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Panel to USF: Close school of anesthesia

Inspectors say the program, already on probation, isn't doing enough for students. But school officials say things are improving.

By LISA GREENE
Published May 11, 2006

In a stinging letter dated May 2, the inspectors said USF isn't doing enough to support the program for training residents. The strongest criticisms were aimed at the unusual agreement USF made last fall with a private anesthesiology group to teach residents at Tampa General Hospital.

That change was designed to lift the program out of probation, where it has been since March 2004. But many faculty members don't have teaching experience, do too little scholarly research and provide too little supervision of residents in some instances, reviewers said.

Residents, who learned of the recommendation Wednesday, are scared they will get into trouble for complaining, and faculty members aren't concerned about residents' "well-being and working environment,'' reviewers said.

But USF medical school leaders say that the program already has made significant improvements since the national group put it on probation two years ago and that many of the letter's complaints aren't accurate.

USF plans to make more changes and fight to keep the program running, the medical school dean said.

"The bottom line is, the committee has given us an incredible opportunity to revamp our anesthesiology program and build a state-of-the-art one, and that's what we're working to do,'' said Dr. Stephen Klasko, medical school dean and vice president of USF Health.

If the Accreditation Council for Graduate Medical Education follows the recommendation, the program would lose accreditation in July 2008.

Such moves are rare. Last year, ACGME reviewed about 4,200 of more than 8,000 programs. Of those, 54 were put on probation and 20 lost accreditation.

Residencies give more specialized training to doctors who have completed medical school. USF's four-year program has about 45 residents and 10 interns, or first-year students.

It's considered a fundamental part of any medical school and losing it would be a blow to the Medical College's prestige.

Klasko said the problems cited by inspectors in 2004 have been fixed. Inspectors said at the time that some residents lacked supervision at Tampa General.

Klasko, who joined USF in fall 2004 with the program already on probation, made the controversial arrangement with the private practice group, Florida Gulf-to-Bay Anesthesiology Associates, a year ago.

That ended USF's anesthesiology practice at Tampa General, and residents were suddenly being taught by doctors they had been competing against. But Klasko defended the change Wednesday, saying the competition between the two medical practices didn't help residents either.

USF has to consider less traditional arrangements because, unlike many medical schools, it doesn't own its own teaching hospital, he said.

USF has until July 1 to appeal. The question is whether to object to the letter, which was based on findings in September 2005, or to submit a new program, said Dr. Peter Fabri, USF's associate dean of graduate medical education.

"This program has been on a phenomenal trajectory for the past 12 months,'' Fabri said. "The problem is one of timing. Most of the items in that letter are not substantially accurate. ... The real question is, how do we demonstrate to all concerned that this is a high-quality anesthesiology program?''

For example, the letter said only 54 percent of USF anesthesiology residents passed certifying exams from 2000 to 2004. That's true, said Dr. Enrico Camporesi, the new anesthesiology department director. But in 2005, the pass rate rose to 90 percent.

Camporesi, who was meeting Wednesday evening with residents, said he wants to reassure them that he welcomes criticism, and that he has talked to faculty members about openness.

"I will defend the right to have multiple opinions,'' he said.

Reviewers said "faculty intimidation of residents has occurred.'' Fabri said there was an incident two years ago involving someone who left USF.

The report also said the program director defers too many decisions to Dr. Devanand Mangar, the well-known anesthesiologist who directs the private group. Mangar couldn't be reached late Wednesday.

It is unclear what changes USF intends to make. Klasko plans to negotiate with Tampa General and other hospitals in the next few weeks. USF is willing to invest more in the anesthesiology program, but Klasko said that money needs to go for doctors with academic credentials, not doctors who only treat patients.

"Whatever model we come up with is going to have a significantly increased academic component,'' he said.

Tampa General president and CEO Ron Hytoff said in a statement that he supports USF giving more information to ACGME, and that patient care won't be affected.

Ultimately, Klasko said, the changes ACGME wants will go beyond anesthesiology. The group is pushing to make all residency programs focus more on how residents learn, he said, not just how many babies they deliver or procedures they perform.

-- Lisa Greene can be reached at (813) 226-3322 or greene@sptimes.com

[Last modified May 11, 2006, 06:10:33]