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ACGME
Weighs In On WSU/DMC
By
PAUL NATINSKY
While the immediate graduate medical education
crisis at WSU/DMC has been averted by a three-and-a-half-year
contract, underlying issues remain, including those
addressed in a Dec. 6 letter from the Accreditation
Council for Graduate Medical Education.
The
letter is addressed to the WSU/DMC Dean of Graduate
Medical Education and Vice President Academic Affairs,
Mark Juzych, MD, from Pat Surdyk, Executive Director
of the ACGME Institutional Review Committee. It grants “Continued
Accreditation” but contains five citations and mandates
a progress report by Feb. 1, 2007.
The
citations are listed below. In addition to the corrections
required by ACGME looms the issue of the institutions’ reputation
with prospective residents and fellows. It is widely
acknowledged that damage has been done, but the extent
won’t be known until the next resident match process
takes place and rankings appear for the program.
Look for continuing coverage in the Detroit Medical
News magazine as well as the e-newsletter.
AREAS
NOT IN SUBSTANTIAL COMPLIANCE (CITATIONS)
The
Review Committee cited the following areas as not
in substantial compliance with the ACGME's Institutional
Requirements:
Citation
#1
Previous Citation, Statement of Commitment: The Sponsoring
Institution continues to demonstrate non-compliance by failing
to maintain a current signed statement outlining its commitment
to provide the necessary educational, financial, and human
resources in support of GME. The recent mediated joint sponsorship
agreement focuses primarily on the clinical relationship of
the partners that comprise the Sponsoring Institution. It provides
no evidence that the governing authorities, administrations,
and GME leadership of these partners will engage in joint efforts
to support the best interests of its residents and GME programs.
The Sponsoring Institution's continued failure to comply with
this requirement is a matter of serious concern to the Institutional
Review Committee (IRC), especially in ascertaining the partners'
joint accountability for their responsibilities and commitment
as the Sponsoring Institution.
Citation
#2
Institutional Responsibilities, Designated Institutional Official
(DIO) Annual Report: The DIO did not deliver an annual report
to Oakwood and William Beaumont Hospitals. The DIO's responsibility
to deliver an annual report on behalf of the Sponsoring Institution
extends to all participating institutions.
Citation
#3
Institutional Responsibilities, Organized Administrative System:
The organizational chart included in the Institutional Review
Document (IRD) identifies two separate organizational structures
responsible for GME. Rather than delineating how the Sponsoring
Institution functions as a single entity with administrative
oversight for the GME program, the organization chart depicts
two boards, one of Wayne State University (WSU) and one of
Detroit Medical Center (DMC) with the DIO functioning as Assistant
Dean and Vice President of Academic Affairs in what appears
to be a dual reporting role. In general, the organizational
structure with two separate lines of authority could be construed
as not supporting a unified commitment to GME on the part of
the joint partners that form the Sponsoring Institution.
Citation
#4
Institutional Responsibilities for Residents, Resident Work
Environment: The Sponsoring Institution does not maintain a
learning environment in which residents can consistently raise
and resolve issues without fear of intimidation or retaliation.
Although residents report they have the opportunity to provide
annual evaluations of the faculty and their programs, communication
between the residents and administrative staff at DMC does
not meet the expectations outlined in the Institutional Requirements.
Residents fear retaliation when interacting with unnamed administrative
personnel at the DMC.
Citation
#5
Institutional Responsibilities for Residents, Resident Work
Environment: Although residents indicate that the Sponsoring
Institution provides adequate and appropriate call rooms in
most cases, they report a shortage of call rooms in Anesthesiology.
Citation
#6
Internal Reviews, Process-Scheduling: Although most internal
reviews were conducted at mid-cycle, the reviews for Pediatric
Hematology/Oncology and Radiation Oncology were both late.
At the time of the next review, the institution's accreditation
status will be in jeopardy if these areas have not been addressed
satisfactorily and/or other major areas warranting citation
develop.
REQUEST
FOR PROGRESS REPORT
The Review Committee requests a progress report in which each
of the following citations is addressed. This information is
requested in triplicate by the date given above. The Committee
warned that an inadequate response to the following issues
could result in a shortened review cycle.
Citation(s) - # 1; # 3; # 4;
The
following documentation should be included in the
progress report:
Citation
# 1
The signed statement of commitment in compliance with Institutional
Requirements, II.A 1.
Citation
# 3
An organizational chart to complete Attachment 2 of the IRD,
in compliance with Institutional Requirements, I.B.1-2, II.B.2.
Citation
# 4
Development of a forum by which resident staff can communicate
with DMC administration supported by carefully-selected, impartial
faculty to ensure that: 1) resident concerns regarding their
experience at DMC will be addressed in a protected and effective
manner; and, 2) that these issues will be reviewed and implementation
of any resulting improvements and/or changes monitored by the
Sponsoring InstitutionGs GMEC as required by Institutional
Requirements III.F.1., III.F.1.a-b.
At
the next site visit, the IRC will pay particular
attention to how the Sponsoring Institution will
demonstrate its joint commitment to addressing the
administrative issues that have contributed to its
past instability. These critical issues are detailed
in Citations #1, #3, and #4 listed above. Implementation
will be carefully reviewed by the site visitor as
will the Sponsoring Institution's ability to maintain
the appropriate competency-based educational programs
required for an effective GME program, with faculty,
program directors, and administrators having sufficient
time and resources to devote to their respective
programs.
The
IRC also noted, as mentioned earlier in this letter,
that the current mediated agreement focuses largely
on structural issues between the two partners that
comprise this Sponsoring Institution. The agreement
outlines continued changes over the next several
years that will result in three separate institutions,
with the Sponsoring Institution remaining, while
WSU and DMC evolve as independently accredited sponsoring
institutions. This situation will require both WSU
and DMC to develop independent GME organizational
structures that comply with the Institutional Requirements,
requiring separate institutional review by the IRC.
The complexities of these evolving structures must
be taken into account as the joint partners consider
future plans; such eventual changes cannot impede
the move toward a stable, committed joint arrangement
as presented by the current Sponsoring Institution.
Underlying the structural complexities represented
in the current agreement, the best interests of the
residents and their education must be preeminent.
The residents have been eloquent in their support
for the Sponsoring Institution, for the quality education
they believe they now receive, and for their hope
that their education will continue in a stable environment.
The Sponsoring Institution's commitment and efforts
to maintain such a setting will be closely monitored
over the next several years.
It
is the policy of the ACGME and of the Review Committee
that each time an action is taken regarding the accreditation
status of a institution, the residents and applicants
(those invited for interviews) must be notified.
This office must be notified of any major changes
in the organization of the program. When corresponding
with this office, please identify the program by
name and number as indicated above. Changes in participating
institutions and changes in leadership must be reported
to the Review Committee using the ACGME Accreditation
Data System.
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