Impaired Medical Student Policy

PLFSOM hereby establishes this policy to identify and aid, within ethical and legal parameters, for students who previously have been or are currently impaired.

Purpose:
This Policy will work in conjunction with the Impaired Physician Policy, see Impaired Physician/House Staff/Medical Student Policy https://elpaso.ttuhsc.edu/som/gme/_documents/impaired%20physician%20policy%20dec2014.pdf it is designed to:
1. Identify and adequately address the needs of medical students with ongoing impairment,
2. enhance awareness among faculty and students of the typical characteristics of the impaired medical student in an effort to identify students in need of help,
3. promote educational programs and other methods of primary prevention of impairment of all medical students,
4. provide treatment and monitoring of students identified as impaired,
5. take administrative actions as necessary, and
6. Preclude non-treatable or unresponsive individuals from achieving professional status necessary to practice medicine.
Review:
The Student Affairs Committee will review this PLFSOM policy biannually and submit recommendations to the Faculty Council.
Definitions (taken from Impaired Physician Policy):
1. Impairment by substance abuse or misuse refers to any condition, resulting from substance abuse that interferes with the individual’s ability to function at work as normally expected.
2. Impairment for other neuropsychiatric illnesses or medical reasons refers to any other categories of impairment including major debilitating illnesses, depression, dementia, or other psychopathology or disruptive behavior that may interfere with the individual’s ability to function at work as normally expected.
3. Symptoms of impairment may also include declining work performance as manifested by unavailability, missed appointments, lapses in judgment, incomplete medical records, mood swings, unexplained absences, embarrassing behavior, signs of intoxication or self- medication, and/or withdrawal from hospital or other professional activities. Family problems and change in character or personality are further accompaniments of impairment.
Presentations:
1. To promote prevention of impairments, the Chair of the Physician Wellbeing Committee (PWC), or designee, shall make a presentation each year at Freshman Orientation to promote awareness of this policy by:
  1. discussing this policy with the entering class,
  2. introducing the members of the committee, and
  3. Distributing other helpful, applicable educational literature which will be developed by the PWC and made available to all medical students.
Reporting possible impairment:
1. Self-reporting. Any medical student who is concerned that he/she might be impaired or likely to become impaired should contact a member of the PWC who will bring the matter to the PWC to formulate a plan of action to provide appropriate assistance resources to the student.
2. Report by others. Any person (i.e., student, faculty, staff, or administrator) who has reasonable cause to suspect that the ability of a medical student to perform may be impaired shall, in good faith, report the student to a member of the PWC.
3. If a report is determined to be made in bad faith or malicious, that person will be reported to the Dean and may be subject to action under applicable institutional policies and/or laws and regulations.
Basis for intervention:
Behavior that may be associated with, but not limited to, the following conditions:
1. Demonstrated ineffectiveness in handling the stress of school and/or other outside personal problems
2. Psychoactive substance abuse or dependence
3. A psychiatric disorder
4. A physical illness with pathophysiological and/or psychological manifestations
5. Self-reporting by consulting with a member of the PWC
6. Concern expressed to the PWC by a faculty member, administrator or another student
Verification:
1. Reports of impairment will be reviewed by the PWC and the PWC will decide whether to go forward under this policy based on the evidence presented, or document the file that no further action is warranted.
2. The PWC may consult with representatives of the Texas Medical Association Physician Health and Rehabilitation Committee at the local or state level.
Process:
1. The chair of the PWC or the designee will meet with the identified student (or person who is reporting a student) to gather information about the concern.
2. The PWC subcommittee will meet to discuss the concerns and formulate a plan for the student.
3. The plan will be discussed with the student. If the student agrees with the committee recommendation they will proceed with implementation.
4. The PWC may direct the student to obtain a drug test if there is concern about use of substances.
5. Costs of treatment will be the student’s ‘responsibility.
6. The student selects a treating provider and must sign a release of information for that provider to communicate with an assigned PWC member.
7. The student must seek a provider as recommended by the PWC in a timely manner (not more than 2 weeks).
8. The provider will discuss with the designated PWC member prior to onset of treatment to advise them of the treatment plan and the approximate amount of time required. The provider will make periodic progress reports to the designated member. At the end of the projected treatment period, the provider will report to the designated member that a) treatment has been completed successfully, b) further treatment is required and likely to produce a favorable outcome, or c) treatment was unsuccessful.
9. The student will meet with the PWC member on a regular basis to review their progress.
Monitoring:
1. The student successfully completing the treatment obligation will be monitored by the designated faculty member of the intervention team. The faculty member will prepare a report of the anticipated scope and time frame of monitoring which the student will acknowledge by signature, and a copy will be given to the student.
2. Monitoring may include, but is not limited to, random drug and alcohol testing, after-care therapy sessions and formal or informal meetings with the selected PWC faculty member.
3. If post-graduate monitoring is recommended, the appropriate Impaired Health Professions Committee (i.e., TMA) will be notified.
Leave of Absence and Re-entry:
1. An impaired medical student will be allowed a leave-of-absence in accordance with the policy set forth in this PLFSOM Student Handbook.
2. If the student requests a medical leave-of-absence, the designated faculty member described above may provide the written statement from a physician as required in the Student Handbook.
Unresponsiveness to intervention:
1. If the PWC determines that evaluation, treatment and/or monitoring are warranted and the student does not responsibly cooperate or respond, the PWC, by majority vote of the Committee, may refer the student to the grading and promotion committee for administrative action, which may include, but is not limited to, administrative leave of absence, suspension, or dismissal.
Confidentiality:
1. All Committee activities shall remain confidential.
2. Representatives of administration will not be notified of specific cases unless the impaired student refuses or is unresponsive to the appropriate treatment, the student’s ‘actions endanger the public or himself/herself, or a leave-of-absence is sought by the PWC and/or student.
3. Although specific cases will be presented to the PWC, confidentiality will be maintained to the extent reasonably possible.
Files:
1. All files will be kept by the Chair of the PWC for five years after the student graduates.
2. For those who require post-graduate monitoring, the file will be transferred to the appropriate Impaired Health Professionals Committee in the state where the individual resides in accordance with laws and regulations governing such actions.
Student Participation:
1. Student representatives shall serve as ad hoc members of the committee. Three students across the four classes will be appointed by the Associate Dean for Student Affairs. The student representatives will attend training with the rest of the committee and be available for committee work related to their peer group.