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UNC School of Medicine Independent Student Analysis

In the Fall of 2018, students at the UNC School of Medicine (UNC SOM) conducted the Independent Student Analysis (ISA), a component of the LCME reaccreditation process that serves to assess, commend, and critique medical education at UNC SOM. This comprehensive evaluation affords the students and faculty the privilege of earnestly celebrating the institution’s strengths, as well as facilitating discussion of the school’s weaknesses and catalyzing changes where reform is needed.

This report was prepared by the ISA Steering Committee using the results of the ISA Student Survey. The following analysis provides a framework to understand student satisfaction and perspectives on various aspects of medical education at UNC SOM. Based on these results, the Steering Committee developed a series of recommendations for the School of Medicine’s faculty and administration.

A total of 828 students received the ISA Student Survey, and 780 students responded.  Given the high degree of participation (94%), we have confidence that these results are representative of the whole student body.

Full Independent Student Analysis, February 2019

Institutional Responses to Independent Student Analysis Findings

Faculty Lead: Dr. Lisa Rahangdale | Student Lead: MS4 Danielle Ellis

ISA Finding 8.3: Opportunities for applicants from underrepresented minority groups (race/ethnicity, gender, religion, etc.) to meet with diverse faculty and staff.

  • The Admissions committee now invites students from groups, such as LMSA, SNMA, and QSA, to speak to the group of prospective students as a whole and individually during the interview lunch.
  • The Admissions Committee has added a “check if you would like someone from specific groups to contact you” box to UNC’s application.  List of specific groups provided on application.

ISA Finding 8.4: Access to scholarship information prior to matriculation.

  • Launched an improved website that more clearly lists internal and external scholarship opportunities.  The website also displays statistics on the percentage of recipients and dollar amount of distributed scholarships.  Website can be found at:
  • Hired a full-time scholarship coordinator to work with the Office of Admissions, Office of Financial Aid, Office of Finance and Budget, and Medical Foundation to ensure scholarships are advertised, coordinated, and dispersed.

Faculty Leads: Drs. Julie Byerley and Beat Steiner | Student Leads: MS3 Ben Keepers and MS4 Danielle Ellis

ISA Finding 3.2: Transparency of Administrative Activities.

  • Class meetings are now more frequent, scheduled in advance, and published on academic calendars for all phases.  Class meetings intentionally correspond to milestones, such as Step 1, Step 2, MSPE, and ERAS.  Staff and faculty seek input from student representatives when setting class meeting agendas.  Agendas and accompanying material is distributed prior to class meetings.
  • Improved general correspondence from the Executive Vice Dean, Dr. Julie Byerley, and Senior Associate Dean for Medical Student Education, Dr. Beat Steiner.  Specifically, better and more timely communication around major decisions that affect students.  Correspondence aims to provide rationale for decisions, indicate whether student input was sought, and reinforce shared mission and goals.
  • A new website displays the outcomes of various curriculum committees, as well as lists task forces and the names of students involved in them.  Student participation in tasks forces to date include Foundation Phase Midcourse Feedback Committee, Step 1 Task Force, Individualization Phase Evaluation Task Force, New Child Adjustment Work Group, Application Phase Attendance Policy Task Force, and Foundation Phase Scheduling Task Force.  Website can be found at:
  • A revamped website more clearly lists school policies.  Website can be found at:

ISA Finding 3.4: Clarity in the Specific Roles of Different Faculty and Administration.

Staff Lead: Senior Director of Academic Affairs, Johanna Foster | Student Lead: MS4 Demetra Schmerhorn

ISA Finding: 7.23: Flexibility in scheduling of third year rotations: Students wanted greater predictability in clinical assignments for Central Campus students during Application Phase. Clinical assignments that are farther from the Chapel Hill area pose logistical challenges for which students would like to prepare or even avoid.

  • Altered the Campus Rank Process to include more specific regional options associated with Central Campus (the campus with the greatest level of variability in locations).
  • Beginning with the Class of 2022, students ranked the following options:
    • Asheville Campus
    • Charlotte Campus
    • Wilmington Campus
    • Central Campus – Raleigh Region
    • Central Campus – Greensboro Region
    • Central Campus – Cross Regional
  • The school better communicated that the Central Campus – Cross Regional option may entail assignments to Greensboro, Butner, or Raleigh depending on clinical capacity.
  • For students assigned to Central Campus – Cross Regional will continue to have the opportunity to express location preferences for rotations. Clerkship coordinators will continue to take this information into account, but cannot guarantee that students will receive their first choice in locations. Coordinators will continue to review locations assignments to ensure that any one student is not over-assigned to a specific location.
  • Per school policy, a student who is dissatisfied with the campus assignment has the option of requesting another campus.  Administration will take the request into consideration but will not guarantee a change. A student’s personal, family, and medical circumstances may change after campus assignments, necessitating a change in campus. Academic Affairs and Student Affairs makes every effort to facilitate a campus change.
Faculty Leads: Drs. Julie Byerley and Beat Steiner | Student Leads: MS4s Danielle Ellis and Ned Hardison

ISA Finding 2.1: Accessibility to the Dean for Medical Education.

  • Transitioned Town Hall meetings to a  gathering in the early evening to allow for participation across more years where students can interact with the deans and key administrative directors. Food and drinks are provided to establish a more social event to facilitate communication.
  • The Executive Vice Dean, Dr. Julie Byerley, and Senior Associate Dean for Medical Student Education, Dr. Beat Steiner, send weekly reflections to students about important happenings.

ISA Finding 2.6: Student awareness of governing, faculty-led committees for the medical school.

Launched an accessible, well-publicized website on governance.  Website can be found at: The website displays the following:

  • Displays the established curriculum committees with an up-to-date meeting calendar.
  • Provides most recent meeting highlights for each committee.
  • Includes information on how students can attend meetings as student citizens.
  • Shows who the student curriculum reps are and clarifies their roles are (direct communication to cohorts after meetings)
  • Lists Ad Hoc committees for issues that arise organically (e.g. the Step 1 task force, the “adjusting-for-Berryhill-destruction” task force, etc.) and displays the names of students who were involved in the task forces.
Faculty Leads: Drs. Georgette Dent and Neva Howard | Student Leads: MS4s Sam Robin and Topher McCauley

ISA Finding 6.23: Availability of Tutorial Help.

  • Increased the time of physician educators, Drs. Neva Howard (70%) and Christina Shenvi (50%), to manage the newly established Office of Academic Excellence.  Dr. Christina Shenvi was named the Director of the Office of Academic Excellence. Dr Howard now coordinates with college advisors and Student Progress Committee to improve their ability to help with academic assistance and counseling, with a specific focus on Step 1 preparation.
  • Hired an administrative assistant, Ebony Alston, for the Office of Academic Assistance to schedule meeting for students and manage data.
  • Dr. Howard created an Individualization Phase elective that will train MS4, MD-PHD, and MD-MPH students to become Foundation Phase and Step 1 tutors. Previously, there was a demand for 60 hours per week tutoring during dedicated Step1 study, which only addressed the academic needs of students at risk for failing Step 1. Dr. Howard’s efforts will greatly increase tutor capacity and quality for all students, especially for those in need of assistance before and during the dedicated study period for Step 1.
  • Dr. Debbie Ingersoll, Director of Academic Assistance, will meeting with every MS1 student prior to the start of summer break to establish Step 1 study plans.
Faculty Lead: Dr. Alice Chuang | Student Lead: MS2 Seth Alexander

ISA Finding 4.5 Adequacy of Responses to Reported Mistreatment.

UNC SOM management of mistreatment includes the following:

  • Enhanced reporting
    1. There are multiple methods for reporting listed here
    2. Additionally, students can report using their rotation evaluations
    3. In AY 18-19 (Application Phase) the school recorded over 80 reports.
  • Bystander Training
    1. Faculty, residents and fellows in all departments are undergoing bystander training by Drs. Alice Chuang and Cam Enarson
    2. MS1 students received peer bystander training before entering Clinical Week
    3. MS2 students will receive both faculty and peer training prior to starting Application Phase
  • Incident Management
    1. A Learning Environment Committee was established in January 2019 to triage and review all incident and determine appropriate management (Dr. Chuang triaged all in AY18-19 so far). Students do not play a role in this because of possible Human Resources and FERPA issues in discussing these incidents.  These discussion are necessary to in order to appropriately triage the intervention needed.
    2. Human Resources and Equal Opportunity Center are also involved in triage.
    3. All reports are addressed individually:  typically if identity of reporter is known, the learner is approached to obtain more information.  Next, the case is triaged and then feedback is given to individual physician. Severe cases or repeated reports are escalated.
  • Culture Change
    1. All departments (faculty, residents, and fellows) receive bystander training and awareness interventions so understand how to create a positive learning environment and what contributes to a negative learning environment.  Additionally, definitions of mistreatment, microaggressions are reviewed.  To date, Drs. Julie Byerley, Cam Enarson, and Alice Chuang have presented to over 60 clinical and basic science departments.
Faculty Leads: Drs. Alice Chuang and Liz Steadman | Student Leads: MS4s Sam Robin and Drew Alexander

ISA Finding 7.3: Quality of Advising on Upcoming Educational Milestones (board exams, applying to residency, etc.).

  • Class meetings for the academic year are strategically planned out for all years (MS1-MS4) with input from elected student representatives.  Meetings will cover relevant milestone information. The timing of each meeting will be intentional in an effort to provide important information at a time that is most useful to the students.
    • PowerPoint slides from the class meeting will be sent immediately to the student body afterwards.
    • Lecture capture of each meeting will be posted online as soon as possible.
  • Brown bag lunches are now coordinated to follow class meetings. This will give students an additional opportunity to follow up with their advisors should they have questions about any information that was given during the class meetings.
    • Advisors will know what will be discussed during class meetings before the meeting happens.  This will increase advisor awareness and help them answer student questions about the meeting.
    • Advisors will have an agenda to discuss during brown bag lunches, in case students don’t have many questions to ask. This will reinforce what was covered during the class meeting and give students a second opportunity to have more conversations about their questions or concerns.
  • Whitehead class representatives will take meeting notes as a part of their roles.  These notes will be disseminated to the student body in an effort in increase transparency and awareness of topics discussed.
Faculty Leads: Drs. Sarah Smithson and Beat Steiner | Student Leads: Alexis Hollingsworth

7.60 Adequacy of Education in First Aid/Emergency Response.

  • MS1 students will receive Basic Life Support training during the Immunology Block prior to Community Clinical Week.
  • Optional Stop the Bleed training sessions will be offered in October during the Hematology Block.  This training was launched by the White House in 2015 and is designed to train, equip, and empower bystanders to help in a bleeding emergency before professional help arrives.
Faculty Lead: Dr. Kurt Gilliland | Student Lead: MS2 Seth Alexander

ISA Finding 5.7: Adequacy of Education in How to Best use Institutionally-Provided Study Resources.

  • Dr. Kurt Gilliland will hold a focus group with MS3 students, including those from various campuses, about their ability to use resources for shelf exam preparation.  He will also contact each regional campus’s leadership with their view of student preparation.
  • Developed a training schedule for MS1 students (Class of 2023) about how to use various educational resources. The schedule will be accurate to the day/time level and will propose how faculty, in partnership with students, will train students in use of platforms such as Anki and USMLE-Rx, etc. Some sessions will repeated for convenience, whereas other sessions will build incrementally on previous sessions.
    • Dr. Neva Howard has scheduled Anki sessions for the Class of 2023.
    • Dr. Neva Howard is scheduled for a class meeting for the Class of 2023, September 9, 2019, to teach students how to build a training schedule.
    • Dr. Kurt Gilliland sends weekly USMLE-Rx questions each week to the Class of 2023, beginning the first week of medical school.  The Office of Academic Excellence tracks question completion.
    • Dr. Neva Howard sends out weekly UWorld questions to the Class of 2022 and tracks performance and completion.
Faculty Lead: Dr. Georgette Dent | Student Leads: MS4 Kate Dickson and MS3 Abby Loszko

ISA Finding 6.26: Quality of Health Insurance.

  • Communication around Health Care Options: Clarified if a student opts out of UNC’s Student Blue plan and then completes Application Phase at a campus other than Central, then the student’s private insurance may bill services as out of network.  The Executive Director of Campus Health is reviewing information sent to students regarding which plans are in network and will work with the branch campuses regarding network coverage. One related issue is that the campus health services at Charlotte and Greensboro will bill the student’s insurance, but the campus health services in Asheville and Wilmington will not.
  • Concern about Student Blue Plan access to specialists: The UNC Campus Health has a referral specialist that assists students in identifying a specialist that will accept the student’s insurance. The Executive Director of Campus Health will work with branch campuses to determine if there are referral specialists at those locations.
  • Financial Aid for Health Costs: Financial aid has reconstituted the Financial Aid Review Board (FARB) to improve communication with students and is specifically including information about reimbursement of health care expenses in class meetings.  FARB has student representatives from every class.
  • Comparability of Health Care at Branch Campuses, including Mental Health Services: The Executive Director of UNC Campus Health has compiled a chart with information about medical services at each campus.  View Chart.
  • More Wellness Resources: Hired another Wellness Coach, Darren Livingston, in addition to Wellness Coach Alli Shad.  Access to Wellness Program Resources:

ISA Finding 6.27: Transparency about Health Insurance Pricing for Dependents of Students

  • The Associate Dean for Student Affairs contacted the Interim President of the UNC System regarding the importance of the system providing students with an insurance option that will cover dependents. The UNC System is working with Blue Cross & Blue Shield of North Carolina to look at the pricing of dependent health care insurance for the 2020-2021 academic year.
  • The school now provides students with information regarding extramural options for dependent health care insurance (e.g. ACA, AMSA, AMA, etc.).  Website can be found at:
Faculty and Staff Leads: Dr. Alice Chuang, Dr. Liz Steadman, and Johanna Foster | Student Leads: MS3s Angela Ning and Abby Loszko

ISA Finding 6.12: Adequacy of Counseling about Elective Choices.

  • Ongoing multi-year effort to clarify and standardize the course catalog to simplify course selections.
  • Clarification of the roles of College Advisor versus Career Goal Advisor
    • College Advisor development to learn the course catalog in order to better advise students of varying specialties.
    • Career Goal Advisor introduction meeting moved from December to August in Application phase to provide more access to specialty specific advising on choosing electives.  Additionally, Dr. Alice Chuang will lead a session for students who are undecided.
  • Include mean course rating and duty hours on course catalog to help students make better informed decisions on elective choices.

ISA Finding 6.13: Student Awareness of Elective Choices (pertains to Foundation Phase).

  • Centralized as much as possible the information given to students about Foundation Phase Electives through a website, class meeting, and streamlined email messages.
  • Included all Foundation Phase electives in the course catalog, in a section clearly marked for Foundation Phase.  Selections can be found at:
  • Elective Policy now restricts Foundation Phase electives to semesters 2 and 3, thus eliminating or reducing as much as possible the demands put on students to decide on electives prior to starting medical school.  Starting in AY2020-21, CAMPOS Spanish Language courses will only be offered in semesters 2 and 3.  Established a centralized approval process for students to take electives:
    • Students must be in good academic standing during semester 1 of Foundation Phase to take electives
    • The process will start with students speaking with Dr. Ingersoll, who will ask College Advisors to approve student requests.
Faculty Lead: Dr. Cam Enarson | Student Leads: MS4 Drew Alexander and MS2 Seth Alexander

ISA Finding 4.11: Adequacy of Student Relaxation Space at the Medical School Campus.

  • The construction plans for new Medical Education Building (MEB) includes ample and dedicated student relaxation space.
  • During the construction of MEB, the lobbies of MBRB will be converted to student relaxation space.

ISA Finding 4.12: Adequacy of exercise facilities at the medical school campus

  • The construction plans for new Medical Education Building (MEB) includes a medium-sized fitness center/space on the ground floor.
  • During the construction of the MEB, a ground floor MacNider room will be converted to a small fitness center in September 2019.

ISA Finding 4.15: Access to secure storage space for personal belongings at the medical school campus.

  • MS1 and MS2 Foundation Phase students have assigned lockers.
  • UNC Hospital leadership is in the process of securing designated lockers for Central Campus students.
  • UNC Hospitals is in the process of allocating additional working/learning spaces on 3 West and 3 Anderson.
  • Every campus provides secure storage for inpatient and outpatient settings.
Faculty Lead: Dr. Kurt Gilliland | Student Leads: MS2 Josh Ewy and MS3 Matt Fordham

ISA Finding 7.13: Adequacy of basic science education in Microbiology.

  • More instructional time and labs have been allotted to Microbiology over the course of the last two academic years.
  • For the Class of 2023 in AY2019-20, the Principles of Medicine Block is dedicated an entire week to Microbiology content, which is led by Dr. Marcia Hobbs.

ISA Finding 7.14: Adequacy of Genetics Education.

  • Dr. Bradford Powell is creating study sheets for each organ-system genetics topic mapped to key Step 1-related diseases and syndromes.

ISA Finding 7.15: Adequacy of Biochemistry Education.

  • Instructional time for Biochemistry has been relocated to later in Foundation Phase to be closer to the time of Step 1 preparation.  Dr. Steve Crews will is leading this effort.

ISA Finding 7.16: Adequacy of Pharmacology Education.

  • Allocated more instructional time to Pharmacology in AY2019-20.
  • Drs. Jim Fiordalisi and Neva Howard developed pharmacology quizzes for each block of the medical science courses.
Faculty Leads: Drs. Beat Steiner, Georgette Dent, and Lisa Rahangdale | Staff Leads: Kelly Cash and Sheila Graham-McDonald | Student Leads: MS4s Kate Dickson and Topher McCauley

ISA Finding 6.20: Student awareness of Scholarship Opportunities.

  • Launched an improved website that more clearly lists internal and external scholarship opportunities.  The website also displays statistics on the percentage of recipients and dollar amount of distributed scholarships.  Website can be found at:
  • Hired a full-time scholarship coordinator to work with the Office of Admissions, Office of Financial Aid, and Office of Finance and Budget, and Medical Foundation to ensure scholarships are coordinated, advertised, and dispersed.
  • Included scholarship material into admissions packet.

ISA Finding 6.19: Timely Communication of Additional Financial Costs Incurred by Courses/Clerkships.

  • Provide financial information at four key times in the curriculum, an effort led by the Office of Financial Aid, including:
    • Provided itemized list of Step 1 study resources as recommended by Dr. Neva Howard.
    • Improved communication of added university fees associated with moving from 10 month student status to 12 month student status, the time period of transitioning from Foundation Phase to Application Phase.
    • Provided Itemized list of Step 2 costs (study resources and travel).
    • Distributed a “what to expect” document based on prior MS4 students’ costs for interview season.

ISA Finding 6.18: Transparency surrounding tuition increases.

  • Dr. Beat Steiner, Senior Associate Dean for Medical Student Education, will initiate an annual tuition meeting to share information about upcoming or recommended changes in tuition.
  • Created a website displaying how tuition dollars are used.  Website can be found at:
  • Dr. Julie Byerley, Executive Vice Dean, will continue to work with university system and Dr. Wesley Burks, Dean for the Medical School, to stabilize tuition costs.
Faculty Lead: Dr. Beat Steiner | Student Leads: MS4s Caroline Fryar and Sam Robin

ISA Finding 7.46: Subjectivity of Grading in Clinical Clerkships.

  • Launching a new evaluation model in Individualization Phase to standardize the process across all sites in North Carolina.  Model is entails identifying a Head Evaluator who gathers ratings and comments from Contributing Preceptors.  Contributing Preceptors can be a balanced mix of physicians and residents.  The Head Evaluator must be a physician or chief resident.  Every course will also have an identified Distributor who will orchestrate the dissemination and collection of evaluations.  The Distributor distributes evaluations to Contributing Preceptors with input from student when appropriate. Students cannot distribute evaluations to selected preceptors as this represents the potential for bias.  Students will now be able to begin each Individualization Phase course understanding the evaluation process and who is responsible for its implementation beginning September 2019.

ISA Finding 7.47: Transparency of Alpha Omega Alpha and Gold Humanism Society Distinction Criteria.

  • Alpha Omega Alpha (AOA)
    • Updated the UNC AOA website clarifying election policies and AOA eligibility. Specifically listed the membership of the student and  faculty committees; clarified that foundation phase grades do not count in the AOA calculation but that Foundation Phase evaluation comments are visible to committee members, explained the policy for delayed and leave of absence students.  Website can be found at:
    • Included AOA information in the Transition to Application Phase course materials at all campuses.
    • Set up consistent reminder from AOA student leadership to Student Affairs to ensure that AOA policies are presented each year during Application Phase class meetings.
  • Gold Humanism Honor Society (GHHS)
    • Revise GHHS website to provide more detail on process and timeline for selection of students.  Website can be found at:
    • Included GHHS information in the Transition to Application Phase course materials at all campuses.
    • Set up consistent reminder from GHHS leadership to Student Affairs to ensure that this information is included in Application Phase class meetings.
Faculty Lead: Dr. Alice Chuang | Student Leads: MS4s Caroline Fryar and Angela Ning

ISA Finding 7.51: Assistance in Choosing a Specialty.

  • Clarify the roles of College Advisors vs Career Goal Advisors (CGA) to students.
  • Move Career Goal Advisors introduction meeting from December to August class meeting in Application Phase.  Dr. Alice Chuang developed a session for undecided students.
    • In July class meeting, assign or strongly advise students to use the Careers in Medicine (CiM) assessments on AAMC website.
    • College advisors to debrief and help interpret CiM assessments.  Sara Tinkham now serves as primary staff support to facilitate CiM.
    • Reorganized Career Opportunity Series (COS), departmentally sponsored lunches to highlight specialties.  Lunches will run from September to April.  Will include non-direct patient care sessions in COS series.