Minutes 03.10.11

Minutes 03.10.11

University of Virginia School of Medicine
Curriculum Committee
Minutes – 03.10.11


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, Bart Nathan,  Linda Waggoner-Fountain, Bill Wilson,  Mary Kate WordenJohn Hemler,  Christina Portal,  Nicole White,  Debra Reed (secretary)   Guest:  Trevor Posenau

 

  1. The Mulholland Report was presented to the Curriculum Committee by the Editor, Trevor Posenau   An electronic version of the report was sent to the Committee members on Friday 3/4/11.    Trevor thanked Troy Buer, Michelle Yoon, Donald Innes, John Jackson and the 12 section writers for all their hard work on this in depth report.  This report is prepared from data on the 2009-2010 clerkship year.

    Structural changes were made to the clerkship report this year.  A SMEC update section has been added to reflect changes made since the data was collected. 

    Two new clerkships, Perioperative and Acute Care and Geriatric Medicine, were added.    Surgical subspecialties were added to the clerkship year.

    For the class of 2011, the overall mean rating for all the clerkships was 3.60./4.0.  This is a slight increase in comparison to 08-09 but the overall mean rating has remained relatively consistent for the past decade.

    Mulholland Report 2011

    There were variations in means at various sites and clerkships but substantial variations were not noted.

    Discussion and Recommendations
    The third year of medical school presents new challenges as students begin clinical work and apply the knowledge that was acquired over two years in the classroom. Subjective grading adds stress because students must gain rapport with their housestaff and attendings. This pressure to perform is compounded by the students' lack of control over attending and housestaff schedules and the variability of grading between different physicians and between different clerkship sites. Performance during clerkships holds critical importance for residency applications. Furthermore, students must use clerkship experience to consider future career interests. Accordingly, it is no surprise that the most frequent recommendations made by the Class of 2011 relate to factors affecting clinical performance and preparedness for shelf exams.


    Orientation policies in the various clerkships and clerkship sites was discussed.  Standardization of clinical skills in orientation might best be taught here at UVA in a one-day introductory session, with abbreviated site specific orientations at away sites.  Use of the Simulation Center in these orientations should be encouraged.  Hands on activities by the students during orientation is always appreciated by the student.

    Developing a rapport and obtaining feedback from attending and resident physicians has become more difficult with the shortened work hours for housestaff and shortened rotations of faculty on the wards.  While the preceptor program helps assure a cohesive experience in some clerkships, it should be encouraged in all clerkships.  Also more frequent (daily or every few days) meetings with the attending/housestaff supervising the student would be welcomed.  Some feel that this daily feedback would not be representative of the students entire clerkship performance but if it were advertised as such, it would still be very helpful to the student.  Whether specific days during a clerkship should be set aside for feedback or whether the student should initiate the feedback session was discussed.  The midclerkship reviews provide the student with information on whether they have covered the necessary learning objectives for the clerkship and should be continued even if more frequent feedback is arranged.


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    Orientation - Clear learning objectives and expectations for the clerkships are essential and allow students to focus their efforts on the most important information and responsibilities. Students respond very positively to concise orientation sessions that define the objectives and also present some of the basic and unique knowledge for each clerkship. We also desire that attendings and housestaff define expectations at the initial meeting with students.

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    Rapport with attending physicians and housestaff- The Class of 2011 praised clerkships that allowed students to work extensively with individual attendings and housestaff. The rapport that develops over multiple days allows students to feel more comfortable asking questions and seeking feedback. Furthermore, students are more satisfied
    with their effort when their skills and knowledge are demonstrated to the same individual(s) over multiple days. Clinical preceptor programs have been initiated within several clerkships and have received high praise. We recommend that all clerkships seek to maximize rapport building by allowing students to rotate with the same housestaff and attendings for several consecutive days. For clerkships where this is less feasible, a preceptor program is encouraged.

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    Feedback - Students learn and improve from feedback. Students also feel more confident in their performance when feedback is given. We encourage all clerkships to remind attendings and housestaff to provide frequent feedback to medical students. Clerkships with scheduled feedback sessions were praised, and scheduled feedback is
    recommended for all clerkships.

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    Teaching - Students respond very positively to focused teaching sessions that are relevant to the shelf exam. Many clerkships received high praise for the quality of teaching on the wards and in lectures, and we encourage the continuation of these efforts. Impromptu chalk talks and team teaching sessions provide context for specific patients
    and are highly valued by students. However, in certain clerkships, scheduled teaching sessions and workshops were felt to interrupt clinical duties. This issue is explained in detail in the individual clerkship chapters, and we recommend adjusting the times of scheduled sessions that remove students from important clinical responsibilities.

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    Patient Responsibility - Patient care is the core third year experience, however students frequently desired more involvement in patient care and procedure experience. We recommend that all clerkships maximize student involvement in patient assessment, patient presentations, and management decisions.

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    The class of 2011 did not receive reimbursement for travel. We recognize that this was a necessity of the financial climate, but we recommend that travel reimbursement be restored when fiscally possible.



    Orientation policies in the various clerkships and clerkship sites was discussed.  Standardization of clinical skills in orientation might best be taught here at UVA in a one-day introductory session, with abbreviated site specific orientations at away sites.  Use of the Simulation Center in these orientations should be encouraged.  Hands on activities by the students during orientation is always appreciated by the student.

    Teaching was varied at various clerkship sites.  Creating attending and resident physician development is being discussed at the upcoming Clinical Medicine Committee.   Residency directors will need to work with the clerkship directors to develop faculty development sessions to improve consistency in this area.  Students respond more positively to clinically based topics in didactic sessions.  The School of Medicine should encourage student engagement and hands on learning in didactic sessions as much as possible.  The faculty development program would  be developed here at UVA and shared via webinars or during visits here from outside faculty and housestaff.


    The Curriculum Committee agreed that patient responsiblity should be maximized throughout the clerkships.  Some surgical subspecialties due to the complex nature of their practice, provide less patient responsibility for the students.  Subspecialty directors should be asked to work to improve this.

    Travel reimbursements in this financial climate cannot be restored at the present time.

    More thought provoking suggestions:


Donald J. Innes, Jr., M.D./
dmr