Future of MUN internal medicine program at stake following Royal College review

A review has found serious issues within Memorial University's internal medicine training program, calling into question the program's future.

Dean of Medicine confident standards can be met ahead of 2019 accreditation review

The Internal Medicine program at MUN's Faculty of Medicine is under review, following a notice of intent to withdraw accreditation issued by the Royal College of Physicians and Surgeons of Canada. (Memorial University)

A review has found serious issues within Memorial University's internal medicine training program, calling into question the program's future.

CBC News has learned the faculty of medicine at Memorial received a notice of intent to withdraw accreditation from its internal medicine program from the Royal College of Physicians and Surgeons of Canada (RCPSC) in late April, following a review it conducted in the fall of 2016.

The college is the national organization that awards accreditation for speciality medical programs in Canada.

Residents enrolled in MUN's internal medicine program work closely with physicians in St. John's to learn how to practise medicine and tackle the wide variety of illnesses that affect adults.

In a letter obtained by CBC News, the college listed several weaknesses, including a lack of space for teaching and a lack of timely feedback for residents after clinical teaching rotations.

The Dean of Medicine at Memorial University says it's "not an option" for the program to lose accreditation. Dr. Margaret Steele said the school is confident it will successfully pass an external review in 2019. (Eddy Kennedy/CBC)

The college also noted issues that remain involving harassment and intimidation between faculty members and residents and a setup that gives residents "excessive levels of of professional responsibility that are disproportionate to their level of training, competence, and experience."

Following the notice, the university will have two years to respond to the organization's concerns before an external review is conducted in 2019.

It's an opportunity for us to really enhance the internal medicine program.- Dr. Margaret Steele

If the school fails that review, the internal medicine program will lose accreditation, something Dean of Medicine Margaret Steele says is not an option.

"We have 24 months to enhance the program and address the weaknesses, so we are confident that we'll be able to ensure that we get our program meeting all the standards for royal college accreditation," she said.

School still has full accreditation

Steele stressed that the school still has full accreditation and faculty members are already taking steps to address the college's concerns.

"The important thing is it's an opportunity for us to really enhance the internal medicine program," she said. 

Many of the residents in the internal medicine program work in the Health Sciences Centre in St. John's. (CBC)

In a memorandum sent Tuesday obtained by CBC News, Steele outlined the university's plans to make sure it passes the external review.

"To correct the issues highlighted, we will need the involvement and collaboration of residents, faculty and staff, leadership of the discipline, and leadership of the faculty of medicine," she wrote.

Steele told CBC News the university is working to address concerns about excessive levels of professional responsibility.

"Part of our plan will be talking to the faculty and working with the faculty around appropriate supervision for the various levels of residents. In addition, oftentimes more senior residents will also supervise more junior residents.

"We'll also be engaging our faculty development program here at Memorial, so they'll also be doing faculty development around giving appropriate feedback, teaching tips at the bedside, those types of things."

Past history of intimidation and harassment

Steele said the concerns about intimidation and harassment within internal medicine is something the university takes very seriously.

"Prior to the survey coming, we developed a robust assessment of faculty, and in fact it's cited as a strength."

She said residents are able to assess faculty members, and if their concerns escalate, the internal medicine discipline chair will meet with the faculty member in question.

"I've asked Dr. Tanis Adey who's a psychiatrist and an expert in professionalism to lead a group to review our practices and policies."

Students become residents following the completion of a four year (in some cases three year) undergraduate medical program. (Wikimedia)

Steele has asked Adey to come up with a list of recommendations to ensure the faculty of medicine maintains a culture of professionalism throughout all its programs.

Residents' association responds

Dr. Aarun Singh Leekha is a third year psychiatry resident at MUN and president of the Professional Association of Residents of Newfoundland and Labrador.

He said that while he can only speak to his own experience as a resident within the internal medicine department for two months, it was a challenging time with excellent teachers.

Dr. Aarun Singhleekha is hopeful that the notice of intent to withdraw accreditation will push MUN to pool resources and tackle the internal medicine program's weaknesses. (Mark Quinn/CBC)

He's not worried about the program losing its accreditation.

"Currently the residents in the program are still being sufficiently and proficiently trained in internal medicine. They are not concerned that there's any negative outcome following the intent to withdraw."

Thirty-three residents are currently enrolled in MUN's internal medicine program and 17 more are expected to enter the program in July.


Andrew Sampson is a journalist with CBC in Halifax.