Clinical Competency:

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Clinical Competency

• Academic and Technical Standards Of A Program

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Academic and Technical Standards

• A program can set academic and technical
  standards for its students

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Example Academic Standard

• Earn at least 84 semester hours of credit while
• Maintaining a cumulative average of C or 70

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Example Technical Standard

• Independently, observe the patient/client
  accurately
• Integrate all information received by whatever
  senses employed

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What Is A Technical Standard?

• All nonacademic admissions criteria
• Must be met by student
• To enable student to participate in and
  successfully complete the chosen program
• Including behavioral, professional and
  intellectual standards

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Purpose Of Technical Standards

• Assist the professional school in selecting
  retaining and graduating those applicants and
  students best qualified to complete the required
  training

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Authorization For Technical Standards

• Title II of the ADA and Section 504 of the
  Rehabilitation Act
• Must be reasonable
• Based on legitimate educational goals of the
  program
• Must be clearly identified in the student
  handbook, field manuals, institutional catalogs,
  and/or program brochures

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Notification

• Student must have reasonable notice
• Standards must be in writing
• Brochures
• Admissions application
• Affidavit

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Continual Monitoring

• Performance must be continually monitored from
  entrance to graduation
• Progress reports, written evaluations
• Prevents unqualified students from making it to
  graduation and then being told at the last minute
  they may not graduate

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Criteria for Decisions

• Subjective grading should be a rational exercise
  of discretion
• Students must have access and be made aware of
  the criteria for making such decisions

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Following the Standards

• Include the consequences for inadequate
  performance and removal procedures
• Immediate notification by University of
  deficiencies in performance and possibility of
  failure or expulsion
• Give opportunity to remedy deficient areas

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Follow the Procedures

• Decisions made in good faith, not arbitrarily or
  capriciously
• The University must follow its procedures once a
  decision for unsatisfactory performance has been
  made
• Students should be entitled to a hearing prior to
  dismissal

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Example of Procedure

• Purpose and scope of rules
• Responsibilities and rights
• Composition of the council
• Violations of the rules

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Example of Procedure - Contd

• Procedures
• Sanctions
• Appeals
• Honor/professional ethics education
• Amendments

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Example

• Continuing student in a clinical program
• Monitor progress reports and written evaluations
• If at any time the students conduct or behavior
  is deemed to endanger the health and safety of
  that individual or others, notify the student
  immediately
• Follow procedures for reevaluation or removal if
  necessary

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Disabilities

• University should make every reasonable effort to
  allow otherwise qualified persons with
  disabilities to engage in their programs
• Including making reasonable accommodations in
  response to a request by an individual with a
  disability

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Otherwise Qualified

• Otherwise qualified
• Can the disabled person satisfy the programs
  requirements despite the disability
• One who is able to meet all of a programs
  requirements in spite of the disability

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What Is A Disability

• The mental or physical condition must
  substantially limit a major life activity,
• The person has a record of such an impairment, or
• The person is regarded as having such an
  impairment

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What Is A Major Life Activity

• Caring for ones self, performing manual tasks,
  walking, seeing, hearing, speaking, breathing,
  learning, and working
• Important life activities are restricted as to
  the conditions, manner, or duration under which
  they can be performed in comparison to most
  people

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Types Of Claims

• ADA and Section 504
• Contract claims
• Negligence

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University of Missouri v. Horowitz

• Medical student was evaluated according to
  procedure during final year
• Failed evaluation due to poor performance on a
  rotation
• Council voted to dismiss the student

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Holding

• A subjective, expert evaluation is required to
  determine whether an individuals performance
  satisfies a predetermined set of standards
• That standard is set by a similar academic
  judgment
• This type of judgment is no less academic even
  though it measures actual conditions of practice
  rather than a grade for written answers

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Southeastern Community College v. Davis

• Davis applied to the Colleges nursing program
• Serious hearing disability
• Refused to admit because the College determined
  that her hearing disability would interfere with
  her safely caring for patients

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Holding

• Section 504 does not limit an educational
  institutions requirement that a prospective
  student must meet reasonable physical
  qualifications for admissions into a clinical
  training program
• Not required to lower or substantially alter its
  standards in order to accommodate a disabled
  person

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Anderson v. University of Wisconsin, et al

• Law student dismissed due to poor academic
  performance caused by alcoholism
• Student did not maintain sufficient average as
  required by the law school
• Threatened fellow student while drunk

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Holding

• Can consider academic performance and sobriety
  when deciding whether an applicant is entitled to
  an education
• Student with below the required average is not
  qualified to stay UNLESS he can show that the
  source of the academic problem has been abated

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Professor Liability

• Generally, as long as the professor was acting
  within the scope of their authority, there should
  not be individual liability

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Developing The Standards

• Should be defined as the essential functions that
  the student must demonstrate in order to fulfill
  the requirements of a program
• They are pre-requisites for entrance,
  continuation, promotion, retention, and
  graduation from the University

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Contd

• Connect technical standards with the licensing
  requirements necessary for a profession

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General Categories

• Observation
• Communication
• Sensory and motor function
• Intellectual, conceptual, integrative and
  quantitative abilities, and
• Behavioral and social

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Necessity

• Explain why the requirement is necessary

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Purpose

• Each student must successfully fulfill the
  prerequisites for admissions, continuation and
  graduation from the program

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ADA

• Include a statement concerning the ADA

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Procedure For Notification and Review

• The materials distributed to prospective students
  should include academic and technical standards
  for notification purposes
• Clearly define suspension and dismissal
  procedures
• Clearly define appeal procedure
• Strictly follow

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Criminal Background

• Courts generally hold that a University may deny
  or revoke admissions because of a prospective
  students past criminal record
• Crime may not be compatible with Universitys
  goals or values, or
• Prospective student failed to disclose
  accurately or completely information on the
  application

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Off-Site Clinics and Internships

• Students skills and abilities
• Specific needs in the clinical setting
• Goals and purposes of the program
• Potential impact of the requested accommodation
  on the program AND on the quality of education
  the student would receive
• Availability of alternatives

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Monitor the Site

• Imperative for the University to be familiar with
  the site and monitor the off-site program
• Ensures the student is receiving a meaningful
  opportunity to participate in the program
• Safety of site itself

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Summary

• Notification and awareness
• Clarity of standard
• Monitor consistently
• Strict application of any procedure in place

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Sources

• Anderson v. University of Wisconsin, et al., 841
  F.2d 737 (1988).
• Board of Curators of The University of Missouri
  et al. v. Horowitz, 435 U.S. 78 (1978).
• Southeastern Community College v. Davis, 442 U.S.
  397 (1979).
• St. Thomas University, 23 NDLR (LRP) 160 (2001).

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Sources Contd

• Derek Langhauser, Use of Criminal Convictions in
  College Admissions, 154 WELR 733 (2001).
• ADA Title III Technical Assistance Manual at
  http//www.usdoj.gov/crt/ada/taman3.html.
• SYNFAX WEEKLY REPORT, Week of April 20, Insuring
  Clinical Competency (1998).
• Patty Gibbs, Gatekeeping in Social Work
  Education, BPD GATEKEEPING WORKSHOP, (October,
  1998).
• University of Massachusetts Medical School
  Technical Standards at http//www.umassmed.edu//so
  m/adm.