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Summary of January 8, 2004 CME Minutes

  1. Review of December 11, 2003 Minutes

Discussion returned to the importance of addressing the “syllabus” issue.  The expectation that everything the students need to learn should be contained in the syllabus conflicts with the Case goal of producing lifelong, self-directed learners skilled in learning from multiple resources.  Since this issue pertains to the first two years of the curriculum, a work group of subject committee chairs in the core curriculum could be established to look into the matter.  Student representatives maintained that the students are neither opposed to using primary sources nor use them as sparingly as was the impression at the last CME meeting.  Students are not relying solely on the syllabus.  The syllabus is valued for its conciseness—it condenses material making it a useful tool when reviewing for Case exams.  It is true that some students believe that all the material covered in an interim examination should either be included in the syllabus or come from specific textual references by the faculty.  There needs to be a clarification of what is expected regarding source material, as there is wide variation among subject committees.  Currently, there is no consensus among committees about useful primary sources.  This needs to be decided and communicated to the students.

  1. Comments from the Chair

Dr. Altose responded to Dr. Louis Binder’s report on the AMA Section on Medical Schools that suggested potential new LCME accreditation standards.  Dr. Altose foresees service learning as being incorporated into our curriculum under Dean Horwitz’s “civic professionalism.”  Quality improvement and prevention of medical errors will be incorporated into the Tuesday morning ICM clinical learning groups.

  1. Comments from the Vice Dean for Education and Academic Affairs

Dr. Lindsey Henson announced completion of the series of planning retreats that began February 2003 for the new Year III clinical curriculum to accommodate both the College and University students starting in 2006.  A summary of the previous six retreats was distributed at the recent January 7, 2004 clinical retreat.  The current stage of development of the clinical curriculum calls for obtaining both positive and negative feedback from the faculty on several comparative models with the focus on:

  • Private ambulatory care

  • Design of the basic clinical core curriculum—which disciplines go together

  • How to best utilize the clinical learning group (CLG) concept of ICM.

Dr. Linda Lewin heads the University clinical curriculum committee and Dr. Bud Isaacson is in charge of the College clinical program.  Based on faculty feedback on the several models, one single model will be designed and presented at the annual education retreat at Landerhaven on February 27 for further input.  The next step will be for Dr. Lewin and Dr. Isaacson to present the model to the CME in April and then to put together a working group in May with the target date of 2006 for the new Year III curriculum in mind.

Preparing Year I and Year II ICM for a smooth transition into the new third year curriculum is already underway.  Next year will witness some changes in mastering clinical skills, interviewing skills, communication skills, and physical diagnosis.  One half-day per week will be designated for the student to pursue the clinical curriculum.  The class will be divided into fourths, patterned after the societies.  By making ICM more rigorous, it will assume equal importance with the basic science curriculum.

Year III currently consists of 50 weeks.  This number will be condensed into 30 weeks for the clerkships with an additional 16-week advanced core clerkship, which can easily incorporate a third and fourth year research project.

  1. Report from the Student CME

Mr. Jason Garnreiter (Year II student representative) and Mr. Christopher Utz (Year I student representative) met with Dean Horwitz on January 5, and explained the students’ desire to be informed about:

  • Proposed curricular changes

  • How the University program will be integrated with the College program

  • Role of PBL in the University medical curriculum

  • Laptop changes

  • The Dean’s proposal for a School of Medicine and Health.

The student meeting with the Dean will take place Monday, February 2.

  1. Report from the Nervous System Committee

Dr. Altose welcomed Year II Nervous System subject committee guests, current co-chairs, Drs. Jerry Silver and Elizabeth Pehek and committee member Dr. Steven O’Gorman.  Dr. Silver presented highlights from this year’s committee.  The current leadership arrangement is for multiple neurosciences co-chairs to rotate through the basic science leadership over three years, with Dr. Silver at the helm this year, Dr. Pehek taking over for next year, and Dr. O’Gorman the year after that.  The chair acts as the designated “go to” person for the students, but all three faculty members participate in the committee and help each other.  Dr. Mark Cohen’s decision to step down has left no Pathology chair for the committee.  Dr. Brian Maddux will continue to provide the clinical leadership.

Dr. Silver explained that the Nervous System Committee (NSC) has been evolving over more than 30 years and what started out as a one-semester course is currently condensed into two and one-half months.  This year alone the NSC lost 11 hours.  Dr. Silver praised Dr. David Katz as being an outstanding past-chair who restructured the lectures.  NSC’s long history of pairing one basic scientist and one clinical scientist as co-chairs has resulted in close integration.  Dr. Silver, who was a student here in the 70’s, is proud of the committee and considers it “one of the best courses in the country.”  He could envision “tweaking” the spacing of lectures but would not recommend any sweeping changes.

Dr. Silver cited the following as strengths of the NSC:  the committee system that affords a broad sampling of anatomy, physiology of the circuit and the consequences of disturbing that circuit; excellent, exciting lectures; and expertise of the faculty participating in the course.

Dr. Silver next cited problems encountered.  He specified examples of lack of professionalism among certain students.  The caustic criticism of a few students took such an unprofessional turn that one lecturer formally recognized for his teaching excellence decided to resign from the committee after reviewing the nature of the written comments.  Dr. Silver acknowledged the value of constructive criticism, which leads to the incorporation of suggestions/changes that improve the committee.  Constructive student feedback influenced the Nervous System Committee leadership in deciding which 11 hours of lecture to trim.  He felt, however, that either the committee chairs or a student committee needs to screen the written student feedback comments

Another frustration for faculty is student lecture attendance, particularly at 8:00 a.m.  Furthermore, Dr. Silver regards as highly unprofessional the way one-half to two-thirds of the total students drift in by 10:00 a.m.  Arriving promptly at 8:00 sends a positive message to the faculty lecturer.  Drifting into lecture is just inconsiderate and rude.  Dr. Silver opposes mandatory attendance.  However, he suspects a correlation between attendance and exam scores.  Twenty-two students failed the interim exam, which required only a 65% pass mark.  The Nervous System Committee is one of the most difficult.  Much material is presented in a short time.  However, all material in the exam is covered in lecture.  Additionally, afternoon review sessions are offered.

Dr. Silver also expressed concern that current students tend to ask less questions than in years past.  As an immediate solution, he recommended ensuring that lecture does not run overtime to allow sufficient time for faculty to stimulate discussion with students.

Another frustration consisted of the significant number of students exempted from taking the exam (either midterm or the final) on the day it is given.  Dr. Silver would like to see a more uniform policy on who gets to postpone taking an exam.  Dr. Silver also raised the issue of the number of remediation exams allowed.  Discussants returned to this matter later in the meeting requesting clarification of the remediation policy.

Year II student representative, Mr. Jason Garnreiter mentioned very positive feedback from his classmates.  The Nervous System Committee is difficult but challenging, and this is perceived as a positive attribute.  While Mr. Garnreiter attends lecture, he recognizes the multiple learning styles found in his class.  Like Dr. Silver, he opposes making lecture attendance mandatory.  Some students choose to use lecture time in a productive manner, even though they are not in class listening to lecture.  Mr. Garnreiter pointed out the need to address mastery of pathology.  The mean score of his classmates in pathology is in the 40’s. 

Discussants felt that professionalism should come under the purview of the CME.  There could be an explicit delineation of professionalism expectations that would be explained to the students and for which they would be held accountable. 

  1. Report from the Flexible Program Council

Dr. Kent Smith, Flexible Program Coordinator, expressed his enthusiasm for the new Type A elective designed by Dr. Jonathan Karn and Dr. Michael Lederman, consisting of a fascinating 6-credit series on AIDS and HIV.  Open to both medical and graduate students, the elective may offer funded summer research opportunities.

See Curriculum Revision Update section.

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