University of South Florida College of Medicine



University of South Florida

College of Medicine

LCME Institutional Self-Study

Report of Committee Six:

Medical Students: Student Services/

Learning Environment

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 5

V. Areas of Strength 5

VI. Areas of Concern and Challenges 6

VII. Review of Compliance with Established LCME Standards 6

VIII. Recommendations, Possible Solutions and Strategies 10

IX. Issues of Concern Relevant to Other Committees 10

X. Attachments 10

XI. Narrative of Process 11

XII. Database Accuracy 11

XIII. Committee Membership 11

1 Executive Summary/Key Issues

STUDENT SERVICES

• Outstanding Office of Financial Aid services available

• Office of Student Affairs plays key role with students immediately upon matriculation

• Student Records maintained in a confidential and safe environment

• Students are transitioned into medical school through a very careful process that includes orientation and the Profession of Medicine course. Independent counseling services are available at all times for students.

LEARNING ENVIRONMENT

• Students have adequate study space, lounge areas, and locked areas to put away valuables at all clinical sites

• Policies for advancement and disciplinary action of students are fair and readily available to students

• Policies for teacher-learner conduct exist in the College of Medicine

• The process of selecting a residency by the student is enhanced by choosing a faculty advisor prior to the beginning of the 4th year of medical school and counseling about residency selection and electives is readily provided to the student

• Students are allowed to review their grades and evaluations and challenge their grade/evaluation when appropriate

2 Responses to Questions in Guide to Institutional Self-Study

5. Comment on the levels of student attrition and academic difficulty in relation to your school’s admission requirements, academic counseling efforts, and remediation programs. How effective are counseling and remediation systems?

Committee Response: The attrition rate at the college is low as noted in the report. Students encountering academic difficulties receive excellent support from the Offices of Student Affairs and Academic Enrichment. Since the last LCME report the completion rate for admitted students has remained high with an approximate graduation rate of 98% (576 graduates/588 matriculants) of admitted students. Approximately 15% of students over the past six years have significant academic difficulty including course exam failures (more than one), shelf exam failures, course failures, or USMLE Board failures. Thus, the majority of the students experiencing significant difficulties are successfully remediated. This results from close monitoring of student performance by course directors as well as the Offices of Student Affairs and Educational Affairs and follow-up of all failing scores including academic counseling, personal counseling, and tutoring services.

6. Analyze the pattern of career choice among your recent graduates. Is the pattern congruent with your school's mission and goals? Evaluate the effectiveness of your systems of career counseling, residency preparation, and the selection of elective courses.

Committee Response: The pattern of career choices has been relatively stable for the past six years for graduates from the college with one notable exception. There has been an increasing trend for graduates to do their residency training in Florida. The increase has risen from 38% in 2001 to 65% in 2006. The graduates continue to choose a diverse group of specialties (range of 17 (2001 and 2004) to 21 (2006). Approximately 40% of all graduates over the 6-year period have selected a primary care specialty (family medicine, internal medicine, medicine-pediatrics, or pediatrics). The career-counseling, residency-preparation, and elective-selection all work extremely well. Students consistently report receiving the support necessary to make informed choices on residency and the majority of students match at one of their top choices. These outcomes are highly consistent with the missions of the college to prepare students to enter any area of medicine they desire, to satisfy the needs for primary care physicians and to train future doctors for the state of Florida.

7. Evaluate the level of tuition and fees in relation to the size of graduates’ accumulated debt, and to the level of financial aid needed and available. What is the school doing to minimize student indebtedness? Comment on the effectiveness of debt counseling programs.

Committee Response: The level of tuition and fees is about 55% of the annual costs of medical school per annum and is somewhat less compared to overall indebtedness at the end of four years as a result of the use of a majority of scholarship funds on a needs-based apportionment. Scholarship funding is about 12% of all student costs. Student indebtedness is addressed in annual presentations to students to try to limit debt accumulation and manage indebtedness. USF COM students are below the average for public universities in the level of debt.

8. Evaluate the adequacy of student support in the following areas:

Committee Response:

• Personal counseling and mental health services.

HELPS program provides comprehensive counseling and mental health services independent of any faculty. In addition, students receive counseling from faculty on a requested basis and from the assistant and associate deans of Student Affairs on a daily basis.

• Preventive and therapeutic health services, including immunizations and health and disability insurance.

Student health service provides primary health-care appraisal and services for all USF students. There is an infectious diseases nurse at the medical center to help students in the event of a medical exposure incident, routine PPD testing, and some immunizations. A requirement for student health and disability insurance ensures that students are properly covered.

• Education of students about bodily fluid exposure, needle stick policies, and other infectious and environmental hazards associated with learning in a patient-care setting.

Education is provided to students at orientations (Year 1 and Year 3 as well as for the Longitudinal Clinical experience course) about exposures, needle sticks, and other infectious and environmental hazards by the infectious diseases nurse or clinical faculty members. Students carry exposure contact information at all times.

9. Comment on the effectiveness of school policies for addressing allegations of student mistreatment, and for educating the academic community about acceptable standards of

conduct in the teacher-learner relationship.

Committee Response: The Office of Student Affairs and the individual departments of the College of Medicine each have developed policies in the event that students feel as if they were mistreated on their clinical or classroom assignment. Although there are some programs in place such as resident education on how to teach and to incorporate medical students as part of a medical team, this committee feels that having a formalized process, such as a student-faculty compact should be considered.

10. Evaluate the familiarity of students and course/clerkship directors with the school’s standards and policies for student advancement, graduation, disciplinary action, appeal, and dismissal. Review the adequacy of systems for providing students with access to their records, and assuring the confidentiality of student records.

Committee Response: The responses to the LCME standards below will highlight the completeness and thoroughness of our Student Handbook in addressing all of the above items. Student records are available in the Office of Student Affairs and confidentiality is maintained as described in the LCME standard response below.

11. Assess the adequacy and quality of student study space, lounge and relaxation areas, and personal storage facilities. Do available resources for study contribute to an environment conducive to learning?

Committee Response: Study areas and personal locker space are available on request at all hospitals affiliated with the USF College of Medicine. The only concern raised by students on the committee were related to the main student lounge area on campus, and that issue is being actively addressed by a separate committee with construction already begun on the new student lounge.

3 Analysis of Recommendations and Deficiencies Relevant to Committee as Identified

by Most Recent LCME Review in 1999

Survey Team Report:

While not constituting violations of accreditation standards, there are opportunities for improvement in some areas

• There is a limited amount of funding available for scholarships. Among other things, this limits the ability of the college to meet its objectives related to the recruitment of underrepresented minority students.

5 Major Changes Since Last LCME Review in 1999

No major changes since last LCME Review, other than increase in scholarship funding as will be noted below.

6 Areas of Strength

All student health services are a great strength here at USF in view of many of the standards noted above. Our committee has been very satisfied with the work done by the Office of Student Affairs, Office of Academic Enrichment, Student Health Services, and Office of Financial Aid to name a few. The adaptation process of first-year students as they begin medical school is incredibly strong, and the preparation for making residency choices and career planning is also outstanding.

7 Areas of Concern and Challenges

The major area of concern has been as mentioned with developing a written faculty-student compact on behavior, and also with better defining resident-student relationship and education. Scholarship money is maximized as best as possible given the current source of funding as noted in the document above.

8 Review of Compliance with Established LCME Standards

MS-18. The system of academic advising for students must integrate the efforts of faculty members, course directors, and student affairs officers with the school’s counseling and tutorial services.

There should be formal mechanisms for student mentoring and advocacy. The roles of various participants in the advisory system should be defined and disseminated to students. Students should have options that allow them to obtain advice about academic issues or academic counseling from individuals who have no role in making promotion or evaluation decisions.

Committee Response: The database emphasizes the strong role that mentoring and advocacy has here at the USF College of Medicine. The Profession of Medicine course was recognized as a nice tool for the adaptation of medical students into the academic system, and the course allows them to work with senior medical students and faculty physicians on developing basic exam skills and presentation skills during the first three weeks of medical school.

Learning Community is a required activity for all students that places first year medical students with their counterparts in the medical school and with two faculty advisors.

There are other programs identified in the database that are available at all times from the pre-matriculation period to the clinical year’s period.

MS-19. There must be a system to assist students in career choice and application to residency programs, and to guide students in choosing elective courses.

Committee Response: The database identifies our strengths in this item. The Careers in Medicine website is a praised tool used by medical students in helping them make important decisions on their future specialty. The workshop run by Dr. John Molidor has drawn high praise by both student and by faculty in regards to its completeness and its usefulness. An academic advisor is selected by students to discuss career choices during their third year of medical school and that faculty individual is instrumental in the formation of the 4th year schedule for the student

MS-20. If students are permitted to take electives at other institutions, there should be a system centralized in the dean’s office to review students’ proposed extramural programs prior to approval and to ensure the return of a performance appraisal by the host program.

Committee Response: The database clearly reflects the process for this item, and students are able to view this process in the Student Handbook

MS-21. The process of applying for residency programs should not disrupt the general medical education of the students.

Students should not be exempted from any required educational experiences or assessment exercises in order to pursue other activities intended to enhance their likelihood of obtaining a desired residency position.

Committee Response: Students are given two elective periods during their fourth year of medical school to use for the sole purpose of going to interviews for residency. The students are encouraged to use their free periods during the height of interview season for the specialty that they have chosen for their match. There is plenty of time with this flexibility in schedule for those students to also interview for preliminary first-year positions if they are required to complete a year before entering their chosen specialty

MS-22. Letters of reference or other credentials should not be provided until the fall of the student’s final year.

Committee Response: The Letters of Recommendation are not released until the fall of the senior year of medical school. The Dean’s Letter is released on November 1 of each academic year.

MS-23. A medical school must provide students with effective financial aid and debt management counseling.

In providing financial aid services and debt management counseling, schools should pay close attention and alert students to the impact of non-educational debt on their cumulative indebtedness.

Committee Response: The process of financial aid here at USF was studied by the committee and its student members, and the consensus here is that the Office of Financial Aid is extremely helpful to all medical students in need of financial aid. The office recognizes the difficulty in arranging appointments during the clinical years and makes every effort to schedule appointments that fit into those students’ schedules.

MS-24. Medical schools should have mechanisms in place to minimize the impact of direct educational expenses on student indebtedness.

The LCME considers average student debt, current and the trend over the past several years: total number of students with scholarship support and average support per student: percentage of total financial need supported by institutional and external grants/scholarships, and the presence of activities at the school or university levels to enhance scholarship support as key indicators in the assessment of compliance with this standard. In addition, the LCME will consider the entire range of other activities that a school could engage in, such a limiting tuition increases and/or supporting students in acquiring external financial aid.

Committee Response: Scholarship money at USF has increased since the last site visit in 1999. Available resources are maximized to the benefit of the students. A table showing the increases in scholarship money since the last LCME visit is available from the Office of Financial Aid.

MS-25. Institutions must have clear and equitable policies for the refund of tuition, fees, and other allowable payments.

Committee Response: The Student Handbook clearly details the process of policies for refund of tuition, fees, and other payments to students who withdraw from the medical school. The Student Handbook is available online on the Student Affairs webpage.

MS-26. Each school must have an effective system of personal counseling for its students that includes programs to promote the well-being of students and facilitate their adjustment to the physical and emotional demands of medical school.

Committee Response: Personal counseling is available to students at many different levels. The Student Handbook highlights these, including an outside association (Wood and Associates) which comments on the effectiveness of the HELPS program.

MS-27. Medical students must have access to preventive and therapeutic health services.

Committee Response: Health care services are provided by the Student Health Services (SHS) at the University of South Florida as highlighted in the Student Handbook. Students on the committee were satisfied with their past experiences with SHS.

MS-27-A. The health professionals who provide psychiatric/psychological counseling or other sensitive health services to medical students must have no involvement in the academic evaluation or promotion of the students receiving those services.

Committee Response: The Student Handbook and the database highlight completion of this standard by the medical school.

MS-28. Health insurance must be available to all students and their dependents, and all students must have access to disability insurance.

Committee Response: All students must provide verification of health insurance at the start of each academic year to the Office of Student Affairs. They are also required to have disability insurance, which is purchased through the Office of Student Affairs.

MS-29. Medical schools should follow accepted guidelines in determining appropriate immunizations for medical students.

Medical schools in the U.S. should follow guidelines issued by the Centers for Disease Control and Prevention, along with those of relevant state agencies. Canadian schools should follow guidelines of the Laboratory Center for Disease Control and relevant provincial agencies.

Committee Response: The Student Handbook highlights the strength of this standard at USF.

MS-30. Schools must have policies addressing student exposure to infectious and environmental hazards.

The policies should include 1) education of students about methods of prevention; 2) the procedures for care and treatment after exposure, including definition of financial responsibility; and 3) the effects of infectious and environmental disease or disability on student learning activities. All registered students (including visiting students) need to be informed of these policies before undertaking educational activities that would place them at risk.

Committee Response: There are occupational health resources available at the university and at all affiliated hospitals. Students are provided orange cards with the numbers of offices and people to contact if they suffer an illness or accident at each affiliated hospital. This policy is discussed at the beginning of each clerkship as well. No need for improvements were identified by the committee.

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.

The standards of conduct need not be unique to the school but may originate from other sources such as the parent university. Mechanisms for reporting violations of these standards -- such as incidents of harassment or abuse -- should assure that they can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, and support educational activities aimed at preventing inappropriate behavior.

Committee Response: The database reflects its material from the Student Handbook regarding student abuse, sexual harassment policy, sexual battery policy, and victim’s advocacy policy.

No weaknesses noted in those policies.

The committee recommends that we should possibly explore developing a student-faculty compact on behavior as to what will be acceptable to the working relationship between these two parties.

The committee also feels that a resident-student teaching policy should be developed, and to further explore if there is sufficient resident orientation on how to teach students in the current graduate medical education program

MS-33. The medical school must publicize to all faculty and students its standards and procedures for the evaluation, advancement, and graduation of its students and for disciplinary action.

Attach a copy of, or web site URL for, the school’s standards and procedures for the evaluation, advancement, and graduation of students, and the procedures for disciplinary action. How are these standards and procedures publicized to faculty members and students?

Committee Response: The Student Handbook describes clearly all policies for disciplinary actions and appeals. No action was recommended by the committee in this area

MS-34. There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, or dismissal.

Committee Response: The due process for grade appeals as well as disciplinary action hearings and appeals are listed in the Student Handbook. The appeals process including all parties involved in the algorithm are detailed in that section.

MS-35. Student records must be confidential and available only to members of the faculty and administration with a need to know, unless released by the student or as otherwise governed by laws concerning confidentiality.

Committee Response: Student records are maintained in fireproof safes in the Registrar Office. Confidentiality laws are followed closely as detailed in the Student Handbook.

MS-36. Students must be allowed to review and challenge their records.

Committee Response: The process of appealing a grade to the faculty member and to the department chairperson are clearly outlined in the Student Handbook and have been included in the database. Students on the committee were very satisfied with the appeals process.

MS-37. Schools should assure that students have adequate study space, lounge areas, and personal lockers or other secure storage facilities.

Committee Response: Study areas and personal locker space are available on request at all hospitals affiliated with the USF College of Medicine. The only concern raised by students on the committee were related to the main student lounge area on campus, and that issue is being actively addressed by a separate Committee, with construction already begun on the new student lounge.

9 Recommendations, Possible Solutions and Strategies

None.

12 Issues of Concern Relevant to Other Committees

Student lounge space was being examined by a separate committee as noted above.

13 Attachments

None.

14 Narrative of Process

The committee met five times during the period of late November 2005 through April 2006. Meetings were held at USF from 5 PM to 7 PM. Attendance at the meetings was good and members did their required assignments. Medical students were very active in the individual meetings.

15 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.

16 Committee Membership

Joe Lezama, MD, Self-Study Committee Chair

Associate Professor, Internal Medicine

Assistant Program Director, Internal Medicine

Chief, Medical Service, James Haley Veterans Hospital

Michael Albrink, MD

Associate Professor, Surgery

Lynn Crespo, PhD

Associate Professor, Molecular Pharmacology & Physiology

Director, Pharmacology Education

Peter Dunne, MD

Professor & Chair, Neurology

Elamin M. Elamin, MD

Associate Professor, Anesthesiology & Medicine

John Greene, MD

Professor, Interdisciplinary Oncology & Internal Medicine

Chief, Interdisciplinary Oncology

Monina S. Mabuti, MD

Assistant Professor, Internal Medicine

James C. Mayer, Jr., MD

Associate Professor, Obstetrics/Gynecology

Director, Undergraduate Women’s Health Care Education

Keith R. Pennypacker, PhD

Associate Professor, Molecular Pharmacology & Physiology

Samuel Saporta, PhD

Professor, Pathology & Cell Biology

Faculty Council

John Sinnott, MD FACP

Professor, Internal Medicine

Associate Dean, International Affairs

Clinical Director, Signature Research Program in Allergy,

Immunology & Infectious Disease

Antoinette C. Spoto-Cannons, MD

Assistant Professor, Pediatrics

Director, Undergraduate Children’s Health Care Education

Michael Harrington

Medical Student, Year 4

Christy Shamas

Medical Student, Year 3

Lisa Moody

Medical Student, Year 2

Patrick Teefey

Medical Student, Year 1

Steven Specter, PhD, Administrative Liaison

Professor, Molecular Medicine

Associate Dean, Admissions & Student Affairs

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