Minutes 11.21.13

Minutes 11.21.13

University of Virginia School of Medicine
Curriculum Committee
Minutes – 11/21/13

Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Gretchen Arnold,  Stephen Borowitz, Megan Bray,  Donna Chen,  Peter Ham, Donald Innes (Chair),  Sean JacksonKeith Littlewood, Nancy McDanielBart NathanSabrina Nunez,  Theresa Schlager, Neeral Shah, Amita Sudhir,  Linda Waggoner-Fountain, Casey WhiteBill WilsonMary Kate WordenElizabeth Bradley, Lee Eschenroeder, Jean-Baptiste Maitre, Derrick ThielDebra Reed (secretary)

  1. 2013 Annual Family Medicine Clerkship Review   This annual review was conducted by Curriculum Committee members:  Theresa Schlager and Elizabeth Bradley and presented  for Curriculum Committee discussion by Elizabeth Bradley.      

    The Family Medicine clerkship goal is to provide students with the clinical skills, knowledge, problem solving skills, and professional attitudes necessary to access and care for patients in the family practice setting.

    At the core of the Family Medicine setting is providing comprehensive care to the patient and their family. The reality of primary care is that it includes many varieties of care including acute and chronic medical care, prenatal care, obstetrical delivery care, pediatric care, basic preventive care, basic mental health care, inpatient care, nursing home care, etc. The experiences while varying from practice to practice are comparable and meet the core learning objectives for Family Medicine.

    On the Family Medicine clerkship the student becomes an integral member of an active community practice seeing 80-120 patients from a diverse population of patients presenting with a wide variety of problems. The student experiences the diagnosis and treatment of common and undifferentiated medical problems, and experiences continuity of care by seeing patients at follow-up visits, patients with chronic medical problems and patients presenting for preventive health visits. The students also attend to patients presenting with a variety of psychosocial issues.

    Clerkship Strengths


    Clerkship Weaknesses


    Recommendations


    As reported in 2012, the Family Medicine clerkship is well organized and operates smoothly thanks to the leadership of the director Peter Ham and coordinator Leslie Stewart. Keep up the good work.

    Dr. Ham relayed that one of his greatest challenges currently is accessing instructional design, assessment and curriculum development resources which he feels would improve the quality of the educational experience. This is likely not unique to Dr. Ham, thus a discussion with the Curriculum Committee about how to best harness the resources we have in the Office of Medical Education would be useful.

    Casey White will outline resources in the Office of Medical Education that are available to the Clerkship Directors at a Clerkship/PostClerkship meeting.  

    The Committee discussed how best to make sure threads such as “military culture” are covered appropriately in the appropriate clerkships.  Coordination amongst the clerkship directors will be necessary.    Nancy McDaniel will add this to the agenda of an upcoming Clerkship/PostClerkship Committee meeting.

    How to address perceived “unevenness” across the clerkship sites was discussed.   The workshops all take place in-house help alleviate the variability of experience due to multiple clerkship sites.    The Committee recommends that an OSCE be developed to assess student progress.  This OSCE should be done after the midpoint of the clerkship but allowing time  at the end of the clerkship if remediation is necessary.   An OSCE would help to determine whether   deficiencies exist in certain clerkship sites.

  2. 2013 Annual Surgery Clerkship Review.  This  annual review was conducted by  Curriculum Committee members:  Bart Nathan and Mary Kate Worden and presented  for Curriculum Committee discussion.

    After reviewing submitted self study, the Curriculum Committee reviewers met with Clerkship Director, Eugene McGahren, Associate Clerkship Director, Anneke Schroen, and Clerkship Coordinator  Sylvie Moore on  11!313.

    The current rotation is 6 weeks long and students are located in a wide variety of locations and surgical specialties.  The clerkship directors feel the current length of the clerkship is sufficient, but would prefer to increase to 8 to 12 weeks.

    Recommendations made in 2012-2013:


    Recommendations made for 2013-2014:


    The Surgery Clerkship Directors were asked to develop a “night float” elective since there is no night float experience available in the clerkship. 

    Jim Martindale has met with the Surgery Clerkship Directors to review the midclerkship quiz items for variety, links to learning objectives and quality of the questions. Additional work is needed to improve the quality of the questions and number to enlarge the pool of questions.

    Surgery Clerkship Directors noted that student competence with anatomy principles has not changed from previous years.  The Committee noted that some difficulties with anatomy have been reported by the Surgical Subspecialties, i.e. orthopedic surgery.

    Clerkship Directors did report increased mispronunciation of medical terms.  There is speculation that this may be due to decreased attendance at lectures where students hear the correct pronunciation.  CPD mentors are encouraged to always correct student mispronunciations during their sessions.

    Enhancing the pool of quiz questions and developing appropriate feedback for the quizzes will be recommended.

    Keith Littlewood noted that the “practice room” is no longer available in the OR so the Surgery practice sessions may move to the Simulation Center.

  3. 2013 Annual Peri-Operative/Anesthesiology Clerkship  Review

    2013 Peri-Operative (Anesthesia) Clerkship Review This annual review was conducted October 25, 2013 by Curriculum Committee members,  Donald Innes and Steve Borowitz, and resented  to the Curriculum Committee.  

    Clerkship Director, Ashley Shilling, MD, and Associate Director,  Stephen Collins, M.D.

    The Peri-Operative clerkship introduces basic skills and important concepts within the environment of the operating rooms, pre-operative and post-operative setting.  Interactive group didactic sessions augment individual rotations, incorporating basic science principles with clinical practice; including interprofessional education. The clerkship focuses on skills, concepts and tasks related to: pre- and post-operative evaluation (informed consent, patient education, optimization and risk-stratification), patient monitoring, pain management, airway and ventilation management, and fluid and intravenous management. Shock recognition and management, cardiac and respiratory physiology, and pharmacology of anesthetics, narcotics, neuromuscular blockers, vasopressors and ionotropes are reviewed. Perioperative patient safety and general principles of quality care are key components.

    Strengths of the Peri-Operative Clerkship:
      
    Comments by students were nearly all positive. Some typical  comments follow:

    Although not perfect:

          Areas of Concern for the Peri-Operative Clerkship:

    Recommendations

           
    Anesthesiology Discussion  

    The required Life Saving Techniques Workshop is now incorporated into the start of the Peri-operative-Surgical Specialty clerkship section of the 12-week Surgery block. 

    The most recent April 2013 Mulholland Report does not take in to consideration the expansion of the Peri-operative clerkship to two weeks. 

    In summary, the Peri-Operative clerkship is well organized and operates smoothly thanks to the devoted effort of Ashley Shilling, MD and Stephen Collins, MD.

  4. XCredit Update - Sean Jackson updated the Committee on X-Credit and the AAMC database.

    Stage 1: Prepare AAMC CI report for school year 2012-2013, which doesn't include our clerkship, selective and electives because the related courses were not in CXCREDiT yet.  Originally, AAMC's deadline for the report submission was on 11/30/2013. Because of all kinds of unexpected problem, they have postponed the deadline to February, 2014.

    John Jackson and John Voss have finished the work on converting old keywords to new keywords for 2012-2013 related contents.  The report requires program description and med level description, John Jackson helped on that. We were able to generate the report from XCREDiT. We submitted it to AAMC and the report was checked by AAMC system and passed the business rules.  However AAMC has technical problem on the server side, the system could not save our report. They are fixing it. We are not the only school that encounters the problem and we have not heard back from them. At this point, we can not do anything.  

    If they fix their problem and are able to save our report (in xml format),  they will generate a report which should be viewed and verified by school Dean (Dr. Innes), if the Dean doesn't approve it, we need to work on any updates required by Dean and resubmit the report, if Dean approves it, it is done.  Since John Jackson has been working on this project and knows very well about our curriculum, Dr. Innes may ask John to review the report and tell us if any changes need to be made and resubmit.

    To make it simple, our status is that we've submitted the report, because of AAMC server  problem they can not save the report to generate readable report for school to review, we can not go forward now.

    Stage 2: Get XCREDiT ready for AAMC CI report for future years. 

    1.     John Jackson has given few training sessions to our clerkship coordinators to tell them how to enter data into XCREDiT. And also gave trainings to our ISCs about how to deal with assessment only events in OASIS and XCREDiT in order to have data in XCREDiT for future report.

    2.     John also worked with Ye to modify XCREDiT to handle selective and electives. We had the design already. Ye is programming it in XCREDiT. John talked to related parties about learning objectives for selective and electives and we can plan how to enter them into XCREDiT. 

    3.     John Voss and John Jackson also worked on new keywords system. The keywords are finalized. John Voss and John Jackson still needs to work together to map old keywords to new additional keywords since last time they finished the mapping.

    4.     John Voss and John Jackson has worked together to build our competency maps. The work is done. Once Ye uploads them into XCREDiT and they may work together later to map learning objectives to competency. 

    5.     Ye (Chen) plans to upgrade XCREDiT in the week of DEC 16 when there is less traffic on XCREDiT. The upgrade will have new keywords system, convert old keywords to new keywords automatically, have the function to handle selective, elective courses and clerkship data for future AAMC CI report.

    6.     After the upgrade, John Jackson and John Voss may need to involve in further improvement since they are going to use the system to map learning objectives to competencies. 

 

Donald J. Innes, Jr., M.D.
Debra Reed