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Summary of February 27, 2003 CME Minutes




1.         Comments from the Chair

At the February 17 meeting of the Faculty Council, Dr. Altose presented a

proposal to amend the charge to the Committee on Medical Education.  It was proposed that membership with voting privileges include all four curriculum council chairs (Curriculum Leadership Council, Clinical Rotation Development Council, Flexible Program Council, and Cleveland Clinic Lerner College of Medicine Curriculum Steering Council).  On February 17, 2003, the Faculty Council approved that each of the four council chairs would be a voting member of the CME.  The second proposed change was to clarify the mechanisms for the appointment of curriculum council chairs.  The Faculty Council approved the mechanism whereby the Dean or his designee shall appoint curriculum council chairs upon the recommendation of the CME in consultation with the Faculty Council.


Dr. Altose indicated his intention to have the CME review the charges to, the responsibilities of, and the selection of the curriculum council chairs before the end of the academic year.


2.         Report from the Student CME

Doc Opera XVIII will take place Saturday, March 8, at 8:00 p.m. at the Masonic Auditorium.  Twenty-five percent of all ticket sales will be donated to the Free Clinic.


Peter V. Scoles, M.D., Senior Vice President for Assessment Programs of the National Board of Medical Examiners, addressed both the faculty and the students in two separate sessions on the Clinical Skills Exam (CSE), Friday, February 21, 2003.  This examination will be first offered to the Class of 2005.  “Resigned but not happy,” students felt there was insufficient medical student involvement at a national level when the decision was made to implement this examination.  There was also great concern over the expense and time commitment in taking this examination.


Other issues raised during subsequent discussion:

·        Students requested assistance from the School of Medicine in obtaining discount fares for travel and accommodations.

·        It was suggested that passing the Clinical Skills Examination not be a requirement for graduation.

·        An end-of-third-year OSCE would help prepare students for the Clinical Skills Examination.


3.         Report from the CCLCM

Dr. Andrew Fishleder provided an overview of the research curriculum of the Cleveland Clinic Lerner College of Medicine, whose goal is to train physician investigators.  Dr. Fishleder acknowledged the work of Linda Graham, M.D., who chairs the CCLCM Research Committee that has been meeting for the last nine months.  Dr. Fishleder’s first handout “Research Thread Objectives” defines the purpose of the research thread in the curriculum as instilling “a passion for scientific inquiry and a problem-solving approach to medicine and health care.”  The Goals are outlined and developed under three main headings:

·        Developing the knowledge base and critical thinking skills for clinical and basic research

·        Developing skill sets required for clinical and basic research

·        Understanding the ethical, legal, professional, and social issues required for responsible conduct of clinical and basic research


The second handout was a detailed “Draft Proposal for the Summer Clinical Research Curriculum,” prepared by Michael S. Lauer, M.D., for the Research Committee.  This comprehensive clinical research curriculum is covered during the second summer immediately preceding Year II.  Overall structure consists of the following learning formats:  didactic sessions excluding lectures, independent study, field trips, and mentored clinical research experience.  During this time the student develops a clinical research-related protocol.  The six core areas of clinical research addressed are 1) Clinical epidemiology, 2) Basic biostatistics, 3) Practical methods of data analysis, 4) Presentation of results, 5) Ethical and legal issues, and 6) Socioeconomic aspects of clinical research.  Each core area is further developed in outline form.


The third handout delineates Summer I and Summer II in block schedule form, with a breakdown of Monday through Friday by hour.  The Basic and Translational Research Block runs for 10 weeks starting in mid-July immediately preceding Year I.  The Clinical Research Block runs for 9 weeks starting in mid-July immediately preceding Year II.  In addition to the PBL core curriculum, lab time, and independent study, research seminars will take place once a week during Summer I.  During Summer II, the development of a protocol is added to biostatistics, seminar, problem sets, field trips, Journal Club, and independent study.


4.         Faculty Development and Recognition of Teaching Contributions

Dr. Terry Wolpaw invited everyone to view the posters created by the Scholars Collaboration in Teaching and Learning Project at the annual medical education retreat on February 28, 2003.  Each poster represents the joint effort of one Year II student, one Year IV student, and one faculty member.


Dr. Altose introduced guest Dr. Daniel Wolpaw whom he had charged with developing a methodology for recognition of teaching at the beginning of the CME’s academic year.  Visit Dr. Dan Wolpaw’s PowerPoint Presentation to the CME, which was also presented at the annual medical education retreat held February 28, 2003.


Dr. Dan Wolpaw acknowledged the other members of the Working Group for Teaching Recognition that he chaired:  Alan Hull, M.D., Ph.D., Linda Lewin, M.D., Scott Simpson, Ph.D., and Terry Wolpaw, M.D.  Dr. Dan Wolpaw began by citing existing means of recognition for teaching and their drawbacks.  Awards, Master Teacher Societies, Academies (UCSF and Harvard), and Promotion involve only a few individuals, favor senior level faculty, and tend to be too complex and too exclusive/divisive. 


The challenge to recognizing excellence in teaching consists of devising a process that would be both “accessible and meaningful.”  The Working Group for Teaching Recognition has devised a practical plan that applies to all teaching faculty, offers the opportunity to obtain recognition on a yearly basis without exclusions for previous awards, and produces concrete data that can be used on a curriculum vitae and for salary/promotion reviews.  Dr. Wolpaw outlined the three goals of the recognition system that he developed further during his presentation:

·        Track educational activity easily and accurately.

·        Evaluate quality in teaching and other activities of medical education.

·        Devise a peer review process to achieve validity that would meet the rigors of academic scholarship.


Dr. Wolpaw designated the various considerations of teaching:  1) quantity, 2) quality, 3) roles (encompasses running a committee, directing a lab, designing a curriculum, attending on the wards, etc.), 4) a process that is simple, fair, transparent, and recognizable, and 5) scholarship in teaching.  Dr. Wolpaw stressed that the biggest challenge is determining quality of teaching, as that is subjective and liable to be influenced by popularity and other bias.


To develop a system predicated on the existence of Educational Scholarship, Dr. Wolpaw needed certain guidelines.  He cited basic points developed by the AAMC task force in 1999 and outlined by Fincher et al in the September 2000 issue of Academic Medicine:

·        Educational scholarship can be defined.

·        Teaching can be scholarly.

·        The assessment of scholarship in teaching can be improved.

·        Teaching must be evaluated in order to be considered a legitimate scholarly activity.

·        An infrastructure for supporting educators as scholars is needed.

Unlike existing mechanisms to support peer-reviewed research, “parallel mechanisms for peer review of teaching scholarship are highly variable.” (Fincher et al)


Dr. Wolpaw reviewed the three basic goals in more depth.  Educational activity can be tracked easily and accurately by revising the Faculty Activity Summary [Annual Professional Review (APR) at the Cleveland Clinic].  Dr. Wolpaw has created a draft online version of the Faculty Activity Summary for Medical Education taking into account 10 areas:

·        Teaching activities

·        Mentorship/advising

·        Presentation of educational scholarship in mediums such as faculty development, education research, a presentation in regional or national forum

·        Educational/programmatic leadership

·        Curricular innovation/contribution

·        Teaching/education-related awards

·        Education research or projects

·        Best effort-contribution in education (this area developed further by Dr. Wolpaw in his presentation)

·        Personal development as an educator

·        Goals in medical education


Providing the opportunity to evaluate quality in teaching and other activities of medical education would be achieved via the “Best Contribution.”  Each teaching faculty member would submit a one-to-two page narrative describing what he/she considers to be his/her best effort-contribution in education over the last year.  This submission is manageable on a yearly basis.  The range of eligible activities includes, but is not limited to:  small group facilitation, lecture, curricular innovation or enhancement, research or project resulting in poster/abstract/publication, educational leadership role, and mentoring.  The description should exhibit as much as possible Glassick’s 6 Criteria for Describing and Evaluating Scholarship in Teaching:

·        Clear goals and objectives

·        Adequate preparation (includes special training)

·        Appropriate methods (technique/methodology, time allowances, etc.)

·        Measures of quality/effectiveness, accomplishment of objectives

·        Effective presentation, including making results or process available to colleagues

·        Reflective critique (critical analysis of the educational contribution based on feedback and reviews)

The “Best Contribution” format enables faculty to describe what they have done, evaluate what they have done (the “reflective critique” criterion), and plan what they will do next.


Utilizing the “Best Contribution” format brings the challenge of designing a recognizable and rigorous peer review process within reach.  Qualified peer-reviewers, either internal or external, could be used to evaluate and score the best contribution narratives.


Recognizing contributions to medical education at CWRU School of Medicine involves a four-step process:

·        Submit the Activity Summary or APR with the “Best Contribution” narrative.

·        The summary will be screened for the threshold of overall educational activity.

·        Qualifying narratives will be reviewed and scored by peer reviewers.

·        The Awards Committee makes the final recommendations to the Dean.


Dr. Wolpaw next mentioned the benefits of the recognition process and the tangible results of the recognition.


Dr. Wolpaw concluded his presentation by reiterating the plan for meeting the three goals of teaching recognition:

·        Track educational activity easily and accurately via the revised faculty summary.

·        Provide the opportunity to evaluate quality in teaching and other activities of medical education based on the “best contribution” narrative.

·        Design a recognizable and rigorous peer review process to achieve validity comparable to traditional scholarship using peer reviewers to score the best contribution narratives.


Discussion reflected much enthusiasm for the teaching recognition system.  The consensus was that this plan should not just be limited to medical school but applied to residency education, graduate school, and undergraduate education.


While the system recognizes activities such as laboratory teaching, mentoring, innovative approaches appreciated by students, etc., as well as traditional lecturing, it was not intended to address the concerns of the basic scientist who has not been given sufficient teaching opportunities and, therefore, does not have access to equal opportunity in medical education.  While this is an important issue, it lies outside the scope of this project.


The Faculty Activity Summary for Medical Education is intended to replace the current Faculty Effort Report.  However, it is still incomplete at this time.  E-mail any suggested changes to  Dr. Wolpaw has a six-month time frame in which to obtain approval for the Faculty Activity Summary.


In response to suggested entry-nomination by peers and students and an evaluation of whether the objectives of the “best contribution” selection were taught, Dr. Wolpaw agreed that the “best contribution” needs to have been well-received by the students.  However, he recognized the working group’s desire for a relatively simple, straightforward nominating process.  Dr. Wolpaw explained that he expected student assessments would be considered by the awards committee, but he also recognized their tendency to turn into popularity contests.


Dr. Altose concluded the meeting by thanking Dr. Dan Wolpaw for his outstanding presentation.  He felt that the charge to Dr. Wolpaw for creating a process to recognize faculty contributions to medical education had been met with an equitable, well-constructed, comprehensive package.


See Curriculum Revision Update section.

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