Minutes 02/22/06

Minutes 02/22/06

University of Virginia School of Medicine
Principles of Medicine Committee

This special meeting of the Principles of Medicine Committee continued the discussion on issues concerning the 1st semester of the new medical curriculum.  In particular, emphasis was placed on identifying strategies for reducing stress on the medical students during the Fall of their 1st year because self-reported data collected from the current 1st year class suggested that medical students were experiencing increased stress due, at least in part, to the new schedule in the period from August to Thanksgiving.  Approaches that might improve the situation that were introduced at the last two meetings include: 1) elimination of cumulative honors, 2) changes on scheduling of the Exploratory, 3) changes in scheduling in the 1st semester that would spread out the material in the courses over a longer time period, 4) issues related to having 3 versus 2 exams in each course and the role that quizzes can play, and 5) changes that courses could make within the existing schedule framework.  Discussion at this meeting focused primarily on issues (1) and (2) with some time devoted to (3) and (4).

  1. Cumulative Honors:  Cumulative Honors was not part of the original recommendation from the Pass/Fail Grading Committee.  It was added at the level of the Dean=s Executive Committee at the request of a few Department Chairs.  It was fixed at a constant and arbitrary 20%. The purpose of having cumulative honors after 2 years appeared to have been to provide a credential that could be used at the time of the Residency Match program. Given this goal, we do not yet know the effect of cumulative honors because the first class (Class of 2007) has not yet gone through the Match.  Given that only 20% of the class has cumulative honors and given that our medical classes already have a very high rate of matching with one of the top 3 choices, it may not be possible to ever obtain data as to whether cumulative honors increases the success of our medical student classes in the residency Match.  Wagonner and Suriano (1999) Academic Medicine 74:51-58 did a comprehensive analysis of the criteria used for residency placement and found that, of 12 criteria used for their survey, grades in the first two years rated last. Mo Nadkarni indicated that, for the UVa Internal Medicine resident selection process, performance in the first two years (grades and any honors) counted very little towards resident selection.  There is some anecdotal data suggesting that cumulative honors increases stress and competitiveness among our medical students, at least among those that choose to "go for it", and may work against the original goal of pass-fail to reduce stress and competitiveness.
    As a part of the pass-fail grading study, some data were collected regarding grading preferences from the Classes of 2007 and 2009 (both classes under Pass/Fail system with cumulative honors (se below):


    As a part of the assessment of the new curriculum, a survey of the current 1st year medical students conducted by Bob Bloodgood in November of 2005 elicited the following comments related to cumulative honors:

     (A)  The notion that honors will be awarded at the end of our second year leads me to question myself and compare myself with my perceptions of the people who receive those honors.
     (B)   I do believe that the Honors is a strange way to distinguish students that excel.
     (C)   I do not like to compete with classmates for the top 20%
     (D)   I enjoy that it is pass/fail. It does take the pressure off but I would prefer it be pure pass/fail.
     (E)  I feel that the effect of having Honors/Pass/Fail has been to increase competition among students as opposed to relieving it. If we have pass/fail, it should truly be pass/fail.

    A survey of the current 1st year students conducted by the 1st year class representatives to the Principles of Medicine Committee included the following question: AWould you like to get rid of cumulative honors?@ 67% of respondents said Ayes@ and 32% said Ano@ with an n=40.

    The self-study document prepared by the medical students as a part of the on-going self-LCME review recommended that we Acontinue to assess the impact of the pass/fail grading system on student well-being and consider removal of the Apass with distinction@ recognition.

    Sixtine Valdelievre commented that many medical students were concerned about the arbitrary number of 20% medical students assigned cumulative honors and felt that a much smaller percentage would be more appropriate (if cumulative honors were retained).

    The committee members presented were polled as to whether they recommended the elimination of cumulative honors effective for the next medical class (Class of 2010) and the vote was 15 vs 1 in favor of elimination of cumulative honors.

  2. Exploratory.   The Exploratory was introduced for the first time in Fall 2005 for the Class of 2009; half the class was assigned to do the Exploratory in the Fall and half in the Spring.  There was considerable feedback from 1st year students taking the Exploratory in the Fall that the Exploratory came at a bad time because of the intensity of other coursework in the beginning of the Fall semester under the new curriculum.  Concern was expressed about inequities resulting between students taking the Exploratory in Fall versus Spring (total academic load and issues of numbers of free afternoons).  A vigorous discussion of the Exploratory ensued.  Mo Nadkarni, director of the Exploratory reported that a number of changes are being phased into the Exploratory program including: 1) number of hours per week has been reduced, 2) elimination of some of the sites, including remote sites, 3) implementing a choice of semester in which to perform the Exploratory (1st semester Yr 1, 2nd semester Yr 1; summer between Yrs 1 & 2), 4) addition of social medicine instructional modules. Dala Alexander and Darci Lieb reported that they are receiving many enthusiastic reports from students doing the Exploratory this semester.
    John Gazewood suggested the idea of having each student do the Exploratory over the entire first year but decompressed (once every other week, for instance).  Don Innes suggested a new model where all 1st year students would do their Exploratory experience in the Spring of the 1st year but only a portion of them would do Community Service Learning while the rest would participate in The Healer=s Art, which would be expanded somewhat (number of sessions, readings, paper to write) to make it more equivalent in time commitment to the Community Service experience.  Data from the Pass/Fail Grading Study suggests that Spring of the 1st year is the least stressful of the first four semesters in medical school.  It was suggested that students could choose when to do the Exploratory and this choice could possibly include Yr 1 Sem1, Yr 1 Sem2, summer between Yr 1 and Yr2 and Fall of Year 2.
    Howard Kutchai expressed concern about the welfare of the first year given a compression of some material in the Fall, lengthening of the entire year and the fact that having only two exams makes it more difficult for students who score very low on one exam to compensate for this in the other exam.  He recommended not adding new curricular elements (such as the Exploratory) to the first year of the curriculum.  He suggested a menu of Social Medicine Electives that could even be completed in the 4th year of the curriculum.  Claudette Dalton suggested that the basic underlying problm with the first year is the Afirehose of content@ to which the students are subjected and suggested that the first thing we need to do is to directly address that problem.

    A poll of the committee members was taken.  The question was: AHow many of you would favor not having the Exploratory required for any particular student in the first semester of medical school.@  The results were 13 votes in favor and 0 votes opposed.

  3. 1st semester schedule: The last few minutes of the meeting were devoted to a lively discussion of whether to change the basic first semester schedule for Fall 2006.  Barry Hinton (on behalf of the Gross Anatomy course) has requested that Gross Anatomy be spread over the entire Fall (with no additional hours added).  This request responds directly to many student complaints that the pace of the material in Gross Anatomy was too fast and did not allow time to digest material between sessions (which averaged 4 times per week under the new schedule).   Wendy Golden (on behalf of the Medical and Molecular Genetics course) asked via e-mail that the new experiment in scheduling a single course (MMG) between Thanksgiving and Christmas be maintained.  The survey of the current 1st year students by the 1st year student representatives asked: ADo you like only having  MMG between Thanksgiving and Winter Break?  92% responded YES and 7% responded NO (N=41).   With Medical and Molecular Genetics now being placed in the Fall of the 1st year, it was pointed out that there would be some possible negative downsides of spreading Gross Anatomy evenly over the Fall semester that could include: 1) students having to simultaneously study 1 more course than ever before (Gross Anatomy, CTS/Physiology, Biochemistry, PoM1 and Medical and Molecular Genetics all at once); 2) There would be an extra exam in each exam period, 3) Problems could arise with scope and sequence of the curriculum because some of MMG builds on material presented in Biochemistry.  Since time ran out and committee members  were disappearing rapidly, it was decided to poll the Committee by e-mail on their support for the two simplest options: 1) Keep Fall schedule as it was in Fall 2005 or 2) Spread all of the 1st semester courses over the entire semester.

The recommendations coming out of this meeting  will be presented to the Medical Curriculum Committee at its meeting on March 2nd.

Next Meeting:   Wednesday, March 8th at 2:00 PM.  The guest speaker will be David Slawson from the Department of Family Medicine, who will speak on Evidence-based medicine and its application to the early part of the medical curriculum.  There will also be a report by Bob Bloodgood on the March 3rd Curriculum Committee meeting.

Future Agenda Topics:  

 1. Finalizing schedules for 2006-2007 academic year
 2. Discussion of exams versus quizzes and their usefulness (how many of each are optimum?)
 3. 4th year medical student teaching awards
 4. Proposal from some 1st year medical students to have all exams in the morning.
 5.  IAMSE  webcasts on teaching technology