Surviving the LCME Visit Lessons Learned AJ Copeland

Surviving the LCME Visit: Lessons Learned AJ Copeland, MD, FACS Clerkship Director Associate Professor Department of Surgery Uniformed Services University of the Health Sciences Bethesda, MD

Our LCME Visit • October 2015 • First institution evaluated using the new LCME standards • On the heels of a major overhaul of the medical school curriculum

LCME Outcome • Feb 2016: full 8 -year accreditation • Some reporting requirements • Diversity, Dean’s control of financial management, Strategic planning, Student Counseling • Few intersect with Clerkship directly

Preparation • • • Review LCME report from 2008 Self-study, internal Data Collection Instruments Independent Student Analysis LCME “bulletins” LCME “prep” sessions LCME “dress rehearsal”

What We Expected • Element 3. 6: Student Mistreatment • Element 5. 5: Resources for Clinical Instruction • Element 9. 1: Preparation of Resident and Non-faculty Instructors • Element 9. 3: Clinical Supervision of Medical Students • Element 9. 4: Direct Observation of Core Clinical Skills • Element 9. 8: Fair and Timely Summative Assessment

What We Expected • Element 3. 6: Student Mistreatment • Element 5. 5: Resources for Clinical Instruction • Element 9. 1: Preparation of Resident and Non-faculty Instructors • Element 9. 3: Clinical Supervision of Medical Students • Element 9. 4: Direct Observation of Core Clinical Skills • Element 9. 8: Fair and Timely Summative Assessment

What We Expected • Element 3. 6: Student Mistreatment • Element 5. 5: Resources for Clinical Instruction • Element 9. 1: Preparation of Resident and Non-faculty Instructors • Element 9. 3: Clinical Supervision of Medical Students • Element 9. 4: Direct Observation of Core Clinical Skills • Element 9. 8: Fair and Timely Summative Assessment

Student Mistreatment • Student reporting of mistreatment at USUHS consistently falls below the national averages across all subtypes • Student awareness of mistreatment policies and procedures had been significantly below the national averages

Student Mistreatment: Reported Table 3. 6 - 3. a Student Mistreatment Experiences Data Source: AAMC GQ Data 2013 -2014 Provide and review school and national benchmark data from the AAMC Graduation Questionnaire (GQ) on the percentage of medical students that reported one or more of the following experiences for the listed academic year. AY 2013 -14 Never Once Occasionally Frequently School% Nation% Publicly humiliated 82. 44 77. 35 9. 92 12. 39 7. 63 9. 55 0. 0 0. 71 Threatened w/physical violence 99. 24 98. 30 0. 0 1. 31 0. 76 0. 35 0. 05 Physically harmed 99. 24 97. 62 0. 76 2. 11 0. 0 0. 23 0. 04 Required to perform personal services 90. 15 91. 93 3. 79 4. 74 6. 06 3. 07 0. 0 0. 26 Subjected to unwanted sexual advances 95. 45 95. 57 3. 03 2. 45 1. 52 1. 80 0. 19 Asked to exchange sexual favors for grades or other awards 100. 0 99. 78 0. 0 0. 11 0. 08 0. 0 Denied opportunities for training or rewards based on gender 96. 97 94. 50 1. 52 2. 45 1. 52 2. 76 0. 0 0. 29 Subjected to offensive, sexist remarks/names 90. 91 86. 79 3. 79 5. 22 5. 30 7. 43 0. 0 0. 56 Received lower evaluation/grades based on gender 95. 45 93. 88 3. 03 4. 06 1. 52 1. 85 0. 0 0. 22 Denied opportunities for training or rewards based on race or ethnicity 99. 24 97. 12 0. 76 0. 93 0. 0 1. 44 0. 0 0. 51 Subjected to racially or ethnically offensive remarks/names 97. 69 93. 28 1. 54 3. 10 0. 0 3. 29 0. 77 0. 33

Student Mistreatment Awareness of Mistreatment Policies Among Students AY 2013 -14 USUHS % National % 74. 8 93. 3 Awareness of Mistreatment Procedures Among Students AY 2013 -14 USUHS % National % 65. 5 78. 6 Source: AAMC Graduation Questionnaire

Student Mistreatment Rx • Student mistreatment definitions and policies are now highlighted in the new student orientation • During the Transition to Clerkship week, students receive explicit training on how to recognize and respond to student mistreatment in the clinical environment • OSA now generates an annual policy reminder, via email, to ensure that it reaches our geographically disparate student body • Additional informational and periodic reminders regarding the So. M’s policies on student mistreatment are disseminated to faculty orientation and So. M- sponsored faculty development programs.

Student Mistreatment Awareness of Mistreatment Policies Among Students AY 2013 -14 AY 2014 -15 USUHS % National % 74. 8 93. 3 90. 2 94. 5 Awareness of Mistreatment Procedures Among Students AY 2013 -14 AY 2014 -15 USUHS % National % 65. 5 78. 6 70. 6 80. 8 Source: AAMC Graduation Questionnaire

Sample Questions • Do you feel that the resources available to you, as clerkship directors, are adequate to provide students with the appropriate degree of clinical instruction? • How were the objectives for your clerkship developed? Who was involved? • How do you know that all sites are adhering to the same set of objectives? • How do you ensure that your clerkship objectives are current? • How does your clerkship contribute to the overall School of Medicine goals and objectives?

Sample Questions • What types of assessments are used in your clerkship? Who developed them? • What do you do if you want to change an assessment measure? • Tell us about a challenge you faced as a clerkship director, and how you dealt with it. • How do you prepare residents for teaching in your clerkship? What information/guidance do they receive? • What document outlines the University’s approach to student mistreatment and where can it be found?

Sample Questions • How do you provide residents with feedback on the quality of their teaching to students? • How do you prepare residents to assess students? • Who determines what conditions are listed in the students’ clerkship “passport”? How do you know if a student successfully completes his/her passport? • What does your clerkship do to ensure that students are appropriately supervised? • How do you encourage self-directed learning in your clerkship?

Sample Questions • How do you provide residents with feedback on the quality of their teaching to students? • How do you prepare residents to assess students? • Who determines what conditions are listed in the students’ clerkship “passport”? How do you know if a student successfully completes his/her passport? • What does your clerkship do to ensure that students are appropriately supervised? • How do you know if students are learning what you think they should?

LCME Standard 6 • 6. 2 : Required Clinical Experiences. “The faculty of a medical school define the types of patients and clinical conditions that medical students are required to encounter, the skills to be performed by medical students, the appropriate clinical settings for these experiences, and the expected levels of medical student responsibility. ”

LCME Standard 8 • 8. 6 Monitoring Of Completion of Required Clinical Experiences. “A medical school has in place a system with central oversight that monitors and ensures completion by all medical students of required clinical experiences in the medical education program and remedies any identified gaps. ”

LCME Standard 8 8. 6 Monitoring Of Completion of Required Clinical Experiences • Looking for central “control” rather than merely “oversight” • Site visitors were dismayed that each Clerkship was using a unique method to track student core experiences • LCME designated this an issue to be monitored and reported upon

LCME Visit Pearls • • Know your vulnerabilities as a program Prepare! Be honest with the site visitors Explain your challenges and what you are doing to overcome them