Section 5: Technical Standards and Disability Resources

Technical Standards

Preamble

UNLV is committed to the policy that all persons shall have equal access to its programs, facilities and employment without regard to race, sex, color, creed, religion, national origin, ethnicity, gender, age, marital status, pregnancy, disability, public assistance status, political affiliation, veteran status or sexual orientation.

In adhering to this policy, UNLV School of Medicine abides by Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990 (ADA), and the 2008 ADA Amendments Act that restated the original legislative intent that the definition of disability be construed in favor of providing broad coverage of individuals under the law including the invisible disabilities: learning disabilities and reading disorders. UNLV School of Medicine encourages all qualified individuals to apply for admission to the School of Medicine.

UNLV School of Medicine recognizes the MD degree as a broad and undifferentiated degree requiring the acquisition of general knowledge and basic skills in all fields of medicine necessary to care for patients.The education of a physician requires assimilation of knowledge, acquisition of skills and development of judgment through patient care experiences in preparation for independent and appropriate decisions required in practice. The practice of medicine requires collaboration among physicians, other health care professionals, as well as patients and their families.

Within the LCME standards, UNLV School of Medicine has the responsibility for the selection of students; the design, implementation and evaluation of its curriculum; the evaluation of student's performance; and the determination of who should be awarded a degree. Admission to the UNLV School of Medicine and retention decisions are based not only on prior academic achievement, but also on non-cognitive factors, which serve to ensure students can complete the essential functions of the academic program required to graduate. The UNLV School of Medicine strives to select applicants who have the ability to become highly competent physicians. The goal is to produce skilled individuals who can practice as physicians and whom put their patients first in the provision of safe and effective medical care.

UNLV has a responsibility to the public to ensure its graduates can become fully competent physicians. It is important that students admitted to UNLV School of Medicine possess the intelligence, integrity, compassion, humanitarian commitment and physical and emotional capacity necessary to the practice of medicine.The intention of an applicant or student to practice a narrow part of clinical medicine or to pursue a non-clinical career does not alter the requirement that all medical students take and achieve the competencies included in the full medical school curriculum. This includes all evaluations of academic and professional conduct, and the USMLE licensure examinations which are required by the UNLV School of Medicine for promotion and graduation.

These technical standards have been developed and approved by the faculty and reflect the essential relationship of medical education to the practice of medicine. Central to the school's mission, it is recognized that all candidates must demonstrate skills in observation, communication and motor functions, as well as mature behavioral and social attributes.

Medical students admitted to the School of Medicine must be able to meet, with or without reasonable accommodation, the abilities and expectations delineated below throughout their enrollment in the School of Medicine.

UNLV School of Medicine Technical Standards for Admission and Matriculation refer to the cognitive, behavioral and physical abilities required for the satisfactory completion of all aspects of the curriculum, and the development of professional attributes required by the faculty of all students approved to graduate with the MD degree. Essential abilities are listed below and cannot be altered without fundamentally risking patient safety and the well-being of patients and the public, and the institutional educational mission.The individual student must be able to function independently in his/her care and interactions without the use of a surrogate in any of the following categories:

  1. Individual and Cognitive Ability: Students must have the ability to master information presented in coursework presented in multiple formats including: lectures, small group discussion and seminars, written materials, projected images, other forms of media and web-based formats, and simulations requiring different skills.

    Students must have the cognitive abilities needed to master relevant content in basic science and clinical courses at a level deemed appropriate by the faculty. Students may be required to comprehend, memorize, and analyze material. They must be able to discern and comprehend dimensional and spatial relationships of structures and to develop reasoning and decision-making skills appropriate for the practice of medicine.

    Successful completion of examinations is an essential component of the medical school curriculum and is a requirement of all students as a condition for continued progress through the program.
     
  2. Professionalism, Behavioral and Social Aspects of Performance: The student must possess personal qualities including compassion, empathy, altruism, integrity, responsibility, sensitivity to diversity and tolerance.The student must understand and apply appropriate standards of medical ethics. The student must maintain appropriate personal and professional boundaries in all settings, including those in which he/she is caring for patients and their families, or when interacting with faculty, residents, peers, staff and other members of the health care team. The student must be able to function as a member of a multidisciplinary health care team in each setting and regardless of specialty.
     
  3. Communication: The student must communicate effectively in English with patients, families, faculty, physicians and other members of the health care team.The student is required to process all information provided by patients, families, peers, coworkers and faculty, including the recognition of the significance of non-verbal responses in order to provide appropriate, timely, and focused follow-up inquiry. The student must be capable of responsive and empathetic communication, which establishes rapport and promotes openness on issues of concern and sensitivity to cultural differences.

    The student must process and communicate information on a patient's status in a timely manner and with a level of accuracy and in a comprehensive manner to physicians and other members of the health care team in settings in which time is limited. Written, dictated, or electronic medical record entries of patient assessments, treatment plans, prescriptions, etc., must be timely, complete and accurate. The ability to interact with and utilize electronic medical records is essential. Of primary importance is patient safety and the student must recognize that he/she may lack the skills or knowledge to make the correct decision or manage a situation without assistance.
     
  4. Physical and Mental Requirements: These include required abilities in the area of observation, perception, sensory and tactile functions, fine and gross motor coordination, and stamina necessary in the examination, assessment, and safe care of patients.

    The student must be able to obtain a medical history and perform a physical examination without the use of an intermediary. The student will be required to perform a comprehensive physical examination during the Introduction to Clinical Medicine component of the curriculum. See Required Components of the Physical Exam.

    Medical student learning takes place in an environment focused upon unpredictable needs of patients. Academic and clinical responsibilities of students may require working during day and evening hours, any day of the week, at unpredictable times and for unpredictable durations. Students must be able to adapt to changing environments, demonstrate flexibility and learn to function during the uncertainty inherent in clinical environments. In addition, the student must have the physical and emotional stamina, stability, and capacity to function in a competent manner in clinic, hospital, classroom and laboratory settings which may involve heavy workloads, long hours and stressful situations. The student must have the emotional and psychological stability to function under stress.

    The student must possess the emotional health required for appropriate utilization of intellectual abilities, exercise of good judgment, and the timely completion of all responsibilities attendant to their academic work, team work and patient care.

    An individual whose performance is impaired by the abuse of alcohol or other substances is not a suitable student for admission, retention, promotion or graduation.

All accepted students must certify that they have read and understand their responsibility of meeting the essential functions as outlined in the UNLV School of Medicine Technical Standards Admission and Matriculation. Students must continue to meet the essential functions as outlined in the UNLV School of Medicine Technical Standards throughout their enrollment.

Disabilities and Accommodations

Accommodations in the Curriculum of the School of Medicine

UNLV complies with the provisions set forth in Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990 (and ADA Amendments), offering reasonable accommodations to qualified students with documented disabilities. Students enrolled in the UNLV School of Medicine must follow the approved process for requesting and receiving reasonable accommodations. Enrolled students are responsible for requesting accommodations and for providing the appropriate and required documentation of the disability in a timely manner to the University Disability Resource Center (DRC). Students can contact Bryan Hilbert, 702-895-0866 or email bryan.hilbert@unlv.edu. The UNLV DRC coordinates all accommodations for students with documented disabilities. The DRC is the official office to review and house disability documentation for students, and to provide them with an official Academic Accommodation Plan to present to the faculty if an accommodation is warranted. The student will follow the procedures required by the DRC to document and determine the nature of the disability. The DRC will review documentation and will engage the UNLV School of Medicine and the student to review accommodation requests in light of the essential elements of the MD degree program and to determine reasonable accommodations on a case-by-case basis.

Accommodations for Examinations Foundations Phase

Students requesting Accommodations for Examinations must make the request, in advance, to the UNLV DRC which will have the responsibility and authority to request and review documentation supporting examination accommodations. Requests may not be made to the Senior Associate Dean of Student Affairs and Admissions, Course or Supervisory Faculty. Students should allow six weeks prior to the first exam for their request and supporting documents to be reviewed by the DRC. Students who have previously had accommodations are strongly encouraged to contact the DRC prior to the six to eight weeks first day of instruction.

UNLV DRC will notify the Senior Associate Dean for Student Affairs and Admissions of the decision made for each accommodation request and provide documentation to the student for the Senior Associate Dean for Student Affairs and Admissions (Senior Associate Dean). The Senior Associate Dean will inform the Student Progress Committee of all accommodations. Students must provide this documentation to the Senior Associate Dean no later than two weeks prior to the exam. The Office of Student Affairs will direct the course directors/coordinators to provide the accommodation.

Reasonable accommodations are designed to effectively meet disability related needs of students, yet NOT fundamentally alter the essential components of the educational program, create an undue burden for the university or provide new programming for disabilities not available to all medical students. Consideration of the potential impact on patient safety will be essential in the review of individual cases.

Accommodations for Examinations Clerkship and Career Explorations & Scholarship Phases

The curriculum for the Clerkship and Exploration phases of the program varies from the curriculum during the Foundations phase. Due to these changes, students need to work with the DRC to determine if their accommodations continue to be required. If the DRC determines they are required, the DRC will work with the UNLV School of Medicine Office of Student Affairs and Admissions to review the accommodation requests in light of the essential elements of the MD program and requirements of the Clerkship and Career Explorations & Scholarship Phases. Students must contact the DRC at the beginning of the Transitions to Clerkships course.

Potential Impact of Acquired Disability Following Matriculation to the UNLV School of Medicine

This matter will be referred to the Senior Associate Dean for Student Affairs and Admissions. Reasonable accommodations are designed to effectively meet disability related needs of students, yet NOT fundamentally alter the essential components of the educational program, create an undue burden for the university or provide new programming for disabilities not available to all medical students. Consideration of the potential impact on patient safety is essential in the review of individual cases.

Fitness for Duty

UNLV School of Medicine Technical Standards (delineated above) are required for admissions to medical school and for students to advance through academic requirements, and graduate from the UNLV School of Medicine.

  • Individual and cognitive ability
  • Professionalism, behavioral and social aspects of performance
  • Communication skills
  • Physical and mental requirements

Medical students must maintain these minimal technical standards throughout their enrollment in medical school, with or without reasonable accommodations. All students who have difficulty meeting standards of academic progress, professionalism standards or both are encouraged to meet with the Senior Associate Dean for Student Affairs and Admissions as soon as possible, prior to an academic failure or professionalism violation. The Senior Associate Dean for Student Affairs and Admissions will work with the student to develop a plan to address the concerns or problems to help the student succeed. Students experiencing difficulty meeting requirements can access, or will be encouraged to access, support services through the Counseling and Psychological Services Center (CAPS) at the UNLV. A student's initial discussions with Student Affairs is confidential and voluntary.

If a student's academic or behavioral performance raises questions or concerns with respect to (i) safety and welfare to self or others, (ii) the maintenance of order or continuity of School of Medicine programs or (iii) the student's ability to meet Technical Standards, UNLV School of Medicine may request or require a Medical Clearance and/or a Fitness to Participate in the Academic and Clinical Program of Studies Evaluation.

Each student, faculty and staff member who is aware that he/she may have a condition which could impact the safe environment for students, employees and patients has a primary responsibility and duty to report this condition to the Senior Associate Dean for Student Affairs and Admissions. The Office of Student Affairs will work with the student to identify support and resources.

In addition, any faculty, staff, or student who observes conditions or behavior which could endanger the student, others or patients, has a responsibility to report this to a faculty member and/or the Senior Associate Dean for Student Affairs and Admissions.

If circumstances are acute, processes are in place to provide immediate support and assistance, and for the School of Medicine to take action to ensure the safety of the medical school and university community. See Involuntary Leave of Absence Policy and Process.

Confidentiality

Due to the sensitive nature of conditions or behaviors which could arise requiring this evaluation, every effort to protect the confidentiality of the student and information and actions taken in these cases will be made. The safety and well-being of the student, and others in the medical school and university community, as well as patients, may require additional steps which could prevent complete confidentiality. In this case, the safety concerns are the primary responsibility of the medical school administration.

Evaluation

The medical school will require that the evaluation is conducted by an individual trained to address educational, medical, and psychological issues pertaining to medical student performance. The School of Medicine will refer the student to specific provider identified by the School of Medicine. The provider will have no student evaluation or teaching responsibilities in the medical school. Currently enrolled students will not pay for this evaluation. If required by the School of Medicine, the costs of the evaluation will be the responsibility of the School of Medicine. Students have the option to obtain this evaluation outside of the School of Medicine. Students must request this from the Senior Associate Dean for Student Affairs and Admissions, and the provider must be approved in advance by the Senior Associate Dean for Student Affairs and Admissions. The student will be responsible for the cost of the provider and evaluation if an individual other than the one identified by the School of Medicine is opted for by the student.

UNLV School of Medicine will require that the student provide results of the evaluation to the Medical Student Progress Committee and the Senior Associate Dean for Student Affairs and Admissions and/or the appropriate University official for purposes of assessment and determination.

Required Components: Basic Physical Exam of the Adult

Preparation

  1. Hand washing
  2. Optimize conditions (e.g., lighting, availability of equipment for examination)
  3. Ensuring patient modesty and comfort

Basic Exam Sequence

  1. Observation of general appearance
  2. Obtaining vital signs
  3. Obtaining blood pressure in either arm
  4. Palpation of radial pulse; count for 15 seconds
  5. Observation of respiratory rate; count for 15 or 30 seconds

Skin and Nails

  1. Examine hands and fingernails
  2. Examine skin throughout physical exam

Head and Face

  1. Observe, inspect, and palpate head, face, hair, scalp and skull
  2. Have patient bite down while palpating masseter muscles
  3. Have patient raise eyebrows, squeeze eyes shut and show teeth

Eyes

  1. Test Visual acuity
  2. Perform external eye examination: lids, lashes, conjunctivae, and sclera
  3. Test extraocular movements
  4. Test corneal light reflection and comparison of size and shape of pupils, cornea, anterior chamber and iris
  5. Test for direct and consensual reaction to light
  6. Perform funduscopic exam, describing red reflex and blood vessels, retinal background, cup and disk and macula

Ears

  1. Inspection of auricle and mastoid, palpation of helix and tragus
  2. Use otoscope to examine external canal and tympanic membranes
  3. Test hearing

Nose and Mouth

  1. Inspection of the external nose
  2. Inspection of the nares, nasal cavities, septum and turbinates
  3. Inspection of the lips, mucosa, tongue, floor of mouth, palate, tonsils and oropharynx
  4. Inspection of the teeth and gums
  5. Have patient phonate and inspect palate and uvula
  6. Have patient extend tongue

Neck and Thyroid

  1. Inspect for asymmetry
  2. Check range of motion of neck
  3. Have patient shrug shoulders and turn against resistance
  4. Examine facial skin bilaterally on forehead, cheeks and mandibular regions
  5. Palpate lymph nodes in anterior and posterior cervical regions
  6. Examine thyroid gland
  7. Palpate thyroid gland

Chest

  1. Inspection of chest, including respiratory effort, presence of distress
  2. Palpate chest-place hands on chest and confirm symmetry
  3. Percussion of posterior lung fields
  4. Percuss spine and costovertebral angles
  5. Auscultate chest: posterior, lateral and anterior areas

Breasts

  1. Inspect for asymmetry, nipple inversion, skin changes
  2. Have patient place hands on hips and contract pectoralis muscles

Axillae

  1. Palpate four axillary lymph node groups

Heart and Vessels

  1. Inspect and palpate for apical impulse, lifts and thrill
  2. Auscultate the precordium over the cardiac apex, left lower sternal border,
  3. Determine heart rate and rhythm
  4. Listen for normal and abnormal sounds at each location

Pulses and Lymph Nodes

  1. Palpate carotid arteries
  2. Auscultate carotid arteries with bell of stethoscope
  3. Locate and palpate the DP and PT pulses
  4. Check for edema

Abdomen and Inguinal Areas

  1. Expose and inspect the abdomen for distention, scars and masses
  2. Auscultate abdomen for bowel sounds and bruits
  3. Percuss abdomen in all four quadrants
  4. Percuss the Liver
  5. Palpate all four quadrants, lightly then deeply
  6. Palpate for the liver and the spleen
  7. Palpate inguinal region for lymph nodes, femoral pulses
  8. Auscultate inguinal region for bruits

Neurological Examination

  1. Evaluation of mental status
  2. Cranial nerve testing
  3. Examination of extremities for symmetry, muscle tone and bulk
  4. Test upper extremity strength: shoulder abduction, elbow motions
  5. Test lower extremity strength: hip flexion, knee range of motion
  6. Test upper extremity (pronator) drift
  7. Test deep tendon reflexes: Biceps/Triceps/Patellar/Achilles
  8. Test plantar response (Babinski)
  9. Test sensation (light touch and vibration)
  10. Test cerebellar function with finger-nose-finger or heel-shin test
  11. Test gait

Male Genitalia

  1. Describe male genitalia
  2. Examine penis and urethral meatus
  3. Examine the scrotum, palpating testes and epididymis
  4. Examine for inguinal hernias bilaterally

Rectal Exam

  1. Examine Anal orifice
  2. Perform digital exam noting sphincter tone and palpating prostate and rectal vault
  3. Perform stool examination for occult blood

Conclusion of exam and instructions to patient