Minutes 02.01.01

Minutes 02.01.01

University of Virginia School of Medicine
Curriculum Committee
Minutes 02.01.01

Pediatric Pathology Conference Room, 4:00 pm

Present (underlined) were: Reid Adams, Robert Bloodgood, Victoria Camerini, Anita Clayton, Al Connors, Gene Corbett, Joseph Dubose (Alexandra Yamshchikov), Joanna Goldberg, Donald Innes (Chair), Jerry Short, Bill Wilson, Debra Reed (Secretary), Guests: Susan Squillace, Brian Wispelwey

Brian Wispelwey and Susan Squillace, co-chairs of the PoM-2 Design Group briefed the Curriculum Committee on their progress in addressing the charge of the Curriculum Committee.

The Planning Committee devised One-year and Five-year Plans in response to the preliminary goals outlined by the Curriculum Committee.

a) Ensure a smooth integration of the PoM-1 content and skills with PoM-2, especially in regard to interviewing skills and physical diagnosis.
b) Increase the frequency of patient contact and the level of physical examination and interview skills training in PoM-2. Develop a plan to increase formal inpatient and outpatient clinical exposure in the second year for all students.
c) Ensure a smooth transition from PoM-2 into the clerkships in regard to clinical interview and physical examination skills. Develop a plan to incorporate elements of the skills and content currently addressed in the Basic Patient Care Skills course (Transition course) into PoM-2.
d) Improve the interdisciplinary nature of weekly tutorial cases to involve when appropriate Ob/Gyn, Pediatrics, Surgery, and Psychiatry as well as Medicine.
e) Improve topical coordination between PoM-2 and the other second year courses (Introduction to Psychiatric Medicine, Microbiology, Pathology and Pharmacology).

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1. Merge the current ICM course with the new PoM1 course with the following priorities:

a) Ensure a smooth transition of the PoM1 content and skills with PoM2
b) Increase the frequency of patient contact and the level of physical examination and interview skills training in PoM2.

One-year plan

Proposal: Enhance tutorial sessions by expanding and highlighting psychosocial components of cases.

Methods: A portion of cases (25-35%) will be examined with attention to psychosocial components currently included in cases. Psychosocial components will be expanded as needed. Teaching points will be written to be included in tutors' packet to ensure comprehensive and uniform discussion of psychosocial issues in relation to cases.

Needs: A committee consisting of the course director, one PoM-1 course director, a behavioral scientist, and two to three tutors will be assembled to review cases, add new material to cases as needed, and develop the teaching points for use by tutors.

Proposal: Increase the frequency of patient contact and level of physical examination skills training using standardized patient exposure in a longitudinal manner over the entire PoM-2 course.

Methods: The standardized patient program, led by Ms. Lisa Doyle, will be expanded in the PoM-2 course to allow students monthly-standardized patient exposure. Fourth year students will be utilized as mentors and trainers for PoM-2 students. A longitudinal curriculum will be developed for this experience, which allow students to build and practice physical examination and interviewing skills.

Needs: A new faculty position (minimum of 50%-dedicated time) is needed to direct this effort. This faculty position will be responsible for designing the curriculum of this experience; recruiting, training, evaluating and providing feedback to 4th year student mentors/trainers; and working with Lisa Doyle in recruiting, training, and evaluating the standardized patients.

Five-year plan

Proposal: Each student in the PoM-2 course will be paired with an institutional clinical faculty for bi-weekly two-hour sessions of patient care throughout the PoM-2 course.

Methods: PoM-2 students will be assigned a faculty clinical mentor each semester. Students will spend one semester working with a generalist mentor and one semester with a sub-specialist mentor. Students and mentors will be required to meet a minimum of two hours every other week for a patient care experience. Ideally, these experiences will occur in the clinician's primary outpatient setting with an emphasis on the approach to the patient on initial presentation including history taking and physical examination.

Needs: Sufficient institutional faculty will need to be given protected time and compensation to prepare for clinical sessions and meet with students. Approximately three hours every other week will be required of each faculty. In addition, clinical space will need to be committed for these patient encounters. If existing space is used during times that will conflict with patient care sessions, Department's will need to be compensated for revenue lost as a result of use of clinical space for teaching activities. It will be crucial for the Curriculum Committee, with the support of the Dean, to work actively with Department Chairs to recruit and support faculty that participate in this activity. Faculty will need financial support, protected time, as well as recognition of this effort as a crucial part of their role as teaching faculty and a factor considered when determining suitability for promotion.


2. Enhance the curricular offerings of the current ICM course by meeting the following goals:

a) Improve the interdisciplinary nature of weekly tutorial cases.
b) Improve topical coordination between PoM-2 and the other second year courses.

One-year plan

Proposal: Review current tutorial cases to ensure adequate representation of issues related to multiple disciplines.

Method: A small group of faculty and students will review all existing cases for the purpose of ensuring adequate representation of issues related to obstetrics, gynecology, pediatrics, surgery, psychiatry and geriatrics. Cases will be expanded, where appropriate, to include these areas and, if needed, new cases will be developed to highlight the unique issues related to these disciplines. New cases will be developed in a format that can be used both as paper-based or web-based sessions.

Needs: A tutorial case working group will be needed to review cases, expand them as appropriate, and create new cases that incorporate multi-disciplinary issues. The group should include faculty representation from each discipline, a faculty member who is familiar with preparation of cases for web-based use, and a group of students who can assist with development, testing and evaluation of revised and new cases. It is anticipated that the majority of tutorial cases will have additional materials added in order to accommodate multidisciplinary issues as well as issues discussed elsewhere in this document including psychosocial and ethical issues and teaching related to epidemiology.

Proposal: Improve topical coordination between the Ethics course and PoM-2.

Method: Six new ethics lectures will be developed to coordinate with the tutorial cases that develop ethical issues through the life span. The Ethics and Law program in the Center for Biomedical Ethics will be represented in these sessions. Issues presented in lectures will be illustrated in tutorial cases. Topics to be presented in the lecture series and illustrated in the cases include informed consent, reproduction, neonatology and pediatrics, ethical issues in impairment, disability and rehabilitation, end-of-life care, and clinical trials.

Needs: Additional time will be needed for six new ethics lectures. The faculty of the Center of Biomedical Ethics will work with the tutorial case working group to add elements to the tutorial cases as needed to illustrate the issues discussed in the new ethics lectures.

Proposal: Improve topical coordination between PoM-2, Pathology and Pharmacology.

Method: The leaders of the three courses are currently meeting to identify areas of problematic overlap with particular emphasis on ensuring consistently in presentation of materials. The three course leaders are reviewing handouts from each course, areas of inconsistency are being identified, and work is beginning to present a unified message to students in areas where conflict exists. The intent of this unified message will not be to ignore differing opinions but to highlight areas where controversy exists and differences of opinion are justified.

Needs: Course leaders are currently involved in this process.

Proposal: Improve topical coordination between PoM-2 and Epidemiology

Method: From the perspective of the PoM-2 design group, several topics introduced in the Epidemiology course can be illustrated in the tutorial cases and reinforced throughout PoM-2. Issues related to pre-and post-test probability, evaluating new tests and treatments and determining prognosis could be incorporated into tutorial cases. It is likely that many tutorial leaders already consider these issues but the development of teaching guidelines that emphasize these areas would ensure their discussion in a uniform manner. The tutorial case working group will work with the Epidemiology course director to identify topics that could be illustrated in a portion of the tutorial cases and develop teaching points to assist tutors in emphasizing these topics.

Needs: The tutorial case working group, in conjunction with the Epidemiology course director, will need time to review existing cases, incorporate new materials as needed and develop teaching points.

Five-year plan

Proposal: Eliminate redundancy in the second year curriculum.

Method: The course leaders responsible for the second year curriculum will review all materials presented in the second year curriculum looking for areas of redundancy. Decisions will be made regarding the most appropriate place for specific topics to be taught and redundant materials and lectures will be eliminated. This is crucial in order to provide the additional time in the second year to allow for new lectures (in Ethics) and new patient care experiences.

Needs: The Curriculum Committee should provide the mandate and structure for this process to occur.


3.Ensure a smooth transition from PoM-2 into the clerkships.

One-year plan

Proposal: Provide opportunities for students to practice clinical skills, including patient presentation, in order to better prepare them for incorporation into the clerkships.

Method: Case presentation skills will be reinforced in the small groups by providing students with a weekly opportunity to present or critique the presentation of tutorial cases. Each week a student will be assigned the task of preparing the previous weeks case for presentation to include differential diagnosis and treatment plan.

Second year students will be required to join rounds with inpatient teams from internal medicine, surgery, obstetrics and gynecology and pediatrics in order to gain exposure to the clinical clerks role on the inpatient team.

Needs: A faculty development session designed to prepare tutorial case leaders to assist students with case presentation skills will need to be developed and made available to all tutorial case leaders. While tutorial leaders may feel proficient in case presentation, it would be ideal for all group leaders to follow a single, systematic approach to case presentation in order to instruct students in a uniform manner.

Proposal: Restructure the "Basic Patient Care Skills" course to better meet the needs of students entering the clinical clerkships.

Method: The current "Basic Patient Care Skills" course works to provide the knowledge, skills and attitudes essential for the transition to the third year. Experience with the course has shown that, while many sessions are just right at the time they are taught, others are too early and some are too late or, in the students' perception, unnecessary. At the present time, sessions related to MIS training, professionalism, legal and behavioral issues, infection control and PPD testing seem the most relevant to the period just prior to the beginning of clerkships. More information is needed from junior and senior students regarding the ideal locations for teaching the other skills currently included in the "Basic Patient Care Skills" course.

Needs: The "Basic Patient Care Skills" course director will need to restructure the current course to include the above issues. Additional information is needed from current 3rd and 4th year students regarding the appropriate placement of other Transition Course materials.

Five-year plan

Proposal: Restructure the individual clerkship orientations to better meet the needs of students.

Methods: Each clerkship will provide students with a more comprehensive orientation session. The orientation will include an introduction to the specialty, goals and objectives of the rotation, and details of expectations. Special attention will be given to expectations of students with regard to participation in rounds, patient presentation, and note writing.

Clinical skills workshops specific to each rotation (e.g. cervical exam, pediatric venipuncture, scrubbing) will be taught during the orientation sessions. Clinical skills necessary for multiple clerkships (e.g. ECG interpretation, X-ray interpretation) will be presented in a longitudinal manner over multiple clerkship orientation sessions so students have an opportunity to develop their skills as they progress through their clerkship year.

Certain skills taught in the current "Basic Patient Care Skills" course are rarely used by students in our institution because of the support provided by other health care providers. A discussion needs to take place regarding the necessity of teaching these skills (e.g. venipuncture, IV line placement, Foley catheter placement, and arterial blood gas draw). If skills are considered essential for medical student education, opportunities to practice them must be identified in order for students to gain competency.

Needs: The Curriculum Committee, in conjunction with the clerkship directors, will need to develop a uniform set of clerkship orientation sessions and a longitudinal curriculum for third year clerkship procedural skills. Individual clerkship directors will need time and support to develop these sessions and the clerkship rotations will need to be modified to allow all students at least one day of orientation for each clerkship. A designee of the Curriculum Committee will work with the clerkship directors to develop the longitudinal curricular sessions and incorporate them into the clerkship-specific orientation sessions.

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The proposals would require:

Ethics 6 hours/year
Epidemiology merged/blended with PoM2 - 16 hours - no change
Monthly standardized patients (2 hr/month) x 9 = 18 hours/year

24 hours of time will have to be devoted to the above programs.

Required weekend inpatient rounds 4 hrs/semester. Such clinical experiences in PoM-1&2 should be uniform for all students.

Further discussion is needed. Plan to meet February 22, the fourth Thursday of the month.


 -Don Innes
-dmr