University of Virginia School of Medicine
Curriculum Executive Management Group
Minutes – 02.16.12

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Peter Ham, Donald Innes (Chair), Keith Littlewood, Nancy McDaniel, Bart Nathan, Casey White, Mary Kate Worden, Guests: Eugene Corbett,  Arthur (Tim) Garson, Thomas Gampper, Mo Nadkarni,  Bill Wilson,  Debra Reed (Secretary)

1. Perspective:  Leveraging the Health Care Workforce:  What Do We Need and What  Educational System Will Get Us There?     Dr. Arthur Garson, Jr  met with the  Group to discuss his recent article published in Academic Medicine (Acad Med 86: 1448, 2011)  He reviewed the questions posed in this article and asked for input from the group on how best to address these many answerable questions. 
   
   

   1.	How much does each member of the public want to know about their health?  What are the best delivery methods?
   2.	How to incent health behavior?
   3.	Do we know what trained lay people can do under nurse/physician supervision?
   4.	Are “well rounded” practitioners better?  How is “better” defined?  What surrogate outcomes are available?  Do Art majors make better physicians or nurses?  How much uindergraduate non-medical work is needed?  If the BNS makes less errors than the Associate, why?  Is it the 2 extra years?  What do we know comparing the MD European 6-year with the US 4+4 for physicians?  Do physicians need to be “older?”
   5.	Why are all medical school curricular requirement be the same for basic science regardless of courses taken in college?  Should all types of physicians receive the same type and duration of medical school education?
   6.	How much basic science is needed in a curriculum?  When is it best taught?  How is it best taught?  Does the “integrated” basic and clinical curriculum improve retention of what is necessary?  Do all need the same amount?  How much retention at the end of medical/nursing school?  Are there data on physician outcomes from schools providing less basic science?
   7.	Other than for career choice, what data show the necessity of electives in medical or nursing school?
   8.	Why is there the proliferation of advanced nursing degrees?  Do we know that a Doctor of Nursing Practice provides better care as a “mid-level practitioner” than a nurse practitioner than an experienced nurse (5 years)?
   9.	What is the value/necessity of the dual MD degree:  MD-PhD, MD-MPH?
   10.	In teaching in teams, who is on  the team, and when? Public, community worker, nurse, doctor, dentist, researcher (basic, clinical community), public health professional?  What is taught? Professionalism, communication, leadership?
   11.	What is needed for job training and job satisfaction?

   
   Dr. Garson discussed these questions with the Group.  What studies might be undertaken to address these questions here at UVa or in concert with other schools of medicine or nursing?
   
   
2. CPD Mentor Through the Clerkship Year.  The CPD mentor program was intended to provide mentorship for 4 years of medical school. The Group discussed the importance of continuing CPD mentorship of students from CPD -1 throughout the clerkship year. Maintaining the mentorship throughout the clerkship year would provide a valuable means to determine student progress in the clerkship year and enhance the longitudinal mentorship experience. Whether this could become a weekly event (~4 hours per week) during the clerkship year was discussed.       
   
   Students at away locations would be necessarily exempt from attending a weekly group meeting at UVA.  The ability to attract a sufficient number of physician mentors to maintain the preclerkship CPD and clerkship CPD groups is an unknown as three “starting” mentor cohorts of ~26 mentors each would be needed.  It was suggested that two CPD groups be merged for the clerkship year since at any one time one third of the students would not be in attendance due to away rotations.   The mentor would monitor progress and take action if a student is not progressing as expected. Activities during these weekly CPD sessions could include case presentations to the group, career counseling, student learning portfolio review, reflection on clinical medicine, discussions of ethical issues, review and assessment of students clinical proficiency, and remediation efforts if needed. The ability to monitor, and provide formative feedback and assistance to the student in areas of knowledge, skills, and behaviors is essential to their professional development.
   
   Negatives included the disruption of pulling students off the clerkships for one afternoon and that this should be minimized if possible. The CPD group felt that they were working well as a CPD team but were not yet ready to change the structure of the clerkships/CPD mentor experience as the clerkships are working on a lot of changes as well.
   
   The concept of extending the CPD mentorship on a regular basis throughout CPD-1 and 2 and if possible at points in the elective period was approved by the CEMG.  The timetable and frequency may be determined by funding and faculty availability.
   
   

Donald J. Innes, M.D.
dmr