University of Virginia School of Medicine
Surgery Conference Room, 4:00 p.m.
Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary)
- Clinical Connections. Recent rumors about the demise of the Clinical Connection program next year are untrue. There are no plans to suspend this essential program.
- Transition Course. The transition course for 2007 has been tentatively scheduled for Tuesday, April 24 - Saturday, April 28. The course has traditionally run from Monday - Friday but with the new curriculum the course will now occur in April when laboratory space in the School of Nursing building is unavailable. Tentative plans include an introduction to DX/RX, Career Day, Becoming a Clinician Ceremony, and Information Management. The laboratories will be held on Friday afternoon and all day on Saturday in the School of Nursing. The possibility of moving the "Becoming a Clinician" ceremony to later in the year will be explored by Chris Peterson. Possible use of the patient simulator for the transition course will be discussed by Drs. Jerry Short and Marcus Martin.
- Clerkship Clinical Skills Program. Eugene Corbett outlined the progress of the program from its inception to the present. The developers coined a term "strategic incrementalism" to define how workshops and skills assessments are developed through gaining faculty participation. This is done slowly and staedily with intentional limitation of faculty time required for development and implementation of each skills education activity spread among many faculty. The program is made up of three components:
1. Clinical Skills Workshops
At present some 31 workshops have been developed for the Family Medicine, Internal Medicine and Pediatrics Clerkships but only at UVA. Expanding these offerings to students whose clerkships are at outside sites is planned. Workshops are 1-2 hours long. Kavita Sharma reported that most students feel the clinical skills workshops are very valuable. The developers' goal is to expand these workshops into all clerkships. Funding has not been a problem thus far from the Deans and Chairs of the Departments involved.
2. Clinical Skills Learning Assessment
Since the program began in 2003 it has used objective structured clinical examinations (OSCE) to assess clerkship students' ability to perform selected and discrete clinical skills utilizing simulation, standardized patients and (more recently) real patients. It involves a formative design so that students are at first challenged to perform a specific clinical skill within a period of time, followed by a feedback session with standardized or real patients and faculty that provides the opportunity for students to learn how to improve their skill performance. Skills include communication, physical examination and basic clinical tests and procedures. During 2006-07 all students will be required to participate in these assessment exercises. To date, 24 OSCE exercises have been fully developed and tested. Over 70 faculty from 10 departments have participated in this program.
Results of student performance in these clinical skills assessment have been varied. The Committee discussed the results to date and whether performance and grade anxiety might be affecting the scores. Informing students that these assessments are not part of their grade on multiple levels was suggested. The differences between the OSCE setting and the real world of clinical practice were discussed. Also, students site lack of skill repetition opportunity as a main reason for subpar performance. While the ideal method for a specific clinical skill evaluated in the OSCEs and the real world way of the wards may not be exactly the same, students should learn the ideal method. The faculty and residents are the models for students so faculty and resident development should also be a part of any effort to improve clinical skills.
3. Development of a UVA Clinical Skills Web site
When asked what other institutions are doing to enhance clinical skills for medical students, Dr. Corbett noted that some do have programs similar to the one at UVA, some use a faculty mentor system in which faculty members are assigned to students for all four years and are responsible for overseeing student's clinical skill education. Others have a Clinical Skills Center and educational activities are built around this facility. Many are using teaching attendings to enhance clinical skills.
The Curriculum Committee will complete their discussion of this program at its next meeting and issue a statement.
- Agenda for 2006-07 continued. In no particular order: a) Chris Peterson will provide the Committee with a brief update on the 2006 Cells to Society evaluations. b) 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. c) Review of clerkship grade distribution histograms 2005-2006. d) A review for unwanted redundancies and especially "gaps" similar to "Content in Color" for the Clerkships should be performed this fall. e) Monitoring of Passports and of OASIS. f) address the August Problem List, g) Social-economic, professionalism and behavior, cultural competence, and ethics in the curriculum: SIM, PoM-1, and Dx/Rx, and h) Evaluate the Exploratory concept form the Cells to Society Curriculum, i) nutrition in the curriculum. Please send items for consideration by the committee to D J Innes.