1. Best Practices in Medical Excuse Notes

2. PANEL
Margaret Higham MD Medical Director of Health Service Tufts University Jeff Maher MD & Julie Gray PA Medical Director and Physician Assistant Bowdoin College Ryan Travia M.ED. Associate Dean of Students for Wellness Babson College

3. Agenda Brainstorm guiding principles from different perspectives
Describe the models from our three institutions
Identify other best practices from the audience

4. Who are the Constituents?
Health Service
Counseling Services
Victim Advocates and Title IX
Deans
Student Accessibility Office
Faculty
Students
Athletics

5. Goals—Health Service Help students develop personal agency
Help students learn to balance health in the context of life
Provide confidentiality
Ensure adequate clinical resources for those who are truly sick—not drive unnecessary volume to Health Service
Have clinical staff working at their top of their skill level—not rubber stamping minor illness issues
There are different needs for students with short term illness, from those with chronic or longer term conditions
Advocate for students who need extra support or have significant medical needs
Provide faculty with targeted assistance—not as a rubber stamp, but for important situations.

6. Goals—Deans Identify students who are struggling
Help students be successful
Provide confidentiality
Connect students to resources such as Student Accessibility Services
Help students learn to balance health needs in the context of their academic and co-curricular life

7. Goals-Faculty Maintain the integrity of their curriculum Fairness
Ensure that students are truthful
Reduce the burden of individualized adjustments

8. Goals—Students Not be penalized for being sick I am special
Get help navigating systems
Learn to balance health with co-curricular life
Maintain a confidential space

9. Tufts Policy & Process

10. Tufts Process Benchmarked processes at other institutions
Duke process unique and intriguing
Met with our Academic Deans—They were enthusiastic
Presented at Faculty Meeting as a fait accompli—they were not enthusiastic
Different processes for short term and long term illness

11. Tufts—Short Term Illness
Short Term—2-3 days
Medical documentation provided only for in-class mid term or final
Student must be seen prior to exam
On day of or day before exam
Faculty gets to decide how this is handled
All other issues communicated directly between student and faculty
“Short Term Illness Notification Form,”
Created by IT
Student initiated through our SIS
Copy goes to dean—helps maintain integrity of process
If student has multiple Illness Notification Forms, Dean proactively reaches out

12. Tufts—Long Term Illness
More severe or prolonged illness—HS clinician s Academic Dean (w student verbal consent)
Dean notifies faculty, requests flexibility
Mono, Flu, hospitalizations
Concussion
Faculty decides what flexibility means
Some illness so prolonged or severe that medical leave needed

13. Tufts—Challenges Need ongoing commitment
HS staff MUST be consistent
This is a University Policy—not just a HS policy
Hard to communicate policy w all faculty—large university
Info included in major communications to faculty
What if faculty tells student to get a “doctor’s note?”
Direct student to Academic Dean
Give student copy of policy to show prof
What if student illness doesn’t rise to level of missing exam?
You have to be willing to hold your ground

14. Tufts Process Ongoing
Consistency and Commitment to following the policy from HS clinicians
Review policy regularly in clinical meetings, review difficult cases
Need trust between HS and Deans, regular meetings
Regular reminders to Faculty about the policy from the Deans

15. Babson Policy & Process

16. Babson General policy of not providing medical excuse notes
Most requests go through Class Deans/Academic Advisors, often in consultation with Health & Wellness
In reality, feels very case-by-case
For longer-term illness lasting more that a few days, typically coordinated through the CARE Team or via Medical Withdrawal Policy, as appropriate

17. Medical Notes—Babson Cont.
Sexual Assault Prevention & Response Services (SAPRS)
Coach student to self-advocate
Contact class dean
Contact faculty directly
Distinction between accommodations and assistance
Counseling
Encourage students to share what they are comfortable communicating to professors
If seeing psychiatrist (limited availability) and appointment conflicts with class, will provide a note at student’s request
If no prior relationship with student, will not provide documentation and direct to class dean
SAPRS – Accommodations are required by law and their implementation is mandated and supported by TIX and General Counsel. Assistance requests are things that would make the students situation more manageable, less stressful, etc...but are not necessarily "owed" to the student - that is to say, these would be above and beyond requests. Have to make such distinctions very clear in requests. An assistance request is a more collegial, casual or phone call.
Counseling – will not provide notes for therapy appointments if students do not provide times to meet outside of class (more availability for therapists).

18. Babson—Short Term Illness
Always strive for student-faculty communication
Health & Wellness staff will advocate, as appropriate; may contact class dean or faculty with verbal or written consent from student
Exam Excuse Form

19. Babson—Long Term Illness
More severe or prolonged illness—still encourage student-faculty communication
Health & Wellness staff will communicate with class deans or faculty with verbal/written consent from student
Exam Excuse Form
Concussion Protocol
Some illness so prolonged or severe that medical leave needed
Concussion protocol may recommend no cognitive activity (class, reading, homework, quizzes/test, limited screen time) for period of time. Copies go to Academic Services, Accessibility Resources

20. Babson-Challenges Consistency Privacy/Confidentiality Trust
Faculty expectations vary widely
Because this is managed through multiple offices on campus – both in Academic Affairs and Student Affairs – consistency remains a challenge.
Typically, choice is centralized around privacy concerns and comfort level of potentially being associated with a particular office (i.e. Counseling/SAPRS). Why it’s sometimes easiest to go through Class Deans who can say that the “student is dealing with a personal issue,” without revealing any details, which they may not even be privy to… does require trust and that we are properly vetting requests.
Faculty or class deans sometimes requesting more information than is necessary