1. Report from the Student CME

Year II representative, Mr. Jason Garnreiter, mentioned that Doc Opera, the annual student/(faculty) musical/comedy revue, raised over $2,000 to donate to the Free Clinic.

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

Dr. Robert Daroff, Vice Dean for Education and Academic Affairs for the University Program, mentioned that Dean Horwitz had asked him to form a Policy Steering Committee consisting of the following four working groups:

• Medical Student Research and Thesis – chaired by Dr. Claire Doerschuk

• Leadership and Civic Professionalism – chaired by Dr. David Aron

• Clinical Mastery – chaired by Dr. Daniel Ornt

• Basic and Clinical Science (Curriculum) – chaired by Dr. Murray Altose

The Policy Steering Committee plans to meet weekly.  Faculty will be invited to participate in the working groups that represent these various curricular initiatives.

3. Medical Student Research Program

Dr. Claire Doerschuk, Associate Dean of Medical Student Research of the new Office of Medical Student Research, described the mission of the School as including a commitment to research, which the medical student thesis requirement begins to fulfill by providing every student the opportunity to become involved in research and be educated in scientific methodologies.  The purpose of the thesis requirement is to have the student explore in depth one area of his/her own interest—in a wide range of either basic, translational, clinical, or population-based research or other scholarly work—and experience firsthand reading/evaluating the literature and writing the paper.

In order to facilitate the students’ awareness of research opportunities on campus, the following three resources are in development:

• A searchable online database of faculty research and scholarship interests accessible not only to students but also to faculty in hopes that this might spur faculty collaboration

• A seminar series focusing on large on-campus research programs represented by principal investigators, center directors, faculty heading forefront technologies, etc.

• Access to a calendar of research seminars offered by the various departments at Case and the Cleveland Clinic and annotated for the students.

The thesis is a requirement starting with the Class of 2009.  During Year I, the student will select a faculty adviser and, after reading and discussions with the adviser, will write a one-to-two-page thesis proposal—describing a focused question for research or scholarship and an approach for answering it.  Each thesis proposal must come before the Thesis Committee for determination of feasibility of the project.  Students may submit their proposal as early as the spring of Year I (in anticipation of using the 12-week summer between Years I and II), or later in their undergraduate career, provided that it is approved before the end of Year III.  The thesis will be in the format of a prominent journal manuscript in the discipline that the student has selected.  While the thesis does not have to be published, it must meet the standards of “high quality, potentially publishable work.”  The anticipated minimum time commitment for the thesis is currently estimated at 16 weeks.  The faculty adviser provides ongoing evaluation of the student’s progress during the project.  The students will also evaluate their research experience, resulting in student suggestions for making it more valuable. 

The Associate Dean of Medical Research chairs the Thesis Committee, which is composed of faculty qualified to review the student’s selected area and their thesis proposal.  Once completed, the thesis is submitted to the Thesis Committee, who will evaluate it.  Most likely, there will be three to four thesis committees, whose membership will have varying expertise, to share the efforts of this review process.  The thesis must be presented to the Thesis Committee by March of Year IV.  The Office of Medical Student Research monitors progress reports regularly submitted by both the students and by the faculty advisers.  The Thesis Committee’s role includes 1) evaluating both the thesis proposals and the completed theses, and 2) when necessary, following up on progress reports meriting concern referred by the Office of Medical Student Research. 

Dr. Doerschuk described funding sources being explored for medical student research:  incorporating positions for short-term medical student training in NIH T32-grants already supporting pre- and post-doctoral fellows, obtaining T35 grants for medical student stipends to support students during the summer between Years I and II, and approaching private foundations. 

In response to discussants’ questions, it was explained that the curriculum revision will ensure both flexibility/adequate protected time for the research thesis.  Opportunities will exist both during the summer and school year and there will be up to a 16-week block in Year III where research could be done.

4. Report from the CCLCM Vice Dean for Education

Dr. Lindsey Henson, Vice Dean for Education for the Cleveland Clinic Lerner College of Medicine, presented the process of assessment for the CCLCM student—competency mastery—to the CME at the March 11 CME meeting.  She completed the explanation of the student assessment process, developed by the CCLCM Student Assessment Task Force, with today’s presentation.  Dr. Henson mentioned that she sought input from Dr. Stephen Post, Committee on Students chair, and from Dr. Dan Anker, for his familiarity with institutional by-laws, in devising a process for summative assessment of the CCLCM students. 

The Medical Student Promotions and Review Committee (MSPRC) for the College Program has a role similar to that of the Committee on Students for the University Program in determining whether or not students have met standards necessary for promotion.  After reviewing each College student’s Summary Portfolio indicating levels of achievement in the nine competencies, the MSPRC determines whether the student will be promoted, promoted pending remediation, required to repeat all or part of the year, or dismissed from the medical school.  Membership in the MSPRC consists of 9 voting members and 4 non-voting ex-officio members.  Dr. Henson emphasized that the physician advisers, who provide ongoing formative assessment to the College Program students are not part of the MSPRC.  The 9 voting members of the MSPRC will be initially appointed by the Dean on recommendation from the Vice Dean for Education for the CCLCM.  New members replacing them will be elected from CCLCM faculty as terms of the initial members expire.  The 4 non-voting ex-officio members consist of the Vice Dean for Education for the CCLCM, the CCLCM Executive Dean, the CCLCM Associate Dean for Admissions and Student Affairs, and the Chair of the Committee on Students or his/her designee.  A quorum of 7 of the 9 voting members is needed for MSPRC meetings, and all official decisions require the approval of a simple majority of the members present.

Since the assessment method at the College Program is so different from that at the University Program, it was decided to have a separate review committee.  However, the MSPRC does provide a formal written report to the Committee on Students at the end of each year and as needed during the academic year.  For each of the five years of undergraduate medical education in the College Program, the student must submit his/her Summary Portfolio for review.  The Summary Portfolio is reviewed by two members of the MSPRC.  If there is consensus between the two reviewers, the decision will be presented to the MSRPC for its vote.  If there is disagreement between the two reviewers, the full MSPRC reviews the student’s Summary Portfolio before taking a vote.  The student may appeal an adverse action to the MSPRC and present new evidence at the appeals hearing.  If the MSPRC upholds the adverse action, the student may appeal to the Dean of the Case School of Medicine, who reviews procedural issues only.  The Dean may uphold the decision or ask the MSPRC to reconsider the Case.  The MSPRC makes the final decision.

5. Update on the Community Primary Care Preceptorship

Dr. Linda Lewin, Director of the Community Primary Care Preceptorship (CPCP), and Ms. Betzi Bateman, Web Developer/Instructional Designer, first presented to the CME at the November 14, 2002 meeting, where they demonstrated Module 1 of the innovative CPCP multi-media online curriculum.  They returned today to give an update on the recently completed project, demonstrating features of all four modules.  Begun as a required component of the Primary Care Track, the CPCP Web-based learning tool has been expanded this year to reach interested non-Primary Care Track students as an elective offering.  This project was designed to complement and enhance learning in the ambulatory primary care clinical setting as experienced in the existing Primary Care Track Year II 6-month longitudinal preceptorship and the Year III 11-month continuity clinic.  These three components of the CPCP were funded by a HRSA (Health Resources and Services Administration) grant.  The CPCP Web site was designed as an interactive two-year continuum (Years II and III) with four modules and a core list of learning objectives in online format to maximize use of the students’ time and allow easy access from any location.  The program is included in the Case eCurriculum at http://mediswww.case.edu/cpcp with login in the student area as “guest.”  Modules provide students with Checklists and several exercises to complete under both the Activities and Evaluations categories.  Faculty provide written feedback to all SOAP note submissions but not necessarily to all posts on the discussion board.

The CPCP Internet-based curriculum features a “blended,” or “hybrid,” learning environment, where electronic learning is combined with the actual preceptor site experiences.  There are virtual offices, patient homes, etc.  Scenario-based learning is used to illustrate specific examples.  Interactive learning principles include online quizzes, which provide immediate feedback; streaming video and streaming audio; and sharing of student answers/ideas via a discussion board.  Feedback surveys follow each module.  It takes about 7 hours for the student to complete each module, which is spread out over 4 months. 

At the beginning of Year II, students start Module 1—You, the Primary Care M.D.—which takes place in the Primary Care Physician’s office and familiarizes the student with staff, patients, insurance, charting, and prescription writing.  Module 2, The Art of Medicine, occurs during the second half of Year II and features more advanced communication issues to prepare students for some of the challenges they will face when interviewing difficult patients.  Module 3 in Year III deals with the Practice of Medicine and focuses on the most common diagnoses in Primary Care Medicine, allowing the student to choose tests and diagnoses in the form of a video game.  Another video gives tips on avoiding overuse of antibiotics.  Links to guidelines group online resources by content category and help the student become familiar with using these resources.  Module 4, Disease Prevention, goes into the patients’ homes.  Screening tests and common procedures for patients at different ages are covered.

Dr. Lewin expressed concern about the future of the CPCP Web site, as the grant ends this June.  She hopes that this learning tool will become part of the bigger Primary Care milieu.  She suggested that the CPCP Web site—or its individual modules—could be adapted for use in other programs.

Dr. Altose complimented Dr. Lewin and Ms. Bateman on this high quality, valuable exercise.  He cited two issues:  1) finding a way to incorporate the Web site into Dean Horwitz’s curriculum renewal project, and 2) identifying an “advocate” for the CPCP Web site prior to Dr. Lewin’s relocation.

6. Report from the Flexible Program Council

Dr. Kent Smith, Flexible Program Coordinator, mentioned six new Type B electives:

• Pain Management (V.A.)

• Physician Home Care in Geriatrics (Metro)

• Bioethics (Cleveland Clinic)

• Primary Sports Medicine for Children (Rainbow)

• Forensic Pathology (Coroner’s Office)

• Clinical Online Preventive Medicine—tentative title—in process of being created.

7. Virtual Microscopy Demonstration

Dr. Joseph Miller presented the virtual microscopy-based teaching system that he is coordinating to integrate laboratory-based content into all aspects of the curriculum.  Currently, the observation of glass slides beginning in fall of the first year serves to learn the structure, variability, and basic physiological function of normal tissues and organs (“histology’); the BBD1 committee extends this to the evaluation of pathological tissues and organs.  This system is being structured not simply as an electronic replacement of an optical microscope but as an integrating mechanism applicable throughout the extended curriculum - to make it broad-based and multi-functional.  The Web Enabled Virtual Microscopy program is included in the Case eCurriculum at http://vmicroscope.cwru.edu.  Dr. Miller will be putting a tutorial online to help faculty utilize this system in the various facets of the curriculum.

This system can be used in any aspect of the curriculum by any faculty member or student associated with the School of Medicine, including the Cleveland Clinic Lerner College of Medicine program.  Additionally, it can be available for other schools and graduate programs associated with Case Western Reserve University through the School of Medicine, including the residency programs.  Its features can be incorporated selectively into any learning format:  lecture, syllabus, small groups, case-based PBL modules, self-paced study modules.  It can also be linked into any of the other electronic curriculum-based learning tools that currently exist or are under development.  Currently, the exam system is being amended and performance-tested for incorporation of virtual microscopy slides into exam questions and also into formative exams or quizzes. 

Dr. Miller thanked Dr. Lindsey Henson for funding the development of this learning system. He also noted the significant efforts of David Pilasky and Wei Wang in the Office of Biomedical Information Technologies.

Dr. Miller presented the current status of this system and a timeline for continued development.  During fall 2003, the basic core virtual microscopy system became operational.  During the past year, Dr. Miller and the pathologists have selected glass slides from the CWRU-SOM teaching collections, and these are currently being digitized in the virtual slide format.  They are being entered into the system, and Dr. Miller anticipates that both the normal and histopathology CWRU-SOM teaching slide collections should be online by fall 2004.  Additional content, such as electron micrographs and examples of the gross pathology associated with various diseases, will be incorporated into the database.  The goal is to incorporate all of these into one common, interactive database.  Images that will be used for primary exams will be isolated into a secure database. 

Individual faculty will be able to construct customized lessons related to their materials.  Dr. Miller will have a comprehensive histology lesson covering all tissues and organs online this fall.  This will be a resource available to all faculty and students.

Dr. Miller demonstrated online several examples of how this system can be used now.  He showed how to access the system and its database.  By choosing the specific sample of interest from the dropdown list, he demonstrated how to link it to a lecturer’s syllabus notes.  [The faculty member should carefully consider that using this ‘real time microscopic analysis’ of a ‘virtual glass slide’ in primary large group lecture format can slow the pace because it generally requires more time to search a slide as compared to having a preselected static micrograph (‘Kodachrome, JPEG’).]  It is possible to include both the diseased and the normal linked to a web-based module site.  In a matter of seconds, one can “cut and link” the desired image.

Dr. Miller concluded his demonstration with one word of warning:  Eliminating the traditional laboratory format with experienced faculty physically present to answer students’ questions combined with the students’ lack of participation may result in students losing the skill to apply and integrate their textbook knowledge to actual samples (‘patients’).  The individual student is left to apply and integrate the laboratory-based committees’ content without the expertise of the faculty’s help. We need to incorporate a faculty-mediated mechanism for students to reinforce what they learned correctly and to help them correct what they learned less well.

Dr. Altose felt we should focus on how best to communicate the availability of this valuable resource to all faculty involved in medical student education.

See Curriculum Revision Update section.