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Grand Forks Herald, August 18, 1996

Herald staff and wire reports

The internal medicine residency program at the UND is in danger of losing its accreditation.

A report from the Accreditation Council of Graduate Medical Education found 35 deficiencies, said Dr. Richard Olafson, assistant dean of the UND Medical School's Fargo campus.

"We're fully accredited for one year with a warning, but we're addressing the issues," Olafson said.

But H. David Wilson, dean of UND's School of Medicine and Health Sciences, said the school is looking at this as a positive opportunity for change.

Olafson agreed. "This review is a mandate for change," he said. "It is a tremendous opportunity to build a `state-of-the-art' residency program from the ground up."

Wilson said when a program is inspected, it's expected there will be room for improvement -- "even at Harvard," he said.

UND has 24 internal medicine residents, all based in Fargo. The school admits eight students each year to its three-year program. Internal medicine doctors perform most medical procedures with the exception of major surgery.

More than half of the school's hospital teaching is done at the Veterans Administration hospital in Fargo, and that brought criticism in the report, Wilson said. As a result, "We're looking at widening the scope of patients that our students see," he said. "That's not representative of the population." A site evaluator said the residents aren't receiving broad training at the VA, where the patients are mostly male and elderly.

The evaluation also said residents don't have enough contact with faculty and don't have enough time to study. And the program was told to add preventive medicine and legal and ethical issues to its curriculum.

The site evaluator visited the UND campus last summer and submitted a report in April.

UND called in a consultant last week to give a second opinion. Dr. Tom Nasca, associate dean of Jefferson Health System in Philadelphia, confirmed the 35 deficiencies and said he could add 15 more.

"Change is difficult for people to recognize. We're going to have to have some major shifts in the program to accomplish all the changes that are here," Olafson said.

UND's internal medicine residents are performing above national averages, leading faculty members to question the evaluation, Olafson said.

Doctors must graduate from accredited programs to be certified by the American Board of Internal Medicine. If they're not certified, they still may practice, but they would be at a disadvantage to competitors.

UND plans to choose a successor within a few weeks to Dr. Richard Gray, who left as chairman of the internal medicine residency program. Gray has established a heart institute in St. Paul.