Areas of Concern

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Full Policy Contents

Policy Statement
Reason for Policy

Additional Contacts

Effective: 11/1/2016
Last Updated: 09/18/2019

Responsible University Office:
Medical Student Education

Responsible University Administrator
Senior associate dean for medical student education

Policy Contact:

RESPONSIBLE Competency directors, course and clerkship directors
ACCOUNTABLE Curriculum Council Steering Committee
SUPPORT Medical Student Education
CONSULT General counsel
INFORM Lead advisors
Learning Technology, Medical Student Education

LCME Standards

3.5 Professionalism


This policy provides information on policies and procedures for the assignment, remediation and tracking of the Area of Concern (AOC) notification throughout all phases of medical education training. Course site leaders, clerkship directors and coordinators are expected to comply with the reporting requirements. All faculty members, resident physicians, fellows, and volunteer faculty members are expected to be knowledgeable and mindful of these guidelines while medical students are experiencing their respective courses/clerkships/electives.

Policy Statement

The AOC notification can be assigned during pre-clerkship courses, clinical clerkships and electives, or outside of course work on or off campus property. A student may also be evaluated and an AOC assigned by individuals who carry a “dean” title within the IUSM Educational Affairs unit who are not in the Office of Student Affairs for misconduct as outlined in the Academic Misconduct and Professional Conduct policies.

During courses/clerkships/electives, the notification to the student may be made as part of the mid-point feedback, at the end of the course/clerkship/elective, or at any other point during the course/clerkship/elective. The AOC notification should not be considered as a grade (or a component of a grade); it is intended to formally indicate concern with a student’s abilities in a competency area.

The AOC notification will not be included in the Medical Student Performance Evaluation. Failure to complete the AOC intervention plan may result in referral to the AOC Review Committee and possibly referral to the Student Promotions Committee (SPC); the SPC can then determine if the student’s failure to comply or repeated challenges warrants placing the student on Academic Monitoring or Academic Probation. Repeated AOCs will result in review by the AOC Review Committee, which will determine if referral to the SPC is warranted. The AOC notification is not appropriate for an egregious event. Egregious events should be referred to the SPC.

A notification of Area of Concern may be assigned to any of the following six competency areas or to “outside course/clerkship/elective.”

  • Patient Care (PC).
  • Medical Knowledge (MK).
  • Professionalism (P).
  • Interpersonal Skills and Communication (ISC).
  • Practice-Based Learning and Improvement (PBLI).
  • System-Based Practice (SBP).

Reason for Policy

The IUSM uses a competency-based curriculum. Early identification of students with challenges in the competencies enables educators to quickly intervene to help these students meet the identified milestones for the course or clerkship, and the institutional learning objectives (ILO).

This policy is intended to provide a method by which faculty can identify “low level” concerns in a course/clerkship/elective, and facilitate the opportunity for additional coaching by the lead advisor and/or competency director before these behaviors have a significant impact on performance outcomes.

The goals of the policy are to:

  • Provide early notification of a potential issue to students to encourage timely change.
  • Decrease assignment of Isolated Deficiency and failing grades.
  • Provide a formal process for the course/clerkship/elective directors and other educators to identify “non-failing” behaviors or trends.
  • Provide opportunities for early intervention.


Revised, reviewed, and approved by the Curriculum Council Steering Committee 09/17/2019.


When an educator (faculty or staff) recognizes an AOC, he/she (or the appropriate course, clerkship or elective director) should discuss his/her concerns with the student, and may then elect to initiate an AOC within the school management system. The initiation of the AOC is communicated automatically to the assistant dean of academic advising. The assistant dean of academic advising contacts the student, the student’s lead advisor, the course/clerkship/elective director, and the regional campus associate dean, and assigns the AOC to a specific competency director.

The competency director issues a Concern Intervention Plan Tracking Form to the lead advisor that either contains the appropriate intervention, from the appropriate competency director’s toolbox or developed specifically for the student. The lead advisor coaches the student through the interventions under the guidance of the identified competency director. In some cases, the competency director may meet with the student and coach the student through the intervention, or may enlist the assistance of other appropriate faculty members. The intervention must be completed within 30 days. Once the lead advisor completes the AOC Intervention Plan Form, the competency director notifies the faculty member who initiated the AOC, the regional campus associate dean and the assistant dean of advising that the intervention have been completed. If the intervention plan is not successfully completed within 30 days, the student will be referred to the Competency Committee and possibly the AOC Review Committee or SPC.

The AOC Review Committee will consist of the Senior Associate Dean for Medical Student Education and/or the Associate Dean for Curricular Development & Oversight, and two other individuals who are appointed by the Senior Associate Dean for Medical Student Education.

A student may appeal a submitted AOC if he/she feels it was submitted in error or its submission was not in accordance with existing policies. The appeal must be in writing and made within 7 days of being notified of the AOC. A three-member committee appointed by the Senior Associate Dean for Medical Student Education (AOC Appeal Committee) will review the appeal to the AOC and a decision will be rendered within 14 days of submission of the appeal.


No sanctions will occur if the student successfully completes the assigned intervention plan. However, referral to the AOC Review Committee will occur:

  • If the remediation is not completed
  • If a student has received three AOC notifications in different competencies, or two AOC notifications in the same competency.


AOC Appeal Form

Related Policies

  • Academic Misconduct Policy
  • Professional Conduct Policy

Additional Contacts

Subject Contact Email Phone
Technical assistance Educational Technology
Operatoins Medical Student Education 317-274-1965


Approved by Curriculum Council Steering Committee 10/11/2016.
Moved to the policy template 11/29/2016.
Name changed from Satisfactory with Concerns to Area of Concern 12/13/2016.
Friendly amendments made and approved by CCSC 2/14/2017.
Major revision including contacts, policy statement, elimination of Definitions and addition of Forms section and rewritten Procedure to include appeals process.
Approved by the FCC 07/23/2019.
Approved by the CCC 08/06/2019.
Approved by the CCSC with friendly amendments 09/17/2019.