Shield of the SOM Committee on Medical Education
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Summary of June 10, 2004 CME Minutes

  1. Comments from the Chair

Dr. Murray Altose reported that Dean Horwitz’s initiative for curriculum revision is moving forward via the Policy Steering Committee with its four working groups.  Of top priority is incorporation of the medical student research program.  The revision is looked upon as an opportunity for real curricular innovations.  When asked about the “articulated” role of the CME in the curriculum revision, Dr. Altose replied that it is to “review, evaluate, and provide feedback” until we are content with the end product.  While the Dean mandates the curriculum revision, in the final analysis, it is the faculty that presents the curriculum, and the CME is made up of representatives of the faculty.  This is the established process:  A major proposal is presented to the CME.  The CME evaluates each proposal, decides whether it is appropriate for endorsement, and then presents the recommended proposal to the Faculty Council.

  1. Report from the CCLCM Curriculum Steering Council

Dr. Lindsey Henson, Vice Dean for Education for the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, provided an update on its first annual retreat held June 4.  A CME member congratulated her on such a successful retreat, where both University and College Program leadership placed a high priority on innovation in education.  Focus of the retreat was on interactive review of the Year I curriculum, accomplished via small group workshops and posters representative of each course.  Bruce Koeppin, M.D., Ph.D., University of Connecticut School of Medicine, provided an overview of the LCME for the College’s impending site visit in September.  The College welcomes its first class of 32 students this July.  Orientation takes place Tuesday, July 6 though Friday, July 9.  Classes begin Monday, July 12.  There will be a joint white coat ceremony for Year I College and University Program students, which will offer a session on professionalism.  Currently, every Year I College course is being reviewed.  Dr. Henson will provide an update on the Status of the Year I Course Review at the final CME meeting of the year on June 24.

  1. Overview of the Years I and II Reproductive Biology Committees

In 2000, Dr. J. Ricardo Loret de Mola became committee co-chair of the Reproductive Biology Section of the Endocrinology/Reproductive Biology committees for both Years I and II.  Year I is a “combined” committee of endocrinology and reproductive biology, whereas, in Year II, Reproductive Biology stands alone.  Initially, his task was to revamp the committee—separating out normal physiology for Year I and the pathophysiology for Year II, then blending in basic and clinical sciences, and recruiting new lecturers.  Because of his contact with students in all years, Dr. Loret de Mola could see how Years I and II impact on Year III and what specific knowledge needed for the clinical rotations was lacking.  He has tried to improve the lectures and provide the students with a much better basic understanding of the normal menstrual cycle and ovulation.  Dr. Loret de Mola’s ultimate vision is achievement of a women’s health continuum starting from the Year I medical student, crossing all undergraduate medical education years, reaching to the resident and beyond to continuing medical education credits for the practicing physician. 

Dr. Loret de Mola felt that the committee is well received by the students.  He presented results from student evaluations.  Historically, Year II earns higher marks than Year I, perhaps due to the extensive amount of material covered during the 13-day combined Year I endocrinology/reproductive biology committee.  Student ratings covered the following areas:

Lectures rated as “valuable” or “extremely valuable”

Small Groups rated as “valuable” or “extremely valuable”

Small Group Leaders receiving a 3 or 4 on a 4-point scale with 4 being the best score

Overall Committee rating as “excellent” or “good”

Student Confidence on having learned the material

Exam as Representative of what was taught – “strongly agreed” or “agreed”

Dr. Loret de Mola highlighted strengths/accomplishments of the committee:

  • Separation of normal physiology from pathophysiology

  • Variety of learning formats offered to students:  integration of syllabus, slides, video and audio streaming of all lectures

  • Introduction of new lecturers and faculty:  The participating pool has been enriched by including faculty from Ob/Gyn and Urology at both the MetroHealth Medical Center and the Cleveland Clinic in addition to their University Hospitals counterparts.

  • Removal of outdated and irrelevant lectures and inclusion of video streamed lecture slides on the eCurriculum

  • Experiment with “large group” discussion on contraception:  Dr. Loret de Mola chose a topic of interest to the students.  Students were instructed to study the syllabus, slide presentation, audio and video presentations—all on the eCurriculum—prior to coming to class.  Dr. Loret de Mola spent the first part of the class session answering student questions to clarify the material.  Then he asked different students to comment on one of the ten cases.  Each presentation of the clinical scenario was followed by group discussion.  Student feedback showed that the “experiment” was positively received and perceived as fun.  It is also one way of using fewer faculty with a larger audience to encourage much interaction.

  • Addition of small group discussions to the Reproductive Biology committee in both Years I and II for the first time during the 2003-04 year

  • Improved syllabus and learning objectives

  • Addition of examination questions to be field-tested and then validated prior to counting towards the examination:  In collaboration with Dr. Wile to improve our testing, Dr. Loret de Mola is introducing 5 new questions on every exam as field questions, which can eventually become part of a permanent bank of secure questions.

  • Presence of Reproductive Biology committee chair for all lectures to evaluate presentations and material

Dr. Loret de Mola then highlighted areas requiring improvement:

  • Ongoing effort to remove weak lectures and lecturers has resulted in an increased pool of faculty lecturers.  Dr. Loret de Mola would like to take advantage of our technology to make outstanding lectures taking place elsewhere available to our students online.

  • Ongoing weeding out of examination questions not matching current lecture material and addressing resistance from lecturers to write new exam questionsFaculty development is needed on how to write examination questions.

  • Find more time to teach the physiology and pathophysiology needed for third and fourth year rotations by eliminating irrelevant information from the current curriculum

  • Need for more figures in the syllabus to make it more interactive

  • Inappropriate, unacceptable, tasteless feedback on lecturers and small group leaders written by some students:  Presenting such remarks to teaching faculty would not only be offensive but counterproductive.  Dr. Loret de Mola would prefer that such individual students sign their own names and speak directly with him.  However, one CME member felt that it is better to retain anonymity when soliciting honest feedback.  It was pointed out that this issue of inflammatory feedback has come to the attention of the CME throughout the year and that the society deans and the Associate Dean for the Office of Curricular Affairs are addressing it now.  Additionally, student feedback models at other medical schools are being studied.  For now, the subject committee chair can choose to filter the feedback him/herself or contact the Office of Curricular Affairs for help. 

  • Student attendance (lecture attendance usually between 40 to 50%):  Placing the start of the Year II committee at the beginning of the new year has caused poor attendance for the first few lectures.  However, this was improved by better scheduling in 2004.

  • Integration of “orphan” lectures, which are important but not in synch with the theme of male/female reproduction

  • Repetition of material—important principles but they impinge on time for new ideas and concepts

Dr. Loret de Mola concluded his presentation by mentioning his future plans:

  • Development of an online integrated women’s health curriculum from Years I through IV and beyond:  With the help of Dr. Nosek, Dr. Loret de Mola started a Web site for students to view material posted by committee chairs from Years I through IV.  Currently, the Year III clerkships at University Hospitals, MetroHealth Medical Center, and the Cleveland Clinic all teach different things.  This variability among rotations could be somewhat normalized by having a Web site for the entire medical school.  This Web site could reduce the frequent repetition of lectures at all the clinical sites by videostreaming the lectures on the eCurriculum for students to view before the clerkship small groups in preparation for discussion.  This would make it possible to have the same lectures and the same teaching across sites when dealing with a specific case. 

  • Development of a Year IV elective curriculum:  Students could sign up for an elective course with lectures and exams via the Internet, yet take clinical rotations with any clinical faculty.  Electives in Reproductive Endocrinology and Infertility would be created with all the didactic material and examinations online.  At the end of each chapter, the student would take the online exam to progress to the next step, and results would be e-mailed to the preceptor.  This program could be open to all medical school students enrolled in any medical school in the United States (for free).  It would promote the prowess of Case’s commitment to education by allowing any medical student anywhere to set up rotations with any practitioner in the country (or the world).  The practitioner could then focus on the clinical experience, since all the didactics are addressed.  This would enable more people to participate in medical education by eliminating the administrative hassles.  Case would provide a final score and the proper credit to the students.  We could then get medical societies to buy into this idea and validate the course.  Once it is accepted, it could be packaged and sold.
  • Development of more small groups:  Six different small groups, each dealing with a different clinical scenario and taking place simultaneously, could be videostreamed on the eCurriculum, allowing the student wider exposure and the ability to learn without physically being present.  While there would not be interaction, the student could observe.  This would also be an additional opportunity to develop more exam bank questions.

  • Revamping of all questions for the electronic examination:  time-consuming task requiring obtaining the questions from the lecturers, screening the questions, and re-writing many of them.

  1. Update from the Clinical Curriculum Council

Dr. Michael Nieder, Clinical Curriculum Council Chair, announced that there will be a Foundations of Clinical Medicine retreat to unify components of the new program on Wednesday, July 21

He next focused on solving the challenge presented by the Ob/Gyn clerkship this year.  There will be an initial meeting of the three Ob/Gyn clerkship directors and society deans (the surrogate representatives of the students) to address the problem.  Perceptions that the evaluation methods were not equivalent at all clerkship sites necessitated the changing of some grades this year.  Dr. Nieder explained that 47 students completed a survey of the Ob/Gyn clerkship with some recurring criticisms.  The first step is determining whether the raw data are valid, as this was not a random sample of the class.  Plans have already been made for this analysis.  Dr. Nieder explained that while the School of Medicine does not mandate what the clerkships teach, it can mandate that content is taught to the same goals and objectives and can mandate how mastery is tested.  One suggestion to implement an OSCE brought out the following considerations, the last from an Ob/Gyn physician present at the meeting:  1) The OSCE is expensive due to the involvement of standardized patients, 2) Organizing an OSCE is a great deal of work, and 3) The OSCE is not always helpful in the area of women’s health.  Dr. Nieder plans to address the reality that the Ob/Gyn experience is different at each of the three sites by:  1) meeting with the stakeholders (clerkship directors and society deans), 2) determining whether the data are valid, 3) learning why the convener system is not functioning as well in Ob/Gyn as in the other clerkships.

Discussants made the following points.  When the convener system was created under Dr. Marjorie Greenfield’s tenure as Clinical Rotation Development Council (CRDC) Chair, all stakeholders agreed to the system.  [Excerpted from June 13, 2002 CME meeting, from Patient-Based Program Annual Report for 2001-2002 presented by its Coordinator Dr. Jay Wish:  There exists a “convener” (chosen from among the clerkship directors) for each core clerkship to determine a common set of goals regarding content areas to be covered and a common evaluation process.  Then, each site determines how it wants to meet those goals.]  By our next LCME site visit, we must be able to list across sites the common core problems seen by our students and document that each student either saw or was taught the particular problem.  The LCME requires “comparable objectives” and “equivalent evaluation,” while allowing that the teaching may be different.

  1. Update from the Office of Biomedical Information Technologies

Dr. Thomas Nosek, Associate Dean for Biomedical Information Technologies, announced that the incoming College Program students will be here for computer orientation July 6.  Anyone seeking access to the Cleveland Clinic Lerner College of Medicine eCurriculum, please contact Dr. Neil Mehta (mehtan@ccf.org) for a password.  Dr. Nosek mentioned that the BIT office is currently involved in a major restructuring of the School of Medicine Web site.  During today’s CME meeting, our potential to create a computer-generated examination was mentioned.  In order to do this, we would need key words assigned to each question and a 1,000-question database.  Dr. Nosek reminded that the technology/structure already exist to create a totally online course where faculty are not needed, as suggested by Dr. Loret de Mola.  The Health Promotion/Disease Prevention is one such example.  The BIT office is eager to work with any faculty interested in a similar endeavor.

  1. Concluding Remarks from the Chair

Dr. Altose encouraged faculty leading curriculum initiatives to take advantage of the many valuable resources we have here at Case: the Office of Curricular Affairs, the Office of Biomedical Information Technologies, and the Cleveland Health Sciences Library.  Please check out the many services offered.  Staff are eager to work with faculty in all aspects of curricular and personal development.

See Curriculum Revision Update section.

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