University of Arizona medical school in Tucson fails to get full 8-year extension for accreditation

A medical school class at Tucson’s College of Medicine || Facebook

By Alison Steinbach || Arizona Republic

All is not in perfect health at Arizona’s flagship medical school.

The national accrediting group for the University of Arizona College of Medicine — Tucson did not grant the school the typical eight years of approval until its next survey during a recent program evaluation.

Instead, the Liaison Committee on Medical Education, which reviews and accredits American medical schools, is requiring follow-up to address areas of concern ranging from student satisfaction to school processes.

The committee informed UA President Robert Robbins this summer that the College of Medicine — Tucson MD program would continue with full accreditation, but “for an indeterminate term,” with further consultation this winter and a virtual limited survey visit in 2023 or 2024.

UA’s newer medical school in Phoenix, on the other hand, received continued full accreditation with its next full survey visit scheduled for the 2029-30 school year, even though some issues were raised, including about the school’s affiliation with Banner Health.

This is the first time the Tucson college has received accreditation only for an indeterminate term, school officials said.

Accreditation for an indeterminate term means the Tucson medical school must work to address areas of noncompliance and underperformance before the accreditor will set the date of the next full evaluation.

If the school hasn’t made enough progress by the time the limited review happens next year or the year after, the accreditor could place the medical education program on probation or remove its accreditation, committee members informed Robbins in a letter.

“We are very confident that we will address all these issues,” said Dr. Kevin Moynahan, vice dean for education at UA College of Medicine — Tucson.

“There’s not even a hesitation, not even a bit of not being confident that we are going to address all these issues. … We’ve addressed the majority of them already even long before they (LCME) will get here.”

Medical schools need accreditation from the Liaison Committee on Medical Education for certain federal funding, state licensure and student eligibility to take the licensing exam and enter residency programs.

Programs typically are reviewed on eight-year cycles, but that timeline can shorten if there are areas of noncompliance with accreditation standards that need monitoring. Tucson’s review in 2023-24 will be a “limited” virtual survey rather than a full review.

Dr. Veronica Catanese, co-secretary of LCME, said in a statement that schools often have issues to follow up on after their reviews.

“During its accreditation review, the Liaison Committee on Medical Education (LCME) identifies areas that medical schools need to address and for which the LCME requires follow-up, whether through status reports or through focused survey visit reports,” Catanese said.

“It is very uncommon for a school not to have areas that require follow-up information as directed by the LCME.”

Points of concern at medical school

The Tucson college of medicine was deemed out of compliance with three of the 12 overall accreditation standards the committee uses to evaluate programs: educational resources and infrastructure; curricular management, evaluation and enhancement; and teaching, supervision, assessment, and student and patient safety.

The committee found the medical program was “unsatisfactory” in a number of areas, including:

Bylaws were unclear in terms of leadership responsibilities.

Diversity categories were inconsistent and may not have been approved or codified.

Students were dissatisfied with cramped and uncomfortable lecture halls and access to spaces.

Students were dissatisfied with study and storage spaces on campus and at hospital and clinical sites.

The requirement that students “actively participate in care” was interpreted differently based on individual students.

The school had low ratings for genetics and biostatistics and epidemiology to prepare students for clinical work.

Students were dissatisfied with the school’s responsiveness to feedback on courses and clerkships.

The school had no process to make sure clerkship experiences and assessments were comparable across all locations.

Students had no clear way to appeal decisions.

The school’s tuition refund information was unclear.

College working to address issues

Medical school officials say they are analyzing the committee’s findings and are working to address issues. Efforts include creating focus groups, implementing curricular changes, gathering student feedback and changing policies, some of which is already underway.

“The college anticipates a virtual, limited survey in academic year 2023-24 and is confident that it will demonstrate continued compliance with LCME standards for accreditation,” according to a document provided by college officials. The documents, which explain how the college plans to address each issue, are posted online but require a UA login to view.

The college is pushing that information out to students, faculty and residents so they know what the accreditation findings were and can discuss them to help “build a better place,” Moynahan said.

Elzada Hasecic as a student practicing ultrasound treatments at the UA College of Medicine — Phoenix

The Tucson medical school program was in compliance with a need for monitoring in four standards: mission, planning, organization and integrity; academic and learning environments; competencies, curricular objectives, and curricular design; and curricular content.

The committee had concerns about the college’s education improvement plan, its higher than average student mistreatment rates based on gender and race, its financial stability given recent negative operating margins, and its need to post final grades faster, among other issues. The school will need to follow up on those areas, too.

In terms of higher rates of student mistreatment, the college’s response document said it is “committed to do better” and will use a new professionalism task force, surveys and focus groups to understand student concerns and address problems.

The program was in compliance with five of the 12 overall standards.

Per the college, of the 93 elements evaluated, the program was satisfactory in 74, satisfactory with a need for monitoring in eight and unsatisfactory in 11 elements.

Moynahan said the average school that gets full accreditation usually has eight or nine citations; they had 11.

“There were a few surprises, but overall we are pleased we got full accreditation and we are appreciative of the accreditation process, as it allows us to engage in continuous quality improvement,” he said.

“We didn’t agree with all their findings, but at the end of the day, we are beholden to them and we plan to make sure that they are happy with our progress,” Moynahan said.

The accreditation status, decided in June, was based on a January virtual survey visit plus student satisfaction surveys, graduate questionnaire reports by the Association of American Medical Colleges and reports from the college.

Some of the surveys were from 2020 during COVID-19, so that may have affected some student satisfaction elements, said Raquel Givens, the college’s director of accreditation.

This winter, the accrediting committee will meet with the dean and some faculty and staff to discuss the school’s action plan to address the areas deemed unsatisfactory and in need of monitoring.

Officials say they’ve already addressed seven of the 11 unsatisfactory elements, with the other four in progress.

“It’s manageable stuff. There’s nothing that’s like, ‘Wow, we can’t overcome this, we’re not going to be able to get through this.’ It’s all doable,” Givens said.

If the action plan is approved, LCME will do a limited survey visit in time to evaluate the program’s accreditation status at its June 2024 meeting.

UA College of Medicine — Tucson is ranked 74th best medical school nationally for research and 78th best for primary care by U.S. News & World Reports.

Phoenix medical school gets 8-year OK

The UA College of Medicine — Phoenix program passed its accreditation visit with more success, receiving full program accreditation for an eight-year term. The program has a status report due in 2024 but its next survey visit isn’t until the 2029-30 school year.

“The fact that they don’t plan another visit to the college until 2030 is a great relief and worth celebrating,” Dr. Steven Lieberman, faculty lead during the accreditation cycle, said in a news release.

The accreditor still raised concerns, however, which the school will need to provide updates on. The committee found noncompliance with two of the 12 overall standards: educational resources and infrastructure; and medical student health services, personal counseling and financial aid services.

The accreditation committee flagged the school’s relationship with Banner Health, asking for more information about the affiliation and emphasizing the importance of monitoring whether there’s enough student access to clinical training given ongoing negotiations with Banner.

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Other unsatisfactory areas included: responsiveness to student problems; mistreatment based on gender or race; parking issues at St. Joseph’s Hospital; and dissatisfaction with counseling for careers and electives.

The Phoenix medical program was in compliance with four standards and in compliance with a need for monitoring with six standards, many of which the committee said are improving but still need watching.

The Phoenix medical school launched its four-year program in 2007 as a branch campus of Tucson’s UA College of Medicine, which opened in 1967. After a few hiccups along the way to full accreditation as an independent institution, the Phoenix college of medicine first got full accreditation in 2017. This year’s visit resulted in its first full accreditation for the maximum eight-year term.

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