Report of Committee One Institutional Setting Governance and Administration

 The vice president and dean, the vice deans and the clinical and basic science chairs together withthe Faculty Council and representative of the student body comprise an effective gove

College of Medicine

LCME Institutional Self-Study

Report of Committee One: Institutional Setting:

Governance and Administration

Study Year 2005-2006

The contents of this report represent the judgments and opinions of the members of this Self-Study Committee The committee has made every effort to ensure that the information represented is accurate The LCME administrators have not audited the data in the text of the report and there may be some discrepancies within the database or executive summary as a result While every attempt has been made

to provide and evaluate information accurately and objectively, the committee acknowledges that any errors of fact in this report are unintentional.

(Printed October, 2006)

Table of Contents

I Executive Summary/Key Issues 3

II Responses to Questions in Guide to Institutional Self-Study 3

III Analysis of Recommendations and Deficiencies Relevant to Committee as

Identified by Most Recent LCME Review in 1999 14

IV Major Changes Since Last LCME Review in 1999 14

V.Areas of Strength 14

IV Areas of Concern and Challenges 15

VII Review of Compliance with Established LCME Standards 15

VIII Recommendations, Possible Solutions and Strategies 19

IX Issues of Concern Relevant to Other Committees 19

X Attachments 19

XI Narrative of Process 19

XII. Database Accuracy 19

XIII. Committee Membership 19

I Executive Summary/Key Issues

 The College of Medicine at the University of South Florida has developed an appropriate model

of shared governance between the administration and the faculty that facilitates extensive

communication and discussion of institutional priorities

 The vice president and dean, the vice deans and the clinical and basic science chairs together withthe Faculty Council and representative of the student body comprise an effective governance structure that contribute to effective institutional planning with respect to the education, research and service missions of the college

 The various administrative and policy committees described in the Faculty Bylaws provide an efficient advisory function to the dean of the College of Medicine

 Previous extensive planning and development activities have resulted in the college’s

commitment to provide an outstanding educational environment and an innovative curriculum to encourage lifelong learning by medical and graduate students

 The implementation of modern information technology has contributed to the success of the college’s educational endeavors

 Significant resources have been committed to encourage students to engage in the completion of anumber of dual degree programs

 While the College of Medicine does not own a “teaching” hospital, cordial relationships have been developed with a number of local clinical institutions that provide appropriate training environments for clinical care delivery These include Tampa General Hospital, the H Lee Moffitt Comprehensive Cancer Center and Research Institute and the James A Haley Veteran’s Hospital

 The Board of Trustees and the president of the University of South Florida have adopted an appropriate governance strategy and provide efficient oversight of the operations of the College

of Medicine

 A number of new facilities, such as the Center for Advanced Healthcare will greatly improve and expand the education, research, and service missions of the College of Medicine

II Responses to Questions in Guide to Institutional Self-Study

1 Describe how institutional priorities are set Evaluate the success of institutional planning efforts and discuss how planning has contributed to the accomplishment of the school’s academic purpose, research prospects, and goals of the clinical enterprise

Committee Response:

How are institutional priorities set?

While a formal, institution-wide structure provides input and guidance for decisions regarding priorities

of the college, final decisions are made jointly by the executive committee of the college; i.e the vice president for USF Health and dean of the College of Medicine as well as the vice deans and the clinical and basic science chairs Included in the structure are the student body and their governing representativesand faculty represented by an elected Faculty Council Reporting to the council are policy committees

whose authority and responsibility are specified by the Faculty Bylaws of the College of Medicine In addition, there are a number of administrative committees that report to the dean of the College of Medicine.

The Policy Committees comprise:

3 Committee on Continuing Medical Education

4 Committee on Curriculum

5 Committee on Graduate Medical Sciences Education and Graduate Student Affairs

6 Committee on Graduate Medical Education

7 Committee on Professional Student Affairs

The Administrative Committees comprise:

1 Academic Performance Review Committee

2 Committee on Appointment, Promotion, and Tenure

3 Committee on Medical Student Selection

4 Committee on Space

5 Faculty Relations Advisory Committee

Offices of the college administration, as well as the individuals and support personnel, who are assigned

to them, complement and assist the major Policy and Administrative Committees

These offices include the following:

Vice Dean, Educational Affairs ……… ….…… Paul M Wallach, MD

Vice Dean, Research Affairs ……….……… Abdul Rao, MBBS, MA, DPhil

Vice Dean, Clinical Affairs……….……… Robert J Belsole, MD

Senior Executive Associate Dean for Faculty and Academic Affairs … John S Curran, MD

Associate Dean for Clinical Practice……… … Enrico Camporesi, MDAssociate Dean Quality……….… … ….…Michael Parsons, MD

Associate Dean for Undergraduate Medical Education… …Bryan Bognar, MDAssociate Dean for Academic Enrichment………….……… Deanna Wathington, MD

Associate Dean for Student Affairs and Admissions Steven C Specter, PhD

Associate Dean for Research ……….……….…….……Lynn Wecker, PhD

Associate Dean for Graduate Affairs……….… …Joseph J Krzanowski, PhD

Associate Dean for Graduate and Post Doctoral Affairs (Interim)………… Michael Barber, DPhil

Associate Dean for Business Affairs and Technology……… Joann M Strobbe, MEd

Associate Dean for Diversity Initiatives……….….… Marvin T Williams, PhD

Associate Dean for Continuing Professional Development……….… Deborah Sutherland, PhD

Assistant Dean for Clinical Outreach……….… Heidi M Stephens, MD

Associate Dean for Graduate Medical Education & Veterans Affairs….… … Peter J Fabri, MD

Assistant Dean for Student Affairs……….……….……… Carolyn Nicolosi, MS

Assistant Dean for Special Projects……….…………Karen M BurdashExecutive Director of USF Physicians Group……… ….… ….…Joseph M Jackson Director of Admissions……… ….……… Robert E LarkinDirector of Area Health Education Center……….…… Cynthia S Selleck, DSN

Director of Business Affairs ……… ……….….Jean G Nixon

Director of Compliance ……….………Patricia J Bickel

This structure provides a mechanism whereby any student or faculty member can introduce ideas and suggestions for change in any area with assurance that they will be formally considered The process for diverse routes of input to the dean is outlined to follow:

Figure 1

University of South Florida College of Medicine

Routes of Input for Shared Governance

b) Evaluate the success of institutional planning efforts and discuss how planning has contributed

to the accomplishment of the school’s academic purpose, research prospects and goals of the clinical enterprise.

The pre-eminent mission and responsibility of the college has always been medical student education The 1997 Strategic Implementation plan states “A principle role of the College of Medicine is to select and educate students of Health and Biomedical Science through the creation and support of a scholarly environment of discovery and research The college will foster excellence in the lifelong endeavors of education, research activity, and compassionate patient care relevant to improvement of the health of the community.”

The College of Medicine (COM) has engaged in a series of strategic planning activities over the past decade as indicated by the most recent strategic plan There is a high degree of continuity across these planning activities in terms of the over-arching goals of the college:

Dean of the COM STEPHEN K KLASKO, MD, M.B.A., F.A.C.O.G.

Executive Council of the COM Faculty Council of the COM

Sandra Gompf, MD President

Student Executive Council David Wilson, MS IV., President

Departmental Delegates and Committees of the Faculty

Department Chairs

Clinical and Basic Science Class Officers and Representatives

Department Faculty Individual Faculty

Members

Individual Students

 A commitment to provide the highest quality and most relevant educational and training programspossible

 Dedication to conducting basic and translational research that advances knowledge and results in improvements in health and patient care

 The acquisition, generation and management of financial resources in a manner that makes the realization of these goals possible

Evaluation and improvement of the undergraduate medical education curriculum is an on-going process atthe College of Medicine Since 1999 the college has made significant modifications in the Year 1 and 2 curricula, moving to a model that is more integrated and interdisciplinary and that places a greater

emphasis on the application of important basic science concepts to clinical medicine

A critical component of the Year 1 and 2 curricular reforms is the Longitudinal Clinical Experience (LCE)program that pairs first and second year medical students with medical school faculty and private medical practice preceptors for one half-day per week Over the course of two years, each medical student works with three different preceptors in primary and specialty practice areas

In early 2004 with extensive faculty and student involvement and aided by the Office of Educational Affairs, the college began “The Program to Advance Clinical Education” (PACE) to evaluate the

adequacy of the Years 3 and 4 curricula PACE is being conducted within the context of the numerous published studies that have concluded that the clinical component of U.S undergraduate medical

education has not kept up with changes in health care delivery systems, evolving practice requirements, changing patient expectations, increasing emphasis on quality improvement and evidence-based medicineand constant innovations in medical informatics and technology The goals for the new Years 3 and 4 program, which were implemented in 2005-2006, include the following: (a) development of an

interdisciplinary clerkship model; (b) creation of a new methodology for oversight of clerkships; (c) assurance that learning experiences expose students to common disorders that are representative of those seen in clinical practice, including important concepts of the major fields of medicine that develop procedural skills appropriate for all medical school graduates, including patients presenting de novo who

do not yet have a diagnosis; (d) integration of important contemporary issues in medicine; (e) realization

of a more robust fourth year; and (f) increase of enhanced technology

The new Clinical Skills Center opened in the fall 2005 and is one of the most advanced facilities of its kind in the nation The quality of the USF College of Medicine undergraduate medical education programconsistently ranks among the best in the nation, according to national measures such as the following:

 USF medical school graduates’ 2001 through 2004 for the first time pass rates on the USMLE Step 1 ranged from 99% to 100% National pass rates ranged from 94% to 96%

 USF medical school graduates’ 2002 through 2005 for the first time pass rates on the USMLE Step 2 ranged from 99% to 100% National pass rates ranged from 94% to 96%

 On the AAMC 2004 Medical School Graduate Questionnaire, 51% of USF COM graduates reported that they “strongly agreed” that they were satisfied with the overall quality of their medical education program, as contrasted to 39% of national medical school graduates

The college is committed to assuring that our medical school graduates possess the concepts, skills and attitudes required for the effective and successful practice of medicine in today’s healthcare delivery environment In addition to the modifications being made to the Year 3 and Year 4 curricula, several other initiatives are also underway

The first initiative, internally referred to as the “Physicians Who Get It” initiative, identifies a skill set (including communication and negotiation skills, conflict resolution, leadership and management skills, the ability to work as a team member, etc.) that is considered imperative for today’s practicing physicians

to possess The next challenge is to design curricular components for these skills and to reach consensus about how to incorporate them into the curriculum The second initiative underway aims at significantly increasing the number of medical students who graduate with a dual degrees, such as MD/MS, MD/MBA and MD/MPH Highest priority will be given to the MD/PhD in biomedical sciences and a new program

in biomedical engineering We also offer MD/MBA and MD/MPH degrees It is the college’s objective that 20% of medical school graduates will ultimately complete a dual degree The college is also actively investigating the creation of a range of “scholarly concentrations” which would permit students to include

a focus of study in a specific area of interest during their medical studies Potential “scholarly

concentrations” would include community/public health, international health, biomedical

ethics/humanities, immunology, clinical research, leadership development, academic medicine, aging, the business of medicine, neurosciences, infectious diseases, oncology, bioinformatics/biostatistics and sports medicine, among others

In order for the College of Medicine to achieve the curricular and educational reforms planed for the next five to ten years, it is imperative that the college’s instructional technology resources be significantly enhanced The college has approved and has implemented the following new computer requirements beginning the 2005-2006 academic year:

 Notebook computers for all new students will permit each classroom and lab to serve as a

computer lab

 Handhelds for all third year students will offer students experience with the technologies that nowexist in clinical practice

Other instructional technology applications being implemented by the college include the following:

 An enhanced student clinical encounter system permitting real time review of activities in

comparison to benchmarks

 Increased use of simulators

 Expanded use of computer-delivered testing

 Enhanced use of digital imaging for histology, pathology and microbiology

Graduate education has been recognized as fundamental to achieving the strategic goals of the College of Medicine These goals include the development and training of future scientists and clinicians who will beresponsible for generating pioneering advances in health care and basic research as well as providing the educators and researchers of tomorrow In addition, the development of new, interdisciplinary graduate programs can provide a pool of highly-qualified individuals who can compete for local academic and industrial positions Thus, a strong graduate program that comprises a diverse array of talented Doctoral and Masters students provides an essential complement to the traditional medical student programs and stimulates the research endeavors of the faculty

The College of Medicine offers graduate programs leading to the Doctor of Philosophy in Medical Sciences, the Master of Science in Medical Sciences, the Master of Science in Bioinformatics and

Computational Biology and the Master of Arts in Bioethics and Humanities

The Doctor of Philosophy (PhD) degree in Medical Sciences is available with concentrations in Pathology

& Cell Biology, Molecular Medicine, Neuroscience and Molecular Pharmacology and Physiology A combined MD/PhD program is also under development and initial students are being recruited

A recent development in preparing students for a research career has been the institution of a

Multidisciplinary Biomedical Sciences (MBS) doctoral program that combines strong biomedical

sciences training with increased research opportunities This program enables students to enter graduate doctoral education in an undifferentiated status by participating in a comprehensive course entitled Foundations of Medical Science Students enrolled in the MBS program participate in a common first semester curriculum that provides an essential background in biochemistry, molecular biology and cell biology, combined with laboratory rotations to identify an area of research and a mentor In addition to theMBS program, students with a specific interest in one department/concentration may apply to both the MBS program and one department/concentration.

The University of South Florida School of Physical Therapy was established in 1998 within the College

of Medicine The first class of 14 students graduated in 2001 and was awarded the entry-level Master of Science in Physical Therapy (MSPT) degree The school has subsequently enrolled 30 students in the MSPT degree program Responding to national educational trends and changes in scope of physical therapy practice within the healthcare environment, School of Physical Therapy faculty developed and submitted a curricular implementation proposal to replace the entry-level MSPT degree with the first professional Doctor of Physical Therapy (DPT) degree Following university review and approval, the Florida Board of Governors granted new degree implementation authority to USF in October 2004, enabling USF to becoming the first public university in Florida to offer the Doctor of Physical Therapy entry-level degree The charter DPT class of 30 students began their 3-year course of study in August

2005 The final two groups of matriculating MSPT students will complete their studies in August 2005 and 2006 A one-year transitional Doctor of Physical Therapy (DPT) degree program is being made available for USF MSPT graduates and will begin in August 2006

Evaluation and improvement of the physical therapy curriculum is an on-going process within the School

of Physical Therapy Since August 2004, the school’s curriculum committee has made significant

modifications to the new DPT curriculum, building an innovative model that is more integrated and interdisciplinary within the resources of the College of Medicine and Health Sciences Center, and that places our Year 1 DPT students with Year 1 medical students in key “foundations of doctoring” courses These changes were reviewed and approved by the College of Medicine Committee on Curriculum in March 2005 Additional interdisciplinary opportunities are being developed and are evolving outside the classroom, so that teaching and learning together are translated into the teamwork of practicing

collaboratively

Demand for access to physical therapy education is growing strong The USF School of Physical Therapyhas responded to this increasing demand for access to physical therapy education in Florida by increasing its entering class size from 30 in 2004-2005 to 36 (+20% increase) with the implementation of the new DPT degree in 2005-2006

Like many other public schools of medicine, one of the significant challenges facing our program is maintaining and increasing funding for our educational mission in an environment of limited and

competitive resources There is the potential for increasing the number of state supported medical schools

in Florida which would most likely negatively impact the funding provided to USF COM General revenue funding, as a percentage of the College of Medicine’s operating budget, has declined steadily over the past five years from 22.4% in FY 1999-2000 to 15.1% in FY 2001-2005 This reality combined with increased pressure to produce more clinical revenue and contract grant funding has increased the emphasis placed on clinical practice and research Concomitantly, the college is implementing critical curricular reforms, particularly related to increasing small-group methods of active learning, that are oftenmore costly than the traditional undergraduate medical curriculum Unfortunately, however, some of the educational facilities of the college are 35 years old and inadequate to support further important

curriculum reforms aimed at enhancing methodologies and programs within the college While we have recently renovated larger-group classrooms for first- and second-year medical students that are state-of-the-art, and we have a recently completed innovative clinical skills center, there is still a significant need

for a building that is designed for small-group instruction, mid-sized programs, learning communities, andsimulation Beyond these very urgent needs, a new medical education building would allow the college toachieve greater national prominence and further all of its educational missions Thus with this

combination of pressures, the college needs to focus much of its energies on ensuring appropriate faculty and financial resources for the educational mission

2 Evaluate the role of the governance structure in the administrative functioning of the medical school Is the governance structure appropriate for an institution of this size and characteristics? Describe any situations that require review by or approval of the school’s governing board prior to taking action

Committee Response: The governance structure of the College of Medicine is well defined in the

Bylaws of the Faculty which serve as a “Constitution” for the College of Medicine The dean is the chief academic and administrative officer of the college and is responsible for the implementation of its policies

in accordance with university and Board of Trustee’s policies There is a well-defined structure for collegeorganization composed of Basic Science and Clinical Science Departments that reports directly to the dean Each department and the Schools of Physical Therapy and Basic Biomedical Sciences are

administered by a director or vice dean who is responsible for the organization and implementation of its programs Recent initiatives have, at times, been less than optimal in assuring bilateral communication and using the faculty structure for initiatives being administratively directed at USF Health Concerns have been recognized and are being addressed quite productively

Internal governance is accomplished through two advisory bodies to the dean The first is the Executive Council which is the senior representative body composed of the dean, the department chairpersons, the director of the School of Physical Therapy, and the president and vice-president of the faculty and the

president of the College of Medicine Student Government who serves as an ex-officio, non-voting

member of the Executive Council This function is now being accomplished by a monthly “All Chairs Meeting” within the intent but not the letter of the Bylaws of the Faculty

The College of Medicine Faculty Council is a representative body of the organized faculty which is advisory to the dean and is also responsible for recommendations for both policy and administrative committee nominations It is composed of the Officers of the Faculty, the immediate past-president of the faculty and members of the core faculty elected from each of the departments of the college and the school The Faculty Council routinely meets on a monthly basis to discuss all matters brought before it byany of its members, the dean, standing committees of the college or the executive council Recently it has been used as a “Town Hall” forum to communicate decisions of the administration to the faculty in a “top down” format and not within the intent of the perception of the faculty as a vehicle for shared governance.Rapid changes are underway as administratively directed by the USF Health administration which has engendered substantial concern among the faculty relative to the principles of shared governance

enunciated in the Bylaws of the Faculty which state the following: “The Faculty Council shall, by

majority vote, make recommendations to or advise the dean and executive council on these matters.” Definite constructive efforts have now been made to engage the faculty in a collegial debate over

departmental reorganizations, consolidations, and redirection to fulfill the strategic directions enunciated

in the Collegiate Strategic Plan as revised in 2006

Collectively, there is optimism that at this time of substantial change there is increased recognition of the importance of engagement of the faculty in the development of new signature programs, reinvigoration and investment in the program in graduate medical sciences, searches for chairs and outstanding research scientists, development of new clinical programs, implementation of an asset and investment management