CC Minutes 05.01.14

CC Minutes 05.01.14

University of Virginia School of Medicine
Curriculum Committee
Minutes – 05/01/14

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Stephen Borowitz, Elizabeth Bradley, Megan Bray, Donna Chen,  Peter Ham, Donald Innes (Chair),  Sean Jackson,  Keith Littlewood, Nancy McDaniel, Mark Moody,   Bart Nathan,  Sabrina NunezTheresa Schlager, Neeral Shah, Amita Sudhir,  Linda Waggoner-Fountain, Bill Wilson,  Mary Kate Worden,  Lee Eschenroeder,  Jon Pomeraniec, Guest: Brandon Hunter, Debra Reed,  (secretary)

  1.  Announcements:

    The Curriculum Committee welcomed the newest member of the group,  Mark Moody, Director of Educational Technology.


  2. USMLE Step 2 Clinical Skills (CS) interim summary released for the class of 2014.  This report provides information on examinees who took the exam from July => March 21,2014.
    Results are posted on the web at:

    http://www.med-ed.virginia.edu/handbook/pdf/usmle2cs-14.pdf


    For May grads-to-be in 2014 (143):   3 took CS in 2012 (dual degree MBA/MPH); 63 took CS early (not included in interim summery) 3/18/2013 - 6/30/2013; 2 in class of 2015 took CS in early March and were included in interim report.


    The Committee noted that the range of all scores was quite large and that the UVA ranges were well within the national ranges.  It was noted that UVA students who fail to pass the exam on their first attempt have successfully completed the exam on their second attempt.  The Committee believes over-confidence without demonstrating the steps to the diagnosis may be a contributing factor in the failures on the first attempt.

  3. Shelf Exam Policy.  Recent change in the shelf exam policy for SMD16 for the clerkships was discussed.  SMEC representative, Brandon Hunter, asked whether the policy could be made retroactive for the SMD15 class.  Policy changes may not be made retroactive as per University policy.   This change was approved March 3, 2014, applicable for the clerkship year 2104-2015.

    Assessment Policies for both classes can be found at:


    http://www.med-ed.virginia.edu/handbook/policy/examPolicy.cfm
     

    Policies will be reviewed for the Clerkship Directors at the next Clerkship/PostClerkship meeting.

  4.  Summary of Results of SMD13 Intern Survey.  Elizabeth Bradley presented the summary and noted that the findings were very similar to those obtained last year.  Both resident program directors and UVA graduates were polled.   The major difference from last year to this year is that instead of asking the interns to rate their abilities on the ACGME competencies, they were asked to rate their abilities overall in comparison to their peer interns.   The response rate was 60% for graduate and 69% from program directors.   Paired ratings of the Residency Directors and the interns in the same residency programs (n=59) are below:


     

    SMD 2013 (n)

    Residency director rating higher

    16

    Intern rating higher

    17

    Both rating the same

    26

    Total

    59

    Mean rating for both groups

    3.6


    Three themes emerged from the interns’ responses to the survey question – “How could the UVA SOM prepared you better for residency?”
    1) Provide more opportunities to practice procedures such as blood draws, IVA placement, ABGs, etc.

    (Note from CC members - this is a common complaint for interns at most US medical schools – due to Hospital regulations it is difficult to address.  Use of the Simulation Center is very helpful and could be expanded but does not completely prepare a student for most procedures)

    2) Allow students to take on more responsibility typical of an intern, from entering orders, to making medical decisions, to placing IVs, to taking call, to being on nights. 

    (Note from CC members – the recent work of Steve Borowitz and the EPIC group has improved the ability for students to write notes in the patient chart – some clerkships take advantage of this feature of EPIC but others have not.  Linda Waggoner-Fountain, CPD-2 Director, will work with all clerkships to have students use EPIC in this manner.

    3) Students suggested having a required intern rotation late in the fourth year, having a longitudinal checklist of procedures to achieve unassisted upon graduation and providing more exposure to and experience with the routine aspects of being a resident.

    The Committee reviewed selected student comments and noted that the last one listed was well expressed.

    “Though I was initially nervous about how well prepared I might be for residency, I found that I was much more prepared than I thought and had a leg up on more than a few of my fellow residents.  So many interns from other medical schools do not get the same level of exposure to so many different fields as we do, and I found that to be helpful when taking care of various issues that might arise with any patient.  I wouldn’t change my education at UVA at all and am still glad today that I chose it for my medical education.”


  5. Pathoma.  Robin LeGallo, Pathology Thread Leader, has reviewed Pathoma, an online resource used by students in their study of Pathology.   She reports that she has have viewed most of the content and thinks it should be a recommended as an additional resource but not the primary pathology reference nor required content.  She noted that it is a very well done instructional resource but has no primary references, little histology or gross imagery.  It does an excellent job walking through pathogenesis in a manner similar to Khan academy but there is no information that is not included in Robbins.  Robbins is the primary pathology textbook that will serve the students throughout their careers and ideally should be revisited over and over.  Replacing it with an online source as primary content outside what we are delivering will not serve them well in the long run. The Curriculum Committee endorses the use of Pathoma as a study guide but not as the primary resource for Pathology material.


  6. Clerkship Course Grade and Shelf Exam Scores Across the Clerkship Sites.  James R. Martindale, Ph.D., Office of Medical Education, Director of Test Development, reports that no statistically significant mean differences in course grade or shelf exam score exist across clerkship sites for any of the clerkships with one exception in the course grade.  This is in the Ob/Gyn clerkship where a statistically significant mean difference in course grade only between the two sites (Richmond and UVa) appears.  The mean difference is quite small, only 1.35 points. In terms of practical effect size this is considered small (as measured by Cohen’s d = .39).  The number of students evaluated differs greatly between the two sites (24 vs 123) and this may account for the slight discrepancy.  Additionally, no statistically significant mean differences in either course grade or shelf exam score exist for the surgery or medicine clerkships when looking at which team students were assigned.



  7.  2014 and 2015 Clerkship Grade comparisons.  The large number of A’s given in Family Medicine has been noted and led the Curriculum Committee approving Family Medicine as a P/F course in 2014.


    2014 Clerkship Grades
    2015Clerkship Grades

  8. MSPE’s.  All clerkships are required to create a summary for the students’ MSPE in Oasis. Some clerkships have been simply saying  “see all comments” in Oasis, however, this practice must be discontinued. The purpose of the summary is for the clerkship director to synthesize the comments into a coherent message.   Linda Waggoner-Fountain will make this an agenda item for the next Clerkship/Postclerkship meeting.  The UVA School of Medicine MSPE’s clerkship director comments are edited by the College Deans and that is noted in the application packets.

  9. Neurology and Pediatrics Comparison of Final Grades VS Shelf Exam Scores  Comparisons of Pediatric Clerkship final grades versus the Shelf Exam Scores showed minimal correlation – Correlation Coefficient 0.44.   Comparisons of Pediatric Clerkship final grades versus the Shelf Exam Scores showed minimal correlation - Correlation Coefficient 0.22.

    Neurology VS Shelf Exam 2013 14


    Pediatric Shelf vs Final Grades 2013 14


    The committee discussed curving the final grades in the clerkships.  Linda Waggoner-Fountain will bring this topic to the Clerkship/PostClerkship meeting and develop a more consistent policy that all clerkships should follow in regard to grades.  The grading policies must be clearly delineated for students in every clerkships.

  10. Clerkship Shelf Exam Failures.    Don Innes reported the students who fail one clerkship shelf exam often fail shelf exams in other clerkships and almost always do pass the exam on the second attempt. 

     

  11. Clerkship Learning Objectives.  Don Innes noted that the OBGYN Clerkship Learning Objectives should be the model for the rest of the clerkships.  The OBGYN LO’s are linked to the competencies (linked to the revised ACGME 8).   The numbering system for the OBGYN LO’s adheres to the requirements for entry into XCREDIT.  These LOs should be the model for all other clerkships.  Linda Waggoner-Fountain will address this as well at a subsequent Clerkship/Postclerkship meeting.

     

    Donald J. Innes, Jr., M.D.
    Debra Reed