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, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Debra Reed (secretary) Guest: Anne Chapin
Clinical Medicine Committee (CMC) Update. (Bill Wilson)
The CMC met last week and discussed the LCME issues specifically related to the clerkships.
Cultural competency. How to best assess cultural competency will be further discussed after Fern Hauck and her committee have presented their recommendations.
"Residents as teachers." The CME recently announced a series of lectures aimed at enhancing "residents as teachers." Department chairs and program directors will be asked to encourage their residents to attend one or more of the lectures provided by the CME. The biggest challenge to improving residents as teachers may lie at the outside institutions.
Comparable experience at all clerkship sites. Steps are being taken by clerkships which have multiple sites to ensure a comparable experience for all students.
Additional time for a student with a diagnosed learning disability taking a shelf exam was discussed. It is possible to grant additional exam time for such an individual but it must be requested at least two weeks prior to the exam and proper documentation must be submitted. More detailed information on this process will be obtained from Student Affairs.
Clinical Practice Examination (CPX). Anne Chapin, Director of the CPX program, presented the 2007 CPX report to the Committee.
The CPX is a performance-based assessment consisting of seven standardized patient encounters developed or approved by clerkship directors. After six of the patient encounters, students have 12 minutes to complete a patient note. After one case, students provide an oral presentation to a resident. The graded components of the CPX are the patient encounter (SP checklist), patient note and oral presentation. Students who score below the 16th percentile on four or more cases do not meet passing criteria.
The CPX now occurs over the course of 10 days in April. This year, 124 students completed the CPX. Two were unable to participate because of illness and two because of scheduling conflicts. These four students will be rescheduled next year.
Overall case means ranges from 66% to 80%. Overall student scores range from 87% to 54%. One student did not meet passing criteria.
Over the past 10 years, case means and ranges have remained relatively consistent. Many students report that the CPX provides a good learning experience. Most students welcome the opportunity to practice doing a performance exam in preparation for the USMLE Step 2 CS exam.
The physical exam scores consistently lower than history-taking, clinical courtesy or patient interaction sections. Items most often scored "done incorrectly" are most often due to students listening to chest and lungs through the gown or patient clothing and doing abdominal exam through gown or clothing. Many physical exam items are not done at all - often pulses (carotid or extremities) or examination of the thyroid or neck is omitted. 10% of students do not introduce themselves at all or only use their first name when meeting the patient. There is a range of 10-25% of students not washing their hands. Risk assessment and social history questions are more frequently omitted.
Low scores can be explained by:
Confusion about correct skill performance: "Tell us if we are expected to perform physical exams that meet OSCE criteria, or if we should just examine patients as we normally do in daily practice."
Inexperienced in a performance examination setting: "think we should be doing this throughout our medical education and not just once a year."
Attitude - some students less serious about exam - flippant.
"During the time period this exam takes place students are trying to get together schedules for fourth year and financial aid and the last thing I want to do come in to work for 5 hours on a Saturday to do a series of remedial fake H&Ps. This is an activity that would be appropriate for the end of POMII exercises in 2nd year."
Students perform as they see "real doctors" practice during the clerkships.
For the future... Add an extra session at end of CPX in case of student illness/cancellations. Provide opportunity for students to choose cases in which they would like to practice a patient encounter and receive SP feedback.
Data on 2007 score distributions and group performance was provided.
The scripts for the CPX cases were either invented here or taken from a standardized patient database and modified for use at UVA.
Scheduling some of the CPX sessions on weekends was difficult for some students but students are allowed to swap CPX exam times to accommodate prior commitments.
A passing grade on the CPX exam is required for graduation from the University of Virginia School of Medicine. Students who do not pass the requirements are presented to the Student Promotions Committee and recommendations made for remediation, including spending a month with an attending and/or retaking the CPX examination.
[Note: The student who received a deficiency (F) in the 2007 CPX was asked to review their videotape with Ms. Ann Chapin and work with a faculty mentor for remediation, and to retake the CPX in February 2008.]
Comparison of the Clinical Skills OSCIs (CS OSCIs) developed by Gene Corbett and company and the CPX were discussed. The CS OSCIs are not required but strongly recommended to all students. CS OSCI's are comprised of topics such as "giving bad news," taking an accurate blood pressure, starting an IV. The CPX is more formal than the CS OSCIs.
Anne Chapin noted that some schools have a smaller exam following each clerkship concentrating on patients specific to the clerkship.
Since our students seem to be doing well on the boards, the Committee agreed that the CPX should continue to run during the third year. It was suggested that the CPX Office send multiple reminders to students, especially in the 2-3 months prior to the CPX.
Principles of Medicine (PoM) Committee Update. (Bob Bloodgood)
Recording of Lectures underway- keywords and seems to be going well thus far.
Renovations for teaching spaces in Jordan
Subcommittee on Course Evaluations Melanie McCollum and a subcommittee are looking into whether the current course evaluations completed by students should be revised and if so, in what way.
Assessment of New Curriculum - 2nd year - Some Course Directors have expressed concern that the cumulative mean for their course has gone down with implementation of the new curriculum. Statistics were presented.
Attendance vs course performance vs USMLE I - Self-reporting attendance data seems to show a decrease in attendance during the third and fourth quarters of the second year whereas in previous years, the decrease seemed to occur only during the fourth quarter. Some students admit to forgoing lecture attendance to study, yet some acknowledge that in hindsight forgoing lecture may not have been a good idea.