Management of Fitness for Duty

Scope

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Policy Statement

While struggling learners who are able to participate in safe patient care may be helped by remediation, a fitness for duty evaluation would be more appropriate if the trainee is disruptive to the learning/clinical environment or is not able to provide safe care at a level commensurate with their training.  The approach to fitness for duty concerns should be through expert assessment, intervention, care, and compassion, as opposed to punitive or threatening methods.

Fitness for duty evaluations may be requested by a program director or the Senior Associate Dean for Graduate Medical Education in the following situations:

1. consistent or egregious failure to fulfill patient care responsibilities at a level commensurate with training
2. failure to abide by rules, regulations, IUSM and affiliate hospital policies, procedures, or standards of affiliate hospitals
3. activity or professional conduct considered to be either a threat to the quality of patient care or disruptive to hospital operations or teaching programs
4. activities that constitute a material breach of the letter of appointment.

It is expected that any resident who is recommended for specific fitness for duty evaluations will comply with recommendations. Refusal to cooperate with fitness for duty evaluation may be considered grounds for non-reappointment or termination.

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Reason for Policy

The purpose of this policy is to address the management of fitness for duty concerns for residents providing clinical care in any area of the IUSM Clinical Learning Environment, including affiliate hospitals, clinics, or associated clinical practice areas. It is the intent of this policy to provide means to recognize fitness for duty performance concerns with the goal of assisting the resident in finding appropriate resources that facilitate resident participation in safe patient care and in smooth workplace operations, while ensuring patient safety. Fitness for duty concerns may rise from a variety of factors influencing individual resident performance, including but not limited to academic issues, disruptive behavior, learning disability, mental or physical illness, substance related disorders, or skills incongruent with specialty requirements.

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Procedures

Fitness for duty concerns about residents should be promptly communicated to the program director and Clinical Competency Committee as part of the standard resident evaluation process. All fitness for duty concerns and any related issues should be directly communicated to the Senior Associate Dean. Examples of potential fitness for duty concerns are contained in the Forms section of this policy.

Resident fitness for duty concerns will be considered for referral by the program director on a case-by-case basis, drawing on available resources to assist in resident evaluation. When evaluating fitness for duty, program directors should focus on a resident’s ability to practice medicine with skill, regards to safe patient care, and within the context of the clinical learning environment of the specialty. Resources employed by the program director in evaluating resident fitness for duty may include the following: institutional and clinical affiliate standards, specialty board requirements, and eligibility requirements (GME policy reference).

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Definitions

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

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Implementation

The Designated Institutional Official (DIO) for GME is responsible for implementation of this policy. 

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Oversight

Policy authority for this document resides with the Graduate Medical Education Committee.  The DIO and the Graduate Medical Education Committee are responsible for oversight.  This policy will be reviewed every three years or more often if deemed necessary.

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Forms

Examples of potential fitness for duty concerns

Management of Impaired Residents policy

Time Off Work policy

Remediation, Probation, Non-Reappointment, Summary Suspension, and Termination of Appointment policy

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History

1. First draft of policy gme-adm-0047 on 25 May 2022.
2. Reviewed at GMEC on 21 September 2022.
3. Policy approved on xx mmm yyyy.
4. Policy published on xx mmm yyyy.

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