Shield of the SOM Committee on Medical Education
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Summary of 9-14-00 CME Minutes 

1.  Announcements of new CME members:  1) Dr. G. David McCoy, Chairman of Environmental Health Sciences, 2) Dr. Robert Harvey of Physiology and Biophysics, and 3) Dr. James Arnold, Chairman of Otolaryngology Head and Neck Surgery.

2.Dr. Linda Lewin, Co-Director of the CLICS Program, presented the results of a 1999-2000 pilot program for third year medical students.

  • Contemporary Learning in Clinical Settings (CLICS) program originated as a grant that Dr. Sally Hodder and Dr. Clint Snyder wrote to HRSA (Health Resources and Services Administration) focusing on “Undergraduate Medical Education for the 21st Century” (UME-21) by introducing third year students to topics relevant to medical practice but not included in the curriculum.

  • Four individual cases became four separate discussion sessions included in the already existing Primary Care Track (PCT) small group format and were spread out over the year at the three sites:  Henry Ford, University Hospitals, and Metro.

  • Students evaluated the cases after each session via a questionnaire.  Students indicated their interest in the topics by giving high ratings to the case scenarios.

  • Student performance in the CLICS was later evaluated through OSCE stations at the end of the third year.  PCT students take a Generalist OSCE at the end of their third year.  Students participating in the OSCE included a control group of non-PCT volunteers who did not attend the CLICS sessions as well as the generalist students who did attend the CLICS sessions.   PCT students performed better than their non-PCT colleagues on the OSCE stations linked to the CLICS sessions.  (Handout distributed at meeting indicates average numerical scores for each of the two groups on each topic.)  The OSCE format provides a useful evaluation mechanism of what we are accomplishing in teaching CLICS topics.

  • Currently, we do not have a form for testing—no whole-class evaluation after the third year—except for the Primary Care Track OSCE for PCT students.  The idea of a Year III comprehensive OSCE was raised.  It was anticipated that 50 stations and 40 faculty to evaluate and grade the students would be needed.  Discussants expressed enthusiasm over the prospect of having 50 different competencies delineated as learning objectives to be mastered by all students at the end of their third year.   The following motion passed unanimously:  that the CME get input from the Clerkship Directors and the Clinical Rotation Development Council on the idea of establishing a third year whole-class comprehensive OSCE.   This input is to evaluate the potential behind the idea, not to recommend implementation.

3.Student CME Report – Year II student representative Scott Walker mentioned that the Committee of Student Representatives (CSR) entertained considerable discussion on testing in the first and second years.  (This is developed later in the meeting under Other Business.)

4.Setting agenda items for the coming 2000-2001 academic year

The CME is awaiting the report from the Committee on Committees, which reviews all the standing committees and their charges.  Dr. LaManna has already met with the chair, Dr. Michael Maguire.  We are expecting a refinement of the CME charge based on the creation of both the Curriculum Leadership Council (CLC) and the Clinical Rotation Development Council (CRDC).  Once completed, the report from the Committee on Committees will be sent to the Faculty Council.  From there, it will proceed to the general faculty.  The CME is responsible for evaluation of the curriculum.   Again this year, it will entertain the two annual reports introduced last year:  1) Joint Degrees by Mr. Joseph Corrao, Registrar, and 2) Analysis of CWRU Graduate Placement in Residency Programs by Dr. Richard Aach, Associate Dean of Residency and Career Planning.   Dr. Kristi Zakariasen, Director of Curricular Administration, is in charge of the day-to-day running of the curriculum on a full-time basis.

5.Year II Student representative Scott Walker distributed a handout pertaining to students’ perception of the need for change in the current examination system.  The recent modification of the secure exam system as it exists today only evolved last year.   Prior to this, a student could approach the Dean of Students and review the actual secure exam with him to see exactly where mistakes were made.  However, this is no longer possible.  Second year students registered their dissatisfaction with the current system to the Committee of Student Representatives (CSR).  Over 70 first year students have signed a petition to eliminate secure exams.  Acknowledging that there was no intentional plan to undermine the educational mission, Mr. Walker spoke for his student colleagues’ perception that assessment in its current form is impeding the educational mission and needs to be changed.   Delineation of desired student changes follows:

I. Students must have the right to review their exams after receiving their scores and to discuss the exam and specific questions with the relevant Committee Chairperson or other appropriate and knowledgeable instructor.

II. The mean and standard deviation for several previous years should be reported along with each score and the current class aggregate data, so that students may make informed judgments about the relative adequacy of their knowledge base.

III. Each Committee should schedule a formal (post-) review session and print the date and time of such a review in the official printed syllabus.

IV. Any time it is determined that the process of examination can be reasonably modified so as to increase the educational value of the examination without detracting from its assessment value, such modifications should be urged and adopted.

Mr. Walker and his colleagues are seeking the endorsement of the conditions stated above from both the CME and the CLC.   Under current circumstances, students can never see the questions they missed on the exam.

Previously, students could request to see their exams in the Office of Student Affairs with the Dean of Student Affairs.   An unrelated error resulting in the Xeroxing and release of some secure exams led to a subsequent change in policy:  eliminating the students’ opportunity to see questions missed as all exams are shredded and only the examination sheet is scored.  Students feel that the educational component of assessment has been compromised.

Discussion followed on the School’s two responsibilities:  1) education, and 2) assessment, and the impossibility of fulfilling both optimum educational and assessment goals via the same examination mechanism.  The Executive Committee and the faculty have chosen assessment as the dominant priority for the interim exams.  In general, discussants expressed a desire to reinstate the arrangement whereby students could make arrangements to review their exam performance and see what they missed without, however, the release of the exams for students to keep.  Secure exams have yielded the following benefits:

  • Quality questions can be re-used without having to resort to minutia.

  • Data on repeat questions can be accumulated.

  • The examination process has been streamlined.

  • A higher quality comprehensive exam has resulted.

The CME remains unchanged from the policy it had voted on regarding secure exams.  Input from the Curriculum Leadership Council and the Committee on Students is needed before further action can be taken with regard to the student desire for change in the secure exam system as it exists today.

See Curriculum Revision Update

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This page was last updated on 10/10/00 by John Graham.

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