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Faculty Conflict of Interest Form

Related Policy: Occasions may arise in which a faculty member has direct supervision over a student in matters of assessment and/or promotion and in which there may be a potential conflict of interest in this role. The conflict may arise as a consequence of any of a number of situations such as:

a. The student may be a relative through lineage, marriage, or other relationships;
b. The student may have a close personal relationship through settings such as places of worship, civic organizations, sports, recreational, or other social settings;
c. The student may be a patient in the practice of a clinical faculty member;
d. Or other relationships identified by the faculty member or student.

The nature of the conflict need not be disclosed. When such a conflict is recognized by the faculty member, it is the responsibility of the faculty member to notify the VTCSOM Office of Faculty Affairs, either through this document or directly. Should a conflict be identified by the student, the student should notify the VTCSOM Office of Student Affairs.

If a conflict of interest is identified by either party, the student schedule will be modified to avoid assessment of the student by the faculty member. Similarly, if a conflict of interest is identified, by either party, the faculty member will be asked to recuse him/herself in decisions regarding promotion of the student.

Related Accreditation Standard: LCME 3.6, Faculty Involvement in Student Assessment
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