Minutes 02.10.11

Minutes 02.10.11

 University of Virginia School of Medicine
Curriculum Committee
Minutes – 02.10.11

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Megan Bray, Troy Buer, Chris Burns, Donna Chen, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), John Jackson, Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Linda Waggoner-Fountain, Bill WilsonMary Kate Worden,  John Hemler,  Christina Portal,  Nicole White,  Debra Reed (secretary)   Guests:  John Bell, Selina Noramly


  1. Treatment of copyrighted materials and student educational records.  John Jackson outlined a new policy developed with input from Madelyn Wessel, Associate General Council for the University.

    To offer more nuanced options in the treatment of copyrighted materials and student educational records,  we propose the following changes to the UVa School of Medicine's Student Source web site. This proposal reflects the unique needs of the medical curriculum, the diversity of approaches to educational materials of our faculty, and the University's need to comply with applicable laws.

    Most SOM courses are team delivered with as many as 100 faculty and or residents teaching in a single course.  Further instructors and students all need to review educational content from other courses due to the integration of our curriculum.  The School of Medicine maintains its own academic record system (Oasis) for student schedules, grades, calendars and evaluations.  All medical students along with all faculty or staff involved in teaching or evaluation activities have Oasis accounts.

    For the above reasons, we propose three access levels for our course web sites:

    1.     Viewable by anyone (world wide web accessible)
    2.     Viewable only to Oasis account holders
    3.     Viewable only to students enrolled in the course

     Option 1 would only apply to web pages created by SOM faculty and staff, which are wholly the intellectual property of the University of Virginia and which do not integrate third party copyrighted content of audio/video or recordings of students.

    Option 2 would apply to all documents uploaded within course web sites.  Course materials made available to students through this access level could (as long as compliant with copyright fair use guidelines), include third party materials (such as individual books chapters or PowerPoint's integrating content such as graphs, images, etc.). 

    Option 3 would apply to podcasts of "engagement activities" in which students could be identified as class participants to ensure compliance with FERPA and other privacy requirements.

    Archiving of Materials

    Since medical school courses do not follow a semester schedule, and may be as short as one week or as long as 52 weeks, we propose that all materials in access levels 2 and 3 be kept available for each full academic year.  At the end of each year, these materials will be securely archived and removed from public view. Archived materials would only be available to authorized administrative users who have need to research historical materials.

    The Committee unanimously approved this proposal and it will be implemented on 3/2/11.  The Committee thanked John Jackson and Madelyn Wessel for their diligence on this project.

  2. Systems Based Practice - John Bell (former UVA SOM student and member of the Curriculum Committee while a student) outlined his proposal for the addition/implementation of System Based Practice into the UVA SOM curriculum.

    Health System Curriculum Proposal

    Medical students are required to have some knowledge in how the health system functions to achieve the competencies expected of a UVA School of Medicine graduate and to be able to function and show competency in Systems Based Practice as a resident physician. Medical students currently receive little formal training on how the health system functions. In today's world of medicine physicians need a thorough understanding of how the health system functions in order to provide top-notch care, interact professionally and efficiently with other providers, and be able to earn a living.  Also, physicians who understand the system within which they work will be able to help shape the changes to that system which will occur and retain control of patient care decisions needed to ensure that patients receive the best care possible.

    This proposed curriculum would introduce students to many of the topics that will help them be able to find their way through the health system and to be better physicians.  It will then have students apply their knowledge at first to cases in Clinical Performance Development (CPD) and then on the wards in the Clerkships and Post-clerkship periods and finish with a project where they have to synthesize their knowledge and possibly help the UVA health system to improve.

    This horizontal and vertically integrated curriculum will emphasize real world contexts and foster interdisciplinary learning opportunities for medical students with nursing students and other health care workers.  Finally, this curriculum will take advantage of a highly interactive learning environment utilizing various types of technology as well as various teaching techniques as appropriate to fully engage the students.

    Curriculum Goals
    Students will:


    value how clinical decisions affect the patient, the hospital/clinic, their financial situation, and the health system.


    recognize and defend how the information collected from an excellent history and physical exam will allow for more efficient, more economical, and safer medical practice.


    understand how the different parts of the medical system interact allowing for much smoother and efficient use of the system.


    understand how excellent medical writing aides communication and improves appropriateness of billing.


    understand how the current system and possible future systems would alter the incentives between physicians and hospitals and the care they provide and patients and the care they seek and the lifestyle decisions that they make.


    understand how a working knowledge of the health system allows for intelligent improvements to be made to the system.

    Course Topics


    Insurance (how patients get covered) – what patients are charged (Medicare/Advantage, Medicaid, Employer based Insurance, Self-Insured, and uninsured/self pay)


    Insurance (how doctors and hospitals get paid)


    Impact of  Tests and Imaging Ordering (Golden Pen/Mouse)


    Insurance (how Medicines are paid for) Pills vs. IV meds and DME and Therapy services


    The Skilled Nursing Facility- Types/Reasons for Stays/How Stays get paid for/How one get admitted to one


    Medical Writing –why bother (Communication/Billing/Legal)


    Handoff of Care – (Outpt/Inpt/between inpt shifts/Inpt-Outpt)


    Other Medical Professionals – Who they are and what they do - (PT/OT/RT/SW/Nursing/PCA/Nutritionists/Wound Care/Pharmacists)


    Current Incentives in Medical Care – fee for service and results (SGR and RVUs)-other alternatives (i.e. capitated ACOs, medical homes)


    Top of the Cliff vs. Bottom of the Cliff Medicine


    Electronic Medical Records – Chart lore/Gibberish Notes/Intercommunication and HIPAA


    Organization of Health Care – Types of practices and how organization of care incentivizes certain types of care.

    Rough Curriculum Outline


    1st and 2nd year course - topic introduced with large group learning activity ~ once per month and consolidated with application of this topic in the weekly small group sessions of CPD. Topics will start general knowledge and slowly incorporate the level of medical knowledge that students are obtaining.


    3rd year – integrated into the introduction to clerkships and with integration into different clerkships (i.e. student morning report in medicine clerkship) focus on medical writing and intro into how hospital runs and continued application of 1st and 2nd year topics.


    4th year – integration into portion of DxRx for some advanced topics and final project on quality improvement proposal or research paper on health system issue with change idea presented in poster session to share ideas with students evaluating each others’ posters.

    Dr. Bell’s proposal was unanimously endorsed by the Curriculum Committee.  He was asked to continue to develop learning objectives for each topic and work with Eugene Corbett, Veronica Michaelsen and Kimberlye Joyce to integrate these topics into the Next Generation Curriculum.

  3. Bon Secours Affiliation Agreement.    The Curriculum Committee discussed the proposed Bon Secours Affiliation Agreement.   Megan Bray, OBGYN Clerkship Director spoke to the comparability issues at Bon Secours.    She believes the program can maintain comparable educational experiences at this site since all didactic presentations would be available to all students in the clerkship regardless of physical location (Bon Secours, UVA, Roanoke).  OB/GYN selectives here at UVA would also allow students to participate in activities that are not available at Bon Secours.  Students who have objections to participating in the clerkship at Bon Secours should not have a problem with the match as most students (>75%) get their first choice for clerkship placement at the present time.  The Curriculum unanimously endorsed this affiliation and supports further development of the plan.

  4. Defining MCM.  An MCM Action Plan was distributed to the Committee.  Items were outlined by Veronica Michaelsen and the Committee discussed.


Donald Innes