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Summary of February 13, 2003 CME Minutes




1.         Comments from the Chair

Dr. Altose provided an update on the CME workgroup, a concept derived from the January 9 discussion on the role of the Flexible Program in Years I and II.  The workgroup will be chaired by Dr. Louis Binder.  Drs. Binder, Altose, and Henson will determine the membership of this committee charged with evaluating the whole Year I and II curriculum with respect to:

·         Re-articulating goals and objectives

·         Determining how each offering contributes to these goals and objectives

·         Assessing balance among the components—Core Academic Program, Patient-Based Program, and Flexible Program

·         Offering recommendations to the CME for any changes in the curriculum.

The plan is to have the workgroup present its recommendations to the CME prior to the end of this academic year.


2.         Comments from the Vice Dean

Reminder:  the annual medical education retreat will take place Friday, February 28, 2003 at Landerhaven.  The focus of this interactive retreat is on faculty development, recognition for teaching, and the promotions process, with the intent to generate a letter to incoming Dean of the Medical School, Dr. Ralph Horwitz, describing the interests and expectations of the faculty.


3.         Student CME

Year I student representative Ms. Connie Liu announced that the CWRU School of Medicine has been awarded the 2003 Paul R. Wright Award in Medical Education by AMSA (the American Medical Student Association) for its exceptional focus on Activism in Medicine:  Integration of Advocacy Skills into the Medical Education Curriculum.  (Access the impressive application compiled by the following students:  Mr. Chris McCoy (’05), Ms. Connie Liu (’06), Ms. Kyl Dinsio (’06), and Mr. Alexander Tsai (M.D./Ph.D. ‘03-’06), at url:


Year II student representative Mr. Brian Chow introduced the Student Syllabus Reform Initiative.  He held up the “blue notebook” containing selected samples of both outstanding and deficient syllabi, that is available upon request for those interested.


Year II student Ms. Jaime Rice, Student Committee on Medical Education Chair from the Committee on Student Representatives (CSR), gave a presentation summarizing the Syllabus Reform Proposal.  The previous idea of having a template to serve as a model for all syllabi was abandoned in favor of establishing minimum syllabus standards that will enable students to learn the most effectively.  Salient points made by Ms. Rice include:

·        A syllabus is needed for all lectures—even those by a guest lecturer—and it is the responsibility of the committee chair to enforce this policy.

·        Learning objectives must be provided for each lecture to indicate the most important material.  Learning objectives also serve as an important self-assessment tool for the students.

·        Figures should be clear, of sufficient size, and embedded in the relevant text.

·        There should be adequate room in the margins for students to take notes.

·        Students pay attention to the date of the most recent update of the syllabus; they want the syllabus to reflect the most recent information.


The Syllabus Reform committee has made one copy of the current syllabus accessible to all students in a central location for them to enter their corrections.  This edited copy will be given to the committee chair with the desire that the individual professors will in turn make their corrections for the coming year.  The students’ proposal also recommended that subject committee chairs provide feedback to lecturers on their syllabi with recommendations for improvement.  Students offered their services to faculty preparing and editing the syllabus and are planning to present a “superior syllabus award” in recognition of special efforts by certain faculty.


In the discussion that followed, it was pointed out that a high quality syllabus would serve as an important learning tool and would not provide an excuse for students to be absent from lectures.  Syllabus preparation is not a high priority for many of the faculty that lecture in the Core Academic Program.  One suggestion was pairing up a student to work with one of the lecturers during the year on the preparation of the syllabus.


The CME voted to endorse the Syllabus Reform Proposal as presented by Ms. Jaime Rice.


The CME further recommended that Dr. Nosek assist the students and the CLC chair in the development of a standardized syllabus format to be shared with all subject committee chairs, section leaders, and lecturers.  Responsibility rests with the Curriculum Leadership Council Chair to work with committee chairs, section leaders, and lecturers to meet the standards for the syllabus as outlined in the Syllabus Reform Proposal and to establish a mechanism for regular syllabus review with feedback to lecturers with recommendations for revision.  The initial main emphasis should be the inclusion of learning objectives in all syllabi.


4.         Report from the Clinical Rotation Development Council – Dr. Christopher Brandt

Dr. Brandt presented a proposed revision of the third year core clerkship rotation schedule:  CRDC clerkship proposal.


The current clerkship schedule poses certain problems.  The Psychiatry Clerkship is divided into one 4-week block and two 1-week rotations.  While the integration between the 1-week Psychiatry rotation and Ambulatory Medicine rotation works well, the Psychiatry/Pediatrics pairing does not.  In addition, evaluating the student on his/her Psychiatry performance over the entire block of time proved awkward and impractical.  Also, there was no scheduled time for electives, which was a particular detriment to students whose career choices and Early Match decisions needed special attention.  These needs are currently handled on an ad hoc basis by the Patient-Based Program Coordinator and the Registrar.


The CRDC has proposed to adopt as of July 2003, a new Year III schedule consisting of seven 8-week core blocks, six of which will be taken within the 52 weeks of the third year and the remaining rotation to be deferred to the fourth year.  Configuration of the seven core blocks is as follows:

·        Pediatrics (8 weeks)

·        Inpatient Medicine (8 weeks)

·        Ambulatory Medicine/Family Medicine (8 weeks)

·        Surgery (8 weeks)

·        Psychiatry (6 consecutive weeks) + Elective or Vacation (2 weeks)

·        Neurosciences (4 weeks) + Elective or Vacation (4 weeks)

·        OB/GYN (7 weeks) + Elective or Vacation (1 week)

Any rotation considered necessary for inclusion in the Dean’s letter must be completed by October of Year IV.  Inpatient Medicine and Ambulatory Medicine blocks will remain together for integration purposes and to facilitate the current OSCE structure administered three times a year.  Maximum vacation for the third and fourth years will be 13 weeks.


Pros and cons of the proposed changes were discussed.  The following strengths of the proposal were noted:

·        The proposal affords students a little more elective time in the third year and the availability of two-week electives.


The following areas of concern were raised and addressed:

·        There will be a mixing of third and fourth year students on the clerkships, which will provide an extra challenge for the clerkship directors.  Students come with different levels of learning experience, and grading can be a problem, particularly if third and fourth years students are being compared with one another.  However, no serious problems were previously encountered with this mix in our clerkships.

·        Since some students will have elective time relatively early on in the third year, good advising and mentoring will be needed.  There will also be a need to coordinate the third and fourth year schedules.  As the core clerkship lottery/scheduling system is in early April, students need counseling relatively early on.  Dr. Smith and Dr. Haynie are currently creating an advising system that will be in place this spring for all Year II students.

·        Flexibility in the system to enable all Year III students to complete the essential third year clerkships of Medicine, Surgery, and Pediatrics will be enhanced by additional rotations at the Cleveland Clinic.  Furthermore, these clerkships can be completed as late as August of the fourth year.

·        Deferring a rotation to the fourth year makes possible the presence of a student lacking the core skills in an Acting Internship.  Elective sponsors will need to determine whether prerequisite experience will be required.


CME endorsement of the new third year core clerkship rotation schedule as bolded above passed by a majority.


5.         Aging and Geriatrics Vertical Theme

Dr. Jerome Kowal presented an update on the Aging and Geriatrics vertical theme.  He and his colleagues have previously appeared before the CME—initially on October 22, 1998, when the CME voted to establish Aging and Geriatrics as a vertical theme, and to provide substantial updates of their progress reports on September 9, 1999, and on February 10, 2000.  A comprehensive review of the Geriatrics curriculum in Year I was provided at those meetings.  At this meeting, Dr. Kowal provided a review of Year II, including an attachment of detailed lecture coverage by date for the 2001-2002 academic year.


Dr. Kowal explained the importance of preparing physicians equipped to deal with the rapidly growing aging population.  He expressed concern for how the medical school will support development and implementation of this vertical theme.  He described his vision as including 1) Incorporation of geriatrics material into the horizontal subject committee structure using the following formats:  a) lecture, b) case-based learning, and c) the electronic syllabus, and 2) creating free-standing time for subjects not amenable to inclusion in existing committees.  Both a comprehensive 10-component Content Outline for the Geriatric Medicine Vertical Theme and 13 Geriatric Medicine Learning Objectives for All CWRU Students can already be found on the eCurriculum.


Dr. Kowal summarized recent activities of the Geriatrics vertical theme faculty:

·        Exploring outside grant opportunities—including the Reynolds Foundation 2003 initiative, a collaboration of four different geriatric sites—the Cleveland Clinic, University Hospitals, VA, and MetroHealth Medical Center

·        Canvassing of geriatric material in the second year

·        Working on a geriatrics module with Dr. Linda Lewin for the Primary Care Track

·        Working with advanced Physical Diagnosis focusing on an older person at the VA site

·        Student research projects—funding summer study between Year I and Year II, where a student can earn up to $4,000.


Resources are needed for faculty incentive and securing protected time, Web site maintenance and clearinghouse function, periodic review and evaluation, and distribution of information and facilitating access to the new information.  Dr. Kowal emphasized his desire for “a collegial environment to optimize the opportunities for collaboration and creativity.”


6.         Announcement

The Clinical Skills Examination (USMLE Step 2½) is to go into effect in 2004 as a licensing requirement starting with the Class of 2005.  url:  Click on link at top right of page:  February 5, 2003 News Release Re Clinical Skills Examination.


Friday, February 21, 2003, Dr. Peter V. Scoles, Senior Vice President for Assessment Programs at the National Board of Medical Examiners, will conduct a presentation on the Clinical Skills Examination, where he will address:

·        Faculty from 12:00 noon to 1:00 p.m. in room T501 of the medical school.

·        Students from 1:15 to 3:30 p.m. in a student forum in the Community Room of Hanna Pavilion, first floor.


See Curriculum Revision Update section.

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