University of Virginia School of Medicine
Curriculum Committee
Minutes – 08/16/12

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Megan Bray,  Donna Chen,  Thomas Gampper, Peter Ham, Donald Innes (Chair), John Jackson, Keith Littlewood, Nancy McDaniel, Mohan Nadkarni, Bart Nathan, Selina Noramly,  Linda Waggoner-Fountain, Casey White,  Bill Wilson,  Mary Kate Worden, Courtney Chou, Jennifer Hsu,  Brandon Hunter, Guests:  Elizabeth Bradley, Debra Reed (secretary)

1. Announcements.  The Curriculum Committee welcomes Selina Noramly who was recently elected Co-Chair of the Preclerkship Committee.
   
   
2. Comprehensive End of Pre-clerkship Phase Evaluation Summary (August 2010-December 2011).  Elizabeth Bradley, author of the report, discussed the report findings with the Curriculum Committee.   This is the first comprehensive package of evaluation data for the Next Generation Curriculum.   Suggestions for improving this report in subsequent years to be more useful to the Curriculum Committee and System Leaders are welcomed.  Many lessons were learned during this evaluation of the first 18 months of the Next Generation Curriculum and improvements have been incorporated into the 2011-12 evaluations.  Determination of hours spent in various activities has been refined and can be misleading in the early reports.  The Committee noted differences in mean scores for formative versus summative exams in some systems.  Whether this difference was statistically significant was discussed.  It was also noted that data obtained for the individual systems was remarkably consistent.  Differences in observer versus student perception of activities were also noted.  Classification of activities in Oasis has also been vastly improved since the first iteration of the Curriculum resulting in more accurate data for 2012-13. Some of the data that is self-reported by students and the lack of laboratory observation may contribute to inaccuracies in some of the numbers on the report.    Students almost always reported more hours of active learning than was reported from data obtained from Oasis and the observers.
   
   Active Learning.  The Committee discussed the LCME definition of active learning and how that requirement is covered in the Next Generation Curriculum.  The Team Based Learning Activities (TBLs) now in place does not completely meet the LCME definition.  The Curriculum will be explored for other areas that do meet this requirement or ways to modify TBLs to make them conform to the LCME standard.
   
   
   

   SPECIAL INSTRUCTIONS FOR SECTION II:  EDUCATIONAL PROGRAM FOR THE M.D. DEGREE
   Definitions:
   Active learning:  the process by which a medical student 1) independently, or collaboratively with his or her peers, identifies his or her learning objectives and seeks the information necessary to meet the objectives and/or 2) contributes to the learning of a group with information that he or she prepares and discusses.  In active learning, the learner has a role defining his or her own learning outcomes or those of his or her peers.

    
3. Clerkship Administration.  The Committee reviewed a revised job description for the clerkship director.  A suggestion to include “timely” reporting of student grades will be incorporated into the final draft.  Members were asked to submit any other concerns/changes to Don Innes by Monday.  A final draft of this document will be forwarded to all Clerkship Directors.
   
   
4. Medicine Clerkship Schedule for SMD 16. 
   
   
   The committee reviewed the proposed medicine clerkship schedule for SMD16.  This schedule would incorporate 1-2 afternoons of various specialty clinics into the clerkship.  This would provide students with valuable exposure to these areas early, while still allowing further exploration during fourth year selectives.
   
   Medicine Clerkship:
   Two three-week service rotations
   2-4 students  at Salem for 3 weeks; UVA for 3 weeks
   Two afternoon clinics/week  (cardiovascular; hematology/oncology; gastrointestinal; endocrine; pulmonary; rheumatology; etc.)
   *  Similar organizational structures are used successfully in the Surgery and Pediatric clerkships.
   *  Medicine shelf-exam administered at the end of the 12-week period.
   *  Medicine grade (Gen Med; AIM) is A-F; EM is also A-F separate.
   
   The Committee discussed various scenarios regarding this plan. If scheduling details and student tracking issues can be worked out, the Committee urges implementation of the plan.    Faculty development will be necessary to help faculty evaluate students that are only seen in clinic for four hours each week over a three-week period.  Student duties in afternoon clinics were discussed and will be discussed further with Internal Medicine administration. Members were asked to forward any other concerns by e-mail to Don Innes.
   
   The Committee supports having students rotate to Salem and back to UVA for thee week during the General Medicine portion of the rotation so that all students have a portion of Medicine at UVA.
   
   Grading for the now longer three-week Emergency Medicine clerkship will become A-F rather than Pass/Fail.  For this extended Emergency Medicine clerkship, student will sometimes be assigned to alternative shifts (evenings/night).
   
   Grading for Surgery, Medicine (including AIM), Ob/Gyn, Pediatrics, Neurology, Psychiatry, Family Medicine, and Emergency Medicine will be in the A, B, C, D, and F format. Surgery Specialties and Peri-Operative Medicine will be Pass/Fail.
   
   Although some concerns about specialty clinics, e.g. assignment and monitoring of clinic students; faculty assessment of students; clinic capacity, were expressed the 3-3 rotation format is least disruptive; allows for a more comparable experience for students assigned to the Salem VA rotation (all students will have a minimum three week UVA experience), and easiest to administer. 
   
   One afternoon clinic related to the student's service (Heme/Onc in-patient and Heme/Onc clinic)  and one to a second specialty (e.g. Cardiovascular) is the goal. 
   
   An alternate plan using a 4-2 rotation format is "choppy" for 1/3 of the students; does not address the General Med issue at Salem.
   
   
5. Clerkship/System Evaluations.  The Clerkship Evaluation form is being honed to combine the checklist with the previous version of the clerkship evaluation.  A draft of this evaluation form will be circulated to the Curriculum Committee next week.    All clerkships will be evaluated this Fall by the full Curriculum Committee. The Curriculum Committee will also evaluate all systems during the Winter/Spring months. The Committee would also like to review and meet with the directors of Dx/Rx, the Transition Course, Orientation and ACE requirements.
   
   

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