Element 2.4 – Sufficiency of Administrative Staff

A medical school has in place a sufficient number of associate or assistant deans, leaders of organizational units, and senior administrative staff who are able to commit the time necessary to accomplish effectively the missions of the medical school.

Hidden Curriculum

The roles of associate or assistant deans, unit leaders, and senior administrative staff are critical not only for fulfilling their individual responsibilities but also for ensuring that the broader mission of the medical school is achieved effectively. Effective leadership and adequate protected time to get the job done is critical.  Note that student perceptions of adequacy of responsiveness to their concerns can affect how the LCME interprets this element. They may feel there are not enough personnel/FTE to address issues. This can arise in any area (e.g. faculty development, faculty affairs etc.). If one of these elements is problematic and it’s perceived there is not enough faculty/FTE you can get dinged here.

Best Practice

While many schools have evaluation mechanisms for department chairs and senior administrative staff, the LCME requires these processes to be formally documented. To evaluate the sufficiency of senior administrative staff, some approaches may include assessing the alignment between their workload and the expectations of their roles, gathering feedback from faculty, staff, and students on their effectiveness and accessibility, and reviewing the time spent on administrative duties versus other responsibilities. Additionally, conducting regular performance reviews that include measurable goals and outcomes can help ensure that senior administrators are adequately equipped to support their departments and the institution’s broader mission.

But who qualifies as senior administrative staff? While the DCI glossary provides a definition…

“People in academic leadership roles, to include but not limited to, associate/assistant deans, directors, academic department chairs, and people who oversee the operation of affiliated clinical facilities and other educational sites. Many, if not most, of these people also have faculty appointments, and for tracking purposes should only be counted in one category.”

…make sure you have followed this definition and defined it “out loud” in your DCI. Also make sure that everyone at your school understands too as the word “staff” sometimes confuses people -like your Dean and above…😊 Finally, ensure that your school has a clear and detailed organizational chart for the SOM that outlines the senior administrative staff and their reporting structure.

Continuous Quality Improvement

It’s important to note that the ISA questions in the DCI have changed, and a high number of students disagreeing with administrative staff not being accessible, aware of student concerns, and response to student problems will result in a citation.  You will want to have a way you keep your finger on the pulse of this. Many schools do annual “internal ISAs” or add questions to course/clerkship evaluations to do that.  If more than 15-20% of students disagree with this line of questioning – I’d be doing something about it as 85% seems to be the holy grail for reasons no one knows.   

Additionally, it’s a good practice to regularly review your Department Chair staffing chart, particularly the number of vacancies/interims, as these seem to accumulate at some institutions over the years. You don’t want that number to be huge at the time of your visit or have someone whose been interim for the past 8 years lol. (Yes, I’ve seen this.)