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Summary of June 24, 2004 CME Minutes

  1. Overview of the Year II Musculoskeletal/Integument Committee

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).

  1. Comments from the Chair

Dr. Murray Altose presented the recommendation of Dr. Amy Wilson-Delfosse for the position of Basic Science Curriculum Council Chair.  The CME approved the appointment of Dr. Wilson-Delfosse as Basic Science Curriculum Council Chair.

  1. Report from the Flexible Program Council

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 entry1) 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.

  1. Concluding Remarks from the Chair

Dr. Altose thanked elected outgoing CME members for their terms of service:  Dr. Mireille Boutry, Dr. Hue-Lee Kaung, and Dr. Terry Wolpaw (who will still attend meetings in her capacity as Associate Dean for the Office of Curricular Affairs).  Dr. Altose also recognized Dr. Jason Chao, unable to be present at the meeting, who has been re-elected for another term.

See Curriculum Revision Update section.

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