Minutes 05.10.01

Minutes 05.10.01

University of Virginia School of Medicine
Curriculum Committee
Minutes 05.10.01

Surgery Conference Room, 4:00 pm

Present (underlined) were: Reid Adams, Robert Bloodgood, Victoria Camerini, Anita Clayton, Al Connors, Gene Corbett, Donald Innes (Chair), Howard Kutchai, Nelle Linz (David Shonka), Jerry Short, Bill Wilson, Debra Reed (Secretary)

  1. PoM-2. The Curriculum Committee discussed the 2001-02 PoM-2 curriculum proposals presented by Brian Wispelwey at last weeks meeting. 

    Micromanagement of the PoM-2 course is undesirable and unnecessary. Recommendations to the course directors will be made offering leeway in design and implementation.

    A. Enrich interview and physical examination skills. The committee examined several means by which this might be accomplished.
    1. a) a one-on-one clinical mentorship,
      b) extension of one or more of the tutorial sessions per PoM-2 section (GI, Pulmonary, etc.) by one hour and incorporating physical diagnosis & interviewing techniques specific to the section,
      c) a compromise plan in which two physicians would meet with four or six students in a tag team setting, and
      d) expansion and enhancement of the current H&P sessions.

    Discussion: A free standing one-on-one clinical mentorship, fostering collegiality and providing increased exposure to patient interviewing and physical diagnosis activities, would be difficult if not impossible to organize and staff for the fall 2001 session.

    Extension of one or more of the tutorial sessions per PoM-2 section (GI, Pulmonary, etc.) by one hour and incorporating physical diagnosis and interviewing techniques specific to the section in the additional hour was proposed. The Standardized Patient Program would provide patients (standardized and real) for these activities. This proposal is limited by the availability of small group and examination rooms. Although only anecdotal, several current tutorial leaders have reportedly indicated that they would not continue if a third hour were required.

    Because of these limitations, a compromise plan was explored in which two physicians would meet with four or six students each week. The two faculty for each "four to six" students approach would allow a more diverse patient population than would be available through a single faculty member and would allow flexibility in scheduling interview and physical diagnosis sessions; either or both faculty could meet with the students, depending on their schedules. The two leaders could meet with all of the students or they could choose to break the group into two sub-groups.

    Expansion and enhancement of the current H&P sessions as an alternative means of providing increased exposure to patient interviewing and physical diagnosis activities was discussed. An organized program is already in place in which physicians meet with and observe 2nd year students on three occasions throughout the year. In addition there is an initial H&P session with a fourth year student. It is proposed that the physician sessions be expanded to 6 or 7 per year.

    The format should be reconsidered.* Guidelines and expectations for the student and faculty will be required. The program will need careful monitoring to ensure active participation by the faculty.

    We recognize that providing students with regular H&P skill practice using H&P mentors may be a challenge, based on some of the problems some students have with accessing faculty in connection with the current three H&Ps in ICM. However, the Committee feels strongly that your energies would best be focused on improving and expanding the H&P program. This will have the effect of meeting the goals of improving the student interview and physical examination skills through practice and linkage to Pharmacology and Pathology. Furthermore an expanded H&P program can foster collegiality and become the mentoring program discussed in option "a". This proposal requires no additional time from the weekly tutorial leaders.

    We believe an expanded H&P program can be implemented for the fall 2001 session. Both course directors, Brian Wispelwey and Darci Lieb, will need to devote energies to improving the H&P program in the manner described. The committee has confidence in their ability to accomplish this goal.

    * The 3-4 hour H&P "experience" should be shortened.

    B.Attendance at one weekend of rounds per year. The requirement that each student attend one weekend of rounds per year clearly has great motivational value in the first year of medical school. Reports from students regarding the weekend rounds program already in place in PoM-1 and suggested for PoM-2 have been highly variable. Additional student and faculty guidance from the PoM directors is needed. Specific expectations or objectives for faculty and students would help to create a more uniform experience for all students. It is suggested that PoM-2 delay implementation of a weekend rounds program until changes have been made in PoM-1. The Committee expects that every effort will be made to ensure that weekend rounding is a positive experience for all students and faculty.

    C. Creation of new and revision of old tutorial cases to incorporate issues such as sexual health, geriatrics, palliative care and end-of-life issues whenever possible is encouraged. Use of computers during the tutorial sessions for displaying radiographs, laboratory findings, the physical sounds and sights of the physical examination are encouraged. Ethical, cultural and epidemiologic facets should be added to the tutorial cases when appropriate. Cases illustrating sexual health, geriatrics, palliative care, and end-of-life issues should be developed. The clinical breadth of the overall group of cases should be increased and the use of radiology images, ECG tracings, and microscopic and other clinical images encouraged whenever possible. Linkage to the Pathology and Pharmacology courses is encouraged.

    D. New evening laboratories in the Gastrointestinal and Geriatrics sections of PoM-2 were discussed. In the short term, we believe PoM-2 course effort is best used in the further development of the H&P program. Gastrointestinal and geriatric clinical laboratories should be considered for the future.

    E. The fourth year clinical teaching elective should be pursued. A dialog with Margaret Mohrmann will need to be initiated because this elective will not be limited to a two, four, or six-week block but will involve a student time commitment extending over a whole semester. Whether students should receive elective credit for this activity or be reimbursed monetarily was discussed. It is important that students participating in a teaching elective have clear goals and objectives for the activity so that they receive a valuable educational experience as well as their contribution to the education of first and second year students. The use of 4th year students to help teach H&Ps has potential and would be a learning/growth experience for both the 2nd and 4th year students. Concern was raised about relying too heavily on the 4th year students, as ideally teaching of H&Ps should be conducted by experienced faculty.

    F. Improve the distribution of ethics material (approximately 6 hours, transferred from the first year curriculum) in PoM-2.

    G. Incorporation of the second year preceptorship into PoM-2 will allow PoM-2 to provide preparation for this experience and, following the preceptor week, to provide a reflective experience. The current preceptor experience itself seems well placed in the curriculum and provides a positive experience for nearly all second year students.

  2. Cultural Competency. The work of the task force on Clinical Cultural Competencies is proceeding well. An update from Dr. Maurice Apprey was distributed to the Committee. The Committee believes that cultural awareness is already taught in the curriculum, but should be formalized, documented and made consistent for all students. Cultural sensitivity might better be defined as individual sensitivity. Learning to deal with people as individuals should be a primary goal.

    It was suggested that cultural "awareness" would be a more compassionate term than cultural "competency". It was also felt that experiences within cultural enclaves in the US are probably more appropriate than international experiences, as many "cultural responses" are a result of the "new" environment and would otherwise be "masked" within the home culture. Concern was raised as to the sizable financial impact, varying degrees of hardship, and in some locations considerable health and safety concerns for students when "requiring" clinical experiences in international settings.

-Don Innes