University of Virginia School of
Minutes – 07/05/12
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, Jennifer Hsu, Debra Reed (secretary)
Core Clerkship Schedule (Class of 2015). The Curriculum Committee discussed recent e-mail correspondence received regarding the proposed core clerkship schedule for the Class of 2015. Concerns from Preston Reynolds, Peggy Plews-Ogan, Linda Waggoner-Fountain, Bill Wilson, Mo Nadkarni, Evan Heald and Sean Reed were outlined. These faculty, as well as Gene Corbett, expressed concern regarding the modification of the Ambulatory Internal Medicine (AIM) portion of the Internal Medicine clerkship from a four-week to a three-week experience. Among their concerns were 1) AIM is a highly successful clerkship in it’s present four week length; 2) proposed changes would decrease the effectiveness of AIM; 3) overall primary care experience would be decreased; 4) move to subspecialty rotations would be in direct opposition to the nationwide need for primary care physicians; 5) student ratings of AIM are among the highest for any of the clerkships; 6) faculty mentoring is very well received by the students during AIM; 7) students choosing primary care as their profession may be impacted if there is less clerkship time spent in primary care 7) preparing more students to choose Primary Care practice will be necessary to meet the needs of the Affordable Care Act .
These concerns were brought to the attention of the Committee and discussed at length. It was noted that while AIM will be reduced by one week in this proposal, the mid four-week workshops should be incorporated into other areas of the Medicine clerkship experience and the net loss of time in AIM is actually less than one week. The Committee also agreed that if the curriculum were fine tuned, this schematic should result in sufficient time for AIM and not hamper the mentor/student relationship. A student on the Committee agreed that three weeks versus four in AIM should not diminish the student perception of AIM.
It was noted that the mission of the UVA School of Medicine is to produced undifferentiated physicians – to prepare students for all types of practices, e.g. research, primary care, surgery, specialty medicine, etc.
Varying the length of other portions of the Medicine 12 week experience were discussed and deemed less appropriate.
Operational issues, i.e. number and caliber of preceptors was discussed.
A weekly afternoon clinic experience during the inpatient portion of the medicine rotation will also be explored, further enhancing the students’ outpatient experience.
The Committee requests that students participating in the inpatient portion of the medicine clerkship at an outside institution, e.g. Veterans Administration Hospital, spend three weeks on rotations inside the UVA Health System and three weeks at the outside rotations – a model similar to that used in Surgery. The Medicine clerkship is asked to implement “Tele-rounds” between UVA and the outside sites by the Curriculum Committee.
The Committee voted on the clerkship proposal and was approved unanimously by those in attendance. The total combined tally including email votes is 13 yes, 4 no, 2 not voting.
LCME Requirement Regarding Faculty. An LCME requirement regarding faculty appointment and supervision was discussed. The UVA SOM will be required in the upcoming LCME review to
a) List any required clerkship rotations in which students may be supervised (assessed or graded) by physicians who are not medical school faculty members. What steps are taken to provide faculty appointments to those physicians participating as teachers/supervisors in required clinical clerkship rotations? C) Where direct teaching of students is carried out by individuals who do not hold faculty appointments at the medial school, describe how the teaching activities provided by these individuals are supervised by medical school faculty members. Comment on the adequacy of the supervision of medical students during required clinical experiences. Discuss the effectiveness of efforts to ensure that all individuals who participate in teaching, including resident physicians, graduate students, and volunteer faculty members, are prepared for their responsibilities in medical student teaching and assessment and that supervision is provided by members of the faculty.
To this end, all preceptors in AIM and Family Medicine must become faculty of the University of Virginia, all faculty must attend faculty development sessions on a yearly basis, and clerkship directors must actively observe teaching in the outpatient clinics on a routine basis.
Clerkship Subject Exam Policy. Clerkships using USMLE subject exams will be required to develop a standardized grading policy. The Subject Exam pass/fail decision point should be consistent over all the clerkships. Casey White recommends the Hofstee Method for determining this point.
The Hofstee Method was reviewed and it’s use approved for the Class of 2015. For consistency the most recent “Recommended Hofstee Passing Grade” will be used. This will be discussed at the next Clerkship/Post-Clerkship Committee meeting and a formal policy will be created after that discussion.
[Each clerkship using the USMLE Subject Exam in 2012 - 2013 must have a stated pass-point for the Subject Exam. Please submit your Subject Exam pass-point to Debra Reed at email@example.com]
Mid-Clerkship Examination. Nancy McDaniel, Don Innes, Casey White and Jim Martindale will be working with the clerkship directors to develop mid- clerkship examinations for the medical students.
Donald J. Innes, Jr., M.D.