A Message from Dean Tolar

To be, or not to be. There is no question. That is the importance of the Liaison Committee on Medical Education (LCME) accreditation.

Today marks the beginning of our one-year countdown to the LCME Accreditation Site Visit.

I would like to thank all of you—faculty, staff, and students—who have already contributed to and are hard at work preparing parts of the institutional self-study. This is a tremendous effort, and greatly appreciated.

In the year to come, we will all be asked to participate in this effort in one way or another. Our challenge is to capture the excellence of this Medical School and to address the areas we will be working to improve (whether identified by student survey or through the critical analysis of our education program already conducted). It is a challenge that I know you will meet with the commitment you show in your daily work.

Bearing in mind the importance of accreditation, I would like to ask everyone to please engage when asked. We will need timely responses to requests for information, active membership in committees, and willing participation in the site visit itself.

To keep you informed of the progress of the work, to ensure transparency, and to generate discussion, we will post updates on our LCME landing page.

I know that you support the efforts of the Medical School in many ways and that this is added on top of your already significant workload. I hope you know that your work and time are valued, respected, and critically important.

Please join me as we start this year of reaffirming our commitment to excellence, improvement, and the drive to meet the needs of our changing world.

Welcome to your first edition of our LCME update.  We are now less than a year away from our site visit!

As your Faculty Accreditation Lead (FAL) I want to thank all of you who have been a part of the enormous amount of work to get us where we are today.  We have completed the first draft and its revisions of the Data Collection Instrument (DCI) and the Independent Student Analysis (ISA) that together provide the data for us to be able to answer the questions in our Self Study Guide to address our areas of strength and weakness.  We are laser focused on our two major goals for this visit:

1. No surprises--we want to identify all of the potential areas for concern so that we can be actively addressing them when the site visitors arrive.
2. An eight-year accreditation decision!

Towards the first goal, each month we will share with you one of the 12 standards and identify a few of the areas of strength and areas for improvement.  We want this to be a transparent and learning process for the organization.

I appreciate in advance all of the hard work that is upcoming in this next twelve months, and am confident we are well on the way to reaching the educational vision for the University of Minnesota Medical School:
 

A community, learning together to prepare exceptional physicians to improve the health and well being of Minnesota and beyond.

With gratitude,
Bob

Standard of the Month: Standard 1 (of 12): Mission, Planning, Organization, and Integrity

What's the Theme?

The 12 Standards are organized to flow from the level of the institution to the level of the student. So, it's not surprising that the first Standard covers topics such as the medical school's Strategic Plan, the Constitution and Bylaws, the overall structure of governance, including faculty participation in such governance, and our agreements with affiliate partners.

Specifically, Standard 1 states:

"A medical school has a written statement of mission and goals for the medical education program, conducts ongoing planning, and has written bylaws that describe an effective organizational structure and governance processes. In the conduct of all internal and external activities, the medical school demonstrates integrity through its consistent and documented adherence to fair, impartial, and effective processes, policies, and practices."

What are we doing well?

UMMS has a strategic plan originating in 2014 to create a culture of excellence in education, patient care, and research. An area we sought to grow and foster through this strategic plan is relationships with affiliate partners and community stakeholders. One of the many ways we have pursued that goal has been by increasing our longitudinal integrated clerkships by expanding to three of our major partners: The Veterans Administration Hospital, Health Partners, and HCMC. This meets our institutional strategic goal to provide education advancing all aspects of medicine through innovative teaching and learning practices that set national trends.

As an extension of the institutional Strategic Plan, a major initiative to develop an Undergraduate Medical Education Strategic Plan was completed in 2018. The development of this UME strategic plan engaged over 500 students, faculty, health system leaders, alumni, and staff. The UME Strategic Plan defines seven principles and their respective goals to guide the medical school into the future of medical education. We are almost through our first year objectives and many of us from across all of our sites and both campuses are working on the 2019-2020 Academic year objectives now.

What are we working on?

As is the case with any effective strategic planning, on-going revision and renewal is essential. A process is being developed to review the Institutional Strategic Plan in order to clarify progress on established objectives and revise aspects as needed to reflect current priorities.

Finally, a substantial effort is being undertaken to review and revise the medical school's constitution and bylaws to ensure they accurately represent the structure, roles, and responsibilities of the school and its members.

Dear Students, Staff, and Faculty:

We are now closing in on ten months until our site visit.  In this month’s LCME newsletter, we highlight the second standard. This is particularly rewarding as we see a standard that resulted in a citation in 2012 and has now become a real strength.  We hope to have lots more of these successes based on everyone’s hard work for this self-study cycle.

Speaking of hard work, we want to express our gratitude for the incredible work you all are doing to make this site visit a success.  Today we begin a column entitled “With Gratitude” to do just that.  We will highlight a group of participants each month.

As always, please let us know if you have any questions. (rengland@umn.edu). 

With gratitude,
Bob

With Gratitude:

When reflecting on the work that’s been done in preparation for our Site Visit in April 2020, it’s amazing to see how many people and areas are involved in supporting the Self-Study process. Whether through participation on committees, writing sections of the Self-Study materials, or providing essential information, many people across the medical school and its affiliate partners have gone above and beyond to ensure that the school is successful. Throughout the remainder of the Self-Study, this newsletter will highlight groups and individuals to express gratitude for their commitment.

This month’s expression of gratitude goes to the more than 75 faculty, staff, and students who comprise the five Self-Study Sub-Committees. Take a moment to review the committee lists and, for those you may know, thank them for their service.
(https://www.med.umn.edu/education-training/lcme-accreditation/committees)

These committees were charged with critically analyzing specific questions posed by the LCME and writing summary reports to form the basis for an Executive Summary. The committees have been meeting since January and are now wrapping up their work. They have provided exceptional analyses, identifying what we’re doing well and key opportunities for improvement. Their hard work is one of the cornerstones of our accreditation work and it is with extreme gratitude that we thank them.

Standard of the Month: Standard 2 (of 12): Leadership and Administration

What's the Theme?

We move from the institutional strategic plan (Standard 1) and overall governance structure to the role faculty play in achieving the components in that strategic plan and in overall governance. Standard 2 covers such topics as faculty appointment policies and procedures, access and authority of the Dean, sufficiency of administrative staff and integration of faculty into Standing Committees.

Specifically, Standard 2 states:

"A medical school has a sufficient number of faculty in leadership roles and of senior administrative staff with the skills, time, and administrative support necessary to achieve the goals of the medical education program and to ensure the functional integration of all programmatic components.”

What are we doing well?

One outcome from our previous LCME accreditation in 2012 was a citation of Non-Compliance with the sufficiency of key leadership positions. This was due to a significant amount of turnover and/or vacancies in leadership positions within the Dean’s Office and other key organizational units.

A number of efforts have been put into place to resolve this citation including:

• 2013: successfully recruiting and filling the positions of Vice Dean for Medical Education, Associate Dean for Admissions in the Twin Cities, and an Associate Dean for Student Affairs & Admissions in Duluth
• 2014: Approval to create an Assistant Dean for Student Affairs position on the Twin Cities Campus and increases to the number of faculty advisors to meet student needs
• 2015: Increased collaborative efforts between Student Affairs on the Twin Cities and Duluth campuses to better address student needs across campuses
• 2014-present: Over the past five years, we have surveyed our students on both campuses regarding their levels of satisfaction with support from Student Affairs, and have shown year-over-year improvement. On our most recent survey (spring 2018) response rates were all above the 95th percentile on satisfaction for all classes and across both campuses. This is a remarkable accomplishment!

What are we working on?

While there is always room for improvement, Standard 2 does not currently have any notable action plans associated with it.

Dear Students, Staff, and Faculty:

We are now closing a little over nine months until our site visit. In this month’s LCME newsletter, we highlight the third standard. This standard at first glance seems a hodge-podge of expectations but perhaps can be summed into a central theme: the learning environment. We are working on a lot of fronts to optimize the learning environment-from our efforts to build diversity, to increasing student reporting when things do not go well (see below), to clinical learning environment rounds where we observe students in their authentic settings and help sites make improvements. We have visited four sites over the last year, including a recent trip to Duluth to visit the Essentia system and St. Luke’s Hospital. I am always inspired by the number of faculty and staff I meet across our state who are sincerely dedicated to ever-improving the student experience, and by the gratitude of the students even as they offer constructive criticisms in the spirit of improvement.

As always, please let us know if you have any questions. (rengland@umn.edu)

With gratitude,

Bob

With Gratitude:

The next couple of months will see final work being done on the Data Collection Instrument (DCI) in preparation for it to be formatted, reviewed, and collated for submission to the LCME in December. For the people who worked on the initial draft, this means going back into the DCI to provide revisions, corrections, and in some cases, significant re-writes resulting from sub-committee recommendations, new or changing program structures, or data reflecting the upcoming 19-20 academic year.

As a result, the amount of time and effort that has gone into the DCI by individuals across the medical school, including our affiliated sites, cannot be overstated. By our last estimate, more than 200 people have been engaged in providing content for the Self-Study. A couple of quotes help to highlight this effort:

“I would love to acknowledge the hard work of providing the correct data for the DCI and participating in reviewing responses and participating in workgroups that our Duluth Campus administrative team has done. Dr Robin Michaels, Dr Kevin Diebel and our former campus administrator, Jim Keith provided the majority of our Duluth Campus information while incorporating the extra work into their regular heavy load of teaching and administration.”
Paula M. Termuhlen, MD, Regional Campus Dean

“The Clerkship Directors and Coordinators have played an integral part in collecting data, reviewing information, and answering the 10,000 LCME-related surveys sent.”
Jess Blum, PhD, Director of Integrated Education - Clinical Sciences

“The Course Directors, 1Health Team, and Jamie Larson have significantly contributed to collecting data and reviewing responses to questions in the DCI. They have been willing to help, no matter the ask, at every step of the way and we truly appreciate this substantial effort; one that is in addition to their daily responsibilities. Working with this group of educators has truly made this difficult and complex process a team effort, and for that, we thank them.”
Kelaine Haas, PhD, Director of Integrated Education - Foundational Science

Chances are, if you engage with someone in medical education administration, they have played an integral part deserving of our gratitude and we thank each and every one of them.

Standard of the Month: Standard 3 (of 12): Academic and Learning Environments

What's the Theme?

This month we move to Standard 3 of 12.  In this Standard the topics address broader institutional efforts around scholarly work, appreciation for, and programs to facilitate diversity, and methods for community members to address circumstances that might interfere with the successful achievement of those goals.

Specifically, Standard 3 states:

What are we doing well?

The LCME understands the value and importance of having students interact with residents during their medical education program. Element 3.1 looks specifically at the instances of student-resident interaction during the clinical years.  Interactions with residents provides students with an opportunity to see, first hand, what the next stage of their training will encompass.  With over 900 residents and fellows across our sites, we know that every one of our medical students will interact with residents on at least one of their clinical rotations. Resident engagement enhances the learning environment and provides students with critical information they can use as they weigh their own options for residency selection. In addition, student evaluations of residents who supervise them are consistently quite high. 

What are we working on?

Element 3.6 addresses the ways a medical school minimizes incidents of student mistreatment and how it handles those incidents when and if they do arise.  Responses by graduating students on the AAMC Graduation Questionnaire around experiences of mistreatment have generally been better than the national average with the exception of responses about inappropriate remarks (language of a sexist, LGBT-specific, or generally demeaning nature). These responses are in contrast to the number of mistreatment complaints submitted by students to school officials. In addition, the Independent Student Analysis (ISA) distributed last January showed that clinical students were less satisfied with the procedures for handling mistreatment than we would like to see.

Efforts are being made to increase awareness of mistreatment: what constitutes mistreatment; how to report it; and reducing the fear of reporting.  

Dear Students, Staff, and Faculty:

We are now closing in on a little over eight months until our site visit.  In this month’s LCME newsletter, we highlight the fourth standard. This standard explores a medical school’s faculty, seeking to ensure that the faculty have a rich environment to carry out the school’s mission and that the students have ample access to an accomplished faculty.  I think this is one of the areas in which our school shines, and am proud to be a member of the University of Minnesota faculty. 

Additionally, over the last month so many of you put in countless hours to update our Data Collection Instrument (DCI) and to draft the student response to the Independent Student Survey (ISA).  We are so grateful for all of this work.  Through this process we have been able to really understand our strengths so that we might further exploit them, and identify the areas that we need to work on in our efforts to continually improve our medical school. 

This process has underscored one of my favorite quotes from a great mentor and a University of Minnesota Medical School Graduate, Paul Batalden, who said of health professionals, “we must come to work every day with two jobs: the job of doing our job, and the job of improving our job.”

I am honored to continue to both do and improve with all of you. As always, please let us know if you have any questions. (rengland@umn.edu) 

With gratitude,
Bob

With Gratitude:

Compiling information across the entire spectrum of the educational program into a single source has been a great way to see areas of contribution to medical education by specific groups and/or individuals. One such group are Residents.  We would be remiss in not mentioning the immense value that residents provide our medical students in their mentoring and teaching roles.  Residents not only serve as role models to our medical students but they also offer students the chance to learn about the next stage of their professional training.  In fact, 100% of our medical students will work with residents on at least one required clerkship (for most, it’s more than one). 

In addition, residents serve as an integral part of the formal educational team responsible for supervising medical students, ensuring that learning objectives are being met, and providing direct feedback to students on their clinical skills. 

Each year, the medical school recognizes residents through its inclusion in the Distinguished Teaching Awards.  Below are the recipients of these awards for the previous three years.  However, each and every resident deserves our gratitude for their significant contribution to the success of our medical students and educational mission.

Recipients of the Distinguished Teaching Awards:

2019
Margot Zarin-Pass, MD

2018
Kelsey Gelhaus, MD 
Annie Jacobsen, MD

2017
Salma M. Shaker, MD

Standard of the Month: Standard 4 (of 12): Faculty Preparation, Productivity, Participation, and Policies

What's the Theme?

This month we move to Standard 4 of 12.  In this Standard we look at “Faculty Preparation, Productivity, Participation, and Policies.”   It focuses on areas designed to ensure faculty have access to opportunities that contribute to the medical school’s mission and from which medical students can benefit.

Specifically, Standard 2 states:

“The faculty members of a medical school are qualified through their education, training, experience, and continuing professional development and provide the leadership and support necessary to attain the institution's educational, research, and service goals.”

What are we doing well?

Standard 4 provides us with the opportunity to highlight our exceptional and engaged faculty, each of whom contributes to the success of the medical education program every day. Some of the information we have compiled for this Standard may not be commonly known by members of our community.  So below are just a few facts you may not know: 

• The medical school has more than 1900 full-time clinical faculty
• The medical school has more than 200 full-time basic science faculty
• Our faculty numbers place us close to the 80th percentile when compared to all other medical schools (90th percentile compared to other public medical schools)
• The medical school has more than 1400 adjunct basic science and clinical faculty comprising 26 basic science and clinical departments across both campuses
• Faculty contributions to scholarly activity have been consistently increasing each year, with close to 2000 articles published in peer-reviewed journals and 461 faculty members serving as co-investigators or PIs on extramural grants as of 2018 data.

What are we working on?

Element 4.1 ask the medical school to evaluate that it has a sufficient number of faculty, with appropriate qualifications and time needed to deliver the curriculum and to fulfill other needs or responsibilities.

The medical school was cited during our last site visit in this area.  Specifically, the Site Team found that while the faculty on the Duluth campus is adequate to meet the current needs, retirements or other unexpected attrition could be a risk to meeting the educational needs of students in Duluth.  In 2015 we were able to have this citation removed by reporting on our recruitment efforts that increased the total number of faculty in Duluth and included increased faculty development efforts to improve retention and satisfaction. Ongoing monitoring of this Element is important, however, to minimize the chances of another citation in this area. 
 
To date, eight basic science faculty have been hired in Duluth, all of whom contribute to teaching the curriculum with two more being added shortly to address specific areas of shortage. Four clinical faculty have also been added in Duluth, including a new department head for Family Medicine and Biobehavioral Health. Additionally, five social scientists have been hired to contribute to the teaching mission on the regional campus.  Finally, efforts are underway between leadership on both campuses to enhance procedures for identifying and remedying unexpected and expected attrition, including ways the Twin Cities can support the teaching needs in Duluth. 

Dear Students, Staff, and Faculty:

First and foremost, welcome to the Class of 2023! We are delighted to have you join us and anxious for your input to help on our road to continuous improvement.

We are now closing in on a little over seven months until our site visit. In this month’s LCME newsletter, we highlight the fifth standard. This standard explores medical school’s resources, such as facilities, finances, technology, etc. to ensure a high-quality education. As you will see, we have had some challenges, particularly in the area of facilities, but are working across both campuses to make improvements. 

The more I get into this process, the more grateful I am for the enormous human and other resources we have at this medical school.  It only serves to bolster my desire to improve so that we may meet our educational vision:

“A community, learning together to prepare exceptional physicians to improve the health and well being of Minnesota and beyond.”

As always, please let me know if you have any questions. (rengland@umn.edu) 

With gratitude,
Bob

With Gratitude:

It goes without saying that a medical school wouldn’t be much of one without its students. Nowhere has that been more evident than through the ways students have been, and continue to be, engaged in the accreditation Self-Study.  Over the last year, students have been involved with every aspect of the process. Most notably, the Independent Student Analysis (ISA) Committee has worked hard to create, distribute, and tabulate the ISA Survey, which garnered input from approximately 84% of the student body. Currently, the Committee is working hard to compile this data into a Summary Report that will serve as part of the medical school’s self-study package it submits to the LCME.  

Students also served on each of our LCME Sub-Committees, working closely with faculty and administration over the course of the spring 2019 term to critically analyze every aspect of the medical education program. Students will also be integral participants during the Site Visit scheduled in April 2020. These efforts are all above and beyond what students do every day through their participation in Student Council, curriculum committees, and other forums where student voices contribute to the shape of the medical school experience.

The medical school is deeply grateful for the dedication and commitment students demonstrate every day to improve the student experience, patient outcomes, and the medical school in general.   

Standard of the Month: Standard 5 (of 12): Educational Resources and Infrastructure

What's the Theme?

This month we move to Standard 5 of 12. In this Standard we look at “Educational Resources and Infrastructure.” Its focus is on ensuring that the medical school has the structural and functional components necessary to meet it’s educational and strategic goals.

Specifically, Standard 5 states:

“A medical school has sufficient personnel, financial resources, physical facilities, equipment, and clinical, instructional, informational, technological, and other resources readily available and accessible across all locations to meet its needs and to achieve its goals.”

What are we working on?

For this month, what we’re working on and what we’re doing well are combined, since they cover the same topic, educational facilities.

In 2012, Element 5.11 (Study/Lounge/Storage Space/Call Rooms) was found to be “In Compliance with a Need for Monitoring.” At the time, the LCME Site Team noted low levels of satisfaction among students on study space and relaxation space on the AAMC Graduation Questionnaire (GQ).  In addition, the team noted that students were aware of the existence of problems with these spaces, but acknowledged that efforts were being made to make improvements.

The medical school was able to resolve this citation in 2015 as a result of several efforts including renovations to the surrounding common areas and student spaces (such as the Adytum).  Most notably, however, was the medical school’s successful effort to secure funding for the new Health Science Education Center, slated to open in 2020.

The Health Sciences Education Center (HSEC), which will accommodate more than 3000 academic health professions students and faculty, is a state-of-the-art education building that will provide space for teamwork and learning across health professions' schools.  The Center will include active learning spaces, large classrooms and meeting spaces, the Simulation Center, Library, and student service spaces.  In addition, current efforts are underway to add several health-related services, such as mental health, in an effort to improve access to, and awareness of, these services.  For more information about the HSEC visit: https://www.health.umn.edu/education-training/health-sciences-education-center-hsec 

Constructing a new building takes time. The HSEC will help the medical school’s Twin Cities campus address many facilities-related issues.  But there is still much work to be done to provide students with the facilities they need for an optimal learning environment and to improve student satisfaction.  For example, on the most recent GQ for the Class of 2019, students reported the lowest level of satisfaction with study and relaxation space yet.  Further, the Independent Student Analysis (ISA) distributed to all students last January, show low levels of satisfaction across all years, including students on the Regional Campus in Duluth.  While the HSEC will address many needs, it will not help our students in Duluth or our students rotating outside of the University of Minnesota campus. The medical school is currently working to review and address the availability of study space, relaxation space, and secure storage at its clinical placement sites in an effort to ensure that students off-site have access to spaces that continue to provide for their educational needs.

On the Regional Campus in Duluth, efforts are currently underway to add dedicated study space that includes the renovation of a lockable room with space for approximately 10 study carrels, and the addition of more study carrels in the Student Affairs hallway.  Other spaces are also being assessed to supplement needed study space. Major classroom renovations are also planned for Summer 2020 that will increase seating and improve the overall environment.

This month in our LCME update, as we are now only a little over a half a year to our site visit, we review standards 6 and 7, focused on our desired outcomes and the curriculum to get us there. As I have gotten to know the curriculum better, both through this accreditation process and through my additional time here, I am in awe of the amount of work it takes to make a doctor. Although we have many opportunities to improve, I am confident in the impressive efforts of our faculty, staff and students to make this a great and ever better curriculum. I am also impressed that we are all driven by the right intentions to prepare exceptional physicians to improve the health and well being of Minnesota and beyond.

I am so appreciative of the flexibility and innovation of our community as we have worked to improve our curriculum. Only through curricular reform can we strive for our educational strategic plan guiding principles of promoting evidence-based education, standardizing the outcomes and individualizing the learning pathways, and empowering students (at least in part by engaging them in all aspects of curriculum design and implementation).

We will continue to work to ensure that each year is better than its predecessor. While we do so, please know that I am grateful to be part of a community-driven to improve the lives of our patients through the education and training of our students, residents, fellows and faculty

With gratitude,
Bob

What's the Theme?

This month brings us to the halfway point as we review Standards 6 and 7 of 12. In Standard 6 we look at “Competencies, Curricular Objectives, and Curricular Design” and in Standard 7 “Curricular Content”. These focus on ensuring students receive the necessary curriculum and opportunities in basic sciences, clinical care, research, service-learning, etc. to become good physicians. 

Specifically, Standard 6 states:

“The faculty of a medical school define the competencies to be achieved by its medical students through medical education program objectives and is responsible for the detailed design and implementation of the components of a medical curriculum that enable its medical students to achieve those competencies and objectives. Medical education program objectives are statements of the knowledge, skills, behaviors, and attitudes that medical students are expected to exhibit as evidence of their achievement by completion of the program.”

Standard 7 states:

“The faculty of a medical school ensure that the medical curriculum provides content of sufficient breadth and depth to prepare medical students for entry into any residency program and for the subsequent contemporary practice of medicine.”

What are we doing well?

1. As evidenced by the Independent Student Survey (ISA)* distributed last January, students are quite satisfied with the 2-3rd year curricula on the TC Campus and both years on the DU campus. Specifically, the Duluth campus deserves a shout out in the area of overall satisfaction and satisfaction with the curriculum. 98% percent of DU first years and 95% of second years reported they were satisfied or very satisfied with the first-year experience, and 88% of second years reported they were satisfied or very satisfied with year 2. On the TC campus, 92% of second years were satisfied or very satisfied with year 2, and 88-90% of students from years 3-4 also were satisfied or very satisfied with their second-year experience. Regarding the 3rd year, 93% of 3rd year students and 95% of 4th year students were satisfied or very satisfied with the quality of the clinical clerkships.
2. Also as evidenced by the results of the ISA, students are overall satisfied with the availability of service-learning and community service opportunities across both campuses (89%-93% of students report being satisfied or very satisfied with the availability of service-learning).  The combination of service-learning experiences integrated into the formal curriculum coupled with the breadth of community service opportunities available through student organizations and administrative offices is a strength within the UMMS. Some key highlights of service-learning and community service are provided below.

Service Learning
Twin Cities students are required to complete service learning projects over the course of several semesters in their required Essentials of Clinical Medicine (ECM) course. Students are able to select an area in which they would like to complete their service-learning project: community service; public health and health policy; or quality improvement & patient safety. 
 
Duluth students participate in community health needs assessment projects as part of the Rural Medical Scholars Program (RMSP).  The project is conducted within the rural community in which they are participating for the clinically-related portion of their pre-clerkship experience. Throughout the two-year program, students write multiple reflection papers and participate in the Brain Awareness Program, where they teach sessions on brain function and development in public schools.

Community Service
In addition to the required experiences, students have access to a variety of community service opportunities. 

• Recurring community service projects, such as providing free laundry services and reading to children at a local laundromat. This is a monthly activity organized by the Gold Humanism Honor Society (GHHS)
• Educational events for children (eg a Science Museum of Minnesota volunteer program arranged through the GHHS). Twice weekly, students volunteer at the museum to answer questions about medically related content and to get children excited about science careers
• Ad hoc opportunities with other student groups including the Student Wellbeing Committee and Women in Medicine Group
• Students enrolled in the Rural Academy of Leadership (RAL) on the Duluth Campus volunteer time at the student-run HOPE Clinic, participate in a longitudinal community service project, and complete two self-reflection papers about their experiences throughout the duration of the course. 
• Another student-run clinic is the Phillips Neighborhood Clinic (PNC) on the Twin Cities Campus.  The PNC is an interprofessional clinic governed by a student board. 100 students from the MS1 and MS2 classes participate in this opportunity annually.
• Students enrolled in the Medical Education Through Diversity and Service course on the Duluth Campus write research papers on major health concerns and issues within a global region of their choosing. 

What are we working on?

In the area of curriculum, one major area for improvement is the overall quality of the first year in the TC. MS 2 students from the TC were only 68% satisfied or very satisfied with their year 1 experience. On the bright side, the MS 1s in the middle of the year were 91% satisfied or very satisfied with their first year experience, suggesting significant improvement from the many changes to the first year we have instituted in the past two years in response to student feedback.
While there is still work being done, a few notable examples of changes already implemented are included below.  

• Increased clinical correlations have been incorporated into the Year 1 Neuroscience course, thanks to the amazing partnership of Matt Chafee and Jamie Starks. 
• A new clinical infectious disease specialist was hired to introduce clinical correlations in the Year 1 Microbiology and Immunology Course. 
• The Foundations of Clinical Thinking (FCT) course, which had previously been co-curricular, was moved into the formal curriculum. 
• The fall semester was shortened by three weeks both to make it more humane (from 19 weeks to 16 weeks) and for regulatory compliance.
• Major changes and improvements were made to the Gross Anatomy course based on student feedback thanks to the hard work of Tony Weinhaus and his staff.

* The ISA Committee is currently finalizing the ISA Executive Summary, which includes survey results.  The Committee will make the Summary available to the medical school community once it is finalized.

With Gratitude:

Self-Study processes include the establishment of a Self-Study Task Force composed of key representatives of faculty, students, administration, and leadership who serve as the executive committee for the accreditation process.  This Task Force assists with the creation and oversight of the LCME Sub-Committees, reviews and provides feedback on the Data Collection Instrument, provides direction on action plans, reviews the Independent Student Analysis, and supports the creation of the Executive Summary.   

Some of the members from this group will continue to be engaged as part of a newly created Continuous Quality Improvement (CQI) Committee.  This new committee will allow the medical school to continue to monitor on-going LCME-related action plans and identify areas for continuous improvement.  

We would like to show our gratitude to those members of the Task Force who have, for the past year, given their time and expertise to serve and support the accreditation process. 

Chairs:
Jakub Tolar, MD, Medical School Dean
Paula Termuhlen, MD, Regional Campus Dean
Robert Englander, MD, MPH, Associate Dean for UME and Faculty Accreditation Lead

Members:
Felix Ankel, MD
David Bernlohr, PhD
Austin Calhoun, PhD
Kevin Diebel, PhD
Christine Kiel
Michael Kim, MD
Badrinath Konety, MD, MPH
Robin Michaels, PhD
Peter Mitsch, CPA
Dimple Patel, MS
Anne Pereira, MD, MPH
Mark Rosenberg, MD
Timothy Schacker, MD
Yoji Shimizu, PhD
Amanda Termuhlen, MD
Ezgi Teryaki, MD
Claudio Violato, PhD
Meghan Walsh, MD, MPH
Chloe Hedberg, Twin Cities medical student
Lindsay Johnson, Duluth medical student
Sarah Kemp, Twin Cities medical student

We are now less than 5 months to our site visit, and as last week was Thanksgiving the theme of my letter will be gratitude. I hope you all had a wonderful holiday. 

First, I am grateful for the more than 250 people who have participated in our Self-Study process, bringing us ever closer to readiness for the submission of our Data Collection Instrument and its Executive Summary (likely to end up around 600 pages with >2,000 pages of supporting documentation) and our Independent Student Analysis, presented at the Education Council two weeks ago. 

I am also grateful to the Medical School community writ large. As we have gone through this process, I am both proud of the many things we are doing well and ever impressed with the willingness of our faculty, staff and students to face our challenges head-on and work towards continuous improvement.

Finally, as this is the month that we discuss Standards 8 and 9, focused on curriculum, teaching, and assessment, I am grateful for the true village it takes to make a doctor-the amazing UME staff that I have the joy of working with every day, the course and clerkship directors and their discipline leads and site directors, the faculty who teach on the front lines every day, and the students who contribute by giving feedback and then using that feedback to help us design and implement change. 

With gratitude,

Bob

• the need for rest and recuperation during clinical courses to optimize learning 
• the need to consider requirements for exams during the clerkships and the resultant necessary study time
• career development needs to prepare for the Match and residency  

Happy New Year and welcome to 2020, the year of our accreditation site visit. I have to admit it seemed so far away when we first notified the LCME that I would be the Faculty Accreditation Lead 2 ½ years ago. As with every new year, I have spent a great deal of time in reflection, especially as I have read and reread our Data Collection Instrument that details every aspect of our school, from soup to nuts.

One of the many areas we can be proud of is the focus of this month’s LCME Newsletter. Standard 10 is all about how we recruit, retain, advance and graduate medical students. Efforts on both the Central Campus in the Twin Cities and the Regional Campus in Duluth have resulted in impressive growth in the diversity of our matriculating classes since the last site visit. I continue to marvel at the amazing classes of students they recruit each year.

Kudos to Dimple Patel, Associate Dean for Admissions on the Central Campus, Dr. Robin Michaels, Associate Dean for Student Affairs and Academic Life who was overseeing admissions for most of the past five years on the Regional Campus, and Dr. Kendra Nordgren, Assistant Dean for Admissions, who ably has taken over the reins for Dr. Michaels. Finally, Dr. Yoji Shimizu, Director of our MD/PhD program, has overseen impressive recruitment and retention efforts for the school’s superb MD/PhD students. While I know each of them would still tell me “we have lots more work to do”, I think it is well worth taking a moment to celebrate their (and as a result of our) successes.

I also want to thank all of the members who serve on the Admissions Committees for the two campuses MD degree programs and the MD/PhD program. The commitment of time and the devotion to recruiting outstanding classes year after year is a true labor of love from the many participants.

Finally, this standard also addresses how we advance students. I want to thank the many members of the Committee on Student Scholastic Standing on the Central Campus (COSSS) and the Scholastic Standing Committee (SSC) on the Regional Campus. I sit as an ex-officio member on COSSS. I am ever impressed by the gravity of the decisions they have to make, and the commensurate seriousness and dedication of the members of the committee.

At this time of resolutions, I am more resolved than ever to continue to celebrate our successes and to find the opportunities in every challenge we face.

Cheers to a spectacular 2020...

Bob

The final few Standards of the DCI focus more specifically on students, beginning with Standard 10 that covers, “Medical Student Selection, Assignment, and Progress.”   The Elements within this Standard include topics on admissions, scholastic standing committees, and the policies that govern the selection, progression, and graduation of students. Specifically, Standard 10 states:

“A medical school establishes and publishes admission requirements for potential applicants to the medical education program, and uses effective policies and procedures for medical student selection, enrollment, and assignment.”

What are we doing well:
Both the Regional and Central Campuses, including the MD/PhD program, continue to recruit and admit the best and brightest through their robust and intensive admissions processes. These efforts have resulted in some notable achievements:

• The UMMS ranks second in the nation for graduating Native American students. In particular, the Regional Campus in Duluth matriculated a record number of Native American students in 2019 (18.5%) and reported an overall percentage of UIM students in the class (including Native American students) at 22%.
• Recruitment and admission of those underrepresented in medicine has increased dramatically since 2012 for all three programs (TC MD, DU MD, and MSTP). For the incoming class of 2019, 18.8% of the total class was underrepresented in medicine.
• The Central Campus in the Twin Cities has more recently reconfigured their admissions process to include the Multi-Mini Interview (MMI) format, in addition to a traditional interview. The MMI structure challenges applicants to demonstrate skills at multiple stations rather than only talking about them during a single interview.
• The Admissions Offices review applications for the medical school’s Essential and Desired Qualities (https://med.umn.edu/admissions/how-apply/selection-criteria/essential-and-desired-qualities)  throughout the entire admissions process to ensure that the students admitted are poised for success at the University of Minnesota Medical School and throughout their careers.

What are we working on:

Standard 10 did not receive any citations from the previous LCME visit in 2012 and as you can see from the above, we’ve only continued to improve in these areas during the intervening years. The staff, faculty, and offices involved in this Standard should take great pride in their efforts over the years to proactively identify and address areas for improvement. Their hard work is what has allowed the medical school to admit, progress, and graduate some of the finest physicians and physician-scientists in the country, many of whom will go on to practice in Minnesota.   

We maked a real milestone in our reaccreditation cycle as we held a three-day Mock Site Visit Sunday, January 26 through Wednesday, January 29 and then submitted our Self-study Package to the LCME on January 31. I am so grateful to the hundreds of people and the thousands of hours they have devoted to helping us achieve both of these milestones.

Our Mock Site Visit was a success, helping us to learn so that we can put our best foot forward in April. The consultants definitely pointed out some opportunities for improvement. All of those areas, I am happy to report, have active action plans ongoing already.

While a brief celebration is in order, we cannot be complacent and will continue to work hard to ensure that we reach our two goals of an eight-year accreditation decision and no surprises on our inevitable citations.

Special thanks to all of you who traveled from our Duluth campus to be here for the visit, those of you who participated via video conferencing, and our many partners from around the state who weathered the new security system here to participate live! One of the most impressive reflections of the site visit team was the truly unique extent to which, as partners across the state, we are truly a single community dedicated to preparing exceptional physicians to improve the health and well being of Minnesota and beyond.

We will be working closely with you over the ensuing months to make sure we are addressing all of our challenges while optimally preparing you for the actual site visit.

With gratitude,

Bob

What's the Theme: 

Standard 11 out of 12 continues the focus on more direct student services and programs. Standard 11 covers, “Medical Student Academic Support, Career Advising, and Educational Records.”   The Elements within this Standard include topics on Career and academic advising, elective opportunities, and access to, and confidentiality of educational records. 

Specifically, Standard 11 states:

“A medical school provides effective academic support and career advising to all medical students to assist them in achieving their career goals and the school’s medical education program objectives. All medical students have the same rights and receive comparable services.”

What are we doing well:

We are now just over a month away from the site visit!  We are actively finalizing the details to try to ensure a seamless three days.   Today’s newsletter highlights the 12th and final standard focused on medical student health services, personal counseling, and financial services.  You will note that an area for improvement from our 2012 visit was Financial Aid/Debt Counseling/Student Educational Debt. In addition to holding tuition steady for five years (2014-2018), the Office of Financial Affairs has done a wonderful job of optimizing the use of grant and scholarship dollars available, resulting in our students indebtedness now being below the national average for both public and all schools. Kudos to Kristin Basballe and her team on the Central Campus and Dina Flaherty on the Regional Campus for all their hard work.

I hope that you will take the time to read our Executive Summary that was submitted as part of our Self Study Package to the LCME.  It provides an overview of where we are and the progress we have made since the last visit.  Each time I read it I am reminded of the dedication of all of you throughout the state to preparing exceptional physicians to improve the health and well being of Minnesota and beyond.

Wishing us all an early start to spring and no snow during the Site Visit!

With gratitude,

Bob

Standard of the Month: Standard 12 (of 12): Medical Student Health Services, Personal Counseling, and Financial Aid Services 

What's the Theme: 

We’ve reached the final Standard of the Data Collection Instrument (DCI). Standard 12 covers “Medical Student Health Services, Personal Counseling, and Financial Aid Services.” The Elements within this Standard include topics on financial aid and debt management, personal counseling and well-being, and policies related to tuition refund, immunizations, and student exposure.

Specifically, Standard 11 states:

“A medical school provides effective student services to all medical students to assist them in achieving the program’s goals for its students. All medical students have the same rights and receive comparable services.”

What are we doing well:

IMPORTANT SELF-STUDY UPDATE
Due to the COVID-19 pandemic, the LCME decided to postpone all April and May Site Visits. The new rescheduled date has been set for July 15-17, 2020 (Wednesday - Friday). We will be working closely with the LCME and our Site Team over the coming weeks to work out the details of the Site Visit. For those directly involved in the accreditation process, notifications will go out regarding the next steps and additional activities.

Official Site Visit from the LCME rescheduled to:
July 15-17, 2020

This month, I wanted to acknowledge the tremendous efforts seen throughout our institution in just the past few weeks. It is in times of intense pressure and adversity that we see the true “spirit” of a community and ours has been a shining example of leadership, commitment, and resolve. For example, in just a short time, those involved in medical education are re-envisioning and implementing innovative curriculum, high-quality patient care is still being maintained through the tireless dedication of our health professionals, our school has stepped up to provide critical research to aid us in this pandemic, and leadership is guiding us with clear vision and purpose. There is no doubt that once we come through this, the medical school will be better and stronger for it. 

We are grateful to every member of the medical school, our affiliate partners, and the larger community who have demonstrated, and continue to demonstrate, the highest ideals of excellence through these trying times.

With gratitude,

Bob

What's the Theme: 

As we were supposed to have our LCME visit this month, we have already covered all 12 Standards in prior newsletters! As such, the theme for this month is one of reflection. Reflection on the significant amount of work that’s been done over the past two years conducting the Self-Study and reflection on the work so many have put in to improve the educational program and the student experience since the last Self-Study in 2013. While not exhaustive, a few highlights are provided below.

• Extensive initial review of, and recommendations for revising, the medical school’s Constitution and Bylaws with the intention of updating them in the 2020-2021 Academic Year

• Improvements in addressing mistreatment by increasing awareness of mistreatment policies and procedures and reporting of mistreatment incidents. 
• Upgrades to study and lounge spaces on the Regional Campus in Duluth 
• Securing over $100 million for the construction of the Health Sciences Education Center, (HSEC), a state-of-the-art interprofessional space expected to open in fall 2020 

• Restructuring the interprofessional education program through piloting the Better Together curriculum. The program, done in collaboration with the School of Nursing, allows students the opportunity to learn more about the roles of health professionals and patient experiences impacted by effective teamwork. 
• Establishment of a Task Force to evaluate Duty Hours requirements in the clinical clerkships resulting in a new Duty Hours Policy to increase Independent Learning Time and allow more time for wellness and self-care
• Creation and implementation of a new Patient Encounter Tracking System for students to log encounters, including opportunities to review required encounters during mid-clerkship feedback

• Improved tracking of residents receiving learning objectives; creation of “Back to School” program to improve resident preparation for their teaching responsibilities
• A new process developed to annually verify all Clinical Site Directors’ faculty appointment status 
• Approval of revised policies on Student Advancement and Graduation Requirements, Leaves of Absence, and academic progression

• The hiring of a Career Development and Faculty Advisor Coordinator to help guide students in the necessary steps from matriculation through a successful match
• Identification of specialty-specific advisors within departments to assist students with career advising needs 

• Creation of medical student Confidential Bridging Counseling on the Central Campus, including the recent expansion of staffing
• Improved monitoring and adherence to immunization requirements for students on clinical clerkships

Faculty Accreditation Lead Message:

July 15th - 16th saw a major milestone in our accreditation process with the completion of our Virtual Site Visit. The visit was completely seamless thanks to the amazing work of the Accreditation Team-Joe Oppedisano, Ali Niesen, and Tami Brown and the special help from Monica Rogers and Austin Calhoun. I am so grateful for their impressive work. Special thanks to all of the participants-students, faculty, and staff. You all represented us with poise, knowledge, and professionalism.

Our original goals were twofold: to have a process of improvement that alerted us to all of our vulnerabilities resulting in no significant surprises, and to achieve an eight-year accreditation. I am excited to tell you that, based on their exit summary, we are likely to achieve the first goal-no significant surprises. They will clearly have citations, but in every case, we can speak to the work towards improvement that has already begun.

We remain grateful to every member of the medical school, our affiliate partners, and the larger community who have demonstrated, and continue to demonstrate, the highest ideals of excellence through these challenging times.

With gratitude,

Bob

What's the Theme: 

Having just completed the virtual Site Visit offers a chance to take stock of where we’ve come and where we’re headed in our re-accreditation process that began more than two years ago.

Over the past 2+ years, hundreds of members of the UMMS community have been engaged at some level with the Institutional Self-Study. This included: 1) countless hours compiling the Data Collection Instrument (DCI), 2) analysis of the Independent Student Analysis (ISA), and 3) an LCME Executive Task Force and five sub-committees that reviewed the UMMS' performance in meeting LCME requirements.

The result was a Self-Study Package submitted to the LCME in January, 2020 consisting of a 550+ page Data Collection Instrument (with several thousand pages of appendices), an Independent Student Analysis Summary Report, a 35-page Executive Summary highlighting our findings, and the successful coordination of UMMS’ first fully virtual Site Visit. The Self-Study also identified many opportunities for quality improvement, most of which have been initiated or addressed.

What to expect going forward:

In the week following the virtual Site Visit, UMMS received an Exit Report compiled by the Survey Team. This provides some insight into their initial impressions. Subsequently, in the next two months, the UMMS will receive an official Survey Report from the LCME, with the recommended accreditation finding for each Element (Satisfactory, Unsatisfactory, or Satisfactory with Monitoring). The UMMS will have 10 days to provide a response to these findings. The Survey Report, with the UMMS response, will be submitted to the LCME to vote on the final outcome at their October meeting. 

What we're working on:

The Survey Team’s Exit Report provided some initial impressions of our performance during the virtual Site Visit. The good news is almost all of the issues noted by the Survey Team were identified during the Self-Study and have already seen significant improvement. Below are some highlights, by theme, from the Exit Report. 

• Diversity - The Survey Team acknowledged efforts towards preparing, recruiting, and matriculating a diverse student body but noted opportunities for improving diversity in administrative leadership and faculty positions that meet school-identified diversity categories.
• Facilities - The Survey Team noted the medical schools’ efforts towards addressing the sufficiency of campus facilities since the last Site Visit in 2012. However, student satisfaction with campus facilities continues to be low. The new Health Sciences Education Center on the Twin Cities Campus and new renovations on the Duluth Campus are expected to improve student satisfaction. Medical school administrators and student leaders are working closely to monitor satisfaction and address other student facilities needs as they are identified.
• Curriculum Structure - The Survey Team noted some concerns about the comparability of the curricula on the two campuses and between clinical sites. However, they also acknowledged the UMMS’ approval to revise the Graduation Competencies from 60 to 34, its current review of all pre-clerkship course learning objectives, and recent efforts to revise the list of required clinical encounters and procedures with improved clarification around levels of responsibility. 
• Academic Workload - The Survey Team noted some student dissatisfaction with the current pre-clerkship workload and efforts by the Education Council and Office of Curriculum to establish expectations regarding pre-clerkship contact hours, resulting in a revised Academic Workload Policy.
• Curriculum Content - The Survey Team noted some low satisfaction on the ISA with the adequacy of education in caring for patients from different backgrounds, which contrasts with high levels of satisfaction on the Graduation Questionnaires. Faculty and administration also acknowledged the need to improve the amount and effectiveness of the curriculum devoted to this content and have already been working on a number of initiatives to address this issue.  The Survey Team also acknowledged the implementation of new interprofessional education content to address low levels of satisfaction on the Twin Cities campus.
• Student Assessment - The Survey Team identified issues related to the way in which the UMMS assesses students during the clerkship phase and ensures such assessments are taking place. There were some issues related to the observation of students performing a history and physical, amount and quality of formative feedback, and oversight of student assessment by physicians with faculty appointments. The Survey Team acknowledged the work the UMMS has already done to address these areas.  
• Advising and Wellness - The Survey Team noted higher levels of dissatisfaction by students at the time of the ISA (January 2019) regarding career advising, accessibility of personal counseling and mental health services, and clerkship student access to Boynton Health Services. The Survey Team did acknowledge UMMS' efforts at addressing these areas such as creating a residency match coordinator position, developing longitudinal career preparation programs,  creating Confidential Bridging Counseling in the Twin Cities, and adding free telepsychiatry services to students in Duluth.

We also continue to make progress on ways to inform the UMMS community about the many improvements being implemented in the educational program including:

• Developing web-based dashboards that reflect the status of ISA recommendations, LCME monitoring efforts, and strategic planning.
• Working with the Medical Education Outcomes Center (MEOC) to identify and consolidate important data across the medical school designed to inform discussions on institutional performance and allow for a more seamless sharing of information.