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What Medical School Probation Means for Students

Though the medical school accreditor says probation is unlikely to affect them, M.D. students worry.

 When a student at the University of Texas's Health Science Center—San Antonio recently learned that his school had been placed on probation, he contacted Elizabeth Wiley, a student at George Washington University's School of Medicine and Health Sciences to understand what medical school probation means. 
Wiley still remembers receiving an E-mail in October 2008 informing first- and second-year students at GW to report to a mandatory meeting the following day. "I think we all were kind of like, 'What's going on?' but didn't necessarily have a sense of how outside the realm of normal this was," says Wiley, then in her second month at GW.
At the meeting, the more than 300 students learned that the medical school accreditor, the Liaison Committee on Medical Education (LCME), had placed the school on probation. Jointly funded by the Association of American Medical Colleges (AAMC) and the American Medical Association (AMA), the LCME reviews the 135 U.S. and 17 Canadian medical schools it accredits every eight years. It's empowered to put schools on probation—typically a two-year process, during which schools remain accredited—and to revoke accreditation.
"[T]here wasn't any audible gasp or anything that was overly dramatic," GW's Wiley says. "As more information was becoming available, there were certainly some emotions in the room." And, Wiley remembers, students posed some questions "that may have been a little charged" and made "a lot of attempts to blame different entities in the school."
[Read about George Washington University's medical school probation.]
Wiley says she wasn't familiar with the LCME at the time, and the questions her peers posed—ranging from what probation meant to how it would affect residency prospects—suggested they weren't either. Students became less concerned as they learned more about the reasons for the probation, which GW described as "curricular issues, lack of study space ... [and] administrative, clinical faculty challenges," Wiley says. "I did feel like I had some sense walking out of that meeting of what needed to happen."
Barbara Barzansky, the LCME secretary, was recently quoted in The Daily Texan, the student newspaper of University of Texas—Austin, saying probation doesn't usually affect students or the volume of applicants to a school on probation. She clarified over E-mail that she was speaking generally and anecdotally. "We have never done a study of the effects of probation," she says.
The LCME doesn't publicize the reasons schools are put on probation and doesn't release its reports on schools' violations—which lends a cloak of secrecy and ambiguity to the probation announcements that schools are required to issue. Though GW said at the time that the LCME concerns were "mostly superficial," they included high levels of student debt and inadequate monitoring of students' time with patients, according to a 2009 Washington Post article.
Wiley says she became convinced that GW would resolve its issues and would be taken off probation, which did happen in 2010. "I don't think that wringing your hands and freaking out about the prospect of what this is going to look like when you are on the residency trail is really a good use of anyone's time, resources, or energy," Wiley says.
The 272 students at the Puerto Rico-based San Juan Bautista School of Medicine, which had its accreditation revoked in October 2011, weren't as lucky as their peers at GW.
"It was frustrating and very scary, because I didn't know what was going to happen," says Angie Lastra, who has since transferred to the Loma Linda University School of Medicine in California. "We felt like it was the end of the world," she added in a Loma Linda release.
San Juan Bautista is the first school "in recent history" to lose its accreditation, says Barzansky, the LCME secretary. Citing LCME policy, Barzansky wouldn't comment on why San Juan Bautista lost its accreditation. Lastra says she is one of 11 students to transfer from the school to Loma Linda, and some other students have transferred to other U.S. medical schools, though San Juan Bautista still operates. 
page for San Juan Bautista students on the AAMC website says it's up to other schools to decide whether to accept credits; San Juan Bautista students cannot take the U.S. Medical Licensing Examination and are ineligible for residencies.
According to the LCME website, four schools are currently on probation: Marshall University's Joan C. Edwards School of Medicine, the Health Science Center—San Antonio, the Ponce School of Medicine, and the Commonwealth Medical College.
Francisco Gonzalez-Scarano, vice president for medical affairs and dean of the Health Science Center—San Antonio, says probation is relatively tame. The recent news that the school was placed on probation "caught everyone by surprise," Gonzalez-Scarano says, but he notes that no school on probation has ever lost its accreditation.
San Juan Bautista was never placed on probation—Gonzalez-Scarano speculated at bankruptcy being the problem—and two medical schools have closed before losing accreditation: Oral Roberts University in 1990, and the Keck School of Medicine at University of Southern California, which closed in 1921 and reopened in 1928.
Gonzalez-Scarano has heard rumors that probation announcements loom on the horizon for other schools, and that the LCME is under pressure to be tougher in its reviews. Barzansky, the LCME secretary, says her organization only releases information when schools are placed on probation, and "is under no pressure and treats all schools according to its procedures."
Barzansky also notes that schools that have undergone the probation process "have come out better," and some say probation helped them marshal resources to attack difficult problems. But she admits it's not all rosy. "Of course there's going to be frustration," she says. "It's very embarrassing to be held up in front of your peers."
John Byrne, a student at the Health Science Center—San Antonio, said he first heard about his school's probation in a meeting for student leaders an hour before the public announcement.
"My initial reaction was disappointment," he says. "Although it was challenging to hear about the probationary status, I know that the long-term implications will be positive."

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