NEWS FLASH SMU doesn't win approval at Ca Board meeting

[azskeptic]

Originally Posted by wolfvgang22

Doh! Looks like we got moved to the relaxing lounge...sorry!

actually it started in the relaxing lounge...ha ha

[Skipper]

hmm interesting...we were looking for an embyrology teacher to replace the local farmer we have that teaches embyro....the farmer is cashing in his early retirement.....lol

we are looking for a physio teacher....know anyone?

lol

the skipper

[Scott1981]

ok ok...... ill take the physio 1 job. ill start teaching physio 2 after i finish taking physio 2.

[Skipper]

sounds great....in return Skipper U will award u with an Doctoral Degree in Advanced Bartending....

the skipper

[azskeptic]

Originally Posted by Scott1981

ok ok...... ill take the physio 1 job. ill start teaching physio 2 after i finish taking physio 2.

why not? a neew med school in England squatting was just started by a resident....and another school that is being planned in the carib. is being started by a year 2 student at Ohio....

[WestTexasRN]

Originally Posted by AssyrianSkipper

hmm interesting...we were looking for an embyrology teacher to replace the local farmer we have that teaches embyro....the farmer is cashing in his early retirement.....lol

we are looking for a physio teacher....know anyone?

lol

the skipper

Anyone asked those ladies at the PR? They have plenty of hands-on exp and they make wonderful visiting profs.

[JTP73]

Originally Posted by azskeptic

Just had a phone call from someone who attended the meeting.

Report was released at the meeting and hopefully I'll have where it is at shortly.

Here's the report: (AZSkeptic, I beat ya to it! he! he! )



– DRAFT --
December 15, 2004


To: Division of Licensing
Medical Board of California

From: The Site Team

Harold J. *****, M.D., Ph.D., Consultant
Richard Fantozzi, M.D., Member
Joyce Hadnot, Deputy Director
Anita Scuri, Legal Advisor
Martin Pops, M.D. (Chicago Site Visit)

Subject: Report on Site Visits to St. Matthew’s University School of Medicine, Its Branch Campus in Windham, Maine, and Teaching Hospitals Offering Clerkships to Its Students

Introduction

A survey of the St. Matthew’s University School of Medicine (“SMUSOM”) campus in Windham, Maine was conducted on May 11 and 12, 2004 by a team representing the Division of Licensing of the Medical Board of California (“Division”). A team also visited four teaching hospitals offering clerkships to SMUSOM students on May 24-25, 2004 in Chicago, Illinois. Thereafter, the site team conducted a survey of the principal campus on Grand Cayman, British West Indies, on June 17 and 18, 2004.

The purpose of the site visits was to determine whether the school provides an educational program that is equivalent to the requirements of Business and Professions Code Sections 2089 and 2089.5 and meets the requirements of Title 16 Cal. Code Regs. sections 1314.1. The team members were Richard Fantozzi, M.D., division member, Joyce Hadnot, Deputy Director of the MBC, Anita Scuri, Legal Counsel from the Department of Consumer Affairs, and Harold *****, M.D., licensing consultant. Martin Pops, M.D., Ms. Hadnot, and Ms. Scuri conducted the site visit to four teaching hospitals in the Chicago, Illinois

This report consists of three consolidated reports on the principal campus on Grand Cayman, the Windham, Maine branch campus, and four teaching hospitals in and near Chicago, Illinois that offer clerkships to SMUSOM students, together with a recommendation from the site team.


Part 1. Campus on Grand Cayman, British West Indies

The main purpose of this site visit was to review and evaluate the program at SMUSOM’s main site on Grand Cayman Island (SMUCI). The evaluation was aimed at obtaining an overall perspective of SMUSOM. More specifically, the evaluation was intended to focus on the preclinical education of medical students in preparation for their clinical clerkships, on the physical facilities, on selection of and feedback from the hospitals utilized for clinical clerkships, on student life and support systems, on research, and on relations with local government

This portion of the report will address the following topics:

• Chronology and Rationale for Locating on Grand Cayman Island
• Ownership
• Administration
• Governance
• Faculty
• Admissions
• Students
• Pre-Clinical Curriculum
• Selection and Evaluation of Clerkship Sites
• Facilities on campus--Building, Classrooms, Laboratories, Residence hall
• Facilities off campus--Hospitals, Clinics, Physicians’ Offices
• Library and Learning Resources
• Research
• Relations with Local Government

Chronology of the Request by SMUSOM for Recognition and Rationale for Locating on Grand Cayman Island

SMUSOM was conceived in 1996 and chartered in 1997. The first class of medical students matriculated in September of that year on Ambergris Cay in Belize, Central America. SMUSOM submitted the first request for recognition by California in July 1998. A report covering the documentation submitted by SMUSOM and requesting additional information was submitted to the Division in June 2000. Hurricane Keith struck that location in October 2000, seriously damaging the facilities, necessitating a temporary relocation to the University of Central Florida, and obviating a possible site visit at that time.

In August 2001, the Division became aware of serious turmoil on the Belize campus resulting in the eventual loss of all facilities there.

Under new ownership, an essentially completely new central administration, and with a small cadre from Belize, a search for an alternate site eventually focused on the Cayman Islands whose economy was then at a low point. Further investigations identified a building then occupied by the local Cable and Wireless Company and available for leasing. It appeared ideal for serving SMUSOM’s information technology needs. Cordial relations were established with the local government, the necessary permits obtained, a lease on the building signed, and SMUSOM relocated to Grand Cayman in May 2002.

The Division deemed the information then on hand obsolete. SMUSOM was asked to submit a new application, which reached the Division in September 2002. This set of documents was reviewed by the Division in January 2003. A decision to make site visits was rendered in May 2003 to take place later that year. Changes in California’s government delayed approval for site team travel until May 2004, when the first two of the three mandated site visits took place.


Ownership

SMUSOM is a proprietary, for-profit institution that derives all of its income from student tuition and fees. It is owned by 3 individuals - Michael Harris, M.D., President and CEO, Galen Swartzendruber, M.D., investor, and S. K. Asthana, M.D., all located in Niceville, FLA - who also comprise the Board of Directors.


Administration

The SMUSOM administration is headed by Michael Harris, M.D., President and CEO, who reports to the Board of Trustees (vide infra). Dr. Harris is directly responsible for strategic planning, relations with diverse governmental officials, and the overall budget and other fiscal matters. He is the ultimate authority but reports to the Board of Trustees (see Governance) on issues pertaining to academic matters, hiring and firing of faculty, salaries, publications, locating and acquiring sites to meet the requirements of the academic mission and accommodations for students, and authorizing issuance of diplomas.

Dr. Harris’ base and OB/GYN practice are located in Niceville, Florida, near SMUSOM’s head office in Oviedo, Florida. He heads the Board of Directors and divides his time between Florida and SMUCI with occasional visits to the Maine campus. .

Dr. Harris is an expert in matters of locating desirable real estate and its acquisition (See Facilities).

Dr. Harris is assisted by a Vice President, a Chief Financial Officer (CFO) and a large number of Deans. The Deans oversee the academic activities of their respective faculties, coordinate interactions—such as they are-- between them at SMUCI and the SMUM site in Maine, and formulate and propose budgets for presentation to the President,

Jerry Thornton, Ph.D., Vice President and Chief Operations Officer (COO) has been with SMUSOM since Belize days. He is in charge of operations at the head office in Florida, which includes admissions, financial aid, marketing and advertising. He has also been the principal contact between SMUSOM and the Division.

B. D. Owens, Ph.D., is Chief Financial Officer (CFO) and oversees the controller, financial matters and ancillary services, including student residences. He participates in the search for suitable real estate for acquisition by the institution.

The SMUSOM administration is enthusiastic, innovative, effective and responsive to the needs of a growing institution. It is also very effective in matters pertaining to real estate acquisitions and relations with governmental authorities.


Governance

Governance of SMUSOM is vested in the Board of Trustees, which may delegate authority. Delegation is primarily to the President or the COO who may re-delegate authority to Deans and other Administrative Officers. The Board of Trustees is composed of four members who have no financial ties to the institution and who serve without financial compensation other than reimbursement for travel expenses incurred in connection with its meetings. The Board meets four times yearly, including once at SMUCI. The current Board members are:

Elizabeth Armstrong, Ph.D., Associate Professor of Pediatrics, Harvard Medical School, Boston, Massachusetts;
Mark Stewart Calkins, M.D., Physician, Niceville, Florida;
Stephen P. Doheny, M.D., Physician, Niceville, Florida; and
James P. Richburg, Ed.D., President, Oskaloosa Community College, Niceville, Florida.

Responsibilities of the Board of Trustees are specified in its by-laws.


Faculty

The basic science faculty is comprised of individuals who, with very few exceptions, have been with SMUCI for considerably less than two years. In many cases, in fact, individual faculty members in responsible positions had only been on site for a few weeks or months prior to this site visit.

In Maine, faculty are employed on short-term contracts ranging from one to three years, renewable solely at the institution’s pleasure. In Grand Cayman, continuing employment at SMUCI is also contingent on approval of visa extensions by the local government. A few faculty members have 5-year contracts, but most have one-year contracts due to government regulations. This policy partly reflects the administration’s desire for change, as may be needed, and partly the limitations on visas for work in the Cayman Islands. Faculty indicated that some students are acting (and being paid) as teaching assistants. There is no academic tenure.

Students expressed their appreciation to the site visitors for the close and continuing interactions with the faculty who are said to be generally available. Students interviewed during the Chicago site visits uniformly expressed their opinion that the quality of the education they received in Maine was far superior to that which they received on Grand Cayman.


Admissions

Admissions requirements, criteria and procedures are spelled out in the catalogue. The completed application file must consist of the following:


· Completed application form
· Personal statement
· Three letters of recommendation
· Official academic transcripts
· TOEFL score of 550 or greater
· MCAT scores (if available but not required)
· $75 non-refundable application fee
· Six current passport photos
· Request for financial support, if applicable
· Financial aid forms and backup (if applying for financial aid)
· Proof of health insurance coverage, application, or waiver

Students with foreign (non-U.S.) transcripts are required to present evaluations on a course-by- course basis from the World Evaluation Services or other credentialing authority.

A pre-admission undergraduate degree is preferred but not required. 90+ semester credit hours are considered sufficient to satisfy the pre-medical academic preparation requirements. A GPA of 3.0 or better is preferred but significant numbers of students whose records fall below - and even much below - that level have been accepted. An extended pathway exists at two other offshore sites for those deemed inadequately prepared for the study of medicine yet give promise of eventual success.

Students are required to be computer literate and to bring their own lap tops to school.

Applications are submitted to the Oviedo, Florida, office. When completed, they are electronically scanned and immediately made available to the Admissions Office at SMUCI for review, screening and scoring by two members of the Admissions Committee who also rate the institutions at which applicants completed their previous studies. If the screeners are in accord, their decision is final. If in disagreement, they consult with each other in efforts to reach agreement. If agreement is still lacking, files are reviewed by the full Admissions Committee, which renders the final decision.

Students offered acceptance are so notified, interviewed in person or by phone, and provided with informational materials about SMUSOM’s programs, requirements, location, living conditions, housing, required immigration documents and learning materials. They have two weeks to submit a non-refundable $500 deposit, which is applied to the first year’s tuition.

Discussions about the student’s ability to finance his/her education are initiated. The overall cost approximates US$200,000. The school has arranged for low cost loans up to the full amount, as may be needed. When questioned by a team member, students did not know the terms and conditions of their loans. The school should provide students with more information as to the nature and effects of the large long-term debt they will be accruing.

The applicant/acceptance ratio typically runs 3:2 (i.e., 40% are rejected at this stage). As a rule, 90% of those who meet the admission criteria will be accepted. Of these, some 50-60% will actually matriculate. Note: This small ratio of applicants to acceptances suggests an insufficiently critical discriminatory admissions policy and consequent practices which may account - at least in part - for the apparently high attrition rate and the 19% figure for students in academic difficulties in the first year.

Prior to matriculation, and before issuing a visa, the Caymanian government requires documentary evidence from the civil authorities of a clean record covering the student’s past 10 years’ residences. (Note: Some unresolved questions about specifics in this connection have been posed to the Caymanian Ministry of Education but the team has not received an answer.)

Note: SMUSOM literature states that transfer students are accepted up to the beginning of the 5th semester. Specific inquiries (in Maine) indicated that some transfers have been accepted up to and even into the 4th year although this practice is said to have been abandoned recently. Transfers in the last year of medical school are not acceptable under California law (Business and Professions Code 2089(a). Requirements for transfers are identical to those for entering 1st year students plus transcripts from their previous medical school(s). They must not have been dismissed for ethical or behavioral causes.


Students

Enrollment has grown rapidly from the first class of 25 students in September 1997 in Belize to more than 300 currently at SMUCI and Maine and well above that number in the clinical years. Current total enrollment for the entire school is approximately 645 students.

Since the beginning, 263 students have graduated, 158 have withdrawn, and 29 have been dismissed. Of the graduates, 2 have completed residency training, 101 are in their residencies and the present status of 36 is unknown. 134 students are currently in clinical rotations in the U.S.

Among those listed as withdrawn, the present status of 101 is unknown.

The student body is composed mainly of Americans (approximately 85%), with a smattering of students from Canada, Caribbean and other countries. Many tried and failed to gain admission to U.S. medical schools; some did not apply to U.S. schools because they believed they could not compete effectively (grades, MCAT scores); and quite a few transferred in from other Caribbean medical schools (notably Ross, AUC and St. Lucia). A significant number chose the study of medicine after having had other successful careers (in professional sports, business, law and paramedical fields), or having earned advanced degrees in non-medical sciences and later decided on the study of medicine.

A wide range of student support services includes academic and personal counseling, financial aid, and arrangements for health care. Student housing is available in the Residence Hall, and a housing service helps to arrange off-campus accommodations. A local chapter of the American Medical Student Association is supplemented by several other student organizations and clubs which arrange educational, social and sporting activities. A nearby SMU-owned athletic field is available for soccer and other field events.

A system of student government works closely with the Administration.

By all indications, students are eminently satisfied with these arrangements and appreciative of SMUSOM’s efforts on their behalf.


PreClinical Curriculm

The courses taught in the preclinical curriculum correspond to the constellation of those usually covered in the preclinical curriculum of U.S. medical schools. Specific comments regarding the supporting materials, examination policy and practices, as well as the imaginative approaches to the ICM and CP courses at both Maine and Grand Cayman, are included elsewhere in this consolidated report.


Selection and Evaluation of Clerkship Sites

Upon completion of the pre-clinical 5 semesters at SMUCI and in Maine, students leave the respective sites to embark on their core clinical clerkships in hospitals affiliated with SMUSOM in the District of Columbia and 11 States including Florida, New York, Illinois, Georgia and Maryland. In addition, 6 hospitals in the UK and 1 in Canada are utilized for core clerkships. Approximately 80% to 90% of clinical core rotations take place in the Chicago and Atlanta areas. Most U.S. hospitals used for core rotations are ACGME accredited. A list of criteria exists for determining eligibility of a potential site for clinical instruction. Satisfactory completion of the USMLE Part 1 prior to commencing a clerkship is not required by all of these hospitals. Until January 1, 2004, the school assigned students to clinical rotations who had not taken or passed Step 1. Beginning January 1, 2004, the school will not assign a student to clinical rotations without formal notification that the student has passed Step 1.

Each hospital used for core rotations is supposed to have a formal affiliation agreement with SMUSOM and a director of medical education (DME) appointed to the SMUSOM clinical faculty to oversee clerkship arrangements. The site visit in Chicago indicated that some such affiliation agreements are in verbal form and others have been arranged with an individual physician and not with the institution itself.

In the middle of the 5th semester, students receive an orientation session from the Dean for Clinical Sciences about the hospitals available for core clerkships. Recently, the Chair for Preclinical Studies brought an upper class student to assist in the orientation. There is no formal arrangement for providing feedback from more senior students or graduates to 5th semester students concerning advantages or disadvantages of specific training sites (By the same token, there is no formal feedback system from graduates about their satisfaction level with the education received at and through SMUSOM. Nor is the tracking system of graduates anywhere nearly complete (see below). These omissions would seem particularly worrisome in such a new school with a minimal track record. An alumni organization might prove useful for these purposes.

There are, however, web sites, chat rooms and contacts with upper class friends that may be accessed by individual students; and some pertinent information is logged in the files of the Dean for Clinical Sciences.

SMUSOM claims that each site used for core rotations was visited at least yearly by each chief of each department. The team was advised that the review process has been modified and that now one chief will conduct the site visits for all of the sites. Currently, that individual is an internist who has been with SMUSOM for approximately one year. Information gained at the site visit indicated that this individual’s inspection might consist of one to one and half hours at a particular site, including lunch, and might well cover several sites in one or two days. Most worrisome is the fact that an individual representing one clinical discipline might well review several core clerkships in a variety of clinical disciplines if conducted in the same institution.

SMUSOM’s clinical curriculum comprises 46 weeks of core clinical clerkships in the 3rd year and 30 weeks of selective and elective clerkships in the 4th year. The 3rd year core includes a total of 46 weeks, as follows::

• Internal Medicine 12 weeks
• Surgery 12 weeks
• Pediatrics 6 weeks
• Ob/Gyn 6 weeks
• Family Practice 4 weeks
• Psychiatry 6 weeks



The 4th year curriculum consists of a combination of 16 weeks from an approved list of selectives and 14 weeks of freely chosen elective clerkships each of which may run for 4, 6, or 8 weeks in duration.

Whereas the core clinical clerkship sites in the relatively small number of States in which they are carried on are selected and monitored by or under the aegis of the Dean for Clinical Sciences, the elective clerkships are located in 38 States, the UK, Canada and Ireland. Students find their own electives. The school gives them a list of locations previously utilized by SMUSOM students. Their selection is determined in accord with several factors, including person-to-person interactions among physicians on the faculty with personal contacts/knowledge of such sites, and students’ and/or their parents’ requests for clerkships in the vicinity of their homes and/or potential practice locations, etc. This practice has resulted in some electives in non-teaching hospitals.

Supervising faculty are required to submit performance and demeanor evaluations for every student’s clinical experience.


Facilities

The entire campus is fiber optic wired and features a fully functional campus-wide computer system. A comprehensive wireless capability enables all students to obtain server-stored materials, go on the web, search journals and reference works, and communicate directly with faculty and other students.

The principal base for SMUCI consists of a 21,000 sq.ft. building containing administrative and faculty offices and three classrooms equipped for electronic data presentations and communications seating upwards of 120 students each.

This building also houses an anatomy/histology laboratory with several plastinated cadavers, anatomical models, microscopes, and slides which can be projected onto an overhead display.

Other facilities include a small microbiology laboratory in which some basic techniques are demonstrated; rudimentary physiology and pathology laboratories; a large room subdivided to serve the needs of the 4th and 5th semester ICM and Patient Care courses; some facilities equipped with data ports for student use; and some space for recreation. This building is leased from “Cable and Wireless”, a local company which had installed extensive electronic capabilities for both hard-wired and wireless communications that eminently suited SMUCI’s needs. The lease has one year to run and may be renewed for an additional three years. Drs. Harris and Owens are actively pursuing a nearby location for purchase and use on a permanent basis.

Initially, only the two upper floors were used by SMUCI, which has lately taken over the entire building.

This building is air-conditioned and much used by students for their studies. It used to be open 24/7 but the hours have recently been reduced much to the students’ regret. They have expressed hopes that the status quo ante will soon be restored.

The Residence Hall for students is owned by the SMUSOM corporation and was acquired under extremely favorable terms. It is a modern building located about a mile distant from the main campus along the highway connecting both sites. It can accommodate 82 persons in single and double occupancy rooms. Security arrangements include several strategically placed surveillance cameras and 24-hour watch personnel.

In addition to the dormitory there is a swimming pool with a good amount of deck space, chairs and umbrellas, and a fully equipped kitchen for student use.

(It may be noted in passing that the students expressed their delight in and admiration for the administration’s seeing to the rapid development of excellent facilities and for the attention paid to their needs and requests).

The clinical facilities available to SMUCI consist of two hospitals, physicians’ offices and clinics utilized for instruction of 4th and 5th semester students. With patients’ permission, students spend 2 to 4 hours weekly shadowing physicians and observing procedures. These activities are integral with the ICM and Patient Care (Clinical Procedures) courses and are designed to prepare students for the clinical clerkships by introducing them to the nature and culture of medical practice, physician-patient interactions, medical ethics, and the nature of and interactions with the health care team.

Instruction at the clinical sites is coordinated by the Chair for Preclinical Studies, Dr. Gordon Green, a recently arrived pediatrician from Canada with extensive experience in pediatric emergencies, advanced training in public health, and a deep interest in recent developments in medical education. He is very well qualified for his critically important roles, personally participates in all clinical activities, and seems highly regarded by students and local medical personnel.

By all indications these instructional activities are well received by students and the voluntary teaching faculty who seem interested in and enthusiastic about their teaching roles.

The 128-bed George Town Hospital is the main medical facility for the Cayman Islands. It is a recently completely refurbished, clean, airy facility which provides a complete range of medical and surgical services with the exception of cardiac and intracranial surgery. Patients requiring these and other high intensity services are airlifted to US hospitals in Florida or Texas at government’s or insurance carrier’s expense.

The Chrissie Tomlinson Hospital is a modern, clean, airy, fully equipped private facility housing 18 Beds, four of which are maternity beds.

Note: All residents on the Caymans are required to carry health insurance. This also applies to the SMUCI community. At present, the government pays the entire cost for civil service employees, indigents and their families but this will change later this year to a bilateral contributory system. A scheme for co-payments will also be introduced to limit abuses and overuse. For the private sector, premiums are shared equally between employer and employee.


Library and Learning Resources

A very capable professional librarian supervises the campus library, which houses a limited number of books and journals. It provides access to most of the biomedical data bases and adjunct resources and subscribes to services which enable access to most of the journals students and faculty might require for study and in support of eventual research projects.

The library supports and is supported by informational technology in the form of a virtual living/learning environment which provides access to and between all students and faculty anywhere on campus and including the residence hall (vide infra). Included among its features and services are

• Facilities for video conferences - which may include communications between SMUCI and SMUM;
• Stored folders for every professor’s lectures in power point format;
• Projectors and desktop machines in the classrooms;
• High speed Internet access on campus and the residence hall;
• Voice-over IP phone system; and
• A variety of on-line resources.


Research

The issue of research being conducted by SMUCI faculty and involving student participation is of utmost importance for the following reasons:

• To maintain and enhance the continuing effectiveness of the faculty to teach at the cutting edge of their discipline;
• For faculty to serve as role models for students;
• To enable students to observe, study and participate in the research process; and
• To enable students to learn critical assessment of the research process, results and publications.

None of these objectives is within reach at SMUCI at the present time. Perhaps a journal club might be a useful beginning to address issues related to review and analysis of published research in pursuit of some of these objectives.

Most of the faculty are not now and have not been engaged in active research endeavors for the past several years. Most of the faculty have authored no publications in peer-reviewed journals for years past. No extramural funds for research are currently targeted for SMUCI, which has allocated small amounts in support of some projected research activities on the island. These are intended to involve some faculty and students in studies involving the local biota and presumptive genetic peculiarities among the indigenous population.

At the site visit, the Dean for Research was unable to answer a question as to the existence of a budgetary line item for research. When a “Research “ page from the itemized budget was eventually produced, it indicated that approximately $600,000 were being devoted to this topic. Of this amount, $250,000 was identified as supporting the off-site project indicated above, the proposal for which had not yet been submitted.. These funds will not be provided to SMUCI but to the institution at which that project is actually being conducted. Almost all the remaining funds identified within the research category are targeted for supporting activities – half of two faculty members’ salaries and ten percent of other faculty members’ salaries, housing, vehicles, transportation, utilities, mail, etc., and seem to relate to ongoing supporting services and overhead at SMUCI. The school allocates a maximum of $2,500 per faculty member making a presentation, a total of $3,000 seed money for student projects, and $850 in “prize money” for a student competition. No extramural funds in support of research have been received at SMUCI at this time.

SMUCI has made available some small amounts to support research on the island by a few students with prior research experience and under faculty supervision. Some equipment and glassware destined for these projects had apparently arrived just before the site visit. These projects should get under weigh in the near future.

The site visiting team was informed of several ideas for research to be conducted eventually on site by faculty with student involvement but these are not yet in being. Moreover, no facilities dedicated to the conduct of research activities were identified.

SMUSOM has established a (U.S.-IRS code) section 501(c)(3) foundation to eventually receive tax- favored extramural contributions in support of research and other qualified activities.

It may be presumed that interesting topics for research will eventually be identified and pursued by faculty and students. Such efforts are still destined for the future.


Relations with Local Government

In company with members of the SMUSOM Board of Directors and Administrators, the site visitors met in his office with the Hon. Roy Bodden, Minister for Education, Human Resources and Culture. Government clearly views the arrival and continuing presence of SMUSOM as a major and most welcome addition to the Caymans’ economy. The Minister insisted that due diligence had been conducted prior to granting permission for SMUSOM’s relocation there. This is said to have involved background checks on each of the Directors in terms of their financial history and police records.

The Minister maintained that SMUSOM’s aims, objectives, curriculum plans and involvement with local institutions and the medical profession met with approval after having been subjected to careful scrutiny. With an advanced degree in education, the Minister reviewed and applauds SMUSOM’s educational direction and activities. He declared himself pleased that SMUSOM offers one full scholarship annually for a Caymanian citizen.

The Minister stated that incoming students must apply for a visa to be renewed biennially. The initial application must be accompanied by a letter from the police authority at the student’s current residence and speaking to any problems with the law. Inquiries are said also to involve communications with the FBI and Interpol, as appropriate. It is not clear whether convictions for felonies or misdemeanors would preclude admission to the island. It may be that background checks only cover a student’s residence over the past 5 years, if that. An inquiry along these lines was directed to the Minister by e-mail but no reply has as yet been forthcoming

SMUSOM graduates are eligible for licensure (registration) to practice in the Caymans provided they can find a sponsor and obtain a visa/work permit (a fairly complicated process). The government imposes strict controls on this privilege, including on the mix of medial specialties intended to meet the defined needs of the population.

A private, mostly social meeting between one site visitor (Dr. *****) and the Honorable Gilbert McLean, Minister for Health Services, Agriculture, Aviation and Works and the Chief Health Officer, Dr. K. Kumar, resulted in essentially the same welcome, laudatory comments and appraisals. On direct questioning, the latter indicated some interest in personal involvement in SMUSOM’s ongoing activities.


Part 2. Branch Campus in Windham, Maine



This portion of the report will concentrate on matters chiefly pertaining to the SMUM branch campus unless otherwise indicated. It will address the following:

Rationale for seeking a Branch Campus and its Selection
Advantages of the MD/MHSA Program to SMUSOM and SJCOM
Interrelationships between the two Degree Programs
Curriculum at SMUM
Selection of Students for the SMUM Program
Evaluation of Student’s Progress
Support for Students at SMUM
Physical Facilities
Advantages/Disadvantages of the SMUM Program
Faculty
Research
Academic Interactions between Grand Cayman and SMUM
Summary and Conclusions
Acknowledgment


The following is based on interviews with faculty, students and administrators of SMUM, inspection of selected physical facilities, and literature provided to the team by SMUSOM and SMUM.


Rationale for Seeking a Branch Campus and Its Selection

According to the information provided, SMUSOM determined that a satellite campus on the U.S. mainland and offering a Master’s Degree in matters relating to medical economics and administration would enhance SMUSOM’s image and serve as an effective marketing device for attracting students in a competitive environment. Accordingly, SMUSOM administrators sought a connection with an institution offering an instructional program which would serve medical students’ needs and interests toward both conducting an efficient medical practice and possibly offering additional or alternate career opportunities.

Through prior personal contacts between representatives of SMUSOM and St. Joseph’s College of Maine “(SJCOM”), an ongoing on-site and distance-learning program leading to a Master’s Degree in Health Science Administration (MHSA) was identified at SJCOM in Windham ME, and deemed suitable for the stated purposes. Negotiations between the two institutions led to formal agreements and the first SMUSOM students were concurrently enrolled in the SJCOM MHSA program in the Year 2000.


Advantages of the MD/MHSA Program for SMUSOM and SJCOM

The advantages for SMUSOM are the uniqueness of this offering among offshore medical schools catering primarily to U.S. students, i.e., as a marketing device; a location on the U.S. mainland for U.S. and other students enrolled in an offshore medical school; and for some SMUSOM students to interact - albeit on a limited basis - with students pursuing other fields of endeavor.

The principal benefit for SJCOM seems to be the income from tuition paid by the SMUSOM students - amounting to $250/ credit unit for a total of $11,250/student for the entire course of study. Additionally, students from other disciplines pursuing the MHSA program seem to benefit from their occasional interactions with SMUSOM students.


Interrelationships Between the Two Degree Programs

SMUSOM students enrolled in the MHSA program are enrolled separately in SJCOM and pay tuition and fees separately to the two institutions. The application/admissions processes for the two programs are also completely separate.

The MHSA program consists of 15 courses at 3 units/course, for a total of 45 units. The tuition amounts to $250/unit for a total of $11,250 for the complete program. SMUSOM students enrolled in the MHSA program are required to have completed at least one semester’s course work (2 courses = 6 units) on the Grand Cayman campus, but exceptions can and have been made (to this and most other “requirements”).

Students may be selected for the MHSA program at any time before the beginning of the 3rd semester. They ‘must’ take 2 MHSA courses in each semester on Grand Cayman. SJCOM has stationed two faculty members there for this purpose. They are not directly affiliated with SMUSOM.

At SMUM, students take 2 MHSA courses/semester in each of the 4th and 5th semesters. For the SMUM students, these courses are taught in the evening on the SJCOM campus by SJCOM faculty. Except for those students pursuing the 5th semester in the summer, the SMUM students do not interact with SJCOM students. In the summer, SMUM students’ classes are shared with MHSA graduate students from elsewhere. They may also live in the dormitories on the SJCOM campus.

SJCOM faculty teaching SMUM students receive stipends from SMUSOM.

The remaining units/courses to complete the requirements for the MHSA are taken in the “distance learning” mode utilized by SJCOM for the past 2 decades. Typically, students are required to take at least one course/semester in the “distance learning” mode but this requirement may be and is often modified for the SMUM students because of the time commitments required by clinical clerkships and residencies. SJCOM has approximately 950 students on campus. It also has 2,500 undergraduate students and 2,000 graduate students, all engaged in distance learning. 34 SMUSOM students have graduated with a degree from SJCOM since 1998.

Students enrolled in the joint degree program have declared career interests in hospital administration, managing their own practices, and even forsaking a medical career entirely in favor of full time involvement in some non-medical career.

At present, some 55 students are enrolled at SMUM in the joint degree program.


Curriculum at SMUM

The SMUM academic program addresses the 4th and 5th semester courses in the SMUSOM medical curriculum. Whereas the course titles at SMUM are identical with those on Grand Cayman, there is limited interaction as between the 2 faculties and essentially no effort made to standardize or coordinate course or examination content between the 2 locations.

Course content and presentation sequence are apparently determined on the basis of chapters in text books, audio-visual and other materials obtained from various sources, and the faculty’s personal files.

The basic science courses include pharmacology, clinical therapeutics, pathology, microbiology and a mini exposure to clinical laboratory medicine. In clinical therapeutics a microbiology laboratory experience is said to be just getting under weigh and will cover bacterial cultures and susceptibilities to antimicrobials, and a computer modeled epidemic.

The preclinical courses include Patient Care I and II (essentially ICM- History and Physical Examination); Clinical Skills - specific diagnostic examinations and procedures; Current Topics in Medicine - attendance at medical grand rounds at the Maine Medical Center (“MMC”) followed by a lecture on a specific clinical problem.

ICM and CS courses see students interviewing and practicing selected clinical techniques on plastic models and on each other. A limited exposure to simulated patients is being introduced.
They also interview patients at Mercy Hospitals and in the clinics and doctors’ offices.


Selection of Students for SMUM

Students volunteer for this experience. They are selected on the basis of a personal interview on Grand Cayman and satisfactory performance in their course work. Students may enter into the joint degree program at any time before the 3rd semester but ‘must’ take at least two courses toward the MHSA degree before coming to Maine. This requires enrollment in the MHSA program not later than the 3rd semester. On occasion, students have been permitted to transfer directly into the 4th semester in Maine from another offshore medical school, but this is said not to be possible anymore.

As an aside, students have been and are permitted to transfer directly into the 4th year at SMUSOM from another offshore medical school by special permission from the Clinical Dean (a practice generally not permitted under LCME rules and specifically not permitted under California Business and Professions Code Section 2089(a)).

In general SMUSOM students tend to be older than the usual run of medical students. They have often pursued other activities, especially paramedical careers, prior to commencing medical studies.


Evaluation of Students’ Progress

At SMUM each student’s progress is monitored closely. In the 15 week courses, if a student seems to be in academic trouble by week 7 or 8 s/he may self -refer or be referred for counseling. Attempts are made to determine the cause(s) and remediation is proposed. Students may also opt to discontinue the course, receive a W letter on their transcript and resume at the next opportunity.

The usual causes for problems showing up in marginal or poor academic performance involve medical, family, psychological or financial matters and assistance is aimed at diagnosis and remediation, if possible.

If still or newly in trouble at week 12, the student is advised to withdraw and repeat at a later date. S/he will be advised that continuing on is at his/her own risk and might well result in a failing grade. A student may repeat a course once but will be dismissed after 2 failures in the same course.
With a course value of 4 units apiece, any combination of W and F grades amounting to 24 units will result in dismissal by SMUSOM. Moreover, since MSHA enrollment presupposes enrollment at SMUSOM, discontinuation also means the end of enrollment at SJCOM.

The faculty estimates that +/- 80% pass USMLE on first 2 tries. They may be permitted to begin a clerkship in the US without having passed Step 1 but must have documented passage by 90 days or discontinue. They may continue without having passed in UK hospitals.


Support for Students at SMUM:

A) Medical: Students requiring medical attention are seen at student health at SJCOM and by local physicians, and hospitalized at MMC, if required.

B) Mental Health: Students may refer themselves or be referred for counseling to the Dean of students who may act as counselor and/or refer to mental health professionals at SJCOM.

C) Financial Aid: Students may be eligible for one or more established bank loan programs up to the full costs of tuition, fees, and living expenses ($190,000) with repayment deferred until after residency training.

It should be noted that the director of student affairs does not have access to the student information compiled by the dean in Grand Cayman.


Physical Facilities (Classrooms, Hospitals, Clinics, Offices, Libraries, Laboratories)

SMUSOM owns a 6,300-sq. ft. brick and wood 2-story building just off the highway and 3.5 miles distant from the SJCOM campus along a winding, lakeside road. This building houses 2 classrooms utilized for the clinical skills (CS) course, an extremely small library with computer-based access to the major data bases, and faculty offices. Some 3,000 sq. ft. are lent to SJCOM until Fall 2004 to house support facilities for the “distance learning” program.

SMUSOM also leases a tripartite, one-story wooden bungalow behind the above-mentioned building which houses 2 essentially bare classrooms and administrative offices.

SMUSOM utilizes facilities in Portland ME, (approximately 30-45 minutes by automobile from the Windham facility) at the Maine Medical Center (MMC), Mercy Hospital, and the Foundation for Blood Research, and clinics and physicians’ offices scattered throughout the area.

At the MMC, SMUM students have access to classrooms, auditoria, and a large, fully equipped library. MMC is an affiliate of the University of Vermont School of Medicine and medical students from that college, from Dartmouth, Harvard, Tufts and elsewhere rotate through the MMC. There seems to be little interaction between the SMUM students and the others in the 4th semester, although there is expected to be more in the 5th semester.

Clinical clerkships are not available for SMUSOM students in Maine, apparently at the behest of the University of Vermont.

At Mercy Hospital, students shadow Physician Assistants (PA) and their physician supervisors from admission to discharge as part of their Introduction to Clinical Medicine (ICM) and CS courses. They experience their first exposure to sick and injured patients in this setting.

At the Foundation for Blood Research, a freestanding, grant-supported research organization, students spend up to 8 hours in their only laboratory experience while in Maine. In a well- equipped research laboratory, this experience consists of exposure to a few, selected laboratory techniques - e.g., ELISA, PCR, and DNA gel electrophoresis - related to a specific clinical problem.

In the offices and clinics, students shadow mainly primary care physicians as part of their ICM and CS courses.

At SJCOM, students have access to a large library, good dining facilities, and medical and mental health services.

The teaching faculty are compensated on an hourly basis by SMUSOM.


Advantages/Disadvantages of the SMUM Program

Advantages:
--Education and training to cope with administrative, legal and financial aspects of a medical practice, hospital administration, or other careers relating to the medical/health care arena.
--Education and training for a career in medical administration as an option for a second or alternate career.
--Location on the U.S. mainland.
--Varied selection of settings for ICM and CS courses, including a major teaching hospital (MMC) with superb library facilities.
--Some interactions with students from U.S. medical schools.
--SJCOM’s storybook location in a bucolic lakeshore setting.

Disadvantages:
--Remote location of the SMUM base in Windham ME.
` --Travel time in excess of 30 minutes each way between the Windham campus and the clinical facilities in Portland.
--Dearth of interactions with the majority of SMUSOM students, other medical students, students at SJCOM, and with more than a very limited number of faculty, especially in the basic sciences.
--Essentially no opportunity to observe - let alone participate in research - medical or other.
--Limited base/sources of information available concerning potential clinical sites and also previous experiences of SMUSOM or other medical students at potential clinical clerkship sites in the U.S. and UK.



SMUM Faculty

Basic science courses at SMUM are taught in classrooms mostly by retired clinicians and/or those from academic positions elsewhere with backgrounds and interests in particular fields of instruction.

The basic science faculty presented to the site visitors included representatives from pharmacology, therapeutics, pathology and microbiology. They were enthusiastic both about the students and the opportunities to teach. For teaching they utilize lectures often in power-point format from notes and summaries of literature sources. Standard databases are available both through the libraries and through personal computers.

ICM and CS are taught in part by retired medical practitioners and in part by actively practicing physicians, nurses and paramedical personnel in classrooms, clinics and offices, and in diverse hospital settings, including attending at grand rounds at MMC. The faculty presented to the site visitors were enthusiastic - even passionate - about teaching their topics.

There is little evidence of activities at SMUM aimed at keeping faculty current in the fields in which they are teaching, or in other facets of faculty development.


Research

There is none to speak of at SMUM.


Academic Interactions Between Grand Cayman and Maine Campuses

Course content, format, suggested modifications, and evaluation of student performance are discussed periodically by telephone and occasionally via videoconferences between the faculties and administrators at Grand Cayman and Windham. There is no plan to standardize or directly coordinate course content, format, sequence of presentations, or examination content.

The content and format of interim examinations are developed locally. There is a plan to use the USMLE SHELF examinations of PART 1 in the near future both for practice and as final course examinations on both campuses.

At present, there is very little formal feedback from more advanced students or clinical clerkship directors about the adequacy of the SMUM students’ preparation for the clerkships.


Interactions Between SMUM and SMUSOM on Grand Cayman

Academics: Beyond general agreement on curriculum content, academic interactions between the two sites are sporadic and few - mostly via telephone, videoconference, and e-mail. Faculty members meet to discuss topics of mutual interest and concern at the time of graduation. Few of the faculty at either campus have ever visited the other. Even at SMUM, it seems as though few of the (small) faculty have met each other.

Administrative: Policies and procedures for admission, curriculum content, evaluation of student performance, grading, student discipline, acquisition, promotion or termination of faculty, and all other policy matters are determined by the central administration at SMUSOM on Grand Cayman and at the Florida Office. Interpretation of these determinations and actual implementation are carried out at SMUM.


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