Shield of the SOM Committee on Medical Education
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Summary of 5-23-02 CME Minutes 

  1. Dean Berger visited the CME to conduct a question-and-answer session regarding two recent announcements:  a) the creation of the Cleveland Clinic College of Medicine of CWRU, and b) the appointment of Lindsey C. Henson, M.D., Ph.D., as CWRU Vice Dean for Medical Education and Academic Affairs.

Incoming President Edward Hundert, M.D., worked with the leadership at the Cleveland Clinic Foundation, the university, and the CWRU School of Medicine to reach an agreement.  While some students may elect to spend an additional year, the CCF College of Medicine is intended to be a four-year curriculum to train 40 students per class to be clinical investigators, enrolling its first class in the fall of 2004.  Tuition for the CCF College of Medicine will be the same as CWRU medical school tuition.  CWRU will set the tuition.  There will be an integrated admissions process where the applicant indicates if he/she is interested in a specific track.  Dean Berger sees the main challenge as interaction between CCF and CWRU to overcome a “them” versus “us” mindset.  Dean Berger feels that in order to elicit mutual cooperation on both sides, it would be preferable to avoid trying to impose any rigid requirements.  Dean Berger emphasized that the CCF College of Medicine is not meant to be an M.D./Ph.D. program.  We are talking about distinct tracks.  Dean Berger mentioned his desire to see the Primary Care Track a little more solidified.  He also would like to see a Molecular Genetic Medicine offering here similar to the HST program (Harvard-MIT Division of Health, Sciences, and Technology Medical Sciences M.D. Program).  The tentative curriculum plan conceived during late summer/last fall by basic science chairs for the CCF College of Medicine has been abandoned.  Curriculum details will be developed; there is no distinct plan for the CCF College of Medicine curriculum at present.  We have one year before applications for the class entering in 2004 go out to put the curriculum in place.  Dean Berger mentioned that he has notified the LCME of the establishment of the CCF College of Medicine of CWRU and has indicated his intent to keep them posted of curriculum and resource development.  Dr. Andrew Fishleder, Chairman of the Division of Education at the Cleveland Clinic Foundation, will be the CCF liaison here.  Dr. Andrew Fishleder conducted a background/question-and-answer session regarding the CCF College of Medicine initiative at the October 25, 2001 CME meeting.  The purpose of that meeting was to establish a dialogue between CWRU and the CCF.  At that meeting, discussants had the opportunity to express their preferences.  Perhaps some of that feedback may yet be taken into consideration when planning the curriculum.  (The October 25, 2001 CME minutes can be found on the Web site under heading “Minutes of Past Meetings.”)  Among her many responsibilities, Dr. Lindsey Henson will be the liaison for all parties involved in the CCF College of Medicine initiative.  She will begin her position full-time here at CWRU in mid-September.

  1. ICM (Introduction to Clinical Medicine) Annual Report for 2001-2002 – Co-Directors Ms. Kathy Cole-Kelly and Dr. Ted Parran (Co-Director Dr. Elizabeth Patterson was unable to be present.)

ICM consists of the following components:  1) Tuesday morning small groups, 2) Interviewing Skills Program, and 3) Family Clinic.  Small groups have been running smoothly and are well integrated with the core curriculum.  Preceptors have improved their facilitating skills in both the Problem-Based Learning and Clinical Science components.  A valuable new addition this year is Ms. Maureen Cecil, who brings 14 years of experience as a standardized patient at NEOUCOM to head the Interviewing Program.

ICM Plans (immediate and long range)

  • Improving the consistency of Year II small group sessions (Per the Curriculum Leadership Council’s instructions, ICM had to reduce the formerly 3-hour Year II morning sessions to 2-hour sessions, resulting in more sessions but shorter ones and moving some of Year II material into Year I.)

  • Increasing the number of Year II ICM correlation conferences—students love the patient contact that they provide.

  • Increasing the amount of Family Clinic team meetings, which involve students doing oral presentations as well as write-ups

  • Providing more training to standardized patients—Standardized patients have a skills checklist for use in evaluating student performance in the interview and clinical correlation and to provide students with immediate feedback.  This skills checklist is also used in ICM faculty development.  Using standardized patients represents the concerted attempt to make the situation feel “real.”

  • Pursuing a fail/pass/commendation/honors evaluation system for all of ICM to eventually replace the current satisfactory/unsatisfactory system so that ICM can qualify as the “pre-clerkship clerkship”—Benefits:  allows for distinction, Challenges:  a) the necessary rigor of evaluation, b) timeliness, and c) remediation

  • Integrating some ICM stations in the end-of-second-year Physical Diagnosis OSCE (already achieved)

  • Including exam questions integrating ICM material on subject committee exams as well as on the Year I comprehensive exam

  • Communicating to all basic science chairs what ICM is doing concurrent with their particular subject committee

Conclusion:  Ms. Cole-Kelly expressed confidence that our students will be well prepared to meet the USMLE Step 2½ clinical skills exam.

  1. Flexible Program Annual Report for 2001-2002 – Dr. Charles Malemud (Co-Coordinator) (Co-Coordinator Dr. Tarvez Tucker was unable to be present.)

The Flexible Program Advisory Committee (FPAC) was an outgrowth of the afternoon Flexible Program breakout session led by Dr. Tarvez Tucker and Dr. Malemud during the November 28, 2001 Medical Education Retreat.  (Minutes of the breakout session can be found on the Web site under the “Projects” heading, “Retreats,” Educational Retreat at Landerhaven November 28, 2001, pages 11-15.)  The FPAC met four times during 2002.

The FPAC’s focus for the coming year:

  • Scrutinizing the five objectives of the Flexible Program

  • To increase the student’s capacity for critical and analytical thinking in the medical sciences

  • To provide opportunities for meaningful student involvement in scholarly activities, both independently and in consort with professional colleagues

  • To allow students to pursue individual areas of concentrated study in-depth and across traditional disciplinary boundaries

  • To expose student to newer concepts, areas of controversy, issues of social relevance, and changing technology in medical science

  • To increase student’s initiative, responsibility, and capacity in self-education in the medical sciences.

  • Continuing revision of the Type A electives program—satisfactory completion of which is necessary in order to advance to Year III.

  • Measuring quality of teaching

  • Grading—discussion of pass/fail/“no record” designations

  • Should team teaching be approved?

  • How can we improve the number of clinical faculty offering Type A electives and Type B electives taken in the fourth year?  A subgroup will be created to set up a data sheet.

  • Reassessing Areas of Concentration with respect to mentoring and why certain AoCs are failing to attract students

  • Preparation of the new Type A catalog, where each elective will be categorized as either basic science or clinical science (This delineation is currently decided by the Coordinator.)

  • Emphasizing to faculty that all spheres of teaching count in promotion and tenure, according to Dr. Richard Eckert, Chairman of the Committee on Appointments, Promotion, and Tenure

  • Monitoring of joint-degree programs

  • Desire to establish a Flexible Program Council parallel to the Clinical Rotation Development Council and the Curriculum Leadership Council—with perhaps both a Council Chair and a Coordinator due to the extensive nature of the program (The Flexible Program contains over 320 electives.  Henry Ford will continue to be listed in the Type B catalog until they express a desire to curtail the listing.  Currently, we have 67 electives at the Cleveland Clinic Foundation that have been established for quite a while.)

  • Type B electives project description for the catalog, where there will be a description for every elective, including those that are student-initiated

  • Creation of a fourth year plan by students—indicating what they have planned and where they are headed.

Dr. Malemud thanked the Office of the Registrar for their invaluable help.  Dr. LaManna acknowledged the greater level of complexity inherent in the Flexible Program than we all anticipated.

Dr. Arnold mentioned that students often choose fourth year electives that allow them to “pick up the pieces” of what they missed in the third year.  He suggested putting together a sample of CWRU graduates who became interns in general surgery, the surgical specialties, and internal medicine and ask them what courses they took.  Then he would ask the residency directors if this choice were appropriate.  He also suggested setting up the results so that they could be tracked.  Dr. Malemud replied that only the Office of the Registrar keeps track of these data, and the office is extremely understaffed.  Dr. Arnold asked if it would be possible to add the following question to Dr. Aach’s existing survey to the residency program directors:  Is there consensus among your faculty what students should do with their fourth year?

Dr. McCoy brought up the topic of the Areas of Concentration, which are listed on the commencement program.  Primary Care is considered an AoC.  If we were to discount AoCs in both Primary Care and in Emergency Medicine, Dr. McCoy surmised that there would hardly be any other Areas of Concentration.  Dr. Malemud replied that the Flexible Program is not currently attuned to conducting that assessment and evaluation.  The immensity of the program requires a significant amount of work to monitor.  We currently have Areas of Concentration where students have not been registered in several years, and we do not know why.  Dr. Malemud clarified that the Class of 2004 has experienced an apparent increase in the number of students taking Diversified electives in lieu of an Area of Concentration.  Recent trends cited include significant decreases in the Neurosciences AoC, Internal Medicine AoC, and Primary Care Track AoC.  There was an increase in the Emergency Medicine AoC.

Dr. Nosek mentioned that an online catalog currently exists for all electives with the key words included.  There is detailed information on every elective.  Every elective and Area of Concentration is tracked.  Student-initiated electives, however, are not in the descriptive database, but they are tracked as well.  It would be possible to have a student evaluation to determine the quality of the electives.  We already have online student course evaluations in place.  We would need, however, a mechanism insuring that all students complete the evaluation for the electives.

In response to a question about whether it is more valuable for students to complement or to pre-specialize during their fourth year, Dr. LaManna mentioned that students get advice from their mentors, friends, residents, and interest groups.  Dr. Aach cited the following three areas of performance as most valued by residency program directors and listed them in order of their importance:  a) overall core clerkships, b) specialty areas, and c) the USMLE.

  1. PDA (Personal Digital Assistant) Update – Dr. Tom Nosek, Associate Dean for Biomedical Technologies

There was no faculty mandate for first and second year students to use PDAs or for the school to provide them.  However, students were greatly encouraged to use PDAs.  This spring the Pharmacology teaching faculty recommended that first year students use the ePocrates pharmacology database on their PDAs for the Fundamentals of Therapeutic Agents (FTA) subject committee.  Dr. Nosek will provide more information when the results of the student evaluations of using PDAs and ePocrates are tabulated.  The university “No Strings Attached” conference held May 1 and 2 was exceptionally well attended.  The focus was on wireless technology, including PDAs.  Health professionals dominated the pool of those wishing to speak at the conference, and in next year’s annual conference, health-related technology issues will be emphasized.  Dr. Jason Chao is establishing a prototype for other clerkships with his grant integrating PDA use in the Family Medicine core clerkship.  July 2002 is the start date of the implementation phase of his grant.  Dr. Chao is getting PDAs for use in the whole eight-week block of Family Medicine and Ambulatory Medicine.  After going through a few complete cycles, Dr. Chao plans to report back to the CME in January 2003.  Dr. Nosek foresees a strong need for PDAs in the third year.  Currently, it is the residents, not the faculty, who are making the most use of PDAs—for reference, patient tracking, and drug dosage (ePocrates—a free high quality database).  The success of PDA use will depend on whether or not faculty promote its use to the students.  PDA use needs to be a faculty-led endeavor.

  1. Patient-Based Program Coordinator, Dr. Jay Wish wanted the CME to give some forethought to an issue that he will raise during his Patient-Based Program annual report at the June 13 meeting.  A few students are postponing third year core clerkships to take electives/AIs (Acting Internships) in disciplines such as Neurosurgery, ENT, and Ophthalmology, which have an early match.  It has been his practice to grant these exceptions on a case-by-case basis (5-10 students per year), provided that the student also obtains the consent of the clerkship director whose core clerkship is being postponed.  Dr. Wish feels that there has been no problem resulting from this practice, but he would like the CME to consider a formal policy in this area at the June 13 meeting.

 

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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