This privileged communication
is the property of the
Committee on Accreditation of Canadian Medical Schools
TEAMREPORT
OF THE
SITE VISIT OF
UNIVERSITY OF ?????
FACULTY OF ?????
City, Province
DATE
PREPARED BY AN AD HOCSITE VISIT TEAM
FOR THE
COMMITTEE ON ACCREDITATION OF CANADIAN
MEDICAL SCHOOLS
AND THE
LIAISON COMMITTEE ON MEDICAL EDUCATION
1
TABLE OF CONTENTS
Page
Memorandum...... 1
Site Visit Team Composition......
Acknowledgement......
Disclaimer......
Final Site Visit Team Element Rating Summary Table......
Summary of Site Visit Team Findings......
History of the School......
Accreditation History of the School......
Curriculum Description......
Key Parameter Overview Summary Table (last full visit vs visit)......
Evaluation of the DCI......
Evaluation of the MSS......
Evaluation of the ISA......
Evaluation of the CGQ and AFMC GQ......
Evaluation of Standard 1......
Evaluation of Standard 2......
Evaluation of Standard 3......
Evaluation of Standard 4......
Evaluation of Standard 5......
Evaluation of Standard 6......
Evaluation of Standard 7......
Evaluation of Standard 8......
Evaluation of Standard 9......
Evaluation of Standard 10......
Evaluation of Standard 11......
Evaluation of Standard 12......
COREAPPENDICES
Appendix / Standard / Element / DCI Document / Title / Page No.(in site visit report)
C-1 / Schedule of the visit
C-2 / Medical School Self-Study Element Rating Summary Table
C-3 / Self-Study Taskforce and Subcommittee membership
C-4 / Independent Student Analysis Summary
C-5 / Campus maps
C-6 / 1 / 1.1 / Appendix 1.1 a / The strategic plan executive summary
C-7 / 1.3 / Table 1.3-1 / Standing Committees
C-8 / 2 / 2.2 / Appendix 2.2 a / Dean’s abbreviated curriculum vitae (no more than 4 pages).
C-9 / 2.3 / Appendix 2.3 a / Organizational chart illustrating the relationship of the medical school dean to university administration, to the deans of other schools and colleges, and to the administrators of the health science center and affiliated teaching hospitals (if relevant).
C-10 / 2.3 / Appendix 2.3 b / Dean’s position description. If the dean has an additional role (e.g., vice president for health/academic affairs, provost), include that position description, as well.
C-11 / 2.4 / Appendix 2.4 b / Organizational chart of the dean’s office
C-12 / 3 / 3.3 / Table 3.3-1 / Diversity Categories and Definitions
C-13 / 3.3 / Table 3.3-2 / Students, Faculty and Academic and Educational Leadership
C-14 / 3.6 / Table 3.6-1 / Awareness of Mistreatment Policies Among Students
C-15 / Table 3.6-2 / Awareness of Mistreatment Procedures Among Students
C-16 / Table 3.6-3 / Student Mistreatment Experiences
C-17 / Table 3.6-4 / Student Mistreatment Experiences by Curriculum Year
C-18 / 4 / 4.1 / Table 4.1-1 / Total Faculty
C-19 / Table 4.1-6 / Protected Faculty Time
C-20 / 4.2 / Table 4.2-1 / Scholarly Productivity
C-21 / 5 / 5.1 / Table 5.1 / Medical School Revenue Sources
C-22 / 5.1 / Appendix 5.1 b / An expenditures summary for the fiscal year in which the full site visit takes place (based on budget projections) and for each of the prior three fiscal years. Use the format and row labels from the “Revenues and Expenditures History” from the school’s completed AFMC Canadian Financial Questionnaire
C-23 / 6 / 6.1 / Table 6.1-1 / Competencies, Medical Education Program Objectives, and Outcome Measures
C-24 / 6.2 / Table 6.2-1 / Required Clinical Learning Experiences (Required Patient Encounters and Procedural Skills)
C-25 / 6.3 / Appendix 6.3 a / Schedules that illustrate the amount of time in the first and second years of the curriculum that medical students spend in self-directed learning sessions.
C-26 / 6.4 / Table 6.4-1 / Percentage Total Required Clinical Learning Experience Time
C-27 / Table 6.4-2 / Inpatient and ambulatory patient experience
C-28 / 7 / 7.1 / Table 7.1-2 / Curricular Content
C-29 / Table 7.1-3 / General Medical Education – Curricular content social sciences
C-30 / 7.2 / Table 7.2-2 / General Medical Education
C-31 / Table 7.2-3 / General Medical Education
C-32 / 7.4 / Table 7.4-2 / Clinical reasoning
C-33 / 7.5 / Table 7.5-2 / General Medical Education – Common Societal Problems
C-34 / 7.6 / Table 7.6-2 / Cultural Competence and Health Dispartities
C-35 / 7.7 / Table 7.7-2 / General Medical Education - Preparation for Residency
C-36 / 7.8 / Table 7.8-2 / Communication Skills – Preparation for Residency
C-37 / 8 / 8.1 / Appendix 8.1 a / An organizational chart for the management of the curriculum that includes the ‘curriculum committee’ and its subcommittees, other relevant committees, the undergraduate dean or equivalent, and the individuals or groups with involvement in curriculum design, implementation, and evaluation
C-38 / 8.2 / Appendix 8.2 a / One example from a required learning experience in the first two years and one from a required clinical learning experience illustrating the way in which the learning objectives are linked to the medical education program objectives.
C-39 / 8.4 / Table 8.4-1 / Monitoring of Medical Education Program Outcomes
C-40 / Table 8.4-2 / LMCCQE Part 1 Results of First-time Takers
C-41 / Table 8.4-3 / LMCCQE Part 2 Results of First-time Takers
C-42 / Table 8.4-4 / Adequacy of Curriculum in Preparation for Residency
C-43 / Table 8.4-5 / Overall Satisfaction
C-44 / 8.6 / Table 8.6-1 / Patient encounters and procedural skills
C-45 / Table 8.6-2 / Alternative Clinical Experiences
C-46 / 9 / 9.1 / Table 9.1-1 / Provision of Objectives and Orientation
C-47 / Table 9.1-2 / Resident Preparation to Teach
C-48 / 9.4 / Table 9.4-1 / Observation of Clinical Skills
C-49 / Table 9.4-2 / Methods of Assessment – Year 1
C-50 / Table 9.4-3 / Methods of Assessment – Year 2
C-51 / Table 9.4-4 / Methods of Assessment – Year 3
C-52 / Table 9.4-5 / Methods of Assessment - Year 4
C-53 / 9.7 / Table 9.7-2 / Mid-point Feedback
C-54 / Table 9.7-3 / Mid-point Feedback
C-55 / Table 9.7-4 if appropriate / Longitudinal Integrated Clerkship Feedback
C-56 / 9.8 / Table 9.8-1 / Availability of Final Grades
C-57 / 10 / 10.4 / Table 10.4-1 / Entering Student Mean Performance Data
C-58 / 11 / 11.1 / Table 11.1-1 / Academic Advising/Counseling
C-59 / Table 11.1-2 / Academic Advising/Counseling by Curriculum Year
C-60 / Table 11.1-3 If applicable / Academic Advising/Counseling at geographically distributed campuses and sites where medical students spend six or more consecutive months
C-61 / Table 11.1-4 / Attrition and Academic Difficulty
C-62 / Table 11.1-5 / Attrition and Academic Difficulty by Curriculum Year
C-63 / Table 11.1-6 / Average Graduation Rates Over Five Years
C-64 / 11.2 / Table 11.2-1 / Career Planning Services
C-65 / Table 11.2-2 / Career Planning Services by Curriculum Year
C-66 / Table 11.2-3 / Electives Advising
C-67 / Table 11.2-4 / Electives Advising by Curriculum Year
C-68 / Table 11.2-7 / Residency Match Rates
C-69 / 11.6 / Appendix 11.6 b / A sample MSPR for a recent graduate with good overall performance and a sample MSPR for a student who has experienced difficulty. Personal identifiable information should be removed. Schools with geographically distributed campus(es) should provide data for each distributed campus.
C-70 / 12 / 12.1 / Table 12.1-3 / Financial Aid and Debt Counseling Services
C-71 / Table 12.1-4 / Financial Aid and Debt Counseling Services
C-72 / Table 12.1-7 / Average Medical School Educational Debt
C-73 / 12.3 / Table 12.3-1 / Personal Counseling
C-74 / Table 12.3-2 / Wellbeing Programs
C-75 / Table 12.3-3 / Student Support Services by Curriculum Year
C-76 / 12.8 / Table 12.8-1 / Student Education on Exposure to and Prevention of Infectious Diseases
C-77 / Table 12.8-2 / Student Knowledge of Post-Exposure Treatment
C-78 / Table 12.8-3 / Protocol for exposure to infectious and environmental hazards
SUPPLEMENTAL APPENDICES
S-1NAME of appendix......
S-2NAME of appendix ......
1
MEMORANDUM
TO:Committee on the Accreditation of Canadian Medical Schools
FROM:The Secretary of the ad hoc Site Visit Team That Visited
[Name of School] on [Dates]
RE:Report of the Site Visit Team
On behalf of the ad hoc CACMS Site Visit Team that visited the [Name of School] on [Dates], the following report of the team’s findings is provided.
Respectfully,
______
[Name], Secretary
The schedule of the visit is included in Core Appendix C-1.
SITE VISIT TEAM COMPOSITION
Team Chair:NAMESpecialty
School
City, Prov
Team Secretary:NAMESpecialty
School
City, Prov
Team Member:NAMESpecialty
School
City, Prov
LCME Team Member:NAMESpecialty
School
City, Prov
Student member:NAMESpecialty
School
City, Prov
Faculty Fellow:NAMESpecialty
School
City, Prov
ACKNOWLEDGEMENT
The team expresses its sincere appreciation to Dean [Name] and the staff, faculty, and students of [Medical School Name] for their many courtesies and accommodations during the visit. [Others’ names] merit special recognition and commendation for their thoughtful visit preparations and generous support during the conduct of the visit.
DISCLAIMER: This report summarizes the findings and professional judgments of the ad hoc site visit team that visited the [Name of the University and name of the medical school] on [Month, days, year of the site visit], based on the information provided by the school and its representatives before and during the accreditation visit, and by the CACMS. The CACMS may come to differing conclusions when they review the team’s report and any related information.
FINAL SITE VISIT TEAM ELEMENT RATING SUMMARY TABLE
This table should be completed by the team secretary and verified by the team members.
Site Visit Team CACMS Element Rating Summary Table 2018-2019 [Name of the School]
Standard / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12Element / 1.1 / 2.1 / 3.1 / 4.1 / 5.1 / 6.1 / 7.1 / 8.1 / 9.1 / 10.1 / 11.1 / 12.1
1.2 / 2.2 / 3.2 / 4.2 / 5.2 / 6.2 / 7.2 / 8.2 / 9.2 / 10.2 / 11.2 / 12.2
1.3 / 2.3 / 3.3 / 4.3 / 5.3 / 6.3 / 7.3 / 8.3 / 9.3 / 10.3 / 11.3 / 12.3
1.4 / 2.4 / 3.4 / 4.4 / 5.4 / 6.4 / 7.4 / 8.4 / 9.4 / 10.4 / 11.4 / 12.4
1.5 / 2.5 / 3.5 / 4.5 / 5.5 / 6.5 / 7.5 / 8.5 / 9.5 / 10.5 / 11.5 / 12.5
1.6 / 2.6 / 3.6 / 4.6 / 5.6 / 6.6 / 7.6 / 8.6 / 9.6 / 10.6 / 11.6 / 12.6
5.7 / 6.7 / 7.7 / 8.7 / 9.7 / 10.7 / 12.7
5.8 / 6.8 / 7.8 / 8.8 / 9.8 / 10.8 / 12.8
5.9 / 7.9 / 9.9 / 10.9
5.10 / 10.10
5.11 / 10.11
5.12
Label the number of the element using the following code.
Labeling Code / ColorSatisfactory
Satisfactory monitoring
Unsatisfactory
Delete instructions after completing the tables.
Note: If element 1.1 was rated as Satisfactory, the cell with the corresponding element number would be shaded green as shown above as an example.
(Click the Tables TAB, click on the Shading tool (paint can on the right side of the toolbar) select the green, yellow or red color as needed from the Standard Colors that are below the Theme colors)
SUMMARY OF SITE VISIT TEAM FINDINGS
The following is the Summary of Site Visit Team Findings, linked to elements rated as Satisfactory with a need for Monitoring (SM) or Unsatisfactory (US). The findings are listed in order by the number of the element. Standards where all elements are rated as satisfactory are not listed. Note that the team’s positive observations are not included in the Site Visit Report.
Instruction to the team secretary: See Site Visit Team Evaluation of Elements section D of this guide regarding the formulation of findings. Add rows as needed. Delete the examples from the table.
Element RatingSM, US / Standard
Element number and short title
Finding
Element number and short title
Finding
Examples:
Standard 4
US / 4.4 Feedback to Faculty
Finding: Faculty members in the departments of internal medicine and surgery do not receive regularly scheduled and timely feedback from departmental and/or medical education program or university leaders on his or her academic performance and progress toward promotion and, when applicable, tenure at each campus. This was an area of noncompliance at the time of the last full accreditation visit.
SM / 9.7 Time Formative Assessment and Feedback
Finding: The medical school recently implemented a new system to ensure that:
i. Formal feedback occurs at least at the mid-point of each required learning experience and
ii. Formal feedback occurs approximately every six weeks for the clinical skillscourse that is one year long and for the longitudinal integrated clerkship.
The school provided evidence that the system has been effective for the last 6 months.
HISTORY OF THE SCHOOL
The CACMS Secretariat will provide the brief history of the medical school. Note that campus maps are Core Appendix C-4.
ACCREDITATION HISTORY OF THE SCHOOL
A table listing the standards (now elements) and status of standards (e.g., NC, CM), the type and timing of follow-up and the status of the medical education program since the time of the last full accreditation visit will be provided by the CACMS Secretariat to be inserted here.
CURRICULUM DESCRIPTION
The CACMS Secretariat will insert DCI Appendix 6 a(schematic or diagram that illustrates the structure of the curriculum, and 6 b (new curriculum structure if under revision) and Appendix 6 c (structure of any parallel curriculum if applicable).
Provide a brief description of the design of the curriculum and any parallel curricula by including information from the medical school’s responses to narrative questions from the DCI Overview for Standard 6 a) and b) and by referring to the diagrams and Tables. If a major curricular revision is underway briefly describe the new curriculum. Limit the text in this section to one-half page.
The CACMS Secretariat will insert completed Tables 6.0-1, 6.0-2 and 6.0-3 from the School’s DCI
OVERVIEW DATA
Table 6.0-1
Table 6.0-2
Table 6.0-3
KEY PARAMETERS OVERVIEW SUMMARY TABLE
(Standard 1, Table 1.0-1 This table will be provided by the CACMS Secretariat.
Comment briefly by referring to the table below, on the changes that have occurred between the last full accreditation visit and the current visit related to the number of faculty, students, residents and financial resources. Limit this section to one-half page or less.
The following table compares selected data from the time of the last accreditation visit to information provided for the current visit
EVALUATION OF THE DCI
Comment briefly on the quality, completeness and internal consistency of the information provided in the DCI. Describe the medical school’s response to requests for additional information or clarification of information provided in the DCI. Limit this section to one-half page or less.
EVALUATION OF THE MSS
- Briefly describe the level of participation of faculty, students and various members of the academic community by referring to Core Appendix C-3 Self-study committee membership.
- Describe the quality of MSS evaluation of elements and the Taskforce Summary Statement reflections on current findings.
- Describe the extent to which the MSS Report reflected and incorporated medical student concerns identified in the ISA.
- Comment on whether the MSS Report and DCI accurately portray the circumstances at the school vs. discussions with students, faculty and others at the time of the visit.
- Contrast the site visit team’s findings vs. MSS findings by referring to the MSS Element Rating Summary Table (Core Appendix C-2) and the Site Visit Team Element Summary Table.
- Describe the medical school’s awareness of areas requiring improvement and the extent to which the medical school is taking steps to address deficiencies.
Limit this section to one-page or less.
EVALUATION OF THE ISA
- Briefly describe the level of student participation, the strengths of the medical school and main concerns identified by students that relate to accreditation standards.
- Comment on the utility of the report to the site visit team in evaluating the medical education program.
- Briefly summarize general student opinion of the medical school and of the educational experience it provides, based on the information contained in the ISA and discussions with students during the visit.
- Comment also on the extent to which students believe that they have adequate representation in decision-making bodies that directly affect their education and that their voice is heard on issues of importance to them.
Note that the summary of the ISA is Appendix 4 of the Core Appendix.
Limit this section to one-half page or less.
EVALUATION OF CGQ and AFMC GQ DATA
Comment briefly on the level of student participation in the graduation questionnaire and the use of the CGQ and GQ data by the team in evaluating the medical education program. Limit this section to one-half page or less.
EVALUATION OF ELEMENTS BY STANDARD
For each of the 12 standards, in numeric order, insert the completed element-rating table and element evaluation forms. See instructions on the evaluation of elements in Guide for the Conduct of a CACMS Accreditation Visit.
APPENDIX
1