University of Virginia School of Medicine
Curriculum Committee
Minutes – 04/05/12

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Megan Bray, Chris Burns, Donna Chen,  Thomas Gampper, Peter Ham, Donald Innes (Chair), John Jackson, Keith Littlewood, Nancy McDaniel, Mohan Nadkarni, Bart Nathan, Linda Waggoner-Fountain, Casey White, Bill Wilson,  Mary Kate Worden, Courtney Chou,  Jennifer Hsu, Guests:  Pam Clark, Sharon Rubin,  Debra Reed (secretary)

1. Clerkship Grade Audit.  The University Audit Department has completed a review of student grades in the SOM’s UME Clerkship program.  Departmental grades from two clerkship periods for three SOM departments were matched to the Student Information System (SIS).  The Departments selected were Family Medicine, Neurology and Surgery.  The grades in all departments agreed with what was recorded in SIS, with one exception.  For the sample reviewed all grade components were supported by source documentation.  The one incorrect grade occurred when interim clerkship coordinator was assisted by another department’s clerkship coordinator, and the two departments used different grading scales.  This resulted in a student getting a slightly lower grade than he/she should have gotten.  The grade was corrected during the audit.  It was observed that the three clerkships using different grading criteria and different grade scales.  The administration of the clerkship programs was somewhat decentralized as each individual department handled their own clerkship program.  Several of the clerkship coordinators are planning on developing a manual starting in June 2012.  Audit supports development of this manual  and suggests that it include general clerkship information as well as how the clerkship programs are managed in the various departments.  In addition, the SOM plans to implement a more centralized administration of the clerkship programs, which the Audit Department believes would provide a more unified approach. 
   
   
2. USMLE Shelf Exam Contribution to Clerkship Grades.   The USMLE shelf exam grade contributions for each clerkship have been confirmed.
    

   NEURO	10%
   OBGYN	25%
   PEDS	25%
   MEDICINE	33%
   FAMILY MEDICINE	35%
   SURGERY	40%
   PSYCH	50%
   PERIOPERATIVE/ACUTE CARE	0%
   GERIATRICS	0%

   
   
3. System Review Schedule.  System Reviews have been scheduled for future CC/CC Executive Group meetings as follows:
   
   4/12       Megan Bray and Alan Dalkin  Endo Repro 
   4/19       Mary Bryant and Jen Marks    CPD 
   4/26       Melanie McCollum MSI and  4:45  Kambiz Kalantarina  RENAL
   5/3         Selina Noramly, Linda Waggoner Fountain  MCM and Chris Burns MIS 
   5/17       Elizabeth Gay, Stuart Lowson, David Moyer   Pulmonary
   
   
4. Mulholland Report. Sharon Rubin presented the class of 2012 Mulholland Clerkship Report Findings to the Committee.  Overall mean rating of the clerkships was consistent with previous years. 
   
   
   
   
   
   
   
   
   
   Sharon outlined recommendations made to the individual clerkships and steps being taken to address these concerns:
   UVA Internal Medicine (IM)
   Increase simulation center exercises
   Add a night float
   Standardize the role of students in Epic – notes, pended orders
   
   Roanoke IM
   Increase procedural exposure 
   Standardize expectations and experiences across teams 
   Improve communication between on-call housestaff and students 
   
   Salem IM
   Develop teaching workshops for housestaff  
   Improve student housing – ie. Hot water, heat, air conditioning
   Add additional learning experiences, i.e. teleconferenced lectures, to insure standardization of experiences across sites 
   
   AIM
   AIM workshops – improve scheduling before IM shelf exam
   Streamline extra clinical requirements
   
   UVA Pediatrics
   Suggest students follow same intern and resident team during call
   
   Family Medicine
   Increase pediatric and OBGYN exposure 
   Reimburse students for travel and food fairly among students
   Continue to recruit  preceptors closer to Charlottesville
   
   UVA OBGYN
   Increase student involvement in  clinic
   Increase student participation: L&D procedures and postpartum rounds
   Consider lengthening OBGYN clerkship to 6 weeks
   
   Surgery
   Improve service specific orientation 
   Encourage routine feedback 
   Provide student access to service specific information before turning in preferences for Surgery Subspecialties
   
   Salem Surgery
   Improve ratio of students per rotation to number of cases/OR time 
   Consider increasing formal didactic sessions
   
   Roanoke Surgery
   Increase opportunities for students to present H&Ps etc. 
   Increase outpatient exposure
   Enhance the learning environment
   
   Neurology
   Increase inpatient exposure and clinical responsibilities 
   Increase opportunities for outpatient exposure 
   Revise the take home exam
   
   UVA Psychiatry
   Increase autonomy and responsibility during morning rounds   
   Provide exposure to outpatient 
   
   Roanoke Psychiatry
   Provide attending specific orientation  
   Support staff and residents should better delineate the procedure for getting students involved when on call 
   Increase student responsibilities
   
   Salem Psychiatry
   Internet and hot water should be available to students in their living quarters
   Orientation for all students assigned to forensic ward on how to deal with possibly
   
   Western State Psychiatry
   Provide an orientation for all students assigned to forensic ward on how to deal with aggressive patients
   
   Perioperative and Acute Care ED
   Assign M3 to specific resident or tech instead of alert pager
   
   Perioperative and Acute Care Anesthesiology
   Assign M3 to 1-2 residents per week or 1 attending each morning
   
   Geriatrics
   Increase clinical time with physician mentors in Geriatrics
   Streamline workshops and non-clinical assignments 
   Standardize learning objectives, especially for palliative care
   
   Surgical Subspecialties
   Students requested informal or formal orientation
   
   The Committee thanked Sharon Rubin and all the other Mulholland editors for their efforts in compiling the Mulholland Clinical Clerkship Report for the Class of 2012.
   
   
5. Hematology System Review.  Don Innes and Pam Clark discussed their response to the Hematology 2011 System Evaluation and outlined plans for the 2012 Hematology System. 
   
   Response to the 2011 Hematology System Evaluation
   
   The UVA NxGen Curriculum System Evaluation Report for the Hematology System 2011, Curricular Weeks 69-71 and the Oasis Data Analysis Report for the Hematology System - 90-909 have been carefully reviewed.
   
   Drs. Pam Clark and Don Innes have attended and participated in the majority of System wide meetings in an effort to understand what knowledge and skills the students bring to the Hematology system - what we need to introduce as first time material, to cover as review material, or to advance to a more sophisticated application level.
   
   Dr. Sabrina Nuñez was and remains essential to the health of the Hematology System for her invaluable counsel, energy, and insight. Plans are for Dr. Michael Douvas to join us. The 2012 ASH Annual Meeting and Exposition is December 8-11, 2012.
   
   The following goals for Fall 2012 Hematology System are based on the System Evaluation and Oasis Data and include observer data, student feedback and System Leader observations.  The major areas to address are 1) the need to review and improve the learning objectives – especially the LO relation to resources, 2) increase the proportion of active learning sessions, and 3) identify topics for better integration of material. A timeline for implementation of the goals for the Hematology System is outlined in the following paragraphs and figures.
   
   Learning Objectives
   
   ·         Learning objectives need to be reviewed and improved although the majority of objectives were clear and precise. Learning objective relation to resources should be confirmed. All examination questions have been linked to learning objectives. 
   
   ·         Additional MCQs for practice, quizzes, and exams will be required which will need support from the Office of Medical Education.
   
   
   Increase active learning
   
   Active learning accounted for 52 % of the time in the Hematology System as judged by students, but accounted for only 33% as judged by observers with only ~2/3 of the sessions observed.  To achieve the goal of 60% active learning, we propose the following:
   
   ·         We will more tightly align our faculty with school of medicine instructional designers to improve interactive teaching modalities. The instructors, instructional designer, and system leaders will work as a team to accomplish this.
   
   ·         Student feedback and observer comments will be used to guide individual instructors. Places have been identified where team teaching, e.g. teaching by a clinician and a pharmacologist or a clinician and pathologist, will make the content more active, integrated, and meaningful.
   
   ·         A TBL exercise has been added to the anemia section. We will consult with the TBL-Education Group to determine the best approach and for support in implementation.
   
   
   ·         The Bone Marrow Failure session will be moved to a case based problem set session with an online resource.
   
   
   ·         One hour of Transfusion Medicine has been moved to an online format providing another hour of problem solving cases.
   
   ·         The Platelet disorders will be an online resource
   
   ·         The problem solving cases regarding the Bleeding/ Thrombotic Patients has been identified as a place where active learning will make the content more integrated and meaningful. Again, the instructors, instructional designer, and system leaders will work as a team to accomplish this. 
   
   ·         Lymphoma lectures are cut from 2 hours to 1 hour with an increase in the lymphoma case laboratory from 2-3 hours and an increase in the WBC Malignant Disorders (leukemia) from 2 to 3 hours.
   
   ·         The Benign Disorders Including blood borne organisms will be switched from lecture to a case laboratory with small group problem sets.
   
   Improve Integration
   
   ·         The Patient Presentations will be moved to the end of the week, usually Friday, following the content material pertinent to the patient’s medical condition. This change was requested by students and CPD.
   
   ·         The Bone Marrow Failure session will be moved from week #1 to week #2 as students suggested decompressing week one. 
   
   ·         The Clinical Approach to Lymphadenopathy Splenomegaly will be moved to week #2 and better integrated into the problem solving cases on Lymphoma and WBC Malignancy. 
   
   ·         Treatment (chemotherapy for leukemia and lymphoma) will remain as a lecture (pharmacology) but be woven into the problem solving cases on Lymphoma and WBC Malignancy.
   
   
6. Comparative performance of Clerkship Grades.  A graph showing the comparative performance in clinical clerkship grades for the Class of 2012 was distributed.  Casey White noted the wide differences in grade allocation between the clerkships.  The Committee considered standardized guidelines on grade allocation for the clerkships.  The affect the grade allocations have on resident program selection was also discussed.  The graph will be presented to the Clinical Medicine Committee for comment on grade distribution, shelf exam allocation, and use of common scale (A, B, C, D, F with or without plus designation).
   
   

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