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Summary of 3-23-00 CME Minutes 

 

1. Year I Student CME representative Scott Walker mentioned that in response to Dr. Nosek’s memo, a poll of his classmates opposed making the electronic syllabus the official syllabus by a 27 to 1 margin. Dr. Nosek will personally meet with the students.

2. Proposal to Expand Year I Primary Care Track Physical Diagnosis to Entire Year I Class – Dr. James Carter, Dr. Baha Arafah, Ms. Teri Novak

As agreed at the February 24 CME meeting, proponents of the expansion of the Year I Physical Diagnosis pilot to the entire first year class returned with data from a survey of the four classes answering the following two questions:

  1. If you had had the opportunity to begin Physical Diagnosis instruction in Year I, would you have taken it?
  2. If Year I Physical Diagnosis were made an essential component of the curriculum, would you be in favor of it?

While Ms. Novak acknowledged that she did not get a huge response, what she did get enthusiastically supported the proposal and offered valuable comments. The response rate for each class follows:

    • 25% of Year IV (handed out during the commotion of Match Day—92% of the sample favored expansion of the PD I pilot)
    • 39% of Year III (the biggest response—100% of the sample eagerly endorsed the project)
    • 28% of Year II (86% of the sample had a favorable response to Question 1, 80% of the sample had a favorable response to Question 2)
    • 29% of Year I (97% of the sample had a favorable response)

The majority of student comments indicate the desire for early introduction of Physical Diagnosis and commendation for the current Primary Care Track model.

Dr. Pamies presented the requested hard data indicating whether the PD I pilot adversely affected student performance on core material. Results of subject committee interim exams taken before, during, and after the PD I pilot were given. Total number of Year I identifications and number of PCT student identifications per interim exam were compared. Dr. Pamies concluded that having Physical Diagnosis in Year I did not adversely affect the performance of students in the core material. It was also pointed out that the PD I Primary Care Track pilot has been successful for a cross-section of students; it was not restricted to the top students in the class.

Dr. Katz expressed a need to discuss the proposal to expand the PD I Pilot before the Curriculum Leadership Council. He felt duty-bound to express his concern, because Year I of the new curriculum has resulted in a higher rate of identifications than ever seen before. He is concerned whether adding another requirement would adversely affect the weaker students. He admitted that the PD I expansion might be beneficial to the students in offering them a nice break from the core. Ms. Novak explained that PD I takes place after hours from 5:30 to 8:30 p.m. one night a week for 15 sessions and concludes with 1 session of an observed history and physical. Dr. Katz will put expansion of the PD I pilot to the entire Year I class on the April 28 CLC retreat agenda.

Dr. Arafah was optimistic that we would have both the resources and personnel needed to implement PD I for the entire first year class. In one and one-half years, finances will be an issue. The Macy Foundation grant has currently agreed to support standardized patients and program assessment costs for the academic year 2000-2001 and for half of 2001-2002. By fall of 2002, new resources will be needed. Up to now, the Primary Care Track has financed the PD I pilot. Dr. Carter mentioned that the Primary Care Track grant has paid the $15,000-18,000 necessary for one-quarter of the class. This is outside money and will not be renewed. Dr. Arafah estimated that it would cost between $60,000 and $70,000 for Year I student costs for the expansion to the whole class. Dr. Arafah estimated that four or five faculty would be needed for the entire Year I expansion. Resources are needed to pay some faculty, the standardized patients, assessment costs, and his and Ms. Novak’s salary support. Dr. Carter pointed out the growing popularity of the preceptor role among fourth year students, who receive one Type B elective credit. Already 55 fourth-year preceptors have signed up for the 2000-2001 academic year.

Dr. Greenfield recommended

that Physical Diagnosis, as currently implemented in the PD I pilot of the Primary Care Track, be expanded to include the entire Year I class beginning for the class of 2004 entering in August 2000.

There were none opposed and one abstention.

Dr. LaManna will submit a report and recommendation from the CME to the Faculty Council. The proposal will also be discussed by the Curriculum Leadership Council, since the Year I curriculum is involved.

3. Revisitation of Alternative to Elective-Credit-for-Remediation Component of Curriculum Leadership Council Year II Proposal

Discussion led to an acceptance of the original proposal as voted upon by the CME but brought up significant areas of the Flexible Program that need to be reviewed.

The "fifth component" of the Year II exam proposal reads: Students remediating a Year II subject committee identification should be given credit, equivalent to one Type A elective, for their remediation effort. Dr. Katz explained the purpose was to send the following message to the student:

    • Remediation is important.
    • Mastery of the core material is the first priority.
    • A successful remediation effort is equal in terms of value to an elective.
    • This is a means of unburdening the student and giving him/her credit.

Dr. Katz viewed the CLC proposal as a support mechanism for students.

Points of contention brought up during discussion:

    • Flexible Program Coordinator’s position that the Flexible Program is for enrichment to enhance the core content, not for remediation
    • Giving credit for remediation compromises the value of those students who excelled. Standards need to be set with respect to consistency and fairness.
    • Option to "waive" the elective requirement during remediation rather than to give elective credit for the remediation effort—view that electives are a privilege
    • Opposition to preventing students from taking electives while remediating—discussants were divided on this alternative to the CLC proposal, and some, therefore, endorsed giving credit for remediation rather than prohibiting all students from taking electives during remediation.

The existence of the following Type B electives as current precedents in the Flexible Program had the biggest impact on today’s CME decision to accept the elective-credit-for-remediation component:

    • Dr. Wile’s "Readings in Medicine," which hones test-taking skills for the USMLE Step 2
    • Dr. Pamies’ "Topics in Medicine," which is a review of clinical material in preparation for the USMLE Step 2
    • The case of a student remediating a two-month OB/GYN clerkship who spent one month remediating in the fourth year and received Type B elective credit.

The general consensus was that giving elective credit for remediation may be unfair to students deserving enrichment, but it is not inconsistent with existing policy.

Dr. Greenfield moved to…

Let the fifth component of the Curriculum Leadership Council’s Year II Exam Requirements for promotion to the third year stand as originally passed by the CME February 10: "Students remediating a Year II subject committee identification should be given credit, equivalent to one Type A elective, for their remediation effort."

She recommended…

that this issue be reconsidered when the Flexible Program is re-evaluated.

4. Dr. Katz invited all CME members to attend the daylong Curriculum Leadership Council retreat at the Valleevue Sheep Barn on Friday, April 28, 2000. The purpose is to evaluate Year I of the revised curriculum.

See Curriculum Revision Update

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This page was last updated on 3/22/00 by Eric Schmidt.

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