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Handbook 2006
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Section 6: Medical Center - On the Wards
YOU
AND THE MEDICAL CENTER ON THE WARDS
In your first and second years, your ICM instructor will orient
you to the LAC+USC Medical Center. In your third and fourth
years, you will be oriented to your specific duties and responsibilities
at the beginning of each clerkship. Any special departmental
rules regarding dress, hours, call schedules, etc., will be
described and the evaluation criteria will be explained. Be
sure to ask any questions regarding protocol, ward functions,
evaluations, etc., so that you clearly understand what is
expected of you.
Supervision
By State Law, medical students have license to practice medicine
under supervision only. All student workups and orders must
be countersigned by the resident or preceptor to whom the
student is assigned. If students are uncertain about protocol,
or have questions about patient management, they are urged
to seek assistance.
Patient Responsibility
Medical students have the responsibility to work up and care
for any and all patients assigned to them by the preceptor
who supervises their work. Medical practice involves inherent
risks, e.g., infection from patient to health care worker,
and students will learn to manage these risks while simultaneously
meeting professional obligations to provide needed care.
Any student who questions their assignment based on concerns
for his/her health or for other reasons should discuss these
first with the clerkship director, medical student educator,
or preceptor. Failing resolution of these concerns, the student
should bring his/her concerns to the attention of the Assistant
or Associate Dean for Student Affairs.
HIV/AIDS Policy at the Keck school of Medicine Office
It is the policy of the Keck School of Medicine that all
health care providers and all students involved in clinical
care are expected to attend all patients, regardless of disease.
Medical students, residents and faculty members have a fundamental
responsibility to provide care to all patients assigned to
them. A failure to accept this responsibility violates a basic
tenet of the medical profession: to place the patient's interest
and welfare first. Faculty have a special responsibility to
model the professional behavior and attitudes expected of
physicians in training, in their own willingness to provide
competent, sensitive, and compassionate care to all patients.
(Section 2 for implementation and guidelines).
ABSENCES
Absence for Reason of Illness
Absence due to illness must be reported to the clerkship
director or medical student educator on a required clerkship,
or to your preceptor on an elective or selective, as soon
as possible. In case of extended absence (2 days or more),
a note from a physician (who is not a relative) is required,
and the absence will be reported to the Office of Student
Affairs. A physician note may be requested for any absence,
at the discretion of the clerkship. All absences must be made
up; the plan for make-up of the time missed will be determined
by each clerkship director. Unexcused absence may be grounds
for a failing clerkship grade and/or disciplinary action.
Only by successfully petitioning the Clinical Sciences Student
Performance Committee may a student obtain a waiver from having
to make up lost time.
If the illness is anticipated to last more than three months,
the student must apply for a Leave of Absence through the
Associate Dean for Student Affairs.
Absences for Reasons Other than Illness
Anticipated absences must be approved in advance
by the clerkship director or designee, and the required
Student Absence Request Form (page 6-6) must be submitted
with the request along with supportive documentation. Students
will generally be required to make up absences, at the discretion
of the clerkship director. Some general guidelines include:
USMLE – will not be considered
an excused absence; this must be taken during vacation
time.
BLS/ACLS Training – will not be
considered an excused absence; this must be taken during
vacation time.
Residency Interviews – interviews
scheduled during a clerkship, elective or selective must
be approved in advance. Printed email verification of the
invitation to interview must be submitted with the request.
While faculty will try to accommodate reasonable requests,
students are not guaranteed time away from courses.
OBSERVANCE OF CALL SCHEDULES AND DUTY HOURS
Students must work assigned call hours for all clerkships
Students are expected to observe all assigned duty hours.
When you are on call during a clerkship you are expected to
remain within the hospital or assigned clinical site. Call
schedules cannot be switched without approval from the medical
student educator or clerkship director.
Professional Liability and Legal Limitations of Student
Practice
The California Business and Professions Code states that
it is lawful for a student who is regularly matriculated in
a legally chartered school approved by the Medical Board of
California to diagnose and treat the sick whenever and wherever
prescribed as a part of his course of study.
Anything that a student does which is not prescribed
as a part of his/her course of study is the practice of medicine
without a license.
Malpractice insurance protection is provided while you are
acting within the scope and in the course of your duties for
the University in your capacity as a student of the Keck School
of Medicine. All petitions for Off-Campus Electives must be
submitted six weeks prior to the elective, and must be approved
by the Clinical Curriculum Committee. Taking clerkships which
are not approved by the School may be considered the unlawful
practice of medicine (since malpractice insurance does not
cover unlawful acts, the student and his preceptor would,
therefore, be personally liable).
To cover you medically and legally under the County as well
as by the University, you must be enrolled as an Affiliating
Student Physician at the Medical Center. As such, you should
be aware of two special County rules which apply to medical
students as well as employees:
- Soliciting Business for Attorneys (Capping):
It is illegal for any County employee to solicit business
for attorneys, both on or off County property. To do so
is illegal under Sections 6151, 6152, and 6153 of the Business
and Professions Code of the State of California.
- Conflict of Interest: It is illegal for
a person employed in a full-time position in the County
service to engage outside of the regular working hours,
in any gainful profession, trade, business, or occupation
whatsoever for any person, firm or corporation, or governmental
entity, or to be so engaged in his own behalf, which profession,
trade, business or occupation is incompatible with, or involves
a conflict of interest with, his duties as a County officer
or employee, or with the duties, functions or responsibilities
of his appointing officer or of the Department by which
he is employed.
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PROFESSIONAL RESPONSIBILITY
Behavior
Students are expected to display a professional manner at
all times and show courtesy, not only to patients and their
relatives, but to other members of the professional team.
Students are required to identify themselves as student physicians
at all times. Students must maintain strict confidentiality
of patient information following HIPAA guidelines.
Identification
Students must wear their Identification Badge at all times.
Failure to do so may result in a citation by Security. Your
I.D. Badge not only assures patient security throughout the
hospital, but authorizes your presence on the ward. If your
I.D. Badge is lost, please contact the Office of Student Affairs
at (323) 442-2553 to report the lost badge and secure a replacement.
The student will be responsible for a $50 lost badge fee.
Students are encouraged to use care in handling their I.D.
Badges.
Dress
While on the ward, students are expected to present a neat
and clean appearance. Specific requirements will be identified
during clerkship orientation. Students should wear their short
white Keck School of Medicine coat over conventional dress.
The LAC+USC Healthcare Network Dress Code is provided on pages
6-7 and 6-8 for your reference.
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MEDICAL RECORDS
On clerkships where the student may be working in a role
similar to an intern, students should be aware that JCAHO
requires that the initial workups on a patient be recorded
on the chart within the first twenty-four (24) hours. The
hospital chart is a LEGAL DOCUMENT and, as
such, facetious remarks have no place in the record. All entries
to the record must be SIGNED, and identified
by year of training (USC III, USC IV, etc.). All charting
is to be done in BLACK ink. Charts must be
kept near the patient and should not be removed
from the Ward unless the chart is accompanying the patient
to another location. Charts may not be photocopied.
Moreover, the Health Insurance Portability and Accountability
Act (HIPAA) Privacy Rule generally prohibits health care providers
(such as USC physicians, pharmacists, dentists, allied health
professionals as well as USC's hospital partners), health
plans (such as the USC Network) and clearinghouses, from using
or disclosing an individual’s "protected health
information" without an authorization from a patient.
An online HIPAA education privacy program is available through
the University’s compliance webpages (www.usc.edu/compliance)
and must be taken by faculty, staff and other USC employees,
as well as students, volunteers, agents and certain other
individuals who have access to patient health information
through USC providers.
ALL MEDICAL STUDENT WORKUPS AND ORDERS ON HOSPITAL
CHARTS MUST BE COUNTERSIGNED BY THE RESIDENT OR ATTENDING
PHYSICIAN. STUDENTS MAY NOT FORGE THEIR INTERN'S OR RESIDENT'S
COUNTERSIGNATURE, EVEN WITH APPROVAL. We need not
remind you of the seriousness and consequences of forging
another person's signature.
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HOSPITAL POLICY ON ORDERING DIAGNOSTIC STUDIES
Students are not to order/submit laboratory work, x-rays,
or other diagnostic studies on themselves, or on another student.
Any student performing such unauthorized studies under his/her
own, or a patient's name, will be billed
for payment, and will be subject to disciplinary action
by the hospital and the School.
REFERENCES
Students should be aware of the following reference materials,
generally available at the Clerk's Desk on most Wards:
Nursing Procedures Manual
Describes hospital procedures, policies, etc.
The Drug Formulary
Describes drugs available for use, rules for prescribing,
writing prescriptions, etc.
The X-Ray User's Manual
Describes x-ray services available, how to order, how to
prepare patients, etc.
NOTE: See the pages which follow for Approved
Abbreviations, Venipuncture Protocol, Medical Center Services,
and Hospital Locations.
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LAC+USC HEALTHCARE NETWORK DRESS CODE
Purpose
LAC+USC Healthcare Network personnel recognize that dress,
grooming and personal cleanliness contribute to the morale
of all employees, and impact the image that the LAC+USC Healthcare
Network presents to patients, families and the community.
The image presented by students, staff and faculty affects
the willingness of patients to choose a LAC+USC Healthcare
Network facility to obtain their medical care. These guidelines
serve to establish a minimum dress code standard for all LAC+USC
Healthcare Network employees.
Policy
All employees, including County, contract, University and
volunteers, shall present a clean, neat appearance and dress
according to the requirements of their position.
Where uniforms are required, the employee shall wear the
required uniform while on duty. The employee is also responsible
for maintaining the uniform in good repair.
Each department shall enforce supplementary dress code standards
in accordance with the applicable Memorandum of Understanding
(MOU) provisions where the safety of the employee and/or patient
are not addressed in the minimum standards.
Guidelines Minimum Standards
- The official LAC+USC Healthcare Network photo identification
badge must be worn at all times, between the shoulder and
waist, with the name and picture easily visible.
- Clean and shined shoes of leather or leather type material
and constructed of sufficient strength to protect the foot.
- Hair is to be clean and neatly groomed; for patient care
and areas containing moving equipment, hair must be secured
at the shoulders. Beards and mustaches are to be neatly
trimmed to show evidence of grooming and good care.
- Nails are to be clean, and of a length that does not interfere
with work performance, personal safety and/or patient care.
- Cosmetics should be appropriate for a business environment.
- Jewelry may be worn that is consistent with the work assignment,
not injurious to the patient, and does not pose a potential
safety problem to the employee. Dangling jewelry including
ornate rings, long neck chains and earrings that extend
below the ear lobe may not be worn by patient care personnel
for safety reasons. Body piercing ornaments and earrings
worn in other visible exterior parts of the body other than
the ear are not permissible.
- Hosiery or socks shall be worn at all times.
Examples of Inappropriate Attire:
- Jeans-style pants
- Tight, sheer or revealing clothing (i.e. clothing items
constructed of spandex material, leggings, etc.)
- T-shirt, undershirts, or sleeveless shirts worn by themselves.
T-shirts with a collar (i.e. Polo shirts) are acceptable.
- Shorts of any type.
- Sandals (i.e. thongs or beach wear).
- Midriff or off-the-shoulder blouses, sweaters, and dresses.
- Spaghetti-strap or strapless blouses and dresses.
- Sweatshirts/pants or exercise attire.
- Wear of OR/procedure room attire outside of the patient
care areas (i.e. masks, booties, hair coverings).
- Patient clothing including patient gowns, slippers and
isolation gowns.
- Torn or unclean clothing or uniforms.
- Ill fitting clothing and uniforms (i.e. oversized, potentially
hazardous).
- Caps or hats.
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