Section XI: Policies on Writing Orders, Medical Liability Insurance, Health Insurance and Other Health Policies

Medical Liability Insurance

It is ideal in medical education to allow third-and fourth-year medical students to write orders on the inpatients they are following. This practice must be viewed as an educational activity and not as a service activity. As a learning experience, teaching occurs when a supervising physician (either resident or attending); reviews the orders, discusses them with the student, provides constructive feedback, and countersigns the orders.

Under these circumstances students are covered by the university's medical liability insurance. The key conditions are that 1) the student is functioning under the direct supervision of a licensed physician, and 2) the orders are countersigned before they are executed.

The university's medical liability insurance also covers Brown medical students when they are doing clinical electives at institutions other than Brown's affiliated hospitals, so long as the above guidelines are followed and the clinical elective will fulfill an MD degree requirement.

The medical liability insurance also covers students for any injury that results to a patient as a consequence of a student's actions in carrying out the usual and customary functions of a medical student in the course of caring for a patient. This includes taking a history, conducting a physical examination, and performing procedures of an investigatory or therapeutic nature. However, the same conditions apply, namely, that the student must be functioning under the direct supervision of a licensed physician.

Particular prudence should be exercised in the performance of procedures. It is customary for students to become proficient in certain basic procedural skills such as phlebotomy, placing intravenous catherters, inserting urinary catheters and nasogastric tubes, doing lumbar punctures and obtaining other bodily fluids and tissues of a relatively simple nature, and minor surgical procedures. Other activities that are customarily conducted by students may include administering skin tests and, relatively nontoxic medications by injection, and applying dressings, splints, and casts. Even when conducting these procedures, the student should be closely and personally supervised by a licensed physician while gaining proficiency. After proficiency has been obtained, the student must perform these procedures only when they have been ordered by a supervising licensed physician. It is important for students to inform their supervising physician when they have not attained proficiency in a given procedure in order to receive close, personal supervision, even though it is the supervising physician's responsibility to ascertain the student's competence and provide appropriate supervision.

In situations that go beyond the usual and customary functions of medical students, it is imperative that the procedure is conducted under the direct, close, and personal supervision of a licensed physician. This would include such activities as major surgery, reduction of fractures, invasive procedures (e.g., bone marrow biopsies, organ biopsies, central line placement, thoracentesis, endotracheal tube insertion), and administration of relatively toxic substances (e.g., intravenous narcotics, chemotherapeutic agents, provocative tests, general anesthetics). Students should refuse to do these procedures without the direct, close, and personal supervision of a licensed physician.

Students should also refuse to obtain informed consent from patients for any procedure. This is the responsibility of the physician performing the procedure. Students are encouraged, however, to be present when the physician discusses the procedure with the patient as part of the informed consent process, in order to become acquainted with how this extremely important process occurs.

Students must always wear their identification name tags when dealing with patients and staff in the hospital. Students must identify themselves as medical students and sign all notations they make with the identification that they are medical students (e.g., John Smith, AMS III).

The best way to avoid being involved in a malpractice suit is to always act professionally, respect the rights of patients and treat them respectfully and kindly, act prudently, know the limits of your competence, and don't be afraid to say "I don't know," or "I'm not comfortable doing such-and-so." Listen to what staff nurses say and don't do something they don't want you to do.

If a student is involved in a medical malpractice action, legal representation is provided by the University's Office of General Counsel, provided the student has acted within the guidelines specified above.

Students on Leave of Absence (LOA) are not eligible for Brown's medical/professional liability insurance during their time away from medical school.

Health Services Fee and Health Services Resources

 

All medical students who are not enrolled in the Academic Scholar Program(ASP) or on LOA must pay an annual health service fee each semester.  This fee, which is separate from the charge for student health insurance, covers most general medical care at Health Services, including primary care by provider staff, use of Brown University Emergency Medical Services, nursing services and 24/7 medical advice and campus-wide health education. Also covered is access to Brown University Psychological Services, which provides assessment of problem situations, short-term psychotherapy, and crisis intervention. Coverage during the summer months is optional.

Students enrolled in the ASP are eligible to use Health Services as long as they have paid the health services fee via their student account. At the time these students apply for the ASP, they should request access to health services on the ASP approval form or notify the Office of Records and Registration at ams-student-records@brown.edu.

Health Services records are confidential and are not released to anyone, including family, legal guardians and faculty, without written authorization from the student.  There are a few exceptions when release of specific information without a student's expressed consent is necessary in emergencies or is required by law.  Additional information can be found on the Health Services website (Link) at http://www.brown.edu/Student_Services/Health_Services/.

Student Health Insurance

Health insurance is not included in the Health Services fee.  All students must have separate health insurance to cover services not provided by the Health Services fee (such as lab, x-ray, pharmacy and hospital expenses). All active students are automatically enrolled in the Brown Student Health Insurance Plan (SHIP). This plan is designed specifically to complement the services provided by Health Services. The University's Office of Insurance and Risk is responsible for SHIP.

Students who are covered under a parent's, spouse's, or other comparable health insurance plan may complete an online form to waive them from participating in SHIP. When evaluating your plan, you must verify that your plan provides adequate coverage that is accessible in the Providence area. Information is sent to students each May with instructions on how to waive out of the plan. Students must complete an online waiver form annually at www.universityhealthplans.com. The deadline for completing the waiver is June 1st.  Please be aware that not all non-SHIP insurance plans will cover the testing routinely required by clinical sites of health care workers (e.g., titers, vaccinations).

International Students - It is particularly important that you verify that your insurance plan provides adequate coverage that is accessible in the Providence area before waiving the Student Health Insurance Plan.

Students on Leave of Absence (LOA) who need health insurance will need to purchase insurance directly from the Office of Insurance & Purchasing Services. Students not previously enrolled in the student health insurance program at Brown are not eligible to purchase coverage while on LOA.

Students  enrolled in the ASP who need health insurance are eligible for Brown's health insurance. In order to verify coverage, students should work directly with the Insurance Office to request coverage during their time away.

More information is available at: 

http://www.brown.edu/about/administration/insurance/

Accidents and Injuries While in the Hospital

 

Students who are involved in an accident or who are injured while in one of the affiliated hospitals as part of their educational program should go immediately to the hospital's Employee Health Service for attention and treatment. This is particularly important in accidents and injuries involving needle sticks or other possible contamination incidents. The Employee Health Service staff is familiar with the testing and/or treatment protocols utilized under these circumstances. Students should also notify the Associate Dean for Medical Education as soon after the incident as conveniently possible.

If the accident occurs outside of an affiliated hospital, such as in a doctor's office or community health center, students should obtain the needed health care in the most expeditious manner possible, and then contact the Associate Dean for Medical Education. Students may also call University Health Services for advice at (401) 863-3953.

Immunizations


Rhode Island state law (R23-1-IMM/COL) and Brown University Health Services require all medical students to have received the following vaccines and blood tests. Please be aware that these requirements may exceed CDC recommendations.

  • A record of two MMR vaccines and positive serological tests for immunity to Measles, Mumps and Rubella. History of disease is not acceptable. A copy of the lab report must be attached.
  • Positive serological test for immunity to Varicella (chickenpox). History of disease alone is not acceptable. A copy of the lab report must be attached OR a record of Varicella vaccine, two doses, at least one month apart.
  • A record of Hepatitis B vaccine, three doses. If series is complete, a Hepatitis B Surface Antibody titer must be done with a copy of the lab report attached.
  • Tdap (Tetanus/Diphtheria/Pertussis) booster within the past 10 years.
  • Tuberculosis testing is required within the past 6 months. Accepted testing includes the PPD skin test (two-step testing will be required during the first year if applicable and will be performed at Brown); or a TB blood test, either QuantiFERON-TB Gold In-Tube test or T-Spot TB test.

In addition, all medical students are required to have an annual influenza vaccine. Influenza vaccines are offered at onsite clinics at the medical school each fall, and are also available at Health Services or through some of the hospital employee health departments.

Brown Health Services reviews students' immunization records annually to ensure that they have met the Rhode Island Department of Health requirements. AMS is notified by Brown Health Services of non-compliant students.

Other Training Requirements

All medical students are required to be compliant with the following requirements:

  • N95 respirator training and fit-testing: annually
  • Respiratory Medical Evaluation form: completed once prior to the start of first year
  • Completion of HIPAA training modules: every 2 years
  • Bloodborne Pathogen/Universal Precautions training: provided during 1st year orientation and again during the Clinical Skills Clerkship (CSC) prior to the start of 3rd year
  • BLS training: 2-year certification; training is provided during 1st year orientation
  • ACLS training: 2-year certification; training is provided during the CSC

Please note: non-compliance with any of these requirements and immunizations can result in an interruption of your clinical rotations or Doctoring mentor sessions until you have been cleared to resume these activities.

Additional Resources at Brown

Dr. Christine Montross, Assistant Professor of Psychiatry & Human Behavior, is the Lead Ombudsperson for Student Wellness and Mistreatment at the medical school. If you believe you would benefit from psychotherapy or psychiatric treatment, or have experienced mistreatment, please contact Dr. Montross at Christine_Montross@brown.edu

Dr. Montross can help determine the type of treatment the student is seeking, and will connect the student with an appropriate provider.  All discussions are completely confidential.

Dean of Chemical Dependency, Kathleen McSharry (401) 863-2536 
The Dean of Chemical Dependency provides comprehensive academic and social support in non-clinical settings for Brown students, faculty, and staff affected by alcohol or drug abuse. You can contact her by email at Kathleen_McSharry@brown.edu.

Health Education (401) 863-2794 
Located on the third floor of Health Services, Health Education provides confidential appointments for drug or alcohol concerns, nutrition and eating concerns and  other health-related topics for Brown students.

Counseling and Psychological Services (401) 863-3476 
Counseling and Psychological Services (CAPS) provides crisis intervention, short-term individual therapy, group therapy and referral services.  The office is located in room 516 of J. Walter Wilson.

See Section XIII of the handbook regarding the role of the Student Health Council.