Prior to 2001, the
Musculoskeletal committee was a Year II committee and covered both normal
and pathophysiology. In 2001, two committees were formed. Year I
Musculoskeletal, currently chaired by Dr. Jung Yoo and situated within the
Homeostasis I section, covers normal physiology, anatomy, histology, and
biochemistry, etc. Year II Musculoskeletal, chaired by
orthopaedic surgeon Dr. Brian Victoroff, is combined with the
integument committee and covers all pathology. Dr. Victoroff presented an
overview of the Year II combined Musculoskeletal/Integument committee,
designed to cover the overlapping fields of orthopaedics, rheumatology,
and dermatology.
Dr. Victoroff
described the diversified format of the 40-hour
Musculoskeletal/20-hour Integument committee, consisting of lectures,
small groups, poster sessions, a field trip, and lab. Dr. Victoroff
highlighted the committee’s strengths (including both students’
enthusiasm for the course and a unique interactive exam), problems
(suggesting revisiting the remediation process), and “wish list”
(incorporating Physical Medicine Rehabilitation, reintroducing a
Multidisciplinary Trauma Symposium, re-establishing the career option
panel discussion).
Dr. Kent Smith,
Flexible Program Coordinator, mentioned pending projects seeking
resolution in a timely manner: 1) creation (in collaboration with the
Office of Curricular Affairs) of a standard online elective evaluation
form to be completed by the students, 2) examination of the Areas of
Concentration by the CME, and 3) accurate Flexible Program description
needed in time for publication of the 2004-2005 Curriculum Handbook.
Dr. Smith
continued by presenting highlights of the history of the
electives program using Dr. Thomas Daniel, Emeritus Professor of
Medicine and CME minutes as sources. The early 1970’s marked
the formation of the “elective” program, which was offered but
not required. In 1984, the electives program was renamed the
“Flexible Program,” as steps were taken to offer more structure and
more depth. Dr. Daniel served as the Director of the Flexible Program
from 1984 to 1993. During the curriculum revision in the late 1990’s,
focus was on the basic science and clinical core curricula. However, new
goals to add rigor to the Flexible Program were formulated that aspired 1)
to increase the number of dual degrees awarded to encompass half the
class, and 2) to officially recognize Area of Concentration completion
(one-half the work required for a Master’s degree) by awarding some form
of “certificate.” These plans remained on the drawing board, however, and
were never implemented. The thesis requirement was
tried at Case during the late 1950’s up
until 1965 or 1970, but since there was an inadequate number of offerings
from the faculty, the thesis requirement was dropped. However, some
excellent products emerged during the six weeks at the end of Year I
allotted for thesis work. The original 13 Type A elective requirement
still stands. One notable change was made last year, however, by
allowing Year I students to take one Type A elective during Period 1
with permission from the Committee on Medical Education. This has worked
out well.
Dr. Smith mentioned
some strengths of the Flexible Program: 1) the wide
variety of elective offerings, and 2) faculty enjoyment of the
early individualized student contact in these introductory
experiences. Areas requiring attention include: 1) lack
of integration with the core curriculum, 2) inadequate
evaluation of the electives program (this issue is
currently being addressed as mentioned earlier), and 3) somewhat
inconsistent attitude of students toward the elective
commitment.
From the beginning,
Flexible Program requirements consisted of 13 Type A electives
(Years I and II) and 6 Type B electives (Years III and IV). Type B
electives are usually one-month long rotations. However, some Type B
electives are available as a two-week option. Another example of one-half
Type B elective credit is that awarded to fourth year student preceptors
teaching Physical Diagnosis. Of the current seven and
one-half required Type B elective credits, 6 credits must be clinical.
Clinical electives are defined as involving “either direct
patient care, a support service that impacts on clinical decision making
(such as radiology or anatomic pathology), or medical education involving
patients (as the physical diagnosis precepting).”
Listings of both
Type A and Type B electives
circulated at the CME meeting have a course number for each entry, name of
faculty sponsor, and the number of student subscribers for each of the 5
periods (Type A) and for each of the months (Type B) during the 2003-2004
academic year. Not every elective has unlimited slots available.
Most students take an
Acting Internship (AI), a Type B elective. Heavily subscribed AI’s
include Internal Medicine, Pediatrics, Radiology, Orthopaedics, and
Reading Electives for the USMLE Step II.
Dr. Smith concluded
his presentation by referring to the article “My Favorite Year—Opinions
of CWRU Alumni about their Final Year of Medical School,” written by
Dr. Jack Medalie, Dr. Linda Headrick, and Ms. Pamela Glover and published
on the Primary Care Track Web site in 2000. The article presents the
results of a survey about the fourth year—which is representative of
individual electives chosen by the student—sent to graduates of the
Classes of 1985, 1986, 1987, 1993, and 1998, so as to get resident
perspective and beyond—as well as a few recent graduates at the time who
served as the pilot. “…the vast majority felt that the 4th
year was the best year at the Medical School …and they strongly
recommended not changing the basic concept of student chosen electives.”
In light of the
current examination of the Flexible Program, the following relevant points
were made. Dr. Smith supported using some Type A elective hours as an
introduction to the required research course. It was also pointed out
that currently, one Type A elective credit is given for remediation.
Currently, Type A elective approval has not been rigorous. Should there
be restrictions, discussants recommended consistent pre-requisites for
all electives. It was agreed that all proposals for
Flexible Program electives should have a process where they can be
reviewed, be assessed, and demonstrate rigor. When
questioned whether anyone looks over the student’s elective choices for
cohesiveness, Dr. Smith replied that if the student is not in an Area of
Concentration, the answer has been “no.” The Society Deans plan to
monitor this more carefully. Students have taken whatever they want with
the stipulation that they must earn 13 Type A credits by the end of Year
II. Dr. Altose felt that guidance or oversight is a separate issue. Past
advising/mentoring of students has not been very successful due to too few
explicit expectations for what students and advisers should do. It is
hoped that the current society dean structure will remedy this problem.
When asked how to evaluate the elective proposal and the follow-up
student-based feedback, the Associate Dean for Curricular Affairs
recommended requiring the following proposal for each elective
entry: 1) learning objectives, 2) an implementation, or
action, plan (which for successive years cites specifics to
improve the elective), 3) student assessment for mastery, and 4)
a program evaluation completed by the students. With this
broad-based re-assessment of all the electives, one discussant noted the
different expectations now for medical education as opposed to the
time when the Flexible Program originated. It was suggested that the
Flexible Program Coordinator and his staff use the six-week time slot from
August to mid-September to contact all Period 1 electives sponsors
and get the information requested from them regarding specific learning
objectives, implementation plan, and student assessment description.
Dr. Smith and Dr. Altose will do a preliminary screening and then bring
the results before the CME. The Flexible Program could coordinate with
the student’s thesis topic by both enhancing and contributing time toward
thesis preparation.
