Summary of 6-6-02 CME Minutes
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: email@example.com. 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:
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:
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:
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:
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:
Dr. Henson concluded the discussion by describing the goal as integration of the faculties and the exciting new research collaboratives that will result.
Revision Update section.