SCHOOL OF MEDICINE STUDENT HANDBOOK

ADDITIONAL POLICIES REGARDING
COMPLETION OF PROGRAM
ALL CLASSES

Special Services and Accommodations

Medical Liability

Infectious Diseases

Immunization Records

Needle Stick Injuries and Occupational Exposures

Case School of Medicine Current Communicable Disease Policy

Guidelines for a Leave of Absence

A leave of absence must be completed in one year.  A second year may then be requested.  The MD degree must be awarded within six (6) calendar years of first matriculation, except for those students in the Medical Scientist Training Program (MSTP).

Students returning after a leave of absence for elective reasons who are entering Year III will select clerkships after all students in the entering third-year class have made their clerkship choices.

Students returning after a leave of absence for elective reasons will pay tuition at the level of the class they join.

Students on any kind of leave of absence are responsible for clearing all their financial obligations (loans, health insurance, computer, other) through the Office of Financial Aid.

Students on a leave of absence who have not completed one full semester should note that during the leave absence they are:

• Not eligible for the University sponsored student medical plan,
• Not covered under the University medical malpractice liability insurance,
• Responsible for arranging for any applicable loan repayment grace period.

All students on a leave of absence must notify their Society Dean of their intent to re-enter school by the April 1 preceding the academic year of re-entry.

Return to top

Special Services and Accommodations

Students with documented disabilities may be eligible for special services and accommodations. To initiate the process, a written request for accommodations should be submitted to the Coordinator of Disability Services in Educational Services for Students (ESS). Further information on how to proceed appears in Appendix I, Disabilities and Accommodations.

Medical Liability

It is the policy of the School of Medicine that medical students can diagnose or treat a patient only under the supervision and control of a licensed clinical faculty member.  If in doubt, students must ask the faculty member for clarification.

The School of Medicine endeavors to select students carefully, to evaluate students thoroughly, and to provide adequate supervision in the clinical setting.  Clinical faculty members must supervise and evaluate students appropriately.  It is the right and obligation of a faculty member to define and, if appropriate, curtail an individual student’s activities consonant with the student’s abilities and trainee status.

All students must wear their identification badges that clearly designate their student status and are to be introduced to patients as trainees.  However, the trainee status of a medical student does not allow delivery of substandard care.

All medical students, upon becoming aware of any alleged injury, incident, claim or suit involving themselves must notify the Office of Student Affairs in the School of Medicine immediately. Failure to do so may jeopardize any insurance coverage otherwise available.

Students are provided liability coverage when engaged in patient care as part of their educational program and when supervised by a licensed clinical faculty member.  Such coverage extends only while officially registered as students and not during vacations, leaves of absence, or other periods of non-student status.  Coverage does not extend to activities undertaken outside of the educational program.  Any questions concerning liability issues involving patients should be directed to the Office of Student Affairs.

Return to top

Infectious Diseases

Physicians and medical students have a long and honored tradition of caring with compassion and courage for patients afflicted with infectious diseases.  That tradition is highly valued at CWRU, and CWRU students and faculty will continue to uphold it.  The School of Medicine provides education in the biological, clinical, and psychosocial aspects of infectious diseases, including AIDS, and students are taught to use precautions that should avoid or minimize risk. The faculty and affiliated hospitals care for such patients in a competent, ethical, and humane manner.  In their educational program students participate in the care of infectious patients and must be aware of the risks stemming from contact with the blood or secretions of such patients. Students are expected to participate with appropriate safeguards in the care of every patient whose care and condition is within the students’ current realm of responsibility and competence even though the patient may be infectious.  Students are not expected to learn procedures known to present some inherent hazard on patients know to present some unusual risk.  Students should advise their supervisors when the combination of their level of expertise and the disease state of the patient constitute a greatly increased level of risk to themselves or their patients.

Students who have contracted a communicable disease have a responsibility to their patients, peers, staff, and faculty tot take all steps to prevent the spread of disease.  These individuals must obtain the care of a physician who is qualified to treat the disease and its complications.  These individuals must identify themselves as medical students to the physician and explain the extent of their responsibilities for patient care.  These individuals should also report their disease state to the Office of Student Affairs.  The School of Medicine holds this information in the strictest of confidence but may not allow the student to care for patients when such contact might place patients at risk.  It is the responsibility of the students to follow the advice of their physician and the School of Medicine and to follow all current guidelines for health care workers provided by the Centers for Disease Control.  Training in these guidelines is offered annually through the Office of Student Affairs.

Return to top

Immunization Records

In order to assure that all students are protected against preventable communicable illness, these requirements must be met prior to registration.

1. Print and complete the General Medical Form and Immunization Record which can be found by clicking on “New Student Medical Packet” at http://studentaffairs.case.edu/health/forms/.  The instructions and a return envelope are sent to all new students by the Office of Admissions.  It is however, the responsibility of each student to obtain and complete the forms and submit them to the University Health Service.

2. The immunization history must be completed and signed by a physician or the student may send a copy of her/his school immunization record.

3. For the protection of the University community, the University requires that all entering students to be immunized with 2 doses of Measles, Mumps, and Rubella (MMR) or provide proof of immunity by antibody titer.  The student is also required to have had a Tetanus-Diphtheria booster within the past 10 years and documentation of immunization for polio.

4. Medical students do encounter certain exposure risks when caring for patients with infectious disease.  Medical students can also expose patients, some of whom have compromised immune status to infectious diseases.  Therefore, the School of Medicine has adopted three additional requirements:

• a. 2-Step tuberculin skin test done by the Mantoux technique using PPD (Tine and Monovacc tests not acceptable) at the start of the first year of Medical School and annual PPD testing thereafter.  If a PPD result is positive, a clinical evaluation and chest x-ray must be done with no further PPD skin testing in subsequent years.  If the PPD has been positive in the past, records of the PPD and chest x-ray must be provided.

NOTE:  Tuberculin testing is provided by the Health Service at the beginning of each school year at no cost to the student.

• b. Hepatitis B vaccination, followed by demonstration of antibody response.

c. A documented history of Varicella (chicken pox) illness OR immunization with 2 doses of Varicella vaccine (Varivax) OR documentation of a positive Varicella antibody titer. If the antibody titer is negative, then vaccination with 2 doses of Varivax is recommended.

Students may be delayed in starting some clinical activities by lack of compliance with these immunization requirements.

5. Students who have not been immunized because of religious beliefs must provide documentation certifying that fact.  Individual exceptions to immunization requirements may be made for valid medical reasons.  These individuals may be excluded from academic activities or residence halls in the event of an outbreak or such diseases.

Return to top

Needle Stick Injuries and Occupational Exposures

Students who in the course of their clinical experiences or laboratory work experience a needle stick injury or occupational exposure should contact the 24-hour needle stick hotline maintained by the University Health Service: (216) 368-6635.  The University Health Services website for medical students regarding post-exposure followup on needle sticks is: http://studentaffairs.case.edu/health/needlestick/medical.html

The student on a clerkship or clinical elective in one of the affiliated hospitals should, in addition, contact the designated individual, usually infection control personnel or an infectious disease staff member, for up-to-date medical advice at the time of the occurrence. The University Health Service can provide ongoing information and advice following the acute incident. The Associate Deans for Student Affairs, Dr. Robert L. Haynie or Dr. C. Kent Smith, should be informed of these occurrences, so that they can offer information, advice, and support for the student.  Reporting of injuries and occupational exposures is also critical to the development of effective policies and procedures.

Return to top

Case School of Medicine Current Communicable Disease Policy

I. Mission of the Policy

• To assure that patients in a hospital or clinical setting are not at risk when cared for by students infected with Hepatitis B (HBV), the human immuno-deficiency virus (HIV), or other communicable diseases.

• To minimize the risk to students of infection with HBV or HIV when placed in a hospital or clinical setting for clerkships.

• To minimize the risk of HIV-infected students developing serious complications from clinical assignments.

• To provide students infected with HBV or HIV with counseling on medical and career options.

• To respect the privacy rights of students and facilitate students’ voluntary cooperation by keeping all medical information on students confidential to the extent possible.

To require self-reporting of HBV or HIV by students to a confidential Review Panel, similar to the self-reporting that is required by law for physicians licensed in the State of Ohio.

II. Summary of Policy for Hepatitis B, HIV and Other Communicable Diseases

• All medical students must provide documentation verifying that they are protected from acquiring or passing on HBV, in accordance with the procedures set out in Section IIIA, Hepatitis.

• The School of Medicine encourages all students to know their HIV status.

• This communicable disease policy and the self-reporting requirements apply to all students in the Medical School, regardless of year.

• All students must self-report infection with HBV (e-antigen positive) or HIV to the School of Medicine’s Communicable Disease Review Panel (“the Review Panel”). This requirement is intended to assure that students’ clerkships in a hospital or clinical setting are tailored so as to protect patients from risk when cared for by these students and so that students receive appropriate counseling on medical care and career options. The Review Panel and/or the student will notify the student’s attending physician and the hospital(s) or clinic(s) to which the student is assigned of the student’s medical condition, so that the clerkship can be adjusted if necessary. The Review Panel considers each case on an individualized basis.

• Medical students who test positive or contract a communicable disease other than HBV or HIV that is reportable to the Ohio Department of Health (see Appendix V) and is listed in Appendix IV to this Policy must report the illness to the University Health Service. The University Health Service will consult with the student, the student’s attending physician, and the hospital(s) or clinic(s) can take steps to minimize the risk of spreading the disease to patients.
  

III. Policy and Procedures

A. Hepatitis B

1. Requirements for all medical students

All medical students must be protected from acquiring or passing on Hepatitis B (HBV). Medical students can fulfill this requirement by using one of the three methods set out below:

• a. Receive the series of HBV vaccinations at the University Health Service and show evidence of immunity following the series, through a positive HBV surface antibody blood test;
• b. Show documentation of immunity with a blood test, if the student previously received a HBV vaccine elsewhere; or
• c. Show documentation of previous infection with HBV, with either positive HBV surface antigen or antibody.

These requirements MUST be completed before any student will be permitted to begin any clerkship or any Type A clinical elective involving patient contact.

All documentation shall be submitted to and testing done through the University Health Service. The University Health Service will keep all medical testing and results confidential to the extent possible. Medical students should be aware that evidence of current infection with HBV is by law reportable to the Department of Health.

The University Health Service shall ensure that all laboratory tests are conducted by an accredited laboratory at the lowest possible cost to the student.

2. Requirements for Students with Previous HBV Infection

For those medical students with previous HBV infection, the following applies:

• a. If the student documents antibodies to HBV, such evidence of antibodies is acceptable, and nothing further need be done.
• b. If a student is a chronic carrier of HBV, each case will be reviewed on an individual basis. However, the following process applies to all situations:
  
  
  • i. A student who tests positive for Hepatitis surface antigen must have further testing (such as testing for Hepatitis e-antigen) performed at the University Health Service to determine the level of infection.
  • ii. If the student is found to be e-antigen positive or otherwise believes or has reason to believe that he or she is e-antigen positive, the student must self-report this fact within forty-eight (48) hours to the Medical School’s Communicable Disease Review Panel (“the Review Panel”). Students should do this by notifying the Associate Dean for Student Affairs, who is a member of the Review Panel (368-2212).
• c. Medical students who learn that another medical student is infected with HBV shall advise the infected medical student of the duty to report the fact to the Review Panel.
• d.  Students who are chronic carriers may be referred to hepatologists in the community for further evaluation and treatment of this condition.

B. HIV Policy

• 1.  For protection of patients, to assist infected medical students with obtaining appropriate medical guidance and career counseling, and to minimize serious complications for the infected student, the Medical School encourages all medical students to know their HIV status.
  
  

• 2. HIV screening is available from the University Health Service or at other testing sites in Cleveland.

  • a. All HIV-related testing is conducted in accordance with Ohio law, and health care consent policies for HIV testing.

• 3.  Medical students who believe or have reason to believe that they are infected with HIV must self-report that fact within twenty-four (24) hours to the Medical School’s Communicable Disease Review Panel (“the Review Panel”).  Students should do this by notifying the Associate Dean for Student Affairs, who is a member of the Review Panel (368-2212).  See procedures for governing Review Panel set out in Section C below.
  

• 4.  Medical students who learn that another medical student is infected with HIV shall advise the infected medical student of the duty to report the fact to the Review Panel.

• 5.  Medical students who believe or have reason to believe that they are infected with HIV should seek immediate medical care.  If requested, students who are infected with HIV may be referred to physicians in the community or at the University Health Service for further evaluation and treatment of this condition.

C. Review Panel Procedures

• 1.  Each medical student infected with HBV or HIV must participate in a confidential review and monitoring process conducted by the Communicable Disease Review Panel. The Review Panel will handle each infected medical student’s situation on an individual basis. Through this review process, the Review Panel will tailor the infected student’s clinical clerkship program so as to attempt to minimize the risk to patients for whom the student will be caring and minimize the risk of serious complications for the infected student.

• 2. The Review Panel generally will consist of the Director of the University Health Service, the Senior Associate Dean for Students, the Associate Dean for Student Affairs, the Vice Dean for Medical Education and Academic Affairs, and other faculty members in health sciences with expertise in infectious disease and/or infection control. The student’s treating physician and a representative of the University Attorney’s Office will be consulting, but not voting, members of the Review Panel.

• 3. The Review Panel will conduct a confidential review of the student’s condition, the student’s clinical schedule, and the possible impact the condition may have on the student’s patients and clinical work.

• 4. In order for the Review Panel to make appropriate recommendations as to the infected student’s medical school program, the infected medical student will be asked to identify in writing his or her treating physician, and to notify the Review Panel as to any change in treating physician.  The infected student will be asked to authorize release of medical information to the Review Panel and to the hospital(s) or clinic(s) where the student will be performing clerkships or clinical work.  The Review Panel will consult with the student’s treating physician as part of its review process.

• 5. The Review Panel will make recommendations on any restrictions that should be placed on the student’s clerkships and/or precautions that must be taken during clerkships or other clinical work.  Such limitations may include that all third-year rotations be done at a single hospital, that the student perform non-invasive clerkships first before performing invasive clerkships (e.g., surgery and obstetrics and gynecology), or that the student not be permitted to engage in invasive procedures during clerkships such as surgery and obstetrics and gynecology.

• 6. The Review Panel will, when appropriate, advise the student and make recommendations on appropriate infection control techniques and universal precautions.

• 7. Before notifying the student of its recommendations, the Review Panel will forward its proposed recommendations to the Dean of the Medical School, who may make modifications to those recommendations. As part of this process, the Review Panel may disclose, to the extent necessary, information concerning the student’s status and the Panel’s recommendations to the Dean, so that the Dean will have adequate information to review the situation.

• 8. Following the Dean’s approval and/or modifications, the Review Panel will document the restrictions or precautions to be placed on the student and notify the student as to the restrictions or precautions in writing.  The Review Panel or its designee will then take steps to assure that these restrictions or precautions are implemented in arranging the student’s clerkships or other clinical work.

• 9. The Review Panel or its designee shall report to the hospital(s) or clinic(s) to which the student is assigned the student’s HBV or HIV status and of the Review Panel’s recommendations for precautions or restrictions, if applicable.  The Review Panel will make this report and submit other documentation as appropriate to the Hospital Epidemiologist or Infection Control Review Panel for the hospital(s) or clinic(s).  The hospital’s epidemiologist or infection control review panel can then determine precautions or restrictions, if any, that should be implemented during the clerkships.  The Review Panel will advise the hospital(s) or clinic(s) on the confidentiality of the information disclosed.

10. The Review Panel may also conduct a review to determine whether any patients treated by the student were at a significant risk of exposure to HBV or HIV.

11. The infected student shall not perform or participate in any invasive or exposure-prone invasive procedures without the approval of the Review Panel through the review process set out above. Medical students with HBV or HIV must adhere to universal precautions when performing any invasive procedure in a clerkship or clinical work.

12. The Review Panel or a designee of the Review Panel (such as the Associate Dean for Student Affairs of the School of Medicine) will meet with the infected student periodically to assure that the student is complying with the restrictions placed on his or her clerkships and program of study, and to discuss any problems the student may be experiencing. Alternatively, the Review Panel may require the student to submit periodic confidential written reports updating the Review Panel on clerkship activities and clinical work and any problems the student may be experiencing.  The Review Panel also may consult with the student’s treating physician to obtain updated information on the student’s condition.
 

D. Confidentiality and Career Counseling

• 1. The Review Panel will, to the extent possible, hold in strict confidence all information in its possession relating to the HBV or HIV status of a medical student.  The Review Panel may disclose information relating to a student’s HBV or HIV status, to the extent necessary, to the hospital or clinical setting at which the student is performing clerkships in order for the hospital’s epidemiologist or infection control review panel to tailor the medical student’s clerkships or clinical work.  The Review Panel also may disclose, to the extent necessary, such information to the Dean making a final decision under this policy or hearing an appeal filed by a student.  The Review Panel also may disclose, to the extent necessary, such information to other administrators or faculty within the Medical School in connection with a disciplinary action involving the student’s violation of this policy.  Medical students should be aware that evidence of infection with HBV or HIV is by law reportable to the Department of Health.

• 2. When possible, the Review Panel will not discuss the name of the infected student during their review, but instead will discuss the situation anonymously.

• 3. Medical students should also be aware that the University Health Service may be obligated to inform the Review Panel of a student’s HBV or HIV status if the University Health Service believes that the student poses a threat to patients under the particular circumstances of the case.

• 4. Students may obtain career counseling regarding their HBV or HIV status from the Review Panel, at the University Health Service or at the Medical School, if the student wishes to divulge this information to those offices.

  E. Sanctions for Violation of the Policy

• 1. If the Medical School learns that a medical student is aware of their infection with HBV or HIV but has failed to report this status to the Review Panel as required above, the medical student may be subject to disciplinary action, up to and including expulsion from the Medical School.

• 2. The Review Panel has the right to require the student to enter into the confidential review and monitoring process as set according to the established policy.

• 3. If an infected medical student fails to a) follow the restrictions or recommendations of the Review Panel, b) use universal precautions, c) conform to minimal standards of care, or d) otherwise take steps to ensure patient safety, the Review Panel may notify the Medical School’s Associate Dean for Student Affairs, who may take appropriate disciplinary action, including but not limited to oral or written warning, suspension from clinical exposure and referral to the Committee on Students for disciplinary action.

F. Policy Concerning Other Communicable Diseases

• 1. If a medical student is engaged in any Type A clinical elective or clerkship or otherwise has patient contact and tests positive for any other communicable disease other than HBV or HIV that is reportable to the Department of Health and is listed on Appendix IV, that student must report the disease to the University Health Service.  See Appendix IV for a list of diseases that must be reported to the University Health Service.

• 2. The University Health Service will consult with the student to advise the student on requirements for minimizing the spread of the communicable disease.

• 3. When appropriate, the University Health Service also will advise the student of the need to notify the hospital(s) or clinic(s), and the attending physician, to which the student is assigned of the student’s condition, so that the hospital(s) or clinic(s) can determine what restrictions, if any, need to be placed on the students interaction with patients or what precautions the student must take.  The University Health Service will work with the student to assure that the hospital(s) or clinic(s) receive(s) notice of the communicable disease either by the student self-reporting the disease either by the student self-reporting the disease or the University Health Service reporting the disease to the hospital(s) or clinic(s).

• 4. The student must follow the restrictions or precautions set out by the University Health Service and/or the hospital(s) or clinic(s) at which the student is performing the clerkships or clinical work.

• 5. Failure of a student to report one of the listed communicable diseases to the University Health Service may result in disciplinary action, including but not limited to oral or written warning, suspension or expulsion.  In addition, failure of a student to follow the restrictions or precautions placed on him or her by the University Health Service and/or the hospital or facility at which clinical work is performed may result in disciplinary action.

• 6. The Review Panel reserves the right to review and monitor students with communicable diseases other than HBV and HIV when the Review Panel determines that patients may be at risk because of the condition or that additional precautions are necessary to assure patient safety.

G. Appeals

1. Students may request reconsideration of any decision or recommendations of the Review Panel by requesting in writing that the Review Panel by requesting in writing that the Review Panel reconsider the decision or recommendations. The request for reconsideration must be submitted to the Review Panel within five (5) working days of the Review Panel’s decision. If the student seeks reconsideration, the student is permitted to appear before the Review Panel to present information on the issue. The Review Panel may affirm its prior decision and/or recommendations or modify them. Before notifying the student of its decision on the reconsideration request, the Review Panel will forward its proposed decision to the Dean of the Medical School for approval and/or modifications. The Review Panel will provide to the student in writing the decision on the reconsideration request, including any modification in its decision and/or recommendations.

2. Any decision of the Review Panel or any other decision made pursuant to this Policy can be appealed to the Dean of the Medical School.  The appeal must be submitted in writing within ten (10) working days of the date of the decision being appealed.  The decision of the Dean is final.

Return to top