University of Virginia School of Medicine
Curriculum Committee
Minutes – 02/07/13

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, Selina Noramly, Theresa Schlager, Amita Sudhir,  Linda Waggoner-Fountain, Casey White,  Bill Wilson,  Mary Kate Worden,  Courtney Chou,  Yasmin Poukazemi , Jean-Baptiste Maitre ,   Debra Reed (secretary), Associate Advisors: Elizabeth Bradley, Sabrina Nuñez, Guests: Robin LeGallo

A clerkship review from 2011-2012 was conducted – Psychiatric Medicine Clerkship

1. Proposal to fine tune the fall semester for 2013   The proposal introduced at last weeks meeting splits the current introductory course into two segments – Foundations of Medicine (6 weeks) and Cells, Tissues and Neoplasia (4 weeks). This will limit the time commitment for the leaders.  All learning objectives will be reviewed to improve integration within the foundations and across systems, as well as to check for relevance for a generalist physician and clerkships. CPD-1 talks that now take place in the afternoon hours are moved to the morning and/or transferred to other systems. Human Development/Behavior is aligned with the CPD interview. Increased emphasis will be placed on active learning and reducing lecture.  Two documents providing an overview of the proposed thematic structural reorganization; a spreadsheet listing all the current learning units with topics, hours and proposed disposition. Clicking on topic titles will show the learning objectives for the session.
   
   a.       Thread Leaders could and should be playing a greater role in ensuring that the content that is within their domain is placed and sequenced appropriately in the four years of the curriculum. The new leadership will be required to review all learning objectives to improve integration within the foundations and across systems, as well as to check for relevance for a generalist physician and clerkships. The Threads are optimally placed to help with this. Donna Chen, for instance, has done an excellent job with ethics across the four years. 
   
   b.      Robin LeGallo, Sabrina Nuñez presented an over view of their preliminary plans and took questions. After brief further discussion a vote was taken approving the proposal. The vote was 14 for; 0 against and 1 abstention. 
   
   
2. Psychiatric Medicine Review (Robert Bloodgood, Nancy McDaniel, Brandon Hunter (MS2)).  The reviewers outlined their findings from the Psychiatric Medicine clerkship review.  
   
   2012 Review: Psychiatry Clerkship
   
   The reviewers met with Dr. Herrington, clerkship director on November 13, 2012: this review is based on that conversation and a review of the Clerkship report submitted by Dr. Herrington.
   
   Positive Aspects of the Psychiatry Clerkship
   
   

   ·	Concentrated psychiatric experience in settings that are unique
   ·	Clinical exposure to acute psychiatric illness
   ·	Lecture/didactic topics are uniform across the sites
   ·	Method of evaluation is the same across clerkship sites

   
   Challenges and ongoing opportunities
    

   ·	Loss of Carilion/Roanoke as clerkship site. That rotation had leadership and educational experiences that were well regarded by students
   ·	Challenge is to provide similar experiences for all students across sites
   ·	No associate program director
   ·	Overall score for clerkship declining with low scores for Salem rotation; site director is stepping down from this role; as of Dec. 2012, new director has not been identified
   ·	Clerkship website in need of updating; in particular, more information is needed about site at Salem and rotation at Western State
   ·	More students will be assigned to UVA and Western State with same number for Salem
   ·	Students work with UVa residents only at UVa
   ·	Little exposure to ambulatory psychiatry in clerkship other than Emergency Department Consultation or on Psychiatric Consultation Liaison Service
   ·	Clerkship requirements sign off is more challenging in Oasis whereas the paper passport has worked well for this clerkship
   ·	Grading rubric is currently only USMLE subject examination (50%) and clinical grade/evaluations (50%); changing to rubric as suggested by curriculum committee (subject examination 25%, professionalism 5%, clinical 50%, other evaluation 20% such as OSCE) is seen by Dr. Herrington as prohibitive (due to limited faculty time)
   ·	Inconsistency in grading (as well as grade inflation) across sites due to differing grading philosophy among attendings

      
   Issue of the four sites and whether they provide a comparable experience:
   
   The Psychiatric Medicine Clerkship currently uses four sites.  Some data from student reviews of the Clerkship from recent Mulholland Clerkship reports are shown here:
   
   Psychiatric Medicine Clerkship – Overall Score:
   

   Class	2012	2011	2010
   Year Assessed	2010-2011	2009-2010	2008-2009
   All Sites	3.39/4.00	3.65/4.00	3.51/4.00
   UVa	3.45/4.00	3.64/4.00	3.27/4.00
   Carilion/Roanoke	3.73/4.00	3.77/4.00	4.00/4.00
   Salem VA	2.79/4.00	3.44/4.00	3.36/4.00
   Western State	3.58/4.00	3.74/4.00	3.60/4.00

   
   Note the major decline in student satisfaction from 2011 to 2012 for the Salem site. This is likely related to changes in faculty.
   
   Roanoke will cease taking any UVa medical students and hence will be lost as a Psychiatric Medicine Clerkship site.  Dr. Herrington indicated that the plan is to consolidate to three sites with students approximately as shown here:
   

   Site	Roanoke	Salem	Western State	UVa
   Prior number	3	3	3-4	4
   New number	0	3	4	5-6

   
   The report was discussed resulting in the following recommendations.
   
   Recommendations:
    

   ·	Name an associate program director from the UVa faculty before March 2013.
   ·	Arrange a joint Psychiatry clerkship site meeting, at least once per year, in addition to the existing Joint Clerkships meeting; this could be done by teleconference.
   ·	Identify a new site director for Salem before March 2013.
   ·	Devise a mid-clerkship examination using cases demonstrating minimum competency on the patient checklist – 1 of 8 cases to be selected for evaluation using a grading rubric.
   ·	Adjust the grading rubric to meet the Curriculum Committee guidelines (subject examination ~25%, professionalism ~5%, clinical ~50%, other evaluation ~20% such as OSCE).
   ·	Correct the Inconsistency in grading by devising guidelines and education for attending physicians. Review the grades and grading procedures with the attending physicians.
   ·	Update and enrich the website (using a combination of Med Ed technology support, Med Ed Research [learning objectives review] and Clerkship Committee support).
   ·	Produce shared core learning materials (power points, references) with nuances of the sites added where appropriate, e.g. military or veteran issues at Salem, criminal units at Western State.
   ·	Investigate the new iPhone Oasis electronic sign off with John Jackson
   ·	Reallocate UVa resources from the selective to the clerkship and elective programs.
   ·	Consult with Stephen Borowitz regarding use of a “UVA student note” format being developed for Epic that will be communicated to the students during the transition course.  Inform your teaching faculty of this standard format and need for feedback to students regarding their notes at the same time.  Report back to the Curriculum Committee how student notes are used in Psychiatric Medicine. Steve Borowitz will speak about this at the Joint Clerkship meeting on 2/20/13.

   
   A progress report with detailed plans addressing each of the above recommendations is due to the Curriculum Committee by March 4, 2013.
   
   
3. Attendance
   
   A decision is needed on whether to continue using attendance quizzes. It is agreed that attendance should be required for patient interviews and for group activities in which process is important to the exercise, e.g. small group activities such CPD-1 groups, TBLs and participatory problem sets.
   
   Recording attendance at all functions has been found to be intrusive, disruptive and considered by many to be insulting. Not all students participate thus any data must be considered suspect. A proposal to eliminate recording of attendance at sessions other than those listed above was made. Questions regarding the Education Research Database were raised. Research should inform and guide our curriculum, but we must guard against research interfering with our curriculum. Before a decision is made the opinion of Casey White in Medical Education Research will be sought.
   
   If the decision is to continue taking attendance at all sesions we must make the process less "intrusive".
   
   
4. Academic Policy on Professionalism.
   
   Changes in the following italicized blue portion of the document were considered. Discussion will be continued.
   
   Any breach of professionalism resulting in a recorded observation, e.g., Concern Card, letter, written report, etc., must be addressed with the student by his or her College Dean and documentation of the discussion be recorded, placed in the student’s file by the registrar and reviewed by the Chair ASAC. If a student receives three or more written observations of concern, or is cited for a single egregious breach of professionalism, notice will be sent to the full ASAC for review. If recorded observations do not reach the level of ASAC review they should be purged from the student record at graduation.
   
   General Operational Procedures
   The ASAC will schedule quarterly meetings and will also meet on an as needed basis (within 10 days of a report, e.g. egregious behavior) to address immediate issues. The ASAC committee may be superseded by University policy or legal action.
   
   The Policy on Academic and Professional Deficiencies name shall be changed to Policy on Academic and Professional Advancement.
   
   
5. Future scheduled meetings:
   2/21     Medicine /AIM clerkship review
   3/7       CV, Pulm, Renal Reviews
   3/21     Endocrine/Reproductive, Heme reviews

Donald J. Innes
dmr