Shield of the SOM Committee on Medical Education
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Summary of May 22, 2003 CME Minutes

  1. Comments from the Acting Chair Dr. Louis Binder

Dr. Binder mentioned how impressed he was with the School of Medicine graduation held in Severance Hall on Sunday, May 18.  He also recognized the fine work of the eight-member Year I Comprehensive Examination Committee chaired by Dr. Marcia Wile.

  1. Comments from the Vice Dean for Education and Academic Affairs

Dr. Lindsey Henson presented an update on reorganization efforts and curricular governance.  There will be a new Office for Education and Academic AffairsSeptember 2005 is the target date to start the new curriculum.  The three curriculum councils are being restructured.  The Curriculum Leadership Council will become the Basic Science Council whose scope will extend over all four years of the undergraduate medical education curriculum.  The Clinical Rotation Development Council will become the Clinical Curriculum Council whose scope will also extend over all four years.  The Flexible Program Advisory Council, which focused on enrichment, will be replaced by an as yet unnamed council dedicated to realization of these core principles of Dean Ralph Horwitz’s vision:

  • Scholarship and Research

  • Civic professionalism integrated with public health

  • Leadership skills involving interaction with the Weatherhead School of Management

A Vice Dean’s Curricular Advisory Committee will hold weekly meetings.  Membership will consist of the three council chairs, the chair of the Committee on Medical Education, the new Associate Dean for Curricular Affairs (Dr. Terry Wolpaw), the Director of Medical Student Research, and the Vice Dean for Education and Academic Affairs.  The administration is optimistic about making the new medical education building a reality.

Dr. Henson cited the following target dates:

  • 2003 – Start of the Cleveland Clinical Lerner College of Medicine (CCLCM)

  • 2005 – Start of the new curriculum with implementation in Year I

  • 2006 – Implementation of the modified Year III curriculum of both the “university” and “college” programs.

With respect to length of the new curriculum, Dr. Henson envisioned either 1) a four-year curriculum with a fifth year option for an enhanced program leading to a Master’s degree, or 2) a five-year program.

Some sort of scholarly effort designed to stimulate critical thinking skills will be required.

As the revised curriculum is projected to start in two years, Dr. Henson encouraged faculty and students to pilot programs during this interim period before the final decision regarding the make-up of the curriculum is made.

  1. Year-End Report from the Student CME

Year II student representative Mr. Brian Chow highlighted how he and his colleagues from the Class of 2005 have been at the forefront of much innovation and change:

  • Computerized examinations have been running smoothly and quickly identify areas of weakness.

  • Widespread adoption of the post-examination review session has succeeded as an educational tool for students in a secure examination environment.

  • Student-initiated syllabus reform (including print and electronic formats) originated with the Class of 2005 and is being developed and implemented as a collaborative effort by students, faculty, and staff.

  • Student interest in improving the alternative to the Animal Lab is discussed in depth further on.

  • Implementation of the Clinical Skills Examination for licensure, starting with the graduates in 2005, requires examination, transportation, and hotel costs regarded as a significant burden by the students.

  • Erosion of the “free afternoon”—a powerful recruiting tool—is the result of many expanding programs, which need monitoring before they all collide.

  • There is an urgent need to resolve frustration arising among faculty and students over decreased lecture attendance during the second half of Year II, when studying for the USMLE Step 1 takes place.  On occasion, this has resulted in unprofessional behavior on the part of some faculty who confront the students who are in class.

The issue of unprofessional behavior on the part of faculty who yell at students or hold those present responsible for correcting the absentee problems will be addressed.  Dr. Henson questioned whether our students lack enough free time to study for the USMLE Step 1.  The unstructured afternoons impact on the length of the year.  Additionally, there are two short subject committees at the end of Year II, the timing of which interrupts any long blocks of dedicated USMLE study time.  From a practical standpoint, students cannot get everything in class that they are expected to know for the USMLE Step 1, and, consequently, require additional study time.  The USMLE Step 1 is variable over a two-month period with the Prometric Testing Center appointments process.  There are currently six weeks between the end of Year II and the beginning of Year III.  Students value this time and use it for important personal matters.  The perception is prevalent among CWRU students that since the first two years are ungraded, it is important to do well on the USMLE Step 1 for residency placement.

Year I student Ms. Connie Liu attended both the animal lab experience and the alternative simulation during the Fundamentals of Therapeutic Agents (FTA) subject committee.  She observed the lab and participated in the simulation.  The consensus among her classmates about the simulation was that it was not adequate.  It offered an explanation of one experiment and a collection of data.  The following was missing—the opportunity for a student to:

  1. Administer a drug

  2. Control the amount of the drug

  3. Control the order in which the drugs are administered

  4. Incorporate the concept of variability.

Additionally, it is frustrating for the student to interpret the results of the simulation on his/her own without dialogue or supervision.  The animal lab experience teams four or five students with one or two teaching assistants.  The simulation presents written explanations of the results of one experiment.  In order to get further explanation or answers to questions that arise during a simulation, the student has to e-mail the professor and wait.  Students would like to have teaching assistants and professors available during the simulation.  Dr. Henson sees the need for a viable option to the animal lab so that two equivalent experiences could be offered to the students.  Ms. Liu will write up the student perspective on the animal lab alternative and direct it to both Dr. John Mieyal, FTA chair, and Dr. Henson.

  1. Flexible Program Year-End Report

Dr. Kent Smith, Senior Associate Dean for Students, has been overseeing the Flexible Program since March 2003.  He mentioned one major goal:  enhancing the new Year III schedule by the addition of several new two-week third and fourth year Type B electives.  In April, a memo was sent to all department chairs encouraging the development of two-week electives.  The Class of 2005 was notified in May of the new Year III two-week elective offerings via the ListServ.  Several traditional one-month Type B electives have been re-formatted to have a two-week option.  Two-week electives encourage the student to sample a wider variety of disciplines.  Dr. Smith emphasized the broad range of excellent electives and listed some of the most heavily subscribed Type A and Type B electives.  One change in the program is the reduction of fourth year Physical Diagnosis precepting from four weeks of credit to two weeks.  Having written a portion of the Dean’s Letter this year, Dr. Smith mentioned how valuable the Flexible Program is to the students, the various possibilities that it offers, and its unique role in the curriculum.  Dr. Smith recognized the excellent work of Dr. Charles Malemud, who managed the Flexible Program for the past two years, and the Flexible Program Advisory Council.  He also recognized the Office of the Registrar for its fine work in preparing the Type A and Type B catalogs.  The Type A and Type B catalogs are now online as well as in hard copy.  To view, go to the School of Medicine home page, Medical Students, Catalog Links, Choose Type A electives Catalog, Type B Electives Catalog, or Core Clerkships Catalog.

  1. Scholars Collaboration in Teaching and Learning Year-End Report

Dr. Terry Wolpaw provided an overview of the Scholars Collaboration in Teaching and Learning during its first year of existence.  She delineated the Collaboration’s objectives:

  1. To create a community of scholars among faculty and students as innovative educators

  2. To provide dedicated time for scholarly activities, self-reflection, team building, and feedback

  3. To enhance knowledge and skills in teaching and learning resulting in increased self-confidence in one’s abilities as an educational innovator

  4. To enable development as leaders in medical education

  5. To increase educational scholarship and productivity

During the 2002-2003 academic year, “Collaboration” participants consisted of 10 faculty, 10 Year II medical students, and 10 Year IV medical students, selected for their commitment to medical education.  Ten project group triads, consisting of one faculty member, one Year II student, and one Year IV student each participated in the year-long faculty/student development program in teaching and learning that included a structured monthly curriculum and project implementation.  Six senior faculty served as mentor/facilitators for the triads.  Levels of interaction included:  1) Curricular and teaching feedback received by the faculty from the student learners, and 2) Insights on teaching and learning received by the students from the faculty.  Each triad created a curricular innovation that could be integrated into the medical school’s offerings.

Dr. Wolpaw recapped the lessons learned:

  1. The integrated student/faculty development program worked.

  2. The faculty respected the students.

  3. Students are interested in developing as educators.

  4. Faculty/student teams enhanced project quality.

  5. The program created a safe environment for the active exchange of ideas between faculty and students for learning.

The Scholars Collaboration will be able to continue during the upcoming 2003-2004 academic year and to maintain the current number of participants.  The biggest challenge is obtaining funding to sustain this initiative.  Once the School of Medicine has indicated curriculum priorities for innovation, the Scholars Collaboration will seek proposals from faculty applicants for projects in these areas.  Currently, pre- and post-program questionnaires, along with end-of-year feedback, are being analyzed.  The program will be revised based on the feedback received.

Discussants expressed support for the program.  Due to funding limitations, the Collaboration cannot expand to include interns and residents among the scholars this coming year.  However, it might be possible to pilot one or two project groups consisting of one Year II student, one Year IV student, and one resident each.

Dr. Wolpaw recognized Dr. Norman Robbins, Professor of Neurosciences, for bringing his presentation on Incentives for Medical Teaching before the Committee on Medical Education at the December 13, 2001 meeting.  In response, the CME formed a working group chaired by Dr. Wolpaw to address problems and solutions pertaining to this topic, which eventually resulted in writing a letter to secure funding from the Provost for the Scholars Collaboration in Teaching and Learning.  Dr. Wolpaw also wished to acknowledge the enormous contribution of Dr. Clint Snyder, who co-directed the Scholars Collaboration this year.

  1. Recognizing Contributions to Medical Education Year-End Report

Dr. Dan Wolpaw explained an innovative methodology to recognize teaching contributions at CWRU before the Committee on Medical Education on February 27, 2003 and at the Medical Education Retreat at Landerhaven on February 28, 2003.  This program was developed by the Working Group for Teaching Recognition that Dr. Wolpaw chaired.  The rationale behind the system:  Rather than recognize the person (an approach with built-in biases), focus on what teachers do and what they think is important.  “…evaluate scholarship and quality in the various products of educational effort, rather than [solely on] … the quality of the teachers themselves.”  Targeting a large population of individuals in a broad range of diverse teaching roles, this system enables any educator to submit annually a one-to-two page “Best Contribution narrative” written in a manner that meets the rigors of predetermined scholarship criteria.  This system eliminates the divisiveness often inherent in the awards process.  In addition, receiving the award does not depend on having contact with a huge number of students. 

The process of the recognition system follows:

  1. Track faculty effort in medical education easily and accurately through a revised, computerized, faculty activity summary.

  2. Provide the opportunity to evaluate quality in teaching and other activities of medical education via an optional “Best Contribution narrative” submission.

  3. Utilize a recognizable and rigorous peer review process through submitting the Best Contribution narratives to outside peer review.

Dr. Wolpaw explained how the review system might work once the Best Contribution narrative was submitted and screened to determine if it met a threshold of overall activity.  The Best Contribution submission is intended to be a scholarly manuscript demonstrating Glassick’s 6 Criteria for Describing and Evaluating Scholarship in Teaching.  The write-up of a teaching project for a Best Contribution narrative is to be a structured process equivalent to submitting a journal article for publication.  The narratives will be submitted to outside peer reviewers—two reviewers for each document.  It is anticipated that these reviewers could be solicited from the alumni of the Harvard Macy Physician Educator Program.  Since 1994, this program has brought together hundreds of committed medical educators from diverse backgrounds who can be contacted via a ListServ and invited 1) to provide reviews of the Best Contribution narratives, and 2) to indicate in what field of expertise they would want to do a peer review.  Once the peer reviewers have scored the Best Contribution narratives, these submissions would be sent to an in-house group of senior educators, who would take into consideration available learner assessments and then make recommendations to the Dean.

Dr. Wolpaw’s Faculty Activity Summary online draft is progressing.  Faculty suggestions have been incorporated into the Education section.  The Faculty Activity Summary (Annual Professional Review at the Cleveland Clinic) enables easy, accurate tracking of educational activity.  In its current revised state of development, it includes the following six sections:

  1. ID/Demographic information

  2. Medical Education Activity including Best Contribution narrative

  3. Research Activity

  4. Service

  5. Effort distribution including patient care time

  6. Comments + signatures

Means of evaluating the recognition of teaching program include:

  1. Objective data:  Track number of Best Contributions submitted, peer-review scores, and percent recognized.

  2. Yearly survey of faculty beginning prior to program initiation aimed at gauging impact on School of Medicine culture in education

  3. Structured interviews with individuals to assess the process that has been put into place and to track career impact for those a) receiving awards, b) applying but not receiving awards, and c) not applying (not filling out Best Contribution section)

  4. Regular survey of Promotions and Tenure committee aimed at assessing impact/awareness of this program on promotions process

Dr. Wolpaw acknowledged that the Best Contribution narrative may have more impact on the less advanced educators, but he recognized the need to try the program out on everyone and then study the results.  He also stressed that this program is not meant to replace traditional teaching awards.  This teaching recognition system is a totally inclusive, voluntary program.  Avenues of traditional recognition, such as published papers and grants, affect only a small number of teaching faculty.  The product-centered, educator-initiated approach allows the program to be applied not only to medical school teaching but also to teaching contributions on any level.  Dr. Wolpaw raised the likelihood that approval of the new Faculty Activity Summary will have to go before the CME and then to Faculty Council.

 

See Curriculum Revision Update section.

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