More medical schools face LCME sanctions after deviating from standards

The organization that accredits U.S. medical schools has become stricter in recent years and is doling out more serious actions against schools it deems have strayed too far from national standards.

Five medical schools are on probation with the Liaison Committee on Medical Education, including one that took the LCME to court after the organization pulled its accreditation in June.

"We certainly have more schools on probation now than ever before," said LCME Co-Secretary Dan Hunt, MD. "You can go through years and years [of LCME history] and no schools are on probation."

Being placed on probation is a major hit for medical schools. School officials say they must work quickly to defend their schools' reputations and answer the LCME's concerns to avoid losing accreditation.

The LCME was formed in 1942 to oversee medical education in a collaboration of the Assn. of American Medical Colleges and the American Medical Association. The committee doesn't release year-to-year statistics of actions against schools, but its own analysis found that severe actions have more than tripled during the last 15 years.

From 1996 to 2000, only three schools were recommended for probation of 108 schools reviewed for accreditation. But from 2004 to 2009, 10 schools were recommended for probation of 107 schools reviewed.

The number of schools facing severe actions has continued to increase since then, Dr. Hunt said.

Risks of probation

LCME officials attribute the shift to 2002 revisions that helped better organize the committee's national standards. That year, the standards were reformatted and numbered, allowing the LCME to more clearly identify and reference areas of noncompliance, Dr. Hunt said.

"Now it's much easier for survey teams and schools and the LCME to see if there is compliance," said Barbara Barzansky, PhD, MPHE, LCME co-secretary and AMA director of undergraduate medical education. "There is a lot more information that is being provided to teams."

The LCME will place a school on probation if it is deemed to have a history of noncompliance or if the committee believes a violation of standards jeopardizes the quality of education, Barzansky said.

Schools are notified that they have been recommended for probation and can appeal. If the probation moves forward, schools must submit an action plan showing how they plan to address the LCME's findings.

"The LCME is bound by regulations of the U.S. Dept of Education, which says that deficiencies need to be addressed within two years," Barzansky said. "Unless there is an extension for good cause -- such as revenue sources or needing to build a building -- something that is out of the school's control."

Schools now on probation are the School of Medicine at the University of Texas Health Science Center at San Antonio; Marshall University Joan C. Edwards School of Medicine in Huntington, W.Va.; the Commonwealth Medical College of Scranton, Pa.; and Ponce School of Medicine in Ponce, Puerto Rico.

A fifth school, San Juan Bautista School of Medicine in San Juan, Puerto Rico, lost LCME accreditation in June, but it was reinstated at a Nov. 16 LCME appeals hearing ordered by the federal district court in Puerto Rico. The school is on probation pending a full survey visit scheduled for early 2012.

Violations differed among the schools. Among problems cited were a lack of policies to ensure diversity among students and faculty, no central management of clinical programs and a heavy reliance on lecture courses for the first two years of medical school.

Making corrections

The LCME notified the University of Texas Health Science Center at San Antonio that it had been placed on probation in a June 16 letter. In a Sept. 12 letter, the school responded by saying, in part, that the LCME had found the school in compliance as recently as February 2008. "In addition, the curriculum and procedures that the LCME evaluated during the site visit of January 2011 were the same as those approved within the previous three years," the letter said.

Being put on probation is a significant reprimand and has required the school to respond to numerous media inquiries and address the concerns of the community, said Francisco Gonzalez-Scarano, MD, dean and vice president for medical affairs for the school.

"In that sense, it is a distraction from our main purpose, which is to improve the medical education for our students," he said. "The potential plus side, if there ever is one, is that it does focus the institution very effectively in examining its educational programs."

The Marshall University School of Medicine was notified that it had been recommended for probation in June. An appeal in October failed to reverse the LCME's decision.

"It does affect recruiting of students," said Robert C. Nerhood, MD, who became the school's dean in July. "We've had to work pretty hard to try to reassure the students that we are going to deal with the LCME's concerns.

"We are fully accredited. We have no intention of being discredited. We will do whatever needs to be done to restore full accreditation," he said.

Representatives of all the schools said they are working to show the LCME that they are in compliance with its standards. Dr. Hunt said schools need to stay on top of the national standards to avoid problems.

"We tell schools, 'This is not your father's LCME,' " he said. "In order to avoid embarrassing situations, you can't wait until a year or so before your survey to go back and look at the standards. I think that's what you could do in the early days. That doesn't work now. Schools need to be continuously monitoring this."