Minutes 04.08.09

Minutes 04.08.09

University of Virginia School of Medicine
Principles of Medicine Committee

  1. ADA medical education grant proposals: Proposals are due by May 4, 2009. This year proposals are being accepted in two areas: A. medical education research and B. Innovations in medical education. The Group on Research in Medical Education (GRIME) chaired by Jerry Short is willing to critique ideas for grant proposal projects at its meeting on Thursday, April 23rd from 9:00-10:00 AM. If you wish to present at that meeting, please contact Jerry Short at jshort@virginia.edu

  2. Job Descriptions for leaders of the new curriculum: Don Innes has requested that the Principles of Medicine Committee hold a special meeting on Wednesday, April 22, 2009 to consider drafts of job descriptions for Systems Leaders and Content Directors for the "Next Generation" curriculum. However, due to scheduling problems, this meeting will not be held and we will distribute these job descriptions to the members of the Principles of Medicine Committee by e-mail for their review and input.

  3. NBME Self-Assessment of Year 1: Jerry Short reported on the status of the NBME self-assessment that will given to the current 1st year class (for the 1st time) on April 24, 2009. The draft exam of 150 questions (plus 150 back-up questions) was received from the National Board of Medical Examiners (NBME) and was reviewed by a group 1st year course directors to determine if the questions were appropriate for our curriculum. The group decided that, in general, the questions were applicable to our 1st year curriculum and should be able to be answered by our students. It was decided not to attempt to do any question substitutions. The only concern of the group was a surprising amount of repetition in a couple of areas within the 150 questions. Proctors for the exam have been identified and there will be a training session for the Proctors on Wednesday, April 22nd.

  4. Assessment of the new Curriculum: Elizabeth Bradley, Chair of the Evaluation Community for the "Next Generation" Curriculum, asked the members of the Principles of Medicine Committee to respond to the following questions:

    a.  Are you aware the curriculum is changing? 
    b. What are your hopes/expectations of the new curriculum? 
    c. What improvements in medical education would you like to see?
    d. What evaluation questions/information would be useful to you?
    e. How will you know if we have educated better residents or doctors?

    The discussion is summarized below:

    * The most important generalization from this session is that course directors want to see a thorough comparison of the existing curriculum (instituted in Fall 2005) with the new Organ Systems curriculum to determine if the Organ Systems curriculum results in a better education for our medical students than the current curriculum. This does seem to be a clear consensus view. 
    Bring our basic science and clinical faculty together working to model the team-based concept used in clinical care delivery and used in research.
    * In terms of the first question, all of the course directors are aware of the new curriculum to one degree or another but desire to know more details.

    De-emphasize the focus on the USMLE exam as the major goal of the curriculum or the major outcome measure (ie. teaching to the test). It may not be measuring much of what happens in medical school and may not be predictive of excellent clinical practice.

    * Use cumulative or semi-cumulative exams in the various Organ Systems units in order to prepare for the USMLE [medical student comment] 
    There is a need to shift the student mindset from being individually-centered to being team-centered. One way to do this is to move away from tests and test results as being the goal of medical school. 

    The curriculum needs to emphasize useful recall "on the job" at a later date, while in residency and clinical practice. For this reason, assess retention and application of information.


    There is a need for students to come to Clerkships better able to apply pre-clinical material to Clerkships. Can this skill be assessed? Note: some professional specialty organizations have prepared lists of things that are necessary for students to be prepared for a certain kind of Clerkship.


    Should Clerkships begin with a Clinical Reasoning pre-test (perhaps designed by the faculty associated with that Clerkship)?

    Will the organ systems method for organizing the curriculum allow medical students to prospectively appreciate the value of the basic sciences (for clinical training and clinical practice) any better than the current curriculum?

    There is a perception by a number of course directors that one way to improve the medical curriculum is to make the 4th year more valuable that it is currently. It needs more structure. There is a current perception by many medical students that the post-Clerkship period (and certainly the post-Match period) is a "gut", less challenging than the rest of the curriculum. As time continues to be taken away from the basic sciences and shifted to the post-Clerkship period, course directors was reassurance that this time is going to be well utilized. 

    Need for more faculty development. 

    It is important to be able to distinguish between (and separately assess) the content of the curriculum versus the manner of delivery of the curriculum.

    Need for more active learning and more consistency of the materials utilized in the curriculum (ie. PoM2 handouts). [medical student comment] 
    In the development of the various Organ Systems Units, there will be a tension between the goal of consistency across the units (such as in handouts and in the chosen distribution of time among different kinds of educational activities) and the idea of allowing for individual unit and individual faculty member creativity and academic freedom. 

    There needs to be an on-going assessment of both content and instructional methods. We (course directors) hope that the assessments will actually be distributed widely, actually studied and actually utilized. It has not always be felt that this was the case in past curriculum assessment.

    One course director suggested not using handouts. Other course directors, as well as students present, saw a value in lecture handouts and other types of handouts to guide learning.

    It was pointed out that there was a study of what Clerkship Directors wanted in terms of the characteristics of medical students at the time of entering Clerkships. Clerkship Directors did not want "entitled" clerks. They wanted a good work ethic and a willingness to search out information. They don't want to hear clerks saying: "since it wasn't in the handout, you can't test me on it". Are we setting a bad example in the basic sciences?  

  5. A new student-designed medical curriculum: Ben (Brad) Bradenham, the 2009-2010 chair of the Student Medical Education Committee (SMEC) presented the outline of a new medical curriculum (called "A Truly Cavalier Curriculum") which he is developing. It is based on the 6 pillars of Leadership, Mentorship, Scholarship, Community and Integration. Among some of the innovative features of this curriculum would be:

    a. A system of "medical colleges" that would bring together groups of medical students and faculty with common interests in specific professional areas, who would interact throughout medical school. 
    b. An emphasis on medical students "giving back" to the school by serving as tutors, standardized patients and in other roles. This would also help students begin to acquire the skills necessary for being effective medical educators. 
    c. An emphasis on scholarship: design in the opportunity for medical student scholarship throughout the four years of the curriculum, culminating in a thesis and 4th year presentation of the work in a yearly medical school-wide symposium. 
    d. Emphasis on global health projects, sustained enough to really accomplish some good in an underserved area of the world.
    e. Emphasis on integration of the curriculum in terms of basic sciences and clinical sciences and on a close working relationship between basic science and clinical faculty. The basic science portion of the curriculum should be led by basic scientists with the clinicians in an advisory role. 

The next meeting of the curriculum committee will be held on Wednesday, May 13, 2009, at 2:00 PM.  This will be the last regularly scheduled meeting of the current academic year.