Essential Qualifications and Fitness for Duty Policy

It is the policy of the University of Arizona College of Medicine – Phoenix (COM – P) that all students possess the capability to complete, with or without reasonable accommodations, the entire curriculum established by the College of Medicine – Phoenix, which is required to achieve a Doctor of Medicine (MD) degree. The medical curriculum requires demonstrated proficiency in a variety of cognitive, problem-solving, communicative, and interpersonal skills. To achieve these proficiencies, COM – P requires that each student be able to meet the following:

1. Motor Skills: A student should have sufficient motor function to execute movements required to provide general care and treatment to patients in all health care settings. A student must be able to elicit independently information from patients by palpation, auscultation, percussion, and other diagnostic maneuvers. A student must be able to safely execute motor movements reasonably required to provide general care and emergency treatment to patients.
2. Sensory/Observation: A student must be able to acquire the information presented through demonstrations and experiences in the basic and clinical sciences. A student must be able to observe a patient accurately, at a distance and close at hand, and observe and appreciate non-verbal communications when performing clinical assessment and intervention or administering medications. A student must be capable of perceiving the signs of disease and infection as manifested through physical examination. Such information is derived from images of the body surfaces, palpable changes in various organs and tissues, and information communicated by patients and body functions. A student must be able to adhere to the standards of patient assessment and standards of care, including the use of technological equipment.
3. Communication: A student must communicate effectively, sensitively, and rapidly with other students, faculty, staff, patients, family, and other health care professionals. A student must demonstrate a willingness and ability to give and receive feedback. A student must be able to: convey or exchange information at a level allowing development of a health history; identify problems presented; explain alternative solutions; and give directions during treatment and post-treatment. A student must be able to process and communicate information on the patient’s status with accuracy in a timely manner to members of the health care team. A student must be able to elicit information from patients, describe changes in mood, activity, and posture, and perceive nonverbal communications.
4. Cognitive: A student must be able to problem solve rapidly. This critical skill demanded of physicians requires the ability to learn and reason, and to integrate, analyze, and synthesize data concurrently in a multi-task setting. In addition, a student must be able to comprehend three-dimensional relationships and to understand the spatial relationships of structures. A student must be able to measure, calculate, reason, analyze, integrate, and synthesize in the context of the study of medicine. A student must be able to comprehend extensive written material. A student must also be able to evaluate and apply information and engage in critical thinking in the classroom and clinical setting. A student must be able to consider alternatives and make decisions for managing or intervening in the care of a patient.
5. Behavioral/Social: A student must possess the ability to exercise good judgment, and to complete all responsibilities attendant to the diagnosis and care of patients and families. In addition, a student must maintain mature, sensitive, effective, and harmonious relationships with patients, students, faculty, staff and other professionals under highly stressful situations. A student must have the ability to function effectively under stress and to adapt to an environment that may change rapidly without warning and/or in unpredictable ways. A student must be able to exhibit empathy, integrity, and concern for others.
6. Professional Conduct: A student must abide by professional standards of practice. A student must be able to engage in patient care delivery in diverse settings, and be able to deliver care to all patient populations.

Fitness for Duty evaluations are used to determine if a student's academic or behavioral performance is/may be affected by impairment that includes but is not limited to: medical, behavioral or substance use issues. The purpose of the Fitness for Duty evaluation is to determine the student's ability to perform their academic and clinical duties responsibly and safely; meaning the student is  not a danger to patients, colleagues, self, or anyone in the learning environment or university/clinical properties.

1. The College of Medicine – Phoenix may require a Fitness for Duty evaluation when:
   1. There is a report from any source to the Associate Dean, Student Affairs regarding a concern about a student that may threaten the health or safety of the student, patients, colleagues, anyone in the learning environment or University/clinical property.
   2. There is a report from any source to the Associate Dean, Student Affairs regarding a concern that the student is struggling to meet the Essential Qualifications.
2. A student may be immediately removed from the learning environment by the Associate Dean, Student Affairs during the course of the Fitness for Duty evaluation process. Depending on level of concern, the students may be placed on leave of absence, virtual learning, or another appropriate disposition, pending completion of the evaluation.

Definitions

Fitness for Duty evaluation: An evaluation to determine the student's ability to perform their academic and clinical duties responsibly and safely. The evaluation is completed by a physician or psychologist selected by COM-P, who has no role in the teaching or assessment of medical students, and who has not had mental health contact with students. The Fitness for Duty evaluation is not a confidential clinical encounter between the student and evaluator.

Impairment: Conditions that may affect a student's academic or behavioral performance include, but are not limited to: medical, behavioral issues, or substance use.

Essential Qualifications: All accepted candidates to COM-P are required to sign the Essential Qualifications as a contingency of their admission to and continued enrollment at COM-P. Each student endorses an acknowledgement of said requirement, which becomes a permanent part of the student record.

Fitness for Duty Evaluation Report: A written report by the physician or psychologist who conducted the evaluation. The report is addressed to the Associate Dean, Student Affairs and includes opinions regarding the student's ability to meet the Essential Qualifications with or without accommodation.

Notification: Any and all notifications must be made in writing. Email communication satisfies that requirement.

Process

1. Any individual concerned that a student is experiencing and/or demonstrating serious academic or behavioral deficiencies that interfere with the student’s ability to perform the skills set forth in the Essential Qualifications Policy, or who otherwise creates a concern for the health and safety of the student, others, or university/clinical property, must report the concerns to the Associate Dean, Student Affairs.
2. The Associate Dean, Student Affairs will review the reported concerns and will determine if a Fitness for Duty evaluation is required.
   1. The Associate Dean, Student Affairs will notify the Associate Dean, Curricular Affairs and Program Evaluation and/or Associate Dean, Clinical and Competency Based Education, as well as notification to the Senior Associate Dean, Academic Affairs.
   2. Fitness for Duty evaluations will be conducted by a physician or psychologist who was selected by COM-P and has no role in the teaching or assessment of medical students, who is not a COM-P employee or contractee, and who has not provided medical or behavioral care to the affected student.
   3. The Associate Dean, Student Affairs will provide the pertinent information to the evaluator(s) selected to perform the Fitness for Duty evaluation.
   4. The evaluator will generate a written Fitness for Duty Evaluation Report addressed to the Associate Dean, Student Affairs regarding the student's ability to perform the Essential Qualifications, with or without accommodations.
3. The evaluator will generate a written Fitness for Duty Evaluation Determination addressed to the Associate Dean, Student Affairs regarding the student's ability to perform the Essential Qualifications required for the MD Program.
4. The Evaluation Determination is not required to include specific health information about the student.
5. If accommodations are required for the student to meet the Essential Qualifications, the Evaluation Determination will note this fact.
6. If a student requires accommodations to meet the Essential Qualifications, the Associate Dean, Student Affairs will refer the student to the Disability Resource Center (DRC).
   1. It is the student’s responsibility to initiate contact with the DRC and complete the DRC’s assessment and accommodation process.
   2. If the student fails to contact the DRC within two weeks of the Evaluation Determination, the student will be deemed unable to meet the Essential Qualifications of the MD Program.
7. A student who cannot meet the Essential Qualifications will be offered a medical or personal leave of absence when eligible and such leave meets the conditions of the Leave of Absence Policy and subject to the progression timeline.
   1. An additional evaluation will be required prior to reintegration into the curriculum subject to the process outlined above.
8. If a student has exhausted all leave of absence options, the student may withdraw from the MD Program.
9. The Fitness for Duty Evaluation Report and all written records regarding the decisions and determinations will be kept in the student's permanent file secured in Docuware.
   1. A Fitness for Duty Evaluation Report will be considered valid for up to six months after the date of the report if there are no new or continuing concerns. After six months a new evaluation may be required.
   2. Once a Fitness for Duty evaluation is received by Student Affairs, it becomes part of a student educational record and is protected by FERPA.
10. A student who refuses a Fitness for Duty evaluation will not be permitted to continue in the curriculum and may be dismissed from COM-P in accordance with the Dismissal Policy, Enrollment, Sequencing, and Grading for Pre-Clerkships Policy, the Grading and Progression for Clerkships and Selectives Policy, the Grading and Progression for Electives Policy and Student Progress Policy.
11. The cost(s) for the initial and any subsequent required Fitness for Duty evaluations will be the responsibility of COM-P. The cost(s) for any treatment will be the sole responsibility of the student.