University of Virginia School of
Minutes – 06/16/11
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, Bart Nathan, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Thomas Jenkins, Long Vinh, Sam Zhao, Debra Reed (secretary)
1. Clinical Performance
Development - 2: Clerkships. Eugene Corbett outlined the
recommendations of the Working Group on Clinical Skills Education in
regard to the Clerkship year.
1. Establish a CPD leadership process in the School of Medicine:
A. Create a CPD leadership committee in the SOM to provide centralized and integrated oversight of CPD design & implementation, administration, program evaluation and accountability.
Recommended CPD leadership committee members:
- CPD-1 Co-Directors
- CPD-2 Co-Directors
- CPD-3 Director
- Clerkship Directors
- Student Medical Education Committee (SMEC) representation
- Clinical Performance Education Center representation
- Overall CPD Director
B. Designate one overall CPD director who reports to the Associate Dean for Undergraduate Medical Education.
This reorganization (A & B) will help ensure that students’ clinical performance education is an integrated, longitudinal and developmental experience.
C. Appoint CPD-2 co-directors who, working with clerkship directors, are directly responsible for oversight of CPD activities within clerkships. This will include providing for clerkship director input, standardized clerkship design & implementation, coordinated administration, program evaluation and accountability.
The CPD-2 Co-Directors are also responsible for overseeing decision making and management as it relates to the following:
· OASIS database utilization in the clerkships
· Financial support issues
· Clerkship accountability
· Faculty development and resident teaching skills programs
· Technical support (website, online cases, etc)
This leadership structure should replace the current Clinical Medicine Committee.
- Standardize clerkship experiences.
The CPD-2 leadership should oversee the design and implementation of a standardized clerkship experience. Ultimately this should emphasize maximum patient care involvement and continuity of student-teacher mentoring. To this end the following should be implemented in this effort:
- Develop clerkship-specific learning objectives
- Approve clerkship-specific student schedules
- Set expectations for the degree of student autonomy
- Limit orientation time/content to maximum of 1 day
- Establish student on-call requirements
Clinical Performance Documentation :
- Provide guidelines/expectations for student note-writing, documentation and review by attending physicians and residents
- Review and coordinate clerkship passports, and establish uniform criteria for sign-off procedure.
- Specify guidelines for utilization of the Student Learning Portfolio for tracking clinical experiences, recording personal reflections, and documentation of student evaluation & feedback by clinical mentors (CPD-1-2-3)
- Assure that daily student-patient contact responsibilities occur from the beginning of and throughout the clerkship period
- Specify the number and kind of clinical case exposure (ED2)
- Require a specified number of independently performed student History and Physical Examinations including write-up (student autonomy issue)
- Set expectations for both inpatient and outpatient patient experiences in each clerkship discipline
- Designate faculty who are available to students throughout each clerkship period who are responsible for individual student evaluation and feedback
- Designate responsibility for attending-student rounds in each clerkship
- Identify specific clinical skills to be learned and practiced throughout the year
- Develop clinical skills workshops in all clerkships.
- Offer Systems-Based Practice experiences in all clerkships (e.g., ethics, medico-legal, interprofessional, health system)
- Encourage teaching-by-student time and include evaluation & feedback on such student performance by attending physician, peers (also a CPD-3 goal)
- Advance attending expectations of students’ clinical performance as the year progresses (developmental principle)
- Maintain basic science learning/involvement in each clerkship
- Ensure continuity of CPD mentoring throughout four years (CPD -1-2-3)
- Standardize clerkship student assessment:
The CPD-2 leadership should design and implement a standard approach to student assessment. It is recommended that clinical performance evaluation should comprise the majority of any clerkship grading procedure, with written examinations contributing less than 50% to the overall grade:
Suggested elements to consider in clerkship grading procedures:
- Shelf/written examination
- OSCEs in all clerkships
- Preceptor evaluation (Uniform Clerkship/CPD-3 evaluation form)
- Mid clerkship evaluation and feedback process/form)
- Resident evaluation
- Peer evaluation
- Self evaluation
- The use of all 12 clinical competency objectives categories
- Proportionality of elements for grading to be determined
- Design a longitudinal/continuity clinical experience
The Curriculum Committee should appoint a subcommittee to develop a plan for the design and implementation of a longitudinal clinical experience for all medical students within the four year curriculum.
Considerations should include any combination of outpatient or inpatient experiences. Multiple selective options should also be considered. For example:
- Weekly outpatient clinic attendance any time within the 4-year curriculum
- A longitudinal clerkship experience
- A longitudinal CPD-3 experience
- Longitudinal care of patients which includes transitional care opportunities (long-term care, nursing home, rehabilitation hospital care)
This longitudinal experience is required in order to ensure that student-patient continuity is contained in the School of Medicine curriculum. This is an essential underlying principle of both contemporary clinical practice as well as that required for clinical performance development education.
The committee discussed these recommendations and the logistics and how to overcome difficulties in implementation. Some type of centralization and standardization of the clerkship CPD experience is necessary. The LCME has mandated creation of a longitudinal experience for the clerkship year. A CPD passport spanning the clerkships is being developed. This passport should satisfy the LCME standards requiring documentation, assessment and feedback and should insure and enhance student clinical performance during the clerkship year.
Difficulties in implementing the longitudinal experience arise from
the multiple clerkships and multiple sites for the clerkship. The
Committee agreed that some variables are difficult to overcome but at
the end of the clerkship year most students have had an equitable
experience. How to better document this and proper provide
feedback to the student was discussed. Concern over bias in subsequent
clerkships if student deficiencies were shared was
discussed. It was suggested that the College Dean’s be made
aware of deficiencies/problems with student clerkship performance and
work to remediate these issues in subsequent clerkships.
Variations in the amount of faculty/student contact hours and patient/student contact hours throughout the clerkships should be addressed. Constraints on physician time and medical privacy/legal issues do have an effect on these issues.
Implementation of the CPD recommendations The CPD leadership
must compile the student expectations for the clerkships especially
looking for areas needing standardization. Expectations and
responsibilities are outlined on the website of each clerkship.
Guidelines regarding the required number of H&Ps, write-ups, and
presentations must be stated. The nature of the required feedback
must be developed for clerkship faculty and be monitored by the
Clerkship Directors for adherence.
School of Medicine expectations for teaching faculty in the clerkships must be defined and faculty must be aware of their teaching responsibilities. Assigning CPD goals and grading policies for each clerkship rotation taking into considering the student’s rotation placement in the clerkship year is necessary.