FAULKNER STATE COMMUNITY COLLEGE SURGICAL TECHNOLOGY PROGRAM. INFORMATION And APPLICATION PACKET

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1 FAULKNER STATE COMMUNITY COLLEGE SURGICAL TECHNOLOGY PROGRAM INFORMATION And APPLICATION PACKET Revised April

2 Dear Prospective Surgical Technology Student, Thank you for your interest in the Surgical Technology Program at Faulkner State Community College. For your convenience, please find enclosed in the application packet information regarding the program, as well as an application for admission to the Surgical Technology Program. Please note that the General Biology (BIO 103) and Medical Terminology (HPS 105) courses must be completed prior to entry into the program. However, the Program Director may allow an exception to these two requirements in certain circumstances based upon applicants prior medical experiences or academic records. In addition to the BIO 103 and HSP 105 courses, it is highly recommended that prospective students complete the general education course requirements, as well, such as English Composition 101 and 102 (ENG 101 and 102), MATH 116 or higher (Mathematical Applications or more advanced), and Biology 201 and 202 (Anatomy and Physiology I and II) prior to entrance into the program. Regarding the beginning of the program, classes start each Fall Semester. There is a class limit of 24 students. Prospective students are rank-ordered using a point system to determine acceptance into the program. This point system is outlined in detail in the enclosed Surgical Technology Program application packet. We hope that you find this information, as well as information contained in the application packet very helpful. However, if you have any questions, please contact staff personnel in the Allied Health Department at (251) or Ms. Yvette Jackson at We look forward to having you as a one of our students. Again, thank you for your interest in the Surgical Technology Program at Faulkner State Community College. Sincerely, Jean D Graham, MSN, ANP, CNOR Director of Nursing and Allied Health 2

3 ADMISSION CRITERIA The following information details the admission requirements for the Surgical Technology Program: 1. Student must be unconditionally admitted to FSCC. [Note: The Admissions Office must receive an applicant s application for admission to the College by July 1 st, which is the same deadline that the applicant s special application to the Surgical Technology Program must be received in the Allied Health Surgical Technology Program s Office. Succinctly stated, both applications must be received in the respective offices by July 1 st.] Application must be updated if student did not attend FSCC the semester prior to application deadline. Official transcripts of all college work attempted at any institution other than FSCC must be sent by the institution s Registrar directly to FSCC s Registrar. 2. In addition to the special application for admission to the Surgical Technology Program, which the Allied Health Department Surgical Technology Program office must receive by July 1 st, the department must receive applicant s Health Examination Form and Immunization Form by the July 1 st deadline, as well. 3. Student must have a minimum cumulative GPA of 2.0 on a 4.0 Scale. 4. Student must complete Medical Terminology (HPS 105) and meet ONE of the following requirements: a. Completion of General Biology (BIO 103) b. Completion of Anatomy and Physiology I and II (BIO 201 and BIO 202) AND Microbiology (BIO 220) WITHOUT General Biology (BIO 103) and Note: All courses must be completed with at least a grade of C, prior to the beginning of Surgical Technology Program course work. 5. Upon admittance to the program, student must be eligible for enrollment in the following courses (provided they have not already completed said courses): a. MTH 116 (Mathematical Applications) or Higher Level Math b. BIO 201 and BIO 202 (Anatomy & Physiology I and II) [Note: General Biology, BIO 103, is a pre-requisite for BIO 201] c. ENG 101 (English Composition I) d. HPS 105 (Medical Terminology) 6. Student must be in good standing with the college. 7. Student must meet the essential functions and technical standards required for the Surgical Technology Program, as listed in this packet. Nondiscrimination Policy It is the official policy of the Alabama State Department of Postsecondary Education and FSCC that no person in Alabama shall, on the grounds of race, color, qualified disability, gender, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment. 3

4 FAULKNER STATE COMMUNITY COLLEGE SURGICAL TECHNOLOGY PROGRAM APPLICATION I. PERSONAL DATA Date: Last Name: First: MI: Maiden: Social Security Number: FSCC Student Number: Mailing Address: City: State: Zip Code: Telephone: ( ) address: Emergency Contact: Telephone: ( ) II. EDUCATION High School Graduation Year: High School Name: GED (if applicable): Date Completed: Are you currently taking college courses? Yes No If yes, what college: List all colleges attended and the year(s) attended: Name of College (DO NOT ABBREVIATE) Year(s) attended Degree (if completed) III. EMPLOYMENT Are You Currently Employed? Yes No Place of Employment: Employer s Address: Employer s Phone Number: ( ) Name of Supervisor: Are You Employed Full-Time Part-Time Initial Date of Employment: IV. ESSENTIAL FUNCTIONS Each student in the Surgical Technology Program must be able to adhere to the essential functions that are listed in this application packet. Please read thoroughly the essential functions. Are you able to meet the essential functions with or without reasonable accommodations? Yes No 4

5 If No, please explain Any student requiring accommodations must meet with the Vice President of Institutional Advancement and Student Development at Faulkner State Community College. At any point during the course of the program that a student fails to meet the essential functions, the student must withdraw from the program until such time that the functions can be met. I understand that completion of this application is a component of the student profile and does not in itself grant admission to the Surgical Technology Program. I understand a new application must be submitted if I am not selected and wish to reapply. I certify that the information given in this application is true and correct. I understand that providing false information may be deemed sufficient reason to dismiss me from the Surgical Technology Program and/or deny my admission to said program. All application materials become the property of Faulkner State Community College. It is the sole responsibility of the applicant to ensure that the Allied Health Department Surgical Technology Program has received all of the requested documentation. All information must be received by July 1 st, or the application will be considered incomplete. It is recommended that applicants check with the Admissions Office at (251) to confirm that their College application is up-to-date and transcripts are on file. Applicant s Signature Date Please mail your completed Surgical Technology Program Application, Health Examination Form, and Immunization Form to the: Allied Health Department Surgical Technology Program Faulkner State Community College 1900 Hwy 31 South Bay Minette, AL (Note: In the alternative, you may hand deliver the above referenced information to the Allied Health Department Surgical Technology Program in the Tyson Building, Room 162, on the Bay Minette Campus.) For specific questions regarding the Surgical Technology Program, please contact the Allied Health Department at (251) For general questions regarding admission to the College, please contact the Admissions Office at (251)

6 PART I: COMPLETED BY STUDENT FAULKNER STATE COMMUNITY COLLEGE STUDENT HEALTH EXAMINATION FORM Name Soc Sec # DOB Sex Address City State Zip Phone Person to notify in case of emergency Address Phone PART II: COMPLETED BY PHYSICIAN, NP, or PA History (If any of the following are answered affirmatively, please give details). Does this person have or has this person ever had any of the following? Yes No Yes No Operations Cancer Serious Accidents Diabetes Mellitus Seizures disorder Hearing Difficulty Cardiovascular Disease Visual Impairment Tuberculosis GI Disease Muscular-skeletal problems GU Disease Any other pertinent health issues Allergies: Physical Exam Fill in All Blanks Ht Wt B/P P Vision: Rt eye Corrected Nose, Mouth Throat Lt eye Corrected Chest/Lungs Hearing: Rt ear Lt ear Heart Abdomen GU Extremities Reflexes ROM Is this person able to perform essential functions such as reading fine print, lifting lbs, pulling and pushing lbs, walking or standing for 12 hrs at a time, bending freely, hearing soft sounds, and performing fine motor skills? Yes No (Please circle answer.) If no, explain 6

7 FAULKNER STATE COMMUNITY COLLEGE STUDENT HEALTH EXAMINATION FORM (cont d) PLEASE LIST ALL MEDICATIONS TAKEN BY STUDENT: Physician s name DATE Physician s signature Address: 7

8 I certify that has had the following: MMR Vaccine: Date Or Titer: Varicella Vaccine: Date Or Titer: Tetanus Vaccine: Date TB skin Test: Date Results Or Chest X-ray: Date Results Hepatitis B Vaccine Date 1 st dose Date 2 nd dose Date 3 rd dose Name of Practitioner (MD, NP, or PA) Signature of Practitioner 8

9 SURGICAL TECHNOLOGY PROGRAM APPLICANTS RANK-ORDER USING THE POINT SYSTEM The Surgical Technology Program utilizes the following rank-order point system to select applicants for enrollment in the Surgical Technology Program: Total points possible 140 points 1. Points for Grades in Selected College Courses 120 points (pts) possible: A B C Intermediate College Algebra (MTH 100 or higher) 30 pts 20 pts 10 pts Anatomy & Physiology I (BIO 201) 30 pts 20 pts 10 pts Anatomy & Physiology II (BIO 202) 30 pts 20 pts 10 pts Microbiology (BIO 220) 30 pts 20 pts 10 pts 2. Points for GPA 10 points (pts) possible: 0 pts 5 pts 10 pts GPA < Additional Points 6 points (pts) possible: 1 point each for the following required courses passed with at least a grade of C : a. English Composition I (ENG 101) b. English Composition II (ENG 102) c. General Psychology (PSY 200) d. Fundamentals of Public Speaking (SPH 107) e. Medical Terminology (HPS 105) f. Humanities - i.e., Literature, or Art or Music Appreciation 4. Additional points 4 points (pts) possible: a. Intermediate College Algebra (MTH 100) 3 pts b. Finite Mathematics (MTH 110), Pre-Calculus Algebra (MTH 112), Calculus or Statistics Course 4 pts ESTIMATED PROGRAM COSTS One year Certificate Degree at $138/credit hour (in-state) $ Two year Associate Degree at $138/credit hour (in-state) $ (Out-of-state tuition $247/cr hr) Additional costs such as books, supplies, uniforms, etc.: Medical Insurance $ Health physical (for those who are uninsured): $45.00 Scrub suits, Scrub jackets, shoes $ Goggles $12.00 Hepatitis B vaccine $ Tetanus vaccine $20.00 TB skin test $20.00 (MMR if haven t had the disease or haven t proof of immunization) Background Check $59.00 Drug Screen $50.00 Certification Exam/AST Membership $ Books Associate degree *$ Certificate *$ Approximate total costs for Certificate Degree *$9, Approximate total costs for Associate Degree *$10, *The figures above are approximate figures and are subject to change. 9

10 CURRICULUM MAP FOR SURGICAL TECHNOLOGY PROGRAM Although there is more than one way to take the courses required for the Surgical Technology Program, the following schedule is recommended for program participants pursuing an Associate Degree. Students entering the program for the Fall Semester* are advised to adhere to the following curriculum map: ASSOCIATE DEGREE Term Courses Credit Hour Fall BIO 103 General Biology (pre-requisite) 4 MTH 116 Mathematical Applications 3 ENG 101 English Composition I 3 PSY 200 General Psychology 3 (General Biology is pre-requisite for Anatomy & Physiology and Microbiology. Students having already completed Anatomy & Physiology and Microbiology are exempted from taking General Biology) Spring BIO 201 Anatomy & Physiology I 4 BIO 220 General Microbiology 4 ENG 102 English Composition II 3 SPH 107 Fundamentals Public Speaking 3 Summer BIO 202 Anatomy & Physiology II 4 HPS 105 Medical Terminology (pre-requisite) 3 Fall SUR 100 Principals of Surgical Technology 5 SUR 101 Intro to Surgical Technology 3 SUR 103 Surgical Procedures 5 SUR 107 Surgical Anatomy& Physiology 3 Spring SUR 104 Surgical Practicum I 4 SUR 105 Surgical Practicum II 5 Summer SUR 106 Role Transition in Surgical Tech 1 SUR 205 Surgical Practicum IV 5 SUR 108 Pharmacology for the Surgical Tech 2 Note: Orientation to College (ORI 101) is a required course for the Associate Degree in the Pre- Surgical Technology Program * Students may begin classes during the Spring Semester or Summer Term, as well. 10

11 CERTIFICATE The curriculum map, as noted below, is recommended for students who are pursuing the Certificate in the Surgical Technology Program. Note: BIO 103 (General Biology) is a pre-requisite course for BIO 201 (Anatomy & Physiology I) and BIO 220 (Microbiology.) Students who have already completed BIO 201 (Anatomy & Physiology I) and BIO 220 (Microbiology) are exempted from having to take BIO 103 (General Biology.) However, for students who must complete the pre-requisite courses, both courses may be taken during the Summer Term, prior to commencing the program for the Fall Semester. Term Courses Credit Hour Summer BIO 103 General Biology (pre-requisite) 4 HPS 105 Medical Terminology (pre-requisite) 3 Fall BIO 201 Anatomy & Physiology I 4 SUR 100 Principals of Surgical Technology 5 SUR 101 Intro to Surgical Technology 3 SUR 103 Surgical Procedures 5 SUR 107 Surgical Anatomy& Physiology 3 Spring SUR 104 Surgical Practicum I 4 SUR 105 Surgical Practicum II 5 BIO 202 Anatomy & Physiology II 4 BIO 220 Microbiology 4 Summer SUR 106 Role Transition in Surgical Technology 1 SUR 108 Pharmacology for the Surgical Technology 2 SUR 205 Surgical Practicum IV 5 SPH 107 Fundamentals Public Speaking 3 ENG 101 English Composition I 3 MTH 116 Mathematical Applications 3 Note: Orientation to College (ORI 101) is a required course for the Associate Degree in the Pre- Surgical Technology Program *It is recommended that students take one or two more courses (i.e., Mathematics and English) when taking the prerequisite Biology and Medical Terminology courses. PROGRESSION POLICY (Requirements for Graduation) In order to continue in the Surgical Technology Program, the student must: 1. Maintain at least a grade of C in BIO 103 (General Biology), BIO 201 and 202 (Anatomy & Physiology I & II), BIO 220 (Microbiology), HPS 105 (Medical Terminology), and in each Surgical Technology course; 11

12 2. Complete all required general educational courses in semesters as scheduled, unless completed at a prior time; [Note: All exceptions must be approved by the Director of Nursing and Allied Health.] 3. Maintain the ability to perform essential functions; 4. Maintain current, health professional CPR, required immunizations, and medical insurance; 5. Maintain the sequence of Surgical Technology Program courses; [Note: Withdrawals or a grade of D or F in a Surgical Technology course will stop progression in the program until the course(s) is (are) successfully repeated. Course repetition will be based on instructor s approval and program resources.] 6. Complete the required clinical rotation surgical cases and hours; 7. Adhere to clinical facility and program policies and procedures, and; 8. Maintain professional and ethical standards and professional patient care. NOTE: Failure to meet any of the above requirements may result in failure of a course or termination from the program. ESSENTIAL FUNCTIONS The essential functions, delineated below, are necessary for Surgical Technology Program admission, progression, and graduation, as well as for the provision of safe and effective surgical care. As specified, the essential functions for the Surgical Technology Program include, but are not limited to, the ability to: SENSORY AND PERCEPTION Visual Observe and discern subtle changes in physical conditions and the environment Visualize different color spectrums and color changes Read fine print in varying levels of light Read for prolonged periods of time Read cursive writing Read at varying distances Read data/information displayed on monitors/equipment Auditory Interpret monitoring devices Distinguish muffled sounds heard through a stethoscope Hear and discriminate high and low frequency sounds produced by the body and the environment Effectively hear to communicate with others Tactile Discern tremors, vibrations, pulses, textures, temperature, shapes, size, location, and other physical characteristics Olfactory Detect body odors and odors in the environment 12

13 COMMUNICATION/INTERPERSONAL RELATIONSHIPS Orally and in writing, engage in a two-way communication and interact effectively with others from a variety of social, emotional, cultural, and intellectual backgrounds Work effectively in groups Work effectively independently Discern and interpret nonverbal communication Express one s ideas and feelings clearly Communicate with others accurately in a timely manner Obtain communications from a computer COGNITIVE/CRITICAL THINKING Effectively read, write, and comprehend the English language Consistently and dependably engage in the process of critical thinking in order to formulate and implement safe and ethical nursing decisions in a variety of health care settings Demonstrate satisfactory performance on written examinations, including mathematical computations without a calculator Satisfactorily achieve program objectives MOTOR FUNCTION Handle small delicate equipment/objects without extraneous movement, contamination, or destruction Move, position, turn, transfer, assist with lifting, or lift and carry patients without injury to patients, self, or others Maintain balance from any position Stand on both legs Coordinate hand/eye movements Push/pull heavy objects without injury to patient, self, or others Stand, bend, walk, and/or sit for 6-12 hours in a clinical setting performing physical activities requiring energy without jeopardizing the safety of the patient, self, or others Walk without a cane, walker, or crutches Function with hands free for nursing care and transporting items Transport self and patient without the use of electrical devices Flex, abduct, and rotate all joints freely Respond rapidly to emergency situations Maneuver in small areas Perform daily care functions for the patient Coordinate fine and gross motor hand movements to provide safe effective nursing care Calibrate/use equipment Execute movement required to provide nursing care in all health care settings Perform CPR and physical assessment Operate a computer 13

14 PROFESSIONAL BEHAVIOR Convey caring, respect, sensitivity, tact, compassion, empathy, tolerance, and a healthy attitude toward others Demonstrate a mentally health attitude that is age appropriate in relationship to the patient Handle multiple tasks concurrently Perform safe, effective nursing care for patients in a caring context Understand and follow the policies and procedures of the College and clinical agencies Understand the consequences of violating the Student Code of Conduct Understand that posing a direct threat to others is unacceptable and subjects one to discipline Meet qualifications for licensure by examination as stipulated by the Alabama Board of Nursing Not pose a threat to self or others Function effectively in situations of uncertainty and stress inherent in providing nursing care Adapt to changing environments and situations Remain free of chemical dependency Report promptly to clinicals and remain for 6-12 hours on the clinical unit Provide nursing care in an appropriate time frame Accept responsibility, accountability, and ownership of one s actions Seek supervision/consultation in a timely manner Examine and modify one s own behavior when it interferes with nursing care or learning Upon admission, an individual who discloses a disability can request reasonable accommodations. Individuals will be asked to provide documentation of the disability in order to assist with the provision of appropriate reasonable accommodations. The College will provide reasonable accommodations, but is not required to substantially alter the requirements or nature of the program or provide accommodations that inflict an undue burden on the College. In order to be admitted, one must be able to perform all of the essential functions with or without reasonable accommodations. If an individual s health changes during the program of learning, so that the essential functions cannot be met with or without reasonable accommodations, the student will be withdrawn from the Surgical Technology Program. The Surgical Technology Program faculty members reserve the right at any time to require an additional medical examination, at the student s expense, in order to assist with the evaluation of the student s ability to perform the essential functions. Requests for reasonable accommodations should be directed to: Dr. Brenda Kennedy, Vice President of Institutional Advancement and Student Development and ADA Coordinator for the College at (251) ONLY THE ADA COORDINATOR CAN DETERMINE REASONABLE ACCOMMODATIONS. Please refer to the ADA section in the FSCC Catalog and Student Handbook for additional information regarding the College s ADA Policy. For respective students, please adhere to following additional requirements: 1. Provide documented evidence of physical clearance by licensed primary health care provider, as requested on the Program History and Physical form; 2. Complete all referrals, as indicated by the primary health care provider on the History and Physical Form; 3. Submit to the Surgical Technology Program any additional reports obtained from referrals, and; 4. Submit to the Surgical Technology Program and the immediate instructor any instruction for emergent treatment and contact information for significant others. 14

15 HIV or Hepatitis B Reporting Policy Public law # , Section 633 and The Alabama Infected Health Care Worker Management Act require HIV or Hepatitis B infected healthcare workers to notify the State Health Officer within 30 days of the time the diagnosis is confirmed. Physicians caring for HIV or Hepatitis B infected healthcare workers are mandated to notify state health officials within 7 days of the diagnosis. All students are required to comply with this law. Drug Screening As stipulated by the agencies with which the Surgical Technology Program contracts for clinical experiences, each student accepted into the program must test negative to drug screening, as a precondition to beginning clinical rotations. Background Check As stipulated by the agencies with which the Surgical Technology Program contracts for clinical experiences, each student accepted into the program must perform a background screening prior to beginning clinical rotations. Positive results from the background check may prohibit a student from being placed in clinical sites; thereby, prohibiting student from progressing in the program. Miscellaneous Students may be expected to travel outside of their immediate residential areas. Students must have reliable transportation to meet program clinical requirements. Students must maintain current CPR certification throughout the entire program. Students must maintain current health insurance for program clinical experiences. The Surgical Technology Program is a daytime program Monday Friday. 15

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