University of South Florida College of Medicine



University of South Florida

College of Medicine

LCME Institutional Self-Study

Report of Committee Nine:

Educational Resources: General Facilities/

Clinical Teaching Facilities

Study Year 2005-2006

The contents of this report represent the judgments and opinions of the members of this Self-Study Committee. The committee has made every effort to ensure that the information represented is accurate. The LCME administrators have not audited the data in the text of the report and there may be some discrepancies within the database or executive summary as a result. While every attempt has been made to provide and evaluate information accurately and objectively, the committee acknowledges that any errors of fact in this report are unintentional.

(Printed October, 2006)

Table of Contents

I. Executive Summary/Key Issues 3

II. Responses to Questions in Guide to Institutional Self-Study 3

III. Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999 5

IV. Major Changes Since Last LCME Review in 1999 7

V. Areas of Strength 7

VI. Areas of Concern and Challenges 8

VII. Review of Compliance with LCME Established Standards 8

VIII. Recommendations, Possible Solutions and Strategies 13

IX. Issues of Concern Relevant to Other Committees 13

X. Attachments 13

XI. Narrative of Process 13

XII. Database Accuracy 14

XIII. Committee Membership 14

1 Executive Summary/Key Issues

• Progress toward meeting deficiencies noted in 1999 LCME review.

Regarding facilities, the site visit team noted that “in some cases, the amount of space at the medical school is qualitatively and quantitatively inadequate to support the mission of the medical school. This includes the amount of laboratory and office space in some departments”.

The committee is happy to report that significant progress has been made in improving both the quantity and quality of teaching and research space in the College of Medicine and its affiliates. Classrooms, teaching labs, small-group-conference rooms, lounges, and offices have been significantly expanded and upgraded in terms of aesthetics and technology and, as we reported below, even greater expansions and upgrades are planned or in progress for use in the near future. The concerns expressed by the site visit team in 1999 have been fully addressed and corrected.

• Current status of general and clinical teaching facilities.

All facilities for teaching, research, and service meet the needs of the current medical class. The main facilities on the north campus and all of the affiliated clinical teaching sites and hospitals provide a physical and programmatic environment that is very supportive of medical student education. As we discussed below, many new buildings have been completed over the past few years or are currently in progress on both the main campus and affiliated sites that significantly promote the goals of the college and directly enhance the medical student educational experience. The offices of medical education, research, and practice plan have been strengthened and provide careful oversight of the educational and research programs. Many consider the general clinical teaching facilities to be stronger than ever.

• Areas needing improvement.

All medical teaching institutions face challenges because of their size and complexity of mission. The committee noted several areas in need of special attention to further enhance the overall educational setting. Currently, these facilities will not support expansion of the medical class. Also, the technology capability of the conference rooms needs to be standardized and the research office, lab, and core facilities need to be upgraded to accommodate anticipated expansion of the research enterprise. A third area of continued focus is security for all students and staff. Educating students and staff as to security procedures and features in their environment is a constant challenge. Signage and education programs must be continually evaluated for effectiveness. Finally, the college administration is encouraged to aggressively pursue outside funding to expand the teaching, research, and service facilities. Very important building projects are proposed in order to accomplish the college’s mission.

2 Responses to Questions in Guide to Institutional Self-Study

5. Evaluate the adequacy of the general facilities for teaching, research, and service activities of the medical school. Is the opportunity for educational excellence or educational change (e.g., introduction of small-group teaching) or for the attainment of other medical school missions constrained by space concerns?

Committee Response:

The general facilities for teaching are highly adequate for the current class size and have been expanded and updated in the last few years. The classrooms and laboratories on the north campus have been upgraded in comfort and technology and are adequate for the current class of 120. New small-group- conference rooms have been added in the past few years, however scheduling the rooms is still problematic, and some of the rooms are remote, ill-equipped, and hard for students to find. A new clinical skills center of 8000 square feet has been added and includes 12 exam rooms, a conference room, classroom, simulator room, 3 offices, lockers, server room, and control room. In addition, a new 70- million dollar Center for Advanced Medical Learning and Simulation is planned for construction in the USF Research Park on the north campus. Although the current student lounge and study room facilities are minimal, a new health club/lounge facility is planned along with a computer lab/study room on the north campus. Parking for students is currently adequate and will be improved by a new parking garage under construction. Finally, the administrative space has been expanded into the new Children’s Medical Services building on the north campus.

The general facilities for research are adequate for the current needs of the institution and have been expanded and updated since the last review. However, the existing research facilities will not support any expansion of the research enterprise. Some remodeling of the main research buildings on the north campus has been completed and two new research facilities have been completed and occupied since 2000. These are a 50,000 gross-square-foot Children’s Research Institute at All Children’s Hospital in St. Petersburg providing laboratory and office space and the Stabile Research Building at the Moffitt Cancer Center on the USF north campus providing 200,000 square feet of research and office space. Equipment cores at these facilities have also been expanded as has the animal facility now consisting of 11 separate animal facilities totaling 92,000 square feet with a professional staff of 4 veterinarians and 5 facility managers. A 30,000 square-foot mouse facility at the Moffitt Cancer Center was recently occupied.

The general facilities for service in terms of patient care are highly adequate. The medical clinics on the north campus have been renovated and upgraded to enhance the patient experience. Similar improvements have been made at the other patient-care sites such as Tampa General Hospital. In addition, two new patient care centers are expected for completion in the next two years. These are the Center for Advanced Health Care (USF North campus– 194,400 square feet) and the Center for Advanced Health Care South (south campus 130,000 square feet) adjacent to the Tampa General Hospital.

6. Discuss the adequacy of security systems on each campus and at affiliated sites.

Committee Response: Security on the north campus has been upgraded and is highly adequate for protection of students and staff. USF police patrol the facility 24/7 and, in addition, 24-hour emergency-call telephones are in parking lots and student-teaching areas. In the past three years, approximately 160 security cameras have been added to the MDC complex and the main building complex now contains a card-access system for after-hours entry. The USF police maintain an education program on public safety for the medical students. Security at the affiliated hospitals serving as teaching sites have standard security personnel and protocols common to large metropolitan hospitals. After-hours parking for students is secure at All Children’s Hospital, Moffitt, and Tampa and Bay Pines VA hospitals; however, at the south campus complex containing Tampa General Hospital, 17 Davis Center, and Harbourside Medical Tower, 24-hour parking is in short supply and students must frequently park in remote areas. A 1400-car parking garage is planned at TGH to open in the spring of 2007 to alleviate parking problems. The Genesis Clinic and 30th Street Clinic are open from 7 a.m. to 5 p.m. and provide no special security measures for staff or students.

7. Analyze the clinical resources available to the medical school. For the size of the student body, are there adequate numbers of patients and supervisors available at all sites? Is the patient mix appropriate? Are clinical facilities, equipment, and support services appropriate for exemplary patient care? Discuss the availability, quality, and sufficiency of ambulatory care facilities for teaching.

Committee Response: The clinical resources available to the medical school are excellent. More than adequate numbers of patients and supervisors for the size of the student body are at all sites providing a good patient mix. In fact, many patients who could be “teaching patients” are not utilized so as not to overload the students. Even the patient mix at the VA Hospital has an increased number of women and younger patients reflecting the changes in the military workforce. The clinical facilities, equipment, and support services are excellent. We have very high-quality Ambulatory Care Facilities. In addition, a new Advanced Center for Healthcare (Ambulatory Care Facility including an Ambulatory Surgical Center) is being built. Also, a similar facility is being built adjacent to Tampa General Hospital. These will be great additions. Attached to this report is a logbook of the students’ various clerkship experiences which demonstrate the richness and diversity of the patient population. Initially, there were some questions about the outpatient pediatric practice at the university because we hired new pediatricians, expecting that it would take time to build their practices. This, however, is not a problem. In addition, we are expanding our geriatrics outpatient practice, but one can see that we have more than sufficient elderly patients to meet our teaching needs.

Attachment 1 - Clerkship Logbook Data

8. Describe and evaluate the interaction between the administrators of the hospitals/clinics used for teaching and the medical school administration. Does the level of cooperation promote the education of medical students?

Committee Response: The college does not own or operate hospitals or surgery centers at this time. It does, however, operate several ambulatory clinics. At every clinical facility containing educational programs for medical students, there is regular and on-going communication at the highest levels of leadership between the clinical facility and the college faculty.  Our students are welcomed and culturally adapt to the daily life of the clinical facility. Conference rooms, call rooms, and educational facilities are available to the students and teaching faculty at all the facilities. All the hospitals have significant libraries with links to the educational resources of the college. Even during times of organizational stress, the student's role is not compromised in any way.

9. Describe and evaluate the level of interaction/cooperation between the staff members of the hospitals/clinics used for teaching and medical school faculty members and department heads, related especially to the education of medical students.

Committee Response: The clinical staffs at all of the facilities are attuned to the students’ interests and needs. Administrative staff has clear mandates from their senior leadership to promote and support the student experience. In some of our hospitals, such as Tampa General and All Children's, there are college faculty and community physicians. Some of these community physicians are very active members of the clinical faculty and are important in the educational process of the students. On the other hand, some community physicians elect not to participate or are not selected to participate in student education. This variety in community effort has had no effect on the educational integrity of our student programs. Even though the medical-staff leadership at most hospitals is not controlled by our clinical department heads, this fact has had no adverse impact on student education.

3 Analysis of Recommendations and Deficiencies Relevant to Committee as Identified by Most Recent LCME Review in 1999

The LCME site visit team noted a deficiency in space and facilities for teaching and research. They went on to say “in some cases, the amount of space at the medical school is qualitatively and quantitatively inadequate to support the missions of the medical school. This includes the amount of laboratory and office space in some departments”.

A great deal of progress has been made in improving the teaching facilities on the COM main north campus since 1999. Main teaching classrooms have been remodeled and the media equipment has been upgraded; video and audio streaming are now available. Several new small-group conference rooms have been renovated and added to the existing inventory so that 25 are now available. In addition, a centralized booking system has been instituted to regulate the usage of some of the rooms. The student laboratories have been renovated to add student capacity, and the internet service has been upgraded to high-speed and high-volume capability. In addition, a new clinical skills center of 8000 square feet has been added and includes 12 exam rooms, a conference room, classroom, simulator room, 3 offices, lockers, server room, and control room. The student lounge facility is quite limited; however, a new facility is scheduled for completion by the fall of 2006.

For clinical teaching facilities, the COM has embarked on an aggressive building program with the development of two patient-care centers anticipated for completion in 2006 and 2007, respectively. These are the Center for Advanced Health Care (USF north campus– 194,400 square feet) and the Center for Advanced Health Care South (south campus 130,000 square feet) adjacent to the Tampa General Hospital; these centers will bring significant medical outreach to the community and provide additional teaching and office facilities for the students and faculty. Beside these two patient-centered facilities, USF Health, in collaboration with the BRS Corporation, is developing a 70 million dollar Center for Advanced Medical Learning and Simulation. This high tech, state-of-the-art hotel/training and research complex located in the USF Research Park is an academic/private partnership which includes a 350-room hotel and 120,000 square-foot building dedicated to advanced medical training, simulation and research. The research components include: a prototype/concept development laboratory (6,000 square feet) for interdisciplinary R & D in robotics, computer-assisted surgery, and image-guided surgery; Clinical Research Offices (6000 square feet) to house research coordinators and senior research staff; and the Center for Clinical Research (50,000 square feet) for multidisciplinary health sciences research. The projected date for occupancy is December 2007. In addition, a faculty office building is planned in cooperation with the H. Lee Moffitt Cancer Center and Research Institute; furthermore, the Children’s Medical Services building, 60,000 square feet, was completed on the north campus in 2005 providing faculty office space, conference rooms, and teaching facilities.

Regarding research and research support space, progress has also been made in adding to existing facilities. Since 1999, a 50,000 gross-square-foot Children’s Research Institute has been finished at All Children’s Hospital in St. Petersburg providing laboratory and office space. Also, the Stabile Research Building has been completed at the Moffitt Cancer Center on the USF north campus providing 200,000 square feet of research and office space. The Moffitt complex has an excellent equipment core that is available to COM faculty on a fee-for-service basis and contains services ranging from analytical microscopy to proteomics. In addition, the COM has a newly established imaging core facility. The centralized animal program in support of research has also expanded greatly since 1999 and is fully accredited by AAALAC. The program consists of 11 animal facilities totaling 92,000 square feet and has a professional staff of 4 veterinarians and 5 facility managers. The most recent facility addition is a 30,000 square-foot mouse facility at the H. Lee Moffitt Cancer Center occupied during the fall of 2004. This facility dedicated to the care and use of genetically engineered mice was completed within the Stabile Research Building. Construction was supported in part by NIH/NCRR grant #1 C06 RR17510-01, and equipment costs were partially supported by NIH/NCRR grant #1 G20 RR019609-01. This facility contains a mouse models core, in vivo imaging core, and a mouse pathology core. A surgical core is also available for use by students and faculty and contains all necessary rooms from locker rooms to 4 operating rooms.

Areas needing improvement

In spite of these gains, many of the offices and laboratories in phases I and II of the main COM building complex on the north campus are in need of renovation with many existing today as originally constructed in 1975-1976. However, the five-year Capital Improvement Plan and Legislative Budget Request for USF contains as priority #7 an HSC Major Renovations /Remodeling of Core Labs & Classrooms project estimated at $10 million. In addition, the five-year Budget Request contains as priority #6 a Research Building II/Vivarium Expansion project of 263,000 square feet and a cost of $113.8 million.  Equipment cores are available at Moffitt and an imaging core facility is established in the COM; however, the need exists for further core development in the COM. Regarding teaching facilities, although the student classrooms and labs are sufficient for the current class size of 120, the rooms cannot support class size growth. In addition, although the number of small-group rooms is sufficient, it is sometimes difficult to schedule room usage and some of the rooms are quite remote from each other and from the main classrooms. However, the five-year Capital Improvement Plan and Legislative Budget Request includes as priority #5 a College of Medicine Clinical Teaching Labs/Teaching Facility project of 300,000 square feet at a cost of $109 million.

4 Major Changes Since Last LCME Review in 1999

• Renovation and upgrade of lecture rooms and labs

• Addition of small group conference rooms

• Construction of 8000 square foot clinical skills center

• Planning for new student health club/lounge facility and computer lab/study room facility

• Construction of new research buildings at All Children’s Hospital and Moffitt Cancer Center

• Construction of 30,000 square feet of additional animal facilities

• Renovation of north campus research space

• Construction of Children’s Medical Services building for administration offices and patient care on north campus

• Planning for Centers for Advanced Health Care on north and south campuses

5 Areas of Strength

Student class rooms and labs remodeled and fitted with new electronic and internet capability

New, state-of-the-art clinical skills center is available

• New patient care and research facilities have either recently opened or will be opened in the next three years

• Significant upgrades have been made to the security of the main COM complex on the north campus

At the clinical teaching sites, the number of patients and supervisors is more than adequate

The patient mix is more than adequate at the teaching sites

• New affiliation agreements signed with clinical sites and the interaction between administrations at the clinical sites and the COM is excellent

Excellent animal facility

VI. Areas of Concern and Challenges

• Educating students as to security procedures and features in the learning environment is a constant challenge. Signage and education programs must be continually evaluated for effectiveness.

• Existing teaching and research facilities do not allow for expansion of programs; however, a number of building projects are planned to address this deficiency.

• Many research offices and labs on the north campus are in need of renovation; however, funding for renovation projects is being sought.

• Research equipment core facilities on the north campus need to be developed to complement the core facility at the Moffitt Cancer Center.

7 Review of Compliance with Established LCME Standards

ER-4. A medical school must have, or be assured use of, buildings and equipment appropriate to achieve its educational and other goals.

The medical school facilities should include offices for faculty, administrators, and support staff; laboratories and other space appropriate for the conduct of research; student classrooms and laboratories; lecture hall(s) sufficiently large to accommodate a full year’s class and any other students taking the same courses; space for student use, including student study space; space for library and information access; and space for the humane care of animals when animals are used in teaching or research.

Committee Response: The learning environment for medical students includes the buildings on the north campus at USF as well as affiliated clinical facilities in Hillsborough and Pinellas counties. The north campus facilities include the MDC, MDL, and MDA main complex, as well as the adjacent Haley VA, COM medical clinics, and H. Lee Moffitt Cancer Center. Within a short walk on the north campus are the Shriners Hospital and the University Psychiatry Center. Students also receive training at facilities at some distance south of the north campus such as the 30th Street Clinic and Genesis Clinic and also are trained at more remote facilities such a the South Campus Complex (Tampa General Hospital, 17 Davis Clinic and Harbourside), as well as All Children’s Hospital and Bay Pines VA across Tampa Bay in Pinellas County. The bulk of didactic and group-conference teaching for years I and II of the curriculum is done at the main complex of the north campus and contains approximately 27,000 square feet of classroom, laboratory, and small group meeting rooms.

In addition, a new clinical skills center of 8000 square feet has been added and includes 12 exam rooms, a conference room, classroom, simulator room, 3 offices, lockers, server room, and control room. For clinical teaching facilities expansion to accommodate growth and new programs, the COM has embarked on an aggressive building program with the development of two patient care centers expected for completion in 2006 and 2007, respectively. These are the Center for Advanced Health Care (USF north campus– 194,400 square feet) and the Center for Advanced Health Care South (south campus 130,000 square feet) adjacent to the Tampa General Hospital and these facilities bring significant medical outreach to the community and provide additional teaching and office facilities for the students and faculty. In addition, a faculty office building is planned in coordination with the H. Lee Moffitt Cancer Center and Research Institute; furthermore, the Children’s Medical Services building, 60,000 square feet, was completed on the north campus in 2005 providing faculty office space, conference rooms, and teaching facilities.

The main general facilities complex on the north campus consists of phases I, II, III; the space assigned for the medical student teaching mission is composed of administrative/office (78,381 square feet), instruction (74,083 square feet), and research laboratory (59,700 square feet). Office and research space are also found within walking distance of the main complex at the Haley VA, Moffitt Cancer Center, Psychiatry (98,410 square feet) and Ophthalmology Centers (123,700 square feet). The space currently available is adequate for the teaching, research, and service missions of the college but will not support significant expansion of these goals and many areas are in need of renovation to enhance the academic environment of the college. Student lounges and recreation areas are currently minimal. Scientific equipment cores for research are limited to just one at this time in the main building complex. Regarding animals for teaching and research, the animal facilities are more than adequate and will support expansion of programs.

ER-5. Appropriate security systems should be in place at all educational sites.

Committee Response: Security for main complex on north campus

The University of South Florida Police Department (USFPD) is the primary resource that provides security on the north Tampa campus. USFPD is a State of Florida Certified Law Enforcement Agency that has additionally achieved accreditation status granted by the Commission for Florida Law Enforcement Accreditation, Inc. It operates 24-hours per day, 7-days per week, and 365-days per year. USFPD patrol officers are deployed on campus in marked and unmarked patrol cars, motorcycles, bicycles, scooters, and on foot to provide quick responses as well as a high degree of visibility and accessibility to students, faculty, and staff. The University Police detachment assigned directly to USF COM employs two full-time officers (1 sergeant and 1 law-enforcement officer) and two security guards. These four individuals receive back-up support from the rest of USFPD as needed.

In addition to security personnel, in each of the parking lots that surround the complex, Blue Light Emergency Telephones automatically connect to the Police Dispatcher when the receiver is lifted; the location of the caller is displayed immediately to the dispatcher in the event the person is unable to speak. In each of the Student Labs, emergency telephones also connect the caller directly to the Police Dispatcher when the receiver is lifted. Besides the standard 9-1-1 number for emergency calls, two additional direct telephone lines are highly publicized as intake lines for police assistance.

Within the past three years, approximately 160 security cameras have been added to the MDC complex, pushing the total number to approximately 200. These cameras can be viewed by law enforcement personnel at both the main campus police office and at the COM complex police office. In addition, COM works with the Maintenance Department of the Division of Physical Plant to maintain an aggressive light-bulb outage replacement policy, e.g. both Physical Plant and the night-shift security guards monitor exterior lighting with the goal of replacing a burned-out bulb the next day. Several new pole lights have also been added around the complex in the last three years, the most recent being at the north entrance of the USF Health Library.

As a result of the September 11th attacks, the university has implemented a plan to increase security throughout the campus. The COM is in the final stages of a process that will implement a card-access system for after-hours entrance to all of its facilities. At the time of this writing, approximately 95% of the MDC complex is on the card-access system, with the balance due to be finished in the near future. The final phase of this project is a total re-keying of the interior doors of the complex.

All students are urged to call the USF Health police office if they find themselves here after hours and feel that they need an escort to or from the parking lots. In the event that an officer or security guard is not available, the call is routed to the main campus police office for assistance. Additionally, the University Student Government maintains the Safe Team, a student run organization that provides security escorts, usually in lighted golf carts, for students at night. The USFPD provides many educational and training programs to students throughout the year, including Rape Aggression Defense (RAD) classes, Personal Safety classes, and Burglary and Theft Prevention classes, among others. Each year, the police officers speak to the new incoming Med I class as part of their mandated orientation session. Handouts on various subjects are distributed throughout the year; articles on security regularly appear in campus newspapers, on-line newsgroups, on-line bulletins, and newsletters. The USFPD maintains a web site that posts many emergency notices and community crime alerts in addition to providing general security and safety information to the USF community.

Security at affiliated hospitals

All hospitals serving as teaching sites have standard security personnel and protocols common to large metropolitan hospitals. These include Tampa VA and Bay Pines VA, Moffitt Cancer Center, Tampa General Hospital, and All Children’s Hospital. After-hours parking for students is secure at All Children’s Hospital, Moffitt, and Tampa and Bay Pines VA Hospitals. At the south campus complex containing Tampa General Hospital, 17 Davis Center, and Harbourside, 24-hour parking is in short supply and students frequently park in remote areas. Tampa General remote parking is in Ybor City and is available to students as well as TGH employees with a parking pass. This is a city lot and is guarded from 5 a.m. to 8:30 p.m.. Shuttle buses and security personnel escorts are available for students after hours, but students tend not to use these services. A 1400-car parking garage is planned at TGH to open in the spring of 2007 to help with parking problems. The Genesis Clinic and 30th Street Clinic are open only during the day (7 a.m. to 5 p.m.) and provide no special security measures for staff or students.

ER-6. The medical school must have, or be assured use of, appropriate resources for the clinical instruction of its medical students.

Clinical resources should be sufficient to ensure breadth and quality of ambulatory and bedside teaching. This includes adequate numbers and types of patients (acuity, case mix, age, gender, etc) as well as physical resources.

Committee Response: The Medical School has more than adequate resources for the clinical instruction of our medical students. We are fortunate to have several inpatient and several ambulatory care facilities that allow for excellent bedside and ambulatory teaching. In addition to our currently existing excellent facilities, we are adding new Ambulatory Healthcare Centers at the university as well as on the south side of town adjacent to Tampa General Hospital. The mix of patients seen on the Inpatient and Ambulatory Care Clerkships is excellent. The student logbook data attached to this report attests to that. In fact, there is considerably more patient material available than we utilize so as not to overwhelm our students. Although initially there was some concern as we were developing the Pediatric and Geriatric practices at the university, those issues have now largely resolved (Please see C-7 Clinical Teaching Facilities). The only remaining issue is that as we go to more small-group teaching, the conference room space at our inpatient and ambulatory care facilities are limited and sometimes difficult to schedule. It should be noted, however, that we are building a new Advanced Center for Healthcare at the university and it will provide additional small-group learning space. We are also building a new outpatient facility adjacent to Tampa General Hospital which will also provide additional small-group learning space. Tampa General Hospital is undergoing an expansion. Upgraded conference rooms will be a part of that expansion. Therefore, we are making progress and should have, with all this new construction, adequate small-group conference rooms at most of our facilities.

Attachment 1 - Clerkship Logbook Data

ER-7. A hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources.

Appropriate instructional facilities include areas for individual student study, for conferences, and for large group presentations (lectures). Sufficient information resources, including library holdings and access to other library systems, must either be present in the facility or readily available in the immediate vicinity. A sufficient number of computers are needed that allow access to the Internet and to other educational software. Call rooms and lockers, or other secure space to store personal belongings, should be available for student use.

Committee Response: This will be discussed by self-study committee #10.

ER-8. Required clerkships should be conducted in health care settings where resident physicians in accredited programs of graduate medical education, under faculty guidance, participate in teaching the students.

It is understood that there may not be resident physicians at some community hospitals, community clinics, and the offices of community-based physicians. In that case, medical students must be adequately supervised by attending physicians.

Committee Response: Residents are acknowledged as an integral part of the teaching team for our students on clinical rotations. To assure that the residents are prepared for this role they are given formal orientation upon entering training by the Office of GME on how to teach and evaluate medical students. This has been in place for the last three orientation cycles dating back to 2003 so that 90%+ of all residents have experienced the program. The same office presents a half-day program to all residents entering their final year of training on the same topic. This program is interactive whereas the program at the general orientation is more didactic. Clinical departments are expected to give all residents a copy of the student learning objectives and certain departments sponsor additional programs annually for the purpose of enhancing the resident’s teaching and evaluation skills. In addition, clerkship directors regularly distribute educational materials and formal student evaluation by the students includes residents in selected departments, but that is left to the discretion of the department and/or clerkship director.

ER-9. There must be written and signed affiliation agreements between the medical school and its clinical affiliates that define, at a minimum, the responsibilities of each party related to the educational program for medical students.

Written agreements are necessary with hospitals that are used regularly as inpatient sites for core clinical clerkships. Additionally, affiliation agreements may be warranted with other clinical sites that have a significant role in the clinical education program.

Affiliation agreements should address, at a minimum, the following topics:

- The assurance of student and faculty access to appropriate resources for medical student education.

- The primacy of the medical school over academic affairs and the education/evaluation of students.

- The role of the medical school in appointment/assignment of faculty members with responsibility for medical student teaching.

- Specification of the responsibility for treatment and follow-up when students are exposed to infectious or environmental hazards or other occupational injuries.

If department heads of the school are not also the clinical service chiefs at affiliated institutions, the affiliation agreement must confirm the authority of the department head to assure faculty and student access to appropriate resources for medical student education.

The LCME should be advised of anticipated changes in affiliation status of a program’s clinical facilities.

Committee Response: To specifically address the issue of medical student education, addenda have been created for addition to the affiliation agreements with the major clinical-teaching affiliates such as Tampa General Hospital, All Children’s Hospital, Moffitt Cancer Center, Shriners Hospital, Florida Department of Health, and LifePath Hospice. The addenda language was crafted by Attorney Bryan Burgess, USFPG, in consultation with the Associate Dean for Medical Education, College of Medicine, and the addenda have been executed so far by Tampa General and All Children’s Hospitals. Approval by the other affiliates is expected by June, 2006. The language in the addenda is substantially the same for each affiliate and the Tampa General Addendum can be found as an attachment to this report.

Attachment 2 - Sample Addendum to Affiliation Agreement Regarding Medical Students

ER-10. In the relationship between the medical school and its clinical affiliates, the educational program for medical students must remain under the control of the school’s faculty.

Regardless of the location where clinical instruction occurs, department heads and faculty must have authority consistent with their responsibility for the instruction and evaluation of medical students.

The responsibility of the clinical facility for patient care should not diminish or preclude opportunities for medical students to undertake patient care duties under the appropriate supervision of medical school faculty and residents.

Committee Response: Faculty supervision of student learning experiences is assured at several levels. At the highest level, a faculty committee is responsible for the development and implementation of each clerkship in collaboration with the clerkship director. The Committee on Curriculum regularly reviews each clerkship to assure it is meeting the objectives of the educational program. Only core faculty serve as clerkship directors. In turn, clerkship directors communicate with all faculty through the electronic logbook system. All faculty involved in the clerkship educational process are expected to personally oversee all aspects of the student’s clerkship experience and meet with the student regularly for both educational and feedback purposes. This includes some direct observation of the student’s patient encounters, review of clinical notes, and discussing with the student significant clinical findings from the patient at hand. Residents also participate in this process but the ultimate responsibility for the student rests with the faculty.

Required clerkships are almost exclusively staffed by core faculty. However, many of the clerkships supplement the faculty with voluntary faculty for specific purposes. This most commonly relates to generating a clinical experience for the student that is somehow unique and enhances the experience of the student in our own USF clinical venues. For example, a student might be assigned to a voluntary faculty for the purpose of a rural experience. All faculty members who participate in a required clerkship program are required to apply for and be granted voluntary clinical faculty appointments. At the assistant professor rank, such applications are reviewed by the clinical department chair. At higher ranks, a voluntary faculty appointment and promotion committee reviews the applicant’s credentials. Such voluntary faculty members are provided the educational objectives of the clerkship and are provided appropriate and necessary educational materials to support their involvement in the clerkship. Such voluntary faculty members evaluate the students at the end of each rotation and are in turn, evaluated by the student.

8 Recommendations, Possible Solutions and Strategies

• Emphasize on-going program of student training for security features and procedures at all training sites

• Provide online scheduling and technology standards for small-group-conference room; construct small group conference teaching facility

• Provide passes to students for parking on site at TGH

• Renovation of existing research lab and office space; build new research office and lab space

• Build-up research infrastructure including equipment cores and administrative support

• To be competitive for top students in the state, plan for expansion and renovation of student areas

9 Issues of Concern Relevant to Other Committees

• Classroom and small-group-conference room facilities, committee 4

• Research lab and office space, committees 2, 3, and 7

• Student safety at TGH, committee 4

• Student lounge and study room space, committee 4

Attachments

Attachment 1 - Clerkship log data and faculty assignments pp. 5, 11

Attachment 2 - Sample Addendum to Affiliation Agreements Regarding Medical Students p. 13

11 Narrative of Process

The committee met as a group on 4 separate occasions and discussed process, databases and goals. Extra data on security measures for students at clinical facilities was obtained by the committee. From these meetings, key sections of the report were drafted, circulated via the Internet, discussed, modified and approved by the committee. A preliminary report was written and submitted on March 2 discussing sections III, V, VI, and VII of the final report. The final report was submitted June 1, 2006.

12 Database Accuracy

Database section included the required LCME database elements. The committee reviewed the sections appropriate to our deliberations. The accuracy of the databases was confirmed through committee discussions.

13 Committee Membership

Thomas Klein, PhD, Self-Study Committee Chair

Professor, Molecular Medicine & Interdisciplinary Oncology

Karen Bruder, MD

Assistant Professor, Obstetrics/Gynecology

Faculty Council

John B. Downs, MD

Professor, Interdisciplinary Oncology

Patricia J. Emmanuel, MD

Associate Professor, Pediatrics

Chief, Pediatric Infectious Diseases

Mike Garry, Sergeant

University of South Florida Police Department (USF Health office)

Allan L. Goldman, MD

Professor & Chair, Internal Medicine

R. Kennedy Keller, PhD

Professor, Molecular Medicine

John Liston

Assistant Vice President, USF Health Operations and Facilities

William G. Marshall, Jr., MD, MBA

Assistant Professor, Surgery

Associate Vice President, USF Health

Clinical Research & Venture Development

Jane L. Messina, MD

Associate Professor, Pathology & Medicine

Director, Pathology Residency Training Program

David J. Orban, MD

Associate Professor & Director, Emergency Medicine/Internal Medicine

Dorothy Shulman, MD

Professor, Pediatrics

Michael Small

Medical Student, Year 4

John Mullinax

Medical Student, Year 3

Elizabeth Tatum

Medical Student, Year 2

Elizabeth Melzer

Medical Student, Year 1

Robert Belsole, MD, Administrative Liaison

Professor, Surgery

Vice Dean, Clinical Affairs

John Curran, MD, Administrative Liaison

Senior Executive Associate Dean, Academic Affairs

Patricia Haynie, PhD, Administrative Liaison

Assistant Professor, Internal Medicine, College of Medicine

Assistant Professor, Health Policy & Management, College of Public Health

Associate Vice President, Strategic Planning, Analysis & Operations, USF Health

Mohamad Kasti, MS, MBB, MCA, Administrative Liaison

Chief Operating Officer, USF Health

Joann Strobbe, MEd, Administrative Liaison

Chief Financial Officer & Associate Vice President, Finance, Administration & Technology

USF Health

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