GME Policy: Resident/Fellow Fitness for Duty

  • Origination Date: March 28, 2017
  • Last Review Date: March 28, 2017
  • Next Review Date: March 2019
  • ACGME Institutional Requirement #: IV.H.2.
  • ACGME Common Program Requirement #: VI.A.1., VI.A.2., VI.A.5., VI.A.6.e
  • Shortlink: http://z.umn.edu/gmeimfitnessforduty

Policy Statement

Trainees are required to report to work physically and mentally capable of safely performing the functions of their job.  Trainees must not report to work if they are impaired for any reason.  Trainees must not consume alcohol or any controlled substance while on call, including “at home call.”  Trainees must self-regulate their use of prescribed or over the counter medications to ensure these medications do not cause impairment.  Trainees must manage their sleep to avoid excessive fatigue. Programs have a responsibility to remove trainees from patient care activities if the trainee’s impairment poses a threat to patient safety.

Reason for Policy

The purpose of this policy is to define expected trainee conduct as it relates to fitness for duty, to provide guidance and direction on how to proceed when confronted with a potentially impaired trainee, and to help trainees in obtaining assistance when needed.

We are committed to providing healthy, safe, and supportive training environments for all trainees, as well as safe, high-quality care for patients.  Trainees practicing while impaired can have serious adverse effects on patient safety, and negative impacts on their own performance and safety as well as that of others in the workplace.

Procedures

Reporting

Responsibility to Report: Anyone who is aware of signs of impairment in a trainee has an obligation to make a report to the trainee’s Program Director or supervisor on duty.

Self-Reporting: Any trainee who believes they themselves may be impaired is required to contact their Program Director or supervisor on duty to report the situation. If a trainee is approached by a co-worker or patient who is concerned the trainee may be impaired due to fatigue or any other reason, the trainee has a professional responsibility to contact their Program Director to inform them of the concern.

Review

  1. The Program Director shall obtain as much detailed information as possible at the time of the report from sources including the trainee and the reporter. Based on the information gathered, the Program Director will determine whether additional review is needed.
  2. If indicated and depending upon the circumstances, additional review may be carried out by the Program Director, by a committee, by an outside consultant, or by some other appropriate person(s) or agency. The trainee and the reporter, as well as other appropriate sources, should be interviewed as a part of the review.
  3. The highest priority is patient safety.  If the Program Director cannot ensure the trainee’s ability to safely care for patients, the trainee should be immediately removed from duty and placed on paid administrative leave pending further review.
  4. The Program Director shall notify the Associate Dean for GME of the trainee fitness for duty review.

Results of the Review

Based on the results of the inquiry, the Program Director may choose one of the following determinations:

  1. No Impairment
    1. Trainee, Associate Dean for GME, and other relevant parties (if applicable) shall be informed of the outcome of the review.
    2. A written report of the review and its outcome shall be maintained by the program separate from the trainee’s file. This documentation may be a relevant source of information in any future reviews.
  2. Evidence of Impairment
    1. Trainee, Associate Dean for GME, and other relevant parties shall be informed of the outcome of the review.
    2. If required by law, an immediate report shall be made to the Minnesota Board of Medical Practice or other organizations.
    3. Further action(s) may include:
      1. Referral to an appropriate resource (such as the Resident Assistance Program, Health Professionals Service Program, Physicians Serving Physicians, or relevant rehabilitation or treatment programs)
      2. Restriction of privileges based on the impairment
      3. Discipline or dismissal, pursuant to the GME Discipline, Dismissal, Non-Renewal Policy & Procedure
    4. A written report of the review and its outcome shall be kept in the trainee’s file.
    5. Except in the case of dismissal, the Program Director and the trainee shall draft a written plan to address the impairment. It is advised that this be done in consultation with the Associate Dean for GME and the Office of the General Counsel. A signed copy of the plan shall be kept in the trainee’s file.  The Program Director and trainee shall periodically review the impairment and the plan, and document such review in the trainee’s file.

Guidelines

Due to the safety-sensitive nature of their work, trainees must manage their off-duty exposure to substances that may cause impairment, including prescription medications. Because these substances affect each person differently, there are no universally applicable standards.  In the case of alcohol, we reference U.S. FAA regulations for airline pilots as a guideline. These regulations prohibit pilots from operating an aircraft within 8 hours of the consumption of any alcohol, or while having a blood alcohol content of 0.04% or greater regardless of length of time since last consumption [FAR 91.17]. The institution expects trainees to refrain from alcohol consumption within 8 hours of reporting for duty or being on call.

Additional Resources

Subject Contact Phone Email
Associate Dean for GME John Andrews, MD 612-626-4009 andrews@umn.edu
Director of Learner Development Scott Slattery 612-626-7196 slatt008@umn.edu
Policy Christy Illig 612-626-0631 gme@umn.edu
Fitness for Duty Guide for Programs Christy Illig 612-626-0631 gme@umn.edu
Fitness for Duty Flowchart Christy Illig 612-626-0631 gme@umn.edu

 

Definitions

An impaired resident/fellow (trainee) is defined as any trainee who is unable to safely care for patients, perform duties normally expected of a trainee physician, or engage in peer interaction necessary for patient care for any reason, including but not limited to: personal stress; fatigue; medical condition (including physical disability or mental illness); use of alcohol or controlled substances, including drugs prescribed by a physician; or use of over the counter medication.

Fit for duty is defined as being physically and mentally capable of safely performing the functions of one’s job.  Fitness for duty includes being free of alcohol and drugs that have not been legitimately prescribed, and being free from impairment that affects job functioning for any reason, including but not limited to personal stress, fatigue, use of drugs prescribed by a physician, or use of over the counter medication.

Related Information

Fitness for Duty Guide for Programs

Fitness for Duty Flowchart

University of Minnesota Drug Free University Policy

University of Minnesota Code of Conduct

GME Discipline, Dismissal, Non-Renewal Policy & Procedure

Resident & Fellow Assistance Program

Health Professionals Services Program

Minnesota Board of Medical Practice

History

Effective:
March 28, 2017: Approved by the Graduate Medical Education Committee (GMEC).