MHSA – Technical Standards

Touch: Patient care during anesthesia requires a clinician to utilize the sense of touch for examination. The education of the student, therefore, requires a student to perform and have the ability to touch a human being of both sexes as part of learning to assess and treat, as well as to be touched by both sexes as a part of the physical examination education. The sense of touch required includes being able to discriminate through palpation of warm, cold, and normal temperatures; and normal soft and supple tissue from tissue with spasm or other restrictions. Students must be able to discern between bone, muscle, fascia, and skin to detect any abnormalities. Students must also be able to palpate the abdomen and judge for acute conditions as well as to palpate the size of internal organs and a soft abdomen from an acute and guarded abdomen. Students must also be able to palpate pulses and identify anatomical landmarks for regional line and invasive monitor placement. Therefore, students who attend the MHSA program agree to touch others and to be touched in order to acquire the skills necessary for palpation and examination of peers (classmates) in these laboratories. As a stipulation of enrollment in the MHSA program and attestation of having agreed to the policies herein, students agree to touch other students in the process of examination and to be touched and to participate as both provider and patient in the student practice sessions under the supervision of faculty. Acquiring the skills to palpate and examine patients requires examination of disrobed patients of both genders; therefore, examination of fellow students of both genders, and to be examined by fellow students of both genders who may be partially disrobed, is required. These are requirements for all students, regardless of cultural or religious beliefs, in order for students to acquire the skills necessary to safely practice osteopathic medicine. Students who have questions regarding the accommodations made for cultural or religious beliefs may inquire with the Director of Admissions or when visiting for an interview.

Vision: Anesthesiologist Assistants utilize the sense of vision to identify tissue texture changes; skin lesions and rash types; skin color changes such as cyanosis or erythema; and skin, nail, and mucus membrane color. Vision is also required to perform an examination of the eyes (including skilled fundoscopic exams), ears, nose, throat, genitalia, and other areas of the human body in the process of diagnosis. Vision is also required to master fine skills such as suturing or using a scalpel, surgical removal of foreign bodies or certain tissues, and other surgical procedures. Vision is required to interpret many diagnostic tests, including, but not limited to: x-ray, CT scan, MRI, and PET scan in formulating an accurate diagnosis, as well as dynamic visualization of monitors, video images, the surgical field, and ultrasound monitors. The use of an intermediary to perform these basic competencies does not result in the same level of competency as an anesthetist, as it is mediated by another individual’s power of selection and observation without the same level of knowledge or experience. Therefore, correctable vision to a reasonable level is required for students to meet technical standards for admission and continued enrollment.

Hearing: The sense of hearing is required in anesthesiology including the necessity of hearing during patient interviews; recognizing inflections in a voice that occur with pain, illness, or injury; and hearing bodily functions such as heartbeat, murmurs, blood pressure, lung sounds, bowel sounds, the flow of blood through vessels, and other sounds associated with normal and abnormal findings medical conditions. A key feature of the anesthetist is to combine auditory input from monitors and distinguish such from ambient and background noise during perioperative care. Anesthesiologist Assistants practice patient-centered care with a focus on how any illness or injury to one area of the body impacts the person as a whole. Therefore, the sense of hearing is required to directly communicate with a patient and is used in the perioperative setting to communicate with multitudes of healthcare providers, patient advocates, and ancillary staff simultaneously. Hearing cannot be readily or efficiently provided through an interpreter that does not have the appropriate medical knowledge. The program provides reasonable accommodations for students who have difficulty with hearing but can independently meet these standards with accommodations. Reasonable accommodations provided while learning at the MHSA program on the VCOM-Auburn campus include specialized stethoscopes and specialized noise-canceling or amplifying headsets/earbuds for the classroom. VCOM also provides accommodations through the recording of all lectures so they may be viewed by students in a separate room where they are able to listen at increased volumes and sped up, slowed, or repeated as needed. Students who are unable to hear all parts of the lecture are provided with the opportunity to listen to the recorded lectures outside of the classroom in order to keep pace with their classmates. Students should be aware that these services are provided in lieu of CART services, which are not as efficient or reasonable in accommodating a student with hearing deficits. Applicants that have questions regarding the use of recorded lectures or headsets in lieu of CART services may visit the VCOM-Auburn in advance to sample them prior to enrollment.

Smell: An Anesthesiologist Assistant also uses the sense of smell, and although not considered an essential sense, it is one that cannot be accommodated.

Students must be able to communicate orally and effectively in English as the curriculum, testing, and clinical training experiences are only offered in English. Students 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 provided in English. The program requires the functional ability to speak, hear, and observe patients in order to elicit accurate medical information. Students must learn and demonstrate the ability to gather medical information in a humanistic manner and must be able to recognize, describe and address changes in patient mood, activity, posture, and other physical characteristics; perceiving the patient’s nonverbal communication, which are skills required in delivering patient-centered medical care. Students must be able to communicate through written, typed, and verbal conversation to effectively, and efficiently, communicate with the patient and all members of the health care team. Students must be able to demonstrate effective communication in a taped video exam setting with standardized patients in the first two years and demonstrate competency in communication in the clinical setting. These requirements are essential to safe and high-quality patient care.

Reading: Students, as well as CAAs, are required to read large volumes of medical literature in order to learn the required information for practicing medicine and to maintain up-to-date knowledge throughout their medical careers. This requires a proficiency in reading and comprehension to complete and acquire medical knowledge presented in all coursework in the given timeframe.

Students who qualify for reasonable accommodations for reading, writing, and interpreting disabilities include extended time on written exams.

Students must have sufficient motor function to elicit information from patients by palpation, percussion, and other diagnostic measures. Students must have sufficient motor function to carry out maneuvers of general medical care and emergency care, and to deliver basic surgical and anesthetic care. Examples of the use of motor function are cardiopulmonary resuscitation, administration of intravenous fluids and intravenous medications, management of an airway, hemorrhage control, closure by suturing of wounds, and placement of regional anesthetics and invasive monitoring lines. This requires the use of extremities in palpation, positioning, and carrying out maneuvers of manipulation and resuscitation.  These actions require fine and gross motor and sensory function. Students must be able to perform these maneuvers.

Physical strength and stamina are required in the medical training environment. Applicants 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 to perform osteopathic examination and treatment, and to stand and walk for long hours in the clinical setting during clinical training (as well as residency and practice) when applying.

VCOM seeks to provide reasonable accommodations for students with motor and physical disabilities at the Auburn facility. As an example, prior VCOM students have been accommodated who required wheelchair assistance and who have had limited use of one upper extremity. It is important to note that VCOM, Bluefield, nor the MHSA program can guarantee accommodation for physical disability at clinical rotation sites not owned or operated by VCOM.

Students must have the ability to reason, calculate, analyze, measure, and synthesize information in order to critically evaluate the patient; and access, synthesize, and utilize the most recent evidence-based information for treatment. Students 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 anesthesiology. Students must be able to comprehend three-dimensional relationships and to understand spatial relationships as it pertains to body chemicals and ultrasound functions to relational anatomical functions in order to succeed in the program and to administer safe perioperative care.

In order to pass all requirements of the MHSA program and to succeed in practice, students and graduates will be 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 clinical settings without accommodation. This type of demonstrated intellectual ability must be performed in a rapid and time-efficient manner so as not to place patients with emergent conditions at risk. Emergent situations, as well as busy clinical environments, produce visually distracting and noisy

environments. Examples of emergent situations in which students must perform include, but are not limited to, cardiopulmonary compromise, cardiopulmonary resuscitation, acute patient detioratation, massive transfusion situations, obstetrical and neonatal emergencies, trauma presentations, poisonings and toxic exposures, shock, and hemorrhage. The intellectual abilities described above are necessary for the practice of osteopathic medicine. As such, students must be able to gain knowledge through the use of all of the types of learning materials that the program curriculum offers. These abilities must also be applied to emergent situations; therefore, the program curriculum requires students to examine patients, calculate and make medical decisions in timed testing situations and in the presence of noise and distraction, all of which a CAA faces daily wherever medicine is practiced.

Students with intellectual disabilities who qualify for Section 504 eligibility may be granted reasonable accommodations in the classroom on written examinations. Such accommodations are not possible in clinical situations or in simulated clinical situations when preparing and testing students to be practice-ready.

While separate testing environments and extended time may be offered for written exams, these accommodations do not extend to clinical examinations (both simulated and practice-based) as there are no such reasonable accommodations for patient care environments, which require recall and performance in a timely manner in noisy and distracting environments, in clinical practice.

Ability in Standardized Test Taking: The Master of Health Science in Anesthesia program requires successful passage of the national certification exam prior to graduation; therefore, students must be able to perform satisfactorily on timed, computerized, multiple-choice standardized exams and on clinical standardized patient exams. NCCAA determines the student’s ability to receive accommodations (or not) for these exams and; therefore, the student’s ability to pass board exams with the accommodations awarded by NCCAA is the technical standard. Students may ask for accommodations by the NCCAA; however, these are not guaranteed.

Students must have the appropriate mental health that allows for full use of his or her intellectual capabilities at all times. This is important for the health of the patient, for whom the student will care for while a student and as a future anesthetist. Mental health stability is required for effective communication and for professional, ethical, mature, sensitive, and compassionate patient care. Students must have the mental health stability to function effectively under the high degree of stress that is required to complete the curriculum, be successful during testing situations in medical school and in national board testing, and to be board certified after graduation.

Applicants or students who have mental impairments associated with abnormally irresponsible or aggressive conduct are not eligible for admission or continued enrollment.

Students who have serious mental health disorders that impair their ability to function in stressful situations are not generally able to be successful in the curriculum or in the responsibilities required for safe and effective patient care. Students must be able to tolerate mentally taxing and emotionally taxing workloads. Applicants who have conditions that do not allow mentally taxing workloads must consider the long hours of study, the hours required in the classroom and laboratories, and the stress of test performance when applying.

Students must have the emotional stability to be able to safely and effectively care for patients without medication known to adversely affect intellectual abilities and clinical judgment. Students 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 required.

To be successful, a student must be free from significant mental impairment that renders the student to be lacking in the required mental capacity to maintain safety, without substantial supervision, for patient care. The student must have cognitive, interpersonal, and social capacity for the vocational effectiveness that is required for medical practice.

VCOM, Bluefield University, and the MHSA program consider impairment from addiction to be a serious mental illness. Impaired clinicians from substance abuse have unpredictable incapacitation of mental judgment, alertness, and emotional stability, resulting in a risk to patients for receiving unsafe medical care. Substance abuse that affects mental capacity and reasoning are causes for not accepting and/or dismissing a student in order to protect patients. Students found to be using illicit drugs will be dismissed for unprofessional behavior. Any evidence of addiction will be considered a risk to patients and the student will be required to be evaluated immediately and be subject to any or all of the following: suspension, dismissal, or unplanned leave for treatment at the discretion of the Dean.

The college maintains the right to convene a Progress & Promotions Committee to determine whether the applicant or student poses a danger to self or others. Such an evaluation may require an independent forensic evaluation of the student by a psychiatrist and other psychological health providers.

Mental health capacity must be such that an emotional support animal is not needed in order to participate in the curriculum or provide medical care.

Students must demonstrate the capacity to make professional and ethical decisions expected of a medical professional at all times to be successful in the curriculum and to effectively and safely care for patients. This requires students to demonstrate careful and safe decision-making at all times, to be free from addiction, to discriminate between legal and illegal behaviors, to make moral rather than immoral decisions, to make ethical rather than unethical decisions, and to demonstrate professional rather than unprofessional behaviors. Professional and ethical attributes are those expected of a physician by all of society and generally by medical boards. These attributes are those that instill a sense of trust by patients in the medical community. Students who perform in an unethical or unprofessional manner are subject to dismissal.

Students must be in reasonable health to complete the physical requirements of the curriculum, including the physical requirements required to participate in the anatomy laboratory, learning and simulation laboratories, in patient care, and other environments required to complete the curriculum. The safety of the patients cared for by students must take priority over the students’ ability to participate, just as the health of patients cared for by a physician takes priority. Students with communicable diseases, such as Hepatitis C and HIV, will be restricted from certain learning environments. The college follows the CDC guidelines for patient care in making these determinations. Students with any chronic medical conditions should be aware that they may not be accommodated to participate in all clinical settings if such accommodations are believed to place the patient at risk.

Accommodations may not be possible that allow the student to use service animals in certain clinical care settings, where the use of such animals may place an increased risk to the patient and/or do not meet the hospital requirements. Where technology exists, the college requires a transition from the use of a service animal to an alternate method of monitoring prior to the clinical years so that the student may meet the requirements of the clinical site.

Students should also be aware that information regarding their immunization and health status and communicable diseases will be provided to the clinical sites where they will participate in patient care. The clinical sites will keep the student’s health information as confidential as possible while protecting the health of the patient. Requirements

for students with communicable diseases are provided by the Director of Clinical Affairs and are updated annually according to CDC guidelines. VCOM does not own or operate the hospitals and clinics in which students receive their clinical training; therefore, students must follow the rules of each hospital and/or clinic in order to participate in the clinical environments. Decisions regarding placement of students in the clinical setting to assure safety and the best learning environment is the decision of the Assistant Program Director for Clinical Affairs and the Medical Directors. Students should request information from the college as to whether their condition meets technical standards.

The program is also concerned with the health of students and considers this when determining their ability to participate in clinical learning environments. The program reserves the right to restrict students to certain clinical environments in order to protect students from adverse physical/medical risks. This includes students who are or may become immunosuppressed, pregnant or have other acute and chronic illnesses that would endanger their health. These students may be restricted from certain clinical environments, including, but not limited to, international rotations and mission trips in developing countries, infectious disease rotations, and other at-risk environments.

Students who become pregnant must inform the Associate Program Director for Academic Affairs or the Assistant Program Director for Clinical Affairs of the pregnancy before participating in at-risk environments such as anatomy laboratories, or environments where infectious diseases pose a risk.