Shield of the SOM Committee on Medical Education
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Summary of 6-6-02 CME Minutes
Special Meeting
called by the Dean
to introduce
Lindsey Henson, M.D., Ph.D.
Vice Dean Designate for Education and Academic Affairs

CME Chair, Dr. LaManna called this special CME meeting to order.  Due to a conflicting meeting called by incoming CWRU president Dr. Edward Hundert, Dean Berger could not be present as planned at today’s meeting.  Dr. Kent Smith explained that the purpose of today’s meeting was to introduce and hear remarks from Dr. Lindsey Henson, Vice Dean for Education and Academic Affairs, and to welcome back Dr. Andrew Fishleder as the newly appointed “Executive Dean” at the Cleveland Clinic College of Medicine of CWRU.

Like Dr. Hundert, Dr. Henson comes from the University of Rochester medical school.  While her position here does not technically start until September 15, she welcomes e-mail contact at her current address:  lindsey_henson@urmc.rochester.edu.  She also mentioned that she will be at CWRU on June 27 and June 28 and is looking forward to meeting with individuals wishing to speak with her.

Dr. Henson described some of the factors influencing her decision to accept the Vice Dean position.  Dr. Henson was attracted to CWRU for many reasons:  there is a real opportunity for innovative change given the expected outcome of our LCME accreditation review, faculty are energetic and have many exciting ideas for curricular reform and new initiatives, the Dean supports educational innovation, and we have the opportunity to create one of these new innovative programs at the Cleveland Clinic with our new affiliation that was just signed.  CWRU is also one of the few United States schools having both an undergraduate and medical school next door to each other on the same campus.  Dr. Henson had a conversation with Dr. David Stevens, our former Vice Dean for Medical Education and current Executive Secretary of the LCME and Vice President for medical school standards and assessments at the Association of American Medical Colleges.  Dr. Stevens said that based on our recent LCME “no concerns” site visit recommendation, CWRU should be “pushing the envelope” as we create innovative new programs.  Dr. Henson also mentioned the significance of having her current colleague Dr. Edward Hundert, who is so very knowledgeable in medical education, as the new university president.  Dr. Henson mentioned two concepts that she would like to develop at CWRU School of Medicine:

  1. To make medical education at CWRU even more like graduate education, with the latter’s emphasis on thinking instead of memorizing.

  2. To provide an opportunity for our medical students to be engaged in aspects of the university education.

Dr. Henson would like us to come up with innovations that other schools will look to as prototypes.  From talks with faculty members here, Dr. Henson recognized additional pathways that are beginning to be addressed:

  1. Creation of an academy, or “community,” of medical educators to focus on faculty development and mentoring that will produce master educators (Dr. Terry Wolpaw’s pilot project)

  2. Need for the city of Cleveland to have a state-of-the-art clinical skills teaching and training center

  3. Establishment of new funding to support our teachers and educators—Dr. Henson made that a defining component of the Vice Dean’s role.

Dr. Henson continued by briefly describing her role as Vice Dean for Education and Academic Affairs according to the agreement reached with Dean Berger.  The Vice Dean is responsible for:

  • All aspects of educational programs, including ongoing innovations and continuous improvement

  • Launching new tracks and programs within the CWRU School of Medicine

  • Helping to launch and ensure the success of the affiliation with the Cleveland Clinic

  • Working with the Dean to develop new funding to support the education mission

  • Developing a method to determine reimbursement for teaching.

Dr. Henson stressed that she had mission-based budgeting for educators specifically written into her contract and that she is experienced in this area.

Dr. Henson next spoke briefly about the revised agreement signed three weeks ago between the Cleveland Clinic Foundation and CWRU to form the Cleveland Clinic College of Medicine of CWRU, which is intended to produce physician investigators.  This version of the agreement approved by both parties in May leaves out the proscriptive detailing found in the original October agreement that was approved by the CWRU Board but awaited approval by the CCF Board.  The revised May agreement avoids restrictive details and instead spells out a process for creating the appropriate curriculum for the CCCM (Cleveland Clinic College of Medicine).  The agreement recognizes that it costs money to teach.  Compensation is needed in the form of released time or dollars for clinicians pressured to generate patient hours and basic scientists pressured to secure grants.  It also specifies a long-term commitment—a mandatory 5-year termination notice by either side—so that students enrolled in the program can be assured that they will graduate.  Dr. Henson spoke of a 5-year curriculum when taking into account a year for the required thesis.

Dr. Henson cited “several key differences” of the revised agreement signed in May compared with the October version:

  • An “agreement to agree” that recognizes that an education and research program will change and evolve

  • Gives flexibility for collaborative design of the programs, rather than spelling out rigid details in the agreement itself

  • A main resource CCF is bringing to the agreement is recognition of the loss of revenue due to teaching by the faculty.

  • The final agreement is a long-term commitment, with an initial term until 2014—a 5-year termination notice is required and it cannot be given until the first class graduates in 2009.

  • All degrees (M.D. and any graduate degrees) will be granted through CWRU.

Dr. Henson next addressed the issue of “What does the agreement say?”  The terms “the College” and “CCCM” are both used to refer to the Cleveland Clinic College of Medicine of CWRU.  It is a “distinct entity” within the CWRU School of Medicine.  Its goal is to train M.D. investigators and not duplicate the existing M.D. programs already established at CWRU.  Optimal class size for this clinical investigator track is targeted at 30 students per year, allowing for up to a maximum of 40 students per year.  The goal is to have approximately 150-160 students in the 5-year program.  Dr. Henson and Dr. Fishleder talked with leadership of the Harvard-MIT Division of Health, Sciences, and Technology Medical Sciences M.D. Program when considering numbers.  The HST has between 25 and 30 students in its special track.  All CCCM students will be trained in research methods and complete a thesis, which may be a clinical research project as well as a basic science laboratory project.  The program will be designed to grant the M.D. degree, but a subset of the students may wish to pursue a Master’s or Ph.D. degree in addition.

The faculty of the CCCM will be non-tenured and will be appointed to the “Faculty of the CCCM of CWRU.”  There will be a Committee on Appointments and Promotions at the Cleveland Clinic rather than a Committee on Appointments, Promotion, and Tenure, as exists at CWRU.

Faculty at the College are responsible for initial curriculum design for the College programs, with curriculum developed and approved by faculty and committees of CCCM, then approved by CWRU.

Instead of drawing an organizational structure, Dr. Henson described a “lean” administrative structure at the CCF and here at CWRU to support it.  The Vice Dean for Education (Dr. Henson) is responsible for the academic (curriculum and faculty affairs), financial and operational affairs of the College.  As for all the other CWRU medical education programs, the Vice Dean reports to the Dean, but is also accountable to CCF for responsible management of CCF resources for the College program.  Thus, the Vice Dean has a “dual” job.  Dr. Andrew Fishleder has been the Chairman of the Division of Education at the Cleveland Clinic Foundation for 11 years.  He is the “Executive Dean” at the College and also continues in his previously established responsibilities at the Clinic.  The Executive Dean at the College is selected by the Dean, the Vice Dean, and CCF and is responsible for academic functions of the College and reports to the Vice Dean.

Committees, associate deans, and faculty of the College report to the Executive Dean (Dr. Fishleder) and through the Executive Dean to the Vice Dean (Dr. Henson) and the Dean for their academic functions.  Dr. Fishleder, the Executive Dean, is at the Clinic 100% of the time to manage the College.  He and Dr. Henson are collaborating on figuring out the composition of a small curriculum steering committee, charged with oversight of the curriculum, (to serve as a standing committee) and 3 associate deans.  Dean Berger has already approved their proposal for this structure.  Thus, the process is underway for Dr. Henson and Dr. Fishleder to define the committees and associate deans for the College, with approval of the Dean.

The Vice Dean and Executive Dean will establish an admissions process.  The admissions process is not worked out yet, but Dr. Henson has a meeting scheduled with Dr. Kirby to begin those discussions.

Relevant CWRU committees will have CCCM representation, and relevant CCCM committees will have CWRU-SOM representation.  Dr. Henson invites you to nominate yourself or someone else whom you think would be interested in serving in this capacity.  Dr. Henson mentioned that when undergoing their curriculum re-design at the University of Rochester, the small steering committee met weekly for one-two hours during the entire first year and a half of planning and only decreased the frequency of meetings to every other week after the first two years had been implemented.  There are other committee options for service, such as the Committee on Appointments and Promotions.  There is a Curriculum Design Task Force already established at the Clinic whose members have been holding four-hour retreats on Saturday mornings since February.  The Task Force was conceived when CCF was planning to create its own medical school and will continue as one of the curriculum planning groups as we go forward.

With completion of Dr. Henson’s presentation, the meeting was opened to discussion.

When asked about the vision behind the curriculum development for the College, Dr. Andrew Fishleder replied that about 30 CCF faculty making up the Curriculum Design Task Force have been meeting for five months now and are excited about developing a track to train physician investigators.  He realizes that it will take a long time to measure the outcome of this program.  There exists a concept of what the clinical investigator program is all about.  There are ample opportunities for collaboration in both the teaching and research venues.  The CCF has had long-term involvement with medical students.  There are approximately 25 full-time Ohio State University students in both the third and the fourth years.  Students from Penn State University also come to the Clinic to do their clerkships.  (CWRU students can participate in Clinic clerkships in Family Medicine, Neurosciences, OB/GYN, and Surgery.)  The Flexible Program Coordinator added that we have 67 electives at the Cleveland Clinic with research opportunities available and also the potential to create new electives to train clinical investigators.

Given the early stages of planning, Dr. Henson addressed as best she could the following concerns raised:

  • We are not far enough along in the planning process to know whether CCCM students will do some of their training here at CWRU.  The goal is a special educational program focusing on research in an organ-based curriculum with an additional year for a thesis.  The design should allow interested CWRU students to participate in various aspects of the curriculum.

  • As stipulated in her contract, Dr. Henson will pay attention to eliminating redundancy and duplication of effort and resources in the CCCM curriculum.

  • In response to a question reflecting concern about over-extended facilities, Dr. Henson does not foresee a class of 175 students at the CWRU campus.  In addition, Dr. Henson will meet with the lab-based longitudinal committees to determine what resources it does not make sense to duplicate.

  • Concern over the limited amount of time to achieve such a comprehensive endeavor prompted Dr. LaManna to advocate an “April Fool’s” April 1, 2003 deadline for designing the CCCM, as the literature and application forms must be mailed by May 2003.  This gives us less than one year to prepare for the class entering in August 2004.  The agreement is signed and is flexible enough to create a sound academic curriculum.  Dr. Henson mentioned that we will need people for committees soon.

  • Recommendation to include the CWRU hallmark known for exposing students to patients right from the start of medical school.  Dr. Henson agreed that clinical work starting at the beginning of medical school needs to be included in the curriculum.

  • In response to an inquiry regarding the amount of leeway we are given to “push the envelope” with respect to the LCME requirement for “comparable objectives and equivalent evaluations,” Dr. Henson replied that Dr. Stevens advised us to look at WAMI’s innovative program, which doesn’t exactly fit the LCME “standard” but has been easily accredited because of excellent outcomes.

  • Dr. Henson suggested doing something new involving other university programs.  We have two distinct advantages:  1) a new university president with medical education experience, and 2) an LCME review that gives us a blank slate.  Dr. LaManna cited Dr. Abraham Flexner as saying that medical schools should be in universities.

  • Perception of two separate groups of students getting CWRU M.D. degrees without establishing ties between them—Dr. Henson plans to work on establishing ties between the two groups of medical students.

  • How can we hold the CCCM group to the current internal yardsticks we use to measure our students’ performance?  Dr. Henson plans on using “equivalent but not necessarily the same” evaluation standards.

  • Dr. Henson suggested that due to our focus on writing learning objectives for the curriculum revision, perhaps CWRU faculty could lend a hand in this particular area for the CCCM curriculum.

  • Dr. Terry Wolpaw, Medicine clerkship director, enthusiastically offered her clerkship to pilot new ideas.  Dr. Henson is intrigued with the aspect of graduate education that allows the student time to think and figure things out on his/her own.  In Dr. Henson’s view, it is not like this in medical school.  Graduate school offers time for problem solving when the student does not have scheduled classes.  She would like to test out this concept of having nontraditional time for problem solving built in and less core clinical time in a medical setting.  Dr. Wolpaw volunteered her Medicine clerkship for such a pilot and test.

  • With the creation of the CCCM, it is not yet known whether there will be a central Committee on Medical Education and whether the Faculty Councils will be together.

  • Dr. Henson mentioned her firsthand familiarity with what was involved when the University of Rochester was starting with an entirely new four-year curriculum to replace an existing one.  She emphasized the need to work at a rapid pace.

  • In response to an inquiry as to whether there is a market for physician scientists, Dr. Henson replied that while the University of Rochester is known as the “home of biopsychosocial medicine,” many entering students express an interest in research.  However, in Dr. Henson’s opinion, the medical school was never able to make the student skilled enough to feel confident in that area.  She suggested incorporating into the outcome measures of the CCCM curriculum, a means of determining what percent of graduates remain involved in research.  Realistically, the percent should range somewhere between higher than average but not as high as 100%.  Currently, there are plans to set aside one year to do the thesis in the CCCM track.  However, there is no idea as to the particular year in the curriculum.

  • The current Family Medicine clerkship already uses family doctors in the community, including the Clinic, University Hospitals, and MetroHealth Medical Center.  It’s as if a “northeast Ohio” clerkship already exists.  Dr. Henson did not anticipate any restrictive measures limiting certain sites to the CCCM track that would upset this existing arrangement.  Graduates cannot obtain licensure in California without doing four weeks of Family Medicine, and our graduates must be able to get a California license.

  • We will have to figure out the appropriate time—what is the most practical—for student crossovers on both the Clinic and CWRU sides.  A student in the Primary Care Track can get a normal degree at the end of four years.

  • The Harvard HST is the closest existing model, but it is not the same as the CCCM.  With respect to outcome measures, we plan to collect data on the residency match, the percent of graduates that stay in research, and USMLE performance.  Discussants suggested looking at our M.S.T.P. (Medical Scientist Training Program).  It is a research-oriented separate track going through a 2-7-2 year cycle.  In addition, its students are registered as graduate students.  Additionally, it was suggested to make use of Type B electives in the fourth year as possibly eliminating the need for a fifth year.

Dr. Henson concluded the discussion by describing the goal as integration of the faculties and the exciting new research collaboratives that will result.

See Curriculum Revision Update section.

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This page was last updated on 06/28/02 by John Graham.

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