Minutes 08.31.06

Minutes 08.31.06

University of Virginia School of  Medicine
Curriculum Committee
Minutes
08.31.06

Surgery Conference Room, 4:00 p.m.                       

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve BargmannDaniel Becker, Robert BloodgoodGene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill WilsonDevin Mackay, Kavita  Sharma,  Debra Reed (secretary)

  1. Don Innes opened the meeting with a brief discussion of the summer events. 

    *

    Dr. Peter S. Ham was approved by the committee as new co-director of the Family Medicine Clerkship.

    Dr. Walter S. Davis was approved by the committee as new co-director of the PoM-1 course.
    * Neuroscience has been offered assistance in their endeavor to improve the Neuroscience course.
    * Content in Color, the content review of Foundations and Core Systems courses has been completed. This is based on the content outline for USMLE-Step 1. Only rare items are apparently not covered by any course. A number of topics are cover in several courses. The Principles of Medicine Committee will be asked to review these apparent "gaps" and check the redundancy for value.
    * Annual Course Reviews have been received from all courses. These will be reviewed by the Principles of Medicine Committee with generation of a report to the Curriculum Committee this fall. This is the first year of a three-year cycle. The Annual Reviews will also be distributed to Curriculum Committee members.

    The review process is tiered with the Directors reviewing their own programs yearly (See attachments); a Principles of Medicine or Clinical Medicine Committee review of all annual reports with cross-course comparison and generation of a full report every three years, and the Curriculum Committee's oversight of the review process and with receipt and review of the full report from the Principles of Medicine or Clinical Medicine Committee review. The Curriculum Committee may ask for a review of a course or clerkship at any time. [Clerkships/Electives/Selectives and Basic Science Courses: Monitoring the Content, Depth, Breadth, and Current Relevance of the Curriculum 1.0 -DJI 06.14.06]

  2. An Introductory Anesthesia Experience has been arranged following a meeting of Hilary Sanfey (UVa Surgery), Eugene McGahren (UVa Surgery), Steve Remine (Carilion Surgery), Gary Collins (Salem VA Surgery), RobertSmith (Salem VA Surgery), George Rich (UVa Anesthesiology, chair) and Ed Nemergut (UVa Anesthesiology).

    At UVA, Drs Nemergut and Rich feel that the [anesthesia] experience is accomplished best by having the students complete the three days in a consecutive block. Students will therefore be assigned accordingly with Dr. Nemergut supervising their assignments and experience. At Roanoke and Salem, the three days may be accomplished either in a block, or as individual days, according to what is determined to be best by Dr. Collins and Dr. Remine in conjunction with their anesthesia colleagues at those particular sites. Dr. Collins and Dr. Remine will monitor the students' experiences in those rotations. The Surgical Chief Resident at Salem will also help in facilitating and monitoring the anesthesia experience there.

    The anesthesia experience may include exposure in the operating room and pre-operative areas, clinics, and anesthesia conferences as deemed appropriate by the supervising individuals. It would be expected that the students should gain an appreciation for the anesthetic issues and management related to the care of surgical patients. They should also have the opportunity to experience some of the technical procedures involved in anesthesia care where appropriate. I have attached a set of objectives, and a checklist for potential procedures as prepared by Dr. Nemergut to serve as a guideline for this (see attached).

    Where possible, the experience should be as least disruptive to the students' surgical experiences and their interaction with their surgical teams as possible. For example, where possible, a student could be assigned to a room where her/his primary surgical team is already operating. However, discretion in this matter will be left to Dr. Nemergut at UVA, Dr. Remine at Roanoke, and Dr. Collins at Salem.

    The students will be advised to document completion of this anesthesia component on their "Passports".

  3. The Clerkship Clinical Skills Education Program (CCSEP) is an interdisciplinary effort of the departments of Internal Medicine, Pediatrics, and Family Medicine. Its purpose is to maintain and expand clerkship clinical skills workshops (now number 31, small group sessions which bring together selected faculty to teach basic clinical skills to students), establish a clerkship-level clinical skills assessment process (osce assessment exercises now number 28), and develop a UVA clinical skills education website. The program also involves faculty development with emphasis upon clinical skills teaching skills. Skills assessments are done twice per year (Nov, Feb). Data from recent assessments showed less-than-expected student performance levels, with scores ranging from 30-86% of expected for 24 basic clinical skills. In one instance, fewer than 40% of students identified an abnormal heart rhythm. Clearly, we need to improve clinical skills teaching. Future plans involve incorporation of all the clerkship disciplines in enhancing the teaching and assessment of clinical skills. Gene Corbett will present additional information on this program at the September 7, 2006 meeting.

  4. The Clinical Skills Education program (CSE) during the general medicine inpatient clerkship rotation is also expected to improve students' clinical skill performance. This program pairs students with selected attending physicians during scheduled afternoon sessions when bedside teaching is emphasized. Early reports are very positive. Michael Rein was asked to include evaluation of this project in the Medicine clerkship evaluation process and provide this information to the Curriculum Committee.

  5. Cumulative Honors Survey (Bob Bloodgood)

    The latest study information on the Pass/Fail grading systems shows:
    * No decline in attendance at scheduled academic activities 
    * No decline in academic performance [level of courses]
    * Increase in well-being
    * USMLE Part I data shows no statistical difference since P/F instituted

    Survey of Class of 2007 on Cumulative Honors (Pass with Distinction) N=??

    Increased stress

    Decreased stress

    No effect on stress

    Decided to go for cumulative honors

    70%

    0%

    30%

    No conscious decision either way

    8%

    50%

    42%

    Decided not to go for cumulative honors

    0%

    92%

    8%


    Conclusions:

    * Choosing to "go" for cumulative honors increased level of stress
    * Choosing not to "go" for cumulative honors reduced level of stress
    * Inclusion of cumulative honors probably reduced the magnitude of the positive effect that the change to Pass/Fail had on student well-being

    Survey of Class of 2007 on Cumulative Honors (Pass with Distinction)

    Regretted decision

    Awarded cumulative honors

    Decided to go for cumulative honors

    21%

    52%

    No conscious decision either way

    11%

    11%

    Decided not to go for cumulative honors

    0%

    7%



    Increased stress

    Decreased stress

    No effect on stress

    Decided to go for cumulative honors

    70%

    0%

    30%

    No conscious decision either way

    8%

    50%

    42%

    Decided not to go for cumulative honors

    0%

    92%

    8%



    * Comparison of Pass with Distinction and AOA Groups: 79% overlap
    * Cumulative Honors (Pass with Distinction) will be suspended with the class of 2011.
    * Performance data for individual students from the two classes (Pre-Pass/Fail; Post-Pass/Fail) was compared. Numerical grades showed no statistical difference in grades.

    Dr. Short related the latest information obtained from a survey of the third year class asking students whether they preferred the pure Pass/Fail or Pass/Fail/Pass with Distinction system and results were split down the middle with 53% for P/F and 47% P/F/Pass with Distinction.

    The Committee agreed that results of the Step 2 exam for these two classes should also be compared.  Bob Bloodgood noted a new paper suggesting that grades in the first two years of medical school are a valid predictor of performance in residencies and in clinical practice.  (Gonnella JS et al:  An Empirical Study of the Predictive Validity of Number Grades in Medical School Using 3 Decades of Longitudinal Data:  Implications for A Grading System. Medical Education,  38: 425-434, 2004.)

  6. Clinical Service Work Hours are being monitored. Clerkships have been reminded of our policy.

    Medical students rotating on clinical services (clerkships, selectives and electives) should be subject to the same principles that govern the 80-hour work week for residents. Clerkship directors are responsible for monitoring and ensuring that duty hours are adjusted as necessary. Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents*. (Curriculum Committee 9/9/2004)  * LCME Standard ED-38
  7. Study Hours in the First Two Years of Medical School. Adjustments have been made to the first and second year course schedules to allow keep or increase as many afternoon study hours as possible in the first two years. The Principles of Medicine Committee will continue to monitor this.

    Anatomy, Biochemistry, Cell & Tissue Structure/Physiology, and PoM-1 in the fall Foundations; Social Issues in Medicine and Patient Clinician Encounter Program (PCEP) in the spring Foundations; PCEP, Intro Psychiatric Medicine, Pharm, Path, Micro and PoM-2 in the fall Core Systems, and Epidemiology, Micro, Path, Pharm, and PoM-2 in the winter Core Systems.
  8. Selectives Supervisors. All selectives are now required to have their own supervisor. Although originally planned for the Clerkship Directors to monitor selectives in their areas, it has become apparent that direct contact people are needed for all selectives. These selective supervisors will be trained in the use of OASIS and required to use it in a timely and consistent manner. They will be similar to electives supervisors.

    The Selective and Elective supervisors are responsible to the Selectives and Electives Director for providing the goals and objectives in a description of the Selective or Elective experience; identifying the time and location for assembly; assigning students to appropriate faculty, and completing the P/F grade and evaluation of the student.  The supervisor is a role model and mentor, and can have a huge positive influence on the development of a young MD to be.
  9. PoM1 Course Co-Director Position. John Gazewood will be stepping down as Course Director for PoM1 at the end of this academic year. An advertisement will be e-mailed to faculty seeking qualified applicants for a co-director position. This will be forwarded to the Curriculum Committee members for comment before it is sent out.
  10. Job Descriptions for Directors.  The Committee will develop more detailed job descriptions for all course and clerkship directors. Address the complexity of the contemporary clerkship; availability to students, demands of clinical service.
  11. Health Sciences Library.  The Library's new study rooms are now open and available to the students 24 hours/day. The Library is applauded for this addition.
  12. Audience Response System. The Audience Response Systems in Jordan 1-14 and 1-5 are now in operation. First and second year students have been provided with the hand held devices. John Jackson will hold a training session for faculty at the October 11, Principles of Medicine Committee. The system will provide real time feedback to the professors in the Jordan Hall lecture halls.
  13. All Clerkship Evaluations on Time for both the last period (4) of 2005-2006 and for the first, most recent rotation of 2006-2007. Evaluations are due 5 weeks from end of clerkship rotation or two weeks following receipt of subject exams.

    Period 4 (
    4/3/06 - 6/24/06)
    Due 7/31/06

    Date                         

    Received                           

       Status     

    Med

    7/28/06

    Complete 

    Fam Med

    7/28/06

    Complete

    Peds

    7/14/06

    Complete               

    OB/GYN         

    7/14/06

    Complete

    Psych

    7/25/06

    Complete

    Surg

    7/31/06

    Complete

    Neuro

    7/27/06

    Complete


    Clerkship Evaluations - 2006-07

    Rotation 1A  - end 7/22

    Grades & Evaluations Due:  08.25.06

    Received

    Status

    Fam Med

    08.25.06

    Complete

    OB/GYN

    08.09.06

    Complete

    Psych

    08.25.06

    Complete

    Neuro

    08.25.06

    Complete


  14. Agenda for 2006-07. The Committee was asked to send agenda items to Don Innes for the coming year. a) Gene Corbett was asked to update the Committee on the Clerkship Clinical Skills Education Project at the next meeting of the Committee. b) Chris Peterson will provide the Committee with a brief update on the 2006 Cells to Society evaluations. c) The Committee will seek a method to enhance incorporation of the history of medicine into the curriculum through Joan Klein, librarian of the historical collection. d) Review of clerkship grade distribution histograms 2005-2006. e) A review for unwanted redundancies and especially "gaps" similar to "Content in Color" for the Clerkships should be performed this fall. f) Monitoring of Passports and of OASIS. g) address the August Problem List.

Donald Innes
Dmr