Medical school attempts to recover from setbacks

Two programs on probation, one closed since beginning of 2013

The Spectrum

A month ago, The New York Times touted UB's up-and-coming downtown medical campus as part of the revitalization of the City of Buffalo.

Construction for the new medical school, which will cost $375 million, is scheduled to start this fall; the school is scheduled to open in August 2016. University officials see the new campus as a critical way to make long-term improvements to UB's rank and the Buffalo economy.

Yet, early this year, the Accreditation Council on Graduate Medical Education (ACGME) placed two of UB's surgical residency programs, general surgery and pediatric surgery, on probation. In June, UB closed its dermatology program after four faculty members left and ACGME withdrew its accreditation.

UB is attempting to reconfigure all three programs. Roseanne Berger, the senior associate dean of Graduate Medical Education, said the university is taking the probations as an opportunity to revamp the programs while enhancing the medical school as a whole.

Though the probation happened in the beginning of the year, The Buffalo News broke the story on Aug. 10, after a reporter got word that the programs were on probation.

Less than 1 percent of the nation's medical residency programs are on probation, according to the ACGME Data Resource Book.

ACGME, which is responsible for the accreditation of about 9,200 residency education programs, cited the general surgery program for the following issues: teamwork, engagement of the residents in planning and quality and lack of a robust system for monitoring duty hours. The main issue with the pediatric surgery program - a fellowship program - was a shortage of pediatric surgeons to adequately train UB's two fellows, according to Berger.

The day-to-day functions of the general surgery and pediatric surgery programs aren't affected by the probation, Berger said. But some wonder if the probation will have a long-term effect on UB's hope to become a world-class medical school.

General surgery program

General surgery and pediatric surgery are in the process of modifying their programs to comply with ACGME's new standards, according to Berger.

ACGME is scheduled to visit the general surgery and pediatric surgery programs at UB by late October, according to Peggy Simpson, the executive director of ACGME's Review Committees for Surgery, Plastic Surgery and Thoracic Surgery. Simpson said it is likely that the council's Residency Review Committee for Surgery will consider the accreditation status of each of these two programs at a meeting in February.

The program is attempting to fix its teamwork issue by implementing new systems for improving communication within the healthcare team, according to Berger.

General surgery is tackling its residents' engagement issue by involving the residents more in the planning process and giving them the opportunity to provide feedback on their training. The residents will be invited to town hall meetings to comment on their training and provide input on modifications that they think may be helpful.

UB is buckling down on tracking residents' work hours in the general surgery program by implementing a web-based system in which all residents can record their working hours on a daily basis.

Pediatric surgery program

The program responded by reducing enrollment from two fellows to one, a common training program size in the specialty. UB and Kaleida are recruiting another pediatric surgeon to the region to assist the program.

The program also modified the single fellow's schedule to ensure it does not exceed the work hour limits set by ACGME for residents and fellows in training (80 hours per week).

Berger said that surgeons and fellows continue to train in both programs and residents are unaffected.

Some residents, however, are concerned that the programs' probation - and the dermatology program's closing - will negatively affect UB's ranking and future recruitment of residents, according to one resident who requested anonymity.

This year, the number of residents who chose to stay at UB for their residency after medical school increased by 50 percent from last year, according to Berger.

The general surgery and pediatric surgery programs will be reviewed at the February meeting of the ACGME and a decision about their probation will be made at that time. The dermatology department submitted an application for a new program, and action on it is pending.

Dermatology program

After four faculty members - three from Roswell and one from the VA Hospital - resigned from the dermatology program late last year, UB chose to close the residency program.

Animesh Sinha, the chair of the dermatology department, said the department is adjusting its program in three ways: strengthening ties with adjunct and faculty members; strengthening ties with UB's partnering institutions - like ECMC, Roswell Park, the VA Hospital and Kaleida Health - to align efforts to recruit faculty and enhance the department; and placing a major focus on recruiting top-tier clinical and research teaching faculty.

When UB closed the residency program in June, the department helped place its five remaining dermatology residents in new programs around the country.

"I think we were all disappointed that we had to deal with the loss of faculty and the reconfiguring," Sinha said. "...We worked with [the residents] very closely ... to ensure they were kept in the loop about everything, and we worked with them to find the best fit for them."

The department expects to get some response from ACGME about its reapplication this fall, Sinha said.

Sinha noted that, like every medical school department, the dermatology department is always striving to strengthen its mission of research, education and clinical service.

"That's always an ongoing thing," Sinha said. "I think departments go through changes over time and I think the focus, for me, remains since I got here is it's a great opportunity to build a program to a stronger place than it's ever been."

When asked if the program's closing will negatively affect UB or its ranking, Sinha said UB historically has a "very strong academic dermatology legacy," and the department's goal is to rebuild itself as strongly as it can.

"It's still a very exciting time to be at UB and at UB's medical school with the real exciting changes on campus," Sinha said. "Dermatology will be a part of that."