Minutes 03/25/09

Minutes 03/25/09

Joint Clinical Medicine Meeting -
Charlottesville, Fairfax, Roanoke & Salem
Wednesday, March 25th, 2009
University of Virginia

Present:
Allen Blackwood    Daniel Harrington Elizabeth McCuin        
 Brad Bradenham  Evan Heald

Eugene McGahren

 Megan  Bray  Joy Hilton Amanda Murchison
 Bev Brown  Allison Innes

Yvonne Newberry

 Randolph Canterbury  Donald Innes

Enrique Perez

 Anne Chapin  John Jackson Andrew Pfeffer
 Jill Clarke  Animesh Jain Claire Plautz 
 Eugene Corbett  Mehdi Kazemi William Rea
 Alicia Freedy  Megan Keeley Jorge Rivera
 David Geldmacher  Amy Kryder Ashley Shilling
 Aval-Na'ree Green  Tananchai Lucktong Jerry Short
 Peter Ham  Sandi Lunetta Amy Tucker 
     

Welcome - Randolph Canterbury, Senior Associate Dean for Education|

New Clerkships 2009-2010

Geriatric Medicine - Aval-Na'ree Green
During the 2-week Geriatrics Clerkship, students will participate in the ongoing, daily care of older patients with a wide variety of acute and chronic illnesses and abnormal physical findings. Each student will be paired with a primary geriatric physician mentor who will provide clinical teaching and ongoing feedback to the student. Additionally, each student will be responsible for his or her own panel of patients at a skilled nursing facility.  Throughout the clerkship students will work with a variety of geriatric focused health professionals as part of the interdisciplinary care team. This includes nurse practitioners, therapists, certified nursing assistants, and social workers. It is expected that throughout the course of the 2-week clerkship students will be involved with and responsible for admission assessment, discharge planning, ongoing care and management, writing orders, and working with families. Students will also participate in clinical skills workshops providing instruction and practice of skills pertinent to the care of older adults. As with all other clerkships, students and faculty will use a Clinical Skill Passport to assist teaching and learning of several geriatric focused skills. Faculty will use the PassPort to guide teaching and feedback to students, and students will use the Passport to track their learning needs more effectively.

Perioperative & Acute Care Medicine - Ashley Shilling and Claire Plautz
This 2-week course will teach medical students basic clinical concepts and skills through direct patient exposure, focused didactics, problem-based learning sessions, and programmed procedural training. Focus will be placed on peri-operative medicine, pharmacology and physiology, crisis management, and cardiac resuscitation, as well as essential clinical skills including airway management, wound care, ECG and radiograph interpretation and intravenous access.  Passport-directed objectives and competencies will be mastered within the high-yield specialties of Anesthesiology and Emergency Medicine.

The Curriculum at the Carilion Clinic School of Medicine - Dan Harrington
Dan Harrington reported the sad death of Dr. Elizabeth Vogel, who was instrumental in developing our educational programs. She and Dr. Mark Greenawald developed the a number of professional development offerings:

"Resident as Teacher" curriculum
Physician Leadership Academy
Faculty Development Fellowship
Distinguished Educators Society planned
Scholars Program planned


Applications for Pulmonary and ID Fellowships have been submitted to the ACGME. In addition there are plans for development of Cardiology, GI, Critical Care, Surgical Critical Care, Psychosomatic, and Addiction fellowships. A Program Director for Emergency Medicine Residency has been hired and an application forwarded to the ACGME. A Pediatric Residency is in the planning stages.

The new Virginia Tech Carilion School of Medicine and Research Institute is under construction at the Riverside Center. It will be a four year medical school with 42 students per year in a patient centered curriculum using a modified PBL format. All students will be required to complete a research project and thesis.

Carilion

Currently VTC is a candidate school with an LCME visit in February 2009 with an anticipated decision from LCME in June 2009. The first class is expected to enroll August 2010. The 4 domains of study are threads throughout a 4-year curriculum and include: Basic Science, Clinical Science, Research, and Interdisciplinary.


Core Clerkships, Selectives, & Electives
- Meg Keeley, Allison Innes, Jill Clarke


Move of the Surgery Selectives to the 3rd year.

 a. Assigned/scheduled by lottery in OASIS 
 b. Evaluations done same way as for 4th year students - paper selective evaluation form
 c.   Evaluations are due 2-weeks after end of the rotation


Revew of the 4th year

 a. Requirements
 b. ACE Electives (review & discuss breakdown of what SMD 09 chose to do)
 c.  New Electives (Wilderness Medicine Immersion & RAM Clinic both with Dept. of Emergency Medicine - Guatemala, Newborn Nursery, Semester @ Sea; Translation Research with the BME department, Calls of Medicine in Biomedical Ethics/Humanities, Health Policy Scholars Program, Human Rights Elective, Geriatric Clinic Elective, Vulnerable Pediatric Population Elective)
 d. MD/MBA Program

Student Medical Education Committee Focus - Brad Bradenham, Andrew Pfeffer, and Animesh Jain

Brad Bradenham outlined the purpose of the Student Medical Education Committee is:

  1. "To encourage & help evolve better methods of teaching and learning medicine at UVA."
  2. "Facilitate dialogue among students, and between students and faculty, on issues relating to medical education."
  3. "To help facilitate institutional memory and transparency"

There will be one representative per clerkship. Clerkship reps will meet with clerkship directors and try to provide real time feedback for each of the clerkships. A 3rd Year Reps will also meet as a group to discuss broader 3rd year issues, e.g., 3rd Year Grading Survey. A "history of the clerkships" is a possible project for the coming year.

Luncheon Clerkship Workshop Meetings - "Calling Attention to Basic Science Principles in the Clerkships" or How to Integrate Basic Science Material into the Clinical Years 

  1. Surgery - would not want to initiate new didactic lectures but would encourage lecturers to include basic science reference into their current lectures.   Physiology and pharmacology information would be a good fit for integration into current Surgery lectures e.g. how drugs  work (mechanisms) and how that relates to the physiology of the disease process.  Student might be asked to research these topics and present their findings to the team.  The goal is not to dilute the clinical information in the didactic sessions but rather to enhance it.
  2. Pediatrics - also would not want to initiate new didactic lectures and there is already basic science information in their didactic sessions.  To clearly delineate during lectures what information is basic science material would make it more visible and apparent to the student. 
  3. OBGYN - During student presentations, encourage students to provide basic science correlations - i.e. clinical connections during the basic science years in reverse.  Attendings should be encouraged to "think out loud" when reviewing cases - mentioning pertinent basic science facts.
  4. Neurology - Increase neuroscience participation in case based learning modules much as neurology is included in neuroscience.
  5. Medicine- Basic Science is not just "information" regurgitation but should be tool to enhance "best practice."  Encourage students and faculty to include current literature when discussing mechanism of disease and site relevant clinical trials whenever possible.  In determining the "best practice" in taking care of a particular patient describe why treatment works or why it doesn't.  Provide "cheat sheet" for faculty with germane clincical trials for intergration and discussion on the floors.
  6. Family Medicine - Has received very positive feedback from preceptors on how students often provide them with current and relevant basic science information because they are "closer to the basic sciences."   Pharmacology, physiology and epidemiology would be logical areas to expand into during family medicine case presentations or didactic lectures.  Ask students "why" - what is the underlying medicine - have student make the basic science connection.
  7. Acute Care/Anesthesiology - Simulation Center cases would be perfect opportunity to enhance basic science instruction with no detriment to patient care.  Anesthesiology by it's nature creates discussion of pharmacology and physiology issues.
  8. Geriatrics- pharmacology and age associated changes in physiology would be very appropriate lines of discussion.

Implementation of clerkship enhancements is made difficult the fact that students are taught by multiple attending physicians.  If basic science information is to be consistently included in the clinical years, appropriate faculty development and materials should be provided for all faculty.
 


Clinical Skills:  Student Readiness for Clerkships
- Gene Corbett

IDEAS TO BETTER PREPARE STUDENTS FOR CLERKSHIP YEARS

  • CD's noted that students seem to have a lack of repetitive exposure to procedures such as inserting NG tube and IVs, taking BP, history taking, etc. 
  • Student motivation needs to be enhanced.  Self-learners must be created in the basic science years and beyond.   
  • Students need to feel "ownership" of their own education and be an integral part of the team.  Repetitive exposure to skills such as history taking is very important throughout medical school.
  • Just talking to a real or simulated patient repeatedly during the first two years would enhance student ability to feel comfortable with patients.
  • Students need to think about the "why" in their medical education. 
  • Now the first two years are more "passive" learning but with the new curriculum should become more "active" learning.
  • Videotaping of clinical skills is a very effective teaching method and should be enhanced.  Feedback from an attending is particularly helpful.
  • More patient contact should be arranged in the first two years - establish a minimum number of patients each student should talk to or interview.
  • Help students to appreciate the psychosocial issues they will see when they go out on the clerkships.

Attached is the AAMC monograph - Clinical Skills Education

You can also download it at https://services.aamc.org/Publications/index-page?fuseaction=Product.displayForm&prd_id=141&prv_id=165

Next Generation Curriculum - Don Innes

Progress report on the New Medical Education Building now 28% complete and on time for completion February 2010.

Next Generation Curriculum: Why?

  1. Scientific teaching - instructional decisions are evidence based
  2. Learner centered environment - How does the student learn this subject best?
  3. Integrated learning - learn by building connections to ideas, skills, people, etc.
  4.  Advanced technology available in the New Medical Education building - simulation, standardized patients, learning studio
  5. USMLE integrated Gateways A & B
  6. Attract students to a contemporary interactive curriculum
  7. Education Task Force

Fall 2009 Meeting Date - The fall meeting will be October 21, 2009 at the Salem Veterans Administration Hospital in Salem, Va.