Technical Standards in Health Sciences Programs

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Technical Standards in Health Sciences Programs

• Martha R. Smith
• Office for Student Access
• Oregon Health Science University

2
Topical Agenda

• Laying the groundwork
• Admissions Requirements
• Technical Standards
• Faculty Concerns
• Why have Technical Standards
• Use of Technical Standards
• Nitty Gritty Details
• Creating Essentials
• Martha R. Smith, OHSU 2006

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Laying the groundwork

• Students with disabilities must be otherwise
  qualified (able to meet the academic and
  non-academic requirements of the program with or
  without a reasonable accommodation)
• Programs may include non-academic requirements as
  part of their entrance requirements (experiences,
  skills, CPR certification, etc..)
• Martha R. Smith, OHSU 2006

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Admissions Requirements

• Admissions requirements need to be legitimate and
  nondiscriminatory
• They must be related to the goals and objectives
  of the program
• Cannot be written based on the status of not
  having a disability
• Can be as a result of accreditation or licensure
  requirements
• Martha R. Smith, OHSU 2006

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Admissions Requirements

• Non-academic admissions requirements must be a
  skill, knowledge, ability or credential that the
  person already possesses and will not be taught
  in the program.
• Cannot base admissions decisions on the concern
  that a student may or may not be able to get a
  job as a result of their disability or the need
  for accommodations.
• Martha R. Smith, OHSU 2006

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Technical Standards

• The term technical standards refers to all
  nonacademic admissions criteria that are
  essential to participation in the program in
  question. (34 CFR 104 Appendix A, 5)
• Can be used as admissions criteria and as
  participation criteria
• Can apply to the whole program, stages of the
  program or only one part of the program
• Must be related to essential requirements/aspects
  of the program
• Can be met with or without a reasonable
  accommodation
• Martha R. Smith, OHSU 2006

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Technical Standards

• Institutions/programs are not required to have
  technical standards by 504 and ADA
• Individual accrediting bodies might require some
  form of technical standards or prerequisites
• Should be developed through a collaborative
  process
• Martha R. Smith, OHSU 2006

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Technical Standards are not

• Essential Functions this is an employment term
  specific to a particular job at a particular
  employment site
• The essential function of being a student is
  LEARNING how to become a nurse, physician,
  veterinary technician, etc..
• Martha R. Smith, OHSU 2006

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Faculty Concerns

• Students have the skills/abilities necessary to
  successfully complete the program
• Students at the completion of the program will
  have all the requisite skills and experiences to
  enter the profession as a competent practitioner
  (undifferentiated)
• Martha R. Smith, OHSU 2006

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Faculty Concerns

• Professionalism
• Integrity
• Ethics (ethical responsibilities are the same
  with or without a disability)
• Patient safety
• Martha R. Smith, OHSU 2006

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Why have Technical Standards?

• If an accrediting or licensure body does not
  require specific technical standards why have
  them?
• Martha R. Smith, OHSU 2006

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Why have Technical Standards

• Health sciences programs are expensive and time
  intensive programs want to be fairly sure a
  student is going to be successful in completing
  the program once the student is accepted
• Narrows/limits the eligibility pool
• Informs students (potential students) of what is
  expected of them in the program
• Martha R. Smith, OHSU 2006

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Why have Technical Standards

• Choosing carefully who gets to be a part of the
  profession
• Concerns regarding competency and ultimate safety
  issues
• The state Board or accrediting body might require
  them
• Martha R. Smith, OHSU 2006

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Use of Technical Standards

• Informational
• Entrance Requirements
• Technical Standards Agreements
• Participation/Exit Requirements
• Martha R. Smith, OHSU 2006

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Informational Technical Standards

• Providing information readily available on
  websites and elsewhere that indicates the kinds
  of skills, tasks, experiences and requirements a
  student will encounter and will be expected to
  show competence in during the program and prior
  to successful completion of the program
• Martha R. Smith, OHSU 2006

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Informational Technical Standards example

• The School of Dentistry provides this
  description of technical standards to inform
  prospective and enrolled students of the skills
  required in the provision of oral health care
  services. These technical standards reflect the
  performance abilities and characteristics that
  are necessary to successfully complete the
  requirements of the dental, dental hygiene, or
  advanced dental education programs at the school.
  These standards are not requirements of admission
  into the programs. People interested in applying
  for admission to the programs should review these
  standards to develop a better understanding of
  the physical abilities and behavioral
  characteristics necessary to successfully
  complete the programs.
• http//www.dentistry.vcu.edu/public/technical_sta
  ndards.html Martha R. Smith, OHSU 2006

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Technical Standards Agreement

• Signed agreement based on the honor system
• Some programs have students sign the agreement as
  part of an entrance requirement
• Some programs have students sign an agreement
  only once the student has matriculated into the
  program
• Martha R. Smith, OHSU 2006

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Admissions Technical Standards

• Based on assumptions (Subjective). Many of the
  lists of physical abilities are based on the
  assumption of how a task needs or will be
  completed with that physical ability in the
  actual program (lab/clinical)
• It is easy to list specific experiences, skills
  or knowledge someone must have. It is harder to
  list abilities or characteristics.
• Martha R. Smith, OHSU 2006

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Admissions Technical Standards

• How do you test for them?
• Most often use the honor system ( signed
  agreement) as proof of satisfying the technical
  standards.
• If you ask one student to prove they meet the
  standards you must ask all students
• Martha R. Smith, OHSU 2006

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Example Admission Technical Standard

• The following technical standards specify those
  attributes the faculty believes are necessary for
  completing the educational programs in nursing.
  These standards describe the essential functions
  students must demonstrate to fulfill the
  requirements of the degree programs in nursing
  and thus are prerequisites for entrance,
  continuation, and graduation.
• ObservationStudents must be able to observe a
  patient accurately, at a distance and
  close-at-hand, noting nonverbal as well as verbal
  signals.
• http//www.mc.uky.edu/Nursing/StudResources/underg
  rads/handbook2005-06/tech_stand.htm Martha R.
  Smith, OHSU 2006

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Example Admission Technical Standard

• This document outlines the minimum abilities
  each applicant should possess prior to entry into
  the program. In order to assume the
  responsibilities and perform the duties of a
  dental hygienist, individuals must be able to
  satisfactorily possess/accomplish the following
  
• Applicants must possess the emotional health
  required for full utilization of his/her
  intellectual abilities, exercise of good
  judgment, and prompt completion of all
  responsibilities associated with the care of
  patients.
• http//www.usd.edu/dhyg/technicalstandards.cfm
• Martha R. Smith, OHSU 2006

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Participation/Exit Technical Standards

• Based on observable behavior (objective)
• Technical standards can apply to the whole
  program, stages of the program or only one part
  of the program.
• Martha R. Smith, OHSU 2006

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Example Participation/Exit Technical Standards

• Students of the Nursing Program are expected to
  fulfill the following technical standards
• Acquire information from demonstrations and
  experiences in the basic and applied sciences,
  including but not limited to information conveyed
  through lecture, group seminar, small group
  activities and physical demonstrations.
• Accurately elicit information, including a
  medical history and other information required to
  adequately and effectively evaluate a clients
  condition.
• http//www.lemoyne.edu/nursing/technical.htm
• Martha R. Smith, OHSU 2006

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Nitty Gritty Details

• What vs. How
• Entrance vs. Exit requirement
• Employment tensions
• Requirements, Criteria, Competencies, Oh my
• Limits on Accommodations
• Martha R. Smith, OHSU 2006

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What vs. How

• Technical Standards should focus on the what
  that has to be done, the skill or task not how
  that skill or task is accomplished. In fact
  there might be multiple ways to accomplish the
  task.
• Example (What) Must be able to move patient
  safely from bed to wheelchair and from wheelchair
  to bed
• NOT
• (How) Must be able to stand and bend and use
  your legs to balance while safely moving a
  patient from bed to wheelchair or from wheelchair
  to bed. Martha R. Smith, OHSU 2006

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Example What vs. How

• MEDICAL TECHNOLOGY TECHNICAL STANDARDS
• Technical Standards
• Acquire information from demonstrations and
  experiences in the basic and clinical sciences,
  including but not limited to information conveyed
  through lectures, laboratory dissection,
  demonstrations, discussions and clinical
  experiences.
• Adapt and function effectively under the various
  circumstances and rigors which are inherent in
  Medical Technology.
• http//www.upstate.edu/chp/mt/standards.php
• Martha R. Smith, OHSU 2006

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Example How vs. What

• Nursing Technical Standards for Nursing
• Technical Standards for Admission, Academic
  Progression, and Graduation in Undergraduate and
  Graduate Nursing Programs
• Motor Ability The student must have sufficient
  levels of neuromuscular control and eye-to-hand
  coordination as well as possess the physical and
  mental stamina to meet the demands associated
  with extended periods of sitting, standing,
  moving, and physical exertion required for
  satisfactory and safe performance in the clinical
  and classroom settings including performing CPR
  if necessary. The student must possess the
  ability of manual dexterity such as to draw up
  solutions in a syringe.
• http//www.drexel.edu/cnhp/nursing/technical.asp
• Martha R. Smith, OHSU 2006

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Entrance vs. Exit

• Cannot use exit criteria as entrance (admissions)
  criteria.
• Example Must have hearing sufficient to detect a
  heart murmur through a stethoscope.
• If the person already knows how to do this why
  are they going to enter this program?
• Non-academic admissions requirements must be a
  skill, knowledge or credential that the person
  already possesses and will not be taught in the
  program.
• Martha R. Smith, OHSU 2006

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Example Exit vs. Entrance

• Technical Standards for admission to the COCC
  Nursing program include the following
• Hearing Ability
• 2.  Hearing ability sufficient to assess clients
  and their environments and to implement the
  nursing care plans that are developed from such
  assessments.
• Examples of relevant activities are            
  
• Detect sounds related to bodily functions using
  a stethoscope     
• Detect audible alarms e.g. monitors, fire
  alarms, call bells      
• Communicate clearly in telephone conversations
       
• Communicate effectively with clients and with
  other members of the healthcare team
• http//alliedhealth.cocc.edu/Programs_Classes/Nurs
  ing/NursingTech/Default.aspx Martha R. Smith,
  OHSU 2006

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Employment Tensions

• The tension between program requirements and
  employment expectations and requirements
• Students are students not employees Technical
  standards or program requirements must focus on
  outcomes or competencies specific for the program
  not on what MIGHT be needed or required at an
  employment site
• Martha R. Smith, OHSU 2006

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Example Employment Tensions

• The following are examples of essential
  functional abilities needed to be successful in
  the Nursing Program. All students are required to
  meet these essential functions.
• Physical endurance sufficient to provide nursing
  care for an entire shift
• Maintain physical tolerance for an entire
  assigned shift (typically 8 or 10 hours)
• http//www.pcc.edu/programs/nursing/essential.htm
• Martha R. Smith, OHSU 2006

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Requirements, Criteria, Competencies, Oh my

• Essential requirements ( the elements that make
  the program what it is, if you remove those
  essential elements it is no longer a course in
  American History, a clinical rotation in
  pediatrics, etc..)
• Performance criteria (passing grade of C, change
  IV bag correctly, write paper with complete
  bibliography)
• Martha R. Smith, OHSU 2006

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Requirements, Criteria, Competencies, Oh my

• Classroom assignments are not technical standards
  
• Core competencies ( tasks, skills, knowledge that
  you must demonstrate competency in before you can
  proceed further in the class/course/program/gradua
  tion)
• Martha R. Smith, OHSU 2006

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Limits on Accommodations

• Technical standards and essential requirements
  can be met with or without a reasonable
  accommodation
• Cannot set arbitrary limits on or exclude
  accommodations as part of the requirement
• Martha R. Smith, OHSU 2006

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Limits on Accommodations?

• The use of an intermediary that would, in
  effect, require a student to rely on someone
  elses power of observation and/or communication
  will not be permitted.
• http//medschool.duke.edu/wysiwyg/downloads/Tab4.
  technical.standards.pdf
• Martha R. Smith, OHSU 2006

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Limits on Accommodations?

• Qualified students with documented disabilities
  are readily provided with reasonable
  accommodations at DMS, and those accommodations
  sometimes involve an intermediary or auxiliary
  aid. However, no disability can be reasonably
  accommodated at DMA with an auxiliary or
  intermediary that provides cognitive support,
  substitutes for essential clinical skills, or
  supplements clinical and ethical judgment. That
  is to say, accommodations cannot eliminate
  essential program elements.
• http//dms.dartmouth.edu/admin/olads/esmpg.shtml
• Martha R. Smith, OHSU 2006

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Reminders

• Non-academic admissions requirements must be a
  skill, knowledge, ability or credential that the
  person already possesses and will not be taught
  in the program.
• technical standards refers to all nonacademic
  admissions criteria that are essential to
  participation in the program (34 CFR 104
  Appendix A, 5)
• Martha R. Smith, OHSU 2006

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Meeting Faculty Needs

• Are there other ways for faculty to get the
  right students for the program without a list of
  technical standards that are focused on
  abilities/physical characteristics?
• Vet Tech example Veterinary Technology
  Program requires all applicants to observe 40
  hours in a veterinary clinic or hospital for
  eligibility for admission to the program. The
  purpose is to introduce the applicant to the
  Veterinary Technology profession, and to allow
  that person to observe the activities of
  veterinary hospitals so that he/she will,
  hopefully, be able to decide if this is truly the
  occupational training he/she desires.
• http//spot.pcc.edu/vettech/Source20Documents/obs
  ervation_letter.doc
• Martha R. Smith, OHSU 2006

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Working backwards to Create Essentials

• List educational objectives
• Course, Lab, Clinical, program
• Are there accreditation or licensure
  requirements?
• Course, Lab, Clinical, program
• List skills and knowledge student must learn and
  how to measure the outcomes/performance
• Course, Lab, Clinical, program
• Martha R. Smith, OHSU 2006

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Working backwards to Create Essentials

• List activities that will occur to facilitate
  these objectives and the acquisition of the
  skills and knowledge
• Course, Lab, Clinical, program
• List skills, knowledge and other criteria
  students must have prior to this course, lab,
  clinical, program (technical standards,
• prerequisites)
• Adapted from Scott, S.S. (1990). Coming to terms
  with the otherwise qualified student with a
  learning disability. Journal of Learning
  Disabilities, 23, 398-405. By Patricia Anderson,
  University of Connecticut, A.J. Pappanikou Center
  on Special education and Rehabilitation.
• Martha R. Smith, OHSU 2006

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Contact Information

• Martha R. Smith
• Director, Office for Student Access
• Oregon Health Science University
• 503-494-0082
• smitmart_at_ohsu.edu