Minutes 04.20.06

Minutes 04.20.06

University of Virginia School of  Medicine
Curriculum Committee

Surgery Conference Room, 4:00 p.m.                       

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve BargmannDaniel Becker, Robert BloodgoodGene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson,  Anthony DeBenedet, Sixtine ValdelievreDebra Reed (secretary) Guest:  Michael Rein, George Rodeheaver

  1. Internal Medicine Clerkship Review.  Michael Rein, Director of the Internal Medicine Clerkship, met with the committee to discuss the recent Clerkship review.  The Committee thanked Dr. Rein for a clear and comprehensive self study report.  Dr. Rein noted that the Internal Medicine Clerkship objectives are in line with the 12 compentencies set forth by the Curriculum Committee.   

          Dr. Rein also confirmed that while the patient base is different, students do receive a comparable experience across the three in-patient clerkships sites (UVA, Roanoke, Salem).   Shelf exam scores from students at the the various AIM sites reveal no discernable differences across the sites.  

          Dr. Rein noted that the annual mean performance on the subject examination in Internal Medicine is above the national mean.  The UVA scores have risen fairly consistently for many years, but the national mean has also risen over this same period. 

          The major strengths of the clerkship are the skill and interest in teaching of their faculty and residents, the support of the Chair, the nature of the three in-patient sites (assures an excellent mix), and the Ambulatory Internal Medicine portion of the course which is always well-received.  A further strength is the transparent, reproducible grading system that compares students to previous classes. There is close contact between the Clerkship directors at the major sites and between AIM preceptors and the AIM faculty administration.  The recently instituted Ethics rounds once every two weeks has been a success. 

          Weaknesses of the clerkship included the inability of the clerkship to adequately teach physical diagnosis especially in the newly shortened clerkship.  The Service Center of the Hospital is also a limiting factor in the types of patients students encounter.  The total amount of time that a student must spend on an inpatient service that has primary responsibility for patient care is probably somewhat reduced by curricular change in that the inpatient subspecialty rotations have been moved to the fourth year, and they have been diluted by the addition of selectives that do not have primary responsibility for patients.  Dr. Rein also noted that in the future, one-third of our students will have none of their third year Internal Medicine at University Hospital.  This may make it somewhat harder to obtain strong letters of recommendation for the approximately 45% of our students who go on to take Categorical, primary Care, or Preliminary Internal Medicine Residencies.  He also noted that the faculty of our Division of Hematology/Oncology has been below full strength for some years, and the Bone Marrow Transplant Service has been closed.  This past year, the Division has been able to field only one attending physician for the inpatient service. The ACGME defines the maximum number of learners per attending physician, and this number does not permit third or fourth year students to be present on rounds.  We have been unable to offer this subspecialty rotation to our third year students and will not be able to offer AIs, ACEs, or inpatient selectives to fourth year students next year. 

          Dr. Rein asked the Curriculum Committee for suggestions on how to better maintain contact with the teaching faculty.  The Curriculum Committee suggested e-mail and a comprehensive website as excellent tools for outlining expectations and goals for teaching faculty. 

          Implementation of the Clinical Skills Educator Program in May, 06 should greatly enhance the Internal Medicine Clerkship.

  2. Clinical Skills Educator Program.  (Michael Rein)     Recruitment of faculty for this program has begun.  Faculty will sign up for 4-week blocks.  They will meet with the students (2-3) for two hours, twice each week in the afternoon.  Faculty and students will define the time and afternoons. 

          Students will present cases, usually presenting patients that they have worked up.  The CSE will spend as much time as possible with the students at the bedside reviewing physical examination, and directly observing the student's physical examination and presentation skills.  The faculty will provide formative feedback.  They will also review the labs, EKGs, Radiographs, etc. and the students' write-ups in the charts as well. The CSE will go through all elements of the physical exam (attached) during the month.  

          At the end of the month, the CSE will provide a narrative evaluation of the accomplishments and performance of each student.  The exercise will not be formally graded, but the narrative will help to prepare a summary of each student at the end of the clerkship.  [The clerkship director is asked to provide the goals, objectives, and curriculum to the medicine clerkship directors at Carilion and Salem sites for incorporation into their rotations. It is of further note that the initiation of the CSEP began with student comments on the close attention and time spent on physical exam findings by attendings at the Roanoke and Salem sites as compared with UVA.] 

         Thus far there has been a relative paucity of interested faculty. Dr. Rein is concerned that there will have to be 4 students on some rotations.  Recruitment for the CSE positions has begun.  Anyone interested in a CSEP position should contact Michael Rein. It was suggested that he discuss the importance of the CSEP with his new Chair.

  3. Use of Microsurgical Simulators for Medical Student Education in Microsurgical Technique.    The Curriculum Committee reviewed a proposal from Dr. Nava Guillermina, Dr. David Drake and Lester Amiss, from the Department of Plastic Surgery to use live animals for microsurgical technique instruction as an elective experience for fourth year medical students.    The "Use of Live Animals in Medical Education" policy states that "The benefits of the educational activity must be substantial.  Live animals should be used only if educational goals cannot be fulfilled using a simulator or other non-living model." It further states that the proposal "must document that the goals and content are essential to the education of a physician and that there are no alternatives to the use of animals."

    George Rodeheaver, Chair of the Animal Care and Use Committee attended this portion of the meeting as an ex officio member and as a member of the Plastic Surgery faculty, was also able answer a few questions on their behalf.  He was asked about the threshold for student proficiency before use of live animals.  The protocol is below:

    It was unclear what the level of competency must be for the student could work with a live animal. [Dr. David Drake in a telephone conversation (04/26/06) indicated that students should achieve level 4 or 5 performance in all categories before proceeding to an animal.] When asked what training program was used for plastic surgery residents, Dr.Rodeheaver replied that he did not believe animals were used in residency training. [Dr. David Drake in a telephone conversation (04/26/06) indicated that a similar protocol has been submitted to the Graduate Medical Education Committee for action, although it has yet to be approved.] The Curriculum Committee voted to support this proposal as a valid educational experience.  The proposal will now go on to the Animal Care and Use Committee; then assuming approval, to the Vice President and Dean of the School of Medicine.
  4. Attendance at lectures was discussed briefly and a summary of student comments on attendance presented by Sixtine Valdelievre.

  5. Teaching Spaces Proposal from the Principles of Medicine Committee April 12 meeting was presented.
    "The Principles of Medicine Committee believes that it is essential to have two large teaching spaces available (each accommodating an entire medical class) that are capable of being optimally configured so as to allow the medical school faculty to present simultaneously a "traditional" lecture format presentation to both the 1st and 2nd year medical school classes."

    A brief discussion, including availability of the Old Medical School Auditorium for lecturing, ensued; however, further discussion was postponed until a later meeting.

Donald Innes