§ 21.4265 Practical training approved as institutional training or on-job training. ( a ) *Medical-dental internships and residencies.* ( 1 ) Medical residencies (other than residencies in podiatric medicine), dental residencies, and osteopathic internships and residencies may be approved and recognized as institutional courses only when an appropriate accrediting agency accredits and approves them as leading to certification for a recognized professional objective.
( 2 ) The appropriate accrediting agencies are: ( i ) The Accreditation Council for Graduate Medical Education, or where the Accreditation Council for Graduate Medical Education has delegated accrediting authority, the appropriate Residency Review Committee,
( ii ) The American Osteopathic Association, and
( iii ) The Commission on Dental Accreditation of the American Dental Association.
( 3 ) These residency programs— ( i ) Must lead to certification by an appropriate Specialty or Subspecialty Board, the American Osteopathic Association, or the American Dental Association; and
( ii ) Will not be approved to include a period of practice following completion of the education requirements even though the accrediting agency requires the practice.
( 4 ) Except as provided in paragraph (a)(5) of this section, no other medical or dental residency or osteopathic internship or residency will be approved or recognized as institutional training.
( 5 ) A residency in podiatric medicine may be approved and recognized as institutional training only when it has been approved by the Council on Podiatry Education of the American Podiatry Association. (Authority: 38 U.S.C. 3688(b))
( b ) *Nursing courses.* ( 1 ) Courses for the objective of registered nurse or registered professional nurse will be assessed as institutional training when they are provided in autonomous schools of nursing, hospital schools of nursing, or schools of nursing established in other schools or departments of colleges and universities, if they are accredited by a nationally recognized accrediting agency or if they meet the requirements of the licensing body of the State in which the school is located. The hospital or fieldwork phase of a nursing course, including a course leading to a degree in nursing, will be assessed as an institutional course when the hospital or fieldwork phase is an integral part of the course, the completion thereof is a prerequisite to the successful completion of the course, the student remains enrolled in the school during the period, and the training is under the direction and supervision of the school.
( 2 ) Courses offered by schools which lead to the objective of practical nurse, practical trained nurse, or licensed practical nurse will be assessed as institutional training including both the academic subjects and the clinical training if the clinical training is offered by an affiliated or cooperating hospital and the student is enrolled in and supervised by the school during the period of such clinical training. Also they must be accredited by a nationally recognized accrediting agency or meet the requirements of the licensing body of the State in which the school is located.
( 3 ) Except for enrollment in a nurse's aide course approved pursuant to § 21.4253(a)(5), VA shall not approve an enrollment in a nonaccredited nursing course which does not meet the licensing requirements of the State where the course is offered. (Authority: 38 U.S.C. 3452, 3688)
( c ) *Medical and dental specialty courses.* ( 1 ) Required clinical training included in a school course given in an affiliated hospital, clinic, laboratory, or medical center as a part of a medical or dental specialty course whether accredited or nonaccredited offered by a school such as X-ray technician, medical technician, medical records administrator, physical therapist or dental technician shall be assessed as institutional training provided: ( i ) The student remains enrolled in the course during the clinical period;
( ii ) The clinical training is; (*a*) An integral part of the course; (*b*) A prerequisite to the successful completion of the course; and (*c*) Under the direction and supervision of the school; and
( iii ) The course includes substantial technical or professional training and does not consist of training preliminarily directed to clerical, administrative, secretarial, or receptionist duties.
( 2 ) Medical and dental specialty courses offered in hospitals, clinics, laboratories, or medical centers which are accredited as institutional courses by a nationally recognized accrediting agency will be assessed as institutional training.
( 3 ) Clinical training included in a school course given in a physician's office or a dentist's office, also called externship, will be recognized as part of the institutional training if the course is accredited by a nationally recognized accrediting agency and meets the other requirements of paragraph (c)(1) of this section. If the course is not so accredited such practical or on-the-job training or experience in a physician's office may not be included unless the program is approved as a cooperative course.
( 4 ) Nonaccredited courses offered in hospitals, clinics, laboratories, or medical centers will be considered on-the-job training when the courses meet the requirements of § 21.4262.
( d ) *Medical and dental assistants courses for the Department of Veterans Affairs.* A course prescribed by the Secretary for full-time physicians' assistants or for full-time expanded-function auxiliaries (formerly referred to as dentists' assistants) may be approved as institutional training, if the course is conducted at Department of Veterans Affairs facilities or in facilities operated by hospitals, medical schools, or medical installations pursuant to a contract with the Department of Veterans Affairs. (Authority: 38 U.S.C. 7407)
( e ) *Professional training courses.* ( 1 ) Any non-medically related professional internship program, such as a clinical pastoral course, will be recognized as an institutional course when it is accredited as an institutional course by a nationally recognized accrediting agency, and
( 2 ) The approved facility for such a course must be the institution or other facility where the training is given.
( f ) *Other practical training courses.* ( 1 ) Other off-campus job experience included in a school course, variously described by schools as internship, residency, practicum, externship, et cetera, may be included as a part of a cooperative program when the course meets the requirements of § 21.4233(a).
( 2 ) However, such off-campus courses may be considered as resident institutional training only if all of the following conditions are met. The course is: ( i ) Accredited by a nationally recognized accrediting agency or is offered by a school that is accredited by one of the regional accrediting associations;
( ii ) A part of the approved curriculum of the school;
( iii ) Directly supervised by the school;
( iv ) Measured in the same unit as other courses;
( v ) Required for graduation; and
( vi ) Has a planned program of activities described in the school's official publication which is approved by the State approving agency and which is institutional in nature as distinguished from training on-the-job. The description shall include at least: ( A ) A unit subject description;
( B ) A provision for an assigned instructor;
( C ) A statement that the planned program of activities is controlled by the school, not by the officials of the job establishment;
( D ) A requirement that class attendance on at least a weekly basis be regularly scheduled to provide for interaction between instructor and student;
( E ) A statement that appropriate assignments are required for completion of the course;
( F ) A grading system similar to the system used for other resident subjects offered by the school; and
( G ) A schedule of time required for the training which demonstrates that the student shall spend at least as much time in preparation and training as is normally required by the school for its other resident courses.
( g ) *Nonaccredited courses.* Any nonaccredited internship program not given in a school will be recognized as other on-the-job training when it meets the requirements of § 21.4262 and when the program is required for licensure by the State in which it is offered. (See § 21.4275 for measurement.)
[41 FR 26683, June 29, 1976, as amended at 43 FR 25429, June 13, 1978; 49 FR 39545, Oct. 9, 1984; 54 FR 34984, Aug. 23, 1989; 61 FR 6783, Feb. 22, 1996]