University of Virginia School of Medicine
Joint Clinical Medicine Meeting
(Charlottesville, Fairfax, Roanoke & Salem)
Salem Veterans Administration Hospital, Director's Conference Room, 10:30 a.m.
Present were: Maureen McCarthy, Dan Harrington, Thomas Martin, Megan Bray, Yvonne Newberry, Elizabeth McCuin, Thomas Eldridge, Pavan Reddy, Jorge Rivera, Mehdi Kazemi, Gary Harpold, Evan Heald William Rea, Allison Innes, Donald Innes, Michael Rein, Eugene McGahren, Hilary Sanfey, Farahaba Lakhdir, Anne Mounsey, William Erwin, Mark Schleupner, Tananchai Lucktong, BK Ahmad, Peter Schofield, John Jackson, Gene Corbett, Elizabeth Bradley, Veronica Michaelson, Shannon Starkey, Kim Clark, Toni Williams, Sandi Lunetta, Ginger Shouse
The 5th meeting of the Joint Clinical Medicine Meeting began with a warm welcome to the clerkship directors, coordinators, administrators, and guests by Maureen McCarthy, our host.
John Jackson presented an explanation of new features on the OASIS Upgrade for the clerkships and the selectives/electives program. Despite difficulties with the upgrade itself the OASIS program and the upgrade features seem to be working well for all. Following the joint presentation, John Jackson taught an OASIS workshop for the coordinators.
An overview of the Clerkship Clinical Skills Education Program was provided by Gene Corbett, Elizabeth Bradley, Veronica Michaelson. The Clerkship Clinical Skills Education Program (CCSEP) is an interdisciplinary effort of the departments of Internal Medicine, Pediatrics, and Family Medicine. Its purpose is to maintain and expand clerkship clinical skills workshops (now ~31 small group sessions which bring together selected faculty to teach basic clinical skills to students), establish a clerkship-level clinical skills assessment process (OSCE [Objective Structured Clinical Examination] assessment exercises now 28 OSCEs), and develop a UVA clinical skills education website. The program includes faculty development with emphasis upon clinical skills teaching skills.
The goals of the program are to develop clinical skill teaching modules, incorporate the modules into the clerkships, and measure their effect on clinical skill abilities. This program should progress to include more modules and evaluation of all students' clinical skills. Depending on interest level workshops for Surgery and OB/GYN and Neurology are anticipated.
A brief mini-skills workshop on the eye examine was demonstrated illustrating clinical skills teaching principles. The nature of the workshop with formative assessment followed by teaching using a faculty observer/evaluator/teacher was reviewed. This was followed by a request for help in identifying key clinical skills to be taught (needed by UVA students) and the need for module authors and faculty observers. It was suggested that we increase clinical skills practice time & opportunity in the clerkships, e.g. replacement of a lecture with a skills workshop. Skill workshops should be coordinated between clerkships. The CCSE staff can help clerkships with the creation and evaluation of skills workshops, and faculty development.
The luncheon clerkship meetings provided time for clerkship specific discussion in Family Medicine, Internal Medicine, Neurology, Obstetrics & Gynecology, Pediatrics, Psychiatry, and Surgery. A brief sharing of ideas on clinical skills teaching followed lunch.
Michael Rein discussed the importance of the clerkship narrative evaluation in an informative and entertaining talk entitled "The Narrative Part of the Clerkship Evaluation: A Personal Reflection." The importance of the narrative as an element in the evaluation of the student was emphasized. While numerical scores are summative, they are rarely specifically helpful to the student. Narrative can provide truly normative information, which will be helpful to the student in the future.
The narrative avoids pigeon-holing as not everyone neatly fits into the numbered questions, but allows for an individuals particular skills or problems to be highlighted.
The narrative also allows one to stress what one feels is most important. Some consider medical reasoning the single most important characteristic, so discuss it at greater length in the narrative, while someone else might consider accuracy of collecting data most important and focus on accuracy.
The narrative can make a difference in a borderline score and is helpful when writing letters for students who have done well clinically but performed poorly on the Subject Examination.
Michael offered examples of comments unique to the narrative:
- Clinical anecdote: "particularly helpful to patient with..."
- Comments from patients or families
- Provided current literature to team
- Gave talks
- Stayed late
- Helped with other patients
- Served as patient advocate
- Great sense of humor
- Took ownership of his/her patients
- Functioned independently
- Took initiative
He also made note of certain elements he has found helpful as a reader of narratives.
- Overall evaluation of performance
- Specific descriptions of various elements
- Interaction with patients
- Interaction with team (including nursing, PT, social work, etc.)
- Contributions to team
- Worked hard vs. not present much
- Active in rounds and conferences vs. reticent
- Helped with other patients
Don Innes, Dan Harrington, and Maureen McCarthy each provided brief institutional updates. Indications of a generally positive LCME visit and the restoration of full ACGME accreditation status brought the meeting to a close on an upbeat note.
**** Please mark your calendars for the next Joint Clerkship meeting to be held Wednesday, March 14, 2007 in Charlottesville.