University of Virginia School of  Medicine
Curriculum Committee
Minutes
11.10.05

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,  Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) 

1. Clerkship Grades.  Dr. Wilson was asked to remind the Clerkship Directors that course grades must be submitted within 5 weeks of the end of the clerkship period.  The importance of timely feedback to students on the clerkship experience is again emphasized.  An ongoing updated table of clerkship evaluation completions should be e-mailed to all the course directors regularly. For instance:
   
   Clerkship Grades 2005-2006
   

   	Period 1 (6/27/05 – 9/17/05) Due:  10/24/05		Period 2 (9/19/05 – 12/17/05)Due:  1/30/06
   	Date Received	Status	Date Received	Status
   Med		NA as of 11/10/05
   Fam Med	10/25/05	Complete
   Peds	10/14/05	Complete
   OB/GYN	10/28/05	Complete
   Psych		NA as of 11/10/05
   Surg		NA as of 11/10/05
   Neuro		NA as of 11/10/05

   
   

   	Period 3 (1/3/06 – 3/25/06) Due:  5/22/06		Period 4 (4/3/06-6/24/06) Due:  7/24/06
   	Date Received	Status	Date Received	Status
   Med
   Fam Med
   Peds
   OB/GYN
   Psych
   Surg
   Neuro

   
   On Time = Clerkship grades received within 5 weeks of end of clerkship period (except Period 2 – extra week for holidays; NBME not report within that time)
   
   Days Late = Number of days post the 5 week period
   
   
2. Electives/Selectives.  Meg Keeley, Director of the Electives/Selectives will begin a series of individual meetings with the directors of the Medicine, Psych, OB/GYN and the Surgery subspecialties.  They will discuss the 2 week length of the selective, frequency of their selectives – 2 week selectives/electives offered throughout the year, recruitment of students for their selectives, scheduling priorities for students identified with an interest in the subspecialty, the development of a short statement of goals and objectives – a stated curriculum, and evaluation procedures (P/F with narrative).   It was noted that almost all of the subspecialties previously participating in an early match are now participating in the ERAS regular match day.
   
   
3. MD.,Ph.D. Curriculum Issues. The Committee was asked to clarify aspects of the MD curriculum as it relates to MSTP – MD/PhD students. The specific questions are below.
   
   1)In spite of increased clerkship time for traditional med students, are MSTP students still only required to do 14 months of required clerkships?  Has this number increased (or decreased) with these changes?
   
   Requirements for the MD degree include 40 weeks of core clerkships (includes Neurology); 4 weeks of medicine selectives; 4 weeks of surgery selectives; 2 weeks of ob/gyn selectives and 2 weeks of psychiatry selectives; 4 weeks of the Advanced Clinical Elective (ACE).
   
   #The Advanced Clinical Elective (ACE) is required of students for the MD degree. See note below. The Committee believes that the high level of clinical thinking and patient care skills exercised in the ACE is a fundamental part of the education required for the MD degree.  The MD/PhD student has limited clinical experience as the PhD research experience is allowed to substitute for the elective requirement.
   
   2) Will we [MSTP students] be required to take "basic science for careers"?
   
   The answer to this will depend on the final format of the BS4C course. Dr. Perina is in charge of the development of this course. At this time it is anticipated that PhD students would not be required to take this program; however, the BS4C may offer valuable opportunities for MSTP students depending on the course composition. The Committee will reserve judgment about the BS4C program until the curriculum for this course has been further developed.
   
   3) Will we [MSTP students] be required to take the public policy class [Dx/Rx: US Health Care System course]?
   
   Again this brings up the issue of what is required for the MD degree. The Curriculum committee finds that knowledge of social, economic and political issues in medicine are critical to the education of a physician and concludes that the Dx and Rx: The US Health Care System is required of all students for an MD degree.
   
   
4. USMLE Step 3. UVA students taking the USMLE Step 3 exam for the first time passed  99-100% of the time for the years 1998-2001.
   
   
5. Impact of the New Curriculum on First Year Students.  Bob Bloodgood presented data from recent surveys of the first year medical students on the impact of the new curriculum.
   
   Four generalizations from the comments of the Class of 2009 were outlined:
   
   a)   Students are uniformly happy with pass-fail grading and fell that it reduces stress of medical school.
   
   b)   A number of students expressed concern about Cumulative Honors and suggested it eroded benefits of pass/fail.  None spoke in favor of cumulative honors.
   
   c)   A number of students complained about the intense pace of the first year curriculum and the effects on their learning and their personal life.
   
   d)   Several students spoke negative about the Exploratory in the first semester (relating it to the pressure of the fast pace of academic work and lack of free time for a life).
   
   Scores on the mid term examinations from CTS/Physiology and Anatomy were also compared.  Mean scores decreased slightly (different exams and amounts of material), but the number of students below the Pass rate remained consistent between years.
   
   The committee considered this early data seriously and will continue to closely monitor the academic and well being of the class.  Despite the relatively minor changes in the curriculum, the need for adjustments is not unexpected. Changes in the flow and pacing of material, relaxation and opening more opportunities in the service Exploratory, and more sessions with the first year class to explain and to listen, have started.
   
   The Committee stresses the importance for faculty to exercise care in commenting on the curriculum as faculty attitudes are powerful influences on the perception of students.
   
   
   # The Advanced Clinical Elective (ACE) is a required 4-week clinical experience involving the highest level of patient involvement allowed a medical student.  The purpose of the ACE is to better prepare the student for residency. The exercise of clinical thinking and patient care skills (e.g. diagnosis, prognosis, management) under direct supervision of attending physicians and senior residents is central to the ACE experience.  It is expected that a special professional relationship develop between the attending and the student, modeling the principles and commitments of the physician’s professional life.
   
   Advanced Clinical Electives are offered in medicine, surgery, obstetrics & gynecology, neurology, and pediatrics.  Each ACE is a clinical experience for senior students with primary emphasis placed on enhanced involvement with medical or surgical patients.
   
   Each student will work up and manage together with the residents and attending physicians the medical or surgical care of selected patients. The student is assigned patients in whose care they will participate with the responsible physician. The ACE may also entail the supervised follow-up of discharged patients.
   
   The goal of the ACE is enhancement of the student's training in clinical medicine by undertaking an important supportive role in the medical management of hospitalized patients under appropriate physician supervision and guidance. Students will be placed on the same call schedule as an intern and will participate with the upper level resident on assignment.  For example, this includes following the same night call, weekend call and weekend rounds as the intern.

Donald Innes
dmr