Minutes 04.29.04

Minutes 04.29.04


Surgery Conference Room, 4:00 p.m.

Present (underlined) were: Reid Adams, Eve Bargmann,  Robert Bloodgood,  Anita Clayton,  Gene Corbett, Carl Creutz,  Donald Innes (Chair),  Vern Juel, Howard Kutchai, Chris Peterson, Jerry Short, Linda Watson,  Bill Wilson, Brian Wispelwey, Nnaemeka Anyadike, John Bell,  Maria Meussling,  Debra Reed (secretary)

  1. The Committee thanked Maria Meussling for her valuable service to the Committee in the past year and welcomed Nnaemeka Anyadike from SMEC and Michael Richardson as the Mulholland representatives.

  2. Information Management/Critical Thinking.  Goals and objectives have already been developed and the subcommittee will meet 4/30/04 to finalize an “action plan.”  This will be forwarded to Don Innes early next week.

  3. Diagnosis and Treatment – The US Health  Care System.  A proposal for a fourth year capstone course was distributed.  Feedback was requested from the Curriculum Committee.

    The goals of the capstone course are:

    1)  to introduce students to key health policy, economic and legal issues that will shape their practices for decades

    2) to develop a curiosity, a comfort level and a shared vocabulary for dealing with these complex questions and issues 

    3) to challenge students to address current policy on economic and legal issues as raised in policy journals, legislation, court cases and contemporary media

    The course will take place in eight days (3/7-16/05) with plenary sessions each morning and small group discussion sections each afternoon.

    Topics suggested for each day:

    “Myths About US Health Care System” – Arthur Garson

    “Follow the Money – Structure and Financing of the US Health System” – Tom Massaro

    “Patients and Populations – the Tension between Individual Medicine and Public Health” – Gaare-Bernheim/Panel

    “Disparities in Access, Coverage and Health Outcomes:  The Moral Imperative” – Norm Oliver

    “The Age of the Consumer:  Implications for Medical Practice” – Tom Massaro

    “The Most Regulated Industry in the US: Implications for Medical Practice” – TBD

    “Managing Innovation: Technology and Practice Changes” – TBD

    “First, Do No Harm: Evidence Based Medicine, Quality and Patient Safety” – Garson & Moreno

    Curriculum Committee comments on the proposal:

    1. Consider the tensions of running a business and being a healer needs to be addressed – perhaps best done in small group sessions.
    2. Where are the small group preceptors coming from?
    3.Physician payment mechanisms should be included – should be in the “Follow The Money” sessions, e.g. How is the resident paid? –would be of interest to the 4th year student
    4. Small group sessions should be focused and case based whenever possible.
    5. The D&D team should be aware of the Economics seminars developed by John Voss/Joel Schectman  for AIM.  These might be included or expanded on in one session.

  4. Humanistic Medicine Curriculum Thread.  Marcia Childress presented recommendations from the Humanistic Medicine Study Group (Marcia Childress, Julia Connelly, Margaret Mohrmann and David Morris).  They based their report on a review of what is currently being offered in the way of humanistic medical teaching at UVA, knowledge of what is being taught across the US and United Kingdom, and awareness of the competencies – including professionalism, that the ACGME now requires U.S. trained residents to demonstrate in order to complete their training.

    Any humanistic medicine curricular thread is about the cultivation and refinement of the young physician’s reflective and self-reflective capabilities, critical thinking and communication skills, understanding (and balancing) of professional and personal values, cultural competency, and sense of professionalism.  

    The Group determined that UVA already has a strong, diverse and balanced program of education in humanistic medicine.  The curricular thread has a generous presence through all four years of undergraduate medical education.  However, virtually all [many as PoM-1 in the first year and  Clinical Connections in the third year are required] humanistic medicine curricular elements are elective, very few are required.  Thus, in practice, the humanistic medicine thread seems peripheral to the main thrust of the curriculum.  The curricular path does not appear essential to the making of a good physician.

    The Humanistic Medicine Study Group recommends that the school raise the importance and visibility of humanistic medicine for our students, their teachers, and the public by making humanistic medicine 

    (a)        a core component of the school's educational mission, and 
    (b)        a more explicit and central part of every UVA medical student's education.

    To this end, UVA medical students should be required to participate in the humanistic medicine curricular thread to a greater extent than at present. Only modest incremental changes in the substantial curricular offerings already available to our students are needed to accomplish this.

    Students should have a generous say in determining how they fulfill their humanistic medicine requirements. We recommend for first- and second-year students a selective in humanistic medicine, by which the school would require coursework in the general area of humanistic medicine but allow students their own particular course choices.    

    Because humanistic medicine addresses the full spectrum of the physician's formation, the humanistic medicine curricular thread in the four-year undergraduate medical curriculum should be seamlessly aligned with 

    (a)        initiatives for UVA premedical students
    (b)        humanistic medicine competency requirements for residents,
    (c)        continuing medical education, and
    (d)        faculty development interests of physicians in practice and teaching.

    Specific new proposals for implementation include:

    1. Ethics Night – Annual dinner with speaker and round-table ethics discussion (mix of premed and med students) - Gold Foundation grant available.

    2. CLAS Course taught by HIM Faculty – “Vocation” – USem for first year undergrads and “Death in American” – Upper level Religious Studies seminar for undergrads.

    3. Medical School prematriculation reading list – short list of suggested summer reading for entering medical students.

    4.Include topics in PoM1 – “Narrative Medicine,” “Reflective Writing,” and two week unit on ethics.

    5. Medical Center Hour – require student participation in a specific number of events each year (now feasible since Jordan 1-5 is linked to Jordan Conf. Ctr. Auditorium).  Also possibly invite 15 students to have lunch with speaker after the presentation.

    6. HIM Exploratory – Students must choose at least one HIM exploratory (e.g. Healer’s Art; Suffering, Med & Faith) (years 1 and 2)

    7. Year 3 – Becoming a Clinician Ceremony to mark passage into clinical training (required)

    The Committee will discuss these proposals at the May 6th meeting and provide recommendations to the Group.

  5. A regular Ethics Rounds was suggested (Brian Wispelwey) which could be modeled along the lines of the Medicine Morning Report (Michael Rein) in which the medical students would focus on ethical or cultural issues that had arisen on the service instead of physical/laboratory diagnostic/theraputic issues.

  6. The need for trained mentors for medical students is acute. This could be a major focus of the ADE.

Donald Innes