Minutes 10/20/04

Minutes 10/20/04

University of Virginia School of Medicine
JOINT Clinical Medicine Committee

UVaDonald Innes, M.D., Allison Innes, Ph.D., William Wilson, M.D.;   CHS - Daniel Harrington, M.D., Jeannie GarberVAMC - Stephen Lemons, Ed.D.;   AIM -Evan Heald, M.D.,  Ashutosh Kaushal, M.D., Thomas Eldridge, M.D.;  F P Ann Mounsey, M.D., Roger Hofford, M.D., Karen Maughan, M.D., Beverly Brown, M.D.; I M - Michael Rein, M.D., William Erwin, M.D., Edward Arsura, M.D., Mehis Kazemi, M.D.;   Neuro  - Joel Shenker, M.D., Donald Nolan, M.D.;  OB - Jennifer Wenger, M.D., David Williams, M.D.; Peds - William Wilson, M.D.,  Preston Boggess, M.D., James Kim, M.D.; Psych - Pamila Herrington, M.D., William Rea, M.D., Pavan Reddy, M.D., Ed Kantor, M.D.;  Sgy -Curt Tribble, M.D., James Foster, M.D., Wayne Wilson, M.D., Jorge Rivera, M.D. (bold print indicates attendance)

Welcome - Dr. Donald Innes

Dr. Harrington welcomed Dr. Innes and the clerkship directors to Carilion Roanoke Memorial Hospital . Dr. Innes explained the purpose of the meeting:   to review curriculum modifications and updates over the next two years to meet new LCME requirements.  The attendees introduced themselves.

Upcoming USMLE Changes - Dr. William Wilson

Step 2CS Exam Dr. Wilson explained that this is a national standardized exam initiated this fall to assess clinical skills of undergraduate medical students with a Pass/Fail grade.  As of now passing the Step 2CS is not required for training licensure but is required for medical licensure. 

UVa currently requires taking, but not passing the Step 2CS for graduation. A passing grade on the Step 2CS is required to take the Step 3.  The exam costs ~$950 and the number of testing sites will increase to a total of 5 by the end of this year.

Dr. Erwin raised the concern that currently residency programs have few objective standards available by which to evaluate where in the graduating class a medical student placed and that the pass/fail grade is of little or no value to that end.   Dr. Wilson thought that board scores, letters of reference, and in-house evaluations would continue to provide sufficient input; Dr. Erwin, from the perspective of a residency director, stated that letters of recommendation are generically non-descriptive and largely biased in favor of the medical student.

LCME Standards Changes Dr. Wilson explained that the LCME has instituted new standards in documenting the acquisition of clinical skills that will provide uniform testing within a clerkship.  The wording of some of the standards needs interpretation and clarification. 

  • ED-2 specifies the major conditions/diseases and variety of patient encounters.
  • ED-30 would require that formative evaluations be submitted within 4 - 6 weeks of the end of the clerkship.
  • ED-31 requires that students be evaluated sufficiently early in the clerkship to allow remediation of deficiencies and that strengths and deficiencies be specified.
  • ED-38 encourages balancing student duty hours with time to rest--especially during clinical years--and reassessing the educational value of clinical duties. 

Praise/Concern Card - Dr. Allison Innes

Dr. Innes encouraged everyone to use the links she distributed listing various clerkship feedback forms on-line, such as the Praise/Concern Card, to annotate student behavior and performance.  The forms are simple to complete, and the results are sent immediately to Dr. Innes’s e-mail Inbox and generate an auto response.  The results are not filed in the student’s file nor shown to the students but provide the University with feedback regarding positive behavior to be encouraged and commended and inappropriate behavior to be addressed. She also announced the beta testing of the RAFT clerkship evaluation system. The importance of timely and meaningful narrative feedback to students was emphasized.

Curricular Changes - Dr. Donald Innes

Cells to Society is UVa’s new model curriculum to address the changing needs of medicine in the future through courses designed to integrate knowledge with clinical skills to improve retention; to insure student competency; to foster humanitarianism, professionalism, and independent and creative thinking and leadership; and to provide early exposure to medical disciplines.  A critical factor in accomplishing the curriculum’s goals is to provide sufficient time to acquire patient-care knowledge and skills and balance content and process.

The first two years would involve scientific, humanistic, and professional foundations and applied basic science.  The clinical years would involve a combination of uniform core curriculum and a greater number of high quality selective and elective clinical experiences.

Summary  - Dr. Donald Innes

UVa needs to obtain further clarification regarding “specific condition” in ED2 and determine how to comply, and we should continue what we are doing well and include the praise/concern card for feedback, and adopt clerkship-wide guidelines for duty hours.

Ongoing joint meetings are recognized as important to the success of our educational program. The value of joint face-to-face meetings was recognized and alternating between sites was suggested. A winter meeting will be planned for Charlottesville .  A tentative theme is "Challenges for the Clerkships, Electives and Selectives: Sharing Educational Innovations - Solutions and Evaluations."

This was followed by a luncheon provided by Carilion Roanoke Memorial Hospital , during which clerkship specific meetings of Family Med, Intern Med, Neurology, OB/Gyn, Pediatrics, Psychiatry, and Surgery were held. The discussions were lively and Don Innes circulated from group to group.

Each clerkship discipline will be asked to develop plans for their "Core Clerkship" and share these at the winter meeting.

Donald Innes, M.D.
Associate Dean for Curriculum
UVa School of Medicine
University of Virginia

Our thanks to Carilion  Medical Center for hosting us and providing lunch and to Sandi Lunetta for arranging the meeting and selecting a great lunch.