Minutes 01.03.13

Minutes 01.03.13

University of Virginia School of Medicine
Curriculum Committee
Minutes – 01/03/13

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 WhiteBill WilsonMary Kate WordenBrandon HunterDebra Reed (secretary)

Two clerkship reviews from 2011-2012 were conducted – Pediatrics and Obstetrics & Gynecology

2011-12 Clerkship Reviews

1. 2012 Pediatric Clerkship Review (Reviewers: Amita Sudhir, Gretchen Arnold): 

Clerkship Director:  William G. Wilson MD,

Reviewers met with Dr. Wilson, clerkship director; this review is based on our conversation with him and the report he submitted.

Positive and Unique aspects of the Pediatric Clerkship

  • Caliber and dedication to teaching on behalf of faculty and residents.  Many faculty and residents have received teaching awards within the School and University-wide. 
  • Currently, UVA medical students perform 3 points higher on the SHELF exams than the national average
  • Pediatrics continues to be a popular specialty choice for graduating UVA medical students.
  • CLIPP cases for key pediatric presentations give students an opportunity to work through these cases outside the clinical setting.
  • Strong leadership by the clerkship director to provide the finest pediatric clinical education possible.

Challenges and ongoing opportunities

  • Future reduction of 25% of time students will spend in the Pediatrics clerkship.  This will not be augmented by selective time as [had been done in the past] with some other clerkships. 
  • Lack of pediatric experiences for students in CPD 1 and 2.
  • Lack of sufficient number of non-University outpatient clinics that do not require significant commute for students.
  • Pediatrics is a complicated clerkship as it is a “microcosm of the whole third year” from newborns to in-patient and out-patient experiences.
  • Need to  include mid clerkship evaluation and evaluation of cognitive achievements

Recommendations:

  • 1 week of inpatient time will be augmented by a “night float” inpatient experience.  Students will do 3 weeks out inpatient pediatrics, 1 week in the newborn nursery, 1 week on outpatient peds, and a third week where mornings are in the outpatient setting and afternoons in the nursery. In addition, more didactic content will be offered. 
  • Some workshops may be eliminated (adolescent and pediatric puzzlers; however, phone triage and otitis media workshops will be retained) to allow for more clinical time.
  • Clerkship learning objectives are being revised to reflect the objectives developed by the national organization of Pediatric clerkship directors [with the help of Michelle Yoon]. 
  • CPD-1 content is being revised to include more pediatric education. [Seven pediatric cases will be used beginning 2013.]
  • Students have access to virtual pediatric cases (CLIPP).  Free half days for students to work on CLIPP cases will be eliminated to allow for more clinical time.
  • Elimination of the Roanoke pediatric clerkship has been addressed by the development of the Bon Secours pediatric clerkship program. 
  • Individual email will be sent to each student letting them know if they are making satisfactory progress or if there are any issues at the midpoint of the clerkship.
  • Students will do an online formative test that gauges progress but does not grade.
  • Recommended reading lists will be updated to include more recent publications.
  • Retain the system in which students receive feedback through open evaluations (i.e. evaluations are available for students to see as soon as they are completed).
  • Work with the OSCE Group to develop a Pediatric OSCE.
  • Consider moving the Otitis Media and the Telephone Skills workshop to the Transition Course.
  • Work with CPD-1 to develop and improve learning objectives regarding pediatrics.

 

A progress report with detailed plans addressing each of the above recommendations is due to the Curriculum Committee by February 13, 2013.

Amita Sudhir outlined the reviewer comments from the Pediatric Clerkship review.    The reviewers noted strong, longstanding and devoted leadership of the clerkship by Bill Wilson providing the finest clinical education possible.   The future reduction of 25% of the time is being addressed.  Some of the workshops and didactic content now in the Pediatric clerkship will either be discontinued or relocated either to the transition course, online offerings, intersessions, or CPD1.  A midclerkship evaluation is being developed in cooperation with Michelle Yoon and a fourth year teaching elective student.  Learning objectives are being revised to reflect the objectives developed by the national organization of Pediatric clerkship directors.   Learning objectives and midclerkship evaluation should be ready for the incoming 2013 class.   Linking learning objectives to specific resource material is challenging because no one learning resource covers all items.  There are multiple online resources available to the pediatric clerkship students. Inpatient time will be augmented by a “night float” inpatient experience.  Students will do three weeks of inpatient pediatrics, one week in the newborn nursery, one week on outpatient peds, and a third week where mornings are in labor and delivery and afternoons in the nursery.  Free half days for students to work on CLIPP cases will be eliminated.    Lack of Pediatric experience in CPD 1 was noted.  Bill Wilson was asked to work with CPD leaders to develop cases for CPD1 with pediatric content.  Two workshops in particular, the otitis media and telephone triage sessions, ideally should be moved to the transition course as they are relevant to multiple clerkships.   It may be too late to incorporate these two workshops into this year’s transition course but Nancy McDaniel will look into it. Feedback is provided to students from the evaluations in pediatrics and will be expanded to include the midclerkship exam.  CLIPP cases provide immediate feedback to the students.  The recommended reading list while a bit dated is reviewed every year by faculty and will be updated as necessary.   Casey White will meet with Bill Wilson to discuss development of a Pediatric OSCE.


2.  OB/GYN Clerkship Review (Reviewers:  John Jackson, Bill Wilson). 

Clerkship Directors:  Megan Bray, Yvonne Newberry

Reviewers met with Dr. Bray, clerkship director, and Ms. Newberry; this review is based on our conversation with them and their report.

Positive and Unique aspects of the ObGyn Clerkship

  • Caliber and dedication to teaching on behalf of faculty and residents. 
  • Use of a national curriculum (which has learning objectives and questions) to help guide the content of the curriculum [Association of Professors of Gynecology and Obstetrics (APGO)]
  • Varied clinical experiences for medical students, ranging from obstetrics to gyn clinic to surgical services.
  • Excellent “pocket-sized” handbook that has been developed for the clerkship
  • Well-organized clerkship, that is almost “self-contained”
  • Mid-clerkship feedback sessions from the clerkship director
  • [Strong leadership by Dr. Bray and Ms. Newberry]

Challenges and ongoing opportunities

  • “Capacity” is an ongoing issue with this clerkship, particularly related to the obstetrical services, number of students, and patient volume
  • “Capacity” will continue to be a problem with the upcoming increase in clerkship duration from 4 weeks to 6 weeks; this will increase the number of students on the overall rotation by 50%
  • Carilion is no longer taking UVA med students on the OB-GYN service; a new site at Bon Secours-St. Mary’s in Richmond has been in place for over a year, but additional sites or alternative sites would be ideal
  • There has been some turnover in the overall departmental faculty. Although there is ongoing recruiting, the overall faculty numbers are down slightly.
  • Students are not currently able to chart in the electronic medical record at Bon Secours-St. Mary’s Hospital.
  • The Obstetrics and Gynecology department’s residents as teachers program has not been maintained.

 

Recommendations:

  • A modified schedule to adjust for the increase in clerkship duration and the number of students.  The two weeks of Ob/Gyn selective has been eliminated. [The new schedule will include one week of benign and one week of neoplastic GYN, and ½ days at the Northridge GYN clinic.]
  • Additional sites for student placement are desired. Administrative inquiries are being explored.
  • Work with Bon Secours to expand to four students per rotation.
  • Address with Bon Secours methodology in Epic allowing student notes to be part of the patient record and can have faculty/resident feedback attached but in which student notes are not used in patient care.   This should allow students to enter notes in the electronic medical record at Bon Secours-St. Mary’s Hospital.
  • The ObGyn clerkship supports the development of a centralized resident teaching program [but the department of Obstetrics and Gynecology must do it’s part to train and monitor with feedback, residents and fellows in their roles in teaching and assessment in the Ob/Gyn clerkship (See LCME ED-24 Require and record attendance at an annual retreat focused on teaching for PGY1s; required weekend course on the role of the resident in teaching for PGY3s.  The following is a note from Dr.  Chris Chisholm to  Dr. Rollins: 
    "If you are asking how we teach our residents to be effective teachers, we do a session on teaching skills during PGY1 orientation, and provide them with a copy of the Whitman "Residents as Teachers" text. At department expense, each PGY3 resident attends the weekend-long CREOG Resident Workshop, the theme of which is "preparing residents to be teachers and leaders." Our residents all attend the monthly GME Institutional Curriculum which includes periodic sessions on teaching skills, providing feedback, etc." [Added 1/9/13 as correction to minutes.]


A progress report with detailed plans addressing each of the above recommendations is due to the Curriculum Committee by February 13, 2013.

 

It was noted that the clerkship has very strong and competent leadership in Megan Bray and Yvonne Newberry.   Plans for the expanded clerkship (6 weeks in 2013/14) were communicated to Don Innes who reported to the Curriculum Committee.   Students will rotate through the weekends allowing a less saturated weekday experience and more effective use of weekends.  Students will experience one week of benign and one week of neoplastic GYN, students will be spending ½ days at the Northridge GYN clinic. Bon Secours may be expanding to four students per rotation (3 at present). Exploring other outside sites for this clerkship (e.g. Fairfax) is being discussed.    Clerkship leaders plan to increase use of the Simulation Center and include topics such as suturing and ethics.  

Lisa Rollins is working on developing GME “resident as teacher” programs and will be supported by the School of Medicine.  The Curriculum Committee requests that each clerkship address resident as teacher training for their specific department as it relates to the clerkship.  At present OBGYN does not have a program for their residents.

 

3.   Future Curriculum Committee agenda

  • Meg Keeley has been asked to attend an upcoming Executive Management Group meeting to discuss electives/selecties.
  • The criteria for problem sets in the preclerkship curriculum will be discussed and refined in 2013. 
  • Clerkship progress in developing consistent learning objectives, resources and assessments will be reviewed.  Progress toward the standardization of grading policy for the clerkships will be verified. 
  • Reviews will be completed for the Medicine, Surgery, Geriatric and Psychiatric Medicine Clerkships.

Donald J. Innes
dmr