Minutes 06.12.08

Minutes 06.12.08

University of Virginia School of  Medicine
Curriculum Committee

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) Guests: Darci Lieb, Jonathan Evans, Elizabeth Bradley

  1. Basic Science For Careers (BS4C) Report, March 10 - 28, 2008  Darci Lieb presented a review of the BS4C program held March 10 - 28, 2008.  Darci Lieb, Debra Perina, Jerry Short, Don Innes, and students Doug Clark and Animesh Jain reviewed the course in May.  BS4C was generally well received by students with mean ratings well above 3 on a 4-point scale. The main criticism was that the 3-week program was too spread out and that the days/hours should be consolidated. Students used this time to study for USMLE-2CK and simply well deserved downtime following the intense clerkship period. The attendance policy was too strict and the large sessions were not judged as valuable as the small group sessions.  Pairing of a basic scientist with a clinician did not occur in the majority of sessions, some presenters were unprepared, some sessions were judged to be at too basic a level, and finally some students felt the program did not prepare them for the boards (note the survey was prior to USMLE).  Logistical planning for the program needs to be redesigned. 

    A set of revisions to the BS4C program were proposed. 
    a. Concentrate the program within two identical weeks followed by DxRx
    b. Require 24 hours of BS4C short sessions. Generally this would be 12 two-hour sessions.
    c. Balance students between the two weeks (~70 @) according to student preference
    d. Three sessions daily, Monday - Thursday 9-11, 11-1, and 2-4
    e. Designated clerkships would be responsible for providing concurrent groups (~10-12). This will ease administration and allow a wide range of choices for students.
    f. Provide a basic template for formatting a session  - brief case based interactive session with co-teaching with basic science faculty where appropriate. Encourage experimentation with active experiential learning.
    g. Administrative timelines appeared reasonable.

    Discussion centered on discontinuing the program entirely versus adopting the proposed revision for 2009 and working to further improve it considering the coming change in USMLE - "Gateway A". The consensus was to approve the revision for 2009 and to refocus the program on the original objectives with the added objective of board preparation.

  2. Proposal for a 2-Week Geriatric Clerkship.  Earlier discussions at the Curriculum Committee recognized the need for geriatrics education and training. Furthermore, one of the stated reasons for increasing the class size was to produce more physicians to care for the growing elderly population. Bill Wilson and Don Innes met with Jonathan Evans and Elizabeth Bradley to learn more of what might be included in a required geriatrics curriculum. A proposal for a UVA geriatrics program was requested. 

    Jonathan Evans and Elizabeth Bradley presented their proposal to the committee. During the proposed 2-week Geriatrics Clerkship, students will actively participate in the ongoing, daily care of older patients who have a wide variety of acute and chronic illnesses and abnormal physical findings. Each student will be paired with a primary geriatric physician mentor who will provide clinical teaching and ongoing feedback to the student. Additionally, each student will be responsible for his or her own panel of patients at a skilled nursing facility.  Throughout the clerkship students will work with a variety of geriatric focused health professionals as part of the interdisciplinary care team. This includes nurse practitioners, therapists, certified nursing assistants, and social workers. It is expected that throughout the course of the 2-week clerkship students will be involved with and responsible for admission assessment, discharge planning, ongoing care and management, writing orders, and working with families. 

    Student will also actively participate in a series of case based clinical skills workshops. These sessions will provide students with needed instruction and practice of skills pertinent to the care of older adults. The timing of the workshops will also allow ample time for students to practice their developing skills at their clinical sites. As with all other clerkships, students and faculty will use a Clinical Skill Passport to assist teaching and learning of several geriatric focused skills. Faculty will use this tool to guide teaching and feedback to students, and students will use the Passport to track their learning needs more effectively.

    Curriculum Topics for Geriatric Clerkship:

    The following topics form the foundation of information students will learn regarding the care of older patients. These topics are foundational regardless of chosen career specialty, because they are basic and necessary for providing quality patient-centered care to older adults.

    1. Population aging and the impact on health care delivery, the economy, and society.
    2. Important age-related changes in anatomy and physiology and the implications for drug prescribing.
    3. Atypical presentations of illness-what and why?
    4. Evaluation and diagnosis of common geriatric syndromes:
         a. Delirium
         b. Dementia
         c. Falls
         d. Incontinence
         e. Failure to Thrive
    5. Roles and responsibility of working on an interdisciplinary care team.

    The Geriatrics proposal was enthusiastically received. A two-week Geriatrics experience should fit well into an "Expansion" proposal to accommodate as many as 20 additional medical students per year on clerkship rotations (142 -> 160). This "Expansion" proposal extends the current 10-month clerkship rotation period to 12 months with two months focused on acquisition of concepts and skills that are generally useful to all physicians, that address un-met educational needs, and/or allow for selectives not requiring core clerkship experiences. The knowledge, skills, and attitudes to be included in this expansion must derive from the " Twelve Competencies Required of the Contemporary Physician" and should whenever possible actively engage learners.

Donald Innes
Animesh Jain