University of Virginia School of Medicine
Curriculum Committee
Minutes – 02/21/13

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),

1. New Fall First Year Courses Named/Defined for Registrar  - approved by Curriculum Committee:
   
   Foundations of Medicine introduces the scientific principles that underlie the practice of medicine as well as the psychosocial, communication and ethical issues important for patient care.   Biochemistry, pharmacology, genetics, cell biology, physiology and epidemiology are emphasized as they relate to human health and disease. The importance of the doctor-patient relationship is introduced, as is an ethical approach to issues in medicine.
   
   Cells, Tissues and Mechanisms of Disease introduces the organization of the human body emphasizing human development and cell and tissue function. This foundation is extended to the study of pathologic mechanisms of disease including cell injury, adaptation and death, inflammation, healing, circulatory disturbances and neoplasia. Neoplasia is the model for application of foundational concepts in genetics, growth regulation and clinical research.
   
   
2. IRB Training Requirement.  The Committee approved a requirement that the online IRB training module be successfully completed by all fourth year students by  March 15, 2013.  A tracking mechanism to ensure all students meet the requirement will be set up.
   
   http://www.virginia.edu/vpr/irb/hsr/citi.html
   
   
3. Dean’s Town Hall Meeting for SMD 2016.  A Dean’s Town Hall meeting was held 2/21/13 with about 42 students attending.  Students were mostly content with current curriculum and policies.  Some suggested more in-depth basic science in the curriculum but others felt levels were already adequate.  Trying to attain the proper balance is always difficult but during problem sets and TBLs in particular,  students are encouraged to  explore areas of interest in more depth during self-study and ask “why”  of their instructors whenever necessary.  A full set of notes from the meeting will be distributed to the Committee for review when available.
   
   
4.  Joint Clerkship Meeting.  A joint clerkship meeting with attendees from all sites who host UVA clerkships – UVA,  Salem VA, Richmond Bon Secours, Fairfax Inova and Western State was held at UVA on 2/20/13. 
   
   
5. A clerkship review for 2011-2012 was conducted –  
   
   Internal Medicine Clerkship Review 2012 
   
   Interviewers: Linda Waggoner Fountain & Casey White,  Medical Student:  Jeremiah Garrison
   
   Clerkship Directors: Brian Wispelwey (IM) & Evan Heald (AIM)  
   
   Sources of Information:
    

   ·	Interview with Brian Wispleway & Evan Heald along with Jeremiah Garrison, Casey White and Linda Waggoner Fountain
   ·	IM and AIM CPD 2012 Review Document

   
   Background:
    
   

   ·	Dr. Wispleway is the IM Clerkship Director
   ·	The current IM rotation is 4 weeks long and the current AIM clerkship is 4 weeks long and the students on IM are located in three different sites, UVA, Roanoke and Salem VA.
   ·	This coming year the clerkship will increase to a 12 week with six weeks of general IM, three weeks of AIM and three weeks of Acute Care Medicine.

   
   Positive & Unique Aspects of the IM Clerkship
   
   

   ·	Students have a wide variety of internal medicine experiences and students are exposed to a wide variety of diseases
   ·	Faculty and residents have earned many teaching awards.  There is a culture of teaching from committed attending and housestaff.
   ·	Direct patient involvement
   ·	Active teaching rounds that are patient and family centered
   ·	Medical student morning report led by clerkship director is commented on as a real strength of the clerkship
   ·	Have added 2 hours/week of CSEP
   ·	Include ethics rounds on alternate weeks with discussing active patient issues
   ·	Defined SIMPLE cases for students to work through with clerkship director tracking progress of students
   ·	Mid- and end of clerkship evaluations include history taking, physical exam, use and interpretation of diagnostic tests, clinical procedures, and professionalism.
   ·	Variability of experience between the three sites.   This should decrease with elimination of Roanoke experience secondary to new medical school in Roanoke.
   ·	Limited opportunity for procedures  [a national problem]
   ·	Would like the clerkship to be longer and allow the students to have more specialty ward time.
   ·	Challenges of trying to pair students with faculty in inpatient and ambulatory settings when on subspecialty services
   ·	Optimization of use of all available clinical sites with elimination of Roanoke site and increase in length of clerkship

   
   In summary, the Internal Medicine clerkship is well organized and will have more emphasis with longer IM clerkship experience with the clerkships curriculum revision beginning in March 2013.
   
   Ambulatory Internal Medicine  (AIM) Clerkship Review 2012 
   
   Interviewers: Linda Waggoner Fountain & Casey White
   
   Clerkship Directors: Brian Wispleway (IM) & Evan Heald (AIM)
   
   Concerns:
    

   ·	With the reduction to 3 weeks, we need to find another place for the AIM workshops - intercession will be an excellent place for this
   ·	Very few preceptors are able to attend planned faculty development activities, so this might be a very "unstandardized" experience for students - perhaps we should develop online activities to try to ensure that everyone is on the same page?
   ·	AIM's objectives are the same as Medicine's with the exception of a few that address ambulatory medicine directly.  A set of  objectives unique to AIM would help to focus the student.
   ·	We need to understand the distinct values and differences in AIM and Family Medicine.

   
   Recommendations for Medicine/AIM
   
   

   ·	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)
   ·	Teleconference the medical student morning report at UVA to other clinical sites.
   ·	Work with the OSCE group to use the medicine OSCE as an objective measure of student competency
   ·	Explore with the Simulation Center the use of additional simulation for clinical skills learning.
   ·	Complete the learning objectives, resources; formative and summative assessments for the Medicine clerkship – Class of 2015.
   ·	Revise workshops to make the most of the clinical experience
   ·	Collaborate with Family Medicine to maximize opportunities for student learning in both AIM and Family Medicine.
   ·	Investigate the new iPhone Oasis electronic sign off with John Jackson
   ·	Reallocate UVa resources from the selective to the clerkship and elective programs.
   ·	Make use of the “UVA student note” format in Epic that is being 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.

   
   Dr. Linda Waggoner-Fountain presented the reviews for the Medicine/AIM clerkship.  The Committee discussed the reviews.  Variability between sites will hopefully diminish with the new clerkship schedule.  At most, students will spend 3 weeks at an outside institutions.  All students will have a minimum of  3 weeks at UVA while on the Medicine clerkship.  Plans are in development to address concerns raised by this review – ie developing a core teaching  faculty roster,  broad based curriculum for specialty medicine services, possible grade inflation due to reduction in the shelf exam score from 33% to 30% of the total grade, teleconferencing rounds and didactic sessions with outside facilities.  
   
   A progress report with details of how the above recommendations were addressed is due to the   Curriculum Committee by March 15, 2013.
    
6. Intersession.  An intersession at the midpoint of the clerkships will not be held for the Class of 2015.  Patient safety (Peggy Plews-Ogan) and  Information Management (John Voss)  will be strategically place to elsewhere in the clerkship curriculum.
   
    
7. Teleconferencing.  A teleconferencing setup for use by Medicine, OBGYN, Pediatrics and other clinical experiences  will be made available to link to ouside facilities providing further comparability in student learning.  Medicine, OBGYN, Psychiatry and Pediatrics will be asked to submit iders for teleconferences  in which student/faculty interaction is most valuable.
   
   
8. Student Notes on Clerkships (EPIC).   The Curriculum Committee approved a mandate  that students  in all core clerkship experiences  be expected to write notes in Epic and have these notes reviewed and critiqued by a clerkship instructor.  All students and teachers (attending and resident physicians) are to be instructed in the approved procedure for student EPIC notes.   The mechanism has been reviewed by the Hospital and Legal Team and approved.   The following statement will be automatically attached to all medical student notes <ATTENTION:  This note has been created by a medical student and is meant to be used for educational  purposes only.  DO NOT refer to this note or the associated feedback for patient care, billing, compliance purposes or medicolegal purposes. >        The Committee agreed that the development of good  patient record keeping  skills is a requirement  for all medical students  and is an essential skill to be assessed in all core clerkship experiences. 

Donald J. Innes
dmr