S2811

An Act concerning clinical clerkship programs and amending P.L.2003, c.133.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 2 of P.L.1997, c.390 (C.18A:64H-2) is amended to read as follows:

2. There is hereby established the Advisory Graduate Medical Education Council of New Jersey, which shall be responsible to the [Commission on Higher Education] Department of Health. The purpose of this council shall be to make recommendations for the support, through federal, State and private funds, of graduate medical education programs in private nonprofit and public hospitals in the State, and to make recommendations for the development and implementation of new graduate medical education programs which will meet the needs of the citizens of the State. The functions of the council shall include, but not be limited to:

a. Obtaining and evaluating information concerning the graduate medical manpower needs of the citizens of the State;

b. Recommending standards and criteria for participation by private nonprofit and public hospitals in the State;

c. Reviewing individual institutional applications and recommending awards of support to particular institutions based on conformance with the identified needs of the citizens of the State and the standards and criteria recommended by the council;

d. Annually reviewing the educational programs provided by participating hospitals;

e. Annually reporting to the Governor and the [Education] Senate and General Assembly Health Committees of the New Jersey Legislature on the council's activities pursuant to the provisions of [this act] P.L.1977, c.390 (C.18A:64H-1 et seq.).

(cf: P.L.1994, c.48, s.171)

2. Section 5 of P.L.1977, c.390 (C.18A:64H-5) is amended to read as follows:

5. The [Commission on Higher Education] Commissioner of Health, upon the advice of the Advisory Council, [with the concurrence of the Commissioner of Health,] shall:

a. Plan for the development and implementation of graduate medical education programs in the State;

b. Set standards for qualification for participation by public and private nonprofit hospitals in the State;

c. Establish standards for the use and expenditures of funds appropriated pursuant to this act;

d. Determine the number and type of graduate medical education programs which should be supported in particular hospitals in relation to total State needs.

(cf: P.L.1994, c.48, s.174)

3. Section 8 of P.L.1977, c.390 (C.18A:64H-8) is amended to read as follows:

8. The [Commission on Higher Education] Commissioner of Health shall promulgate such rules as are necessary to carry out the purpose of [this act] P.L.1977, c.390 (C.18A:64H-1 et seq.).

(cf: P.L.1994, c.48, s.175)

4. Section 1 of P.L.2003, c.133 (C.18A:64H-9) is amended to read as follows:

1. a. There is created, within the [Office of the Secretary of Higher Education] Department of Health, the "Advisory Committee on Alternatively Accredited Medical School Clinical Clerkships."

The advisory committee shall consist of 11 members as follows: the Commissioner of Health [and Senior Services] or [his] the commissioner’s designee, who shall serve ex officio; four members appointed by the Governor who include one representative of the Medical Society of New Jersey, one representative of the New Jersey Association of Osteopathic Physicians and Surgeons, one representative of the New Jersey Hospital Association and one representative of an alternatively accredited medical school; two members appointed by the President of the Senate who include one representative of the New Jersey Council of Teaching Hospitals and one representative of a teaching hospital in New Jersey that has students from an alternatively accredited medical school participating in a clinical clerkship program; two members appointed by the Speaker of the General Assembly who include one representative of an alternatively accredited medical school and one representative of a teaching hospital in New Jersey that has students from a medical school of Rutgers, The State University in a clinical clerkship program; one member appointed by the State Board of Medical Examiners; and one member appointed by the President of Rutgers, The State University. No two members of the advisory committee shall be representatives of the same medical school or hospital.

b. Members shall serve for a term of three years from the date of their appointment and until their successors are appointed and qualified, except that of the members first appointed, four members shall serve for a term of one year, three members shall serve for a term of two years and three members shall serve for a term of three years. Vacancies shall be filled for the balance of the unexpired term in the same manner as the original appointments were made. A member of the advisory committee shall be eligible for reappointment.

c. The members of the advisory committee shall serve without compensation, but shall be reimbursed for necessary and reasonable expenses actually incurred in the performance of their duties, within the limits of funds appropriated or otherwise made available to the advisory committee for this purpose.

d. The advisory committee shall select a [chairman] chair from among its members, who shall serve a one-year term but may serve successive terms. The advisory committee shall meet upon the call of the [chairman] chair or of a majority of its members. A majority of the members of the advisory committee shall constitute a quorum, and no action of the advisory committee shall be taken except upon the affirmative vote of a majority of the members of the entire advisory committee.

e. As used in [this act] P.L.2003, c.133 (C.18A:64H-9 et seq.), "alternatively accredited medical school" means a medical school located outside the United States provided that the medical school:

(1) is in a country that applies accreditation standards that have been determined by the National Committee on Foreign Medical Education and Accreditation within the United States Department of Education to be comparable to the accreditation standards applied to medical schools located within the United States; or

(2) [that continues to meet] is accredited by an accrediting body recognized by the World Federation for Medical Education as having accreditation standards comparable to the Liaison Committee on Medical Education or the American Osteopathic Association; and

(3) meets the accreditation standards of [that] the country [; and

(3) has medical school students participating in a clinical clerkship program in New Jersey prior to the effective date of this act, or is approved by the Advisory Graduate Medical Education Council of New Jersey pursuant to section 4 of this act to operate a clinical clerkship program in this State] in which the medical school is located.

(cf: P.L.2012, c.45, s.78)

5. Section 4 of P.L.2003, c.133 (C.18A:64H-12) is amended to read as follows:

4. a. A medical school located outside of the United States: (1) in a country that applies accreditation standards that have been determined by the National Committee on Foreign Medical Education and Accreditation within the United States Department of Education to be comparable to the accreditation standards applied to medical schools located within the United States; [and] or (2) that is accredited by an accrediting body recognized by the World Federation for Medical Education as having accreditation standards comparable to the accreditation standards applied to medical schools located within the United States; and (3) that continues to meet the accreditation standards of [that] the country in which the medical school is located, but is not an alternatively accredited medical school, as that term is defined in Section 1 of P.L.2003, c.133 (C.18A:64H-9), or authorized to operate a clinical clerkship program in this State on the effective date of [this act] P.L. , c. (C. ) (pending before the Legislature as this bill) [, as that term is defined in this act,] may apply to the Advisory Graduate Medical Education Council of New Jersey, pursuant to this section, to be approved to operate a clinical clerkship program in this State, provided that the medical school meets the criteria for an alternatively accredited medical school as defined in subsection e. of section 4 of P.L.2003, c.133 (C.18A:64H-12).

b. The council shall adopt regulations specifying the criteria for approval of a foreign medical school to operate a clinical clerkship program in the State. The criteria shall include, but not be limited to, satisfactory evaluation[,] pursuant to a site visit[,] of the applicant's institution, including both its main campus and any clinical facilities in locations other than the main campus.

c. The applicant shall be responsible for all costs incurred by persons designated by the council, who are experienced in medical education program evaluation, for [conducting the site visit, and by the council for] reviewing and processing the application.

d. After a medical school is approved by the council to operate a clinical clerkship program, it may apply to the council for authorization to operate a specific clinical clerkship program in this State, in accordance with standards adopted by the council. The standards shall include, but not be limited to, those standards listed in paragraphs (1) through (9) of subsection b. of section 5 of [this act] P.L.2003, c.133 (C.18A:64H-13).

e. A medical school that has been approved by the council, pursuant to [this act] P.L.2003, c.133 (C.18A:64H-9 et seq.), to operate a specific clinical clerkship program in this State shall be deemed an alternatively accredited medical school for the purposes of [this act] P.L.2003, c.133 (C.18A:64H-9 et seq.) and authorized to operate a clinical clerkship program in this State, provided it maintains its accreditation status as provided in subsection e. of section 1 of [this act] P.L.2003, c.133 (C.18A:64H-9).

f. [A] An alternatively accredited medical school authorized to operate a specific clinical clerkship program pursuant to this section may apply to the council to increase the number of students participating in the clinical clerkships or to increase the number of programs operated by the school, pursuant to the requirements of section 5 of [this act] P.L.2003, c.133 (C.18A:64H-13).

6. Section 5 of P.L.2003, c.133 (C.18A:64H-13) is amended to read as follows:

5. The Advisory Graduate Medical Education Council of New Jersey shall review each application made by an alternatively accredited medical school to increase the number of students participating in clinical clerkships or to increase the number of programs operated by the school. The application shall be made in a form and manner prescribed by the council.

a. The council shall notify the applicant, in writing, of the approval or disapproval of an application within 90 days; except that, if the council determines that the application is not complete or additional information is required before the council can make a determination, the council shall notify the applicant in writing and shall have an additional 90 days after receipt of the requested information to approve or disapprove the application. If the council does not affirmatively approve or disapprove the application, or request additional information concerning the application, within 90 days of its submission, the application shall be deemed approved.

b. The council shall approve an application if the applicant demonstrates that it meets the registration standards comparable to those promulgated by the Liaison Committee on Medical Education, which include, but are not limited to: (1) a requirement that a medical student who will participate in a clinical clerkship program shall have successfully completed the United States Medical Licensing Examination-Step 1 and provided proof of the successful completion of the exam within 3 months of the start of the student’s clinical clerkship; (2) the hospital is accredited by the Joint Commission on Accreditation of HealthCare Organizations or a comparable U.S. HealthCare Accreditation Organization; (3) the clinical clerkship program shall take place in a hospital with an approved Accreditation Council for Graduate Medical Education or American Osteopathic Association residency training program in the clinical area of instruction for which credit is sought; (4) clinical instruction shall be supervised by a Director of Medical Education; (5) clinical instruction shall be provided pursuant to a written agreement that includes a written curriculum for each individual clinical subject; (6) the hospital shall insure that there is a minimum daily census in each clerkship area that will meet the instructional needs of the clinical subject; (7) [the hospital] a medical student who will participate in a clinical clerkship program shall have [on the premises] access to a library [facility] that has adequate resources to support clinical clerkships in each core area; (8) each department chair shall be board certified in the specialty area in [his] the chair’s department; and (9) the hospital shall ensure a ratio of no less than one medical resident for every two clinical clerkship students.

c. If the council disapproves the application, the notification of disapproval shall specify each deficiency, including the reason the applicant failed to meet the registration standards, and shall provide information on remedial steps that applicant must take to meet the standard. An applicant shall be provided the opportunity to submit evidence of remediation, within a time period specified by the council.

d. The applicant shall be responsible for all costs incurred by the council for reviewing and processing the application.

(cf: P.L.2003, c.133, s.5)

7. Section 7 of P.L.2003, c.133 (C.18A:64H-15) is amended to read as follows:

7. The [Commission on Higher Education] Commissioner of Health, in consultation with the Advisory Graduate Medical Education Council of New Jersey, shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of [this act] P.L.2003, c.133 (C.18A:64H-9 et seq.).

(cf: P.L.2003, c.133, s.7)

8. This act shall take effect immediately.

STATEMENT

This bill revises the requirements for certain medical schools located outside of the United States to operate clinical clerkship programs in New Jersey by amending P.L.2003, c.133.

Under current law, unless a medical school is already considered an alternatively accredited medical school, a medical school located outside of the United States can only apply for the authorization to operate a clinical clerkship program in the State if the medical school: (1) is in a country that applies certain accreditation standards, which have been determined by the National Committee on Foreign Medical Education and Accreditation (NCFME) within the United States Department of Education to be comparable to the accreditation standards applied to medical schools located within the United States; and (2) that continues to meet the accreditation standards of that country. Any medical school that satisfies this criteria and is approved by the Advisory Graduate Medical Education Council of New Jersey to operate a clinical clerkship program in this State is deemed to be an “alternatively accredited medical school.”

This bill amends these requirements and permits certain medical schools located outside of the United States that are accredited by an accrediting body recognized by the World Federation for Medical Education (WFME) as having accreditation standards comparable to the Liaison Committee on Medical Education (LCME) or the American Osteopathic Association (AOA), to apply for the authorization to operate a clinical clerkship program in the State.

The bill revises the requirements for an alternatively accredited medical school to increase the number of students participating in clinical clerkships or to increase the number of programs operated by the school.

The bill establishes the Advisory Graduate Medical Education Council of New Jersey and Advisory Committee on Alternatively Accredited Medical School Clinical Clerkships within the Department of Health. Under current law, these entities were established under the Commission of Higher Education.

The bill requires Commissioner of Health, in consultation with the Advisory Graduate Medical Education Council of New Jersey, to adopt regulations to implement the provisions of the bill.

It is the sponsor’s intent that this bill will broaden the pool of medical schools that might be eligible to operate a clinical clerkship program in the State, by accepting and considering the applications of medical schools that have been accredited by standards that have been recognized by either the NCFME or the WFME. It is the sponsor’s belief that this bill might increase the number of clinical clerkship opportunities in the State and the number of medical school students who complete their medical school training in New Jersey, which would increase the likelihood that a student will continue to pursue residency and employment opportunities in New Jersey and thereby increase the supply of physicians in the State.