A hard-hitting and critical report by the organization tasked with defining standards for physician assistant programs nationwide found the University of Toledo severely lacking when it pulled its accreditation earlier this month, citing insufficient faculty, lack of administrative oversight, and insufficient curriculum.
The Accreditation Review Commission on Education for the Physician Assistant in an Oct. 6 letter determined UT’s program “is no longer capable of providing an acceptable educational experience for its students.”
The move came seven months after the accrediting agency placed the program on probation, the first time that has happened since the program’s inception in 1996.
The most striking finding hitting at the heart of the program: “The Program did not provide evidence that the curriculum was of sufficient breadth and depth to prepare the student for the clinical practice of medicine.”
The 27-month program serves about 128 students and for now cannot enroll new students. The current students are eligible to take their certification exams after they graduate because the UT program was accredited when they enrolled, according to the National Commission on Certification of Physician Assistants.
University officials in a statement said they are appealing the decision and listed several examples refuting the agency’s findings.
“We disagree with this decision and are appealing it because we believe the University demonstrated compliance with the accreditation standards,” the statement read.
The commission’s 33-page letter concluded that existing students are unlikely to receive adequate instruction, the program did not have the resources to educate students, and there was “no reasonable expectation of rapid corrective action.”
UT officials refused to release the report for almost a week, then finally emailed a copy to The Blade on Thursday.
The letter details observation from a June 19 site visit, which found, among other things, found that UT did not provide instruction on rehabilitative or palliative care, disease surveillance or reporting, or on helping patients cope with injury and stress. The visit also found issues with the program’s supervised clinical practice experiences, which is where students gain hands-on experience in their field.
Namely, the agency determined UT could not show that all of its clinical experiences effectively prepared students for the real world.
“A few clinical students stated that they believed they had gained only superficial knowledge in some areas because they could not adequately respond to questioning by preceptors on topics which the students felt they should be knowledgeable,” the letter read. “Further, review of the Program’s syllabi showed that a number of courses did not include sufficient instructional objectives to prepare the student for the practice of medicine.”
Another factor cited in the accreditation withdrawal is the pass-rate for the physician assistant certifying exams. For UT’s class of 2012, 100 percent passed on their first try. That number was 95 percent in 2013, 85 percent in 2014, and 92 percent in 2015.
But the first-time pass-rate dropped to 74 percent for the class of 2016, more than 20 percentage points below the national first-time pass rate of 96 percent.
UT officials maintain that 100 percent of their students do pass their certification exams, but some need to take the test multiple times before they do. Officials also contend the university does provide adequate instruction, and said UT has a “proven track record in recruiting, retaining and graduating a significant number of underrepresented minority students” in the program.
“We have clearly demonstrated exemplary classrooms, a world-class immersive interprofessional simulation center, a medical center and expert faculty to educate students at The University of Toledo,” the statement read.
The report by the accreditation team noted that even some “Straight A” physician assistant students at UT did not pass the certification exam on the first try, labeling the 2016 passage rate “very low.”
The accrediting body also took issue with the physician assistant program’s leadership. The report noted that senior institutional officials were not familiar with Linda Jo Dill’s role as interim program director and were not able to say whether she was providing appropriate leadership. At the time of the site visit, there was not a clinical coordinator and there had been no one advising students in their clinical phase, the letter said.
UT hired a clinical coordinator in May, 2017, and since the report Patricia Hogue has been removed as department chairman, but remains on staff as a faculty member. Linda Speer, who also heads the family medicine department, has stepped in as chairman of physician assistant studies.
Dr. Christopher Cooper, vice president for clinical affairs and dean of the College of Medicine and Life Sciences, the former Medical College of Ohio,said the university is “in the final negotiations with a candidate” for program director. When that position is filled, Ms. Dill will remain employed as a faculty member.
Dr. Cooper said the university has been working to fill the program director position permanently well before the accreditation issue, and he disagrees with the commission’s conclusion.
“We feel pretty strongly that at the time of the site visit we did have sufficient faculty to lead the program and we were meeting the standards set by ARC-PA,” he said.
Dr. Cooper said students who applied to UT’s program were notified that the university will not admit a new class, and current students have been kept in the loop.
The university plans to submit its appeal by Nov. 3, a process that will cost at least $5,000. UT is working with a Washington-based law firm, Powers Pyles Sutter and Verville, to craft its appeal. Information about the exact cost was not provided on Thursday night.
“The university is very committed to the success of the students in the program and the success of our students generally,” Dr. Cooper said. “We’ll see how the appeal turns out. I think on the part of the leadership and the faculty, we’re working hard to make sure that the program does well.”
Of the more than 75 UT programs that participate in accreditation processes, the physician assistant program is the only one currently that does not meet the required standards.
Contact Sarah Elms at selms@theblade.com, 419-724-6103, or on Twitter @BySarahElms.
First Published October 26, 2017, 4:17 p.m.
