1. Comments from the Vice Dean for Education and Academic Affairs
Dr. Lindsey Henson provided an update on the Clinical Skills Examination (CSE) component of the USMLE Step 2. Passage of the CSE will become a licensure requirement for anyone graduating medical school in 2005 and beyond. The CSE will be offered at various testing centers among the 6 national sites. Chicago and Philadelphia are the testing sites closest to CWRU. The CSE consists of 10 to 12 standardized patient stations. Six percent of U.S. medical students in the pilot failed the exam. Members of this subgroup acknowledged that they had either never been observed or had been observed two times at most when doing a medical history and physical examination during their undergraduate medical education.
Dr. Henson presented the recommendations of a committee charged with developing CWRU’s approach to preparing our students for the CSE. Students should be given ample opportunities starting early on in the curriculum so that 1) at risk students can be identified and remediated, and 2) all students become comfortable with the CSE format and accustomed to the testing environment. Preparation for the CSE should include not only the clinical education program but also “systematic assessment of student’s clinical skills, remediation of individual students and/or enhancement of the clinical education program for all students as indicated by outcomes of these assessments, and practice with an exam similar in format to the USMLE for all CWRU SOM students.”
Dr. Henson listed developed multi-station clinical skills activities for CWRU students and plans for enhancing them:
· End-of-Year-II Physical Diagnosis OSCE (Objective Structured Clinical Examination)
· Communication skills sessions developed with the Macy Grant that are linked to each of the core clerkships
· Year III end-of-Medicine/Family Medicine-outpatient-block OSCE
· The Primary Care Track currently requires an end-of-Year-III Generalist OSCE. This clinical skills exam will be used as the model for an end-of-Year-III “mini-CSE” OSCE for all students.
· Communication skills stations developed as part of a grant, implemented for two years but not currently in use, will be incorporated into the “enhanced” exams just mentioned.
While students are encouraged to take the CSE during medical school, the committee recommended not requiring passage of the CSE for graduation. The committee was undecided as to requiring all students to take the CSE prior to graduation. The CSE component of the USMLE Step 2 can be taken during residency as well as medical school. If taking the CSE became a graduation requirement, Year IV students would qualify for the low interest rate of a Stafford loan in borrowing the $1,500 to $2,000 needed for the CSE. However, repayment of this amount inflates to about $5,000. The CSE is more affordable when taken as a resident than as a medical student.
It has not been decided whether we plan to help our students who fail the CSE after they graduate. If the student is doing his/her residency elsewhere, it is unlikely. The Dean for Student Affairs advocated requiring taking the CSE during medical school, because the month of June can be used to help those students who failed.
It is not yet known whether the CSE will become a requirement for obtaining a training license, which is mandatory in some, not all, states.
The majority of people involved want the CSE scored Pass/Fail. However, some residency directors expressed their preference for a percentage ranking of scores that could be useful in residency selection of candidates.
With regard to timing of the two components, the already existing written part of the USMLE Step 2, which is required for graduation at CWRU, must be taken by January 31 of Year IV. The written part and the CSE component of the USMLE Step 2 can be taken in any order. Should CWRU decide to require taking the CSE, we would need to set a deadline. Lag time with regard to both 1) taking the test and receiving the scores, and 2) before being able to re-take the CSE should one fail—is significant. While the standardized patients quickly score the clinical skills, the physicians need time to hand-score the H&P (medical history and physical examination) and the SOAP (Subjective/Objective Assessment and Plan) note.
2. Report from the CCLCM Curriculum Steering Council
Dr. Andrew Fishleder, co-chair of the Cleveland Clinic Lerner College of Medicine Curriculum Steering Council, presented guidelines for developing evaluation principles for “the College.” Evaluation is felt to drive learning. The CCLCM wants to assure scientific expertise and a cooperative approach to research among its physician investigators. Dr. Fishleder distributed a handout on evaluation principles for the CCLCM. Key components of the College’s goal include promoting scientific inquiry, critical thinking, clinical expertise, lifelong learning, self-assessment and self-improvement. The evaluation system will be designed to encourage student achievement in each of these areas. Five “Evaluation Principles” follow:
1. The guiding principle for evaluation in the College is to enhance student learning.
2. The curriculum is to be tailored to the educational needs of the individual student based on assessment of student progress in the core basic sciences, clinical program, and research. Faculty and students will work in partnership to ensure that each graduating student demonstrates competency in all areas of learning. Ongoing cycles of self-assessment and advising from faculty will ensure that students master areas of relative weakness and develop further in areas of relative strength.
3. Testing and assessment will be progressive and cumulative in order to encourage integration of previous material with new knowledge and assess the individual student’s mastery of prior areas of weakness.
Dr. Fishleder anticipates the development of specific methodologies that enable the student to return to his/her areas of weakness.
4. Evaluation of experiential learning will be utilized to document the breadth of clinical exposure, identify gaps in clinical experience, demonstrate the understanding of relevant basic sciences, and display critical thinking related to scientific inquiry.
5. Student progress in clinical disciplines, in addition to basic and research, will be determined by competency assessment rather than grades. The faculty will establish standards for competencies which all graduates must achieve. There will be no class ranking system.
Dr. Fishleder mentioned that a learning portfolio will be used to document competency achievement.
All faculty are invited to attend the Special Morning Workshop on Learning Portfolios, April 18, 2003, from 7:00 a.m. until 9:00 a.m. in the new Intercontinental Hotel at the Cleveland Clinic. Discover how learning portfolios are used in evaluating medical school performance from faculty of the University of Dundee in Scotland. The remainder of April 18 focuses on further developing learning portfolios for the College curriculum specifically and is for CCLCM faculty and CWRU faculty who are involved in curriculum planning groups for the College program.
Dr. Fishleder concluded his presentation by taking questions. The student will use computer-based learning to master areas of weakness. The CCLCM model of competency assessment can be a transition into the (Accreditation Council for Graduate Medical Education) ACGME-mandated competency assessment for residents. Dr. Henson pointed out that the evaluation principles in the College program are very different from those of the University medical program, but this will not preclude students from either program rotating to different training sites.
3. Report from the Clinical Rotation Development Council
Dr. Christopher Brandt, CRDC chair, mentioned that many clinical faculty from CWRU and CCF attended the March 19 retreat on clinical curriculum planning for the CCLCM held at the Cleveland Clinic. A follow-up retreat will take place May 21. The May 21 retreat is a continuation of the March 19 retreat dealing with clinical curriculum planning for CCLCM.
Dr. Henson announced that one week ago, CWRU received an enthusiastic letter from the LCME complimenting the fine work that has gone into planning the CCLCM and anticipating a visit upon implementation of the College.
4. Report from the Patient-Based Program
Dr. Jay Wish, Patient-Based Program Coordinator, announced that the new third year schedule for next year along with the lottery system has been presented to the Year II class. There exists flexibility to accommodate students desiring exposure to early match specialties during Year III. Only Internal Medicine and Family Medicine must be taken during Year III. All else is “negotiable.”
Year II student representative Mr. Brian Chow expressed appreciation for the support and cooperation shown by the Registrar, Mr. Joe Corrao. Mr. Chow mentioned his classmates’ concern over drawing the four-week Neurosciences/elective block at the very beginning of Year III. Plans for solving this situation include 1) a new advising system, and 2) electives targeted for the beginning of Year III. Dr. Henson, Dr. Smith, and Dr. Haynie will be implementing an advising system in August for first and second year students. Four societies will be created, each having its own dean. Students will continue with their same adviser throughout their four years of undergraduate medical education. Dr. Henson invited suggestions to name the societies.
Starting this July, when Dr. Aach becomes part-time, Dr. Smith will share responsibility for writing the Dean’s Letter.
Dr. Smith is developing electives to be taken at the beginning of Year III. These early electives will be designed to teach how to do certain things while enhancing the student’s learning experience.
5. Report from Information Technology
Mrs. Virginia Saha, Director for the Cleveland Health Sciences Library, announced that Dr. Nosek and she recently returned from a AAMC Group on Information Resources annual meeting in San Antonio. The GIR membership includes information technology officers of the AAMC schools and affiliated hospitals and directors of the AAMC schools’ libraries. She and Dr. Nosek presented a poster on our electronic curriculum entitled “eVerything for eVeryone eVerywhere: The Case Western Reserve University Medical eCurriculum.” Of particular interest to attendees was electronic testing.
The library now has the latest revision of Bloom’s Taxonomy entitled “A taxonomy for learning, teaching, and assessing: a revision of Bloom’s taxonomy of educational objectives”/editors, Lorin W. Anderson, David Krathwohl; New York: c2001 call number: LB 17 T235t2001.
Renovation of the Health Sciences Library continues. A mid-July finish is targeted.
CWRU is hosting the second annual “No Strings Attached” (NSA) Conference on Wireless—Technology and PDAs in Higher Education, April 9 through April 11.
6. Update on Faculty Development
Dr. Terry Wolpaw mentioned that the Scholars Collaboration in Teaching and Learning is sponsoring faculty development on teaching in both small and large groups. All ten posters produced by the Collaboration were submitted and accepted for exhibit during Research Showcase 2003, Friday, April 4.
See Curriculum Revision Update section.