Shield of the SOM Committee on Medical Education
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Summary of 4-25-02 CME Minutes 

  1. Announcements by the Vice Dean

  • On April 10, 2002, the CWRU Board of Trustees approved five new degree programs affiliated with the M.P.H. program:  i) M.D./M.P.H.,  ii) J.D./M.P.H.,  iii) M.B.A./M.P.H.,  iv) M.S.N./M.P.H.,  v) Anthropology/M.P.H. (where the student can get an M.A. or/and a Ph.D. in Anthropology).
     

  • We are working with Dr. Jonathan Lass of University Hospitals in an effort to include more ophthalmology in the curriculum.
     

  • Plans for putting together a group to look at professionalism throughout all four years of the curriculum are underway.  Dr. Terry Wolpaw and Dr. Clint Snyder applied for a Provost Opportunity Fund grant.  Their project, “Scholars’ Collaboration in Teaching and Learning,” was accepted for funding in the amount of $175,000.  This was one of only eight projects at the University accepted for funding.  This project will hopefully be the seed for the establishment of an Academy of Teaching here in the School of Medicine.
     

  • A new surgery core clerkship offering at the Cleveland Clinic will accept two students per each eight-week rotation.

  1. While there was no immediate Student CME report on the syllabus initiative, representatives were encouraged to present one as soon as possible if they hoped to incorporate changes into the syllabus for the coming year.
     

  2. Curriculum Leadership Council Update – Dr. William Merrick, chair
    Highlights of the Wednesday, March 6, 2002 CLC meeting

  • Distribution of the 2002-03 Core Academic Program final schedule specifying dates and time slots committee-by-committee
    The long 5-hour days that are currently Wednesday and Friday will be switched to different days of the week.  The original intent when devising the 5-hour day was that the last two-to-three hours would be associated with a lab to avoid lecture overload.  For the 2002-03 academic year, Year II students will have Tuesday and Thursday as the 5-hour days.  Year I students will have Tuesday along with another day.  Year I students have one two-hour small group ICM session every Tuesday, so this makes for a nice balance with the Core Academic Program offerings on that day.  It is hoped that the individual subject committee chairs will plan their 5-hour days by scheduling either a lab, a clinical correlation, or a small group so that there will be no more than three hours of lectures on such days.
     

  • Presentation on evaluation in the Patient-Based Program – Ms. Kathy Cole-Kelly, Dr. Ted Parran, and Dr. Elizabeth Patterson
    Everything is in place to monitor student progress in the Patient-Based curriculum.  Currently, there is enough scoring to generate a quantitative evaluation.  Dr. Merrick is looking toward being more readily able to identify students at risk.  This will be of particular importance once the USMLE Step 2½ clinical skills exam becomes official.  Dr. Merrick hopes that within five-to-seven years, we will be able to identify a correlation in performance in the Patient-Based Program using all or a part of the patient-based evaluations and the clinical skills licensure exam similar to the current situation in the Core Academic Program, where the Year I comprehensive examination serves as a reliable indicator of USMLE Step 1 performance.
     

  • Student electronic note service
    We have always had a student note-taking service.  Now that service is in an electronic format.  Of exceptional value, the notes are contained in 8 megabytes—compact enough to fit on a PDA.  Portability coupled with the efficient search engine could be very useful to students during their third year clerkships.  The issue discussed at the March 6 CLC meeting:  Did the CLC want to sanction the electronic student notes as part of the e-curriculum?  The faculty decided that they did not want to represent the student notes on the e-curriculum for two main reasons:

  1. There were errors, although the information provided is approximately 95% correct.
     

  2. By virtue of assigning the student notes a location on the CWRU e-curriculum home page, they take on the aura of authenticity.  Neither the faculty nor the administration wanted to assume this responsibility.

However, this decision was in no way meant to disparage the value of the electronic notes.  Students could still put the electronic notes on their own CDs.

  • Student feedback sessions and the student evaluations of committees that Ms. Minoo Golestaneh compiles for the subject committee chairs
    Are we asking enough questions?  Are we asking the right questions?  Currently, we are not getting student feedback regarding Physical Diagnosis and ICM (Introduction to Clinical Medicine) in time to correct any existing problems.  Students need to be made aware of their option to contribute feedback on PD or ICM at any subject committee’s student feedback luncheon.  Dr. Merrick recommended adding evaluation questions regarding the longitudinal committees of Histology, Gross Anatomy, and Pathology as subsets to each simultaneously occurring subject committee.  The added assessment allows for immediate correction of perceived problems.
     

  • Agenda items of Friday, June 7, 2002 CLC Retreat

  1. To generate a CLC constitution that would delineate the rights, privileges, and responsibilities of the CLC chair and the subject committee chairs.
    If we are going to replace people, we have to have a process in place to select the next committee chairs.  Additionally, we need to emphasize that all teaching is owned by the faculty through the CLC.  This is a preemptive measure to avoid any disputes between hospitals as to who owns the committee, since Year II subject committees are commonly chaired by clinical faculty.
     

  2. To put in place a timely record-keeping system to ensure that student evaluations arrive at the Office of the Registrar in enough time for the Committee on Students to have the results and for the Office of Student Affairs to work with students so that they do not fall too far behind
    Hopefully, in the future, all Patient-Based Program activities will be graded at the end of each semester.
     

  3. Whether to require attendance in  the practical committees of Histology, Gross Anatomy, and Pathology
    Mandatory attendance is now required in the Patient-Based Program.  It is the CLC’s feeling that the student cannot learn the material on his/her own in these longitudinal committees.  The student needs to view the slides under the microscope, do the dissection, and, in general, have direct contact.  The topic of mandatory attendance is up for discussion.  The outcome will depend on how the CLC members vote and whether, indeed, the CLC has the authority to require attendance.

  • Highlights of discussion following Dr. Merrick’s presentation

  1. With respect to grading of the Family Clinic component, students not yet assigned a patient could carry an “Incomplete” until the requirement is fulfilled.
     

  2. There is a satisfactory/unsatisfactory evaluation in place in the Patient-Based Program, but there exists no way to predict how well students will do on a clinical skills exam.  Dr. Merrick is hoping to generate numbers that have predictive value.  Dr. Merrick hopes that our evaluative tools will evolve so that we can answer the following questions:  Is the aggregate score indicative of clerkship performance?  Is one of the subset scores a better indicator of clerkship performance?  Currently, there is no way to track borderline students identified under the pre-clerkship components of the Patient-Based Program through the clerkships
     

  3. Virtual simulations as learning tools—enhancements or replacements?
    It is up to the individual subject committee chair to decide the role of virtual simulations as learning tools.  Dr. Joseph Tomashefski, who is in charge of the longitudinal Year II Pathology committee, strongly believes that the “old-fashioned” microscope and slides will be relevant for at least another 20 years.  Dr. Merrick stated that students do well looking at Kodachrome 2" x 2" slides digitally projected on a screen but have considerable trouble using the microscope and glass slides on an individual basis in the lab, in part due to a lack of mastery in how to use a microscope.  Students are expected to look at the glass slides and master the microscope by the end of Year I so that they will be ready for Year II.  Dr. Joe Miller regards looking at histology glass slides under a microscope as a process where students learn to integrate the material in the first year.  He and Dr. Tomashefski are looking into how to improve Year I Histology and the outcome of Year II slide interpretation. 
    Dr. Nosek described the virtual microscope program as going beyond projecting Kodachromes.  It has taken the original glass slides and digitized them into a new format.  He referred to the tendency for faculty to want to create “their own thing” from scratch as expensive and time-consuming.  The message out there is to share more.  Publishers are looking for ways to customize so that each faculty member can cut and paste the items that he/she wants.  Dr. LaManna mentioned that approximately 14% of medical schools have done away with microscopes.  Dr. Nosek stressed the convenience of our virtual microscope program that can be used wherever, whenever you want.
     

  4. Student feedback/evaluations
    The usual 15 students attending a Thursday feedback session do not necessarily represent a majority opinion.  Feedback in such a forum is mainly anecdotal and representative of a sampling of the numbers.  A more accurate picture is given by the online questionnaires that the entire class (approximately 140 students) fills out after a subject committee.  The student must complete the online questionnaire in order to receive his/her interim score.  Dr. Merrick has approximately 30 pages of evaluations printed out per committee.  In these questionnaires, each student rates a lecture (the computed score represents the average of 140 students’ assessments) and provides additional comments.  The comments are especially useful when they point out what teaching tool—for example, the introduction of a particular patient—served to drive home an item.  Only the subject committee chair sees these composite online evaluations.  There are two overall evaluations for each subject committee:  1) the computer-generated questionnaire completed by all students, and 2) the Student CME letter put together by six students after soliciting feedback from their classmates.
    Dr. Nosek recommended having a committee to review the online questionnaire evaluating the subject committee.  The questionnaire keeps getting longer and longer in an effort to gather more data, while the students would like to condense the evaluation and reduce the length of time it takes to complete.  Dr. Nosek would like to see a standardized questionnaire that could be used from committee to committee so that we could compare results.  Dr. LaManna suggested getting examples from other universities.  Those people interested in being on a committee to review the online questionnaire evaluating the subject committee, please contact Lois at lsk2@po.cwru.edu.
    Regarding the issue of professionalism, several discussants referred to instances of highly inappropriate comments from students about faculty lecturers.  This is one reason that the online questionnaires are “filtered” through the subject committee chairs to decide what feedback should be forwarded to their faculty.  Sometimes a summary of the feedback prepared by the committee chair is helpful.  Also, there are instances of having up to 100 different lecturing faculty in a committee.  Students are requesting photos of the one-time lecturer in such a committee to jog their memories when completing evaluations.  Credibility of the online questionnaires was raised, being that there is a high return on evaluations, yet few students may actually be attending the lectures.  Dr. Merrick stated that approximately 80% of the students are attending all classes in Year I.  There is a “no opinion” option on the online questionnaire for the student who did not hear a specific lecture.  Dr. LaManna mentioned that the issue of relaying student feedback to faculty falls under the jurisdiction of both the CLC and the CME.  Perhaps the CME could become involved since student feedback impacts faculty development.
     

  5. Upcoming CLC debate over mandatory attendance in the longitudinal committees
    Year IV student representative Ms. Abbie Miller recalled that her class did not have to pass Gross Anatomy, Histology, or Pathology.  However, she felt the majority of the students went to the lab.  There was an appreciation that someone donated his/her body for students to learn.  In her opinion, the textbook seemed more valuable than the lab in general.  She did, however, learn the most when the residents were in the lab.  She recommended increasing the number of residents in the anatomy lab if attendance becomes mandatory.  Dr. LaManna replied that whenever possible, we try to have Neurosurgery, ENT, and Orthopedics residents in the labs.  The Orthopedics residents are required to participate.  They have to take the exam and get graded.  Dr. Merrick promised that the CLC would not require attendance and then not have sufficient resource people in the lab.  Quality as well as quantity of the residents is important, too.

  1. Dean Berger’s plans to use Mount Sinai as a clinical teaching site
    The actual building is being torn down.  The site has the potential to house a clinical teaching and evaluation site similar to that of NEOUCOM.  It could be especially useful in preparing students for the USMLE Step 2½.  It could eventually be home to the anticipated end-of-third-year performance-based OSCE.  Dr. Linda Lewin and Dr. Terry Wolpaw are chairs of the committee dealing with the new clinical teaching site.

See Curriculum Revision Update section.

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This page was last updated on 04/15/02 by John Graham.

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