Minutes 100208

Minutes 100208

University of Virginia School of  Medicine
Curriculum Committee
Minutes 10.02.08

Pediatric Conference Room, 4:00 p.m.                       

Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Guest: Darci LiebSteven Heim, Greg Hayden, Debra Reed (secretary)

  1. HRSA Grant: Enhancing the Culturally Competent Care of Vulnerable Populations -  Global Health in Your Own Back Yard. Steven Heim, Gregory Hayden and Eugene Corbett met with the Curriculum Committee to discuss the project's goals and objectives, how the project will help to address LCME findings, potential synergies between this project and current curriculum plans and to ask for feedback from the Committee. 

    This HRSA Predoctoral Training Grant is a 3-year proposal (Year 1 currently funded) with a collaborative effort between Department of Family Medicine, Division of General Medicine, Geriatrics, and Palliative Medicine and the Division of General Pediatrics. Steven Heim, Gene Corbett, Greg Hayden, Preston Reynolds, Lisa Rollins, and Elizabeth Bradley are the steering committee members.

    The purpose of the grant is to create a longitudinal predoctoral curriculum, enhancing knowledge, skills, and attitudes; helping to provide culturally competent care, with a focus on vulnerable populations such as immigrants and refugees, the elderly, patients with HIV/AIDS and vulnerable children.

    The grant seeks to develop new and enhance existing classroom and experiential curricula, develop new and integrate current clinical opportunities, expand opportunities in the MSSRP, and provide faculty development to improve knowledge and skills both in providing and teaching.

    Dr. Heim noted that socio-cultural differences influence communication, clinical decision-making, patient satisfaction, patient adherence to treatment and overall quality of care.  

    Dr. Heim presented various definitions of cultural competency including the LCME Standards ED21, 22 and 26.

    "Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients' social, cultural, and linguistic needs"(Betancourt et al., 2002)

    "Cross-cultural education can be divided into three conceptual approaches focusing on attitudes (cultural sensitivity/ awareness approach), knowledge (multicultural/ categorical approach), and skills (cross-cultural approach), and has been taught using a variety of interactive and experiential methodologies" Institute of Medicine. Washington, DC: The National Academies Press; 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

    The Cultural Competency Advisory Committee led by Fern Hauck defined Cultural Competency as: Functioning effectively as an individual or organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities. This includes demonstrating sensitivity and responsiveness to patients' and colleagues' gender, age, culture, religion, disability, physical appearance, ethnicity, gender identification, and/or sexual orientation.

    Specific activities of the grant:

    Project Goal #1: Develop new and enhance existing classroom and experiential curricula that prepare students to provide culturally competent care to vulnerable populations.

    a) Link explicitly the cultural competence objectives taught in the four-year curriculum to the recommended AAMC objectives.
    b) Review and enhance course specific learning content regarding cultural competency in the first-year POM I course.
    c) Expand the existing Social Issues in Medicine (SIM) course in year one and two.
    d) Develop and implement a new workshop in the Family Medicine Clerkship
    e) Develop and implement new workshops in the Ambulatory Internal Medicine Clerkship
    f) Develop and implement new workshops in the Pediatrics Clerkship
    g) Expansion of student evaluation and assessment activities specific to cultural competence in the third-year.
    h) Provide five new fourth-year experiential electives

    Project Goal #2: Develop clinical opportunities that prepare students to provide culturally competent care to vulnerable populations.
    a) Expand the Summer Preceptorship for students that have finished their first year of preclinical course work
    b) Place third-year students with an interest in caring for vulnerable populations in community-based practices that serve such patients
    c) Expand clinical elective offerings focusing on the care of vulnerable populations in the fourth year

    Project Goal #3: Provide rising second year students seven-week summer research opportunities with faculty who work with vulnerable populations in Family Medicine, General Internal Medicine, and Pediatrics.

    a) Provide additional Medical Summer Research Project (MSSRP) slots within Family Medicine, General Internal Medicine and General Pediatrics with projects focused on the respective vulnerable populations.
    b) Facilitate lunch-time meetings for participating summer students to discuss their projects with each other, and with faculty facilitators
    c) Coordinate student presentations at end of the summer to describe their work, with participation of faculty and residents from each participating Department/Division

    Project Goal #4: Provide faculty development to improve faculty members' own knowledge and skills in providing culturally competent care to vulnerable populations and their teaching of these concepts and skills to students under their supervision. 

    a) Survey faculty to determine level of cultural awareness/sensitivity
    b) Provide faculty development sessions to the three participating departments on specific topics related to teaching students how to provide culturally competent care to vulnerable populations

    Steve Heim asked the Committee for additional suggestions of ways to enhance Cultural Competency education.  He also noted that the purpose this grant is not designed to interfere with Course Directors' control over their curriculums but rather to encourage course directors to look for ways to incorporate cultural competency education whenever possible.

    Faculty development will also be an important part of the grant's goals.  Students note that often they feel more culturally competent than the professors who teach them.

    "Ethics" Rounds in the medicine clerkship with Walt Davis often deals with cultural issues.   Family Medicine is already working on a similar type of rounds and other clerkships will be encouraged to do likewise.

    The standardized patient program will also seek to include a cultural competency component in some of their cases.  The steering committee is working to add a cultural competency component to other current activities such as PoM1 and 2 tutorials. 

  2. Curriculum, Principles of Medicine and Clinical Medicine Committee retreat on September 20, 2008.    The Collaboration site for the SOM Curriculum Renewal is up and running at:

    https://collab.itc.virginia.edu/portal

    The site has resources from the September 20th retreat including powerpoints, relevant journal links, and group reports.  

    The committee was asked to review the material on the Collaboration site and be prepared to discuss at the next Curriculum Committee meeting.  

    It was noted by Bob Bloodgood that while the groups at the meeting did draft these proposals in response to a specific request, they might not be heartily endorsed by the Principles of Medicine and Clinical Medicine Committees.

    Timetable:
    September 2008 - Present Working Parameters; Curriculum Workshops
    October - January 2009 - Curriculum Design Workshops (final)
    June 2009 - Final Organizational Plan for Curriculum
    September 2009 - Form organizational units
    November 2009 - Complete unit curriculum detailed learning plans for Foundations & Systems
    January 2010 - Critique & Correction of learning plans for Foundations & Systems
    March 2010 - Complete unit learning materials, e.g. selected readings, handouts, laboratory arrangements, and curriculum support needs, e.g. classrooms
    August 2010 - phased beginning of Next Generation curriculum for Class of 2014

    Rationale for a Fully Integrated Curriculum: The design of the UVA curriculum should attract, motivate and guide outstanding people by nurturing the dreams of those embarking on a career in medicine, engage the creative abilities of people to generate new knowledge and improve the quality of life, and foster excellence in medical education by blending compassion, technical ability and thirst for knowledge. 

    Modern education practice has demonstrated the value of active and experiential learning, e.g. problem-based learning, simulation, case studies, small group earning, assessment as learning, and service learning. Such learner-centered education has been successfully applied in many medical schools. We must take advantage of this new knowledge and capability.

    The learning of medicine should occur within a clinical context or framework to energize students and improve retention of knowledge, skills, and attitudes. It should be competency based with early and regular clinical experiences. A new learning space and Clinical Performance Education Center will allow for more simulation and practice. Learning then becomes more efficient and meaningful.

    The new USMLE assessment tools for measuring a "physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care." Emphasis is placed on "the importance of the scientific foundations of medicine in all components of the assessment process. The assessment of these foundations should occur within a clinical context or framework, to the greatest extent possible." Assessment should "explore means of enhancing the assessment of clinical skills important to medical practice" and to focus "on the doctor's ability to access relevant information, evaluate its quality, and apply it to solving clinical problems."

    It was noted that active learning and traditional learning are not mutually exclusive learning styles and that both are necessary for a well-balanced curriculum. Finally, in our current curriculum the components are lodged so tightly in place that attempts to adjust even one piece are often blocked by the lack of plasticity. Moving to an integrated curriculum requires rethinking all aspects of the curriculum.

Donald Innes