University of Virginia School of
Minutes – 04/18/13
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, Thomas Jenkins , Jean-Baptiste Maitre, Derrick Thiel, Yassaman Pourkazemi, Elizabeth Bradley, Debra Reed (secretary),
Clerkship Grades. Clerkship Grades submission dates for SMD14 Period 6B were reviewed and it was noted that all were submitted on time with two exceptions a) Acute Care and Perioperative Medicine due to the snowstorm yet within six weeks and b) Psychiatry due to an individual who as of March will no longer be teaching in the Psychiatry clerkship. Fourth year student Tom Jenkins reported that feedback was good and consistently within the 4-6 week time frame, and that it was most helpful especially midway in the clerkships.
2012 CV, Pulmonary, Renal System Review Responses were reviewed by the Committee. The sequence of Renal, Cardiovascular and Pulmonary is anticipated to be the same for 2014. The three systems need to further integrate between systems, i.e. acid-base problems.
Our current Next Generation Procedures and Policies Manual, pg. 14, states “A maximum of 4 hours of pre-recorded lectures may be assigned per week. If more than 4 hours of pre-recorded lectures [PRL] need to be assigned in a given week, a corresponding amount of time needs to be cleared from the scheduled class time (8:10 AM to 12:00 PM) to accommodate these lectures.” After much discussion the Committee agreed that assigned preparation time must be balanced with “consolidation” time and the time for required readings (handouts, texts, articles, etc.) must be considered in the same manner as PRLs. The Committee requests that all systems have a summary of each days required preparation with pages or estimated times noted – a “Week-at-a-Glance."
2012 CV CURRICULUM COMMITTEE RECOMMENDATIONS AND RESPONSE
CV-System Specific Conclusions 2012 & Response From Dr. John Dent (4/10/13) in blue below:
1. System Leadership: The students praised the Cardiovascular System Leadership. They commented repeatedly on the responsiveness of Drs. Dent and Nunez to student comments and concerns. Students appreciated their kind and caring demeanor, and their passion for and skill in teaching.
I plan to attend the entire course again, and I am increasing Sabrina's role in the course.
2. Clinical Relevance: The students praised the clinical relevance of the CV System. From content to process, the material was provided in a clinical context that both reinforced student learning, and continually reminded them of how it is a prelude to their future as physicians.
We are retaining most of last year's clinical material, although based on their feedback we are further simplifying some sections. For example, in EP we have created two larger interactive sessions called "bradycardias" and "tachyarrhythmias" that will replace more segmented talks from last year.
3. Content Delivery: Student praised the short pathology pre-recorded video lectures that Dr. LeGallo created. Some suggested that they be used for Histology content as well.
Bob has agreed to provide a PRL for histology, and Robin has cross-linked histology and pathology in her course outline. The histology lab will be in the large room with 'virtual' slides, run a bit longer than last year, and there will be follow-up questions in a problem set later in the week. Bob endorsed all of these changes.
4. Physiology Content: The strongest concern voiced by the students focused on the Physiology content. Students commented that the learning objectives, assessment questions, delivery, and level of difficulty of the Physiology can all be reworked, in an effort to improve student learning and comprehension.
We are currently reworking the LOs for physiology. The content will be more integrated into the course. Manoj Patel will do cellular EP, and fortunately for us, he has previously taught the students parts of this in the neuroscience course and MSI, so we'll have great continuity. Three other distinguished faculty will take other parts of physiology.
We have a 90% completed schedule and have obtained commitments from 90% of faculty for their time slots. This year an additional focus is trying to synchronize our material better with CPD, meeting scheduled. HTN will be synchronized with the renal section. Cardiogenic dyspnea is likely to be re-covered during a special pulmonary session. There will be a 2 hour in class problem set each week. All questions from last year will be edited, and a number of new ones entered. We hope to have all of this done by end of May.
2012 PULMONARY CURRICULUM COMMITTEE RECOMMENDATIONS AND RESPONSE
Pulmonary-System Specific Conclusions 2012 & Response from Dr. Elizabeth Gay (4/10/13) in blue below:
1. Organization of Content: The students? biggest concern appears to be that of the overall organization of the content in the Pulmonary System. They felt that it was choppy, and jumped around too much. They felt that a stronger foundation of Physiology needs to be established early in the System.
Response: Organization: please see attached schedule for 2013. with more physiology in the first week. Please also see a draft plan of a organizational chart for pulmonary.
2. Clinical Relevance: The students praised the clinical relevance of the Pulmonary System. From content to process, the material was provided in a clinical context that both reinforced student learning, and continually reminded them of how it is a prelude to their future as physicians.
Response: Clinical context remains in place.
3. System Leadership: The students spoke highly of the Pulmonary System Leadership even as they provided constructive feedback about the System. They commented on the responsiveness of Dr. Gay to student feedback. The students found her dedicated and patient throughout the System.
Response: Leaders the same this year, which will allow continuity and progress.
4. Content Delivery: As in Cardiovascular, the students praised the short pathology pre-recorded video lectures that Dr. LeGallo created, and the pathology thread throughout the Pulmonary System.
Response: Dr LeGallo is preparing short PRLs for the major topics of pulmonary pathology this year.
5. Learning Objectives: The learning objectives need refinement and they need a stronger and more direct link to assessment questions.
Response: System leaders will work with Michelle Yoon to personally write LOs for all sessions, allowing better planning across the system. The system leaders will also then be able to link questions more directly to LOs, with a plan to write questions over the summer with individual faculty. By doing more of the LO and question work, we hope to free faculty to work on engagement in their sessions.
2012 RENAL CURRICULUM COMMITTEE RECOMMENDATIONS AND RESPONSE
Renal-System Specific Conclusions 2012 & Response from Dr. Kambiz Kalantari (4/10/13) in blue below:
1. System Leadership: The students spoke highly of the System Leaders. Specifically, they found them to be approachable, helpful, and understanding. Students also appreciated their visibility in the classroom, as well their stellar teaching.
Response: Dr. Rosner and I are planning to continue to attend all sessions this year and will be available to address students’ concerns in and out of the classroom throughout the length of our system.
2. Learning Objectives: The students felt the learning objectives in Renal could be refined. They commented that they were too vague, and didn't link well to lectures or assessments. This made it difficult for student to know what to focus on learning.
Response: We agree with the comments made regarding some LO’s and are currently in the process of completely revising them. The new LO’s will be detailed, relevant and mostly of higher levels of Bloom’s taxonomy. I have already contacted Casey White and obtained her presentation on how to write LO’s which I will discuss with all the faculty. I am also meeting with Michelle Yoon to work on our LO’s on 4/15/13. Some of our faculty have already attended Casey White’s workshops and are currently working on their LO’s.
3. Frequent quizzing: The students appreciated how the frequent quizzing in the Renal System helped them stay on top of the material. However, due to vague learning objectives, it was difficult to know how to prepare for assessments.
Response: We will make sure there is clear connection between all LO’s, the material covered in our system and all practice, quiz and exam questions.
4. Clinical Relevance: Again this year, students praised Renal for it’s clinical relevance. The course content integrated the basic science and clinical content well, supporting student learning of the material.
Response: We will follow the same pattern in covering our material as we have in the past, moving from physiology to pathology to the clinical syndromes and management issues. Since we have moved ahead of CV system this year, some new content has been added to our system. This year we will have two additional days which will be partly used to cover the new material.
5. PRL’s: Students commented that they found the PRL’s to be of high quality, and useful to their learning. The students appreciated applying the material in class. They did not however seem to support the use of even more PRLs in Renal, in an effort to free up class time for active learning sessions
Response: We are not planning to add new PRL’s except in case of the newly added content (e.g., regulation of blood pressure). In fact, we have added a few short review sessions before case discussion session in the classroom to bring up the highlights of what is covered in each PRL. This is was in response to some verbal feedback we received from the students last year.
Core Clerkship Elements. Proposed revisions to the Core Clerkship Elements were discussed amended and approved.
A core clerkship is a required academic period of instruction based in clinical experience in which the medical student learns and participates in patient care broadly, but is generally focused on a single medical discipline. The experience grows out of a set of knowledge, skills, and attitudes based on the Twelve Competencies Expected of the UVA Physician.
Elements Expected of All Clerkships
Orientation, learning objectives and learning materials.
Direct participation in and observation of patient care with resident/fellow/attending physician and including daily discussion of evaluation, differential diagnosis, treatment, and follow-up.
Daily medical student presentation of patient history & physical examination (or follow-up) to supervising resident/fellow/attending physician.
Regular patient-based formal teaching such as Clerkship Directors (or Designee) Rounds, student morning, report or Ethics Rounds
Regular teaching conferences, e.g. Grand Rounds, Clinical Pathologic Conferences, journal clubs
Clerkship Requirements (electronic record of clinical exposure and experience)
Self-learning: student should review and personally perform patient's medical history and physical examination, review imaging and pathology laboratory studies, and read about the patient's disorder and read about diagnostic and treatment options. Reading may include relevant basic science, anatomy and procedures.
Student communication to team in oral and written format
Direct teaching time with an attending physician at least three days a week
Evaluation of knowledge, skills, and attitudes both formative and summative relating to the clerkship
Other recommended elements of clerkships:
Clerkship designated learning events, e.g. radiology rounds
Exercises in Clinical Problem Solving, e.g. CLIPP and SIMPLE cases, Virtual Patient
New patient admission opportunities, e.g. night call, night float, day on call
In ward rotations, student should experience the life of a residen
Workshops for clinical skill learning
OSCE type evaluations
Self Directed Learning (SDL) in CPD
Nancy McDaniel proposed SDL activities across CPD.
CPD-1 Every student determines their own question/ rom the case/skill/etc. One student presents to the group in depth (about 15 minutes or so and articulates references used at the next meeting of CPD group. A second student gives a 5-minute presentation on their topic at the next meeting. All students record topic/question that they chose and researched in their e-portfolio. Every student records an SDL every week of CPD. Presentations occur every 3 weeks for each student during which they receive feedback from the group and the mentor.
CPD-2 Every student on clerkships is expected to read about their patients and research questions that come up in clinic, on rounds or in procedures. Each student will research and record 3 topics/SDL per week in Oasis. This will be recorded as a list that does not require sign-off as it is student directed.
CPD-3 Each student will research and record 3 SDLs per week while on the ACE.
Anne G. Tuskey, M.D. was approved to replace Brian Behm, M.D. as one of the leaders of the Gastrointestinal System. She will join Neeral Shah and Sabrina Nuñez and is enthusiastic about assuming Brian's role. Anne has already worked with Brian, Neeral and Sabrina and we feel confident the new team will make a great GI System. Financially, Anne will pick up the funding as of May 1st that would otherwise have gone to Brian. Both the Chair of Medicine and the GI Division Chief support Anne as a GI system leader.
We are sorry to lose Brian Behm as a GI system leader. His teaching was greatly admired and he worked diligently to integrate the pharmacologists into GI, making it a successful model for cardiovascular. We hope you will continue to teach in GI to whatever degree your clinical work allows as you are a great model for our students. Thank you.
Donald J. Innes, M.D.