Minutes 05.15.08

Minutes 05.15.08

University of Virginia School of  Medicine
Curriculum Committee
Minutes
05.15.08

Pediatric Conference Room, 4:00 p.m.                       

Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary)

  1. PoM1 Course Assessment.    Discussion of the PoM1 Course Assessment of 5/8/08 was continued with the suggestion that the search for appropriate patients for H&P exercises include the post-partum ward, the ER and the renal dialysis unit.   Planned changes to the ethics portion of the course seem warranted and beneficial to the course.  The Committee will review student evaluation data after the changes.   The Committee agreed that while most of the students' ethics education takes place in the clerkship/elective years, the groundwork must be laid in the preclinical years. Recommendations and proposals for the coming year were reviewed. A communication to the course director will be formulated.

  2. 2009-2010 Clerkship/Elective Calendar.  The Clerkship/Elective calendar for 09-10 will be adjusted by one week so that the beginning of each clerkship and elective period is in sync.  The Committee reviewed the modifications and approved the change.

  3. Comprehensive Exam Proposal.   A proposal to develop a comprehensive exam after the first year was discussed. 

    1.  Currently, medical students take the following comprehensive exams during the four years of medical school and after their first year of residency.

    Year 1

    Year 2

    Year 3

    Year 4

    PGY 1

     

    USMLE Step 1

    USMLE Step 2CK (Clinical Knowledge)

     

    USMLE Step 3

     

     

    USMLE Step 2CS (Clinical Skills)

     

     

     

     

    UVA Clinical Performance Exam

     

     


    2.  Initial reports indicate that the USMLE is planning to discontinue Steps 1, 2, and 3 and replace them with two Gateway exams using the following schedule:

    Year 1

    Year 2

    Year 3

    Year 4

    PGY 1

     

     

    Gateway 1: Licensure for the supervised practice of medicine

     

    Gateway 2 Licensure for the unsupervised practice of medicine



    Final approval of the new licensing design is scheduled for consideration by the full boards of the FSMB and NBME no earlier than Spring 2009.  As noted by the USMLE, "If changes are approved, it will take at least two additional years to work out the details for a reasonable transition to the new design, structure, and to begin implementation." 

    2.     In order to plan for the new design, a new sequence of comprehensive tests is proposed that would give students more experience with comprehensive tests before taking Gateway 1. 

    Year 1

    Year 2

    Year 3

    Year 4

    PGY 1

    NBME/UVA Foundation of Medicine Exam

    NBME Comprehensive Basic Science Exam

    Gateway 1: Licensure for the supervised practice of medicine

     

    Gateway 2 Licensure for the unsupervised practice of medicine

     

     

    UVA Clinical Performance Exam

     

     



    3.     The NBME/UVA Foundation of Medicine Exam could be constructed in 2008-2009 using NBME's Customized Assessment Service and offered to students in Spring 2009. 

    In order to construct this test, a committee of faculty would identify the topics to be included on the test.  Next, the NBME would provide questions from the NBME test item bank related to the topics.  Twice as many questions would be provided as would appear on the completed test.  The faculty committee would select the questions to be included on the test.  The test would probably consist of 150 questions and require three hours to administer.  The test would be administered by computer to two groups of 70 students each in the Health Sciences Library on a Saturday in the spring.  The NBME charge for 140 students would be

     Administrative Fee   $1,500
     Exam Fee ($40 per student x 140 students)     $5,600
     Total                  $7,100
                               
           
    The process of constructing the exam should be a useful faculty development project.  The review of first year course material and the experience of taking an NBME-type exam should be useful to students. 

    It is recommended that taking the exam be required of students, but that no passing score be set until UVA has several years experience with the exam.  Since this is an exam based on the UVA curriculum, there would be no national norms comparing UVA students to a national norm group.

    4.     When Step 1 is discontinued in the future, the NBME Comprehensive Basic Science Subject Exam could be substituted for it and offered at the end of Year 2.  This is a standardized exam given at some other medical schools.  It would provide national norms for comparison purposes.  .The cost of this exam is currently $42 per student.

    The Committee discussed the reasons this proposal was developed - preparing the student better for USMLE Step 1 thus improving scores, identifying students who may need remediation, and consideration of test scores by the promotions committee were noted. Standardized testing at other US medical schools was outlined.

    NBME/UVA Foundation of Medicine Exam
    - the examination should cover anatomy, biochemistry, histology, genetics, physiology, and neuroscience
    - all students (starting with the Class of 2012) must take the examination and the results used for formative (not part of a grade) self-assessment (helping the students to understand criteria by which they will be measured on USMLE; measure of what they are learning relative to their peers)
    - provides practice in USMLE format and computerized testing environment
    - review of material - synthesis and integration of basic science material before using the normal to study abnormal function
    - identify students who may need remediation for mentoring
    - feedback to faculty - familiarize faculty with USMLE style questions
    - could serve as a measure of remediation, by a successful end-of-year examination

    The primary hypothesis is that the students with this new practice and self-assessment tool will improve their performance on USMLE-1 as measured by the class mean compared to historical controls.

    The Committee was appraised of the availability of appropriate testing facilities, cost of the tests. Student stress levels, the timing of implementation, and the need to gather outcome data were considered.

Donald Innes
dmr