setting.

Mandatory  Sessions: Educational sessions that are critical to the MD program and the student’s progress are deemed to be mandatory. If missed, mandatory sessions can put the student at a disadvantage within the program and may affect their performance in program and national exams. Many educational sessions have an assessment component within them. Assessment may range from an in-session assignment to written or oral exam/quiz to OSCEs to assessment of clinical skills. Absences from sessions that include assessment are difficult to accommodate, both because of the impact on the comparability (i.e., fairness) of assessment among students and because of the need to either reschedule the session or forego the opportunity for assessment (and possibly accepting a grade of zero).

Non-Mandatory Sessions: Non-mandatory sessions are valuable important components within the curriculum, but are such that absences from them can be relatively easily made up with extra effort on the student’s part (i.e. self-directed learning through a lecture or obtaining lecture notes from a colleague). Note that non-mandatory does not mean that the material taught in it will not be assessed.

This policy applies to all undergraduate students registered in Years 1 and 2 of the Doctor of Medicine (MD) program at the University of Saskatchewan irrespective of the geographically distributed site/campus to which they are currently assigned.

1.0 Sessions

2.0 Types of Absences

2.0 TYPES OF ABSENCES

It is recognized that there may be circumstances that merit absence from educational activities. In determining these circumstances, the following principles will be considered and respected:

1. Equity and transparency within the limits of confidentiality.
2. The ability to fulfill academic responsibilities (those of the student and those of others involved in the educational process).
3. The well-being of the student, including recognition of and respect for the student’s abilities and limitations
4. The integrity of all aspects of the M.D. program and those involved in the program (i.e. students, faculty, staff, allied health professionals, etc.).

Notation of all absence requests will be made on the student’s file to track absences, which will inform future absence requests.

In all cases, students in academic difficulty may be denied planned absence requests if it is felt that the absence(s) may further affect their academic performance.

2.1      Planned Absences (Including from Mandatory Sessions)

Planned absences are intended to allow students to request time away from mandatory or non-mandatory sessions for important professional or personal reasons.

2.1.1. Limitations on planned absences:

Planned absences may not be requested and will not be approved for Final examination periods (including OSCEs). Absences for final examinations will only be considered for reasons of illness or personal/family emergencies. Please see the Deferred Exam Policy.

Accommodating absences that involve a deferral of a quiz, mid-term or end-of-module exam is particularly challenging to arrange; therefore students will be limited to maximum one absence per academic year involving a deferral of a quiz, mid-term or end-of-module exam. Any absence requests beyond one that involves such a deferral will be considered in exceptional circumstances only. Please see Deferred Exam Policy.  Given the nature of how some sessions are scheduled, it may not be possible for the UGME program to reschedule a missed session.  Students will still be responsible for learning the content in the missed session.

Shadowing is not considered a legitimate reason for a planned absence, and planned absences for the purposes of shadowing will not be approved.

2.1.2   Types of Planned Absences:

• Observance of a religious/faith holiday
• Health care appointment which cannot be scheduled outside of academic hours
• Attendance at a funeral or memorial service (when date is known in advance)
• Presentation at an academic conference
• Attendance at an academic conference
• Invited and active participation in organized athletics or other competition
• Active participation in a major personal celebration or event (i.e. wedding, baptism, etc.)
• Attendance at a College of Medicine committee meeting
• Appointment with another College of Medicine or University office/leader
• Important professional leadership activities associated with University of SK, College of Medicine and groups affiliated with the College of Medicine
• Other planned and/or foreseeable absences

2.1.3. Guiding Principles/Considerations for Planned Absences: Reason for the absence

• The type and number of session(s) that will be affected, including, type and weight of assessment, and importance to the course/program.
• The student’s academic performance to date.
• The student’s professional performance to date.
• The number of absences to date and/or scheduled/planned.
• Note that the UGME program will endeavour to adapt the schedule to accommodate SMSS-identified events of importance to the medical student community.

2.1.4. Typical Outcomes in the Case of a Request for a Planned Absence:

Observance of a Religious/Faith Holiday

• Requests will generally be approved, save for extraordinary extenuating circumstances.
• The College of Medicine must provide a compelling reason if not approved.
• The College of Medicine will pursue alternative arrangements to enable the student to make up any missed assessments and/or other critical mandatory sessions due to a religious or faith holiday.

Health Care Appointment

• Requests for an absence from a non-mandatory session will generally be approved.
• Requests for an absence from a mandatory session will be dealt with on an a case-by-case basis.
• Students are requested to make every effort to schedule health care appointments at a time that does not require an absence from educational sessions.

Attendance at a Funeral or Memorial Service

• Requests will generally be approved, save for extraordinary extenuating circumstances.
• The College of Medicine will pursue alternative arrangements to enable the student to make up any missed assessments and/or other critically mandatory sessions due to a funeral or memorial service.

Attendance at Academic Conferences

• Requests for an absence will generally be granted to a maximum of 3 days per academic year.
• Request for absences more than the allowable amount will be addressed on a case-by-case basis. Consideration will be given to those who are presenting or are involved in an administrative capacity or organization meetings at a conference.
• Requests for an absence from mandatory sessions will be dealt with on a case-by-case basis. Specific considerations include the relative weight of the assessment to be missed, logistics of rescheduling the assessment, impact of foregoing the assessment (i.e., lost opportunity for feedback, a grade of zero, etc.) and student academic performance.
• Students are required to submit the conference program and, if applicable, confirmation of acceptance of their paper/poster as part of their initial request.

Invited and Active Participation in an Organized Athletics or other Competition, at the Varsity Level or Equivalent

• Recreation-level athletic/sports activities will not be considered an acceptable reason for absence
• Requests for an absence from a non-mandatory session will generally be approved.
• Requests for an absence from a mandatory session will be dealt with on a case-by-case basis. Specific considerations include the relative weight of the assessment to be missed, logistics of rescheduling the assessment, impact of foregoing the assessment (i.e., lost opportunity for feedback, a grade of zero, etc.) and student performance.
• Students are required to submit documentation of their official invitation to participate as part of the initial request.

Active Participation in a Major Personal Celebration or Event (i.e. wedding, baptism, etc.)

• Requests for an absence from non-mandatory sessions will generally be approved to a maximum of 3 days per academic year.
• Requests for an absence from mandatory sessions will be dealt with on a case-by-case basis. Specific considerations include the relative weight of the assessment to be missed, logistics of rescheduling the assessment, impact of foregoing the assessment (i.e., lost opportunity for feedback, a grade of zero, etc.) and student academic performance.
• Students are required to provide a description of the event and their participation in the event as part of their initial request.

Attendance at a College of Medicine Committee Meeting

• Requests for an absence from a non-mandatory session will generally be approved.
• Requests for an absence from a mandatory session will not be approved other than in exceptional circumstances for meetings in which the student member’s participation is essential and the meeting cannot be scheduled at another time; confirmation from the Chair will be required.

Appointment with another College of Medicine or University Leader

• Requests for an absence from a non-mandatory session will generally be approved.
• Requests for an absence from a mandatory session will not be approved other than in exceptional circumstances for an appointment in which the student member’s participation is essential and the appointment cannot be scheduled at another time; confirmation from the Leader will be required.
• Students are requested to schedule these appointments outside of curriculum time to the greatest extent possible.
• College leaders are asked to be cognizant of the students’ academic program when requesting appointments.

Primary Caregiver Responsibilities

• Students may have significant responsibilities as a caregiver, this will be considered when requests for absences are made.
• An example of a planned absence includes medical appointments for children or other dependent family members for which the student’s presence is required. Where possible, appointments should be scheduled outside of scheduled curriculum time.
• Other requests for absence will be addressed on a case-by-case basis.
• Requests for an absence from a non-mandatory session will generally be approved.
• Requests for an absence from a mandatory session will be approved on a case-by-case basis.

Vacation

• Vacation requests during pre-clerkship will not be approved as planned absences.

Other PLANNED Absences

• Requests will be considered on a case-by-case basis.
• Note that the UGME Program will endeavor to adapt the schedule to accommodate SMSS identified events of importance to the medical student community.

2.2      Flex Days

Flex days are intended to allow students the option of taking a planned absence without the need to provide a reason or documentation in support of that absence. Note: The UGME program does not expect students to use flex days for medical concerns.  If a student has a medical concern (which includes mental health), then they should apply for a unplanned absence for illness. 

Flex days may be used for absences from non-mandatory sessions and some specific types of mandatory sessions.

2.2.1.  Limitations on Flex Days:

A student may request a maximum of 3 Flex Days per academic year.

Flex days may not be requested and will not be approved for the following:

• Year or course orientations
• Clinical Skills sessions
• Anatomy Labs
• Sessions involving interprofessional learning
• quizzes, team based learning sessions (TBLs), mid-term or end-of-module exams
• Final exams (including OSCEs)

Flex days may be requested and will be considered for the following:

• small group case-based seminars or learning sessions (such as small groups in Foundations or Clinical Integration courses)*
• module orientations**

    *   There may be exceptions which will be identified to students as not eligible for Flex Days.

** Students are responsible for familiarizing themselves with information covered in the module orientation, even if absent.

2.3       UNPLANNED ABSENCES

2.3.1.  Types of Unplanned Absences:

• Illness and/or injury
• Serious situation with a family member or other loved one
• Personal crisis
• Transportation problems
• Other reasons

 2.3.2.  Guiding Principles/Considerations for Unplanned Absences:

• Acknowledgement that unforeseen and emergent circumstances arise and that the student has the right to determine how best to deal with such circumstances, including being absent from educational sessions
• Students must notify a staff or faculty member within the College of Medicine, or the Office of Student Affairs within a reasonable timeframe surrounding the unplanned absence. Failure to notify is unacceptable and the College may not be obligated to provide make-up sessions or assessments.
• Acknowledgement and respect of the supportive and compassionate environment that the College endeavours to provide to all individuals
• Understanding that any absence may have consequences and create added responsibility as it relates to the student’s medical education
• Given that all courses will continue during an absence, the volume of material and the number of clinical skills sessions that are missed must be considered in the plans for return to classes after absence. If a student misses more than 3 weeks of school, the Year Chair will work with the Director, Academic and Student Affairs/ Associate Dean to determine the appropriate course of action, which may include recommendation of withdrawal from the current academic year and re-entry into the following academic year.
• For unplanned absences greater than 1 week (whether continuous or cumulative), the Year Chair in consultation with the Directors Academic and Student Services will determine the appropriate course of action. Student Affairs representatives will assist with planning for either a withdrawal or return to program after an extended absence. In the case of continuous absence greater than total number of allowable approved absences for this policy (5 days – see below), students should work with the Year Chair and Office of Student Affairs and refer to the Leave of Absence Policy for further direction.

Acute Illness and/or injury

• Once able, the student should contact the UGME office and indicate the absence was due to illness or injury
• Additional documentation may be required depending on the nature of the missed session(s), scheduled assessment (if any), the duration of the absence and history of past absences
• When possible, arrangements will be made to ensure the student is able to make up missed sessions and/or assessments at a later date which may include alternative formats.

Serious Situation involving a Family Member or other Loved One

• Once able, the student must contact the site specific UGME or Student Affairs office and indicate the absence was due to a personal problem affecting a family member and/or loved one
• Additional documentation may be required depending on the nature of the missed session(s), scheduled assessment (if any), the duration of the absence and history of past absences
• When possible, arrangements will be made to ensure the student is able to make up missed sessions and/or assessments at a later date which may include alternative formats

Personal Crisis

• Once able, the student must contact the site specific Student Affairs office and indicate the absence is due to a personal crisis
• Student Affairs will work with the student and the UGME office to determine the appropriate course of action
• When possible, arrangements will be made to ensure the student is able to make up missed sessions and/or assessments at a later date which may include alternative formats.

Transportation Problems

• The student must contact the UGME office as soon as possible once it is apparent that an absence is likely to result from the delay.
• Supporting information and documentation must be provided, which includes the nature of or reason for the travel delay
• When possible, arrangements will be made to ensure the student is able to make up missed sessions and/or assessments at a later date which may include alternative formats
• Arrangements and accommodations will NOT be made for absences that result in the poor planning on the part of the student

Other Reasons

Other unplanned absences will be dealt with on a case-by-case basis.

3.0 Total Absences

3.1.     Guiding Principles:

• Significant absences may impact a student’s learning, and the program reserves the right to limit absences in order to best support learning.
• Processing absence requests requires significant administrative resources and reasonable limits are required in order to allow Administrative Coordinators to attend to other important responsibilities.

3.2. Process:

• All absences will be tracked by the relevant UGME Administrative staff.
• A student may be allowed a maximum of 5 approved absences (combined Planned and Flex Day absences) per academic year. Exceptions may be made to the 5 maximum days for planned absences due to leadership activities for students in good academic standing. Please see Student Leadership Absence Policy.
• Students in academic difficulty may have their application for approved absences declined if there is concern that additional absences may put the student at further academic risk, regardless of number of approved absences used to date. This limitation would be only applied in consultation with the student and the Year Chair.
• Students who have unplanned absences due to illness or personal circumstances and who subsequently apply for Planned or Flex Day absences which would result in an excess of 5 total absences per year, may have Planned or Flex Day absences declined. This will depend on academic performance, the relative importance of the activity for which the student is requesting an absence, and potential impact of the individual and cumulative absences on learning and assessment. The Year Chair will be consulted on this decision.

Pre-clerkship administrative staff and Year Chairs/ Year Site Coordinators are responsible for operationalizing the procedures outlined, with oversight by the Program Manager, and consultation as required with the Academic Director, and Associate Dean UGME.

Instances or concerns of non-compliance with the Pre-Clerkship Attendance and Absence Policy should be brought to the attention of the Vice-Dean, Education or the Associate Dean, Undergraduate Medical Education, within the College of Medicine. 

1. Procedure for Applying for Planned Absences:

• Students should not book travel until their request is fully approved. Students are responsible for any costs incurred if booked travel must be cancelled.
• The student must submit an absence request online using the Application for Absence link on the Pre-Clerkship Attendance and Absence Policy Students may  directly (email or in person) contact their UGME (site specific) Administrative Coordinator to initially discuss the absence.  This should be done as soon as the student becomes aware of the need for an absence. The guideline is a minimum of 4 weeks in advance of the planned absence.
• As part of the request, supporting documentation may be required. If the supporting documentation is confidential in nature (i.e. medical, or sensitive family matters), documentation can be submitted to the Student Affairs Office at the student’s site. The UGME office will consult with Student Affairs as part of their consideration, without breaching confidentiality.
• The College of Medicine will consider the request and provide a decision in a timely manner. The guideline is within 2 weeks of the request or in advance of the absence, whichever is longer. Note: each site will have a slightly different approval process. This process may include the relevant module or course personnel.
• The Administrative Coordinator will either deny the request, approve the request, or conditionally approve the request.
• Conditional approvals may occur in the setting of a mandatory session, in which the Module or Course Director must be consulted to determine if/how an alternate learning experience or assessment can be provided. This may include the student requesting a deferral of an assessment (see Deferred Exam Policy). In limited situations, this may include the Administrative Coordinator switching students between groups, with the agreement of both students.
• In the event of a conditional approval, the Administrative Coordinator and/or student will consult with the relevant Preceptor/Module or Course Director to determine if the requested absence can be accommodated.
• The Administrative Coordinator will advise the relevant Module or Course Director and/or Administrative staff member of an approved planned absence.
• In the event that a mandatory learning activity is scheduled for the student after a planned absence has been approved, the student will not be penalized professionally or by a loss of academic marks. When possible, a missed session will be rescheduled; marks for missed assessments will be addressed through re-weighting or alternate assessment, if required, as determined by the Module/ Course Director.

   1.1. Appeals of Planned Absence Request Decisions:

• The appropriate site Administrative Coordinator will approve or deny planned absence requests based on this policy.
• If a student disagrees with Administrative Coordinator’s decision, the student may appeal the decision to the appropriate Year Chair or designate, by providing, in writing (email acceptable) the reasons why the student is appealing the decision. The decision of the Year Chair is final. The Student may seek guidance from the Office of Student Affairs in requesting such an appeal.

2. Procedure for Applying for Flex Day Absences:

• Students should not book travel until their request is fully approved. Students are responsible for any costs incurred if booked travel must be cancelled.
• The student must submit an absence request online using the Application for Absence link on the Pre-Clerkship Attendance and Absence Policy Students may  directly (email or in person) contact their UGME (site specific) Administrative Coordinator to initially discuss the absence.   The guideline is a minimum of 1 week in advance of the planned absence. Flex Days will not be retroactively approved.
• The College of Medicine will consider the request and provide a decision in a timely manner, ideally by 3 days prior to the requested absence. Note: each site will have a slightly different approval process. This process may include the relevant module or course personnel.
• The Administrative Coordinator will either approve the request, deny the request, or conditionally approve the request. 
• Conditional approvals may occur in the setting of a mandatory session, in which the Module or Course Director must be consulted to determine if/how an alternate learning experience or assessment can be provided. In the event of a conditional approval, the Administrative Coordinator and/or student will consult with the relevant Preceptor/Module or Course Director to determine if the requested absence can be accommodated.
• The Administrative Coordinator will advise the relevant Module or Course Director and/or Administrative staff member of an approved Flex Day absence.
• In the event that a mandatory learning activity is scheduled for the student after a Flex Day absence has been approved, the student will not be penalized professionally or by a loss of academic marks. When possible, a missed session will be rescheduled;; marks for missed assessments will be addressed through re-weighting or alternate assessment if required as determined by the Module/ Course Director.
• If an assessment (such as an in-class or out-of-class assignment) is due on a day that a Flex Day has been approved, the student is still responsible for completing the assignment by or before the stipulated due date, and reviewing the content missed. For assessments that cannot be done without attendance, a student should anticipate receiving a potential zero on that assessment.
• Flex Days are on a first-come, first-served basis and requests will be declined if > 20% of a small group or > 20% of the class for a large group session would be away on Flex Days on a given day.

    2.1. Appeals of Flex Day Request Decisions:

• The site-specific Year Administrative Coordinator will approve or deny planned absence requests based on this policy
• If a student disagrees with the Administrative Coordinator’s decision, the student may appeal that decision to the appropriate Year Chair or designate, by providing, in writing (email acceptable) the reasons why the student is appealing the decision. The decision of the Year Chair shall be final for appeals of Flex Day decisions. The Student may seek guidance from the Office of Student Affairs in requesting such an appeal.

3. Procedure for notification for Unplanned Absences:

• In all cases, the students should ensure the personal well-being and immediate safety of themselves and others affected within the situation.
• Student must notify the UGME office (site specific) as soon as they are able to do so after attending to the emergent needs/issues. If a student is ill, the student should make every effort to advise the office with as much advanced notice as possible. This is particularly important for mandatory sessions and assessments.
• Medical or other documentation of the need for the absence may be required. The UGME office will advise the student if any other documentation is required. If the supporting documentation is confidential in nature (i.e. medical, or sensitive family matters), documentation can be submitted to the Student Affairs Office at the student’s educational site.
• The UGME office will work with the student to reschedule any mandatory assessed sessions that may have been missed due to the unplanned absence as appropriate.

This policy will be housed on the College of Medicine Sharepoint, in the UGME Admin common folder.  It will also be housed in SAMC Sharepoint folder.  This policy will be posted on UGME page of the College of Medicine website, under the Policies, Procedures and Forms link.  Any updates approved by SAMC will be distributed to the Year 1 and Year 2 Chairs and all admin coordinators/support staff responsible for Pre-Clerkship at all sites, who will distribute it to all pre-clerkship faculty leads and the Pre-clerkship Sub-committees.

Academic Director, UGME
Phone: 306-966-2750
Email: medicine.ugme@usask.ca