University of Virginia School of Medicine
Curriculum Committee
Minutes
10.02.03

Surgery Conference Room, 4:00 p.m.                       

Present (underlined) were: Reid Adams, Eve Bargmann,  Robert Bloodgood,  Anita Clayton,  Gene Corbett, Carl Creutz,  Donald Innes (Chair),  Vern Juel, Howard Kutchai, Chris Peterson, Jerry Short, Linda Watson,  Bill Wilson, Brian Wispelwey, Maria Meussling, David Shonka,  Ryan Zaklin, Guest:  Dean Arthur Garson,  Debra Reed (secretary)

Curriculum Development Team Reports.

1.      Foundations of Medicine and Core Systems Design and Development Team.  Members:  Eve Bargmann, Internal Medicine, Co-Chair; Bob Bloodgood, Cell Biology, Co-Chair; Carl Creutz, Pharmacology; Eugene Corbett, Internal Medicine; Maria Meussling, 4th year, Mulholland President; John Bell, 2nd year; Jerry Short, Associate Dean for Education Support.

The team, charged with the design and development of: Foundations of Medicine (the 1st year continuum) and Core Systems (the 2nd year continuum), met on 9/25/03.  A major goal of the team is to increase the retention of basic science material past USMLE Step 1 by coupling the learning of scientific concepts directly to clinical cases/experience.  Discussion focused on two broad areas: 1) how to find time in the curriculum in 1st two years to increase clinical experiences; and 2) how to improve the curriculum.

The team is building on a strong foundation of 1st and 2nd year curriculum improvement in recent years:

• 1st year integration of CTS and Physiology into Organ Systems approach
• 1st year integration of DNA Biochemistry and Medical Genetics
• 2nd year integration of Pathology, Pharmocology and PoM2 by Organ System
• Creation of PoM1 and coordination with PoM2
• Increased use of Powerpoint, Web sites, Web testing  and evaluation

  Issues for the team:

1. Finding time in the 1st and 2nd years to accommodate Cells to Society and the enhancements to the 3rd and 4th years of the curriculum (ie. end 2nd year early in order to start Clerkships earlier)
2. How to link themes from Cells to Society with the rest of the 1^st/2^nd  year curriculum
3.   Identify the best learning sequence for the material in the Years 1 & 2
4. Consideration of movement towards a systems approach
5. Other types of integration/reorganization of the curriculum (integration of basic sciences; integration of basic science and clinical)
6. Enhancing clinical/patient exposure in first two years
7.   Implications of change for the MSTP Program

 Data and Input for the Team:

• Detailed data on existing curriculum (hrs & topics) – Dr. Short
• AAMC Exit Interview Data – Dr. Short
• Summaries of Town Meetings with 2nd year students – Dr. Short
• 3rd and 4th year medical student focus group (next week)
• Principles of Medicine Committee  (mtgs 9/17/03 and 10/1/03)
• Consult curriculum people at outside institutions

  Possible ways to find time in Year 1 and Year 2?

1. Efficiencies gained from integrating curriculum and eliminating overlap
2. Elimination of 2nd year Spring break and preceptor experience
3. End the 1st year later or start the 2nd year earlier
4. Expand instructional hours in the week (start at 7:00 AM; use afternoons)
5. Convert instructional time to self-study time
6. Trim the depth of the basic science material
7.   Identify the basic science material least important for practice of medicine

 Discussion of Improvements in Curriculum at 1st Team meeting:

1. Limit number of contiguous lecture hours
2. Utilize student input to identify the most and least valuable material in the basic sciences
3. Start with certain diseases and then transition into the basic sciences and then refer back repeatedly to the diseases.
4. Could one coordinate histology and histopathology?
5. Could one combine the 1st and 2nd year organ systems approaches?
6. Should any basic sciences be moved into 3rd year to be taught during the Clerkships or during Basic Science for Careers?
7. Could clinical skills be taught in Gross Anatomy using cadavers?

 Feedback from Principles of Medicine Committee:

1. Considerable concerns about change in general
2. Impact on faculty time
3. Impact on the autonomy of courses and course directors
4. Resistance to the organ systems concept
5. Fear of impact on integrity of a discipline and continuity of presentation
6. Concern about cuts in the time for basic sciences
7. Resistance to integration with clinical material
8. Concern about amount of clinical/patient exposure in 1st  and 2nd years
9. Concerns about top down management of the curriculum

Dean Garson addressed some of the concerns of the Team.  He charged the team with finding evaluation data/information from other schools who initiated a systems based curriculum – those that still have it and those who have returned to a more traditional medical curriculum.  Dean Garson wants the best curriculum possible but is very open to ideas on what that might be.  When something makes intuitive sense it is retained longer.  The Dean wants the Curriculum Committee to make the best curriculum possible and make it sensible.  Present the information a student needs in a way that it can be retained beyond the USMLE tests.  The Dean affirmed that the development process is a joint process involving administration, faculty and students. Members of the Committee noted that there is very little published data on medical school curriculum but what is readily available is ambiguous.  The Dean suggested further research by the Committee.  The Committee also noted that everyone is probably never going to agree on what is best but a concensus must be reached taking into consideration cost versus value.  Student evaluation data should be a key element in the process.  Development of the best curriculum will develop the best professionals.

2.         SOM Information Management Design/Development Team.  The Team met for an organizational meeting 9/26/03 with Linda Watson, Brian Wispelwey, and Jason Lyman in attendance. The team endorsed the name of the team as the "Information Management and Critical Thinking” Design and Development Team (InfoTeam for short).  Brian Wispelwey and Jason Lyman agreed to be co-chairs with Linda Watson.  The following faculty will be asked to join the team:

Steve Heim (FamMed/Epi)
Mike Rein (Int Med)
Karen Grandage (Library)
Elizabeth Bradley (AIM)
Veronica Michaelson (Med Ed)
Steve Collins (HES/Med Student)
Seth Robinson (Resident)
Karen Johnston (Neurology Residency Program Director)

Meetings will be mostly by email; face to face when necessary; with broad solicitation of feedback from additional faculty and students as appropriate along the way.

The team’s task is  to plan integration of Information Management and Critical Thinking into a 4 year curriculum including methods for evaluating mastery of defined competencies with attention to the related competencies required in the residency programs and to faculty development.  Timeline: by August 2004.

Starting Points:

• build on what we are already doing in teaching these skills
• review the AAMC information management competencies (1998) and adapt as needed; correlate with related ACGME competencies
  
  
  NEXT STEPS:

1. Invite new members
2. Review AAMC competencies; provide feedback to Linda
3. do inventory of existing information management teaching activities (Jason to provide CDR teaching details to Linda for incorporation onto inventory chart).
4. solicit feedback at Curriculum Open House on Sept 30th (Karen Grandage will represent our team from noon-2:00)

 3.  Cells to Society.  Chris Peterson, Jerry Short, Marcia Childress, and Gene Corbett. 

Background: One of Dean Garson’s priorities for advancing the medical school curriculum. Focuses on and connects the patient to all other aspects of the Foundations of Medicine curriculum.

Goals:

• Inspire and motivate students to learn the Foundations of Medicine as the fundamental basis for the practice of scientific medicine.
• Demonstrate to first year medical students how the Foundations of Medicine relates patient care.
• Introduce and justify all the content areas of the Foundations of Medicine as pertinent to patient care and patient outcome.
• Introduce small group and self-directed learning.

Objectives:
After participating in this learning experience, each medical student will be able to:

• Explain to peers at least one significant feature of a disease [e.g. diabetes] in each of 16 areas.
• Explain to peers how the disease’s symptoms, risk factors, or physical findings relate to several “cellular” and “societal” features of the disease.

Cells to Society - Features of a Disease

Clinical

• typical symptoms
• risk factors
•   physical findings

“Cells”

• laboratory studies
• imaging studies
• cell and tissue structure
• biochemistry
• physiology
• genetics
• therapy

“Society”

• effect on patient’s daily activities
• effect on patient’s thoughts/feelings/beliefs/relationships
• effect of cultural context on E & M
• health education and/or health behavior change
• ethical issues
• effect on the source of payment (insurance/Medicaid/Medicare/
   other) for patient’s medical needs
• public health effects and health care policy implications

Activities (1):

• Pre-test (~30 items, multiple choice, anonymous, linked by code to post-test)
• Patient interview by faculty member with student participation and discussion

Activities (2): 

• Small groups (faculty +/or 4th year MS facilitator)
• Discuss case using PoM I categories
• Develop individual learning objectives
• Each student’s learning objectives must relate a symptom, a risk factor, or a physical finding to one “cell” area and one “society” area
• Each group must cover all 7 “cell” areas and all 6 “society” areas
• Learning objectives can address pre-test items

Activities (3): 

• Small groups (continued)
• Individual self-directed search for answers.
• Intra- and inter-group cooperation is encouraged. 
• Facilitators can provide suggestions for search but may not provide answers or specific sources.
• Group reconvenes to develop a report and places it on the course website.
• Group also develops additional questions for expert panel.
• All website reports are reviewed and the results in each area are summarized by course leaders in each area and posted on course website.

Activities (4): 

• Summary of student reports
• Expert panel
• Experts in all aspects of the disease under consideration
• field questions from students
• present particularly challenging issues that remain unanswered
• Post-test

Initial Time Assessments

            Introduction and pre-test: ?  hour

           Patient interview: 1-2 hours

           Small groups: 7-8 hours

               Includes

            Post-test:? hour

                             TOTAL ~ 12+ hours