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Summary of April 24, 2003 CME Minutes

  1. Report from the Curriculum Leadership Council

Dr. William Merrick, CLC chair, highlighted the quarterly CLC meeting held on March 5.  He began by summarizing the “chairman’s remarks”:

  • The post-exam review focusing on the 20 questions that proved most difficult for the students has become semi-standard.  This explanation of the thought process leading to the correct answer and pointing out misconceptions has been well received by the students and successfully incorporated into the established testing environment where exams are secure and students do not have access to them.

  • With the onset of the new academic year, a concerted effort will be made to provide students with examples of professionalism and to further a collegial relationship between faculty and students.

  • The calendar is in place.  Next year Winter Break will start the Saturday before Christmas with school resuming the Monday after New Year’s Day.  Spring Break is designed to occur after completion of a subject committee.  In order to achieve this, Spring Break will be staggered—Year I students will not be on vacation the same week as Year II students.

  • There has been some change in the exam process.  Dr. Marcia Wile remains in charge of providing committee chairs with the results of their exam and the technical feedback.  The decision to drop an exam question or to change the pass mark remains at the subject committee chair’s discretion.  A mathematical equation is already in place, and this formula can be used to modify the pass mark when appropriate.

  • The students have provided a preferred syllabus model.  Two syllabi were presented as “ideals.”  Dr. Merrick will be working with Year II student Ms. Jaime Rice on implementation of this project.

  • A concerted attempt will be made to eliminate the single “cameo” lecture by a faculty member for the coming year.

Dr. Merrick next summarized the rest of the March 5 CLC meeting:

  • Pharmacology will be integrated as a longitudinal committee in Year II.  Examination questions throughout Year II will account for 35% of the student’s grade and the Drug Action and Biodisposition (DAB) subject committee examination will account for 65% of the student’s grade.

  • Video streaming of lectures has been well received by students and not affected class attendance.  Relevant copyright issues are being researched by Dr. Henson.  A vote by the CLC has resulted in adoption of the following policy starting with the coming year:  All lectures will be audio streamed and video streamed unless 1) the faculty member indicates he/she does not want the streaming, or 2) a patient is present, or a patient’s confidentiality could be compromised.

  • In general, faculty feel that the remediation process is working.  The main concern is the distracting effect of the new committee on the weak student remediating a past committee.

  • See Ms. Minoo Golestaneh for a calendar of future CLC meeting dates.

  1. Report from the Clinical Rotation Development Council

Dr. Christopher Brandt, CRDC chair, described the efforts to review the clinical curriculum in both the “college” and the “university” programs.  A small ad hoc committee has been created in anticipation of the May 21 retreat dealing with clinical curriculum planning for the CCLCM.

Previously, so-called orphan topics (otolaryngology, orthopedics, emergency medicine, and ophthalmology) were covered during specific core clerkships.  With the revised, more flexible scheduling of clerkships going into effect for the coming year, the CRDC will determine whether these topics should remain where they are or if they would be better served as two-week electives.

  1. Report from the Flexible Program Council

Dr. Kent Smith announced that he is at present overseeing the Flexible Program.  A memo has been sent to all department chairs encouraging sponsorship of two-week Type B electives in the third and fourth years.  The increased flexibility in the new Year III core clerkship schedule is conducive to two-week elective offerings which afford the student exposure to new areas before residency selection.  The one-month Type B electives will continue.

Dr. Smith described the newly created advising system of four “societies” with their respective deans following the same students from Year I through all four years.  This new organization will serve to guide students through the many elective opportunities in the curriculum.

Dr. Linda Lewin is developing a second and third year continuity experience in the Primary Care Track.  This will offer elective Type A credits now and probably Type B in the third year.  This learning model may be applied to all specialties.

  1. Comments from the Chair

Dr. Murray Altose recalled how the curriculum councils were established by Dean Berger to develop new initiatives during the curriculum revision.  Now that the medical school has entered a different phase, it is the feeling of Dean Horwitz, Dr. Henson, and Dr. Altose that it is time to redefine expectations of the councils.  The CLC and the CRDC were originally intended to be two separate bodies focused on different content and different years of the curriculum—the CLC as overseeing the first two years of undergraduate medical education and the CRDC as overseeing the third year.  There now exists the desire for an expanded council perspective over all four years of undergraduate medical education.  In addition, Dean Ralph I. Horwitz has delineated the following as priorities1) professionalism, 2) scholarship among medical students, 3) community participation, and 4) a revisited electives program reflecting this agenda.  Dr. Altose suggested the concept of one council overseeing the basic science curriculum over the full four years, a second council overseeing the clinical curriculum over the full four years, and a third council that would focus on a curriculum that addressed student scholarship, professionalism, and community service.

Dr. Altose pointed out that the curriculum councils would be expected to address:  1) curriculum content, 2) presentation, 3) evaluation, and 4) continuity within the four-year undergraduate medical experience, and to promote innovation and continuous improvement.

The call for a “grass roots” group responsible for ensuring continuity and innovation yielded the following concerns by discussants:  1) Oversight committees are not necessarily the best place to develop operational details.  2) A commitment this significant requires sufficient resources to make the time available to engage the parties needed.

Dr. Altose pointed out that the curriculum council chairs are appointed by the Dean or the Dean’s designee.  (CME Charge, Appendix I:  “Each chair is appointed by the Dean of the School of Medicine, in consultation with the Vice Dean for Education, the Faculty Council, and the Committee on Medical Education.”)  Dr. Altose suggested that these appointments include expectations on both sides regarding the “product” and the “resources,” respectively.  In the meantime, Dr. Louis Binder’s committee (formed February 13, 2003) to evaluate the curriculum components of the first two years will remain on hold.

  1. Cancer Genetics Vertical Theme Update

Guests Georgia Wiesner, M.D. (Director of the Center for Human Genetics) and Anne Matthews, Ph.D. (Director of Genetic Counseling) presented an update on the progress of the Cancer Genetics vertical theme.  (They first addressed the CME at the February 14, 2002 meeting.)  They have also submitted their Essentials of Clinical Cancer Genetics proposal to the National Cancer Institute, with the endorsement of the CME, to create a stand-alone Internet-based curriculum applying the principles of cancer genetics to clinical practice, genetic counseling, and patient care that would fit into the CWRU School of Medicine curriculum and could go out to other schools.

The essential units of instruction are broken down into 11 topics.  (To view them, log onto the CWRU eCurriculum, Vertical Themes menu, Cancer Genetics link.  Each unit links to its learning objectives.)  To date, only the first unit, “Cancer as a Complex Human Disease,” has been developed.  A genetic counseling video complements this site.  Additional videos and animations are planned to illustrate concepts.  This first module will need to be further developed.  Dr. Wiesner projected a chart indicating the number of existing exam questions pertaining to general as well as specific knowledge of each of the 11 proposed topics during the 1999-2000, 2000-2001, and 2001-2002 academic years.  Several topics were not covered at all or had very few references.  The targeted sites for inclusion of new cancer genetics material are the Hematology/Oncology section in Year II and the Basic Genetics component of the Molecular, Cellular and Developmental Biology Section in Year I.

Dr. Klara Papp is working with Drs. Wiesner and Matthews to incorporate a three-tier conceptual framework for students:

  • Tier 1—demonstrated recall of factual knowledge

  • Tier 2—demonstrated comprehension by applying facts to new situations

  • Tier 3—demonstrated clinical problem solving through assessment and selection of appropriate course of action

Dr. Wiesner projected a chart describing the evaluation section of the grant that will measure mastery of the concepts taught in the “Essentials” curriculum during the Hematology/Oncology Year II August subject committee and the OSCE exams occurring throughout Year III—as administered to individual classes listed by their entering year:  2003, 2004, and 2005.  If funded, the electronic Essentials of Clinical Cancer Genetics curriculum will start development and implementation in 2004.  The table denotes a means of evaluation and comparison of student exposure to the new material.  The class entering in 2003 remains the control group (the group without exposure to the Essentials of Clinical Cancer Genetics curriculum) through graduation.  The classes entering in 2004 and 2005 will each be exposed to the “Essentials” curriculum via the enhanced Year II Heme/Onc Committee offerings and the Year III OSCEs.

Dr. Wiesner presented reasons why cancer genetics would be a strong vertical theme:

  • Cancer genetics principles have a strong link to pathophysiology and disease expression.

  • Adaptability of the electronic framework to other related courses

  • Easy linkage with other sites (CWRU and non-CWRU)

  • Ease in updating site

  • Its course offerings could improve completeness and accuracy of the curriculum.

Dr. Wiesner concluded her presentation with a chart indicating current Cancer Genetics offerings and potential offerings throughout the four-year curriculum.  There are plans to build on a case-based model.  The current Year I Genetics subject committee and both the Year II Hematology/Oncology subject committee and the Gastrointestinal/Metabolism/Nutrition subject committees could be enhanced by a Type A elective in the Molecular Genetics of Cancer.  Current Year III offerings include Family History in Primary Care and Genetic Testing for Breast Cancer.  Two Type B electives could be offered for Years III and IV:  1) Hereditary Cancer Syndromes, and 2) Clinical Evaluation and Counseling in Family Cancer.  Currently, there are only two places in the clinical curriculum, both in Family Medicine, where clinical cancer genetics is taught—lectures delivered by Dr. Louise Acheson and Dr. Wiesner.

  1. Health Sciences Library Update

Mrs. Virginia Saha announced that renovation of the Health Center Library should be completed by mid-July.  All journals published prior to 1970 are being moved to the Allen Memorial Library.  The Health Center Library has added some new databases to its collection, including Incyte’s Proteome BioKnowledge Library.  The Library is considering joining BioMed Central, so that fees will be waived for authors contributing papers to the database which is an alternative to the traditional format.

  1. A memorial service will be held today at 6:00 p.m. in Rainbow Babies & Childrens Hospital for CWRU graduate Dr. Dale Williams, Class of 2000.

See Curriculum Revision Update section.

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