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Health Policy for Medical Students

picture of students
 

Annual Physical Examination    
Entering medical students are required to complete a Renaissance School of Medicine at Stony Brook University History Form prior to their first day of enrollment.

  • This form includes a physical exam, health history, tuberculin test, record of immunizations and lab report
    with quantitative titer values for:  MMR, Hep B and Varicella.
  • The form must be completed by the student and a health care practitioner and must be signed and dated by both.
  • Students with positive PPD readings must submit a chest x-ray report dated within the last 2 years. 
  • Forms should be submitted to the Renaissance School of Medicine Student Affairs Office, where a copy will be retained.
  • Original health records are maintained by the Student Health Service (SHS), located on West Campus.  Information on
    the Student Health Service can be found at: http://studentaffairs.stonybrook.edu/shs/index.shtml
  • All SOM students are required to have an annual physical assessment, which includes a physical exam and PPD
    reading.  Physical Assessment forms are available in the Student Affairs Office and should be submitted to the
    Office upon completion.  Physical assessments, TB testing and titers can all be completed at the Student Health Service. 

Immunization History and Proof of Immunity
Hepatitis B
All medical students are required to have been immunized against Hepatitis B and provide a quantitative titer value. 
Hepatitis B immunization consists of a series of three vaccines that should be completed prior to or as soon as possible
after matriciation to ensure safety at the time of patient contact.  Students who do not wish to be immunized for
Hepatitis B must submit a signed declination to the Student Affairs Office and to Student Health Service. 

Rubella
Rubella immunity via history of disease or documented vaccine; AND quantitative titer value.

Rubeola
Rubeola immunization is required for all students.  Students must provide physician documentation of a history of the
disease or receipt of two doses of the vaccine; AND quantitative titer value. 

Mumps
Students must provide physician documentation of a history of the disease or a receipt of the vaccine; AND
quantitative titer value.

Varicella
Students with or without a histor of varicella disease or immunization must submit a quantitative titer for varicella antibody.

Polio, Tetanus, Diphtheria
Documented proof of immunization against polio, diphtheria and tetanus is required of all students.  Tetanus immunization
must be within ten years. 

A booster will be required in the case of a negative titer for any of the above.  The booster whould be followed by another
titer reading within the appropriate amount of time.  A second negative titer will not require another booster. 

Tuberculin Testing
Renaissance School of Medicine requires annual tuberculin (intradermal) testing for actively enrolled students.  All students, including
those who have received BCG vaccine, must have a documented tuberculin test unless a previously positive reaction can be
documented, or unless completion of adequate preventive therapy or adequate therapy for active disease can be documented. 
Student Health Service can place, read and document test results.  Plans for the evaluation and management of medical
students with positive tests or of those whose tests become positive during medical school can be made in conjunction with
the Student Health Service.  Students who are not in compliance will be barred from participation in clinical activities regardless
of the clinical site.  Should a sutdent develop symptoms suggestive of tuberculosis, a chest x-ray will be required before the
student is allowed to resume clinical activities.   

Micro-Particulate Respirators
Because of the increasing prevalence of tuberculosis and the appearance of multiple drug resistant strains, some of the hospitals
and sites where students train require that students be fitted for a micro-particulate respirator (HEPA).  At this time, these masks
are not required at all clinical sites. 

Clinical Site Health Requirements 
Some of our clinical affiliates may have additional health requirements exceeding those of the University and Renaissance School of Medicine. 
Students will be informed of these policies and, where possible, the SOM will expedite the process for student compliance.  It is,
however, the student's responsibility to maintain compliance with additional health requirements.  The clinical affiliate requirements
must be met before a student can begin any clinical rotations or electives at that site.  At present, Nassau University Medical
Center (NUMC) has the following requirements:

  • Annual physical examination.
  • Copy of the lab report containing quantitative titer results for Hep B, Measles, Mumps, Rubella and Varicella. 
  • Tetanus immunization within ten years.
  • A record of annual PPD readings.  If no record of annual PPD readings, the student must have 2 PPD readings within the last 12
    months.  If a second PPD is required, the student can have it placed and read at NUMC Employee Health Clinic at no cost. 
    "Annual" is defined as never having a gap or expiration between PPD readings.  All PPD readings must have been done within 12
    months of each other.
  • Students with a positive PPD history must submit proof of the positive reading AND a chest x-ray report dated witin one year
    of the start date of the rotation.
  • In lieu of a recent chest x-ray, students may submit a doctor's note indicating symptomatic status. 

This information is to be submitted to NUMC 4 weeks prior to the start date of the rotation.  For more information please call the
NUMC Academic Affairs Office at 516-572-5399.  NUMC's info can be found at:  http://www.nuhealth.net/education/ume.

Fourth Year Electives 
When applying for away electives, please be aware that, typically, a site's health requirements must be met as part of the
application process.  However, if your health status is up to date at the time of the application, the site may accept your
current status (with documentation) for the application.  Keep in mind that you will be required to provide updated information
prior to the elective start date. 

Immunization Health Compliance Monitoring
Compliance with the SOM health policy is monitored on CBase.  The date of a student's most recent physical assessment will
be entered on CBase upon submission of a completed physical assessment form to the Student Affairs Office.  Students will
be notified by e-mail one month prior to the expiration date of the most recent assessment.  The Office of Undergraduate
Medical Education and all clinical affiliates will have access to this CBase information and can monitor compliance prior to the
beginning of each clinical rotation or sub-internship. 

Exposure to Infectious and Environmental Hazards 
Contact with patients is an integral part of the medical education at Renaissance School of Medicine. Contact with patients
may entail exposure to hazards, including exposure to patients with contagious diseases that can be transmitted to students
and other healthcare providers by way of airborne droplets or needle-puncture wounds involving infected body fluids. Examples
of these diseases include tuberculosis, hepatitis B, hepatitis C and AIDS.  Although the risk of contracting serious illness from
these hazards is very small, the medical school seeks to reduce incidents of students' exposure to infectious diseases and
environmental hazards.  Mandatory educational sessions on universal precautions for bloodborne pathogens are provided within
the first week of Phase 1 for entering students and prior to the start of the primary clinical clerkships in Phase 2.   Information
about safety and response to exposure to infectious agents or hazardous substances is presented during new student orientation
programming, and prior to the start of the primary clinical clerkships.  Information is also provided during course orientations for
those specific courses in which students may be exposed to infectious agents and/or toxic substances.  An orientation PowerPoint
presentation is available on online and may be accessed by any student via their student ID number.   Students receive training in
proper blood-drawing techniques and patient-isolation policies prior to the intense clinical exposure in Phases 2 and 3. In addition,
physicians are available to advise students and answer any questions through Student Health Services. The school reserves the right
to restrict student contact by a patient believed to pose a risk to the health of the student.

Bloodborne Pathogen Exposure
The following are instructions for what students should do should they experience a needlestick or bloodborne pathogen
exposure from a splash or sharps at Stony Brook Hospital, Winthrop University Hospital, Nassau University Medical Center,
the Northport Veterans Administration Medical Center or any other clinical rotation site while you are a medical student at
Renaissance School of Medicine. 
 

The CDC web page http://www.cdc.gov/niosh/topics/bbp/emergnedl.html has information on bloodborne pathogen exposures and
healthcare workers.  Please familiarize yourself with this information and the risks to you as a healthcare provider.  Another useful
website is http://nccc.ucsf.edu which provides expert consultation including a hotline to obtain information from anywhere: 
1-888-448-4911 (see website for hours of operation).

What is the risk of infection after an occupational exposure? 
(Source:  http://www.cdc.gov/oralhealth/infectioncontrol/faq/bloodborne_exposures.html).  
Hepatitis B Virus (HBV)
Healthcare workers who have received the hepatitis B vaccine and have developed immunity to the virus are at virtually no risk
for infection.  For an unvaccinated person, the risk from a single needlestick or cut exposure to HBV-infected blood ranges from
6%-30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual.  Individuals who are both hepatitis B
surface antigen (HBsAg) positive and HBeAg positive have more virus in their blood and are more likely to transmit HBV. 

Hepatitis C Virus (HCV)
Based on limited studies, the estimated risk for infection after a needlestick or cut exposure to HCV-infected blood is approxiately
1.8%.  The risk following a blood splash is unknown but is believed to be very small; however, HCV infection from such an exposure
has been reported. 

Human Immunodeficiency Virus (HIV)

  • The average risk for HIV infection after a needlestick or cut exposure to HIV-infected blood is 0.3% (about 1 in 300).  Stated
    another way, 99.7% of needlestick/cut exposures to HIV-contaminated blood do not lead to infection.
  • The risk after exposure of the eye, nose or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1000).
  • The risk after exposure of the skin to HIV-infected blood is estimated to be less than 0.1%.  A small amount of blood on intact
    skin probably poses no risk at all.  There have been no documented cases of HIV transmissions due to an exposure involving a
    small amount of blood on intact skin (a few drops of blood on the skin for a short period of time).  The risk may be higher if the
    skin is damaged (for example, by a recent cut), if the contact involves a large area of skin or if the contact is prolonged.                                                                                                                                                                                          ___________________________________________________________________________________________________________

    If a student is exposed to the blood of a patient, the following is recommended: 

    1.  Immediately following an exposure to blood:  "Wash needlestick or sharps-induced injuries and cuts with soap and
    water.  Flush splashes to the nose, mouth or skin with water.  Irrigate eyes with clean water, saline or sterile irrigants. 

    2.  Immediately inform the supervising resident or attending physician and complete an incident report. 
     Prompt reporting
    is essential because, in some cases, post-exposure treatment may be recommended and it should be started as soon as possible. 
    The student who sustains occupational exposure, should access post-exposure services within hours as opposed to days, after the
    exposure.

    3.  Go for Post-Exposure Services:  If exposure occurs at:  
        
    a.  Stony Brook University Hospital

              Monday-Friday (8 AM - 4 PM) - Go immediately to Employee Health and Wellness (EHW) Services at Stony Brook University
    located on level 3, Room 557, phone number 631-444-7767 (4-7767 in-house).
              All Other Times - Go immediately to the Emergency Department at Stony Brook University Hospital 
        b.  Winthrop University Hospital, Northport VA Hospital or Nassau University Medical Center 
              Go to the Emergency Department.  The clinician in Stony Brook University Hospital Employee Health and Wellness (EHW)
    Service or the Emergency Department (ED) evaluates the type and severity of exposure and counsels the student on the risk
    of transmission of HIV, HBV and HCV.  Post-exposure management and prophylaxis (PEP) will be recommended in accordance with
    CDC guidelines.  See CDC website - http://www.cdc.gov/niosh/topics/bbp/emergnedl.html.  Since the student may only given a
    one or two-day supply of post-exposure medication, it is important to schedule a follow-up appointment as soon as possible. 

    4.  The clinician in the EHW or the ED will contact the source patient's physician, nurse practitioner, midwife or physician's
    assistant to determine whether the source's HIV, HBV or HCV status are known. 
    The law requires obtaining inofrmed consent
    before testing a person for HIV.  In addition, the person being tested must receive pre- and post-test counseling.  If the patient lacks
    capacity to consent, counseling must be provided to the healthcare agent, guardian or other person lawfully authorized to make
    healthcare decisions for the patient.  No student or resident may order an HIV test.

If the student is treated in the Emergency Department, they may only be given a one or two day supply of post-exposure medication. 
The student is then referred to Stony Brook Occupational Health at 631-444-6250, or their personal physician, for follow-up counseling
and testing, and to obtain additional medication if needed. 

After a student has reported the bloodborne exposure and received initial management from the Emergency Department, they should
inform the Office of Undergraduate Medical Education.  In the event of non-bloodborne exposure, the student shoudl see their primary
care practitioner on an acute visit basis. 

HIV Testing
HIV testing is not required. The HIV Testing Policy for healthcare workers, including students, is provided in a manner that protects
patient rights and is consistent with other relevant medical center policies.  No student will be tested without his/her consent.  Some
highlights follow:

HIV Testing of Health Care Workers Who Are Medical Students: 
Healthcare providers who are students of Renaissance School of Medicine who need to be tested will be referred to Occupational
Medicine or Student Health Service. Testing is anonymous and confidential.

Test Results 
To provide confidentiality, written test results will be post-mailed in an envelope marked "confidential") or given in person to the ordering
healthcare provider.  Results will not be given verbally, by phone or by fax.

The physician who ordered the test or his/her representative will inform the tested individual of the test result face-to-face, whether positive
or negative, and provide post-test counseling.  If the tested individual is to be discharged from the medical center before test results are
available, this individual must be given a follow-up appointment with his/her primary physician or designee in the appropriate outpatient setting
for receipt of this information.

HIV Testing of a Source Patient
Written, informed consent must be obtained before a licensed physician, nurse practitioner, nurse midwife, or physician's assistant may order an
HIV-related test

Health Insurance Policy
All Stony Brook University students are required to have health insurance coverage.  Students who do not have private insurance coverage
through a parent, employer, spouse, domestic partner or through their own individual plan are required to be enrolled in the university’s Student
Health Insurance Plan (SHIP).

  • All students will be automatically enrolled in and charged for the SHIP.  However, students may opt out of SHIP through SOLAR and by
    providing documentation of private insurance to the Student Affairs Office.
  • Stony Brook’s SHIP is offered through Aetna Student Health.
  • SOM students are enrolled in a clinical plan, which provides additional coverage for treatment resulting from clinical incidents.
  • Information on Aetna can be found at: www.aetnastudenthealth.com.
  • Management of the Student Insurance Plan is through the Faculty Student Association (FSA), located in the Student Union. The FSA 
    can be reached at: 631-632-6517; email: christine.lamont@stonybrook.edu.
  • Detailed information about student health insurance can be found at:  http://studentaffairs.stonybrook.edu/shs/insurance/domestic.shtml.

Student Health Center 
The Student Health Center at Stony Brook University is the on-campus source for meeting all students’ primary health care needs. The staff
of physicians, physician assistants, nurse practitioners, nurses, social workers, health educators, laboratory technologists, and technical and
administrative staff are dedicated to the mission of providing students with quality medical care, and the services necessary to optimize
preventive health and wellness.  For fee services, insurance is billed first and students are responsible to cover the cost of any co-pay or
uninsured services. Complete information on the Student Health Center can be found at:http://studentaffairs.stonybrook.edu/shs/index.shtml