University of Virginia School of Medicine
Clinical Medicine Committee
Members present (underlined): Donald Innes; Adams, Reid; Rein, Michael; Maughan, Karen;; Herrington, Pamila; Juel, Vern; Wenger, Jennifer; Short, Jerry; Corbett, Eugene; Keeley, Meg; Owens, Gary; Innes, Allison; Petri, William; Squillace, Susan; Heald, Evan; Bradbeer, Clive; Chapin, Ann; Mit Robertson, Wilson, William;
- The meeting was called to order at 5 PM in the Pediatrics-Pathology Conference Room.
- We discussed the "clinical skills passports" program. This is a "work in progress", and there may be need to modify or revise some of the passports, based on the experiences in individual clerkships. If there are modifications, they need to be made soon so that the new versions can be ready for use with the upcoming clerkship year. It was suggested that we circulate existing passports among the clerkship directors, and later drafts of proposed changes. The issue of "overlap" of items was also discussed. It was felt that there were some items (related to physical examination skills or patient interviewing) that may merit duplication, while other items that may be unique to a given clerkship may not need duplication.
- Dr. Allison Innes discussed some information about the USMLE Step 2B exam, which will be a "standardized patient exam" activity. It is hoped that our current CPX exam will help prepare our students for the new national requirement, which is scheduled for implementation for the upcoming 3rd year class.
- The idea of "patient logs" was discussed. It is apparent that the LCME is asking for documentation of clinical experiences of medical students, in part to ensure adequate patient numbers and diversity. Several clerkships are now using some form of a patient log, either for the entire clerkship or for a defined time period. The clerkship directors were asked to think about the method that would be most appropriate for their clerkships. A suggestion was to create "learning logs", which not only served to document numbers, but also to document "what I learned from this patient". Experiences elsewhere suggest that the success of such a reflective activity vary dramatically with the individual student.
- The impact of the "80 hour work week" on medical student education was discussed. There is concern that informal teaching time may decrease, given the requirements that limit housestaff hours during the week and also consecutive hours in the hospital. Several services have used "teaching residents" in the past, but this activity may not be feasible. Some of the teaching duties will be assumed by faculty. This led to discussion of several ideas, some of which have been used at other institutions, including the use of non-physician educators (physician assistants, nurse practitioners), or MD "hospitalists" for teaching some clinical skills, or the use of "master teacher" educators whose role was to teach. It was commented that bedside teaching may be most effective when the teaching physician is also the physician who is involved in the care of the patient.
- The meeting ended with a wide-ranging discussion of curriculum modification, including possible modifications to the clinical years, which might include shortening of some of the "core" clerkship experiences and expanding elective or selective experiences. Concern was expressed that we should have good reasons to change or shorten clerkships that have been successful in the past. One possible advantage of compacting the "core" experiences was that this might make it easier to move the beginning of clerkship experiences back by several months (into the later part of the second year). This would also give a longer time period for elective and selective experiences before residency choices need to be made. The members of the committee were encouraged to think about how the clerkships are now configured and how they could be modified, perhaps with added later selective experiences, without diminishing the educational value of the clinical rotations.
- The meeting was adjourned at 6:10 PM.
William G. Wilson, MD
Chair, Clinical Medicine Committee