Technical Standards for Admission to VCOM
and Continued Enrollment

Osteopathic physicians utilize touching as part of the osteopathic approach to treatment. As part of the educational process, VCOM students must be able to tolerate being touched and to touch others in order to acquire the skills necessary for palpation and examination. This palpation is performed in a professional and appropriate manner. Acquiring the skills to palpate and examine patients requires a student to examine disrobed patients of both genders and this is mandatory to successful completion of the curriculum at VCOM. In physical diagnosis and osteopathic manipulative medicine laboratory experiences, as well as other clinical laboratories where skills are acquired, students are required to participate in the examination of 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 of all students, regardless of cultural beliefs, in order for the student to acquire the skills necessary to practice medicine. Students who have any concerns should discuss them with the Assistant Vice President for Student Services prior to applying.

In addition, the applicant must possess the abilities and skills in the following five areas:

1. Observation
   The student must be able to visually observe 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. The use of a trained intermediary in such cases would compromise performance, as it would be mediated by another individual's power of selection, observation, and experience. Observation requires the functional use of vision and somatic sensations and is enhanced by the sense of smell.

2. Communication
   The student must be able to communicate effectively in English as the curriculum and clinical experiences are offered in English. 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 be able both to describe changes in mood, activity, posture, and other physical characteristics and to perceive nonverbal communication. The student must be able to communicate effectively and efficiently in verbal and in written form. The student must be able to communicate effectively and efficiently with the patient and with all members of the health care team in order to successfully complete the curriculum.

3. Motor
   Candidates must have sufficient motor function to elicit information from patients by palpation, percussion, and other diagnostic measures. The candidate 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, as well as the senses of touch and adequate vision for inspection.

4. Intellectual
   The candidate must have the ability to reason, calculate, analyze, measure, and synthesize information. The candidate must be able to comprehend, memorize, synthesize, and recall a large volume of information without assistance, to successfully complete the curriculum. The candidate must be able to comprehend three-dimensional relationships and to understand spatial relationships to succeed in school and to administer medical care. The candidate 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, to problem solve, and to calculate and make decisions in timed situations and in the presence of noise and distraction. The above intellectual abilities are necessary to successfully complete the curriculum, and 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. 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 in medicine 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.

5. Behavioral and Social Attributes
   The candidate 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. Candidates must be able to function effectively under stress and with physically taxing workloads. Candidates must have the emotional health to be able to function without the aid of medications that are known to affect intellectual abilities and judgment. The candidate 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. Inability to demonstrate the emotional health necessary for the delivery of quality and safe medical care is mandatory throughout medical school. VCOM considers addiction or the participation in substance abuse as a risk for unsafe medical care.

VCOM is committed to making accommodations for the student whose handicaps allow them to accomplish a successful career as an osteopathic physician. Reasonable accommodations do occur for all students; each student, however, is required to function with independence and all the skills described above that VCOM holds as mandatory for the safe and effective practice of osteopathic medicine. While VCOM is committed to making the accommodations that make a student successful, VCOM is also committed to patient safety and assuring a safe and effective environment that does not place patients, students, or others at risk. Each technical standard has been chosen as those necessary for the safe and effective practice of osteopathic medicine. Students who do not meet the above technical standards should not apply to VCOM.

If a student has a question as to his/her ability to meet the minimal technical standards listed, the student is required to notify the Office of Admissions in advance of applying so that reasonable testing may occur. Students must identify to the Office of Admissions, all areas where there is question in meeting these technical standards.

Assistance with Disabilities

Requesting Assistance: Additional special learning needs should be discussed with the Assistant Dean for Medical Education. VCOM makes reasonable accommodations including seating arrangement adjustments, provide visual or auditory aids, and other classroom or learning needs. A letter from a health professional verifying the need is generally required. Examples of assistance include: VCOM has wireless auditory assists for each classroom. The curriculum is provided visually on line and verbally in the classroom so that various learning styles may be met. Extended test taking times are given for every exam extending up to twice the normal time for national board test items. All test taking environments are quiet and monitored so as to be free from distraction and noise. These are examples of how VCOM meets the needs of students; however, an individual student should meet with the Assistant Dean for Medical Education if he or she requires assistance with individualized needs. Dr. Brian Hill is the Assistant Dean for Medical Education and he may be reached at 540-231-4000 or bhill@vcom.vt.edu to make an appointment in person.

If a student has a difficulty with the facility, the Chief Operating Officer should be contacted. The entire building was designed to accommodate those with disabilities and meets ADA guidelines. The Chief Operating Officer can be reached at bprice@vcom.vt.edu or by calling through administration.

If a student requires special assistance not listed above they should meet with the Assistant Vice President for Student Services contact information bking@vcom.vt.edu or call the student services office through the main phone tree. A contract exists with a primary care practice to assist with meeting health care needs, and minimum co-pay is required for an appointment. The College holds a contract with an outside counseling service for free and confidential counseling. The Assistant Vice President for Student Services (contact information above) will make arrangements with the best resources available to the student from the community or University resources.

All students who request accommodations or assistance due to a disability, must supply a verification of the disability from their health care professional and must provide a waiver that allows the College administration and the health care provider to discuss the accommodations needed. In the case that the College requests a second opinion, students may be required to have an independent evaluation for the disability at the College's request from an unbiased third party health provider. Students should be familiar with the technical standards of the College and the accommodations that are already provided. Students are not compared with other students in their performance within the College but instead are evaluated as to the ability to gain the minimal amount of knowledge and perform the clinical skills necessary to practice safely and competently as a physician.

Any student who experiences difficulty obtaining an accommodation for a disability should contact the Human Resources Director rhudson@vcom.vt.edu, whose office is on the third floor, or dial human resources in the finance section of the main phone tree, for further assistance. Students should first contact the Director for Human Resources with a specific request regarding a disability that is not currently being met or if they feel they are being discriminated against in any way to begin the resolution process. Please refer to the Resolution and Grievance Procedure section of the catalog/handbook which describes the Resolution and Grievance Procedure. The College seeks to accommodate those with a disability wherever possible. The College supports non-discrimination on the basis of gender, age, religion, national origin, color, or race. Therefore it is generally true that difficulties can be resolved through the resolution process.

All individuals listed above may be contacted at 2265 Kraft Drive; Blacksburg, VA 24060, phone: 540-231-4000.

Health Requirements

ANNUAL TB TEST (Date of placement and date of reading with results). If you have a history or a positive PPD skin test, 10 mm or more in duration, do not get another PPD. Instead, you will need a chest x-ray and to submit documentation. A new convertor (new positive result) or those with a positive chest x-ray must follow up with the Health Department or their physician and submit documentation.

TETANUS TOXOID IMMUNIZATION (Within the last ten years). Submit documentation. Requirements or procedures for late acceptance and international students may be individualized.

HEPATITIS B VIRUS (HBV): General: Hepatitis B exposure may result in acute liver disease with or without jaundice, subclinical disease or chronic infection. After a needlestick accident from a HBV infected person to an un-immunized person, risk of infection ranges from 3-30%.

Prevention: ALL students are required to receive HBV vaccination (3 doses at appropriate intervals) prior to matriculation. This will result in successful immunization in 95% of healthy young adults. Test for anti-HBs (antibodies to HBV surface antigen) should be performed 1-2 months after completion of the vaccination series. Students admitted with documented prior vaccination history should also provide immune status documentation. If that is not available, current immune status should be determined. Those who do not seroconvert should be REVACCINATED with a full series. If after a second series, titers remain below 10mlU/mL, the person is considered at risk for acquiring HBV. Education principles of UNIVERSAL PRECAUTIONS (see below) will be provided regarding treatment in the event of exposure.

MEASLES (RUBEOLA), RUBELLA, AND MUMPS with vaccination dates and proof of immunity by antibody TITERS; laboratory documentation is required. If titer does not indicate proof of immunity, a booster Rubeola, and/or Rubella, and/or Mumps will be required.

VARICELLA history of disease will not be accepted. Student must provide proof of immunizations or positive TITER.

MENINGOCOCOCCAL VACCINE; proof of immunization is required. This vaccine can prevent four types of meningococcal disease, including two of the three types most common in the US (serogroup C, Y, and W-135) and a type that causes epidemics in Africa.

INFLUENZA vaccine is routinely recommended for all healthcare providers yearly, but is not required.

ADDITIONAL IMMUNIZATIONS may be required for those students participating in international rotations.

Evidence of the above requirements is required prior to matriculation at VCOM and must be verified with the Registrar. Incomplete forms will prevent matriculation.

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:

• for touching blood and body fluids requiring universal precautions, mucous membranes, or non-intact skin of all patients, and
• for 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 needlestick 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, handwashing 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.

Students' Involvement in Patient Care

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