University of Virginia School of
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
- PoM-2. The Curriculum Committee discussed the 2001-02 PoM-2
curriculum proposals presented by Brian Wispelwey at last weeks
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.
- 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
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
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
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.
- 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