Nevis/St. Kitt 04/01/2019 03/07/2019 Final Review Redetermination

U.S. Department of Education

Redetermination for the Government of St. Kitts and Nevis


Prepared February, 2019

Background

In 1998, the Government of St. Kitts and Nevis and the Medical University of the Americas (MUA) signed an agreement chartering MUA on the island of Nevis. The islands of St. Kitts and Nevis are joined together as a federation, although each exercises considerable autonomy over internal island matters. In 2007, the Premier of the Government of Nevis signed an agreement designating the Accreditation Commission on Colleges of Medicine (ACCM) to act on Nevis’s behalf as the MUA's accreditor. Also in 2007, a second medical school, the University of Medicine and Health Sciences (UMHS) was opened on the island of Nevis, and since 2015, ACCM is the accreditor for that school, as well. The Government of Nevis appeared at the Spring 2012 NCFMEA meeting seeking an initial determination that the standards used by the ACCM to evaluate the island’s medical schools are comparable to those used to evaluate medical schools in the United States. At that time, the Committee recommended comparability for Nevis, but also requested that the country provide additional information regarding concerns in two areas, specifically attrition and the number of students passing the USMLE Step 1 out of the initial cohort. At its April 2014 meeting the NCFMEA accepted ACCM's report. The NCFMEA also requested that ACCM, on behalf of the Government of Nevis and St. Kitts submit an update report in two years that includes specific information about how many students took the U.S. Medical Licensing Exam out of those admitted into the program at MUA, the attrition rate, and the reasons for the attrition. At its April 2016 meeting, the NCFMEA accepted ACCM's report, and urged the ACCM to consider alternative methods of tracking student performance data in order to provide more useful USMLE pass rate and residency placement data. In the Spring of 2019, the ACCM on behalf of the Government of St. Kitts and Nevis submitted a report for a redetermination of comparability for review at the Spring, 2019 meeting. That report is the subject of this analysis. The ACCM accredits two medical schools in the Federation, MUA and UMHS. During the award year 2018, which is the most recent year for which figures are available, 262 American students received $ 14,115,571.00 in Title IV funds to attend MUA. UMHS does not currently participate in the William D. Ford Direct Loan Program.


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 NCFMEA may wish to see the revised template inspection report the ACCM will use in future to document review of medical schools in the area of active learning and independent study skills, and a completed inspection report using the revised template, once available. [Curriculum, Question 4] -- The NCFMEA may wish to see the revised template inspection report the ACCM will use in the future to document review of medical schools in the area encouragement of and support for service-learning activities, and a completed inspection report using the revised template, once available. The NCFMEA may wish to review a completed annual database report using the 2018-2019 format, once available. The NCFMEA may wish to request information documenting the request for and review of information in this area in the self-study report template and in a completed self-study report. [Curriculum, Question 5] -- The NCFMEA may wish to see the revised template inspection report the ACCM will use in future to document review of medical schools in the area of supporting disciplines, and a completed inspection report using the revised template, once available. The NCFMEA may wish to review a completed annual database report using the 2018-2019 format, once available. The NCFMEA may wish to request information documenting the request for and review of information in this area in the self-study report template and in a completed self-study report. [Supporting Disciplines] -- The NCFMEA may wish to see the revised template inspection report the ACCM will use in future to document review of medical schools in this area, and a completed inspection report using the revised template, once available. The NCFMEA may wish to review a completed annual database report using the 2018-2019 format, once available. [Ethics, Question 1] -- The NCFMEA may wish to request more information about how the ACCM uses the data collected on admissions in its evaluation of the medical schools. [Admissions, Recruiting, and Publications, Question 1] -- The NCFMEA may wish to request additional information about what the agency's requirements are for an agreement by the institution with an individual staff member with roles both at the institution and the hospital, rather than an agreement between the institution and a clinical site. The NCFMEA may wish to inquire whether the ACCM reviewed this agreement and for documentation of that review. [Clinical Teaching Facilities, Question 1] -- The NCFMEA may wish to request additional information about how the ACCM’s on-site review provides a thorough comprehensive review of the school which addresses the agency’s standards, in particular in regards to how the on-site inspection reports address all subparts of the agency's standards. [Onsite Review, Question 1]

Staff Analysis


Overview of accreditation activities


Country Narrative

The Medical School of the Americas situated on the island territory of Nevis currently enrols American students on its Medical Programmes, see (Exhibit 20). The University of Medicine & Health Sciences (UMHS) situated on the island territory of St. Kitts currently enrols American students on its Medical Programmes, see (Exhibit 20). To assist with this submission, please see Exhibit 51 for both MUA and UMHS which provides a Lists of Exhibits


Analyst Remarks to Narrative

The ACCM, which is the accrediting body designated by the government of St. Kitts and Nevis, provided a document which stated that 43% of the graduates of the Medical University of the Americas in 2016 were U.S. citizens.


Standards


Country Narrative

The Medical School of the Americas situated on Nevis has been certified by the Office of Federal Student Aid to participate in the William D. Ford Direct Loan Programme, see Certificate (Exhibit 21). Not Applicable – as the University of Medicine & Health Sciences (UMHS) is not yet eligible to participate in the William D. Ford Direct Loan Programme as it currently only meets two out of the three criteria.


Analyst Remarks to Narrative

The ACCM provided a screenshot of a list of schools which included the Medical School of the Americas. It isn't clear from the screenshot, however, what this list consists of, what year it applies to, or the source of this list. The NCFMEA may wish to request documentation of participation in the William D. Ford Direct loan program by at least one school in the country, to include a clear source of the documentation and the year to which it applies.

Country Response

Please see attached further documentation to show that the Medical School of the Americas situated on Nevis has been certified by the Office of Federal Student Aid to participate in the William D. Ford Direct Loan Programme, see Certificate (Exhibit 21). We also attach updated Exhibit Lists to assist (Exhibit 50 & 51).

Analyst Remarks to Response

In response to the draft staff analysis, the agency provided the Medical University of the Americas Foreign School Program Participation Agreement (exhibit 21) which shows an approval expiration date of March 31, 2020. The Medical School of the Americas appears in the 2019-2020 Direct Loan participating institutions list found at https://ifap.ed.gov/ifap/fedSchoolCodeList.jsp. The publicly available database of participating schools is uploaded below (1920FedSchoolCodeList).


Staff Conclusion: Comprehensive response provided