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Summary of May 13, 2004 CME Minutes

  1. Comments from the Chair

Dr. Murray Altose presented two items at the last Faculty Council meeting:  1) the nomination of Dr. Michael Nieder to replace Dr. Linda Lewin as Clinical Curriculum Council Chair, and 2) a brief overview of the medical student research and thesis program (as presented by Dr. Claire Doerschuk at the April 8 CME meeting), which will become effective beginning with the Class of 2009 entering in Fall 2005.  Both items were approved by the Faculty Council.  In response to a discussant’s question regarding the Clinical Skills exam report presented, Dr. Altose replied that the Faculty Council favors a comprehensive plan in place to prepare our students for the licensure exam and requests periodic updates.  In an update on the implementation of the new methodology to acknowledge faculty teaching, Dr. Altose announced that approximately 35 individuals have been recommended for their Best Contribution submission.  Dr. Dan Wolpaw is currently working with the Dean’s Office to recognize them.

  1. Report from the Vice Dean for Education and Academic Affairs for the University Program

Dr. Robert Daroff mentioned that candidates for Basic Science Curriculum Council Chair will be interviewed next week.

  1. Report from the Vice Dean for Education for the College Program

Dr. Lindsey Henson reminded that the first annual retreat for the College will be held on Friday, June 4, from 8:00 a.m. until 4:30 p.m. at the Intercontinental Hotel.  Preparation for the upcoming LCME site visit will take place during the morning.  The rest of the day will include posters and workshops dealing with the curriculum.  R.S.V.P.s are needed, as lunch is being served.  Orientation for College Program students takes place Tuesday, July 6 through Friday, July 9.  A draft of the LCME database for our site visit in September 2004 is being reviewed by a consultant before submission.

  1. Report from the CCLCM Curriculum Steering Council

Dr. Lindsey Henson mentioned that several smaller CSC meetings have been cancelled to allow sufficient time for the Tuesday, May 25 CCLCM Curriculum Steering Council meeting, where the entire Year I curriculum will be reviewed.

  1. Report from the Student CME

Congratulations to Year IV CME representatives Mr. Kimathi Blackwood and Mr. Jim Lan, who are graduating Sunday, May 16.

Mr. Christopher Utz, Year I student representative, mentioned the newly elected CSR (Committee on Student Representatives) officers’ desire to do something for the incoming College Program students during their orientation and wanted to know whom to contact.  Dr. Jeffrey Hutzler, Associate Dean for Admissions and Student Affairs at the College, is the contact person.  CSR would also like to add representatives from the incoming College class. 

  1. Overview of the Pulmonary Committee

Dr. Anthony DiMarco, chair of the Year I Pulmonary committee, summarized the positive and negative aspects of the committee as viewed from a ten-year perspective of personal involvement.  The two-week Pulmonary committee is a component of Homeostasis I.  Logistics constrain the December/January Pulmonary committee to be divided by a two-week holiday break.

Dr. DiMarco described the core content

  • 14 hours of formal physiology lectures

  • 5 hours of small group physiology sessions focusing on the three areas most useful to students treating patients:

  • Mechanics of Breathing

  • Gas Exchange

  • Control of Breathing

  • 4 hours of histology lectures

  • 7 hours of histology labs

Supplemental content covers:

  • 2 hours of interactive clinical correlation lectures (patient presentation sessions and patient management sessions)

  • 4 hours of an in-hospital hands-on experience in a hospital pulmonary function lab, occurring during one morning

  • 2 hours of an end-of-course review session

Dr. DiMarco highlighted the positive aspects of the Pulmonary committee:

  • Strong clinical orientation with useful practical knowledge—offering what is necessary to manage common clinical pulmonary problems

  • High quality faculty—hand-selected over time who have considerable expertise in their area

  • High level of organization—logical flow from beginning to end, from lecture to related small groups—with integration of various aspects of pulmonary physiology

  • Cooperation with several teaching hospitals (including UH, Metro, VA, Cleveland Clinic) in providing a pulmonary physiology workshop.  (Students are distributed at different sites on the same day.)

  • Strong syllabus complementing the lectures

  • Strong small group sessions promoting student interaction

Dr. DiMarco highlighted the negative aspects of the Pulmonary committee, most of which result from the holiday break splitting the two-week committee:

  • Poor student attendance prior to Christmas and the first day back from winter break

  • Repetition of material—considered necessary to compensate for the break

  • Lack of broader exposure to the field of respiratory physiology (for example, cellular/molecular biology) due to the short period of time allotted

  • Lack of discussion of active areas of pulmonary research which would be useful to students for their upcoming summer research projects

Dr. DiMarco concluded with the following recommendations:

  • Eliminate the holiday break within the Pulmonary committee

  • Compress physiology aspects of the course

  • Eliminate redundancy

  • Incorporate a broader exposure to pulmonary physiology including molecular/cellular biology

  • Discuss/review controversial aspects of pulmonary physiology and active areas of research

  • Maintain the committee’s current high level of organization

  • Encourage outside reading

  • Foster potential research interests/projects

Year I student representative, Mr. Chris Utz, felt that the Pulmonary committee offers excellent delivery of lectures and a function lab that is well received by the students.  Mr. Utz agreed that the break occurring during the Pulmonary committee poses a problem.  Year IV student Mr. Kimathi Blackwood did mention one positive schedule change that has already occurred:  the decision to split the formerly combined Cardiovascular and Pulmonary offering into separate committees. 

When asked whether the needed repetition is preventing the students’ broader exposure, Dr. DiMarco replied that an additional two days would be very useful.  There was agreement among discussants who felt that cellular biology could be effectively integrated into the Pulmonary committee.

Dr. Altose thanked Dr. DiMarco for his concrete suggestions for better use of time and space within the Pulmonary committee and hopes to see the curriculum evolve to accommodate them.

  1. Report from the Clinical Curriculum Council

Dr. Linda Lewin, Clinical Curriculum Council Chair, recapped how student concern over discrepancy in grading across clerkship sites of the same clerkship (presented by the Year III student representative, Mr. Brian Chow, at the December 11, 2003 CME meeting) triggered the Council’s investigation into grading distribution in general.  In reality, the present distribution is as follows:  30-40% honors, 30-40% commendable, and the remainder satisfactory. 

Pertinent CME archives points of reference—independent of today’s meeting:

April 24, 1997 CME meeting, the following motion passed:  the adoption of the “commendation” evaluation to be awarded to the second quartile of students in the core clerkships based on prospective grading criteria.  This grading policy change is to be implemented with the Class of 1999, and will, therefore, go into effect this July 1997.  The motion passed:  6 in favor, 0 opposed, 1 abstention.  Footnote:  Awarding of “honors” is based on the prospective grading criteria set down by the clerkship and may exceed the top 25% of the clerkship class.  Awarding of “commendation” is based on the prospective grading criteria set down by the clerkship and is not rigidly limited to the second quartile of the clerkship class.  (This policy change was presented to the Faculty Council at the April 28, 1997 meeting.)

June 24, 1999 CME meeting:  Patient-Based Program Annual Report, 1998-1999 by Dr. Jay Wish, Patient-Based Program Coordinator:  The “commendable” category was originally introduced to decrease the number of “honors” awarded and recognize approximately the second quartile of students.  There has not been a decrease in the number of honors or commendable grades awarded. 

February 28, 2002 CME meeting:   Dr. Jay Wish, the Patient-Based Program Coordinator, mentioned that the core clerkship grading percentages usually break down this way:  35% for honors, 40% for commendable, and 25% for satisfactory.

December 11, 2003 While more than the originally intended percent of students earn honors and commendable, the following attitude has prevailed:  Since 1) Case students were getting good residencies in the match, and 2) a survey of residency program directors indicated our Dean’s Letter adequately fulfilled their needs, it was decided to leave the grading system as it was.

Update from the Registrar (not recorded in the CME minutes):  Starting with the Class of 2005, “honors” and “commendable” appear in the Case School of Medicine transcripts, as well as in the Dean’s Letter.  With previous classes, honors and commendable only appeared in the Dean’s Letter.

Dr. Lewin mentioned that the Clinical Curriculum Council had recommended getting data from the other Consortium Schools to see how they deal with grade inflation.  After analyzing data received from 8 of the other consortium schools, the Clinical Curriculum Council made the following recommendations:

  • Have targets across disciplines and across institutions, but do not enforce rigid adherence to them.  Communicating the “targets” to the different institutions is necessary, as the Cleveland Clinic has been used to limiting the award of honors to only 10% of the students during their affiliation with the Ohio State University.  The guidelines to aim for follow:  30% honors, 40% commendable, and 30% satisfactory.  However, clerkships grades are not to be determined by grading on a curve.  Theoretically, all students meeting the prospective grading criteria qualify.  (Later, however, during discussion, it was pointed out that “honors” is awarded only to students who “distinguish” themselves by doing something outstanding; therefore, grading is, in effect, “on a curve.”  “Could every student get honors?” is a different question, separate and apart from the issue of guidelines.)

  • The Dean’s Letter should include an indication of the distribution of clerkship grades in each discipline so that the residency program director will understand how honors, commendable, and satisfactory translate for each clerkship.  A histogram would depict the distribution of grades in one discipline at all sites over the whole academic year.  It was also pointed out that if a histogram is felt to be too cumbersome, information on the distribution of grades in each discipline could be incorporated into the text of the Dean’s Letter.

When asked whether the original student claim regarding grading disparity between institutions was substantiated, Dr. Lewin mentioned that in the 2002-2003 academic year, there were not significant differences across sites, with the exception of the Medicine clerkship.

The issue of including a histogram in the Dean’s Letter stimulated much discussion with opposing viewpoints.  Discussants admitted to being conflicted.  A summary of arguments for and against follows.

Arguments for opposition to inclusion of the histogram in the Dean’s Letter:

  • Main argument:  Many of the 13 Consortium Schools do not include a histogram.  We may be hurting our students.  Hypothetically, if we indicate that a Case student received honors where many honors were awarded (for example, 30%), that may hurt him/her when being compared with students from other institutions not furnishing histograms or raw data.  A student submitting an application for a very competitive residency may be particularly vulnerable.

  • Satisfaction with the current Dean’s Letter that indicates the caliber of each student via “codes words,” such as “outstanding,” “excellent,” “good…”

  • Impracticality of deciphering the multi-page histogram or monogram, which supplies much more information than is desired

  • Goes contrary to Case philosophy by making it easier for the residency program director to “pigeonhole” the student

Arguments in favor of including the histogram in the Dean’s Letter:

  • Interpretable data are necessary to provide a breakdown of the grading distribution for each discipline.  The histogram is the standard favored by the AAMC in comparing students.

  • Desire to strengthen the Dean’s Letter as a letter of “evaluation” (it is no longer a letter of “recommendation”) by adding rigor to the current “code words” used as grading descriptors

  • Students at schools using histograms do not fare worse in getting residencies.  Do we only compare ourselves with the other Consortium schools?

  • If full disclosure would indeed prove to be a deterrent to our students’ attainment of top residencies, wouldn’t this serve as an incentive for us to do a better job?

Dr. Linda Lewin moved

that the CME endorse 1) the following clerkship grading distribution guidelines:  30% for honors, 40% for commendable, and 30% for satisfactory, and 2) the inclusion of (“a histogram,” which was amended before the vote to) “distribution data” in the Dean’s Letter to explain the variation in clerkship grades.

Dr. Kent Smith moved to table the motion.  He favored postponing taking action until Dr. Aach, the Associate Dean for Residency and Career Planning, could address the CME to present relevant data from the last five years on the Dean’s Letters, as that would pertain to the discussion.  Dr. Smith was not in favor of using a histogram for several reasons, including a concern that it would contribute to an over-emphasis on the importance of grades in the clerkships.

The motion to table failed:  4 in favor of tabling the motion made by Dr. Lewin; 5 against tabling the motion made by Dr. Lewin.

Dr. Katz seconded the original motion made by Dr. Lewin and amended it by suggesting the replacement of “histogram” with “distribution data.”  The motion passed:  9 in favor, 1 opposed.

It was clarified that the motion pertains only to University Program students, as the College Program students do not receive grades.

Dr. Lewin opposed “grandfathering out” current Year II students, who may have a different perception of clerkship grade distribution.  The policy would take effect immediately upon agreement by the Faculty Council and would affect current third year students who are just beginning the process of obtaining letters.

Dr. Lewin thanked everyone, as she mentioned that this is her last CME meeting.  Discussants recognized Dr. Lewin for her “brilliant job of restructuring the Clinical Curriculum Council to cover all four years of the curriculum” and for her fine working relationship with the Society Deans.  Dr. Altose spoke for many by simply telling Dr. Lewin that she will be missed.

  1. Report from the Flexible Program Council

Dr. Kent Smith, Flexible Program Coordinator, mentioned that the Flexible Program is working with the Office of Curricular Affairs and the Registrar to develop an improved online evaluation of both Type A and Type B electives.

  1. Update from the Office of Biomedical Information Technologies

Dr. Thomas Nosek, Associate Dean for the Office of Biomedical Information Technologies, announced that his office is currently experimenting with different formats for the eCurriculum that would enable faculty members to modify their documents directly without the need of a “middleman.”  The document appears as a Word file that the faculty member can edit and send back, where it automatically goes into a server in the right location.  BIT is asking first and second year students to try out this new format.  The Word document can be useful to the students in that the individual can format it to his/her own tastes—with features such as highlighting, taking notes within the document, etc.—and save it.  Not only an enhancement of the eCurriculum, this format frees up BIT time to work with the faculty on content and improving figures.

Dr. Nosek mentioned other BIT projects.  Students are now able to upload their individualized information—such as their clinical research, their activities—to BIT for inclusion in their ePortfolios.  Dr. Nosek has been working with Dr. Steven Ricanati on what will become part of a larger ePortfolio project.  Tentative target date for completion of this project is August, when the new students arrive.  Additional projects include research proposals and reports, the Year III Clinical Transaction Pathway pilot that starts this fall, and the new clerkship evaluation of students online system.

Clinical evaluations are important.  Unanticipated slowdowns have occurred due to the necessity of meeting with all the clerkship directors individually and creating a system tailored to the unique features of their particular rotation.  For example, some clerkships weight their evaluations—i.e. assigning more weight to an attending’s evaluation than a resident’s evaluation, whereas, other sites weight all evaluations equally.  When the system was piloted in Dr. David Preston’s Neurosciences clerkship, there was just one person involved.  No one anticipated the variability between sites and resulting time-intensive “people coordination” involved in expanding the project.  In response to a suggestion calling for standardization of the clerkship evaluation, the Clinical Curriculum Council Chair explained that each clerkship is structured differently.  While each component percent determining the grade may remain the same across clerkship sites, the means by which they arrive at that is site-specific and different.  Instead of completing the new clerkship evaluations of students for all clerkships by this July 1, as intended, Dr. Nosek explained that the Office of Biomedical Information Technologies will gradually phase in each clerkship’s evaluation with a target date of July 2005 for completion of the task.


See Curriculum Revision Update section.

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