Future of MUN internal medicine program at stake following Royal College review

A review has found serious issues within Memorial University's internal medicine training program, calling into question the program's future.

CBC News has learnedthe faculty of medicine at Memorial received a notice of intent to withdraw accreditation from its internal medicine program from the Royal College of Physicians and Surgeons of Canada (RCPSC) in late April, following a review it conducted in the fall of 2016.

The college is thenational organization that awards accreditation for speciality medical programs in Canada.

Residents enrolled in MUN's internal medicine program work closely with physicians in St. John's to learnhow to practise medicine and tacklethe wide variety of illnesses that affect adults.

In a letter obtained by CBC News, the college listed severalweaknesses, including a lack of space for teaching and a lack of timely feedback for residents after clinical teaching rotations.

The college also noted issues that remain involving harassment and intimidation between faculty members and residentsand a setupthat gives residents "excessive levels of of professional responsibility that are disproportionate to their level of training, competence, and experience."

Following the notice, the university will have two years to respond to the organization's concerns before an external review is conducted in 2019.

It's an opportunity for us to really enhance the internal medicine program.- Dr. Margaret Steele

If the school fails that review, the internal medicine program will lose accreditation, somethingDean of Medicine Margaret Steele says is not an option.

"We have 24 months to enhance the program and address the weaknesses, so we are confident that we'll be able to ensure that we get our program meeting all the standards for royal college accreditation," she said.

School still has full accreditation

Steele stressedthat the school still has fullaccreditation andfaculty members arealready takingsteps to address the college's concerns.

"The important thing isit's an opportunity for us to really enhance the internal medicine program," she said.

In a memorandum sent Tuesdayobtained by CBC News, Steele outlined the university's plans to make sure it passes theexternal review.

"To correct the issues highlighted, we will need the involvement and collaboration of residents, faculty and staff, leadership of the discipline, and leadership of the faculty of medicine," she wrote.

Steele told CBC News the university is working to address concerns about excessive levels of professional responsibility.

"Part of our plan will be talking to the faculty and working with the faculty around appropriate supervision for the various levels of residents. In addition, oftentimes more senior residents will also supervise more junior residents.

"We'll also be engaging our faculty development program here at Memorial, so they'll alsobe doing faculty development around giving appropriate feedback, teaching tips at the bedside, those types of things."

Past history of intimidation and harassment

Steele said the concerns about intimidation and harassment within internal medicine is something the university takesvery seriously.

"Prior to the survey coming, we developed a robust assessment of faculty, and in fact it's cited as a strength."

She said residents are able to assess faculty members, and if their concerns escalate, the internal medicine discipline chair will meet with the faculty member in question.

"I've asked Dr. Tanis Adey who's a psychiatrist and an expert in professionalism to lead a group to review our practices and policies."

Steele has asked Adey tocome up with a list of recommendationsto ensure the faculty of medicine maintainsa culture of professionalism throughout all its programs.

Residents' association responds

Dr.AarunSingh Leekhais a third year psychiatry resident at MUN andpresident of the Professional Association of Residents of Newfoundland and Labrador.

He saidthat while he can only speak to his own experience as a resident within the internal medicine department for two months, it was a challenging time with excellent teachers.

He'snot worried about the program losing its accreditation.

"Currently the residents in the program are still being sufficiently and proficiently trained in internal medicine. They are not concerned that there's any negative outcome following the intent to withdraw."

Thirty-three residents are currently enrolled inMUN'sinternal medicine program and 17 moreare expected to enter the program in July.