Minutes 10.18.12

Minutes 10.18.12

 University of Virginia School of Medicine

Curriculum Committee
Minutes – 10/18/12

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold, Robert Bloodgood, Steven Borowitz, Megan Bray,  Donna Chen,  Peter Ham, Donald Innes (Chair), John Jackson, Keith Littlewood, Nancy McDaniel,  Selina Noramly, Bart Nathan, Theresa Schlager,  Amita Sudhir,  Linda Waggoner-Fountain, Casey White,  Bill WilsonMary Kate Worden,  Courtney Chou,  Jeremiah Garrison,  Guest:  Jen Marks,  Debra Reed (secretary)

  1.  Announcements

    Don Innes welcomed the three faculty members elected by the Faculty Senators of the School of Medicine for at large Curriculum Committees positions  - Steven Borowitz, M.D., Amita Sudhir, M.D. and Teresa Schlager, M.D.

    A dramatic drop in clerkship “away time” for students from an average greater than 20 weeks away to an average of 12.46 weeks away was seen in the recent clerkship match. This data was collected after the 59 trades made by students. Low:  7 weeks, High: 21 weeks, Avg: 12.46 weeks, Mode: 10 weeks.

  2. Visitation in the SOM Teaching Space.  The Curriculum Committee adopted the following policy regarding visitation in the SOM Teaching space.

    “No visitors are permitted in the Learning Studio, Auditorium, Laboratories or other student venues during scheduled School of Medicine undergraduate medical education activities.”* 

    *The Clinical Performance Education Center administration will be responsible for the visitation policy in their facility.

  3. Cardiovascular/Pulmonary/Renal Schedule Change for 2013.  John Dent, System Leader for Cardiology, has requested a “swap” of dates for the Cardiology system with the Pulmonary or Renal System in August-October, 2013.  A satisfactory solution is currently being devised with details still being worked out.

  4. Class of 2014 Credits required for graduation.   The Curriculum Committee approved the following numbers of elective credits needed for graduation for the Class of 2014.

    34 Elective credits
    4 credits for ACE
    2 credits for DxRx (March 4-15, 2013)
    4 credits for Medicine Selectives (2 2-week selectives)
    4 credits for Surgery Selectives (2 2-week selectives)
    2 credits for Psychiatry Selective

  5. Neurology Clerkship Leadership.  Dr. Karen Johnston, Chair of Neurology, announced that the current Clerkship Director for the Neurology clerkship, Priscilla Potter would retire December 31, 2012.  She nominated the current co-director, Guillermo Solarzano, to assume the role of Clerkship Director on 1/1/13.  The Curriculum Committee Executive Management Group recommended approval of Dr. Solarzano as Neurology clerkship director.  The Curriculum Committee approved.  Dr. Johnston and Dr. Solarzano will be notified.

  6. Clinical Performance Development (CPD) Review.  Elizabeth Bradley outlined the findings in the CPD-1(b), Spring 2012 - Evaluation Summary: Student and Faculty data. 

    Notable was the perceived shortage of hands-on procedural skill instruction by both faculty and students. Jen Marks noted that this has been addressed for SMD15 by faculty development with the preceptors and by requiring each student to purchase their own instruments (stethoscope, hammer, etc.). Students and faculty asked for more time to practice PE skills. With 4 hours per week available, why is this an issue? Is too much time spent on case discussions? Is student “confidence” in skills as opposed to knowledge a factor? Consideration must be given to rebalancing the cases and the Hx&PE experiences. CPD leaders asked for assistance in developing methods to ensure student practice of clinical skills outside of structured class time.

    Criteria for achieving a “passing” grade in CPD-1 must be defined and distributed to all CPD faculty and students, and posted on the course website. These requirements must define the components of a student’s grade and how the components are compiled to create a final P/F grade. Levels of competency [expectations] should be defined for each third of the course and evaluated in the written summative of the student’s progress to provide encouragement and allow for corrective action when needed.

    CPD-1 course is graded Pass/Fail, the Curriculum Committee asks that additional assessment of student procedural skills as measured against the expectations (learning objectives) be incorporated.  A periodic written summative of the student’s progress is indicated. Assessment should include attendance and level of participation of each student.  

    Some clerkship directors have noted that some students from the first CPD iteration do not seem to be fully prepared for the clerkships.  Jen Marks suggested a “boot camp” approach during orientation might be necessary.  She also suggested that a mechanism be developed to allow students to experience a typical clerkship rounding experience early in CPD-1. This would make them aware of the necessity of learning and practicing these H&P skills.  Expectations have been more clearly defined for SMD15.  The Committee suggested that third year/fourth year students might be recruited to talk to the students about the importance of learning these skills as well as helping students outside of class with the practice of these skills. Procedural skills are generally well-liked and fun, but could be rebalanced with the need for additional time for H&P skills training, practice and assessment. Although students report that basic science is integrated with clinical care it is not clear how this is assessed. Active learning (Dan Hunt definition) in which the student determines LO & selects resource; presents and is critiqued, must occur more frequently – an objective of 2 students/week (in the course of 15 weeks each student would have 5 such active learning experiences.

    Clinical Performance Development (CPD) Review: CPD-1(b), Spring 2012

    1. Rebalancing the cases and the Hx&PE experiences – fewer or shorter cases and more Hx&PE experience.
    2. Increase the number of hands-on physical examination skill instructional sessions in which feedback is provided. Construct exercises that build in practice of learned examination skills as the year progresses and new skills added.
    3. Criteria for achieving a “passing” grade in CPD-1 must be defined and distributed to all CPD faculty and students, and posted on the course website. These requirements must define the components of a student’s grade and how the components are compiled to create a final P/F grade.
    4. Levels of competency [expectations] must be defined for each third of the course and evaluated in the written summative of the student’s progress to provide encouragement and allow for corrective action when needed. 
    5. CPD-1 course is graded Pass/Fail, the Curriculum Committee asks that additional assessment of student clinical skills.  A periodic written summative of the student’s progress is required. Assessment should include attendance and level of participation of each student. 
    6. Active learning experiences must occur with increased frequency. These are defined as experiences in which the student determines their own learning objective(s) and selects resource(s); presents, and is critiqued, must occur more frequently – an objective of 2 students/week, e.g. in the course of 15 weeks each student would have 5 such active learning experiences.
    7. Procedural skills, e.g. ultrasound, NG-tube placement, synovial fluids, etc. should be rebalanced with the need for additional time for H&P skills training, practice and assessment.
    8. Development of a mechanism to allow students to experience typical clerkship rounding experiences in CPD-1 to raise student awareness of learning and practicing H&Ps and presentation skills is suggested.
    9. Third year/fourth year students might be recruited to emphasize the importance of learning H&P/presentation skills to first year students. They could also help students outside of class with the practice of these skills (possibly a College activity).
    10. Identify points in CPD where basic science is integrated with clinical care.


    Jen Marks and Nancy McDaniel noted that variability between mentors is expected with faculty development sessions provided to attempt to moderate these differences.  She also noted only two of the mentors for SMD14 are also mentors for SMD15 the effect of which is unclear.   

    CPD morning lecture activities were not evaluated. Elizabeth Bradley will consider such an evaluation.

    Casey White (not present) noted in an e-mail that while this review noted that basic science and clinical care are integrated in CPD, how we assess this integration should be investigated further.

    Steve Borowitz noted that the ability for students to learn to assimilate patient information requires real patients rather than simulated patients.  Simulated patient information is usually already condensed for the student.

    It was noted that only 79 students responded to this survey.  The Committee discussed whether making it a requirement would increase this number and that a larger number of students might influence the data.

    The Curriculum Committee thanked Drs. Jen Marks, Mary Bryant and Nancy McDaniel for their hard work on this valuable course.  A new co-leader to replace Mary Bryant who recently left the University is being actively sought and should be in place shortly.

    A progress report with detailed plans addressing each item is due to the Curriculum Committee by March 15, 2013.

  7. Curriculum Committee Clerkship Reviews

    Timeline for completion of Clerkship Reviews:
    1.  Clerkship Review form sent to Clerkship Directors October 4th.
    2.  Clerkship Director will complete Clerkship Review form by October 26th.
    3.  Curriculum Committee will review the forms and conduct interviews with Clerkship Directors by November 19th.
    4. Report to Curriculum Committee December 14th.

    Pediatrics
    William Wilson wgw@virginia.edu

    Amita  Sudhir as2cd@Virginia.EDU
    Gretchen Arnold gvn8r@Virginia.EDU

    OB/GYN
    Megan Bray mjb7c@Virginia.EDU
    Yvonne Newberry  ygn7w@Virginia.EDU

    Bill Wilson wgw@virginia.edu
    John Jackson jmj5g@virginia.edu

    Neurology
    Priscilla Potter pfp7a@Virginia.EDU
    Guillermo E. Solorzano ges3b@Virginia.EDU

    Peter Ham  ph2t@Virginia.EDU
    Selina Noramly sn8d@Virginia.EDU

    Psychiatric Medicine
    Pamila A. Herrington  pah5g@virginia.edu

    Nancy McDaniel nlm9m@Virginia.EDU
    Robert Bloodgood rab4m@virginia.edu

    Family Medicine
    Peter Ham ph2t@Virginia.EDU

    Theresa Schlager TAS8N@hscmail.mcc.virginia.edu
    Donald Innes dji@virginia.edu
    Elizabeth Bradley ejb4a@Virginia.EDU

    Surgery
    Gene McGahrenedm6k@Virginia.EDU
    Anneke Schroen ats2x@Virginia.EDU

    Bart Nathan brn3a@Virginia.EDU
    Mary Kate Worden mkw3k@Virginia.EDU

    Medicine/AIM
    Brian Wispelwey bw9g@Virginia.EDU
    Evan Heald  ebh3a@Virginia.EDU

    Linda Waggoner-Fountain law4q@Virginia.EDU
    Casey White cw4xz@virginia.edu

    Emergency Medicine/Perioperative
    Ashley Shilling abm5f@virginia.edu
    Amita Sudhir as2cd@Virginia.EDU

    Megan Bray mjb7c@Virginia.EDU
    Keith Littlewood kel2n@Virginia.EDU

    Geriatrics
    Huai  Cheng HYC9J@hscmail.mcc.virginia.edu

    Stephen Borowitz smb4v@Virginia.EDU
    Donna Chen dtc6k@Virginia.EDU



    Student Members:
    Courtney Chou ctc6n@Virginia.EDU
    Jennifer Hsu jyh3j@Virginia.EDU
    Brandon Hunter rbh8d@virginia.edu 
    Jeremiah Garrisondjg5jn@virginia.edu

    Curriculum Committee reviewers are asked to invite all students to the individual clerkship meetings.  Whenever possible, one student representative should attend.

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