VCOM Student Policies and Procedures Handbook

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Clinical Policies and Procedures

White Coats and VCOM ID Badges

The VCOM short white coat and ID badge identifies the individual as a medical student at VCOM. Students must wear their VCOM white coat and ID badge in all VCOM designated clinical settings and to designated and approved VCOM events. The VCOM white coat and ID badge should not be worn by students nor should students verbally represent themselves as representing VCOM for non-VCOM sponsored events, including but not limited to: “shadowing” experiences which are not part of the VCOM curriculum, volunteer activities which are not VCOM sponsored, or functions which are not VCOM events such as those which are of a political or social nature.

Students should not give their white coat or ID badge to another student or an individual who is not a VCOM student. If the VCOM white coat or ID badge is missing or stolen, the student must report this to the Assistant Vice President for Student Services as soon as possible. Not wearing the white coat and ID badge as required, wearing the VCOM white coat or ID badge to non- VCOM sponsored events, or giving or loaning these items to others is considered unprofessional behavior and subject to disciplinary action (see the Honor Code and the Professional and Ethical Standards Board sections of this Handbook). Any questions or clarification should be directed to the Assistant Vice President for Student Services.

Students’ Involvement in Patient Care

Upon admission, students are required to obtain and to provide the required documentation indicating that they do not have conditions that would endanger the health and well-being of patients. The documentation includes immunizations and titers for immunity, verification from a physician who has performed a medical history and physical examination as to the health of the student and background checks for a legal history. Students must also be able to demonstrate that their health and abilities will enable them to meet the technical standards of the program. See Technical Standards for Admission to VCOM and Continued Enrollment, Health Requirements, Screening and Occupational Exposure of Students, and Alcohol and Drug Testing in this Handbook, or in the College Catalog, or on VCOM’s website at: www.vcom.vt.edu.

Patient Confidentiality

During the course of study, students will come in contact with a patient's confidential information. Special laws, such as the Health Insurance Portability and Accountability Act (HIPAA), govern the release of confidential patient information to others. In general, students are permitted to discuss patient information with medical personnel who are directly involved in providing the patient's care or, in some cases, in making a medical presentation. Students must obtain permission for presentations and should not divulge a patient's name or other confidential information identifying the patient. Students should not divulge a patient's confidential information in casual comment or in any other arena in which they do not have the patient or physician’s permission to do so.

Any discussion of a patient, peer, physician or healthcare facility should be a professional discussion and not cause misunderstanding or distrust of the medical care offered at the site. Failure to adhere to this professional behavior may constitute a violation of the VCOM Honor Code.

Performing Patient Care Activities

Student involvement in patient care is permitted when authorized by the assigned preceptor. The student's preceptor is the faculty member responsible for supervising the student in assigned patient care. Students may not perform any medical treatment or procedures without appropriate supervision. The preceptor generally should be present for any treatment, procedure, or invasive exam. Students are not to take the place of qualified staff. Students may not write patient care orders independently and all such orders must be reviewed and approved by the preceptor. Students may not accept payment or remuneration for services.

Clinical Rotation Assignments

Clinical rotations are assigned by the Office of Clinical Affairs. Third year students request their five top choices of clinical sites. Utilizing a “match process,” staff in the Office of Clinical Affairs attempt, to the best of their ability, to make clinical site assignments based on the students’ top choices. When it is impossible to meet the student’s top choice(s), assignments are made with the aim of best meeting, collectively, the student’s educational goals and geographic/personal preference.

Fourth year students complete a Clinical Rotation Schedule Form with their proposed rotations and schedule and submit it to the Office of Clinical Affairs for approval. Utilizing a “match process”, the Office of Clinical Affairs attempts to meet student requests to the best of their ability. When requested rotations, times, or locations cannot be accommodated, the Office of Clinical Affairs will make assignments based on the students educational goals and geographic/personal preferences.

Change of Rotation Requests—Extreme Hardships

Although rarely granted, students who wish to change their rotation site after assignments have been made may only apply for a change of rotation site if they have an extreme hardship. A change of rotation request form must be completed and students must designate the nature of extreme hardship on the form. In addition, to the Change of Rotation Request form, students must write a letter describing the necessity of the change; students are required to verify all information leading to an extreme hardship request. That letter must accompany the Change of Rotation Request form. A student may discuss their circumstances to determine if they qualify for an extreme hardship, in advance, with the Director of Clinical Rotations. Upon receipt of the Change of Rotation Request form and letter, information is carefully reviewed by the Associate Dean for Clinical Affairs and an appointed committee from Clinical Affairs and faculty who make the decision on all hardship requests. If the student if not satisfied with the outcome of the decision, they may appeal the decision to the Dean; the Dean’s decision will be final.

The Clinical Program

The responsibility for decisions directly affecting the educational experience of students in their clinical setting resides with the Associate Dean for Clinical Academic Affairs.

The Associate Dean for Clinical Academic Affairs is responsible for supervising and directing the clinical education of VCOM students. To fulfill this role, the Associate Dean for Clinical Academic Affairs may delegate appropriate authority to the DSME and Clinical Department Chairs within the College.

The Associate Dean for Clinical Academic Affairs is responsible for decisions directly affecting the educational experience of the students within the clinical site. The Associate Dean for Clinical Academic Affairs has the authority to evaluate, establish, and arrange for clinical rotations at hospitals and/or clinics that he/she believes are of high quality, and to make decisions relative to preceptors, services, academic issues, and behavioral issues that occur. Decisions will be made to maximize the educational experience of the student. Other factors that may be considered in such decisions include personality conflicts, availability of staff, hospital census, or any other factor that impacts medical education.

The Associate Dean for Clinical Academic Affairs may require student attendance at scheduled conferences and presentations, writing of papers, case presentation and other appropriate activities. In short, the Associate Dean for Clinical Academic Affairs has the authority and responsibility to enforce the academic policy of the College at the clinical sites. In the event that a student does not abide by the decisions of the Associate Dean for Clinical Academic Affairs, further procedures may be initiated as defined in the in this Handbook and at VCOM’s website at www.vcom.vt.edu.

The Associate Dean for Clinical Academic Affairs is responsible for providing a progress report for VCOM students to the Promotion Board with recommendations for pass or failure, following the completion of all third year requirements. The Associate Dean for Clinical Academic Affairs is also responsible for providing a progress report for VCOM students to the faculty at the completion of fourth year to recommend for graduation.

As part of the Medical Student Performance Evaluation (Dean’s letter), the Associate Dean for Clinical Academic Affairs will provide an assessment of the student’s strengths and weaknesses in their clinical training. Both cognitive skills and non-cognitive issues will be addressed. This assessment is based on discussions during site visits, preceptors or site leadership. student interviews, as needed, evaluation forms and log sheets. Those students who are experiencing clinical academic difficulties will be required to meet with the Associate Dean for Clinical Academic Affairs. All students are encouraged to meet with the Associate Dean for Clinical Academic Affairs, especially those who are unsure of the direction of their fourth year.

If a student fails a clinical rotation, the Associate Dean for Clinical Academic Affairs will interview the student and either the appropriate clinical chair or the Associate Dean for Clinical Academic Affairs will interview the preceptor; a written record of these interviews will be kept. The Associate Dean for Clinical Academic Affairs also will make a recommendation to the Promotion Board concerning the student's failure based on overall performance and overall knowledge content that was gained or missed. This recommendation is non-binding. The Promotion Board makes the final decision. The Associate Dean for Clinical Academic Affairs may enlist the appropriate clinical chair to assess the student difficulties and the terms of the remediation.

The Vice Dean (or his/her designee)  has the authority to initiate interim temporary suspension or an immediate medical leave for VCOM students. If the Vice Dean (or designee) determines that a student may constitute a threat to their own welfare or that of fellow students, staff, or patients, the student may be suspended or placed on medical leave effective immediately. Once placed on leave or suspended, the student is no longer covered by VCOM policy (liability coverage, etc.). This notification must be in writing, and the Dean must be notified within three working days of such action. Possible situations where such action may be necessary include, but are not limited to the following:

1. Substance abuse (alcohol & other drugs);
2. Medical or psychological illnesses;
3. Suspected or alleged illegal behavior (until evidence resolves or substantiates evidence);
4. Suspected or alleged physical, sexual, or emotional abuse (until evidence resolves or substantiates allegation), or
5. Other unethical or unprofessional behavior.

The power of the Vice Dean (or designee) to initiate interim suspension is not limited to the above list. Immediately following a temporary suspension, a Behavioral Board or Promotion Board will be called. The initial step in the process is to notify the Dean as to the need for such a hearing.

Early Clinical Experience

Osteopathic medical students in years one and two have approximately 20 one-day clinical experiences. These experiences are in both ambulatory and hospital sites. The experiences are varied and include such experiences as pharmacology rounds, geriatric assessment, Appalachian medical missions, and internal medicine rounds.

Clinical Core Rotations

Osteopathic medical students in years three and four are assigned to regional hospital sites. Here the clinical experiences occur primarily within hospital sites for inpatient experiences, in ambulatory family practice sites, in geriatric acute care facilities, and in rural small and critical access hospitals for the underserved care experience. The didactic and online curriculum for the educational program in each institution is provided by VCOM. In addition, the clinical rotations are assigned and the program assessment is managed through the campus office for Clinical Affairs, therefore VCOM is the main point of contact for each site regarding the educational programs for students.

Osteopathic Medical Student—Year Three

VCOM’s third year osteopathic medical students are required to complete nine clinical rotations. Each rotation is estimated at 180 hours, with 160 hours in the regular program and 20 hours or greater on call per month. The required rotations for third year are listed below; all rotations must be taken and completed at VCOM core rotation sites. These rotations must be successfully completed to progress to the fourth year.

Core rotations are:

Family Medicine	Pediatrics
Underserved Care	Psychiatry
Internal Medicine	Medical Selective
Surgery	Geriatrics
Obstetrics/Gynecology	Capstone experience

Clinical Modules and VCOM TV

Students are provided with required curriculum during the third year. Independent learning objectives are provided for the core discipline rotations. Campus clinical conferences occur and are broadcast to each clinical site. Students are required to attend the monthly clinical
conferences.

Students are also provided with web-based teaching including clinical case modules, VCOM TV delivered presentations, and interactive web based instructional programs. These programs provide additional hours of curriculum instruction. The modules contain clinical material, basic science review/integration, and osteopathic principles and practices.

Clinical cases include:

Family Medicine	20 hrs
Underserved Care	20 hrs
Internal Medicine	20 hrs
Surgery	20 hrs
Obstetrics/Gynecology	20 hrs
Pediatrics	20 hrs
Medical Selective	20 hrs
Psychiatry	20 hrs
Geriatrics	20 hrs

Some departments require additional curriculum such as Sim-cases or online programs and presentations on VCOM TV. Specific requirements are listed on the clinical chair’s webpage.

Examinations

A post-rotation exam follows each third year rotation and a comprehensive exam is given at the end of the third year. Students who do not pass the post-rotation exam are given one chance to remediate. If the exam is failed twice, the student will be given an F and the case will be sent to the Promotion Board. Students must pass the comprehensive exam at the end of the year in order to progress to fourth year.

A Clinical Performance Examination also is given to assess clinical skills at the end of the third year. Students must take and pass the OSCE and Standardized Patient Exams in order to progress to the fourth year.

Exams cover the educational objectives in the Learning Objectives for Ambulatory Care Rotation guide, the Learning Objectives from the Core Disciplines guide, and the material found in the web-based instruction. Students must successfully pass the Comprehensive MS III examinations prior to taking required fourth-year rotations.

Osteopathic Medical School—Year Four

To become eligible for graduation, each fourth year student must have passed the written COMLEX Level 2 including the PE component.

Requirements:	VCOM 4th Year Medicine Selectives	8 weeks
	VCOM Surgical Selectives	8 weeks
	Emergency Medicine	4 weeks
	Electives	16 weeks
	Vacation and Interviews	2 weeks
	Research, Thesis and Board Preparation (comprehensive clinical review)	6 weeks

Note: Minimum requirements for clinical rotations are 160 hours each for four week rotations, and 80 hours each for two week rotations.

Medical and Surgical Selectives are to be completed at VCOM sites where VCOM has established rotations, affiliation agreements and faculty. An exception may be granted for up to two Selectives in an outside region where AOA post-graduate programs exist. 

Most rotations are scheduled on a four week basis. The scheduling document accommodates for the approved two week rotations. Rotations cannot be split.

Choosing In-Region Medicine and Surgical Selectives

Students request dates, specialties and include desired preceptor if known. The Office of Clinical Affairs will schedule the rotations according to the availability of rotation and numbers of requests. Students are not to make their own arrangements for these rotations as these will not be honored.

Choosing an AOA Approved Residency Selective Site

VCOM does not arrange student’s selectives that are outside VCOM’s regional sites. If a student chooses to do one or two selectives at hospitals where AOA accredited post-graduate programs exist, they must arrange those rotations themselves. Students may do two selectives where AOA accredited post-graduate programs exist or at a military facility (HPSP students only). All paperwork for selectives must be completed and submitted during the approved selection time period as noted by the Office of Clinical Affairs.

VCOM will not approve selectives to be taken outside of the VCOM region at a hospital where only ACGME residencies exist or at a hospital where no residency exists. Students cannot ask for an exception as it will not be provided.

VCOM consistently updates its core clinical training sites; therefore, students are encouraged to access this information via VCOM’s website at: www.vcom.vt.edu.

VCOM selectives are chosen from the VCOM Surgical and Medical Selective lists and are based on a student's self-assessment of areas where they would benefit most from further education and patient exposure, along with input from the Associate Dean for Clinical cademic Affairs.

Four electives may also be scheduled outside VCOM regional hospital sites, however, each elective site must be pre-approved through the Associate Dean for Clinical Academic Affairs.

Formal curriculum delivery continues in year four. The curriculum consists of clinical rotations and a thesis level written case presentation or publication for original research, and periodic internet delivered presentations.

Selectives and Elective Rotations

Medicine Selective Rotations

List 1: A minimum of two rotations must be taken from the following areas. A rotation may not be repeated in these disciplines: Cardiology, Nephrology, Pulmonology, Infectious Disease, Hospital based Internal Medicine, Critical Care, Intensive Care, Sub-Internship, Pediatric hospital-based subspecialties. One of these must be taken within the last five months of the fourth year.

List 2: An additional rotation may be taken in one of the following as a medicine selective: Neurology, Rheumatology, Endocrinology, Internal Medicine, Family Medicine, VCOM International Medical Missions, Psychiatry, Hematology/Oncology, OMM, Physical Medicine and Rehab*, Allergy/Immunology*, Sports Medicine* from a primary care focus and Gastroenterology.

In order to offer the student a broad scope of training, medical selectives are not to be repeated.

Surgical Selective Rotations

Ophthalmology*, Otorhinolaryngology*, Oromaxillofacial surgery*, Orthopedic Sports Medicine, Anesthesiology*, Orthopedics, Neurosurgery, Cardiovascular surgery, Plastic Surgery*, Surgery Trauma Unit, Urology*,
Vascular surgery, Urogynecology, Gynecology/Oncology Surgery, Ortho Spine Surgery, Surgical Critical Care.

In order to offer the student the broadest content possible, surgical selectives are not to be repeated .

*May be two or four weeks. Students should not schedule more than four, two-week rotations.

Elective Choices

All electives require prior approval by the Associate Dean for Clinical Academic Affairs.

Elective rotations may be repeated.

Elective rotations include:

• All rotations outlined in the third year Core.
• All rotations included in the Medical Selective List
• All rotations included in the Surgery Selective List
• The additional rotations of: Occupational Medicine, Forensic Pathology, Pathology, Pediatric subspecialties, Addiction Medicine, Adolescent Medicine, Maternal/Fetal Medicine, Reproductive Endocrinology, Radiology, Dermatology, Palliative Care, Gynecology, Clinical Research, Trauma, Biomedical Research, Proctology, Pain Management, Urgent Care, Rural Medicine, Health Policy, CDC, NIH, or other federally sponsored rotations.

Other electives not included may be approved on a one by one basis if approved by the Associate Dean for Clinical Academic Affairs.

Non-VCOM International Medical Missions rotations must be affiliated with a medical school, DOCARE or a federally sponsored organization and approved in advance by the Associate Dean for Clinical Academic Affairs. VCOM does not assume any liability for health or safety while on international rotations.

Required Textbooks

Each rotation has a required and suggested textbook reading list. Students are responsible for purchasing the required textbook and the NMS series (text/case book and board review) for that discipline. A book list is mailed annually to students and each discipline lists the required textbooks online. In addition, information about required textbooks is presented to each class during the Introduction to Clinical Rotation Series.

In order to acquire the knowledge for the post-rotation exam and for ongoing board review, students must read all assigned text and use the NMS series to review the online cases.

Rural and Underserved Clinical Training

In general the majority of students spend five months in a micropolitan area or small city and five months in rural or small community hospitals. One of the rural months may include a critical access rural practice or at a rural hospital. In some cases students spend all nine months in a rural and small community hospital setting.

VCOM has developed a model medical curriculum that provides significant training experiences in rural areas. VCOM has established the resources for an academic environment in the rural and community based hospitals through electronic libraries, advanced telecommunications and videoconferencing systems, and a structured academic program. Rotations in the rural sites are designed to provide optimal learning experiences, and students will gain an appreciation for the many rewards of rural and community based medicine. Students have one-on-one teaching experiences with the preceptor and will have opportunity for hands-on learning experiences.

Clinical Competencies

In the clinical setting students assume the responsibility for obtaining knowledge from the readings and experiences rather than from lectures and laboratories. Although faculty physicians will direct learning, the faculty member’s first obligation is to patient care. Students must become self motivated learners which includes the skills for life long learning that a physician must acquire to become and remain competent.

During the rotation students must learn the objectives outlined for that rotation located on the clinical chair’s website. Students must also read all assigned text and that text associated with the cases from the NMS series, and complete the cases on the clinical chair’s website. These assignments will prepare the student for the post-rotation exam and for COMLEX Level 2, including the PE component.

Students must also conduct literature research in those areas assigned by the preceptor or about a patient they may have managed on the service.

VCOM Core Hospital Sites

VCOM consistently updates its core clinical training sites; therefore, students are encouraged to access this information via VCOM’s website at: www.vcom.vt.edu.

Notice of Site Changes

Hospital sites are subject to change based on the VCOM administration, student training needs, and/or administrative changes in hospitals. While the training sites are subject to change without notice to students, those students who are in clinical rotations at the time of the change will be accommodated for the duration of the rotation when possible. Rotation site changes will be updated annually.

Director of Student Medical Education

The DSME oversees the clinical site in the evaluation, establishment, and arrangements for clinical rotations at hospitals/clinics, collaborating with VCOM through the clinical chairs and the Associate Dean for Clinical Academic Affairs.

The DSME may require attendance at scheduled conferences, grant leave of up to four days per year under the excused absence policy, and assign additional requirements such as: written papers, attendance at special events, presentation at rounds, etc. The DSME, just as the Associate Dean for Clinical Academic Affairs, has the authority and responsibility to enforce VCOM's academic policies of VCOM in the clinical site.

In the event that the DSME determines that a student may constitute a threat to the welfare of themselves, fellow students, staff, or patients, the DSME may suspend the student or place the student on leave.

Medical Records/Charting

The responsibility given to students for medical records varies among the hospitals and clinics. Some sites allow students to write full progress notes and orders directly into the patient's chart. When this is allowed, notes must be immediately co-signed by the supervising physician and that physician must follow this with his or her physician note. At no time do student notes serve as the physician preceptor’s notes. Billing must be directly related to the physician preceptor’s notes. Some other hospitals/clinics have separate pages in charts set aside for"Student Progress Notes." These should also be reviewed and co-signed by the attending physician. Notes are usually written in the SOAP format. If dictation or computerized entry is allowed by students at a particular hospital or clinic, the resulting notes must also be reviewed and approved by the attending. The student is responsible for obtaining charting instructions from the preceptor or rotation coordinator.

NOTE: The student is responsible for knowing proper procedure and must sign and date all entries on the medical record by name and educational status (e.g., John Doe, MSIII or OMSIII).

Supervision of Students

A student on clinical rotations must be supervised in patient care situations. Supervision involves a responsible licensed physician to:

• Be physically located in the facility where patient treatment is rendered;
• Grant authorization of services provided by the student doctor;
• Examine all patients seen by the student doctor;
• Witness procedures when performed by the student doctor; and
• Assure that the documentation in the patient's medical record is appropriate.

Student Problems/Issues

If a precepting faculty suspects or identifies problems with a student's progress or performance they are to contact the Associate Dean for Clinical Academic Affairs. All reports will be thoroughly investigated and, should action be taken, the appropriate procedures as outlined in this Handbook will be followed. Examples of such problems may include, but are not limited to:

• Poor interpersonal skills (i.e., personality problems, etc.);
• Deficient clinical skills;
• Below average academic performance;
• Unexcused absenteeism;
• Medical or psychological illness;
• Suspected substance abuse (alcohol and other drugs);
• Suspected illegal behavior; or
• Suspected physical, sexual, or emotional abuse.

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

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 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.

 

Health Requirements

Students must maintain these health requirements as detailed below throughout enrollment. VCOM may require the following laboratory tests and immunizations:

Annual TB test (PPD)
Tetanus toxoid immunization
Hepatitis B virus (HBV)
Measles (Rubeola), Rubella and Mumps
Varicella
Meningococcal Vaccine
Influenza

VCOM does not waive these requirements for religious reasons or personal preferences.

Specific information about the documentation required for each laboratory test and immunization can be found on VCOM’s website at www.vcom.vt.edu. Evidence of the above requirements is required each year while at VCOM and must be submitted to the Office of Clinical Affairs.

Required laboratory tests and immunizations may change annually based on recommendations from the Centers for Disease Control (CDC), the United States Prevention Task Force, and healthcare facilities. Students will be notified of any change.

Universal Precautions

Universal Precautions is an approach to infection control according to which all human blood and certain human body fluids are treated to be as if known to be infectious for HIV, HBV, and other blood-borne pathogens.

Universal precautions shall be practiced in the care of all patients. Gloves should be worn:

• When touching blood and body fluids requiring universal precautions, mucous membranes, or non-intact skin of all patients, and
• When handling items or surfaces soiled with blood or body fluids to which universal precautions apply.

Sterile gloves shall be worn in connection with surgical procedures involving soft tissue or bone.

Gloves should be changed after contact with each patient. Hands and other skin surfaces should be washed immediately or as soon as patient safety permits if contaminated with blood or body fluids requiring universal precautions. Hands should be washed immediately after gloves are removed. Gloves should reduce the incidence of blood contamination of hands during phlebotomy, but they cannot prevent penetrating injuries caused by needles or other sharp instruments. Institutions that judge routine gloving for all phlebotomies is not necessary should periodically reevaluate their policy. Gloves should always be available to health care workers who wish to use them for phlebotomy. In addition, the following general guidelines apply:

• Use gloves for performing phlebotomy when the health care worker has cuts, scratches, or other breaks in his/her skin.
• Use gloves in situations where the health care worker judges that hand contamination with blood may occur, e.g., when performing phlebotomy on an uncooperative patient.
• Use gloves for performing finger and/or heel sticks on infants and children.
• Use gloves when persons are receiving training in phlebotomy.

Masks and protective eyewear or face shields should be worn by health care workers to prevent exposure of mucous membranes of the mouth, nose, and eyes during procedures that are likely to generate droplets of blood or body fluids requiring universal precautions. Gowns or aprons should be worn during procedures that are likely to generate splashes of blood or body fluids requiring universal precautions.

All health care workers should take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures; when cleaning used instruments; during disposal of used needles; and when handling sharp instruments after procedures. To prevent needle stick injuries, needles should not be recapped by hand, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulated by hand. After they are used, disposable syringes and needles, scalpel blades, and other sharp items should be placed in puncture-resistant containers for disposal. The puncture-resistant containers should be located as close as practical to the use area. All reusable needles should be placed in a puncture-resistant container for transport to the reprocessing area.

General infection control practices should further minimize the already minute risk for salivary transmission of HIV. These infection control practices include the use of gloves for digital examination of mucous membranes and endotracheal suctioning, hand washing after exposure to saliva, and minimizing the need for emergency mouth-to-mouth resuscitation by making mouthpieces and other ventilation devices available for use in areas where the need for resuscitation is predictable.

Although universal precautions do not apply to human breast milk, gloves may be worn by health care workers in situations where exposures to breast milk might be frequent, e.g., in breast milk banking.

Screening and Occupational Exposure of Students

Prior to matriculation students must submit documentation regarding screening exams such as: TB, Hepatitis A, Hepatitis B, Rubella, Rubeola and Varicella immunity. These requirements change annually according to national health standards and clinical site requirements. Screening is required in the first year because students participate in early clinical experiences that involve exposure to patients. Students who are concerned about caring for patients at risk should consider the program requirements and should seek an alternate profession if they believe they cannot provide hands-on care to patients without causing risk to patients or themselves. Students who develop a concern after beginning classes should seek counseling so they may determine how best to successfully complete their training program while protecting themselves and the patient. For more information about the screening and occupational exposure of students and Universal Precautions, please visit VCOM’s website at www.vcom.vt.edu.

Methods to prevent exposure to communicable diseases include the following: standard precautions in handling bloody/body fluids with gowns, gloves and eye protection; using engineering controls by placing sharps in containers and using red bags for infectious waste; using work place controls consistent to the clinical training site; Hepatitis B vaccines; keeping all completed lab procedures in appropriate manner so as not to splatter or spill body fluids; not eating or drinking in environments where exposure is present; not handling contact lenses in a contaminated environment; and appropriate hand washing.

Occupational exposure to blood borne pathogens may occur as an accident (needle sticks, bites, ocular exposure, chapped skin, etc). When this exposure occurs it should be reported immediately to the medical supervisor or faculty supervisor present so appropriate measures can be instituted.

While VCOM does not require HIV and Hepatitis C testing for admission, VCOM recommends that students have such testing prior to matriculation for their personal information. Students are exposed to many infectious diseases during their training, and though most infections can be prevented through the use of universal precautions, having this information prior to such exposures can prove invaluable if the student does develop the disease. Students, as future physicians, should consider the safety of the patient first and foremost and act accordingly. Again, this information should not be submitted to VCOM and is for the student’s personal use only.

Alcohol and Drug Testing

VCOM promotes a safe, healthy, and productive learning and working environment free from the influences of drugs and alcohol and to ensure the safety and welfare of students, faculty, and patients cared for by VCOM representatives. This policy, while in place to ensure safety, does not preclude criminal action by means of other institutional policies and/or state and federal law.

Any student, faculty member, or other VCOM staff may be required to submit to drug and/or alcohol testing based upon reasonable suspicion, including, but not limited to:

• Direct observation of drug or alcohol use or possession;
• Physical symptoms related to the influence of drugs or alcohol;
• Abnormal or erratic behavior that is disruptive or a risk to others;
• Arrest or conviction of a drug or alcohol related offense on- or off-campus;
• Documented information from a credible source submitting a complaint;
• Evidence that a previous drug or alcohol test was tampered with; or
• Possession of drug paraphernalia.

Testing will be done by order of the Associate Dean for Clinical Academic Affairs at a qualified designated laboratory site identified by the Office of Clinical Affairs. In general, the site will carry a forensic testing program certified by the College of American Pathologists for testing.

Random drug screening is performed on one or two occasions during enrollment at VCOM and may also be done by order of the Associate Dean for Clinical Academic Affairs.

A positive drug test may be appealed and repeated within three days of the original test. Any student who fails the alcohol or drug test will be subject to disciplinary action as designated and described in this Handbook. For patient, faculty, and/or student safety, compulsory expulsion may result if a student refuses to consent to testing. All testing is done in confidence except for use by the Professional and Ethical Standards Board and in cases where it is required for long term monitoring by the State Medical Board; all results are held in confidence.

Self-identification as a substance abuser will result in the student being offered an approved treatment program. The cost of treatment is the responsibility of the student. Monitoring of successful completion will be the responsibility of the Associate Dean for Clinical Academic Affairs. The student treatment records will be held in confidence except where required by the State Board of Medicine.

Drug and Alcohol Abuse Prevention

VCOM prohibits the unlawful possession, use, or distribution of illicit drugs and alcohol by students and employees on VCOM’s property or as part of any VCOM sponsored activities. Information is distributed annually to students and faculty regarding the use of illicit drugs and the abuse of alcohol, including health risks and legal sanctions. A copy is available from the Assistant Vice President for Student Services.

Confidential counseling services and treatment referrals can be arranged via the Assistant Vice President for Student Services or Associate Dean for Clinical Academic Affairs. In order to ensure student confidentiality, such counseling or treatment referrals will be made to an off-site provider. If the student prefers to make a contact on their own they may do so to the provider listed below. The student is responsible for the costs of such treatment.

New River Valley Community Services, Access Services
540-961-8300 or 540-961-8444
http://www.nrvcs.org

In addition, VCOM provides alcohol and substance abuse prevention information on-line for all students and employees. See Human Resources section on Alcohol and Substance Abuse Prevention.

Background Checks

A background check is mandatory upon admission. A background check is required to assure the applicant is not a risk to fellow students and has the appropriate insight and judgement to become a physician professional with ethical behaviors.  Applicants must report any arrest, including but not limited to misdemeanor or felony.  Applicants who do not disclose a prior arrest for anything beyond a minor traffic offense will be considered as not acting in a professional and ethical manner.

Applicants with prior felonies as an adult who apply for admission must realize that it is difficult to obtain a medical license with a history of a felony.  Applicants who have prior background checks that reveal a record of criminal behavior must also realize that if accepted, clinical training will be limited to those hospital sites that allow students with prior offenses.

Students have periodic background checks performed during the four years of training. Current or accepted students who do not report an arrest to the Office of Student Services within the next business day but not greater than 72 hours are considered as acting in a unprofessional and/or unethical manner. 

Applicants or students who have a prior conviction or condition that might threaten the student's success and well-being of their patients are not considered. A Professional and Ethical Standards Board (PESB) hearing and possible dismissal will result if a student has not reported arrests, lies on a background check, or lies about an illegal action.

Illegal Behavior

Any student involved in an arrest for any illegal behavior (whether guilty or not guilty) while at VCOM must report that to the Associate Vice President for Student Services within the next business day, but not greater than 72 hours from the time of the incident. Being advised by a third party to withhold this information from VCOM is not an acceptable excuse to not meet this requirement.  Failure to report such activity may result in dismissal from VCOM. Such reports will be reviewed by the Associate Vice President for Student Services and will be considered as to whether the student needs to be referred to the Honor Code Committee, PESB, or it may be determined that no action is required.