University of Virginia School of
Minutes – 02.06.14
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, Bart Nathan, Sabrina Nunez, Theresa Schlager, Neeral Shah, Amita Sudhir, Linda Waggoner-Fountain, Casey White, Bill Wilson, Mary Kate Worden, Derrick Thiel (alternate Jonathan Pomeraniec), Tom Jenkins, Debra Reed (secretary)
The Committee welcomed Jonathan Pomeraniec, substituting for Derrick Thiel.
Surgical OSCEs were to begin Spring 2014 but the start date has been postponed to Spring 2015.
Interprofessionalism (IPE) in the transition course update being conducted by Tina Brashears and Chris Peterson during the transition course. The workshops, developed during the grant period, will be incorporated into appropriate clerkships in the coming year.
Approval of the Study Period prior to Step 1 as Special Studies MED 8699
For Federal Loans students need to be enrolled in courses for the entire time of the loan. This was identified as a compliance issue for a number of medical schools at the AAMC’s professional development conference for financial aid professionals, since most medical schools have a study period prior to Step 1. Students technically cannot be considered “enrolled” – and should not be receiving federal financial aid – if they are not currently enrolled in/participating in any classes. There is already a course set-up that could be used for this purpose –that could be set up in OASIS with approval from the Curriculum Committee.
The Committee approved the following policy: Students will be required to enroll in the course titled Special Studies MED 8699 (P/F) during the period of study for the USMLE Step 1 examination effective 2014.
Clerkship NBME Subject Examination
The Committee discussed and approved this three part policy regarding NBME Subject Examination Scores:
a) The NBME Subject Examination (in all clerkships where it is a component of the clerkship grade) must be passed using the Hofstee Method recommended cut-off for the examination. b) The original NBME Subject Examination score is used in calculating the student’s final clerkship grade.
c) The NBME Subject Examination must be passed using the Hofstee Method recommended cut-off for the student to be eligible to sit for the USMLE-2CK Examination.
SMD17 and SMD18 Weekly Schedules. The Committee reviewed and approved the weekly preclerkship schedules for SMD17 and SMD 18. The schedules are posted on the Curriculum Website at:
Revised Curriculum Governance Document. A revised Governance Document has been approved by the Dean and is now available on the Curriculum website at:
Medicine and Ambulatory Internal Medicine (AIM)Clerkship Review. Casey White and Linda Waggoner-Fountain met with Evan Heald, Medicine Clerkship Co-Director/AIM Director on December 18, 2013. Linda Waggoner-Fountain and Casey White met with Brian Wispelwey, the Clerkship Director for Medicine on January 9, 2014.
Recommendations 2013 and outcomes in italics
· Revise the grading system with increased clerkship length and students spending more time in the ambulatory setting (current grading is 1/3 inpatient, 1/3 AIM and 1/3 shelf examination). (Done.) · Teleconference the medical student morning report at UVA to other clinical sites. (Done.) · Work with the OSCE group to use the Medicine OSCE as an objective measure of student competency. (In progress.) · Explore with the Simulation Center the use of additional simulation for clinical skills learning. (Not done.) · Complete the learning objectives, resources; formative and summative assessments for the Medicine clerkship – Class of 2015. (Learning objectives done; J. Martindale working on reporting assessments across all clerkships.)
· The new six-week schedule has led to significant improvement in the clerkship experience. · Morning report is now teleconferenced to other sites. Not all students can make every morning report session (those on MICU, etc.). · Grading was 1/3 Medicine, 1/3 Shelf, 1/3 AIM. It is now 45% Medicine, 30% Shelf, 25% AIM. · Students are unhappy they are not able to choose the subspecialty to which they’re assigned. · If the clerkship was eight weeks a night float experience could be added. · The new three-week schedule for AIM has been the biggest challenge this year
Dr. Wispelwey believes assigned grades should be distributed so that 30% (or 35%) receive A/A-, 25% receive B/B-, and so forth. Actual data show the following distribution:
Class of 2014: Class of 2015: A+/A/A-: 40.1% A+/A/A-: 35.1% B+/B/B-: 57.1% B+/B/B-: 63.5% C+: 1.4% C+/C/C-: 0.0% D: 0.7% D: 1.4%
Concerns Specific to Medicine:
· Dr.Wispelwey believes that every student should have a cardiology and oncology experience. · The teleconferencing equipment is works only ~50% of the time. · The quality of the VA residents in Salem is not the same as the quality of UVA residents; students have noted this as a problem. It is not as big of a problem this year because students do not go to Salem for the whole Medicine experience (they go for ½). At one time the SOM was discussing sending UVA residents to the VA but it is not clear what was or is planned now. · All students should have an ICU experience (this could include a cardiology and oncology focus). · It is problematic that UVA students graduate without having drawn blood or started an IV. · Residents do not have sufficient time to train students. · The new curriculum is deficient in preparing students to begin clerkships.
Concerns Specific to AIM:
· Reduction of AIM from 4 weeks to 3 weeks, decreases emphasis on ambulatory medicine · 2 days of workshops which takes away from clinical experience at clinical sites. · Some workshops have been moved and some have been changed or eliminated. Cultural competence has been reduced with no debriefing. Pulmonary workshop changed to reading chest radiograph rather than PE, change in health economics workshop · Coordinator of sites (LM) is quite stretched in her role · Mid-rotation feedback is after 6 days of working with preceptor · Inherent differences between sites and preceptors.
Medicine Clerkship Evaluations:
Results from 2013-2014 student evaluations of the clerkship are as follows; 75.36% of the 70 respondents so far this year said they would give the clerkship a grade of “A”.
Medicine Clerkship 2013-2014
% Yes/Strongly Yes
Objectives clearly defined. 88.57% House staff time to teach. 100.00% Attendings effective teachers. 98.57% Feedback during clerkship. 98.57% Opportunity H&P and presentations. 96.78% Diverse patient load. 85.71% Level of patient responsibility adequate. 88.57% Adequately involved in procedures.* 69.84% Outpatient exposure. 91.31% Staff (e.g., nurses, clerks) interested and cooperative. 77.15%
*It is unclear whether students in the third year curriculum would no what would constitute “adequate” involvement. However, interns from UVA surveyed last year overwhelmingly reported they were under-trained in procedures compared to others in their cohort from other medical schools.
Student Comments (on evaluations):
The students had very positive comments about their experience on the UVA Medicine clerkship. They called it “well run and enjoyable” and “well organized.” The described the attendings and in particular the residents as “friendly and encouraging” and “interested in teaching;” they also commented on the “great focus on evidence-based medicine.” One concern was the timing of the morning report – several students commented that it makes them late for rounds and they do not want to look as if they are late for or not interested (in rounds). Unfortunately, there were a significant number of negative comments about the VA/Salem experience – they describe the experience with Salem residents as “poor, with zero teaching and unfriendly;” they also commented on the living conditions as “horrible.”
· Determine how Medicine OSCE will be factored into the Medicine grade (what %, etc.) beginning 2014-2015 year. See clerkship statements below. · Present options related to VA (quality of residents and experience) to Curriculum Committee. · Determine how to guarantee every student adequate exposure to oncology and cardiology. · Explore how the Simulation Center can enhance the Medicine/AIM clerkship learning experience (possibly more exposure to procedures). · Determine what are issues with teleconferencing equipment and address (CW talked to SOM IT, now fixed). · Standardize Night Float system (OB/GYN and Peds accomplish this with less time) · Include an OSCE at beginning of AIM and make this a part of the workshop · Give feedback to Dr. Heald on what students missed in similar workshops prior to AIM experience · Consider Structured Clinical Observations (SCO) for preceptors at AIM clinical sites. SCOs provide guidelines and observation sheets for history-taking, physical examination, and information-giving skills. · Create website for AIM that is easily found and not buried in IM website · Explore learning objectives for AIM and Family Medicine to determine overlap (CW handling – not a priority for Medicine clerkship), as well as universal passport overlap
Please see attached letter.
A plan and timetable to address the recommendations is requested by March 15. The grading should be addressed prior to the first day of the new clerkship year*.
General Recommendations for the Clerkship Committee
Ensure that medical students know how to address unprofessional activity by resident or attending physicians, nurses, or others. Lesley Thomas will address such issues at the Joint Clerkship Meeting on 2/19/14.
Develop a Universal Passport to better ensure that all required procedures/skills are available to all students. Much depends on the assertiveness of the student. All students currently learn phlebotomy in CPD-1 and again in the Transition course.
Sandardize criteria for grade assignment across clerkships.
*The Curriculum Committee will reset grading standards for the clerkships at our next meeting.
Donald J. Innes, Jr., M.D.