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Summary of January 13, 2003 CME Minutes

 

1.                  All documents pertaining to curriculum update presented by Dr. Andrew Fishleder at the December 12, 2002 CME meeting are now on the eCurriculum.  Choose the Cleveland Clinic Lerner College of Medicine of CWRU Curriculum Online” link.

 

2.         Comments from the Chair

Dr. Altose referred to an editorial by Jordan J. Cohen, M.D., AAMC President, “Clinical Skills Under Scrutiny” that appeared in the December 2002 edition of the AAMC Reporter.  (URL:  http://www.aamc.org/newsroom/reporter/dec02/word.htm .)  The NBME Clinical Skills Examination (the USMLE “Step 2½”) is driven by the licensing authorities’ concern over the numbers of physicians who do not possess the necessary basic clinical and communication skills.  Initially skeptical about the need for the USMLE Clinical Skills Examination, Dr. Cohen came to the conclusion that “the well-validated CSE planned by the NBME would add a needed measure of assurance to the public that our graduates are, indeed, prepared to meet their obligations as physicians.”

 

Dr. Altose requested input from the students on the proposed new licensing standards.  Year IV student Mr. Scott Walker, who has expressed student opposition to the Clinical Skills Examination, would like to articulate an effective voice to dissuade licensing boards from requiring the new clinical skills examination.

 

See plans for the upcoming symposium under Comments from the Vice Dean for Education and Academic Affairs.

 

3.         Longitudinal Nutrition Curriculum—Proposal for a Vertical Theme

Dr. Altose referred to the CME’s responsibility to promote curriculum enhancements.  Two approaches currently underway are 1) developing new programs, such as those initiated by the Scholars Collaboration in Teaching and Learning Project, and 2) identifying, developing, and implementing vertical themes.  The CME is currently entertaining vertical theme proposal presentations with the intent to recommend one or more for support by the Dean’s Office.

 

Dr. Mireille Boutry provided an overview of the Longitudinal Nutrition Curriculum along with fellow presenters Dr. Edith Lerner, Mss. Ning Liu and Sheira Schlair (Year IV students), and Mr. John Castor (Year II student).  Nutrition is a Scholars Collaboration in Teaching and Learning Project.

 

The goal of integrating basic and clinical sciences in a Longitudinal Nutrition Curriculum is warranted by results of the AAMC exit questionnaires of 2001 and 2002, indicating that approximately two-thirds of CWRU medical students, as well as two-thirds of U.S. medical students, do not feel prepared “to manage the diets of patients affected with renal, cardiac, and diabetic diseases.”  The curriculum is developed in collaboration with the Department of Nutrition.  Learning objectives for the course are specified.  A problem-based learning approach focuses on nutrition and life cycle (Year I), nutrition in pathology as correlated to different basic science committees (Year II), nutrition in severe disease correlated to the clerkships (Year III), and an elective in clinical nutrition (Year IV).  Six cases, lasting two hours each, would be covered per year, thus requiring twelve hours per year.  To prepare for each case, students will find background information available online with links and references to basic science committees and literature.  A tutor guide will be developed for each case.  Dr. Boutry circulated drafts of the five cases developed to date for Year I.  Each sample case included learning objectives, background information with references, and pre-test assessment questions.  There will also be post-test questions.  The Year IV clinical elective will be tailored to the student’s individual interests and include a dietary self-assessment.  Assessment of student performance in the first two years would be measured by one or both of the following:  1) multiple-choice questions incorporated in relevant end-of-subject-committee interim exams, and/or 2) an end-of-year paper written by the student assessing various nutritional aspects of his/her Family Clinic patient.

 

Plans have been made for immediate implementation of a pilot starting this February.  Two-to-three cases developed in collaboration with the Department of Nutrition—that could be included in the Core Academic Program and/or the Patient-Based Program—will be tested on a group of ten Year I students.  An independent observer will assess the pilot project and feedback sessions.

 

The discussion that followed highlighted the many strengths of the proposed vertical theme:

·        Nutrition is an area of great relevance.

·        There currently exist deficiencies in our curriculum for teaching nutrition.

·        A plan for interesting teaching approaches was presented.

·        Clinical application of basic science

·        Easy integration into the Core Academic Program and Clinical Clerkships

·        There exists a concrete opportunity to pilot the course with students via the Scholars Collaboration in Teaching and Learning Project

 

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

Dr. Henson highlighted upcoming events.

·        The date of the Clinical Skills Exam (USMLE Step 2½) symposium with representation from the NBME has yet to be finalized.  Tentatively, the forums for faculty and students will take place during the afternoon of Friday, February 21, and possibly extend to Saturday, February 22.

·        The annual medical education retreat will take place Friday, February 28, from 8:30 to 3:00 p.m.  Please forward your input to members of the planning committee, who currently include Drs. Terry and Dan Wolpaw, Marge Greenfield, and Lindsey Henson.  The keynote speaker will be Dr. Thomas R. Viggiano, Associate Dean for Faculty Affairs, Mayo Medical School, who will discuss faculty development.  As the retreat’s theme is faculty development and recognition of teaching, there will be a mock review of portfolios of educators up for promotion by a mock promotions committee.

 

5.                  Report from the Curriculum Leadership Council

Dr. William Merrick, CLC chair, presented highlights of the quarterly December 11, 2002 meeting of the Curriculum Leadership Council.

·        Dr. Henson presented an update of the CCLCM curriculum.

q       CLC members expressed concern that there is no mechanism in place to assess performance of “College” students in comparison with that of “University” students, other than USMLE scores and clinical program ratings.

q       There is not yet heavy involvement of committee chairs or teaching faculty in the CCLCM.

·        Remediation, as mandated by the Scoles/Ravdin Proposal for Evaluation of Students’ Performance in the Core Academic Program (October 25, 1993), requires that students demonstrate mastery of all components of the CAP.

q       The faculty consensus was that mastery equivalent to the passing score standard has been accomplished through remediation efforts.

q       During the second semester of Year II, students remediating simultaneously while classes are going on are compromised.  Several alternative times for remediating, such as during holidays, were suggested, although the feeling was that these were no better than the current system.

q       The challenge to devise a standardized program for remediation so that all committees would remediate in the same fashion was raised.

·        Attendance by committee chairs at CLC meetings is not what it should be.  Currently, approximately 40% are present on a routine basis.  It was decided that the hour is not the issue.  In an attempt to “get the word out,” CLC meeting dates have been determined through the daylong retreat scheduled Friday, June 11, 2004!

·        A document entitled a “Working Description of the CLC” has been designed to supersede the old “CLC Constitution.”  The working description is a document to describe the expectations for potential committee chairs.

 

Dr. Altose stated that the CLC’s basic functions—determining content and time allotment and evaluating delivery of the curriculum—were appropriate and relevant and should constitute the CLC meeting agenda.  Dr. Merrick pointed out that the curriculum is never stagnant; it changes between 10-20% every year.  Content and delivery are continually under consideration.  The next CLC meeting is March 5, 2003.

 

6.                  Report from the Flexible Program Council

Dr. Charles Malemud, Flexible Program Coordinator and Flexible Program Council Chair, summarized the December 12, 2002 Flexible Program Council meeting.

 

The December 12 Flexible Program Council meeting focused on registration for Type A electives, with concern over the tendency for students to “double up,” taking 8 Type A electives during Year I, in order to complete the elective requirement of 13 to qualify for advancement to Year III.  Students want to complete their Type A elective requirement before spring of Year II, when they divide their time between studying for the USMLE Step 1, various spring programs, and frequent subject committee interim exams.  The FPC discussed whether the number of Type A electives required for promotion to Year III should be reduced from 13 (as is the requirement for the Class of 2006) to 10 (starting with the Class of 2007).  By a vote of 6 in favor and 0 opposed, the Flexible Program Council endorsed reducing the Type A elective requirement from 13 to 10, starting with the Class of 2007.

 

In the discussion that followed, there was affirmation that the CME was responsible for establishing curricular policies and the CME would take the recommendations of the FPC under consideration.  There had been several ad hoc additions and modifications to the curriculum in the first two years.  For example, Physical Diagnosis I has been added in the evenings along with an ongoing remediation program.  Attendance at autopsies is a requirement in the second year.  The USMLE Step 1 is no longer a fixed-date examination.  The schedule in the first two years is overloaded and is considered to be a logistic burden for the medical students.  The role of the mandatory Type A electives has become less clear.  This led to a proposal that the Flexible Program be made optional so as to serve as pure enrichment.  The CME agreed on the necessity of re-articulating the fundamental goals and objectives of the educational program in Years I and II to evaluate how each of the offerings and programs in Years I and II contributes to the educational goals and objectives, to determine whether there is balance among the curricular offerings in Years I and II, and to make recommendations regarding changes in the curriculum.

 

Dr. Altose indicated that he would establish a workgroup of CME members and other interested parties and outline a charge to the workgroup.

 

See Curriculum Revision Update section.

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