ST. LOUIS _ Multiple gaps in curriculum and inadequate policies have placed St. Louis University's School of Medicine on probation by an accrediting agency.
The school remains accredited but has two years to fix about 20 action items identified as noncompliant during a recent reaccreditation process by the Liaison Committee on Medical Education.
SLU is the only medical school in the United States currently on probation, though other schools, such as Baylor and George Washington universities, have been on probation in recent years.
In a letter dated Feb. 21 to SLU President Fred Pestello, the accrediting group cited a "constellation of standards with which the school is out of compliance, which has compromised the quality of the medical education program."
"If there is not sufficient progress toward compliance with the cited accreditation standards within 24 months, the LCME may choose to withdraw accreditation."
SLU leaders are confident that won't happen.
Medical school dean Dr. Kevin Behrns, who joined SLU Jan. 1, told the St. Louis Post-Dispatch that he was ready to launch a remediation plan to address all of the issues brought to light by the accrediting group. He plans to involve students and faculty in a total evaluation of the medical school's operations and curriculum.
Deficiencies were found in about 20 percent of 93 measures judged by the accrediting body.
Behrns said the review, which comes around every eight years, happened in the middle of phasing in a new curriculum, "which probably created some gaps," he said. Evaluators visited campus in October and made the decision to put SLU on probation mid-February.
SLU notified students, employees and alumni Tuesday morning of the probationary status and the remediation plan.
The deficiencies vary, but multiple items highlight concerns about the way the curriculum is managed. For example, the letter cites a failure to link the school's learning objectives to students' progress in "developing those competencies that the profession and the public expect of a physician."
"If it says the student must know how to do a physical exam of the abdomen then the student needs to show us that," Behrns said.
A few of the concerns also involve the school's affiliation agreements, which aren't specifically named. SLU has a partnership with SSM Health, which in 2015 acquired St. Louis University Hospital. Top leaders from SSM are aware of the probation.
Specifically, the accrediting group says SLU and its affiliates "do not share responsibility for the learning environment." There are no periodic evaluations to better understand how well the learning environment is helping students understand professional standards. Evaluators also criticized the fact that students in clinical settings may be supervised by physicians who are not medical school faculty members.
One needed fix is improving documentation, Behrns said. If a medical student is on rotation at an affiliate hospital such as St. Mary's, and is stuck with a needle while trying to administer an IV, there needs to be documentation of the process or next steps that are to follow.
"That process is not hard wired; we need to have that hard wired," Behrns said.
The medical school also needs to improve central oversight to identify potential gaps in education, Behrns said.
"Say our students don't perform in a topic area very well on a national exam, we need to go back and look at that topic area," he said.
Recruiting and retaining low-income and first-generation college students were other issues the school faces. The University of Missouri's medical school battled a similar issue recently after diversity concerns were raised.
"We didn't measure up," Behrns said.
Both Behrns and Pestello underscored that the school was still accredited, so current and prospective students continued to be eligible to take the national board exams and apply for residency positions.
"We're still accredited, and we will own the issues and fix them," Behrns said, when asked about how this situation could affect the perception of SLU.
The accrediting group offers schools the opportunity to refute probationary status, but Behrns doesn't plan to do that. Instead, he hopes that a few advisory committees and schoolwide input will put the school in a position to be taken off probation within a year.
"I have full and complete confidence that he will aggressively address every issue that's been raised," Pestello said of Behrns.
"The reason it's a big deal is that we didn't exercise the discipline we needed to exercise to make sure that we remain fully accredited," Behrns said. "When you're talking about medicine and taking care of patients, it's all about the details."
The Liaison Committee on Medical Education is co-funded by the American Medical Association and the Association of American Medical Colleges. The organization reviews more than 150 medical schools in the U.S. and Canada.
