SNAP Brochure

Why Have a Committee Such as SNAP?

A physician's primary job is to care for patients. In order to carry out this task and not to cause harm, he or she must be in good physical and emotional health. When a physician has significant problems his or her patients may be in danger. By the same token physicians should care for each other since some colleagues and friends will fail to seek help on their own.

Physicians' health has become an area of increasing concern for state and national medical societies, as well as for medical schools. As many as 14% of all practicing physicians will become impaired during their careers. Up to 10% of medical students may qualify as "problem drinkers." In addition, studies have found high incidences fo depression, anxiety, psychosomatic disorders, and suicide among medical students due to the stress of training.

As physicians in training, and later as practicing professionals, you will be required to make painful, yet ethically and morally correct decisions. Such decisions may include confronting a colleague, friend or fellow medical student or intervening by reporting their impairment. The AMA has established as one of a physician's responsibilities, the identification of and intervention with impaired colleagues. We recognize that this is a difficult task. Nevertheless, it is important to recognize that impaired students are best aided by directing them toward treatment.

In order to aid students who may be having difficulties, whether the result of substance abuse, emotional issues, or unaddressed physical needs, Dartmouth Medical School has established a Student Needs and Assistance Program (SNAP).

The goals of the SNAP Committee are:

• To provide assistance to students at risk for impairment.
• To protect students' privacy.
• To enable them to progress through the medical school curriculum without penalty or delay.
• To serve in an advocacy and supportive role as they address their difficulties.
• To protect patients, hospital staff, and other medical students from the harm that impairment may cause.

Committee Membership

The Student Needs and Assistance Program Committee consists of two student representatives per class and six faculty/staff members. Students are elected during the second term of their first year and serve for the duration of their education at DMS. Faculty members who serve on the Committee on Student Performance may not simultaneously serve on the SNAP Committee.

Identification of Students with Potential Problems

Anyone, including faculty, staff, residents or students, who believes that a medical student may be at risk for impairment can enlist the assistance of SNAP by contacting any of its members in confidence. Two student and two faculty representatives of the committee will find out as much information as possible about the student's situation, and establish if the case merits further review. If it does, the committee as a whole will discuss it and decide if a recommendation should be made for an evaluation by an outside professional. The earlier a referral is made, the greater the likelihood of a successful intervention which would allow the student to continue medical training without interruption.

The SNAP committee has gone to great lengths to build checks and balances into its system and to remain flexible in considering options for treatment. Information brought to the committee is always handled carefully and if there is reason to evaluate further, the committee will do with the student's knowledge. However, if the information presented to the committee does not warrant further action, no action will be taken. To avoid causing unwarranted problems for any student, all actions of the committee are designed with confidentiality being of primary importance

Treatment

When treatment is recommended by the outside evaluator, the SNAP Committee will present treatment options and a list of approved treatment providers to the student. The committee will then monitor progress. Non-compliance (including refusal to participate in treatment or follow recommendations) may result in information about the student being communicated to the Associate Dean for Student Affairs. While the Dean's office is not ordinarily involved, the purpose of informing the Dean is two-fold: (1) to provide some incentive for the student to get help, and (2) to allow the Dean's office to choose an administrative course of action if there is serious impairment which goes unaddressed. This is standard practice followed by medical student health committees around the nation.

In the case of a graduating student, the SNAP Committee will report a continuing case to an appropriate impaired physicians group in the state where the student chooses to undertake residency. The student will be made aware of this action. Hospital and state medical society physician health committees generally operate with the same concerns for privacy and confidentiality as our committee. If, however, a case is closed before graduation, no report is made to any agency. A continuing case is defined as one where the student has not yet completed evaluation and treatment, along with a year of abstinence in substance abuse cases. Where it is appropriate and in the student's best interest, the committee may modify the one year requirement.

Educational Programs

Another responsibility of the committee is the presentation of educational material on the issues of physician and medical student impairment. Formal programs are organized each year to supplement topics (substance abuse, emotional difficulties) which are already built into the curriculum.

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