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Student Health and Effectiveness Committee Policy and Procedures
Article 1: Name
Article 2: Definitions
Article 3: Goals
Article 4: Structure
Article 5: Implementation of Goals
Article 6: Status of the Medical Student
The Student Health and Effectiveness Committee (SHEC) is one aspect of the multifaceted support system for students at ECU-COM. The original "Committee for Impaired Students: began in 1981 as students realized the need to have in place an avenue through which impaired students could receive the confidential help they required without involving the administration or placing their medical education/degree in jeopardy. It is noted that all ECU-SOM students are bound by the rules and regulations of the East Carolina University Policy on Drug Abuse and the North Carolina State laws on illegal substance sales and use. Any infraction of these regulations will result in reporting to appropriate university and legal officials as required by law. These by-laws are an update on the original premise and only to be a framework through which the SHEC is to operate.
The SHEC has been established and currently functions under the following beliefs and concerns:
Having humanitarian concern for all students, including those impaired by alcohol and/or drug dependence and mental illness.
Recognizing that substance abuse and mental illness are treatable conditions.
Acknowledge that, as an institution dedicated to the healing arts, we should facilitate the treatment an/or rehabilitation of future physicians.
Encouraging all impaired medical students to seek help and cooperate in treatment.
Favoring the earliest possible intervention in cases of medical student impairment, when personal, financial, and physical resources are least affected.
Assuring that all Student Health and Effectiveness Committee actions on behalf of the impaired student will be taken in such a manner as to preserve the student's right, upon recovery or remission, to continue his/her medical education without restrictions or stigma.
Respecting the student's right to confidentiality and reporting to the Dean only when the impaired student's actions endanger the public or him/herself and he/she refuses assistance and/or the treatment plan. Academic failure is matter unprotected by confidentiality of the Student Health and Effectiveness Committee. Academic standing is solely an Administrative matter outside outside the boundaries of this committee
Article I. NAME
The name of the ECU School of Medicine Impaired Student Committee will be the "Student Health and Effectiveness Committee" (hereinafter designated the SHEC).
Article II. DEFINITIONS
Impaired Student - An impaired student is one who is not functioning at an acceptable level of competency as determined by the SHEC, or whose behavior seriously endangers himself/herself or others, or whose behavior is disruptive to the goals of combination of the following:
Psychiatric, behavioral, emotional or personal problems which limit capacity as a medical student.
Substance Abuse - Substance abuse is a chronic, progressive, relapsing, family illness characterized by continued and repeated ingestion of an intoxicating substance despite interference with one or several of the five major aspects of the person's life:
Job or School
Marital or Family
Drug Addiction - Dug Addiction is manifest when a person uses a drug to the point where it interferes with the user's health, economics, or social functioning in a pattern characterized by:
Loss of Control
Continued use of the drug despite adverse consequences
Drug seeking behavior
Intervention - An intervention is an organized confrontation between a student member of SHEC, or trained interviewer not affiliated with the medical school and an impaired individual for the purpose of motivating that individual to accept treatment for his/her illness. The SHEC may recommend the presence of any parties who may be beneficial to the intervention process (e.g., spouse, close friend, parent). At the conclusion of an intervention, the student will be asked to sign a consent form and initial a preliminary treatment plan agreed upon by the SHEC and the impaired student.
Individual Assessment Following Intervention - Assessment will consist of an evaluation of an impaired student by an appropriate mental health professional approved by the SHEC for the purpose of determining the severity of the impairment present in the student and of recommending an appropriate therapeutic plan.
The impaired student who have been referred for treatment by the SHEC will be monitored by the SHEC members from those student respective classes (M1, M2, M3 or M4). The monitoring will consist of the following:
The student will meet with their respective SHEC member for no more than 1 hour (unless deemed necessary) by the following schedule:
Bi-monthly for the first three months following the intervention.
Monthly for the completion of treatment or change of treatment plan.
(This timetable is subject to change as required by individual treatment plans.)
The monitoring SHEC member will provide the therapist with a consent form which notifies the therapist of his/her obligation to quarterly inform the SHEC in writing of the student's treatment progress in the following manner:
completed, no monitoring required
completed, further monitoring required, or
terminated against medical advice.
Article III. GOALS
The goals of the SHEC will be:
To promote effective prevention of medical student impairment by providing an educational program for faculty and student in the various factors associated with impairment. The afore-mentioned program will be directed by persons and/or organizations having expertise in these areas. May programs are already in existence including the following:
Peer Counseling Service Sandwich Seminars
M1/M2 Stress Management Group
M2 Substance Abuse Course
CSO sponsored seminars
To encourage self-referral, thus helping the medical student achieve and maintain optimal physical and mental health.
To detect early impairment and refer the impaired medical student for evaluation and treatment in such a way as not to endanger his/her medical career while maintaining his/her confidentiality.
To report to the Dean those impaired student who refuse or are unresponsive to treatment.
Article IV. STRUCTURE
Membership - The SHEC will be comprised of a maximum of eight medical student and one faculty advisor. The success of the SHEC will be dependent on an understanding, empathetic membership who accepts the medical model of substance abuse, substance dependence and psychiatric impairment. Members must be open to their fellow students alternate belief systems and life styles even when these are foreign to their previous life experiences and/or religious beliefs.\
Two student member will be elected from their respective classes for the initial SHEC tenure to being in the Fall of 1991. These students will serve on the SHEC until their class graduates.
The Class of 1995 and all subsequent Freshman classes will select their SHEC members in January of their M1 year. Those student wishing to serve on SHEC will be asked to interview with the SHEC to insure these students understand completely the responsibility they are considering. Once elected to the SHEC, these students remain members until their class graduates.
In order to avoid conflict of interest, student wishing to be on the he SHEC should not hold the following class office(s); president, vice-president, secretary/treasurer, or MSC representative or alternate.
SHEC members will oversee the election of Freshman members. Class officers may oversee the election of SHEC members of the classes of 1992, 1993, and 1994 only.
The faculty advisor will be selected by majority vote of the SHEC membership for his/her interest and knowledge in helping impaired students/physicians; and will be asked to serve a three year term. The faculty advisor may serve as many terms as desired by students. The faculty advisor will not be associated with he Grading and Promotions Committee or with the Administration in any way which which would serve to compromise the goals of SHEC.
In the event a member of the SHEC resigns or has shown reason why he/she should resign, the student chairperson shall approach the resigning student's respective class and ask for interested persons to interview with the SHEC to insure that they understand completely the responsibility they are considering. Election of the replacement will be the majority of the class.
Student members can be asked to resign by their fellow student if their behavior is not exemplary of the goals, beliefs and concerns of the SHEC. Class member shall relay their concerns regarding the SHEC member to their class president who will relay the concerns to the SHEC chairperson. The concerned student(s) will be allowed to express their feelings at the next available meeting. The SHEC member in question will be allowed to air his/her view regarding the concerns. A majority vote of the SHEC members is needed for mandatory resignation. If the behavior of the chairperson is in question, another SHEC member may be approached with the concern.
The faculty advisor may be asked to resign by the student membership of SHEC if his/her actions and/or behavior compromise the confidentiality, goals and beliefs of the SHEC
The student chairperson shall be an M3 and will be elected by a majority of the members of the SHEC. Annual election of the chairperson will be held at the April meeting.
Responsibilities of the chairperson include by are not limited to the following:
Preside over monthly meetings and call emergency meetings as necessary.
Have ultimate responsibility for publishing the SHEC informational pamphlet annually.
Organize educational and training exercised for the SHEC
Designate an interim chairperson when on away electives or not available to the SHEC. (The interim chairperson will have all the roles and responsibilities of the chair person during their tenure. i.e.. hold monthly meetings, provide guidance in investigations, develop educational programming.)
The faculty advisor will be selected at the April meeting when necessary.
The faculty advisor will work with the SHEC chairperson to intervene in any problems concerning student members.
The faculty advisor will not be aware of any student's name or the details of his involvement with he SHEC unless the student requires further monitoring following graduation. Thereby the faculty advisor would be instructed by the chairperson to transfer the file to the appropriate impaired physicians program (see Article IV-G.3)
Meetings - The SHEC will meet at least once a month. Emergency meetings may be called at any time by any member of the SHEC. The chairperson must be notified immediatly when the need for such a meeting is recognized. The faculty advisor should be consulted at the earliest available time when an emergency meeting is required.
Member Education - the members of the SHEC must be educated and trained in he various factors associated with student6 impairment. The chairperson with the aid of the faculty advisor will be responsible for the education of the members by utilizing person and/or organizations having expertise in the areas of student and physician impairment. Special educational materials and seminars should be developed for new freshmen members when they are elected to the SHEC. In-service training/education will take place throughout the year for the full SHEC, preferably at monthly meetings.
A confidential file will be kept on each impaired student involved with the SHEC. Files will be labeled by number to further confidentiality and list of names with corresponding case numbers will be kept in a secured position by the SHEC chairperson.
The faculty advisor will deep all confidential files in a locked, secure location.
If a student is about to graduate or has gradated who has not completed treatment or who requires further monitoring [as determined by the process defined in Article V-E.v (a), (b), (c), his/her file will be transferred by the faculty advisors the North Carolina Physician Health and Effectiveness Committee, or to any similar state impaired physician program, in the state or states in which he/she seeks medical licensure following graduation from medical school. Upon the forwarding of said student's file to the appropriate state impaired physician program, the SHEC's monitoring and involvement with the student will terminate. Any further action, inquires or concerns shall be initiated and undertaken by the state impaired physician program to which the student's file was transferred.
A copy of the impaired student's file will be kept by the faculty advisor for three years following termination of treatment and monitoring.
Confidential files will never be made available to administration of ECU-SOM unless the student has denied or discontinued treatment as defined in Article V-E.v.(b) & (c).
Confidentiality - The SHEC is designed to protect both the impaired student and those who find it necessary to report the impairment of a colleague. All efforts will be made during the investigation process to maintain the confidentiality of the student in question. At no time other during the investigation process will the identity of the impaired student be know to anyone other than the SHEC member to whom the report is made. Other SHEC members will know of the student solely by case number. Only if the student is strongly suspected to be impaired will a case number be assigned and an intervention be established. Academic failure is an administrative matter unprotected by the confidentiality of the SHEC.
Article V. IMPLEMENTATION OF GOALS
During Freshman orientation each year, members of the SHEC will make a presentation familiarizing the student with the SHEC, ECU-SOM student support system in total, and common problems medical students may encounter during their medical education. Special emphasis will be made concerning problems leading to impairment and the positive effects from early intervention.
Self referral will be encouraged and student who feel the need for counseling or more intensive therapy can contact a SHEC member or the ECU Office of Substance Abuse Prevention and Education (757-6793) for referral to appropriate counseling.
A pamphlet describing the SHEC, its by-laws and sample case histories will be distributed to the entire ECU medical community.
When the SHEC becomes aware of persistent or recurrent high stress situations in the medical school experience, the SHEC will bring this notice of the Administration.
The SHEC will follow-up all referrals to the Administration as advocates for the medical student to ensure fair, proper treatment.
any person (student, faculty, house officer, friend, or spouse) who has just cause for suspecting that a medical student may be impaired can and should enlist the assistance of the SHEC by contacting a student member of the SHEC.
Upon receiving a report of alleged impairment requiring immediate attention within the realm of this policy the student member will notify the chairperson as soon as possible without revealing the identity of the impaired student in question. Verification of the alleged impairment and the confidentiality of the student must be maintained even in an emergent situation with the student6's well-being first and foremost. The chairperson, after consultation with the faculty advisor and/or a Psychiatrist, if necessary, will decide if:
If any immediate action be deemed necessary.
An emergency meeting of the SHEC must be called to discuss the case
The matter can wait until the next scheduled meeting of the SHEC
The student reporting the alleged impairment of a fellow student will be asked by the SHEC member receiving the report to substantiate the allegation with specific "symptoms" of the impairment, including the behavior and time frame of the incident(s). The reporting student will be asked to have other concerned student who have witnessed the alleged impaired student's difficulties report to the SHEC member their observations of the student. This protocol will be utilized to further insure non-malicious reporting, increase the confidential nature of the investigation and decrease the intimidation of the investigative process.
A report of alleged impairment will be brought before the SHEC. The case will be discussed at length, without reference to the name of the student in questions. At this time the name of the student in question will only be known to the SHEC member receiving the report(s) of alleged impairment.
The chairperson may ask the SHEC member receiving the original report(s) to further investigate the allegation and gather more data about the case only if sufficient date is not already available for decision. The investigation will continue, following the protocol in Article V-C.1. and may include but not be limited to the following: talking with he student, spouse, classmates, house officers, friends, or faculty. All such investigations are to be discrete and will maintain strict confidentiality.
Preliminary Determination - Once sufficient data have been collected about the case and he matter discussed before the SHEC, a preliminary determination will be made by the SHEC. The preliminary determination will be one of the following:
Primary Drug Addiction
Not Primary Drug Addiction
Significant Problems Present
Psychiatric, emotional, behavioral, personal problems.
Minor Problems Present
No Problems Present
No Malicious reporting
Evaluation and Treatment
If it is preliminarily determined that the student is impaired, then:
The SHEC will arrange an intervention for the student.
The SHEC will consider the findings and recommendations expressed during the intervention.
The SHEC will recommend a course of the treatment to the student.
If the student does not accept evaluation and/or treatment, the SHEC will decide any further course of action, which must include notification to the Dean's Office of its preliminary determination.
If the student accepts treatment, the student will be asked to sign the consent form, initial a treatment plan and will be referred to an appropriate therapist and/or treatment facility. Should the student fail to sign the consent form and treatment plan or accept an appropriate referral, the Dean will be notified.
MONITORING (see II-G.3) will continue until the student graduates or the SHEC decides to terminate formal involvement. If a student graduates who has not completed treatment or requires further monitoring, his/her file will be transferred by the faculty advisor for further monitoring by the state impaired physician program in the state where the graduate wishes to obtain a medical license. The notification will terminate any requirement for further monitoring by the SHEC.
If the student completed treatment prior to graduation, his file will be sealed and held for three years then destroyed. The Administration will not be award of the student's problems nor his treatment; his scholastic record will have not statements concerning the SHEC intervention. The state impaired physician program will not be notified if treatment has been completed.
If the student drops out of treatment against medical advice, or relapses, the SHEC will decide whether the student will require a formal investigation, an intervention and/or a new treatment plan or whether the Dean should be notified at once.
If the is determined that the student is not impaired but has potential problems, then SHEC will offer and encourage counseling to the student.
If it is determined that the student is not impaired and no problem is present, then the SHEC shall determine if the student who reported the alleged impaired student did so for malicious or vindictive reasons, and if so, the reporting student's actions will be subject to review by the Dean.
Article VI. STATUS OF THE MEDICAL STUDENT
In considering the impaired student's; status, the Administration will preserve the student's right to continue his/her education without restrictions, as long as he/she is following recommended treatment. The student's impairment will be handled with he same type of consideration given to a student who missed school due to illness or personal problems. In the event that at student must undergo therapy necessitating absence from school, his/her name only will be revealed to the Dean (without revealing details of the case) so that he/she can be excused from school.
Adapted from the By-laws of the Phoenix Society of LSU School of Medicine
East Carolina University
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