Minutes 10/17/07

Minutes 10/17/07

Joint Charlottesville, Fairfax, Roanoke & Salem
University of Virginia Clinical Medicine Meeting
Carilion Roanoke Memorial Hospital


Present: Anne Chapin, Evan Heald, Michael Rein, Yvonne Newberry, Megan  Bray, Pamila Herrington, David Geldmacher, Megan Keeley, Peter Ham, Hilary A. Sanfey, Eugene McGahren, William Wilson, John Jackson, Allison Innes, Donald Innes, Jerry Short, Daniel Harrington, Rhonda Miller, ElizabethVogel,  Farahaba Lakhdir, William ReaElizabeth McCuin, Mark Schleupner, Tananchai Lucktong,  BK Ahmad, Allen Blackwood, Bev Brown, Roger Hofford, Sandi Lunetta, Henrietta LuneauMaureen McCarthy, Thomas Eldridge, Pavan Reddy, Jorge Rivera, James Kim, Mehdi Kazemi, Gary Collin, Thomas Martin, David Coles, Mark Greenawald, Sixtine Valdelievre,

  1. Welcome - D Harrington, D Innes

  2. USMLE-1, USMLE-2CK & CS, and CPX results - D Innes, A Chapin

    99% of the UVa students passed the USMLE-2CK.

    Anne Chapin reviewed the USMLE Steps 1 and 2, Clinical Skills, and CPX results. Anne reviewed the major components of the CPX (patient encounter, patient note, and case presentation) and how each component was developed and graded and how the third-year class performed.  Scores remained relatively consistent with those of previous years, and students found the exam helpful in preparing for the USMLE Step 2 Clinical Skills.  Students omit some items in a physical exam or do other items improperly.  Some students failed to wash their hands before an exam or introduce themselves.  Low performance can be attributed to students' confusion about correct skills, inexperience with performance exams, modeling doctors who inconsistently apply correct clinical skills, and student attitude.

    Students who fail the exam must retake it after reviewing their performance and, if necessary, work with an attending responsible for addressing shortcomings and evaluating clinical competence.  Students wanted more opportunity to consistently practice those skills evaluated by the CPX, and the group discussed including those skills the CPX evaluates on the passports.

  3. Getting the Most from OASIS - J Jackson

    John Jackson reviewed some of the advanced capabilities of the OASIS program.

  4. Electives and Selectives Update - M Keeley, A Innes, J Jackson

    Selectives will add and drop through OASIS this coming year, and each area will need someone trained in pulling up selectives roster.  The academic year for MS4's starts 3/3 and for MS3's, starts 4/28.  Faculty and course evaluations are not released until after the grades are submitted and only if the faculty member has completed their evaluations of the students.  Students can't see the attending's evaluations of the student until the student has completed the course and faculty evaluations.

  5. Clerkship Websites:  A Focal Point for Students, Residents, and Faculty - J Jackson

    Students want feedback on performance and how they're meeting or not meeting faculty and resident expectations throughout a rotation so they can address those issues before they show up in a negative evaluation.  The four-week length of the rotations makes this an especially important issue.

    The clerkships are revamping their web pages to try to meet some of those needs by including clerkship goals and objectives, expectations of students, grading process, evaluation process, links to OASIS and patient logs, schedules, lecture schedules, and other site specific information.  Everyone should check their information to insure accuracy.

    Family Medicine is focusing on prevention and well-child practices and teaching advocacy for underserved areas.  Surgery is reinforcing the need to understand surgical pathophysiology and procedures and simulations.  Internal Medicine is including specialties that don't have clerkships as well as information addressing ethical and end-of-life issues.  Some sites are developing case studies for group discussion, some are integrating their specialty with other specialties, and some are including morning didactics with follow up and case studies.

  6. Professional Development - M Greenawald and E Vogel

    Carilion's Professional Development team is focusing on improving resident and faculty teaching skills such as teaching to the student, providing feedback, and teaching core competencies via workshops.

  7. SMEC plans - Sixtine Valdelievre Sixtine updated all present as to the current activities of the Student Medical Education Committee (SMEC) and the value of the Mulholland Clerkship Report and thanked the clerkship directors for their thoughtful responses to the report in the past. SMEC hopes to provide near real time feedback on clerkships allowing for early identification of areas of concern and areas of particular promise. She requested that clerkship directors communicate with SMEC if they have concerns.

  8. Topics for 1-2 day Short Courses in Core Clerkships

    Focus interviews
    OSCEs  good/bad interview techniques
    Review and present new material
    Psych issues in physicians

    Breast examination, etc.
    Case studies - 15 @ leader to ID topics beyond OBGYN, e.g. ER abdominal pain eval, This could be done in Surg/Med/Peds with objectives for each

    Case studies, e.g. Jaundice with reinforcement of pathology/physiology
    Procedure simulators, e.g. suturing
    Career development

    Integrate neurology back into topics from the year's clerkships - have didactic cases in AM; career focused in PM

    Family Medicine
    Prevention, screening, immunizations
    Medical informatics - how to keep up
    Life balance; advocacy

    Include speciality e.g. radiology, derm, opthal, ENT, urology
    Review basic science as applied to clinical experience
    Interpretation of the medical literature, career as hospitalist (role of hospitalist as teacher), hospice
    Advanced interviewing skills

    Use design format of BS4C
    Pharmacology for peds

  9. Clinical Skills Working Group - Evan Heald

    Working Group on Clinical Skills Education

    Committee members
    1. Practice of Medicine I : Seki Balogun and Walter Davis
    2. Practice of Medicine II : Brian Wispelway and Darci Lieb
    3. Clinical Medicine Committee : Evan Heald
    4. Electives & Selectives : Meg Keeley
    5. Professionalism : Nancy Payne
    6. Simulation : Marcus Martin, Keith Littlewood, Mark Kirk
    7. Instructional technology/computer support : Veronica Michaelsen
    8. Clinical Skills T&A program (SP program) : Anne Chapin
    9. Educational research & evaluation : Elizabeth Bradley
    10. Student representation, 4th year : Andy Goodman, Matt Borloz, Ann Falor
    11. Basic science faculty representative ; Melanie McCollum
    12. Graduate medical education (GME) : Mary Bryant
    13. Chair : Gene Corbett

    In order to enhance the effectiveness of curricular activities focused upon the clinical skill development of medical students, the Curriculum Committee of the School of Medicine is establishing a Working Group. The purpose of the working group on clinical skills education (WGCSE) is to facilitate the achievement of an integrated four-year developmental clinical skills curriculum in the School of Medicine which ensures that each student meets a defined level of basic clinical performance proficiency prior to graduation. The membership of the Working Group is designed to bring together the leadership of the major curricular activities involved in students' skills education.

    With the establishment of the WGCSE, a number of "next step" tasks can be more effectively addressed:

    1.   Link clinical skills teaching and assessment activities throughout the four years of the curriculum;

    2.   Create a more standardized clinical skill development process that reflects the 12 objectives of undergraduate medical education;

    3.   Expand formal clinical skills teaching throughout the clinical years, thereby addressing the learning of a wider variety of basic clinical skills;

    4. Expand opportunities for specific skills assessments and remediation;

    5. Enhance faculty and resident educational development with emphasis upon clinical skills teaching in small groups and in bedside rounding;

    6. Establish a database for tracking and evaluating clinical skills education outcomes.

    As with all curricular processes, this is a work in progress. It is likely that the content and priorities of this curricular effort will change as the process of making developmental clinical skills education more explicit continues to unfold.

  10. Site Updates

    Salem Update - Dr. M. McCarthy

    As the Salem VA celebrates its 75th anniversary, Dr. McCarthy gave a brief overview of its history, current research projects, and staff changes, as well as its notable achievements and initiatives.  The VA is providing health care services that accommodate the increasing age of veterans with increased health care needs and the increasing number of younger veterans.  The VA also serves as a major teaching facility for residents, medical student, and nursing students in Virginia.

    Roanoke Update - Dr. D. Harrington

    While Carilion transitions to an integrated multi-specialty clinic, it is also developing fellowships and other residencies, a medical school, and a research institute.  Dr. Harrington reviewed recent staff changes and the addition of chairs for each department.  The Physician Development Committee is developing a curriculum for professional development for residents and faculty.

  11. Closing - Dr. Innes

    Dr. Innes thanked the attendees for their participation and valuable suggestions. Suggestions for future meeting topics of interest to the clerkship directors should be sent to Don Innes at dji@virginia.edu The spring meeting will be held April 2, 2008.