Bell Paul F, Semelka Michael W, Bigdeli Laleh
J Grad Med Educ. 2015 Mar;7(1):59-64. doi: 10.4300/JGME-D-14-00308.1.
Despite well-established negative consequences, high rates of substance use and related disorders continue to be reported. Physicians in training are not immune from this, or the associated risks to their health and careers, while impaired physicians are a threat to patient safety.
We surveyed family medicine residency programs' practices relating to drug testing of medical students and incoming residents. The survey asked about the extent to which residency programs are confronted with trainees testing positive for prohibited substances, and how they respond.
The survey was sent to the directors of family medicine residency programs. A total of 205 directors (47.2%) completed the survey.
A majority of the responding programs required drug testing for incoming residents (143, 68.9%). Most programs did not require testing of medical students (161, 81.7%). Few programs reported positive drug tests among incoming residents (9, 6.5%), and there was only 1 reported instance of a positive result among medical students (1, 3.3%). Respondents reported a range of responses to positive results, with few reporting that they would keep open training spots or offer supportive services for a medical student who tested positive.
Changing laws legalizing certain drugs may require corresponding changes in the focus on drug testing and associated issues in medical training; however, many residency program directors were not aware of their institution's current policies. Programs will need to reexamine drug testing policies as new generations of physicians, growing up under altered legal circumstances concerning drug use, progress to clinical training.
尽管存在公认的负面后果，但仍不断有报告称物质使用及相关障碍的发生率很高。接受培训的医生也未能幸免，他们的健康和职业面临相关风险，而受损的医生对患者安全构成威胁。
我们调查了家庭医学住院医师培训项目针对医学生和新入职住院医师进行药物检测的做法。该调查询问了住院医师培训项目在多大程度上遇到学员违禁药物检测呈阳性的情况，以及他们如何应对。
该调查发送给了家庭医学住院医师培训项目的主任。共有205位主任（47.2%）完成了调查。
大多数回复的项目要求对新入职住院医师进行药物检测（143个项目，68.9%）。大多数项目不要求对医学生进行检测（161个项目，81.7%）。很少有项目报告新入职住院医师药物检测呈阳性（9个项目，6.5%），医学生中仅报告有1例阳性结果（1个项目，3.3%）。受访者报告了对阳性结果的一系列应对措施，很少有人表示会为检测呈阳性的医学生保留培训名额或提供支持服务。
某些药物合法化的法律变化可能需要在医学培训中对药物检测及相关问题的关注上做出相应改变；然而，许多住院医师培训项目主任并不了解其所在机构的现行政策。随着新一代在药物使用法律环境变化下成长起来的医生进入临床培训阶段，各项目将需要重新审视药物检测政策。
