Fitness for Duty

Policy Summary

This University of Florida (UF), College of Medicine (UF COM) policy outlines the process for ensuring a medical student’s (student) fitness for duty (FFD) meets the standards of practice as outlined by the College of Medicine Technical Standards. The goal of this policy is to address the need to assess a student’s mental/physical state during curricular activities or when returning to medical school and/or clinical care environment for the safety of the students and patients under the student’s care. The policy also defines the procedures to be followed to ensure the student receives effective treatment with the intention to continue or return to clinical and educational duties. This policy does not supersede or replace federal and state laws and regulations.

UF COM is required to comply with Americans with Disabilities Act (ADA) of 1990. In general, the ADA prohibits: (1) employers/schools from requiring a student to submit to a medical examination; and (2) employer/school inquiries into whether an individual has a disability. However, the protections afforded by the ADA are not without limits. Federal law permits UF COM to require a medical examination of a student if the requirement for the examination is performance-related, consistent with business necessity and if UF COM has a reasonable belief that: 

  1. The student’s ability to perform essential functions may be impaired by a health condition; or
  2. The student may pose a direct threat (i.e., significant risk of substantial harm to self or others) due to a medical condition; or
  3. The student’s conduct is materially or substantially disruptive to a class or curricular activity, disrupts others from the benefit of the instructional program, disruption of UF or UF COM event, displays disorderly conduct or breach of peach under the Law, displays disruptive public intoxication at a university activity, or interferes with the rights of others to carry out their duties on behalf of UF.

Policy

UF and UF COM are committed to the promotion of a safe and healthy environment for our students, patients and staff. In order for appropriate learning and care of patients to occur, each student must be able to perform his/her responsibilities in a safe and effective manner. Those students who are not fit for duty may present a safety risk to themselves, patients or others and may adversely affect learning in the classroom and/or clinical setting, as well as patient care. With the safety of the student and patient in mind, it is important that individuals with a medical condition that affects their ability to perform in a safe manner receive ongoing care and support. The UF COM Associate Dean for Student Affairs encourages students to register with the Disability Resource Center to receive accommodations. The Associate Dean may also be able to provide additional information to resources and is available to meet with a student to discuss support services available within the college. Students must meet minimal technical standard for COM admission, progress during the period of studies and for graduation, with or without reasonable accommodations.

Faculty and Clinical Supervisors are responsible for the safety of students and the patients whom they treat. Whether on or off campus, it is important to communicate observations of erratic behavior that may affect the safety of others. During normal business hours, reporting supervisors, faculty, staff or students should must notify the Associate Dean for Student Affairs, the Assistant Dean of Student affairs or the Associate Dean of Medical Education if the Associate or Assistant Dean of Student Affairs is not available, who will assess the immediate concern, take appropriate action and refer the matter to the Academic Status Committee (ASC). The ASC will follow standard protocol for determining whether additional action is required that may include an extended medical leave of absence.  Should an incident occur outside normal business hours, individuals are strongly encouraged to call 911, the CWC crisis hotline (352-392-1575), or go to the nearest emergency room if concerned about the safety and well-being of yourself or another student.

In order to ensure an individual is ready to return to their academic and clinical duties, UF COM may request an individual to provide evidence of receiving an evaluation that confirms their fitness for duty from a provider who is trained in FFD evaluations.   

If the student is found to be impaired, he or she will be relieved of their clinical/educational responsibilities until it is determined they are fit to return to their clinical/educational responsibilities. Participation in a treatment or rehabilitation program does not guarantee continued enrollment and may not necessarily prevent disciplinary action for violation of any UF COM policies. A student must comply with all treatment recommendations resulting from a fitness for duty evaluation before he/she is permitted to return to school. The Associate Dean for Student Affairs will oversee the evaluation process of the student, as well as plan the return to his/her studies. If the student requires a FFD evaluation, a list of providers who have expertise in FFD evaluations will be provided to the student. The student may select from one of these providers.  Every effort will be made to find providers from within and outside of the UF Health system to allow for reasonable choice. The student is responsible for the cost of an evaluation(s). To the extent required by law or UF regulations, UF COM shall protect the confidentiality of the evaluation and the results. Non-compliance with a request for a fitness for duty evaluation shall be cause for disciplinary action up to and including dismissal from medical school. If a student is dismissed, they have the ability to appeal the decision to the Deans Advisory Committee per the student handbook. 

Referral Process

Step One: Incidents should be reported to the Assistant or Associate Dean of Student Affairs. Self-referral by a student is also appropriate. Contact Phone: (352) 273-7971

Step Two: The Academic Leadership from either the Office for Student Affairs or the Office of Medical Education will meet with the student to determine the next course of action, which may include a medical leave of absence and/or referral to the ASC. The ASC must approve a leave of absence greater than 6 weeks, and may refer the student for evaluation as set out below.

  • Students in need of mental health evaluation will be referred for a FFD evaluation prior to rematriculating. 
  • Students in need of evaluation for substance abuse or dependence, psychiatric or physical illness may be referred to PRN, who will provide a FFD prior to rematriculating. 
  • Students in need of a medical evaluation, will be referred to the appropriate physician, and if deemed appropriate, will be referred for a FFD prior to rematriculating.

Step Three: The Associate Dean for Student Affairs will be the referring contact for the evaluations. In order for the Associate Dean for Student Affairs to be allowed to review the recommendations provided by the evaluators as well as an executive summary of any completed initial evaluations, the student will need to sign and submit a waiver to the appropriate provider. The individual student is responsible for any cost associated with evaluation.

Step Four: Prior to rematriculating, a summary of the FFD evaluation will be reviewed by the Academic Status Committee with input from the Associate Dean for Student Affairs. Any academic leaves or adjustments will be addressed as necessary with the Academic Status Committee.  Failure to submit proper documentation may delay return to medical education.

After evaluation, the decision options are:

  • Return to full duty
  • Return to full duty with recommendations for follow up
  • Return to part time duty with recommendations for follow up
  • Not allowed to return to duty

The student and the Associate Dean for Student Affairs will work with the appropriate entities to apply for recommended accommodations to ensure student compliance and success with the recommendations.

Continued matriculation shall be contingent upon compliance with recommendations provided by the formal evaluation. This may include participation in medical treatment programs, periodic drug screen testing and/or professional counseling. Failure to comply with the recommendations or agreed upon accommodations may result in disciplinary action up to and including dismissal from medical school. The Academic Status Committee will determine resolution in cases where students are not compliant with recommendations. The student handbook describes the process of adverse actions and the appeal process for students.

Confidentiality/Privacy of Fitness for Duty Evaluations:

Under the Health Insurance Portability and Accountability Act (HIPAA), documents containing medical information about a student may be considered a medical record and may be regarded as confidential. This information may be shared only as permitted by law.

UF ensures the confidentiality of education and treatment records in accordance with the provisions of various federal, state, and university regulations, including the Family Educational Rights and Privacy Act of 1974 (FERPA), as amended, also known as the Buckley Amendment. FFD evaluations shall be treated as confidential education and treatment records protected by FERPA and shall be maintained by the Office for Student Affairs. These records may be shared only as permitted by law.