Foundations of Medicine and Core Systems Curriculum Retreat

February 5, 2004

Summary report from Core Systems (Year 2) Breakout Group discussion:

Assumptions:

The Core Systems courses would end by ~March 15 (currently ~May 15 with clerkships beginning ~July 1)

“Lost time” would be accommodated by cuts in vacation time and appropriate cuts in first and second year curricular material.

Preserve an average of three afternoons per week of free time (two scheduled afternoons for Anatomy, PoM-1 clinical and Exploratory activities in year 1.

Proportionality, sequence and integration of curricular material and activities are prime goals for the Core Systems courses.

Proposals:

The fall semester following summer break would begin ~August 22 (one week earlier than current start). Course work for would follow a summer break of ~10 weeks (allowing 8 weeks for summer research) and would begin the week following the first year orientation start. This would provide approximately a 10 -week vacation period for most of the class and a 1-week vacation period both before and after 8-week summer research projects.

The start date of August 22 allows for 14-weeks of class; 2 examination weeks; 1-week of vacation at Thanksgiving and 2-weeks at winter break. Following winter break there would be 9-10 weeks of class and 1-week of exams. Approximately 6-weeks would be allowed for USMLE-1 study and examination, vacation and a 1-week transition course. The total weeks available for class is ~23 plus the 6 weeks at the end of the first year, for a total of 29 weeks.

Sequencing and appropriate grouping of systems was extensively discussed.

The course directors of Pathology, Pharmacology, PoM-2 and Psychiatry and Microbiology will meet to explore these options with the goal of improving the sequence and integration of the systems material in the time allotted.

The value of the Second Year Preceptorship, a 1-week experience in a physician office at spring break was discussed. The objective is to help students form a meaningful link between what they have learned in their basic science courses and the realistic, clinical practice of medicine in a primary care setting. The Preceptorship places a student in a private physician office for 5 days. Evidence-based medicine is practiced in conjunction with the library; the student learns health issues such as economics, and develops a relation with community physicians across the state of Virginia – “not the same as being here”.  The Preceptorship is estimated to cost ~$ 35-40,000. Of this amount, ~$28,000 is budgeted for preceptor payments (~$220 per preceptor) and the rest for student travel expenses, housing, Xeroxing, etc. The Preceptorship is used as a recruitment tool and an “evaluation period” for physician preceptors that eventually form the pool of preceptors for Family Medicine and AIM. The Director indicated that the private practitioners learn that “they can do it without going bankrupt” in the preceptorship and only then signup for the 1-month Family Medicine and AIM clerkships. The director fears that without the 1-week preceptorship they will lose the pool of preceptors. Another view is that the demands on the pool will decrease by 140 weeks.

The proposed curricular changes would place the Preceptorship immediately prior to the start of the clerkships. Here it will lose much value as a motivator. Could the Preceptorship be part of a transition course? Can the enhanced physician contact through a clinical Exploratory program meet similar goals and be more closely monitored? Can the advantage of increased clinical time in the clerkship/selective/elective period replace the Preceptorship? What is the value of the Preceptorship weighed against a week of class (USMLE-1)? Can improvement in curricular offerings where student-patient-doctor time is increased balance loss of the Preceptorship?

                [Preceptorship]Underlying that goal are several objectives:

1. Improve their physical diagnosis skills through hands-on patient exams.
2. Improve their history taking skills while integrating principles practiced in the first year PoM-1 course.
3. Understand the role of the primary care physician in the overall medical system.
4. Understand the interactions between the physician and his or her family, colleagues, patients, staff and community.
5. Experience the time, management and cost constraints that impact medical practice.
6. Learn the principles of preventive medicine and observe the importance of the patient’s personal responsibility for health maintenance.
7. Review their differential diagnostic skills and learn to make decisions in the uncertainty of the clinical arena.
8. See diseases in both their earliest and most chronic phases and follow both longitudinally.
9. Apply principles learned in epidemiology to the framing of focused clinical questions.
10. Learn to use the literature to answer clinical questions.

• The majority of the student’s time (approximately 70%) should be spent doing interviews and focused physical exams centered on the patient’s chief complaint.  They should interact with at least two patients a day.
• 10% of the student’s time should be divided between observation and interaction with nursing, business and lab staff.
• 20% of the student’s time should be used to generate a minimum of three focused clinical questions, which are pertinent to the practice at that community based site.

DJI