MU School of Medicine requests early review of probation status

Friday, August 21, 2009 | 12:00 a.m. CDT; updated 4:27 p.m. CDT, Wednesday, September 2, 2009

COLUMBIA — The accreditation council that placed the MU School of Medicine on probation will visit the school on October 27 — earlier than planned — to reassess its accreditation status.

The accreditation body raised concerns about the school's resident education program last April.

Julie Jacob, a spokeswoman for the Accreditation Council for Graduate Medical Education, said the organization's next visit to the School of Medicine has been moved up from the previously scheduled date of April 2011. The school had requested the date change, Jacob said.

After the daylong visit, the council's review committee will meet in January to discuss the visit report. The council will announce its decision on the school's accreditation status within 60 days after the meeting.

If the council decides the school hasn't made adequate changes, it would be given another year to comply with requests before losing its accreditation.

However, Dr. John Gay, associate dean for graduate medical education, is confident that the decision will be a favorable one. He said it is "unheard of" for a medical school to lose accreditation during this process.

"They want to get your attention," he said of the accreditation council's report last spring.

The school is one of five medical schools in the nation currently on probation, according to the accreditation council's Web site.

The school's undergraduate medical education program is reviewed independently of the graduate program, by a separate association called the Liaison Committee on Medical Education.

The graduate accreditation council's last visit to the school was in February 2008. It announced the school's probation status in April of the following year, and released a report detailing the reasons behind the probation in May.

These reasons, according to the school's Web site, included: "the proper referencing of policy language in manuals, resident representation at meetings on campus . . . and the level of resources and oversight associated with institutional administration of residents' daily work." 

The Missourian was unable to independently review the report because peer review reports are confidential by law in Illinois, where the council is based.

Gay said that the probation status is something "everybody's concerned about."

"It's a black eye," he said.

But the balance between patient service and resident education at the residency program is good, he said. He also said that the status of the residency program does not affect the accreditation status of any one medical program.

In response to the report, the residency program has made an effort to reassign non-medical, administrative tasks to non-physician staff members, in order to ease residents' workloads. Gay said that each team of residents is now assigned its own nurse manager and social worker, and the program has worked on the computerization of patient records.

He said the nationwide movement toward electronic medical record systems ensures that patient "hand-offs" — when a patient is admitted, moved to another level or discharged — are safer and more efficient.

The school made several organizational changes in August 2008 — nine months before the probation report's release — including the creation of a new vice chancellor position to oversee the medical and nursing schools, as well as the hospital and clinics, to facilitate communication among administrators.

"These were things we had been looking at all along," Gay said of the council's concerns. "We had been moving in the same direction — they didn't think we were moving fast enough."

During the October visit, the council representative will focus on the school as the sponsoring institution of the resident education program.

There is a separate process for reviewing and granting accreditation status to individual programs.

The MU School currently has two programs with unfavorable statuses: the Orthopaedic Surgery program, which is on probation; and the Neonatal-Perinatal Medicine program, which does not have accreditation because the school decided to withdraw it from the council's system.

Gay said the school decided to withdraw the program because several faculty members retired, so there were not enough faculty to do research or maintain the required faculty-to-resident ratio. He said the school has since hired a new neonatologist, and plans to rebuild the program and reapply for accreditation status.

The Orthopaedic Surgery program is also in negotiations with the accreditation council over its status, having been placed on probation after a site visit a year ago. Gay pointed to leadership changes and resulting instability as the reason behind the program's probation status and said that adhering to the council's resident duty hour limits had been a problem — one which has now been resolved, he said.

The accreditation council mandates a duty hour limit of 80 hours per week for residents — averaged over four weeks — and four days off per month. The maximum shift length permitted is 30 hours, with a limit of 24 hours spent admitting patients.

The MU School's spokesperson, Rich Gleba, said residency programs at prominent medical schools such as The Johns Hopkins Univerisity and Harvard University have also had problems with duty hour limits.

Some worry that the limits are too high. Studies published in the "New England Journal of Medicine" have shown that staying up for 24 hours can hinder a resident's performance as much as having a blood alcohol level of 0.10 would.

The Institute of Medicine last year recommended increasing residents' days off from four to five days a month, limiting hours spent admitting patients during a shift to 16, and counting external moonlighting work as part of the permitted 80 hours.

The institute's proposal pointed out that European medical schools generally have lower duty hour limits: ranging from 37 hours per week in Denmark to as much as 64 in the U.K.

Gay said that the Institute of Medicine's recommendations were "not unrealistic at all," but that a dramatic decrease in permitted duty hours — such as those in Europe — would be an expensive process requiring longer training programs.

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