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.
Report from the Vice Dean for Education and
Academic Affairs for the
Dr. Robert Daroff
mentioned that candidates for Basic Science Curriculum Council Chair
will be interviewed next week.
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.
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.
Report from the Student CME
Year IV CME representatives Mr. Kimathi Blackwood and Mr. Jim Lan,
who are graduating Sunday, May 16.
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.
- Overview of the Pulmonary Committee
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:
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
highlighted the positive aspects of the Pulmonary committee:
orientation with useful practical knowledge—offering what is necessary
to manage common clinical pulmonary problems
faculty—hand-selected over time who have considerable expertise in their
High level of
organization—logical flow from beginning to end, from lecture to related
small groups—with integration of various aspects of pulmonary physiology
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.)
complementing the lectures
Strong small group
sessions promoting student interaction
highlighted the negative aspects of the Pulmonary committee, most
of which result from the holiday break splitting the two-week committee:
attendance prior to Christmas and the first day back from winter break
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:
holiday break within the Pulmonary committee
aspects of the course
broader exposure to pulmonary physiology including molecular/cellular
controversial aspects of pulmonary physiology and active areas of
committee’s current high level of organization
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
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
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:
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
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.
opposition to inclusion of the histogram in the Dean’s Letter:
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.
the current Dean’s Letter that indicates the caliber of
each student via “codes words,” such as “outstanding,” “excellent,”
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
favor of including the histogram in the Dean’s Letter:
are necessary to provide a breakdown of the grading distribution for
each discipline. The histogram is the standard favored by the AAMC in
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
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
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.
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.
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.
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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