AIMS Committee Policy on Impaired Medical Students

The purpose of the policy on medical student impairment is to reduce the likelihood of physician impairment among University of Massachusetts Medical School (UMMS) students and graduates by identifying and treating these problems during medical school.  UMMS has a responsibility to help medical students with problems that impair or threaten to impair their ability to function.  UMMS also has a responsibility to assure safe care to patients treated by students. UMMS recognizes that a small number of medical students may become impaired during their medical school years or may start a pattern which could lead to impairment as a physician.

Medical students are held to the same ethical and behavioral standards as physicians during both the pre-clinical and clinical years of medical school.  Untreated substance abuse or major psychiatric impairment is unacceptable to the school and is cause for administrative action up to and including dismissal.

In order to provide better treatment and rehabilitation for these students and to minimize risk to the public, the Medical School and the AIMS committee instituted the following policy:

AIMS Committee (UMMS Aid for Impaired Medical Student Committee):

A. Composition
UMMS has established a committee on Aid for Impaired Medical Students (AIMS), separate from the Hospital’s Committee on Physician Health and Well-Being.

B. Function
This committee will seek to: (a) Help medical students become free of their impairments; (b) Provide information to referred or concerned students, faculty and therapists; (c) Advocate for students who are in the process of recovery; (d) Review AIMS policies and recommend changes as necessary.

1.  The primary function of the AIMS committee will be to provide information and a forum for discussion regarding the severity of a student’s problem and treatment options. The committee or committee members will be available to talk with students concerned about themselves or others, with faculty concerned about students, or with therapists treating students. Peer teaching sessions will provide information to medical students about the recognition and treatment of substance abuse problems.

2.  A group composed of trained AIMS committee members may assist in interventions with medical students who have untreated impairments, should circumstances support such action.

3.  If substance abuse is suspected the student will be referred to Physicians Health Services (PHS) of the Massachusetts Medical Society (MMS). They will assess the student and if necessary will assist in planning and coordinating the components of a student’s treatment program. PHS will, when appropriate, assist with locating inpatient or outpatient resources and otherwise facilitate treatment, whenever possible.

4.  Supporting the process of recovery through a treatment contract. PHS may decide, in conjunction with the student, that a contract that involves monitoring of the student’s compliance with the treatment program is necessary. If PHS feels a contract is necessary for monitoring the student’s compliance with treatment, the contract will be signed by the student and a representative of PHS.  Through this contract the student agrees to participate in the treatment program. PHS, in return, agrees to advocate for the student in helping the student to continue successfully with his or her professional career, assuming that the student successfully meets the goals of the contract. Aspects of treatment which may be monitored include meetings with monitors who will be aware of the student’s compliance with treatment, psychotherapy and substance abuse counseling, breath, blood or urine monitoring, and participation in a 12-step program (such as AA) or other appropriate program.

5.  The AIMS committee will periodically review the policies under which it operates, and may revise the policy subject to approval by the dean of the Medical School in consultation with appropriate individuals.

For additional information or to contact Physicians Health Service, go here.

Confidentiality is a strict practice of the committee. Names of impaired individuals will be known only to those members of the committee who need to know.  An effort will be made not to involve faculty members in a position to generate subjective grades (small group or clerkship grades) for that student.

Entry into Involvement with the UMMS AIMS Committee
1. Self referral - A student who is abusing drugs or alcohol, or who is otherwise impaired and recognizes that he/she is having difficulty, may seek assistance from the UMMS AIMS Committee, the Student Counseling Service, the Physician Committee on Health and Well-Being, or a private therapist.

Each student who is concerned about his/her substance abuse or behavior will be carefully evaluated to determine if a referral to Physicians Health Service (PHS) is indicated. The committee’s involvement may be limited to discussion or, depending on the severity of the situation, the committee may refer to PHS for assessment, particularly in light of the evidence that some patterns of substance abuse will eventually lead to impaired performance.

A multi-disciplinary treatment approach including monitoring for abstinence from alcohol or other drugs, is an essential part of the treatment.

In the case of a student presenting to the Student Counseling Service with a substance abuse problem, the counseling staff will consult with and refer to PHS, as necessary to assure optimal treatment for the student and safety for patients at UMMHC.

2. Referral by third parties - Faculty members, school administration or fellow students may seek out members of the UMMS AIMS Committee for information and review.  The UMMS AIMS Committee will review information to determine whether it is necessary to initiate an interview with the student in order to evaluate the situation further; information will be carefully reviewed for indications of repeated behavior, severity and the potential for patient and student harm. The purpose of this interview will be to determine whether the student is impaired, or potentially impaired, by substance abuse or psychiatric problems and to assist the student in recognizing the problem and the need for help if a problem is identified. The UMMS AIMS Committee will use this meeting to express a commitment to aid the student, and explain the evaluation and treatment resources available. Confidentiality will be maintained, as required by law, as long as the student is not perceived to represent an imminent danger to patients, to him or her self, or to others.

Consequences of Involvement in the Program
Confidentiality is of utmost importance in order to protect the student and to assure the continued success of therapeutic programs in helping students.

Some students who consult the committee will not require a treatment contract. In these cases, administrative reporting is unnecessary.  In general, a student who self initiates participation in treatment and monitoring overseen by PHS will not be reported to the Associate Dean for Student Affairs. Such reporting will only be done if the student is not in compliance with a contract, or if the committee feels that there may be risks to patients, UMMS or to the student.  In certain circumstances, the Associate Dean for Student Affairs will have made the initial referral and will therefore be aware of the student’s participation.

Successful participation in a treatment or monitoring program by a self-referred student generally will not be reported in the Medical Student Performance Evaluation (MSPE). However, if the original impairment was severe enough to come to the attention of an evaluation board or to be reflected through grades or comments in the student’s transcript, the program to which the student is applying will be made aware of the original problem and the student’s progress.  This may be accomplished through the Medical Student Performance Evaluation (MSPE) or through a supplemental letter. If the student is in compliance with a contract or has successfully completed treatment, PHS would be available to act as an advocate on that student’s behalf.

If the student is not in compliance with a contract (voluntary or mandatory), or PHS feels that patient welfare may be compromised, as for example in the case of a student who has not been monitored for a sufficient length of time, the student will not be supported in an application to a postgraduate program at that time.  Therefore, if a student believes that he/she needs help, it is advisable that the help of PHS be sought as soon as possible.

The University shall distribute the following statement for inclusion in materials related to residency applications by all students: “It is the policy of the University of Massachusetts Medical School not to provide information regarding medical leaves of absence.”

Following acceptance into a residency or graduate training program of a student whose compliance is being monitored or who is in a contract, PHS will strongly recommend that the student report his/her involvement in the contract to the Impaired Physician Committee of the state or the hospital to which the student has been accepted and to the residency training director. Responsibility for further contracting and monitoring will be transferred to the receiving state or hospital Impaired Physician Committee upon the student’s graduation from UMMS.

Lack of success in treatment
If, in the opinion of PHS, the student appears to be demonstrating poor compliance, or treatment does not appear to be leading to a level of recovery sufficient to assure student, UMMS, or patient protection, PHS may require a change of treatment, such as inpatient treatment, in order for the student to remain in compliance with a contract. In the event that no options appear to be successful, PHS will inform the associate dean of student affairs or his/her designee of the student’s difficulty in successfully completing treatment.

Further action will rest with the Associate Dean of Student Affairs and the Dean of the Medical School and may include requiring a leave of absence or dismissal from the school.

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