4.21 Technical Standards for Medical School Admission, Continuation and Graduation & Technical Standards Evaluation Process

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Technical Standards for Medical School Admission, Continuation and Graduation

Applicants to Harvard Medical School are selected on the basis of their academic, personal, and extracurricular attributes. In addition, applicants must have the intellectual, physical, and emotional capacities to meet the requirements of the School’s curriculum and of a successful medical career.

The mission of Harvard Medical School is to provide its graduates with broad undifferentiated general knowledge in all fields of medicine and the basic skills and competence requisite for the practice of medicine. Therefore, the faculty of HMS believes that a broad-based and patient-oriented curriculum is necessary for the development of such knowledge and skills and is best suited to the education of future generalists, specialists, physician investigators, and leaders in medicine. In other words, HMS seeks to graduate students who will have the knowledge and skills to function in a broad variety of clinical situations and to render a wide spectrum of patient care. The following technical standards, first put forward in 1979 by the Advisory Panel on Technical Standards for Medical School Admissions convened by the AAMC and formally adopted by the Harvard Medical School Committee on Admissions in 1989, specify the attributes that the HMS faculty considers essential for completing medical-school training and for enabling each graduate to enter residency and clinical practice. Because these technical standards describe the essential functions that students must demonstrate to meet the requirements of a general medical education, they are essential to continuation, promotion, and graduation.

The term “candidate” refers to individuals admitted to the MD program at Harvard Medical School, as well as current students who are candidates for retention, promotion, or graduation.

All candidates who are accepted to the MD program at HMS will be expected to sign the Technical Standards Acknowledgment prior to beginning coursework and to reaffirm their proficiency in these Standards at the beginning of every subsequent academic year and upon reentry to HMS after any leave of absence from Harvard University.

Introduction and Purpose

The HMS Program in Medical Education is committed to providing equal opportunities for all students and endeavors to select candidates who have the ability to become highly competent physicians and who are well prepared to enter residency training programs and otherwise satisfy HMS academic and performance requirements, including these Technical Standards. 

HMS has responsibility for: the selection of students; the design, implementation, and evaluation of the curriculum; the evaluation of student progress; and the determination of who should be awarded an MD degree upon successful completion of the curriculum and all clinical requirements. In evaluating candidates under these Technical Standards, HMS will conduct a thorough review, including the consideration of academic and non-academic factors, as appropriate, to ensure that the candidate can satisfy the Technical Standards that are prerequisite to graduation.

As noted above, the HMS program is undifferentiated, which means graduates are provided with broad general knowledge in all fields of medicine and the basic skills and competence requisite for the practice of medicine. This patient-oriented curriculum is necessary for the development of such knowledge and skills and is best suited to the education of future generalists, specialists, physician investigators, and leaders in medicine. In other words, HMS seeks to graduate students who will have the knowledge and skills to function in a broad variety of clinical situations and to render a wide spectrum of patient care. The intention of an individual candidate to practice only a narrow part of clinical medicine, or to pursue a non-clinical career, does not alter the requirement that all HMS MD students are required to take and achieve competence in the full curriculum required by the program.

Technical Standards for Medical School Admission, Continuation and Graduation

A candidate for the MD degree must demonstrate proficiency in five categories, including (A) Observation; (B) Communication; (C) Motor Functioning; (D) Intellectual-Conceptual Skills, Integrative, and Quantitative abilities; and (E) Behavioral Attributes, Social Skills and Professional Expectations. Candidates should be able to perform the requisite skills in a reasonably independent manner, with or without accommodation.

A. Observational Skills

Candidates must be able to obtain information and techniques from demonstrations and experiments in the foundational sciences. Candidates must be able to participate in experiments of science, including but not limited to such activities as dissection of cadavers; examination of specimens in anatomy, pathology, and neuroanatomy laboratories; and microbiologic study of microorganisms and tissues in normal and pathologic states. Candidates must be able to acquire information quickly and accurately from patients and assess findings. They must be able to perform a complete physical examination independently, correctly observe and interpret diagnostic representations of patients’ physiological data, and accurately evaluate patients’ conditions and responses (both verbal and nonverbal) to integrate this information and develop an appropriate diagnostic and treatment plan.

B. Communication Skills

Candidates must be able to communicate effectively and efficiently with patients, their families, health care personnel, colleagues, faculty, staff, and all other individuals with whom they come in contact. Candidates must be able to obtain a medical history in a timely fashion, interpret non-verbal aspects of communication or the way a disease or illness may present, and establish therapeutic relationships with patients. Candidates must be able to record information accurately and clearly and communicate with other health care professionals in a timely manner and in a variety of patient settings.

C. Motor Functions

Candidates must, after a reasonable period of training, possess the capacity to independently perform physical examinations and diagnostic maneuvers, e.g., palpation, auscultation, percussion, and other diagnostic maneuvers. A candidate must be able to respond to clinical situations in a timely manner and provide direct general and emergency treatment in a range of situations and conditions to patients. Examples include cardiopulmonary resuscitation, the administration of intravenous medication, the application of pressure to stop bleeding, the opening of obstructed airways, the suturing of simple wounds, and the performance of simple obstetrical maneuvers, among others. These activities require some physical mobility, coordination of both gross and fine neuromuscular functions, and equilibrium. Candidates must also meet safety standards appropriate to the setting and adhere to universal precautions procedures. This includes a range of settings, from trauma wards to surgical units to long-term care scenarios.

D. Intellectual-Conceptual Skills, Integrative and Quantitative Abilities

Candidates must be able to assimilate and engage with detailed and complex information presented through both the didactic curriculum and clinical coursework. Candidates are expected to possess the abilities to measure, calculate, reason, analyze, synthesize/interpret, and transmit information quickly and efficiently in both remote and in-person situations. In addition, candidates must be able to understand the spatial relationships of structures and to adapt to different learning environments and modalities. Candidates must be able to learn, participate, collaborate, and contribute as part of a team effectively. Candidates must be able to interpret connections and make accurate, fact-based conclusions based on available data and information. Candidates must be able to formulate a hypothesis, investigate the potential answers and outcomes, and formulate appropriate and accurate conclusions.

E. Behavioral Attributes, Social Skills, and Professional Expectations

Candidates must exhibit sufficient maturity and emotional stability for full utilization of their intellectual abilities, which includes, but is not limited to, the exercise of good judgment and the prompt completion of all responsibilities associated with the diagnosis and care of patients. Candidates must exhibit integrity, honesty, professionalism, and compassion, and are expected to display a spirit of cooperation and teamwork towards their colleagues, faculty, and support staff. Candidates are expected to understand the legal and ethical aspects of the practice of medicine and function within these standards of the medical profession, including, without limitation, the confidentiality of patient information. Candidates must interact with patients and their families, health care professionals, colleagues, faculty, staff, and students in a courteous, professional, and respectful manner. Candidates must accept responsibility for learning and exercising good judgment and are expected to contribute to collaborative, constructive learning environments; accept constructive feedback from others; and take personal responsibility for making appropriate positive changes. Candidates must possess the physical and emotional endurance to tolerate demanding workloads, to function in a competent and professional manner in high-stress, fast-paced situations, and to adapt to changing environments, display flexibility, and manage the uncertainties intrinsic in the care of patients and the health care system.

Accommodation of Disabilities: HMS will provide reasonable accommodations to individuals with disabilities. Regardless of whether a candidate seeks an accommodation, they still must be able to perform the Technical Standards outlined above. Given the clinical nature of the MD program, time may be needed to create and implement individualized accommodations, and candidates are encouraged to request accommodations as early as possible. HMS’s process to provide reasonable accommodations is described at https://meded.hms.harvard.edu/disability-services. Candidates interested in initiating the accommodation process should contact the HMS and HSDM Office of Disability Services (ODS) at 617-432-9198 or via email at disabilityservices@hms.harvard.edu to schedule an appointment.

HMS will not assume that an individual has a disability. Instead, individuals must self-identify to ODS and engage in the accommodation process if they are requesting reasonable accommodations. This typically will involve the individual providing documentation of their disability and how it presents, followed by an interactive process between the individual and ODS staff to determine an individualized accommodation plan that will not fundamentally alter HMS’s academic or professional standards. Accommodations are not applied retroactively; therefore, timely requests are essential and encouraged. If a student, with or without reasonable accommodation, cannot satisfy these Technical Standards or if the disability would interfere with patient or peer safety, or otherwise impede their ability to complete the undifferentiated HMS program and advance to graduation, residency training, or licensure, then the student may be separated, discontinued, or dismissed from the program.

Technical Standards Evaluation Process

Purpose

A Technical Standards Evaluation is used to assess a student’s ability to meet the Technical Standards set forth in Section 4.21 of the Handbook, including, without limitation, whether the student can demonstrate the essential functions necessary to meet the requirements of a general medical education, with or without reasonable accommodations. Specifically, students must be able to demonstrate abilities and skills in five categories: (A) Observation; (B) Communication; (C) Motor Functioning; (D) Intellectual-Conceptual Skills, Integrative, and Quantitative abilities; and (E) Behavioral Attributes, Social Skills and Professional Expectations. Students should be able to perform the requisite skills in a reasonably independent manner. 

1. The PRB or the Dean for Medical Education may require a Technical Standards Evaluation when:
   1. There is a report to HMS from any source regarding a concern that a student’s performance or behavior may negatively affect the health, safety, or well-being of the student or other students, the student’s patients or colleagues, or anyone else in the student’s environment.
   2. There is a report to HMS from any source regarding a concern that a student may be having difficulty meeting the Technical Standards.
   3. HMS becomes aware of any other concerns that may interfere with a student engaging in their education and clinical requirements and satisfying the Technical Standards.  
2. In accordance with Section 4.03 of the Student Handbook, the Dean for Medical Education, either independently or at the request of the PRB, may suspend a student from HMS or take any other protective action during the course of the Technical Standards Evaluation process.  
3. For students against whom disciplinary charges are pending, the Dean for Medical Education and/or the PRB may, at their discretion, decide to wait until the end of the disciplinary process before beginning a Technical Standards Evaluation.

Procedures

1. The Dean for Medical Education and/or the PRB will consider all reports or other information received that may implicate Technical Standards and may require a Technical Standards Evaluation.
   1. Technical Standards Evaluations will be conducted by one or more appropriately licensed health care providers (the “Evaluator(s)”), none of whom can have previously provided medical or behavioral care to the candidate who is being evaluated. The Technical Standards Evaluation is not a confidential clinical encounter between the candidate and the Evaluator(s).
   2. The PRB or the Dean for Medical Education will provide all pertinent information to the Evaluator(s).
   3. The Evaluator(s) will generate a written Technical Standards Evaluation report addressed to the PRB or the Dean for Medical Education setting forth the Evaluator(s) ' findings as to the student's current ability to meet the Technical Standards set forth in Section 4.21 of the Handbook, including without limitation whether the student can demonstrate the essential functions necessary to meet the requirements of a general medical education.
   4. The Technical Standards Evaluation report need not include specific diagnostic or treatment information about the student, but the Evaluator(s) may include such information if relevant to the finding.
2. If, after consulting with the HMS and HSDM Office of Disability Services (ODS), the PRB or the Dean for Medical Education believes it is possible that the candidate could meet the Technical Standards with reasonable accommodations, then the PRB or the Dean for Medical Education will refer the student to ODS.
   1. It is the student’s responsibility to initiate contact with ODS and complete the ODS’ accommodation process. ODS will notify the PRB or the Dean for Medical Education when the student initiates contact. 
   2. If the student fails to contact ODS within two weeks of the referral by the PRB or the Dean for Medical Education, then the student ordinarily will be placed on an involuntary leave in accordance with Section 2.09 of the Student Handbook.
   3. ODS will follow up with the PRB and the Dean for Medical Education to communicate the student’s requested accommodations, any approved accommodations, and ODS’ assessment of whether they address the student’s ability to meet the technical standards, with reference to the technical standards evaluation report.
3. A student who cannot meet the Technical Standards with or without accommodation will be offered a leave of absence when eligible, provided such leave meets the conditions of the Leave of Absence Policies and is subject to the progression timeline.
   1. An additional Technical Standards Evaluation, conducted in accordance with this section, will be required to determine whether a student may return to the curriculum.
4. If a student has exhausted all leave of absence options, the student may be withdrawn from HMS.
5. The Technical Standards Evaluation report and all written records regarding the decisions and determinations will be kept in the student's permanent education record
6. A Technical Standards Evaluation report will be considered valid for up to six months after the date of the report if there are no new or continuing concerns. After six months, a new Technical Standards Evaluation may be required.
7. A student who refuses a Technical Standards Evaluation may be dismissed from HMS. 
8. The cost(s) for the initial and any subsequent required Technical Standards Evaluations will be the responsibility of the HMS MD program. The student is solely responsible for the cost(s) of any treatment.

Updated 9/18/26

Reviewed and approved by the EPCC 8/17/28