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Summary of April 22, 2004 CME Minutes

  1. Comments from the Chair

With Dr. Linda Lewin’s upcoming relocation in mind, Dr. Daroff, Dr. Lewin, Dr. Terry Wolpaw, and Dr. Altose interviewed candidates for a new Clinical Curriculum Council Chair.  They have recommended Dr. Michael Nieder for the position.  A letter to all basic science faculty went out inviting candidates to apply for the position of Basic Science Curriculum Council Chair.

  1. Report from the CCLCM Vice Dean for Education

Dr. Lindsey Henson, Vice Dean for Education for the Cleveland Clinic Lerner College of Medicine, reported that by the end of May, the first entering class should be finalized.  There is a 32-student maximum.  On Friday, June 4, there will be an all-day retreat for faculty teaching in the CCLCM.  It was decided to extend the invitation to University Program faculty interested in attending.  The first three hours of the morning will be devoted to explaining how to prepare for the impending LCME site visit.  The rest of the retreat will provide an overview of Year I CCLCM courses.

  1. Update on the Policy Steering Committee

Dr. Terry Wolpaw mentioned that the four working groups [Medical Student Research and Thesis, Leadership and Civic Professionalism, Clinical Mastery, and Basic and Clinical Science (Curriculum)] are expected to branch out to involve many faculty.  Dean Horwitz is currently preparing a mission statement.

  1.  Report from the Student CME

New CSR (Committee on Student Representatives) officers have been elected.  This does not affect the student CME representatives, who will remain the same as before.

  1. Update from the Office of Curricular Affairs

Dr. Terry Wolpaw, Associate Dean for Curricular Affairs, announced that she will present the Instructional Support Team (IST) proposal for expansion to Dr. Daroff tomorrow.  The IST was piloted on two subject committees:  Year I Fundamentals of Therapeutic Agents (FTA), co-chaired by Dr. Amy Wilson-Delfosse, and Year II GINUT (GI/Metabolism/Nutrition), co-chaired by Dr. Kevin Mullen.  The rationale behind IST expansion is to provide substantial support for all the teaching committees.

  1. Human Gross Anatomy

Dr. Scott Simpson, chair for the longitudinal Year I and Year II Human Gross Anatomy committee, summarized the significant improvements made and those still needed for Anatomy since 1994 to the present—the length of time that he has been at Case.  Dr. Simpson has been the chair of the Anatomy committee since 1995.  Dr. Simpson views Anatomy’s situation as still challenging but feels we can reach most of the students.

In approximately 2000, Anatomy became a stand-alone committee, a positive change leading to increased visibility and student accountability for mastery of the material.  Previously, Anatomy questions on interim examinations were weighted as a small part of the overall exam score—so much so that it was possible for a student to do quite poorly in Anatomy yet not be identified due to adequate performance on the questions pertaining to the committee into which the regional anatomy was inserted.  Total contact hours for Anatomy at Case are about 120 as compared to the national average of about 180 (national figure includes dissection time).  Case distributes its 120 Anatomy hours as follows:  @ 45 to lecture and the remaining @ 75 to lab.

Anatomy at Case is a longitudinal committee with a single cumulative score for Year I based on performance in the 4 subsections that are offered in conjunction with different subject committees and a second score for the Head and Neck anatomy offering in Year II.  In Year I, each of the 4 anatomy subsets has its own leader, while each concurrent subject committee has its own chair.  Anatomy offerings in Year I run from October to March:

  • Limbs and Back (Musculoskeletal) anatomy during the Neuromuscular subject committee

  • Cardiovascular Pulmonary (Thorax) anatomy during the Cardiovascular and Pulmonary committees

  • GI (Abdomen) anatomy during the Renal and GI committees

  • Pelvis/Perineum (Pelvis) anatomy during the Endocrinology committee

Year II Head and Neck anatomy included in the Nervous System/Mind committee acts as a separate second anatomy committee.  Should a student fail the Year II Head and Neck anatomy, he/she must remediate.  (A student’s ability to pass the Year I Comprehensive Examination prevents mandatory remediation for failed Year I anatomy.)

The minimum passing score for anatomy is 65.0%--no rounding.  During Year I, there are 4 anatomy exams, one for each subset.  The total number of equally weighted anatomy questions is 385—with two-thirds of them done as a practical, proportionate to the amount of time students spend in the lab, and the remaining one-third in multiple-choice-question format.  Year I students having difficulty with anatomy are advised to take the graduate course ANAT 411, which runs from January until the end of the school year.  This is an optional course, but it definitely helps students improve their anatomy skills.

During Year II, there are 2 content-heavy Head and Neck anatomy exams, again consisting of multiple-choice questions and a timed practical exam.  Failure to pass results in a mandatory remediation exam, offered twice during the year:  November/December and in May.

The Year I Comprehensive Examination makes use of our considerable image bank and incorporates 36 multiple-choice anatomy questions with images.

Dr. Simpson acknowledged the various faculty section leaders and additional participants in the lectures, labs, and exams.  Faculty, clinicians volunteers, residents, and Year IV students contribute.  Later in his presentation, Dr. Simpson discussed the difficulty in getting people to teach anatomy.  As members of the anatomy leadership retire, there arenot people ready to replace them.  With the Dean’s ad hoc committee—“Recommendation #5:  The tenure track will be reserved for faculty who engage primarily or substantially in research;…”—encouraging advancement only through research, Dr. Simpson cautioned that a two-layered system will develop with only the nontenure track available to teach.

Dr. Simpson used a graph to compare Year I anatomy performance on different regional exams—both multiple-choice question and practical—and the Year I Comprehensive Examination for the Classes of 2004 through 2007 over the 2001-2004 time period.  The tendency is for the students to do well on the multiple-choice-question exams and a little less well on the practicals, which is still acceptable.  Student performance takes a plunge in the Pelvis/Perineum subsection.  There are several factors contributing to this:

  • Pelvis/Perineum takes place during the last organ system committee of the year.

  • It is the least-weighted of the anatomy committees.

  • Its content has always been challenging for the students.

  • Its leader completed his second year as section leader.

Year II Head and Neck Anatomy, which runs concurrent with the Nervous System/Mind Committee, has also always been difficult for the students.  Dr. Simpson charted the mean score and number of identifications for the Classes of 2004 through 2006.  The graph tracked definite improvement with each successive class.

Dr. Simpson mentioned that Case students score at or above the national mean on the USMLE Step 1.  He also feels that the current weighting of Anatomy is appropriate for our curriculum.

Dr. Simpson listed positive changes:

  • The culture has changed so that there is a better approach to anatomy—faculty are now enthusiastic, student attendance at lectures and labs is good, and student course evaluations are positive.  Previously, there were no syllabus, no lecture titles, etc.

  • Gross Anatomy is a freestanding committee.

  • The challenging Head and Neck Anatomy subset is manageable.

  • Class notes (the online syllabus) are improving.

  • A freestanding Web site with value-added information has been established.

  • Resources are continually improving:  The Office of Biomedical Information Technologies has a large 2,000-plus image bank that is often used in lectures and exams.  Various anatomical models and software programs have been added.  Dr. Simpson would like to make the anatomy assistant position permanent to eliminate the extreme variability in quality that existed among past assistants.

Dr. Simpson listed planned improvements:

  • Specific short-term changes that could be achieved:

    • Improvement of the Pelvis/Perineum section (discussed above)

    • The revision and improvement of class notes—some faculty development on how to write class notes would be useful.

    • The development of alternative testing modalities—Dr. Simpson would like to use more short answer exam questions, but this is too labor-intensive for him alone to write and grade.

  • Structural/long term changes:

    • Development of new faculty—only 2 to 3 current faculty will still be here in 5 years.

    • Restructuring of Anatomy, which is run as a traditional course.  As one possible alternative, Dr. Simpson would like to develop a Year I Introduction to Anatomy that would be less time-intensive and would use prosection-based models instead of dissection-based models.  He would like students to revisit anatomy in Year IV with a clinical anatomy offering, such as the already existing Clinical Anatomy of the Trunk (ANAT 513).  Activities include student lectures, cadaver dissection with an emphasis on surgical approaches, clinical lectures, dog labs—where students perform surgeries on dogs—the latter being an excellent, yet expensive learning experience.

    • We cannot achieve any of these improvements in our current existing space.  We are in dire need of new facilities.

Dr. Simpson focused on significant negatives that have major impact:

  • The dissecting labs are an “embarrassment:”  size, lighting, lack of both storage and changing rooms.

  • Teaching participation/excellence are not rewarded by salary incentives or advancement.  This results in unreliable participation and no motivation for additional time commitment.  Getting anatomy integrated into Years III and IV would require a reward structure for teaching faculty.  Under the current structure, making the time commitment to teaching does not translate into merit.

  • The small pool of knowledgeable core faculty currently contains only one tenured faculty member (Dr. Simpson).  Case needs to allow faculty to advance with a significant teaching contribution.  There is no long-term stability in teaching anatomy here.  In other schools, faculty have the opportunity to rotate every five years—teach anatomy and then do research.  We lack the faculty depth that would allow our faculty to do that.

  • Unreliable clinician participation in lectures and labs.  There are times when faculty have not shown up in the labs.  Participation in labs is not a priority for the clinicians who volunteer.  Currently, no participating clinician has an administrative role in Anatomy.  We need to find mechanisms of support to incorporate engaged clinicians.  Students would then be able to interact with the physicians in practical areas where they will be working.

  • Frustrations with revising curriculum.  Dr. Simpson feels constrained by a lack of time to negotiate with the committee co-chairs to revise the curriculum schedule.  There is no time for value-added activities.

  • No integration/communication with the CCLCM Program – Dr. Simpson has no knowledge of their curriculum.

Dr. Simpson concluded his presentation with two main suggestions:

  • Provide additional rewards for teaching, leadership, participation, and excellence, as reflected in promotion, tenure, and salary.  Dr. Simpson cited the School of Medicine’s diverse, complex mission requiring faculty to perform different roles—research, teaching, service.  Therefore, faculty members should not be measured by just one of these currencies.
  • Define the direction and mission of the Department of Anatomy so that there is stability within the department.  The department has had two long-term Acting Chairs.  The uncertainty needs to end.

 

Many of the points made by discussants and addressed by Dr. Simpson have already been incorporated into the outline of Dr. Simpson’s presentation above.  Additionally, discussants agreed that there is a correlation between student performance in Anatomy and in Years III and IV.  Also, the old residency program director put-down “Case students don’t know their anatomy,” is no longer valid since Anatomy was elevated to a separate committee.  Discussants would like to see anatomy taught in Years III and IV; they see it as a great way to integrate the basic and clinical sciences by bringing anatomy back in a different context—i.e., the patients.  When asked about the use of electronic images and models, Dr. Simpson prefaced his response by acknowledging that by not being a clinician he does not use the information that he teaches the students.  However, students in clinical practice want to get their hands on a body.  He regards prosections and models as a good first step, but students need the experience of doing actual dissections.

  1. Report from the Flexible Program Council

Dr. C. Kent Smith, Flexible Program Coordinator, mentioned that the Flexible Program is running well.  The relatively recent addition of the two-week elective has been popular with the students.  A high percentage of the students take a two-week elective at the end of the Psychiatry rotation.  In an ongoing effort to improve the electives program, Type A electives where the faculty sponsor is not able to be present for multiple sessions are being discontinued.

  1. Health Sciences Library Update

Mrs. Virginia Saha, Cleveland Health Sciences Library Director, suggested to the Associate Dean for Curricular Affairs that the Instructional Support Team include a person knowledgeable in copyright permissions, the licensing of electronic images in particular.

  1. Update from the Office of Biomedical Information Technologies

Dr. Thomas Nosek, Associate Dean for Biomedical Information Technologies, mentioned recent purchases:  electronic anatomical figures for Anatomy, virtual microscope for histology CD-ROM to be used on every student’s computer, and a software program for Nutrition.  Student computers are ordered to arrive next week.  Dr. Nosek’s office is currently setting up a structure whereby faculty can make their eCurriculum changes directly, eliminating the need for a “middle man.”  While this system makes “last minute” changes possible, modifications would then have to be made in issuing the print syllabus.

  1. Report from the CCLCM Curriculum Steering Council

Dr. Lindsey Henson, Vice Dean for Education for the Cleveland Clinic Lerner College of Medicine, focused on course evaluation for the College program.  She recognized the efforts of Ms. Beth Bierer, Dr. Elaine Dannefer, and Dr. Alan Hull in developing the process for reflective evaluation of courses.

Program Evaluation Principles articulate goals and a system to determine how well the College program is reaching those goals—how to collect good, reliable evidence from the faculty and students and use it for continuous quality improvement.  The process for collecting course evaluation information, reporting course evaluation data to relevant parties, and using course evaluation approaches to improve curricular delivery and practice was described.  Methods include—but are not limited to—formative weekly online student feedback, summative online student feedback, post-course review meetings between course directors and students, course director meetings with course faculty, action plan to improve the course developed by the course director and sent—in various stages—to the Curriculum Steering Council, faculty, and students.  A graph describes the progression of the reflective course evaluation process from Information Sources to Analysis/Interpretation to Evaluation/Judgments to Practice.

 

See Curriculum Revision Update section.

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