Minutes 05.27.04

Minutes 05.27.04

UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
CURRICULUM COMMITTEE
Minutes
05.27.04

Surgery Conference Room, 4:00 p.m.                         

Present (underlined) were: Reid Adams, Eve BargmannRobert Bloodgood,  Anita Clayton,  Gene Corbett, Carl Creutz,  Donald Innes (Chair),  Vern Juel, Howard Kutchai, Chris Peterson, Jerry Short, Linda WatsonBill Wilson, Brian Wispelwey, Nnaemeka Anyadike, Debra Reed (secretary)

  1. Major Diseases of Our Time (MDOT).  This one week modular experience would be comprised of basic science and clinical.reviews of major diseases. This course would take place immediately after second year and prior to USMLE-1.   It would act as a “bookend” for the pre-clerkship period with Cells to Society at the beginning and MDOT at the end.    The Committee agreed that for these sessions to be successful, they must be balanced between board review and preparation for the clinical years.   These review session would be in addition to the Board review sessions already offered by Anatomy and Biochemistry. 

    The Committee discussed whether this course should be optional or mandatory and most felt that since it occurs during a time when students are studying for their boards, it should be optional.

    Topics (diseases) such as the following were suggested:

    Asthma
    Heart Failure
    Diabetes (obesity; nutrition)
    Dementia
    Acute renal failure
    Pre-maturity (respiratory distress syndrome)
    HIV (infectious disease)
    Adult respiratory distress syndrome
    Sickle cell disease (anemia – nutritional)
    Pneumonia
    Cancer

    The CDC list/WHO list (by frequency) might be another way to select appropriate topics.

    Members of the Committee was asked to suggest faculty/students who might be good candidates for the “Major Diseases of Our Time” development group.  [Note added later: Dr. Wilson has agreed to gather a Design & Development Team from the clerkship directors, other interested faculty and students (Michael Richardson and others). The Principles of Medicine Committee may provide guidance for topics and information on what is covered in their courses.

    Comments from Committee members included:

    The Design & Development group will research format along with the topics.

    Students must be involved in development, especially fourth years who have finished USMLE-1 and clerkships.

    As an aside it was suggested the periodically over the first two years, students be given anoverview of what they’re learning in all courses – help them know the “big picture”of what they’re learning.

  2. Curriculum for Professionalism.  (Development Committee:  Randolph Canterbury, Marcia Childress, John Gazewood, Holly Glassberg, Allison  Innes, Donald  Innes, Maria Meussling, Jennifer Wenger)  The Design and Development Team on Professionalism elected to adopt the NBME Professional Behaviors for this articulation which expressed the domains of professionalism with greatest clarity and allowed for a measure of evaluation and formative feedback:

    respect
    responsibility and accountability
    knowledge and skills
    excellence and scholarship
    honor and integrity
    altruism
    leadership
    caring, compassion and communication

    The professionalism curriculum links closely to the complete set of twelve UVA Competencies Required of the Contemporary Physician, with special emphasis on competencies 1, 3 and 12.

    A professionalism curriculum requires creating a fully integrated culture of professionalism and the promulgation of individual and institutional values for advocacy of professionalism (awareness; action) and for support mechanisms (means to resolution) for modeling ethical attitudes and behavior.

    The goals and objectives are to establish a climate of professionalism, promoting professional conduct and practice for all students, faculty and staff to support a respectful and reflective learning environment and for the betterment of our patients and community. Academic programs must be established to teach and value a continuum of professional behavior in medical students that will carry on into their residencies and practice years. Attend to informal and hidden curriculums to ensure that there are consistent values and expectations.

    Student objectives include demonstration of professional behaviors (respect, responsibility and accountability, knowledge and skills, excellence and scholarship, honor and integrity, altruism, leadership, and caring, compassion and communication) that form the foundation upon which the practice of medicine rests; the ability to freely discuss issues of professional meaning with professional peers (students, residents, attendings and staff); practice reflection both personally and professionally; explore and develop models of patient-physician relationships, and of collegial and community relationships; achieve a professional and personal definition of service and its meaning, and understand the culture of medicine and how it influences one’s own thinking and professional development.

    Creating the professional culture for physicians begins with the medical school admissions process and matriculation of the student.

    The "White coat" ceremony and reading of the covenant mark the official recognition of the formal, “hidden”, and “informal’ (institutional) aspects of the curriculum.

    Practice of Medicine 1 and 2 are the major educational experiences in the first years of medical school prior to the clerkships that currently directly address the deeper, humanistic professional issues of meaning and sustained commitment in medicine, compassion, and service.

    Medical Center Hour should be mandatory two/three/four sessions per semester throughout PoM-1&2 as appropriate.

    History of Medicine Series of the Claude Moore Library could be utilized as a component of teaching of medical history as appropriate.

    The Exploratories offer an opportunity for community service and for introductory clinical care activities, but importantly provide a venue for reflection.

    The clerkship Clinical Connections program, in particular the "Clinical Conversations" sessions, should play an important role in a professionalism curriculum with programs of self-reflection, simulations, clerkship journals and most importantly reflective discussion of real life experiences.

    Clinical vignettes using “avatars” (web-based speaking animated characters) should be created to explore professional/unprofessional behaviors for use throughout the curriculum, but especially in clerkships.

    Nursing, primarily, and the hospital and School of Medicine administrative staff that interact with the medical students need to be included in their professional education.

    Academic Assessment of the Students Professional Awareness and Behavior should include formative feedback emphasizing the positive behaviors - Professional Performance Feedback. Formative feedback to students must be timely to allow students adequate opportunity to make appropriate changes.

    Faculty Development  will be needed for attending and resident physicians for in the act ofteaching they become a professional role model for medical students. The Academy ofDistinguished Educators (ADE) should take a lead role for faculty development. The ADEcan support a respectful and reflective learning environment, promoting professional conduct for all faculty, staff and students.

    An action plan is being developed to 1) involve students and faculty and staff, aware oftheir Roles, 2) identify a “caretaker” faculty member [of the Curriculum Committee] tomonitor the Professionalism curriculum with the goal of ensuring that each component isfunctioning properly, 3) implement Ethics Report recommendations, and 4) determinemetric methods with the assistance of experts in measurement'

  3. Praise/Early Concerns Cards.  A prototype of a Praise Card/Early Concern Note was distributed to the Committee.  This was based on an ABIM form. These cards would be used by faculty (residents/staff) primarily in the clerkships to record a excellence or when there is cause for concern.  The Committee suggested the addition of  “accepted feedback well” and “accepted feedback poorly”.  Praise cards would be appended to the student’s records in Student Affairs.  Problems outlined in Early Concern notes would be remediated.

The Curriculum Committee will not meet on June 3 or 10 – the next meeting will be held onJune 17, 2004 at 4:00 p.m. in the Surgery Conference Room.

Donald Innes
dmr