Graduate medical education programs at the Tulane University School of Medicine were placed on probation by a national accreditor, the Accreditation Council for Graduate Medical Education, (ACGME) last week. The probation follows a public fight over allegations of racism in the school’s graduate program this February stemming from the suspension of Dr. Princess Dennar, who is Black, from her position overseeing a residency program. 

The school was informed of the decision on July 2, according to an email sent to the School of Medicine by Lee Hamm, the school’s dean. In the email, Hamm wrote that “given issues of confidentiality, we are limited in the information we can share about the ACGME’s decision.”

However, Hamm outlined two broad areas of concern: “oversight of our [graduate medical education] programs;” and “improving our learning and working environments, including enhancing equity, diversity, and inclusion.”

In a Tuesday email, Tulane spokesperson Michael Strecker did not respond to questions about what specifically led to the probation decision. He instead repeated statements from Hamm’s email, and noted the actions Hamm said the School of Medicine has taken or plans to take in response.

In a February interview, John Combes, the chief public policy officer of the ACGME, told the Lens that probation is one of several steps the ACGME can take against a program.

The first step in the process, Combes said, is a warning. Warnings are “not infrequent,” he said.

“And then there’s probationary accreditation, which is much more serious,” Combes said. While a program is on probation, it can’t expand its programs or apply for new ones. “It is really a first-step warning that they are in jeopardy of losing their accreditation if they don’t correct it by the next review cycle.”

The ACGME visited Tulane earlier this spring, in the wake of allegations of racism and retaliation made by an administrator of a Tulane graduate medical education program, and picked up by several other groups affiliated with Tulane.

Dennar was suspended as director of the school’s internal medicine-pediatrics residency program in February, though she remained medical director of another program.

She accused the School of Medicine of retaliating against her for a federal lawsuit she filed in October 2020, which alleged racial and gender discrimination against her and her residents. Dennar said that her program was disproportionately composed of women of color. 

The university denied the allegations, saying that she was suspended because of a review triggered by a warning from the ACGME. Dennar contested that claim in a letter to Tulane President Michael Fitts, arguing that other programs had also been given warning statuses, but the review policy was timed specifically to target her. The ACGME review in question is private.

Following calls from alumni, students, and faculty for more transparency in the suspension and in some cases, the removal of Hamm as dean. Hamm offered to reinstate Dennar, conditioned on her receiving “executive coaching, additional administrative support… and on-going [sic] oversight and guidance.”

Dennar declined to be reinstated, saying that the extra oversight conditions were an effort to deflect blame from medical school leadership.

The lawsuit is ongoing. Earlier this spring, Dennar’s lawyers filed an amended complaint that incorporated the suspension into its earlier allegations.

Combes of the ACGME said in February that the organization could not comment on the specifics of any specific program’s accreditation. However, he said, “there are very widespread concerns about racism and [graduate medical education]. We are very concerned about that as well, and it’s at the front of the values that we have. … And as we become aware of them, we can trigger some internal mechanisms.”

He also said that the ACGME can expedite site visits in cases where “a violation of our requirements puts in jeopardy either the safety or the education of the residents,” and specifically mentioned retaliation as an example.

In a late Tuesday statement provided to the Lens by ACGME spokesperson Susan White, the organization confirmed that its April visit had been triggered by “public reports of racial bias and discrimination” at Tulane’s graduate medical programs. The statement also said that while it could not share details of the decision, “Tulane University School of Medicine; however, is welcome to share information as it sees fit.”

In the February interview, Combes said he couldn’t comment on any pending site visits. The ACGME visited Tulane’s campus in April, and according to its website, estimates that it will conduct a follow-up visit in January 2022.

Before the spring visit, a group of alumni wrote a letter to the ACGME asking the organization to investigate specific elements of Dennar’s claims.

Though it’s not clear exactly what led to the ACGME’s move, Dennar issued a statement on Tuesday in support of the decision. 

‘“While I deeply empathize with the students, residents, fellows, and many of my colleagues who may be unfairly impacted by Tulane’s probationary status—and I continue to offer my support to them—I believe that ACGME’s action is a positive step toward addressing concerns raised by myself and others about racism, sexism, and retaliation at Tulane University.”

In his July 2 email, Hamm outlined a plan for responding to the probation. The plan includes a task force to evaluate Tulane’s process for handling “reports of mistreatment and unprofessionalism of any kind.” He also said that the university would take steps to reduce the clinical workload of residents. Unequal clinical workloads had been an element of several of the discrimination complaints.

Several elements of the plan had already been announced as part of Tulane’s response to Dennar, including the hiring of the international law firm Norton Rose Fulbright to “make conduct an evaluation of the operation, oversight, and supervision of graduate medical education,” and of consulting group Sensei Change Associates “to assist [Tulane] in better understanding individual experiences related to equity, diversity, and inclusion.”

According to Strecker, “the School of Medicine leadership looks forward to receiving recommendations from these two independent experts over the course of the summer.”

This story was updated to include statements received after publication from Dr. Princess Dennar and the Accreditation Council for Graduate Medical Education.