UMMS Student Handbook 2012/13

Section NINE: Health Related Concerns

2012/13 UMass Medical School Student Handbook: first posted date: 08/27/12.
* Revisions approved after this date will be noted in RED.

Blood-Borne Pathogen Exposures: (HIV/Hepatitis B/C & “Needlestick”)

Procedure following Blood/Body Fluid Exposure:

Students who experience a critical exposure such as blood, visibly bloody fluids, or other body fluids e.g. cerebrospinal, synovial, peritoneal, pleural, amniotic, semen, vaginal secretions from a needlestick/ cut or splash to eyes, mouth, nose, or open cut:

Gently bleed, wash, flush affected area with soap and water.
Page the BUGS beeper:
Internal: 77-BUGS (2847)
External: 508-334-1000 request the operator page BUGS (2847)
Notify your supervisor/supervising resident (if there is one) and Clerkship director.
Obtain initial evaluation. -DON’T DELAY - It is important to be evaluated within 2 hours of exposure. You may need immediate treatment.
GO to the appropriate place for evaluation and treatment:
* Employee Health University Campus 774-441-6263 (M - F 7:00am - 4:00pm)
* Employee Health Memorial Campus 508-334-6238 (M - F 8:00am – 4:00pm)
* Employee Health 210 Lincoln Street 508-793-6400 (M - F 8:00am - 4:00pm)
* If after hours, go to the Emergency Department
* DO NOT go to Student Health for any immediate attention for a
needlestick/body fluid exposure.
* At all other sites (rotation/clinical), students should follow the protocol at that site for initial treatment and follow-up will be provided through Student Health.
Fill out incident report (available in each department) and bring to Student Health.
All students with exposures will go to Student Health for Follow-up after initial visit in the ER or with Employee Health.

Employee Health Services will work and advise Student Health Services regarding any necessary follow-up treatment and counseling. Blood-borne pathogen exposure definitions, procedure, immediate and follow-up treatment, is described in UMass Memorial Medical Center’s policy # 5026 “Employee Health Services Blood-Borne Pathogen Exposure of Health Care Workers (HCW) Policy and Procedure,” located in the UMass Memorial Centerwide Policy/Procedure and Guidelines Manual.

Students Infected with a Blood Borne Pathogens

The University of Massachusetts is committed to a policy of non-discrimination and protecting the legal rights and privacy of students infected with blood-borne pathogens while also protecting the health of the public. A student who is infected may attend the University of Massachusetts School of Medicine; however, certain restrictions may be imposed on the scope of the infected student’s training. Actual recommendations and advice to the student will depend on current findings and standards of practice.

All matriculated UMMS students will have their Hepatitis B immunity status confirmed as part of the School’s immunization policy. Although testing for hepatitis C and human immunodeficiency virus is not required for attendance at UMMS, it is the professional responsibility of any student who has risk factors for these diseases to make arrangements for serologic testing.
Students who are aware that they are infected with a blood-borne pathogen [including but not limited to Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human Immunodeficiency virus (HIV)], if not currently under the care of a personal physician,
are strongly urged to contact the Student Health Service so that appropriate medical treatment may be instituted or continued.

Students infected with a blood-borne pathogen must avoid circumstances in which they could potentially transmit their infection to others. They are required, therefore, to disclose their infection status to the Assistant Dean for Student Advising in order to arrange any necessary adjustments to practice. Such notification is considered a professional responsibility of the student, and failure to disclose blood-borne pathogen infection status will be grounds for disciplinary action, up to and including dismissal from the medical school.

The University of Massachusetts School of Medicine reserves the right to restrict students who may transmit blood-borne pathogens from situations that place others at risk. Reasonable adjustments will be made for any student who has tested positive
for a blood-borne pathogen to be able to continue medical education. Restrictions and adjustments will be determined on a case by case basis by the UMMS Blood- Borne Pathogen Review Panel. In addition, the Assistant Dean for Student Advising will provide career guidance and elective rotation oversight to all students who have a blood-borne pathogen infection. Every reasonable effort shall be made to maintain confidentiality regarding the blood-borne pathogen status of students. Nevertheless,
before an infected student begins a clerkship; directors and supervisors of that clerkship may be informed on a need-to-know-basis of limitations imposed on the student’s activities. In the event that an urgent determination is required, the Assistant Dean for
Student Advising will issue temporary restrictions.

The complete UMMS Policy Regarding Students Infected with a Blood Borne Pathogen (http://inside.umassmed.edu/content.aspx?id=23518) contains a list of some of the procedures which infected students may not be allowed to undertake or participate in. Students infected with blood-borne pathogens should be aware that,based on current medical knowledge and practice, they may be restricted from future residency training and specialty practices which require the performance risk-prone procedures.

A student infected with HBV, HCV, or HIV may continue in the MD program as long as he or she is able to carry out the physical and intellectual activities of all students as outlined in the UMMS Technical Standards.

Demonstrated competence on Standard Precautions is required of students in clinical programs of the University of Massachusetts School of Medicine. In addition to the UMMS Policy, students on clinical rotations are also subject to the blood-borne pathogen disease policies for health care workers at those individual host sites.

The complete UMMS Policy Regarding Students Infected with a Blood Borne Pathogen can be found at: http://inside.umassmed.edu/content.aspx?id=23518.

Disability Insurance

The Medical School ensures that medical students are covered by disability insurance. This insurance is required and is paid for by student fees. Benefits begin after 90 consecutive days of disability and include coverage for blood-borne pathogens. Upon completion of medical school the coverage is portable to a residency and then to medical practice at the option of the graduate. Details of the policy are available in the Office of Student Affairs or online at www.medplusadvantage.com.

Back to Top

Exercise Facilities, Student

Student Health Club
The Student Health Club (SHC) is located on the First Floor of the Student Wing. All matriculated students are automatically enrolled in the SHC. Employees/nonmatriculated students can join the SHC for an annual fee. The SHC consists of two rooms. One room is equipped with cardiovascular equipment (stair master, treadmill, elliptical machine, stationary bikes, etc.). The other room contains a wide variety of free weights and assorted high quality machines.

The Center for Health and Fitness
Hours: 24 hour, 7 days / week - access via student ID badge
Contact: Debra Leger, Student Affairs, Office, S1-131, Debra Leger@umassmed.edu
UMass Medical Students also have the opportunity to purchase a student membership to the Center for Health and Fitness on A-Level at a discounted rate. However, there are a limited number of student memberships available and they are sold on a first come first served basis. The Center for Health and Fitness has a myriad of equipment including: CYBEX modular weight training equipment, treadmills, elliptical cross-trainers, stationary bicycles (upright and recumbent), rowing machines, stair steppers, upper body ergometer, air-Dyne bicycles.

To apply for membership:

Complete the Rules for Unsupervised Use & the Informed Consent forms found on the student affairs website at http://www.umassmed.edu/studentaffairs/ studentlife/exercise.aspx.
Return forms with payment to Debra Leger, Office of Student Affairs, Room S1-131.

Access to the Center will be via the UMMS Student ID Badge. Please allow up to two business days for processing and badge activation. Please note: Students should be sure to keep valuables stored safely; UMass or the Center for Health & Fitness is not responsible for lost or stolen items.

Flu Vaccination Policy for UMMMC; Supported by UMass Medical School

UMMMC Influenza Immunization Policy Summary
Audience: Segment 1: All Physicians, Licensed Independent Practitioners, Graduate Medical Education trainees, and medical students are required to receive a flu vaccine shot prescribed for the specified flu season unless they receive an exemption for medical or religious reasons. Those with an exemption (whether religious or medical) must wear a surgical mask while in clinical care buildings on the University, Memorial and Hahnemann campuses (Clinical Care Buildings) during flu season.

Segment 2: All other UMMMC Workforce members* not listed above, receipt of the influenza vaccination is strongly encouraged. Annual influenza vaccination or the proper wearing of a hospital approved surgical mask while at work in Clinical Care Buildings during the flu season is required for all other UMMMC Workforce members not listed above, including employees, contracted and vendor personnel, volunteers and trainees.

Effective Date: Flu season typically occurs sometime between November and March. The exact dates for wearing respiratory protection will be determined by UMMMC and announced.

Where Can I Get a Flu Shot? Flu shots will be available at fairs held across many UMMMC and UMMS locations.

Also, employees can receive their flu shots from the three Employee Health Services offices on a walk-in basis.

General Process:Flu Vaccination Evidence: A sticker will be provided by Employee Health Services when you receive your immunization or by providing proof of immunization to UMMMC Employee Health Services.

Wearing a Mask Process: Surgical masks will be available in the main lobbies of the three Medical Center campuses as well as on the first floor of the University Campus, where the school meets the hospital.

Locations to Wear The Mask: Masks will need to be worn in the clinical care buildings at the Medical Center during influenza season.

Masks will not be required while entering or exiting the building, in elevators, in the cafeteria, or in closed break rooms.

*Definition of UMMMC Workforce: All employees, contractors, volunteers, vendors, trainees (including medical students, interns, residents, allied health professionals and business students), members of the Medical Staff, including employed and private physicians, Licensed Independent Practitioners, Graduate Medical Education trainees, temporary employees, Per Diem employees, and other persons employed, credentialed or under the direction and control of UMMMC whether or not they are paid by UMMMC.

N-95 Respirator Fitting/Mask FIT Testing (Patients with Respiratory Pathogens)

The clinical system is REQUIRING that all students follow recent CDC infection control recommendations that healthcare workers protect themselves from diseases potentially spread through the air (such as H1N1 or tuberculosis) by wearing a fit tested respirator such as a NIOSH-approved N95 respirator.

All entering students are required to have been cleared by Student health Services (SHS) and Environmental Health and Safety (EHS) for either N-95 respirator mask fitting or PAPR mask fitting prior to entering any clinical site.

This process will take place beginning in the 1st year of medical school. You will be emailed a medical clearance form to be completed and sent back to SHS. Once cleared, you will be instructed to call Environmental Health and Safety (EHS) to arrange for a mask fitting.

Students not medically cleared to be fitted for the N-95 mask will need to be trained for the PAPR which would be arranged through EHS. Conditions would include certain medical conditions such as poorly controlled asthma or extensive facial hair.

Any students not cleared by SHS and EHS for either N95 or PAPR mask fitting might not be allowed to participate in clinical rotations. (rev. 06/25/10)

Back to Top

Stress Reduction Program

The Center for Mindfulness and the Stress Reduction Clinic offers a reduction in regular tuition to active medical students of the University of Massachusetts Medical School. Medical Students can enroll in the 8-Week MBSR Stress Reduction Program
at a tuition of $100 per cycle. The CFM SRP accepts up to three (3) students each cycle, a total of twelve (12) per year. Should there be more than three per cycle, they will be accepted on a case by case basis.

Process:

Call the Stress Reduction Program to enroll in an orientation and a class.
Notify the staff that you are a Medical Student
Attend Orientation
Enroll in the program
Pay your tuition fees

For additional information please contact the Center for Mindfulness in Medicine, Healthcare, and Society at 508-856-2656.

Student Counseling Service

Location:	S1-620 (behind the Medical School Library) Enter the library, proceed through the brown steel door next to the computer training classroom.
Telephone:	508-856-3220
Fax:	508-856-3036
URL	http://www.umassmed.edu/psychiatry/studentcounseling.aspx
Hours	Office Hours for Administrative Assistant Monday - Friday 8:15 am - 2:15 pm
Personnel	Alan Brown, MD, Vice Chair for Adult Psychiatry Ruthann Rizzi, MD, Director Phoebe Moore, PhD, Associate Director Marianne Smith, MD Michele Eberhart, Administrative Assistant
Scheduling	To schedule an appointment with a clinician on the Student Counseling Service, please call: 508-856-3220 or - E-mail: charlene.paradise@umassmed.edu or SCS@umassmed.edu.
Services eligible to all	• Medical Students • GSBS Students • GSN Students
Services Provided	• Consultation and Evaluation • Psychotherapy • Medication management • Assistance with stress management
Drop-In Clinic	Established patients will be seen by Dr. Rizzi for uncomplicated medication refills or other quick needs. No appointment is necessary, but early arrival is recommended as students will be seen on a first come first served basis. Drop-In Clinic hours are posted on our website at http://www.umassmed.edu/psychiatry/ studentcounseling.aspx. We will post any Drop–In Clinic announcements or changes to our website; please check the website if you wish to be apprised of such.
Mental Health EMERGENCY	If a mental health emergency arises: • Please try to call our office first at 508-856-3220 • Outside Business hours please call Emergency Mental Health at 508-856-3562 and ask to have Dr. Rizzi paged at 4261.
Short Term/Long Term Use	Many students want to cope more effectively with difficult or stressful academic situations, while others seek counseling to deal with broader life issues. Some students come because of more serious, troublesome, and/or chronic difficulties in their lives. While short-term counseling is most common, it is possible, when time permits, for students to be seen for an extended period. Medication is prescribed when needed.
Privacy and Confidentiality	(SCS) maintains strict standards of privacy and confidentiality. Records are kept separately from students’ general medical records. No information about a student’s contact with the service or information obtained in counseling is released to anyone outside the counseling service staff, including school or hospital administration, faculty, family, or other students, without the knowledge and written consent of the student, unless required by law or in the rare instance of an emergency situation involving someone’s safety.
Fees/Insurance	The costs of these services are covered by the prepaid Student Health Plan fee;there is no insurance billing and no additional charge to students for using SCS.

Student Health Service

Location:	1st floor of the Benedict Building - University Campus – Family Medicine Dept.
Telephone:	(508) 334-8464 Family Medicine Clinic (appointment line/triage): 508-334-2818
Emergency	911
After Hours/Wknds	508-334-2818 for the doctor on call.
Fax:	(774) 443-2350
Prescription Refills	508-334-2818 (Please have your refill information with you when calling)
Email:	studenthealth@umassmemorial.org
Hours:	Student Health Services: Monday - Friday 8:00am - 4:30pm (Closed for lunch from 12:30pm to 1:30pm) Family Medicine Clinic: Monday - Friday 8:00am - 4:30pm Lab: Monday - Friday 7:00am - 6:00pm
URL:	http://www.umassmed.edu/studenthealth/index.aspx
Personnel:	Phillip Fournier MD, Director of Student Health Services Amy Mahoney ANP, BC, Student Health Nurse Coordinator Lori Davis, Student Health Secretary

For administrative questions call 508-334-8464 or e-mail Lori Davis at Lori.davis@ umassmemorial.org, or you can use our general e-mail studenthealth@umassmemorial.org. If you have a billing concern, please e-mail Nancy Whalen at nancy.whalen@umassmemorial.org.

Process to Make an Appointment:

If you have a health concern/illness/injury and would like to be seen, please call the Family Medicine Office at 508-334-2818.
If you have a health emergency, please call 911.
Family Medicine is not a walk in clinic.
Check-in for appointments at the Family Medicine windows.
Always identify yourself as a UMASS student.
Describe your illness/injury to the triage nurse.

E-mail is the preferred method of communication.
Practicing physicians in the FHS/SHS:

Phil Fournier, MD (Director, SHS)
Robert Baldor, MD
Joe DiFranza, MD
Anna Doubeni, MD
Chyke Doubeni, MD
Mary Lindholm, MD
Lynn O’Neal, NP
Michael Reyes, MD
Ed Zaccaria, MD

If you are enrolled in the BC/BS student health insurance plan, the Student Health Service is automatically recognized as the required source of referral. If you are insured through a different plan, you can still use the SHS, as long as your insurance is accepted by UMass Memorial, which accepts most plans.

If you already have an established PCP who is in the BC/BS network, or would like to select a different UMass Memorial physician as your PCP, either on the University campus or in the community at a non-teaching site, we can arrange for you to do so and have this physician be recognized by BC/BS as your PCP for referral purposes. However, to do so you MUST contact SHS to complete the PCP enrollment process.

Student Health Clearance

The University of Massachusetts Medical School (UMMS) requires all students admitted to the Medical School to complete the Student Health Clearance process prior to matriculation. This policy was developed to decrease risk of transmission of potential infectious agents, and it is part of each student’s professional responsibility to maintain this clearance throughout his/her educational experience at UMMS. All clinical sites within UMMS and outside of UMMS require documentation of medical clearance prior to starting any clinical educational experience. Student Health Services (SHS) is responsible for tracking this clearance process for all students and notifying students who need updated clearance information.

The SHS office can help with any questions regarding the clearance paperwork and can assist with resources to help complete the process. Forms that must be completed can be downloaded from the Student Health Services (SHS) website at http://
www.umassmed.edu/studenthealth/index.aspx. For additional information, please call (508) 334-8464.

Any student who fails to comply with SHS requests to complete the clearance process by the first day of class will be reported to the Dean of Student Affairs and the Registrar’s Office for further action including suspension of registration which would result in being withheld from classes and all clinical educational experiences

Student Health Insurance

MA law requires all students to carry health insurance.

The University offers one health insurance Plan with BC/BS.
You have the option to enroll in a plan through UMASS or purchase Insurance with a company of your choice.
Students may also purchase dependent coverage (spouse, children) for an additional cost after the completion of their enrollment in the Student BC/BC health insurance plan.
Students may also enroll in an optional dental insurance plan with Delta Dental for an additional cost.

The Bursar’s Office is responsible for assisting students with health/dental insurance enrollment. Please contact the Bursar Office at (508) 856-6612 with any questions related to enrollment in the BC/BS plan offered.

Please click on the link below for an overview of the UMASS Worcester student health plan offered by BC/BS and a summary of benefits: www.universityhealthplans.com.

You may also call them toll free at 1-800-437-6448. rev. 05/24/11 LDSHS

Student Health Fee: The Student Health fee is different from the student health insurance plan.

This fee is MANDATORY for all students whether or not they have the health insurance plan or their own insurance.
Half of the fee goes to student counseling service and the other half goes to SHS. The SHS half pays for physician and nurse services in the SHS, waiver of co-pay in the SHS, administrative support, and immunizations and infectious disease titers when needed.
The other half of the fee covers Student Counseling Services. This portion of the fee allows these visits to be covered at no cost to the student. Please refer to the Student Counseling link for details. http://www.umassmed.edu/psychiatry/studentcounseling.aspx. rev. 02/08/11 LD

Tuberculin Skin Testing Policy

All students are required to have a yearly tuberculin skin test (TST) previously called a PPD test. A 2-Step screening is required for all new students entering the medical school, graduate school of nursing, or GSBS. A 2-Step TST is done to reduce the likelihood that a “boosted effect” will be misinterpreted as a recent infection or new conversion. The “booster effect” is a delayed-type of hypersensitivity reaction. A positive reaction to the second test probably is a boosted reaction (indicating past infection with tuberculosis - or very rarely an infection with another related bacteria or a reaction to BCG vaccination). The 2-step policy is designed to reduce the potential of overestimation of new infections. Therefore 2-Step testing is used for initial skin testing of adults who will be periodically retested, such as health care workers. A 2-Step test is defined as 2 TST’s done within 3 months of each other. Ideally the optimal time for new students would be within 1-4 weeks of each other.

If you have had a 2-Step test in the past, then all you will need is yearly TST. If you have had a test greater than 12 months, even if that was negative, than a 2-Step is required. If you have had a positive TST in the past than no TST is required (contact
SHS for details).

The Quantiferon Gold Test and T-Spot are two different blood tests that also test exposure to tuberculosis- either test is accepted as an alternative to the 2 step TST upon entrance. Student Health may also use this test in certain circumstances to verify
new conversions or questionable reactions.

For all students who have had a clinical rotation in a healthcare setting in a high endemic area for tuberculosis (contact SHS for a list of these countries) a TST between 8 and 12 weeks after return to the US is required.

All students who have had a known exposure to an individual with active tuberculosis within the preceding 6 months would require a TST performed between 8 and 10 weeks after the exposure.

Note that the BCG vaccination given to individuals in countries with a high endemic rate of tuberculosis boosts the immunity of children to tuberculosis, but does not prevent infection with the organism. In countries where tuberculosis is rare, individuals who receive a BCG vaccination usually stop having a positive TST reaction after 5-10 years (even when tested with a 2-step TST). Consequently, an individual who received BCG in childhood who has a positive TST as an adult very likely has latent
tuberculosis infection, and should consider receiving preventive therapy for this condition. (SHS 12/06:Revised 06/12/2012)