University of Virginia School of Medicine
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) Guest: Brian Wispelwey
- Clinical Skills Education It has come to the attention of the Committee that restrictions have been placed on the teaching activities for certain faculty in Medicine resulting in a shortage of faculty available for teaching the History & Physical Examination portion of PoM-2. Some physicians have also been restricted from serving as tutorial leaders for first or second year students. Apparently, this is an effort to increase the time protection of Medicine junior faculty who are working to develop successful research careers; who require more focus on their research efforts and thus need to be relieved of some of their obligations as clinical educators. Such a restriction involves approximately 22 junior faculty or about 10% of all Medicine faculty.
Brian Wispelwey, PoM-2 course director, agreed to explain the situation to the Committee. The H&P course requires ~145 attending physicians to achieve a student to faculty ratio of 1:1. The H&P program includes 3 H&Ps with faculty and one with a trained fourth year student. After the 22 and certain other "ineligible" faculty are excluded, about 128 faculty remain available for teaching H&Ps. Doubling up stresses the Department of Medicine faculty. Surgery, Family Medicine, and Pediatric faculty could serve, but generally do not present the student with the more complex problems and physical findings associated with typical Medicine patients.
Teaching the full H&P has traditionally been the forte of the Department of Medicine. The Curriculum Committee urges the Department of Medicine to continue supporting the H&P program allowing time to consider a restructuring of how the H&P should be learned and evaluated. The Committee recognizes the need to devote time to research and deeply appreciates the teaching efforts of Medicine. Small group teaching in tutorials or problem solving sessions and one-on-one teaching (as in the H&Ps) represent as much of an important component of the UME teaching effort as does lecturing and should be evaluated as such for P&T.
Proposal to Accommodate Expansion of Class from 142 to 160.
Recent discussions of the Curriculum Committee have led us to explore expansion of the current 10-month clerkship rotation period to 12 months with two months of required additional clinical training.
The School of Medicine decision to increase class size from 142 students to 160 students requires accommodation of at least 18 additional students per class. In addition to obtaining new sites for clinical training, extension of the 10-month clerkship rotation to 12 months will be required to accommodate the expanded class. How can this be done while preserving the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas?
Can a solution to this expansion problem also solve the Anesthesia/ Surgery issues explored in 2007, certain complaints about the timing of the surgical specialties, and the need to place Geriatrics into the curriculum?
The November 2007 Anesthesia Clerkship Task Force [Chris Peterson] report and the related Ashley Shilling proposal for a Medical Student Anesthesia and Basic Skills Clerkship [experience]. The task force principles served as guides.
Additions to the required clinical curriculum should meet the following guidelines:
* The experience must meet high standards with respect to evidence that the added material is necessary for every physician * The required experience meets educational needs not being addressed in other clerkships or required experiences, * The objectives derive from the UVa Competencies Required of the
* Explicit links between clinical content and the basic sciences are included, * The teaching methods are sound and consistent with principles of adult learning * Measurable behavioral objectives for medical students that relate to the "Competencies Required of the Contemporary Physician" are specified, and * Evaluation methods are suitable for the content and level of expected competence.
The Shilling proposal for a Medical Student Anesthesia and Basic Skills [experience] (December 6, 2007) was recognized as a needed element of medical education and was enthusiastically endorsed (with minor modifications); however, placement as a required fourth year experience was a problem.
The Geriatrics proposal (June 12, 2008) 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.
Surgical subspecialties have indicated an interest in offering their selectives interspersed in the clerkship year. There is general agreement that using a 1-day orientation and back-to-back surgical subspecialty selectives (Ophthalmology, Neurosurgery, Orthopedics, Urology, Otolaryngology, and Plastic Surgery) could be successful without a prerequisite of a general surgical experience. Early Surgical subspecialties selectives may be of particular benefit to students interested in Ophthalmology and Otolaryngology as both have early matches.
Expansion of the clerkship rotation period to 12 months with two months of required aditional clinical training might appear as follows.
4 + 2 + 1 + 1
1 +3 +3 +1
* The Medicine, Surgery, Pediatric, Family Medicine, Neurology, Psychiatry, and Obstetrics and Gynecology clerkship rotations would remain unchanged. * Two new experiences of one month each would be added to the rotation schedule. These would be subdivided. * The addition of the two-month session effectively allows as many as 30 additional students to rotate per year.
Experience 1 (4 weeks)
Experience 2 (4 weeks)
Anesthesia/Life Saving/Clinical Skills
Surgery Selective 1
Surgery Selective 2
Anesthesia/Life Saving/Clinical Skills
Medicine Selective 1
Medicine Selective 2
Geriatrics as a 4-week experience
Anesthesia/Life Saving/Clinical Skills
This preserves the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas.
We considered geriatric medicine, anesthesia/life-saving skills, radiology/laboratory diagnosis, clinical skills workshops, and the two-week surgical and medicine subspecialty selectives.
- Standardizes basic clinical experience - Adds an important dimension to the required "core clerkship" curriculum, that of geriatrics and Anesthesia/Life Saving/Clinical Skills - Other topics that could be folded into the Anesthesia/Life Saving/Clinical Skills are Emergency care of elderly, the J. Young "War Games", and clinical skills workshops - A geriatrics program offers experience with age appropriate care - drugs, nutrition, social, family centered and numerous interdisciplinary opportunities for human development and behavior, enhanced physical diagnosis training, cognitive function assessment, rehabilitative medicine, and psychiatric care of elderly - The necessity of the geriatric and anesthesia experiences in light of the new USMLE Gateway Exam proposal - All experiences, including Geriatrics would be Pass/Fail - A negative is that certain subspecialty selectives are not all offered 12 months out of the year so that might limit student choice
In summary, accepting the several proposals (Shilling Anesthesia proposal with modification, Geriatrics Experience, and the restricted Surgical subspecialty offerings) to form a unit allows introduction of several needed elements into the curriculum in a workable format. The Committee members present were in favor of this combination. The opinions of the absent members will be solicited and reported.
First Year Schedule 2008 - 2009 Bob Bloodgood presented a first year schedule proposal to include the required End-of-Year 1-Self-Assessment at the end of the April exam week. This will take no time from the summer vacation/research period and allows for two study days before the first exam (Physiol/C&TS) and a one-day interval between each exam and before the self-assessment. The Committee approved the schedule although concerns were expressed that this self-assessment would increase stress on the students and that they might reduce their attendance at class more than is seen already.
Adjourn for summer ... Items for the fall will include a proposal for the 2009 DxRx course, a proposal from the Working Group on Clinical Skills, and exploring ways to more fully integrate our curriculum and incorporate active learning principles.