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Technical standards

For students beginning in August 2019

Introduction 
According to the Liaison Committee on Medical Education (LCME)—the U.S. Department of Education-recognized accrediting body for programs leading to the M.D. degree in the United States—Geisinger Commonwealth School of Medicine (GCSOM) must develop and publish technical standards for the admission, retention, and graduation of applicants or medical students in accordance with legal standards. [LCME, Standard 10.5] Technical standards must include a statement by GCSOM of the essential academic and nonacademic abilities, attributes and characteristics a medical school applicant or enrolled medical student must possess or be able to acquire, with or without reasonable accommodation, to be admitted to, be retained in, and graduate from GCSOM’s medical education program in all areas of:

  • Cognitive abilities (including intellectual-conceptual, integrative and quantitative abilities)
  • Observational skills
  • Communication skills
  • Physical and motor function
  • Behavioral and social attributes
  • Emotional stability
  • Ethics and professionalism
    [LCME Standards, Glossary]

The technical standards developed by GCSOM and set out below reflect and are consistent with the School’s Mission Statement and educational philosophy. The mission of GCSOM includes educating aspiring physicians to serve society using a community-based patient-centered, interprofessional and evidence-based model of education that is committed to inclusion, promotes discovery, and utilizes innovative techniques.

Diversity is a key driver to the fulfillment of GCSOM’s mission to graduate excellent physicians fully prepared to serve diverse patient populations and reduce prevalent inequities in northeast Pennsylvania and elsewhere. GCSOM seeks to add value to the learning experiences for all participants by providing a diverse and inclusive learning environment. GCSOM is also focused on developing a diverse community of physicians (both primary care and specialists) who are skilled in evidence-based medicine and the latest technology.

Highlights of GCSOM’s medical education program include:

  • A competency-based curriculum with integrated basic and clinical science education;
  • A progressive model of medical education that utilizes clinical training sites throughout the school’s regions;
  • Integrated clerkship in the third year that allows students to follow a panel of patients over the course of six months as they train with clinical preceptors in six different core disciplines (family medicine, internal medicine, pediatrics, psychiatry, obstetrics/gynecology and surgery) while spending the other six months in a traditional block rotation; and
  • A focus on community service and learning to work within an interprofessional medical team.

The GCSOM medical degree granting program extends to six general competencies, including: medical knowledge, patient care, professionalism, systems-based practice, practice-based learning, and improvement and interpersonal and communications skills. Academic requirements include successful completion of:

  • All courses and mandatory academic exercises (Year 1 and Year 2) and posting a passing score on the US Medical Licenses Examination (USMLE) Step 1 examination (Year 2).
  • All components of the Year 3 year curriculum, including clinical rotations/clerkships and mandatory academic exercise.
  • All components of the Year 4 curriculum, including taking and passing USMLE Step 2 Clinical Knowledge (CK) and Clinical Skills (CS) and mandatory academic exercises.

Patient safety and well-being are major factors in satisfying clinical requirements, including adherence to universal precaution measures and meeting health and safety standards applicable to inpatient and outpatient settings and other professional activities.

The technical standards were developed in accordance with legal standards, including Section 504 of the Rehabilitation Act (Section 504) and Title III of the Americans with Disabilities Act (ADA). Section 504 and ADA ensure that applicants and enrolled medical students with disabilities are not discriminated against on the basis of disability and are provided an equal, effective, and meaningful opportunity to enjoy the benefits, privileges, and advantages of a medical education at GCSOM. Equal opportunity/nondiscrimination includes providing reasonable accommodations that enable an individual with a disability to meet the technical standards unless to do so would result in a fundamental alteration in the nature of GCSOM’s education program, an undue burden, or a direct threat to the health or safety of others which cannot be mitigated through the provision of reasonable accommodations.

Reasonable accommodations include, but are not limited to, modifying academic requirements and providing auxiliary aids and services. Academic requirements that are essential to the instruction being pursued by the medical student or to any directly related licensing requirement will not be regarded as discriminatory. If GCSOM determines that a requested academic accommodation would result in a fundamental alteration, undue burden, or direct threat to the health or safety of others, it will consider whether effective alternatives to the requirement exist which would allow medical students to participate in its academic program without waiving or lowering essential requirements (fundamentally altering the nature of GCSOM’s medical education program), or resulting in undue burden or direct threat to the health or safety of others.

Requests for GCSOM-provided reasonable accommodations will be granted in accordance with the policies and procedures described in the Policy and Procedures for Disability Services.

GCSOM’s technical standards were developed by the Technical Standards Committee and approved consistent with applicable GCSOM processes and are reviewed for currency and re-confirmed on a periodic basis. The Technical Standards Committee includes faculty, administrators, and others with expertise in medical education pedagogy and relies on experts in disability law and policy and the provision of reasonable accommodations. The Technical Standards Committee used a careful, exhaustive, and deliberative process to assess and determine the extent to which the technical standards are essential to GCSOM’s academic mission and the health and safety of patients, candidates, and others and are consistent with Section 504 and Title III of the ADA.

For purposes of this document, the term “candidate” will be used to means individuals for admission to GCSOM and GCSOM medical students who are candidates for retention, promotion, and graduation.

Cognitive abilities (including intellectual-conceptual, integrative and quantitative abilities)
Candidates must have sufficient cognitive abilities, including intellectual-conceptual and integrative and quantitative, to acquire foundational scientific and medical knowledge and apply, calculate, analyze, reason, interpret, integrate, and synthesize knowledge and information in a manner that leads to accurate diagnosis, formulation of treatment plans, reasonable prediction of the outcome of diseases and treatment plans, appropriate medical decisions, and informing patients of their choices for care in a health care system.

Examples of intellectual-conceptual abilities include:

  • Acquiring foundational medical knowledge through memorization, calculation, organization, comprehension, and assimilation of detailed and complex information present in the medical student curriculum
  • Discerning and comprehending dimensional and spatial relationships of structures
  • Effectively participating in learning modalities such as individual, small group, and lecture formats in the classroom, clinical settings, and other venues in which the curriculum or required activities are delivered
  • Effectively learning, participating, and contributing as a part of a healthcare team

Examples of integrative and quantitative capacity include:

  • Formulating a hypothesis, investigate the potential answers and outcomes, and formulate appropriate and accurate conclusion
  • Interpreting causal connections, and making accurate, fact-based conclusions based on available data and information
  • Synthesizing information effectively in person, via remote technology, and in other venues and modalities
  • Making concise, cogent, and thorough presentations based on various kinds of data collection, including web-based research
  • Organizing information, materials, and tasks in order to perform efficiently and effectively

Observational skills
Candidates must be able to use observational skills to acquire, assimilate, and apply information that may lead to conclusions or perceptions about the physical, cognitive, social, cultural, and intellectual environment that is gleaned from:

  • Demonstrations and experiments in the basic sciences
  • Written and audiovisual material
  • Patient encounters and one-on-one interactions

Examples of knowledge acquisition through observation include:

  • Acquiring information from physiologic and pharmacologic variables
  • Dissecting cadavers, examination of specimens in anatomy, pathology, and neuroanatomy laboratories; and microscopic study of microorganisms and tissues in normal and pathologic states.
  • Detecting changes in mood, activity, and verbal and nonverbal cues
  • Acquiring information, including but not limited to, direct interaction with patients (e.g., interviews) direct, recorded, or televised medical proceedings, virtual clinical cases, or result of computer-based searches
  • Performing physical examinations, rectal and pelvic exams, and examinations with stethoscopes, otoscopes, fundoscopes, and reflex hammers to integrate findings based on this information and to develop an appropriate diagnostic and treatment plan
  • Interpreting x-rays, MRIs, and other diagnostic findings and other graphic images, and digital or analog representation of physiologic data e.g., EKGs, flow loops, and arterial blood gas.

Communication skills
A candidate must be able to effectively and sensitively communicate information, including eliciting, conveying, clarifying, and acting on the information, and creating rapport by multiple modalities with:

  • Patients and/or designated representatives of patients (including family members)
  • Faculty, colleagues, members of the health care team, support staff, and others with whom the candidate comes in contact

Candidates must be able to:

  • Use interpersonal skills to establish responsive, empathetic and respectful communication and rapport and therapeutic relationships with patients in a way that promotes openness on issues of concern and sensitivity, including potential cultural differences and the use of an interpreter
  • Record information accurately and clearly
  • Recognize urgent situations in which timely supervision, assistance and consultation must be sought
  • Communicate effectively and efficiently in English

Examples of areas in which skillful communication is required include:

  • Participating as an individual and as a member of a group in learning activities
  • Answering oral and written exam questions
  • Presenting information in oral and written form to patients, staff, faculty, colleagues, the healthcare team, and others
  • Taking medical histories and performing physical examinations which include ability to interact with patients
  • Participating in clinical rounds and conferences
  • Interacting with and responding to clerkship administrators and directors
  • Timely and accurately completing and navigating electronic medical record entries of patient assessments, treatment plans, prescriptions, etc.

Physical and motor function 
Candidates must possess sufficient physical stamina to tolerate demanding workloads of medical education program. Candidates must also have sufficient physical and fine and gross motor function to:
  • Elicit information from patients by performing appropriate physical examinations using diagnostic maneuvers and procedures including taking a medical history
  • Complete timed assessments of clinical skills
  • Function in outpatient, inpatient, and surgical venues
  • Ensure that general medical care and emergency treatment is provided to patients

Examples of eliciting information from patients include palpation, auscultation, and other diagnostic maneuvers and procedures such as a pelvic exam and Pap smear.

Examples of physical stamina necessary to tolerate demanding workloads include:

  • Completing the learning and examination schedules for medical education program
  • Participating in clinical activities such as on-call duties and extended days
  • Participating in the direct care setting in surgery, primary care, obstetrics/gynecology and the emergency room.

Behavioral and social attributes
A candidate must possess the behavioral and social attributes to:

  • Work and learn independently
  • Exercise good judgment
  • Develop mature, sensitive and effective relationships with patients, staff, faculty, colleagues, the healthcare team, and others
  • Express compassion, integrity, concern for others

Emotional stability
A candidate must possess the emotional stability and resilience to:

  • Adjust to the stresses and rigor of a medical education program
  • Function in the face of uncertainties inherent in the clinical problems of many patients
  • Interact with patients who are transitioning to end of life, with patients who have clinically definable psychiatric issues, and with patients, spouses, siblings, children and close relatives of seriously ill patients
  • Possess self-awareness and self-analysis of emotional state and reactions
  • Engage in self-reflection
  • Accept and give constructive feedback
  • Adapt to changing environments and display flexibility

Ethics and professionalism
A candidate must exercise the appropriate ethical and professional conduct and personal attributes that are critical to the practice of medicine, including the ability to:

  • Understand, distinguish, and apply the legal, moral, and ethical conduct and values of the practice of medicine and function within both the law and ethical standards of the medical profession
  • Construct frames of reference which delimit appropriate professional, ethical, and moral behavior and values
  • Maintain appropriate professional relationships and boundaries with patients, family, staff, faculty, colleagues, the healthcare team, and others
  • Readily and willingly interact with all members of the healthcare team, faculty and staff, patients and families and care of any patient in a courteous, professional, and respectful manner, regardless of the patient’s age, color, disability, national origin, race, religion, gender, sexual orientation, veteran status, or political beliefs
  • Maintain patient confidentiality
  • Advocate for patients
  • Promptly complete all responsibilities attendant to the curriculum and GCSOM policies and procedures
  • Abide by all state, federal, and local laws and GCSOM policies and procedures related to the use of alcohol and drugs

For more information, see our Technical Standards policy, contact the Admissions Office or Jackie Ghormoz.

 

For current students 2018-2019 academic year

Geisinger Commonwealth School of Medicine is committed to full compliance with section 504 of the Rehabilitation Act of 1973 (PL 93-112) and the Americans with Disabilities Act (ADA PL 101-336) enacted by Congress in 1990.

Qualified and accepted applicants to Geisinger Commonwealth must be able to complete all requirements inherent in and leading to the MD degree. To ensure this, the school has adopted technical standards for the assessment of all accepted applicants to the school. Because the MD degree signifies that the holder is a physician prepared for entry into the practice of medicine, it follows that graduates must have the knowledge and skills to function in a broad variety of clinical situations and to render a wide spectrum of patient care.

Candidates for the MD degree must have somatic sensation and the functional use of the senses of vision and hearing. Candidates’ diagnostic skills will also be lessened without the functional use of the senses of equilibrium, smell and taste. Additionally, they must have sufficient exteroceptive sense (touch, pain and temperature), sufficient proprioceptive sense (position, pressure, movement, stereognosis and vibratory) and sufficient motor function to permit them to carry out the activities described in the sections that follow. They must be able to consistently, quickly and accurately integrate all information received by whatever sense(s) employed and they must have the intellectual ability to learn, integrate, analyze and synthesize data.

A candidate for the MD degree must have abilities and skills of five varieties including observation; communication; motor; conceptual, integrative and quantitative; and behavioral and social. Technological compensation can be made for some handicaps in certain of these areas, but a candidate should be able to perform in a reasonably independent manner.

Observation
The candidate must be able to observe demonstrations and experiments in the basic sciences, including but not limited to physiologic and pharmacologic demonstrations, microbiologic cultures and microscopic studies of microorganisms and tissues in normal and pathologic states. A candidate must also be able to observe a patient accurately at a distance and close at hand. Observation necessitates the functional use of the sense of vision and somatic sensation. It is enhanced by the functional use of the sense of smell.

Communication
A candidate should be able to speak, to hear and to observe patients in order to elicit information, describe changes in mood, activity and posture and perceive nonverbal communications. A candidate must be able to communicate effectively and sensitively with patients. Communication includes not only speech, but reading and writing. The candidate must be able to communicate effectively and efficiently in oral and written form with all members of the healthcare team.

Motor
Candidates should have sufficient motor function to elicit information from patients by palpation, auscultation, percussion and other diagnostic maneuvers. A candidate should be able to do basic laboratory tests (urinalysis, CBC, etc.), carry out diagnostic procedures (proctoscopy, paracentesis, etc.) and read EKGs and X-rays. A candidate should be able to execute motor movements reasonably required to provide general care and emergency treatment to patients. Examples of emergency treatment reasonably required of physicians are cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, the suturing of simple wounds and the performance of simple obstetrical maneuvers. Such actions require coordination of both gross and fine muscular movements, equilibrium and functional use of the senses of touch and vision.

Intellectual  conceptual, integrative and quantitative abilities
These abilities include measurement, calculation, reasoning, analysis and synthesis. Problem solving, the creative skill demanded of physicians, requires all these intellectual abilities. In addition, the candidate should be able to comprehend three-dimensional relationships and to understand the spatial relationships of structures.

Behavioral and social attributes
A candidate must possess the emotional health required for full utilization of his/her intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities attendant to the diagnosis and care of patients, the development of mature, sensitive and effective relationships with patients. Candidates must be able to tolerate physically taxing workloads and to function effectively under stress. They must be able to adapt to changing environments, to display flexibility and to learn to function in the face of uncertainties inherent in the clinical problems of many patients. Compassion, integrity, concern for others, interpersonal skills, interest and motivation are all personal qualities that should be assessed during the admissions and education processes. A candidate must readily be willing and able to examine any patient regardless of the patient’s age, color, disability, national origin, race, religion, gender, sexual orientation, veteran status or political beliefs.

For more information, see our Technical Standards policy, or contact the Admissions Office or Jackie Ghormoz.

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