The Liaison Committee on Medical Education (LCME) has awarded the OHSU School of Medicine undergraduate medical education (MD) program full accreditation. The announcement by the body that accredits allopathic medical education programs in the United States came in late June, following the LCME’s January site visit.
The LCME reviewed the program’s performance on 93 elements and found 76 of them to be satisfactory. Indeed, the survey team noted numerous areas of strength, including the high caliber of the faculty, the experience of the program’s educational leaders and the innovations made to the curriculum. OHSU is a national leader in competency-based medical education, and a 100% residency match for three years running has been a vote of confidence in student preparedness.
The LCME’s findings also affirmed the program’s significant improvement in key areas since its 2012 site visit. Satisfactory areas this year included student indebtedness and financial counseling; quality of educational facilities; and, quality of instruction and grading policies that were deemed unsatisfactory in 2012.
However, the LCME also found that OHSU must improve in 17 elements. For this reason, the school was given an accreditation for an indeterminate length of time until improvements are made.
“I am pleased that the LCME has fully accredited our undergraduate medical education program and want to recognize the incredibly comprehensive preparation by the faculty, staff and especially students,” said School of Medicine Dean Sharon Anderson, M.D. “I would particularly like to recognize staff lead Meghan Rogers and Associate Dean Tracy Bumsted, M.D., for their tireless efforts.”
Dr. Anderson added, “I also want to be clear that we are committed to – and have already begun working – to make the improvements the LCME has asked of us.”
School to focus on key areas
Areas for improvement include nine elements deemed unsatisfactory:
- Diversity, primarily focusing on the need to increase the diversity of the faculty
- Student Mistreatment, with an emphasis on the results from questionnaires that students complete upon graduation
- Study Space, due to the lack of a formal survey after new study space in RLSB opened
- Interprofessional Education, due to a paucity of required interprofessional opportunities
- Formative Feedback, because of insufficient narrative feedback by preclinical instructors
- Appeal Process, due to the inability to formally appeal professionalism monitoring forms
- Academic Advising, because of student dissatisfaction noted on student survey results
- Career Advising, with an emphasis on the results from the graduation questionnaires
- Student Records, related to concerns about the process for challenging unfavorable content in the Dean’s Letter sent to residency programs as part of the Medical Student Performance Evaluation
Student mistreatment by faculty, nurses, residents/interns, staff or peers is measured at every U.S. medical school using a questionnaire filled out by graduating students who are asked to reflect on their four years of training. The accrediting body noted a relatively high percentage of respondents who observed or experienced any one of 11 reportable mistreatment behaviors, which range from public humiliation (such as being called out in front of others) to physical harm. (The LCME excludes a twelfth category, called public embarrassment.)
At the same time, LCME praised the OHSU M.D. program for improving policies to address student mistreatment and for raising student awareness about how to report.
OHSU M.D. program leaders also started educating faculty and other hospital personnel in the last three years to raise awareness about student concerns and set expectations for appropriate treatment. Dr. Bumsted has presented to more than 30 departments and other groups, surfacing the reality that, for many faculty members, attitudes about appropriate student-faculty interaction were ingrained during their own medical training when stern and even discriminatory treatment was tolerated and students feared speaking out.
“We are encouraged that our students show a high degree of knowledge about how to report inappropriate treatment and feel that because our numbers are not zero, it means students do not fear reporting,” said George Mejicano, M.D., M.S., senior associate dean for education. “At the same time, it is critical that we continue to do everything we can to insure a 100 percent welcoming and safe environment in which every one of our students can thrive.”
The LCME also cited eight elements that were found to be satisfactory with a need for monitoring:
- Clinical Sites, due to closing of the Obstetrics & Gynecology clerkship at Salem Hospital
- Information Technology, due to conflicting results from different student surveys
- Self-Directed Learning, due to low satisfaction on student surveys from different classes
- Basic Science Topics, to monitor the coverage of anatomy, genetics and biochemistry
- Special Topics, to monitor coverage of disease diagnosis, management and prevention
- Medical Student Feedback, primarily related to being responsive to student concerns
- Faculty Appointments, due to concerns about provision of feedback to volunteer faculty
- Well-being Programs, due to conflicting results from different student surveys
Action planning commences
Dr. Mejicano expressed appreciation for the LCME’s thorough approach. He noted that changes in administrative procedures and forwarding more recent survey results to the LCME will address several areas. The required curricular changes will be vetted and addressed by the faculty and students serving on the Undergraduate Medical Education Curriculum Committee.
Other areas will require more time and focus.
“LCME appropriately zeroed in on two chronic issues that we must tackle forthwith: faculty diversity and academic/career advising,” Dr. Mejicano said. “Increasing faculty diversity will require a concerted effort and sustained commitment at the highest levels of the institution. In addition, our approach to academic and career advising needs to be rethought, in particular, our well-intentioned faculty coaching program.”
The M.D. program has diversified its student body over time, increasing the percentage of underrepresented minority students from 8 percent of the incoming class in 2015 and to 14 percent in 2019 and has partnered with students to create many supports from the Diversity Navigator program to support for student affinity groups to a dedicated multicultural space. In contrast, the percentage of underrepresented minority faculty across the School of Medicine has hovered at about 5 percent for at least the last five years.
The school will convene a team that will identify areas that can be rapidly improved. This team will also generate a formal action plan to address all areas of concern, including what needs to be done, who will be responsible for completing each task, an associated timeline, indicators that each task has been accomplished, and a summary of the expected outcomes of each task.
The school will submit the action plan to LCME in late fall, followed by a consultation from the LCME Secretariat in early winter. In December 2021, the school will file a progress report on action plan implementation. The school’s next survey date is currently shown as “pending” on the LCME website. When the accrediting body is satisfied with improvements – January 2022 at the earliest – the pending status will be removed.