University of Virginia School of  Medicine
Curriculum Committee
Minutes
10.04.07

Pediatric Conference Room, 4:00 p.m.                       

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Brad Bradenham, Gene Corbett, Wendy Golden, Donald Innes (Chair),  Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) 

1. Working Group on Clinical Skills Education (WGCSE).  Gene Corbett, Chair of the WGCSE updated the Curriculum Committee on the Committee's progress.
   
   Committee Members:   

   1. Practice of Medicine I:  Seki Balogun and Walter Davis
   2. Practice of Medicine II : Brian Wispelway and Darci Lieb
   3. Clinical Medicine Committee : Evan Heald
   4. Electives & Selectives : Meg Keeley
   5. Professionalism : Nancy Payne
   6. Simulation : Marcus Martin, Keith Littlewood, Mark Kirk
   7. Instructional technology/computer support : Veronica Michaelsen
   8. Clinical Skills T&A program (SP program) : Anne Chapin
   9. Educational research & evaluation : Elizabeth Bradley
   10. Student representation, 4^th year : Andy Goodman, Matt Borloz, Ann Falor
   11. Basic science faculty representative ; Melanie McCollum
   12. Graduate medical education (GME) : Mary Bryant
   13. Chair : Gene Corbett
       

   
   In order to enhance the effectiveness of curricular activities focused upon the clinical skill development of medical students, the Curriculum Committee of the School of Medicine is establishing a Working Group. The purpose of the working group on clinical skills education (WGCSE) is to facilitate the achievement of an integrated four-year developmental clinical skills curriculum in the School of Medicine which ensures that each student meets a defined level of basic clinical performance proficiency prior to graduation. The membership of the Working Group is designed to bring together the leadership of the major curricular activities involved in students' skills education. With the establishment of the WGCSE, a number of "next step" tasks can be addressed:
   
   1. Link clinical skills teaching and assessment activities throughout the four years of the curriculum;
   2. Create a more standardized clinical skill development process that reflects the 12 objectives of undergraduate medical education;
   3. Expand formal clinical skills teaching throughout the clinical years, thereby addressing the learning of a wider variety of basic clinical skills;
   4. Expand opportunities for specific skills assessments and remediation;
   5. Enhance faculty and resident educational development with emphasis upon clinical skills teaching in small groups and in bedside rounding;
   6. Establish a database for tracking and evaluating clinical skills education outcomes.
   
   As with all curricular processes, this is a work in progress. It is likely that the content and priorities of this curricular effort will change as the process of making developmental clinical skills education more explicit continues to unfold.
   
   The Committee met first on Sept 4, 2007.         The group engaged in 90 minutes of active discussion on the matter of clinical skills education of medical students. The following set of issues summarizes this initial discussion and identifies many of the essential project activities of the Working Group.  
   
   I.  Identify and develop our curricular map for clinical skills education
   
   Identification of clinical skills education curricular activities that currently exist
   Creation of a set of skills in which all students should be proficient by the time of graduation
   A plan for skills teaching by curricular year (1 through 4)
   Enhancement of skill practice, repetition and reinforcement opportunities Creation of a linked skill development assessment plan ("assessment drives the curriculum")
   Define and implement skill performance standards for each year (e.g., RIME, Miller etc. developmental schemes)
   Develop "product criteria" (graduation standards)
   Outlier identification
   Design and implementation of skills remediation/improvement programs
   How can we best link the 4-year curricular experiences?
   
   II  Determine how we can best inculcate a "clerkship" preparation mentality into years  1&2 
   Among students? 
   Among faculty?
   
   III   Determine how we can better construct the 3rd & 4th year clinical experiences to enhance skill development and the achievement of standardized skill proficiency
   
   IV    Determine how we can best engender/re-establish the student role in the clinical environment (institutional, departmental & hospital accountability, demarginalization)
   
   V     Student issues: 
   
   Encourage self-directed learning (personal accountability) 
   Address the pass/fail problem
   Encourage attendance
   Minimize the influence of personal entitlement
   Create more optimal admissions criteria
   
   VI   Faculty and resident development: 
   Enhance commitment and accountability for students' clinical education 
   Improve the quality of instruction: observation, evaluation & feedback 
   Encourage specific focus upon clinical skills education 
   
   The WGCSE met again on 10/2/07 and will meet monthly on the first Tuesday of the Month
   
   The Committee plans to begin working with the list of clinical skills developed by the AAMC.    
         
   http://www.aamc.org/meded/clinicalskills/
   
   The list will be refined by the WGCSE to determine those skills where  proficiency by our medicals students will need to be taught and assessed. Dr. Corbett also provided some end of student clinical skill performance obtained by the group. 
   
   Table 2: Students Who Missed the Critical Action  
    

   Clinical Skill		Percentage of Students Who Scored Above the  Mean But Missed the Critical Action
   Maintain Confidentiality		59% (n=38/64)*
   Auscultate the Second Heart Sound		42% (n=8/19)
   Measure Blood Pressure		22% (n=13/60)
   Perform an ECG		93% (n=14/15)
   Phone Triage an Infant With Fever		45% (n=5/11)
   Detect an Arrhythmia		56% (n=14/25)
   Examine Child's Ears		38% (n=6/16)
   Maintain Aseptic Technique		97% (n=56/58)
   Interview Through an Interpreter		75% (n=18/24)
   Manage a Medical Error		52% (n=14/27)

   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   *n = number of students who scored above the mean but missed the critical action / number who scored above the group mean
   
   The Curriculum Committee asked that Eugene Corbett and the WGCSE stay in close communication with the clerkship/course directors regarding this project.  Members of the WGCSE will be invited to the April Joint Clerkship Committee meeting.  Marcus Martin noted that more packages are being developed for the Clinical Skills Simulator.  The Curriculum Committee also encourages the Group to think about ways to get the students more involved in the clinical part of their education.
   
   
2. Class Size and the Commission on the Future of the University.  The Curriculum Committee statement regarding medical school class size continues to evolve to one with a more positive and more global perspective.    Members in attendance offered suggestions for several areas of the letter. 
   
   [The issue of class size in isolation is not as meaningful as our size in relation to our resources (patient numbers and kinds, numbers of housestaff, size of faculty, etc.)...  the most important issue by far is "does our class size (in relation to our resources) permit us to have the best possible education for our  students?"  in this context, the issue of patient population is paramount because it is impossible to change over anything but a relatively long time period (more money from Richmond will NOT solve this problem!). Do we not serve the Commonwealth and Society best , by having the best UME of which we are capable?  I believe this is the 'bottom line'.]
   
   The letter will be recirculated to the Committee and members should e-mail dji@virginai.edu your comments/suggestions.

Donald Innes
dmr