University of Virginia School of
Minutes – 10/03/13
Pediatric Conference Room, 4:00 p.m.
Present (underlined) were: Gretchen Arnold, Stephen Borowitz, Megan Bray, Donna Chen, Peter Ham, Donald Innes (Chair), Sean Jackson, Keith Littlewood, Nancy McDaniel (acting Chair), Bart Nathan, Sabrina Nunez, Theresa Schlager, Neeral Shah, Amita Sudhir, Linda Waggoner-Fountain, Casey White, Bill Wilson, Mary Kate Worden, Yasmin Pourkazemi, Jean-Baptiste Maitre, Tom Jenkins, Debra Reed (secretary)
Transition Course Review. Nancy McDaniel, Transition Course Director, outlined the summary of the 2013 Course and potential changes for 2014 (see below).
The Transition Course 2013 was generally well received. Students understand the importance of teamwork in providing excellent patient care and the role of communication in effective teams. They were grateful for opportunities to hear from students about the clerkships and about residency programs from the Program Directors. Students particularly appreciated the clinical skills sessions, but it was clear from both the Transition Course 2013 evaluations and the intern survey conducted earlier this year, that students want more skills and more opportunities to practice those clinical skills to reduce their anxiety about moving from the classroom to the wards.
Although not actually part of the Transition Course, we offered optional weekend rounding from mid-September to late November with Medicine, Pediatrics, and Psychiatry teams. Approximately 90 students have signed up thus far for this pilot program. Of those who have evaluated the experience, over 90% rated “increased their understanding of the various roles of the healthcare team” and “increased their understanding of the in-patient process” as “valuable” or “very valuable”. A whopping 97% would encourage next year’s class to participate. We will survey participants again three months into their clerkships to determine whether this should become a required activity.
Although no final decisions have been made, we met with Gary Owens to consider how we might present a more streamlined version of the Transition Course to returning MSTP students.
Add Norm Oliver’s personal bias survey as one of several surveys during the course (along with Advocacy and USMLE Step 1 prep surveys)
Expand chest X-ray presentation slightly (to 2 hours) to provide more time for cases
Expand the number of skills training opportunities (incorporate Building the Team)
Offer IPE sessions but streamline as noted above and add:
· Short session about a patient experience before Dr. Peggy Plews-Ogan’s safety session · Two afternoon sessions on HeArt of Medicine with SON · Add a tour of the hospital wards of students’ first clerkship rotation accompanied by current clerkship students and eliminate one student panel · Continue the required trainings (EPIC, mask fitting, ITOSCE) · Incorporate Dr. Steve Borowitz’s EPIC talk into Dr. Nancy McDaniel’s overview · Following required training, provide optional scavenger hunt with 4th-year student assistance to provide time to practice and help make it a more “real life” experience
· Reconsider whether to offer the outside physicians panel per Dr. Meg Keeley · Reconsider second student panel related to individual clerkships (perhaps incorporate this information into small group meetings prior to hospital tours) · Downsize number of participants on residents panel
Move Residents “Do’s and Don’ts” presentation to follow hospital tour
Provide the fatigue mitigation session as a PRL (important but can then be easily incorporated into special session for MSTP students)
Eliminate Healer’s Art session (SMD16 students were introduced to this session during Cells to Society)
The transition course strives to alleviate student anxiety about entering the clerkships year. Twenty-nine percent of the students reported that they were more confident about their readiness for the clerkships after the transition course while 66% reported no increase in confidence.
Nancy McDaniel explained that the seemingly redundant sessions in the transition course are in fact expanded sessions with a focus on the clerkship/postclerkship period, i.e. Patient safety by Margaret Plews-Ogan.
The students are informed of appropriate dress codes in both the School of Medicine and the University Hospital during the Transition Course, however, in response to concerns from some faculty on the Committee, this will be enhanced next year. Students will be specifically reminded that appropriate attire is required for orientation day on all the clerkships. Use of cell phones in patient care settings was also discussed. Student may in fact be researching patient care on their smart phones or answering a page while in view of patients, both are acceptable uses of the phone but this should be explained to the patient when appropriate and delayed until after leaving the patient if possible. Talking/texting on the phone is prohibited during all patient encounters.
Cells to Society. Elizabeth Bradley outlined the Cells to Society course review submitted by course director, Marcel Durieux (see below):
The students overwhelmingly liked the course and found it a helpful introduction to medical school. The few dissenters generally would have preferred to see it shorter and more rigorous (this will be addressed next year by a summative test).
As to specific areas, the resource fair had mixed reviews. Most people liked it but some felt that it was too crowded, too confusing or too long. The field trips were evaluated very well, with only a few students feeling that they were not particularly relevant. One issue that was mentioned a few times both for the field trips and the resource fair is that some of the presenters did not tie it in to diabetes as well as they could.
The session on Art and Medicine, in a completely new form this year was evaluated as being very good, with quite a number of students asking for more time for the topic. Healer’s Art, as last year, was loved by a lot, and not liked by another lot. The patient presentation of a poor outcome was a very emotional experience for many of the students – as it was intended to be.
The faculty was, almost without exception, considered to be very strong.
When asked what the students would like to see changed, they gave highly diverse answers, but making it more rigorous and including yet more training for the rest of the year (e.g. a complete TBL exercise) is asked for.
Eightly-nine percent of survey respondents gave the course an A or B grade.
a. Administer a summative test based on the material presented
b. Schedule a complete TBL exercise to provide concept and allow practice
DX/RX. Elizabeth Bradley outlined the DX/RX course review submitted by Carolyn Engelhard, MPA, Course Director (see below).
The 2013 DxRx Short Course student evaluations were mainly positive but there were comments that became content threads as to how we could improve the program. No single day/session took all the hits or garnered the most compliments. Listed below are the thoughts I shared with the DxRx faculty shortly after the program ended regarding how we might improve the course for next year.
The students like the combination of didactic and participatory. Some liked the small group format more than others but few liked having "assignments" over the small group time because they felt rushed to "produce." They preferred having the small groups talk about a particular topic/article/case and then bring that discussion back to the larger group with time to "report out" or simply debrief — i.e., they want to talk/respond and they appreciate indexing their responses to a real situation or person in front of them.
They want the topics to be relevant to clinical medicine, the more "real world" the better. They want to know about the practice of medicine outside hospital walls, the business of running a practice, what practicing in an ACO or PCMH might look like, how to negotiate the very real anxiety of malpractice exposure, and how one defrays medical school debt (most of students mentioned that their debt is around $200K), particularly if they go into primary care. They want to hear from people who are planning/doing what they perceive as the "new world of medical financing" and how they made the decisions they did.
They want to know about the ACA and how the law will effect them, as specifically as possible. If we tell them that the future of primary care will be like "Phoenix rising from the ashes" they want to know why and where the mid-level providers will be in relation to the PCPs in terms of training, autonomy, hierarchy, and salary. They want to know WHY they should choose primary care, not THAT they should.
They are tired of theories, esoteric journal articles, and academic jargon. They want real examples from people who have "walked the walk." Many said they would have liked to hear from patients as well as practitioners "in the field."
As I report this I realize that students as consumers of information don't always know what they need and that the nature of evaluation is to accentuate the negative — to see more clearly what isn't great. As I said above, there were many positive comments, and some of them came out in the short reflection papers I asked the students to write linking an experience during their clerkships with a DxRx topic. Many of the papers were quite poignant and meaningful and reinforced the students’ dedication to patients and medicine within the larger landscape of access, coverage, cost, and quality of health care.
What I have asked the DxRx faculty to think about for next year is the following format — an opening session with a "big picture" overview of our individual topics and then a structured second half (with or w/out small group) that combines specific examples with people who are actively involved in the area we are covering (e.g., solo practitioner, hospitalist, hospital administrator, ID specialist providing care in developing world, physician who has gone through a malpractice litigation, PH surveillance/population health and its impact, the "patient's story," etc.) with the opportunity and encouragement for the students to actively TALK and get involved in some way during the second half. It is often difficult to do this kind of active engagement and discussion among 160 medical students, and I am open to any and all suggestions about how to improve the DxRx experience.
The Curriculum Committee requests a plan detailing the changes discussed above that will be incorporated into the 2014 DxRx course by December 18.
Geriatric Clerkship. Huai Cheng, Director of the Geriatric Clerkship, has responded to Curriculum Committee recommendations for the 2014 Geriatric Clerkship.
Dr. Cheng thanked the committee members for their excellent input on geriatrics grade and rotation. He feels that the bottom line is to help 4th year students to learn what is valuable and meaningful to their career development and to maintain UVA high standards.
Dr. Cheng’s comments (below) were shared with the Committee:
1. I agree with Donna Chen that narrative needs to be voluntary. Because 4th year students have had extensive clinical experience, I feel narrative could be more valuable than before. I agree that more complicated geriatric patients should be focus. In my working with Pediatrics faculty on CMS innovation grant of embracing complex children and geriatric patients recently, I was thinking to integrate narrative with more geriatrics via more guidance from faculty next year. Complex means beyond "organ-based medicine", multiple co-existing conditions and caregiver stress burden etc. I appreciate that the Curriculum Committee has the same view. I will be discussing this with two Ethics teaching faculty and Donna Chen this December or Jan of 2014. Also, I suggest giving 4 or 5% extra credit could be better. I leave to the both of you, Donna, and the Curriculum Committee to decide.
2. I agree that the minimum score for passing should/can be 70%.
3. I also agree that examinations should have minimum passing score for 4th year students. I suggest using a total of 17-18 for passing score (combining written and 2 SP).
4. I will explore potential exposure of more complicated geriatric patients for 4th year students. One of my big concerns is that 4th year students could feel boring about geriatrics if we don't challenge them and make them learn something excited. They already know what they like to do. It is challenging.
The Committee applauds Dr. Cheng’s leadership of this clerkship and thanks him for incorporating the recommended changes for 2014.
Nancy L. McDaniel, M.D.