UniversityofVirginiaSchoolof**Medicine* …...UniversityofVirginiaSchoolof**Medicine* CurriculumCommittee* Minutes01/05/06* SurgeryConferenceRoom,4:00p.m.***** * Present(underlined)were:ReidAdams,*Gretchen

University of Virginia School of Medicine Curriculum Committee Minutes 01/05/06 Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) 1. Isabel. Isabel is a web-‐based clinical decision support system being investigated by the Health Sciences Library for purchase. For a given set of clinical findings or symptoms, Isabel provides the clinician a checklist of likely diagnoses, related diagnoses and causative drugs. The system automatically directs users to relevant literature on a given disease or treatment. The Committee discussed this system and it's possible use in medical education. Primary users would likely be clerkship students, but integration into PoM-‐1 and 2 might be desirable. The Committee realizes that web-‐based systems such as this are going to be integrated into the physician's decision making process and students should be taught how best to use such systems and incorporate critical thinking in their use. 2. Short Clerkship Evaluation Form. The short Clerkship Evaluation form has been sent to the Clerkship Directors. The input of all the Committee members who provided feedback and suggestions in the development of this form was appreciated. The Clerkship Directors were asked to return this information to the Committee by February 3, 2006. Comments from students who reviewed the form were enthusiastic. A group of students has been asked to provide daily schedules from their clerkships as well. After the evaluations forms have been received and reviewed by the Committee, Clerkship Directors will be asked to attend a Curriculum Committee meeting to discuss their clerkship in February and March, 2006. 3. Competencies Required of the Contemporary Physician. An e-‐mail will be sent next week to the teaching faculty to make them aware of these competencies. The Committee was asked for alternative methods to publicize the 12 competencies to all teaching faculty. Not all competencies apply to all courses or clerkships but faculty should incorporate into their teaching and student evaluation those that relate to their teaching activities. The uniform clerkship evaluations of students already directly reflect the competencies. The Committee discussed the competency that states "CompetenceŠin scientific principles as they apply to the analysis and further expansion of medical knowledge" and it was suggested that perhaps a clinical correlation taught anecdotally might be another way to incorporate this into the Curriculum.

In the upcoming LCME review, faculty may be asked about these competencies. Members of the Committee suggested: A. Attend individual Department faculty meetings and briefly (10 min) discuss the competencies with faculty. B. Ask Clerkship Directors to discuss with their teaching faculty. Ask first and second year Course Directors to do likewise. 4. Residents as Teachers (RATS). A group of interested faculty recently met to discuss RATS. John Gazewood noted that Peter Hamm in Family Practice has a brief curriculum already in development for enhancement of resident teaching. Dr. Gazewood will have Peter Hamm contact Don Innes to schedule a meeting with the group working on this. Donald Innes dmr --

University of Virginia School of Medicine Curriculum Committee Minutes 01/19/06

Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) 1. Basic Science for Careers. (Debra Perina) Debra Perina outlined preliminary

plans for the Basic Science for Careers course. This course will be piloted as an elective in 06-‐07 with full implementation planned for the spring of 2008.

Vision

Create a course in the undergraduate medical curriculum following 3rd year core clerkships to review, expand, and focus on basic sciences as applied to a particular discipline

Course Goals

− Relate basic science to individual student’s chosen discipline (future residency) focusing on application of basic science principles used in daily practice of the chosen discipline

− Highlight basic science concepts from Principles of Medicine courses in the post-‐clerkship/pre-‐electives period

− Motivate and mentor students in their chosen field(s) − Increase student interest in academic medicine

− Stimulate critical thinking to enhance their understanding of disease and ability to integrate this into patient care.

− Enhance clinical reasoning and decision-‐making abilities − Promote greater self-‐sufficiency of students in the clinical setting

Format

− 4 week required course for all students − Given May of 3rd year following core clerkships − Prior to elective rotations, residency applications, “audition rotations,”

USMLE-‐2 3 types of teaching venues:

General sessions Topics with universal relevance Entire student group

Major topics in clinical practice with universal relevance relating closely to basic science An integrated and more sophisticated treatment of material from 1st and 2nd years 6 sessions, ~ 3 hours each (~18 hours/student)

Students required to attend all General sessions Topics: Fluid and Electrolyte balance and acid base disorders Drug-‐Drug Interactions Appropriate Antibiotic Prescribing Evaluating Clinical Research Bench to Bedside-‐ answering patient care issues in real time Homeostasis – Maintaining human system wellness preventive

medicine Specialties sessions Topics with career/specialty-‐oriented groups ~10-‐15 students per group Venue for student presentations Focused topics with career oriented relevance #20 sessions, ~3 hours each Students must select 10 sessions, but may attend more ~30 hours/student Content: Topics specific to clinical discipline Case vignettes format Some cases from those identified by students

Relevant Basic Science illustrated Current manuscript discussions Discuss limits of knowledge and identify future research questions

Possible Pairings for Specialties sessions: Surgery -‐ Anatomy Pediatrics -‐ Cell Biology General Internal Medicine -‐ Microbiology Anesthesia -‐ Pharmacology Emergency Medicine -‐ Biomedical Engineering Family Medicine -‐ Biological Physics OB/GYN -‐ Molecular Genetics Cardiology -‐ Electrophysiology Vascular Surgery -‐ Fluid Mechanics Sports Medicine -‐ Biomechanics Pain Management -‐ Neurophysiology Perinatal and Infertility -‐ Physiology Toxicology -‐ Biochemistry Pediatric Infectious Disease -‐ Microbiology Applied sessions Clinical scenarios ~10-‐15 students per group Venue for student presentations and case management Cases developed from specialties Students manage case alone Immediate feedback from faculty Promote critical thinking and independent decision making ~5-‐10 students/group Students attend 7 applied sessions (must sign up in advance) May

attend more Students given case problem in advance to research management Students have access to resources to solve patient management

questions Faculty

− General and Specialties sessions jointly taught by clinician and basic scientist − All sessions are case vignette format − Applied sessions taught by clinicians − Clinician leads case presentation − Basic scientist discusses relevant concepts in context of case

Sample schedules

Required Resources Manpower Faculty General Session Directors 12 Specialties Directors 40 Applied Session Directors 21 Facilities Large lecture hall for General Sessions

7 Intermediate-‐sized rooms for Selective Sessions 18 Small group rooms Student Responsibilities Identify specific cases or questions developed from their experience during

core clerkships to discuss in sessions Attend all General sessions Attend 10 Specialty sessions (must sign up in advance of course). May attend

more Attend 7 Applied sessions (must sign up in advance of course). May attend

more Total class time commitment ~ 20 hours per week Benefits to Students More in depth exposure to specialty areas Relate basic sciences to future practice setting Provides discussion of relevant current literature Enhances overall understanding of specialty which could enhance residency

selection and interview process Benefits to SOM Greater specialty involvement with interested students Recruitment tool for specialties Enhances understanding of basic science relationship to clinical patient care Raise awareness of unanswered questions for future research interests of

students Stimulate interest in academic careers Improve standing of UVA residency candidates Improve USMLE-‐2 performance Incorporates AAMC objectives: Self study, Independent learning, Small group teaching, Information retrieval Next steps…..

− Develop Steering Group to refine content and address ongoing questions − Actual scheduled time within total curriculum − Are 4 weeks needed? − Possible pairing with other rotations − Refine specialty selection and basic science groupings − Pilot course with a select group of students with follow-‐up impact study (2

week elective) in Spring 2007. − Measure impact of course by surveying participating students and selective

directors benched against control group of students who did not participate in the course

− Obtain Departmental Chairs support − Identify all session leaders

− Budget for space and resources The Committee congratulating Dr. Perina on her outstanding work on this

project. The Committee had a brief discussion regarding the timing of the course – whether in May as originally designed or in March

immediately after the clerkship period practical issues such as grading/remediation and space requirements recruitment and compensation of enthusiastic faculty use of computer based learning in the course The Committee endorsed the case based format of the course. It was suggested

that some small group interaction be structured into the General Sessions to enhance student interest. Use of real or standardized patients or the patient simulator was also encouraged.

Dr. Perina asked the Committee to send their thoughts or suggestions regarding

the course to her via e-‐mail <[email protected]>. Sixtine Valdelievre highly endorsed the proposed program and volunteered to

serve as one of the student members of the Steering Committee. 2. Mentorship Program. John Gazewood noted that the faculty mentor program

will begin this week. Four sessions are planned for this year. Recruitment of enough in-‐house faculty was difficult so some students will need to travel to Orange or Stony Creek. He is hopeful that more UVA faculty will volunteer as the program becomes more visible.

3. Curriculum Committee meeting agenda for the next few months was outlined.

Address recommendations from the UVA Self-‐study Subcommittee on Education

for the M.D. Degree. Exploratory placement in the curriculum? -‐time? -‐extent? -‐modifications/true

"exploratory"? integrate with physician experience? -‐other ? Recommendations for first year fall 2006 following evaluation of the Fall

semester of the first year, and options from the Principles of Medicine Committee.

Clerkship evaluation form is due to the Curriculum Committee by 2/3/06. The Committee will review the submissions and arrange interviews with the Clerkship Directors beginning in February.

Clerkships– Neurology integration; Medicine scores; Surgery anesthesia curriculum; Psychiatry and Ob/Gyn curriculum focus

Selectives – program description, curriculum, evaluation (student/program) in Internal Medicine (Acute Cardiology, Coronary Care Unit, Digestive Health, Geriatrics/Palliative Care, MICU, Cardiovascular Emergencies, Acute General Medicine (Roanoke), Infectious Disease), Obstetrics and Gynecology,

Psychiatry, and Surgery (ENT, Neurosurgery, Ophthalmology, Orthopedics, Plastic Surgery, Urology)

Clinical Skills Education Program – Michael Rein Ethics Rounds – Walter Davis Electives -‐ monitor the content, depth, breadth, current relevance [ED-‐37] Meg

Keeley, John Jackson Reflections program – Dan Becker/ Margaret Mohrmann – program structure Clinical Connections – future

Program structure –schedule, full day/1/2 day Organization – CME director, Medical director, Clinical Connections

committee Evaluation (student/program)

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Margaret Mohrmann (guest), Debra Reed (secretary) 1. Exploratory Program. A group of course directors (Bargmann, Bloodgood, Innes,

Kutchai, Lieb, and Nadkarni (Exploratory Program), discussed options for the 06-‐07 Exploratory Program. Options will be evaluated and presented to the Committee.

2. Clerkship Grades. Clerkship Directors are reminded to get the grades (including written evaluations) in on time.

Period 1 (6/27/05 -‐ 9/17/05) Due: 10/24/05 Date Received Status Med 02/03/06 Complete* Fam Med 10/25/05 Complete Peds 10/14/05 Complete OB/GYN 10/28/05 Complete Psych 11/21/05 Complete Surg 11/17/05 Complete Neuro 12/09/05 Complete

*grades 11/22/05; evaluation 02/03/06

Period 2 (9/19/05 -‐ 12/17/05) Due: 1/30/06

Date Received Status Med -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Fam Med 01/25/06 Complete Peds 01/27/06 Complete OB/GYN 01/31/06 Complete Psych -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Surg -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ Neuro 01/26/06 Complete

3. Clinical Connections. The Clinical Connections group met today. The last session

for 05-‐06 (June 23, 2006) has been eliminated because of one-‐time scheduling problems. The Committee suggests that the clerkship schedule remain unchanged and the students be given June 23rd as a day off pending approval by the clerkship directors. [This was approved at the Clinical Medicine meeting February 2, 2006.]

4. Clinical Reflection Proposal. (Margaret Mohrmann, M.D., Dan Becker, M.D.) Drs.

Mohrmann and Becker outlined a proposal for the Clinical Reflection Program. Clinical Reflections was a part of the Clinical Connections Program. The program was not as successful as the organizers had hoped so it was discontinued this year. A committee led by Dr. Mohrmann has proposed a new Clinical Reflection program.

Format: Rationale: Clinical reflection is best accomplished within small groups of willing

students and sensitive, well-‐prepared facilitators, who meet often enough to form a sense of group coherence and safety.

Groups: 8-‐10 students and 2 mentors, one of whom must be a physician, meeting at

least once a month. Once a group is formed it will decide when, where, and how often it will meet, providing needed flexibility.

Required: Clerkship directors must assure students (and their supervisors) that clinical

Reflection Group meetings take priority, so that students are excused from ward duties, including call, for the 1-‐2 hours necessary for the group to get together.

Attendance must be mandatory, but students on out-‐of-‐town rotations can be excused.

Group control of the meeting schedule will allow, adaptation to members’ obligations. Content/Process Goals: To help students learn skills of being reflective about both their clinical

experience and its interaction with their non-‐professional lives, based on the well-‐founded assumption that reflective physicians are better at what they do, more

available – emotionally as well as intellectually – to their patients, and happier in their vocation in the long run.

To have students learn for themselves, by experience, that reflection is a good thing to do, and that shared collegial reflections on the varied aspects of the medical vocation can enhance and support them and their work.

Method: Offer a variety of modes of entering the reflective exercise (e.g., writing, a

common reading experience, art, mindfulness meditation, discussion of selected clinical encounters)

Match student and mentor preferences for method of reflection. In all groups, regardless of method, attend to some common issues/questions and to the

developmental changes that occur in the 3rd year. Evaluation: Of students – at least to begin with presence. Of the “course” – Perhaps attitudinal surveys of students – their views not only of the

project itself, but of themselves as clinicians and of medicine as vocation – at the beginning and at the end of the 3rd year and again toward the end of the 4th year. Potentially, the same instrument could be used with our graduates during and after their residencies.

Mentors: The most important factor in the success of this endeavor is the quality, engagement,

and preparation of the group mentors. The nature of the groups and their scheduling may help attract more qualified mentors, especially among physicians, but once-‐a-‐month group meetings are a lot to ask.

Faculty development: Leading reflective groups is a skill very different from lecturing

or from usual clinical teaching; it requires, among other things, the ability to be silent and non-‐authoritative. Identification, recruitment, and preparation of mentors will be crucial.

Required: substantial and unequivocal support from deans, the Curriculum Committee,

department chairs, and division heads for release time (and ideally, money) for faculty physicians.

Timing: If these ideas are approved and adequately supported by the Curriculum Committee, the

project could potentially be in place for the 3rd year class starting June, 2006, using this spring for planning, recruitment and faculty development.

The Curriculum Committee discussed timing of the Clinical Reflection sessions

and how to involve students on out-‐of-‐town rotations. Keeping groups together with so many students out of town each month will be difficult. The possibility of keeping successful PoM-‐1 groups together for these sessions was mentioned. An AA model with students able to “sign up” on line for monthly sessions was discussed. The Committee agreed with Dr. Mohrmann that if the program cannot be done well it should not be done at all. The amount of mentors needed

for the program was discussed – Dr. Mohrmann believes an absolute minimum of 15 physicians and 15 nonphysicians would be necessary, however, this would made the groups large with approximately 10 students each. More mentors would be optimal but recruitment and training might be difficult. Dr. Mo Nadkarni is attempting to build in reflection time into the exploratory and perhaps this might be another place to incorporate this program

The time (10 meetings per year or 1 per month) and number of clinicians and

non-‐M.D. mentors (15/15), training, and the travel logistics required in this plan are huge. Drs. Mohrmann and Becker will continue to work on the proposal and return with revisions based on suggestions from the Curriculum Committee.

5. Clerkship reviews are due Friday, February 3rd, 2006. [Two have been received

as of February 3rd, 2006.] 6. Emil R. Petrusa, Ph.D., Associate Dean for Curriculum Assessment, Duke

University will be our guest at the next meeting, February 9, 2006. Donald Innes Dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guests: Veronica Michaelsen, Nancy Payne, Emil Petrusa

1. Clerkship Review. The 2006 clerkship self-‐study reviews with the exception of Internal Medicine have been received in the Curriculum Office.

Clerkship Directors will be invited individually to the Curriculum Committee in February, March, and April to discuss their reviews. The Clerkship self-‐study reports were sent to the Curriculum Committee via e-‐mail today. Members of the Committee were asked to review the reports and e-‐mail comments to Don Innes [email protected].

2. Medical Education. Emil R. Petrusa, Ph.D., Associate Dean for Curriculum

Assessment at Duke University School of Medicine met with the committee to discuss his role in assessment, general assessment methods, and recent curriculum revisions at Duke.

Recent curriculum innovations at Duke such as the merger/integration within the first year, “Intersessions” and “Capstone Program” were discussed. The Intersessions are one week long sessions during the clerkship year with three and one half days devoted to intensive sessions on topics not otherwise thought to be thoroughly covered in the Curriculum and one and one half day devoted to individual clerkship orientations. The Capstone program is a one-‐week program in March of the fourth year in preparation for residency. Assessment techniques and methods of providing feedback for the Course Directors were discussed.

Donald Innes Dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) 1. Isabel. Gretchen Arnold updated the Committee on the Isabel system soon to

be available in the Health Sciences Library. Members of the Curriculum Committee and the Clinical Medicine Committee attended a demonstration of the system. This is not a decision support system but rather a totally new way to research the literature. The Curriculum Committee agreed that systems such as this will become common in the practice of medicine and our students should be taught how to use them intelligently. The systems links symptoms/physical findings to relevant medical literature. One individual expressed concerns about the quality of Isabel. [Steve Borowitz with extensive experience in health care computer systems has concluded this is one of the best available systems at this time.]

2. Clerkship Reviews. The Self-‐Study Reports for all the Clerkships with the

exception of Internal Medicine were sent to the Committee members last week. Members were asked to review these reports carefully. Several of the clerkship directors have already been scheduled to meet with the Committee to discuss their report.

March 2 Family Medicine (Karen Maughan, Anne Mounsey) March 9 Psychiatric Medicine (Pam Herrington) March 23 Neurology (David Geldmacher) March 30 OB/GYN (Megan Bray) April 13 Pediatrics (Bill Wilson) 3. Clerkships/Electives/Selectives and Basic Science Courses. How to best

monitor the content, depth, breadth, current relevance of curriculum [ED-‐37] as well as how to remove/add material from the curriculum was discussed. The Committee seeks ways to improve our system of monitoring the content

of the curriculum to insure that we are providing the best medical education possible. The faculty member responsible for teaching the material, with the guidance of the course director, is perhaps the best person to decide what should be taught. The knowledge and skills to be taught should be expressed as objectives. All directors are required to have learning objectives in place for both the course as well as for the individual lectures. The Curriculum Committee should regularly review these objectives. Course and Clerkship/Elective/Selective directors are to report annually to the Curriculum Committee that they have reviewed the content of their course for relevance. Directors may wish to set up an internal (departmental) review committee such as the one in Pediatrics to monitor the content of their curriculum. Student evaluations also provide insight to the Curriculum Committee as to whether objectives are being met. This discussion will continue at a subsequent meeting.

4. The next meeting will be March 2, 2006:

• Clerkship review: Family Medicine (Anne Mounsey) • First year “Foundations” schedule proposals (Bob Bloodgood)

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Anne Mounsey 1. Family Medicine Clerkship Review. Co-‐directors Anne Mounsey and Karen

Maughan were complimented on submitting an excellent review. Anne Mounsey represented the clerkship joined with the curriculum committee to discuss the review.

When asked about cultural competency in the Family Medicine Curriculum,

Dr. Mounsey noted that while they did previously cover this in a workshop, it had been discontinued due to poor evaluations. It is being redesigned (Please see section F5.) to focus on specific goals (obesity in ethnic minorities) and hopefully will be better received.

It would also be beneficial to the program if PDAs could be provided to the

preceptors along with training in how the students are to use them.

Family Practice does not have a problem with recruitment or retention of

preceptors. A large pool of preceptors allows for careful selection and evaluation (by students and faculty) of preceptors, and retention of only those effective teachers.

Comments from one medical student asked to review the Family Medicine

Passport were discussed: [Rather than]"observe" a skin exam… better would be to require the student to

describe a rash to the physician using proper terminology. [Include procedures] such as a pelvic exam, breast exam, testicular exam (breast and testicular are in surgery, but I felt there were actually more opportunities to perform these exams on my family rotation). Some required phlebotomy on the family rotation could be useful as well.”

Family Medicine distributes guidelines to their preceptors. The Curriculum

Committee expressed an interest in the guidelines and would like to share these with the other clerkship directors through the Clinical Medicine Committee.

Dr. Mounsey noted that the departmental and administrative support for the

Family Medicine Clerkship was excellent. The Curriculum Committee thanked Drs. Mounsey and Maughan for an

excellent review and praised them for a well run Family Medicine Clerkship. The clerkship fulfills an important place in the clerkship environment addressing, in cooperation with AIM, essential physical examination, communication and cultural skills in the ambulatory setting.

2. Semester 1 of the Medical Curriculum. (Bob Bloodgood) Dr. Bloodgood

outlined the 05-‐06 changes to the Semester 1 Medical School curriculum: Gross Anatomy, Biochemistry and CTS/Physiology ran only until

Thanksgiving Gross Anatomy and Biochemistry changed from 3 to 2 exams Molecular & Medical Genetics moved to the fall Only 1 course (MMG) taught in 3 week period from Thanksgiving to Winter

Break Cells to Society To evaluate the impact of these changes many sources of data were reviewed

such as student performance data from individual courses; data from medical student evaluations of individual courses; results from Nov 2005 survey (same one used for Pass/Fail grading study – Wellness Survey); notes from “town hall” meeting of Associate Deans with 1st year class and a survey done of 1st year class by 1st yr reps to the Principles of Medicine Committee.

Academic performance data: Total # Failures 4 0 Comparison of Survey Data from Classes of 2007 and 2009 A Summary

[Data collected before Thanksgiving] included the following questions: "Overall, I am satisfied with the quality of my medical education"

dropped from 3.63/4.00 to 2.96/4.00. "My current level of satisfaction with my personal life during the last

month of medical school" dropped from 3.95/5.00 to 3.15/5.00. All of the questions on the DuPuy Wellness Survey showed a

consistent (albeit sometimes small) drop in Wellness during Semester 1 of medical school.

Conclusions from Evaluation of Fall Year 1 of New Curriculum Student performance (scores on individual courses) was as

high as in previous year [less low scores] Number of course failures was down (from 4 to 0) Student feedback suggests increased stress between August

and Thanksgiving, especially associated with Gross Anatomy Student assessment of courses down somewhat for Gross Anatomy, Med & Mol Genetics and CTS/Physiology and up dramatically for Biochemistry

Students liked the experiment in taking a single course between Thanksgiving and Winter Break

The Principles Committed identified potential sources of increased stress

between August and Thanksgiving Addition of Exploratory Decrease in number of exams in Biochemistry and Gross Anatomy

Increased pace of the material in Gross Anatomy (more hrs/week of Gross Anatomy)

Scheduling (overlap of amino acid metabolism with head and neck anatomy)

Comments made by some faculty and 2nd year students to the 1st year students

Course

Fall >04 (Class of >08)

Fall >05 (Class of >09)

Gross Anatomy

88.9% (65-99%)

87.7% (71-98%)

Biochemistry

84 % (56-98%)

87 % (70-98%)

CTS/Physiology

87.4% (66-95.5%)

85.0% (72.4-98.9%)

Med & Mol Genetics

90.0% (78-99%)

91.4% (76.7-97.9%)

The Committee discussed the following possible Strategies for Reducing

Stress in 1st semester of Year 1 Change timing of the Exploratory Eliminate cumulative honors Eliminate the experiment of a single course between

Thanksgiving and Winter Break so as to spread some or all of the other Fall courses (esp Gross Anatomy) over the entire Fall

Adjust the schedule within the period between August and Thanksgiving

Make adjustments within individual courses\ The Principles of Medicine committee developed three recommendations: (1) Exploratory: Recommend that the exploratory not be required

for any particular student during the 1st semester of the 1st year (2) Cumulative Honors: Recommend that cumulative honors be

eliminated from the pass/fail grading system with the Class of 2010. (3) Schedule for Sem 1 of Year 1: Leave the current (new) schedule in place.

The Curriculum Committee discussed numbers (1) and (3) at today’s meeting and unanimously endorsed both measures.

Due to time constraints, the Cumulative Honors program will be discussed at

a later date. Fall semester course directors are asked to work together to optomize their courses to ensure a more balanced student workload. Dr. Bloodgood reports that the Fall 06-‐07 schedule is now being developed and should be ready in a few days. Conflicts with the MSTP program will also need to be addressed.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Pamila Herrington

1. Psychiatric Medicine Clerkship Review. Pam Herrington, Director of the Psychiatric Medicicine Clerkship, met with the committee to discuss the recent review. The linkage from the UVA 12 Competencies Required of the Contemporary Physician to the specific objectives of the Psychiatric Medicine clerkship was clearly expressed and should be a model for other clerkships. Equivalency of experiences across the clerkship sites was discussed. Due to the nature of each clerkship site, the individual experiences can vary, however, the basic core experience as delineated in the objectives is equitable across sites. Dr. Herrington pointed out that the passport helps to assure a standard experience across all the sites. Some students commented in the Mulholland report that they would like more patient care duties on this rotation and Dr. Herrington feels that this will improve with the rotation of students through Rucker 3 in the coming year. Dr. Herrington noted that changes are made each year she is always seeing ways to make the clerkship a better experience for the students. Dr. Herrington plans to develop a series of Powerpoint presentations that would form a core to be used at all sites for lectures. Administrative support for the course is adequate. The Curriculum Committee thanked Dr. Herrington for a fine review and praised her for her commitment to the Psychiatric Medicine Clerkship.

2. Cumulative Honors Grading Program. (Bob Bloodgood) The Curriculum

Committee discussed the recommendation from the Principles of Medicine Committee that cumulative honors be eliminated from the pass/fail grading system with the Class of 2010. Dr. Bloodgood outlined the reasons for elimination of the cumulative honors program, among them, data from various student surveys. It is believed that elimination of the Cumulative Honors program will result in decreased stress for first and second year students and have no effect on residency selection. The Curriculum Committee endorsed the proposal with the modification that it become effective with the Class of 2011 (not the Class of 2010) because of admissions considerations.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Daniela Alexander, David Geldmacher, Darci Lieb, Mo Nadkarni

1. Neurology Clerkship Review. David Geldmacher, Director of the Neurology

Clerkship, met with the committee to discuss the recent Clerkship review. The Committee thanked Dr. Geldmacher for a clear and comprehensive self study report. The Neurology website was also praised for its completeness and the Committee believes it should be a model to the other clerkships. The Committee discussed remediation of students who fail to satisfactorily complete the course. While there are few failures, in most of the cases in recent years, failure to pass the national subject exam has been remediated by allowing the student to retake the test. Student required attendance occasionally has been a problem due largely to the fact that the Neurology clerkship has been in the fourth year when students are interviewing for residencies. Students must make up time if they miss more than the required minimum to satisfactorily pass this course. This will not be a problem when the clerkship completes the move to the third year.

The clerkship will transition to letter grades next year from a P/F grading

system. Members of the teaching faculty are working on developing specific criteria for the new grading system.

Dr. Geldmacher noted that the undergraduate medical education program has

excellent support from the administration and faculty in Neurology and strong competent support staff.

The Oasis system for evaluating students was discussed. The system is an

excellent tool but a way to merge narrative statements from faculty would make it more user friendly.

The clerkship transition from the fourth into the third year, spread over two

years, 05-‐06-‐07, has increased the number of students by 1.5 for the transition. The structure of the clerkship (case studies and varying rotations) provides a comparable experience for all Dr. Geldmacher is closely monitoring the clerkship for any dilution effect on patient encounters.

Dr. Geldmacher believes that the programs at UVA and Roanoke Carilion are

comparable in that he can find no difference in test scores or student evaluation comments between the two institutions. The Salem VA has recently expressed interest in having the Neurology clerkship students at Roanoke spend time at the Salem VA during their Roanoke Carilion rotation. This is in the discussion phase.

2. Social Issues in Medicine: Building Bridges Between Community and Medicine

(Daniela Alexander, Darci Lieb, Mo Nadkarni) The course description for the revised “exploratory” course for 2006-‐07 was distributed to the Committee. In response to feedback received from the students, faculty, and community supervisors, a number of modifications have been made. These changes are designed to promote an ethic of service as well as the competencies of

humanism and professionalism by giving students more choice, and therefore more investment, in their assignments.

No student will be required to do service learning in the fall semester. The

weekly sessions have been reduced to three hours. Although it is a challenge to place potentially all 140 first year students in the spring semester, the students will be given a choice as to which semester in the first year they will do their service learning.

It is hoped that some students who are already engaged in community service in the local

community will want to continue their work in the Fall semester and students who participate in the Medical Student Summer Research Program can get permission from the faculty member to allow flexibility in their summer schedule so they can do their service learning in the summer. Directors are concerned that the timing of selection for this program may be too late to schedule students for the summer service learning exercise.

The survey which helped to place students in an area of interest to them has been refined

and students will also be encouraged to develop their own projects. Some agencies used this year have been dropped due to negative feedback and others added. The Committee asked to review the list of sites available to the students including those removed and added this year.

The didactic portion of the fall course (one introduction, three lectures and one

small group session) will likely be scheduled during the December portion of the first year along with Molecular & Medical Genetics and PoM1.

Dr. Nadkarni noted that he will be applying for a $600,000 grant that has to do

with enrolling students in service related projects in the coming year. [Further discussion on the need for evaluation of the Social Issues in Medicine

exploratory is needed (the current 4th, 3rd, and 2nd year students could serve as control groups, but there is little time to catch the 4th years).]

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Mary Lee Vance

1. The Curriculum Committee reviewed the most recent performance of examinees taking USMLE Step 1 for the first time in 2005. UVA students performed exceptionally well, with a 99% pass rate and a mean score well above the national mean. The Committee was pleased with the result and furthermore noted that the distribution acording to discipline and organ system showed above the mean performance in all areas.

2. Pediatric Clerkship Review. Bill Wilson, Director of the Pediatric Clerkship, met

with the committee to discuss the recent Clerkship review. The Committee thanked Dr. Wilson for a clear and comprehensive self study report and for his strong leadership as clerkship director. Dr. Wilson noted that the Pediatric Clerkship objectives are in line with the 12 competencies set forth by the Curriculum Committee. The primary goal of the Pediatric clerkship is to give a broad exposure to Pediatrics to the medical student. The Clerkship incorporates computer based case study units to provide a uniform exposure for all medical students. Students are given 18 of the computer cases (CLIPP cases), of these, 15 are required for successful completion of the clerkship. The Pediatric clerkship is an eight-‐week rotation made up of 4 weeks of inpatient, 2 weeks outpatient and 2 weeks in the nursery. Although a number of students have noted in the evaluations that they would prefer more time with one attending while on the rotation, this is, unfortunately, not possible due to the attending rotation schedule in Pediatrics. Students do praise the clerkship attendings for the quality of their teaching.

Dr. Wilson noted that the undergraduate medical education program has

excellent support from the administration and faculty in Pediatrics and that the support staff was also very competent. The relatively high student to patient ratio and seasonal differences in disease presentation in Pediatrics, increase the importance of the CLIPP cases.

Pediatric clerkships are located at Charlottesville, Roanoke, and Fairfax. The

shelf exam and in-‐house essay exam scores reveal no difference in scores from the various clerkship sites. There is no evidence for differences between sites from examination of the results on the Standard Clerkship Evaluation Form used for all students.

Student final grades are based on their NBME shelf exam score, an in-‐house

essay exam score, their passport and faculty and resident ratings. Completion of the passport, ED-‐2 patient list and specified computer classes (CLIPP cases) are requirements to receive a grade (these are not graded, but are required). The Pediatric Passport identifies specific clinical skills to be “learned and demonstrated” by the student and directly observed and documented by an attending or senior resident.

3. Student Lecture Attendance. Dr. Mary Lee Vance attended the Committee

meeting to discuss her observations and letter to Dean Pearson regarding

student attendance in lecture. Dr. Vance noted that in a February PoM-‐2 introductory lecture on diabetes only about 15 students were in attendance. During her last endocrine lecture, approximately 50 students (out of ~145) were in attendance. Her concern is that these are clinically relevant lectures that show many slides not available on the web due to copyright issues and students are missing pertinent clinical information by not attending lecture. A brief discussion on required versus non-‐required activities in the School of Medicine ensued. This is an on-‐going discussion in the Principles of Medicine Committee and will be discussed further in the Curriculum Committee at a later date.

Donald Innes dmr

University of Virginia School of Medicine Curriculum Committee

Minutes 04.20.06

Surgery Conference Room, 4:00 p.m.

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Michael Rein, George Rodeheaver

1. Internal Medicine Clerkship Review. Michael Rein, Director of the Internal Medicine Clerkship, met with the committee to discuss the recent Clerkship review. The Committee thanked Dr. Rein for a clear and comprehensive self study report. Dr. Rein noted that the Internal Medicine Clerkship objectives are in line with the 12 compentencies set forth by the Curriculum Committee. Dr. Rein also confirmed that while the patient base is different, students do receive a comparable experience across the three in-patient clerkships sites (UVA, Roanoke, Salem). Shelf exam scores from students at the the various AIM sites reveal no discernable differences across the sites. Dr. Rein noted that the annual mean performance on the subject examination in Internal Medicine is above the national mean. The UVA scores have risen fairly consistently for many years, but the national mean has also risen over this same period. The major strengths of the clerkship are the skill and interest in teaching of their faculty and residents, the support of the Chair, the nature of the three in-patient sites (assures an excellent mix), and the Ambulatory Internal Medicine portion of the course which is always well-received. A further strength is the transparent, reproducible grading system that compares students to previous classes. There is close contact between the Clerkship directors at the major sites and between AIM preceptors and the AIM faculty administration. The recently instituted Ethics rounds once every two weeks has been a success.

Weaknesses of the clerkship included the inability of the clerkship to adequately teach physical diagnosis especially in the newly shortened clerkship. The Service Center of the Hospital is also a limiting factor in the types of patients students encounter. The total amount of time that a student must spend on an inpatient service that has primary responsibility for patient care is probably somewhat reduced by curricular change in that the inpatient subspecialty rotations have been moved to the fourth year, and they have been diluted by the addition of selectives that do not have primary responsibility for patients. Dr. Rein also noted that in the future, one-third of our students will have none of their third year Internal Medicine at University Hospital. This may make it somewhat harder to obtain strong letters of recommendation for the approximately 45% of our students who go on to take Categorical, primary Care, or Preliminary Internal Medicine Residencies. He also noted that the faculty of our Division of Hematology/Oncology has been below full strength for some years, and the Bone Marrow Transplant Service has been closed. This past year, the Division has been able to field only one attending physician for the inpatient service. The ACGME defines the maximum number of learners per attending physician, and this number does not permit third or fourth year students to be present on rounds. We have been unable to offer this subspecialty rotation to our third year students and will not be able to offer AIs, ACEs, or inpatient selectives to fourth year students next year. Dr. Rein asked the Curriculum Committee for suggestions on how to better maintain contact with the teaching faculty. The Curriculum Committee suggested e-mail and a comprehensive website as excellent tools for outlining expectations and goals for teaching faculty. Implementation of the Clinical Skills Educator Program in May, 06 should greatly enhance the Internal Medicine Clerkship.

2. Clinical Skills Educator Program. (Michael Rein) Recruitment of faculty for this program has begun. Faculty will sign up for 4-week blocks. They will meet with the students (2-3) for two hours, twice each week in the afternoon. Faculty and students will define the time and afternoons. Students will present cases, usually presenting patients that they have worked up. The CSE will spend as much time as possible with the students at the bedside reviewing physical examination, and directly observing the student's physical examination and presentation skills. The faculty will provide formative feedback. They will also review the labs, EKGs, Radiographs, etc. and the students' write-ups in the charts as well. The CSE will go through all elements of the physical exam (attached) during the month. At the end of the month, the CSE will provide a narrative evaluation of the accomplishments and performance of each student. The exercise will not be formally graded, but the narrative will help to prepare a summary of each student at the end of the clerkship. [The clerkship director is asked to provide the goals, objectives, and curriculum to the medicine clerkship directors at Carilion and Salem sites for incorporation into their rotations. It is of further note that the initiation of the CSEP began with student comments on the close attention and time spent on physical exam findings by attendings at the Roanoke and Salem sites as compared with UVA.] Thus far there has been a relative paucity of interested faculty. Dr. Rein is concerned that there will have to be 4 students on some rotations. Recruitment for the CSE positions has begun. Anyone interested in a CSEP position should contact Michael Rein. It was suggested that he discuss the importance of the CSEP with his new Chair.

3. Use of Microsurgical Simulators for Medical Student Education in Microsurgical Technique. The Curriculum Committee reviewed a proposal from Dr. Nava Guillermina, Dr. David Drake and Lester Amiss, from the Department of Plastic Surgery to use live animals for microsurgical technique instruction as an elective experience for fourth year medical students. The "Use of Live Animals in Medical Education" policy states that "The benefits of the educational activity must be substantial. Live animals should be used only if educational goals

cannot be fulfilled using a simulator or other non-living model." It further states that the proposal "must document that the goals and content are essential to the education of a physician and that there are no alternatives to the use of animals." George Rodeheaver, Chair of the Animal Care and Use Committee attended this portion of the meeting as an ex officio member and as a member of the Plastic Surgery faculty, was also able answer a few questions on their behalf. He was asked about the threshold for student proficiency before use of live animals. The protocol is below:

It was unclear what the level of competency must be for the student could work with a live animal. [Dr. David Drake in a telephone conversation (04/26/06) indicated that students should achieve level 4 or 5 performance in all categories before proceeding to an animal.] When asked what training program was used for plastic surgery residents, Dr.Rodeheaver replied that he did not believe animals were used in residency training. [Dr. David Drake in a telephone conversation (04/26/06) indicated that a similar protocol has been submitted to the Graduate Medical Education Committee for action, although it has yet to be approved.] The Curriculum Committee voted to support this proposal as a valid educational experience. The proposal will now go on to the Animal Care and Use Committee; then assuming approval, to the Vice President and Dean of the School of Medicine.

4. Attendance at lectures was discussed briefly and a summary of student comments on attendance presented by Sixtine Valdelievre.

5. Teaching Spaces Proposal from the Principles of Medicine Committee April 12 meeting was presented. "The Principles of Medicine Committee believes that it is essential to have two large teaching spaces available (each accommodating an entire medical class) that are capable of being optimally configured so as to allow the medical school faculty to present simultaneously a "traditional" lecture format presentation to both the 1st and 2nd year medical school classes." A brief discussion, including availability of the Old Medical School Auditorium for lecturing, ensued; however, further discussion was postponed until a later meeting.

Donald Innes dmr

University of Virginia School of Medicine

Curriculum Committee Minutes 04/27/06

Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) Guest: Curt Tribble, Doug Newburg 1. University Teaching Awards. The Committee congratulated Reid Adams, who

was awarded the All University Teaching Award. Two other members of the Medical School Faculty, Stephen Borowitz and Mitchell Rosner, also received the award.

2. Clerkship Grades. As of 4/27, the Pediatric, OBGYN, and Psychiatric Medicine

Clerkships have already turned in their student grades due by May 1. The other clerkships are strongly encouraged to meet the deadline for submission of grades. [As of May 2, Family Medicine and Neurology have also been received. The Internal Medicine and Surgery clerkships are late.]

3. Surgery Clerkship Review. Curt Tribble, Director of the Internal Medicine

Clerkship, and Doug Newburg, Course Coordinator, met with the committee to discuss the recent Clerkship review. It was announced that both Drs. Tribble and Newburg will be leaving the University for posts at the University of Florida within the next few months. A new Clerkship Director has not been chosen by the Department of Surgery at this time.

The Committee thanked Drs. Tribble and Newburg for a clear and

comprehensive self study report. Dr. Tribble noted that the Internal Medicine Clerkship objectives are in line with the 12 competencies set forth by the Curriculum Committee. The Surgery Clerkship shelf exam grades are always above the national mean and often higher than the other clerkships at UVA. Grades on the shelf exam do go up slightly throughout the year depending on how many other clerkships the student has participated in before the exam.

Doug Newburg mentioned the difficulties in obtaining timely student evaluations

from the subspeciality faculty -‐ the “lack of a hammer” to elicit timely responses from the faculty. The Course Directors agreed that the Chief Resident(s) in Surgery often sets the tone for teaching and at the present time, they have two great Chiefs.

The Surgery Clerkship does not try to teach a medical student how to be a

surgeon but rather teaches what every physician should know about surgery.

Surgery clerkship students on the General Surgery rotation are required to participate in every fourth night call. They are treated as members of the team and participate in a morning report conference with the day shift following the night call. Dr. Tribble believes student duty hours are not excessive at any of the sites.

Student experiences at the three sites (UVA, Roanoke and Salem) while unique in

each program, are felt to be comparable. Dr. Tribble responded to a student who recently reviewed the passports and

commented that breast and testicular exams were not difficult to come by on most of the surgery teams and that it should be even less of an issue with the new curriculum.

While the Roanoke Surgery program has been panned in the past by the

Mulholland Report, Dr. Tribble feels this is on the upswing with Steve ReMine as the new Course Director in Roanoke. Recent student reports have been much more favorable of the program. Dr. ReMine Dr. ReMine is also working on improving the teaching abilities of the Roanoke residents. One difficulty at Roanoke is that patients and faculty (not residents) have a much closer relationship. Consideration is being given to assigning a student to a faculty member rather than a team in this program.

Departmental support for teaching efforts was deemed adequate and

administrative support excellent. Dr. Tribble was asked about the minutes of the Surgery Educational Committee.

Dr. Tribble has copies of the minutes from these meeting and was asked to transfer them to the Clerkship administrative assistant before he leaves UVA.

4. Motion from the Principles of Medicine Committee. A motion from the Principles

of Medicine Committee regarding the new educational space was discussed. Proposal: Background: The Claude Moore Medical Education Building is currently in the

design phase. The plan is to have two large teaching spaces, each large enough to hold an entire medical school class. One is being called the Large Lecture Room and one is being called a Large Learning Studio. In recent meetings of the Building Committee with the Architects, it appears that the Large Learning Studio will not be designed in such a manner as to accommodate traditional lecture presentations.

Motion: "The Principles of Medicine Committee believes that it is essential to have

two large teaching spaces available (each accommodating an entire medical class) that are capable of being optimally configured so as to allow the medical school

faculty to present simultaneously a "traditional" lecture format presentation to both the 1st and 2nd year medical school classes."

This proposal was voted on with 25 in support of the motion; 1 opposed to the

motion. All course directors and co-‐course directors for all 1st and 2nd year courses are represented in this vote.

Elaboration on the Motion: The members of the Principles of Medicine Committee, being the course directors

for all the courses in the early part of the medical curriculum, embrace innovation and currently teach in a variety of ways. These educational leaders in the School of Medicine welcome facilities that will open up new teaching modes, but not ones that will force the faculty to abandon any of the existing modes of teaching. They want the flexibility to be able to continue to utilize existing modes of teaching, including lecture format, while at the same time experimenting with new ones.

The motion above requests that two large teaching spaces, each with the potential

to be configured for a traditional lecture (among other things) always be available to the faculty. Even if the amount of lecturing we now do were to be drastically reduced, it would be very likely that there would be many times when the medical educators teaching 1st and 2nd year classes would want to use the lecture format at the same time. The course directors of one class do not want their scheduling dictated by the teaching of the other class. The two teaching spaces compatible with a lecturing format need not both be in the new medical education building, although that has definite appeal. If the architects and planners and Deans do not want to design both large teaching spaces in the new building so as to allow (at least for a portion of the time) for a lecture format, another option must be provided. One such option is to provide an additional large teaching space elsewhere in the medical center that would be compatible with lecture format teaching for an entire medical class (such as a re-‐designed old medical school auditorium or a re-‐designed Jordan Hall auditorium) but the medical curriculum would have to have priority for use of that space.

The Curriculum Committee discussed the motion and fully supports the

proposal. Donald Innes dmr


Surgery Conference Room, 4:00 p.m.

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Debra Reed (secretary) 1. Medical Spanish. An e-‐mail was received from Marcia Childress, Associate

Director, Center for Humanism in Medicine, regarding the teaching of medical Spanish in the School of Medicine. She proposes an elective “a four-‐week "immersion" course in beginning medical Spanish that medical students (and a few interested faculty?) could take in the summer following their first year.” Dan Becker outlined the issues. The two classes, Elementary Medical Spanish with15 slots for beginners who've had no Spanish, and an Intermediate Medical Spanish class accepting 20 students, both have wait lists which are growing daily. The Spanish classes have been near or at capacity in every year they’ve been offered since spring 2000. Ms. Childress suggested that given the numbers of students who need language instruction and the fact that Spanish is regularly necessary even when students are working in Charlottesville, a four-‐week "immersion" course in the summer following the first year. The Committee discussed this issue at length. The need for medical students to have some knowledge of Medical Spanish was clearly understood; however, there was some apprehension regarding the depth of medical Spanish instruction and whether this might create liability issues. Some members wondered if students might be better served by being taught how best to use the language interpreters (there is a related OSCE), understand the limits of language competence, and spend some time in the Fall outreach clinics for migrant workers, the OB Spanish clinic or participating in an international elective experience through the Global health Initiative, e.g. <http://mayanmedicalaid.org/global_health_ed.htm>. It was also suggested that a special interest group for first and second year students might be another way for more students to obtain a working knowledge of medical Spanish. Funding for a four-‐week “immersion” course seems unlikely in the immediate future. After much discussion, the Committee recommends that the Medical Spanish program remain as it is for now, that students who are unable to get into the program be given a resource list of other options such as those noted above and a Spanish interest group/club be started. The Medical Spanish elective could be enhanced and given a stronger medical connection by participation in outreach clinics for migrant workers, the OB Spanish clinic, or participating in an elective where Spanish is utilized.

2. LCME ED 33 and ED 37. ED 37. The faculty committee responsible for the curriculum must monitor the

content provided in each discipline so that the schools educational objectives will be achieved.

ED 33. There must be integrated institutional responsibility for the overall design, management, and evaluation of a coherent and coordinated curriculum.

A draft of a proposal to assure compliance with these two LCME mandates was presented to the Committee by the Chair and discussed. It was agreed that students are perhaps the best source of information regarding redundancy in the Curriculum, but Clerkship Directors would need to be the ultimate authority on both what needs to be covered in a course and what new material should be added. The Committee also agreed that the review process should be tiered with the Course Directors reviewing their own courses yearly, a Principles of Medicine and Clinical Medicine Committee review of Course Directors’ review material (perhaps every three years? –five years?) and the Curriculum Committee’s oversight of the review process (every three years? –five years?). Modifications will be made to the draft and a new version presented to the Committee at a subsequent meeting.

3. The next meeting will be May 18, 2006. The main item on the agenda will be the review of the Obstetrics and Gynecology clerkship.

Donald Innes dmr …………………………………………. Subject: Medical Spanish Date: Wed, 22 Feb 2006 16:34:21 -‐0500 Dear Dick and Don, Within the first week after the Class of 2007 began registering for fourth-year electives our Medical Spanish courses for 2006-2007 had filled completely. Both the Elementary Medical Spanish class, which has 15 slots for beginners who've had no Spanish, and the Intermediate Medical Spanish class, which accepts 20 students, also now have wait lists which are growing daily. As you know, our Spanish classes have been near or at capacity in every year we've offered them, since spring 2000. The Center for Humanism in Medicine has neither the budget nor any flexibility in our instructor's teaching schedule (he's full-time at Sweetbriar in addition to teaching for us) to accommodate all the students who are clamoring for Spanish instruction in 2006-2007. While this won't help next year's fourth-‐year class, perhaps the school should be thinking anew about how best to make Spanish language instruction available to students, since a working knowledge of medical Spanish seems quite essential to their clinical competence. While many of our students now enter med school knowing some Spanish, about an equal number still do not. And, among those who know some Spanish, almost none have a working knowledge of the language as it's used in medical settings or an appreciation of cultural issues that can arise in relation to health problems and medical care. Given the numbers of students who need language instruction and the fact that Spanish is regularly

necessary even when students are working in Charlottesville, we might want to think further about organizing a four-‐week "immersion" course in beginning medical Spanish that medical students (and a few interested faculty?) could take in the summer following their first year. If the course were offered in early evenings, students could still work in research labs during the days. Restricting the course to med students – who would already be registered with the school for their summer research – would mean that students wouldn't have to pay tuition. (High tuition, especially for non-‐Virginians ($4000-‐5000), is THE barrier to med students who would pursue either the UVA Summer School's Spanish classes or the five-‐week UVA study-‐abroad experience in Valencia, Spain.) The cost to the School of Medicine for a four-‐week summer course accommodating 15 students would be the instructor's stipend – probably about $5000 per four-‐week course. Students would buy their own books (~$160). Students who completed this summer class would be eligible to take the intermediate-‐level course through our program in their fourth year. Danny Becker and I have talked some about this, and he suggested I let you know what's been happening with our enrollments. I'm happy to talk further with you about all of this, as it is a big piece of the medical school's efforts along the cultural competency lines. Best wishes, Marcia Marcia Day Childress, Ph.D. Associate Director, Center for Humanism in Medicine Associate Professor of Medical Education


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Anthony DeBenedet, Sixtine Valdelievre, Devin Mackay, Debra Reed (secretary) Guest: Megan Bray 1. Clerkship Grades. All clerkships meet the deadline of the five weeks post end of

period with the exception of the Surgery clerkship, which as of May 18th had yet to complete student evaluations. [Note the Surgery Chair has been contacted, May 22, 2006.]

2. Obstetrics & Gynecology Clerkship Review. Dr. Megan J. Bray, Director of the

Obstetrics & Gynecology Clerkship, met with the committee to discuss the recent Clerkship review. I wanted to send you a note and compliment you on your presentation to the Curriculum Committee yesterday, and on your outstanding performance as Director of the OB/GYN clerkship. You assumed that role during

a period of considerable activity, given the upcoming LCME visit and the changes in the curriculum. You have demonstrated great leadership and a positive attitude in managing the clerkship and planning for the next several years.

The Committee expressed thanks to Megan J. Bray, M.D. and Yvonne Newberry, RN, MSN, FNP, the assistant clerkship director for their comprehensive self-‐study report. Dr. Bray presented a brief synopsis of the report discussing the successes and challenges for the OB/GYN clerkship. She reviewed the Clerkship Specific Learning objectives as they relate to the 12 UVA Competencies Required of the Contemporary Physician. The OB/GYN Clerkship shelf exam grades (25% of their clerkship grade) are above the national mean. Students are evaluated (50% of the grade) by all residents and attendings who have worked with the student for an adequate enough period. The director and the assistant clerkship director meet with the students for oral presentations for an additional 25% of their grade in combination with an evaluation of their attendance.

Megan J. Bray, M.D. and Yvonne Newberry, CNP have worked closely with the

new Roanoke program director, Dr. Elizabeth McCuin. By all measures, Dr. Bray, finds the quality of the experience provided to the student to be while individual, of comparable substance and quality compared to UVA. Dr. Peterson noted that she could discern no difference in the students in her practice whether they were at UVA or Roanoke.

The OB/GYN Clerkship has been criticized for limited degree of student involvement in procedures. The faculty and residents have responded to this by making a concerted effort to engage students in procedures with the result that in the last period students were involved in 17 vaginal deliveries, 130 speculum examinations, 91 PAP smears, 114 bimanual exams, 5 endometrial biopsies, 1 vulvar biopsy, 59 cervical DNA probes, 34 rectovaginal exams, 49 breast exams, 35 placental deliveries, and 1 circumcision. This is a most positive development.

Surgery clerkship students on the OB/GYN rotation are required to participate in

4-‐5 night shifts per 6-‐week block structured like a night float system, the week they do OB days.

Megan J. Bray, M.D. and Yvonne Newberry, CNP are developing and assisting other OB/GYN faculty in the development of selectives for the 2006-‐2007 academic year when we move from a 6-‐week OB/GYN experience to a 4-‐week core experience plus 2-‐week selective in OB/GYN. The required selective experiences in OB/GYN will all occur after the core experiences in Surgery, Medicine, OB/GYN, Family Medicine, Psychiatry, and Neurology. Selectives in GYN Oncology, Uro-‐Gynecology, Maternal-‐Fetal Medicine, Midlife Women’s Health, Family Planning, Women’s Imaging, Colposcopy and GYN pathology, Labor & Delivery, Benign Gynecology, Ambulatory OB/GYN, Teen Health, and Latino/Hispanic Women’s Health.

Departmental administrative and faculty support for teaching efforts is excellent. Dr. Hebert has been most supportive of undergraduate medical education. Megan J. Bray, who assumed the duties of clerkship director in October 2005 and Yvonne Newberry, the assistant director, are an excellent team with a positive attitude and superb results. The Curriculum Committee extends a huge “thank you” to the entire department.

3. Evaluation of Spring Year 1 of New Curriculum. Bob Bloodgood presented an

early analysis of data from the 2005-‐2006 year. Student academic performance based on course scores was about the same as in the previous year for both Fall and Spring semesters. The number of failures for the Spring courses was about the same (3 versus 4) as last year and compared with last year the number of failures decreased from 7 to 4. Student feedback was much more positive than in the Fall 05 survey. In the Fall student assessment of courses decreased somewhat for Gross Anatomy, Med & Mol Genetics and CTS/Physiology and increased dramatically for Biochemistry. In the Spring student assessment decreased for Neuroscience and Physiology/CTS, increased for PoM-‐1 and was about the same for Human Behavior. The single course between Thanksgiving and Winter Break appeared to be successful. We will continue to closely monitor the academic progress and general well-‐being of our students.

4. The next regularly scheduled meeting will be June 1, 2006. Donald Innes


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Karen Knight(guest), Debra Reed (secretary) 1. Kavita Sharma, President of the Mulholland Society, and Devin Mackay, SMEC

representative, were welcomed as the new student members of the Curriculum Committee.

Sixtene Valdelivre was praised for her outstanding participation on the

Committee during the 05-‐06 academic year. Her insight and involvement in Committee discussions was invaluable.

2. Duty Hours for Medical Students. The potential need to actively monitor the

clinical duty hours of medical students was discussed. The Curriculum

Committee policy on duty hours for medical student was considered adequate, meeting the LCME standards. The current policy is:

Clinical Service Work Hours - Medical students rotating on clinical services (clerkships, selectives and electives) should be subject to the same principles that govern the 80-hour work week for residents. Clerkship directors are responsible for monitoring and ensuring that duty hours are adjusted as necessary. Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents*. (Curriculum Committee 9/9/2004) http://www.med-‐ed.virginia.edu/handbook/policy/attendance.cfm#clerks

Suggestions for possible ways to monitor adherence to the policy included:

a) Medical Student Advocacy Committee oversight b) A system similar to the “Praise/Concern” cards with monitoring through

Student Affairs c) Use of the “Listening Post” anonymous website on the Student Portal d) Add to the Clerkship Evaluation a question about average hours worked

The ability to make real time adjustments is a downside of suggestions a & d. The ability to have real time monitoring as in b & c raises the possibility that student might feel intimidated. The danger of “counting hours” becoming primary in medical education was raised as a valid concern in light of the resident situation. Drs. Wilson and Innes will draft a plan and report back to the committee.

3. Handouts to Medical Academic Support. The Principles of Medicine Committee

Directors (Bob Bloodgood and John Gazewood) were asked to have all the first and second year course directors send a copy of their handouts to Mary O’Leary in Medical Academic Support for use in the tutorial program.

4. Information Management. Karen Knight updated the Committee on the

Information Management/Critical Thinking (IMCT) curriculum for the four years of medical school. The IMTC curriculum derives primarily from competency #2 and #10, but has links to all in a broad sense of education. The Members of the Health Sciences Library and the Office of Medical Education work closely with the School of Medicine Faculty and Curriculum Committee to plan and develop appropriate learning interventions throughout the undergraduate curriculum.

In Year 1, Information Resources are demonstrated in the Cells to Society

Course, Library tours are arranged, students are introduced to the best print and non-‐print information sources in the field of genetics during the Medical and Molecular Genetics course and in the PoM1 course, students are introduced the concepts of population-‐based medicine using a combination of didactic and small group sessions.

In Year 2 during the Epidemiology course, students are required to find an

original research article of interest to them and critique it using the UJAMA User’s Guides and in previous years, on the eve of their preceptorship experience, students are introduced to MEDLINE search concepts that will enable them to focus their information retrieval to the best clinically relevant sites by applying filters. PoM2 also helps to provide students with a framework for addressing students need to find “quality” information on the web and how to find patient-‐specific information and reconcile inconsistencies or missing data.

In Year 3 the Library coordinates the first Clinical Connections program, entitled

“Information Technology: New Tools for Bedside and Beyond,” part of the Family Medicine Clerkship involves a training session on Information Mastery, and there is an Information Mastery OSCE using standardized patient encounters to develop the students competency in information mastery and critical thinking.

In Year 4, during the DX/RX course, students are introduced to key health policy

issues and required to do independent research. The Library has developed a website to support their research needs.

The first and third years seem particularly strong in IMCT, but additional

opportunities for IMCT instruction are found throughout the Curriculum.

a. The Committee indicated that the IMCT curriculum be timed to meet the needs of the students clinical activities, such that a skill could be learned and then immediately placed into use. A positive example is the IMCT course in the transition week prior to the core clerkships. Students should not have to wait until they do Family Medicine later in the year to be taught good search techniques or PDA uses.

b. The Committee also recommends expanding the PoM2 instructional

opportunities with more directed and documented student searches. Faculty mentors should also attend a development workshop to make sure they feel comfortable with the Information Mastery portion of the cases. A meeting with Brian Wispelwey, Darci Lieb, Karen Knight, Gretchen Arnold, Kavita Sharma, and Don Innes will be arranged to discuss enhancing Information Mastery/Critical Thinking in PoM2. The directed and documented searches should enhance the weekly personal and group objectives of students without interfering with the current content and process,

c. The Committee requests that the Clinical Medicine Committee

development of workshops for faculty and residents for every department to enhance their knowledge and thus the students’ knowledge of IMCT techniques. Each Department’s Residency

Director and Hilary Sanfey who provides an introduction into teaching at the resident’s orientation should be contacted by e-‐mail to arrange this.

d. The Committee requests that the IMCT committee develop a means to

measure the success of the IMCT program. The IMCT committee should work with Jerry Short to devise appropriate metrics and put them into practice for the 2007-‐2008 academic year.

Note: The June 8 agenda will be a review of the Professionalism curriculum conducted by Nancy Payne and a brief discussion of the BS4C curriculum in anticipation of Debra Perina’s visit to the committee June 15. Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) Guest: Nancy Payne 1. 2005-‐06 Professionalism Education at UVA. Dr. Nancy Payne outlined the many

and varied ways that Professionalism is incorporated into the University of Virginia School of Medicine curriculum.

During the first year: a) Medical Center Hour (20 lecture hours) b) “Welcome to the Profession of Medicine” by Dean Pearson during orientation c) Convocation d) Cells to Society e) White Coat Ceremony f) Social Issues in Medicine: Bridges Between Community and Medicine” g) PoM1 and Gross Anatomy During the second year: a) PoM2 During the third year:

a) Becoming a Clinician Ceremony b) “Life and Legal Issues in the Fast Lane: Rules for a Successful Third Year and

How Things Can Go Wrong” – Dean Pearson c) Family Medicine Clerkship – Morning Report, Difficult Patient Workshop,

Interactive Clinical Cases d) Internal Medicine Clerkship – Conduct on the Wards Outlined, Ethics Rounds e) AIM – Clerkship Workshop Program (Medical Economics,

Humanism/Palliative Care) f) Neurology Clerkship – Syllabus, Clinical Activity, Evaluation, Clinical Problem

Sets, Grand Rounds g) OB/GYN Clerkship – Orientation, Cases that address ethical/professional

issues h) Pediatrics Clerkship – Expectations outlined, Ethics Lecture, Clerkship

Workshop Program, Clinical Problem Set Questions, Pediatric Grand Rounds i) Psychiatric Clerkship – Expectations, Evaluations j) Surgery Clerkship – Objectives, Orientation, Morbidity and Mortality’ k) Clinical Connections l) Clerkship Clinical Skills Teaching Project (OSCE) m) Clerkship Student Evaluation form n) Praise and Concern cards o) Clinical Practice Examination During the Fourth Year: a) Gold Humanism Honor Society b) Electives/Selectives – Humanities in Medicine, Human Biology, Ethics and

Society c) American Healthcare Systems: DX-‐RX d) Graduation Dr. Payne believes that while Professionalism is being taught throughout the

Curriculum, there is room for improvement in some areas. a) Develop the Professionalism Curriculum during the Clinical Conversations

segment of Clinical Connections b) Enhance Professionalism education in the second year – concentration on

PoM2 but develop Professionalism curriculum for all other courses as well c) Make sure Professionalism standards learned in first year is not diluted in

Clerkship/Elective/Selective years. d) Ensure that Faculty and Residents know they are being modeled by medical

students and that they demonstrate the best example of Professionalism. The Committee discussed with Dr. Payne how best to implement improvements

and how to evaluate the students’ education in Professionalism. LCME Ed 23 regarding Professionalism was discussed.

It was suggested: a) Enhance recognition of “Acts of Professionalism” b) Publicize the Praise and Concern cards c) Chief Resident/Resident and Faculty CE’s d) Expand Ethics Rounds into other selected Clerkships

e) All students should be evaluated on their professionalism behavior in the clerkships

2. Approval of Surgery Clerkship Co-‐Directors. The Committee approved the

nomination of Hilary A. Sanfey, M.D. and Eugene D. McGahren, III, M.D. for the positions of Co-‐Directors of the Surgery Clerkship. The Committee noted that having co-‐directors in a Clerkship works in Family Medicine and should work well in Surgery as long as there is adequate communication between co-‐directors and individual responsibilities are clearly defined.

3. Clerkships/Electives/Selectives and Basic Science Courses: Monitoring the

Content, Depth, Breadth, and Current Relevance of the Curriculum document will be sent via e-‐mail to the Committee for final comments before adoption. A tiered course/clerkship review process will be formalized. Bob Bloodgood and Bill Wilson were asked to work on a one page format for the yearly review of all courses and clerkship.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) Guest: Debra Perina 1. Basic Science for Careers. Debra Perina outlined the plans for the Basic Science

for Careers program. The course following the 3rd year clerkships is designed to review, expand, and focus on basic sciences as applied to a particular discipline. The course will be taught by basic scientists and clinicians over a three week period followed by the Rx/Dx course. BS4C has three components -‐ General sessions, Specialty sessions, and Applied sessions. In the General sessions a clinician will present a case and a basic scientist will discuss relevant concepts in context of the presented case. Students are required to attend the General sessions (approximately 18 hours per student). These sessions have universal

relevance over all specialties. Some suggested topics include: Fluid and Electrolyte Balance and Acid Base Disorders; Diabetes; Cardiovascular Disorders; Cancer; Lower Respiratory Track Disorders and Preventive Medicine. BS4C includes 14 Specialty sessions focused on particular specialty careers, each ~3 hours. Students must select 7 sessions, but may attend more. There are also Applied Sessions in which students will receive cases developed from specialties sessions in advance. They will manage the case using concepts learned from general and specialties sessions and receive immediate feedback from faculty. Groups of 5-‐10 students will be offered 9 sessions approximately 3 hours each and must attend 5 sessions, but may attend more. Jerry Short has expressed concern that it may be difficult to find large lecture hall space in the mornings for the general sessions. Dr. Perina responded that these sessions could be moved to the afternoon. While small group space is sometimes a problem, it can usually be found. The Committee reiterated that lack of space should not drive the curriculum. Bob Bloodgood suggested that the list of suggested specialties sessions which included Clinical and Basic Science departments might better be classified by topics such as protein structure/function; transcription, gene regulation, secretory pathway cells, cell adhesion and migration and intermediary metabolism. The Curriculum Committee enthusiastically supports Debra Perina’s plans for the Basic Science for Careers program. The next step toward implementation of the course is to pilot a segment in the Spring of 2007 as an elective and measure the impact of the course by surveying participating students. Dr. Perina was asked to work with Jerry Short to develop an optimal pilot, evaluation, and funding process.

2. Focus Group for Clerkship Discussion. Jerry Short will schedule a “town meeting” for the Curriculum Committee and other interested faculty to meet with students who recently completed their clerkships. The Committee will be notified by e-‐mail of the date, time and location. Student have expressed concern that they lack sufficient practice/training in procedures such as insertion of IVs, NG tubes, and Foley’s, and blood drawing and blood gasses. The Committee discussed ways of remedying this such as elective time with the phlebotomy team, ICU or ER staff. The level of procedural competency a student should achieve by the end of the third year or even the fourth year and how much experience is necessary for this level of competency should be delineated. It was suggested that residents in departments such as Medicine, Pediatrics, and Surgery departments might be asked “what do you wish you’d know how to do when you started your residency?”

Note: The [OB/GYN clerkship] faculty and residents have responded to this [request for more procedures] by making a concerted effort to engage students in procedures

with the result that in the last period students were involved in 17 vaginal deliveries, 130 speculum examinations, 91 PAP smears, 114 bimanual exams, 5 endometrial biopsies, 1 vulvar biopsy, 59 cervical DNA probes, 34 rectovaginal exams, 49 breast exams, 35 placental deliveries, and 1 circumcision. This is a most positive development. - May 18, 2006 minutes of Curriculum Committee

3. Internal Medicine Clerkship. Michael Rein has informed the Curriculum

Committee about a problem recently surfacing in the Internal Medicine Clerkship. The Accreditation Council for Graduate Medical Education (ACGME) has recently put UVA on institutional probation, and the program will be reviewed again in about two months. Working through its Internal Medicine Residency Review Committee, the ACGME has decreed that an Internal Medicine Service can have no more than eight learners per attending physician. This does not apply to any other specialty. Learners include both residents and medical students. Dr. Rein has recently learned that it is not possible to simply add a second attending to a team. The major problem is that under these guidelines, only two students at a time may be assigned to the MICU and one student at a time to the CCU. To address this mandate, the Internal Medicine Clerkship will now make the MICU rotation two weeks long rather than four weeks. Medicine would like to continue to provide at least some exposure to all students wanting this highly popular rotation, and students will now be doing the MICU following the core clerkships, rather than as 3rd year students, which may make it easier to get acclimated to this intense environment. Students who have signed up for a MICU rotation in periods 1,2,3,4,5,7,8,or 9, will be assigned to another selective for two of those weeks. If students have signed up for the CCU in period 2b or 6a, it may be necessary to reassign them also. Students will be allowed to choose which other selective(s) they would like to participate in for the remaining two weeks. Options include Acute Cardiology, Geriatrics, Hematology/Oncology, Infectious Diseases, Pulmonary Medicine or Digestive Health. The Committee will monitor this change and it’s effect on the students’ medical education.

4. Introduction to Psychiatric Medicine. Bruce Cohen, Course Director, has

proposed that the weekly interview sessions be reduced from 8 to 6 per student for the 2006-‐2007 year and that if it is unsuccessful, they have the option to revert to 8 the following year. In addition to the 8 sessions, there are two online sessions. The Committee endorsed this proposal and requests evaluation/assessment data on the change.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Dave Ryan, Kavita Sharma, Debra Reed (secretary) Guest: Meg Keeley 1. Neuroscience Course Director. The Committee enthusiastically approved Dr.

Kevin Lee’s nomination of Mary Kate Worden for the position of Neuroscience Course Director after review of her teaching credentials.

2. Electives/Selectives. Meg Keeley outlined her progress in developing the

electives/selectives. The selectives began on Monday, 6/26/06. Approximately half of the class of 2007 are taking 4 weeks of Internal Medicine electives including Acute Cardiology Inpatient; Pulmonary; Infectious Disease; Digestive Health Inpatient; CCU; MICU; Geriatrics and Palliative Care; Cardiovascular Emergencies; Acute General Medicine. The MICU selective was recently changed from 4 to 2 weeks because of ACGME regulations regarding number of learners allowed on a service at one time. Students are allowed time off from their Selectives for boards, interviews (one day per week) as they are in electives. In the 2007 –2008 academic year the Selectives will all be two weeks.

John Jackson has revamped the evaluation of selectives/electives. The student

evaluations of the elective as well as the faculty evaluation of the student will soon be offered on line as it is for the clerkships through Oasis. This evaluation system is being piloted through Radiology now and will be available to all the selectives/electives later this year.

One-‐two week OBGYN selectives in areas such as Urogynogology (received),

Maternal Fetal Medicine/Reproductive Genetics; Infertility; High Risk OB; GYN/ONC are being sought. Psychiatric Medicine has also been asked to provide proposals for selectives such as Child Psychiatry; Geriatrics; Women’s Mental Health, Outpatient; Addictive Medicine. For the present time, surgical subspeciality selectives will all be at UVA. However, Clerkship Directors will ask Roanoke to propose selectives in some of the areas such as OB/GYN.

Dr. Daniel Herrington has recently reported problems providing enough living

space for the students rotating in Roanoke. Care must be taken not to add to this problem with the selectives/electives.

Meg Keeley has asked the Curriculum Committee for help in encouraging

Departments to provide the selective proposals. Students will receive their choices of Selectives by lottery in January.

3. First Year Spring 2006-‐07 Schedule. Since the first year spring schedule has not been finalized, the Committee recommends superimposing last year’s schedule into this year and complete with minor modifications. Students and faculty alike need this schedule as soon as possible. Problems with the loss of time at the beginning of the Spring session, due to the Winter Holiday period, still must be worked out but start dates/exam dates/ etc. must be published immediately.

4. Late grades in Clerkship and Courses. Courses and clerkships are required to

submit grades for students within 5 weeks of the end of the term. PoM1 and 2 are experiencing difficulties obtaining the required student evaluations from some of the mentors. Don Innes will contact these mentors and stress the importance of the 5 week deadline

5. Healers Art. Julie Connely has sent a follow-‐up on the Healer's Art course to the Committee. The Healer's Art course in 2006 had 83 students (mostly first year) and 15 faculty participating. The overall evaluations were positive with students recommending that we offer the course again in 2007. There were many insightful comments from students and faculty regarding personal and professional development.

There was a downside to the session in 2006 that related to the number of

students who signed up. At the time of registration, only nine faculty had been recruited. They decided to recruit more teachers rather than turn students away. Looking back that may not have been the best decision for several reasons. First, the Mulholland Lounge turned out to be too small and too uncomfortable for about 100 individuals. The large group sessions were more difficult for students as they found it was hard to feel safe and trusting. With the diversity of students, some were more committed than others to the course. Faculty also struggled just to regain the feeling of unity, team spirit, etc. Still overall, the student advisors and the evaluations suggest the course remains very worthwhile in supporting the UVA curriculum and addressing areas of medical practice not otherwise discussed so fully.

For 2007, we are planning the following; Ann Kellams and Julie Connely will

share the director role. They have been working together on the many details that need to be organized and addressed. They will limit the number of students to about 54 and plan on nine faculty. The other faculty will be used as reserves in case of emergency and a rotational process for teaching will be implemented. They will offer the course in the winter-‐spring on 2007 and it will focus primarily on first year students, although any students may register. If necessary a first come/first serve selection process will be used. There are a number of other specific issues that we will be attending to in order to make the experience as valuable as possible. Devin McKay noted that he had taken the course and found it very helpful and worthwhile.

6. Lecture attendance. The Committee discussed the attendance issue in years one and two. Student comments collected by Sixtene Valdelivre and self-‐reporting lecture attendance data from the surveys being used for the Pass-‐Fail grading study were provided to the Committee. It appears that the Spring of the second year has the greatest problem with low attendance. Bob Bloodgood presented suggestions from students for improvements to improve lectures, and in turn, improve attendance:

Lectures must have value added (beyond the lecture handout) Don’t just read the Powerpoint Limit the number of Powerpoint slides per lecture Emphasize images and diagrams instead of lists and tables in Powerpoint presentation Follow the order of the handout Don’t use the Powerpoint as the lecture handout Limit the number of lecturers and only use the best educators Reduce number of lectures and add more small group teaching Reduce number of afternoon activities More study days before exams More case-‐based teaching

The Committee discussed reasons for this such as the increased afternoon student

time commitment during this period, the cumulative finals in both Pharmacology and Pathology and the USMLE Step 1 examinations. It is hoped that some of the changes for 06-07, such as the reduction in number of Psychiatric Medicine afternoon sessions and the removal of one of the labs from POM2 will increase lecture attendance.

Donald Innes dmr

University of Virginia School of Medicine Curriculum Committee Summer Update 07/27/06

Voting (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary)

1. Dr. Peter S. Ham was nominated by Dr. Sim Galazka, Chair of Family Medicine, to be the new co-director of the Family Medicine clerkship. Dr. Anne Mounsey, current co-director will continue as co-director. Dr. Ham's CV was distributed by email and an email vote taken. The committee overwhelmingly approved of Dr. Ham as new co-director of the Family Medicine Clerkship.

2. Dr. Walter S. Davis was nominated for co-director of the PoM-1 course. Dr. John Gazewood will continue in his current position as co-director of the PoM-1. Dr. Davis has been engaged with PoM-1 from the beginning, and already plays a significant role in the ethics curriculum and on the

course committee, and is able to start now. Dr. Davis' CV was distributed by email and an email vote taken. The committee unanimously approved of Dr. Davis as new co-director of the PoM-1 course.

3. A letter has been sent to Neuroscience offering assistance in their endeavor to improve the Neuroscience course.

4. The Content Review of Foundations and Core Systems courses (Color Content Review) is attached. This is based on the content outline for USMLE-Step 1. A few items are apparently not covered by any course; however, this may be a misunderstanding of definition. The Principles of Medicine Committee will be asked to review these apparent "gaps".

5. Annual Course Reviews have been received from nearly all courses and will be distributed to Curriculum Committee members for review. Questions include: Are the course objectives congruent with the educational objectives known as the Competencies Expected of the UVA Educated Physician? Please attach a copy of your current course objectives. http://www.healthsystem.virginia.educompetencies-page What changes were implemented during the current version of the course? Note any changes in the stated objectives and in the methods of pedagogy utilized. Were there any notable problems or successes that occurred during this year's course? Were there any particular themes within the comments from the student t evaluations? Have the nature of the evaluation comments changed from the previous year? Have you identified any omissions or unwanted redundancies in course content or process? What changes in the course are being planned for the next year? How will these changes affect the content and student workload?

Donald Innes


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) 1. Don Innes opened the meeting with a brief discussion of the summer events.

• Dr. Peter S. Ham was approved by the committee as new co-‐director of the Family Medicine Clerkship.

• Dr. Walter S. Davis was approved by the committee as new co-‐director of the PoM-‐1 course.

• Neuroscience has been offered assistance in their endeavor to improve the Neuroscience course.

• Content in Color, the content review of Foundations and Core Systems courses has been completed. This is based on the content outline for USMLE-‐Step 1. Only rare items are apparently not covered by any course. A number of topics are cover in several courses. The Principles of Medicine Committee will be asked to review these apparent "gaps" and check the redundancy for value.

• Annual Course Reviews have been received from all courses. These will be reviewed by the Principles of Medicine Committee with generation of a report to the Curriculum Committee this fall. This is the first year of a three-‐year cycle. The Annual Reviews will also be distributed to Curriculum Committee members.

The review process is tiered with the Directors reviewing their own programs yearly (See attachments); a Principles of Medicine or Clinical Medicine Committee review of all annual reports with cross-‐course comparison and generation of a full report every three years, and the Curriculum Committee’s oversight of the review process and with receipt and review of the full report from the Principles of Medicine or Clinical Medicine Committee review. The Curriculum Committee may ask for a review of a course or clerkship at any time. [Clerkships/Electives/Selectives and Basic Science Courses: Monitoring the Content, Depth, Breadth, and Current Relevance of the Curriculum 1.0 -‐DJI 06.14.06]

2. An Introductory Anesthesia Experience has been arranged following a meeting

of Hilary Sanfey (UVa Surgery), Eugene McGahren (UVa Surgery), Steve Remine (Carilion Surgery), Gary Collins (Salem VA Surgery), Robert Smith (Salem VA Surgery), George Rich (UVa Anesthesiology, chair) and Ed Nemergut (UVa Anesthesiology).

At UVA, Drs Nemergut and Rich feel that the [anesthesia] experience is accomplished best by having the students complete the three days in a consecutive block. Students will therefore be assigned accordingly with Dr. Nemergut supervising their assignments and experience. At Roanoke and Salem, the three days may be accomplished either in a block, or as individual days, according to what is determined to be best by Dr. Collins and Dr. Remine in conjunction with their anesthesia colleagues at those particular sites. Dr. Collins and Dr. Remine will monitor the students’ experiences in those rotations. The Surgical Chief Resident at Salem will also help in facilitating and monitoring the anesthesia experience there. The anesthesia experience may include exposure in the operating room and pre-operative areas, clinics, and anesthesia conferences as deemed appropriate by the supervising individuals. It would be expected that the students should gain an appreciation for the anesthetic issues and management related to the care of surgical patients. They should also have the opportunity to experience some of the technical procedures involved in anesthesia care where appropriate. I have attached a set of objectives, and a checklist for potential procedures as prepared by Dr. Nemergut to serve as a guideline for this (see attached). Where possible, the experience should be as least disruptive to the students’ surgical experiences and their interaction with their surgical teams as possible. For example, where possible, a student could be assigned to a room where her/his primary surgical team is already operating. However,

discretion in this matter will be left to Dr. Nemergut at UVA, Dr. Remine at Roanoke, and Dr. Collins at Salem. The students will be advised to document completion of this anesthesia component on their “Passports”.

3. The Clerkship Clinical Skills Education Program (CCSEP) is an interdisciplinary

effort of the departments of Internal Medicine, Pediatrics, and Family Medicine. Its purpose is to maintain and expand clerkship clinical skills workshops (now number 31, small group sessions which bring together selected faculty to teach basic clinical skills to students), establish a clerkship-‐level clinical skills assessment process (osce assessment exercises now number 28), and develop a UVA clinical skills education website. The program also involves faculty development with emphasis upon clinical skills teaching skills. Skills assessments are done twice per year (Nov, Feb). Data from recent assessments showed less-‐than-‐expected student performance levels, with scores ranging from 30-‐86% of expected for 24 basic clinical skills. In one instance, fewer than 40% of students identified an abnormal heart rhythm. Clearly, we need to improve clinical skills teaching. Future plans involve incorporation of all the clerkship disciplines in enhancing the teaching and assessment of clinical skills. Gene Corbett will present additional information on this program at the September 7, 2006 meeting.

4. The Clinical Skills Education program (CSE) during the general medicine

inpatient clerkship rotation is also expected to improve students’ clinical skill performance. This program pairs students with selected attending physicians during scheduled afternoon sessions when bedside teaching is emphasized. Early reports are very positive. Michael Rein was asked to include evaluation of this project in the Medicine clerkship evaluation process and provide this information to the Curriculum Committee.

5. Cumulative Honors Survey (Bob Bloodgood) The latest study information on the Pass/Fail grading systems shows:

• No decline in attendance at scheduled academic activities • No decline in academic performance [level of courses] • Increase in well-‐being • USMLE Part I data shows no statistical difference since P/F instituted

Survey of Class of 2007 on Cumulative Honors (Pass with Distinction) N=81 Increased

stress Decreased

stress No effect on

stress Decided to go for cumulative honors 70% 0% 30% No conscious decision either way 8% 50% 42% Decided not to go for cumulative

honors 0% 92% 8%

Conclusions:

• Choosing to “go” for cumulative honors increased level of stress • Choosing not to “go” for cumulative honors reduced level of stress • Inclusion of cumulative honors probably reduced the magnitude of the

positive effect that the change to Pass/Fail had on student well-‐being Survey of Class of 2007 on Cumulative Honors (Pass with Distinction)

Regretted decision Awarded

cumulative honors Decided to go for cumulative honors 21% 52% No conscious decision either way 11% 11% Decided not to go for cumulative honors 0% 7%

• Comparison of Pass with Distinction and AOA Groups: 79% overlap • Cumulative Honors (Pass with Distinction) will be suspended with the

class of 2011. • Performance data for individual students from the two classes (Pre-‐

Pass/Fail; Post-‐Pass/Fail) was compared. Numerical grades showed no statistical difference in grades.

Dr. Short related the latest information obtained from a survey of the third year

class asking students whether they preferred the pure Pass/Fail or Pass/Fail/Pass with Distinction system and results were split down the middle with 53% for P/F and 47% P/F/Pass with Distinction.

The Committee agreed that results of the Step 2 exam for these two classes

should also be compared. Bob Bloodgood noted a new paper suggesting that grades in the first two years of medical school are a valid predictor of performance in residencies and in clinical practice. (Gonnella JS et al: An Empirical Study of the Predictive Validity of Number Grades in Medical School Using 3 Decades of Longitudinal Data: Implications for A Grading System. Medical Education, 38: 425-‐434, 2004.)

6. Clinical Service Work Hours are being monitored. Clerkships have been reminded of our policy.

Medical students rotating on clinical services (clerkships, selectives and electives) should be subject to the same principles that govern the 80-‐hour work week for residents. Clerkship directors are responsible for monitoring and ensuring that duty hours are adjusted as necessary. Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents*. (Curriculum Committee 9/9/2004) * LCME Standard ED-‐38

7. Study Hours in the First Two Years of Medical School. Adjustments have been made to the first and second year course schedules to allow keep or increase as many afternoon study hours as possible in the first two years. The Principles of Medicine Committee will continue to monitor this.

Anatomy, Biochemistry, Cell & Tissue Structure/Physiology, and PoM-‐1 in the fall Foundations; Social Issues in Medicine and Patient Clinician Encounter Program (PCEP) in the spring Foundations; PCEP, Intro Psychiatric Medicine, Pharm, Path, Micro and PoM-‐2 in the fall Core Systems, and Epidemiology, Micro, Path, Pharm, and PoM-‐2 in the winter Core Systems

8. Selectives Supervisors. All selectives are now required to have their own

supervisor. Although originally planned for the Clerkship Directors to monitor selectives in their areas, it has become apparent that direct contact people are needed for all selectives. These selective supervisors will be trained in the use of OASIS and required to use it in a timely and consistent manner. They will be similar to electives supervisors.

The Selective and Elective supervisors are responsible to the Selectives and Electives Director for providing the goals and objectives in a description of the Selective or Elective experience; identifying the time and location for assembly; assigning students to appropriate faculty, and completing the P/F grade and evaluation of the student. The supervisor is a role model and mentor, and can have a huge positive influence on the development of a young MD to be.

9. PoM1 Course Co-‐Director Position. John Gazewood will be stepping down as

Course Director for PoM1 at the end of this academic year. An advertisement will be e-‐mailed to faculty seeking qualified applicants for a co-‐director position. This will be forwarded to the Curriculum Committee members for comment before it is sent out.

10. Job Descriptions for Directors. The Committee will develop more detailed job

descriptions for all course and clerkship directors. Address the complexity of the contemporary clerkship; availability to students, demands of clinical service.

11. Health Sciences Library. The Library’s new study rooms are now open and

available to the students 24 hours/day. The Library is applauded for this addition.

12. Audience Response System. The Audience Response Systems in Jordan 1-‐14 and 1-‐5 are now in operation. First and second year students have been provided with the hand held devices. John Jackson will hold a training session for faculty at the October 11, Principles of Medicine Committee. The system will provide real time feedback to the professors in the Jordan Hall lecture halls.

13. All Clerkship Evaluations on Time for both the last period (4) of 2005-‐2006 and

for the first, most recent rotation of 2006-‐2007. Evaluations are due 5 weeks from end of clerkship rotation or two weeks following receipt of subject exams.

Period 4 (4/3/06 – 6/24/06) Due 7/31/06

Date Received Status

Med 7/28/06 Complete Fam Med 7/28/06 Complete

Peds 7/14/06 Complete

OB/GYN 7/14/06 Complete

Psych 7/25/06 Complete

Surg 7/31/06 Complete

Neuro 7/27/06 Complete

Clerkship Evaluations – 2006-07

Rotation 1A - end 7/22 Grades & Evaluations Due: 08.25.06 Received Status Fam Med 08.25.06 Complete OB/GYN 08.09.06 Complete Psych 08.25.06 Complete Neuro 08.25.06 Complete

14. Agenda for 2006-‐07. The Committee was asked to send agenda items to Don

Innes for the coming year. a) Gene Corbett was asked to update the Committee on the Clerkship Clinical Skills Education Project at the next meeting of the Committee. b) Chris Peterson will provide the Committee with a brief update on the 2006 Cells to Society evaluations. c) The Committee will seek a method to enhance incorporation of the history of medicine into the curriculum through Joan Klein, librarian of the historical collection. d) Review of clerkship grade distribution histograms 2005-‐2006. e) A review for unwanted redundancies and especially “gaps” similar to “Content in Color” for the Clerkships should be performed this fall. f) Monitoring of Passports and of OASIS. g) address the August Problem List.

Donald Innes

Dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) 1. Clinical Connections. Recent rumors about the demise of the Clinical Connection

program next year are untrue. There are no plans to suspend this essential program.

2. Transition Course. The transition course for 2007 has been tentatively

scheduled for Tuesday, April 24 – Saturday, April 28. The course has traditionally run from Monday – Friday but with the new curriculum the course will now occur in April when laboratory space in the School of Nursing building is unavailable. Tentative plans include an introduction to DX/RX, Career Day, Becoming a Clinician Ceremony, and Information Management. The laboratories will be held on Friday afternoon and all day on Saturday in the School of Nursing. The possibility of moving the “Becoming a Clinician” ceremony to later in the year will be explored by Chris Peterson. Possible use of the patient simulator for the transition course will be discussed by Drs. Jerry Short and Marcus Martin.

USMLE Step 1

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3. Clerkship Clinical Skills Program. Eugene Corbett outlined the progress of the program from its inception to the present. The developers coined a term “strategic incrementalism” to define how workshops and skills assessments are developed through gaining faculty participation. This is done slowly and staedily with intentional limitation of faculty time required for development and implementation of each skills education activity spread among many faculty. The program is made up of three components:

1. Clinical Skills Workshops At present some 31 workshops have been developed for the Family Medicine,

Internal Medicine and Pediatrics Clerkships but only at UVA. Expanding these offerings to students whose clerkships are at outside sites is planned. Workshops are 1-‐2 hours long. Kavita Sharma reported that most students feel the clinical skills workshops are very valuable. The developers’ goal is to expand these workshops into all clerkships. Funding has not been a problem thus far from the Deans and Chairs of the Departments involved.

2. Clinical Skills Learning Assessment Since the program began in 2003 it has used objective structured clinical

examinations (OSCE) to assess clerkship students’ ability to perform selected and discrete clinical skills utilizing simulation, standardized patients and (more recently) real patients. It involves a formative design so that students are at first challenged to perform a specific clinical skill within a period of time, followed by a feedback session with standardized or real patients and faculty that provides the opportunity for students to learn how to improve their skill performance. Skills include communication, physical examination and basic clinical tests and procedures. During 2006-‐07 all students will be required to participate in these assessment exercises. To date, 24 OSCE exercises have been fully developed and tested. Over 70 faculty from 10 departments have participated in this program.

Results of student performance in these clinical skills assessment have been

varied. The Committee discussed the results to date and whether performance and grade anxiety might be affecting the scores. Informing students that these assessments are not part of their grade on multiple levels was suggested. The differences between the OSCE setting and the real world of clinical practice were discussed. Also, students site lack of skill repetition opportunity as a main reason for subpar performance. While the ideal method for a specific clinical skill evaluated in the OSCEs and the real world way of the wards may not be exactly the same, students should learn the ideal method. The faculty and residents are the models for students so faculty and resident development should also be a part of any effort to improve clinical skills.

3. Development of a UVA Clinical Skills Web site http://www.med-‐ed.virginia.edu/courses/clinical skills/

When asked what other institutions are doing to enhance clinical skills for

medical students, Dr. Corbett noted that some do have programs similar to the one at UVA, some use a faculty mentor system in which faculty members are assigned to students for all four years and are responsible for overseeing student’s clinical skill education. Others have a Clinical Skills Center and educational activities are built around this facility. Many are using teaching attendings to enhance clinical skills.

The Curriculum Committee will complete their discussion of this program at

its next meeting and issue a statement.

4. Agenda for 2006-‐07 continued. In no particular order: a) Chris Peterson will provide the Committee with a brief update on the 2006 Cells to Society evaluations. b) The Committee will seek a method to enhance incorporation of the history of medicine into the curriculum through Joan Klein, librarian of the historical collection. c) Review of clerkship grade distribution histograms 2005-‐2006. d) A review for unwanted redundancies and especially "gaps" similar to "Content in Color" for the Clerkships should be performed this fall. e) Monitoring of Passports and of OASIS. f) address the August Problem List, g) Social-‐economic, professionalism and behavior, cultural competence, and ethics in the curriculum: SIM, PoM-‐1, and Dx/Rx, and h) Evaluate the Exploratory concept form the Cells to Society Curriculum, i) nutrition in the curriculum. Please send items for consideration by the committee to D J Innes.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, JohnGazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary)

1. Grade Distribution. A copy of grade distributions on the Medicine clerkship from a number of schools that use different "Pass/Fail" grading systems, courtesy of Dr. Michael Rein and the CDIM group, was distributed and briefly discussed. It was noted that the percentages of

"pass", "high pass", and "honors" grades varied markedly among the institutions.

2. Clinical Skills Program. Dr. Corbett completed his discussion of the clinical skills. The Clerkship Clinical Skills Education Program (CCSEP) is an interdisciplinary effort of the departments of Internal Medicine, Pediatrics, and Family Medicine. Its purpose is to maintain and expand clerkship clinical skills workshops (now number 31, small group sessions which bring together selected faculty to teach basic clinical skills to students), establish a clerkship-‐level clinical skills assessment process (OSCE [Objective Structured Clinical Examination] assessment exercises now number 28), and develop a UVA clinical skills education website. The program also involves faculty development with emphasis upon clinical skills teaching skills.

The Curriculum Committee supports the Clinical Skills Program. The

development of clinical skill teaching modules, incorporation of these modules into the clerkships, and measuring their effect on clinical skill abilities is a valuable addition to the Curriculum. This program should progress to include more modules, evaluation of all students’ clinical skills and further evaluation of the program itself. The program should develop workshops for Surgery and OB/GYN and possibly Neurology. It is worthy of support by the School of Medicine.

3. Content in Color. The “Content in Color for Foundation of Medicine and Core Systems” was discussed by the Curriculum Committee. This is intended as a management tool to identify unwanted redundancies and omissions in the Foundations and Core Systems of Medicine as part of the Curriculum Committee’s monitoring of the content and workload in each discipline. Content in Color will be reviewed at the time of the Principles of Medicine review of all annual reports with cross-‐course comparison and generation of a full report every three years, The Curriculum Committee endorsed development of a similar “Content in Color” for material covered on USMLE Step 2CK for Foundations and Core Systems and for the Clerkships using the content outlines for USMLE Step 2 CK was endorsed. This will be undertaken after the LCME site visit.

4. Dr. Short gave an excellent presentation of several topics related to medical education; this was an abbreviated version of a previous presentation to the Foundations and Core Systems committee, and covered topics such as formative and summative assessment, norm-‐referenced and criterion-‐referenced assessment, and validity and reliability.

5. The meeting was adjourned at 5 PM. The next meeting will be held on

Thursday, September 21.

William G. Wilson


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, John Gazewood, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Darci Lieb (guest), Debra Reed (secretary) 1. Clerkship Grades. Due to the OASIS upgrade and the system being down

Thursday September 21st, grades/evaluations originally due on Friday, September 22nd will be due by noon on Friday, September 29th.

2. Introduction to Psychiatric Medicine. Transportation problems with UVA

Parking and Transportation have on three occasions caused disruption and cancellation of the psychiatric interview groups this year. Never a problem in previous years, there are apparent personnel changes in Parking and Transportation. The Dean and Senior Associate dean have been notified.

3. Ambulatory Internal Medicine. The August issue of the “AIM Connection”

newsletter is now published. It is aimed at the clinical preceptors as an educational tool. This issue of the “AIM Connection” includes tips on using the Passports and a list and description of the Clerkship Clinical Skills Workshop programs.

4. Curriculum Committee Membership. Curriculum Committee members whose

term of service finished this past year are invited to extend their term for 6 months to a year to ensure continuity in light of the LCME visit. http://www.healthsystem.virginia.edu/internet/med-‐curriculum/members.cfm

5. Cells to Society. Chris Peterson, director of the Cells to Society 3-‐day

introductory course, reported on the 2006 “3rd edition”. Student and faculty expressed near uniform praise for the course. Minor improvements were made this year, e.g. organization into themes. Darci Lieb was thanked for her instrumental role in organization and implementation. Chris will evaluate for evidence of “carry through” into the basic sciences.

6. Clinical Medicine Report. Bill Wilson

1. Clerkship Assessment Techniques – Jerry Short 2. OASIS Update for clerkships, selctives, and phase in of electives -‐John Jackson

7. Principles of Medicine and Core Systems Report. Bob Bloodgood

1. Course Assessment Techniques -‐ LCME ED30 (Sept meeting) 2. Audience Response System training (Oct meeting)

already being piloted in CTS/Physiology (5 lectures) 3. Nancy Payne -‐ Professionalism education in 1st & 2nd yr courses (Oct meeting) 4. Review annual course reports – these recent course reports are, for some courses, the

first time to formulate course objectives, and, for many courses, the first time that courses have aligned course objectives with UVa’s 12 competencies.

5. Continuing our assessment of the new curriculum (Class 2009, now in Year 2)

Dropped cumulative honors/pass with distinction Changed scheduling of Gross Anatomy Changed scheduling of Exploratory/SIM

6. Exploratory (Service Learning) morphing into a full-‐fledged course (SIM) -‐ some concerns

Time in the curriculum Impact on existing courses Original intent of Exploratory Process by which courses are added to the curriculum?

7. Web based testing -‐

new secure software package issues about quiet spaces in library overlapping due dates for quizzes/assignments/exams effect on attendance

8. Issues of Videotaping lectures 9. Increase opportunities for PoM-‐2 physical diagnostic training

8. Clerkship Review 2006. The draft document had been circulated for review

prior to the meeting. Minor changes were incorporated into the document a summary of which summary follows. Copies will be sent to all clerkship directors and department chairs.

This 2006 Clerkship Review has revealed strong functioning programs on the part of all clerkships – Family Medicine, Internal Medicine, Neurology, Obstetrics & Gynecology, Pediatrics, Psychiatry, and Surgery. Over 140 students are educated in the various aspects of clinical medicine in a time period totaling 52 weeks at both UVA and sites across Virginia. Each clerkship director is responsible for defining a curriculum in collaboration with faculty and implementing the goals and objectives of the clerkship. The Curriculum Committee recommends that clerkship directors devote a minimum of 20-25% time to clerkship duties. The clerkship directors, with the support of faculty, chairs, and deans must work diligently to ensure that the educational goals of the clerkship are successfully accomplished. As we work to continually improve our curriculum we should look for guidance to the documents 1) Competencies Required of the Contemporary Physician [12 Objectives of Medical Education], 2) Criteria for Curricular Design, Implementation and Evaluation, 3) Fundamental Principles for Medical Education: Guidelines for Curriculum Development and 4) Expectations for the Curriculum. These are available at the Curriculum Web site: http://www.med.virginia.edu/medicine/curriculum/curriculum.html There are numerous strengths in our clerkship program that require continued nurture and support. There are challenges as well and the curricular improvements, outlined above, need the immediate attention of our faculty, department chairs and deans. We must ensure that every graduate of our program meets our “12 Objectives of Medical Education”. As we think about the future, particular emphasis will need to be given to maintaining excellence in scholarship for all our new and graduating students and the enhancement of

their clinical skill education. We must develop a higher level of evaluation and feedback among our teachers and our learners, and reaffirm our commitment to the administrative and financial support of our educational programs. A number of new factors in the health care system limit the effectiveness of the traditional apprentice model of training students to acquire clinical skills. Fortunately, the current report indicates that there have been important improvements in the clerkships and electives and that students continue to perform well on national tests of clinical knowledge and skills. In addition, they successfully match to good residency positions and are evaluated positively by residency directors. The challenge for the future is to create a new model of clinical education that gives students a meaningful role on the health care team and ensures that they acquire the requisite skills despite changes in the health care environment.

Donald Innes


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) 1. The Curriculum Committee welcomed the newest addition to the Committee, Dr.

Wendy Golden. 2. Annual Course Reviews. The Principles of Medicine Committee will review the

annual course reviews in November and provide a summary report to the Curriculum Committee by November 30 for December discussion and action if needed. Bob Bloodgood reported that every course has learning objectives aligned with the Competencies set forth by the Curriculum Committee. Nancy Payne has found these objectives helpful in development of a curriculum for Professionalism.

3. Clinical Skills Education program. Michael Rein has reported that the program

is going well and the early student comments have been very positive. The Committee will ask Dr. Rein for a brief progress summary and to provide any evaluation data that has been collected.

4. Clerkship evaluations. All Clerkship evaluations have been submitted on time

since the last period of 05-‐06. At the end of the first period of 06-‐07, Clerkships

experienced multiple problems with a new version of Oasis. These problems appear to be solved. Early data from the shelf examinations in Psychiatric Medicine and OB/GYN reveals little change in grades with the new clerkship schedule. The Committee will monitor further improvement of the narrative portion of the clerkship evaluation. See 2006 clerkship report.

5. Due date for Clerkships in Color. Bill Wilson agreed that the Clinical Medicine

Committee would begin work on this as soon as the LCME site visit is completed. Clerkships in Color should be completed for Curriculum Committee review in December 2006. Skills/topics from the Step 2 exam will be used as a basis for this report.

6. Medical Neuroscience 2007. New Course Director, Mary Kate Worden, has

developed a new schedule for the 2007 Med Neuro course with the goal of improving the last section of the course and integrating information delivered by different lecturers. She has reordered part of the course schedule, redistributed lecture time between topics and replaced some lectures. She is working with the new clinical course director from the Neurology Department, Myla Goldman, to ensure all clinical cases are integrated with subject matter in the course lectures. All notes will now be distributed in advance. She has not required standardization of notes at this time, but will review feedback on the 2007 course and consider this in future years.

7. Lynda Fanning, MA, MPH, RD, Clinical Nutrition Manager for the University of

Virginia Health System approached Dr. Innes about the place of nutrition in the medical school curriculum. While nutrition is covered at multiple points in the curriculum [David Hall thesis, School of Medicine, Class of 2006], coordination between the nutritional curricular activities is needed. Lynda has agreed to organize a group of educators involved in nutrition education to assess the current nutritional educational activities in years 1-‐4 of the School of Medicine curriculum; assess the adequacy of these activities, and propose action if needed.

8. October 25 Joint Clerkship Meeting. There will be a Joint Clerkship Meeting at

the Salem Veterans Administration Hospital on October 25, 2006. Agenda items include an Oasis workshop, developing narrative evaluations, a session on Clinical Skills Workshop Teaching & Learning, and updates from Salem and Roanoke.

9. Agenda for October/November meetings. On October 12, a discussion of H&P

teaching mentors and an early recap of the LCME visit. [Nutrition in the curriculum will be discussed when the Nutrition group completes their report]. On October 19, Dean Garson will attend the Curriculum Meeting. The Curriculum Committee will discuss the article, NEngJMed: American Medical Education 100 Years after the Flexner Report, http://content.nejm.org/cgi/content/full/355/13/1339 at the October 19 and November 2 meetings. Socio-‐economic, professionalism and behavior, cultural

competence, and ethics issues and the Exploratory will be discussed. Discussion will center on recently instituted programs, e.g. Cells to Society, and whether curriculum goals are being met through these programs.

10. Meeting with First Year Class. Don Innes and Jerry Short met with

approximately 60 students from the first year class on 10/3/06. Comments as a whole were very positive. Students commented that the alcohol abuse topic in POM1 was especially well done and this format should be the model for other topics. The students had a few issues with the Biochemistry course and the mandatory Medical Center Hour sessions. The complete notes are attached.

Donald Innes Dmr

TO: Curriculum Committee FROM: Jerry Short SUBJ; Meeting with First Year Students, October 2, 2006 Date: Oct. 4, 2006 Don Innes and I met with about 60 first year students on Oct. 2, 2006 to get feedback about the first semester. This year’s meeting was more positive than last year’s. Here is a summary of the students’ comments.

1. Biochemistry a. Moves too quickly; extend for one month. b. Distinguish main points from details. c. Clinical correlations are tested, but the slides are not labeled and set

up for students to review them before the test. d. Some notes were delivered just before class; giving students no

chance to review them ahead of time. e. Snacks during the exam were fantastic.

2. CTS/Physiology

a. Students were divided about the usefulness of the extensive quiz questions. Some liked knowing all the questions they would be asked; others found them repetitive and thought they fostered memorization rather than understanding.

b. Some lectures had more information than time; some instructors never got to the last 15% of notes.

c. Notes could be improved by leaving white space for notes and following the layout of notes in Anatomy and Biochemistry.

3. Medical Center Hour

a. Don’t require specific sessions.

4. POM-‐1 a. Lectures could be condensed; most are covered in small group

sessions. b. Small groups are useful c. Cancel POM the week before exams. d. Increase interview opportunities.

5. Other

a. One student said he chose UVA because he could complete 2 years in one-‐and-‐a half.

b. Have instructors show objectives at the beginning of a lecture and return to them several times during the lecture to show students the organization and progress through the lecture.

c. Have the Library subscribe to non-‐medical magazines so students can be broadly cultured: e.g., Economist, New Yorker. (Gretchen Arnold has agreed to do this.)


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) Guests: Darci Lieb, Brian Wispelwey, 1. LCME Site Visit. The LCME site visit (October 8-‐11) is now complete. The visit

seems to have gone quite well. The team was impressed with the collegiality at UVA. Deans Garson and Pearson extend their gratitude to all on the Curriculum Committee for their help in getting ready for this important visit. A preliminary LCME team response should arrive in 3-‐4 weeks with the full report arriving in February 2007.

2. H&P Preceptors for PoM2. In discussing the quality of teaching mentors with

various classmates and even one of the course directors, Devin Mackay noted that there is considerable disparity in the quality of teaching from mentors for the H&P program (3 H&Ps with writeups done by 2nd year students before Winter Break) during the PoM2 course. The difference appears to be in their willingness to teach. Apparently, some mentors are required to participate in this program, and some of those mentors who are required are not always the greatest teachers. The quality of so many small groups and programs like the H&P program is heavily dependent on the quality of the mentor and their passion and ability to teach.

The question was raised as to whether it’s possible to only have mentors that

express a desire to teach (volunteer basis) for the H&P program. Can volunteers be provided with incentives? Can volunteers not be penalized? Is there a way to establish an incentive for the "required" mentors to be more enthusiastic about teaching (for example, can teaching be made a more substantial factor for promotion)?

Brian Wispelwey, PoM2 Course Director, and Darci Lieb, PoM2 Course

Coordinator, discussed their concerns about recruitment for this valuable program. All members of the Internal Medicine faculty are required to act as one-‐on-‐one mentors for this H&P program. Apparently some are not required to participate such as those who are 100% research faculty and see no patients,

those who are on sabbatical or those whose practices are too far away from the University campus. PoM2 also employs some volunteers from the Departments of Family Practice, Pediatrics, Student Health and Emergency Medicine. Every year, some mentors are not asked to participate due to poor evaluations. The Curriculum Committee discussed how best to ensure that this is a positive experience for all students. Enhanced faculty development for teaching, faculty compensation for teaching, and accountability in P&T venues. Department distribution of UME teaching monies should be open and accountable to department faculty and the Dean’s office. Each department seems to have it’s own method of allocating the education funds from the School of Medicine.

3. Dean Garson will attend the Curriculum Committee meeting on 10/19/06.

Members were asked to forward agenda suggestions to Don Innes for this meeting.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) Guest: Arthur Garson, Darci Lieb 1. The Curriculum Committee welcomed Dean Garson to the meeting. Dean

Garson opened the discussion by thanking everyone on the Curriculum Committee for their help with the recent LCME site visit.

The H&P Preceptor discussion of 10/12/06 continued. Kavita Sharma

distributed a compilation of positive and negative feedback from second year students when asked about their experience with the H&P activity. Most student mentors seem to be enthusiastic, flexible and interested in teaching the students. Some students (10-‐15), however, encounter difficulties with faculty. Recruitment of 60-‐70 really good educators for the H&Ps (each doing the H&P exercise with two students) instead of recruiting140 was suggested. The discussion included how to attract the best teachers and retain them. The proposal of a clear definition of “faculty citizenship” and a baseline for a required teaching commitment for all faculty was discussed. The distribution of teaching dollars to departments and accountability within departments was discussed.

At the present time, in the first two years of medical school, PoM2 mentors, PoM1 mentors, and Clinical Epidemiology small group instructors are compensated over and above departmental allocations for their participation in these small group activities. A proposal for allocating teaching dollars within departments based on student contact hours for the third and fourth years of medical school is being developed and should be ready by the end of the year. Chris Peterson thought that teaching efforts by staff personnel such as Nurse Practitioners should be recognized.

The Committee discussed how teaching accountability and student evaluations

of teaching efforts could be looked at in allocating faculty funds for teaching as well as in Promotion and Tenure. Should there be a minimum number of hours spent teaching to be considered for P&T? How would this be determined?

Donald Innes Dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Jennifer Harvey, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) 1. Standard on Service Learning. The AAMC approved a new standard on service

learning. http://www.lcme.org/hearing.htm The standard states “Medical schools should make available sufficient opportunities for medical students to participate in service-‐learning activities and should encourage and support student participation.” The University of Virginia School of Medicine has more than met this standard before it is accepted by the LCME. Two other newly approved standards were briefly discussed – one regarding the learning environment [professionalism] and one regarding clinical and translational research.

2. Exploratory/Social Issues in Medicine (SIM). A brief history of the development

of the Exploratory concept and how it has evolved to where we are now was provided to the Committee. SIM is a direct descendant of the Community Service Exploratory. The Committee discussed the difficulties of assessing the educational benefits of the program. Evaluation data [SIM, M&MG, PoM-‐1, Anatomy, Biochemistry, and C&TS] should be available at the beginning of January. The Committee will do an assessment of time in the curriculum allotted to the program and all available evaluation data. Mo Nadkarni, Darci Lieb and

Daniella Alexander will be invited to meet with the Committee in January 2007. The Committee will then discuss this program again at a later meeting.

[The Exploratory was approved as part of the Decade Plan and subsequently as a

component of the Cells to Society curriculum. The concept of the Exploratory was “to provide an experience in the pre-‐clerkship curriculum to nurture the humanitarian and scientific motivation that called students to the profession of medicine. It was thought that the experience should allow students to express themselves creatively in the basic sciences, in clinical medicine and in service to the community.”

“The program will be initiated with a menu of clinical medicine and community service

options. Selectives from research, humanities, and student-designed projects will be added in the second or third year of the program. New opportunities for experience in research, the humanities, and clinical medicine, e.g. clinical experiences in anesthesiology, family medicine, pathology, should be added to the summer between year 1-2 to supplement the existing “summer research program” and to the post-clerkship electives”. - Cells to Society: A Curriculum for Modern Medicine November 18, 2004

Based on earlier planning committees, the community service component was agreed to be a required component. It was assumed that the student would chose from a menu of clinical and community service activities at least one of which would be service. A late start due to personnel hiring lead to a short time frame for setup and organizational difficulties. As a result all the focus was on the community service activities. The Committee Minutes of 05.05.05 read, “The Exploratory program will be run by Mo Nadkarni and will begin in the fall of 2005. The first year course will initially be 100% community service, thereafter, the program is expected to expand into other areas such as research, medical humanities, and student proposed exploratories.”

In November 2005 the committee studied the impact of the new curriculum on first year students using early data. The committee indicated that it would continue to closely monitor the academic and well being of the class. Despite the relatively minor changes in the curriculum, the need for adjustments was not unexpected. Changes in the flow and pacing of material, relaxation and opening more opportunities in the service Exploratory, and more sessions with the first year class to explain and to listen, had started.

As a result of this and further discussion including the Principles of Medicine Committee in early 2006 a number of changes were phased into the Exploratory program including: 1) reducing the number of hours per week, 2) culling of sites with less educational value, 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), and 4) addition of social medicine instructional modules and with these changed the name from Community Service Exploratory to Social Issues in Medicine.]

Question of how SIM managed to be instituted without going through the

standard approval process was discussed. It was emphasized that a proposal for a new de novo medical school course must be submitted to the Curriculum Committee, which is responsible for the design, management, and evaluation of the undergraduate medical curriculum. [See the 1999 Curriculum Governance document for details as to the role of the Curriculum Committee, the Principles of Medicine Committee, and the Clinical Medicine Committee.]

Modifications to an existing course must be presented to the Principles of

Medicine or Clinical Medicine committees for discussion and comment, and to the Curriculum Committee which is responsible for the design and management of the entire curriculum and to ensure that the curriculum is coherent, coordinated, current, and effective.

The Curriculum Committee of the School of Medicine is responsible for defining the

goals and objectives of the curriculum; for the design, management, and evaluation of the undergraduate medical curriculum in accordance with the accreditation requirements of the LCME and the mission and vision of the School of Medicine. The Committee is responsible for establishing a process for reviewing, evaluating, and revising the curriculum on a recurring timeline to ensure that the curriculum is coherent, coordinated, current, and effective. http://www.healthsystem.virginia.edu/internet/med-‐curriculum/govdoc.cfm

In regard to SIM, the Curriculum Committee will continue to monitor and

evaluate the program with sessions anticipated in January [and June] 2007.

3. Results of the USMLE CS2 Exam (June, 05 – June, 06). Results of the UVA School of Medicine USMLE Step 2 Clinical Skills examination were distributed. Scores were not quite in the range the UVA School of Medicine usually receives from the Step 1 and Step 2 exams. Anne Chapin will be invited to the 11.09.06 Curriculum Committee to help us provide insight on how to improve these scores.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) Guests: Anne Chapin, Peter

Volsky 1. Results of the USMLE CS2 Exam (June, 05 – June, 06). USMLE Step 2 Clinical

Skills examination results were reviewed with Anne Chapin. We discussed clinical skill development factors influencing student performance on CS2. All UVA USMLE 2CS takers have passed. The exam is focused on a Pass/Fail determination. http://www.med-‐ed.virginia.edu/handbook/pdf/usmle2cs-‐06b.pdf

The instruction of history taking and physical examination skills begins in the

first year course PoM-‐1; however, there is minimal exposure or reinforcement of these skills in PoM-‐2. [It is hoped that the Patient Clinician Encounter Program (spring year 1 and fall year two) would, as the program develops, allow additional practice.] H&P skills are part of the Passport checklists. Much of clerkship H&P teaching is done by residents. In the new Clinical Skills Educator program in General Medicine an attending physician provides observation and formative assessment of clinical skills including history taking, physical examination, interpretation, and presentation.

Third year clerkship directors are asked to meet with Anne Chapin to discuss the

USMLE CS2 and CPX. A review of the H&P skills checklist used in PoM-‐1 & 2 and her knowledge of the H&P evaluation methods may help the clerkship directors design more practice time and formative evaluation (especially real time feedback) into their clerkships.

Students get minimal exposure to a test similar to the USMLE CS2 from the CPX

examination during the third year. First Aid for the CS2 examination outlines scoring criteria for the examination. Close attention should be paid to the time allotted for each part of the examination, easing test anxiety, and balancing the history and physical examination required/necessary in light of time constraints.

The Committee agreed that more practice for the students, both in the form of

standardized patient exercises (clerkship assessment and training workshops, Life Saving Workshop, CPX) as well as practice in the wards/clinics with a knowledgeable educator is necessary. Faculty development of bedside and workshop teaching methods were thought to be integral.

2. Assessment of new Curriculum. Bob Bloodgood presented findings regarding the new grading system and new curriculum at the Fall AAMC meeting. The entire presentation is available on the web at:

http://www.people.virginia.edu/~rab4m/PassFailGradingStudy.pdf

Dr. Bloodgood updated the Committee on the most recent results of the survey data of the medical students performed after the first semester of first year. These results were compared to results from the previous three years.

“Have you been under or felt you were under any strain, stress or pressure

during the past month?” Semester Class 2006 Class 2007 Class 2009 Class 2010

Graded, Old P/F, Old P/F, New P/F, New 1 47% 30% 52% 36%

3. Lecture attendance. The Curriculum Committee’s policy on Student

Participation in Education Activities does not address lecture attendance. The policy is posted on the Curriculum website:

http://www.healthsystem.virginia.edu/internet/med-‐curriculum/participation.cfm The Committee decided no policy on lecture attendance was needed. 4. Second Year Student Issues. Members of the second year class have

corresponded specific issues to Dean Garson. Many of the student issues have been dealt with in plans for adjustments for the 2007-‐2008 second year schedule. Plans are to move the beginning of Psychiatric Medicine two weeks earlier to decrease afternoon activities just prior to exams. Pathology will also make adjustments to their schedule to place Neuropathology lectures prior to the tutorials. The January start date will remain at 1/4/07 as it was moved to this date from 1/8 prior to the beginning of the Fall semester to help alleviate afternoon intensity in January and allow for more study time prior to the final examination period. The transition course this year unfortunately will fall on the weekend of the Foxfield races. Efforts were made to readjust the schedule but proved impossible due to the lack of access to Nursing School rooms, faculty to staff the course, and because of disruption to the Transition course.

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary)

1. Social Issues in Medicine Exploratory (SIM) update. It appears that attendance

for SIM lecture series has been great. Wendy Golden attended a few of the lectures and reported that they were well-‐received by the students and quite good. At this point, only four days into this phase of the first year, Genetics is encountering no problems with the addition of the SIM lectures.

2. Clinical Skills Educator (CSE) program update. There was a one-‐time budget

supplement made for this program. The program was designed and budgeted to have four students per preceptor but during Fall ‘06 often had two students to one preceptor, increasing the cost. While no evaluation of the program has been received, it appears to be working well. Many students noted in their clerkship evaluations the significant amount of time spent with an attending. This program will be reviewed at the end of the Clerkhship year. Current plans are to extend the program for the 2007-‐2008 clerkship period with a fixed budget.

3. 2007 -‐ 2008 academic year. Members were asked to begin thinking about the

07-‐08 academic calendar and whether any adjustments needed to be made. Class, exam, holiday, and start/end dates will be reviewed. This will be discussed further at the next meeting.

4. H&P into POM-‐1. Folding the H&P into POM-‐1 and allowing students to learn

from analysis of the presentations of others -‐ somewhat like the Intro to Psychiatry course and a related suggestion that the physical exam be a one-‐on-‐one with the POM-‐1 instructor was discussed. After discussion, the Committee agreed that the program is best located in the second year and in POM-‐2 where it allows students to continue to work on interviewing and exam skills with a one-‐on-‐one relationship, and where they are able to begin to integrate their expanding medical knowledge base into the process of the history, the physical and the write-‐up and presentation. Howard Kutchai noted in an e-‐mail that the first year students lack the background to do what has been done in the 2nd year.

Students learn a great deal from listening to each other present. Such

presentations might be integrated into POM-‐2 groups or into another small group.

The focus should be on improving the quality of H&P preceptor interaction.

Allowing senior residents and fellows to participate in the H&P activity would increase access to instructors. Kavita Sharma noted in an e-‐mail that we have some great residents in Internal Medicine as well as fellows in the various subspecialties who could probably commit more time and likely more energy to this activity. While there is no replacement for the experience of attendings, most of our residents are very skilled in the physical exam and H&P's and should be able to evaluate and supervise a 2nd year medical student.

5. Change to LCME Standard ED-‐1 & 1a. The Committee discussed development of

subcommittees to assess, plan and evaluate the various themes/content in the curriculum such as nutrition, profesionalism, clinical skills education that run throughout the four years. The Committee agreed that a group made up of people not directly involved in the various programs might be more effective. This might offer a “fresh prospective” on these areas. The Committee was asked to forward ideas on how best to comply with the revised ED1 and 1a standards to Don Innes [email protected]. Jerry Short noted that it is much easier to develop a new curriculum based on these standards, but far more difficult to retrofit an established program to the new standards. Outcomes must be evaluated for this information to be useful.

Chris Peterson provided a copy of an article entitled “Educational Strategies to

Promote Clinical Diagnostic Reasoning.” NEJM, 355:2217, November 23, 2006. This article is available on the web at: http://content.nejm.org/cgi/content/full/355/21/2217 The Committee agreed it would be best to determine how to apply these standards to one theme such as Clinical Skills and if successful use that as a model. Faculty development seems to be key in improving student clinical skills training. All faculty who teach students in the first through fourth years should be made aware of the proper methods for H&P skills. Faculty development might be an activity the Academy of Distinguished Educators would be interested in taking on.

Note: A presentation at the Fall AAMC meeting suggested that self-‐assessment has not been a

very useful tool in evaluating outcomes. People who most need help and improvement in a given area are usually the same individuals who are least likely to correctly self-‐evaluate.

6. Medical School at Virginia Tech/Carilion. The Roanoke Times reported today

that Carilion and Virginia Tech are discussing the development of a medical school in Roanoke. Impact of this new school on the UVA program was discussed. http://www.roanoke.com/news/nrv/wb/93731

Donald Innes dmr


Surgery Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Daniel Becker, Robert Bloodgood, Gene Corbett, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Chris Peterson, Jerry Short, Bill Wilson, Devin Mackay, Kavita Sharma, Debra Reed (secretary) 1. Social Security Numbers as Student ID. The following is an excerpt from a

memo sent to all University of Virginia faculty. Due to the University's long-‐standing reliance on Social Security Number (SSN) as

the student ID number, our most common risk for exposure of sensitive information comes from lost, stolen, or hacked desktop and laptop computers which contain lists of student ID numbers. You can play a crucial role in addressing this problem by immediately deleting from your office laptop, desktop, and home computers all files, or at least the portions of those files, that contain the social security numbers of students, e.g. class rolls and grade book files. Electronic media (such as CD's) and paper copies of this information also should be destroyed. Course enrollment and grading records are securely maintained by the Registrar's Office. Copies of this information may be obtained from that office should you find need for it in the future. -‐ Gene D. Block, Tue, 12 Dec 2006

The School of Medicine is working to comply with this mandate. For the four

remaining exams in this period, students will be instructed to use the last five digits of their social security number as the ID number. Medical education grade delivery will be modified to eliminate the social security number identifier in early January.

2. Medical School at Virginia Tech/Carilion. The new school of medicine at Virginia Tech/Carilion plans to open in 2009 or 2010 as a private school with approximately 40 students. Carilion will give the UVA SOM three years notice before decreasing the number of UVA clerkships students at that institution. Impact of this program on the UVA SOM was discussed. The possibility of joining with other local institutions for clerkship education was discussed but due to factors such as lack of housestaff and patient population, this might prove impossible.

3. USMLE Passing Scores Raised. As a result of this [USMLE] review, the Step 1

Committee raised the three-‐digit score recommended to pass Step 1 from 182 to 185. The new minimum passing score will be applied to Step 1 examinations for which the first day of testing is on or after January 1, 2007.

4. Clerkship Content in Color. All of the Clerkship Directors have submitted

information regarding the content of their clerkships. This information has been assembled into one document. This document should help the Clerkship

Directors (Clinical Medicine Committee) outline objectives and reduce unwanted gaps and redundancies.

5. Humanism. Dan Becker spoke briefly about the humanism program which

allows him to meet with the students on the AIM rotation for a one hour lunch. Throughout the course of the clerkship year, he will have met with 100% of the students in these sessions. The sessions began as a replacement for the Clinical Conversations during the Clinical Connections course. Sessions early in the clerkship year were centered around delivering bad news, death and dying, and reflective practice.

The sessions of late have evolved more into sessions dealing with educational

issues such as the students’ feelings of not being part of the “team.” Dr. Becker reports that students are eager to discuss their educational experiences. The Committee discussed how to encourage students to be more aggressive/assertive in their quest for involvement in patient care teams. Offering students strategies on how to become more involved might be a good topic for the Transition course just prior to the beginning of the Clerkships.

Students have also spoken highly of the Clinical Skills Educator program. At the

present time, Internal Medicine is the pilot for this program. As soon as evaluation data can be obtained from the Internal Medicine Program, and if it as positive as early reports, the Curriculum Committee would like to see this program developed in all of the clerkships.

6. 2007 -‐ 2008 Schedule. The Committee discussed the draft 07-‐08 schedule

posted on the web at: http://www.med-‐ed.virginia.edu/handbook/academics/calendar/cal-‐07.cfm The first year will begin Orientation on August 6, 2007; the second year will begin class August 13, 2007. The January 2008 start date for the first and second year will be January 3, 2008. Otherwise the schedule, which is a replica of the 06-‐07, was approved. The first year classes will meet on Labor Day, but the second year classes originally scheduled for Labor Day, will move to the previous Friday afternoon. [A “final” schedule will be reviewed at the next Curriculum Committee meeting.]

Donald Innes dmr

DRAFT First Year - Class of 2011 Foundations of Medicine (Fall/Spring Terms) Monday, August 6 & Tuesday, August 7 - Orientation

Tuesday, August 7 at 5:30 at DoubleTree Hotel - Convocation Dinner

Wednesday, August 8 (Jordan Hall 1-5) - Cells to Society, An Intro begins at 8:00 am

Thursday, August 9 & Friday, August 10 (noon) - Cells to Society, An Intro

Friday, August 10 (noon-3:00) - Activities Fair

Friday, August 10 - White Coat Ceremony (TBA) & reception (4:00 pm)

Monday, August 13 - Foundations of Medicine Classes begin at 8:00 am (Jordan Hall 1-5)

Friday, August 17 - Cadaver Prep (1:00 - 3:00)

Monday, September 24 through Friday, September 28 - Examination period

Friday, September 28, 1:00 pm through Monday, October 1 - Fall Break Weekend

Tuesday, October 2 - Classes resume

Saturday, October 13 (9:00 in Old Med School Auditorium) - Parents' Day

Saturday, October 13 - evening reception at the Med Alumni House - Parents' Day

Monday, November 12 through Friday, November 16 - Examinations

Saturday, November 17 through Sunday, November 25 - Thanksgiving Break

Monday, November 26 - Classes resume

Saturday, December 15 (exam 9-12)

Saturday afternoon, December 15 through Wednesday, January 2, 2008 - Winter Break

Thursday, January 3, 2008 - Class begins at 8:00 am

Monday, February 11 through Friday afternoon, February 15 - Examination period

Saturday, February 16 through Sunday, February 24 - Spring Break 1

Monday, February 25 - Classes resume

Monday, April 14 through Friday afternoon, April 18 - Examination period

Saturday, April 19 through Sunday, April 27 - Spring Break 2

Core Systems Part 1 Monday, April 28 - Core Systems Classes begin in Jordan 1-5 Monday, June 2 through Friday, June 6 - Examination period and end of term Saturday, June 7 through Sunday, August 10 - Summer Opportunities & Break Monday, August 11, 2008 (Jordan Hall 1-14, 8:00 am) - Core Systems Classes resume Second Year - Class of 2010

Core Systems Part 2 Monday, August 13, 2007 (Jordan 1-14) - Welcome and Orientation by Dr. Pearson at 8:00 am; then classes

Monday, September 3, 2007 (Labor Day) - no classes

Monday, October 8 through Wednesday, October 17 - Examination period

Saturday, November 17 through Sunday, November 25 - Thanksgiving Break

Monday, December 10 through Wednesday, December 19 - Examination period

Thursday, December 20 through Wednesday, January 2, 2008 - Winter Break

Thursday, January 3, 2008 - Classes begin

Monday, March 10 through Wednesday, March 19 - End of term examination period *

To be scheduled March-April (before April 16) - USMLE Step 1 Monday, April 21, 2008 through Saturday, April 26, 2008 - Career Day, Basic Patient Care Skills, Information Management, and DxRx Health Policy Courses * The exam schedule is Pharm (Monday, March 10), Micro (Thursday, March 13), Path (Monday, March 17), and PoM-2 (Wednesday, March 19). This is two days shorter than the previous year.

Documents

UniversityofVirginiaSchoolof**Medicine* …...UniversityofVirginiaSchoolof**Medicine* CurriculumCommittee* Minutes01/05/06* Surgery*Conference*Room,*4:00*p.m.***** * Present(underlined)were:*Reid*Adams,*Gretchen

UniversityofVirginiaSchoolof**Medicine* …...UniversityofVirginiaSchoolof**Medicine* CurriculumCommittee* Minutes01/05/06* SurgeryConferenceRoom,4:00p.m.***** * Present(underlined)were:ReidAdams,*Gretchen