Howard U. Programs Lose Accreditation

[Jattdoc]

Hey everbody, I just ran across this article on the washington post website. You can also read it at.

<a href="http://www.washingtonpost.com/wp-dyn/articles/A54599-2002Jun14.html" target="_blank">http://www.washingtonpost.com/wp-dyn/articles/A54599-2002Jun14.html</a>


Howard U. Programs Lose Accreditation
Hospital Appealing Monitoring Agency's Ruling on Emergency, Pediatric Services



By Avram Goldstein
Washington Post Staff Writer
Saturday, June 15, 2002; Page A08

The agency that supervises the nation's graduate medical education system has revoked the accreditation of residency programs in emergency medicine and pediatrics at Howard University Hospital.

If the rulings by the Accreditation Council for Graduate Medical Education withstand appeals by Howard, the number of resident physicians treating emergency patients and children at the hospital on Georgia Avenue NW will drop sharply beginning July 1, 2003, and fall to zero a year later.

Hospitals cannot employ residents in unaccredited programs.

Without the 66 residents working in the emergency and pediatric departments, the hospital would have to reorganize and find attending physicians to replace them. Howard has one of the city's busier emergency rooms.

Officials from the Chicago-based accreditation council said confidentiality rules preclude them from detailing what led to their actions, but they said the revocations could not come without years of warnings.

Howard officials, including university President H. Patrick Swygert, declined to comment. In a written statement issued late yesterday, the hospital said it is appealing the rulings and addressing the accreditors' criticism.

"We are confident that the accreditation for these programs will be restored," the unsigned statement said. "Our goal remains the full and unqualified re-accreditation of these programs."

The appeal schedule calls for a February decision.

Residents are new physicians in postgraduate training in their chosen specialties. They generally work long hours treating patients under the supervision of attending physicians.

Hospitals pay residents relatively low salaries -- typically $40,000 a year -- while collecting millions in special training fees from Medicare and Medicaid.

Accreditation standards cover all aspects of residency training, including teaching methods, working conditions, scrutiny of patient deaths and evaluation of residents.

Howard has 350 residents in 25 specialty training programs, and a disproportionate number of those programs have been flagged by the accreditation council.

In addition to emergency medicine and pediatrics, the council has placed Howard's anesthesiology, family practice, pathology, radiation oncology and urology departments on probation and given the pulmonary disease program the functional equivalent of probation.

Moreover, Howard's management of all 25 of its programs has been labeled "unfavorable" by the council -- a finding that blocks Howard from launching any new or replacement residency program.

A Howard professor with knowledge of Howard officials' thinking, who spoke on condition of anonymity, said the university has hired consultants to fix long-standing residency program problems and help pursue the appeals. Officials are preparing for the worst in case the appeals fail, the professor said.

"You've got to always have a contingency plan, and they've shifted into that mode," the professor said.

Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation's doctors are black.

Few white physicians show much interest in treating patients in African American neighborhoods, so the action is insensitive, said the second professor, who is black.

David Leach, the council's executive director, rejected that argument.

"We refuse to accept the idea of lowering standards because they don't have resources," Leach said. "The message behind that is that the indigent of this country really don't deserve first-rate care, so let's develop two standards."

Newton Osborne, a Howard professor who has worked with or overseen obstetrics and gynecology residency programs at four teaching hospitals, including Howard's until several years ago, said the fault lies with Howard's medical chiefs.

"I had personal run-ins with them while I was chairman because I felt they were not doing what they had to do to protect the health and limb of the patients," he said. "Whenever I sent reports about things that were poorly managed, they would sit there for months and years."

Osborne said Howard's leaders assumed that they were immune from council discipline by virtue of the facility being one of only three predominantly black teaching hospitals in the nation.

"I guess the position of the other people is, 'If [the leaders] are not worried, why should we be?' " Osborne said.

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[med student]

That article is pretty scary because it makes it look like the whole hospital is in horrible shape. I would never want to go there as a patient or as a resident when the accredidation board says
"In addition to emergency medicine and pediatrics, the council has placed Howard's anesthesiology, family practice, pathology, radiation oncology and urology departments on probation and given the pulmonary disease program the functional equivalent of probation.

Moreover, Howard's management of all 25 of its programs has been labeled "unfavorable" by the council -- a finding that blocks Howard from launching any new or replacement residency program."

But the worst quotes in the article was
"Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation's doctors are black."

So therefor what he is saying is hey we suck, we know it but don't take away our accredidation because we are black. That might work if he was talking about a fast food joint but it is a hospital where problems in the hospital could end up killing someone. The fact that a professor would even say something like this shows what a horrible state the school is in. I pity the patients and the residents who work at that hospital.

 

[Harry Hood]

That article is pretty scary because it makes it look like the whole hospital is in horrible shape. I would never want to go there as a patient or as a resident when the accredidation board says
"In addition to emergency medicine and pediatrics, the council has placed Howard's anesthesiology, family practice, pathology, radiation oncology and urology departments on probation and given the pulmonary disease program the functional equivalent of probation.

Moreover, Howard's management of all 25 of its programs has been labeled "unfavorable" by the council -- a finding that blocks Howard from launching any new or replacement residency program."

I am a Howard University med student (class of '03). The reply quoted above is exactly why Avram Goldstein's article is nothing more than sensationalized and unfairly damaging. He conveniently ignores the actual reasons why the accredidation commitee pulled the ER and peds programs respectively. The individual who replied did exactly what the author intended readers to do. Based on the article a reader would come to a much exaggerated and incorrect conclusion about the state of care, resident education, and medical student education at Howard. Programs can get pulled for many reasons. Even if one assumes that Howard was much too slow to react to ACGME criticisms, the author does not let the reader have a clue as to why the said programs are in trouble. Like much of the media, Mr. Goldstein then speculates and incorrectly makes the hospital sound like a death trap to readers. The ACGME can fault programs for issues that have nothing to do with resident education and patient care. Issues like call rooms and lack of faculty research can get programs pulled. The pediatric and ER residents are quite good and the attendings are excellent. I do not feel it is my place to discuss what I have been hearing from individuals in the respective departments. If individuals wish to privately discuss HUH, I would be more than happy.

The article quotes anonymous people out of context. Without knowing what the actual issues are the comments presented by anonymous faculty members and Newton Osborne are hollow. There is no constructive information given by the anonymous faculty members 'arguing' (a juxtaposition be Mr. Goldstein) about whether or not the ACGME should have criticized a 'black institution. The race card was pulled by Mr. Goldstein, how constructive. Dr. Osborne is an OB/Gyn faculty member and probably has alot of insight into ways in which the hospital can better itaself. I can assure you it has little to do with the reason why ACGME revoked accredidation of the Peds and ER programs. Again, more yellow journalism.

Furthermore the comment that the individual made about not wanting to get any care at HU is one of the most ignorant comments considering that HUH has been top 50 hospital, particularly in Endocrine and Rheumatology. The chair of Pediatrics, Dr. Jenkins is an author of the adolescent medicine chapter in Nelson's Textbook of Pediatrics. The surgery department at HUH is top notch. With amazing faculty like Dr. Leffall (former president of American College of Surgeons), Dr. Gary Dennis ( Neurosurgeon- top 100 docs in US), Dr. Myers (ENT top 100 docs), and scores more. Dr. Eddie Cornwell, the Hopkins trauma surgeon featred in hopkins 24/7 is a HU med grad, and was faculty at HU before moving to Hopkins. Howard trains excellent physicians and surgeons.

I myself have plenty of criticisms and praises for my school. I could write for pages....If anyone would want an honsest and balanced appraisal of Howard University's programs, speak to residents. If anyone has questions they can contact me---

 

[Sheerstress]

?He conveniently ignores the actual reasons why the accredidation commitee pulled the ER and peds programs respectively?

?I can assure you it has little to do with the reason why ACGME revoked accredidation of the Peds and ER programs. Again, more yellow journalism.?

Harry:

I read the article and then your rebuttal. I still do not have a good idea as to why the programs lost their accreditation, aside from Dr. Osborne?s statements, which appear to reflect patient care issues.

Without going into case specifics, it would be helpful if you could shed some light on what are the actual reasons for the revocation, i.e. are we indeed talking patient care issues (e.g. too many patients sent home with incorrect diagnoses or inappropriate follow-up, insufficient supervision of residents, inappropriate working conditions for residents), or bad politics between the accreditation council and Howard?s administration. Or perhaps a combination of factors, as is often the case in life.

Sheerstress

 

[Harry Hood]

Sheerstress,

I was shocked that the ER program got cited by ACGME. 1) Howard's ER is an inner city ER with probably the highest census in te area. 2) The attendings are very good. 3) The residents seem happy. Since I was doing a trauma surgery rotation at the time I started asking quesitons when the ER got into some trouble. The ER has been overworked and understaffed since the closing of DC General Hospital about two years, I believe. DC General was closed for financial reasons and was a major source of care for the indignt poppulation in DC. To sum it up- ER attendings. are busy and have been slow with research (yes, attending publishing was the main reason cited). I also think that the ACGME was unhappy with the ratio of faculy to resident ratio, given the busy nature of the ER. But the main reason cited ( at least according to residents I spoke with) was research.

Peds- I can tell you this much- I think it is all about Cesnus. Gergetown peds is on probation. Programs in the area are struggling. I do not know about Georgetown's situtation, but with a Children's National Medical Center right around the corner, there may be too many resident positions at HU for th number of patients seen. Peds residents do go to other sites to train (many residencies do this). Again, DC General closing may have to do with the problem too. DC General had a really high census. Admittedly, census is a more serious reason. I can tell you that the peds department has been sending the residents away, to Prince George's county hospital in MD to get the volume of patients. Unfortunately, all participating hospitals in the area with their own residnecy programs are not going to roll out the red carpet for another institution's residents. The funny thing is that most of the peds residents are really good. Some were amazing and I am probably going to do peds (I am thinking med-peds now) b/c of them. Also the attendings actually teach. I did a rotation at Children's Hospital (CNMC) as part of my peds rotation. I loved the patients. I saw alot of rare pathology. In my humble opinion, the teaching I recieved at Howard is better. Now, that doesn't mean that CNMC isn't a great institution. Howard attendings and residents may have more teaching time. The funny thing is that my classmates who stayed at HU had a slightly better handle on bread and butter peds cases than I did. I came back from CNMC with alot of interesting pathology that I may never see again (Sialidosis, a variant of maple syrup urine disease that was misssed on screening, and Barter's Syndrome to name a few). On a resident level I am sure the training is great. In my opinion the residents were not the happiest bunch. The coolest resident I met, who taught me volumes, was actually a FP resident from the military. Still, CNMC is an amazing place. Bottom line- Howard residents are well taught, see a fair share of pathology, and get fellowships at many institutions. Patient's are not dying left and right.

In my humble opinion the main problem with Howard University Hospital is a problem that plagues many urban hospitals. Poor ancillary staff and a particularly impotent hospital administration that is slow to correct problems. These are issues that can render the medical staff of an entire institution helpless. Interestingly, surgery functions quite well despite this b/c of a militaristic style and the ER, Nursery/NICU, SICU, and MICU, CCU all have good ancillary staff. I have some examples that should not be used to completely tarnish the care at the hospital but should illustrate the slow reaction time of the HU administration: 1) Residents busy wheeling a patient down for a chest x-ray because there is no one available. 2) when am labs are just not done on a bunch of floors because a phlebotomist didn't show for work, the team has yet more work regardless of census. 3) Residents get woken up multiple times at night for simple blood draws or IV placement. This will drain even the most underworked resident. 4. One spends more time hunting down films in radiology than looking at them (again ancillary staff). 5. There is no reason why during rounds in the medical ICU that a nurse should have told our team when we asked for a chart and some supplies at 7:15 am, "I hope you remember I do get off shift at 8 o'clock!" 6. a medical student asks a question of a nurse politely. The nurse does not look at him, turns to her colleauge an says, "I hope he did not ask me a question five minutes before I get off shift! And you can tell him I don't care if I get a write-up. They can't fire me anyway!" (Unions can sure be corrupt too.) 7. an HIV PCR test getting "lost" after a nurse in the surgical ICU ( another place with GREAT ancillary staff, residents and attendings, by the way) gets a needle stick. The test comes up very clearly on the computer but no one can figure out where the test was sent to be processed. 8. a collegue of mine sees a nurse from Howard working another job at a second hospital exhibiting NONE of the bad attitude and laziness she displayed at HUH.

These are all examples that may plague other institutions, I am sure. An institution is as good as it's ancillary staff. Howard has plenty of quality folks working there. I have met many dedicated nurses. Ultimately the real issues here tend to be administrative. At hospitals with top notch nursing and ancillary staff the residents, attendings, medical students and most importantly, the patients all benefit. When ancillary staff is weak, residents and medical students pick up alot of slack. I know that HU does not have an out of control morbidity and mortality rate. I have a feeling that ACGME completely ignored this point. The institution wide problems are probably adminisdtrative. There is a certain amount of beuracratic mire that HU seems to wade in and faculty members and chairs of departments seem to have given up the fight long ago.

I can tell you that despite problems residents and attendings in all departments are quite good. Physicians leaving HU are well trained. When 70% of minority physicians in this country have been graduated by HU, the excellent physician treating you, black or white (I am a nice jewish guy), may have been Howard trained (med school or residency). I hope that in the long run that this will be a good kick in the behind for HUH. I do think that Mr. Goldstein's article unfairly attempts to point readers to poor physician training, and poor patient care by PHYSICIANS when the problems cited by the ACGME probably have little to do with patient care. HUH is really important to the residents of DC. Constructinve criticism, and balanced journalism with a tone of "what can be done to aid an important DC institution in trouble..." is preferable to a speculative tone that slanders. Journalists hate tight lips and HUH has a problem that it is not more transparent of an institution. Mr. Goldstein may have a kernel of truth about Howard's difficulties with the ACGME, but I saw a more understanding and balanced tone by journalists when discussing the Clinton White House than I do here. I saw more balanced reporting of when Yale surgery got canned. People were quick to comment that it was ONLY resident hours, and not, heaven forbid, that Yale trains it's surgeons and for that matter all its residents poorly. With Howard it seems as though people jump to unfair conclusions.

 

[Khalid]

Why doesn't this surprise me?

Like most traditionally Black colleges and universities, the educational standards are well below that of mainstream post-secondary educational institutions. Many will be repulsed by this comment, but the pass rates for prfessional school graduates (and teachers) in a number of fields and disciplines sadly, but clearly, back this statement up.

Why is this?

 

[Harry Hood]

Khalid,

Way to generalize about an institution you are not intimately inolved with. Can you show me your data? Or are you working off of anecdotal research....Instead o looking at this as an institutions problems that will be addressed with appropriately, people automatically go into a tirade about the state of traditionally black colleges. How ridiculous. The HU dental school actually almost got it's acrredidation revoked years ago. It subsequently made corrections like any other insatitution and is a great school. Because of comments like the one's you make the medical school bends over backwards to fail students at the drop of a hat. In Georgetown no student can get kicked out for not passing a medical ethics exam. He or she just takes it again. Howard fails people unremorsefully and gives no make up exams. My friend at Boston University said that a majority of his class failed the psychiatry exam in year one, the school just dropped the passing score. At howard a raw score of 71 % is mandatory on exams regardless of the mean. Khalid, don't give me uninformed gobbeldy-gook. Any problems in black medical education are more complex than a quick generalization.

 

[Khalid]

The only tirade on this thread has been by you, Mr. Hood.

Your need to rationalize the inferior education you and many students receive at historically Black colleges and univerities is understandable, but does not obscure the fact that ACGME felt the need to pull HUH's accreditation.

I, for one, am amazed that ACGME had the courage to take this stance in the face of the criticism it was bound to endure due to HUH's status as a traditionally Black school. I'm sure that ACGME thought long and hard before taking this action and did so in what must have been extraordinarily poor conditions at HUH.

I salute ACGME for having the courage to do something seeming so politically incorrect.

 

[Ryo-Ohki]

Data for Harry

<a href="http://www.upenn.edu/careerservices/gradprof/healthprof/healthstats/natmedstatsmcat.html" target="_blank">http://www.upenn.edu/careerservices/gradprof/healthprof/healthstats/natmedstatsmcat.html</a>

<a href="http://www.aamc.org/students/mcat/examineedata/char99.pdf" target="_blank">http://www.aamc.org/students/mcat/examineedata/char99.pdf</a>

 

[Harry Hood]

Ryo-Ohki,

Way to go for presenting me with MCAT data. The data you present has NOTHING to do with passing licensing exams.

Khalid,

I feel that the ACGME needed to do what it had to. If you read my comment, I feel that it will give HU a kick in the behind to address issues. My comment was only expressing dismay at generalizations and biased washington-post articles. I did not say that the ACGME was wrong. As far as feeling inferior to you, I got 10's on my MCAT's, a 232 on USMLE step 1 and I went to Howard gladly. I have criticisms too...PLENTY of them...but the ACGME's actions are not brave. They are just doing their jobs.

 

[Khalid]

Harry, you mentioned that problems with historically Black colleges are more complex than simple generalizations. I'm curious what you think are some of the complex problems with traditionally black colleges.

Your perspective as someone who has attended a historically Black university would be appreciated. I'm very interested in your insights

Thanks in advance.

 

[Ryo-Ohki]

Yes, MCATS have absolutely no correlation with board exam scores. Absolutely nothing. Seriously. Hmm...why do we even have the MCATs?

And if someone presents board exam data, then you'll say board exams have nothing to do with how good of a doctor you are.

*sigh*

 

[med student]

Well if you care Meharry does have a lower pass rate for the step 1 (around 70%, this is what they told me when I interviewed there 2 years ago) compared to the average for US medical schools (greater than 90%). I have to wonder is this because the education is not as good at schools like Meharry or if it is because the students they accept have lower qualifications (undergrad GPA, MCAT, etc) than at other schools. I tend to think it is the later.

 

[Ryo-Ohki]

I wonder how Harry Hood is going to incorporate this new information in his world view.

 

[Harry Hood]

Ryo-Ohki,

I know a tremendous anesthesiologist at NYU who went to Mt. Sinai for medical school. He did not do nearly as well on his MCAT's by today's competative standards, he got C's in major basic science courses like Organic Chemistry and Gen Chem. He is well regarded and is an awesome physician...He would have had a tough time getting into Sinai today... Does that mean he is not a good doc based on his MCAT score. My sister-in-law is an OB/GYN who also had poor scores (by today's standards) and got in during a relatively easy year....she failed a year of med school...managed to get into UCLA Ob/Gyn and is an EXCELLENT physician in southern Cal. She is extremely well regarded by her collegues and patients. MCAT's aren't the best correlation. Licensing matters, but you have to pass those exams to move on....

Khalid,

I can only tell you about Howard University College of Medicine. That is the point. I can only tell you about programs that I have intimate experience with...I cannot tell you about Meharry or any other traditionally black university....Just like I cannot tell you about Yale's program. I do know about Georgetown b/c my wife goes there. About Howard's problems. Well I do not have time right now...will write soon....

 

[Ryo-Ohki]

If MCATS and GPAs are not the best correlations then what other MEASURABLE criteria should we use to help predict who will become a good doctor? What are some better correlations in your opinion? Perhaps these criterion should be used in place of MCATS/GPA.



I know a guy who dropped out of high school. He eventually got a GED, a college degree, a medical degree and became a great doctor. Therefore the variable "dropping out of high school" does not have a significant correlation with becoming a great doctor.
I have no doubt that there are great doctors who scored very low on their MCATs. However, isolated examples are not indicative of a general trend.

 

[med student]

•••quote:•••Originally posted by Harry Hood:
•Ryo-Ohki,

I know a tremendous anesthesiologist at NYU who went to Mt. Sinai for medical school. He did not do nearly as well on his MCAT's by today's competative standards, he got C's in major basic science courses like Organic Chemistry and Gen Chem. He is well regarded and is an awesome physician...He would have had a tough time getting into Sinai today... Does that mean he is not a good doc based on his MCAT score. My sister-in-law is an OB/GYN who also had poor scores (by today's standards) and got in during a relatively easy year....she failed a year of med school...managed to get into UCLA Ob/Gyn and is an EXCELLENT physician in southern Cal. She is extremely well regarded by her collegues and patients. MCAT's aren't the best correlation. Licensing matters, but you have to pass those exams to move on....•••••Your examples are nice and all but there are exceptions to every rule. If you do well on the MCAT and undergrad GPA you are more likely than not to do better than someone who had a marginal scores and GPA.

I will use meharry as an example again their class in general has below average GPA/MCAT scores and they also had below average pass rates for the Step 1. Sounds like a pretty good correlation to me.

 

[Harry Hood]

Ryo,

The Meharry 70% Step 1 data doesn't really have anything to do with the residency programs of HU Hospital...Many resident went to other med schools...

If you want to talk about the Step 1 scores...I will concede that Howard needs to work on their first time pass rate (it is higher than Meharry's)I cannot quite remember what my class did. Step 2 pass rate is in the high 90's. This speaks much more to HUH and the clinical faculty..

 

[Sheerstress]

"Well if you care Meharry does have a lower pass rate for the step 1 (around 70%, this is what they told me when I interviewed there 2 years ago) compared to the average for US medical schools (greater than 90%). I have to wonder is this because the education is not as good at schools like Meharry or if it is because the students they accept have lower qualifications (undergrad GPA, MCAT, etc) than at other schools. I tend to think it is the later."

At my alma mater (Michigan State University College of Human Medicine), the pass rate for NBME/USMLE Part I was in the 70% range for a long time. Our school has a popular baccalaueate program that will grant medical school admission to those who perform at a certain level (I think it is a 3.0). Most of these students complete the program, and often these are students who would or did not get accepted anywhere else. This is something that has been recognized for some time, and I thing it is a good thing to realize that examination scores are not the only way to measure a student's potential to be a competent physician.

The school did have problems with accreditation in the late 80s, partly due to the board pass rate, and in response, revamped the entire second year curriculum from a lecture style to a problem-based learning style. In the first class that went through that curriculum, the Part I pass rate went up to 98% before plateauing in the next classes at around 92%. I think this says a lot for the learning atmosphere and the program's effectiveness.

So I think that problems with performance are usually attributable to a combination of both the school and the students. The school has to do its job and provide competent teaching, while the students have to work hard and perform at an appropriate level. And once the students hit the wards, patient care is and should be the highest priority.

 

[Ryo-Ohki]

•••quote:•••Originally posted by Khalid:
•Why doesn't this surprise me?

Like most traditionally Black colleges and universities, the educational standards are well below that of mainstream post-secondary educational institutions. Many will be repulsed by this comment, but the pass rates for professional school graduates (and teachers) in a number of fields and disciplines sadly, but clearly, back this statement up.

Why is this?•••••Remember, this is the statement we are arguing over, Harry. Khalid went on a tangent of the original thread topic. He made an assumption that Howard's residency and academic programs are intimately related. However, this has nothing to do with our current discussion.
So, no, we are not arguing about the residency program anymore. We are arguing whether or not MCATS and GPAs are the best measurable predictors of good board scores and eventually doctors.

 

[Harry Hood]

Sheerstress,

You are right on....and that is what Howard as a medical school is dealing with right now for the pre-clinical years. They are in the process of revamping the curriculum. The problem with Howard is that it really doesn't take good care of it's students. The student support, is nill. Complaints about the curriculum fell on deaf ears for YEARS... Administrative issues are at the heart of HUCM quagmires. The students for the most part work hard. Howard is VERY hard on it's students and expects alot...Howard us very aware of reputation. HU fails a number of students yearly.....

 

[Harry Hood]

Ryo-Ohki
How do you explain me....I did just ok on my MCAT's was a slacker in college. I did well on the boards. I will tell you that those scores mean nothing to me regarding the type of physician I will become...I almost laugh, because I think they are BS. A good physician is a person who first and foremost CARES for his patient. He/she is never willing to assume a diagnosis and always makes sure to rule out other diagnoses appropriately. A good physician is allowed to be confident but knows that overconfidence (people who are too smart for their own good) leads to patient morbidity/mortality. A good physician always wants to learn more...and never knows enough...

Board scores...well there is some correlation but next time you go to a doctor ask him/her how many points they beat the mean by....do they remember? Does it make the doctor a bad one if they did under the mean on Step 1? Or if they had to repeat Step 1 or Step 2? I certainly do not think so.

 

[southerndoc]

There is one school that I am familiar with which has very low MCAT scores, yet the school's average Step I is in the 220-225 range. Last year, there was 1 person who failed. The three years before that there were none who failed.

Anyone who scores above a 21 on the MCAT is likely to succeed in medical school if he/she puts forth an effort. Yes, those that score in the 40's will traditionally do better, but it doesn't mean that a score of 21 isn't going to succeed.

Why do we have the MCAT? Because it makes the AAMC more $$$. The GRE could just as accurately predict who will succeed.

 

[Goofy]

•••quote:•••Originally posted by Geek Medic:
•There is one school that I am familiar with which has very low MCAT scores, yet the school's average Step I is in the 220-225 range. Last year, there was 1 person who failed. The three years before that there were none who failed.

Anyone who scores above a 21 on the MCAT is likely to succeed in medical school if he/she puts forth an effort. Yes, those that score in the 40's will traditionally do better, but it doesn't mean that a score of 21 isn't going to succeed.

Why do we have the MCAT? Because it makes the AAMC more $$$. The GRE could just as accurately predict who will succeed.•••••I disagree emphatically with arguments that suggest the MCAT is a good predictor of USMLE outcome. I have seen far too many people do poorly on the MCAT and blitz the boards, and vice versa. These two exams test radically different skills. One is a hoop pre-meds have to jump through, another is a licensing exam. They should not be compared in this way.

 

[Goofy]

•••quote:•••Originally posted by Harry Hood:
•Ryo-Ohki
How do you explain me....I did just ok on my MCAT's was a slacker in college. I did well on the boards. I will tell you that those scores mean nothing to me regarding the type of physician I will become...I almost laugh, because I think they are BS. A good physician is a person who first and foremost CARES for his patient. He/she is never willing to assume a diagnosis and always makes sure to rule out other diagnoses appropriately. A good physician is allowed to be confident but knows that overconfidence (people who are too smart for their own good) leads to patient morbidity/mortality. A good physician always wants to learn more...and never knows enough...

Board scores...well there is some correlation but next time you go to a doctor ask him/her how many points they beat the mean by....do they remember? Does it make the doctor a bad one if they did under the mean on Step 1? Or if they had to repeat Step 1 or Step 2? I certainly do not think so.•••••I largely agree with your comments.

I think you go off the deep end by even hinting a licensing exam suggests medical competence. I assure you it doesn't. The USMLE is a memory test that can be beat rather easily.

Step II attempts to correlate clincal scenarios a bit better, but suggesting this test correlates with clinical competence is purblind in my opinion.

There are just too many intangibles in medicine that a multiple choice exam simply cannot test. These exams are meant to determine if someone has requisite knowledge for licensure, not a predictor of clinical excellence. To blur the line is entirely suspect.

 

[Harry Hood]

klebsiella,

I can assure you, that I agree with your comments 100% !! Passing the boards is the predictor of requisite knowledge....being a good physician is alot of hard work, compassion, and compulsive attention to make sure you have not forgotten something critical...

 

[Khalid]

Yes Ryo-Ohki, I did "assume" that HU residency and med school curriculum are intimately related.

I will also assume that because the board pass rate is so low (forget, MCAT scores!) at traditionally Black Medical Schools that there are many students there who don't belong in Med. School, but are there for social engineering purposes.

Of course, this says nothing about the quality of education at these schools, but...

How's that for turning up the volume on this discussion?

 

[Ryo-Ohki]

MCATs have a significant positive correlation with board scores. This is fact and easily verifiable given the unambiguous origin of the two variables. Many studies have published data on this correlation.

However, even if we pursue and prove this point, detractors will always argue "X is not indicative of one being a good doctor". The variable of "good doctor" is unclear and hard to measure. Many studies offer that supervisor reviews are equivalent to being a good doctor. However this variable has too many interpersonal human factors to be an equivalent (ie: a 43-45 MCAT, perfect board resident is given bad reviews....because he stupidly tells what his supervisor is doing wrong). I do not think the variable of being a good doctor can be resolved this easily. I personally think that a good doctor is someone who extends/improves his patients quality of life. Some people think a good doctor is someone who cares.
Who's right?

Hence, we have to go by board/MCAT.

•••quote:••• A good physician is a person who first and foremost CARES for his patient. ••••Assuming this is a mark of a good doctor....Great. Now tell me how do we measure this. Perhaps we should scrap all MCATs, GPAs, and board scores and just ask prospective students how much they will care for their patients.

We have set defined achievable goals for prospective students (MCAT, GPA, volunteer, research). Tell me, if the MCAT/GPA criterion are so bad, what do you want to replace them with?

 

[Dr. MAXY]

I didn't want to be part of this debate, but I couldn't help it. Some of you kept saying Howard this, Meharry that. At the same time some of you are saying stuff like "they told me they have a low USMLE pass rate, when I interviewed there". If you guys think this schools sucks, then WHY DID SOME OF YOU APPLIED and EVEN WENT TO INTERVIEWS THERE. If you really considered those schools, then there must be something you liked or something great out there.

There are other medical schools around the world that are below Howard and Meharry's standards, and some of those schools accepts people with MCATS of 16, 17 etc. I know some smarty pants will say oh well that's irrelevant because those schools are not in the US. But hey most of their gradutes comes to the US to practice.

And will you guys quit that generalizations about Historical black schools. Howard, Meharry and other Black medical schools were created to give minorities a chance to be educated, because most predominatly white schools wouldn't give them a chance. Most of the graduates from Howard and Meharry Medical schools go back to their respective neighborhoods to practice, and that is really GREAT. I personally do not care if they have the lowest MCAT Scores or the Lowest pass rate. Most of them are great doctors to their people.

My point is, ALL YOU SPOILED BRATs WOULD NOT EVEN STEP IN THE GETTOS OR BLACK NEIGBORHOODS FOR A SECOND, YET ALONE PRACTICE IN THOSE PLACES.
SO if you brats won't do so and others are doing so, must it matter whether they have high board scores? As long as they pass those stupid boards and become good doctors, that's all that matters.

Just my $0.02.

 

[Hornet871]

I agree that MCAT scores generally correlate with USMLE scores, and vice versa, if for no other reason than the evidence Ryo-Ohki cited: that schools whose students have higher MCATs tend also to have the highest pass rates & scores on USMLE.

That being said, however, there is a good deal of anecdotal evidence that corroborates what Klebsiella said, namely, that MCAT scores do not predict USMLE scores - due, in large part, to the exams' testing different sets of skills.

To cite but one anecdotal nugget, I absolutely murdered the MCAT - 14's sciences, 13 verbal - but only scored around the mean on Step 1. I hardly studied for either.

Aside, since the parentheses keys aren't workig: Another David Green in the room would like me to inform you that he did very well on Step 1 - but I'd like to tell you that he got a measly 34 on the MCAT.

Conversely, an acquaintance of mine at med school scored 236 on Step 1 but only had a 23 MCAT.

Another aside: How does one get accepted to med school with a 23? Before you jump to any conclusions, lemme tell ya that this kid's WHITE.

In fact, I know handfuls of people at my school who scored &lt; 30 on the MCAT -

aside: what kind of crappy med school am I at? you and I are both wondering -

but scored in the 2-teens or 220s on Step 1.

So there most definitely are gobs of anecdotal evidence that people who do poorly on the MCAT can kick the USMLE's and med school's butt. I think this is b/c the MCAT tests memorization skills far less than med school classes and the Steps do. I have no idea why the MCAT, which is based more on reasoning than are the Steps, is used as a predictor of medical school success.

Aside: Being good at physics won't do **** for you in med school. I know *****s who can't add or subtract to save their lives who are at the top of my med school class.

Still, people who are smart AND hardworking tend to do well on the MCAT and on the USMLE Steps. As Klebsiella posted earlier, students at Ivy League med schools tend to be shrewder*

*I don't remember if that was the exact word he used

but not necessarily brighter, than those at other schools. Similarly, if someone is gung-ho by age 20 about becoming a neurosurgeon and is smart enough to make it, he/she will do what it takes to get the proper scores on MCATs, USMLEs, and obtaining recs, etc., while other students may be equally smart but not determined/slick enough.

So I guess that doesn't clear anything up. In the end, MCAT and USMLE are correlative, and, together with grades, leave us with no better meter at present with which to predict medical school success.

As for black students, studies at law schools have found that while they may have been accepted with lower credentials than some of their white and Asian counterparts, once in law school, they perform just as well as others. What Ryo-Ohki and others have posted seems to indicate otherwise about med school.

Keep in mind that Howard does not necessarily represent ALL black medical students in America. It is only a segment. There are blacks at every med school in the country, incl the most prestigious ones. One might even argue that Howard represents the lower end of black students; i.e., those who could't gain admission to better schools. This is open to debate, obviously, and I'd appreciate any input from Harry Hood or others who have more insight on this than I.

Then again, a poster earlier noted that 70% of minority docs in the U.S. are from Howard, so perhaps it IS an indicator of black med students in America overall.

Hey, let's keep this civil, boys. :wink:

 

[Hornet871]

hey,

sorry for the annoying format - but not annoying content - of my last post. whenever i put something in parentheses, my post is not accepted. i get an error message saying that parentheses in the html tag are not allowed. so i have to go back and erase the parentheses and replace them with "aside: " and asterisked pseudo-footnotes*.

*lemme know if any of you have encountered this problem.

 

[med student]

•••quote:•••Originally posted by Dr. MAXY:
•I didn't want to be part of this debate, but I couldn't help it. Some of you kept saying Howard this, Meharry that. At the same time some of you are saying stuff like "they told me they have a low USMLE pass rate, when I interviewed there". If you guys think this schools sucks, then WHY DID SOME OF YOU APPLIED and EVEN WENT TO INTERVIEWS THERE. If you really considered those schools, then there must be something you liked or something great out there.
•••••Fact is the only reason I applied to Meharry is because it is an MD school in the US. I would have been willing to go to a less than ideal school to stay in the US. Fortionately I didn't have to go there because the school does have other issues such a lack of funds.

 

[vhl]

Let's not forget that many minority students come from less than ideal academic backgrounds (of course, that will all be fixed once George Bush leaves no child behind...). I'm not a big proponent of affirmative action or quotas, but if you are comparing a rich kid who's gone to private school, Ivy league college, and had all the Kaplan classes ever invented, against a kid from the inner city who had few AP classes, huge class sizes, who went to a big public college and had to do work study in addition to classes and the MCATS, I think you have to cut the poor kid some slack. They may never learn the test taking strategies necessary to kill the boards (or be able to afford the Kaplan lecture series), but remember that unless you want to do ENT or Ortho or someother superselective specialty, the actual score doesn't matter-you just have to PASS.
I look at so many people on this board who have bad grades, or low MCAT scores, and people are usually supportive, advising them to shadow, or do research, or whatever to improve their chances. I think many of the people here (including me!), would have had a much harder time getting into med school if the ADCOMS had just looked at MCATs and GPA. Why should that be different for an historically Black med school? It sounds like what they need to do is figure out how to improve the curriculum so that the USMLE passing rate improves.

 

[Harry Hood]

Thank you very much, vhl. Like any other school. Howard is working on increasing the Step 1 pass rate by revamping it's curriculum. About the Junior year at Howard: Surgery and Medicine are really good departments (and I really dislike surgery). I am finishing medicine and am amazed at the variety of pathology I have seen. Like any institution the teaching depends on which individual residents and attendings one ends up with. Sometimes you can end up with a board score wiz going into radiology who doesn't want to teach, hates medicine and scuts you. Therefore, much of my learning comes directly from my patients and my handy dandy references if my residents and attendings do not have the same enthusiasm that I have. This is certainly true of most places.

 

[Goofy]

Ryo-Ohki said:

•••quote:•••MCATs have a significant positive correlation with board scores. This is fact and easily verifiable given the unambiguous origin of the two variables. Many studies have published data on this correlation.
••••I think there is a tremendous amount of ambiguity with these two variables. Further, there are equal number of studies that debunk the myth that MCAT success predicts stellar USMLE performance. Don't get confused with the 'correlation' argument. It doesn't hold water in my book. Most people in my class wear brown shoes, drink until they are piss drunk. Yet they achieved academic excellence as undergrads, warranting acceptance to an ivy league med school. Is it feasible to suggest alcholics who like brown shoes are more likely to gain acceptance to med school?

•••quote:••• However, even if we pursue and prove this point, detractors will always argue "X is not indicative of one being a good doctor". The variable of "good doctor" is unclear and hard to measure. ••••I try to stay away from the label 'good doctor' as this term too is steeped in ambiguity. What does it mean exactly? A more important attribute to evaluate is clinical excellence, a term more amenable to a meaningful definition.

•••quote:••• I personally think that a good doctor is someone who extends/improves his patients quality of life. Some people think a good doctor is someone who cares. Who's right? ••••Exactly.

•••quote:••• Hence, we have to go by board/MCAT. ••••Nonsense. The MCAT is largely a corrupt entity that leaches money from poor pre-meds. They are a virtual monopoly, with a test that does little if anything to determine med school viability. It is a whimsical hurdle placed before pre-meds to make an unmanageable applicant load easier to handle. That is all.

The board exam is a licensing exam. It was never EVER designed to stratify and determine clinical excellence. In fact the USMLE has been extremely vocal to this end. This is precisely why the USMLE eliminated percentile scores, something they have wanted to do for a long time. They have also fought tooth and nail to eliminate any kind of score at all, making the exam pass/fail. In this way, the exam scoring system would reflect precisely what it was designed for; licensure. The only reason any kind of score remains at all, is because of short-sighted insistence of program directors. The exam will likely become pass/fail in the not too distant future.

•••quote:••• Assuming this is a mark of a good doctor....Great. Now tell me how do we measure this. Perhaps we should scrap all MCATs, GPAs, and board scores and just ask prospective students how much they will care for their patients. ••••I think there is a terrible need to review how students are stratified. There are some excellent tools avidly being used already, like clerkship scores and evals. If a standardized test must be used, a new one must be written.

•••quote:••• We have set defined achievable goals for prospective students (MCAT, GPA, volunteer, research). Tell me, if the MCAT/GPA criterion are so bad, what do you want to replace them with? ••••If I really wanted to predict medical school success, I would probably make undergrads take an exam that focuses on the actual skills necessary to excel in med school. Exams that test memory skills would be an excellent place to start.

The argument that 'we don't have anything else' rings hollow to my ears. If it's broke, lets fix it!

Of course I am not nearly as passionate about this lobby as it may appear. Certainly there are more worthy endeavors to invest energy into, like the fact that a bus loaded with children was viciously attacked by terrorist thugs today. I do think arguments that suggest MCATS and USMLE scores predict clinical excellence is nonsense.

YMMV

K.P.

 

[Noeljan]

Hi
I just have a comment to make, so people are saying that many black kids come from disadvantaged background, well so do many white,spanish, or asian kids. One of my best friends was adopted at 12 years old from china after being an orphan. She then had to struggle with a new country, new language, a new family everything. She then worked hard to grad the top of her(our) high school class and went on to Cornell. She was not given anything easier in the app process.
I also have to say many other people, such as myself come from the "inner city"
And no I am not yet a resident or a med student, I am trying to be. But I think people further contribute to stereotypes when they make such as a matter of fact statements.
BTW I also have a very close sorority sister who is black and has plenty of money to go around.
Ok that's all
Oh and I am also wondering, this is a question: If there are so many other things that should be considered(which I do agree with) would you not agree then that many other non black students who do not make the cut offs should also be given a chance based on their compassion?????
Thanks and I don't mean to offend anyone, but I had these thoughts and wanted to share.

 

[UI2003]

Ok I admit it, I'm a spaz....I created a completely new topic trying to post here so I might as well do it right (ignore the new topic out on the main board):

Can someone who actually attends Howard Medical school (right now!) comment *factually* about the Surgery Residency and its status? Up and coming M4s would really appreciate it Thanks!

 

[med student]

•••quote:•••Originally posted by Noeljan:
•Hi
I just have a comment to make, so people are saying that many black kids come from disadvantaged background, well so do many white,spanish, or asian kids. One of my best friends was adopted at 12 years old from china after being an orphan. She then had to struggle with a new country, new language, a new family everything. She then worked hard to grad the top of her(our) high school class and went on to Cornell. She was not given anything easier in the app process.
I also have to say many other people, such as myself come from the "inner city"
And no I am not yet a resident or a med student, I am trying to be. But I think people further contribute to stereotypes when they make such as a matter of fact statements.
BTW I also have a very close sorority sister who is black and has plenty of money to go around.
Ok that's all
Oh and I am also wondering, this is a question: If there are so many other things that should be considered(which I do agree with) would you not agree then that many other non black students who do not make the cut offs should also be given a chance based on their compassion?????
Thanks and I don't mean to offend anyone, but I had these thoughts and wanted to share.•••••Your right but you will have a hard time geting most people admit it because then people lose one of the big excuses for keeping AA.

 

[Ryo-Ohki]

No, medstudent, we're all

•••quote:••• SPOILED BRATs (that) WOULD NOT EVEN STEP IN THE GETTOS OR BLACK NEIGBORHOODS FOR A SECOND, YET ALONE PRACTICE IN THOSE PLACES.
••••

 

[vhl]

•••quote:•••Originally posted by Noeljan:
•Hi
I just have a comment to make, so people are saying that many black kids come from disadvantaged background, well so do many white,spanish, or asian kids. One of my best friends was adopted at 12 years old from china after being an orphan. She then had to struggle with a new country, new language, a new family everything. She then worked hard to grad the top of her(our) high school class and went on to Cornell. She was not given anything easier in the app process.
I also have to say many other people, such as myself come from the "inner city"
And no I am not yet a resident or a med student, I am trying to be. But I think people further contribute to stereotypes when they make such as a matter of fact statements.
BTW I also have a very close sorority sister who is black and has plenty of money to go around.
Ok that's all
Oh and I am also wondering, this is a question: If there are so many other things that should be considered(which I do agree with) would you not agree then that many other non black students who do not make the cut offs should also be given a chance based on their compassion?????
Thanks and I don't mean to offend anyone, but I had these thoughts and wanted to share.•••••Notice that I (intentionally) didn't mention "Black" specifically anywhere in my post, except in reference to historically Black colleges, which was the subject of the original post. My example would apply to comparing a rich Black kid from Exeter to a poor White kid from the inner city. It's the opportunity that matters, not the color.

 

[MacGyver]

I just love this little tidy section of the article:

"Another Howard professor who spoke on condition of anonymity said the council should not have acted so strongly against the emergency and pediatrics programs because it destabilizes a black medical institution when fewer than 4 percent of the nation's doctors are black.

Few white physicians show much interest in treating patients in African American neighborhoods, so the action is insensitive, said the second professor, who is black."

As for the first statement, what exactly does this source want the accreditation people to do? Have 2 separate criteria for accreditation and give them special privileges JUST because its a predominately black institution? I thought "separate yet equal" accreditation schemes and guidelines was deemed inherently UNEQUAL? I doubt this source would deem "separate yet equal" schools as fair, yet he/she is willing to endorse such a proposal for hospital systems? Its one of the most two-faced arguments I've ever heard.
I guess predominately black institutions should just get a free pass to do whatever they want since they are in the minority.

As for the 2nd statement, I must say that I agree with part of it. It is true indeed that white doctors tend not to treat black patients. But NEWSFLASH! thats true for EVERY SINGLE ETHNIC GROUP. Data shows that black doctors prefer black patients, white doctors prefer white patients, asian doctors prefer asian patients, etc. I'm sick of hearing this stereotype that ONLY white people have racial preferences for treating their own yet all other races are perfectly universal and willing to treat anyone. Thats a crock of BS. All races tend to self-segregate to their own ethnic groups. Its just as true for black doctors as it is for white doctors.

 

[dknykid1980]

Wow, this thread has really gotten pretty interesting.

Anyways, just to let you know I had interviewed at Howard rather recently. It is my understanding that now Howard will implore PBL (problem based learning) starting with last year's class. The reason..I was told that the LCME is now moving towards standardizing this sort of curriculum throughout all US schools. Why? Well, PBL will most likely flatten the playing field, all schools will be equal.

Also, i had an interview with a prof at Finch a couple of months ago. He had personally shown me some data attained by the AAMC showing how high MCAT scores do not correlate with success in med school. Interstingly, one's GPA correlates with success in med school. AND there is NO correlation with MCATs and USMLEs. WHY ? ok, well I was seriously considering going to a caribbean med school (generally thought to have people with low MCAT scores, but thats changing) and almost everyone gets a residency. A lot of caribbean schools have a 90% (well St. George's and Ross) pass rate. If that's the case how do you explain low MCAT scores with high pass rates???

Generally, it is my understanding that one's USMLE pass success is directly proportional with how much time and effort the INDIVIDUAL puts forth.

If you are still not convinced, why do you think US NEWS stopped Ranking med schools. Now they only rank residency programs etc. It was because med schools complained that there was no way to rank med schools, a lot has to do with the INDIVIDUAL. Like Dr. Hood stated, there are great profs at Howard regardless of the fact that it is a TRADITIONALLY black institution. And yes, like Dr. Hood, I'm not African American either. Sure, Howard has a great percentage of AA but not everyone is AA. In addition, after my visit there I found that both the facult and students (yes, AA's included) were among the nicest and caring individuals I've met.

later

 

[dknykid1980]

Ok and also how does one justify say FINCH or MCP theyre are both med schools with lower MCAT scores and GPAs. Does anyone attack them? NOpe, why because they're not traditionally black schools (rather traditionally jewish schools)? DO you see the double standards my friends?

 

[Ryo-Ohki]

Yes, why did usnews stop ranking medical schools?

They only rank residency programs now, you say?

 

[dknykid1980]

sure.

but it still doesnt discredit the fact that just because HU accepts or has accepted more blacks its an inferior school. And it doesnt discredit the fact that a low MCAT correlates to a low USMLE score.

Cheers

 

[njbmd]

Hi there folks,
First of all, no medical school passes boards, you as a person will pass or fail the boards. It's doesn't matter if the school pass rate is 99%-98% if you are in the 1%-2% that fails.

Second, while two of the residency programs lost accreditation, the medical school just came through the LCME accreditation process with flying colors. Go the the LCME website and check that out. The residency programs loseing accreditation through ACGME really have nothing to do with the medical school being accreditated through LCME.

Third, Howard does not and is not implementing PBL. They have had an elective PBL but their curriculum is not PBL. What they did change is from a classical curriculum to an integrated curriculum, much the same as the curriculum at GWU and Hopkins. The new curriculum has been in place for two years now. The class of 2005 will be the first class to take USMLE Step I under the new integrated curriculum.

Fourth, many residency programs are on probation by ACGME. Yale's surgery program just lost accreditation but the medical school is not affected. The folks that are affected are the people who are in that particular residency program.

Finally, people from Howard matched at Hopkins, Tufts, University of VA, Mayo Clinic, UC, Yale, GWU, GT, Stanford , Cleveland Clinic and other good residency programs this year. If Howard was such a horrible school, how do you explain that people who graduate from Howard are able to match well?

You can sit back and argue MCAT scores and entering GPAs if you like but the bottom line about any medical school is that your performance is in YOUR hands. The quality of the medical school that DOES NOT accept you is meaningless. The quality of the medical school that you attend is meaningless if you perform poorly. You can look at all the rankings and scores and averages but the bottom line is that the only numbers that count are the ones on YOUR transcript.

 

[wake up sir your surgery is over]

1. VHL, you need to wake up son. I can only assume that you are either pre med or 1st or 2nd year. What you make on the boards has everything to do with which residency program you go into. Residency programs like to select people who will comfortably pass the liscencing exam for that partticular specialty. What is the greatest predictor of that, scores on past liscencing exams. So don't fool any naieve pre clinical students into thinking that what they make on the boards does not matter. I am going into peds, traditionally one of the least competitive programs and there are programs that will not interview people with board scores below 220.
Ultimately your ability to practice medicine depends on your ability to pass a written exam for certification and then be re-certified every 7 to 10 years, so don't give me this bedwetting liberal socialistic bull#@$% about board scores not meaning anything.

2. Board scores create competiton, competition is good. Competition is essential in creating anal-compulsive extremely bright physicians. Competition to get into med school is part of what makes it so sacred and revered to be here. As a resident you will be in competition for fellowships, as a fellow you will be in competition for a job in a desireable area if you want to live in a big city. As a doctor you will be in competition for patients. Competition is a beautiful thing. It rewards excellence.

I hate people who use anecdotes to prove a point. Peter Jennings dropped out of high school, so should we drop the requirement of a high school diploma to be news anchor at ABC.

Trivializing others accomplisments is the sign of a sore loser. When I meet people who did better on boards than me, I just say congratulations and good luck, I don't tell them that, "well, it really doesn't mean anything."

 

[docmanphilly]

Hey njbmd ---

Fourth, many residency programs are on probation by ACGME. Yale's surgery program just lost accreditation but the medical school is not affected. The folks that are affected are the people who are in that particular residency program.

When did Yale's surgery program lose accreditation? I thought it was just on probation until they straightened out the work hours situation. <img border="0" title="" alt="[Eek!]" src="eek.gif" />