University of Virginia School of Medicine
Curriculum Committee
Minutes – 01/17/13

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Stephen Borowitz, Megan Bray,  Donna Chen,  Peter Ham, Donald Innes (Chair), John Jackson, Keith Littlewood, Nancy McDaniel,  Bart Nathan, Amita Sudhir,  Linda Waggoner-Fountain, Casey White,  Bill Wilson,  Mary Kate Worden,  Yasmin Poukazemi,  Jean-Baptiste Maitre,  Debra Reed (secretary)

1. Geriatric Clerkship Review.   
   
   Reviewers: Stephen Borowitz and Donna Chen met with Huai Cheng, clerkship director; this review is based on our conversation with him and the report he submitted.
   
   Positive and Unique aspects of the Geriatrics Clerkship (currently 2 weeks in 3^rd year)
    

   ·	Caliber and dedication to teaching on behalf of faculty.  Teaching is primarily from faculty in several outpatient settings and in a number of workshops; Geriatric Fellows also provide some teaching.
   ·	Learning objectives and activities are guided by national recommendations (developed by IOM and national experts)
   ·	Clerkship provides didactic teaching as well as quite a bit of one-on-one time with attending physicians.
   ·	The clerkship is one of the newer ones and has made significant changes each year in response to suggestions from students and the Curriculum Committee.
   ·	The Clerkship Director has taken a scholarly approach to the clerkship – UVa one of only a few SOM nationally that has a required Geriatric clerkship.  Dr. Cheng is planning to try and publish our clerkship curriculum and experience.

    
   Challenges and ongoing opportunities
   
   

   ·	Geriatric clerkship is moving to the “4th year” rather than being a 3rd year experience for students.  Thus, clinical knowledge and skills of students will be more advanced and will require adjustments in the clerkship.
   ·	There is concern about the gap year – there are salary concerns as well as concerns about how to maintain faculty interest/commitment during this year, particularly if they are required to assume other responsibilities during this coming year.
   ·	The number of faculty involved in this clerkship is small and there are openings in the Division; recruitment for faculty is on-going and active.
   ·	The current exam is created internally, but the Clerkship Director is looking for a more nationally representative exam.
   ·	Mid clerkship evaluation is difficult with only a 2-week experience.
   ·	There is a lack of geriatric experiences for students during CPD 1 and 2.

   
   Ideas and strategies to address the challenges faced
    

   ·	Possibilities for more advanced activities in the Clerkship could include doing “virtual consults” on active inpatients during which the student identifies and tries to address issues specific to Geriatrics (e.g. identify potential patients in Epic, then review the record, and formulate an assessment and plan regarding specific geriatric issues the identify)
   ·	The Clerkship Director is highly motivated to use the gap year for scholarly activities (e.g., publishing in relation to clerkship).
   ·	The Clerkship Director will brainstorm with CPD leadership about ways to integrate nationally recognized Geriatric learning objectives into some of the CPD-1 cases and activities for CPD 1 and 2 (as other content threads have done).

   
   Other Recommendations for the Future
    

   ·	The Clerkship Director would greatly appreciate ideas related to faculty during in the gap year and the return of students the following year.
   ·	Perhaps faculty could consider devoting some of the time freed up during the gap year to achieve some scholarly activities related to the Clerkship.

   
   Recommendations:
   
   

   ·	Develop a program using “virtual consults” on active inpatients during which the student identifies and tries to address issues specific to Geriatrics (e.g. identify potential patients in Epic, then review the record, and formulate an assessment and plan regarding specific geriatric issues the identify).
   ·	Increase the number of students on the rotation at any one time and have some months when there are no fourth year students - such as after match day (~March 15). The clerkship would have beginning fourth years from the next class but no students about to graduate.  Currently there are 6.5 students per rotation (156/24=6.5). If there were no Geriatric electives after winter break for the graduating class there would be 18 two-week Geriatric rotations with ~9 students per rotation (156/18=8.7). January - mid-March could be used for returning MSTP students, make-up work, and electives; would provide some recovery time for your hard working faculty.
   ·	A “successful aging” interview. You should work with Nassima Ait-Daoud Tiouririne who leads the Human Behavior section of the Mind Brain and Behavior system. We plan to bring some of this developmental-behavioral material to the fall of the first year as students are beginning to learn to interview patients of all ages - adolescents, young adults, middle age and older patients. It would be good if you and Nassima could talk to see if there is a role for a geriatric interview at this stage. You will need to work with the CPD-1 folks - Jen Marks and James Moak to increase student exposure to geriatrics earlier in their medical school career.
   ·	Work with Michelle Yoon to improve the learning objectives, resources; formative and summative assessments for the Geriatric clerkship.
   ·	Work with Keith Littlewood to evaluate the feasibility of coordinating a virtual patient model with the SIM Center.  Due to the one-year hiatus for the clerkship, this is prime time to develop these modules.

   
   
   
2. Surgery Clerkship Review
   
   Reviewers  Bart Nathan  and Mary Kate Worden
   Clerkship Coordinator: Sylvie Moore
   
   Sources of Information 
   

   ·	Interview with Gene McGahren & Anneke Schroen (with Sylvie Moore) on Nov 13th
   ·	Surgery CPD 2012 Review document

   
   
   
   
   Background
   

   ·	Dr. McGahren is the Clerkship Director.
   ·	Assistant Director is Anneke Schroen.
   ·	The current rotation is 8 weeks long and students are located in a wide variety of locations and surgical specialties.

   
   
   
   
    

   o	The first 2 days are spent in didactic sessions 7:00 am-5:00 pm each day.  There is a one hour orientation on Monday, just prior to the start of the didactic sessions.
   o	Day 3 is spent in Life Savings Techniques Workshop, held in SIM Center, supervised by Dr. John Riordan.
   o	Students then begin on their surgical services on the Thursday of Week 1 and spend 3 1/2 weeks on each of two services:  one general/one subspecialty OR two general services.  Students are able to choose their subspecialty assignments, general services are assigned randomly.  However, students have the option of an additional 4 weeks of general surgery, if space allows, instead of a subspecialty.  About 35-40% of students request an extra general surgery rotation.
   o	Final week of the clerkship:  surgical service duties end Tuesday, Wednesday and Thursday are study days, shelf exam is on Friday.
   o	Additionally, students assigned to UVA for the full 8 weeks of the clerkship have 3 overnight call assignments.  Students in Roanoke/Salem take call with their teams at those sites and then have one additional assigned night of call experience at UVA
   o	Additionally, students assigned to UVA for the full 8 weeks of the clerkship have 3 overnight call assignments.  Students in Roanoke/Salem take call with their teams at those sites and then have one additional assigned night of call experience at UVA
   o	This coming year the clerkship will change to a 6 week block.

   
   Positive and Unique aspects of Clerkship
   

   ·	Students have a wide variety of surgical experiences and students are exposed to a wide variety of diseases and procedures.
   ·	Students learn techniques such as suturing and gloving and gowning in orientation workshop
   ·	Faculty and residents have earned many teaching awards. There is a culture of teaching in the various surgical departments
   ·	Shelf exam score have increased since consolidation of didactic sessions
   ·	Life Saving Workshop
   ·	Strong emphasis on working in a team
   ·	Significant improvement in learning objectives with the help of the Med Ed. Office

   
   
   
   
   
   
   
   
   
      
   Perceived  negatives of Clerkship 

   ·	Inconsistency of access to procedures throughout the rotation for the students. Some students have a lot of exposure and opportunity, some almost none.
   ·	Evaluations tend to become all similar without significant distinction for the students.
   ·	Difficulty getting broad exposure as most surgery rotations (even “general”) as becoming more specialized
   ·	Students must travel to Salem and Roanoke for those rotations
   ·	Student documentation in the chart difficult to evaluate

   
   
   
   
   
   
   
   
   
   
   Ideas for improvement
   

   ·	More time in SIM center to learn and practice surgical skills
   ·	More opportunities in OR to do minor procedures (iv’s, Foley, NGT)
   ·	Improved access to EPIC for documentation experience
   ·	“Partner Plan”-viewing other surgical services on a temporary basis to see procedures. Already instituted.

   
   
   
   
   
   
   
   Requirements for improving the Clerkship
   
   

   ·	Policy on student documentation in EPIC
   ·	No further reduction in number of surgical weeks [Agree.]

   
   
   
   
   Recommendations: 

   ·	Develop a consistent written (H&P) note policy. This should be a complete written note structured with a synthesis of information, differential diagnosis and action plan, e.g. SOAP note. Note review and timely feedback to the student is essential.
   ·	Work with Michelle Yoon to improve the learning objectives, resources; formative and summative assessments for the Surgery clerkship.
   ·	Develop online materials, quizzes to ensure that core clinical skills and topics are covered and strengthened.
   ·	All Surgery clerkship sites must have the same learning objectives and these learning objectives are to be closely monitored by the central (primary) UVA clerkship directors.
   ·	Develop consistency in the learning of procedural skills across all surgery clerkship sites.

   
   
   
   
   
   
   
   
   
   
   
   -- Consider a “night float” requirement to increase exposure of students to more procedural skills; exercises in the SIM center.
   
   Stephen Borowitz noted that a “UVA student note” format is being developed for Epic and will be communicated to the students during the transition course.  The Committee asks that the teaching faculty also be apprised of this standard format and need for feedback at the same time.  Steve Borowitz will be asked to speak at the Joint Clerkship meeting on 2/20/13 to talk to the clerkship directors about this.
   
   The Committee reminds all clerkship directors that all sites must have the same learning objectives and these learning objectives are to be be closely monitored by the central (primary) UVA clerkship directors. ED-8 includes the statement “Compliance with this standard requires that educational experiences given at alternative sites be designed to achieve the same educational objectives. Course duration or clerkship length must be identical, unless a compelling reason exists for varying the length of the experience. The instruments and criteria used for student evaluation, as well as policies for the determination of grades, should be the same at all alternative sites.”
   
   The Committee suggested a panel discussion in the transition course to instruct students how to actively participate in clerkships.
   
   
3. Announcements:  The Curriculum Committee will meet on 1/31/13 to review the last two clerkships and respond to some immediate curriculum concerns.  Selectives and Electives will be discussed at this meting.  Members were asked to review the 1/10/12 Curriculum Committee Executive Management Group minutes for information regarding the electives/selectives and be prepared to discuss at the next Curriculum meeting.

Donald J. Innes
dmr