Medical school hits back

The South Pacific School of Medicine has strongly hit back at a consultant’s report used to stop it operating here. The school questioned:
What credentials the consultant had to evaluate medical school education and what the consultant was told to do;
The way in which the medical school’s operations were reviewed, including the consultant not even visiting it, interviewing faculty and looking at its operations.
The medical school vigorously defended the qualifications of its faculty, describing the consultant’s claims about them as “incredible”.
In a letter to Prime Minister Jim Marurai, the school also outlined a series of benefits to the Cook Islands from it operating here.
The Health consultant’s report was used to get Cabinet to withdraw recognition of the school, effectively stopping it continuing to operate here. The school has been leasing the Rakahanga Hostel, for which it has already paid $50,000.
The Medical School’s response to the Cabinet decision is exclusively published in full on pages 14 and 15.

Temu Okotai on behalf of the Rakahanga Hostel Committee receiving the cheque for $50,000.00 from Larry Sands Junior March 2006. Dr Larry Sands on the right.

EXCLUSIVE: Med School replies to PM, challenges consultants

South Pacific School
of Medicine, Avarua
Rarotonga
Cook Islands
March 27,2007

The Honorable Jim Marurai Prime Minister
Minister of Educatton

Kia Orana Mr. Prime Minister:
I have reviewed your letter dated March 14,2007 regarding the South Pacific School of Medicine. We have not received a copy of the report by Health Specialists Ltd so it is not possible to know how the company’s representatives arrived at their conclusions.
We are concerned that at best their report is incomplete as the specific responses the concerns outlined below will illustrate. Furthermore, it would be helpful to understand what foundation the consultants bring to evaluating medical school education, particularly one required to recruit North American students as outlined in the agreement between SPSOM and the DIB.
Please send us the Terms of Reference of Health Specialists Ltd. detailing their assigned task to evaluate a tertiary medical institution, and the Curriculum Vitae of persons who contributed to the report.
It should be noted that the initial interview of the SPSOM Dean with the health consultants was arranged on the spur of the moment and lasted less than 30 minutes. There is no indication from SPSOM staff that the consultants ever visited the school, interviewed any faculty, attended any classes, or read the CV of any faculty. Health Consultants never made follow up phone calls or emails to any persons affiliated with SPSOM despite being given the invitation and information to do so. Had they done so, their conclusions might have been different.
Regarding the specific comments in your letter: .
Q1. SPSOM was unable to present a clear organizational structure and business mechanism that the school is operating under.
ANSW: SPSOM has submitted substantial paperwork to become established, address the DIB’s inquiry etc. This question was not addressed specifically in the course of the brief interview with the Dean. There is no indication that Health Consultants made any effort to request the information in follow up emails, phone calls, or any other kind of communication that would suggest that Health Consultants could make their conclusion with certainty or objectivity.
Q2. The Dean of School was unable to provide a level of confidence and clearly specify the benefits or advantages to the people of the Cook Islands, the Government and its Health Services.
ANSW: The advantages to the Cook Islands have been outlined and detailed in previous submissions to the DIB. The aim was to over 100 students residing and studying in the Cook Islands for the duration of their 18 month basic science training program. The benefits of these students would be further complimented by the permanent and visiting faculty who would provide local investment in terms of purchasing housing, and other goods and services along the lines of a similar cadre of expatriates living in the Cook Islands. This would be equivalent to the same benefits of a project creating a 100 person occupancy hotel or condominium in terms of taxes, investment, employment, human resource development etc. To the extent that international tourists and visitors in general have benefitted the Cook Islands, the school would provide the same or greater benefits. To the extent that these other international projects have been approved and been deemed beneficial to the Cook Islands, the school’s contribution in this arena should share the same confidence as similar projects.
The school’s intended compliment of basic science and visiting clinical faculty would be available to assist in the development of university level classes in biology, chemistry, physics, and mathematics which would then be available to Cook Island students wishing to enter into the medical school or pursue university level coursework elsewhere. This was a specific need identified when an SPSOM delegation visited with personnel from the Human Resources department in October 2005. At that time there was a concern expressed that some assistance might be welcomed for Cook Island nursing students and also for Cook Island students who were already planning to pursue medical studies outside of the country. Addressing this felt need by Cook Island government Human Resource staff should have offered the consultants further confidence that SPSOM could provide a clear benefit to the Cook Islands.
It has been anticipated that visiting clinical faculty would have the opportunity to interact with Cook Island physicians and offer Continuing Medical Education seminars as requested, much along the lines of visiting health teams that have provided courses in the Cook Islands on the invitation of the Ministry of Health. SPSOM has received numerous offers of assistance from highly qualified clinical faculty from Australia, the United States, Singapore, and fhe United Kingdom. To the extent that the courses arranged by the Ministry of Health have benefited the people of the Cook Islands, it stands to reason that SPSOM could offer further benefit in this regard.
It was further anticipated that in conjunction with the Ministry of Health, that as the school matured it would be able to collaborate on research projects addressing the needs and interests of the people of the Cook Islands. Such collaborations are already taking place at various other levels in the health sector in the Cook Islands. SPSOM collaborations might include visiting students as well as faculty from other health science universities located throughout the region and the world. If having visiting students and faculty from New Zealand dental schools, medical schools etc has been to date accepted as a clear benefit to the people of the Cook Islands, then SPSOM’s ability to further facilitate such exchanges must also be accepted as a clear benefit to the people of the Cook Islands. SPSOM could provide a new and expanded network of potential academic exchanges and collaborations through its own unique network of academic resources.
SPSOM offers 10 fully paid scholarships to Cook Island students who wish to become physicians. This opportunity would provide Cook Island citizens the opportunity to begin their medical studies in their home country and offer an additional venue in the region for becoming a qualified physician. Intrinsically it is hoped that providing a Cook Island beginning to medical education and expanding the supply of Cook Island national physicians who share a common language, culture, and heritage would be a clear benefit and advantage to the people of the Cook Islands.
Q 3. The experience, qualifications and skills of the proposed faculty clearly shows limited clinical and academic experience and coupled with lack of evidence of business documentation would indicate that lack of capacity to operate as an internationally recognized medical school.
ANS: This comment is perhaps the most telling in terms of the incompleteness of the report submitted by the consultants. The wholesale dismissal of the persons who have contributed to the school does an extreme disservice to the well qualified persons who have given greatly of themselves to the students and work of the school. This spirit of giving is well illustrated by a recent visiting professor of physiology, Dr Kenneth Dormer. Dr Dormer is tenured and holds the highest possible academic rank of Full Professor at the University of Oklahoma Health Sciences Center, School of Medicine. He has managed millions of dollars in research grants and holds numerous patents on important medical devices. The Cabinet has access to Dr Dormer’s Curriculum Vitae and they may judge for themselves if such a person has “limited academic experience.”
Dr Dormer and his wife came to the Cook Islands in good will to contribute to the school and were able to contribute outside of the school as well. They taught a marriage communication class in Cook Island churches and received favorable media coverage while in the Cook Islands. It is this kind of good will that the concept of the school has engendered and could potentially expand if provided with the opportunity.
The same could be said in different ways about the other faculty who have taught, or have been teaching at the school. As noted in the Dean’s presentation to the Cabinet, and as the supplied CV’s. attest, the school has been blessed by well qualified persons who have considerable training and experience in accredited medical schools and universities. The Cabinet is encouraged to read for themselves the CV. of the faculty.
To suggest that the clinical faculty lack experience is equally incredible. As noted, the clinical faculty who will teach SPSOM students must meet the highest standards set forth by the ACGME (as outlined in the presentation before the Cabinet.) This means that when the student studies surgery the faculties in that surgical program meet the same standards required to train US resident physicians wishing to become Board Certified surgeons. The same is true for the training in pediatrics, internal medicine, psychiatry etc. All of the clinical faculty of SPSOM students must meet the highest standards to have appointments as faculty in their respective training programs. Most of the same ACGME programs host medical students from other US and international medical schools. To again wholesale dismiss these clinical faculties is to suggest that residency and medical training in the US is done by persons who lack “experience, qualifications and skills.” The Medical Council of New Zealand recognizes that the USA has a health system equal to that in New Zealand, for example. It stands to reason that the consultants should be able to draw the same conclusion.
Just as the consultants clearly missed the real experience of the basic science and clinical faculty, they also failed to ask for a business plan. It is unfair to criticize the school for failing to supply a document that was not requested.
Q4. The Dean of School was unable to identify links with credible medical schools in New Zealand, Australia or the wider region.
ANSW: The current charter with the Development Investment Board clearly directs the focus of SPSOM to the Cook Islands and North America. There is nothing in the charter that requires the school to have any linkage to medical schools in the region. It is inappropriate to hold the school to a standard that has never been required or encouraged to date. SPSOM would gladly expand its linkages to such schools if permitted by the charter. It already has informal linkages to such schools through faculty and interested visiting professors who teach or have taught at schools in the region. SPSOM faculty such as Dr Adeniyi and Dr Inaho do have experience teaching at schools in the region. It is ironic that the consultants want the school to have linkages with regional schools but when SPSOM faculty can demonstrate this experience, the consultants label the same experience as “lacking.”
Q5. The South Pacific School of Medicine at this point currently lack experience, resources and are unable or unwilling to answer a number of questions which all contribute to their inability to gain the confidence of stakeholders.
ANSW: The South Pacific School of Medicine has consistently made itself available to answer questions regarding its intent and operations. It cooperated fully with the investigation by the Development Investment Board, has sought numerous meetings with government officials to address concerns, and most recently made itself available to the Cabinet for any questions they might have wished to ask. This characterization by the consultants is not in keeping with the facts.
At the conclusion of the Dean’s brief interview by the Health Specialists consultants, email contacts and follow up information were provided for any questions that might later arise or not have been answered adequately. Had the consultants asked further questions or sought clarifications, they might have received answers. But the consultants were unwilling to actually visit the school, speak to faculty, attend a lecture etc. Furthermore, they did not address any of the supporting documents that they were given.
They failed to acknowledge, for example, other reports that had been submitted in support of the school. Nor did they address the international standards promulgated by the Federation of State Medical Boards (FSMB) that illustrate how SPSOM does in fact meet international standards.
In short, the consultant’s report cannot be relied on to make such a sweeping determination given the objective deficiencies it contains. It ignores entirely the quality checks and adherence to standards that were outlined in the presentation to the Cabinet. It focuses only on perceived deficiencies that have more to do with the manner in which the report was prepared than the available facts support.
We continue to maintain that it is reasonable and desirable to develop a constructive mechanism to objectively address the concerns for providing a quality medical education at SPSOM. We are offering to address any concerns not answered by this brief response. We are asking respectfully that a mechanism and terms be agreed upon to permit the school to operate while upholding the high standards that both the school and the Government of the Cook Islands wish to maintain. We respectfully await your response.

Cc: DIB Short

 

Headlines : Times 194 02 April 2007
- Medical school hits back
- Drum maker in demand
- Woman’s mayoral hopes dashed
- Cooks Tourism named for world travel award
- YOU SAY: Be warned about board sackings
- WE SAY: Anti Media Bill in April?
- Landowner: HQ for Police only
- Idle Te Kukupa was put at risk
- Tough routine for Oceania hopefuls

Headlines : Times 193 26 Mar 2007
- Spanish fleet threatens our fishing
- Red Cross meeting will feature HIV, AIDS, STIs
- Area’s not for huts: Minister
- Achievement gets official recognition
- GOOD SIGNS: Road markings show Police Review action
- Training squad chosen for Oceania
- Tony Iro gets coaching job.
- Watch research, warns Sir Tom
- Lagoon Petero’s training ground