Accreditation and State Liason (ASL) E-Recognition Web Site US Department of Education, Promoting educational excellence for all Americans.
Skip to main content | Home | OPE Home | ASL Home | NACIQI | NCFMEA | User Guide

Back

U.S. Department of Education

 

Redetermination of Comparabilty - Grenada

 
Prepared March 2016
 
Background
 
At its September 1996 meeting, the National Committee on Foreign Medical Education and Accreditation (NCFMEA) initially determined that the standards of the New York State Education Department (NYSED), Office of the Professions, used to evaluate St. George's University School of Medicine (SGUSM) in Grenada (for the purpose of placing St. George's students in clinical clerkships in teaching hospitals in New York State), in conjunction with the standards used by Grenada's Ministry of Health, Housing, and the Environment to evaluate and approve clinical clerkships for St. George's students outside of New York, were comparable to those used to evaluate medical schools in the United States. The country's initial grant of comparability, based upon the NYSED standards, has been continued since that time.

The country's last review for continued comparability was considered by the Committee at the Fall 2013 NCFMEA meeting. At that time, the Committee requested a report, which was reviewed and accepted at the Spring 2014 NCFMEA meeting. The current analysis examines the country's request for a redetermination of comparability.
 
Summary of Findings
 
Additional information is requested for the following questions. These issues are summarized below and discussed in detail under the Staff Analysis section.

-- The country is requested to ensure that its accreditor develops a standard that requires a medical school to develop a mission statement that includes a component related to serving the public good, as required under this section.
[Mission and Objectives, Question 1]

-- The country is requested to provide information and documentation to demonstrate that the CAAM-HP has amended its standards to reflect the requirement that its accredited schools are responsible to an external entity that is independent of the school.
[Governance, Question 2]

-- The country is requested to provide additional information and documentation regarding the incorporation of the term "service learning" into the CAAM-HP standards, as required under this section.
[Curriculum, Question 5]

-- The country is requested to ensure that the CAAM-HP standards include a requirement that institutions publish information related to annual costs of attendance, as required under this section.
[Admissions, Recruiting, and Publications, Question 5]

-- The country is requested to provide additional information and documentation to demonstrate that the CAAM-HP has revised its review guidelines to encompass the timeframes specified under this section for reviewing all of a medical school's clinical sites.
[Onsite Review, Question 3]

-- The country is requested to revise its policies to require that the clinical education programs it accredits must be offered in conjunction with the educational programs offered to students enrolled in medical schools in the approved foreign country or in the United States, as required under this section.
[Onsite Review, Question 5]

-- The country is requested to ensure that CAAM-HP's develops standards for setting outcomes benchmarks for its accredited schools, as required under this section.
[Accrediting/Approval Decisions, Question 2]

-- The country is requested to ensure that CAAM-HP's develops standards for setting outcomes benchmarks for its accredited schools, as required under this section.
[Accrediting/Approval Decisions, Question 3]

-- The country is requested to provide additional information, including timeframes for implementation, on the steps the CAAM-HP is considering to incorporate outcomes data analysis as part of the accreditation decision-making process.
[Accrediting/Approval Decisions, Question 4]

 
Staff Analysis
 
PART 1: Entity Responsible for the Accreditation/Approval of Medical Schools
 
Approval of Medical Schools, Question 1
 
Country Narrative
The Government of Grenada has the authority and the responsibility to license medical schools. We have attached Grenada Act no 17 of 1976 (Exhibit 1), Grenada People's Law 47 of 1982 (Exhibit 2), Grenada Act no 18 of 1996 (Exhibit 3) as amended by Grenada Act 12 of 2011 (Exhibit 4), and Grenada Statutory Rules and Orders no 34 of 2014 (August 2014) (Exhibit 5). These five documents represent the initial and amended authority to operate St. George’s University School of Medicine from 1976 to the present time.
 
Analyst Remarks to Narrative
The St. Georges University School of Medicine (SGUSM) operates under the authority of the government of Grenada. As documentation of this fact, the country submitted copies of various official government documents granting the SGUSM the permission to operate and detailing its responsibilities (Exs. 1-5). The documents were co-signed by various national officials, including the Minister of Education and Human Resource Development.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Approval of Medical Schools, Question 2
 
Country Narrative
As signatories to the Inter-Governmental Agreement establishing the CAAM-HP (Exhibit 6) the participating countries have empowered CAAM-HP with the responsibility for the monitoring and continued certification/licensure of medical schools.
 
Analyst Remarks to Narrative
The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) is currently the entity that the government of Grenada has authorized to monitor the SGUSM, and is the entity that has submitted the current petition on the country's behalf. This represents a change of accreditors since the country's last appearance before the NCFMEA, at which time the country was using the State of New York to monitor the SGUSM. Staff would note that the country's use of New York and its standards was specifically referenced in the NCFMEA's initial determination of comparability for Grenada.

As documentation, the country submitted an agreement that was signed (on varying dates) by members of the Caribbean community (Ex. 6). According to this document, Grenada entered into an agreement to use the CAAM-HP as its accreditor on July 4, 2004 (p. 11). This is confusing to ED staff, since the country has appeared before the NCFMEA on several occasions since that time but did not indicate that it was using the CAAM-HP instead of New York to monitor the SGUSM. Staff is unclear as to whether both entities have been simultaneously monitoring the SGUSM during the intervening period as a means of transitioning to the sole use of the CAAM-HP instead of New York, whether New York is still serving any accrediting function in Grenada, etc. ED staff would note that the country did not notify ED that it was changing accrediting bodies, despite the fact that its initial determination of comparability was specifically tied to the use of New York's standards.

Additional information is requested as to Grenada's change to using the CAAM-HP as its accreditor instead of the State of New York, including timelines for the transition and for the two entities' monitoring and review of the SGUSM.
 
Country Response
The Government of Grenada was asked to provide a response to this request for additional information. The following is their response:

Grenada is submitting this application for the purposes of transitioning from its current system of accrediting medical schools under the standards and procedures of the New York State Education Department (NYSED) to designate CAAM-HP as its accrediting body for the purpose of assessing the quality of medical education programs. CAAM-HP prepared this application at the Grenadian Government’s request as the next, and almost final, step in the process for Grenada to transition from the NYSED system and authorize CAAM-HP to monitor and accredit medical education programs on behalf of the Government.

The Government’s formal designation of CAAM-HP will automatically become effective after the NCFMEA issues its decision regarding the comparability of the proposed system with CAAM-HP serving as Grenada’s medical accreditation body in the form of the letter from the Secretary of Education. In the interim, Grenada will continue with all of the monitoring activities required under its current NCFMEA-approved system utilizing NYSED’s standards. The site visits and other reviews under the NYSED system have continued without interruption, including new site visit reports dated February 28, 2016, which the Government would be pleased to provide to the NCFMEA if useful. This transition has been structured to allow Grenada to make this important change without any lapse in the NCFMEA determination that its system to monitor medical education programs is comparable.

Staff is correct that SGUSM maintains accreditation from Grenada under the NYSED system and from CAAM-HP. SGUSM has chosen to maintain accreditation from CAAM-HP from 2009 through the present. (Exhibit R-1). This additional, voluntary accreditation provides another means of quality assurance for SGUSM, has allowed CAAM-HP to become well-acquainted with the SGUSM programs, and was considered by the Government when it asked CAAM-HP to file this application.

The following additional background is intended to clarify the current status of Grenada’s system, and explain how Grenada has carefully structured its planned transition from the NYSED accreditation system to have CAAM-HP assume the medical accreditation function for Grenada.

As one of 13 signatories to the 2003 CARICOM Intergovernmental Agreement Establishing CAAM-HP (the CARICOM Agreement) Grenada committed to support the establishment of CAAM-HP for the stated purpose of creating an internationally-recognized regional mechanism for the accreditation of training programs in the Caribbean Community. Grenada took action at a later date to give effect to the Agreement and require that institutions obtain CAAM-HP accreditation prior to offering medical education programs in Grenada.

In Grenada, the Ministry of Education retains responsibility to oversee and authorize medical education programs. In 2015, Grenada enacted Act 41 of 2015 (Exhibit R-2). Part 5of the Act grants the Minister of Education authority to issue Orders “necessary or expedient to give effect to the Agreement.” Pursuant to that provision, the Minister recently issued The Caribbean Accreditation Authority Order, 2016. (Exhibit R-3). The Order designates CAAM-HP as the entity responsible for accrediting medical programs in Grenada, to become effective automatically after NCFMEA determines that the system of medical accreditation appointing CAAM-HP as the country’s accreditor is comparable to the standards of the United States medical accreditation system. The Order further states that Grenada will retain its current system of accreditation (utilizing the NYSED standards) until NCFMEA approves the new system with CAAM-HP as the designated accreditor of medical programs. (See Exhibit R-3, Provision 4). The Government understands that this NCFMEA decision must be communicated through a letter from the Secretary of Education.

The Order takes effect automatically upon the decision of the Secretary with respect to the pending petition; there is no need for the Grenadian Legislature or Minister of Education to take any further action. Unfortunately, Act 41 and the Order were not available at the time of our initial application to the NCFMEA in January 2016. The Government has attached those documents here to demonstrate Grenada’s plan to make an orderly transition without any lapse in the NCFMEA’s comparability determination.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information as to Grenada's switch to using the CAAM-HP as its accreditor instead of the State of New York, including timelines for the transition and for the two entities' monitoring and review of the SGUSM.

In response to the concerns raised in the draft staff analysis, the country replied that it is currently using both the NYSED and the CAAM-HP as dual accreditors for the SGUSM, although the information and supporting documentation provided with the agency's petition was solely related to accreditation by CAAM-HP since that is the body that the country would prefer to use in the future. The country reports that an order has been prepared and is ready to be signed (Ex. R-3) that will officially designate CAAM-HP, rather than the NYSED, as the country's accreditor once such an action is formally approved by the NCFMEA. While the country prefers to use CAAM-HP and has prepared an order officially naming CAAM-HP as its accreditor of medical schools, the country must provide the signed order as soon as it is available.

Staff accepts the country's additional information and supporting documentation, and no additional information is requested at this time. However, if the change to CAAM-HP is approved at the current NCFMEA meeting, the country is requested to provide a copy of the signed order switching to CAAM-HP as soon after the meeting as it is signed.
 
Staff Conclusion: Comprehensive response provided
 
Approval of Medical Schools, Question 3
 
Country Narrative
Should circumstances warrant closure or the taking away of the medical school’s license to operate, such a decision would be taken by the Government of Grenada.
 
Analyst Remarks to Narrative
As was noted previously, the SGUSM operates under the express permission of the government of Grenada, which has the authority remove the school's right to operate. Documentation of the government's authority was provided previously and clearly establishes the government as having authority over the school (Exs. 1-5).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Accreditation of Medical Schools
 
Country Narrative
On July 4, 2004 the Government of Grenada, a member of the Caribbean Community (CARICOM), a community of nations established and recognized under the Revised Treaty of Chaguaramas Establishing the Caribbean Community including the CARICOM Single Market and Economy, 1993, (Exhibit 7), signed the Inter-Governmental Agreement Establishing the Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP), (Exhibit 6). Other members of CARICOM are, Antigua, Barbuda, The Bahamas, Barbados, Belize, Dominica, Jamaica, Guyana, Montserrat, St Kitts & Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname and Trinidad & Tobago. The CAAM-HP was officially launched on July 14, 2004 under the aegis of CARICOM as a legally constituted body empowered to determine and prescribe standards and to accredit programmes of medical, dental, veterinary and other health professions education on behalf of the contracting parties in CARICOM.

The Government of Grenada has begun to draft legislation to give effect to the Agreement in Grenada. See Exhibit 8, Letter of authorisation from the Government of Grenada.

In 2011 the World Federation for Medical Education (WFME) granted recognition to the CAAM-HP as part of an evaluation and recognition process that WFME developed in collaboration with the Educational Commission for Foreign Medical Graduates’ Foundation for Advancement of International Medical Education and Research (Exhibit 9, WFME Recognition Letter). The CAAM-HP was the first accrediting agency to be recognized through this process and such recognition came after a formal review of the CAAM-HP’s standards and procedures. As stated in the WFME policy on the Recognition of Accrediting Agencies, “Recognition of an accrediting agency by the WFME Recognition Committee confers the understanding that an agency has been deemed to be credible in its policies and procedures to assure the quality of medical education in the programmes and schools it accredits”.

In 2013 and 2014, the NCFMEA reviewed the information regarding the CAAM-HP’s medical education accreditation activities contained in the application the CAAM-HP submitted on behalf of the governments of Antigua & Barbuda and Jamaica respectively for an initial determination of comparability and determined that the standards and processes used by the CAAM –HP to accredit medical schools in Antigua & Barbuda and Jamaica are comparable to those used to accredit medical schools in the U.S. (Exhibits 10 and 11, NCFMEA Comparability Determination, Antigua and Jamaica).

As stated in the CAAM-HP’s document Procedures of the Caribbean Accreditation Authority for Education in Medicine and other Health Professions, (Exhibit 12) under the heading, Functions of the Secretariat, sub-paragraph (e) the Secretariat shall provide information on the work of the Authority to the Contracting parties; furthermore, the section entitled, Reporting of CAAM-HP Actions to External Groups, states that the Contracting Parties will be notified, through the Secretary-General of CARICOM, within one month of final accreditation decisions taken at a CAAM-HP meeting.
 
Analyst Remarks to Narrative
As was noted under a previous section, the country of Grenada was a 2004 signatory to an agreement establishing the CAAM-HP (Ex. 6, p. 11). However, as also noted previously, the country has appeared before the NCFMEA several times since 2004 and, as recently as its last appearance before the Committee, was reportedly using the State of New York as its designated accreditor.

Although the CAAM-HP is well-established as an accrediting body for several countries that are approved by the NCFMEA, ED was not aware until recently that Grenada had made a decision to switch to using CAAM-HP instead of the State of New York as its accreditor, since ED was never notified of this change. ED staff would note that New York was specifically referenced in the Grenada's initial determination of comparability. ED staff now has additional concerns, based upon the documentation that has been provided with this section, since it appears that the CAAM-HP has not yet been officially appointed to act as Grenada's accreditor for the SGUSM (Ex. 8). Despite the fact that it has not yet been officially appointed, the CAAM-HP has prepared the country's current petition for a redetermination of comparability and appears to be the entity that is accrediting the SGUSM. ED staff is unclear as to whether the State of New York (and its standards) continue to be used to monitor the SGUSM in the interim, how the transition from New York to the CAAM-HP is taking place, whether there has been any lapse in the SGUSM's monitoring during the transition, etc.

Additional information is requested regarding Grenada's transition from using the State of New York to using the CAAM-HP as its accrediting entity, including documentation that CAAM-HP has been officially designated by Grenada to monitor the SGUSM on the country's behalf.
 
Country Response
The Government of Grenada was asked to provide a response to this request for additional information. The following is their response:

As noted above in the response to Question 2 (Approval of Medical Schools), at this time Grenada is continuing to use the NYSED standards to monitor medical education programs, and SGUSM has been continuously reviewed under the NYSED standards from 1987 to the present without any lapse or interruption. SGUSM has also voluntarily maintained accreditation from CAAM-HPfrom2009 through the present.

Pursuant to that provision of Act 41, the Minister recently issued The Caribbean Accreditation Authority Order, 2016 (Exhibit R-3), which officially appoints CAAM-HP as the entity responsible for accrediting medical programs, to become effective after the Secretary issues a determination in writing that the system of medical accreditation centered upon CAAM-HP is comparable to the standards of the United States medical accreditation system.

Thus, Grenada has formally designated CAAM-HP as the entity responsible for medical accreditation in Grenada, and that designation will take effect automatically as soon as the NCFMEA and Secretary approve the current petition. Until the Secretary issues a new letter confirming the comparability of Grenada’s system using CAAM-HP’s standards, Grenada will retain its current system of accreditation, as set forth in the Order.
 
Analyst Remarks to Response
In the draft staff analysis additional information was requested regarding Grenada's transition from using the State of New York to using the CAAM-HP as its accrediting entity, including documentation that CAAM-HP has been officially designated by Grenada to monitor the SGUSM on the country's behalf.

As was noted previously, the country has been using both the NYSED and CAAM-HP as dual accreditors prior to approval by the NCFMEA that the country switch to using CAAM-HP as its sole accreditor. An order is in place and ready to be signed (Ex. R-3) that will designate CAAM-HP as the country's sole accreditor after the NCFMEA formally approves the change to CAAM-HP.

Staff accepts the country's response and supporting documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Accreditation of Medical Schools, Question 2
 
Country Narrative
In order for a medical school to operate in Grenada, it must submit to the accreditation processes and procedures of the CAAM-HP as set out in the document, Accreditation Guidelines for New and Developing Schools (Exhibit 13). CAAM-HP will advise the Minister of Education whether or not the school has met the minimum requirements for establishing the school.

However, it is noted that SGUSOM has been given exclusive rights to operate by the government. See Grenada Act No. 17 of 1976 (Exhibit 1), Grenada Act no 18 of 1996 (Exhibit 3), Grenada Act 12 of 2011 (Exhibit 4) and Grenada Statutory Rules and Orders no 34 of 2014 (August 2014) (Exhibit 5).
 
Analyst Remarks to Narrative
As has been noted in previous sections, the government of Grenada is the ultimate authority for decisions related to the SGUSM's continued operation (Exs. 1-5). The government, in turn, designates an outside accrediting entity to monitor the SGUSM on the country's behalf. In the past, the State of New York has served as the country's designated accreditor, and New York was specifically referenced in the country's initial determination of NCFMEA comparability. The country is apparently in the process of switching from using New York as its accreditor, to using the CAAM-HP, which accredits a number of other Caribbean medical schools. According to documentation presented with a previous section, the CAAM-HP has not yet been officially designated by Grenada as the accreditor for the SGUSM (Ex. 8). Since the country is in the process of changing accrediting entities, it is not clear to ED staff whether New York's monitoring system or the CAAM-HP'monitoring system is currently in use at the SGUSM.

Additional information and documentation are requested as to which accrediting entity's system is currently in use in Grenada.
 
Country Response
The Government of Grenada was asked to provide a response to this request for additional information. The following is their response:

As provided in response to Question 2 (Approval of Medical Schools) and Question 1 (Accreditation of Medical Schools), Grenada’s current NCFMEA-approved system of accreditation remains in place as Grenada transitions to adopt CAAM-HP as its medical accrediting body, consistent with the Grenadian Act 41 and the 2016 Order.(Exhibits R-2and R-3). Regular monitoring and compliance with the NYSED standards will remain a prerequisite to operating medical education programs in Grenada for this transition period until NCFMEA issues its determination. Those monitoring activities have continued without interruption, as reflected in the NYSED approval of SGUSM in 2015 and new site visit reports as recent as February 28, 2016.

Following the Secretary’s letter confirming NCFMEA’s determination of comparability with respect to this application, CAAM-HP will become Grenada’s sole accrediting body for medical education and medical schools will be required to meet CAAM-HP’s standards as a condition of operating in Grenada.
 
Analyst Remarks to Response
In the draft staff analysis, additional information and documentation were requested as to which accrediting entity's system is currently in use in Grenada.

As has been noted previously, the country has been using both the NYSED and CAAM-HP as dual accreditors in preparation for the change to using only CAAM-HP as the country's accreditor. Following formal approval by the NCFMEA, the country will use only CAAM-HP as its accreditor.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Part 2: Accreditation/Approval Standards
 
Mission and Objectives, Question 1
 
Country Narrative
Yes, the CAAM-HP requires medical schools to have an educational mission that serves the public interest. As the CAAM-HP has set out in its Revised Standards for the Accreditation of Medical Schools in the Caribbean Community, Exhibit 14, doctors who have graduated from medical schools accredited by CAAM-HP in accordance with its Standards,

“Should be capable of serving patients in resource poor conditions as well as in the modern hospital or clinical setting. Graduates should be skilled in making clinical diagnoses and undertaking basic treatment of those conditions that do not require specialist skills, but must know how to access specialist skills and facilities when required. The graduate doctor must also be capable of absorbing postgraduate training and after a period of supervised practice to enter independent practice in CARICOM countries. Graduates must have the capacity and desire for life-long learning so they can practice in circumstances where knowledge, health conditions and cultures are different or change over time.”

The Standards expect that a doctor “should be a promoter of health for the individual as well as the community, and must have the clinical competencies to be able to diagnose and treat illness in resource constrained circumstances. They must be aware of modern techniques of diagnosis and care and how they may be accessed when not available in the setting in which they practice. They must be aligned with international codes of conduct for health professionals and practice within the law and ethical code of conduct of the country or jurisdiction in which they practice. They should be an advocate for the patient, particularly those disadvantaged by age, or economic circumstance and to do so irrespective of ethnic, racial, religious, political or other circumstances.” See Standards, Section III, Educational Programme, Exhibit 14.

Standard ED-18 requires that faculty and students demonstrate an understanding of the manner in which people of diverse culture and belief systems perceive health and illness and respond to various symptoms, diseases and treatments. Medical school instruction should stress the need for students to be concerned with the total medical needs of their patients and the effects that social and cultural circumstances have on their health. To demonstrate compliance with Standard ED-18, medical schools should be able to document objectives relating to the development of skills in cultural competence and international human righrs, to indicate where in the curriculum students are exposed to such material and to demonstrate the extent to which the objectives are being achieved.

Standard ED-19 requires medical schools to recognize and address appropriately gender, cultural and religious biases in themselves and others. A medical school’s objectives for clinical instruction should include student understanding of demographic influences on health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of diseases. The objectives should also address the need for self-awareness among medical students of any personal biases in their approach to health care delivery.

Standard ED-20 requires a medical school to teach medical ethics with respect for religious and other human values and their relationship to law and governance of medical practice. Students must be required to exhibit scrupulous ethical principles in caring for patients and in relating to patients’ families and others involved in patient care, strive to encompass community concerns.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical
Education Database, Section III: Educational Programme, Exhibit 15, at Part B and the Site Visit Report of 2015, Exhibit 16.

The CAAM-HP has a process through which it develops and approves new or revised standards and procedures. See Procedures of the CAAM-HP, Exhibit 12, Appendix E. As part of the process of standards revision, consideration will be given to standards related to how the CAAM-HP evaluates a medical school’s mission in relation to managing health problems of the individual and the community, taking charge of health promotion and prevention of disease and maintaining acceptable scientific and ethical standards of the profession.
 
Analyst Remarks to Narrative
The narrative notes that CAAM-HP has several standards related to culture and belief systems, as well as gender, cultural, and religious bias, etc. (Ex. 14, pp. 24-25). However, ED staff is unable to find any requirement in the agency's standards that a school develop a mission statement to drive the development of educational objectives that support the school's mission or that such a mission statement be related to serving the public interest, as required under this section.

The country is requested to provide information and documentation to show that the CAAM-HP standards require accredited medical schools to develop a mission statement as a precursor to developing appropriate educational objectives in support of the school's mission. Such a mission statement should include a component related to serving the public interest.
 
Country Response
CAAM-HP accreditation standards are undergoing a process of revision, a task which has been assigned to an Advisory Committee whose terms of reference and membership is attached (Exhibit 14-A).

Among the recommendations for inclusion in the proposed revised standards is a new
IS-1 which reads as follows:

Institutional Setting

IS-1 (new standard)
• An institution that offers a medical education programme must engage in a planning process that sets the direction for its programme and results in measurable outcomes.

Explanatory Note:

To ensure the ongoing vitality and successful adaptation of its medical education programme to the rapidly changing environment of academic medicine, the institution needs to establish periodic or cyclical institutional planning processes and activities. Planning efforts that have proven successful typically involve the definition and periodic reassessment of both short-term and long-term goals for the successful accomplishment of institutional missions. By framing goals in terms of measurable outcomes wherever circumstances permit, the institution can more readily track progress toward their achievement. The manner in which the institution engages in planning will vary according to available resources and local circumstances, but it should be able to document its vision, mission and goals; evidence indicating their achievement; strategies for periodic or ongoing reassessment of successes and unmet challenges.

The Committee has been mandated to submit a draft set of standards detailing changes/recommendations and impact on the Medical Education Databases and the Annual Medical School Questionnaire. The aim is to have the drafts submitted for discussion to the CAAM-HP 2016 Annual Board meeting in July.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide information and documentation to show that the CAAM-HP standards require accredited medical schools to develop a mission statement as a precursor to developing appropriate educational objectives in support of the school's mission. Such a mission statement should include a component related to serving the public interest.

In response to the draft, the country reports that CAAM-HP is in the process of revising its accreditation standards. It reports that one proposed standard will specify that a medical institution must have a planning process that sets the direction for medical program and results in measurable outcomes.

ED staff notes that the proposed revision to the CAAM-HP standards does not address the requirement for a medical school to develop a mission statement prior to developing educational objectives, nor does it require that the mission statement include a component related to serving the public interest, as required under this section.

The country is requested to ensure that its accreditor develops a standard that requires a medical school to develop a mission statement that includes a component related to serving the public good, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Mission and Objectives, Question 2
 
Country Narrative
Standard ED-1 states that “the medical school faculty must define the objectives of its educational programme.” For purposes of the Standard, educational objectives are defined as, “statements of the items of knowledge, skills, behaviours and attitudes that students are expected to exhibit as evidence of their achievement. They are not statements of mission or broad institutional purposes such as, education, research, health care or community service. Educational objectives state what students are expected to learn not what is to be taught.” The Standard continues, “student achievement of these objectives must be documented by specific and measurable outcomes (e.g. measures of basic science grounding in the clinical years, examination results, performance of graduates in residency training, performance in licensure examinations, etc)”.

Standard FA-14 requires a medical school to have mechanisms for direct faculty involvement in decisions related to the educational programme, including curriculum development and evaluation. The Standard notes that the “quality of an educational programme may be enhanced by the participation of volunteer faculty in faculty governance, especially in defining educational goals and objectives.”

Standard ED-29 requires that the faculty must be responsible for the detailed design and implementation of the components of a coherent and coordinated curriculum that is designed to achieve the school’s overall educational objectives. In accordance with Standard ED-30, the curriculum should include:

• Logical sequencing of the various segments of the curriculum;
• Content that is coordinated and integrated within and across the academic periods of study;
• The development of specific course or clerkship objectives;
• Methods of pedagogy and student evaluation that are appropriate for the achievement of the school’s educational objectives.

Faculty engaged in curriculum management are expected to evaluate programme effectiveness through outcome analysis. See Standard ED-31. Curriculum management also includes review of the stated objectives of individual courses and clerkships as well as methods of pedagogy and student evaluation to assure congruence with institutional educational objectives. See also Standard ED-33, which requires the faculty committee responsible for the curriculum to monitor the content provided in each discipline so that the medical school’s educational objectives will be achieved.

With regard to clinical education, Standard ED-2 requires that educational objectives include quantified criteria for the types of patients, the level of student responsibility and the appropriate clinical settings needed for the objectives to be met. Courses and clerkships that require physical or simulated patient interactions should specifically monitor and verify by appropriate means, the number and variety of patient encounters in which students participate so that adjustments in the criteria can be made if necessary without sacrificing educational quality.

Standard ED-3 requires that the objectives of the educational programme be made known to all medical students and to the faculty, residents/junior staff and others with direct responsibility for medical student education. The dean and the academic leadership of any clinical affiliates where the education programme takes place are also expected to exhibit familiarity with the overall objectives for the education of medical students. See also Standard ED-22 which requires that faculty, residents/junior staff, graduate students and postdoctoral fellows serving as teacher or teaching assistants are familiar with the educational objectives of the course or clerkship and should be prepared or received training for their roles in teaching and evaluation.

Standard ED-26 requires that a medical school conduct ongoing assessments that assures students have acquired and can demonstrate on direct observation the core clinical skills, behaviours and attitudes that have been specified in the school’s educational objectives. Such assessment should include evaluation of problem solving, clinical reasoning and communication skills all in relation to both individuals and communities.

To guide programme improvement, Standard ED-42 requires medical schools to evaluate the effectiveness of the educational programme by documenting the extent to which its objectives have been met. Medical schools must consider student evaluations of their courses and professor, acceptancs and an appropriate variety of outcome measures in assessing programme quality. Appropriate outcome measures for evaluating the effectiveness of the educational programme include data on student performance, academic progress, programme completion rates, acceptance into residency/postgraduate performance and practice characteristics of the medical school’s graduates. Medical schools must evaluate the performance of students and graduates in the framework of national and international norm of accomplishment and performance within the wider health care system.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15 at Part B and Medical Education Database, Section IV: Faculty, Exhibit 17 at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18 at Questions III. A.1; III.D.11 and III.D.12; IV.C.8 and IV.C.9.
 
Analyst Remarks to Narrative
As described in the country's narrative, CAAM-HP's standards require that a medical school's faculty define the objectives of the educational program and that the faculty be involved in decisions regarding the curriculum and the development of the educational program.

The country provided a copy of the CAAM-HP standards. As documentation of the implementation of those standards, it also provided a copy of a 2011 site visit report to the SGUSM (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Mission and Objectives, Question 3
 
Country Narrative
Standard ED-29 requires that the faculty must be responsible for the detailed design and implementation of the components of a coherent and coordinated curriculum that is designed to achieve the school’s overall educational objectives.

Standard ED-5 requires that “faculty approve a curriculum that provides a general professional education and fosters in students the ability to learn through self-directed, independent study throughout their professional lives.”

Standard FA-14 requires a medical school to have mechanisms for direct faculty involvement in decisions related to the educational programme, including curriculum development and evaluation. The Standard notes that the “quality of an educational programme may be enhanced by the participation of volunteer faculty in faculty governance, especially, in defining educational goals and objectives.”

An institutional body (commonly called a curriculum committee) must oversee the educational programme. Standard ED-29 notes that an “effective central curriculum authority will exhibit…faculty, student and administrative participation.”

The faculty committee responsible for the curriculum must monitor the content provided in each discipline so that the school’s educational objectives will be achieved. See Standard ED-33. The curriculum committee is tasked making sure that each academic period maintains common standards for content, which address the depth and breadth of knowledge required.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15 at Part B and Medical Education Database, Section IV: Faculty, Exhibit 17 at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-Study for Programmes of Education in Medicine, Exhibit 18, at Question IV. C.8 and IV.C.9.
 
Analyst Remarks to Narrative
The country's narrative notes that the CAAM-HP standards require that the faculty be involved in curriculum development and that faculty serve on a Curriculum Committee that oversees the educational program. However, the standards described in the narrative do not appear to address faculty involvement in the development of the medical school's educational objectives, as opposed to the development of a curriculum that would be driven by those objectives.

Additional information and documentation are requested to demonstrate that the CAAM-HP standards require that faculty be directly involved in the development of the medical school's educational objectives.
 
Country Response
Standard ED-1 requires that the medical school faculty must define the objectives of its educational programme.

It further explains that “educational objectives are statements of the items of knowledge, skills and behaviours and attitudes that students are expected to exhibit as evidence of their achievement. They are not statements of mission or broad institutional purpose, such as education, research, health care or community service. Educational objectives state what students are expected to learn not what is to be taught.

Student achievement of these objectives must be documented by specific and measurable outcomes such as measures of basic science grounding in the clinical years, examination results, performance of graduates in residency/internship training, performance in licensing examinations etc.

This requirement is also addressed in Medical Education Database Section III at Part B.
 
Analyst Remarks to Response
In the draft staff analysis additional information and documentation were requested to demonstrate that the CAAM-HP standards require that faculty be directly involved in the development of the medical school's educational objectives.

In response to the draft analysis, the agency notes that its Standard ED-1 requires that the medical school faculty must define the objectives of its educational program and that this requirement was addressed in its documentation.

ED staff accepts the country's narrative and previously submitted documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Mission and Objectives, Question 4
 
Country Narrative
Standard ED-1 defines educational objectives as “statements of the items of knowledge, skills, behaviors, and attitudes that students are expected to exhibit as evidence of their achievement.” The Standard cautions that educational objectives “are not statements of mission or broad institutional purpose, such as education, research, health care, or community service. Educational objectives state what students are expected to learn, not what is to be taught.”

Standard ED-1 further requires that student achievement of educational objectives be documented by specific and measurable outcomes (e.g., measures of basic science grounding in the clinical years, examination results, performance of graduates in residency training, performance in licensure examinations, etc.).

To guide programme improvement, Standard ED-42 requires medical schools to evaluate the effectiveness of the educational programme by documenting the extent to which its objectives have been met. Medical schools must consider student evaluations of their courses and professors and an appropriate variety of outcome measures in assessing programme quality. Appropriate outcome measures for evaluating the effectiveness of the educational programme include data on student performance, academic progress, programme completion rates, acceptance into residency/postgraduate programmes, postgraduate performance, and practice characteristics of the medical school’s graduates. Medical schools must evaluate the performance of students and graduates in the framework of national and international norms of accomplishment and performance within the wider health care system. See also Standard ED-31, which requires medical schools to engage in curriculum management, to include the evaluation of programme effectiveness by outcomes analysis.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards define what an educational objective is and also specify that achievement of educational objectives be demonstrated via measurable outcomes measures. Student evaluations of courses and professors are also used to determine whether the students feel that educational objectives are being met.

As documentation of the implementation of its standards, the agency provided a copy of a 2011 on-site review report from SGUSM (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Mission and Objectives, Question 5
 
Country Narrative
Student achievement of the medical school’s educational objectives must be documented by specific and measurable outcomes (e.g., examination results, performance of graduates in residency training, performance on licensure examinations, etc.). See Standard ED-1.

Standard ED-5 requires a medical school to design and its faculty to approve a curriculum that provides a general professional education and fosters in students the ability to continue to learn through self-directed, independent study throughout their professional lives.

Standard ED-24 requires the medical school faculty to establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes. Such evaluation should “measure not only retention of factual knowledge, but also development of the skills, behaviors, and attitudes needed in subsequent medical training.” The students’ ability to use data for solving problems commonly encountered in medical practice should also be evaluated. The Standard specifies that the “sole use of frequent tests which condition students to memorize details for short-term retention only is not considered a good system of evaluation to foster self-initiated learning,” which is an essential objective of a programme of medical education.

A medical school’s faculty committee responsible for the curriculum must monitor the content provided in each discipline so that the school’s educational objectives must be achieved. See Standard ED-33. The final year of the educational programme should complement and supplement the curriculum so that each student will acquire appropriate competence in general medical care regardless of their subsequent career specialty.

Standard ED-42 requires medical schools to evaluate the effectiveness of the educational programme by determining the extent to which its objectives have been met. Among the kind of outcome measures that serve this purpose are acceptance into residency/post-graduate programmes, post-graduate performance, and practice characteristics of graduates.

Standard ED-43 requires medical schools to evaluate the performance of their students and graduates from within a framework of national and international norms of accomplishment and performance within the wider health care system.

The Standards related to Continuing Professional Education (“CPE”) address the continued learning needs of medical graduates. A medical school should provide programmes for the CPE of its graduates; when appropriate, such programmes should be offered in consultation with and with the cooperation of national and regional authorities. See Standard CE-1. Such CPE programmes should be of acceptable educational quality and promote quality of care through self-evaluation. See Standard CE-2.

CE-2. They should also be conducted according to relevant standards and criteria developed by the medical school, in keeping with those standards and criteria of relevant national and regional authorities.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B and Medical Education Database, Section VII: Continuing Professional Education, Exhibit 19, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require the ongoing evaluation of medical students throughout their educational program. Student achievement is required to be evaluated through a variety of means, but schools must consider outcomes-related data, including acceptance into residency/post-graduate programs, post-graduate performance, and practice characteristics of graduates. The CAAM-HP standards also require medical schools to offer meaningful programs of continuing education to address the needs of graduates.

As documentation of the implementation of its standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Governance, Question 1
 
Country Narrative
Standard IS-1 provides that accreditation will be conferred only on those programmes that are legally authorized under applicable law to provide the programme(s) of education for which accreditation is sought. The Standard also requires that an educational institution be registered by the government of the jurisdiction in which it operates. The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B. As part of the accreditation process, a medical education programme provides the CAAM-HP a copy of its charter or other legal instrument in order to demonstrate that the programme has legal authority to operate.

In the case of SGU, the medical school is legally authorised to provide a programme of medical education under the following Acts: Grenada Act No. 17 of 1976 (Exhibit 1), Grenada Act no 18 of 1996 (Exhibit 3), Grenada Act 12 of 2011 (Exhibit 4) and Grenada Statutory Rules and Orders no 34 of 2014 (August 2014) (Exhibit 5).

Please note the addition of a specific requirement to provide a copy of the charter or any other documentation evidencing a school’s legal authority to operate. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B, IS-1 (c).

Private/for-profit institutions will be required to obtain a charter from the government of Grenada following advice from CAAM-HP that such institutions have met the minimum requirements to operate and been given Initial Provisional Accreditation. See Procedures of the CAAM-HP, Appendix A, Exhibit 12.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that a medical school be legally authorized to operate in the country in which is it located.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report, as well as extensive documentation specific to Grenada demonstrating that the SGUSM is legally authorized to operate in that country.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Governance, Question 2
 
Country Narrative
A medical school is accountable to the CAAM-HP for purposes of accreditation and must adhere to its Standards. See Procedures, Exhibit 12. Also, a medical school is accountable under its charter to the government of Grenada; particular requirements for operation in the jurisdiction are generally specified in a medical school’s government-issued charter.

With reference to SGUSOM, the Board of Trustees is the governing body to which the administrators of the medical school are accountable for the operation and success of the school and its programmes. The SGU has a conflict of interest policy with respect to the members of the Board of Trustees. See the Board of Trustees Conflict of Interest Policy in Exhibit 21, SGU Database 2014, Section I: Institutional Setting- pages 9-12.

The non-governmental governing board of a medical school provides oversight. The CAAM-HP Standards state, in relevant part: “The governing body responsible for oversight of the medical school should be composed of persons who have the educational needs of the institution as their first priority and no clear conflict of interest in the operation of the school, its associated hospitals, or any related enterprises.” See Standard IS-3. In addition, the Standards require that the “terms of the governing body members should be sufficiently long to permit them to gain an understanding of the programmes of the medical school.” See Standard IS-4. Medical school governance structures vary in Caribbean countries depending on a variety of factors.

At present, CAAM-HP does not have a policy requiring that a school’s governing board be external to or independent of the medical school.
The CAAM-HP asks a school to evaluate its governance structure, including as related to the school’s governing board, in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions I.A.2 and 1.A.3. Also, the CAAM-HP asks a school to report on its governance structure in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B.
 
Analyst Remarks to Narrative
In its narrative, the country acknowledges that the CAAM-HP standards do not require that a school's governing board be external to, or independent of, the school. The standards do require that board members prioritize the needs of school and have no conflicts of interest. In the case of the SGUSM, the school's administration is responsible to both the country's government and to a board of trustees, and the SGUSM has a conflict of interest policy to govern its board.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Additional information and documentation are requested to demonstrate that the CAAM-HP has amended its standards to reflect the requirement that its accredited schools are responsible to an external entity that is independent of the school.
 
Country Response
A standard requiring accredited medical schools to be responsible to an external entity that is independent of the school is to be included in the revised standards as per the attached Terms of reference to the Advisory Committee (Exhibit 14-A).
 
Analyst Remarks to Response
In the draft staff analysis, additional information and documentation were requested to demonstrate that the CAAM-HP has amended its standards to reflect the requirement that its accredited schools are responsible to an external entity that is independent of the school.

In its response, the country notes that CAAM-HP is in the process of revising its standards, although the revisions have not yet been formally accepted.

The country is requested to provide information and documentation to demonstrate that the CAAM-HP has amended its standards to reflect the requirement that its accredited schools are responsible to an external entity that is independent of the school.
 
Staff Conclusion: Additional Information requested
 
Administrative Personnel and Authority, Question 1
 
Country Narrative
The standards and requirements regarding how medical schools are to be administered in Grenada are set forth in the Standards under the heading “Institutional Setting, A. Governance and Administration.”

Pursuant to Standard IS-2, the manner in which a medical school is organized, including the responsibilities and privileges of administrative officers, faculty, students, and committees must be promulgated in medical school or university by-laws.

Pursuant to Standard IS-3, the governing body responsible for oversight of the medical school should be composed of persons who have the education needs of the institution as their first priority and have no clear conflict of interest in the operation of the school, its associated hospitals, or any related enterprises.

Pursuant to Standard IS-4, the terms of the governing body members should be sufficiently long to permit them to gain an understanding of the programme(s) of the medical school.

Pursuant to Standard IS-5, administrative officers and members of the medical school faculty must be appointed by, or on the authority of, the governing body of the medical school or its parent university.

Pursuant to Standard IS-9, the medical school administration should include such associate and assistant deans, department chairs, leaders of other organizational units, and staff as are necessary to accomplish the missions of the medical school. The Standard also notes that there should not be excessive turnover or long-standing vacancies in medical school leadership. Medical school leadership is defined to include the dean, vice/associate deans, department chairs, and other positions where a vacancy could negatively impact institutional stability, especially with regard to planning or implementing the educational programme. Areas that commonly require administrative support include admissions, student affairs, academic affairs, faculty affairs, postgraduate education, continuing education, hospital relationships, research, business and planning, and fundraising.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B.

The CAAM-HP asks a school to assess the organizational stability of the medical school administration in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Question I.A.4.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards address medical school organization, governing body oversight and members, and a requirement that medical school administrators and faculty be appointed under the authority of the university or its governing board. The standards also specify that the medical school administration should include enough deans, department chairs, unit leaders, and support staff to accomplish the school's missions.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Administrative Personnel and Authority, Question 2
 
Country Narrative
Under Standard IS-6, the dean or chief medical officer of the medical school must have ready access to the administrative head of the school or other school official charged with final responsibility for the school, and to other school officials as are necessary to fulfill the responsibilities of the dean’s office.

Standard ER-2 requires that an accredited programme have current and anticipated financial resources adequate to sustain a sound programme of medical education and to accomplish other institutional goals. Under the Standard, the cost of conducting an accredited programme should be supported by diverse sources, including tuition, endowments, support from the parent university, covenants, grants from organizations and individuals, and appropriations by the government. Evidence of compliance with Standard ER-2 includes documentation of adequate financial reserves to maintain the programme in the event of unexpected revenue loss along with demonstrated effective fiscal management of the medical school budget. Such information may be submitted to the CAAM-HP under confidential cover. Standard ER-3 states that pressure for institutional self-financing must not compromise the educational mission of the institution nor cause it to enroll more students than its resources can accommodate.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B and Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B. A school is also asked to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions V.A.1 through V.A.4.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the dean of the medical school must have access to the institution's administrative head, or another school official with the final responsibility for the school, as well as to other school officials who are necessary for the dean to fulfill the responsibilities associated with the dean's office.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Administrative Personnel and Authority, Question 3
 
Country Narrative
Under Standard IS-7, there must be a clear understanding of the authority and responsibilities for medical school matters among the administrative officials of the school, the dean of the school, the faculty, and the administrative officials of other components of the medical teaching complex of the university.

Standards ER-2 and ER-3 require that the medical school have financial resources adequate to sustain a sound programme of medical education while accomplishing other institutional goals. Standards ER-4 and ER-5 require that a medical school have adequate buildings and equipment appropriate to achieve its educational and other goals. Standards ER-6 through ER-11 require sufficient access to resources and authority needed to carry out clinical teaching activities. Standards ER-12 and ER-13 require that adequate information resources and library services be provided.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B and Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B. A school is also asked to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions V.A.1 through V.A.4.

CAAM-HP Standard ER-11 identifies the role that department heads and clinical faculty must have with respect to the medical programme and clinical affiliates. The Standard requires:

"In the relationship between the medical school and its clinical affiliates, the educational programme for medical students must remain under the control of the school's faculty.

"Regardless of the location where clinical instruction occurs, department heads and faculty must have authority consistent with their responsibility for the instruction and evaluation of medical students.

"The responsibility of the clinical facility for patient care should not diminish or preclude opportunities for medical students to undertake patient care duties under the appropriate supervision of medical school faculty and junior staff / residents."

Clinical rotations are carried out at 73 affiliated hospitals in the USA, Canada, Grenada and the UK.

Hospitals visited:
2007: St Joseph’s Medical Center, New Jersey, Long Island Hospital, New York, Long Island College Hospital, New York, USA and the Staffordshire General Hospital, UK

2011: The Brooklyn Hospital Centre, New York Methodist Hospital, Sound Shore Medical Centre of Westchester, Elmhurst Hospital Centre, Saint Barnabas Medical Center, Mt Vernon Hospital, USA and the Watford General Hospital, UK

2015: St George’s Public General Hospital, Grenada, Hackensack University Medical Center, Newark Beth Israel, Richmond University Medical Center, Lutheran Medical Center, Kings County Medical Center, Woodhull Medical Center, Flushing Hospital and Southside Hospital all in New York, USA; Russells Hall Hospital in Birmingham, North Middlesex Hospital, and Watford General Hospital, UK

CAAM-HP assesses compliance with Standard ER-11 through discussions with clinical faculty during site visits to affiliated clinical locations. Furthermore, the CAAM-HP self-study document asks medical schools to “describe and evaluate the interaction between the administrators of the hospitals/clinics used for teaching and the medical school administration.” It also asks medical schools to “describe and evaluate the level of interaction/cooperation between the staff members of the hospitals/clinics used for teaching and medical school faculty members and department heads.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that there be clear lines of administrative authority in a medical school, that the medical school program must remain under the control of the medical school faculty, and that department heads and faculty must have the authority for the instruction and evaluation of the medical school students. The standards require that the medical school must have sufficient resources to sustain the medical school program and support institutional goals.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Chief Academic Official, Question 1
 
Country Narrative
As set forth in Standard IS-5, the Chief Academic Officer, administrative officers, and members of a medical school faculty must be appointed by or on the authority of the governing body of the medical school or its parent university.

Under Standard IS-8, the dean or chief academic officer must be qualified by education and experience to provide leadership in medical education, in scholarly activity, and in the care of patients.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B.

In addition, the site visit team determines the adequacy of the chief academic officer’s qualifications and experience. Determinations are based on information solicited through the database document (e.g., curriculum vitae), the team members’ professional expertise, and the team’s interactions with the chief academic officer during the site visit. Criteria such as the individual’s medical qualifications, experience in teaching, patient care experience, research and publications, and professional affiliations are taken into account.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards contain requirements related to the dean or chief academic officer's qualifications and also require that the person be appointed by the school's governing board or its parent university. The country reports that the dean's qualifications are evaluated during on-site reviews.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Chief Academic Official, Question 2
 
Country Narrative
The CAAM-HP does not prescribe the manner in which a medical education programme must select a chief academic official. However, such process must result in a chief academic official who meets the CAAM-HP’s standards, meaning the person must be “qualified by education and experience to provide leadership in medical education, scholarly activity, and he/she or his/her deputy in the care of patients” as set forth in the Standards (i.e., IS-8).

The CAAM-HP asks a school to address the chief academic official’s qualifications in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B. Site visit teams are able to assess whether the chief academic official is qualified to occupy his or her position based in part on a medical education programme’s Database responses about the experience and qualifications of its chief academic official.

Under Standard IS-5, the chief academic officer must be appointed by or on the authority of the governing body of the medical school or its parent university. The process to select the chief academic official must result in a chief academic official who meets CAAM-HP standards, particularly IS-8, which requires the chief academic official to be “qualified by education and experience to provide leadership in medical education, scholarly activity, and he/she or his/her deputy in the care of patients” as set forth in the Standards. If a site visit team finds deficiencies with respect to a medical school’s compliance with IS-8, the team would evaluate the factors that contributed to selection of an unqualified chief academic official, including the selection process.

The Dean of the School of Medicine is the Chief Academic Officer of the SOM, directs all programmes and activities within the SOM and advises the Chancellor on all matters that are related to the SOM. The Dean is the Chair of the School of Medicine Council of Deans and the Executive Council of Deans and is a member of the University Council of Deans. In 1981 the current dean accepted the position as Dean of Clinical Studies and Chair of the Department of Medicine at St. George’s. He has been at SGUSOM for over 30 years. See Exhibit 21.
 
Analyst Remarks to Narrative
Although they do not specify the hiring process for the chief academic official, the CAAM-HP standards require that the chief must be appointed by either the school's governing body or the parent university and must be qualified for the position by both education and experience. Site visit teams review the chief's qualifications while conducting the on-site review.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Faculty
 
Country Narrative
Standard FA-7 requires that medical school faculty must make decisions regarding student admissions, promotion, and graduation.

Standard FA-13 requires that the dean and a committee of faculty should determine medical school policies. The committee, which should consist of the heads of major departments, may be organized in any manner that brings reasonable and appropriate faculty influence into the governance and policy-making processes of the medical school.

Standard FA-8 requires that a medical school possess clear policies for faculty appointment, renewal of appointment, promotion, granting of tenure, and dismissal that involve the faculty, the appropriate department heads, and the dean/Chief Academic Officer.

Standard FA-14 requires that a medical school must have mechanisms for direct faculty involvement and decision-making relating to its educational programme(s). Important areas where direct faculty involvement is expected include admissions, curriculum development and evaluation, and student promotions. This Standard also requires that faculty should be involved in decisions about any other mission-critical areas specific to the schools. Strategies for assuring direct faculty participation may include peer selection or other mechanisms that bring a broad faculty perspective to the decision-making process, independent of departmental or central administration points of view. The quality of an educational programme may be enhanced by the participation of volunteer faculty and faculty governance, especially in defining educational goals and objectives.

Standard ED-1 requires that medical school faculty define the objectives of the educational programme. Such objectives should state what students are expected to learn, not what is to be taught. Objectives for clinical education, including quantified criteria for the types of patients, the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met are also required. See Standard ED-2.

Pursuant to Standard ED-5, the faculty must approve a curriculum that provides a general professional education and fosters in students the ability to learn through self-directed, independent study throughout their professional lives.

Pursuant to Standard ED-29, the faculty must be responsible for the detailed design and implementation of the components of the curriculum. The educational programme as a whole must be overseen by an institutional body such as a curriculum committee consisting of faculty, students, and administrative representatives. Id. The curriculum committee is expected to lead, direct, coordinate, control, plan, evaluate, and report on the programme. See Standard ED-31. The faculty committee responsible for the curriculum must monitor the content provided in each discipline, giving careful attention to the impact on students of the amount of work required. See Standards ED-33 and ED-34.

Standard FA-15 requires that faculty should meet often enough for all faculty members to have the opportunity to participate in the discussion and establishment of medical school policies and practices.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B and Medical Education Database, Section IV: Faculty, Exhibit 17, at Part B.

The CAAM-HP also asks a school to address these topics in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.A.1; III.D.11 and III. D.12; IV.B.4 through IV.B.7; IV.C.8.
 
Analyst Remarks to Narrative
As described in the narrative, CAAM-HP has numerous standards that contain appropriate requirements related to admissions, the hiring, retention, promotion, and discipline of faculty and all phases of the curriculum, including the clinical education portion. Faculty members participate in decisions either by virtue of their job assignments or descriptions or by participation on decision-making committees, such as curriculum committees.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Remote Sites, Question 1
 
Country Narrative
The CAAM-HP’s accreditation process encompasses complete education programmes (basic sciences and clinical sciences) regardless of the distance to remote sites. As explained in the CAAM-HP’s accreditation guidelines:

“The ‘scope of recognition’ for the CAAM-HP, as recognised by the participating countries of the region, is the accreditation of medical, dental, veterinary and degree nursing education programmes that are provided in the participating countries.

Several schools offer multiple parallel segments of their education programmes, sometimes by way of separate campuses where students may complete portions of their study, or through distinct 'tracks' within educational programmes where students at a single location may learn similar content using varying educational methods. Schools may also offer programmes or parts of programmes in countries outside of the participating countries, that is, in the case of offshore schools, clinical clerkships may be offered outside of the country in which the school is located. The basic sciences portion of the programme cannot be taken outside the country in which the medical school is located.

By restricting the scope of recognition to complete education programmes, the CAAM-HP is able to focus its assessment activities on comprehensive and comparable units of analysis, independent of the administrative structures of the schools that provide them. Thus, it does not confer accreditation on programmes of one or two-year duration, except as elements of a complete educational programme. Nor does it normally accredit programmes provided outside the participating countries even if the school responsible for the programme operates in the region.” See Exhibit 13, Accreditation Guidelines for New and Developing Schools.

In the case of the medical school in Grenada the medical education programme is conducted in the host country as well as in affiliated hospitals in the USA, Canada and the UK. In addition, St George’s University School of Medicine has a partnership with the University of Northumbria in the UK (the Keith B Taylor Global Scholars Programme (KBTGSP) which permitted a significant number of students to undertake the first year of their studies in the UK before moving to Grenada to complete the Preclinical part of the course. This is a breach of CAAM-HP’s procedures. However, US students attending Northumbria are not eligible for Title IV Benefits. See Exhibit 23.
 
Analyst Remarks to Narrative
The country reports in its narrative that the CAAM-HP accredits a medical school's entire program, to include both the basic sciences component and the clinical sciences component. The basic sciences component must normally be offered in the country in which the school is located, but the clinical sciences component may be offered in other locations since more hospital sites are needed than are located in the agency's Caribbean countries. The CAAM-HP accreditation guidelines document supports the information provided in the narrative (EX. 13).

The narrative notes that in the case of Grenada, a special cooperative arrangement is in place that allows a small number of students to undertake the first year of basic science study at the University of Northumbria in Great Britain before transferring to Grenada to finish their basic science studies. As has been noted in past discussions with the NCFMEA, there are no U.S. Title IV students in the program at Northumbria, so no violation of Title IV requirements results from this arrangement and the agreement with Northumbria has therefore been accepted by the NCFMEA.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Remote Sites, Question 2
 
Country Narrative
As set forth in the Standards, when a medical school offers all or part of its medical education programme at geographically separate locations, there must be comparable educational experience and equivalent methods of evaluation across all alternative instructional sites within a given discipline.

Standard ED-7 sets forth in detail the requirements to be applied to the evaluation of the medical school to ensure that the quality of its education programme at geographically separate sites is comparable to that at the main campus and that students are evaluated in a comparable manner at all sites. For example, Standard ED-7 sets forth:

-- Course duration or clerkship length should be identical, unless a compelling reason exists for varying the length of the experience;

-- The instruments and criteria used for student evaluation, as well as policies for the determination of grades, should be the same for all alternative sites;

-- Faculty at each site should be sufficiently knowledgeable in the subject matter to provide effective instruction and should possess a clear understanding of the objectives of the educational programme and the evaluation methods used to determine achievement of those objectives;

-- Opportunities to enhance teaching and evaluation skills should be available for faculty at all instructional sites;

-- While the types and frequency of problems or clinical conditions seen at alternate sites may vary, each course or clerkship must identify any core experiences needed to achieve its objectives and ensure that students receive sufficient exposure to such experiences;

-- The proportion of time spent in inpatient and ambulatory settings may vary according to local circumstance, but in such cases the course or clerkship director must ensure that limitations in learning environments do not impede the accomplishment of objectives;

-- The course or clerkship director should orient all participants, both teachers and learners, about the educational objectives and the assessment system used;

-- Course or clerkship directors should review student evaluations of their experiences at alternative sites to identify any persistent variations in educational experiences or evaluation methods.

Several other Standards provide additional detail to operationalize the effective administration of the requirements set forth in Standard ED-7. For example:

Standard ED-35 requires the medical school’s academic officers to be responsible for the conduct and quality of the educational programme and for assuring the adequacy of faculty at all educational sites.

Standard ED-36 states that the academic officer in charge of each geographically separate site must be administratively responsible to the Chief Academic Officer of the medical school.

Standard ED-37 requires the faculty in each discipline at all sites to be functionally integrated through appropriate administrative mechanisms. Medical schools should demonstrate the means by which faculty participate in student education consistent with the objectives and performance expectations established by course or clerkship leadership. Mechanisms to achieve appropriate functional integration may include regular meetings, electronic communication, periodic visits to all sites by course or clerkship leadership, and sharing of course or clerkship evaluation data and other types of feedback regarding faculty performance of their educational responsibilities.

Standard ED-38 requires that there be a single standard for promotion and graduation of students across all geographically separate sites.

Standard ED-39 requires the “parent” school to assume ultimate responsibility for the selection and assignment of all medical students in the case when geographically separated campuses are operated.

Standard ED-40 states that students assigned to all campuses should receive the same rights and support services.

Standard ED-41 states that students should have the opportunity to move among the component programmes of the school.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B. The CAAM-HP also asks a school to assess its practices in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.B.5 and III.D.13.
 
Analyst Remarks to Narrative
As is discussed in the country`s narrative, CAAM-HP has numerous standards that address requirements that require a school to offer comparable programs sites that are geographically apart from the main medical school campus. Students must be held to the same standards at all sites, and the programs, faculty, facilities, support services, etc. must be comparable. The branch locations must be administratively responsible to the chief administrator at the main campus. Course duration and evaluation instruments must be the same. Acceptance, promotion, and graduation requirements must be the same.

The country`s documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country`s narrative and supporting documentation, and no additional information is requested.
 
Program Length, Question 1
 
Country Narrative
Pursuant to Standard ED-4, the degree programme of medical education leading to the M.D. (or equivalent) degree must include at least 130 weeks of instruction, scheduled over a minimum of four calendar years.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part A, item (a), p. 1 and Part B.
 
Analyst Remarks to Narrative
As reported by the country in its narrative, the CAAM-HP standards specifically require that the program leading to the M.D. or equivalent degree must include 130 weeks of instruction that take place over at least four calendar years. Grenada is not a European Community country.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 1
 
Country Narrative
Standard ED-6 states that the “curriculum must incorporate the fundamental principles of medicine and its underlying scientific concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop students' ability to use principles and skills wisely in solving problems of health and disease.” The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As noted in the country's narrative, the CAAM-HP standards contain precisely the same language and requirements that are specified in the NCFMEA Guidelines.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 2
 
Country Narrative
Under Standard ED-6, the curriculum must incorporate the fundamental principles of medicine and its underlying scientific concepts; allow students to acquire skills of critical judgment based on evidence and experience; and develop students’ ability to use principles and skills wisely in solving problems of health and disease. The curriculum must include current concepts in the basic and clinical sciences, including therapy and technology, changes in the understanding of disease, and the effect of social needs and demands on care.

The curriculum must include behavioral and socio-economic subjects, in addition to the basic sciences and clinical disciplines. See Standard ED-9. Pursuant to this Standard, subjects widely recognized as important components of the general professional education of a physician should be included in the medical education curriculum. The depth of coverage of the individual topics will depend on the school’s educational goals and objectives.

Pursuant to Standard ED-10, the curriculum must include the contemporary content of those disciplines that have been traditionally titled among anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, community and preventative medicine, as well as ethics, law, and international codes of conduct.

Pursuant to Standard ED-11, instruction within the basic sciences should include laboratory or other practical exercises that entail accurate observations of biomedical phenomena.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the curriculum include basic sciences, the clinical disciplines, and behavioral and socio-economic subjects. The curriculum must include anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, community and preventative medicine, as well as ethics, law, and international codes of conduct.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 3
 
Country Narrative
Pursuant to Standard IS-12, students should have the opportunity to participate in research and other scholarly activities of the faculty.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part A, item (d). The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions I.B.3 through I.B.5.
 
Analyst Remarks to Narrative
As is described in the country's narrative, the CAAM-HP standards include the requirement that medical students have the opportunity to participate in research and other scholarly activities with the medical school faculty.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 4
 
Country Narrative
Pursuant to Standard IS-11, the programme of medical education should be conducted in an environment that fosters the intellectual challenge and spirit of inquiry appropriate to a community of scholars.

Pursuant to Standard ED-11, instruction within the basic sciences should include laboratory or other practical exercises that entail accurate observations of biomedical phenomena.

Pursuant to Standard ED-15, critical analyses of data must be a component of all segments of the curriculum.

Pursuant to Standard ED-21, the curriculum must include elective courses to supplement required courses. While electives permit students to gain exposure to and deepen their understanding of medical specialties reflecting their career interests, they should also provide opportunities for students to pursue individual academic interests.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section I: Institutional Setting, Exhibit 20, at Part B, and Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B. The CAAM-HP also asks a school to assess the structure of its educational programme in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.B.3 and III.B.4.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include requirements that the medical program be offered in an intellectually challenging environment, include labs and other practical experiences that will include accurate biomedical observations, require students to undertake critical analyses of data, and include electives that will allow students to deepen their understanding of medical specialties that reflect their career interests.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 5
 
Country Narrative
While the term “service-learning” is not used in the region the concept is being applied.

Students have the opportunity to study in practical ways the health care delivery system and social services of the country in which their medical school is located. Clerkship students are able to apply what they have learned about community-based care, rehabilitation of patients, and the role of the practicing physician in community health care and promotion. They also develop their ability to collect relevant information through observation and practical participation in health activities in the community and are encouraged to reflect upon their experiences. Please refer to Standard ED-13.

The service is addressed in ED-10 (Exhibit 15) as a basic science to be introduced in the early years of the curriculum; in ED-12 (Exhibit 15) exposure to family medicine takes the student into a primary care setting which in the Caribbean may be in community clinics in both rural and urban settings. In ED-13 (Exhibit 15) primary care is listed on a par with the traditional major disciplines of Medicine and Surgery.

CAAM-HP’s Advisory Committee will take into consideration the need to look into a standard specific to service-learning during the standards and procedures revision exercise.
 
Analyst Remarks to Narrative
The country reports in its narrative that the term "service learning" is not generally employed in the region the CAAM-HP serves. Nevertheless, the CAAM-HP standards include requirements that could be construed to be related to the concept, since students learn about health care and social service delivery systems in the Caribbean country in which the medical school is located, in both rural and urban settings. The agency reports that it is also considering revising the CAAM-HP standards to incorporate the term "service learning" in order to more closely mirror the requirements in the NCFMEA Guidelines. Additional information is requested about this change to the CAAM-HP standards.

The country is requested to provide additional information and documentation regarding the incorporation of the term "service learning" into the CAAM-HP standards, as required under this section.

 
Country Response
A standard requiring an institution that offers a medical education programme to make available sufficient opportunities for medical students to participate in community-based learning activities (Community Health/Primary Clerkships, sometimes referred to as service-learning) of direct relevance to the health needs of individuals in and of the community as a whole is to be included in the revised standards as per the attached Terms of reference to the Advisory Committee (Exhibit 14-A).
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation regarding the incorporation of the term "service learning" into the CAAM-HP standards, as required under this section.

In its response, the country notes that the CAAM-HP is in the process of revising its standards, and that those standards will address the requirements of this section.

The country is requested to provide additional information and documentation regarding the incorporation of the term "service learning" into the CAAM-HP standards, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Curriculum, Question 6
 
Country Narrative
Pursuant to Standard ED-10, the curriculum must include the contemporary content of those disciplines that have been traditionally titled among anatomy, biochemistry, genetics, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, community and preventative medicine, as well as ethics, law, and international codes of conduct.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include a requirement that the medical school curriculum include study in anatomy, biochemistry, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Curriculum, Question 7
 
Country Narrative
Introductory education within the basic sciences should include laboratory or other practical exercises that entail accurate observations of biomedical phenomena. See Standard ED-11. Critical analyses of data must be a component of all segments of the curriculum, pursuant to Standard ED-15.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the basic science component of the medical education program include lab or other practical exercises that include observations of biomedical phenomena and require that critical analyses of data be a component of all segments of the curriculum.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Clinical Experience, Question 1
 
Country Narrative
Pursuant to Standard ED-13, clinical experience in primary care, internal medicine, obstetrics and gynecology, child health/pediatrics, psychiatry, and surgery must be included as part of the curriculum. Student clinical experience must be based on out-patient, in-patient, and emergency settings.

Standard ED-2 requires that the objectives of a medical school for clinical education include quantified criteria for the types of patients, the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met. The Standard further requires that each course or clerkship that requires physical or simulated patient interactions should specify the number and kinds of patients that students must see in order to achieve the objectives of the learning experience. They should also specify the extent of student interaction with the patients and the venue(s) in which the interactions will occur, irrespective of the student’s religious beliefs and with full respect for the autonomy of the patient. A corollary requirement of the Standard is that courses and clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which patients participate so that adjustments in the criteria can be made if necessary without sacrificing educational quality.

The clinical sciences component must cover all organ systems and include the important aspects of preventative, emergency, acute, chronic, continuing, rehabilitative, family medicine and end-of-life care. See Standard ED-12.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the clinical component of the medical school program include experience in primary care, internal medicine, obstetrics and gynecology, child health/pediatrics, psychiatry, and surgery. Student clinical experience must be based on out-patient, in-patient, and emergency settings. The standards also require the clinical sciences component to cover all organ systems and include aspects of preventative, emergency, acute, chronic, continuing, rehabilitative, family medicine and end-of-life care.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Clinical Experience, Question 2
 
Country Narrative
The Standards state: “[Graduates] should be capable of serving patients in resource poor conditions as well as in the modern hospital or clinic setting. Graduates should be skilled in making clinical diagnoses and undertaking basic treatment of those conditions that do not require specialist skills, but must know how to access specialist skills and facilities when required. The graduate doctor must also be capable of absorbing postgraduate training and after a period of supervised practise to enter independent practise in CARICOM countries. Graduates must have the capacity and desire for life-long learning so they can practise in circumstances where knowledge, health conditions and cultures are different or change over time. Since the further professional education of graduate doctors, before they are accepted to practise independently, varies from country to country, CAAM-HP may make recommendations as to the licensing requirements for graduate doctors who wish to practise in CARICOM countries. This acknowledges that most of the doctors currently being trained in the CARICOM region are being trained to enter countries where the professional requirements for further training towards independent practise may not be the same as those within CARICOM countries. For example, the assessment examination (USMLE 1 and 2) used by the USA to determine whether a graduate from a school in a CARICOM country, or other foreign locations, is capable of entering residency programmes in the USA is not considered by the competent CARICOM body, the Caribbean Association of Medical Councils (CAMC), to be a sufficiently thorough process to assess a doctor who wishes to enter independent practise in CARICOM countries. The standards are therefore written to assure governments, students and the public that graduates of medical schools in CARICOM countries attain educational standards that allow them to adapt to practise anywhere in the world.” See Revised Standards, Introduction, Exhibit 14.

Standard ED-5 requires that “[t]he medical school must design and the faculty approve a curriculum that provides a general professional education, and fosters in students the ability to learn through self-directed, independent study throughout their professional lives.” Standards ED-2, ED-10, ED-12, ED-13, ED-14, and ED-16 also address matters related to this topic.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require medical schools to have a curriculum that provides a professional education and also fosters the student's ability to learn through independent study throughout their careers.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Clinical Experience, Question 3
 
Country Narrative
Standard ED-2 requires that the objectives of a medical school for clinical education include quantified criteria for the types of patients, the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met. The Standard further requires that each course or clerkship that requires physical or simulated patient interactions should specify the number and kinds of patients that students must see in order to achieve the objectives of the learning experience. They should also specify the extent of student interaction with the patients and the venue(s) in which the interactions will occur, irrespective of the student’s religious beliefs and with full respect for the autonomy of the patient. A corollary requirement of the Standard is that courses and clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which patients participate so that adjustments in the criteria can be made if necessary without sacrificing educational quality.

Standard ED-13 requires a medical education programme to give students clinical experience in primary care, internal medicine, obstetrics and gynecology, child health/pediatrics, psychiatry, and surgery.

Standard ED-14 requires that educational opportunities be available in multi-disciplinary content areas, such as emergency medicine and geriatrics.

Standard ER-6 requires that the medical school have, or be assured use of, appropriate resources for the instruction of its medical students. Clinical resources should be sufficient to ensure breadth and quality of both ambulatory and bedside teaching. Such resources include adequate numbers and types of patients (acuity, case mix, age, gender, etc.) as well as physician resources for the treatment of illness, the prevention of disease, and the promotion of health.

When national and regional examinations are given at the request of government authorities (in order to license graduates), Standard CE-5 requires that such “examinations should cover the diagnosis, prevention and treatment of conditions which occur in the region and may include the diagnosis of transmissible disorders that occur internationally.”

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B; Medical Education Database, Section V: Educational Resources, Exhibit 22; and Medical Education Database, Section VII: Continuing Professional Education, Exhibit 19, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include a number of requirements related to the medical school's clinical education component. The standards require clinical experience in primary care, internal medicine, obstetrics and gynecology, child health/pediatrics, psychiatry, and surgery, as well as in multi-disciplinary content areas such as emergency medicine and geriatrics. The clinical component should include experience in both ambulatory (outpatient) and bedside (inpatient) settings.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Supporting Disciplines
 
Country Narrative
Standard ED-14 requires that educational opportunities be available in multidisciplinary content areas, such as emergency medicine and geriatrics, and in the disciplines that support the practice of medicine, such as diagnostic imaging and clinical pathology.

The clinical curriculum of a medical school must include elective courses to supplement required courses. See Standard ED-21.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require educational opportunities in a variety of content areas, including diagnostic imaging and clinical pathology. The curriculum must also include electives to supplement the requirements covered in this area.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Ethics, Question 1
 
Country Narrative
Required curricular content includes instruction on ethics, law, and international codes of conduct. See Standard ED-10.

Standard ED-20 mandates that a medical school must teach medical ethics with respect for religion and other human values and their relationship to law and governance of medical practice. Under the Standard, students must be required to exhibit scrupulous ethical principles in caring for patients and, in relating to patients’ families and others involved in patient care, students must strive to encompass community concerns. Each school must ensure that students receive instruction in medical ethics, human values, and communication skills before engaging in patient care activities. As students take on increasingly more active roles in patient care during their progression through the curriculum, adherence to ethical principles must be observed, evaluated, and reinforced through formal instructional efforts. Scrupulous ethical principles imply the characteristics of honesty, integrity, maintenance of confidentiality, and respect for patients, patients’ families, other students, and other health professionals. Standard ED-20 also requires that in student-patient interactions there should be a system for identifying possible breaches of ethics in patient care through such means as faculty/resident observation of the encounter, patient reporting, or some other appropriate method.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require instruction in medical ethics, law, and international codes of conduct. The standards require that student patient interactions include a system for identifying ethical breaches in patient care through faculty/resident observations, patient reporting, or some other appropriate method.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Communication Skills, Question 1
 
Country Narrative
As set forth in Standard ED-16, a medical school must provide specific instruction in communication skills as they relate to physician responsibilities, including communication with patients, families, colleagues, other health professionals, team work, and resolution of conflict.

Standard ED-20 requires that each school ensure that students receive instruction in communication skills before engaging in patient care activities.

Standard ED-26 requires that a medical school demonstrate that it engages in ongoing assessment of students to ensure that they have acquired and can demonstrate on direct observation the core clinical skills, behaviors, and attitudes that have been specified in the school’s additional objectives, including assessment of students’ problem solving, clinical reasoning, and communication skills in relation to both individuals and communities.

As set forth in Standard ED-27, the directors of all courses and clerkships of a medical school seeking accreditation must have designed and implemented a system of formative and summative evaluation of student achievement in each course and clerkship. Adherence to this Standard ensures that students have sufficiently developed communication skills.

Standard ED-28 states that narrative descriptions of student performance including personal qualities and interactions should be included as part of evaluations in all required courses and clerkships where teacher-student interaction permits this form of assessment.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include requirements for instruction in communication skills related to physician responsibilities, including communication with patients, families, colleagues, other health professionals, team work, and resolution of conflict. The standards also require ongoing evaluation of students' communication skills throughout the course of the medical education program.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Design, Implementation, and Evaluation, Question 1
 
Country Narrative
Pursuant to Standard FA-14, a medical school should have mechanisms for direct faculty involvement in decisions related to the educational programme, including curriculum development and evaluation.

As set forth in Standard ED-29, within a medical school, there must be an integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum. The faculty must be responsible for the detailed design and implementation of the components of the curriculum. An institutional body (commonly, a curriculum committee) must oversee the educational programme as a whole. An effective central curriculum authority will exhibit: faculty, student, and administrative participation; expertise in curriculum design, pedagogy, and evaluation methods; and empowerment to work in the best interest of the institutional programmes without regard for parochial or departmental pressures.

Standard ED-32 requires that the academic faculty of a medical school must have sufficient resources and authority to fulfill the responsibilities for the management and evaluation of the curriculum. The Standard provides that the kind of resources needed by the Chief Academic Officer to ensure effective delivery of the educational programme include: adequate numbers of teachers who have the time and training necessary to achieve the programme’s objectives; appropriate and adequate teaching space for the methods of pedagogy employed; appropriate educational infrastructure (e.g., computers, audio-visual aids, laboratories, etc.); educational support services such as examination grading, classroom scheduling, and faculty training; and support services for the efforts of the curriculum management body and for any interdisciplinary teaching efforts that are not supported at a departmental level.

Pursuant to Standard ED-32, the Chief Academic Officer must have explicit authority to ensure the implementation and management of the educational programme and to facilitate change when modifications to the curriculum are deemed to be necessary.

Standard ED-33 requires that the faculty committee responsible for the curriculum must monitor the content provided in each discipline so that the school’s educational objectives will be achieved. The committee working in conjunction with the Chief Academic Officer of the school should assure that each academic period of the curriculum maintains common standards for content. Such standards should address the depth and breadth of knowledge required for a general professional education in medicine, currency and relevance of content, and the extent of redundancy needed to reinforce learning of complex topics. The final year should complement and supplement the curriculum so that each student will acquire appropriate competence in general medical care regardless of their subsequent career specialty.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B and Medical Education Database, Section IV: Faculty, Exhibit 17, at Part B. The CAAM-HP also asks a school to assess its curriculum management practices in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.D.11 and III.D.12.
 
Analyst Remarks to Narrative
As described in the country's narrative, there are several CAAM-HP standards related to curriculum development and ongoing evaluation of the medical education program. The standards require that the faculty be involved in the development of the curriculum, and that a curriculum committee oversee the educational program as a whole. The committee must include faculty, staff, and student representatives. The chief academic officer, working in conjunction with the committee, has the responsibility for implementing the educational program that is developed by the faculty and for facilitating changes to the program when evaluation shows that modifications are needed.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Design, Implementation, and Evaluation, Question 2
 
Country Narrative
As set forth in Standard ED-29, within a medical school, there must be an integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum.

Pursuant to Standard ED-30, a medical school’s curriculum must be designed to achieve the school’s overall educational objectives. The Standard specifies that to do so, a curriculum should include: logical sequencing of the various segments of the curriculum; content that is coordinated and integrated within and across the academic periods of study (horizontal and vertical integration); the development of specific course or clerkship objectives; and methods of pedagogy and student evaluation that are appropriate for the achievement of the school’s educational objectives.

Standard ED-31 sets forth that curriculum management should involve leading, directing, coordinating, controlling, planning, evaluating, and reporting and that evidence of effective curriculum management should include: evaluation of programme effectiveness by outcomes analysis; monitoring of contents and workload in each discipline, including the identification of omissions and unwanted redundancies; and review of the stated objectives of individual courses and clerkships as well as methods of pedagogy and student evaluation to assure congruence with institutional educational objectives and ongoing review and updating of content and assessment of course and teacher quality.

Pursuant to Standard ED-32, the Chief Academic Officer must have explicit authority to ensure the implementation and management of the educational programme and to facilitate change when modifications to the curriculum are deemed to be necessary.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B. The CAAM-HP also asks a school to evaluate the effectiveness of its educational programme in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.C.9 and III.C.10; III.E.14 and III.E.15.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require each medical school to have its own ongoing process of program evaluation. The curriculum must be driven by stated objectives and evaluated on a regular basis to ensure that the objectives are being met, including the sequencing of curriculum segments, coordination of content, and the review of the stated objectives, including updating of curriculum content as necessary. As noted previously, the chief academic officer, in coordination with the faculty and curriculum committee representatives, is responsible for implementing the educational program and making changes when necessary.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated in a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Design, Implementation, and Evaluation, Question 3
 
Country Narrative
As set forth in Standard ED-29, within a medical school, there must be an integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum.

Pursuant to Standard ED-30, a medical school’s curriculum must be designed to achieve the school’s overall educational objectives. The Standard specifies that to do so, a curriculum should include: logical sequencing of the various segments of the curriculum; content that is coordinated and integrated within and across the academic periods of study (horizontal and vertical integration); the development of specific course or clerkship objectives; and methods of pedagogy and student evaluation that are appropriate for the achievement of the school’s educational objectives.

Standard ED-31 sets forth that curriculum management should involve leading, directing, coordinating, controlling, planning, evaluating, and reporting and that evidence of effective curriculum management should include: evaluation of programme effectiveness by outcomes analysis; monitoring of contents and workload in each discipline, including the identification of omissions and unwanted redundancies; review of the stated objectives of individual courses and clerkships as well as methods of pedagogy and student evaluation to assure congruence with institutional educational objectives and ongoing review and updating of content and assessment of course and teacher quality.

Pursuant to Standard ED-32, the Chief Academic Officer must have explicit authority to ensure the implementation and management of the educational programme and to facilitate change when modifications to the curriculum are deemed to be necessary.

Standard ED-31 states that evidence of effective curriculum management includes “[e]valuation of programme effectiveness by outcomes analysis.” See also Standards ED-42 and ED-43.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B. The CAAM-HP also asks a school to evaluate the effectiveness of its educational programme in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions III.C.9 and III.C.10; III.E.14 and III.E.15.
 
Analyst Remarks to Narrative
The country's narrative describes the CAAM-HP standards related to the curriculum development process. However, the standard discussed do not contain any specific requirements related to the evaluation of program quality, such as data on student performance, academic progress and graduation, acceptance into residency programs, and postgraduate performance; the licensure of graduates, particularly in relation to any national norms; and any other measures that are appropriate and valid in light of the school’s mission and objectives, as required under this section. Additional information is requested for this section.

The country is requested to provide additional information and documentation to demonstrate that the CAAM-HP standards address the evaluation of the medical school's curriculum, including how its accredited medical schools must use data to address internal program effectiveness and continuous improvement.

 
Country Response
ED-24 states that “A medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviours and attitudes.
Evaluation of student performance should measure not only retention of factual knowledge, but also development of the skills, behaviours and attitudes needed in subsequent medical training and practice. The use of data for solving problems commonly encountered in medical practice should be evaluated.”

ED-42 reads as follows: To guide programme improvement, medical schools must evaluate the effectiveness of the educational programme by documenting the extent to which its objectives have been met.

In assessing programme quality, schools must consider student evaluations of their courses and teachers, and an appropriate variety of outcome measures.

Among the kinds of outcome measures that serve this purpose are data on student performance, academic progress and programme completion rates, acceptance into residency / postgraduate programmes, postgraduate performance, and practice characteristics of graduates.

CAAM-HP asks a school to address these in its Medical Education Database Section III, ED-42 as follows:

a. Check all indicators used by the medical school to evaluate educational programme effectiveness.

-Student scores on internally developed examinations
-Performance-based assessment of clinical skills (e.g., OSCEs)
-Results of CAMC, USMLE, PLAB or other national examinations
-Student evaluation of courses and clerkships
-Student advancement and graduation rates
-Specialty choice of graduates
-Assessment of residency performance of graduates
-Licensure rates of graduates
-Specialty certification rates
-Practice location of graduates
-Practice type of graduates
-Other (specify)

b. For each checked item, indicate

1. How the data are collected (including response rates for questionnaires)

2. What groups or individuals review the data (e.g., curriculum committee, department chairs)

3. How the information is used for curriculum review and change


c. Provide evidence that the educational programme objectives in the domains of knowledge, skills, behaviours, and attitudes are being achieved.

In addition, ED-43 states that: Medical schools must evaluate the performance of their students and graduates in the framework of national and international norms of accomplishment and performance within the health care system.

CAAM-HP asks the schools to address these topics in the Medical Education Database Section III, Part B.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation to demonstrate that the CAAM-HP standards address the evaluation of the medical school's curriculum, including how its accredited medical schools must use data to address internal program effectiveness and continuous improvement.

In its response, the country notes that CAAM-HP Standards ED-24 and ED-42 require schools to provide data to show that educational objectives have been met. This may be demonstrated through the use of a variety of types of data, including a number of types of outcomes data, including results of national examinations, retention and graduation rates, licensure and certification rates, and placement data such as the type of practice a graduate enters. This is evaluated as a part of the agency's on-site review process.

ED staff accepts the agency's narrative and previously submitted documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Admissions, Recruiting, and Publications, Question 1
 
Country Narrative
Standard MS-5 mandates that medical schools must select students who possess the intelligence, integrity, and personal and emotional characteristics necessary for them to become effective physicians in the social as well as the scientific sense. Standard MS-6 provides that the selection of individual students should not be influenced by political or personal financial reasons. Standard MS-7 provides that medical schools should have policies and practices ensuring the gender, cultural, racial, cultural, and economic diversity of their students.

The CAAM-HP requests data from schools about the mean scores for all examinations taken by students in the entering the first year class. St George’s University School of Medicine requires all North American applicants to submit MCAT scores. See admission requirements at http://www.sgu.edu/school-of-medicine/sgu-medical-sciences-admissions.html.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part A, items (a), (b), (e), and (f) and Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards mirror the language and requirements contained within the NCFMEA Guidelines for this section. The country reports that the CAAM-HP collects data from schools about the mean scores for all examinations taken by students in the entering first year class and that the SGUSM requires all North American applicants to submit MCAT scores to the CAAM-HP.

The country's documentation of the implementation of the CAAM-HP standards is demonstrated by a copy of a CAAM-HP Medical Education Database (Ex. 24).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Admissions, Recruiting, and Publications, Question 2
 
Country Narrative
As set forth in Standard MS-1, a medical school should require as conditions for admission an undergraduate degree or an adequate level of preparation in the sciences. Students granted admission into a medical school should have a general education that includes the social sciences, history, arts, and languages in order for development of physician competencies outside of the scientific knowledge domain.

Neither the CAAM-HP nor the government of Grenada mandates admissions standards. The CAAM-HP requires the faculty of a medical education programme to make decisions regarding admission, promotion, and graduation of its medical students. See Standard FA-7.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require the medical school to set admissions standards. A student should have an undergraduate degree or an adequate level of preparation in the sciences and a general education that includes the social sciences, history, arts, and languages. The agency requires the faculty of a medical school to make decisions regarding admission, promotion, and graduation of its medical students.

As documentation of the implementation of the CAAM-HP standards, the country provided a 2011 copy of a SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Admissions, Recruiting, and Publications, Question 3
 
Country Narrative
Standard MS-2 requires that the faculty of each school must develop criteria and procedures for the selection of students that are readily available to potential applicants and to their collegiate advisors.

Pursuant to Standard MS-3, the final responsibility for selecting students to be admitted for medical study should reside with a duly constituted faculty committee. Persons or groups external to the medical school may assist in the evaluation of applicants but should not have decision-making authority. The catalogue or informational materials must enumerate the school’s criteria for selecting students and describe the admissions process.

Pursuant to Standard MS-8, a medical school must develop and publish technical standards for the admission of handicapped applicants.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B. The CAAM-HP also asks a school to assess its admissions practices in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Question II.A.1.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require the medical school faculty to develop selection criteria. The criteria must be available to applicants and include published standards for the admission of handicapped applicants. A faculty admissions committee should have the final responsibility for selecting students to be admitted. External groups may not have decision-making authority regarding admissions. The school's catalog or other published materials must list the selection criteria and describe the admissions process.

As documentation of the implementation of the CAAM-HP standards, the country provided a 2011 copy of a SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Admissions, Recruiting, and Publications, Question 4
 
Country Narrative
As set forth in Standard MS-4, each medical school should have a pool of applicants sufficiently large and possessing the published qualifications to fill its entering class. The size of the entering class and of the medical student body as a whole should be determined not only by the number of qualified applicants but by the adequacy of critical resources, namely: finances; size of the faculty and the variety of academic fields they represent; library and informational systems resources; number and size of classrooms, student laboratories, and clinical training sites; patient numbers and varieties; student services; instructional equipment; and space for the faculty.

The same Standard requires that class size considerations should also include: any need to share resources to education graduate students or other students within the university; the size and variety of programmes of graduate medical education; and responsibilities for continuing education, patient care, research, the size of the community, and the sensibility of the individual patient.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B. The CAAM-HP also asks a school to assess its admissions practices in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions II.A.1 and II.A.2, p. 9.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the school have a qualified pool of applicants that is large enough to fill its entering glass. The size of the entering class and the medical school student body as a whole should also be determined by the adequacy of critical resources such as finances, the size of the faculty and variety of academic fields they represent, library and informational systems resources, the number and size of classrooms, student laboratories, and clinical training sites, number of available patients, student services, instructional equipment, and space for faculty.

As documentation of the implementation of the CAAM-HP standards, the country provided a 2011 copy of a SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Admissions, Recruiting, and Publications, Question 5
 
Country Narrative
As set forth in Standard MS-9, a medical school’s catalogue or equivalent informational material must describe the requirements for the M.D. (or equivalent) degree to be awarded by the school and all associated joint degree programmes. It must provide the most recent academic calendar for each curricular option and describe all required courses and clerkships offered by the school. The Standard requires that a medical school’s publications, advertising, and student recruitment material should present a balanced and accurate representation of the mission and objectives of the programme.

As per Standard MS-3, the school’s catalogue or informational materials must enumerate the school’s criteria for selecting students and describe the admissions process.

Standard MS-27 requires a medical school to publicize to all faculty and students its standards and procedures for the evaluation, advancement, and graduation of its students.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.

The CAAM-HP has never considered it necessary to require medical schools to publish the language of instruction of all countries except Suriname over which CAAM-HP has jurisdiction are former British Colonies and English is their official language and there is no other language of instruction.

SGUSOM requires applicants whose principal language is not English to have achieved a minimum score on the Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS).

All publications, for example, the School of Medicine Catalog 2014-2015 is provided by the school on its website at http://www.sgu.edu/school-of-medicine/sgu-medical-sciences-program.html. Information with respect to the estimated cost of attendance is available at https://mycampus.sgu.edu/web/financial-aid/student-budgets?p_p_id=49&p_p_lifecycle=1&p_p_state=normal&p_p_mode=view&_49_struts_2Fmy_places%2Fview&_49_groupId=248516&_49_privateLayout=false.
 
Analyst Remarks to Narrative
As described by the country in its narrative, the CAAM-HP standards address many of the requirements of this section, including the publication of information about the medical school's educational program, admissions requirements, advancement in the program, and evaluation, advancement, and graduation requirements. The country reports that the CAAM-HP has no requirements related to language of instruction since English is the official language of instruction in the countries whose schools it accredits.

Although the CAAM-HP standards cover most of the requirements of this section, they do not appear to address any requirements related to the publication of annual costs for attendance, including tuition, fees, and required health insurance, or the publication of requirements related student conduct and procedures for disciplinary action. Additional information and documentation showing that the standards address those areas is therefore requested.

 
Country Response
CAAM-HP has not found it necessary to require a medical school’s catalogue or equivalent informational materials to include tuition and fees as all schools do provide this information on their websites and in catalogues.

The following standards address the requirements for health insurance, student conduct and procedures for disciplinary action:

MS-22 Health services and disability insurance must be available to all students, with options to include dependents.

Students must have access to preventive and therapeutic health services.

MS-26 Each medical school / university must define and publicise the standards of conduct for the teacher-learner relationship, and develop written policies for preventing and addressing violations of those standards.

Mechanisms for reporting violations of these standards, such as incidents of harassment or abuse, should assure that complaints can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, preventing inappropriate behaviour, and the corrective measures to be employed where such behaviour occurs.

MS-27 The medical school must publicise to all faculty and students its standards and procedures for the evaluation, advancement, and graduation of its students and for disciplinary action.

MS-28 There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, dismissal or other disciplinary action.

CAAM-HP asks the schools to address these topics in the Medical Education Database Section II, Part B.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation to show that the CAAM-HP standards address requirements related to the publication of annual costs for attendance, including tuition, fees, and required health insurance, or the publication of requirements related student conduct and procedures for disciplinary action. Additional information and documentation showing that the standards address those areas is therefore requested.

In its response to the draft, the country states that CAAM-HP has not found it necessary to have a requirement related to the publication of annual costs for attendance, since schools publish this information of their own volition. Nevertheless, the agency should have a standard in place to ensure that its accredited institutions do indeed publish this information, rather than relying upon the schools to do this voluntarily.

The country notes that CAAM-HP standard MS-22 includes a requirement that health services and insurance be available to all students. Standards MS-26 and MS-28 address conduct and the requirement that there be procedures in place related to adverse actions taken against students. Compliance with these standards is evaluated during the course of the on-site review process.

Staff accepts the agency's narrative and previously submitted documentation regarding health insurance and procedures related to adverse actions taken against students. However, the country is still requested to ensure that the CAAM-HP standards include a requirement that institutions publish information related to annual costs of attendance, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Admissions, Recruiting, and Publications, Question 6
 
Country Narrative
Standard MS-30 requires that students must be allowed to review and challenge their academic records. Standard MS-29 requires that student records must otherwise be confidential and available only to members of the faculty and administration with the need to know, unless released by the student or as otherwise governed by laws concerning confidentiality in the jurisdiction in which the medical school operates. The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that students be allowed to view and challenge their academic records and that the records be confidential unless released by the student.

As documentation in support of its narrative, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Student Achievement, Question 1
 
Country Narrative
Pursuant to ED-24, the medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes.

Pursuant to ED-27, the directors of all courses/clerkships must design/implement a system of formative and summative evaluation of student achievement in each course/clerkship.

Pursuant to MS-27, the medical school must publicize to all faculty and students its standard procedures for the evaluation, advancement, and graduation of its students and for disciplinary action.

Pursuant to ED-38, there must be a single standard for promotion and graduation of students across geographically separate campuses.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B; and Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described by the country in its narrative, the CAAM-HP standards require that the medical school faculty establish a system for the evaluation of student achievement, and the directors of all courses/clerkships must design/implement an evaluation system for student achievement in each course/clerkship.

Although the standards meet most of the requirements of this section, they only specify that the medical school publicize to all faculty and students its standard procedures for the evaluation, advancement, and graduation of its students. This would appear to imply that the faculty itself does not develop the procedures for student evaluation, advancement, and graduation, but rather is instead notified of what they will be.

Additional information and documentation are requested to show that the CAAM-HP standards require that the medical school faculty is charged with developing the procedures for student evaluation, advancement, and graduation, as required under this section.

 
Country Response
ED-24 indicates that, The medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviours, and attitudes.

Evaluation of student performance should measure not only retention of factual knowledge, but also development of the skills, behaviours, and attitudes needed in subsequent medical training and practice.

The ability to use data for solving problems commonly encountered in medical practice should be evaluated.

The sole use of frequent tests which condition students to memorize details for short-term retention only, is not considered a good system of evaluation to foster self- initiated learning.

CAAM-HP asks the schools to address this topic in the Medical Education Database Section II, Part B.
 
Analyst Remarks to Response
In the draft staff analysis, additional information and documentation were requested to show that the CAAM-HP standards require that the medical school faculty is charged with developing the procedures for student evaluation, advancement, and graduation, as required under this section.

In its response, the country notes that the requirements of CAAM-HP Standard ED-24 specifies that medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes. This requirement is evaluated during the course of the agency's on-site review process.

Staff accepts the agency's response and previously submitted documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Student Achievement, Question 2
 
Country Narrative
The Government of Grenada relies on the CAAM-HP to evaluate student achievement in the context of accreditation, continuing accreditation, and licensure processes, all in accord with published standards. Those are the national requirements with respect to evaluation of student achievement. Medical schools are free to establish their own methods of evaluating student achievement, so long as such methods satisfy relevant Standards, including those identified here.

Pursuant to Standard ED-1, educational objectives (i.e., statements of the items of knowledge, skill, behaviors, and aptitudes that students are expected to exhibit as evidence of their achievement) must be documented by specific and measurable outcomes—that is, measures of basic science grounding in the clinical years, examination results, performance of graduates in residency training, performance in licensure examinations, etc.

Standard ED-24 charges the medical school faculty with the responsibility to establish a system for the evaluation of student achievement that employs a variety of measures of knowledge, skills, behaviors, and attitudes. Under the Standard, evaluation of student performance should measure not only retention of factual knowledge but also development of skills, behaviors, and attitudes needed in subsequent medical training and practice. The ability to use data for solving problems commonly encountered in medical practice is to be evaluated. The Standard makes clear that the sole use of frequent tests which condition students to memorize details for short-term retention only is not considered an acceptable system of evaluation to foster self-initiated learning.

As per Standard ED-25, a school’s Chief Academic Officer, curriculum leaders, and faculty should understand or have access to individuals who are knowledgeable about methods for measuring student performance. Under this Standard, a medical school should provide opportunities for faculty members to develop their skills in such methods.

Likewise, pursuant to Standard ED-26, there must be ongoing assessment that assures that students have acquired and can demonstrate on direct observation the core clinical skills, behaviors, and attitudes that have been specified in the school’s educational objectives. There must be evaluation of problem solving, clinical reasoning, and communication skills in relation to both individuals and communities.

Under Standard ED-27, it is specified that directors of all courses and clerkships should design and implement a system of formative and summative evaluations of student achievement in each course or clerkship. Those directly responsible for the evaluation of student performance should understand the uses and limitations of various test formats, criterion-referenced versus norm-referenced grading, reliability and validity of issues, formative versus summative assessment, and objective versus subjective formats. Each student should be evaluated early enough during a unit of study to allow time for remedial work, if necessary. Courses or clerkships that are short in duration may not have sufficient time to provide structured activities for formative evaluation. In such cases, some alternative means, such as self-testing or teacher consultation, that will allow students to measure their progress in learning should be provided.

Standard ED-28 provides that narrative descriptions of student performance including personal qualities and interactions should be included as part of the evaluation in all required courses and clerkships where teacher/student interaction permits this form of assessment.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, Grenada has not set any governmental requirements for the evaluation of student achievement and instead relies upon the CAAM-HP requirements in this area. Medical schools are therefore free to establish their own requirements, as long as they do not conflict with the CAAM-HP standards. The CAAM-HP standards require that medical schools establish educational objectives and that achievement of the objectives must be demonstrated via measurable outcomes. Evaluations employ a variety of methods and apply to both courses and to clerkships.

The country gave evidence of the implementation of the CAAM-HP standards by providing a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Student Achievement, Question 3
 
Country Narrative
Pursuant to Standard ED-24, the medical school faculty must establish a system for the evaluation of student achievement throughout medical school that employs a variety of measures of knowledge, skills, behaviors, and attitudes. The CAAM-HP Standard states that the “sole use of frequent tests which condition students to memorize details for short-term retention only, is not considered a good system of evaluation to foster self- initiated learning.” See Standard ED-24.

Pursuant to Standard ED-26, there must be ongoing assessment that assures students have acquired and can demonstrate on direct observation the core clinical skills, behaviors, and attitudes that have been specified in the school's educational objectives; there must be evaluation of problem solving, clinical reasoning, and communication skills, in relation to both individuals and communities. See Standard ED-27.

Pursuant to Standard ED-37, each student should be evaluated early enough during a unit of study to allow time for remedial work. Courses or clerkships that are short in duration may not have sufficient time to provide structured activities for formative evaluation, but should provide some alternate means (such as self-testing or teacher consultation) that will allow students to measure their progress in learning.

Pursuant to Standard ED-38, there must be a single standard for promotion and graduation of students across geographically separate campuses.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the medical school develop a system of student achievement throughout the medical school program, that there be ongoing student assessment, that students receive evaluation and feedback early enough in their studies to allow for any necessary remediation, and that there be a single, consistent standard for promotion and graduation across all of a school's campuses.

The country demonstrated compliance with the requirements of the CAAM-HP standards by providing a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Student Achievement, Question 4
 
Country Narrative
The CAAM-HP extensively monitors and appraises performance outcomes, although it has not set metric standards in that regard. Under the Standards, medical schools are free to establish their own methods of evaluating student achievement. Since Grenada has determined to adopt the Standards and Procedures of the CAAM-HP with respect to the accreditation of medical schools, Grenada does not set specific national requirements by which medical schools are to evaluate student achievement, nor has it established students’ performance outcomes measures, benchmarks, or requirements for schools to determine whether to grant accreditation or approval to that school.

CAAM-HP considers examination-results data as part of its assessment of whether a medical programme has evidence that its objectives are being met. Outcomes data of in-course examinations, both promotional and non-promotional and degree granting examinations must be documented in the Institutional Database and in the Annual Medical Schools Questionnaire of accredited institutions. See SGU’s Medical Education Database Section III- Educational Programme and its Annual Medical School Questionnaire, 2014-2015, Exhibits 26 and 27.

The data on degree granting examinations will, where appropriate, be checked against international norms of accomplishment including USMLE Steps I and II and Caribbean Association of Medical Councils (CAMC) examinations. Such examination results and their patterns will be taken into account by CAAM-HP in coming to its accreditation decisions. Failure to progress in the course, to graduate, or to achieve international assessments at rates of 50% or less will be considered poor outcomes that can affect accreditation decisions and status.
 
Analyst Remarks to Narrative
As described in the country's narrative, neither Grenada nor the CAAM-HP has set metrics related to performance outcomes, and medical schools are free to establish their own methods of evaluating student achievement. The country states that CAAM-HP considers course exam results, promotional exam results, and degree-granting exam results in evaluating a school, and that information must be reported by the school to CAAM-HP annually. The country adds that data on degree-granting exams is checked by CAAM-HP against international norms for USMLE Steps I and II, and failure to achieve rates above 50% compared to the international assessments will be considered a poor outcome that can affect accreditation status.

As documentation, the country provided copies of the CAAM-HP database and annual report forms that require reporting related to outcomes.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.


 
Student Achievement, Question 5
 
Country Narrative
Pursuant to Standard ED-42, medical schools must evaluate the effectiveness of the educational programme by documenting the extent to which its objectives have been met. In assessing programme quality, schools must consider student evaluations of their courses and teachers, and an appropriate variety of outcome measures.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require medical schools to evaluate the effectiveness of the program by documenting the extent to which the school's educational objectives have been met. In conducting this evaluation, the school must consider student evaluations and an appropriate variety of outcomes measures. As was established in a previous section, CAAM-HP evaluates a medical school's entire program of study, including both the basic science portion and the clinical portion. As such, the CAAM-HP requirements cover both courses and clerkships, as required under this section.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report.

Staff accepts the country's narrative and documentation, and no additional information is requested.
 
Student Services, Question 1
 
Country Narrative
Standard MS-16 states: “There must be a system to assist students in career choice and application to internship, residency and postgraduate programmes, and to guide students in choosing elective courses.”

Standard MS-19 requires medical schools to provide students with effective financial aid and debt management counseling, which includes alerting students to the impact of their total indebtedness.

The CAAM-HP Standards address health-related policies in Standards MS-20 to MS-24.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.
 
Analyst Remarks to Narrative
As the country describes in its narrative, the CAAM-HP standards address all of the requirements of this section, including the health-related policies in Standards MS 20-24, which were not discussed in the narrative. The standards address student financial aid and debt counseling, medical program and career counseling, and the requirements related to mental and physical health services.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Student Services, Question 2
 
Country Narrative
Standard MS-30 requires that students must be allowed to review and challenge their academic records. Standard MS-29 requires that student records must otherwise be confidential and available only to members of the faculty and administration with the need to know, unless released by the student or as otherwise governed by laws concerning confidentiality in the jurisdiction in which the medical school operates. The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include the requirement that students have access to their records, have the right to challenge their records, and that the records will be available for review by the faculty and administration, but will otherwise be maintained confidentially unless released by the student.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Student Complaints, Question 1
 
Country Narrative
As per the Procedures, Exhibit 12, p. 21 and Appendix H, the CAAM-HP will accept and investigate complaints about programme quality that, if substantiated, may constitute non-compliance with accreditation standards. Pursuant to the CAAM-HP Procedures: “Any person concerned about the quality of an undergraduate education programme accredited by the CAAM-HP may contact the CAAM-HP Secretariat to discuss lodging or lodge a complaint. Only those complaints will be investigated that, if substantiated, may constitute non-compliance with accreditation standards. The CAAM-HP will not intervene on behalf of an individual personal complaint regarding, for example, matters of admission, appointment, promotion, or dismissal of faculty or students unless the matter is deemed to represent a breach of accreditation standards.” See Procedures, Exhibit 12, Appendix H.

Pursuant to the Procedures, the “CAAM-HP Secretariat will make an initial determination of whether the complaint contains issues relating to the programme’s compliance with accreditation standards. If the CAAM-HP Secretariat determines that the complaint does raise such issues, the secretariat will contact the dean, including the letter of complaint and corroborating information, and citing the information that the dean should provide in response. A response from the dean will ordinarily be requested within four (4) weeks. The initial letter of complaint, including the corroborating materials, and the response from the dean will be reviewed by an ad hoc subcommittee on Complaints that is appointed by the secretariat in consultation with the Chair.” See Procedures, Exhibit 12, Appendix H. If the subcommittee determines that some areas of non-compliance with Standards exist, it will present its findings and recommendations to the CAAM-HP at the CAAM-HP’s next regularly scheduled meeting. See Procedures, Exhibit 12, Appendix H.

Standard MS-26 requires each medical school to define and publicize the standards for conduct for teacher-learner relationships and develop written policies for preventing and addressing violations of those standards. Mechanisms for reporting violations of those standards, such as incidents of harassment or abuse, should assure that complaints can be registered and investigated without fear of retaliation. The policies also should specify mechanisms for the prompt handling of such complaints, preventing inappropriate behavior, and corrective measures to be employed where such behavior occurs.

Standard MS-28 requires that a medical school must have a fair and formal process for taking any action that adversely affects the status of a student. The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, and opportunity for the student to respond and to appeal any adverse decision related to promotion, graduation, dismissal, or other disciplinary action.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B. The CAAM-HP also asks a school to assess its practices in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions II.C.9 and II.C.10.

Grenada does not have a written procedure for addressing student complaints that is separate from the procedures set forth by each school and the CAAM-HP.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP procedures provide for a process by which students may submit complaints about a medical school directly to CAAM-HP. At the campus level, the CAAM-HP standards require that the school have standards for student and teacher conduct, as well as an academic review process for the consideration of any actions taken that adversely impact the status of the student.

The country notes that the CAAM-HP does not require the school to have an internal complaint procedure for reviewing and addressing student complaints at the school level. Instead, the students must take their complaints directly to CAAM-HP. This is not acceptable. CAAM-HP should require schools to have a complaint policy to address student complaints in-house as a prerequisite to having the students elevate their complaints to the agency level. This policy should include timelines for submitting, reviewing, and responding to student complaints. Furthermore, a record of student complaints should be maintained on campus for review during CAAM-HP on-site visits. Any pattern of complaints that raises concerns related to a particular area should then be factored into the school's accreditation decision.

The country is requested to provide information and documentation to show that the CAAM-HP standards require schools to have a process for addressing student complaints at the school level.
 
Country Response
CAAM-HP does require a medical school to have a process for addressing student complaints at the school level as per standards MS-26 and MS-28 which read as follows:

MS-26 Each medical school / university must define and publicise the standards of conduct for the teacher-learner relationship, and develop written policies for preventing and addressing violations of those standards.

Mechanisms for reporting violations of these standards, such as incidents of harassment or abuse, should assure that complaints can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, preventing inappropriate behaviour, and the corrective measures to be employed where such behaviour occurs.

MS-28 There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, dismissal or other disciplinary action.

CAAM-HP asks the schools to address these topics in the Medical Education Database Section II, Part B.

If students feel that their complaint has not been satisfactorily addressed by the school then CAAM-HP will accept and investigate complaints about programme quality that, if substantiated, may constitute non compliance with accreditation standards as per the Procedures, Exhibit 12, page 21 and Appendix H.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide information and documentation to show that the CAAM-HP standards require schools to have a process for addressing student complaints at the school level.

In its response, the country notes that these requirements are addressed under CAAM-HP Standards MS-26 and MS-28, which specify that institutions must develop a code of conduct, develop written policies for addressing violations of conduct, and have a formal process for addressing adverse actions against students. Compliance with these requirements is evaluated during the course of the agency's on-site review process.

ED staff accepts the country's response and previously submitted supporting documentation and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Student Complaints, Question 2
 
Country Narrative
As per the Procedures, Exhibit 12, p. 21 and Appendix H, the CAAM-HP will accept and investigate complaints about programme quality that, if substantiated, may constitute non-compliance with accreditation standards. Pursuant to the CAAM-HP Procedures: “Any person concerned about the quality of an undergraduate education programme accredited by the CAAM-HP may contact the CAAM-HP Secretariat to discuss lodging or lodge a complaint. Only those complaints will be investigated that, if substantiated, may constitute non-compliance with accreditation standards. The CAAM-HP will not intervene on behalf of an individual personal complaint regarding, for example, matters of admission, appointment, promotion, or dismissal of faculty or students unless the matter is deemed to represent a breach of accreditation standards.” See Procedures, Exhibit 12, Appendix H.

Pursuant to the Procedures, the “CAAM-HP Secretariat will make an initial determination of whether the complaint contains issues relating to the programme’s compliance with accreditation standards. If the CAAM-HP Secretariat determines that the complaint does raise such issues, the secretariat will contact the dean, including the letter of complaint and corroborating information, and citing the information that the dean should provide in response. A response from the dean will ordinarily be requested within four (4) weeks. The initial letter of complaint, including the corroborating materials, and the response from the dean will be reviewed by an ad hoc subcommittee on Complaints that is appointed by the secretariat in consultation with the Chair.” See Procedures, Exhibit 12, Appendix H. If the subcommittee determines that some areas of non-compliance with Standards exist, it will present its findings and recommendations to the CAAM-HP at the CAAM-HP’s next regularly scheduled meeting. See Procedures, Exhibit 12, Appendix H.

To date, the CAAM-HP has received no formal complaints from any SGUSOM student.

Grenada does not have a written procedure for addressing student complaints that is separate from the procedures set forth by each school and the CAAM-HP.
 
Analyst Remarks to Narrative
As was noted in the previous section, the CAAM-HP does not have a policy or standard that requires that schools develop in-house complaint procedures. Instead, students must take their complaints directly to the agency.

The country is requested to provide information and documentation to demonstrate that the CAAM-HP requires schools to develop complaint procedures for addressing student complaints at the school level.
 
Country Response
CAAM-HP does require a medical school to have a process for addressing student complaints at the school level as per standards MS-26 and MS-28 which read as follows:

MS-26 Each medical school / university must define and publicise the standards of conduct for the teacher-learner relationship, and develop written policies for preventing and addressing violations of those standards.

Mechanisms for reporting violations of these standards, such as incidents of harassment or abuse, should assure that complaints can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, preventing inappropriate behaviour, and the corrective measures to be employed where such behaviour occurs.

MS-28 There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, dismissal or other disciplinary action.

CAAM-HP asks the schools to address these topics in the Medical Education Database Section II, Part B.

If students feel that their complaint has not been satisfactorily addressed by the school then CAAM-HP will accept and investigate complaints about programme quality that, if substantiated, may constitute non compliance with accreditation standards as per the Procedures, Exhibit 12, page 21 and Appendix H.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide information and documentation to demonstrate that the CAAM-HP requires schools to develop complaint procedures for addressing student complaints at the school level.

As the country noted in the previous section, these requirements are addressed in CAAM-HP Standards MS-26 and MS-28, which require the development of a code of conduct, as well as procedures for addressing violations of the code and a process for addressing any adverse actions against students. These requirements are evaluated during the course of the on-site evaluation process.

ED staff accepts the country's narrative and previously submitted supporting documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Finances, Question 1
 
Country Narrative
As set forth in Standard ER-2, the current and anticipated financial resources of the medical school must be adequate to sustain a sound programme of medical education and to accomplish other institutional goals. The costs of conducting an accredited programme leading to an MB BS (or equivalent) degree should be supported from diverse sources, including tuition, endowments, support from the parent university, covenants, grants from organizations and individuals, and appropriations by government. Evidence for compliance with this Standard will include documentation of adequate financial reserves to maintain the educational programme in the event of unexpected revenue losses and demonstration of the effective fiscal management of the medical school budget. This information may be submitted to the CAAM-HP under confidential cover. SGUSOM provided this information prior to the site visit. Reference is made to Exhibit 28, SGU Financial Information, 2013 and 2014.

Pursuant to Standard ER-3, pressure for institutional self-financing must not compromise the educational mission of the medical school nor cause it to enroll more students than its resources can accommodate. Reliance on student tuition should not be so great that the quality of the programme is compromised by the need to enroll or retain inappropriate numbers of students or students who qualifications are substandard.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions V.A.1 through V.A.4.

Pursuant to Standard MS-4, the size of the entering class and of the medical student body as a whole should be determined not only by the number of qualified applicants but also by the adequacy of critical resources (e.g., finances, size of the faculty, library and information systems resources, number and size of classrooms, patient numbers and variety, student services, instructional equipment, etc.). After conducting a site visit of a new school, the CAAM-HP will determine if the school must reduce the number of students that they plan to enroll owing to any deficiencies in their resources. If needed, the CAAM-HP may impose an enrollment cap on a school that is currently operating in order to ensure there are sufficient resources for its operation. The CAAM-HP can evaluate the adequacy of critical resources through unannounced visits as well.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section II: Medical Students, Exhibit 24, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require a school to have adequate financial resources to support the educational program. Financial pressures should not cause a school to enroll more students than it can accommodate or to enroll students with substandard qualifications. The size of the student body should be determined not only by the students' qualifications, but also on the school's adequacy of critical resources. The CAAM-HP reviews the size of the student body relative to the school's resources and may cap the size of the student body if it feels that the school does not have the necessary resources to support the program.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33). It also provided a copy of the SGUSM's consolidated financial statements (Ex. 28). The statements show that the primary source of income for the school comes from tuition. It appears that the school had sufficient income to provide funding for members' (presumably stockholders or owners) equity, with cash remaining on hand.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Facilities, Question 1
 
Country Narrative
As per Standard ER-4, a medical school must have, or be assured use of, buildings and equipment appropriate to achieve its educational and other goals. These include: offices for faculty, administrators, and support staff; teaching laboratories and other space appropriate for conduct of research and space for humane care of animals when animals are used in teaching or research; student classrooms and laboratories; lecture halls sufficiently large to accommodate a full year’s class and any other students taking the same courses; space for student use, including student study space; and space for library and information access.

As per Standard ER-6, a medical school must have, or be assured use of, appropriate resources for the clinical instruction of its medical students. Clinical resources should be sufficient to ensure breadth and quality of ambulatory and bedside teaching, including adequate numbers and types of patients as well as physical resources for treatment of illness, prevention of disease, and promotion of health.

As per Standard ER-7, a hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources, including areas for individual student study, for conferences, and for large group presentations such as lectures. Library holdings and access to other library systems must either be present or readily available in the immediate vicinity. Sufficient computers, call rooms, and lockers should be available for student use.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions II.C.11; III.A.2; V.B.5 through V.B.6 and V.C.7.

Determinations as to whether the above Standards are satisfied are made by site visits to the facilities of each medical school to be evaluated for accreditation by the CAAM-HP, as set forth in the Guidelines for Accreditation Survey Visits on behalf of the CAAM-HP, Exhibit 29.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include requirements that address the medical school's facilities, including classrooms and lecture halls, study space, laboratory and research space, libraries, humane research animal care, office space for faculty, staff, and administration, and hospitals and other clinical facilities. The adequacy of the school's facilities is verified during the course of the on-site review.

As documentation of its narrative, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.


 
Facilities, Question 2
 
Country Narrative
Pursuant to Standard ER-4, a medical school must have, or be assured use of, buildings and equipment appropriate to achieve its educational and other goals. These include: offices for faculty, administrators, and support staff; teaching laboratories and other space appropriate for conduct of research and space for humane care of animals when animals are used in teaching or research; student classrooms and laboratories; lecture halls sufficiently large to accommodate a full year’s class and any other students taking the same courses; space for student use, including student study space; and space for library and information access.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B.
 
Analyst Remarks to Narrative
As was noted under the previous section, the CAAM-HP standards require compliance with the requirements of this section.

Staff accepts the country's previous narrative and supporting documentation, and no additional information is requested.
 
Faculty, Question 1
 
Country Narrative
The requirements for accreditation of medical schools related to the size of the faculty and the qualifications for appointment to the faculty are set forth in Standards FA-1 through FA-12. These Standards provide that recruitment and development of the medical school’s faculty should take into account its mission, the diversity of its student body, and the population that it serves. See Standard FA-1. The Standards further provide that there must be a sufficient number of faculty members in the subjects basic to medicine and in the clinical disciplines to meet the needs of the educational programme and the other missions of the medical school. See Standard FA-2. In this regard, the Standards provide that in determining the number of faculty needed for the educational programme, medical schools should consider that faculty may have educational and other responsibilities in academic programmes other than medicine. In the clinical sciences, the number and kind of faculty appointed should also relate to the amount of patient care, health promotion, and prevention activities required to conduct meaningful clinical teaching across the continuum of medical education.

The Standards also provide that persons appointed to faculty positions must have demonstrated achievement commensurate with their academic rank, see Standard FA-3, and that members of the faculty should have the capability and continuing commitment to be effective teachers. See Standard FA-4. Effective teaching requires knowledge of the discipline and understanding of curriculum design and development, curriculum evaluation, and methods of instruction. Faculty members involved in teaching, course planning, and curriculum evaluation should possess or have ready access to expertise in teaching methods, curriculum development, programme evaluation, and student evaluation. Such expertise may be supplied by an office of medical education or by faculty/staff members with background in educational science. Faculty involved in the development and implementation of a course, clerkship, or other large curricular unit should be able to design the learning activities and corresponding evaluation methods (student and programme) in a manner consistent with the school’s stated objectives and sound educational principles. Among the lines of evidence indicating compliance with this Standard are the following: documented participation of the faculty in professional development activities related specifically to teaching and evaluation; attendance at international, regional, or national meetings on educational affairs; and evidence that the faculty members’ knowledge of their discipline is current. See Standard FA-4.

As per Standard FA-5, physicians appointed to the faculty from outside of the school on a part-time basis or as volunteers should be effective teachers, serve as role models for students, and provide insight into contemporary methods of providing patient care, prevention of illness, and promotion of health in the community.

Standard FA-6 requires that faculty members should have a commitment to continuing with scholarly productivity characteristic of an institution of higher learning.

The CAAM-HP asks a school to address these topics in its Database responses. See Medical Education Database, Section IV: Faculty, Exhibit 17, at Part B. The CAAM-HP also asks a school to assess and evaluate itself with regard to these topics in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions IV.A.1 through IV.B.7.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards include numerous requirements related to the medical school's faculty. Recruitment should take into account the diversity of the student body. There must be a sufficient number of basic science and clinical faculty to meet the needs of the program. Faculty members should have demonstrated achievements appropriate to their rank. Faculty should be appropriately qualified and capable of curriculum development and implementation. Faculty should demonstrate a commitment to ongoing scholarly development. Faculty members should be capable of making decisions regarding student admissions, promotion, and graduation, as well as providing academic and career counseling.

The standards appear mute on whether clinical-site instructors or supervising teachers are members of the medical school faculty. Additional information is therefore needed in this area.

The country is requested to provide additional information and documentation as to whether clinical-site instructors or supervising teachers are required by the CAAM-HP to be members of the medical school faculty.
 
Country Response
Standard ED-23 states, Supervision of student learning experiences must be provided throughout required courses / clerkships by members of the medical school's faculty.

CAAM-HP asks the schools to address this topic in the Medical Education Database Section III, Part B.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation as to whether clinical-site instructors or supervising teachers are required by the CAAM-HP to be members of the medical school faculty.

In its response to the draft, the country notes that CAAM-HP Standard ED-23 requires that supervision of clerkships be supervised by members of the school's faculty. Compliance with this standard is evaluated during the course of the on-site review process.

ED staff accepts the country's narrative and previously submitted documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Faculty, Question 2
 
Country Narrative
Standard FA-9 requires that a medical school should have policies that deal with circumstances in which the private interests of faculty members or staff may be in conflict with their official responsibilities. Standard FA-8 requires that there be clear policies for faculty appointment, renewal of appointment, promotion, granting of tenure, and dismissal that involve the faculty, the appropriate department heads, and the dean/Chief Academic Officer.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section IV: Faculty, Exhibit 17, at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Question IV.B.5.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards address faculty conflicts of interest to cover instances where the private interests of medical school faculty or staff conflict with their official responsibilities.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Library
 
Country Narrative
The Standards relating to the quality of a medical school’s library are set forth in Standards ER-12 through ER-13. Standard ER-12 provides that a medical school must have access to a well-maintained library and information facility sufficient in size, breadth of holdings, and information technology to support its education and other missions. This Standard also provides that there should be physical or electronic access to leading biomedical, clinical, and other relevant periodicals, the current numbers of which should be readily available. The library and other learning resource centers must be equipped to allow students to access information electronically, as well as to use self-instructional materials.

Standard ER-13 requires that the medical school’s library and information service staff must be responsive to the needs of the faculty, junior staff/residents, and students of the medical school. Professional staff should supervise the library and informational services and provide instruction in their use. The library and information services staff should be familiar with current international, regional, and national information resources and data systems and with contemporary information technology. Both school officials and library/information services staff should facilitate access of faculty, residents, and medical students to information resources, addressing their needs for information during extended hours and at dispersed sites.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B. The CAAM-HP also asks a school to address this topic in its self-study report. See Guide to the Institutional Self-study for Programmes of Education in Medicine, Exhibit 18, at Questions V.D.10 through V.D.13.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards address both the library facility itself and the qualifications of the library staff. The library facility must be well-maintained and have sufficient print and electronic holdings to support the educational program. The library staff should be professionally qualified, responsive to the needs of the medical school's faculty, staff, and students, and available to address their needs during extended hours and at various sites.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a 2011 SGUSM on-site review report (Ex. 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Clinical Teaching Facilities, Question 1
 
Country Narrative
As set forth in Standard ER-9, there must be a written and signed affiliation agreement between the medical school and its clinical affiliates that defines, at a minimum, the responsibilities of each party related to the educational programme for medical students. Under the Standard, written agreements are necessary between the medical school and hospitals or clinics that are used regularly as in-patient care sites for core clinical clerkships. Additionally, affiliation agreements may be warranted with other clinical sites that have a significant role in the clinical education programme.

The Standard also requires that affiliation agreements address, at a minimum, the following areas: the assurance of student and faculty access to appropriate resources for medical school education; the primacy of the medical school over academic affairs and the education/evaluation of students; the role of the medical school in appointment/assignment of faculty members with responsibility for medical student teaching; and specification of responsibility for treatment and follow-up when students are exposed to infectious or environmental hazards or other occupational injuries.

Under Standard ER-10, if the department heads of the school are not the clinical service chiefs, the affiliation agreements must confirm the authority of the department head to assure faculty and student access to appropriate resources for medical student education. Pursuant to Standard ER-10, the CAAM-HP should be advised of anticipated changes in affiliation status of a programme’s clinical facilities.

Likewise, under Standard ER-11, in the relationship between the medical school and its clinical affiliates, the educational programme for medical students must remain under control of the school’s faculty. Regardless of the location where the clinical instruction occurs, department heads and faculty must have authority consistent with their responsibility for the education and evaluation of medical students. The responsibility of the clinical faculty for patient care should not diminish or preclude opportunity for medical students to undertake patient care duties under the appropriate supervision of medical school faculty and junior staff/residents.

The CAAM-HP reviews affiliation agreements executed by each school to ensure such agreements are consistent with the Standards; it does not formally approve affiliation agreements.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards specify that there must be a signed affiliation agreement for each clinical site that the medical school uses. The agreements must specify the responsibilities of each party for the clinical education program and address appropriate resources, acknowledge the medical school's primary authority over academic affairs and the education and evaluation of students, the role of the school in the appointment and assignment of clinical faculty, and the treatment of students who are exposed to hazards or are injured. The CAAM-HP must be notified of anticipated changes in affiliation status of a program’s clinical facilities. The CAAM-HP reviews, but does not approve, the affiliation agreements.

As documentation of the implementation of the CAAM-HP standards, the country provided a copy of a CAAM-HP medical education database (Ex. 22).

Staff accepts the country's response an supporting documentation, and no additional information is requested.

 
Part 3: Accreditation/Approval Processes and Procedures
Onsite Review, Question 1
 
Country Narrative
The CAAM-HP conducts an on-site review at a medical school prior to granting it accreditation. The on-site review includes a review of the school’s admissions process, its curriculum, its faculty, the achievement of its students and graduates, and the facilities and academic support services available to students. See the Guide to the Institutional Self-Study for Programmes of Education in Medicine, Exhibit 18 and the Procedures, Exhibit 12.

Exhibit 30 is an Overview of the CAAM-HP Surveyors’ Orientation.

Exhibit 31 is CAAM-HP’s Schedule for a Full Accreditation Survey of SGUSOM. These visits were carried out in 2007, 2011 and 2015.

Exhibits 32, 33 and 16 are Site Visit Reports of 2007, 2011 and 2015 compiled by the respective teams following site visits to the SGUSOM. Exhibit 34 is the report of the visit to Northumbria, UK.

The CAAM-HP’s on-site reviews encompass the main campus of the medical school, any branch campus or campuses, and any other additional location or locations operated by the medical school as well as (required) clinical clerkship sites affiliated with the medical school. Exhibit 29 is the CAAM-HP’s Guidelines for Accreditation Survey Visits on behalf of the Caribbean Accreditation Authority for Education in Medicine and other Health Professions. See p. 12, which describes how the site visit schedule should be determined if geographically remote sites will be visited. Please seealso the CAAM-HP’s Procedures, Exhibit 12. See p. 14, which requires a medical school to notify the CAAM-HP when a new geographically remote programme or campus is to be established; in such cases, a limited survey visit may be conducted.
 
Analyst Remarks to Narrative
The country's narrative notes that the CAAM-HP conducts on-site reviews that encompass the medical school and all branch campuses, other locations, and clinical clerkship sites prior to granting accreditation. The areas reviewed encompass all of the requirements of this section.

As documentation of the information provided in the narrative, the country provided a CAAM-HP self-study guide (Ex. 18), CAAM-HP procedures manual (Ex. 12), and sample SGUSM on-site review reports (Exs. 16, 32, and 33).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Onsite Review, Question 2
 
Country Narrative
The CAAM-HP’s on-site reviews encompass the main campus of the medical school, any branch campus or campuses, and any other additional location or locations operated by the medical school as well as (required) clinical clerkship sites affiliated with the medical school. Exhibit 29 is the CAAM-HP’s Guidelines for Accreditation Survey Visits on behalf of the Caribbean Accreditation Authority for Education in Medicine and other Health Professions. See p. 12, which describes how the site visit schedule should be determined if geographically remote sites will be visited.
With respect to the quality of teaching sites, the Standards by which the quality of the sites are evaluated, and who is responsible for ensuring that quality, Standards ER-6 through ER-8 provide that a medical school must have, or be assured use of, appropriate resources for the clinical instruction of its medical students. See Standard ER-6. Under that Standard, clinical resources should be sufficient to ensure breadth and quality of both ambulatory and bedside teaching. Such resources include adequate numbers and types of patients (acuity, case mix, age, gender, etc.) as well as physical resources for the treatment of illness, the prevention of disease, and the promotion of health.

Standard ER-7 requires that a hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources. Appropriate instructional facilities include areas for individual student study, conferences, and large group presentations such as lectures. Sufficient information resources, including library holdings and access to other library systems, must either be present in the facility or readily available in the immediate vicinity. A sufficient number of computers are needed that allow access to the internet and to other educational software, and call rooms and lockers or other secure spaces to store personal belongings should be available for student use.

Pursuant to Standard ER-8, required clerkships should be conducted in healthcare settings where staff in accredited programmes of graduate medical education, under faculty guidance, participate in teaching the medical students.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B.
 
Analyst Remarks to Narrative
As discussed in the country's narrative, the CAAM-HP reviews encompass the entire medical education program, including all clinical clerkship sites. The agency's procedures address how remote sites will be scheduled for review. The sites are evaluated against the CAAM-HP standards and must address the quality of the sites and who is responsible for quality assurance. The standards also include requirements related to the quality of the quality and types of instruction provided, as well as the need for appropriate facilities and other resources, such as instruction space and library facilities. The staff in clinical settings must be a part of accredited graduate medical education programs.

As documentation of the implementation of the CAAM-HP clinical clerkship review process, the country provided copies of the CAAM-HP review guidelines (Ex. 29), the CAAM-HP medical education database (Ex. 22), and sample site visit review reports.

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Onsite Review, Question 3
 
Country Narrative
The CAAM-HP’s on-site reviews encompass the main campus of the medical school, any branch campus or campuses, and any other additional location or locations operated by the medical school as well as (required) clinical clerkship sites affiliated with the medical school. Exhibit 29 is the CAAM-HP’s Guidelines for Accreditation Survey Visits on behalf of the Caribbean Accreditation Authority for Education in Medicine and other Health Professions. See p. 12, which describes how the site visit schedule should be determined if geographically remote sites will be visited. Exhibit 13 contains the CAAM-HP’s Accreditation Guidelines for New and Developing schools, which requires—as an essential prerequisite for obtaining initial or provisional accreditation—schools to identify their clinical teaching sites. Clinical site visits occur during every accreditation and reaccreditation review, and may be scheduled during the period of accreditation. See Example of the CAAM-HP’s Schedule for a Full Accreditation Survey for SGUSOM, Exhibit 31.

St George’s University School of Medicine has established a partnership with the University of Northumbria in the UK (the Keith B Taylor Global Scholars Programme (KBTGSP) which permits a significant number of students to undertake the first year of their studies in the UK before moving to Grenada to complete the Preclinical part of the course. In addition, a number of students undertake some or all of their clinical placements in the UK. The site was visited in 2011 and 2015. See Exhibits 33 and 34.

CAAM-HP will review core programmes at all sites. A representative sample of teaching sites will be reviewed at the time of a major survey visit, and all other sites will be reviewed within the period of accreditation granted. A core programme site is defined as one where students are assigned on a year round basis and is provided with faculty and administrative support.

While CAAM-HP appreciates that written procedures establishing specific time frames for review would facilitate timely review of clinical sites, CAAM-HP is also of the view that since accreditation is given for a specific time frame, this does suggest that there is a time frame for review. CAAM-HP’s Procedures also provide for a limited site review at a specified time if circumstances so warrant.
 
Analyst Remarks to Narrative
The country states that the CAAM-HP review guidelines call for the basic science component of the medical education program to be visited during the on-site review. At that time, a sample of the clinical sites will also be conducted as part of the review, and then the rest of the sites not included in the sample will be visited at some point during the period of accreditation. The country reports that the CAAM-HP has not developed requirements related to the timeframes specified in this section, and the CAAM-HP feels that the fact that all sites are visited during the period of accreditation is sufficient. ED staff notes, however, that the CAAM-HP accreditation period is of a greater length than the time period specified under this part, and therefore at least some of the reviews of clinical sites have the potential to fall outside the timeframes specified in this section.

The country is requested to provide additional information and documentation to demonstrate that the CAAM-HP has revised its review guidelines to encompass the timeframes specified under this section for reviewing all of a medical school's clinical sites.
 
Country Response
CAAM-HP has adopted the requirement that all clinical sites must be visited. However, there are factors which make it challenging to set a specific time frame for reviewing all of a medical school’s clinical sites.

Caribbean off-shore medical schools such as St George’s University, with a large student population and more than one intake of students per year have several clinical affiliates in the United States, the majority of which are located in one large city. These schools have to date been accredited for four years which is the length of their medical education programme. CAAM-HP is of the view that this time frame is sufficient to visit those sites not included during the accreditation site visit. Bearing in mind the intake of students each semester there will therefore always be clinical students assigned to the clinical affiliates. It is unlikely therefore that reviews of clinical sites will fall outside of the period of accreditation. However, should it be the case that all sites were not visited during the period of accreditation, note that a new cycle of accreditation visits will follow and any remaining site(s) will be included in the next cycle.

The schools with a smaller student population and with more than one intake per year have fewer clinical sites and to date these schools have been accredited for two years only. CAAM-HP is of the view that the sites not visited during the accreditation exercise will be visited during the period of accreditation.

For the medical schools of the regional university and the national university clinical rotations are carried out in-country. In the case of the regional university with four clinical teaching sites and a large site visit team of 8 surveyors it is possible to visit all sites during the accreditation visit.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation to demonstrate that the CAAM-HP has revised its review guidelines to encompass the timeframes specified under this section for reviewing all of a medical school's clinical sites.

In its response, the country notes that CAAM-HP requires that all clinical sites be visited. However, the agency makes the argument that setting a specific time frame for conducting the evaluations is "challenging." While it appears that in most instances the agency is meeting the timeframes specified in this section, the agency appears reluctant to formalize these requirements.

The country is again requested to provide additional information and documentation to demonstrate that the CAAM-HP has revised its review guidelines to encompass the timeframes specified under this section for reviewing all of a medical school's clinical sites.
 
Staff Conclusion: Additional Information requested
 
Onsite Review, Question 4
 
Country Narrative
Pursuant to Standard ER-6, a medical school must have, or be assured use of, appropriate resources for clinical instruction. A hospital or other clinical facility that serves as a major site for medical student education must have appropriate instructional facilities and information resources. See Standard ER-7. Pursuant to Standard ER-9, there must be a written and signed affiliation agreement between the medical school and its clinical affiliate that defines, at a minimum, the responsibilities of each party related to the educational programme for medical students, and the following areas:

- The assurance of student and faculty access to appropriate resources for medical student education.
- The primacy of the medical school over academic affairs and the education / evaluation of students.
- The role of the medical school in appointment / assignment of faculty members with responsibility for medical student teaching.
- Specification of the responsibility for treatment and follow-up when students are exposed to infectious or environmental hazards or other occupational injuries.

CAAM-HP reviews affiliation agreements during an accreditation site visit to assess whether they comply with CAAM-HP standards. CAAM-HP will make findings regarding affiliation agreements if it has concerns regarding any such agreements’ compliance with relevant standards, and it will take appropriate action based on such findings, as it would any finding.

During a site visit, CAAM-HP site visitors also interview medical students and staff and review the independent student analysis to determine the total number of students at individual teaching sites, regardless of the medical school of origin, and to assess whether the site has facilities and resources sufficient for that total number of students. Please see response to Clinical Teaching Facilities, Question 1 for additional information regarding review of affiliation agreements. Reference is also made to the 2015 site visit report, Exhibit 16.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require that the medical school have a signed affiliation agreement with each clinical site. The standards specify what should be covered in the affiliation agreement. The CAAM-HP reviews all affiliation agreements for compliance with its standards, although it does not formally approve the agreements. The affiliation agreements are again reviewed during the course of the agency's on-site review visits to the various clinical sites.

As documentation of the implementation of the CAAM-HP requirements, the country provided a copy of a 2015 site visit report (Ex. 16).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Onsite Review, Question 5
 
Country Narrative
CAAM-HP has standard operating procedures to address matters pertinent to the NCFMEA Guideline, Part 3 Accreditation/Approval Processes and Procedures, Section 1(e). Specifically, CAAM-HP does not accredit multiple schools or their operations at a single clinical site at one time. Each school is accredited individually, and a site visit team interviews only the students of the school under review when it visits a school and its clinical affiliates. For example, during the first half of 2013 CAAM-HP paid two visits to one hospital in Chicago that has a single coordinator responsible for the educational experience of students from multiple schools; the site visit team conducted interviews with students of the school under review and not with students from all schools that use the location. Site visitors do not evaluate a clinical site with regard to students of medical schools that are not within the jurisdiction of CAAM-HP.

However, CAAM-HP recognises that with a number of schools within its jurisdiction using the same facilities for clinical training and in the light of the requirement that all clinical sites be visited, it may become necessary to make simultaneous assessments on behalf of more than one school. Consideration will be given to this during the revision of the standards and procedures in 2016.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP conducts reviews of clinical sites for only one of its accredited medical schools at a time, even if more than one school has clinical students at the site. The country reports that the CAAM-HP may need to undertake multi-school reviews of clinical sites in the future, based upon workload. At clinical sites that serve more than one school, there is a single clinical education coordinator that is responsible for overseeing the clinical program.

It does not appear that the CAAM-HP policies specify that clinical programs must be offered in conjunction with the education programs offered to students enrolled in medical schools in the approved foreign country or in the United States. Additional information is requested in this area.

The country is requested to provide additional information and documentation to demonstrate that the clinical education programs the CAAM-HP accredits must be offered in conjunction with the educational programs offered to students enrolled in medical schools in the approved foreign country or in the United States.
 
Country Response
CAAM-HP’s policies do not specify that clinical programmes must be offered in conjunction with the education programmes offered to students enrolled in medical schools in the approved foreign country or in the United States in the light of the Caribbean context.

In the Caribbean region, i.e. the Caribbean community (CARICOM), over which CAAM-HP has jurisdiction, there are three (3) different types of institutions offering medical education programmes:

(i) The regional university (University of the West Indies) with five-year medical education programmes offered in Jamaica, Bahamas, Barbados and Trinidad. The clinical education programmes are conducted in-country at the University Hospital of the West Indies (Jamaica), and government public hospitals and community health facilities through Memoranda of Understanding with the respective governments, Jamaica, Bahamas, Barbados and Trinidad.

(ii) National universities in Guyana and Suriname, University of Guyana and University of Suriname respectively, which offer five-year programmes with clinical rotations in the countries’ government public hospitals through affiliation agreements with the respective governments.

Schools located in countries listed in (i) and (ii) above have no need to have clinical rotations done in the United States or any other ‘approved foreign country’.

(iii) Offshore, for–profit schools in Anguilla, Antigua, Aruba, Belize, Curacao, Dominica, Grand Cayman, Grenada, St Kitts & Nevis, St Lucia, St Vincent, which in general target students from North America. These schools offer a four-year medical education programme with the basic sciences at the main campus in the Caribbean and clinical rotations at United States based hospitals through clinical affiliation agreements. In CAAM-HP’s experience to date, it is the desired intention of these schools to offer clinical rotations in the United States and in fact some schools do make this point in their advertisements as a factor in attracting potential students.

If “approved” is to be interpreted to mean “friendly” then all the countries mentioned above are indeed ‘friendly’ to the United States and may be regarded as “approved foreign countries”.

The matter of the clinical programmes being offered in conjunction with the educational programmes offered to students enrolled in medical schools in the approved foreign country or in the United States could conflict with the requirement that supervision of student learning experiences must be provided throughout required courses/clerkships by members of the medical school’s faculty, Standard MS-23.

This is a matter to which CAAM-HP will need to give very careful thought before adopting such a policy.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation to demonstrate that the clinical education programs the CAAM-HP accredits must be offered in conjunction with the educational programs offered to students enrolled in medical schools in the approved foreign country or in the United States.

In its response to the draft, the county acknowledged that CAAM-HP’s policies do not specify that clinical programs must be offered in conjunction with the education programs offered to students enrolled in medical schools in the approved foreign country or in the United States.

The country is requested to revise its policies to require that the clinical education programs it accredits must be offered in conjunction with the educational programs offered to students enrolled in medical schools in the approved foreign country or in the United States, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Qualifications of Evaluators, Decision-makers, Policy-makers
 
Country Narrative
As set forth in the Procedures, Exhibit 12, the CAAM-HP Secretariat recruits and trains a suitable group of surveyors who are knowledgeable about medical education. The Secretariat maintains an updated roster of experienced and competent educators and practitioners in the respective disciplines from which to select appropriate ad hoc team members. Deans of schools are given particular consideration for team membership.

The Procedures also set forth (p. 15) that the Secretariat staff conducts accreditation orientation sessions for surveyors at times that will be publicized well in advance. See Overview of the CAAM-HP Surveyors’ Orientation, Exhibit 30. In addition, interactive workshops are offered as required for in-depth training of prospective surveyors, focusing on the interpretation of standards and the assessment of compliance. The survey team must include experienced surveyors as well as other qualified professionals who would have participated in a CAAM-HP training workshop.

The CAAM-HP Secretariat is responsible for appointing survey teams. Each survey team is appointed on an ad hoc basis. The composition of a survey team is determined by the characteristics of the school to be visited. The CAAM-HP’s Secretariat includes a representative cross-section of basic science and clinical educators and practitioners in each ad hoc survey team. Survey teams include one member of the CAAM-HP or of the Secretariat. Survey team appointments are in keeping with the CAAM-HP’s Conflict of Interest Guidelines. See Procedures, Exhibit 12. To avoid potential conflicts of interest, the dean of a school to be visited is asked to review the composition of the proposed survey team and to inform the Secretariat of any potential problems.

A full survey visit typically involves five persons, including a chair; a secretary; two or more members, one of whom should be a basic scientist faculty member or educational scientist and one of whom should be a clinician/practitioner; and a CAAM-HP member who is an educational administrator/senior faculty member and has not previously participated in a site visit. A limited or focused visit will be conducted by experienced surveyors, typically including three team members.

As stated in Article 1, Use of Terms, of the Agreement Establishing The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (“Agreement”), “Contracting Party” means a Member State or an Associate Member State of the Community for which this Agreement is in force. “Community” means the Caribbean Community (CARICOM), including the CARICOM Single market and Economy established by the Revised Treaty of Chaguaramas signed at Nassau, the Bahamas, on July 5, 2001. Member States that to date have signed the Agreement are Antigua & Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Jamaica, St Kitts & Nevis, St Lucia, St Vincent and the Grenadines, Suriname, and Trinidad & Tobago. Since the establishment of CAAM-HP in 2004, the persons whom the Contracting Parties have appointed to the CAAM-HP have been the Chief Medical Officers of the Member States that have signed the Agreement. Chief Medical Officers are the most senior medical professionals in the Member States’ ministries of health.
 
Analyst Remarks to Narrative
As described in the country's narrative, CAAM-HP maintains a roster of qualified on-site evaluators for use in conducting on-site reviews in its behalf. The evaluators are educators and practitioners, with many serving as the deans of medical education programs. Team members are chosen on an as-needed basis, based upon the reviews that are to be conducted. The CAAM-HP conducts on-site reviewer orientation training to familiarize the evaluators with the agency's requirements. Site review teams also include one CAAM-HP representative in addition to the educators/practitioners. Teams are usually comprised of a team chair, a team secretary, two additional reviewers, and the CAAM-HP representative.

As documentation of the implementation of the CAAM-HP procedures, the country provided a copy of the agency's procedures document (Ex. 12) and the agency's on-site reviewer training document (Ex. 30).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Re-evaluation and Monitoring, Question 1
 
Country Narrative
As per the CAAM-HP’s Procedures, Exhibit 12, an education programme once accredited remains accredited until the CAAM-HP terminates the programme formally or the programme itself terminates its accreditation status. Notwithstanding the foregoing, accreditation by the CAAM-HP does not end merely because a certain period of time has passed. Programmes typically are subject to review on a six-year cycle. The CAAM-HP may determine that an earlier review is necessary; in that case, the accreditation status does not change until a formal action is taken by the CAAM-HP.

As described in the Procedures, Appendix A, there are several “states of accreditation”; although six years is the maximum period for accreditation, the CAAM-HP may decide that a school must be monitored during shorter intervals. See Procedures, Exhibit 12. For example, a school with provisional accreditation will be accredited for a period of two years up to a maximum of the length of the academic programme. See Procedures, Exhibit 12.

All schools are expected to submit to the CAAM-HP Annual Progress Reports demonstrating that areas of concern/weaknesses are being addressed. In the event such reports are not submitted or submitted outside of the time stipulated, CAAM-HP may determine that a sanction should be imposed.
 
Analyst Remarks to Narrative
As describe in the country's narrative, CAAM-HP's typical grant of accreditation lasts six years, but lasts until the agency takes formal action to either grant reaccreditation, or deny reaccreditation, to the school. The agency may specify shorter periods of accreditation as needed, such as for schools on provisional accreditation, which may be granted for only two years. The country notes that, in addition to periodic reaccreditation reviews, all accredited schools must also submit annual reports for review by the CAAM-HP.

As documentation to support its narrative, the country provided a copy of the CAAM-HP procedures document (Ex 12), as well as a copy of the CAAM-HP annual report form (Ex. 25).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Re-evaluation and Monitoring, Question 2
 
Country Narrative
As set forth in the Procedures, each accredited medical school is required to complete annual questionnaire surveys that are carried out under the auspices of the CAAM-HP. The Annual Medical School Questionnaire collects academic and enrollment data and is the administrative responsibility of the Secretariat staff who will review the questionnaires to keep the content consistent with other CAAM-HP survey documents and bring any significant changes to the notice of the Chair of the CAAM-HP. Data received from the CAAM-HP annual questionnaires are compiled into a statistical summary report for the CAAM-HP members and otherwise made available to relevant schools and the public. A copy of the CAAM-HP Annual Medical School Questionnaire is attached as Exhibit 25.

As per the Procedures, Exhibit 12, p. 21 and Appendix H, the CAAM-HP will accept and investigate complaints about programme quality that, if substantiated, may constitute non-compliance with accreditation standards.

Site visitors are made aware of any complaints before their visit. A site visit team will need to discuss in their site visit report any complaints raised by students during their review, including those that rise to the level of breaching Standards.
 
Analyst Remarks to Narrative
As described in the country's narrative, and in the previous section, the CAAM-HP requires its accredited schools to submit annual reports in order for the agency to evaluate the school for continued compliance with its standards throughout the accreditation period. The agency compiles the annual report form data into a summary report for each school

As was also noted in a previous section, the CAAM-HP has established a process for students to submit complaints directly to the agency. The country reports that CAAM-HP site visitors are made aware of any student complaints prior to conducting the on-site review. The on-site review team must also report any student complaints that arise during the course of the on-site review visit.

As was noted in a previous section, ED staff has a concern that the CAAM-HP has no requirements in place for a student complaint process at the school level, but instead expects students to register their complaints directly with the CAAM-HP. This does not follow standard operating procedures for recognized accrediting agencies. The typical complaint process is for student complaints to first be addressed at the school level, then elevated to the accrediting agency if the complaint is not resolved to the student's satisfaction by the school. The school should keep a copy of all student complaints for review during on-site reviews, and patterns of complaints may be identified which would raise concerns related to the school's compliance with the agency's standards. Such a pattern of student complaints should be considered in reaccreditation decisions.

The country is requested to provide additional information and documentation to demonstrate that the CAAM-HP requires its accredited schools to develop student complaint procedures for implementation at the campus level.
 
Country Response
The following CAAM-HP accreditation standards require medical schools to have a student complaint process at the school level:

MS-26 Each medical school / university must define and publicise the standards of conduct for the teacher-learner relationship, and develop written policies for preventing and addressing violations of those standards.

Mechanisms for reporting violations of these standards, such as incidents of harassment or abuse, should assure that complaints can be registered and investigated without fear of retaliation.

The policies also should specify mechanisms for the prompt handling of such complaints, preventing inappropriate behaviour, and the corrective measures to be employed where such behaviour occurs

MS-28 There must be a fair and formal process for taking any action that adversely affects the status of a student.

The process should include timely notice of the impending action, disclosure of the evidence on which the action would be based, an opportunity for the student to respond, and an opportunity to appeal any adverse decision related to promotion, graduation, dismissal or other disciplinary action.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information and documentation to demonstrate that the CAAM-HP requires its accredited schools to develop student complaint procedures for implementation at the campus level.

In response to the draft analysis, the county notes that the CAAM-HP standards require that accredited schools define and publicize standards of conduct, develop policies for dealing with violations of those standards, and specify how complaints will be promptly registered and evaluated. The agency's standards also require that there be a formal process for handling any actions that may negatively impact a student's status.

ED staff accepts the agency's response and supporting documentation, and no additional information is requested.
 
Staff Conclusion: Comprehensive response provided
 
Substantive Change
 
Country Narrative
Pursuant to Standard ED-8, accredited programmes must notify the CAAM-HP of plans for any major modification of the curriculum. The notification should include the explicitly-defined goals of the change, the plans for implementation, and the methods that will be used to evaluate the results. Planning for curriculum change should consider the incremental resources that will be required, including physical facilities and space, faculty/resident support, demands on library facilities and operations, information management needs, and computer hardware. In view of the increasing pace of discovery of new knowledge and technology in medicine, the CAAM-HP encourages experimentation that aims at increasing the efficiency and effectiveness of medical education. As part of its planned standards revision process, described earlier, the CAAM-HP expects to consider the establishment of timeframes within which a medical education programme must notify the CAAM-HP of plans to undergo a substantive change.

Pursuant to Standard ER-1, the CAAM-HP must be notified of plans for or the implementation of any substantive change in the number of students enrolled or in the resources of the institution, including the faculty, physical facilities, or the budget.

As set forth in the Procedures, accreditation is awarded to a programme of medical education based on the judgment of the CAAM-HP that there is an appropriate balance between student enrollment and the total resources of the institution, including the faculty, physical facilities, and available funding. See Procedures, Exhibit 12, p.14. Plans to significantly alter the educational programme; a significant change in student enrollment; or a change in institutional resources, so that the balance between enrollment and resources is altered, may trigger a request for additional written information or an unplanned accreditation review or survey visit of a previously accredited medical school. See Procedures, Exhibit 12, p.14.

Accredited institutions are required to notify the CAAM-HP if there is a planned change in programme ownership or governance. See Procedures, Exhibit 12, p. 41. In such cases, the school is asked to supply a written report that will be reviewed by the CAAM-HP. A limited survey visit also may be conducted. The report and visit allow the CAAM-HP to determine whether reasonable compliance with accreditation standards can be assured and the current status and term of accreditation continued under the new ownership or governance. The same procedures apply whether a new geographically remote programme or campus is to be established.

The CAAM-HP asks a school to address this topic in its Database responses. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B and Medical Education Database, Section V: Educational Resources, Exhibit 22, at Part B.

CAAM-HP appreciates the benefit that specified deadlines may provide to medical education programmes and CAAM-HP to facilitate timely review and implementation of appropriately assessed substantive changes. It is proposed that Standard ER-1 be amended to read as follows:

CAAM-HP must be notified one year in advance of plans or the implementation of any substantial change in the number of students enrolled or in the resources of the institution, including the faculty, physical facilities or the budget.
 
Analyst Remarks to Narrative
As described in the country's narrative, the CAAM-HP standards require medical schools to notify the agency of substantive changes. The standards specify the circumstances that constitute a substantive change, such as a change in the curriculum, the number of students to be enrolled, or in institutional resources such as faculty, facilities, or budget, or a change in ownership or governance. The school must notify the agency via a report of planned changes, and the notification may trigger an on-site visit. The agency requires a one-year advance notification of any substantial change in the number of students enrolled, or in the resources such as the faculty, physical facilities, or budget. The country reports that the CAAM-HP is in the process of adopting additional notification timeframes.

As documentation of the implementation of the CAAM-HP requirements, the country provided a copy of the CAAM-HP procedures document (Ex. 12) and CAAM-HP database documents (Exs. 15 and 22).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Conflicts of Interest, Inconsistent Application of Standards, Question 1
 
Country Narrative
Grenada’s policies regarding bias and conflict of interest by persons involved in the accreditation, evaluations, and decision-making processes are those established by the CAAM-HP for such purposes. Appendix C of the Procedures, Exhibit 12, sets forth the Conflict of Interest Guidelines and Statement for the CAAM-HP Members, Staff, and Surveyors.
 
Analyst Remarks to Narrative
The country reports that the CAAM-HP has a conflict of interest policy that covers those persons who are involved in the accreditation, evaluation and decision-making processes, including CAAM-HP members, staff and on-site reviewers.

As documentation of the CAAM-HP procedures, the country provided a copy of the CAAM-HP's conflict of interest policy (Ex. 12).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Conflicts of Interest, Inconsistent Application of Standards, Question 2
 
Country Narrative
In order to ensure that the standards for accreditation/approval of medical schools are applied consistently to all schools that seek accreditation/approval, survey teams include one member of the CAAM-HP and/or of the Secretariat.
 
Analyst Remarks to Narrative
As described in the country's narrative and under previous sections, each CAAM-HP on-site review team includes one CAAM-HP representative to serve as a resource person. ED staff also noted under a previous section that all on-site review team members must undergo orientation and training on the agency's policies and standards prior to participating as a member of an on-site review team.

As documentation of the CAAM-HP's procedures related to this area, the country provided a copy of CAAM-HP training materials that are used to orient on-site reviewers prior to serving on an on-site review team (Ex. 30).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Accrediting/Approval Decisions, Question 1
 
Country Narrative
The site visit team, following deliberations during their visit, will detail in their written report the medical education programme’s level of compliance with each individual accreditation standard. See Guide for Writing a Report on a Visit of a Survey Team, Exhibit 35; Procedures, Exhibit 12.
 
Analyst Remarks to Narrative
As described in the country's narrative, CAAM-HP accrediting decisions are based upon its review of the report of an on-site evaluation team that has been trained in the agency's standards

As documentation of the implementation of the CAAM-HP procedures, the country provided a copy of the CAAM-HP site team report guidelines (Ex. 35).

Staff accepts the country's narrative and supporting documentation, and no additional information is requested.
 
Accrediting/Approval Decisions, Question 2
 
Country Narrative
The CAAM-HP does not base any part of its accreditation on benchmarks, such as licensing rates or established minimum levels of performance of graduates of its accredited medical schools.
 
Analyst Remarks to Narrative
The country reports in its narrative that the CAAM-HP has not set any outcomes benchmarks for use by its schools.

The country is requested to provide additional information as to the CAAM-HP's rationale for not setting outcomes benchmarks for its accredited schools.
 
Country Response
In CAAM-HP’s experience, data such as performance in postgraduate residency programmes, licensure exams, specialty exams/certifications or other forms of evaluation usually confirm deficiencies that are readily apparent from the accreditation process. Additionally, school supplied data are insufficiently consistent to serve as a determinative factor in accreditation decisions. CAAM-HP has asked schools to collect this data systematically. CAAM-HP recognizes and supports the importance of benchmarks as part of the quality assurance process and will give this further consideration during the standards revision process.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information as to the CAAM-HP's rationale for not setting outcomes benchmarks for its accredited schools.

In its response, the country notes that it does not collect this data, but will give the requirement further consideration during its standards revision process.

The country is requested to ensure that CAAM-HP's develops standards for setting outcomes benchmarks for its accredited schools, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Accrediting/Approval Decisions, Question 3
 
Country Narrative
The CAAM-HP does not at present base any part of its accreditation on benchmarks, such as licensing rates or established minimum levels of performance of graduates of its accredited medical schools. Accredited schools are required to submit to the CAAM-HP an Annual Medical School Questionnaire, Exhibit 25, which requests data on the placement for residency of the last graduating class. CAAM-HP does comment on such data. SGUSOM has provided residency data in its progress report of 2013, Exhibit 36.
 
Analyst Remarks to Narrative
As described in the narrative and in the previous section, the CAAM-HP has not set any outcomes benchmarks for its schools and does not use performance data in reaching an accrediting decision.

The country is requested to provide additional information about the CAAM-HP's rationale for not setting performance benchmarks for its schools.
 
Country Response
In CAAM-HP’s experience, data such as performance in postgraduate residency programmes, licensure exams, specialty exams/certifications or other forms of evaluation usually confirm deficiencies that are readily apparent from the accreditation process. Additionally, school supplied data are insufficiently consistent to serve as a determinative factor in accreditation decisions. CAAM-HP has asked schools to collect this data systematically. CAAM-HP recognizes and supports the importance of benchmarks as part of the quality assurance process and will give this further consideration during the standards revision process.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information about the CAAM-HP's rationale for not setting performance benchmarks for its schools.

In its response, the country acknowledges that it does not set benchmarks for its schools.

The country is requested to ensure that CAAM-HP's develops standards for setting outcomes benchmarks for its accredited schools, as required under this section.
 
Staff Conclusion: Additional Information requested
 
Accrediting/Approval Decisions, Question 4
 
Country Narrative
In the CAAM-HP’s experience, data such as performance in post graduate residency programmes, licensure exams, specialtyexams/certifications, licensure or other forms of evaluation usually confirm deficiencies that are readily apparent from theaccreditation process. CAAM-HP has asked schools to collect this data systematically.

Standards ED-42 and ED-43, and their related Database requests, require schools to provide data on the performance of graduates in licensure examinations and placement in postgraduate training programmes. See Medical Education Database, Section III: Educational Programme, Exhibit 15, at Part B. The CAAM-HP is considering steps to incorporate more systematically and comprehensively outcomes-data analysis as part of the accreditation decision-making process.

CAAM-HP supports the general trend to assess outcomes data as part of the quality assurance process, while it also recognizes ongoing discourse regarding the specific role outcomes data should play in that process and the extent to which outcomes data should be part of a holistic quality assurance review or a determinative factor in final accreditation decisions.

CAAM-HP notes however, that specific measures such as residency placement in U.S. programmes over which a school has no control may not necessarily be the best tool for assessment.

Steps to incorporate more systematically and comprehensively outcomes-data analysis as part of the accreditation decision-making process will be included in the revised standards.
 
Analyst Remarks to Narrative
As has been noted in previous sections, the CAAM-HP has not established any performance benchmarks for its schools. The country reports that the CAAM-HP does require its schools to provide data on the performance of graduates in licensure examinations and placement in postgraduate training programs and to report this information to the agency. The country reports that the CAAM-HP is in the process of considering steps to incorporate outcomes data analysis as part of the accreditation decision-making process.

The country is requested to provide additional information, including timeframes for implementation, on the steps the CAAM-HP is considering to incorporate outcomes data analysis as part of the accreditation decision-making process.

 
Country Response
Given the process for formal adoption/acceptance of new standards and policies, that is, approval from all stakeholders, implementation is not likely before 2018.
 
Analyst Remarks to Response
In the draft staff analysis, the country was requested to provide additional information, including timeframes for implementation, on the steps the CAAM-HP is considering to incorporate outcomes data analysis as part of the accreditation decision-making process.

In its response to the draft, the country states that it is unlikely to implement outcomes data analysis into its review process until 2018.

The country is requested to provide additional information, including timeframes for implementation, on the steps the CAAM-HP is considering to incorporate outcomes data analysis as part of the accreditation decision-making process.
 
Staff Conclusion: Additional Information requested