St. Louis University School of Medicine on Probation?? Really?? Time to Throw The Red Flag!

One of us remembers attending his son’s White Coat Ceremony when he was beginning his first year at SLU School of Medicine some nine years ago. The guest speaker, a female physician addressing a group of fledgling medical students who were facing medical education long known for grinding students down, described the behavior of a flock of migrating geese. She described how members of the flock take the lead position for a while, and then, when fatigued, drop back to draft off the others. She also noted that when a single goose was not able to continue, it was common that another member of the flock would drop out to stay with the one who just couldn’t go on. All these years later we wish that more of those who manage and regulate medical education had the good sense of a flock of geese, and the moral compass and compassion that has, we believe, guided SLU to place a very high value on the mental health and well being of the medical students in attendance at their University.

Over 50 % of doctors suffer from burnout and we lose more than 400 doctors a year to suicide caused by a toxic work environment. About 1/3 of resident physicians suffer from burnout. It starts in medical school.
Three years ago the Journal of the American Medical Association- Psychiatry published an article titled: Med Student Depression, Suicide: National Response Required. SLU has been one of the most active and undeniably the most successful medical school to address this ongoing tragedy, basing medical education on the Jesuit underpinnings of educating and nurturing the whole person; mind, body, spirit, and heart. The innovations that have been put in place at SLU School of Medicine, while beyond the scope of this article, have resulted in a reduction of the prevalence of depression from approximately 30% of students to 6% which is about the rate in the general population, all without any reduction in academic achievement. These accomplishments are unmatched by any other medical school on earth.

The Wall Street Journal article titled “Medical School Seeks to Make Medical Training More Compassionate” published March 22, describes how the Icahn School of Medicine at Mount Sinai has embarked on a soul searching campaign of culture change after a 27 year old student there jumped to her death last summer from her eighth floor dorm residence. We applaud the school’s efforts. SLU School of Medicine wrote the book on such culture changes, and it wasn’t a recent suicide that drove them to change. They realized it was the right thing to do years ago.

On the very day the above article was published, we and Michele Dietl, who lost her son Kevin to suicide when he was 10 days from graduation from the Kirksville College of Osteopathic Medicine met with new SLU School of Medicine Dean Kevin Berhns. Dean Behrns came to SLU from Florida about three months ago. We met with him in part to make sure he is aware of the magnitude of the accomplishments of SLU SOM and that his new University has lead the nation in medical education innovation over the last decade. We felt we needed to do this because when SLU School of Medicine was astonishingly put on probation last week by the Liaison Committee on Medical Education(LCME), claiming deficiencies in “Academic and Learning Environments”, and “Curricular Management, Evaluation and Enhancement”, areas where SLU has robust outcomes data to convincingly refute these assertions, Dean Behrns chose not to ask for reconsideration, a built in option, which quite possibly could have avoided probation.
In football when a head coach sees a blown call that hurts his team he throws a red flag on the field to call for a careful review of the video replay.
It may be that Dean Behrns feels you just can’t fight City Hall or LCME, but we wonder if others would have recognized LCME probation as a blown call and thrown the red flag in a heartbeat. We hope the new Dean will take that step, but if not, someone should. The Accreditation Council for Graduate Medical Education, (ACGME) which oversees training programs for resident physicians will be implementing significant changes in the requirements for training programs regarding the mental health and well being of these doctors beginning in July, and that’s a very positive step. LCME should follow their lead.

Sadly over the last decade med students have died by suicide in medical schools all over this country at an alarming rate, yet not one of these med schools is currently on probation. Over the same time period, no med student at SLU School of medicine has died by suicide, and SLU has essentially eliminated depression in its first and second year med students and yet it ends up on probation. We believe it is time that LCME take depression and suicide more seriously, and require med schools to periodically measure the prevalence of depression among their students. We believe if the LCME accreditation process can lead to probation for SLU School of Medicine, then the process that LCME is using is broken and should be redesigned. SLU School of Medicine is a beacon of hope and light to medical education but due to an outdated process, the LCME failed to appreciate the fact that what they observed at SLU SOM is the proper future of medical education.

State Representative Dr. Keith Frederick
State Senator Dr. Robert Onder