University of Virginia School of Medicine
Clinical Medicine Committee
Members present (underlined): Rein, Michael F; Herrington, Pam ; Adams, Reid B; Newburg, Doug; Corbett, Eugene; Wenger, Jennifer; Maughan, Karen L; Mounsey, Anne; Short, Jerry; Innes, Donald J; Innes, Allison H; Chapin, Anne E; Lieb, Darci G; Jackson, John M; Keeley, Meg M. ; Shenker, Joel; Wilson, William; McIntosh, Paul, Vladimir Goodkorsky
The meeting was called to order at 5 PM. in the Surgery Library.
The major agenda item was discussion of the LCME standard "ED2", and how we will meet that standard. The standard, from the LCME website, was circulated to the membership:
ED-2. The objectives for clinical education must include quantified criteria for the types of patients (real or simulated), the level of student responsibility, and the appropriate clinical settings needed for the objectives to be met.
Each course or clerkship that requires interaction with real or simulated patients should specify the numbers and kinds of patients that students must see in order to achieve the objectives of the learning experience. It is not sufficient simply to supply the number of patients students will work up in the inpatient and outpatient setting. The school should specify, for those courses and clerkships the major disease states/conditions that students are all expected to encounter. They should also specify the extent of student interaction with patients and the venue(s) in which the interactions will occur. A corollary requirement of this standard is that courses and clerkships will monitor and verify, by appropriate means, the number and variety of patient encounters in which students participate, so that adjustments can be made to ensure that all students have the desired clinical experiences. [Annotation revised and approved June 2004, effective immediately.]
An email from another institution that has recently had an LCME sitevisit was circulated; this email reflected on the way in which the LCME team viewed the activities at that school, particularly regarding ED2. The OB/GYN clerkship at that school was the only one that was felt to be "in compliance"; that clerkship used wire-bound notecards that were distributed to students; these were "signed off" by faculty or housestaff as the students saw the patients required. These were also used to log procedures or demonstration of specific knowledge, and a student needed to see "90%" of the problems in the list to satisfy that requirement.
There was considerable discussion about how we can meet the standard. It was felt that the major problem would be the issue of "real time" tracking of the patients or required diagnoses (clinical problems/clinical presentations) being seen, and the mechanism to adjust the rotation to ensure that all students had the desired clinical experiences. John Jackson described a web-based log that was currently being used by Family Medicine; it was felt that this format could be modified for use to track specific encounters that will be required of each student. It was pointed out that a logbook was not sufficient to meet the ED2 standard, although logs are helpful in comparing sites and in monitoring the overall experiences of our students. The possibility of using an "incomplete" grade for those students who had not successfully met the clerkship requirement was also raised. This is similar to the approach currently in use with the passports. Electives and menu-driven selectives are not thought to be included under ED2, unless they contribute substantially to the minimum requirements of the clinical curriculum as outlined by the School of Medicine.
- Each clerkship director was asked to form an internal committee to develop a list of "required" diagnoses (which can also be presenting complaints or disease or patient categories). These should be sent to me (email@example.com) for distribution. It is hoped that we can be ready to implement this in late June, with the upcoming clerkship year.
- Don Innes would like for each clerkship to present an overview of the proposed curriculum reform at a Departmental faculty meeting within the next several months. He has a PowerPoint presentation that might be helpful in showing how the curriculum fits together over the 4 years. It may also be helpful if someone from the Curriculum Committee or the Contemporary Clerkships and Electives/Selectives Committee were present to help answer some of the broader questions that might arise.
John Jackson introduced Dr. Vladimir Goodkorsky, who has recently joined the University and will be working in Medical Education.
The meeting was adjourned at 6 PM.
William G. Wilson, MD
Chair, Clinical Medicine Committee