FACULTY OF MEDICINE
UPDATE ON ACCREDITATION
and a FOCUS ON
OUR LEARNING ENVIRONMENTS
PLASTIC SURGERY, Dean Brian Postl, Feb. 13, 2013
Title of presentation
umanitoba.ca
PRESENTATION OVERVIEW
1.
Accreditation Update – UGME
2.
PGME Accreditation
3. The Learning Environment, Mistreatment and Accreditation
a. Source Documents re: provision of a safe learning
environment
b. Learner Feedback
c. Action to date
d. Prevention and mitigation
ACCREDITATION UPDATE
POST UGME SURVEY – APRIL 3-6, 2011
Survey team was very impressed:
 Remarkable effort
 Team approach
 Very well-organized survey visit
 Student participation
 Generous support throughout visit by faculty, staff, students
Thanks to all faculty, staff, residents, students, for past
and continued commitment
ACCREDITATION UPDATE
POST UGME SURVEY – APRIL 3-6, 2011
October 2011 – Received consolidated Liaison Committee on
Medical Education (LCME) and Committee on Accreditation
of Canadian Medical Schools (CACMS) letter :
“…the CACMS and the LCME voted to continue
accreditation of the educational program leading to the
MD degree … for an unspecified term.”
• October 2012 Letter following August 2012 update:
continuing accreditation for unspecified term
• Dec. 5 & 6, 2012 Secretariat Consult Visit for Aug.2013 report
ACCREDITATION UPDATE
LCME/CACMS CONSOLIDATED LETTER
October 2011:
• 118 / 130 standards Compliant
•
4 / 130 standards Compliant w Monitoring
•
8 / 130 standards Non-compliant
October 2012, following August 15, 2012 Update:
• 119 / 130 standards Compliant
•
8 / 130 standards Compliant w Monitoring
•
3 / 130 standards Non-compliant
CACMS/LCME expect compliance with each standard
cited within two years
ACCREDITATION UPDATE
LCME/CACMS IDENTIFIED FACULTY STRENGTHS
• Re-energized leadership in Decanal team
• Dean & Associate Dean, UGME supported by colleagues,
students
• Faculty engaged in current educational program
• OPAL curriculum management system
• Indepth approach to behavioral and socio-economic subjects
admired by students
• Clinical Learning & Simulation Facility (CLSF)
• Medical students’ thoughtful, detailed analysis
• Financial resources and support of WRHA and Province
N=8 IN COMPLIANCE W MONITORING
Institutional Setting (IS) Standards
IS-11 Administrative Structure: Changes in deanery in almost all
major positions; new appointments effective Sept.15, 2011.
Educational Standards for MD Degree (ED)
ED-8 Comparability of Sites: Clerkship directors have not used outcome
measures to examine/assure comparability of clinical
experiences/methods of assessment of sites.
ED-9 Curriculum Renewal: School has initiated a 4-year curriculum
renewal effort schedule to continue into 2013.
ED-35 Review: Evidence of indepth reviews of individual courses,
curriculum years, preclerkship or clerkship years.
N=8 IN COMPLIANCE W MONITORING
Educational Standards for MD Degree (ED)
ED-37 Monitoring Content: Adequacy of monitoring and management
of the content in the final year of the curriculum, particularly electives
ED-47 Student Evaluation: Low student satisfaction with the MSK
(musculoskeletal) course and the Public Health Course - improving
Medical Students Standards (MS)
MS-19 Career Counseling: Update status of system to assist in career
choice, application to residency program, guide to choosing Electives.
MS-31A Learning Environment: In spite of much effort, the school still
struggles to ensure learning environment … promotes development of
explicit, appropriate professional attributes
N=3 NONCOMPLIANCE
Institutional Setting (IS) Standards
IS-1 Strategic Plan: … in the most recent strategic plan (2008)
outcome measures and timelines to track progress . . . were not
clearly defined.
Educational Standards for MD Degree (ED)
ED-31 Formative Feedback - system for ensuring timely midclerkship feedback . . . in two major specialties (surgery & medicine)
not done for 1/3 to 1/2 of students; (medicine improved 2012)
ED-33: Curriculum Management - Recurrent problems with logical
sequencing of segments of the curriculum and content is not
integrated within and across academic periods
ACCREDITATION UPDATE
CONCLUSION
• Lots to be proud of at the Faculty of Medicine.
• Tremendous number of changes over last few years.
• Will continue to work on key areas defined, i.e. UGME
curriculum governance, renewal, evaluation, professionalism.
 Must continue to focus on accreditation standards as part
of our regular day-to-day operations.
 Jan. 2013 – Appointment of Dr. Gary Harding
Associate Dean, UGME & PGME Accreditation
The Learning Environment,
Mistreatment,
and
Accreditation
Source Documents

Royal College of Physicians and Surgeons / College of Family
Physicians of Canada: “General Standards of Accreditation”
 Royal College: “Accreditation And The Issue Of Intimidation And
Harassment In Postgraduate Medical Education: Guidelines For
Surveyors And Programs”

LCME Accreditation Standards

Faculty of Medicine “Guidelines for Conduct in Teacher-Learner
Relationships”

U of M “Respectful Work & Learning Environment” Policy

WRHA “Respectful Workplace” Policy
Faculty of Medicine Guidelines for
Conduct in Teacher-Learner Relations
What’s in the Guidelines?
• Statement of Philosophy
• Responsibilities in the Teacher-Learner
Relationship
• Behaviours Inappropriate to the Teacher-Learner
Relationship
• Avenues for Addressing Inappropriate Behaviour
• Procedures for Handling Allegations
Guidelines on Professionalism & Diversity webpage
PGME ACCREDITATION
Moved to Feb. 23-28, 2014
Canadian Association of Internes & Residents (CAIR) website:
Facts about the Accreditation Process
“Accreditation is singly the most important process
that residents can be involved in.”
“The single most critical "zero-tolerance" issue in
Accreditation is intimidation and harassment.”
CAIR Mantras Intimidation/Harassment
(Canadian Association of Interns & Residents)
Intimidation / harassment include, but not limited to:
 Derogatory written or verbal communication or gestures
re: race, national or ethnic origin, colour, religion, age,
sex, marital status, family status, disability, or sexual
orientation.
 Unwelcome physical contact
 Physical or sexual assault
CAIR Mantras Intimidation/Harassment
Intimidation / harassment include, but not limited to:
 Abuse of authority that undermines a resident’s
performance or threatens a resident’s career
 Patronizing or condescending behaviour intended to
humiliate a resident’s performance (distinctly different
from timely, constructive feedback from preceptors).
 Any coercion in the accreditation process
FOR ROYAL COLLEGE
HARASSMENT VERY SERIOUS
e.g. “Harassment imperils N.L. anesthesia training”
February 2011 - Residency program in Anesthesiology at
Memorial University received Notice of Intent to Withdraw
Accreditation due to “Ongoing allegations of intimidation
which remain unresolved by the program, faculty or
university processes (B3.8)”
“Harassment imperils N.L. anesthesia training”
RE: Notice of Intent to Withdraw Accreditation:
 Major and/or continuing weaknesses are identified which bring
into question the ongoing program accreditation
 Residents in the program, those already contracted to enter
the program, and applicants to the program, must be advised
immediately by the program director of the status of the
program.
 Within 2 years of Notice, an external review is conducted - the
program must show cause why accreditation should not be
withdrawn.
Jan. 2011/July 2012 GENERAL STANDARDS
APPLICABLE TO ALL PROGRAMS
STND B3: STRUCTURE AND ORGANIZATION OF THE PROGRAM
9. “Teaching and learning must take place in
environments which promote resident safety and
freedom from intimidation, harassment and abuse.”
RCPSC Position Paper: “Accreditation And The Issue Of
Intimidation And Harassment In PGME: Guidelines For
Surveyors & Programs”
Definition of Harassment:
. . . Repeated, often public, critical remarks or ridicule.
Singling out for grilling or interrogation. Unjustified
negative remarks or inappropriately positive remarks about
appearance or dress. Unjust assignment of duties.
Definition of Intimidation: . . . the use of authority to
influence someone to do/refrain from an action or to do
something they would not do or should not do otherwise.
e.g. asked to do extra work; refraining from reporting
patient events; falsely positive faculty evaluations.
It can also include ‘flattering’ intimidation such as “you are
different than the others so I wonder if you can..”; “you’re
great, you never complain and I wonder if you could take on
this task for me…”
RCPSC: “Accreditation And Intimidation Guidelines . . .
PRINCIPLES:
1. Timely identification of a concern about intimidation and
harassment should be the goal of all programs.
2. Trainees should be encouraged to inform their program
director or university administration of problems.
3. The initial discussion must occur in a confidential setting.
RCPSC: “Accreditation And Intimidation Guidelines . . .
PRINCIPLES:
4. There should be a process to clarify the facts concerning
the allegation.
5. The process of clarification must occur in an atmosphere
free of retribution.
6. There should be a process to address and resolve
allegations in a timely manner.
UGME STNDS- The Learning Environment
MS-31: there should be no discrimination on the basis of age, creed,
gender identity, national origin, race, sex, or sexual orientation in any of
the program’s activities.
MS-31A Annotation: . . . the school … should regularly assess the
learning environment to identify positive and negative influences on
the maintenance of professional standards and conduct, and develop
appropriate strategies to enhance positive/mitigate negative influences.
MS-32 Annotation: Mechanisms for reporting violations -- such as
incidents of harassment or abuse -- should assure that they can be
registered and investigated without fear of retaliation.
Student Feedback
Canadian Medical School Graduation
Questionnaire (CGQ)
Since 2001, comprehensive, national survey re: graduates’ 4 years
38 questions, many with subsets.
89% U of MB graduates completed 2010
86.5% U of MB graduates completed 2011
89.7% U of MB graduates completed 2012
(75.4% Average ALL Schools 2012)
 Three 2012 Reports received:
o U of M data
o Comparative data for “All Schools”
o U of M narrative comments





Canadian Medical School Graduation
Questionnaire (CGQ) 2012
One specific question re: Plastic Surgery
18. Please select your first choice for a specialty
U of M % - Choosing Plastic Surgery as First Choice
U of M
ALL Schools (N=17)
2010
(N = 92)
2011
(N = 83)
2012
(N = 96)
2012
(N = 2,012)
2.2%
1.2%
0.0%
1.8%
Footnote: For 2013 CaRMS match, no U of Manitoba applicants
CGQ –Key Component on Mistreatment
Survey identifies:
 Awareness of a mistreatment policy.
 Witnessing or experiencing mistreatment.
 Source of mistreatment:
i.e. Faculty, residents, nurses, administrators, students,
patients or patients’ family.
 Category of mistreatment:
i.e. General mistreatment (public belittlement, humiliation);
sexual mistreatment (exchanging favours for grades,
advances, remarks); racial/ethnic mistreatment; sexual
orientation mistreatment.
CGQ –Component on Mistreatment
 Reporting of Mistreatment:
Did you report; if so, to whom; if not, why not (not
important enough, did not know what to do, fear of
reprisal, other)?
 Are you satisfied with the application of the Faculty’s
mistreatment policy?
CGQ 2012, 2011 & 2010
#29. Awareness of a mistreatment policy:
Year
U of M
All Schools
2012
88.5 %
78.3 %
2011
79.3 %
74.9 %
2010
64.8 %
79.6 %
CGQ 2012, 2011 & 2010
#30. Did you witness mistreatment of another learner,
patient or other health care professional?
Year
U of M
All Schools
2012
37.5 % (36 of 96)
38.7 %
2011
38.6 % (32 of 82)
37.9 %
2010
27.5 % (25 of 91)
31.9 %
CGQ 2012, 2011, & 2010
(All = 17 Med Schools)
#30a. Source of witnessed mistreatment:
Source
U of M
U of M
U of M
ALL
ALL
ALL
2012
2011
2010
2012
2011
2010
75.0%
53.1%
84.0%
49.1%
50.9%
50.1%
Residents
75.0
46.9
76.0
41.7
36.4
42.5
Clinical Faculty
58.3
68.8
68.0
78.0
79.0
76.8
Students
30.6
21.9
48.0
22.7
18.0
22.7
Patients/Family
28.1
28.1
40.0
25.0
26.9
29.0
<15.0
<15.0
<20.0
<20.0
<8.0
<20.0
Nurses
All other categories
#31. PERSONAL MISTREATMENT
2012 CHANGE IN SCALE - Includes ALL Students,
i.e. “For each of the types of mistreatment, indicate
frequency you personally experienced
Year
2012
Personally Experienced ANY
FORM of LISTED MISTX – U of M
60.4% (58 of 96)
ALL Schools
57.4%
(1065 of 1856)
“Have you personally been mistreated during med. school?”
2011
27.7% (23 of 82)
24.3%
2010
22.0% (21 of 91)
23.6%
Source of personal mistreatment: (ALL = 17 Med Schools)
Source
U of M
U of M
U of M
All
All
All
2012
2011
2010
2012
2011
2010
55.2%
60.9%
60.0%
73.4%
75.9%
72.4%
Residents
56.9
39.1
50.0
32.0
38.1
31.5
Nurses
43.1
47.8
20.0
34.5
43.0
39.0
Students
13.8
17.4
15.0
7.0
7.9
10.2
Patients /Family
10.3
21.7
15.0
18.5
20.5
20.1
<15.0
<15.0
<10.0
<10.0
<8.0
<10.0
Clinical Faculty
All other
categories
Nature of personal, GENERAL mistreatment (Mistx):
 Public belittlement or humiliation
 Threatened with harm or physically harmed
 Required to perform services (shopping, babysitting)
2011 – 17 of 23 of those who reported mistreatment
2010 – 17 of 21 of those who reported mistreatment
2012 No. Experienced General Mistx
0f N=96 Responses / and U of M% vs ALL%
Gen. Mistx
1X
2-4 X
5-10 X
>10 X
Humiliation/
Belittlement
13
30
9
3
13.5 vs 17.1%
31.3 vs 26%
9.4 vs 5.5%
3.1 vs 1.9%
Threat/Harm
3
3
0
0
3.1 vs 3.5%
3.1 vs 1.9%
8
2
1
0
Perform
Services
8.3 vs 4.6%
2.1 vs 2.9%
No. Experienced SEXUAL MISTX
0f 96 Responses / and U of M% vs ALL% (slide 1 of 2)
SEXUAL MISTX
2012
2011
2010
1X
2-4X
5-10X
0
4
4.2 vs 4.4%
3
3.1 vs 1.4%
3/23
6/21
Offensive sexist
remarks
4
4.2 vs 5.2%
4
4.2 vs 4.1%
1
1.0 vs 0.9%
3/23
4/21
Received lower
grades due to
gender
1
1.0 vs 2.3%
2
2.1 vs 1.2%
0
3/23
4/21
Denied
opportunities
because of gender
No. Experienced SEXUAL MISTX
0f 96 Responses / and U of M% vs ALL% (slide 2 of 2)
SEXUAL MISTX
2012
1X
ASKED TO
2/95
EXCHANGE
SEXUAL 2.1 vs 0.3%
FAVOURS FOR
GRADES
2
UNWANTED
SEXUAL 2.1 vs 2.2%
ADVANCES
2011
2010
2-4X
5-10X
1/95
0
0/23
3/21
0
2/23
5/21
1.1 vs 0.2%
5
2.1 vs 0.3%
No. Experienced RACIAL/ETHNIC Mistx
0f 96 Responses / and U of M% vs ALL%
RACIAL/ETHNIC
MISTX
2012
2011
2010
1X
2-4X
5-10X
Denied
opportunities
because of race
3
3.1 vs 1.6%
1
1.0 vs 1.0%
0
2/23
2/21
Offensive
racial/ethnic
remarks
1
1.0 vs 4.2%
3
3.1 vs 2.4%
2
2.1 vs 0.3%
3/23
3/21
Received lower
grades solely due
to race/ethnicity
1
1.0 vs 2.3%
2
2.1 vs 1.2%
0
2/23
1/21
No. Experienced SEXUAL ORIENTATION Mistx
0f Total Responses / and U of M% vs ALL%
SEXUAL ORIENT’N
MISTX
2012
2011
2010
1X
2-4X
5-10X
Denied opportunities
because of sexual
orientation
0
1/95
0
0/23
1/21
Offensive remarks
because of sexual
orientation
0
0
0/23
2/21
Received lower
grades solely due to
sexual orientation
0
0
0/23
1/21
1.1 vs 0.4%
1/95
1.1 vs 0.5%
1/94
1.1 vs 0.2%
CGQ 2012, 2011 & 2010
#31c. Did you report the incident(s) to a designated faculty
member or member of the medical school administration?
YES
U of M:
2012
10.3% of 58
(N=6)
ALL Schools: 15.5%
2011
26.1% of 23
(N=6)
2010
28.6% of 21
(N=6)
26.9%
25.4%
CGQ 2012, 2011 & 2010
#31d. If yes, to whom did you report mistx experience(s)?
REPORTED
TO
U of M
U of M
U of M
All
All
All
2012
2011
2010
2012
2011
2010
16.7%
16.7%
27.2
42.9%
35.3%
33.3
16.7
33.3
15.6
18.4
9.4
0.0
0.0
33.3
20.0
21.4
18.8
50.0
33.3
50.0
42.8
34.7
50.6
Dean or A/Dean 50.0%
Student Affairs
Designated
counselor or
advocate
Other medical
school
administrator
Faculty
member
Action
1. Distribution of CGQ report to:
 Dean’s Council
 Department Heads
 Curriculum Committees
 Faculty via Dean’s presentations at Grand Rounds
2. Ongoing Scanning of Environment via:
 PreClerkship course evaluations
 Clerkship rotation evaluations
 Electives evaluations
 PARIM survey
Action
3. Meetings with:
 Clinical Departments / grand rounds
 Individual departments identified by residents and
students in Accreditation reports and internal reviews
 WRHA leadership including Nursing
 PARIM and residents
 HSC leadership
4. Core/required presentations by Dean/Associate Deans
during medical students’ and residents’ orientations and
during “Introduction to Clerkship”
Prevention
1. Education of learners :
 Curricular components:
o PreClerkship
o Introduction to Clerkship (ITC)
o Introduction to Residency in renewed curriculum
 Education of teachers including residents, faculty
2. Policy development / entrenchment – Faculty & Program
3. Ongoing management of compliance with standards of
the Royal College and LCME/CACMS
Mitigation
1. Surveillance of learning environment
2. Share information on learning environments through
existing liaison committees
3. Encourage a culture of disclosure and support
4. Move to Zero tolerance
The Learning Environment
Questions
and
Comments
Title of presentation
umanitoba.ca