Technical Standards for Admission and Successful Completion of the Osteopathic Program at VCOM

It is important that students review the Technical Standards for Admission and Successful Completion of the Osteopathic Program at VCOM prior to beginning clinical rotations, just as they did prior to enrollment. The student must self identify if they do not meet technical standards, especially those related to safety and proficiency in patient care.

The requirements to succeed at VCOM are those necessary to successfully complete the medical school curriculum and to safely practice osteopathic medicine with full practice rights. Students must be able to function in a variety of learning and clinical settings and to quickly, accurately, and consistently learn and process data in order to succeed in the medical school curriculum and to meet the technical standards for safely practicing osteopathic medicine as a physician. As the medical school program is a career path toward the practice of medicine in which students often accumulate great debt, all technical standards are considered in relationship to the culmination of the career to the practice of osteopathic medicine.

In addition to the above, the applicant must possess the abilities and skills in the following five areas to be a successful student at VCOM:

I. Observation, Hearing, Palpation, and the Sense of Smell

Osteopathic physicians utilize a hands-on approach to the examination and treatment of a patient. This requires a student to exhibit the sense of touch for examination, to be comfortable and have the ability to touch a human being of both sexes as part of the osteopathic approach to diagnosis and treatment.

Osteopathic physicians utilize visual inspection to examine tissue texture changes, skin coloration, equal position and balance of the musculoskeletal system, fine skills such as suturing or using a scalpel, and surgical removal of foreign bodies or certain tissues. As osteopathic medicine believes in training first a generalist in the first four years moving to specialized training in the residency, the sense of sight for inspection and to perform the above procedures is required to complete the curriculum. The student must be able to visually observe changes in the human body, laboratory demonstrations, microscopic tissue with the aid of the microscope, and computer based pictures used in laboratory demonstrations. The student must be able to visually and accurately observe physical signs and symptoms of a patient used in diagnosis and management. VCOM faculty have found that the use of a trained intermediary to perform such activities does not result in the same level of competency when mediated by another individual’s power of selection, observation, and experience, nor does it assure that the secondary persons perceptions are accurate without an equal education.

The sense of hearing for auscultation is needed in osteopathic medicine to listen for the sounds of bodily functions such as the beat and flow of blood through the heart, lung sounds, bowel sounds, the flow of blood through vessels, and other sounds associated with normal and abnormal findings. Reasonable accommodations may be made for students with hearing loss in the use of the stethoscope and with the student using their own personal hearing aids. The aids must lead to a reasonable hearing level to identify normal from abnormal body sounds. Osteopathic physicians also use the sense of smell, and although not an essential sense, is not easily accommodated.

As part of the educational process, VCOM students learn to touch patients. The only reasonable approach is then for a student to touch and to tolerate being touched. Therefore students who wish to attend VCOM must agree in writing to touch others in order to acquire the skills necessary for palpation and examination of peers (classmates) and to be touched by peers. In addition as not only palpation is required to learn the skills in osteopathic manipulative medicine, but to learn the maneuvers of manipulative treatment while under supervision in the learning environment is required. Prior to matriculation students must sign a waiver whereby they agree to touch other students in the process of examination and to be touched as well as to participate in the practice of osteopathic manipulative medicine skills. Acquiring the skills to palpate and examine patients also requires examination of disrobed patients of both genders. These skills are mandatory to successfully complete the curriculum at VCOM. In courses such as physical diagnosis and osteopathic manipulative medicine laboratory experiences, as well as other clinical laboratories where additional skills are acquired, students are required to participate in the examination and treatment (under faculty supervision) of their fellow students of both genders who may be partially disrobed. Students will need to wear attire such as shorts and to partially disrobe for certain laboratory experiences. These are requirements for all students, regardless of cultural beliefs, in order for the student to acquire the skills necessary to safely practice osteopathic medicine. Students who have any concerns or questions should discuss them with the Associate Vice President for Student Services prior to applying.

II. Communication

The student must be able to communicate orally and effectively in English as the curriculum and clinical experiences are offered in English and the physician must be able to effectively communicate with patients to offer safe and effective medical care. Students are encouraged to learn other languages for medical communication; however, all curriculum and assessment is given in English. VCOM requires the functional ability to speak, hear, and observe patients in order to elicit accurate medical information. The student must learn and demonstrate the ability to gather medical information in a humanistic manner and must be able both to recognize and describe changes in mood, activity, posture, and other physical characteristics and to perceive nonverbal communication required in patient centered medicine. The student must be able to communicate effectively and efficiently in verbal and in written form. The student must be able to communicate in writing, typing, and verbal conversation to effectively and efficiently communicate with the patient and all members of the health care team in order to provide safe and high quality care. The student must be able to demonstrate these forms of effective communication in a taped video setting with standardized patients, in the clinical setting during training, and in the academic setting.

III. Motor

Students must have sufficient motor function to elicit information from patients by palpation, percussion, and other diagnostic measures. The student must have sufficient motor function to carry out maneuvers of general and emergency care and of osteopathic manipulation. Examples of emergent motor functions are cardiopulmonary resuscitation, administration of intravenous fluids and intravenous medications, management of an obstructed airway, hemorrhage control, closure by suturing of wounds, and obstetrical deliveries. In addition, the delivery of osteopathic manipulation requires the use of extremities in palpation, positioning, and carrying out maneuvers of manipulation. These actions require fine and gross motor and sensory function. The student must be able to perform these maneuvers with reasonable accommodations.

IV. Intellectual

The student must have the ability to reason, calculate, analyze, measure, and synthesize information in order to critically evaluate the patient and the most recent evidence based information. The student must be able to comprehend, memorize, synthesize, and recall a large amount of information without assistance, to successfully complete the curriculum and to safely and successfully practice osteopathic medicine.

The student must be able to comprehend three-dimensional relationships and to understand spatial relationships as it pertains to body chemicals and microscopic functions to anatomical functions in order to succeed in school and to administer safe medical care. The student must be able to gain knowledge through all types of learning materials that the VCOM curriculum offers and must be able to perform pattern identification, memorization, recall information, and to identify and discriminate important information and to problem solve.

The curriculum of VCOM mimics in many curricular events and testing situations the clinical setting in which osteopathic medicine is practiced. This requires a student to examine patients, calculate and make medical decisions in timed testing situations and in the presence of noise and distraction. Students must consider these requirements at the time of application and to whether they can meet these technical standards required in the curriculum and in the practice of medicine. The prior intellectual abilities are necessary, as students and graduates will be expected and required to perform pattern identification, immediate recall of memorized material, identification and discrimination to elicit important information, problem solving, and decision-making as to emergent diagnosis and treatment of patients in urgent and emergent settings to pass not only the third and fourth year of medical school but to complete the first year of residency training. Students must be able to recall important information for diagnosis and to calculate therapeutic management of emergent conditions. This type of demonstrated intellectual ability must be performed in a rapid and time-efficient manner so as not to place patients in emergent conditions at risk. It is common for emergent situations to occur in the presence of visually distracting and noisy environments. Such emergent situations include, but are not limited to, cardiopulmonary compromise, cardiopulmonary resuscitation, obstetrical and neonatal emergencies, trauma presentations, poisonings and toxic exposures, shock, and hemorrhage. It is then important for an osteopathic medical student to be able to perform in distracting and noisy environments as this is the most often environment for a physician. These situations are simulated, taught, and tested in the classroom, clinical setting, and in the simulated medicine testing laboratories. VCOM is required by accreditation to require students to pass COMLEX level I, CE, and PE exams therefore the student must be able to perform satisfactorily on comprehensive standardized exams. NBOME determines the students ability to receive accommodations or not for this exam and therefore the students ability to pass the board exams with the accommodation level awarded by NBOME is the technical standard. Students may ask NBOME to be reviewed for accommodations.

V. Behavioral and Social Attributes

The student must have the emotional health needed for full use of his/her intellectual capabilities at all times. The emotional health required for effective communication and for professional, mature, sensitive, and compassionate patient/physician or patient/student relationships must be present. students must be able to function effectively under the high degree of stress and testing required in medical school, in COMLEX national board testing including COMLEX 1, CE, PE, and COMLEX III, as well as in specialty board certification at the end of residency. Students who suffer from test anxiety should strongly consider if they will meet this technical standard as they are essential to the success of a physician in being able to practice.

Students must be able to tolerate physically taxing workloads. Students who have conditions that do not allow physically taxing workloads must consider the long hours of study, the hours required in the classroom and laboratories, the physical strength required in the osteopathic examination and treatment, and to stand and ambulate for long hours in the clinical setting.

Students must have the emotional health to be able to safely care for patients without the aid of medications that are known to affect intellectual abilities and clinical judgment. The student must have the emotional stability and motivation to deliver patient care and to make emergent decisions at all times. The ability to adapt to changing environments and stressful situations and to display compassion and integrity, while maintaining the necessary intellectual capacity to care for patients is one that is observed during the interview process and throughout the progress in medical school. An ability to demonstrate the emotional health necessary for the delivery of quality and safe medical care is mandatory throughout medical school. VCOM and the medical institutions they collaborate with for clinical training consider addiction, mental illness that does not allow safe coherent reasoning or that may cause a risk to the patients the student or physician is caring for, or the participation in any form of substance abuse that poses a risk for unsafe medical care is a reason for not accepting a student or for dismissal.

Students must have the emotional health and social capabilities to effectively and safely care for patients. This requires the student to demonstrate careful and safe decision making at all times, and be able to discriminate between legal and illegal behaviors, moral and immoral decisions, ethical and unethical decisions, and professional and unprofessional behavior. The same behaviors are expected of students throughout their program.

Individuals with Disabilities: VCOM is committed to making reasonable accommodations for students with disabilities whose disability allows them to meet the minimal technical standards above that are required to safely deliver osteopathic medical care and for the student to be able to accomplish a successful career as an osteopathic physician. Reasonable accommodations do occur if with the accommodation the student is still able to meet the technical standards designated to safely practice osteopathic medicine and to be successful in the VCOM curriculum. The student is required to function with independence, to learn and perform all the skills described in technical standards that include coursework, pathology and microbiology laboratory performance, clinical physical diagnosis and osteopathic manipulative medicine laboratories, and frequent and routine testing require. Students must also meet the technical standards to provide safe and effective clinical care with reasonable accommodations to complete third and fourth year rotations in the hospital and ambulatory settings. VCOM faculty and administration require the technical standards to be met (mandatory) for the safe and effective practice of osteopathic medicine. VCOM facilities are handicap accessible.

Self Assessment and Meeting Technical Standards: VCOM is committed to making the accommodations that make a student successful. VCOM has provided reasonable accommodations to many students with various handicaps that have enabled the student to be successful. VCOM is also committed to assuring patient safety and to assuring a safe and effective environment that does not place patients and/or VCOM students, faculty, and staff at risk. Each technical standard listed above was derived from standards that osteopathic physicians deem necessary for the safe and effective practice of osteopathic medicine. Students should read the technical standards carefully to determine if they will be successful in the VCOM program.

If a candidate has a question as to his/her ability to meet the minimal technical standards listed above, he or she should contact the Associate Vice President of Student Services in advance of applying to determine if reasonable accommodations exist to allow the student to complete the curriculum and safely practice osteopathic medicine. All osteopathic medical students must successfully complete the three stages of COMLEX exams to practice medicine therefore the student must have the technical ability to complete comprehensive standardized exams.

In order for VCOM to provide reasonable accommodations, candidates must identify to the Office of Admissions, all areas where accommodations will be needed in order to be successful in the educational program or where there is question in meeting these technical standards. Students who fail in the curriculum or who are suspended or dismissed will not be considered for disability if they have not identified the disability and requested reasonable accommodations in advance. In many cases, VCOM requires a formal disability evaluation by a specialist or team of specialists to identify the appropriate accommodations to assist a student in meeting technical standards and to determine if the provision of accommodations will allow the student to safely and effectively practice osteopathic medicine and participate in patient care. VCOM is committed to providing reasonable accommodations where patient safety and effective practice standards are not compromised.

Student Participation in Special Environments

Education at VCOM takes place in special environments, such as the anatomy lab and clinical facilities that may contain hazardous physical and chemical environments. Working and studying in these special environments may require the student to make an informed decision concerning continued participation because failure to participate in required classes could result in dismissal. Examples may include, but are not limited to: students who believe they are allergic or sensitive to certain chemicals, students who are pregnant and are concerned about potential hazards to a developing fetus, or students who believe they are immuno-compromised or have increased susceptibility to disease. The student must decide upon their ability to participate prior to beginning school. For a student who develops problems or becomes pregnant after starting, their program may be delayed until the student has seen an allergist and has taken appropriate precautions to successfully complete the program, or the pregnancy is completed. If the student is unable to attend, he/she should obtain a medical withdrawal from VCOM.

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