medical doctor program - nvao

report of the assessment committee

Medical Doctor programwo-master

Saba University School of Medicine

27 March 2009

NVAO | Medical Doctor program, Saba University School of Medicine | March 2009 | page 2

Table of contents

Table of contents 2

1 Executive Summary 3

2 Introduction 5 2.1 The aim of this report 5 2.2 The procedure 5 2.3 Assessment committee Report 6

3 Description of the program 7 3.1 Overview 7 3.2 Profile of the institution 7 3.3 Profile of the program 7

4 Assessment per theme and per standard 9 4.1 Aims and objectives 9 4.2 Curriculum 13 4.3 Staff 18 4.4 Services 21 4.5 Internal quality assurance system 23 4.6 Conditions for continuity 25

5 Overview of the assessment 27

Annex 1: Composition of the assessment committee 28

Annex 2: Schedule of the site visit 30

Annex 3: Documents reviewed 31

Annex 4: List of abbreviations 32


1 Executive Summary Since the NVAO has no legal authority to carry out an Initial Accreditation (Toets Nieuwe Opleiding, TNO) in the Netherlands Antilles, this report does not have the status of an initial accreditation report. This report does, however, assess to what extent the school of medicine complies with the NVAO Initial Accreditation framework. The education at and the organization of the Netherlands Antilles medical schools is closely related to the American educational system and traditions. Since the Dutch accreditation framework differs significantly from the American framework, it would be virtually impossible for the Netherlands Antilles medical schools to be fully compliant with all Dutch accreditation standards. Within the Netherlands and Flanders, there is a clear distinction between higher professional education (hbo) and higher academic (wo) education. Universities in the Netherlands and Flanders, are required to have a much stronger emphasis on the development of scientific competencies of students, than institutes of higher professional education (universities of applied science as they are called in the Netherlands). Similarly, the interaction between research and education and the proven scientific competencies of the teaching staff are higher in academic education. The concept of a “teaching university” is not known in the Netherlands and Flanders. All universities are required to have a strong scientific foundation. Since the NVAO Accreditation Framework is based on a bi-national treaty1 of two countries in which all universities are research universities, the program has been evaluated as if it were a program offered by a research university. If the assessment committee would have the opportunity to evaluate the MD programs in the Netherlands Antilles as programs offered by teaching universities, the assessment reports would show more standards being assessed as satisfactory. Another significant difference between the Dutch / Flemish and the United States medical educational system is that all medical students in the Netherlands and Flanders are educated in the context of a university hospital, enabling both bedside teaching within a hospital setting and scientific research in research laboratories under the supervision of experience researchers. It is not the aim of the assessment committee to assess whether or not the Netherlands Antilles medical schools are comparable to Dutch / Flemish Faculties of Medicine, but only to evaluate to what extent the NVAO standards for higher education are met. To some extent the assessment committee has taken cultural and educational differences into account in coming to its judgments, but only to the extent in which the committee would not be violating the NVAO standards. The Saba University School of Medicine (SUSOM) aims to educate physicians for the US and Canadian medical labor market. The school is very successful in doing so. The major change that the school needs to implement in order to comply with all NVAO standards is the emphasis on science. At wo-master level (as distinct from a professional master program) all students need to acquire scientific skills and understanding by being actively engaged in scientific research. Furthermore the teaching staff needs to be (more) involved in active medical research, thus ensuring that the teaching is done by those who are contributing to the scientific developments in their field of expertise.

1

The official title of this treaty is “Verdrag tussen het Koninkrijk der Nederlanden en de Vlaamse Gemeenschap van België inzake de

accreditatie van opleidingen binnen het Nederlandse en Vlaamse hoger onderwijs”, which could be translated as “Treaty between the

Kingdom of the Netherlands and the Flemish Community of Belgium regarding accreditation of programs within Dutch and Flanders higher

education”.


On almost all other aspects, the MD program has been positively assessed. Almost all NVAO standards have been met. The only other unsatisfactory assessment of a standard is the absence of a formal guarantee to complete the program by the relevant authorities. If the school chooses to formally apply for NVAO accreditation, if and when this becomes legally possible, the school needs to invest in the increase of academic orientation in the program, both for students as well as for the teaching faculty. Having witnessed the solid infrastructure, the high level of the students and faculty and the commitment to medical education, the assessment committee is confident that the school will be able to implement the necessary changes in order to become NVAO accredited in the near future. To summarize the assessment committee’s main conclusions: Within the theme “aims and objectives”, only one of the standards has been assessed as unsatisfactory. This is mainly due to the difference between the nature of the school and the accreditation standards as described earlier in this summary. Overall however, the theme “aims and objectives” of the degree course has been assessed as satisfactory. All other themes (curriculum, staff, services, internal quality assurance system and conditions for continuity) have been positively assessed as well, although the assessment committee has identified a need for improvement on some aspects. It is the conviction of the assessment committee that, if the school chooses to opt for NVAO accreditation, the school will be able to reach the expected level on all accreditation standards. The Hague, 27 March 2009 On behalf of the assessment committee, convened to assess the Medical Doctor program at Saba University School of Medicine, Prof. F. Sturmans, MD, PhD D.C. Duchatteau, MSc, MBA (Chair) (Secretary)


2 Introduction

2.1 The aim of this report

The Dutch Higher Education and Research Act limits the authority of the Accreditation Organization of the Netherlands and Flanders (NVAO) to the continental part of the Dutch kingdom and Flanders, Belgium. Since the NVAO has no legal authority to carry out an Initial Accreditation (Toets Nieuwe Opleiding, TNO) in the Dutch Antilles, this report does not have the status of an initial accreditation report. This report does, however, assess to what extent the school of medicine complies with the Dutch / Flemish Initial Accreditation framework. The education at and the organization of the Dutch Antilles medical schools is closely related to the American educational system and traditions. Since the Dutch accreditation framework differs significantly from the American framework, it would be virtually impossible for the Dutch Antilles medical schools to be fully compliant with all Dutch accreditation standards. It is to be expected that in the coming years it will become possible for the NVAO or another accrediting body to carry out accreditations on the Dutch Antilles. This report should therefore be perceived as an advice to the school of medicine on where improvement or change would be required in order to comply to the Dutch / Flemish accreditation framework, if the school chooses to apply for formal accreditation, if and when this will become possible. All schools of medicine on the Dutch Antilles educate their students primarily for the United States medical market. This report therefore does not advise on to what extent graduates from the Dutch Antilles medical schools could be compared to graduates from the Dutch or Flemish university medical centers / faculties of medicine. Neither does this report provide advice to whether or not graduates of the Dutch Antilles medical schools should or could be admitted as medical doctors in the European Economic Region. Although the students are educated within the Kingdom of the Netherlands, this does not imply that graduates are allowed to practice medicine in the Netherlands. The Dutch Ministry of Healthcare, Public Welfare and Sports requires that all graduates from schools of medicine outside the European Economic Region, undergo an individual assessment procedure in order to become eligible for registration as MD (basisarts) in the Netherlands. The assessment committee expresses its hope and expectation that this report will help the school of medicine to prepare for future accreditation, if the school chooses to apply in the coming years.

2.2 The procedure

On November the 5th 2007 the NVAO organized an information session in Willemstad, Curacao, for the Dutch Antilles medical schools about the possibilities and limitations for assessment of the schools of medicine by the NVAO. Five schools of medicine have opted for assessment of the school. In April/May 2008 the schools submitted information files, including a self-evaluation report. The executive board of the NVAO appointed a committee to assess the Dutch Antilles schools of medicine. The assessment committee convened on 9 and 10 July 2008 to discuss its goals, the procedure to be followed, and the submitted documents. Following this meeting the assessment committee formulated several


questions, requesting for additional information and documentation. All schools supplied the assessment committee with the requested information. On 14 October 2008 the assessment committee reconvened to discuss the supplemental information provided by the schools of medicine. In the period of 24 November – 2 December 2008 the assessment committee visited several islands of the Dutch Antilles to visit the schools of medicine. During these site visits the assessment committee met with representatives of management, teaching staff and students and inspected the local teaching and laboratory facilities. On 5 February 2009, the committee convened to discuss the draft reports and to reach a final decision on its conclusions. This report reflects the assessment committee’s findings as finalized on February 5, 2009.

2.3 Assessment committee Report

The first chapter of this report is an executive summary. In the second chapter the aim of this report and the procedure followed by the assessment committee are described. Chapter 3 provides a short summary of the program characteristics. Chapter 4 reports on the findings of the assessment committee, its considerations and conclusion. Subsequently the following elements are discussed:

- aims and objectives: discipline specific requirements, master level, academic orientation

- curriculum: academic orientation, correspondence between aims and objectives and curriculum, consistency of the curriculum

- staff: requirements for academic orientation, quantity of staff, quality of staff - services: facilities, tutoring - internal quality assurance system: systematic approach, involvement of staff,

students, alumni and the professional field - conditions for continuity: guarantee to complete the program, investments, financial

provisions Chapter 5 provides an overview of the assessment, summarized in a one-page table. Four appendices supplement this report: composition of the assessment committee, schedule of the site visits, documents reviewed, list of abbreviations.


3 Description of the program

3.1 Overview

Country the Netherlands Antilles Institution Saba University School of Medicine Program Medical Doctor program Level master Orientation academic (wo) Degree Medical Doctor (MD2) Mode of Study Full-time Field of Study Healthcare

3.2 Profile of the institution

The Saba University School of Medicine (SUSOM, also referred to as “Saba” in this report), was founded as a joint project with the government of Saba, Netherlands Antilles and a group of medical educators from the United States in 1986. The first group of 20 students started their education in 1993. In June 2000, the school graduated 86 students and placed 98% in US residencies. Currently 225 students enroll annually. The facilities of the school have grown in conjunction with the consistent growth of the number of students. Over 1,000 students have graduated from Saba in the past 15 years.

3.3 Profile of the program

General description There are major differences between the United States, Canadian and the European MD programs. In Europe, students start their medical education immediately after graduating from high school. In the American and Canadian context, students first graduate with a bachelor level in a relevant field of study, such as pre-medical sciences or humanities. With a bachelor in e.g. premedical sciences, students can enroll in a four-year MD program. The first two years of the MD program is an in-school program, “the basic sciences program”, aimed to provide students with the knowledge and insights needed to successfully continue to the second stage: the clerkships phase, which also takes approximately two years. Students attending Netherlands Antilles medical schools cannot complete this stage on the islands. For their clerkships students need to go to the United States. In order to be eligible for (core) clerkships in the US, students need to successfully pass the United States Medical Licensing Examination (USMLE) step I exam. After successful completion of the clerkships, students graduate from the school of medicine. Prior to entering postgraduate training in the United States, graduates of medical schools located outside of the United States and Canada must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). In addition to passing USMLE step I, requirements for ECFMG certification include passing the USMLE step II

2

The term MD in this report refers to the title of Medical Doctor (MD or M.D.) as an initial medical degree and a professional qualification.

Although the word “doctor” is part of the title, MD as used in this report does not refer to a post-initial research degree comparable to the

titles PhD as is customary in some countries.


(clinical knowledge) and step II (clinical skills). ECFMG-certified graduates can then apply for residency: continued education for MDs to become medical specialists and necessary for licensure. Credits The basic sciences program consists of five terms, of around 30 (US) credits. The total basic sciences program excluding electives is 154 credits, of which 2.692 hours are contact hours. The third year of the program consists of 42 weeks off so-called “core clerkships”, the fourth year consists of 30 weeks of elective clerkships.


4 Assessment per theme and per standard This chapter presents the assessment by the committee of the six themes and nineteen standards. The assessment committee has reproduced the criteria for each standard. For each standard the assessment committee presents (1) a brief outline of its findings based on the program documents and on documents provided by the institution and the site visit, (2) the considerations the assessment committee has taken into account and (3) the conclusion of the assessment committee. The assessment committee presents a conclusion for each of the six themes based on the underlying standards.

4.1 Aims and objectives

4.1.1 Subject-/Discipline-specific requirements (standard 1.1)

The intended learning outcomes of the program correspond with the requirements set by professional colleagues, both nationally and internationally and the relevant subject / discipline and/or professional practice concerned. Outline of findings The school defines its program as “a comprehensive basic and clinical medicine education program that introduces physicians who are proficient to meet healthcare needs of the global community”. Saba aims to prepare students to “demonstrate the professional and clinical skills needed for medical problem-solving, health promotion, patient care, community services, research and scholarship”. In defining its standards, SUSOM has made use of a variety of internationally accepted standards such as the Liaison Committee on Medical Education, the competencies framework as defined by the Accreditation Council for Graduate Medical Education, the CanMeds 2005 Physician Competency Framework, standards of the UK General Medical Council and the World Federation for Medical Education. In the information file, the school indicates in what manner their educational objectives relate to the international framework. Considerations Saba predominantly educates for the United States and Canadian medical markets. If the school is able to successfully prepare students for the USMLE exams, the intended learning outcomes correspond to the relevant professional practice. Since almost all students do their clerkships in the United States, for which in most cases the USMLE I exam is required, USMLE is a well justifiable aim, even for students who do not plan to stay in the United States. A significant amount of students who plan to practice in Canada will choose to apply for residency positions in the United States, requiring ECFMG certification and the USMLE I and II exams. In conclusion, for both the US and the Canadian medical market, USMLE is an appropriate focus in terms of discipline specific requirements. The requirements for practice within the Netherlands (Raamplan) are of lesser relevance, since it is not the aim of the school to educate for practice in Europe. Although based upon a large number of international standards, SUSOM primarily educates for the United States and Canadian labor markets. The fact that over 90% of the students taking the USMLE exams pass the exam, gives evidence to the claim that the program is in line with US requirements. Saba graduates are eligible to practice in all 50 US states, including the states of New York, California and Florida, the US states with the highest


assessment standards, requiring formal accreditation by means of an investigation including a site visit. During the NVAO site visit, the school has provided the assessment committee with the documents substantiating state approvals. With assistance of the ECFMG, the assessment committee has been able to verify these approvals. Conclusion The assessment committee concludes that the requirements for standard 1.1 ‘Discipline-specific requirements’ are met. The assessment committee considers the correspondence between the intended learning outcomes and the requirements set by professional colleagues, the relevant discipline and professional practice as satisfactory. The assessment committee assesses the standard 1.1 ‘Discipline-specific requirements’ as satisfactory.

4.1.2 Master level (standard 1.2) The intended learning outcomes of the program correspond with the general, internationally accepted descriptions of a Master’s qualification. Outline of findings In the information file, the school has provided a table in which it links its own learning objectives to the Dublin descriptors. The information file, however, does not indicate in which way students are trained to reach the level as described by the Dublin descriptors. The considerations below are therefore based upon discussions with management and lecturers during the site visit. Considerations It is the assessment committee’s impression that the school’s main goal is to prepare students for successfully passing the USMLE exams. Some of the Dublin descriptors do overlap with the USMLE requirements and with what can be expected from a practicing physician. The application of knowledge and understanding can be expected to some extent in the basic sciences phase, and to a much larger extent in the clerkships phase of the MD program. It is in the clerkships phase also that the aspiring physician will be thoroughly trained in his ability to make judgments and to communicate his judgments to his patients and coworkers. The student can also be expected to have acquired efficient learning skills after graduating from school of medicine. The Dublin descriptor “knowledge and understanding” at the master level requires that the student has demonstrated knowledge and understanding that is founded upon and extends beyond the level of knowledge and understanding typically associated with bachelor level. This implies that the graduate at master level is not only able to read scientific journals and to incorporate his findings in his daily practice, but that he is also able to develop his own ideas and to test his ideas in a scientific manner. In short, any graduate at master level is supposed to be educated and trained in the practice of science. The school has some opportunities for students to become further acquainted with the practice of science, by actively participating in research. This opportunity is purely on a voluntary basis. Most students graduate without active research experience. Within the Netherlands and Flanders, as in most European countries, it is the aim of faculties of medicine to not only train doctors at a practical, professional level but also as scientists (limited to the level of what can be expected of a master level graduate) to ensure that physicians continue developing themselves, their knowledge and their understanding as


scientific knowledge expands and progresses. On this aspect Saba needs to adjust its program in order to be fully compliant with the internationally accepted description of a master’s qualification. Management has expressed willingness to increase the scientific training of its students. If such a change would be implemented, this standard would be fully met. If the assessment committee was to accept the concept of a “teaching university”, the school would be assessed positively. In the Dutch/Flemish context, however, the concept of a teaching university is not known. All Dutch and Flemish universities are, by definition, research universities, hence the emphasis on scientific development. Considering the fact that the requirements of most Dublin descriptors have been met, considering the fact that management has expressed its willingness to increase scientific training in the program and considering the fact that the assessment committee has sufficient confidence in the school’s ability to implement the necessary changes with its resources and faculty, the committee has decided to assess this standard as satisfactory, albeit a marginal pass. Conclusion If the Dutch/Flemish accreditation framework would be strictly enforced, this standard would have to be assessed as unsatisfactory, since it is not fully satisfactory due the lack of formal scientific training. Scientific training and experience of the students needs to be increased in order to fully meet all the requirements of this standard. Given the above mentioned considerations, the assessment committee assesses the standard 1.2 ‘Master level’ as satisfactory.

4.1.3 Academic orientation (standard 1.3) The intended learning outcomes of the program correspond with the following descriptions of a Master (academic orientation): – The intended learning outcomes are derived from requirements set by the scientific

discipline, the international scientific practice and, for programs to which this applies, the practice in the relevant professional field.

– An academic master (WO-master) has the qualifications to conduct independent research or to solve multidisciplinary and interdisciplinary questions in a professional field for which academic higher education is required or useful.

Outline of findings SUSOM has received approval from states that evaluate international medical schools and the Accreditation Commission on Colleges of Medicine (ACCM). In addition, the National Committee on Foreign Medical Education and Accreditation (NCFMEA) has determined that the accrediting process used by ACCM is comparable to the accrediting process used by the LCME. Therefore, several states and organizations have assessed that Saba graduates meet the United States and Canadian requirements. These assessments, however, have a professional focus and do not necessarily assess the academic orientation of the program. Whether or not a graduate is able to conduct research is not part of the before mentioned approvals and accreditations. It has been the choice of the schools management to not make academic training a mandatory part of the curriculum. Considerations Since academic development in terms of actively engaging in scientific research and reporting findings in line with academic standards is not mandatory in the curriculum, the


school of medicine is not able to ensure that all graduates have the qualifications to critically assess and to conduct research. Although the school allows students to gain scientific experience, this is purely voluntary. In order to be compliant to the NVAO standards all students need to be scientifically trained and educated. With the current composition of the curriculum, voluntary scientific experience only, the requirements for this standard are not being met. In order to meet the requirements of this standard, the school does need to do more than just change a voluntary research clerkship into a mandatory one. Academic orientation is broader than “technical” scientific training. Academic orientation requires students to critically reflect on their academic development and to gain knowledge and competencies outside of their primary field of study, such as a more general education in e.g. epistemology and the academic tradition. Although it is difficult to specifically define, academic orientation refers to that what distinguishes professional education from scientific education as taught at research universities. Saba cannot be expected to become fully comparable to European, American or Canadian research universities. It can be expected, however, to shift its focus somewhat from predominantly preparing students for the USMLE exam (the professional requirement) to scientific upbringing (the academic requirement). Conclusion The assessment committee assesses the standard 1.3 ‘Academic orientation’ as unsatisfactory. If the school aspires to obtain NVAO accreditation in the near future, scientific training and education and academic orientation in a broader sense need to become an integral and mandatory part of the curriculum.

4.1.4 Concluding assessment of Theme 1 ‘Aims and objectives’ The assessment committee has assessed the three standards of the theme ‘Aims and Objectives’. The discipline specific requirements and master level have been assessed as being satisfactory. Academic orientation, however, is not satisfactory. Considering the fact that two of the three standards have been assessed as satisfactory, considering the fact that management has expressed its willingness to increase scientific / academic development in the program and considering the fact that the assessment committee has sufficient confidence in the school’s ability to implement the necessary changes, the assessment committee is sufficiently confident that the school could be able to reach a satisfactory judgment on all three standards. Overall, the assessment committee is able to assess this theme as satisfactory, provided that the school attains the above mentioned objectives.


4.2 Curriculum

4.2.1 Requirements for academic orientation (standard 2.1)

The proposed curriculum meets the following criteria for academic orientation: – The students develop their knowledge through the interaction between education and

research within the relevant disciplines – The curriculum corresponds with current developments in the relevant discipline(s) by

verifiable links with current scientific theories. – The program ensures the development of competences in the field of research. – Where appropriate, the curriculum has verifiable links with the current relevant

professional practice. Outline of findings In order to ensure that the curriculum corresponds with current developments in the field, SUSOM has appointed a curriculum committee consisting of members who are expected to stay abreast of recent developments in the field. The curriculum committee meets twice per term to review the curriculum and identify opportunities for improvement. In addition to using recent textbooks, Saba requires that students frequently make use of recent scientific publications. Through a well-stocked library and ample access to on-line fulltext resources students have access to recent scientific publications. All faculty members are supposed to stay on top of the latest developments in their fields. Faculty, like students, have access to academic resources. A significant number of faculty members have research experience. Approximately half the teaching staff consists of PhD's. Several faculty members have published in peer-reviewed journals, as can be expected from university faculty. Some faculty members are still actively engaged in scientific research, especially, but not necessarily, in the field of hyperbaric medicine. Saba identifies the success of their graduates in finding residencies and their future career as practitioners as evidence that the program ensures the development of relevant competencies. Considerations The assessment committee finds that SUSOM has taken appropriate measures to ensure correspondence between curriculum and current developments. By appointment of a knowledgeable curriculum committee, the school ensures that the curriculum stays in line with scientific developments. By maintaining an intensive relationship with the hospitals in which the students do their clerkships, the school has created an effective feedback loop to maintain the link between professional practice and the curriculum. The assessment committee has been pleased to see, that many of the faculty members have sufficient relevant research experience. It is the opinion of the assessment committee, however, that active involvement in current academic research is limited. The assessment committee advises the school to increase the opportunities for faculty members to become actively involved in current research. The assessment committee is not convinced that the program ensures the development of competencies in the field of research. The evidence as identified by the school of medicine, the professional success, could be seen as evidence of the graduates’ ability to make use of new scientific findings. Competencies in the field of research however, also include active research competencies, as addressed in the previous section (standard 1.3).


Conclusion The assessment committee assesses the standard 2.1 ‘Requirements for academic orientation’ as unsatisfactory. Although the committee feels that the school of medicine is willing to increase active involvement in scientific research for both faculty members as well as for students, the committee, at this moment, has to assess the standard 2.1 as unsatisfactory. Given the structural measures the school has taken to ensure the link between both scientific and professional developments, combined with the research experience of many of the faculty members in the past, the assessment committee anticipates that in the near future it should be possible to reach a positive conclusion on this standard.

4.2.2 Correspondence between the aims and objectives and the curriculum (standard 2.2) The intended curriculum, the educational concept, the study methods and the learning assessments reflect the intended learning outcomes. The intended learning outcomes have been adequately transferred into the educational goals of (parts of) the intended curriculum. Outline of findings The educational concept of the basic sciences part of the curriculum could be described as "traditional", with a strong emphasis on lectures and examinations mostly based on the reproduction of factual knowledge. In the clerkships phase of the curriculum the educational concept changes drastically. Within a hospital setting students are being educated as is customary in the United States. To help students make the transition from “school” to the hospital, the fifth term has a strong focus on clinical skills and clinical reasoning. Considerations Although the assessment committee uses the word traditional to identify the educational concept, this is by no means a disqualification of the chosen concept. Given the high pass rates for both USMLE I and USMLE II exams and the high rate of success in finding suitable residency appointments, evidence is provided that the educational concept, albeit traditional, is effective. In the discussion of standard 1.2, the assessment committee has made some critical remarks on the aims and objectives of the curriculum. Given the chosen objective, to prepare students for success on the USMLE exams and help students find a suitable place in a residency program, there is a good correspondence between the aims and the objectives of the curriculum. If the school were to decide to follow the assessment committee's recommendation to put more emphasis on the development of students as scientists, changes to the educational concept are required. Conclusion The assessment committee assesses the standard 2.2 ‘Correspondence between the aims and objectives and the curriculum’ as satisfactory.

4.2.3 Consistency of the curriculum (standard 2.3) The contents of the curriculum are internally consistent. Outline of findings


The curriculum has a logical composition. The first four terms have a strong emphasis on knowledge in the basic medical sciences, diseases and the treatment thereof. The curriculum also addresses the “nonbiological” aspects of medicine. In the fifth term, the emphasis shifts towards skills such as physical examination and history taking and clinical reasoning. Together the content of these first terms fully corresponds to the requirements of USMLE I. The clinical skills are not part of the USMLE I examination, but serve to help the student to be more successful in his clerkships. In the second phase of the curriculum, the clerkships phase, the knowledge and skills of the students are transformed into relevant competencies, by means of bedside teaching, case presentations and active involvement in the treatment of patients. The curriculum is in line with the tradition in which doctors have been educated for many decades all over the world. Considerations Within the curriculum there is a clear distinction between the basic sciences such as histology, biochemistry and physiology on one hand and diseases and the treatment thereof on the other and the actual serving the patients’ medical needs on yet another. In the past decades, European medical schools have changed their approach to a more integrated one. Bedside teaching is introduced earlier on in the curriculum and the education on diseases is integrated with the education on the basic sciences. The school of medicine has chosen not to follow these developments, but to remain loyal to the traditional approach, which has proven to be effective for many decades. The assessment committee respects the choice of the school of medicine. The assessment committee concludes, that the curriculum is designed following a logical structure and, that it is internally consistent. Conclusion The assessment committee assesses the standard 2.3 ‘Consistency of the curriculum’ as satisfactory.

4.2.4 Workload (standard 2.4) The intended curriculum can be successfully completed within the set time, as certain program-related factors that may be an impediment to study progress are eliminated where possible. Outline of findings The program can be defined as very intensive: the workload is very high. Students need to spend at least 70 hours per week on their education. Students at Saba can make use of good and modern resources, such as modern classrooms, a good IT infrastructure, well-equipped laboratories and a well-stocked library. The study environment serves to support the students' academic efforts. In the first term, students live on campus, as to make sure that housing problems cannot become an obstacle, distracting the student’s attention. Each new student is assigned to a faculty advisor and paired with a student mentor. This not only helps in early identification of those students having difficulties, but also helps successful students improve their performance. During the site visit the assessment committee has discussed the study load with the students. Students fully acknowledge the fact that studying at Saba is challenging and arduous. They considered the study load to be high, but fully in line with what they expected and what they feel could be expected from a medical school. Students also mention the absence of distracters on the island as supportive of their academic endeavor. Students


have emphasized the role of the school’s dedicated faculty. Professors are easily accessible and willing to help out when needed. Considerations In the European part of the Kingdom of the Netherlands and in Flanders, the annual workload for students is around 1600 hours. At Saba, the number of (mandatory) contact hours alone, not including preparing for lectures and self-study, exceeds this number. This results in a work load of easily 70 hours or more per week. In the clerkships phase this number is even higher. In Europe this would not be acceptable. The assessment committee, however, acknowledges the fact that these intensive workloads are common in the American medical educational system. Out of respect for cultural differences, the assessment committee is willing to overcome this obstacle, provided that the medical school has taken sufficient measures to eliminate where possible program related factors that may be an impediment to study progress. Considering that the school has taken sufficient effort to promote study progress, the assessment committee assesses this standard as satisfactory. Despite the fact that the assessment committee assesses this standard as satisfactory, the committee would like to add a word of caution on this matter. A study load as intensive as it currently is, does not leave much room for academic development of the student in the broader sense. Students should have the opportunity to critically reflect on their development and to gain knowledge and competencies outside of their primary field of study. If the school chooses to implement the recommendations as addressed under standard 1.3, students need to have the opportunity to also receive a more general education in e.g. epistemology and the academic tradition. Proper academic development of the individual can be compromised by the continuous intensity of the program. This issue needs to be addressed if the school chooses to implement the changes recommended under standard 1.3. Conclusion The assessment committee assesses the standard 2.4 ‘Workload’ as satisfactory.

4.2.5 Admission requirements (standard 2.5) The structure and contents of the intended curriculum are in line with the qualifications of the incoming students: a bachelor's degree and possibly a selection (with a view on contents of the discipline). Outline of findings A relevant bachelor’s degree with a sufficiently high grade point average (GPA) is required to apply at Saba. The school has chosen to be, and to remain, a very selective medical school. For every seat, the school has seven applicants. The average bachelor level GPA of students accepted at Saba is 3.42 on a 4-point scale, 3.3 being the minimum. The school is prescriptive in pre-medical entry requirements. The more relevant the bachelor curriculum of the applicant, the higher his or her chance of being accepted. Many students accepted at Saba have already earned a master's degree. Considerations Due to its stringent selection process, the school is able to select the students with a proven academic track record, both in terms of academic skills and learning discipline as well as in terms of relevancy of their bachelor curriculum. In doing so, the school selects the students


with the highest chance of success. The structure and contents of the curriculum are in line with the qualifications of the incoming students. Conclusion The assessment committee assesses the standard 2.5 ‘Admission requirements’ as satisfactory.

4.2.6 Credits (standard 2.6) The program meets the legal requirements regarding the range of credits for an academic master’s program (wo-master): a minimum of 60 credits (1620 hours), 180 credits for medical education. Outline of findings The whole MD program consists of 147 weeks of full-time study. Although the total study load in hours, including self-study, is not specified in the information file, the total study load can be assessed to be well over 10,000 hours. Considerations The minimum requirement of 60 EC (180 EC for medical education) has been met. Conclusion The assessment committee assesses the standard 2.6 ‘Credits’ as satisfactory.

4.2.7 Concluding assessment of Theme 2 ‘Curriculum’ The assessment committee has assessed the six standards of the theme ‘Curriculum’, all but one as satisfactory. Overall, the assessment committee assesses the theme ‘Curriculum’ as satisfactory.


4.3 Staff

During the site visit at Saba, the assessment committee has not only met with faculty members who are involved in the basic sciences part of the MD program, but also with faculty member involved in the clinical part (clerkships) of the program. The meeting with faculty members who are involved in the clerkship phase of the program and the ample documentation on the clerkship phase has given the assessment committee the impression that the clerkship phase is well-organized and that sufficient and qualified staff is available for this phase. Considering that the Saba school has been visited by the assessment committee, and not the affiliated hospitals, and considering that the majority of staff and faculty members met during the site visit are involved in the basic sciences phase of the program, the remainder of this chapter focuses upon the staff for the basic sciences phase of the program.

4.3.1 Requirements for academic orientation (standard 3.1) The program meets the following criteria for the deployment of staff for a program with academic orientation (wo): Teaching is principally provided by researchers who contribute to the development of the subject/discipline. Outline of findings A great number of faculty members have the degree of PhD. Several faculty members can be qualified as experienced researchers, having published numerous articles in peer-reviewed journals. It can be concluded, that teaching is principally provided by researchers who have contributed to the development of the discipline. The current contribution, however, of teachers to the development of their discipline is rather limited. Some research has been carried out in the past and is currently being carried out, especially in the field of hyperbaric medicine. Although there are some examples of current and recent research outside of the field of hyperbaric medicine, the active involvement in research by lecturers is limited. Considerations If this standard would be strictly enforced, the school would be assessed as unsatisfactory on this standard. The assessment committee, however, realizes that students are educated outside the hospital context in the first phase of the program. The opportunities to perform research in such a manner that it would lead to publishable articles in peer-reviewed journals, in this environment are limited. It is the opinion of the assessment committee, that despite the absence of a hospital on the island of Saba opportunities for increased research activities are being left unused. The assessment committee strongly advises the school to increase its efforts to strengthen the link between teaching and research. Given the past research experience of a significant amount of faculty members, the assessment committee evaluates this standard as satisfactory. Conclusion The assessment committee assesses the standard 3.1 ‘Requirements for academic orientation’ as satisfactory, albeit by “a marginal pass”, since strictly speaking it could be argued that this standard is not met.


4.3.2 Quantity of staff (standard 3.2) Sufficient capacity is made available to be able to start the proposed program. Sufficient capacity is made available to be able to continue the proposed program. Outline of findings Since the school has already been offering the MD program for over 15 years, the standard “sufficient capacity is made available to be able to start the proposed program” is of no relevance. The assessment committee has therefore only assessed, whether or not sufficient capacity is made available to be able to continue the proposed program. For the clerkships, only ACGME approved teaching hospitals are contracted. This, to a certain extent, guarantees staff capacity is available for teaching the students in their clerkships phase. The vast majority of students go to a limited number of hospitals. Saba has a long-standing and good relationship with these hospitals. For the basic sciences phase 37 full-time and eight part-time faculty members are contracted by the school. The student to staff ratio is approximately between 7:1 and 8:1. During the site visit, students have indicated that faculty members are always available when needed and that they have sufficient time to be available to help them comprehend their learning material. All disciplines are taught by at least two different faculty members. For half the disciplines a full professor is hired, the number of associate professors ranges from one to five per discipline. Considerations The amount of staff needed is very dependent on the didactical model. There are no “hard criteria” to quantify the need for the number of staff members. The assessment committee concludes, however, that sufficient capacity is made available to continue the program. This conclusion is based on a good student to staff ratio (which on itself is not that strong an indicator), the double coverage of all disciplines and the perception of the students: faculty members are available and have time to help out when needed. The assessment committee therefore assesses the standard as satisfactory. Conclusion The assessment committee assesses the standard 3.2 ‘Quantity of staff’ as satisfactory.

4.3.3 Quality of staff (standard 3.3) The staff to be deployed are sufficiently qualified to ensure that the aims and objectives regarding content, didactics and organization of the program are achieved. Outline of findings In order to be eligible for appointment as faculty at Saba, candidates must have a doctoral degree (MD, PhD or DSc) and experience in teaching and research. The school has provided the assessment committee with the resumes of most faculty members. After thorough consideration of the Saba faculty resumes, the assessment committee concludes that the faculty members are sufficiently qualified to ensure that the aims and objectives regarding content, didactics and organization of the program are achieved. Considerations Holding a doctoral degree is one of the requirements to be hired as faculty. Although the MD degree formally is a doctoral degree, it is a degree signifying a practical qualification as a


physician and not necessarily expressing one's research abilities. A university’s faculty therefore cannot consist of MDs alone. A sufficient amount of PhD's, signifying research experience and competency, is required to uphold academic standards. Since approximately half the Saba faculty has such a qualification the faculty as a whole has been assessed as being qualified. Conclusion The assessment committee assesses the standard 3.3 ‘Quality of staff’ as satisfactory.

4.3.4 Concluding assessment of Theme 3 ‘Staff’ The assessment committee has assessed the three standards of the theme ‘Staff’ as satisfactory. Overall, therefore, the assessment committee assesses the theme ‘Staff’ as satisfactory.


4.4 Services

4.4.1 Facilities (standard 4.1)

Intended housing and facilities are adequate to achieve the learning outcomes. Outline of findings The facilities of Saba are specified in the information file. The school has nine classrooms and lecture halls, outfitted with up-to-date equipment and wireless internet. The school has several laboratories, including an anatomy lab with 10 dissection tables, a physiology lab equipped with the instruments needed to train students in clinical skills (e.g. ultrasound-doppler) and a hyperbaric medicine facility. The school's library is well stocked with relevant books, journals and DVDs. Students have access to online fulltext journal articles. With over 50 meeting rooms and faculty offices, the infrastructure for faculty and management is abundant. The school has three dormitories adjacent to the campus which house 89 students. The school employs a housing coordinator to help students and faculty find local housing. The school has a campus wide wireless network to enable students to access the internet throughout the campus. The library holds 20 workstations with broadband internet connection and printing facilities. These facilities are accessible 24/7. The campus houses a test center with 100 workstations, expanding to over 170. Considerations In the Netherlands and Flemish, medical students are educated within the context of a university hospital. A medical faculty in the Netherlands and Belgium would require a large teaching hospital, enabling bedside teaching during the entire program (not only in the clerkships phase), enabling the development of clinical skills in skills-labs and enabling students to gain research experience in well equipped research laboratories. It is not the task of the assessment committee, however, to assess whether or not the medical schools in the Dutch Antilles are comparable to Dutch / Flemish medical faculties. The facilities have therefore not been evaluated in comparison to Dutch / Flemish university hospitals. The committee has assessed to what extent the housing and facilities are adequate to successfully deliver a basic sciences program. The clinical infrastructure for the clerkship phase has not been assessed. The facilities of the school are excellent. Students have all the resources they need to adequately achieve the learning outcomes. Faculty members have adequate offices. Especially the well-stocked library and the accessibility of online fulltext resources are of relevance to the assessment committee. The facilities at SUSOM are by all means satisfactory. Conclusion The assessment committee assesses the standard 4.1 ‘Facilities’ as satisfactory.

4.4.2 Tutoring (standard 4.2) There is adequate staff capacity to provide tutoring as well as information provision for students, and these are adequate in view of study progress.


Outline of findings During the first term of study, all new students are assigned a faculty advisor and are paired with a student mentor. “The advisor and mentor provide each student with a foundation for a support mechanism, and source for advice throughout the medical education.” If a student falls behind, a faculty instructor will meet individually with the student and work one on one with a student. All faculty members are required to have faculty office time, during which they are available and accessible to all medical students. An information system is in place, to make sure that all students who fall behind are brought to the attention of the Assistant Dean for Student Affairs, so that appropriate measures can be taken. Students are assisted individually to schedule their clerkships. The school also individually supports students when they apply for residency. Logistic (e.g. housing) and personal (counseling) services are available. Considerations On all vital aspects, the school provides tutoring and support, from the day the students start their education until after graduation in finding a suitable residency position. Conclusion The assessment committee assesses the standard 4.2 ‘Tutoring’ as satisfactory.

4.4.3 Concluding assessment of Theme 4 ‘Services’ The assessment committee has assessed the two standards of the theme ‘Services’ as satisfactory. Overall, the assessment committee assesses the theme ‘Services’ as satisfactory.


4.5 Internal quality assurance system

4.5.1 Systematic approach (standard 5.1)

A system of internal quality assurance is in place, which uses verifiable objectives and periodical evaluations in order to take measures for improvement. Outline of findings The information file thoroughly describes all the committees that are involved in the internal quality assurance system. Committees overseeing the school's quality are: executive committee, long-range planning committee, curriculum committee, faculty appointment promotion and tenure committee, student promotions committee, library committee, information technology / faculty liaison committee, research committee, student conduct committee and the student government association. Before and during the site visit, the assessment committee has had the opportunity to read some of the different committees’ minutes. All committee meetings are well documented. In order to improve its quality the school also actively asks for feedback from the preceptors in the affiliated hospitals in which students do their clerkships. Feedback is given not only on the performance of the student, but also on the knowledge and skills of students. The school uses this information to continuously improve its program. Considerations The school has 10 formal committees in place, all involved in improving the quality of the program. The committees work systematically and meetings are well documented. In the months before the site visit the school has appointed a student in the curriculum committee, thus providing the students’ position with a formal vote. The entire system of quality assurance appears to be robust and well functioning. The documentation provides evidence of a systematic approach. The current system of internal quality assurance is satisfactory, but it can be improved by means of increased student involvement. During the site visit management has expressed willingness to improve the students’ involvement (see also standard 5.2). Conclusion The assessment committee assesses the standard 5.1 ‘Systematic approach’ as satisfactory.

4.5.2 Involvement (standard 5.2) Staff, students, alumni and the relevant professional field will be actively involved in the internal quality assurance system. Outline of findings Not all staff members are actively involved in the internal quality assurance system, but many staff members participate in one of the committees, mentioned in the previous section. The professional field is actively involved by the preceptors providing the school with feedback on the level of knowledge and skills of the students, thus enabling the school to make changes in the curriculum if they identify any gaps in the skills or knowledge of the students. Students are involved in several ways:


- the student union serves as a channel for comments from students to faculty and management

- all students evaluate their courses using evaluation forms - a student is appointed in the curriculum committee - at least once per term students meet with their personal tutor.

In addition to these more formal channels, students indicate that the school has a safe, low threshold culture, in which informal feedback from students to faculty or management can be given. In the past the school has proven to listen to student feedback, e.g. in extending the opening hours of the computer facilities in the library. Alumni are not actively involved in the internal quality assurance system. Considerations Staff, students and the professional field are involved in the internal quality assurance system. Alumni are not. The involvement of student in the formal committees can be increased further. To fully comply with the Dutch and Flemish standards, more students would need to be appointed in the committees. The school’s management has indicated that it would be willing to further increase formal student involvement. Although the school can improve its performance on this standard by further involving students and by actively involving alumni in its internal quality assurance system, the assessment committee feels that most relevant parties are sufficiently involved, therefore assessing this standard as satisfactory. Conclusion The assessment committee assesses the standard 5.2 ‘Involvement’ as satisfactory.

4.5.3 Concluding assessment of Theme 5 ‘Internal quality assurance system’ The assessment committee has assessed the two standards of the theme ‘Internal quality assurance system’ as satisfactory. Overall, the assessment committee assesses the theme ‘Internal quality assurance system’ as satisfactory.


4.6 Conditions for continuity

4.6.1 Guarantee to complete the program (standard 6.1)

The higher education institution ensures that its students can complete the program. Outline of findings This standard aims to determine to what extent students that are enrolled in the program have a strong guarantee that they can finish their education, even if the program would cease to be offered for some reason. The school describes itself as a reputable, recognized and as a well resourced institution. The school claims to have sufficient resources to gradually fade out the program, thus enabling all students to graduate, if for some unforeseen reason no new students can be registered. Management has even stated that if a natural disaster would hit the school, the school has enough resources to rebuild its facilities. The school has provided the assessment committee with financial information of the school itself, but not of the mother corporation of which the school is a part. Considerations The track record of the school, 15 years of solid growth, graduating over a thousand students and consistent investment in its facilities, has given the assessment committee no reason to doubt the schools intentions and possibilities to continue offering medical education on Saba. The school, however, is part of a larger consortium of educational institutes. The assessment committee has not been able to assess the financial stability of this mother corporation. In order to become positively assessed on this standard there are two possibilities:

a) the mother corporation provides evidence of financial stability and expresses the guarantee to complete the program to all students who are accepted into the program, thus protecting the students to both bankruptcy as well as a change of policy

b) the school forms a strategic alliance with another medical school in which they mutually agree to enable one another’s students if one of the schools would cease to offer medical education for some unforeseen reason.

Conclusion Although the assessment committee has no reason to doubt either the school’s intentions or the schools possibilities to continue offering medical education, the school offers no formal and verifiable guarantee of completing the program. The assessment committee therefore has to assess the standard 6.1 ‘Guarantee to complete the program’ as unsatisfactory.

4.6.2 Investments (standard 6.2) The proposed investments are sufficient to realize the program (including the facilities and tutoring). Outline of findings The school has already been in service for 15 years. All major investments have been realized. Although the school is still investing in improving its infrastructure, the existing infrastructure already suffices. The school does need to further invest in increasing its


scientific program for faculty and students if the school chooses to apply for formal accreditation in the near future. Considerations Since all major investments have been realized the assessment committee assesses this standard as satisfactory. Conclusion The assessment committee assesses the standard 6.2 ‘Investments’ as satisfactory.

4.6.3 Financial provisions (standard 6.3) The financial provisions to cover the projected deficit are sufficient to cover the initial losses. Outline of findings There are still some deficits due to infrastructural improvement programs, but these are caused by the strategic decision of management to increase the quality of its already good infrastructure. The school already has the possibility to offer its program at breakeven or even to generate a profit. Considerations Although the school is still investing in its infrastructure, there are no more “initial losses”. The assessment committee therefore assesses this standard as satisfactory. Conclusion The assessment committee assesses the standard 6.3 ‘Financial provisions’ as satisfactory.

4.6.4 Concluding assessment of Theme 6 ‘Conditions for continuity’ The assessment committee has assessed the three standards of the theme ‘Conditions for continuity’, of which two as satisfactory. Overall, the assessment committee assesses the theme ‘Conditions for continuity’ as satisfactory, albeit that the guarantee to complete the program must be given in order to become positively assessed at a formal initial accreditation.


5 Overview of the assessment The assessment committee presents its assessments per theme and per standard, as outlined in chapter 4, in the following table. Theme

Assessment

Standard

Assessment

1 Aims and objectives S 1.1 Subject-/ discipline-specific

requirements S

1.2 Master level S

1.3 Academic orientation U

2 Curriculum S 2.1 Academic orientation U

2.2 Correspondence between aims and objectives and curriculum

S

2.3 Consistency of the curriculum S

2.4 Workload S

2.5 Admission requirements S

2.6 Credits S

3 Staff S 3.1 Requirements for academic

orientation

S

3.2 Quantity of staff S

3.3 Quality of staff S

4 Services S 4.1 Facilities S

4.2 Tutoring S

5 Internal quality assurance system

S 5.1 Systematic approach S

5.2 Involvement of staff, students, alumni and professional field

S

6 Conditions for continuity S 6.1 Guarantee to complete

the program

U

6.2 Investments S

6.3 Financial provisions S

U = Unsatisfactory

S = Satisfactory


Annex 1: Composition of the assessment committee Chair Prof. F. Sturmans, MD, PhD Prof.dr. F.Sturmans got his MD degree in 1964 and his PhD degree in 1967 both from the Radboud University Nijmegen. In the academic year 1970-1971 he followed the combined course in epidemiology and medical statistics at the London School of Hygiene and Tropical Medicine. From 1976-1982 he was part time professor of Epidemiology at the Agricultural University Wageningen. From 1976-1979 he was lecturer and from 1979-1985 professor of Social Medicine more in particular Epidemiology at the Radboud University Nijmegen, from 1982-1997 professor of Epidemiology at Maastricht University (between 1985-1990 he was dean of the Medical Faculty). From 1993-2002 he was managing director of the Municipal Health Authority of the city of Rotterdam. From 1997-2003 he was at the same time part time professor of Epidemiology and Health Policy at the Erasmus University Rotterdam. Member Prof. R. Rubens, MD, MSc (°1943) studied medicine and got his medical degree (MD) in Gent University, Belgium in 1967. At the university Hospital of Ghent and the faculty of medicine he trained as a specialist in internal medicine with emphasis on endocrinology and metabolism. In 1971 he went to Leeds University (united Kingdom) where he studied Steroid Endocrinology. After examinations and a thesis he obtained the degree of master of science in steroid endocrinology at Leeds university. In 1973 he was appointed first assistant by royal decree, his research work , foreign degree and papers being declared similar to a PhD thesis by the faculty of medicine of Ghent. He was appointed professor of endocrinology in 1991. His main research interests are steroid endocrinology, medical philosophy, medical history and medical ethics. In 1979 he was appointed full time head clinical staff member of the department of endocrinology. He lectured in endocrinology, medical ethics, medical philosophy and medical teaching. He founded the section of medical social sciences (nursing, speech therapy) at the faculty of medicine and health sciences in Gent. In 2003 he was appointed director for education (educational vice-dean) at the faculty of medicine and health sciences of the university of Ghent. He was member of different panels for the evaluation of new curricula and degrees of the NVAO during the past five years. Furthermore he was involved in general educational evaluation and management for the Flemish Interuniversity Council . He still is the chairman of the Medical Ethics committee of the University hospital of Gent Belgium. He published more than 100 papers about endocrinology, medical philosophy , medical history in international and national journals. He is past-president of the Belgian Society of Endocrinology, member of the British Society for Endocrinology, member of the Society for the social history of medicine(UK), member of the Belgian Society for internal medicine. He is Chairman of the Sarton committee of the university of Gent .The Sarton Committee is dedicated to the study of the history of sciences. Member Prof. F. Bonke, MD, PhD was born in Amsterdam ( jan 1940 ) and studied medicine at the University of Amsterdam (MD in 1964) and got a PhD in 1968 with a thesis on " atrial premature beats ". He became a physiologist with a research specialty on cardiac arrhythmias; therefore he is in principle an experimental cardiologist. In 1971-1972 he was guest professor in physiology at the University of Berne (CH) and in 1975 he became professor in the new medical school of the University of Maastricht. In 1985 he became Rector Magnificus of that university and did this job for six years. Thereafter he got an extra appointment at the


University of Groningen for reorganizing the department of physiology in combination with the set up of a complete new curriculum for the medical school ( based on problem based learning ). He continued his professorship in Maastricht in combination with several interim management activities in health care and education. He became a member of parliament in 2002 with the opportunity to become minister of Health, but he refused to take this job. Today he is still interested and active in the medical educational field as well as in health care/cardiology Secretary D.C. Duchatteau, MSc, MBA is director/partner at LSJ Medisch Projectbureau, a consultancy firm for the Dutch healthcare sector. Special emphasis in his consultancy work is on higher education in healthcare. In the past years LSJ has provided services for the Ministry of Health, the Ministry of Education, the Netherlands Organisation for Health Research and Development, the Council for Public Health and Health Care and several healthcare providers and institutes of higher education. In the recent past Duco Duchatteau has served as acting secretary for several accreditation panels for the Accreditation Organization of the Netherlands and Flanders. Advisor Mrs. M. van Zanten, MEd, FAIMER / ECFMG research associate 1997 - Present: The Educational Commission for Foreign Medical Graduates (ECFMG®) and Foundation for Advancement of International Medical Education and Research (FAIMER®) Research Associate (2000 - present) Assists in the advancement of research activities related to the ECFMG and FAIMER goals of better understanding the educational experiences and migration patterns of international physicians and their impact on world heath. Gathers and analyzes data on worldwide undergraduate medical school accreditation standards and processes. Prepares manuscripts for publication and conducts presentations and workshops at various national and international conferences. Develops and implements ECFMG and FAIMER research projects, incl. communication skills rating studies, case development related investigations, and surveys of international medical graduates’ work place skills. Process coordinator N. Pronk, MBA, Is in his present function (since 2003) policy advisor at NVAO (Nederlands-Vlaamse Accreditatieorganisatie) Former functions: EADTU (European Association of Distance Teaching Universities) - projectmanager (1995) Open Universiteit Nederland - manager student support services /policy advisor (1982) HBO-Raad (Dutch National Council for Professional Universities ; planning officer (1976)


Annex 2: Schedule of the site visit The assessment committee undertook a site visit on 25 and 26 November 2008 as part of the external assessment procedure. Tuesday, November 25, 2008 8:30 Site Visit:

8:30 – 9:00: Introduction & Welcome (Steve Rodger lead but with group) 9:00-9:30: Meeting with President/ CEO of the institutions: President (Dr. David Fredrick); Secretary Board of Trustees (Steve Rodger); and Chairman Board of Trustees (Dr. Paul Dalbec) 9:30 – 10:30: Meeting with Programme management: President (Dr. David Fredrick); Executive Dean (Dr. Arthur Maron); Associate Dean of Basic Sciences (Dr. Hugh Duckworth); Associate Dean of Clinical Sciences (Dr. Michael Eliastam); Assistant Dean Basic Sciences (Dr. Richard Shivers); Clinical Chair (Dr. Tom Ferguson); Academic Development & Accreditation (Dr. Gordon Green) 10:30 – 10:45: Break 10:45 – 11:15: Meeting with students 11:15 – 11:45: Quality Assurance: President (Dr. David Fredrick); Executive Dean (Dr. Arthur Maron); Associate Dean of Basic Sciences (Dr. Hugh Duckworth); Associate Dean of Clinical Sciences (Dr. Michael Eliastam); Assistant Dean Basic Sciences (Dr. Richard Shivers); Clinical Chair (Dr. Tom Ferguson); Academic Development & Accreditation (Dr. Gordon Green)

12:00 Lunch at SUSOM NVAO Team President (Dr. David Fredrick); Secretary Board of Directors (Steve Rodger); Chairman Board of Trustees (Dr. Paul Dalbec); Executive Dean (Dr. Arthur Maron); Associate Dean of Basic Sciences (Dr. Hugh Duckworth); Associate Dean of Clinical Sciences (Dr. Michael Eliastam); Clinical Chair (Dr. Tom Ferguson); Academic Development & Accreditation (Dr. Gordon Green)

12:45 Campus Tour 14:15 Site Visit:

14:15 – 14:45: Call with Alumni (Sahana Vyas, M.D.) 14:45 – 16:15: Meet with teaching staff (includes department heads)

16:15 Committee Discussion (NVAO only) Wednesday, November 26, 2008: 8:30 Site Visit:

8:30 – 9:30 Clinical Hospital Training Program: Associate Dean of Clinical Sciences (Dr. Michael Eliastam); Clinical Chair (Dr. Tom Ferguson); Clinical Chair (Dr. Arthur Maron); Clinical Chair (Dr. Patricia Hough); Director Academic Development & Accreditation (Dr. Gordon Green); Clinical Student Coordinator (Liz Ferguson) 9:30 – 11:00: Closing meeting with senior management

11:30 NVAO Committee Meeting and Lunch


Annex 3: Documents reviewed

- Information file “Doctor of Medicine (M.D.) Programme, Assessment of New Degree Programme, April 15 2008, Saba University School of Medicine” including 6 appendices:

o CVs of staff Administration Basic Sciences Faculty Clinical Science Chairs Clinical Science Faculty

o Financial Details o Description of Curriculum

- Additional information file “Doctor of Medicine (M.D.) Programme, October 2 2008, Saba University School of Medicine” including 4 appendices:

o Approvals & Accreditations for Saba University School of Medicine o SUSOM Recent Research Projects o Clinical Student Performance Evaluation o Student Clerkship Evaluation

- Additional information on CD-ROM: o Minutes of Executive Committee o Minutes of Long Range Planning Committee o Minutes of Curriculum Committee o Minutes of Faculty Senate o Minutes of Promotions Committee o Minutes of Library Committee o Minutes of Faculty Liaison Committee o Minutes of Research Committee o Minutes of Student Conduct Committee o Minutes of Clinical Chairs Meeting o Minutes of Faculty Meeting

- Additional information “Doctor of Medicine (M.D.) Programme, November 25 2008, Saba University School of Medicine”

- Additional information available during site visit o Information file “Accreditations, Affiliations, Approvals” o Student Handbook for the Basic Sciences 2008-2009 o Student Handbook “A Guide to Clinical Training” 2008-2009 o State reports, amongst which New York, California and Florida o ACCM Report o Medline Full Text database coverage list, listing over 1,500 journals o Saba University School of Medicine, information brochure 2007-2009 o PowerPoint presentations handout


Annex 4: List of abbreviations ACCM Accreditation Commission on Colleges of Medicine ACGME Accreditation Council for Graduate Medical Education EC European Credit ECFMG Educational Commission for Foreign Medical Graduates ECTS European Credit Transfer System GPA Grade Point Average hbo hoger beroepsonderwijs LCME Liaison Committee on Medical Education ma master MD Medical Doctor (initial degree) MSc Master of Science NCFMEA National Committee on Foreign Medical Education and Accreditation NVAO Nederlands-Vlaamse Accreditatieorganisatie SUSOM Saba University School of Medicine TNO Toets Nieuwe Opleiding (Initial Accreditation) USMLE United States Medical Licensing Examination WHO World Health Organization wo wetenschappelijk onderwijs


The assessment committee report has been ordered by NVAO for the assessment of the Medical Doctor program of the Saba University School of Medicine. Accreditation Organisation of the Netherlands and Flanders (NVAO) Parkstraat 28 P.O. Box 85498 | 2508 CD DEN HAAG T 31 70 312 23 30 F 31 70 312 23 01 E [email protected] W www.nvao.net Application number # 2962