LIAISON COMMITTEE ON (EDICAL EDUCATION wwleme.org Associaton of American Medical Calleges 2450 N Street, NW, Washington, D.C. 20037, Dan Hunt, M.D, M.B.A. LOME Secretary, 2008-2008 Phone: 202-828-0596 Fax: 202-826-1125 Emaldhuntasameorg Council on Medical Education ‘American Medical Association 515 North State Street Chicago lino 60654 Barbara Barzansky, Ph.D, MPH. LEME Secretary, 2009-2010 Phone: 312-864-4933, Fax: 312-464-5830 Ematbarbarabacanshy@amaassnog October 30, 2008 Brady J. Deaton, Ph.D. Office of the Chancellor University of Missouri-Columbia 105 Jesse Hall Columbia, MO 65211 Dear Chancellor Deaton: The purpose of this letter of accreditation is to inform you of the action taken by the Liaison Committee on Medical Education (LCME) at its meeting on October 6-8, 2008, regarding the accreditation status of the University of Missouri-Columbia School of Medicine, and to transmit to you the report of the LCME survey team that visited the medical school on January 13-16, 2008. After reviewing the report of the survey team, the LCME voted to continue accreditation of the educational program leading to the M.D. degree at the University of Missouri-Columbia School of Medicine for an eight-year term. The program's next full survey visit will take place during 2015-2016 academic year. In its review of the report, the LCME concurred with the survey team that the following items represent institutional strengths: 1. The dean and the Office of Medical Education provide strong leadership and support for the educational program of the school The dean is recognized as an effective fundraiser as evidenced by the growth in the school’s endowment, which has increased from 24 to 75 million dollars. 3. There is strong commitment among the faculty and students for the problem- based learning curriculum. This curriculum has enhanced student recruitment and increased student satisfaction, and it appears to be associated with improved performance on educational outcome measures. 4. The Rural Track program provides students with excellent opportunities for education in rural communities. Itis a highly sought after experience for students that has enhanced the collaboration between the school and ruralBrady J. Deaton, Ph.D. October 30, 2008 Page 2 communities, AHEC, and local health care providers. In addition to offering unique Jeaming experiences, it is designed to help address the state’s physician workforce needs in rural areas. ‘The Advanced Biomedical Sciences selective in the fourth year is a novel approach to providing a bridge to the basic sciences in the clinical curriculum. The variety of ways that this requirement can be met provides medical students with opportunities to meet their professional development needs and goals. 6. The Patient Safety, Quality Improvement, and Teamwork Skills curriculum represents a model for the implementation and integration of leaming and assessment in the area of quality improvement and patient safety throughout the four years of medical school. ‘The LCME identified the following areas of partial or substantial noncompliance with accreditation standards: IS-8. The chief official of the medical school, who usually holds the title “dean,” must have ready access to the university president or other university official charged with final responsibility for the school, and to other university officials as are necessary to fulfill the responsibilities of the dean’s office. IS-9. There must be clear understanding of the authority and responsibility for medical school matters among the vice president for health affairs, the dean of the medical school, the faculty, and the directors of the other components of the medical center and university. Finding: The survey report noted that the CEO of the University of Missouri Health Care reports directly to the university president. While the organizational chart indicates that the dean of the school of medicine reports to the provost, the dean’s primary interactions are with the chancellor. Until recently, the University Physicians” Practice Group reported to the president through the health system CEO. This administrative structure has created difficulties for the medical school, particularly with the clinical chairs. The Self-study report states that the current structure is “widely recognized as awkward and dysfunctional.” Since November 2007, the reporting relationship of the chair of the University Physicians and the Management Committee was changed to a report to the dean ED-24, Residents who supervise or teach medical students, as well as graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation.Brady J. Deaton, Ph.D. October 30, 2008 Page 3 Finding: There is no required institution-wide program for the development of residents as teachers. Therefore, the use of resources such as the TALENT program varies by departments. The monitoring of participation in these activities is done at the departmental level, not centrally ED-31. Each student should be evaluated early enough during a unit of study to allow time for remediation. Finding: Formal feedback sessions at the midpoint of the clerkship do not consistently occur during the required clinical clerkships. MS-32. Each medical school must define and publicize the standards of conduct for the teacher-learner relationship, and develop written policies for addressing violations of those standards. Finding: No specific student mistreatment policy and procedures exist for the school. In the Student Independent Analysis, concern was expressed over the lack of student and staff awareness of the school’s mistreatment policies and procedures. The medical student handbook states that “itis vitally important that such incidents be reported to the Office of Medical Education so that proper action can be taken against offenders. The University of Missouri-Columbia has policies and procedures to assist students who feel they have been the victim of discrimination or harassment.” This is followed by three Web sites to MU resources that actually lead to error messages. FA-1, The recruitment and development of a medical school’s faculty should take into account its mission, the diversity of its student body, and the population that it serves. MS-8. Each medical school should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students. Finding: The survey team noted that the lack of diversity among students and faculty has been a challenging problem for the school for many years. Despite medical school efforts, including pipeline programs and new scholarships, and university efforts, including faculty salary support, the number of medical students and faculty from underrepresented groups remains well below desired levels. Of concer, there was not a single African-American student in the first-year class. There currently is no administrator with leadership responsibilities, such as an associate dean for minority affairs, and no unified strategic plan to address the issue of diversity.Brady J. Deaton, Ph.D. October 30, 2008 Page 4 ER-2. The present and anticipated financial resources of a medical school must be adequate to sustain a sound program of medical education and to accomplish other institutional goals. ‘The LCME noted the following areas in tran: Finding: The survey team reported that “the Dean of the School of Medicine does not control most of clinical revenue; the amount directly distributed to the dean for his discretionary use is derived from a 6% Dean's Tax. Although increases in hospital support, clinical revenue, tuition dollars, sponsored research, and general operating dollars from the campus/state have occurred, the School of Medicine remains seriously underfunded with regard to its educational and research missions.” (Self-study, page 2) mn whose outcome could affect the school’s ongoing compliance with accreditation standards: Faced with critical financial needs, university leaders have drawn up a three-year plan - called Compete Missouri. It is hoped that, by July 2008, this program will raise $7 jon a year through cost savings and new revenues and by not filling many vacant job positions. That money will be redirected to the university's strategic priorities, including faculty salaries. The impact of this initiative on the medical school and its finances is unknown and will need to be followed The School of Medicine capital campaign is ongoing, with an overall goal by 2009 of $100 million, including $25 million in student scholarships and $75 million in faculty support, primarily in endowed positions, Newly defined faculty tracks have been developed and have been approved by the school’s Faculty Affairs Council. Final approval of these tracks must be given by: 1) a faculty vote, which is scheduled for the spring of 2008, and 2) the campus leadership. In the past, student satisfaction with career counseling has fallen below national levels. The Student Independent Analysis indicated some dissatisfaction with guidance services, including academic counseling and faculty mentoring. A new appointment has been made to support these efforts. Progress in this area will need to be monitored. Feedback by students in the Student Independent Analysis and in survey visit sessions indicated a desire to improve the quality, consistency, and perhaps the length of the Neurology clerkship. Efforts are underway within the school to review and improve this clerkship.Brady J. Deaton, Ph.D. October 30, 2008 Page 5 6. Anatomy has been mentioned in the Student Independent Analysis as being poorly integrated in the problem-based learning curriculum. While improvements are under discussion, this area will need to be monitored, To address the areas of noncompliance and transition noted above, the dean is requested to submit two status reports. The first report is due by August 15, 2010; the second report will be due by August 15, 2011 ‘The first report (due by August 15, 2010) should provide the following information: 1, Role and Authority of the Dean (IS-8, IS-9) a. Provide a position description for the dean and, if applicable, the vice president for health affairs or equivalent. b. Supply a chart showing the relationships among the medical school and university administration, other schools and colleges, institutes, centers, etc. Include, if appropriate, the reporting relationships for the directors of any teaching hospitals owned or operated by the medical school or university and for the medical faculty practice plan. ©. Provide an assessment of the adequacy of the dean’s access to university officers and of the functioning of the relationship between the dean and the executive leadership of other components of the health care system. 2. Resident Preparation (ED-24) a. Describe the department and institution-level programs to enhance the teaching and evaluation skills of graduate students, postdoctoral fellows, or residents who teach or supervise medical students. b. Describe how the level of participation is monitored in sessions to enhance the teaching skills of residents, graduate students, and postdoctoral fellows. Provide evidence of resident participation. 3. Mid-clerkship Feedback (ED-31) a. Summarize the opportunities that are available for formative assessment during the preclinical years (e.g., the availability of practice tests, study questions).Brady J. Deaton, Ph.D. October 30, 2008 Page 6 b. Describe the institutional policies and procedures that are in place to assure that students receive formal mid-clerkship feedback. How is the occurrence of mid- clerkship feedback monitored? c. Provide a table showing the percentage of students receiving mid-clerkship feedback for each of the requited clinical rotations. Use data from the 2009 AAMC Medical School Graduation Questionnaire (GQ), if those data are available, and/or student evaluations of the individual clerkships. 4, Student Mistreatment Policy (MS-32) a. Supply a copy of any formal medical school or university statements of the standards of conduct expected in the teacher-learner relationship. Describe the means by which students, residents, faculty (full-time, part-time, and volunteer), and staff are informed about the policy b. Provide a copy (or Web site URL) of any formal or informal policies and procedures for handling allegations of student mistreatment, including avenues for reporting such incidents and mechanisms for investigating them. What evidence is there to indicate the effectiveness of such policies? c. Describe the educational programs provided by the school or other university officials, to avoid or prevent student mistreatment. 5. Diversity among Students, Faculty, and Staff (MS-8/FA-1) a. Provide a copy of all current institutional mission statement(s) and policies that are related to assuring a diverse student body, faculty, and staff. Describe the process by which these statements and policies were developed, approved, and implemented at the institution. Describe how these statements and policies are made known to current and prospective applicants, students, employees, faculty, and staff. b. Describe how the institution defines or characterizes diversity for its students, faculty, and staff, What dimensions of diversity are considered? If different definitions apply to any of these institutional constituencies, provide each relevant definition. In the context of the institution's definition of diversity, describe how institutional policies related to diversity are put into practice in each of the following arcas:Brady J. Deaton, Ph.D. October 30, 2008 Page 7 Student recruitment, selection, and retention Financial aid Educational programs Faculty / staff recruitment, employment, and retention Faculty development Liaison activities with community organizations ¢. Based on the institution’s definition of diversity and the LCME standard that, “schools should consider in their planning elements of diversity including, but not limited to, gender, racial, cultural and economic diversity.” report in the table below information regarding the percentage of enrolled students and employed (full-time) faculty and staff in each of the categories included in the institution’s definition of diversity. ‘Category First Year ‘All Students | Faculty | Staff Students (Full-time) | (Define) 11 Medical School Finances (ER-2)/Transition Area a, Provide a revenue and expenditure summary for the current fiscal year (based on budget projections) and for each of the past three fiscal years. The format for the summary and the data for the three completed fiscal years should be obtained from the “Rev_Exp_History” tab of the school’s completed LCME Part I-A Annual Financial Questionnaire.Brady J. Deaton, Ph.D. October 30, 2008 Page 8 b. Provide a table showing tuition costs for the last three fiscal years and the projections for the next two fiscal years. Provide the average debt of indebted graduates for the 2008, 2009, and 2010 academic years. ¢. Provide an update on the capital campaign and the results of the Compete Missouri initiative, 7. Faculty Tracks (Transition Area) Provide an update on the faculty vote and campus leadership decisions related to the newly defined faculty tracks. Has the new track system been implemented? If'so, indicate when the new system went into effect. 8, Neurology Clerkship and Anatomy Course (Transition Area) a, Summarize the changes made between the 2007-2008 and 2009-2010 academic years in the Neurology clerkship. Provide data from 2009-2010 academic year student evaluations of the clerkship regarding students’ satisfaction with the revised clerkship. b. Summarize the changes made to the Anatomy course between the 2007-2008 and 2009-2010 academic years. Provide data from 2009-2010 academic year student evaluations of the course regarding students” satisfaction with the revised course. The dean is also requested to submit a second status report (due by August 15, 2011) providing the following information: 1. Student Mistreatment Policy (MS-32) a. Provide information from relevant school-generated surveys and/or information from the 2009 and 2010 AAMC Medical School Graduation Questionnaires (GQ) related to student reports of mistreatment and their awareness of and satisfaction with the school’s mistreatment policy. 2. Career Counseling (Transition Area) a. Provide an update on the changes implemented in the mentoring and career advising programs between the 2007-2008 and 2010-2011 academic years.Brady J. Deaton, Ph.D. October 30, 2008 Page 9 b, Provide information from relevant school-generated information and/or information from the AAMC GQ related to student satisfaction with the school’s student mentoring and career advising programs. Accreditation is awarded to the program of medical education based on a judgment of propriate balance between student enrollment and the total resources of the institution, including faculty, physical facilities, and the operating budget. If there are plans to significantly the educational program, or if there is to be a substantial change in student enrollment or in the resources of the institution so that the balance is distorted, the LCME expects to receive prior notice of the proposed change. Substantial changes may lead to re-evaluation of the program’s accreditation status by the LCME. Details are available on the LCME Web site at ‘www.leme.org/classsizeguidelines.htm. ‘A copy of the survey team report is being sent to Interim Dean Robert J. Churchill. The report is for the use of the medical schoo! and the university, and any public dissemination or distribution of its contents is at the discretion of institutional officials. Sincerely, Cade Dan Hunt, M.D., M.B.A. LCME Secretary, 2008-2009 enc: ce: Robert J. Churchill, M.D., Interim Dean, School of Medicine Barbara Barzansky, Ph.D., M.P-HLE., LCME Secretary, 2009-2010