University of Virginia School of Medicine
Pediatric Conference Room, 4:00 p.m.
Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Lisa Herrmann, Evan Lapinsky, Debra Reed (secretary)
Recent articles in Academic Medicine of interest to the Curriculum Committee:
A Change to Pass/Fail Grading in the First Two Years at One Medical School Results in Improved Psychological Well-Being. Bloodgood, R.A., Short, J.G., Jackson, J.M, Martindale, J. R. Acad Med 84: 655-662, 2009.
Commentary: Assessment Is an Educational Tool. Krupat, E, Dienstag, J.L. Med 84: 548-550, 2009.
Close the Book, Recall. Write It Down. Glenn, D. The Chronicle of Higher Education Section: The Faculty - Volume 55, Issue 34, Page A1.
Family Medicine Clerkship Review. Dr. Peter Ham, Director of the Family Medicine Clerkship, met with the committee to discuss the recent Clerkship review.
The Committee expressed thanks to Dr. Ham for his comprehensive self-study report. Dr. Ham presented a brief synopsis of the report discussing the successes and challenges for the Family Medicine clerkship. Departmental administrative and faculty support for teaching efforts is excellent as is clerical support.
The Family Medicine clerkship is highly rated by the student body due in large part to the high quality of the mentors and the ability the student has to actively participate in patient care. Students perform above the national mean on the national USMLE subject exam. Students grades are a compilation of the faculty evaluation (50%), USMLE subject exam (35%), Evidence-based Medicine questions (10%) and Workshop feedback and morning report presentation (5%). The passport ensures that faculty directly observe required clinical skills. All delinquencies are remediated before completion of the course. Students complete the patient logs in Oasis and these are reviewed midclerkship and at the end for completeness. There are online modules for students who may not have had exposure to specific populations or disease processes because of the nature of their individual clerkship site.
The clerkship does an excellent job placing students in an active role. The preceptors are excellent demonstrate their interest in teaching students. Outside preceptors are visited every 1-2 years by the course director. Most communication is usually via e-mail.
Strengths: The Family Medicine Clerkship does an excellent job placing students in an active role. Students take first histories, perform physical exams, interpret tests, perform procedures and formulate diagnoses and plans. They are directly supervised by a practicing physician, often with years of experience, and receive invaluable feedback on their medical knowledge, clinical skill, communication skills, professionalism, and ability to manage information. The high ratings from students reflected in the above graph demonstrate how much students appreciate the chance to "do," feel useful, and develop a mentor relationship with a physician over the course of a month. Students report they "feel like a doctor" and begin to appreciate the whole practice of medicine as a unique art rather than about demonstrating medical knowledge.
The Family Medicine Clerkship connects community faculty with UVA SOM educational missions. Faculty feel validated as clinicians and teachers. The teachers have won awards based on student evaluations. They appreciate the skills students bring to their offices (language, compassion, computers, cultural competency...) the connection to the basic sciences, the praise students give their practices and communities, and the relationship that often ensues.
Challenges: The Family Medicine Clerkship disperses students to many practice sites. While we ensure that each practice site is an excellent learning opportunity, ensuring uniformity in expectations, evaluation, and scope of experience is difficult. As a result, grading is difficult to validate. (Is that student typical or above average? This can be a difficult question for a physician only working with students a few times per year. A pass/fail grading system would be welcomed and would perhaps help with the grading problems in this clerkship.
It is costly and difficult to bring faculty together for faculty development workshops. The clerkship requires student travel and housing for many students which results in expense and lost time for clinical experience.
Maintaining the numbers of family practices necessary for our increasing class size could become more difficult in light of the opening of the new medical school at Virginia Tech as well as the increased enrollment at the Medical College of Virginia. The possibility of extending CME credit to the preceptors for their teaching efforts was discussed.
If a pop-up window could be added to Oasis that would outline descriptions of "typical," "superior," and "honors" for the preceptors, it might help with the standardization problem in the student evaluation process.
Mid-month evaluations of the students are done and are well received by the student.
The Committee applauds Dr. Ham and the Family medicine faculty for their work in maintaining an excellent clerkship experience for the medical students. The clerkship provides a unique longitudinal experience and along with AIM gives the student a well rounded primary care education. Dr. Ham and Dr. Heald (Clerkship director for AIM) work together to avoid repetition (especially in the workshops) and to ensure a comprehensive experience.
Medical Education Competencies. Eugene Corbett gave a brief overview of the AAMC learning objectives and how UVA might alter their objectives to be more like the national objectives. While our objectives were the original basis for the AAMC objectives, the AAMC objectives are less specific and Committee discussed these differences.
University of Virginia School of Medicine Competencies Required of the Contemporary Physician:
Poster - Competencies Defined for the Degree of Doctor of Medicine at the University of Virginia
Gene will draft a modified Competencies for the Committee's consideration.