The headline above appeared in two local news outlets yesterday and is exactly the kind of publicity the University of Louisville does not need. The story was broken<\/a> by David Mann of Business First reacting to a news release from the University. In a subsequent interview, Medical School Dean Toni Ganzel outlined some nine areas of concern to the Liaison Committee On Medical Education (LCME<\/a>) that oversees the accreditation of American Medical Schools. It is by no means clear that all identified problems or their severity have been made public.<\/p>\n As it is, the deficiencies that were identified are fundamental to the basic mission of a medical school: teaching facilities were inadequate, the method of teaching was behind the times, the curriculum needed review, evaluation of students was uneven without appropriate feedback to the students, cooperation among different medical and scientific disciplines was not sufficient, faculty integration with off-campus teaching sites was sub-optimal, and academic affiliations with hospitals were not clear. What else is there to go wrong?<\/p>\n I have always admired Dean Ganzel. She did not create this embarrassing problem, but she was left holding the bag, probably without the authority or the resources to fix it. Control of the Medical Center, including its clinical activities, rests in the President\u2019s office. She obviously needs to minimize the damage and present the matter honestly and in the best possible light. She was effective to the point that the Courier-Journal printed a sub-headline quote<\/a>: \u201cI don\u2019t think this decision is based on the overall quality of the educational experience.\u201d A medical student volunteered that \u201cshe had a good experience.\u201d Would a student have dared say anything else?<\/p>\n Not a big deal?<\/strong> \u201cAccreditation with probation is an action based on determination by the LCME, \u2026 that an accredited program is not in substantial compliance with accreditation standards. Such a determination may be based on the LCME’s judgment, \u2026 that the areas of noncompliance have seriously compromised the quality of the medical education program, or that the program has failed to make satisfactory progress in achieving compliance after having been granted ample opportunity to do so.\u201d<\/p><\/blockquote>\n We do not yet know whether or not the University of Louisville\u2019s Medical School was placed on probation because of serious compromise of quality, or because it did not make satisfactory progress after having had a chance to do so. Which possibility is worse?<\/p>\n There is a category of accreditation one level less damaging than probation\u2013 \u201cAccredited, on warning.\u201d \u00a0Inclusion in this category results if:<\/p>\n \u201c1) one or more areas of noncompliance of recent origin that will, if not corrected promptly (within 12-24 months as determined by the LCME), seriously compromise the ability of the school to conduct the educational program; or 2) one or more areas of noncompliance identified in a previous survey visit that have not been adequately addressed in the interim or have re-emerged as areas of noncompliance.\u201d<\/p><\/blockquote>\n I do know know if UofL received this kind of warning, if so they did not advertise it. My re-reading of the self-examination conducted last year suggests that the school was aware of some of the problems identified by the LCME, perhaps related to the site-visit or \u00a0preparation for it in some way. \u00a0If the school had been warned and was unable to remediate deficiencies, that would be a bad omen indeed. I will ask to see copies of the correspondence between the LCME and the University. Despite its frequent postures otherwise, UofL is a public University. \u00a0We have a right to know how our public funds are being spent and who should be held accountable.<\/p>\n “The survey report and the letter transmitting the accreditation decision will be held confidential by the LCME. The final report may be disclosed by the medical school at its discretion.”<\/p><\/blockquote>\n Why might we be hearing about this?<\/strong><\/p>\n Perhaps the fact that the reflexive non-disclosure position of the University is lifting a little at all is due the mandate by the LCME:<\/p>\n \u201cAny program placed on probation must promptly notify all enrolled students, those newly accepted for enrollment, and those seeking enrollment, of this accreditation status; failure to do so may result in withdrawal of accreditation.\u201d \u201cAn educational program is not required to notify students and the public about a “warning” action, but is free to do so.\u201d<\/p><\/blockquote>\n Who else is on probation?<\/strong> Might the Medical School have to close? (It could be worse!)<\/strong> We must see changes at UofL and in its enabling community.<\/strong> Peter Hasselbacher, MD [Addendum April 26, 2014. \u00a0I filed a Freedom of Information Act request to obtain copies of the survey report and attendant correspondence along with any other materials the School of Medicine thought would enable me to report accurately and fairly on the matter of its probation. \u00a0I received the four documents available below consisting of a portion of the site visit report ( but without the appendices that\u00a0include student and faculty survey results), a letter indicating\u00a0an intention to appeal an early notice impending probation (not provided),\u00a0the full appeal by the medical school, and a\u00a0final letter to President Ramsey indicating\u00a0that the decision to place the school on probation was upheld and was final. \u00a0It is my intention to review the additional voluminous materials not sent in person. In the meantime, these documents are in the public\u00a0domain and readers can begin to draw their own conclusions.]<\/p>\n LCME Documents<\/strong> Let me know if you have problems with\u00a0the size of the report file.<\/p>\n
\nThe school\u2019s understandable impulse is to make it sound like this is no big deal, and that most of the remedies have already been made or are on track. This self-portrait is belied by the language used<\/a> by the LCME itself.<\/p>\n
\nProbation of a medical school is apparently not an everyday event. Currently there are only three American medical schools on probation. One is in Puerto Rico, and the second a school in North Chicago. Both schools have had recurring problems with accreditation. UofL is not in good company. \u00a0No schools “on warning” are listed on LCME site<\/a>. Indeed, UofL was not identified as being on probation until yesterday afternoon after I contacted the LCME for information. Perhaps yesterday was \u201cP-Day,\u201d but the school knew months ago that its teaching facilities were considered to be inadequate. Probation was probably not a surprise.<\/p>\n
\nI am unaware that any American Medical School has had to close because its accreditation was withdrawn. Perhaps one our our readers can help me. It is hard for me to believe that the US Medical School enterprise would allow one of its members to fail altogether. (The LCME is jointly sponsored by the Association of American Medical Colleges and the Council on Medical Education of the American Medical Association.) However, major reorganizations may be demanded. I do not believe that an easy path to full accreditation is the done-deal that our school would like us to believe. In a past life I sat on the University\u2019s Accreditation Committee and know the difficulty of turning the barge around, and the risk of not doing so. I have even heard legislative voices wondering if a University of Kentucky School of Medicine- Louisville Campus<\/em> might not serve the state\u2019s needs better than our present over-competitive and minimally cooperative system of three schools (don\u2019t forget about Pikeville Osteopathic School of Medicine). UofL needs to get its act together for many reasons. The stakes are high.<\/p>\n
\nThere is no question that yesterday\u2019s announcement of probation was sad news for all of Louisville, including me, who spent the better part of my professional career on its faculty. I also admit to feeling more than disappointed if not betrayed. This blot on our reputation could have been avoided. Many voices in our community have been warning that the University\u2019s emphasis on its commercial research enterprise, its real estate ventures, its sports ambitions, and its plan to fund the University on the back of its clinical activities were compromising its fundamental mission as an educational institution for the citizens of Kentucky. \u00a0Those warnings can no longer be discounted or spun away. The University took its eye off the ball and can no longer pretend that all is well behind its academic walls. Its primary mission is badly compromised. Hopefully the shock-therapy applied by the LCME will force needed changes; that leadership of this public resource will be held accountable; and that enabling community and government interactions supporting an obviously flawed status quo<\/em> will be reconsidered. Our students deserve better.<\/p>\n
\nPresident, KHPI
\nEmeritus Professor, UofL
\nMarch 14, 2014<\/p>\n
\nReport of\u00a0Team on Site-visit of April 14-17, 2013. \u00a0(32 MB PDF)<\/a>
\nLetter of Intent to Appeal Decision, Nov 7, 2003. \u00a0 (1.1 MB PDF)<\/a>
\nFormal Letter of Appeal, Jan 28, 2014. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0(3.4 MB PDF)<\/a>
\nNotification of Probation, Mar 13, 2014. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 (1.7 MB PDF)<\/a><\/p>\nShare this:<\/h3>