Minutes 05.12.11

Minutes 05.12.11

University of Virginia School of Medicine
Curriculum Committee
Minutes – 05/12/11

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, Linda Waggoner-Fountain, Bill WilsonMary Kate Worden, Thomas Jenkins, Long Vinh,  Sam ZhaoDebra Reed (secretary)

  1. Role of Medical Students in EPIC.  Sam Zhao presented student  recommendations to the Curriculum Committee for enhancing the role of medical students in Epic. 

    As stated in the document “Competencies Defined for the Degree of Doctor of Medicine at the University of Virginia” (http://www.medicine.virginia.edu/education/medical-students/UME/curriculum/Competencies-IIDR3.pdf/view?searchterm=competencies ), by the time of their graduation, medical students should demonstrate:

    The ability to engage and communicate with a patient, develop a student-
    patient relationship, and communicate with others in the professional setting, using interpersonal skills to build relationships for the purpose of information gathering, guidance, education, support, collaboration and the provision of individualized patient care.

    The ability to record, present, research, analyze and manage clinical information.

    Quality patient care is dependent on health care providers’ efficiently accessing and effectively communicating information about the patient.  Written notes and orders are the most important part of the patient chart.  Written notes and orders should be windows into the clinician’s thought processes – communicating to other care providers what is going on with the patient, why, and what the plan of care is.  For medical students to learn how to communicate in the patient record effectively, they must practice doing so.  Students develop competence by practicing and receiving feedback on their clinical skills, including the writing of notes that communicate their diagnostic reasoning and their therapeutic plan and its rationale, and operationalizing that therapeutic plan through the creation and entry of orders. 

    Both before and after the deployment of the EPIC electronic health record at the University of Virginia, faculty physicians and house-officers have had highly variable expectations of a medical student’s role and authority in documenting within the medical record and authoring medical orders.  We recommend the Curriculum Committee adopt the following universal recommendations around medical student documentation and order entry: 

    1.  In ALL clinical settings, Medical students should document all of their patient encounters within the electronic medical record at the University of Virginia.  


    2.     Medical students should be encouraged to enter patient orders for patients they are participating in the care of. 


    BILLING REGULATIONS AND THE ROLE OF STUDENT DOCUMENTION

    Current CMS regulations state "Students may document services in the medical record; however, the teaching physician may only refer to the student’s documentation of an E/M service that is related to the ROS and/or PFSH. The teaching physician may not refer to a student’s documentation of physical examination findings or medical decision making in his or her personal note. If the student documents E/M services, the teaching physician must verify and redocument the history of present illness and perform and redocument the physical examination and medical decision making activities of the service."

    This means that when documenting to support billing for E/M services, the attending physician may reference the student’s documentation of the patient’s problem list, medication list, allergy list, review of systems, past medical history, past surgical history, family history and social history.

    When documenting to support billing for E/M services, the attending physician MAY NOT reference a student’s documentation of the history of present illness, physical examination, and/or assessment and plan, and rather, must “redocument” these components.

    The Curriculum Committee endorses the students desire to have an active role in EPIC and deems this necessary to the students’ education.  The Clinical Medicine Committee will review the recommendations, possibly invite Dr. Stephen Borowitz to attend and prepare a response to be submitted to the Dean’s Office and Hospital Administration.
  2. Clinical Performance Development.  Eugene Corbett outlined the progress of the Working Group on Clinical Skills Education.    The Group has developed a series of recommendations for CPD. The Committee discussed the progress of the Working Group and their recommendations.   

    The Committee was asked to read the recommendations carefully, consider how best to insure a longitudinal CPD experience for all students, and be prepared to discuss concrete steps at the June 2 Curriculum Committee meeting.

    RECOMMENDATIONS:
     


MCM/MIS/MSI/MBB Testing Recommendations

May 8, 2011

Most recommendations considered beginning for class 2015
Recommendation on summative exam open/close times

  1. Summative exams should open for log-in on Friday at 12:00 noon and close for log-in Sunday at 1:00pm. There is a 4 hour window after log-in to take and finish the exam.
  2. In order to make more vacation time, new material will be taught on Fridays before summative exams.
  3. John Jackson’s office should ensure technical support is available to students over the weekend and particularly on Sunday near closing time.
  4. Systems Leaders will not be designated contacts for technical problems.

Recommendations on exam/quiz score reporting and challenges
Exams (summative assessment)

  1. The process should be implemented with the first summative exam in MCM for SMD15.
  2. The process should be piloted before implementation. If possible, a non-graded anatomy quiz in GI could be the first trial.
  3. Students may challenge a maximum of three questions per exam.
  4. Challenges will be accepted through the online testing system.
  5. Students will have 30 minutes after completing the exam to submit their challenges.
  6. Students will not be given answers or scores before they submit their challenges.
  7. Student review of exams will be done using printed copies that include any answer explanations in the Office of Medical Education until Friday at 5:00pm following the exam.
  8. Exam grades will be posted through Oasis by Monday at 5:00pm the week following (7 days) the exam.
  9. Preliminary grades will not be posted.
  10. Scores will not be made available through the online testing system.

Quizzes (formative assessment)

  1. As per summative assessments, except:
    a)      No challenges accepted (system leaders may always correct any problem questions of which they become aware).
    b)      Quiz grades will be posted by Wednesday at 5:00pm (or within three business days of the quiz closing).

Practice quizzes (ungraded formative assessment)

  1. Students should be given periodic practice quizzes (e.g. weekly).
  2. The questions should closely reflect the style and difficulty of those used in summative exams for that system.
  3. Practice quizzes should be administered through the online system similarly to graded quizzes and exams using appropriate open/close times.
  4. Practice quizzes should contain 15-20 questions for one typical week.
  5. Students should receive immediate feedback for scores, correct answers, and explanations.
  6. No challenges accepted.
  7. Questions that do not reflect those used on summative exams may be made available to students, but to avoid confusion, these should be clearly labeled “Study Aids”, not “Practice Questions”.

Donald Innes
dmr