University of Virginia School of
Minutes – 10/17/13
Pediatric Conference Room, 4:00 p.m.
Present (underlined) were: Gretchen Arnold, Stephen Borowitz, Megan Bray, Donna Chen, Peter Ham, Donald Innes (Chair), Keith Littlewood, Nancy McDaniel, Bart Nathan, Ray Nedzel, Sabrina Nunez, Theresa Schlager, Neeral Shah, Amita Sudhir, Linda Waggoner-Fountain, Casey White, Bill Wilson, Mary Kate Worden, Lee Eschenroeder, Elizabeth Bradley, Tom Jenkins, Jean-Baptiste Maitre, Derrick Thiel, Brian Wakefield, Debra Reed (secretary)
Article of interest:
M McCollum, A Chapin, C Burns, C Peterson: Rewarding Collaborative Learning Skills in the Pre-Clerkship Curriculum, Medical Education, 47:1135-1135, 2013
USMLE Step 3 Announcement
With the introduction of the restructured Step 3 examination in 2014, the USMLE program will no longer require examinees to apply for Step 3 under the eligibility requirements of a specific medical licensing authority.
All other Step 3 eligibility requirements (i.e., medical degree, passing Steps 1-2, ECFMG certification for IMGs) will remain applicable, as will all other USMLE program requirements (e.g., no more than 6 attempts at a Step or a Step component).
This change in the application process is tentatively scheduled to begin in August 2014.
Note: Removing state board sponsorship as part of the Step 3 examination application does not impact medical licensing requirements in the United States. Most medical licensing authorities have, and will continue to maintain, specific criteria for completion of the USMLE.
AAMC Uniform Clinical Training Affiliation Agreement
The AAMC has developed a uniform affiliation agreement to spell out roles and responsibilities between medical education programs and their clinical affiliates. This will provide a consistent framework for managing an increasing number of students participating in clinical training away from their home institutions. The document is now being vetted by University counsel and if approved may be adopted at UVA.
The 2013 Clerkship Self-Study Reviews as well as the recommendations from the 2013 reviews will be sent to Curriculum Committee subgroups 10/18/13.
Members of the Curriculum Committee will review the self-review packet from the clerkship; then arrange a meeting to discuss questions/concerns with the clerkship director. A summary report is due by 11/15/13 for discussion at the 11/21/13 Curriculum Committee meeting.
The summary report should list any recommendations from the previous year along with their outcomes. Similarly, a bulleted list of recommendations for the coming 2014-2015 clerkship period must be submitted as well.
Third and fourth year students on the Committee will be asked to review the recommendations from the subgroups prior to the Curriculum Committee review on 11/21/13.
Assessment Philosophy. The Curriculum Committee discussed a proposed amendment to the Assessment Philosophy document. It is proposed that Clerkship Directors in all clerkships (no matter the length) provide midclerkship feedback to the students. How to best provide mid-clerkship feedback to students on the shorter, two or three week, clerkships was discussed. Amita Sudhir, Clerkship Director for the three week Emergency Medicine Clerkship reported difficulties in obtaining sufficient feedback to warrant a face-to-face feedback session with each student mid clerkship. She mentioned that each day during the clerkship, faculty are asked to provide a “yellow” note, reporting each student’s performance to the Clerkship Director. This feedback is often shared with the student on a daily basis by their attending physician. The daily feedback in this manner when done consistently would be adequate unless remediation is deemed necessary. All teaching faculty should be required to inform the Clerkship Director at the earliest opportunity of poor student performance to allow corrective action. Committee members recommend regular mid-clerkship e-mails to each student containing feedback. Two-week clerkships, i.e. anesthesia, should provide feedback in this manner as well. Students on the Committee report that feedback from faculty who do not directly supervisor their work (i.e. Clerkship Director) is far less useful. This will be taken back to the Assessment Sub-committee.
Follow Up To Epidemiology Thread Leader Review of 10/10/13. This report was recently received from Michelle Yoon, Instructional Designer:
“This fall, I (Michelle Yoon, Instructional Designer) worked with Jean Eby, thread leader for Epidemiology, to review that thread’s learning objectives. I reviewed them for content, wording, and to promote higher level/deeper learning where possible. The content areas that the EPI thread LOs cover include: Introduction to Epidemiology, Introduction to Statistics, Morbidity-Mortality-Prognosis, Prevention, Outbreaks, Diagnostic Testing, Vaccines, and Medical Research. This is the thread in which students gain exposure to a basic understanding of biostatistics, in a relevant context to medicine, healthcare, and public health. Many of the LOs introduced new basic terms and facts to define, identify and describe. However, many of these gave way to LOs at a higher level on Blooms Taxonomy, where students are expected to apply basic epidemiological knowledge to real-life problem analysis and/or problem-solving, especially in relation to disease outbreaks, disease burden, calculating survival/mortality, and the understanding of risks in relation to outbreaks and vaccination.”
Policy on Academic and Professional Advancement. This policy was reviewed by the committee. The changes that are necessary are listed below:
page 1, pg 2 – Clinical Practice Exam (CPX) added to list of courses, clerkships, selectives, electives overseen by the ASAC
page 1, pg 3 – Change Clerkships to reflect that some i.e. Geriatrics are now graded P/F rather than A,B,C,D,F scale)
page 3, table – change CPD grading to Pass/Fail
These changes were tentatively approved, the document will be amended and sent to the Committee by e-mail for final approval.
Biochemistry Thread Report. The Curriculum Committee reviewed the Biochemistry Thread Report as well as information in an e-mail from Selina Noramly, Thread Leader.
I would like to see 3 sessions regain an hour of time that were removed this year in FOM ie 3 additional hours overall. Barring that, I think the amount of class-time for Biochem is probably appropriate for most students. That said, there are some students that need more time for the material... and I think that there are 2 possible ways to address this. 1. More time for biochem overall and we rework the thread or 2. we move ahead with the prematriculation course idea. Please see attached for some rough aggregate survey data from the students about the biochemistry thread. This data comes from part 2 of a survey done post FOM (part 1 of the survey was preFOM). The most relevant slides to the question you are asking of me are slides 18, 19 20. In slide 18 students are queried as to whether they would have considered taking a biochemistry prematriculation course and 70% answered yes. Slide 19 details some of the reasons why they said yes and slide 20 details why they would have said no. Once Mac, Michelle and I have finished analyzing the data, we would be happy to share our conclusions with you and others.
The Committee briefly discussed the prematriculation biochemistry course. A pre-test on basic biochemistry would trigger students lacking the proper biochemistry foundation to take the prematriculation course. Students on the Committee noted that the MCAT will soon include Biochemistry questions on the exam. This change will probably encourage most students to include a biochemistry course in their premedical curriculum. The Committee discussed prerequisites for medical school and concerns from Admissions regarding exclusion of viable students if prerequisites are initiated. This information will be taken into consideration in the tuning of the Foundations of Medicine course for 2014.
Neuroscience Thread Report. The response from Mary Kate Worden, Thread Leader, noted satisfaction that the thread is appropriately covered and properly sequenced. She also believes the thread is well coordinated with topics in neurology, because she and Bart Nathan work closely together in both MSI and MBB. Neuroscience is well coordinated with the basic physiology topics taught in the Fundamentals of Medicine course, as she is system leader for FoM and works closely with the physiology instructors.
Nutrition Thread Report. The nutrition report was reviewed. Don Innes has asked Kate Willcutts, Thread Leader, for more specific information including where nutrition needs to be advanced in the curriculum, but has not received a response at this time. The submitted report appears to outline adequate coverage of the thread throughout the curriculum. If anyone has suggestions for inclusion of nutrition principles into the curriculum, please forward to Don Innes. Students reported adequate nutrition coverage in FoM but sequencing with Biochemistry could be improved to make material more relevant for students.
Peter Ham, Family Medicine Clerkship Director, submitted the following information post-meeting:
The nutrition thread seems very good for preparing students for residency. Things that I get asked about in my clinic that I didn’t see mentioned specifically but are probably covered include the following
Diabetic diets: food substitution, avoiding hyper and hypoglycemia
Adult weight loss diets: caloric restrictions vs low carb Adkins vs Mediterranean. What’s the evidence? Which are fads? How to count calories.
What is a physician supervised weight loss plan (often needed prior to referral for bariatric surgery)
Post bariatric surgery? What do you have to watch out for?
Dehydration and electrolyte replacement
When to order an NG tube, PEG tube PEJ? What’s the evidence they help?
Foods to avoid in gout
Foods to avoid in kidney stones. Is it helpful to analyze the stone?
Calcium and Vitamin D: when to supplement, what foods have some (bone health, kidney stone risks, cardiac risks)
Who should take a multivitamin?
Patients who need to watch their K+ levels. What foods have K+?
Grapefruit juice and foods that change drug metabolism
Non alcoholic fatty liver disease: what to eat?
Food allergies and intolerance. Peanuts, lactose, …
Food recommendations during the first year of life.
Irritable bowel syndrome: what is a bland diet ?
Cultural factors in food: what are some common beliefs about the health benefits of food.
Omega 3 fatty acids: take a pill or just eat fish
Maintenance fluids in the hospital (when to use D5%)
Foods and coumadin
Replacing electrolytes at home or in the hospital with an IV or PO
Below, I listed the things that I thought were very useful to me that seem well covered already.
Covered in first year
Failure to thrive in the elderly
CHD diets: what is heart healthy?
Pediatric Obesity: fitness and nutrition: what to actually recommend?
What is in food, food labels,…
Covered in clerkship
General nutrition counseling for women
Specific nutrition advice for pregnancy
Surgical nutrition: how to transition patients back to PO after surgery?
Nutrition in the ICU
Renal Diet: what should patients with ESRD or CKD eat?
Parenteral feeding in the NICU
Enteral feeding in the NICU
Afternoon Student Led Review Sessions. While this topic will be further discussed when Casey White is in attendance, Dr. Neeral Shah reported that the sessions were very valuable to the students during the GI system and that the sessions did not decrease attendance in the morning activities. Students leading the sessions were not included in exam preparation. While the sessions were voluntary, the material covered was made available to all students via e-mail. Dr. Shah believes the students benefit from this collaborative group learning. Students on the Committee report that the students find these sessions extremely helpful, there is a great deal of Q&A, and they would like to see them continue under the auspices of the individual system leaders.
Donald J. Innes, Jr., M.D.