EAA085 Impaired Student Policy

1. Promote educational programs and other methods of primary prevention of impairment for all medical students,
2. Enhance awareness among faculty and students of the typical characteristics of the impaired medical student to identify students in need of help,
3. Identify and adequately address the needs of medical students with ongoing impairments,
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.

This policy will cover students of the School of Medicine.

This policy shall go into effect when approved by the Dean.

Disruptive Behavior is defined as behavior that has a negative impact on the workplace environment. This includes, but is not limited to, verbal or nonverbal conduct that (1) is violent or threatening to any other person, (2) negatively affects quality of patient care and/or disrupts the operation of the healthcare setting, (3) affects the ability of others to do their jobs, (4) interferes with an individual's ability to practice competently, or (5) adversely affects or impacts the community’s confidence in UTRGV SOM's ability to provide quality patient care.

Fit to duty or Fit to re-enter is a state in which an individual is able to perform their job duties in a safe, secure, productive, and effective manner, and remains able to do so through the entire time they are working. An individual who is not fit for duty may present a safety hazard to themselves, to other persons, or to the public.

Impairment is the state of being diminished, weakened, or damaged, especially mentally or physically. Major symptoms of alcohol/drug use and/or incapacitating medical/psychiatric disorders may include declining work performance as manifested by unavailability, missed appointments, failure to meet deadlines, lapses in judgment, incomplete work, poor communication, mood swings, unexplained absences, embarrassing behavior, temper outbursts, personality/ character changes, disruptive/ distressed behavior, signs of intoxication or self-medication, lack of collaboration/ cooperation with others, lack of preparation, dangerous/ negative behavior towards self or others, and/or withdrawal from professional activities.

Medical Student Evaluation and Promotion Committee (MSEPC): The Medical Student Evaluation and Promotion Committee (MSEPC) is charged with the review of the academic progress and professional development of each student during all components of the four-year medical education program. The Committee has primary responsibility for recommending for graduation only those candidates who have satisfactorily completed all graduation requirements and demonstrated the professional conduct appropriate for a physician. The committee, acting under the authority delegated to it by the Dean, shall be responsible for decisions on leaves of absence, promotion and/or remediation of medical students. Students may appeal any decisions set forth by the MSEPC to the SOM Dean, whose decision is final. Module and clerkship directors are not eligible for membership.

UTRGV SOM encourages students experiencing health problems, physical or emotional, to voluntarily seek assistance before clinical, academic, and professional performance, interpersonal relationships or behavior are adversely affected. Students who voluntarily seek assistance for physical, mental, emotional and/or personal problems, including drug or alcohol misuse, before their performance is adversely affected, will not jeopardize their status as a student by seeking assistance.

Should a faculty member, resident, nursing or other staff member, or other students perceive that a student is mentally or physically impaired, assistance should be offered collegially and confidentially. If a student appears to be acutely impaired or distressed and unable to reason, communicate, or perform medical services in a safe and acceptable fashion, or is exhibiting disruptive behavior, immediate action must be taken to relieve the student of his/her duties and place the student in a safe area away from the clinical or classroom setting. The immediate goal is to provide for the safety of patients, the public, other students, and the student who is suspected of being impaired.

A student with an acute injury which limits dexterity or mobility should disclose their status to a module lead, clerkship director, curricular dean, or the AssociateDean for Student Affairs. As indicated, accommodations may be designed to facilitate the student’s ongoing participation in the curriculum.

A student with a chronic or permanent condition affecting mobility, dexterity, perception, or cognition should disclose their status by including information in the Technical Standards Form completed at the start of the academic year, or at any time the student believes their condition has an impact on their progress through the SOM curriculum. ¹

A student with a communicable disease, acute or chronic, or with immune suppression or deficiency, should confer with their personal physician or staff atStudent Health to determine whether they can safely participate in patient care. ²

If the student is perceived to have the odor of alcohol, or marijuana, or is exhibiting signs or behaviors (e.g., slurred speech, unsteady gait, confusion, sharp mood swings, lack of manual dexterity, excessive health problems, increased absenteeism, tardiness or irritability, severe weight loss, needle track marks especially in the inner elbow, carelessness in appearance and hygiene, disruptive behavior, or euphoria) that cause the observer to suspect the student could be impaired by a substance or health condition, the observer must:

1. If the observer is a student, inform a faculty member, supervisor, or dean.
2. The faculty member, supervisor or dean should immediately inform the student as to why actions are being taken to relieve the student of his/her duties.
3. Immediately notify the UTRGV School of Medicine Office of StudentAffairs (OSA) for further action.
   Office of Student Affairs: 956-296-1540
   Dean on Call: 956-296-2502
4. Do not send the student home or permit them to leave the premises until staff from the OSA arrives and arranges for safe transportation for the student. If circumstances warrant, call campus police (956-882-4911) if the student tries to leave the premises.
5. Write a brief statement describing the circumstances causing concern about impairment and submit to the Office of Student Affairs.

The Associate Dean for Student Affairs, or designee, shall perform a brief assessment of the student to determine immediate needs for care or treatment.Referrals as deemed appropriate may be made to a local hospital emergency department for timely medical assessment and drug and alcohol screening.

Student Health, Counseling, and/or the Collegiate Recovery Center should be utilized secondarily for follow-up. The Associate Dean for Student Affairs, or designee, may takeEmergency/Interim Measures to ensure the health and safety of the subject student, the academic community, and the clinical setting. Such measures are detailed in SOM Policy EAA018 and include Interim Suspension.

The Associate Dean for Student Affairs, or designee, with proper regard for confidentiality, shall apprise the MSEPC of the student’s status and progress. The student may be granted a medical leave of absence to provide for treatment and recovery.

When it is determined by the treating health care professional ³ that the medical student is fit to re-enter medical school, written documentation or recommendation for re-entry must be provided to the Office of Student Affairs.The Associate Dean for Student Affairs shall confer with the Associate Dean forEducational Affairs to develop a plan for the student’s re-entry. The AssociateDean for Student Affairs, or designee, will make a recommendation to theMSEPC about the student’s fitness to return. The MSEPC may establish monitoring criteria to ensure the student remains in good health and performs safely.

If the Associate Dean for Student Affairs, in consultation with a treating physician(if designated) determines that evaluation, treatment and/or monitoring are warranted and the student does not responsibly cooperate or respond, theAssociate Dean for Student Affairs (or designee) shall refer the student to theMSEPC for administrative action, which may include, but is not limited to, involuntary leave of absence, suspension, or dismissal. As detailed in policyEAA018, the student may appeal any adverse action proposed by the MSEPC. ⁴

All records pertaining to the concern about a student shall be kept in a secure filein the Office of Student Affairs and not as part of the student’s educationalrecord. If the need arises for the Medical Student Evaluation and PromotionCommittee to recommend an adverse action, records of the MSEPC’sproceedings shall be handled in the same manner as other records pertaining totheir deliberations and become part of the student’s academic record.

Each year during matriculation orientation an educational component addressingstudent impairment policies and services will be presented. Additional educationwill occur in the clinical orientation between the second and third year of medicaleducation. Information on self-reporting and reporting will be placed in everycourse syllabus. (See Appendix B)

Medical Students must report, in writing, to the Office of Student Affairs thefollowing circumstances within 30 days of their occurrence. Failure to report suchcircumstances may result in immediate filing of a professionalism concern noteand referral to the MSEPC:

1. The opening of an investigation or disciplinary action taken against themedical student by any licensing entity.
2. An arrest, fine (over $250), charge or conviction of a crime, indictment,imprisonment, placement on probation, or receipt of deferredadjudication; ⁵ and
3. Diagnosis or treatment of a physical, mental or emotional condition whichhas impaired or could impair the student’s ability to study medicine.