UNIVERSITY OF LOUISVILLE SCHOOL OF MEDICINE TECHNICAL STANDARDS FOR ADMISSION, CONTINUATION AND GRADUATION
Technical standards consist of the minimum physical, cognitive, emotional, interpersonal, and communication requirements to provide reasonable assurance that candidates for admission, continuation and graduation can complete the entire course of study and all degree requirements; participate fully in all aspects of medical education, training and practice; and anticipate a significant duration of practice.
While the School of Medicine fully endorses the spirit and intent of Section 504 of the Rehabilitation Act of 1973 and of the Americans with Disabilities Act of 1992, it recognizes that the contract between the school and the public includes the expectation that the school will do everything reasonable to ensure that its graduates can become fully competent physicians. Acquisition of competence is a lengthy and complex process, which would be subverted by significant limitations on the students’ ability to participate fully in the spectrum of experiences constituting the medical school curriculum. All candidates for admission, continuation and graduation should be aware that the academic and clinical responsibilities of medical students may, at times, require their presence during day, evening, and night hours, seven days a week.
The school has a major responsibility for the safety of patients with whom the student will come into contact both before and after graduation. Patient safety must never be compromised by any policy of the school; it is thus a major basis for establishing requirement regarding the physical, cognitive, emotional, interpersonal and communication capabilities of candidates for admission, continuation and graduation.
Technical standards provide criteria against which candidates for admission, continuation and graduation from the School of Medicine can be assessed as the faculty operating through its committees exercises its judgment in selecting, promoting and graduating students. The curriculum of the School of Medicine has been designed to provide a generic professional education leading to the M.D. degree and to prepare students to pursue any pathway of graduate medical education and enter the independent practice of medicine. Therefore, an avowed intention on the part of a candidate to ultimately practice in only a narrow portion of the spectrum of medical endeavor does not obviate the requirement for the candidate’s full participation in the entire educational and training continuum. In evaluating candidates for admission, continuation and graduation, it is essential that the integrity of the curriculum be maintained, that those elements deemed necessary for the education of a physician be preserved, and that the health and safety of patients be maintained.
All candidates for admission must fulfill the minimum requirements for admission and all candidates for the M.D. degree must complete all required courses and clerkships as listed in the School of Medicine Bulletin.
Candidates must have functional use of the somatic senses, both exteroceptive (touch, pain, temperature) and proprioceptive (position, pressure, movement, stereognosis, and vibratory), and of the senses of vision and hearing. They must have adequate motor capabilities to negotiate situations in which these senses would be employed, and they must be able to integrate data acquired via these senses. While compensation, modification, and accommodation can be made through technology and other means for some disabilities in any of these areas on the part of candidates, such compensation, modification or accommodation should not preclude the candidate’s ability to act with reasonable independence. The use of trained intermediaries would result in mediation of a candidate’s judgment by another person’s powers of selection and observation. Therefore, extensive assistance from trained intermediaries in meeting these technical standards is an unacceptable limitation.
The following discussion provides a framework for decisions concerning a candidate’s suitability.
Candidates must possess adequate observational skills to participate in classroom, clinical, and laboratory learning environments in an efficient, effective, and safe manner. Candidates must be able to clearly observe a wide variety of patients, both close at hand and at a distance, through visual, auditory, olfactory, and somatic senses. Candidates must be able to recognize non-impaired versus impaired patient function or conditions.
Candidates must be able to communicate in an articulate, effective, efficient, sensitive, and empathetic manner with patients to obtain medical histories and perform physical examinations; elicit information; describe changes in mood, activity, posture and behavior; and perceive nonverbal communication. They must be able to communicate effectively with patients; families and members of the health care team. They must be able to utilize the entire range of human communication skills to gather and transmit as much information as possible in interactions with patients; therefore, candidates must possess and maintain the ability to communicate effectively in the English language, in both written and oral form.
Candidates must be able to perform a basic physical examination, diagnostic tests and therapeutic procedures (e.g. palpation, auscultation, percussion) in an accurate, efficient, timely and coordinated manner using appropriate instruments, tools, and devices (e.g. stethoscope, otoscope, sphygmomanometer, ophthalmoscope, and reflex hammer).
Performing a given skill requires functional use of a variety of exteroceptive and proprioceptive senses which must be integrated effectively with sensorimotor function. Candidates must be sufficiently mobile to participate in classroom, clinical, and laboratory learning environments in a timely, efficient, and effective manner. Candidates should be able to execute movements in a manner necessary to provide safe general patient care (e.g. simple suturing, ability to adhere to universal precautions, and perform patient transfers) and emergency patient treatment (e.g. application of sufficient pressure to stop bleeding, establish airways, administer IV medication, perform CPR, and perform simple obstetric procedures). Candidates must possess adequate gross and fine sensorimotor function to effectively operate a light microscope; use basic diagnostic instruments, tools and devices; operate a computer; and perform a complete physical examination and therapeutic procedures in an efficient and coordinated manner. Candidates must possess adequate sensorimotor function and equilibrium to assume reasonable body postures when performing these skills and to perform them in a manner that does not compromise test accuracy, treatment effectiveness, or patient safety.
Intellectual, Conceptual, Integrative, and Quantitative Abilities
Candidates must be able to analyze clinical data and problem solve to make logical diagnoses and therapeutic judgments for patients. Candidates must be able to make clinical measurements and observations and perform calculations to integrate and analyze data. Candidates must be able to comprehend three-dimensional relationships as related to human anatomy and function. Candidates must be able to integrate rapidly, consistently, and accurately all data received by whatever senses are employed. The significant or long-term disruption of cognitive function associated with mental health conditions and/or learning disabilities rules out a candidate’s acceptability.
Behavioral and Social Attributes
Candidates should be able to establish appropriate relationships with a wide range of patients, patients’ families, faculty members, professional colleagues, and others in the healthcare setting. They should possess the personal attributes of compassion, empathy, altruism, integrity, accountability, emotional stability, tolerance, interest, and motivation, among others. Students are expected to accept appropriate suggestions and criticisms and to respond by modifying their behavior as necessary. Candidates should possess the emotional health required for the full use of their intellectual abilities. They must be able to exercise good judgment and punctually carry out their responsibilities as medical students, including activities related to the care of patients. They must understand the legal and ethical standards of the medical profession. They must be able to display flexibility and adaptability to changing environments, to tolerate physically taxing workloads and long work hours, to function effectively under stress and to be free from impairment due to substance abuse.
If a candidate is known to have a contagious disease and is being considered for admission, continuation or graduation, this consideration must include the school’s responsibility to protect the patient. If transmission of the disease is a significant possibility and would have serious consequences, the candidate is probably not acceptable.
The School of Medicine also has a responsibility to consider the welfare of its students. Should an otherwise vigorous candidate have a disease that in certain clinical settings could place him/her or other students at risk, both the nature of the risk to the candidate or other students and the likelihood that the risk would materialize must be considered.
Implementation of these technical standards across the educational continuum is within the purview of the faculty of the School of Medicine operating through its faculty committee processes. It is the responsibility of the members of faculty committees to determine the appropriate interpretation and application of the standards in individual cases.
November 30, 2007