1. Health insurance
There are inherent risks involved in taking care of patients. For this reason, all Carver College of Medicine students are required to maintain health insurance (or an equivalent alternative care plan) sufficient to satisfy minimum standards of coverage. It is recommended that alternative care plans cover immediate evaluation, testing, initiation of necessary prophylaxis, and follow-up for exposure to blood and body fluids.
If you have questions on the health insurance requirement or the various policies, please call the Benefits Office at 319-335-2676 or toll free 877-830-4001, Fax 319-335-2776 or go to http://hr.uiowa.edu/benefits/health-insurance-graduate-students.
Disability insurance, while not required, should be considered. If you are interested in purchasing disability insurance, we urge you to contact your local insurance agent.
Proof of health insurance coverage
If you have other health insurance and do not want to be billed for the University’s policy, you must submit an annual “Proof of Coverage Form” to University Benefits, 120 University Services Building, Suite 40, Iowa City, IA 52242-1911 in early September. Do not miss this deadline as the Benefits Office does not credit back billed premiums when forms are turned in late. Proof of coverage forms are available at http://hr.uiowa.edu/benefits/health-insurance-graduate-students.
2. Immunization requirements
Immunization is your personal responsibility. You can receive immunizations at your own healthcare provider office, or at Student Health & Wellness.
These are the basic immunization requirements for health science students:
- Measles, mumps, rubella (MMR)
- Two vaccines or positive antibody titres (blood tests) of all three diseases.
- Two doses of each of the single component vaccines are acceptable. The first MMR must be given after the first birthday to be valid, and the MMR vaccines must be at least 28 days apart. For health science students, there is no age exemption for MMR.
- Tetanus/diphtheria/pertussis immunization within the last 10 years.
- Tuberculin skin test (TST) or IGRA (Interferon Gamma Release Assay- Quantiferon Gold or T-Spot blood test) required pre-entrance and annually.
- If you have never had any TB skin testing, the two-step TST is done as follows: The first test is placed and results are read in 48-72 hrs. The second test is placed at least 7 days after the reading of the first test and read at 48-72 hrs. Send documentation of both tests and include placement date, reading date, result, and mm induration.
- If you have documentation of (1) negative TST in the past 12 months or documentation of (2) negative TSTs in your past, you need one more TST to meet the two-step requirement. A TST or IGRA is also required annually, after the two-step is completed initially.
- TSTs must be read 48-72 hours after placement- required documentation includes placement date, reading date, result, and mm induration.
- Those with a history of a positive TST or IGRA must provide a copy of the CXR (Chest x-ray) report.
- If treated for LTBI (Latent TB Infection), provide medication treatment dates.
- Students with a history of a positive TST are also required to complete a symptom assessment initially and annually- form is on the SHW website.pdfform is on the SHW website.
- Hepatitis B (see below)
- Three vaccine series, completed at the appropriate intervals, followed by antibody titre 4-8 weeks after third vaccine.
- The titre is REQUIRED, even if series was completed as a child.
- If antibody titre is negative, follow algorithm form on website.pdfalgorithm form on website for boosters and re-checking titre.
- Varicella (chicken pox)
- Two vaccines or positive antibody titre.
- If you had varicella as a child, you must have a titre to document immunity.
- Health Screening
Other vaccines recommended by the CDC/ACIP and Student Health & Wellness:
- Meningitis: if initial vaccination was given before age 16, a booster is recommended.
- Influenza: many rotation sites and hospitals require this annually.Strongly recommended to reduce the risk of infection not only to the students but also to hospitalized patients who are placed at risk in part because of contact with hospital personnel.
- Hepatitis A: (2) vaccine series.
- HPV (human papilloma virus): (3)-vaccine series for males and females up to age 26.
Students receiving training at other facilities are required to meet the immunization and testing requirements of the training facility.
During the course of clinical training, students will come in contact with patients who have hepatitis B. Students are required to have completed the full hepatitis B immunization series (3 doses), and a hepatitis B titre (blood draw) that confirms immunity to hepatitis B, prior to the end of the first semester of medical school. Immunization is the student’s personal responsibility. Students may wish to contact their personal physician for immunization. Immunization and titres for hepatitis B are available through Student Health & Wellness. The vaccine is given over a period of six months, with three separate shots. The titre is drawn 4-8 weeks after the third shot. All three immunizations must be given to increase the likelihood that the vaccine will be fully protective. The first year financial aid budget is adjusted to include the cost of immunization.
3. Blood Borne Pathogen Exposures
The CCOM is committed to the safety of its students in the clinical setting. Students should not undertake participation in a procedure involving sharps or needles without first completing prescribed training. In the event of a sharps or needle stick injury, the student or his/her supervisor should access this site and proceed as directed. If students or supervisors have uncertainties about how to proceed, then a call should be placed immediately to the Student Health Hotline number 319-335-9704. A student experiencing a needlestick or significant contamination on unprotected skin/eyes/mouth by patient blood or body fluids should immediately:
- Wash/flush the exposed area
- Inform your instructor/preceptor/attending physician
- Identify the source patient
- Identify the source of exposure, including name/hospital number/ID of individual if applicable (preceptor, RA or hospital staff can assist with this)
- Students on rotation at the VA Hospital should seek care at the VA Employee Health Clinic
- Call Student Health Service 319-335-8392
- If Student Health Service is closed, call UIHC ETC 319-356-2233 and ask to speak to the staff M.D.
- Obtain medical care as advised
- Accept responsibility for follow-up
- For the complete protocol for medical students at UIHC or off-site, see the Student Health website.
If a student receives a bill for the procedure, they should submit to insurance. OSAC will cover the cost of any co-pay. Please submit the cost of the co-pay to Financial Services in 1216 MERF.
4. Policy on Respirator Fitting: Airborne Infection Prevention
For M3/4 students in clerkships a didactic lecture regarding infection prevention is provided in Clinical Beginnings. If the student is required to encounter a patient room designated Airborne Infection Isolation (blue sign on the door stating N95 respirator required to enter room) the student must first make an appointment with Student Health to be fitted for a respirator. For most people the standard N95 respirator is sufficient. The cost of the fitting is $52 and will be reimbursed to the student by OSAC. The student must bring the bill to Financial Services, 1216 MERF. Note that the incidence of students encountering this patient isolation is rare (approx 1 per year) and therefore the respirator fittings will be handled on an as-needed basis only.
5. Substance abuse
During recent years there has been increasing recognition that alcoholism and drug dependence constitute a major health hazard for physicians. A study done by the Georgia Medical Society’s program for impaired physicians suggests that one of every eight physicians will have a problem with drugs and/or alcohol at some time during his/her career. Although the average age at which substance abuse is identified in physicians is 45 years, the problem begins much earlier, often in college, medical school or residency. A number of factors contribute to this substantial risk for physicians such as:
- lack of education regarding the risk of substance abuse;
- easy availability of drugs;
- the MDeity complex or physicians’ belief that they should be able to solve all problems and cure all diseases, both those of others as well as their own;
- stress of time demands, unremitting responsibility and cultural expectations;
- early social use of drugs or alcohol as therapy for stress;
- Titanic complex that professes that physicians are “unsinkable”;
- short lived relief that alcohol may give those suffering from clinical depression or clinical anxiety; and
- the common use of alcohol as a central part of many medical student social functions.
The purpose of early identification and evaluation of physician trainees who are impaired due to alcohol or drugs is to provide confidential services that are strictly divorced from disciplinary action and to assist trainees in pursuing career plans. Prevention strategies include awareness of the possible problem of substance abuse, development of various personal techniques for coping with stress, developing appropriate support systems, relapse prevention skills, enhanced communication abilities, healthy recreation skills and learning to seek and use assistance.
Providers for care for students with substance use issues are listed at http://www.medicine.uiowa.edu/md/supporting-students/student-counseling/resources-and-referral-information, including descriptions of available services and access information.
Medical students who are concerned that their own or others’ use of drugs or alcohol has led or may lead to any level of physical, social, academic or mental impairment are encouraged to seek assistance through the Office of Student Affairs and Curriculum, the OSAC Deans, the Medical Student Counseling Center, the University of Iowa Counseling Services (335-7294), University of Iowa Student Health or local community agencies or private practitioners.
The Carver College of Medicine adheres to the policy regarding the use of illegal drugs and alcohol established by the University (Section IID. Policy Regarding the Use of Illegal Drugs and Alcohol, in the Policies & Regulations Affecting Students). This may be found at http://dos.uiowa.edu/policy-list/current-policies-and-regulations-affecting-students-2011-2012-academic-year/student-responsibilities-6/code-of-student-life-2011-2012-academic-year/. In addition, failure to meet specific promotion requirements of the Carver College of Medicine as a consequence of substance abuse will be handled using standard promotions procedures.