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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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