Minues 04/24/08

Minues 04/24/08

University of Virginia School of  Medicine
Curriculum Committee
Minutes
04.24.08

Pediatric Conference Room, 4:00 p.m.                       

Present (underlined) were: Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak Debra Reed (secretary)

  1. Gross and Developmental Anatomy Course Review.  The Curriculum Committee continued discussion of the Gross and Developmental (embryology) Anatomy] Course Review of 4/3/08.  

    Concerns about the impact of changes to the Anatomy course on the over all learning environment were of primary concern. When any course intends to make major changes to their curriculum, fellow course directors should be made aware of the proposed changes - not in any way to discourage changes or usurp course director's authority - but rather to avoid conflicts and to foster a good learning environment for students to do well in all courses.   In particular concerned was raised about the amount of time anatomy requires outside their scheduled time and the impact that has on the other first year courses, shifting study time for students to Anatomy.

    The student evaluations of the anatomy course were lower than previous years - comments regarding anatomy's new teaching method were highly variable with most of the negative comments expressing concern about the lack of specific objectives and the time required for the post-lab were.   Anatomy has written new and more specific objectives for 08-09.

    It was noted that anatomy groups are self-selected unlike any other medical school course (all other courses use a random, alphabetical, or director selected system.  Some students noted in their evaluations of the course that they found this difficult. It is best if Anatomy used an assigned method. 

    Difficulties in obtaining cadavers with low levels of formaldehyde from the State of Virginia were discussed.  It appears that action at the state level is needed to revise the way bodies are embalmed before formaldehyde levels can be corrected.  Correspondence between the new Dean and the new State Chief Medical Examiner should be initiated.

    Anatomy Working Group Report, now it the final stages, was reviewed. The charge of the Medical Anatomy Curriculum Group was to assess the need for anatomic knowledge, skills, and attitudes in the contemporary practice of medicine and to define a program that ensures their delivery within the context of our educational structure and resources, including faculty and physical facilities. The specific objectives of this group are as follows:

     * Define the educational objectives of the core course in gross anatomy.
     * Identify the most effective and efficient learning environments for students to acquire anatomic knowledge and develop critical-thinking skills.
     * Develop a temporary core course program, to be in place from 2008-2009 academic year through the renovation of the Gross Anatomy Facility, that achieves the educational objectives of the course, and that also minimizes student and faculty formaldehyde exposure.
     * Create a vision of a permanent core course program and identify the facilities upgrades and new equipment necessary for implementation.
     * Identify areas for elective studies and propose potential methods of course design. 

    The group's final report will recommend that the course be renamed "Clinical Anatomy & Medical Imaging;" that the course design incorporate and integrate principles of medical imaging with the study of the cadaver in situ; that Fourth Year Anatomy Electives be enhanced; that objectives be rewritten to be more specific; and that formaldehyde exposure in the laboratory be reduced.  Environmental Health (Kristy Davis) will monitor student exposure.

  2. Options to Accommodate More Students (~20) Per Year on Clerkship Rotations

    Option 1 - expand the number of clinical sites available for rotations at UVA and nearby hospitals, e.g. Roanoke Carilon Hospital, Salem Veterans Hospital, Fairfax Inova Hospital, Martha Jefferson Hospital, Augusta Medical Center, Culpeper Regional Hospital, Rockingham Memorial Hospital, Richmond area hospitals. Responsibility for securing clinical training sites is primarily administrative; these decisions should be made in consultation with the Curriculum Committee.
    - If Virginia is to graduate additional physicians training sites must be made available by those communities and their hospitals that will eventually employ these physicians. The hospitals above, especially Martha Jefferson Hospital, Augusta Medical Center, Culpeper Regional Hospital, and Rockingham Memorial Hospital have a moral, community, and regional obligation to contribute to the education and training of physicians serving their respective communities and the region. Additional sites are crucial in OB-GYN if the class size is to be expanded.  

    Option 2 - extend the current 10-month clerkship rotation period to 12 months with two months of elective time
    - effectively adds 30 additional students to rotate per year
    - does grave damage to the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas.
    - forces at least 30 to as many as 120 students to take electives before experiencing all or some of their core clerkships; this weakens the elective experience for those students.
    - shortens the time available for students to experience a variety of medical specialties and make thoughtful reasoned career decisions

    Option 3 - expand the current 10-month clerkship rotation period to 12 months with two months of required clinical training
    - effectively adds 30 additional students to rotate per year
    - standardizes basic clinical experience
    - adds an important dimension to the required "core clerkship" curriculum, that of geriatrics
    - preserves the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas.
    - shortens the time available for students to experience a variety of medical specialties and make thoughtful reasoned career decisions

    The Committee endorses exploration of an opportunity to work with the current president of the Albemarle County Medical Society, Dr. Sam Caughron to increasing ties/communication between community doctors and the School of Medicine. He was thinking of a system where private practitioners would approach UVA departments or doctors to arrange student rotations. The Committee noted that outside sites would need to be monitored carefully to assure comparable experiences at all sites. And that some form of a centralized "clearing house" through the Dean's office would likely be needed.

Donald Innes
dmr