UCI Medical School Cited by Review Panel

IRVINE — A national accreditation council has found deficiencies in one-fourth of UCI medical school’s residency programs, serious enough to result in warnings or probation.

The reviews, conducted by the American Council for Graduate Medical Education, found problems including inadequate supervision of residents, not giving them sufficient exposure to a variety of procedures and medical conditions and a failure to support research in 10 of the 39 residency programs.

If the deficiencies are not corrected by the next review, UCI’s medical residency programs could lose their accreditation and would not be able to train doctors in those fields.

The most serious problems were found in neurology and neurosurgery.

Dr. Thomas Cesario, dean of UCI’s College of Medicine, said the accreditation reports do not mean patients are receiving substandard care because “all care is the ultimate responsibility of the faculty. We have faculty doing more and more hands-on care.”

The issue, he said, is how residents are educated. The accreditation reviews, he said, “tell us what to fix, and we fix it.”

Cesario said most of the problems are easily correctable, requiring changes in documentation or faculty physicians to schedule formal reviews with residents.

At any given time about 4% of the residency programs nationwide receive warnings or are put on probation by the accreditation council, said Dr. John Gienapp, its executive director. The group reviews about 7,600 residency programs at medical schools and hospitals,

Residency programs educate medical school graduates in a specialty, and residents are overseen by faculty physicians.

Cesario said many of the deficiencies are a result of the declining number of patients, making it more difficult for UCI to expose its 670 residents to the variety of medical cases, treatments and procedures necessary to maintain accreditation.

Managed care has reduced the number of hospital visits nationwide. In Orange County, even the Medi-Cal patients who once flocked primarily to UCI Medical Center in Orange are part of a new managed-care program that sends them to private physicians, Cesario said.

“We’re in the midst of radical change. Managed care has penetrated here more than anywhere else in the country,” he said, explaining why he believes a disproportionate number of UCI’s programs received probation or warnings.

Gienapp, however, said that the repetition of certain deficiencies at UCI indicates “there may be some systematic problems. It could be luck of the draw, or it could mean that there are some issues they need to work on.”

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In addition to neurology and neurosurgery, programs receiving warnings were: surgical critical care; child neurology; gastroenterology; hematology; medical oncology; infectious disease; rheumatology; and endocrinology, diabetes and metabolism.

Cesario said he is recruiting a new chief of neurosurgery.

In addition, he said, two residents in neurosurgery are being sent to other medical centers for more experience. The medical school will make sure there are enough patients so neurosurgery residents receive experience, he said.

UCI’s residents work primarily at the school’s medical center, but also at Long Beach Memorial Hospital, the Veterans Administration Hospital in Long Beach, San Bernardino County Hospital, Kaiser Permanente and the Kern County Medical Center in Bakersfield, Cesario said.

The university is considering discontinuing some of its resident programs, or sharing them with other medical schools, such as UCLA, USC and UC San Diego, Cesario said.

UCI Medical Center, struggling to shore up its shaky financial position, has been exploring affiliation with Columbia/HCS Healthcare Corp. or Tenet Health Care Corp.

The affiliation with a network of hospitals would help the school correct some residency program deficiencies, Cesario said, by giving residents access to a larger number of patients needing a wider variety of treatments. “If they’re not getting enough of a certain experience at the [UCI] medical center, we’ll make sure they get it by sending them elsewhere.”