Barbados, Government of 09/27/2019 08/15/2019 Final Review Special Report

U.S. Department of Education

Special Report


Prepared September, 2019

Background

At its September 2016 meeting, the National Committee on Foreign Medical Education and Accreditation (NCFMEA) initially determined that the accreditation standards the Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) used to evaluate medical education programs in Barbados were comparable to those used to evaluate such programs in the United States. At the April 2019 meeting, NCFMEA reviewed the redetermination petition submitted and requested that Barbados provide a special report, which is the subject of this analysis.


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 needs to provide additional information on CAAM-HPs procedures and plans for leveraging new administrative capacity to conduct on-site reviews of RUSOMs core clinical sites on a regular basis.

Staff Analysis


Outstanding Issues

Attrition, completion, and residency placement data - by admissions cohort, and in years four, five, and six of the medical program - for Ross University, School of Medicine (RUSOM


Country Narrative

Please see Attrition. completion and residency placement data by admissions cohort and in years in years four, five and six of the medical programme for RUSOM. Exhibit 1


Analyst Remarks to Narrative

The country provided the requested attrition, completion and residency placement data - by admitted cohort and rates at the 4-, 5-, 6-year points of the medical program at Ross University School of Medicine (RUSOM). CAAM-HP information provided for RUSOM: • Attrition and completion rates by admissions cohort from January 2008 to January 2019 • Attrition rates that reflect withdrawals and dismissals for all basic science curriculum in the past four completed academic years (2014 to 2017) • Completion percentages of the medical school entering class that graduates in 4, 5, or 6 years and the overall graduation rate for a typical class from July 2008 - June 2009 to July 2013 - June 2014 • Residency attainment rates from 2014-2015 to 2018-2019 (The completion graduation rate for a typical class does not include students who transferred into RUSOM from another medical school.)


Shelf exam pass rate data by admissions cohort for RUSOM;


Country Narrative

Please see shelf exam pass rate data by admissions cohort for RUSOM. Exhibit 1.


Analyst Remarks to Narrative

The country provided data regarding the shelf exam pass rate by admissions cohort for Ross University School of Medicine (RUSOM). Specifically, the country provided matriculation terms, first attempt passing percentages, and total number of first attempts from September 2013 to September 2018.


First-time USMLE pass rate data for those students whom are eligible to sit for the USMLE exam for RUSOM


Country Narrative

Please see first-time USMLE pass rate data for those RUSOM students who are eligible to sit for the USMLE exam. Exhibit 1


Analyst Remarks to Narrative

The country provided data on first-time pass rate and average scores on USMLE Step 1, Step 2 CK and Step 2 CS for the 2018 calendar year. However, the country did not provide information on other calendar years, nor did the country clarify the eligibility of the students in the data to sit for the USMLE exam.

Country Response

The responses to these issues are provided in Exhibits 2, 3 and 4.

Analyst Remarks to Response

In response to the draft staff analysis, the country provided the requested first-time USMLE pass rate data of RUSOM students for the calendar years 2013-2018. In addition, the country provided clarification on the eligibility of RUSOM students to sit for the USMLE exam through the institution's listing in the World Directory of Medical Schools, which verifies students enrolled at the listed institutions also meet the Educational Commission for Foreign Medical Graduates (ECFMG) eligibility requirements.


Staff Conclusion: Comprehensive response provided


CAAM-HP’s plan to increase its administrative capacity to accredit medical schools in Barbados, particularly those medical schools with extensive numbers of clinical sites and high enrollment.


Country Narrative

CAAM-HP will be increasing its administrative capacity through the addition of one more senior staff member effective July 1, 2019. RUSOM has advised that they are in the process of reducing the number of its clinical affiliates starting this summer 2019. According to RUSOM their comprehensive plan to restructure its clinical programme is driven by the academic environment at sites and of increasing outcomes of its students in subject clerkship exams to meet the LCME median. This review of sites is being carried out from a "value/outcome" perspective. CAAM-HP is awaiting final confirmation of this number and their geographical location. RUSOM is scheduled for a full accreditation visit in early 2020 at which time as many clinical sites as feasible during the site visit will be visited. Please note that RUSOM is the only medical school in Barbados with extensive numbers of clinical sites and high enrollment.


Analyst Remarks to Narrative

The country indicated in its narrative that there will be one senior staff member added to CAAM-HP, effective July 1, 2019, to increase its administrative capacity. However, it is not clear how the additional senior staff member will contribute to the administrative capacity of accrediting medical schools in Barbados, as no description of the responsibilities of the position was provided. In its narrative, the country described RUSOM's plan and criteria to reduce their number of clinical sites. The country stated that it is awaiting confirmation of the final clinical site number and their geographical locations. Department staff requests the information be provided in response to the draft staff report, if available. The country indicated RUSOM's next full accreditation visit to be conducted in early 2020, and stated that CAAM-HP would visit "as many clinical sites as feasible." However, the country did not provide any further information or documentation concerning CAAM-HP's ability to visit all of RUSOM's core clinical sites.

Country Response

A. The Secretariat's increased administrative capacity of an additional senior person will enable CAAM-HP to undertake more clinical site visits, simultaneously or otherwise. B. CAAM-HP will share information on the final number of clinical sites as soon as it is made available. However, we are advised that the plan to significantly reduce the number of clinical affiliates is ongoing and should be final in a matter of months. C. CAAM-HP will be in a better position to give a more precise response as soon as it receives the relevant information from RUSM regarding the final number of clinical affiliates and their location. Nevertheless, with the additional senior staff at the Secretariat, CAAM-HP is confident that visits to all RUSM's clinical sites will be even more feasible.

Analyst Remarks to Response

In response to the draft staff analysis, the country stated that the addition of one senior staff member will increase CAAM-HP’s administrative capacity by undertaking more clinical site visits. The country indicated that CAAM-HP is confident that visits to all RUSOM clinical sites “will be even more feasible” with the additional senior staff member. The country provided RUSOM’s approximate timeline for the elimination of 11 core clinical sites and a list of the remaining 9 core clinical sites and their respective locations. The country specified that CAAM-HP will provide updated clinical site information as RUSOM undergoes its elimination process. However, the Committee may be interested in hearing more specific information from the country on its procedures or plans to address concerns regarding a comprehensive program review of RUSOM’s core clinical sites.


Staff Conclusion: Additional Information requested