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Gold Humanism Honor Society Nomination Form

The University of Kansas School of Medicine chapter of the Gold Humanism Honor Society, sponsored by the Arnold P. Gold Foundation, recognizes third year medical students, residents and faculty who have displayed outstanding humanistic and professional behaviors and the highest standards of compassion and sensitivity in their interactions with patients, faculty, student peers, and institutional administration.

Based on the statements below, submit a written nomination of a third-year student, resident or faculty member using the online form below. You may nominate more than one individual, and your name is not shared with the nominee(s). Anonymous nominations will not be considered.

Nominations will be accepted on a rolling basis until January 6, 2020. Nominees will be notified and will be asked to submit a written personal statement to support their nomination. All nomination materials will be reviewed by the GHHS Selection Committee. Those selected for membership will be informed via email in early February.

Members of the KUMC Chapter of the Gold Humanism Honor Society should exemplify the following characteristics:

Demonstrated excellence in clinical care Leadership

  • Helps build and maintain a culture that facilitates professionalism
  • Engenders trust and confidence among patients, staff, colleagues, and supervisors
  • Role model by example
  • Serves as an advocate for patients and peers
  • Through personal example encourages and empowers others to hold themselves to higher standards
  • Exemplars for the student body


  • Consistently demonstrates compassion and empathy in the delivery of care to patients
  • Treats the patient as an individual, taking into account lifestyle, beliefs, personal idiosyncrasies, support system
  • Pays attention and is sensitive to the patient's psychological well-being
  • Demonstrates concern for the general welfare of the community

Dedication to service

  • Contributes to the profession


  • Respects institutional staff and representatives
  • Respects faculty during teaching sessions
  • Respects patient rights/dignity
  • Shows respect for those with whom he/she interacts

Demonstrated Professionalism

  • Illustrates professional behavior by example
  • Willing to help others
  • Takes responsibility for appropriate share of team work

Outstanding Interpersonal Skills

  • Empowers patients and colleagues through effective communication and listening skills
  • Demonstrates outstanding interpersonal skills, including listening and effective communication skills. 
  • Demonstrates cultural sensitivity and competence in working with patients and family members of diverse ethnic or religious backgrounds
  • Interacts with patients and their families in ways that empower the patient to participate in their health care to the full extent they desire

Maintaining integrity in the face of difficult ethical issues

  • Demonstrates personal integrity and a willingness to take a stand on principle
  • Deals with confidential information discreetly and appropriately

Becoming effective change agents to improve the health care environment.

  • Exhibits a commitment to enhancing positive interactions among all members of the health care team


  • Willing to admit errors and able to identify own areas for learning/practice improvement
  • Is self-critical and able to identify own areas for learning/practice improvement
  • Seeks and accepts criticism; uses it to improve performance
  • Is personally committed to self-evaluation
  • Willing to seek help from others

All fields are required.

Last modified: Jul 18, 2019