University of Virginia School of Medicine
Surgery Conference Room, 4:00 p.m.
Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Margaret Mohrmann (guest), Debra Reed (secretary)
Exploratory Program. A group of course directors (Bargmann, Bloodgood, Innes, Kutchai, Lieb, and Nadkarni (Exploratory Program), discussed options for the 06-07 Exploratory Program. Options will be evaluated and presented to the Committee.
Clerkship Grades. Clerkship Directors are reminded to get the grades (including written evaluations) in on time.
Period 1 (6/27/05 - 9/17/05)
Period 2 (9/19/05 - 12/17/05)
Clinical Connections. The Clinical Connections group met today. The last session for 05-06 (June 23, 2006 ) has been eliminated because of one-time scheduling problems. The Committee suggests that the clerkship schedule remain unchanged and the students be given June 23rd as a day off pending approval by the clerkship directors. [This was approved at the Clinical Medicine meeting February 2, 2006 .]
Clinical Reflection Proposal. (Margaret Mohrmann, M.D., Dan Becker, M.D.) Drs. Mohrmann and Becker outlined a proposal for the Clinical Reflection Program. Clinical Reflections was a part of the Clinical Connections Program. The program was not as successful as the organizers had hoped so it was discontinued this year. A committee led by Dr. Mohrmann has proposed a new Clinical Reflection program.
Rationale: Clinical reflection is best accomplished within small groups of willing students and sensitive, well-prepared facilitators, who meet often enough to form a sense of group coherence and safety.
Groups: 8-10 students and 2 mentors, one of whom must be a physician, meeting at least once a month. Once a group is formed it will decide when, where, and how often it will meet, providing needed flexibility.
Required: Clerkship directors must assure students (and their supervisors) that clinical Reflection Group meetings take priority, so that students are excused from ward duties, including call, for the 1-2 hours necessary for the group to get together.
Attendance must be mandatory, but students on out-of-town rotations can be excused. Group control of the meeting schedule will allow, adaptation to members’ obligations.
Goals: To help students learn skills of being reflective about both their clinical experience and its interaction with their non-professional lives, based on the well-founded assumption that reflective physicians are better at what they do, more available – emotionally as well as intellectually – to their patients, and happier in their vocation in the long run.
To have students learn for themselves, by experience, that reflection is a good thing to do, and that shared collegial reflections on the varied aspects of the medical vocation can enhance and support them and their work.
Method: Offer a variety of modes of entering the reflective exercise (e.g., writing, a common reading experience, art, mindfulness meditation, discussion of selected clinical encounters)
Match student and mentor preferences for method of reflection.
In all groups, regardless of method, attend to some common issues/questions and to the developmental changes that occur in the 3rd year.
Of students – at least to begin with presence.
Of the “course” – Perhaps attitudinal surveys of students – their views not only of the project itself, but of themselves as clinicians and of medicine as vocation – at the beginning and at the end of the 3rd year and again toward the end of the 4th year. Potentially, the same instrument could be used with our graduates during and after their residencies.
The most important factor in the success of this endeavor is the quality, engagement, and preparation of the group mentors. The nature of the groups and their scheduling may help attract more qualified mentors, especially among physicians, but once-a-month group meetings are a lot to ask.
Faculty development: Leading reflective groups is a skill very different from lecturing or from usual clinical teaching; it requires, among other things, the ability to be silent and non-authoritative. Identification, recruitment, and preparation of mentors will be crucial.
Required: substantial and unequivocal support from deans, the Curriculum Committee, department chairs, and division heads for release time (and ideally, money) for faculty physicians.
If these ideas are approved and adequately supported by the Curriculum Committee, the project could potentially be in place for the 3rd year class starting June, 2006, using this spring for planning, recruitment and faculty development.
The Curriculum Committee discussed timing of the Clinical Reflection sessions and how to involve students on out-of-town rotations. Keeping groups together with so many students out of town each month will be difficult. The possibility of keeping successful PoM-1 groups together for these sessions was mentioned. An AA model with students able to “sign up” on line for monthly sessions was discussed. The Committee agreed with Dr. Mohrmann that if the program cannot be done well it should not be done at all. The amount of mentors needed for the program was discussed – Dr. Mohrmann believes an absolute minimum of 15 physicians and 15 nonphysicians would be necessary, however, this would made the groups large with approximately 10 students each. More mentors would be optimal but recruitment and training might be difficult. Dr. Mo Nadkarni is attempting to build in reflection time into the exploratory and perhaps this might be another place to incorporate this program
The time (10 meetings per year or 1 per month) and number of clinicians and non-M.D. mentors (15/15), training, and the travel logistics required in this plan are huge. Drs. Mohrmann and Becker will continue to work on the proposal and return with revisions based on suggestions from the Curriculum Committee.
Clerkship reviews are due Friday, February 3rd, 2006 . [Three have been received as of February 3rd, 2006 .]
Emil R. Petrusa, Ph.D., Associate Dean for Curriculum Assessment, Duke University will be our guest at the next meeting, February 9, 2006 .