Management of Impaired GME Residents

Scope

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Policy Statement

IUSM expects and requires all residents to report to work on time and in appropriate mental and physical condition to perform their work.  It is recommended that all residents practice preventative health management and recognize significant changes in their physical or mental health. If there is a concern that it may be affecting their performance in the training program, the resident should review concerns with program leadership.  

Drug dependence or addiction can also contribute to an impaired work performance It is the school’s intent and obligation to provide a drug-free, healthful, and secure work environment that promotes safe and quality patient care.  The university, the school, and the affiliated hospitals recognize drug dependency as an illness and a major health problem as well as a safety and security issue.  They also recognize drug usage as a potential health, safety, and security problem.  IUSM also absolutely prohibits the unlawful manufacture, distribution, dispensation, possession, or use of a controlled substance on university premises or while conducting university business off university premises.  Violations of this policy may result in removal from clinical duty and potential termination of employment. 

It is the belief of IUSM that an impaired resident physician is an ill colleague in need of treatment.  The approach to impairment should be through medical intervention, care, and compassion, as opposed to punitive or threatening methods.  It is expected that the impaired resident physician will enter and complete treatment in order to return to training as soon as possible.   

Mental health or substance abuse evaluations may be requested by a Program Director or the Senior Associate Dean for Graduate Medical Education when there is concern that a resident’s performance may be impaired by psychiatric illness or substance abuse. Refusal to cooperate with a mental health or substance abuse evaluation may be considered grounds for termination from the training program. 

IUSM has contracted with the Indiana State Medical Association (ISMA) Physician Assistance Program (PAP), to coordinate efforts in identifying and assisting IUSM physicians with illnesses impairing their ability to practice medicine.  These illnesses may include chemical dependency, psychiatric illnesses or physical illnesses. The Program Director should contact the Senior Associate Dean or the Director of GME if a referral to ISMA is being considered by the program. Pending this discussion, the Director of GME or the Program Director will contact ISMA to initiate the referral.  (Attachment 1)  

As part of this contract, the physician allows regular communication with all necessary and appropriate school and hospital personnel.  Additionally, regular progress compliance letters can be sent on behalf of the recovering physician, when consent is given. 

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Reason for Policy

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Procedures

Pre-employment 

All residents who are new to IUSM undergo a background check as part of the appointment process.  If a background check reveals that a resident has a history of DUI, then the following actions will be taken: 

1. The IUSM Senior Associate Dean will schedule a phone call with the resident to discuss what corrective actions he/she has taken since the incident(s).  This information may be shared with the resident’s program director.
2. Any resident with a DUI within the last five years will need to be evaluated by the ISMA and take any corrective action or additional counseling they recommend.   

Currently Active  

Any faculty, resident, or nursing staff that suspects a resident is impaired should report to the resident’s program director or supervisor at the time of the concern (Attachment 1).  The program director or supervisor will assess the resident. The Senior Associate Dean or Director of GME should be notified if the resident is deemed to be impaired. 

A resident must report any arrest to his/her program director.   

Acute Impairment v. Disruptive Behavior 

If the resident is suspected to be acutely impaired, the resident ought to be removed from clinical activity at that moment in the interest of patient safety and well-being of all involved.  If a program director has reasonable suspicion that a resident is impaired, a summary suspension should be considered and report to the Senior Associate Dean or Director of GME prior to reporting the resident to the ISMA impaired physician program. 

Fitness for Duty 

Fitness for Duty will be assessed on a case-by-case basis using the algorithm (Attachment 3).   

Confidentiality 

Confidentiality of the GME resident seeking referral or who has had a formal or mandatory referral for assistance will be maintained, except as limited by law, ethical obligation, or when the safety of a patient is threatened.  In all instances, every effort to protect the confidentiality of the individual referred for assistance will be made.  The ISMA does not automatically refer a physician to the licensing board for a minor infraction of the contract.  It is only after all attempts to work with a physician have failed that a referral is made to the appropriate board. 

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Definitions

ACGME is the Accreditation Council for Graduate Medical Education. 

A resident is an IUSM resident or fellow, or a non-IUSM resident or fellow electively rotating through IUSM who provides clinical care as part of a GME program. 

Clinical Learning Environment is any area in the IUSM learning environment where residents participate in clinical activities. 

Impairment is “the inability to practice medicine with reasonable skill and safety to patients by reason of physical or mental illnesses or alcoholism or drug dependency.”  (American Medical Association, 1972) 

The Indiana State Medical Association Physician Assistant Program (ISMA PAP) is a program of the Indiana State Medical Association that addresses the needs of physicians impaired by chemical dependence, psychiatric disorders, and physical disability, as well as the needs of disruptive physicians. 

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Implementation

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Oversight

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History

1. Policy IUSM-GME-PO-0002 approved by GMEC and published on 13 February 2013. 
2. Policy approved by the GMEC on 07 September 2016.
3. Policy updated for formatting 27 February 2018. 
4. Policy updated for formatting 27 June 2018.
5. Policy migrated to the policy portal xx May 2022.

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