1. Maintaining Medical Education Standards While Being Sensitive to the Needs of Muslim Students J.W. Nemitz, Ph.D., M. Adelman, D.O., J.D., and R. Foster, D.O. Challenge Resolution Session: Diversity AACOM Presentation, June 2006

2. Case Scenario A 25 year old single, first year, female osteopathic medical student is enrolled in the OPP course where the medical education standard is to randomly assign lab partners. You observe during the third week of class that the student is not with her assigned lab partner, a 36 year old married male, but is at an adjacent table with a female student. You confront her about this after lab and refer her to the course syllabus regarding the assignment of lab partners. Several days later the student e-mails the course coordinator requesting that an accommodation be made on religious grounds that no male student be assigned to her as a lab partner.

3. The Diversity Issue Need to be sensitive to the cultural and religious convictions, beliefs and practices of a diverse student population while maintaining the osteopathic medical education standards of the institution.

4. Protocol for Handling the Request Course Coordinator denies request based on the medical education standard. Appeal of the faculty decision is sent to the Associate Dean for Preclinical Education. Associate Dean investigates the situation. Associate Dean formulates a decision and informs student and faculty. Student given the right to appeal decision to the Academic Dean.

5. Associate Dean Investigation Interview the student Review written documentation Institutional documents Islamic sources Literature search Solicit additional opinions Local/regional Muslim physician community National Muslim medical organization Review all information

6. WVSOM Health and Technical Standards for Admission and Graduation “WVSOM students are required to fully participate in OPP labs which include examination and treatment by randomly selected lab partners with an expectation that the body region is accessible for palpation and treatment.”

7. OPP Syllabus Statement Regarding Randomization of Student Lab Partners “WVSOM students are required to fully participate in OPP labs which include examination and treatment by student lab partners randomly selected from the class. Evaluation and treatment will involve all external body surfaces except the genital regions. Students are expected to allow the body region under study to be accessible for palpation and treatment. Special instruction is given on professional touch and respect of privacy.”

8. Rationale for Institutional Standard for Randomization of Student Lab Partners The random assignment of lab and practical exam partners assures diversity of body type and gender exposure in the OPP course as well as standardization of practical exam partner assignment.

9. Local/Regional Muslim Physician Community Input Local and regional input from Muslim physicians was solicited. Contact information was provided to the student as a support mechanism.

10. National Input: IMANA IMANA: Islamic Medical Association of North America Dr. Shahid Athar, IMANA Ethics Committee Chair

11. Literature Medical Ethics: The IMANA Perspective Culture Competence: Caring for your Muslim Patients, D.L. Pennachio, Medical Economics, 2005. Understanding and Respecting Muslim Patients and Staff Benefits All, E. James, Islamic Horizons, Vol. 6, Issue 25, 14.

12. Muslim Health Care Perspectives Care providers should respect the Muslim patient’s modesty and privacy. Female Muslim patients are to be examined in the presence of another female. IMANA encourages but does not mandate same sex health care provider. Medical students may be allowed during examination of a female Muslim patient, but only with prior patient consent and in the presence of a female nurse or relative. Taken from Medical Ethics: The IMANA Perspective.

13. Islamic Medical Ethics “1. Necessity overrides prohibition that is if there are certain items which are Islamically prohibited, under dire necessity they can become permissible. 2. Harm has to be removed at every cost if possible. 3. Accept the lesser of the two harms if both can not be avoided. 4. Public interest overrides the individual interest.” Taken from Medical Ethics: The IMANA Perspective.

14. Conclusions No written source was found that indicates that touching a Muslim female by a male is forbidden in a medical setting. The medical education standard at WVSOM does not appear to violate Islamic Law based on information provided by an expert. Request for accommodation was denied based on the institution’s medical education standards.