University of Virginia School of
Minutes – 12/5/13
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, Bart Nathan,
Sabrina Nunez, Theresa Schlager, Neeral Shah,
Amita Sudhir, Linda Waggoner-Fountain, Casey
White, Bill Wilson, Mary Kate Worden,
Elizabeth Bradley, Lee Eschenroeder, Jean-Baptiste Maitre,
Mary Grace Baker (alternate), Derrick Thiel,
Debra Reed (secretary)
Clerkship Learning Objectives Statement. The Curriculum Committee discussed and amended a statement regarding Learning Objectives in the Clerkships.
All clerkship directors must have learning objectives for their clerkship. Clerkship Directors must ensure that all involved with teaching medical students, e.g. faculty, resident physicians, and non-faculty, are aware of and use the learning objectives to guide their teaching and assessment.
This statement will be discussed at the Clerkship/Post-clerkship meeting on Monday, 12/9/13, returned to the Curriculum Committee for final approval, and then disseminated to all clerkship teaching faculty by the Clerkship Directors.
Annual clerkship Reviews - Emergency Medicine – Megan Bray presented the results of the recent review of the Emergency Medicine Clerkship.
Reviewers: Keith Littlewood and Megan Bray
Clerkship Director: Amita Sudhir, Associate Director: Chris Ghaemmaghami
Clerkship Coordinator: Aileen Watchko
Sources of Information:
· Interview with Amita Sudhir on Dec 2, 2013 · EM 2013 Review Document
· Well organized clerkship as recognized by students · Dedicated teaching faculty – opportunity for students to work one-on-one with attending physicians · Simulation Exposure · Expanded time frame [from 1à3 weeks]. Clear LO’s vetted with Michelle Yoon · Very procedurally oriented clerkship · Wide variety of patient types- including opportunity to run with CARS
· Inconsistent volume and types of patients per shift · Lack of continuity with attending & residents. Unable to pair students with specific faculty given differences in their shifts. · Clinical Evaluation System: 25% student yellow cards and 25% formal OASIS evaluations as chosen by students [ 3 attending physicians & 3 resident physicians as identified by students] · Problems accomplishing student requirement checklist
Recommendations from 2012-2013 Report and Remedies:
· Time Expansion- YES. Currently a 3 week rotation. Now students work 8 hour shifts (vs. 4). Includes 4 adult shifts, 2 pediatric shifts, 2 express shifts and one CARS shift. · More didactics- YES. Using web based learning modules from radiology. · More simulation- No. · Expanded Orientation- YES. Now full day. Review of expectations in am and didactic learning- BLS, suturing, etc. · Practice Note Writing- YES. 4 written H&P’s. Amita personally reviews one at end of first week with feedback & grades a final one for contribution to final grade. · MC Feedback- NO. Originally thought because 3 weeks wouldn’t need to do. Now will accomplish via email. · MC Evaluation- YES. 2 reading quizzes. · Evaluation System- YES. Previously difficulty getting faculty to fill out OASIS. Instituted yellow feedback cards for students to given resident and attending physicians. Now compromises half of clinical grade. · Peer evaluation- YES. In Simulation Center. · Timing of SHELF along with medicine shelf. YES- working ok. Now allow students to take the exam over the weekend when it comes the same week as medicine shelf and OSCE.
Recommendations for 2014:
· Evaluation System: continue to improve and stream line. · Orientation Handout/booklet: create comprehensive manuscript helpful to students. · MC Feedback: will accomplish via email, based upon yellow card feedback. · Revise Requirement Checklist: Removed some procedures that are accomplished on other clerkships and can’t guarantee on this one- i.e. Pelvic exam. Maintain procedures that should be able to be accomplished and provide simulation opportunity to remedy if can’t- i.e. Foley placement. · As a global recommendation not specific to EM: We suggest that important procedures (e.g. Foley placement) that might be experienced on a variety of specialties but cannot always be guaranteed on any particular rotation be included in a universal passport. This keeps the procedure from being eliminated from all passports, but provides fair opportunity for the student to attain the experience. A further step might be to provide task-trainer/simulation experiences for students who cannot meet a universal passport requirement by the end of the clerkships.
The Committee discussed development of a “universal” passport that would assure procedural skills were learned and evaluated in one or more clerkships. Clerkship leaders will need to work together to develop this checklist. While some procedures are unique to a specific clerkship, others may be taught in multiple venues.
Student “ride alongs” with ambulance services was discussed. Whether making this an elective activity and/or “optional” limits liability was debated. Don Innes will make inquiries with the University Counsel, Evelyn R. Fleming, regarding legalities and liability issues with this practice.
The Committee discussed implementation of Mid-clerkship evaluations at the end of the second week of the three-week clerkship or at the end of the each student ‘s fifth shift.
Annual clerkship Reviews - Psychiatric Medicine. Nancy McDaniel outlined the findings from the recent Psychiatric Medicine Clerkship review.
Reviewers: Neeral Shah, Nancy McDaniel).
Clerkship Director: Pam Herrington Associate Director: TBA
The reviewers met with Dr. Herrington, clerkship director on November 26, 2013: this review is based on that conversation and a review of the Clerkship report submitted by Dr. Herrington.
Positive Aspects of the Psychiatry Clerkship
· Concentrated psychiatric experience in settings that are unique · Clinical exposure to acute psychiatric illness with a variety of psychopathologies · Lecture/didactic topics are uniform across the sites · Method of evaluation is the same across clerkship sites · Exposure to VA Medical System
Challenges and ongoing opportunities
· Challenge to provide similar experiences for all students across sites and ensure common learning objectives are fulfilled · Loss of sites has increased number of students at UVA which has been a challenge to educators, but welcomed by students · In the process of identifying an associate clerkship director · New site director in place at Salem rotation. This site director has planned a series of meetings with students and seems to be improving their experiences. Students only in depth exposure to residents is at the UVA site · Evaluate how effective the new opportunity in ambulatory psychiatry in the “Bridge Clinic” has been in addition to Emergency Department Consultation and Psychiatric Consultation Liaison Service as an optional outpatient experience · Tracking the students utilizing this option of the “Bridge Clinic” has been difficult
Issue of the three sites and whether they provide a comparable experience:
The Psychiatric Medicine Clerkship currently uses three sites. Some data from student reviews of the Clerkship from recent Mulholland Clerkship reports are shown here:
Psychiatric Medicine Clerkship – Overall Score:
Recommendations for 2014:
· Finalize identification of an associate clerkship director · Hold a formal joint Psychiatry clerkship site meeting, at least once per year, separate from the existing Joint Clerkships meeting · Produce shared core learning materials (power points, references) with nuances of the sites added where appropriate, e.g. military or veteran issues at Salem, criminal units at Western State. · Site directors track outpatient clinic attendance at optional activities · Continue to educate housestaff on teaching and evaluating students, using session by Lisa Rollins which was well received
Recent personnel changes in the UVA Department of Psychiatric Medicine have made finding and retaining an Associate Director for this clerkships difficult but should be possible in the near future.
A new Psychiatric Clerkship Director at the Salem VA has been named and Pam Herrington is asked to reach out to this person to make sure student experiences at the Salem VA are equal to those at other sites.
The Committee discussed whether this clerkship might be expanded to include Bon Secours or Fairfax.
Pam Herrington is asked to seek methods to expand the outpatient psychiatric experience at all sites.
The Department of Psychiatric Medicine has hired an “instructor” position for the coming year that will provide assistance to the Clerkship Director on learning objectives and learning materials. Mary Kate Worden would like to ask that this faculty member review the LOs and learning materials for the Mind Brain and Behavior system.
The Committee discussed the excellent work of Derek Mongold, the consulting Psychiatric physician in the Emergency Department and whether his role in the Psychiatric Clerkship could be maximized.
More communication between the Clerkship Director and the faculty both here at UVA and at the away sites is strongly recommended. Expectations and goals should be clearly delineated to all faculty.
Hospitalist Service. Don Innes has communicated with Brian Wispelwey, Medicine Clerkship director, regarding the possibility of Medicine clerkship students working with the Hospitalist program at UVA. At present students are able to arrange an ACE experience with a hospitalist in the fourth year but the clerkship does not provide a hospitalist experience. Incorporating clerkship students into the hospitalist service would likely dilute the experience for the fourth year elective students so we will not move to expand the hospitalist experience into the clerkships at the present time. However, more hospitalists will be encouraged to host ACE students in this highly sought after rotation.
Revisions to LOs / Changes to procedures in the Clerkships. The Clerkship/PostClerkship Committee will be asked to review and approve any and all changes to learning objectives and procedural skills in the clerkships to ensure that proper coverage is accomplished.
Donald J. Innes, Jr., M.D.