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Summary of June 12, 2003 CME Minutes

  1. Dr. Louis Binder served as Acting Chair in Dr. Altose’s absence.
     

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

Dr. Lindsey Henson provided follow-up on her discussion of reorganization and curricular governance at the last CME meeting.  Evolving responsibilities of the three new councils as envisioned by Dean Horwitz, the CME chair Dr. Altose, and the Vice Dean for Education follow:

  • Basic Science Curriculum Council will be responsible for basic science content in all four years of the curriculum.

  • Clinical Curriculum Council will deal with clinical education and training over all four years of the curriculum.

  • New Curriculum Council will oversee the curriculum pertaining to scholarship, civic professionalism, leadership, and bioethics over the four-year curriculum.

A Curricular Advisory Committee, comprised of the Vice Dean for Education and Academic Affairs, the Chair of the CME, and the Chairs of the Curriculum Councils will meet weekly and serve a coordinating and integrating function.  In order to have the new curriculum in place by 2005, a template needs to be completed by the end of this coming 2003-04 academic year.  Ms. Minoo Golestaneh, Director of Curricular Administration, will concentrate her organizational efforts on the basic sciences, while a new “counterpart” position will be created for the clinical operations of the curriculum.

The Year II faculty have agreed on a new calendar.  For the coming year, the original August 4 start date stands.  However, the GI/Metabolism/Nutrition committee has been reduced by 4 days during spring semester.  It is anticipated that some of the cut GINUT material may be incorporated into the small group format ICM (Introduction to Clinical Medicine) and/or CPDP (Core Physician Development Program).  Starting with the reduced-hour 2004-05 academic year, Year I students will get ten full weeks of unscheduled time between the first and second years to accommodate participation in scholarly/research projects.  Dr. Henson designated the academic calendar as the purview of the Dean but described the evaluation process as the responsibility of the faculty.  The faculty might want to examine assessment measures of student performance in light of the new curriculum.  A Year I academic schedule for 2003-04 and 2004-05 should be ready and available at the June 26 CME meeting.

  1. Report from the Curriculum Leadership Council

Dr. William Merrick, CLC chair, summarized the final CLC retreat held Friday, June 6.  Dean Ralph Horwitz presented his vision of CWRU medical education as promoting 1) scholarship, 2) mastery of clinical skills, 3) leadership skills, and 4) public health integrated with civic professionalism as part of the curriculum.  Dean Horwitz also mentioned the possibility of 1) a required thesis, and 2) a five-year medical school curriculum, although it has not been decided whether these features would be 1) required of all students, or 2) offered as a track or an enhancement for a subset of the students.  The question-and-answer period focused on two areas.  One major issue raised at the February 28 medical education retreat:  the need for resources so that faculty, particularly the clinical faculty, can fully participate in teaching.  Dr. Horwitz indicated that there would be resources, but no details were given at the time.  The second point of discussion concerns the development of a new curriculum.  The new curriculum is to be a partnership between the faculty and administration.  Dr. Horwitz cited the CWRU School of Medicine bylaws (CME Charge: Article I, first sentence) which state that the faculty are responsible for the development, delivery, and evaluation of the curriculum. 

Dr. Merrick highlighted examples of effective teaching from the viewpoint of a subject committee chair.  More faculty, often pairing of basic science and clinical preceptors, seems to be key in effective teaching.

During the coming year, the area formerly serving as both the student desk and lab space will become only the student desk area.  Per OSHA (Occupational Safety and Health Administration) regulations, no laboratory work can be done in the student study areas, with the exception of glass-mounted histology slides.

  1. Year-End Patient-Based Program Report

Dr. Jay Wish is concluding his ninth and final year as Patient-Based Program Coordinator.  The Patient-Based Program extends over all four years of the curriculum.  The first two years include 1) the Clinical Learning Groups (CLG’s)—formerly known as Tuesday morning preceptor groups—of ICM (Introduction to Clinical Medicine), 2) Physical Diagnosis, 3) Family Clinic, and 4) the Interviewing Program.  The third and fourth years deal with the core clerkships and Type B electives.  Annual summary documents were provided by the following individual course directors:  1) Physical Diagnosis by Director Baha Arafah, M.D., and 2) ICM by Co-Directors Kathy Cole-Kelly, M.S., M.S.W., Ted Parran, Jr., M.D., and Elizabeth Patterson, M.D.  (ICM report covers Clinical Learning Groups, Interviewing Program, and Family Clinic.)

Dr. Wish mentioned that we have completed the third successive year of the 12-month core clerkship third year.  He deemed it “reasonably successful,” although somewhat hindered by fragmentation of some clerkships, which will be corrected by the new more flexible format for the coming year.  Starting with the 2003-04 academic year, all students are required to complete the Medicine/Family Medicine 16-week block during the third year.  All other clerkships can be completed during the fourth year, allowing students to take electives during the third year, as many have requested, to prepare for residencies which are extremely competitive or have an early match.  Under the just completed 12-month core clerkship year, students desiring exposure to such early match specialties as ENT, Ophthalmology, and Neurosurgery and requiring subsequent postponement of core clerkships were dealt with by the Patient-Based Program Coordinator on a case-by-case basis.  In the new format, the fragmentation of both Psychiatry and Pediatrics has been eliminated.  There has been a major effort to develop several new two-week electives, as two weeks of elective time will be available at the conclusion of the new six-week Ob/Gyn clerkship and at the end of the third year.

This past year marked the loss of the Henry Ford clerkship site.  The Cleveland Clinic Foundation was able to offer all clerkships except Medicine, Pediatrics, and Psychiatry.  For the coming academic year, Clinic offerings will be expanded to include all core clerkships.

Since 2000-01, a Web-based mechanism has been in place for students to evaluate their clerkship experiences.  However, an electronic problem has prevented the downloading of student feedback since October 2002.  Consequently, the data furnished from July 2002 through October 2002 are not truly representative of the yearlong experiences of the entire class.  While there seems to be a transition period until as high a number of Web-based evaluations is received as that of the paper copies, the merits of online evaluations were stressed.  Immediacy of feedback and, particularly, typed comments needing no transcription were mentioned as priorities.  In response to a suggestion requesting proof that each student had completed a clerkship evaluation, Dr. Nosek offered to design a validation screen that would release a ticket allowing the student to enter his/her next rotation.  The CWRU culture recognizes providing feedback as a student’s responsibility.

The Year III CLICS (Contemporary Learning in Clinical Settings) small groups program headed by Linda Lewin, M.D., and Kathy Cole-Kelly, M.S., M.S.W., completed its third successive year.  CLICS groups meet the third Tuesday of each clerkship rotation.  Students explore topics on professionalism, ethics, and communication skills relevant to clinical practice.

When discussing the Family Clinic, Dr. Wish mentioned that the biggest challenge this year was an organizational issue caused by the Ob/Gyn departmental turnover at University Hospitals which impacted on students receiving their patients.  There may be a shift toward more geriatric patients or non-OB patients in the future.

Dr. Wish recognized the evolution of the roles of both the Patient-Based Program Coordinator and the Clinical Rotation Development Council (CRDC) that will soon make way for replacement by the new Clinical Curriculum Council as the oversight structure for the four-year clinical education curriculum.  It is anticipated that a modified third year clinical curriculum will be ready in 2006 to accommodate both “College” and “University” students taking their clerkships together.

  1. Sexual Health as a Vertical Theme

Sheryl Kingsberg, M.D., Assistant Professor of Reproductive Biology and Psychiatry, explained the global appeal of the Sexual Health curriculum for use by any medical school and its more immediate focus as the development of a cross-disciplinary vertical theme on the password-protected CWRU eCuriculum.  The World Health Organization (WHO) and National Institutes of Health (NIH) have declared it the physician’s responsibility to manage the sexual health concerns of patients and have proclaimed sexual health education for physicians of the highest priority.  Physicians are expected to be competent in providing sex education and counseling.  The WHO plans to promote sexual health as one of its major themes in the period from 2004-07.

Encouraged two years ago by Dr. Smith and Dr. Wish, Dr. Kingsberg successfully applied for one of the seven $100,000 grants offered by Pfizer to enhance the sexual health curriculum in north American medical schools.  The feeling that a comprehensive sexual health curriculum would ably fulfill the role of a viable, sustainable vertical theme at CWRU was included in the proposal.  The proposal’s primary objectives for teaching sexual health are to achieve:  1) attitude change among students—particularly to recognize biases and dispel myths, 2) behavior change—particularly to improve communication skills, and 3) knowledge acquisition about all aspects of sexual health.

Dr. Kingsberg mentioned why we are ready for this theme:

  • CWRU ranks in the top 10% of medical schools in number of hours of sexual health content.

  • Sexual health content runs across all four years and does not necessitate the increase of lecture hours.

  • Our biotechnology advances and the eCurriculum are enabling delivery of this curriculum in electronic format.  It is anticipated that the Web site already in development will serve as a clearinghouse for the best sexual health-related Web sites.

Dr. Kingsberg gave a Web demonstration of the Sexual Health vertical theme.

Dr. Kingsberg concluded by mentioning that the Sexual Health vertical theme is sustainable, does not require an investment of more resources, and does not require more hours in the curriculum.  There is much interest in CWRU’s sexual health curriculum among external parties; CWRU could be putting this established curriculum to much better use.  Several discussants wanted to vote to approve Sexual Health as a vertical theme.  However, due to plans to change the curriculum, it was decided to table the vote for approval at this time.

 

See Curriculum Revision Update section.

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