What do you do if your relief comes to work intoxicated: An Impaired Provider Scenario

AudienceThe primary audience for this simulation exercise is emergency medicine (EM) residents, although it could be more broadly applied to all provider groups, including medical students, advanced practice providers, and faculty physicians. IntroductionOver the course of their professional careers, approximately 10-15% of physicians will misuse or abuse alcohol or drugs.1 Unfortunately, Emergency Physicians (EPs) are not immune to this phenomenon, and although EPs make up only 4.7% of the active physician workforce,2 they are over-represented in samples of physicians referred to physician health programs (PHPs) for substance use disorder.3 Despite this increased prevalence, when EPs were referred to a PHP by themselves, family, or colleagues, 84% of them completed the program and were practicing medicine 5 years later,3 which makes recognition and referral of the impaired physician an important step to provide the treatment needed for recovery and ultimately for return to practice. Given the prevalence of substance use disorder in EPs, it is not surprising that the 2019 Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements in Emergency Medicine stipulate that "residents and faculty members must demonstrate an understanding of their personal role in the recognition of impairment, including from illness, fatigue, and substance use, in themselves, their peers, and other members of the health care team."4 Furthermore, the common program requirements also outline that each residency program must have "designated individuals responsible for reporting impaired providers in accordance with each institution's policies as well as being knowledgeable in the resources available to said provider."4 Despite these requirements, there are no best practices available to outline how residency programs can effectively teach trainees how to recognize and report the impairment. This simulation scenario is intended to provide an opportunity for learners to recognize an impaired colleague in a clinical setting, remove them from the clinical care environment, and notify the appropriate contacts, such as a Program Director, Department Chair, or nursing supervisor. To our knowledge, this is the first described simulation scenario where learners develop competency in recognizing and reporting the impaired provider. ObjectivesBy the end of this simulation, learners will be able to: 1) Identify potential impairment in the form of alcohol intoxicati