Student Handbook and Policies

OPERATING POLICY

NON-INVOLVEMENT OF PROVIDERS OF STUDENT HEALTH SERVICES IN STUDENT ASSESSMENT

On occasion medical students may receive healthcare treatment of a sensitive nature from a healthcare provider who also has a teaching and assessment role in the curriculum. It is the school of medicine’s responsibility to ensure that these individuals have no influence on the academic assessment or progress of the student they have treated.

1. Health professionals who provide psychiatric/psychological assessment or treatment, or other sensitive health services to medical students, will have no involvement in the academic assessment or promotion of the medical student receiving those services.
2. If a student is assigned to an educational environment where the supervising faculty member has previously provided mental health assessment or treatment, or other sensitive health care to the student, the faculty member must advise the course/clerkship director of a need to reassign the student to a different evaluating supervisor. It is the responsibility of the course/clerkship director to make sure that faculty are aware of this policy.
3. If a student should be assigned to an educational environment where the supervising faculty member does not immediately recall having treated the student and/or has not initiated the steps in Number 2 (above), the student should request and will be granted an alternative assignment. The student may go directly to the course/clerkship director or to the office of medical student education to have the assignment changed.
4. A faculty mentor involved in the competency development or academic evaluation of a student cannot be a health care provider for a student they are mentoring.
5. A healthcare provider on the Academic Review Committee or on any committee that evaluates students (voting or nonvoting members) must recuse himself or herself from deliberations related to a student that he or she has treated.
6. Those who provide mental health services or other sensitive health care to students may lecture in a large group setting where the students may be present but cannot assign their grade or provide narrative feedback to them. They cannot be a small group facilitator or mentor for a student they have treated.
7. Those who care for students in the Student Health Center may lecture in a large group setting at LLUSM but cannot assign their grade or provide narrative feedback to them. They cannot be a small group facilitator or faculty mentor.

APPROVED BY SMEC: 4/7/23

OPERATING POLICY

COMMUNICABLE DISEASE POLICY

Loma Linda University School of Medicine, in harmony with the University’s Communicable Disease Transmission Prevention Policy is committed to preventing communicable disease transmission among its faculty, staff, students and the patients they serve through a program that includes education, immunizations, safe environments, and provision for special protective measures where scientific literature identifies a risk of transmission. This policy meets a high ethical standard as well as the legal requirements to (1) protect students, faculty, staff and patients from communicable disease transmission, (2) maintain the confidentiality of infected persons, and (3) protect the right of every individual for compassionate care regardless of disease condition.

The primary purpose of this Communicable Transmission Prevention Policy is to insure a safe place for learning as well as to protect patients served.

I. Admission and Retention Policies

A. Compliance with the following requirements for pre-entrance immunization:

1. Measles, Mumps, Rubella: two immunizations or proof of immunity.
2. Tetanus: current within 10 years.
3. One dose of Pertussis vaccination after age 18.
4. Hepatitis B (series of 3 immunizations) plus titer documenting immunity. Non responders shall be revaccinated.
5. Tuberculosis Skin Test (PPD Mantoux): current within 6 months (If student tests positive, a chest x-ray report within five years is required, and annual signs and symptoms form must be completed).
6. Varicella: Must show proof of either: a series of two injections OR a positive Varicella titer.

B. Returning students will be required to have an annual or more frequent tuberculosis skin test (PPD Mantoux) and/or a chest x-ray when indicated.

C. Mandatory screening for HBV, HCV or HIV is not warranted. Infected students will not be prohibited from providing patient care activities. Nevertheless, it is the personal responsibility of the caregiver to reduce the risk of communicable disease transmission. This includes an ethical responsibility to know one’s serological status relating to HBV, HCV and HIV.

D. If students know that they are a source of a significant patient exposure through blood or body fluid, they are mandated and ethically obligated to undergo testing for infection or treatment.

E. Adherence to the infection control practices within clinical settings will be a significant factor in the continued enrollment of the student. Lack of adherence to safety procedures for themselves and/or their patients which are deemed potential and serious hazards to patients and others will be subject to appropriate disciplinary action, including but not limited to restriction of clinical practice (to be determined on a case-by-case basis), or dismissal.

II. Infection Control

A. Students will learn and are expected to use standard universal precautions to protect themselves and their patients.

1. The student will learn infection control precautions appropriate for the handling of blood and body fluids including the use and disposal of needles and other sharp instruments.
2. The student will learn epidemiology, transmission, pathophysiology and management of transmission-based communicable diseases, including airborne, droplet, contact routes of transmission as well as blood borne pathogens in medical school courses as appropriate for the content of the course.
3. Students will be required annually to document completion of a Universal/Standard Precautions education, as well as meet the requirements of the clinical facility to which they are assigned prior to clinical assignment.

B. All students are expected to provide care with compassion and respect for human dignity. No student physician may ethically refuse to treat a patient solely because the patient is at risk of contracting or has an infectious disease such as Tuberculosis, HBV, HCV or HIV.

III. Exposure Management

A. Significant exposure (as defined in Attachment I) to communicable disease will be monitored in compliance with the recommended screening and prophylactic practice of Loma Linda University Medical Center.

B. If an accidental occupational exposure occurs on campus, the incident should be reported to the attending physician and/or clerkship director. The student must be referred to the Emergency Department immediately for medical evaluation. The student needs to identify the injury and him/herself as a LLU student. Such exposure should also be reported by the student to employee health as soon as possible. Student Health must also be given a copy of the post-exposure evaluation and treatment records. It is the student’s responsibility to ensure that this occurs.

C. If an accidental exposure occurs off campus, the incident should be reported to the responsible attending physician who will work with agency personnel for appropriate emergency care. Most affiliated hospitals provide this care at either the Emergency Room or employee health. A report of the incident and source patient results must be sent to LLU Student Health for appropriate student follow-up on campus. It is the student’s responsibility to ensure that this happens.

IV. Evaluation and/or Accommodation

A. Blood borne Pathogen Exposure

1. Once exposed each student will be monitored according to University Employee Health Policy, based upon current national recommendations.
2. Confidential counseling in regards to testing will be available.
3. Testing and health records will be maintained by Student Health Service of Loma Linda University Medical Center. Testing results will be kept confidential.
4. If infected, reasonable accommodations will be made with the student’s assignments based on the broader context of the institutional health and educational program, including the assessment of the provider to patient risks and the individual’s physical and psychological status. See Attachment II.

B. Other types of pathogen exposure will follow the appropriate guidelines from the Center for Disease Control.

Attachment I

DEFINITIONS OF SIGNIFICANT EXPOSURE

A. A significant blood borne or body fluid exposure is defined as:

• a. A puncture with a contaminated needle.
• b. A cut or puncture with contaminated instruments.
• c. Transmission of blood or body fluids to mucous membranes, such as a splash to the eye or mouth.
• d. A cutaneous exposure involving large amounts of blood or prolonged contact with blood – especially when the exposed skin was chapped, abraded, or afflicted with dermatitis.

B. A significant airborne exposure is defined as unprotected exposure to patients known to have transmitted airborne droplet nuclei. Examples include:

• a. Measles
• b. Varicella
• c. Tuberculosis

C. A significant droplet exposure is defined as unprotected exposure to patients known to have transmitted large particle droplets. Examples include:

• a. Invasive Haemophilus influenzae type B disease, including meningitis
• b. Invasive Neisseria meningititis disease, including meningitis and pneumonia
• c. Other serious bacterial respiratory infections spread by droplet transmission such as diphtheria (pharyngeal), mycoplasma pneumonia, pertussis, pneumonic plague, streptococcal pharyngitis, streptococcal pneumonia or scarlet fever;

D. A significant contact exposure is defined as unprotected exposure to patients known to have an infection transmitted by direct contact or by contact with items in the patient’s environment. Examples include:

• a. Gastrointestinal, respiratory, skin or wound infections or colonization with multidrug-resistant bacteria;
• b. Enteric infections such as Clostridium difficile, and entero-hemorrhaghic Escherichia coli O157, Shigella and Hepatitis A, for diapered or incontinent clients;
• c. Respiratory syncytial virus, parainfluenza virus or enteroviral infections in infants and young children;
• d. Skin infections that are highly contagious or occur on dry skin such as herpes simplex virus (neonatal or mucocutaneous), impetigo, major (noncontained) abscesses or decubiti, pediculosis, scabies, staphylococcal furunculosis in infants and young children, herpes zoster (disseminated or in the immunocompromised host), viral or hemorrhagic conjunctivitis, or viral hemorrhagic infections (Ebola, Lassa or Marburg).

Attachment II

PROCEDURE FOR ACCOMMODATING AN INDIVIDUAL STUDENT’S CLINICAL ASSIGNMENTS

1. A student when given reasonable accommodations must be able to perform the routine duties expected of each clinical assignment. The student must be able to meet the minimum requirements of each course/clerkship.
2. A student must be compliant with established guidelines and procedures, such as following Universal and disease specific precautions for patients.

3. The clerkship director in conjunction with the Office of Medical Student Education may make an accommodation for a student’s clinical experience on a case-by-case basis. Decisions about exemptions will be made in consultation with the student’s physician.

   a. Students with a confirmed pregnancy or diagnosed immunologic deficiency may request to be excluded from caring for patients infected with known communicable disease or bloodborne pathogens. In addition, students may request to be exempt from exposure to environmental agents that may be hazardous to the student and/or fetus.

   b. Any student with a communicable infectious process may, in consultation with the clerkship director, request a change in assignment.

OPERATING POLICY

TUITION POLICY FOR STUDENTS WHO ARE REQUIRED TO REPEAT COURSE WORK, TAKE A LEAVE OF ABSENCE, OR WITHDRAW FROM SCHOOL

NOTE: Federal financial aid is not available to students who are required to repeat a year. Repeating students will need to obtain private loans to cover any repeat expenses.

1. First-Year Students: Students who choose to withdraw or take a leave of absence any time before the start of the second block will be charged twenty-five percent (25%) tuition. Students who withdraw or take a leave of absence after the start of the second block but prior to the end of the December Integration Week will be charged forty percent (40%) tuition. Students who withdraw or take a leave of absence after the start of the third block but prior to the start of the fourth block will be charged fifty percent (50%) tuition. Students who withdraw or take a leave of absence after start of the fourth block but prior to the end of the fifth block will be charged seventy-five percent (75%) tuition. Students who withdraw or take a leave of absence after the start of the sixth block will be charged full tuition for the year.

2. Second-year students: The refund policy for the second-year curriculum is based on a student’s progression through the four required primary blocks. Students who withdraw or take a leave of absence before the exam at the end of the first block will receive 100% tuition not including fees. The charge for fees will be adjusted to correspond with the length of time before students who withdraw or take a leave of absence after the first block but prior to the beginning of the second block will be charged twenty percent (25%) tuition. Students who withdraw or take a leave of absence after the start of the second block but prior to the beginning of the third block will be charged 50% tuition. Students who withdraw or take a leave of absence after the start of the third block but prior to the beginning of the fourth block will be charged 75% tuition. Students who withdraw or take a leave of absence during or after the 4th block will be charged full tuition for the year.

3. All third and fourth year medical students will be charged 100% tuition at the beginning of each academic year. If during that year they take a leave of absence, a portion of their tuition may be refunded but they will pay that same percent of tuition at the following year’s rate when they return.

4. When students return from a leave of absence, they will be charged fifty percent tuition (50%) for the classes they failed or were failing at the time of the leave for those terms which they have already paid full tuition during the failed year.

Transcript Grade Notes for Students who Withdraw or Take a Leave of Absence

Students who take a leave of absence or withdraw prior to completion of 80% of a course (not counting final exam weeks) will receive a W on the transcript. Courses that are more than 80% complete will receive an Unsatisfactory grade on the transcript. Since courses begin and end at various times during the term/year, students should consult early with the Dean's Office if contemplating withdrawing from a course.

Financial Policies and Information

The student is expected to arrange for financial resources to cover all expenses before the beginning of each school year. Accounts with other schools with this University must be settled before enrollment will be allowed or services offered. Registration is not complete until tuition and fees for each term are paid; therefore, the student should be prepared to make these payments during scheduled registration periods for each academic year. Tuition and fees may vary from amounts shown. Please refer to the Student Account Disclosure Statement for additional student account financial information.

STUDENT FEES

Enrollment fees

Students attending this University will be charged an enrollment fee, based on the criteria indicated below. Neither the fee in total nor any portion of the fee will be waived under any circumstance. Other school-specific charges-such as technology fees, laboratory fees, etc., may also appear on the student account. The following criteria govern the enrollment fee:

1. Students who are accepted into a degree program and registered will be charged the enrollment fee, regardless of the number of units for which they are registered.
2. Students who are not accepted into a degree program but who are registered as non-degree students for more than four units (five units for School of Allied Health Professions) will be charged the enrollment fee.
3. Students who are working on "In Progress" courses and who are not registered for any other units will be charged the enrollment fee.
4. A student who is charged the enrollment fee but who drops all units before the deadline for a full refund (generally one week after the first day of classes) will receive a full refund of the enrollment fee and will have no access to any University benefits. Please refer to the refund policy.
5. LLUAHSC employees who are "full-time, benefit eligible" will not be charged the enrollment fee, whether they are using their education benefit or not. Spouses of employees who are using the employee benefit will be charged the enrollment fee.
6. Students participating in an off-campus or online program will not be charged the enrollment fee unless the program specifically requires this fee.
7. Other school-specific fees will be charged independent of the enrollment fee.

Other fees

Late registration fee $200

Late payment fee $100

Returned check fee $25

Lost withdrawal check reissue fee $15

Returned direct deposit fee $15

Students who have not paid the balance due for registration, or who have not been awarded financial aid sufficient to cover the balance prior to registration, will be charged a late payment fee. Additional Financial Policies and Information can be found at:

https://llucatalog.llu.edu/about-university/financial-policies-information/

APPROVED BY SMEC: 4/7/23

OPERATING POLICY

MISSING BLOCK OR CLERKSHIP FOR MEDICAL OR COUNSELING APPOINTMENTS

Students are permitted to miss class activities in order to access health services for medical or counseling appointments. When possible, students should avoid scheduling appointments during required laboratory and small group assignments. Clinical students may miss rounds or clinics. Students who need to schedule an appointment during a required activity other than an examination should inform the course or clerkship director of their pending medical appointment and ask to be excused. Students are not required to disclose the reason for the appointment. If a student is not given permission to attend their appointment, they should contact the office of the Associate Dean for Student Affairs. The student will be required to make up missed educational assignments. Students should not schedule medical or counseling appointments that would cause them to miss an examination except in situations of illness or emergency. In such cases they must follow the procedure for obtaining an excuse to miss the exam from the Office of the Senior Associate Dean for Medical Student Education. This procedure is contained in the Examination Policy in the School of Medicine section of the LLU Student Handbook.

APPROVED BY SMEC: 4/7/23

NON-DISCRIMINATION POLICY

Related Entity Specific Policy: LLU Discrimination

While Loma Linda University (LLU) gives preference in its selection processes to students and employees who are aligned with the faith-based mission of the University and the Seventh-day Adventist Church, LLU does not and shall not unlawfully discriminate on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, medical condition, physical handicap, mental condition, veteran's status, or age in the provision of any of its services. Further, LLU is committed to providing a work environment that is free of unlawful discrimination and harassment. In keeping with this commitment, LLU strictly prohibits all forms of harassment, including but not limited to sexual harassment and harassment based on race, color, religion, gender, sexual orientation, gender identity, national origin, medical condition, physical handicap, mental condition, veteran's status, or age. Also prohibited in retaliation of any kind against individuals who file complaints in good faith, or who assist in an LLU investigation.

As of August 2023

OPERATING POLICY

STUDENT MISTREATMENT

Loma Linda University School of Medicine seeks to educate ethical and proficient Christian physicians and scholars through instruction, example, and the pursuit of truth. In order to do this, the School of Medicine and its faculty are committed to the following fundamental values: compassion, excellence, humility, integrity, justice, teamwork, and wholeness. These values may occasionally be formally taught by faculty; but more often they are learned informally by students through observation of models of professional behavior toward students, colleagues, and patients.

Examples of mistreatment include verbal mistreatment,¹ physical mistreatment,² discrimination,³ excessive or unreasonable time demands,⁴ sexual harassment,⁵ and the use of grading or other forms of assessment in a punitive manner. Such behavior by faculty or staff, or other behavior that is inimical to the development of mutual respect, is unacceptable.

In the history of medical education, teachers have, at times, sought to motivate students by publicly degrading or humiliating those whom they judge are inadequately prepared or behaving inappropriately. This practice is not acceptable at Loma Linda University. While teachers do have the responsibility to motivate and correct students, when correction of an individual is needed, this is usually best done in private, but always in a way that shows respect for him/her as a person.

An important part of the teaching of mutual respect among professionals is the perception of students as they observe faculty in their interactions with each other. Therefore, faculty should avoid inappropriate behavior or mistreatment of other professionals and staff. This includes the avoidance of derogatory remarks about or attitudes toward individual colleagues, services, or departments.

Students also learn professional behavior and demeanor by observing their teachers as they interact with patients. Such professional interactions should always be courteous and respectful.

Respect for individuals includes, but is not limited to, such things as punctuality, thoughtfulness, mindfulness of personal space, as well as manner and mode of address, appropriately modest draping of patients, tone and content of verbal interchanges, and body language. In addition, discussion of patients out of their hearing should continue to show the same degree of respect and should not include contemptuous, derogatory, judgmental, or demeaning remarks.

If a medical student expresses an unwillingness to participate in an aspect of training or patient care as a matter of conscience, that stance should be explored in a nonjudgmental manner to ensure that the teacher and student fully understand the issue. The student’s position on matters of conscience should be honored without academic or personal penalty, as long as it does not interfere with the welfare of the patient and the overall educational goals of Loma Linda University School of Medicine.

Any student who feels that he/she may have experienced or observed mistreatment or unprofessional behavior by residents, faculty, staff, or students in violation of these standards of behavior is encouraged to report his or her concerns to one of the individuals below. Reports of unprofessional treatment should be made to the School of Medicine administration. Reports of sexual harassment or any violation of the University’s Title IX policy (see this policy in Section V of this Student Handbook) should be made to one of the administrators listed below or directly to the LLU Title IX coordinator. Within the School of Medicine, mistreatment can be reported to the following administrators: the senior associate dean for medical student education; the associate dean for clinical education; the associate dean for student affairs; the associate dean for curriculum evaluation and learner assessment; the associate dean of physician formation and wholeness; the assistant dean for basic science education; the associate dean for basic sciences and translational research or the assistant dean, graduate student affairs. The Title IX coordinator may be contacted by calling Employee Relations at 909-651-4001 or directly at 909-651-4638.

¹ Verbal or nonverbal mistreatment—includes:

• Shouting, hostility, profanity, or offensive gestures.
• Repeated or blatant conduct directed toward any person, which is intended to insult or stigmatize that person.

² Physical mistreatment—includes:

• Physical punishment, such as hitting, slapping, pushing, or kicking.
• The threat of physical punishment.
• Intentionally or negligently placing another at risk of physical harm.

³ Discrimination—includes:

• Disparate treatment based on gender, gender identity, age, ethnicity, race, disability, or sexual orientation that stigmatizes or degrades that person.

⁴ Unreasonable time demands—includes:

• Requiring a student to perform personal services, such as shopping or babysitting.
• Requiring a student to perform menial tasks with the intent to humiliate the student.

⁵ Sexual harassment—see “Policy Prohibiting Sexual Misconduct and Discrimination on the Basis of Sex (Title IX)” in the University Policy section of the Student Handbook, which is available online. If the mistreatment involves sexual harassment, the procedures of this policy must be followed.

Procedures

Students who believe they have been mistreated have the right, and are encouraged, to initiate one or more of the following procedural options. If, however, the mistreatment involves sexual harassment, the procedure of the sexual harassment policy must be followed. Loma Linda University will ensure that this process occurs fairly and shall be free of retaliation. Students who believe that they have been mistreated should report such conduct to one of the school deans listed above, the University Vice President for Student Experience or the University Provost. Students may meet directly with the individual involved in the mistreatment and come to a mutually agreeable resolution. Students may choose to take someone with them, such as a faculty member, department chair, unit manager, clinical instructor, chief resident, or other individual. If the student is uncomfortable meeting with the individual involved, he/she is encouraged to follow the procedure below. Students are reminded that reporting inappropriate behavior is a personal and professional responsibility.

The procedure includes the following:

1. Report the incident(s), to one of the school deans listed above, or to the office of the University’s vice president for student experience or to the University provost. A systematic method of reporting allows patterns of behavior to be considered in determining the course of action.
2. It is the responsibility of the dean to investigate, document, and coordinate immediate and appropriate corrective measures/protective actions that are reasonably calculated to end mistreatment, eliminate the hostile environment, and prevent reoccurrence.
3. In determining the actions to be taken, consideration will be given to frequency and/or severity of the conduct; as well as the position held by the accused. A primary objective will be to protect the student from adverse consequences for having reported the incident.

Confidential Advisors for Medical Students

Principles Objective: The position of Confidential Advisor for Medical Students (CAMS) was developed to promote a positive educational learning for the School of Medicine (SM). The CAMS will serve as an independent, impartial, informal, and confidential resource for students with concerns related to the educational environment.

Background: While the associate and assistant dean for student affairs, as well as other SM associate and assistant deans provide many types of support for students, they have administrative as well as supportive roles. For this reason, their responsibilities require them at times to address issues related to students’ lapses in judgement and in misconduct, including failures to comply with policies and procedures and meet academic expectations. Because of these dual roles they cannot promise confidentiality in a way a therapist or confidential advisor can. The CAMS, therefore is intended to provide an added resource for students if they wish to discuss concerns in a confidential manner with an experienced and trusted faculty member.

Confidentiality: The University shall protect the privacy of individuals involved in a report of mistreatment to the extent possible. Some level of disclosure may be necessary to ensure a complete and fair resolution. Disclosure may be made only on a need-to-know basis. In keeping with ideals of professionalism and courtesy, the student is advised to refrain from discussing the complaint with individuals not directly involved.

Retaliation Prohibited

All reasonable action will be taken to assure no retaliation against the student, witnesses, or anyone cooperating with the investigation.

Approved by SMEC, October 2023

OPERATING POLICY

GUIDELINES FOR MEDICAL STUDENT SUPERVISION DURING PATIENT CARE EXPERIENCES

The School of Medicine Curriculum Committee has adopted the following guidelines for medical student supervision.

1. Course/clerkship directors and department designee are responsible for ensuring student and patient safety during patient care activities.
2. Course and clerkship directors and department designee must inform students of the expectations for their participation and supervision in patient care.
3. Course/clerkship directors and department designee are responsible for assigning students to designated faculty and resident supervisors for all patient care experiences and for ensuring that faculty, residents, and students are notified of these assignments.
4. Medical students on duty for patient care activities must be directly supervised by qualified faculty and/or resident physicians at all times. Direct supervision implies a physician is either physically present with a student or is on duty and rapidly available to provide personal supervision.
5. Students on duty must have rapid and reliable systems for communicating with their supervising faculty and resident physicians.
6. The degree of direct supervision shall vary according to the clinical task and status of each patient, and be commensurate with each student’s level of training, education and clinical experience.
7. Supervision should foster progressive responsibility and provide opportunities for students to demonstrate increasing independence when appropriate.
8. Course/clerkship directors and department designee are responsible for determining the types of patient interactions and the clinical procedures that medical students can perform during patient care experiences and the levels of direct supervision required for these interactions and procedures. Clerkship directors will provide faculty, resident physicians and students with a list of the types of patient interactions and the clinical procedures that students may perform and the level of direct supervision required for each of them.
9. Course/clerkship directors and department designee will stratify the types of student-patient interactions and clinical procedures that may be performed by medical students according to the potential risk incurred by the student and patient. The level of supervision required for each procedure must be adequate and appropriate for the potential level of risk.
10. Course/clerkship directors or departmental designee are responsible for providing the list of procedures allowed by medical students to faculty physicians, resident physicians, and the students on each clinical service.
11. A supervising physician may delegate some medical student teaching and supervising responsibilities to non-physician care providers after ensuring the non-physician providers are appropriately credentialed and working within the scope of their practice.
12. Physician supervisors should provide students with proximate and constructive feedback related to problem areas that are encountered during direct patient care experiences.
13. Students should immediately report any deviation from this policy, or concern regarding inadequate supervision to one of the following entities: Clerkship director, Associate Dean for Clinical Education, Faculty LIFE Community Mentor or the Office of Medical Education. Students from the Regional Campuses may also report to the Assistant Dean for Regional Campuses, or to the assistant clerkship director or to the respective regional campus Dean.

Defined Levels of direct supervision:

1. Level one - Supervision by a resident or attending physician is physical presence with the student during the patient interaction / procedure.
2. Level two – Supervision by a resident or attending physician is within the immediate vicinity of the patient interaction / procedure.
3. Level three – Supervision by a resident or attending physician is on duty and rapidly available to provide assistance or answer questions.

Expected Level of Supervision based on Student Level of Training and Experience (may be adapted by each clerkship based upon type of interaction and level of student experience):

1. Pre-clinical students must be supervised during all patient-care interactions. Residents or attending physicians should be either physically present or in the near proximity and rapidly available. (level two)
2. Pre-clinical students may observe or participate in procedures with close direct supervision at all times. (level one)
3. Third-year clinical students may complete history and physical examinations, place orders in the electronic medical record and participate in minor procedures (IV, venipuncture, Foley placement) under supervision that is determined by past experience with the skills being utilized. As all third-year students will have completed history and physical examinations they may do these under level three supervision (as defined below). The first time a student does a procedure level one supervision is expected. Subsequently level two to three supervision is expected determined by the experience of the student and risk of the procedure.
4. Fourth-year clinical students may complete history and physical examinations and perform the procedures signed off in their skills books under level three supervision. Which level applies is ultimately determined by the experience of the student and risk of the skill being performed.

Approved by SMEC, October 2023

OPERATING POLICY

NARRATIVE ASSESSMENTS IN THE SCHOOL OF MEDICINE

CATEGORY: MEDICAL EDUCATION

Narrative feedback is defined in this policy as written feedback provided to the learner. Narrative feedback may be formative throughout a course, and summative at the end of a course or educational sequence. Formative feedback will be provided in response to in-person interactions or written submissions to the learner. Summative narrative feedback will be provided to the learner and the competency committee.

Narrative assessments in the School of Medicine will be provided to students in pre-clinical courses where students and faculty interact in small group settings over a period of at least twelve hours. Small group settings are defined as less than 16 students per faculty member. Pre-clinical courses that involve a variety of faculty interacting with students in small group settings over the length of a course will provide narrative feedback to students with input from all of the different activities and interactions. Students will receive written or verbal feedback on the various activities as they complete them, and then summative narrative feedback with the completion of the learning sessions.

Students in clinical courses will be provided narrative feedback from faculty who interact clinically with a student over a minimum of one week. This feedback will also be provided to the clerkship office. Summative narrative feedback is provided by the clerkship office to the student and the competency committee at the conclusion of every third-year rotation. Small group interactions in the third year (as defined by less than 16 students per faculty member) that occur over a minimum of twelve hours will also provide narrative feedback to the student, course director and competency committee.

Students will receive ongoing formative narrative feedback throughout the Christian Physician Formation course from their coaches. Due to the longitudinal coaching relationship between faculty and students in this course and in LIFE communities, summative narrative feedback at the end of three years will be provided to the student in preparation for further growth in residency. This summative feedback will not be provided centrally to the school.

Approved by SMEC, October 2023

OPERATING POLICY

PROCEDURE FOLLOWING OCCUPATIONAL EXPOSURE TO BLOOD/BODY FLUIDS/NEEDLESTICK

If you are exposed: to another person's blood or body fluid (e.g. through a needle stick injury or mucous membrane splash) take the following steps:

1. Remove the soiled clothing and wash the exposed area with soap and water.
2. Notify attending physician, resident, charge nurse, or site coordinator.
3. Obtain the name of the source patient.

4. At LLUMC, report to LLUMC Employee Health for evaluation and treatment. (If the exposure occurs at an off-campus site, present to the designated department at that site—see below). It is vital that this be done in a timely manner. The Centers for Disease Control and Prevention recommends that treatment be obtained within two hours. If it is not possible to meet this timeline, treatment and evaluation should still be obtained as soon as possible.

   LLU Employee Health Services

   11370 Anderson Street, Suite 1250
   Loma Linda, California 92354
   Phone: x88797 or 909-558-8797

   If an exposure occurs after business hours, please report to LLUMC Emergency Department or Advanced Urgent Care

   LLU Medical Center Emergency Department:

   Address: 11234 Anderson St, Loma Linda, CA 92354
   Hours: Open 24 hours
   Phone: (909) 558-4444

   LLU Medical Center East Campus Advanced Urgent Care

   Address: 25333 Barton Rd, Loma Linda, CA 92354
   Hours: Open 24 hours
   Phone: (909) 558-6644

   During this visit to the designated department for immediate intervention, the following will occur:

   • A risk assessment will be performed. This assessment will evaluate the type of exposure that you have received and the benefits of treatment. Baseline blood testing will be performed.
   • You will be given instruction in the procedures to be followed for seeking information regarding the source patient’s infectious status. It is the responsibility of hospital personnel to follow procedures for HIV, Hepatitis B and C, and Hepatitis screening of the source patient. You should have no source patient interaction specific to the screening process.
   • Information will be provided to assist you in making an informed decision regarding post exposure prophylaxis.
   • Vaccinations will be updated as necessary.

5. If the exposure occurs while you are at an off-campus site (including the VA, Riverside County, etc.), follow steps 1-3 above and then report to the location designated by that site for post-exposure assessment and treatment. If you are at outside community clinic not associated with one of the below, please report back to LLU Employee Health Services immediately. Locations and telephone numbers for some frequently used off campus sites are:

   • Riverside University Health System, Occupational Health telephone number (951) 486-4546; or, after hours report to the Emergency Room.
   • Jerry L. Pettis VA Medical Center, you should report to the emergency room for further evaluation.
   • Glendale Adventist Medical Center, Employee Health Service, telephone number (818) 409-8160.
   • White Memorial Medical Center, Report the incident immediately to Employee Health during regular business hours to complete an incident report and exposure forms (ext. 75098). Outside of regular business hours, on weekends and holidays, medical students should report to the Nursing Supervisor, ext. 12822 (Spectralink - ext. 45655). The Emergency Department will provide initial evaluation and treatment. Occupational Medicine will initiate evaluation and treatment when the Emergency Department is not available. Hours of operation are Monday- Friday from 7 am to 4 pm, ext. 6400.

   (Note: telephone numbers may be subject to change)

6. Regardless of where the incident occurred, report the incident to Loma Linda University Medical Center's Employee Health Services, Faculty Medical Offices, 11370 Anderson Street, Lobby Level, Suite 1250. Telephone number, 909-558-8797 or extension 88797, as soon as possible and arrange for them to receive a copy of the post-exposure evaluation and treatment records. The records should include your baseline lab results as well as the source lab results. Remember, it is your responsibility as a student to provide Employee Health with this information. When you report to Loma Linda Employee Health you will be asked to fill out a Student Claim form, if you have not already done so. This form will be given to Risk Management which will open your claim with them to assure that all expenses incurred from the exposure will be paid for by them. It is imperative that this claim form be filled out as soon as possible so that Risk Management is aware of the status of your claim as a work-related exposure.

7. Aftercare will be provided by LLUMC Employee Health Services and will include the following:

   • A post exposure summary with results and follow up dates will be mailed to the address you provided.
   • All information supplied to Employee Health will be maintained in a confidential manner as specified in the Loma Linda University policy for infectious disease education and prevention.

   Costs for initial evaluation and treatment, as well as follow-up care, associated with exposure to Blood Borne Pathogens are covered by the LLU Student Health. Currently for a clinical injury, the plan does waive the student co-payments as long as you are a full-time student in the School of Medicine and/or meet the eligibility requirements for the LLU Student Health Plan. For further description, please refer to the LLU Student Health Plan document or contact the Department of Risk Management (909) 651-4010.

Note: This policy is subject to revision. Students will be notified of any subsequent revisions. It is the medical student’s responsibility to understand the procedure that may take place at other institutions they rotate through i.e., Kettering and Advent Health. These materials are provided to you during your onboarding and orientation.

Approved by SMEC, October 2023

OPERATING POLICY

TIMELINESS OF GRADES

CATEGORY: Medical Education

Pre-clinical students must receive their end of course grades within two weeks of the course finishing.

Clinical students must receive their end of clerkship/course grades within four weeks of the clerkship completion. If grades are not submitted within four weeks, the clerkship director and chair of the department will be contacted, as all clerkship grades must be received within six weeks of clerkship completion without exception.

APPROVED BY: Curriculum Committee, Academic Review Committee

DATE: 2023

OPERATING POLICY

MASTER OF MEDICAL SCIENCE TUITION REFUND POLICY

Students who choose to withdraw or take a leave of absence any time before the start of the second block will be charged 25% tuition. Students who withdraw or take a leave of absence anytime after the start of the second block will be charged 40% tuition. Students who withdraw or take a leave of absence after the start of the third block will be charged 60% tuition. Students who withdraw or take a leave of absence after the start of the fourth block will be charged 80% tuition. Students who withdraw or take a leave of absence after the start of the fifth block will be charged full tuition for the year.

Students who take a leave of absence or withdraw prior to completion of 80% of a course (not counting final exam weeks) will receive a W on the transcript. Courses that are more than 80% complete, will receive an Unsatisfactory on the transcript. Since courses begin and end at various times during the year, students should consult early with the Program Director if contemplating withdrawing from a course.

Chapel Services

In keeping with the commitment of our mission, Loma Linda University (LLU) students have special requirements—such as chapel attendance each Wednesday morning, except during Week of Renewal when these chapel services are held daily. Chapel, which is held in the University Church, provides opportunities to integrate faith and learning.

Campus Spiritual Health

Chapel meets each Wednesday at 11:00 a.m. and represents a critical dimension of the educational experience at Loma Linda University. It is required as part of the curriculum. By devoting one hour each week to a chapel program, the University emphasizes the value of spiritual development, corporate worship, and community. In addition, chapel provides a variety of opportunities for the entire University community to benefit from teaching that integrates faith and learning, and to address current issues that require the implementation of faith in contemporary life. Weeks of Renewal are held in the Fall, Winter, and Spring Quarters of each school year. Central to the mission of Loma Linda University, these weeks are set aside to corporately focus on a relationship with God and the calling to continue the teaching and healing ministry of Jesus. These required meetings are scheduled each weekday morning at the regular chapel time. The School of Religion offers courses that emphasize ethical, theological, and relational development. The University Catalog provides further information. Student-organized spiritual activities and various student organizations, such as Loma Linda University Student Association (LLUSA), foster opportunities for social and spiritual growth.

Chapel Attendance and Decorum

Loma Linda University’s chapel services are at the heart of campus life and central to each academic program’s objectives for mission-focused learning. In keeping with the University’s mission, attendance at chapel is required.

The purpose of chapel is to enhance the spiritual lives of students from diverse backgrounds. Students are expected to be respectful and maintain appropriate decorum. Students must refrain from activities that are at cross-purposes with a religious service, such as, but not limited to, studying, eating, and using electronic devices.

Adherence to the following attendance guidelines is expected:

Attendance

• Regular attendance at chapel is required unless exempted by an academic Program’s schedule.
• All students with a class prior to 3:00 p.m. on the day of chapel are required to attend the service.
• A current LLU student ID badge is required to receive attendance credit.
• Attendance will be taken by scanning the student’s ID badge.
• At the end of chapel, students should wait for an usher to scan their ID badge.
• Only one ID badge will be scanned per person.
• The ushers will dismiss one row at a time.
• The ushers will not scan badges for anyone not in the row in which they were seated.
• Disruptive behavior and/or inappropriate use of technology may disqualify a student from receiving attendance credit.

Tardies

• Students arriving from 11:15 a.m. to 11:20 a.m. will have their ID badge scanned in the lobby and recorded as tardy.
• Tardy students will receive attendance credit when their ID badge is scanned at the end of chapel.
• Three tardies equal one unexcused absence.

Absences

• A record of attendance will be sent to the Dean’s office of each School.
• An email will be sent to the student’s LLU email account if records indicate an absence.
• More than two absences per quarter may jeopardize the student’s status in their academic program.
• Excused absences should be cleared immediately with the Dean’s office of the student’s School.

To request consideration for an excused absence, contact Gaby Kunze at [email protected]. A request for an absence due to illness shall be accompanied by verification from Student Health Services or from the student’s physician.

Medical students are not required to attend chapel on a day in which a midterm or final exam is held or when no classes are scheduled.

Monitor Your Personal Chapel Attendance

To access the chapel attendance record, go to https://llu.edu/campus-spiritual-life/student-services/student-experience and click on “My Chapel Attendance” under the Spiritual Life heading. This university attendance system records attendance on a quarterly basis with the understanding that no more than two absences are allowed per quarter. Note, however, the School of Medicine allows its students to accumulate credits and absences from year to year beginning with summer quarter of their first year. Thus, a student who does not have any absences for a quarter will have two additional absences (for a total of four) available the following quarter and so on. Students are strongly advised to not accumulate a deficit during their first year, especially since the academic requirements of the second year are more time intensive. Failure to meet this responsibility will be subject to the same type of process as any other academic deficiency and will become

Student organizations play a vital role in building community, supporting service efforts, and enhancing the student experience at LLUSM. To ensure alignment with university policies and philanthropic guidelines, all fundraising activities must be reviewed and approved by Student Affairs before they take place or are publicly promoted.

How to Request Approval for a Fundraising Activity

1. Decide on the purpose, date, time, and location of your event.
2. Complete the Fundraising Request Form and submit it to Student Affairs at least 6 weeks before your planned activity. Fundraising Request Form
3. Student Affairs will review your request for completeness and compliance and will contact you if additional information is needed. They will handle all communication with the Office of Philanthropy, so students should not contact Philanthropy directly.
4. Written confirmation will be sent by Student Affairs once your request is approved, and promotion or implementation may begin only after approval.
5. Conduct the event according to the approved guidelines and LLU policies, and notify Student Affairs promptly if any changes arise.

Contact: LLU School of Medicine Student Affairs

Last update: November 10, 2025

RESEARCH CONFERENCE TRAVEL SUPPORT FROM STUDENT AFFAIRS

Loma Linda University School of Medicine is committed to supporting students in research and scholarly activities. This guideline is designed to give students, faculty, and administration clear guidance on funding and conference participation.

The School of Medicine encourages students who are selected to present their research at scientific conferences. Eligible students may receive partial funding to help with travel, with amounts decided on a case-by-case basis.

Students should not present during Sabbath hours. Most conferences are willing to adjust schedules if requests are made early, so it’s the student’s responsibility to contact the conference coordinator in advance to arrange a presentation time that works.

Limitations: Students enrolled in MD-PhD or other dual-degree programs who are currently on a non-MD track are ineligible for funding under this guideline. Virtual presentations are typically not supported, though exceptions may be considered on an individual basis. Please note that the School of Medicine does not cover the cost of poster printing.

Eligibility criteria:

• Students must be currently enrolled and in good standing within the School of Medicine.
• Students must obtain prior approval and receive official time off to attend the conference.
• The research must be conducted under the supervision of a faculty Principal Investigator (PI) at Loma Linda University or an affiliated campus.
• Starting in the second year of the MD program, students may apply for funding for only one conference per fiscal year (July-June).
• When multiple students are presenting the same abstract or poster at a conference, only one student presenter is eligible to apply for funding.

Guideline:

• Students must have an accepted abstract, or equivalent presentation (poster or oral) at a regional or national conference.
• Before requesting funding from the School of Medicine, students are required to seek financial support from their faculty sponsor (PI) and/or the department where the research was conducted.
• Students may apply for School of Medicine funding only after their abstract has been accepted and they have requested support from their PI or department in accordance with this policy.
• Students will receive funding as a reimbursement once travel is complete and all necessary forms have been submitted.
• Note: Financial support will be provided based on the availability of funds.

Funding Process:

1. Get approval from the Assistant Dean for Basic Science Education (MS1 & MS2) [Dr. Cody Carter] or Associate Dean for Clinical Education (MS3 & MS4) [Dr. Kevin Codorniz] and cc Student Affairs. [Gaby Kunze ([email protected])].
2. Contact your research department for available funding.
3. Students should complete the Conference Funding Request Form on the website (once available) or email Student Affairs [Gaby Kunze] directly to request funding.
4. Complete the form at least 3 weeks prior to travel. Retroactive requests will not be accepted.
5. Student Affairs will review the application and notify you of the decision.
   • If approved, use the Travel Portal to submit the prepared application and complete the Check List, generating a TE # for your expense report.
6. Email all receipts/proof of payment to Student Affairs [Gaby Kunze] within 60 days after travel.

Notes: Additional Funding: The Alumni Association may cover extra expenses (e.g., poster printing). Apply here: https://www.llusmaa.org/page/student-research

Contact: Gaby Kunze, Student Affairs Program Coordinator

Last update: November 10, 2025