By Simon Isham & Olivia Krauth–

The body that accredits U of L’s medical school last week placed it on probation, a step just short of withdrawing accreditation. Incoming and current medical school students told The Cardinal that it does not change their perception of the school.

“I am confident that our school will address all issues being cited,” said Matthew Woeste, president of U of L School of Medicine’s class of 2017.  “Our leadership will be very active over the next year working closely with the LCME to ensure we come into full compliance. Many of the necessary changes are already in place, which mitigates my initial concerns. This probation will be a catalyst for positive change at our university. I would choose my medical school again and again.

“The cost of medical education is undoubtedly high. I consider it one of the greatest investments I can make. I also realize our tuition is most appropriately invested into our educators and clinical experience. Both of which I would argue are the best in the state.”

One future U of L medical school student said she isn’t alarmed by the probationary status, despite the fact that the school may lose its accreditation in 2015.  “It reassures me that they’re going to be up-to-date on curriculum changes and they’ll have their new facilities,” said Megan Parker, sophomore psychology major and participant in U of L’s Guaranteed Entrance to Medical School (GEMS) program.

The medical school emailed admitted students about the probation and told them what changes the school plans to implement in response.

Dr. Toni Ganzel, dean of the U of L School of Medicine, says that the school is still a quality institution.

“If you look at our student performance and outcomes, oh, we have a great story to tell,” said Ganzel. “Our numbers are better than ever.” She said U of L medical students perform above the national average in several national medical licensing examinations, including a 99 percent pass rate on step one of the U.S. Medical Licensing Examination.


Administration knew of problems that led to probation

The Liaison Committee on Medical Education, which accredits all American medical schools, pointed out nine changes U of L must make within two years. Despite the probationary status, the university remains fully accredited.

A press release from the university said it will have to make nine policy changes to be restored to good standing. According to LCME regulations, medical schools are required to notify their students and faculty about probationary status, but not when given a warning. LCME does not comment on its warnings.

Ganzel said the school has two years to correct some specific areas that are part of the 131 LCME standards.

Specifically, the nine unmet standards were:

Not having enough active learning

Differing performance measures across sites

Needing more written feedback for students

Needing more integration across disciplines

Not having enough seats for students

Needing more reviews of their curriculum

The lack of academic affiliations with healthcare providers

A lack of lockers for all students at clinical sites

A need for more interaction between faculty across sites

The dean said the unmet standards boil down to two areas of concern:  the condition of the preclinical instructional building and pace of preclinical curricular change. The LCME noted overflowing lecture halls and cramped student study spaces.

Woeste explained that each lecture hall currently holds 160 students, with an “overflow room that streams live classroom events.” He also noted that many classes utilize Tegrity, leading to independent learning for some students.

More than three-fourths of medical students reported to U of L in April 2013 they are pleased with the study spaces available to them saying they were satisfied or very satisfied. LCME found issues with these study spaces, and Ganzel said they will be renovated soon.

The building was cited as a challenge in an April 2013 Institutional Self-Study Report, prepared by U of L for the LCME. The building was described as “adequate, but not state-of-the-art,” and it said that the lecture halls “have been updated as much as possible within the constraints of the physical structure and building codes…”

Ganzel told the Cardinal that the LCME had pointed out the inadequacy of the preclinical instructional building in earlier inspections. “They had cited us on that last time,” said Ganzel on the last LCME inspection in 2006. “We tried to make the case, at our visit a year ago, that although the building was not optimal, but it was adequate,” said Ganzel. “But the site visit team, in their judgment, felt that the building was not adequate.”

Two months ago, Ganzel gave a presentation before the Greater Louisville Medical Society in which she mentioned the inadequacy of the medical school’s facilities.

According to a U of L press release, the new building will have “two large interactive lecture halls, small group learning labs and classrooms, a new student lounge and private study areas” when completed. Architects were brought in to “completely redesign” the instructional space. Ganzel said construction has begun and the renovations are expected to be complete when students return to class this coming August.

The medical school was switching from a discipline-based curriculum to a more integrated one when Ganzel saw other schools being cited by the LCME on curricular matters.

“It’s a huge, time-consuming process,” said Ganzel about revamping curriculum. “Usually, it takes about three years and I said, ‘We’re going to have to blitz and really work to do this.’” The new curriculum will roll out this summer.


Timing of LCME report not to

U of L’s advantage

The LCME visited the university in April 2013. Ganzel, who was then interim dean of the medical school, said that many of the changes recommended in April of 2013 have already been completed, and that others are on the way.

“We are really disappointed with the probationary status, but I’m glad that the changes they are requesting that we make are things that we already implemented this year or are being implemented this coming year,” said Ganzel. Although she said several of the recommended changes were implemented in the time since LCME’s 2013 visit, LCME cannot consider them in a reevaluation.

The medical school will submit an official action plan in August, which will be considered at LCME’s October 2014 meeting. Ganzel anticipates a follow-up visit from LCME in July 2015, with a final decision on probation in Oct. 2015. A consultant from LCME will assist the medical school during the period.

“They’re holding schools to a level of accountability on the specific details of those standards that has really increased over the past few years,” said Ganzel.

When asked if LCME’s standards should reflect more on student performance, Ganzel said, “Outcome is really important. Process is important, but outcome is really key.

“They’re the ones that make the standards, and I, and other deans I know, share that vision of quality. Whatever those standards are, we will do everything we need to insure that those needs are met.”

Former professor speaks out

Dr. Peter Hasselbacher, president of the Kentucky Health Policy Institute and a former professor at U of L’s medical school, posted an entry on the KHPI’s blog the day after the school was officially placed on probation. In the post, he suggested that the nine areas of improvement Ganzel spoke about were not complete or specific.

“I have the greatest respect for Dr. Ganzel. I think she’s one of the more honest, good people at the medical school,” he said. “I think she outlined some of the major areas (from the LCME report), but most of the major areas can circumscribe everything that a medical school does … The LCME would not have pulled the trigger for minor things, things that were unimportant, so I’m assuming that there was more. It’s not her job to air all of the school’s dirty laundry.”

Hasselbacher said he believes that “the nine, not-too-terrible sounding” reasons detailed in the “Business First” article are not the sole reasons for the probation, and that there were many pages more to the report than the summaries shared with the media. He said he believes there is more to the story.

Hasselbacher said: “There are things that the school doesn’t like to talk about, like its relationship with Kentucky One Health and Catholic Health Initiatives. That was obviously a problem for the (LCME) reviewers. It’s a sensitive subject over there. When the reviewers read the contract, the affiliation agreement with Kentucky One, they thought that it invalidated many other affiliation agreements. But it may be that that agreement was rewritten, and I believe Dr. Ganzel implied that it was.”

The Cardinal has made an open-records request for the LCME report and letter, which is currently pending.

“I’ve sat on the accreditation committee for the medical school, years ago, and I know what a lot of the issues are,” said Hasselbacher. “I like to think that I can read between the lines and see just what it is that bothers the LCME.”

“I’m disappointed, ashamed, embarrassed. Members of my family went to U of L. I worked there for almost 20 years. But I must say, I’m not entirely surprised; things have not been going well for the medical school in the last few years. There have been many warnings. It may have lost its focus on the academic programs there. I think the school has denied that fact, but it’s hard to deny it now.”