University of Virginia School of Medicine
Curriculum Committee
Minutes – 05/03/12

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,  Jeremiah Garrison,  Nicole Cresce, Guests:  Sabrina Nunez, Richard Pearson, Debra Reed (secretary)

1. Article of Interest: Charles G. Prober,  Chip Heath:  Lecture Halls without Lectures - A Proposal for Medical Education, N Engl J Med 366:1657-1659, 2012
   
   
2. Microbes System.  Chris Burns discussed the highlights of the 2011 system evaluation and the  plans for improvements in 2012.
   
   Microbes & the Immune System Specific Comments (from the report):
   
   1.         System Leadership: The students felt strongly that the system leadership in MIS was responsive, reassuring and genuinely caring of the students. They felt Drs. Burns and Pearson were excellent teachers, who genuinely cared about student learning.  The students also appreciated the effort made by the System Leaders to communicate with them and provide clear expectations for the course. The students recognized the great effort put forth by Drs. Burns & Pearson.
   
   2.         Learning Objectives: The students remain sensitive to variations in the quality of the learning objectives. Student comments reflect that the quality of the learning objectives in MIS can improve further in terms of specificity and linking to resources.
   
   3.         Learning Activities:  The students’ comments reflect the impact that well designed TBL sessions have on student learning. The System Leaders put forth a concerted effort to provide high quality TBL sessions, with much success.
   
   4.         System Organization: Continuing the effort to thoroughly integrate the material across MIS would be beneficial to student learning. Students commented that continuing to refine the balance between the big picture and the details would improve the System overall.
   
   
   5.         Clinical Relevance and Integration: Students commented that they appreciate when the basic science material was put into a clinical, “real world” context for them. This was accomplished with varied success in MIS.  The percentage of sessions taught by more than one faculty member (approximately 30%) illustrates the effort put forth in MIS to provide an integrated System. Every effort should be made to continue this effort and improve it further.
   
   System Leader Response: 
   MIS has just finished its second iteration after extensive revision brought together four weeks from “Molecular and Cellular Medicine” (MCM) plus three weeks from “Microbes: The Essentials” (MIC) into a highly integrated six week system. This required substantial organizational effort to provide a coherent system that presented diverse content in a coherent manner, while simultaneously reducing class time by one full week (about 15%). MIS also pioneered the implementation of XCREDiT with the able assistance of Dr. Regina Seitz.
   
   The Evaluation Report identifies several strengths in MIS and also areas for improvement. Strengths of MIS include clinical context, integration, faculty, and system administration. Developing learning objective-driven sessions that are well linked to assessments, and increasing active learning are identified as areas for improvement.
   
   Clinical Context
   In the overall curriculum, MIS lies at the junction between foundational and organ-based systems. MIS was designed to help students make this transition by presenting foundational material in a clinically relevant context, mainly by using case studies and team teaching. Students rated items reflecting this goal highly including “Instructor provided link of how the details fit into the larger picture of clinical care” and “Material presented in the context of clinical care”. MIS also sought to bridge this gap by promoting curricular continuity at broad content levels. Students rated MIS highly in “Links to prior material in System” and “Links to material in prior Systems”.
   
   Integration
   For the first time ever at UVA students learned microbiology, immunology, pharmacology and other disciplines related to infectious disease together, on the same day, and in some cases, in the same session. Students highlight this particular aspect of the system in promoting their learning and retention of course material. Students also remarked on the strong relationship between activities in the morning hours and the afternoon CDP small groups to which many of our “wet-lab” activities were transferred. Students scored the system highly on indicators of integration including “Connections between basic and clinical science” and “Inclusion of multiple disciplines”.
   
   The Faculty & System Administration
   Table 1 lists teaching activities from 10 different departments in the system. However, because of departmental organization and the OASIS data set, this doesn’t fully reflect the great diversity of faculty who contributed to the course. There were over 60 scientist and clinician faculty from over 20 departments or administrative divisions within large departments, teaching in 10 curricular threads in the course. Nearly a third of sessions were team-taught by interdisciplinary faculty groups. The students evaluated faculty teaching in the system highly with an average of 3.5 and the average student rating of “Faculty were engaged and enthusiastic” was 3.9. These data emphasize the greatest strength of the course - the outstanding faculty who join together to help students learn.
   
   Learning Objectives
   Students report that the learning objectives and their related resources were a weakness of the system that we plan to improve next year. In addition to further faculty development in this area, vetted learning objectives from professional groups will be adapted and linked to appropriate resources. Examples are the Infectious Disease Society of America and Association of Medical School Microbiology and Immunology Chairs.
   
   Improvements in multiple-choice questions used for practice, quizzes, and exams will require additional support because materials are not readily available from outside sources. We will need support from the Office of Medical Education and particularly experts in item writing to help faculty improve in this area. In MIS we drew most of our 500+ questions from the same pool ensuring that questions given for formative assessment reflected those on the summative examinations. Students were appreciative of this feature of the system.
   
   Learning Activities
   Faculty put a great deal of effort into adapting their teaching to meet NxGen learning goals. MIS emphasized Team-Based Learning as our main active learning strategy with 5 two-hour activities in this six-week system. We plan to increase TBL further in the next two years eventually reaching 8-10 TBL activities. Faculty also endeavored to bring active learning into the classroom in other sessions. The report notes that “lecture is still a dominant form of instruction”. However, the data in Table 3 show that lecture accounted for only about half of the activities in the system (47% scheduled and 55% observed). This is consistent with efforts to shift from lecture to non-lecture formats.
   
   As scheduled in OASIS, MIS planned to have 45% active learning, close to the 50% goal. Some of the activities didn’t meet the SOM standard for active learning with 31-40% observed. Instructional design support and further development of integrated team-taught sessions will help further close this gap.
   
   The Committee askedthat to maintain consistency and continuity for all the systems, the innovations proposed (i.e. substantial increase in TBL sessions) should be discussed at the System Leaders Retreat scheduled for May 9, 2012.  Are two TBLs per week too many?  Due to the decreased Blooms taxonomy scores, MIS System Leader were asked to review learning objectives with the objective of moving up the Blooms to more application and analysis.  
   
   The Committee asked that to maintain consistency and continuity for all the systems, the innovations proposed (i.e. substantial increase in TBL sessions) should be discussed at the System Leaders Retreat scheduled for May 9, 2012.  Are two TBLs per week too many?  Due to the decreased Blooms taxonomy scores, MIS System Leader were asked to review learning objectives with the objective of moving up the Blooms to more application and analysis.     The System Leaders will continue to meet with the faculty of each week to improve the integration of material.   This has led to more joint teaching and simultaneous sessions in which both basic science and clinical medicine is taught.  In addition, the microbiologists have sat in on the immunology sessions which has led to improved integration and reinforcement of material.
   
   The Committee thanked the System Leaders for their work in this evolving and well-received system.  The Committee also endorsed the proposed recommendations for improvement.
   
   
3. Thread Leaders.  Requests have been received for the addition of two more thread leaders.  CPD asked for a thread leader for ultrasound to be added and MSI requested a thread leader for Rheumatology.    The Committee agreed that the addition of the thread leaders is not possible at the present time.  The current thread leader list will be streamlined.  The proposal is to have thread leaders meet on a biannual basis as a group, joining the system leaders meetings, and they will be represented on the Curriculum Committee. Some faculty development may be necessary for their work in monitoring threads in X-Credit. 
   
   This led to a committee discussion of the extent to which many CPD activities, i.e. lumbar puncture, sonogram, etc. should be taught.  This is also now under review by the CPD leaders – each clinical skills is be being looked at to determine its best placement within CPD-1, 2 & 3. 
   
   
4. Clerkship Schedule.  Further details of the 12-week block clerkship schedule   were discussed.  A proposal to add a CPX/OSCE exam prior to the beginning of the clerkships, and after each of the 12-week blocks was presented.    The first would establish a baseline and evaluate the H&P skills learned in CPD-1. The final CPX would assess the H&P skills learned in CPD-2 (the clerkships).  The OSCE/CPXs after the first, second, third and fourth blocks will have a focus on general medicine and surgical H&P skills that should be common to nearly all clerkships. These CPX/OSCE’s will allow monitoring the student’s progression in the clerkships with formative feedback.  The exam prior to the clerkship would be a part of the Transition Course.  The final CPX exam would take place during DX/RX.  The final CPX/OSCE would be comprehensive and include elements of all clerkships. The mid-point CPX/OSCE could be more extensive as there is more time available.  College dean meetings, mentor meetings, and workshops, etc. could be held during the week long mid-point session. The Committee approved of the proposal that will be further developed and then brought back to the Committee with more detail.
   
   The clerkships must offer a mid-clerkship formative evaluation to the students.  This evaluation must be directly tied to the clerkship learning objectives.

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