Summary of 6-13-02 CME Minutes
This is the last CME
meeting of the academic year and also marks the end of Dr. LaManna’s
six-year tenure as CME chair. Dr. LaManna announced that the
Faculty Council approved the appointment of Dr. Murray Altose as
the next CME chair and welcomed him to today’s meeting and into his
new position, officially starting as of July.
There was no
formal Student CME report. Year I student representative Mr. Brian
Chow, currently participating in an NIH summer internship, sent the CME a
brief description of the diverse summer activities of the Class of 2005.
The CME welcomed back Year III student representative Mr. Scott Walker
after a busy year of clinical rotations.
The majority of the
meeting consisted of the remaining annual report presentations.
The unanimous conclusion reached was that this had been a good year on
many levels. While there are always areas needing attention,
improvement seems to have been made, reforms and refinements instituted,
high standards met, and progress taking place toward building a strong
curriculum and satisfying students and faculty.
CLC Chair, Dr.
William Merrick presented the Curriculum Leadership Council Annual
Report for 2001-2002. The CLC meets quarterly and just held its
year-end retreat Friday, June 7. Dr. Merrick highlighted new CLC
The proposal of
Drs. Miller and Tomashefski to include a glass slide
histology/histopathology practical as part of the Year I Comprehensive
Examination was approved by the CLC by a vote of 14 in favor and 5
opposed. This proposal has now
been forwarded to Drs. Wile and Malemud, Co-Chairs of the Year I
Comprehensive Examination Committee. This proposal resulted due to the
number of first year students who did not master differential diagnosis by
examining glass slides under the microscope and,
consequently, had problems in Year II Pathology. Students would have to
be notified, even if this exists only as a possibility, at the beginning
of the academic year. Dr. Merrick said that he will request a rapid
response from the Year I Comprehensive Exam Committee once the new
academic year starts. Practicals have never used glass slides. Dr.
Merrick said that there would be a pre-test format including glass slides
during the year in preparation for this activity should it be included in
the comprehensive examination.
The new CLC
constitution now exists in draft form, pending input from the new Vice
provides a definition of the CLC as consisting of all the
committee chairs for the first two years of the curriculum—including
what constituted both the Core Academic Program and the Patient-Based
lists individual responsibilities for teachers and lecturers and
There is a defined
process for replacing the CLC chair, who has a four-year term.
subject committee chair must have his/her department
chair provide a letter guaranteeing support and relief time to
the CLC chair. This requirement came about due to the difficulty that
clinician teaching faculty face often resulting in a 10-20% decrease in
their patient revenue. A five-year commitment is desired for a subject
committee chair. There is no term limit for subject committee chairs.
The CLC has 2
subcommittees. The Student Performance Subcommittee
identifies weaknesses in the curriculum, where we are not sufficiently
preparing our students for entering either the second or the third
year. The main challenge is for this subcommittee to prepare an
evaluation tool to determine these deficiencies.
Performance Subcommittee evaluates performance of lecturers and
subject committee chairs.
the “carrots” (where bonus points are added) and “sticks”
(where points are subtracted) policies on interim exams resulted in
keeping students more current and small groups becoming more dynamic.
Dr. Merrick described
Dr. Wile’s report to the CLC covering student performance relative to
previous first, second, and third years as well as USMLE performance
as “positive on all fronts.” Students performed as well or better than
previously. Only one student did not pass the Year I Comprehensive
Examination. Scores increased on the USMLE Step 1 taken by the Class of
2003 (the current third year class). The average for CWRU students
continues to climb at a faster rate than the national average, and, for
the first time, the subtest mean values in all areas were at or above the
national average. For the first students of the new curriculum currently
just finishing the third year clerkships (the Class of 2003), the NBME
subject (shelf) exam scores are up in all areas.
student evaluations and the LCME report, our students are happy here!
Faculty were highly
appreciative of the efforts by the professional Audio Visual staff
from the Office of Biomedical Information Technologies. The consistency
of having the same person take care of lighting, slides, and computer
issues greatly pleased the faculty.
end-of-year attendance was
examined. This year, Year I student attendance stayed strong across all
committees. During Year II, however, the third- and second-to-last
committees experienced a precipitous fall-off due mainly to students
studying for the USMLE Step 1 and, sometimes, because students had become
self-learners able to master the material without attending lecture
(although still dependent on a good syllabus). However, this is still
extremely frustrating to faculty lecturing to only 10 students.
At the retreat, Dr.
Ted Parran and Ms. Kathy Cole-Kelly presented a future plan to measure
clinical skills and professionalism in quantitative fashion for ICM
(the Introduction to Clinical Medicine program). With respect to
faculty and professionalism, Dr. Merrick mentioned that most faculty
are professional. However, the most disappointing example of
non-professionalism on the part of the faculty were three instances where
Year II lecturers failed to show
Coordinator, Dr. Jay Wish presented the Patient-Based Program
Annual Report for 2001-2002. Dr. Wish mentioned major changes: 1)
the continued “evolution” of the CWRU relationship with the Cleveland
Clinic (our students participate in Neurology, OB/GYN, Family
Medicine, and starting this July Surgery clerkships at CCF), and 2) the
“de-evolution” of our affiliation with Henry Ford, which is
withdrawing the Primary Care Track positions. Three students in the Class
of 2004 will be spending all or part of their third year in the
traditional track at Henry Ford, but individual clerkships are not
Dr. Wish next talked
about outcome parameters. Ms. Minoo Golestaneh has summarized the
student online clerkship evaluations. Approximately two-thirds of
the students have responded as of April 2002 (5/6 year) to provide us with
Web-Based feedback. Using a scale of 1 to 5, with “1” being the best
rating and “5” the lowest, most clerkship sites ranked in the 1 to 3
range. Most ratings are close to last year’s scores, demonstrating a
consistency in the sites. Other valuable feedback came from the
student-initiated self-study of the curriculum for the LCME accreditation
review, which included an evaluation of CLICS (Contemporary Learning in
Clinical Settings). A bi-modal distribution emerged with regard to
CLICS: one/third of the students highly enthusiastic, while one-quarter
of the students feeling that the time could be better spent elsewhere.
Dr. Wile had provided a summary of the NBME subject exam performance
for Cleveland sites for the Classes of 2003, 2002, 2001, and 2000. Dr.
LaManna clarified descriptors of the following third year
Class of 2003: the
first class to go though the new two-year curriculum and
the second class to go through the 12-month core clerkship third year
Class of 2002: the
first class to go through the 12-month core clerkship third year
Class of 2001:
went through the 13-month transitional core clerkship third year
Class of 2000: had
the original 14-month core clerkship third year (1998-1999).
There has been a
shrinking or disappearance of failure to achieve the minimum level of
mastery on the NBME subject exams. Dr. Wish considered the consistency of
performance across the various clerkship sites a remarkable achievement.
All the clerkship directors meet quarterly. 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. Dr. Wish described his own job as the Patient-Based
Program Coordinator as overseeing implementation of the
Patient-Based Program. It is the CRDC (Clinical Rotation Development
Council) that looks at opportunities for continuous improvement.
Discussion followed. The integration of Family
Medicine and Internal Medicine led to increased scores on the NBME subject
exams. The organized delivery of the educational core content also
helped. Lectures are no longer randomly scattered throughout a
clerkship. Every clerkship has one half-day didactic session each week
that enables incorporation of orphan topics appearing on the NBME subject
examinations that have previously been absent from the third year
curriculum. A few discussants pointed to the need to review data
presented in the tables more critically, particularly if we want to
distribute these figures. Dr. Altose inquired where the NBME subject exam
score data and clerkship site evaluations go. He was interested in the
data reaching the institutions—the educational deans of the hospitals. He
would like to concentrate on sharing the information with people who are
the stakeholders. Currently, the Patient-Based Program Coordinator, the
CRDC, the CME, the Vice Dean, and the clerkship directors receive these
statistics. Again, discussants advocated making certain that the
clerkship site data were comprehensive and correct. It was pointed out
that it would be July before we receive all the NBME scores. Brief
discussion favored keeping the end-of-year reports in June and perhaps
having an update in September.
Cole-Kelly presented the
Macy Initiative in Healthcare Communication Update. This is the
fourth year of the Macy initiative. The first year was for planning. The
last two years have been spent implementing the workshops with each of the
core clerkships. The workshop topics were negotiated with the clerkship
directors after a survey sent to all clerkship directors and other
significant stakeholders in Year III. Feedback from student focus groups
was also taken into consideration. Communication issues are in the
forefront of medical education. The focus was on choosing useful topics.
Through the Macy workshops, standardized patients were used in the
clerkships, and they were very well received by the students. Ms.
Cole-Kelly distributed a handout listing the topics with “scenarios,” for
each of the six core clerkships and the various time allotments.
Medicine: Screening for Addiction with the Chronic Pain Patient:
Sickle Cell Anemia
Talking with Multiple Family Members with Differing Perspectives
for Domestic Violence with the Pregnant Patient
Giving Bad News
and Shared Decision Making
Each workshop happens
during every clerkship cycle, and everyone has all six experiences. At
the meeting, Ms. Cole-Kelly circulated a sample set of pocket-sized
laminated “cue cards”—each card containing key points for that particular
scenario. Ms. Cole-Kelly hopes that we will be able to put this material
on the e-Curriculum so that students can download it onto their Palm
Pilots. Ms. Cole-Kelly explained that the students learn their
communication skills from the role modeling of their clerkship directors
demonstrating the skill, from the standardized patients, and from their
peers’ feedback. The students use a checklist to evaluate the role
model—the clerkship director. Later, the checklist is used in turn to
evaluate the students. One student specifically recommended that “the
residents should get this.”
Ms. Cole-Kelly also
spoke of a new initiative that is being explored that would involve a
collaboration between the medical school and the teaching hospitals. With
the ACGME (Accreditation Council for Graduate Medical Education) now
requiring residencies to demonstrate how they are teaching and evaluating
interpersonal and communication skills as well as professionalism skills
(as two of the six ACGME competencies), Ms. Cole-Kelly felt it made great
sense to protect the investment of teaching these skills to our third
years, to improve the skills of the teachers of the third years (interns
and other residents most often), and to meet the ACGME requirements by
offering a series of workshops for interns in the hospitals. Using the
expertise of those involved in Macy, as well as collaborating with other
interested parties at each hospital, Ms. Cole-Kelly would like to start an
initiative that would meet these needs. She has met with Dr. Charles
Emerman of the MetroHealth Medical Center’s Emergency Medicine Department,
who chairs Graduate Medical Education (GME) at Metro, and Dr. Lou Binder,
faculty member in Emergency Medicine who has an interest in this area.
Ms. Cole-Kelly would like to see collaboration between the hospitals and
medical students so that interns would be evaluated on the basic
communication skills that all interns should be able to demonstrate.
Then, remediation and more advanced skills could be negotiated with each
residency. Ms. Cole-Kelly and Dr. Binder are developing a proposal to be
presented at the GME meeting at MetroHealth Medical Center for
implementing a pilot project. Ms. Cole-Kelly felt it would be very
exciting to have CWRU, in collaboration with the hospital, be actively
involved in medical education from the entering first undergraduate year
through the seventh year occurring during postgraduate training.
There was an interest in seeing those involved in teaching third year
students participate in the Macy communication skills program. All the
clerkship directors have been supportive. Both Dr. Hundert and Dr. Henson
are perceived as wanting more interaction with residency medical
education. Our “partners” in the Macy initiative, New York University and
the University of Massachusetts, also appear to be doing well.
Communication skills has been recognized as a “hot topic” and is included
in the new ACGME (Accreditation Council for Graduate Medical Education)
guidelines. Dr. Armitage would like to pass out the pocket-sized
laminated cards that Ms. Cole-Kelly circulated at today’s CME meeting to
use with his Medicine residents at University Hospitals.
CRDC Chair, Dr.
Chris Brandt, presented the Clinical Rotation Development Council
Annual Report for 2001-2002. The focus of this past year has been to
review and assess the Year III curriculum, implemented in its revised form
in the 2000-2001 academic year. Review and assessment occurred mainly via
monthly meetings of the Steering Committee, retreats of the CRDC faculty
and CRDC Steering Committee, and a focus group composed of some Year III
students. We are in good shape, as evidenced particularly by student
evaluations and examination scores and Dr. Aach’s survey on CWRU
graduates’ performance as residents. The CRDC endorses continuing
support of the Macy and CLICS programs. As the Macy money runs out in
January, Dr. LaManna suggested that Dr. Brandt contact Dr. Henson in
reference to the educational endowment budget. Dr. Wile mentioned that
the Class of 2005 will be the first class to take the USMLE Step 2½, if it
is implemented as originally planned.
rotations interspersed throughout Year III are not working well. They
tend to be observational. They are difficult to schedule and
Department faculty feel that they cannot achieve all their educational
objectives given the amount of time allotted them. The CRDC did look at
alternative configurations; however, they caused too many other
disadvantages, thus, discouraging change at the present moment.
However, the ongoing Psychiatry rotation configuration issue will be
Students in the
current Year III 12-month core curriculum have limited exposure to
certain areas, such as otolaryngology, ophthalmology, dermatology, and
anesthesia, from a career standpoint. One option is to shorten the
second year and use some of that time. Students can currently go
through the Patient-Based Program Coordinator to postpone the
Neurosciences core clerkship until the fourth year to participate in the
aforementioned fields. Students need a letter of reference by July or
August prior to the fourth year for certain specialties in the Early
Dr. Brandt mentioned
the CRDC Steering Committee’s desire for an end-of-third-year OSCE for
all students. Currently, the OSCE takes place only in the Primary
Care Track and in the Medicine clerkship. Reasons for this comprehensive
OSCE include: 1) anticipation of the USMLE Step 2½, and 2) providing an
alternative means of evaluating students that can be formative. The Year
III comprehensive OSCE will require additional resources to support the
required standardized patients and space. The Year III OSCE would fit in
well with the proposed Mount Sinai Clinical Skills Center.
In addition to the
Year III comprehensive OSCE, the CRDC plans to look into the establishment
of continuity clinics for all Year III students, enhancement of the
electronic and PDA-based curriculum, and collaboration with the Cleveland
Clinic faculty to form the clinical curriculum of the Cleveland Clinic
College of Medicine (CCCM) of CWRU.
Dr. Brandt recognized
the valued contributions of those serving on the CRDC Steering Committee
outgoing CME Chair, Dr. Joseph LaManna
Dr. LaManna thanked all those people who served on the CME
during the course of the past six years, a period which spanned two
comprehensive LCME reports and the revision of the CME Charge. Dr.
LaManna believes that our medical school is better now than it was six
years ago. He felt that our overriding concern has always been the
betterment of the students. Two items remain for the CME as “unfinished
business:” 1) the “vertical” themes, and 2) the Flexible Program
revision. In looking to the future, he strongly encouraged the CME to
take as proactive a stance as possible in the CCCM initiative so that it
becomes a collaborative effort for students and faculty of both
institutions. We have the potential to provide the best medical education
possible in the city of Cleveland. Dr. LaManna feels that we have
succeeded in establishing an infrastructure that enables us to adapt our
curriculum whenever necessary. We might normally be poised for a letdown
finding ourselves at the end of a major revision. (The first class of the
“new curriculum” graduates next year.) However, instead, Dr. LaManna sees
us infused with a new sense of enthusiasm that accompanies change: the
deepening relationship with the Cleveland Clinic, the appointment of a new
Vice Dean for Education, and the appointment of a new university
president. Dr. LaManna invites us to welcome the challenge and
Revision Update section.
Return to CME Home Page