Minutes 04.11.13

Minutes 04.11.13

University of Virginia School of Medicine
Curriculum Committee Executive Management Group
Minutes – 04.11.13

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, Debra Reed (Secretary)

  1. CPD-1 Follow-up Report 

    Clinical Performance Development (CPD) Review: CPD-1(b), Spring 2012

    1. Rebalancing the cases and the Hx&PE experiences – fewer or shorter cases and more Hx&PE experience.

      Response: For the Class of 2015 we substituted several cases with one-on-one H&Ps during which the MD mentor supervised & provided feedback to each student individually in the group.  If time allows, we plan to schedule two observed H&Ps for the Class of 2016.

    2. Increase the number of hands-on physical examination skill instructional sessions in which feedback is provided. Construct exercises that build in practice of learned examination skills as the year progresses and new skills added.

      Response: We have provided explicit instructions for groups to practice physical examination skills during any remaining time during CPD sessions.  We plan to have either an OSCE through the CSC this semester or a more informal skills practice session in April in small groups in which each student will be randomly assigned a task to demonstrate (eg, upper extremity examination) to the group & then will receive feedback subsequently. 

    3. Criteria for achieving a “passing” grade in CPD-1 must be defined and distributed to all CPD faculty and students, and posted on the course website. These requirements must define the components of a student’s grade and how the components are compiled to create a final P/F grade.

      -Attend each weekly CPD small group session
      -Prepare for the sessions by doing required readings, etc as outlined in each weekly syllabus
      -Actively participate in discussions and skills activities during each CPD small group
      -Interview the "case patient" & orally present the following week (once every 6 weeks for each student)
      -Research & present an SDL (once every 6 weeks for each student)
      -Perform a comprehensive patient history
      -Perform a complete & proficient physical examination
      -Perform self-assessments for each activity
      -Provide peer feedback for each activity
      -Complete e-SLP entries in a timely manner
      -Attend CPD lectures
      -Pass OSCE scenarios each semester
      -Act with professionalism and respect for all patients, staff, and fellow students

    4. Levels of competency [expectations] must be defined for each third of the course and evaluated in the written summative of the student’s progress to provide encouragement and allow for corrective action when needed. 

      Response: Expectations of students are outlined in weekly syllabi's learning objectives.  In addition to feedback received in-person at week's CPD small group session, a formal written evaluation of  each student is completed by mentors for each third of the course.  This evaluation specifically includes feedback regarding skills development and provides opportunity for constructive commentary as well.

    5. CPD-1 course is graded Pass/Fail, the Curriculum Committee asks that additional assessment of student procedural skills as measured against the expectations (learning objectives) be incorporated.  A periodic written summative of the student’s progress is required. Assessment should include attendance and level of participation of each student. 

      Response: Please see the response to question 4, which includes assessment of procedural skills as well a written summative.  Attendance is mandatory for all students every week.  Every effort is made to shift the student to a different small group on another day of the week if they cannot attend their own.  Participation in skills sessions is also mandatory.  Each students is expected to practice each skill, whether history-taking, physical examination, or procedural, in small group. 

    6. Active learning experiences must occur with increased frequency. These are defined as experiences in which the student determines their own learning objective(s) and selects resource(s); presents, and is critiqued, must occur more frequently – an objective of 2 students/week, e.g. in the course of 15 weeks each student would have 5 such active learning experiences.

      Response: One student each week presents an "SDL" (student directed learning) presentation of his or her chosen topic on a rotating basis.  These learning/teaching opportunities are about 15 minutes in duration, & students are strongly encouraged to use primary literature.  A reference list is a mandatory part of the presentation.  Also in the course of each week's case discussion, students typically do several spontaneous internet searches to seek out answers to questions raised in the unfolding case discussion.

    7. Procedural skills, e.g. ultrasound, NG-tube placement, synovial fluids, etc. should be rebalanced with the need for additional time for H&P skills training, practice and assessment.

      Response: Several procedural skills; eg, urinary catheterization as well as several case (see above) have been eliminated to make time for additional H&P practice sessions.

    8. Development of a mechanism to allow students to experience typical clerkship rounding experiences in CPD-1 to raise student awareness of learning and practicing H&Ps and presentation skills is suggested.

      Response: We are discussing this possibility with the Medicine Clerkships Director.  Logistics are challenging as medicine rounds occur in the mornings, during pre-clerkship didactics.  Weekends may be a possibility, but rounds occur at a different pace & intensity, and "learners" (including residents and clerkship students) are limited to 8 per attending.  Other options include addressing some of these topics and offering opportunities during the Transitions Course, summer break, etc.

    9. Third year/fourth year students might be recruited to emphasize the importance of learning H&P/presentation skills to first year students. They could also help students outside of class with the practice of these skills (possibly a College activity).

      Response: We are currently planning two possible options in this regard.  The first would be a CPD Phase 3 requirement that each student returns to their original small group to assist with a case discussion and/or physical examination practice session.  The latter would be particularly helpful to the remaining five students when the mentor is away with a single student for the observed H&P.

      The second option, probably more optimal but also more logistically challenging, would be a formal teaching elective for credit in which the 4th year student would develop their own curriculum for the PE teaching sessions while the mentor is with individual students to further foster development of H&P skills.  The 4th year student would also then receive evaluations/feedback from preclerkship students regarding the teaching effort.
    10. Identify points in CPD where basic science is integrated with clinical care.

      Response: Every case integrates morning didactic content with clinical reasoning, decision making, & care.   On average the CPD curricula includes 50-60 case discussions over the 18 month duration of the first phase.
  2. Student Sign-Up process in Clerkships.  The group discussed how to make sure all students have access to the sign-up process during clerkships for extra activities.  At present the students are given placement in these activities on a first come – first served basis and students must respond to e-mails to sign up while participating in other clerkship activities. The SIM Center has a policy that seems fairer to all students.  This policy will be shared with the clerkship directors and coordinators as suggested best policy for clerkship activities. Student groups are encouraged to use this process as well.
  3. Shortage of Family Medicine and Ambulatory Internal Medicine Preceptors for Students.  Jill Clark recently reported a shortage of preceptors in FM and AIM when students re-enter the class from the MSTP program etc.  The Committee suggests that Culpepper physicians recently added to the University Physicians Group will be asked to participate in FM and AIM helping to alleviate this shortage in future years.  FM and AIM are encouraged to continue networking to increase the pool of preceptors involved in both these programs and to contact the Dean’s office if help (encouragement) is needed.

  4. Patient Safety Learning Objectives for Clerkships.  Michelle Yoon continues to work with Margaret Plews-Ogan to better delineate the patient safety learning objectives and ensure that resources are linked to these objectives.  As thread leader, Dr. Plews-Ogan is asked to work with course, system and clerkship directors to integrate the patient safety learning objectives where appropriate. 

  5. Student Consent/Options for Medical Education Research.  For all students participating in medical education research activities, the policy for opting out of the activities must be clearly conveyed to the students and faculty involved.  All grant proposals must state that students are permitted to opt out of the studies if desired.   System/Course/Clerkship directors should also reiterate this policy to anyone developing a grant application that involves their area.  Individuals developing grant proposals must contact those System/Course/Clerkship leaders/directors involved for approval prior to submission of the grant application.   

Donald J. Innes, Jr., M.D.
Debra Reed