College of Medicine Incident Card

Use this form to report a co-curricular concern about a student.

The Elson S. Floyd College of Medicine strives to create an environment that produces future physicians who possess not only the knowledge of the most advanced scientific and clinical fundamentals, but are physicians who do so while behaving in ways that honor the profession of medicine. Helping our students achieve this level of professionalism is as important to our medical school as is its success in educating students in the biological and clinical sciences. To support students as they develop competency in the domain of professionalism, the WSU College of Medicine has developed a central system, within the Assessment Unit, to track and communicate issues related to professionalism. This central tracking process ensures that all relevant information is available to help the program support students who exhibit patterns of behavior that may require targeted skills development, remediation and/or other types of support.

MD Program Office of Student Affairs Co-Curricular Concern Card

Campus
Best descriptor of behavior(s) (select all that apply)(Required)
Name of student you are raising concerns about:(Required)
Your Name(Required)