standards for matriculation

8/7/2019 Standards for Matriculation

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Standards for Matriculation, Promotion, and GraduationI. General IssuesA . OverviewMedical educat ion requires that the accumulat ion of scient if ic knowledge beaccompanied by the simultaneous development of specif ic ski l ls and othercompetencies. The City College/Sophie Davis School of Biomedical Educat ion(CCNY/SDSBE) Physician Assistant (PA) Program has a responsibility to society togradua te the best possible and h ighly competent physician assistants:

Admission to the PA Program is offered to applicants who presentoutstanding qualif ications for the study and pract ice of medic ine. Succe ssfully comp let ing the entire PA Program curriculum is necessary forall students. All students must meet both our acade mic standards and our standards forcapacity (SFC) in order to progress through and graduate f rom theprogram.Academic standards refer to acceptable dem onstrat ions of mastery in variousdisciplines, before matriculation and after, as judge d by faculty members,exam inat ions, and other m easure ments of performance. Ac cep table levels ofmastery are required in six broad areas of competency once a studentmatriculates in the physician assistant program:

Medical/scient if ic knowledge Clinical Skills Professionalism Communicat ion/ interpersonal skills Pract ice-base d learning (engaging in sel f -assessment and makingimprovements in one 's learning and performance) Systems-based pract ice (effect ively carrying out responsibilit ies in acomplex system of med ical and asso ciated professionals)

Academic standards, and related grading systems, are addressed in detai l duringeach course and clerkship. Any student, who has specif ic quest ions aboutperforma nce requirements, may speak with course and clerkship directors.Examples accompanying each capacity in Item II below, however, should providean accurate sense of expected performance at the CCNY/SDSBE PA Program.Standards for capac i ty , also known as technical standards, refer to theessential apt i tudes and abilit ies that allow physician assistant students (andphysician assistants) to perform in the vast array of requisite ways summarizedby the six areas of competency above. "Standards for capacity" may soundunfamiliar, even though the abil i t ies they represent are extremely important inthe f ield of medicine. Those abilit ies are the foundation for acade mic success atthe PA Program, and for the eve ntual p ract ice of medicine itself. Our standardsfor capacity are described in detail under item II.All graduates of CCNY/SDSBE PA Program must have the knowledge, skills andother competencies to funct ion in a wide variety of cl inical situat ions and torender a wide spectrum of pat ient care. Historical ly, undergraduate medical


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education in the United States has been structured as a broad general medicalschool model, which is intended to produce generalist practitioners. The academicstandards and standards for capacity are based on that model and the standardsattempt to insure capable, well-rounded future clinicians. *Without the essential capacities, students cannot fulfill the requirements of all thecourses and clerkships at SDSBE/PA Program. Meeting the SDSBE/PA ProgramStandards fo r Capacity (detai led below) is , therefore, required fo r l)matriculation(as well as the abilit ies can reasonably be determined before matriculation), 2)subsequent promotion from term to term, and 3) graduation from theCCNY/SDSBE PA Program. It is important that all applicants and current studentsread this document to better understand what is expected at the CCNY/SDSBE PAProgram.* This model does no t necessarily mean that al l SDSBE/PA Program graduates, given their individualstrengths and preferences, are equally suited for every training program. Instead it means that allgraduates have a strong baseline education on which to draw in a wide variety of situations.B. DisabilitiesIt is our experience that a number of individuals with disabilit ies (as defined bySection 504 of the Rehabilitation Act and the Americans with Disabilities Act) arequalified to study and practice medicine with the use of reasonableaccommodations. To be qualified for the study of medicine at the SDSBE/PAProgram, those individuals must be able to meet both our academic standardsand the standards for capacity, with or without approved accommodation.Accommodation is viewed as a means of helping students with disabilit ies tomeet essential standards, not to circumvent them.C. The Use of Auxiliary Aids and IntermediariesQualified students with documented disabilit ies are readily provided withreasonable accommodations at the SDSBE/PA Program, and thoseaccommodations sometimes involve an intermediary or an auxiliary aid.However, no disability can be reasonably accommodated at SDSBE/PA Programwith an auxil iary aid or intermediary that provides cognitive support or medicalknowledge, substitutes for essential clinical skills, or supplements clinical andethical judgment. That is to say, accommodations cannot eliminateessential/required program elements.Some intermediaries that may be acceptable include sign language interpreters -provided the interpreters offer only translation, and do not perform selective,analytic, interpretive, or integrative functions for the student - or transcriptionistswho provide a similar function. In this way, a deaf student is simply enabled to"listen", but is still responsible for essential communication elements of thecurriculum. (A deaf student would still need to communicate fluently in writtenEnglish without an intermediary.) Similar ly, a paraplegic student might be able touse aids such as a standing wheelchair or a variable - height table in order toexamine a patient.The faculty believes that visual impairments severe enough to require a medicallytrained intermediary cannot be accommodated at SDSBE/PA Program. Certainlythere are advances in technology all the time, and at some point there may beacceptable accommodations fo r blind students, but an intermediary that wouldhave to select and interpret visual information (e.g. slide configurations, clinicalpresentations, etc.), would constitute cognitive support and/or a supplement to


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clinical judgment. This kind of assistance would also, undoubtedly, depend onmed ical/scientific knowledge to some extent. Use of this type of intermediary, inthe faculty's opinion, would represent a fundamental alteration to the physicianassistant program. Reliance on an intermediary trained to perform physicalexams for a student with a severe physical disability would also be unacceptablefor the same reasons.II. CCNY/SDSBE PA Program Standards for Capacity (TechnicalStandards)Students at CCNY/SDSBE PA Program must have capa cities/abilities in five broadareas:

Perception/observation Communication Motor/tact ile function Cognition Professionalism (Ma ture and Ethical Conduct)A . Perception/ObservationStudents must be able to accurately perceive, by the use of senses and mentalabilities, the presentation of information through:

Sm all group discussions and presentations Large-group lectures One-on-one interactions Demonstrations Laboratory expe riments Patient encounters (at a distance and close at hand) Diagnostic findings Procedures Written material Audiovisual m ater ia l

Representat ive examples of materials/occasions requir ing perceptual abil i t iesbeginning in year 1 include, but are not limited to: books, diagrams, discussions,physiologic and pharm acologica l dem onstrat ions, microbiologic cultures, grossand microscopic studies of organisms and t issues, chemical reactions andrepresen tations, photographs, x-rays, ca da ver prosections, live huma n casepresentations, and patient interviews.Addi t ional examples from year 2 include, but are not limited to: physical exam s;rectal and pelvic exams; examinations with stethoscopes, otoscopes,fundoscopes, sphygmom anom eters, and reflex hamme rs; verbal com munic ationand non-verbal cues (as in taking a patient's history or working with a medicalteam); live and televised surgical procedures; childbirth; x-rays, MRIs, and otherdiagnost ic f indings; online computer searche s.B. CommunicationStudents must be able to communicate skillfully (in English) with facultymembers, other members of the healthcare team, patients, families, and otherstudents, in order to:


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Elicit information Convey information Clarify information Create rapport Deve lop therapeutic relationships Demonstrate competenciesyExamples of areas in which skil lful communication is required beginning in year 1include, but are not l imited to: answering oral and written exam questions,eliciting a complete history from a patient, presenting information in oral andwritten form to faculty/preceptors, participating in sometimes fast-paced small-

group discussions/interactions, participating in group dissections, participating inlabs.Additional examples of areas in which skillful communication is required in year 2include, but are not limited to: participating in clinical rounds and conferences;writing patient H&Ps (histories and physicals); making presentations (formal andinformal) to physicians and other professionals; communicating daily with allmembers of the healthcare team; talking with patients and families aboutmedical issues; interacting in a therapeutic manner with psychiatric patients;providing educational presentations to patients and families; participating invideotaped exercises; interacting with clerkship administrators; writing notes and .papers.C. Motor/tactile functionStudents must have sufficient motor function and tactile ability to:

Attend (and participate in) all classes, groups, and activities which are partof the curriculum Read and write Examine patients Do basic laboratory p rocedures and tests Perform diagnostic proced ures Provide general and emergency patient care Function in outpatient, inpatient, and surgical venues Perform in a reasonably independent and competent way in sometimeschaotic clinical environments Demonstrate competencies including manual dexterity

Examples of activities /situations requiring students' motor/tacti le functionbeginning in year 1 include, but are not limited to: transporting themselves fromlocation to location; participating in classes, small groups, patient presentations,review sessions, prosections, laboratory work, and microscopic investigations;using a computer; performing a complete physical exam - including obse rvation,auscultation, palpation, percussion, and other diagnostic maneuvers; performingsimple lab tests; using light microscopes; performing cardiopulmonaryresuscitation.Addit ional examples of experience s requiring motor/tacti le function in year 2include, but are not limited to: accompanying staff on rounds and conferences;performing venipunctures, thoracentese s, paracenteses, endotrac healintubations, arterial punctures, Foley catheter insertions, and nasogastric tubeinsertions; taking overnight call in the hospital; performing physical, neurological,


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gynecological, pediatr ic, and obstetr ic examinations (with the appropriateinstrumen ts); de aling with agitated patients in em ergen cy situations; maintainingappropriate medical records; acting as second assistant in the OR (retracting,suturing, etc).D. CognitionStude nts must be able to demon strate higher-leve l cognitive abilit ies, whic hinclude:

Rational thoughtMeasurementCalculationVisual-spat ial abilityConceptual izat ionAnalysisSynthesisOrganizat ionRepresentat ion (oral, written,, diagrammatic, three dimensional)MemoryApplicat ionClinical reasoningEthical reasoningSound judgment

Examples of applied cognitive abilit ies beginning in year 1 include, but are notl imited to: understanding, synthesizing, and recalling material presented inclasses, labs, small groups, patient interactions, and meetings withfaculty/pre cep tors; understanding 3-dim ensiona l relationships, such as thosedemonstrated in the ana tomy lab; succe ssfully passing oral, prac tical, written,and laboratory exams; understanding ethical issues related to the practice ofmedicine; engaging in problem solving, alone and in sma ll groups; interpretingthe results of patient e xam inations and diagnostic tests; ana lyzing complicatedsituations, such as cardiac arrest, and determining the appropriate sequence ofeve nts to effect successful treatm ent; wo rking through ge netic problems.Addi t ional exa mp les of required cognitive ab ilities in yea r 2 include, but are notlimited to: integrating historical, physical, social, and ancillary test data intodifferential diagnose s and treatment plans; unde rstanding indications for variousdiagnost ic tests and treatment moda lities from med ication to surgery;understanding methods fo r various procedures, such as lumbar punctures andinserting intravenous catheters; being able to think through medical issues andexhibit sound judgment in a variety of clinical settings, including emergencysituations; identifying and understanding psychopathology and treatmentoptions; making concise, cogent, and thorough presentations based on variouskinds of data collection, including web-based research; knowing how to organizeinformation, materials, and tasks in order to perform efficiently on service;understanding how to work and learn indepe ndently; understanding how tofunction effectively as part of a healthcare team.


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E. Professionalism: (Mature an d Ethical Conduct)Students must be able to:

Consistently display integrity, honesty, empathy, caring, fairness, respectfo r self and others, diligence, and dedication Promptly complete all assignments and responsibilities attendant to thediagnosis and care of patients (beginning with study in the first year) Communicate with, examine, and provide care for all patientsincludingthose whose gender, culture, s exu al orientation, or spiritual beliefs aredifferent from students' own. Develop mature, sensitive, and effective relationships, not only withpatients bu t with all members of the medical school community andhealthcare teams Maintain sobriety in all academic and clinical environments, and refrainfrom the illegal use of substances at all times. Abide by all state, federal, and local laws, as well as all CCNY/SDSBE PAProgram and clinical training sites codes of conduct. Tolerate physically, emotionally, and mentally demanding workloads Function effectively under stress, and proactively make use of avai lableresources to help maintain both physical and mental health Adapt to changing environments, displa y flexibility, and be able to learn inthe face of unce rtainty

Take responsibility for themselves and their behaviorsExamples of professional behavior beginning in year 1 include, but are not limitedto: showing up for required experiences on time and prepared; handing inassignments on time; refraining from plagiarizing or cheating; treating faculty,staff, and other students with respect; making an effort to understand prejudicesand preconceptions that might affect patient interactions or collegia! relationships(especially in the areas of race and ethnicity, sexual orientation, ge nder,disability, age, and religious difference); developing successful workingrelationships with preceptors, staff, and peers by accepting constructivefeedback.Addit ional examples of professional behavior in year 2 include, but are not limitedto : maintaining a professional deme anor on service (e.g. white coat, name tag,appropriate attire, neat appe arance , respectful speech, sobriety); representingoneself accura tely; apprec iating and preserving patient confide ntiality;responding sensitively to patients' social and p sycho logica l issues; de velopingem pathic listening skills; unde rstanding social biases and stigmas, and notreinforcing them; advocating fo r patients when app ropriate; using hospital/clinicresources responsibly; showing up prepared and on time for rounds, lectures,conferences, and procedures; getting advice when handling ethical dilemmas;taking co nstructive feed bac k from a ttending physicians , residents and physicia nassistants with open-mindedness and the intention to improve; contributing tothe effectiveness, efficiency, and collegiality of healthcare teams.*** Any student who has a question about whether he or she can meet thesestandards should contact the CCNY/SDSBE PA Program Office about yourconcerns. There are any number of accommodations that can be made forstudents with documented disabilities, but all students should be able to performin a reasonably independent manner. ***

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