Throughout the medical education continuum, some students encounter difficulty in meeting academic or professional standards that leads to remediation or dismissal. Termination of a student without due process may lead to litigation by deprivation of a student's property or liberty interest. This article outlines the concept of procedural and substantive due process as applied to litigated student dismissal cases in undergraduate and graduate medical education. Determination of the amount of due process owed is based on whether the dismissal is academic or nonacademic. The decision to dismiss a student where the entire student record has been reviewed, due process provided, and the institution complied with its own policies is usually upheld by the courts in litigation. Abstract Throughout the medical education continuum, some students encounter difficulty in meeting academic or professional standards that leads to remediation or dismissal. Termination of a student without due process may lead to litigation by deprivation of a student’s property or liberty interest. This article outlines the concept of procedural and substantive due process as applied to litigated student dismissal cases in undergraduate and graduate medical education. Determination of the amount of due process owed is based on whether the dismissal is academic or nonacademic. “University faculties must have the widest range of discretion in making judgments as to the academic performance of students and their entitlement to promotion or graduation.” This excerpt from the US Supreme Court’s decisions in Board of Curators, Univ. of Missouri v Horowitz and Regents of the University of Michigan v Ewing serves as a guiding principle in how due process of the law is meted out in both remediation and termination processes in undergraduate medical education (UME, medical school) and graduate medical education (GME, internship/residency). The Committee provided her notice and said they would consider other grounds they discovered. Student also received notice that it would consider evidence of unethical conduct (dishonesty) that included misrepresentation regarding loans, reasons for not taking NBME exam, lack of congruency in health insurance application, and false pledges during an alumni phonathon. At student’s request, an ad hoc committee was convened to evaluate dishonesty claims. Student appeared with her attorney and was allowed to call witnesses and the session was tape-recorded. The Ad Hoc Hearing Committee found the dishonesty claims credible. The Academic Standing Committee subsequently convened and considered the dishonesty claims as being relevant to student’s credibility. The Committee found she failed to demonstrate the required level of professional responsibility in not taking exams in a timely manner, not accepting responsibility for her actions, and disregarding mandates about the NBME exam. After review of her entire record, the Committee recommended dismissal. An Appeals Committee upheld the dismissal. Student filed a lawsuit alleging defamation, infliction of emotional distress, breach of contract, lack of substantive due process, conversion of student loan money, breach of fiduciary duty, and fraud. Specifically, the clerkship director stated that the failing grade was based on “several episodes of intellectual dishonesty, unsatisfactory ratings from both the students and myself, and a deficit in performance in areas such as self-responsibility for learning, relationships with peers and faculty, and attendance.” The student appealed the grade to the clerkship director and then to the Dean. The failing grade was upheld. The school’s Promotions Committee reviewed the clerkship performance and the student’s entire academic record and recommended dismissal. Performance in the clinical curriculum is also considered “an ‘academic’ judgment because it involves observation of her skills and techniques in actual conditions of practice.” 1 In a concurring opinion in Ewing , Justice Powell stated “Judicial review of academic decisions, including those with respect to the admission or dismissal of students, is rarely appropriate, particularly where orderly administrative procedures are followed.” 2 However, the Supreme Court argues in nonacademic cases that procedural due process requires that a “student be given oral or written notice of the charges against him, and if he denies them, an explanation of the evidence the authorities have and an opportunity to present his side of the story.” 33 Due Process in Graduate Medical Education Failure to provide due process is also considered in cases of residents As such, Overlook’s interest in academic freedom predominates because the relief sought by plaintiff will result in an “appreciable interference” with the Appeal Board’s academic judgment.” They further commented, “A graduate or professional school is, after all, the best judge of its students’ academic performance and their ability to master the required curriculum.” Imposition of legal proceedings for purely academic issues would limit academic deliberations. 36 Further, “If academic termination hearings are transformed into proceedings that involve legal procedures, the academic hearing would become an adversarial and litigious contest. Lapses in professional judgment are sometimes difficult to “prosecute” as compared to purely academic issues. They are often difficult to address with students, residents, and even faculty. These lapses may eventually lead to disciplinary actions by state medical licensing boards. 53 These failures are at times ignored or passed up the chain of command when there were findings to terminate the student or resident earlier in the educational continuum. 54 The courts will look to the judgment of the faculty on whether the individual in question met the institution’s standards provided due process was adequate. 2 In dealing with these type of cases, documentation is critical.