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U.S. Department of Education

 

Special Report

 
Prepared March 2016
 
Background
 
In 1998, the Government of St. Kitts and Nevis and the Medical University of the Americas (MUA) signed an agreement establishing the MUA as the only medical school on the island of Nevis. The islands of St. Kitts and Nevis are joined together as a federation, although each exercises considerable autonomy over internal island matters. In 2007, the Premier of the Government of Nevis signed an agreement designating the Accreditation Commission on Colleges of Medicine (ACCM) to act on Nevis’s behalf as the MUA's accreditor. The Government of Nevis appeared at the Spring 2012 NCFMEA meeting seeking an initial determination that the standards used by the ACCM to evaluate the island's one medical school are comparable to those used to evaluate medical schools in the United States. At that time, the Committee recommended comparability for Nevis, but also requested that the country provide additional information regarding concerns in certain areas. At the its April 2014 meeting the NCFMEA accepted ACCM's report. The NCFMEA also requested that ACCM, on behalf of the Government of Nevis and St. Kitts submit an update report in two years that includes specific information about how many students took the U.S. Medical Licensing Exam out of those admitted into the program at MUA, the attrition rate, and the reasons for the attrition. The following report addresses ACCM's response.
 
Summary of Findings
 
None
 
Staff Analysis
 
The agency has provided all of the necessary information and supporting documentation that was requested for the report, and no additional information is requested.
 
Outstanding Issues
How many students took t he US Medical Licensing Exam out of those admitted into the program?
 
Country Narrative
BACKGROUND:

The ACCM is the accrediting body which acts on behalf of the Government of Nevis and is charged with the accreditation process of the only medical school on that island, MUA. Accreditation has been granted for six years to the school until May 31st 2016.

The accreditation process follows the guidelines laid down by the Liaison Committee on Medical Education upon which ACCM Elements are based. The process also follows the ACCM Protocol. ACCM relies on biennial visits to the Basic Science Campus - the next visit starting May 3rd 2016 is a full accreditation visit, visits to all clinical sites utilised by MUA students and review of the Annual Database and Self-Study (every two years) submitted in February of each year. This is to ensure that the school complies with ACCM Elements of Accreditation including Reports being furnished to the Government of Nevis, the NCFMEA and medical school.

ACCM has also been charged by the NCFMEA to recommend a reasonable first time pass rate for students taking the USMLE Step 1 which has been agreed at 85%.

At the meeting of the NCFMEA 0n April 15th 2014, the ACCM report was unanimously accepted with supplementary information as stated above being requested with a request formally sent to ACCM in a letter from Mr. Arne Duncan on August 8th 2014.

INTRODUCTION:
Since the beginning of the accreditation process, ACCM always requests the following information from the school. This applies to the previous academic year from July 1st to June 30th. The data being presented refer to information provided by MUA to the ACCM from Annual Databases 2013 - 2014 and 2014 - 2015 (Exhibit 1 & 2).

ENROLLMENT: Total enrollment figures for the specific year are requested in the ACCM Annual Database, Question 12 (Exhibit 1)

ATTRITION: Rates are provided, for a specific year including reasons for, as well as leave of absence, in the ACCM Annual Database, Questions 13 & 14 (Exhibit 1)

USMLE: Student pass rates for the previous three years are requested including first time takers as well as multiple takers. Data are also requested for USMLE Step 2 CK and CS in the Annual Database, Questions 42 & 43 (Exhibit 1)

METHODOLOGY
The questionnaire is a standard instrument used by LCME which is designed to measure a single intake as in US mainland medical schools. However, in this situation there are three intakes per year, January, May and September, with three semesters in the first year and two in the second. The final variable is that there are multiple sittings of USMLE which may be applicable into the next academic year and therefore not recorded in that year's Database.

USMLE Step 2 consists of CK and CS of which each part is taken separately over variable time thereby giving rise to some data not being recorded in the relevant year.

We are therefore submitting these data based on guidelines based on U.S. Dept. of Education Guidelines which have the benefit of being a recognised measurement of medical school performance. It should be stressed that for reasons already stated above this is a snapshot of activity over an academic year.

Given these limitations, the data presented show the total numbers enrolled from year 1 through 4, the attrition rate related to total enrollment as well as USMLE first time pass rates and USMLE step 2 CK and CS pass rates.

ACCM has been aware over the years that there are multiple pathways for students to progress. Students in any given cohort do not necessarily progress at the same rate due to academic performance and certified leaves of absence.

It should also be stressed that ACCM are satisfied that all data submitted by the school are correct and confirmed by back-up documentation. As submitted in previous reports, the school has a rigorous policy of academic surveillance as well as a requirement that all students must pass the NBME shelf exam before being allowed into the next module.

All students must pass the USMLE step 1 before being allowed into Year 3 clinical modules.

All students must have passed NBME clinical shelf examination as well as USMLE Step 2 before their MD is conferred.

CURRENT DATA:
The data being presented refer to information provided by MUA to the ACCM from Annual Databases 2013 to 2014 and 2014 to 2015.

USMLE: Those taking USMLE in 2013- 2014 are based on the number who matriculated in 2011-2012 academic years.
243 matriculated in 2011-2012 with 152 taking exam in 2013-2014 of which 139 passed giving a first time pass rate of 87%.
77 left the programme during the first two semesters for various reasons including leave of absence.

Those taking USMLE Step 1 in 2014-2015 are based on the number who matriculated in 2012-2013.
224 matriculated, 119 took the exam with 112 passing giving a first time pass rate of 94%.
105 left the programme for various reasons during the first two semesters.

Regarding USMLE Step 2, 148 took the CK first time and 110 took CS first
time yielding first time pass rates of 91% and 87% respectively and this applies to year 2013-2014.

In 2014-2015, 107 took the CK and 129 took CS first time yielding 85% and 91% pass rates respectively.
 
Analyst Remarks to Narrative
The NCFMEA requested that ACCM, on behalf of the Government of Nevis, and St. Kitts submit an update report in two years that includes specific information about how many students from MUA took the U.S. Medical Licensing Exam out of those admitted into the program. ACCM provided documentation which applies to the previous academic year from July 1st to June 30th. The data being presented refer to information provided by MUA to the ACCM from Annual Databases 2013 - 2014 and 2014 - 2015 (Exhibit 1 & 2). The agency's documentation provides the number students who took the US Medical Licensing Exam out of those admitted into the program during the time period provided.

 
What is the attrition Rate, and the reasons for the attritions?
 
Country Narrative
ATTRITION: Attrition rates are based on data provided by the school in ACCM Annual Database, Questions 12 & 13 (Exhibit 1) and in the MUA Outcomes Table (Exhibit 3)

ACCM calculates attrition rates as a percentage of the total enrollment. In 2013-2014 there were 846 students enrolled over four years (Exhibit 1)
44 students were dismissed for academic reasons giving an attrition rate of 5.26%.
Note is made that the main attrition for academic reasons occurred in the first semester.
If one includes all other reasons for attrition then the rate increases to 10.2%
Note is also made of 18 students withdrawing for “unknown” reasons.

Attrition rates provided by the school for 2014-2015 are exhibited as follows ACCM Annual Database (Exhibit 2) and in the MUA Outcomes Table (Exhibit 3)
Total enrolment was 714 and 42 were dismissed for academic reasons.
That gives an attrition rate of 5.9%
If one includes all other reasons then there is a total attrition rate of 16.4%

ACCM is satisfied that the attrition rate for academic reasons is consistently low over the period. However, there is a considerable rise in the total attrition rate over the period. This matter will be discussed at the Basic Science visit in May 2016.


List of Exhibits:
Exhibit 1: MUA Annual Database 2013-2014
Exhibit 2: MUA Annual Database 2014-2015
Exhibit 3: MUA Table Attrition Rates
 
Analyst Remarks to Narrative
The NCFMEA requested that ACCM, on behalf of the Government of Nevis, and St. Kitts submit an update report in two years that includes specific information on the MUA's attrition Rate, and the reasons for the attrition? ACCM calculates attrition rates as a percentage of the total enrollment. In 2013-2014 there were 846 students enrolled over four years (Exhibit 1). The agency provided sufficient documentation demonstrating the calculation and the reasons for the institution's (MUA) attrition rate.