September 23, 2004 CME
Report from the Basic Science Curriculum Council
Dr. Amy Wilson-Delfosse,
Basic Science Curriculum Council Chair, presented highlights of the
council’s first meeting, held September 14.
Horwitz addressed the council
on curriculum reform
Dr. Tim O’Brien,
Year II Hematology/Oncology co-chair, explained the immediate audience
response system as used in his committee. Students take a mini-quiz at
the end of a lecture and then discuss the results. One function of
the Basic Science Curriculum Council is to share teaching innovations.
Dr. Nick Ziats,
Year I Histopathology chair, provided an introduction to this integrated
committee, which incorporates longitudinal pathology into histology as
of this year.
Bligh-Glover provided an
overview of the tutoring program.
Dr. Terry Wolpaw
announced the series of faculty development opportunities that will be
Another major issue
addressed was that of student attendance—at lectures, small groups,
patient-attended clinical correlation conferences, and team-based learning
experiences. Recognizing attendance as 1) an important component of
professionalism, and 2) fostering a positive learning experience, basic
science council members recommended requiring attendance at small groups,
patient-attended clinical correlation conferences, and team-based learning
experiences. Discussion examined various aspects of the attendance
problem and its repercussions, how attendance can be improved by changing
the intellectual culture/assessment, yet ended with reluctance of the CME
to endorse mandatory attendance.
mentioned that Year II student Ms. Shernett Griffiths conducted a survey,
resulting in student support for required attendance at clinical
correlation conferences and team learning activities. Students were
opposed, however, to requiring small group attendance. Dr. Wilson-Delfosse
mentioned that student attendance at small groups is skewed, as
students often ignore their assigned small group assignment to attend a
different group led by a faculty member perceived to be a superior
One means of
increasing student attendance at small groups is having individual
students lead the groups. One CME member, a clinician and also a
participant in the Hematology/Oncology committee, noted that for the first
time in his 15 years, a student leader failed to show up and he had to
lead the small group. Attendance is never optional in clinical
activities—the absent student risks failing the clerkship or a
substantially lowered grade.
member supported the development of professionalism but noted that the
design of our current exams allows students not attending class to pass at
the same rate as those who do show up. Merely reading a text/syllabus
and taking a test is like passing a “correspondence course.” In his
opinion, we offer little to those students who attend class; there is a
need for a value-added component. He placed responsibility on both
parties: 1) students to be accountable,
and 2) course directors to set a higher standard, incorporating the
student’s interaction with the faculty in the assessment.
discussion developed along two themes: 1) incorporating a “value-added”
component that only classroom attendance makes possible, and 2)
re-designing assessment to measure what the student has gained from that
value-added experience. Focus, for the most part, was on small groups and
how we use them.
mentioned the council’s rationale behind mandating required attendance.
There is a desire for conformity among subject committees.
Inconsistency has been a problem in the past. Additionally, the
curriculum reform will require teaching the students very differently. As
a proactive step, why not address small group learning now?
acknowledged the demonstrated skill of our students in passing
multiple-choice-question exams—interims, the Year I Comprehensive
Examination and the USMLE Step 1. However, multiple-choice-question
examinations reflect “surface” learning. Small group learning
should be different from a mini-lecture. The small group is the venue
where the students struggle with the issues, gain knowledge from their
peers, and learn to articulate their conceptual thinking. How do we use
the small group setting as a method of assessment? We need to be able to
create enough continuity over a committee so that some assessment occurs
in small groups. We need innovative ways to assess students in small
group. Students can be assessed for their preparedness and participation
in the group process using a 5-point Likert scale, for example. A move
away from multiple-choice-question examinations is anticipated in the new
curriculum, and an Alternative Assessment Committee is exploring new ways
to assess student performance.
Variations in the
size of small groups and its impact were discussed. A “small” group
of 25 students over a three-week-long committee cannot be viewed the same
as a Foundations of Clinical Medicine continuity group of 8 or 9 students
staying together for three years. Basic science small groups range in
size from 20 to 50 students per group. This large number of students per
basic science small group has basically been determined by the number of
rooms available in the medical school. The basic science course directors
have been restricted to six rooms of 25 students each for their small
group teaching. Additionally, Foundations of Clinical Medicine has
required small group attendance since inception of its various components;
there was never a need to mandate a policy change.
drawbacks of mandating attendance were mentioned. Monitors would be
needed. The society deans would be forced into an adversarial
relationship with students failing to attend class. What would be the
consequences for a student failing to attend?
There was consensus among
CME members on the importance of professionalism, especially in
regard to any activity involving patients. In the clinical
program, there are established repercussions for students failing
to attend Family Clinic or their clerkships. Dr. Wilson-Delfosse
mentioned that during Years I and II, a significant percentage of students
fail to attend class when a patient is brought in. One discussant’s
suggestion requested that the Dean issue a letter via the ListServ stating
the expectation that all students be present, in proper attire, and
demonstrate a professional attitude when patients are brought to class.
A suggestion to improve small group attendance was inclusion of parts of
the value-added evaluation in the Dean’s Letter. This practice already
occurs, as CPDP small group comments for highly motivated students are
quoted verbatim in the Dean’s Letter.
In conclusion, Dr.
Altose stated that although the CME believed in the importance of
attendance, it did not consider that legislating mandatory attendance even
in small groups, clinical correlation conferences, or team-learning
activities in the subject committees would be helpful or productive.
He suggested that Dr. Wilson-Delfosse take back to the subject
committee chairs the charge to enhance small groups—make them more
attractive and productive—and come up with new ways to assess the students
in their small groups, as suggested earlier in the meeting. It had
also been suggested earlier to link assessment—not only of the material
but also of group process—to the small groups. Perhaps the basic science
council members could elaborate on the size of particular groups, the type
of teaching that goes on—for suggestions on improving them. Dr.
Wilson-Delfosse stressed that without the CME endorsement of required
attendance, it would be up to each course director to decide his/her own
assessment and the issue of establishing consistency across subject
committees would remain unresolved.
Report from the
Clinical Curriculum Council
Dr. Michael Nieder,
Clinical Curriculum Council Chair, reported that all Type B
electives—including all Acting Internships (AIs)—will be on the
same four-week schedule for the 2005-2006 academic year. With the CCC
Chair’s support, the Registrar has been working on getting the clerkship
directors to return the core clerkship evaluations in a more timely
manner. Dr. Nieder mentioned that Dr. Wile has done an analysis on the
NBME subject (shelf) examinations. Dr. Wile added that there will be one
change in the passing score established on the NBME Surgery Subject
(shelf) Examinations. For the 2004-2005 academic year, Surgery will use
the “NBME Quarterly Norms for Examinee Performance.” Surgical clerkship
students must achieve a minimum passing score of the 10th
percentile on the NBME Surgery Subject Examination. Quarter 1 percentile
ranks were used on the August 27, 2004 examination and will be used on the
October 22, 2004 examination; Quarter 2 percentile ranks will be used for
the December 17, 2004 examination; Quarter 3 percentile ranks will be used
for the February 25, 2005 and April 22, 2005 examinations; and Quarter 4
percentile ranks will be used for the June 17, 2005 examination. The 10th
percentile in Quarter 1 is 56; 59 in Quarter 2; and 60 in Quarters 3 and
4. As students tend not to do as well early on in surgery, the NBME pass
mark changes to offer a “handicap” and provides equivalence across
Report from the
Dr. Kent Smith,
Flexible Program Coordinator, mentioned successful implementation of a
policy change authorized last year by the CME: Permission for Year I
students to take 1 Type A elective during Period 1. Dr. Smith suggested
another agenda item for CME consideration at a future meeting:
Are additional hours related to a course permissible as an elective?
Report from the
CCLCM Curriculum Steering Council
Fishleder, Cleveland Clinic Lerner College of Medicine Curriculum
Steering Council Co-Chair, mentioned that all 32 CCLCM students
successfully completed the nine-week summer basic science research block
by producing a research project and presenting an oral presentation on
their research. The LCME visit to the CCLCM took place September 12, and
a written report is expected within three or four months.
Sciences Library Update and Discussion
Mrs. Virginia Saha,
Cleveland Health Sciences Library Director, announced the completion of
the library’s orientation season for the students. This year Mrs. Saha
and her staff presented a full-class lecture in E301 for Year I medical
students that coordinated with research topics for the Fundamentals of
Medical Decision Making (FMDM) subject committee.
Based on her own
experience working with our medical, dental, and nursing students, Mrs.
Saha indicated an area needing attention. Our students seem to know
little about the organization of literature: the fundamentals, “key
words” vs. “subject headings,” their erroneous assumptions that Google is
a research database and that short-lived URLs can be used as footnotes.
The problem extends to faculty as well. Investigators using animals in
their research must comply with Federal requirements for literature
searches on unnecessary duplication and alternatives to using animals and
must search at least two (2) databases to satisfy the law. Beyond trying
a keyword search in PubMed, many faculty are frustrated and ineffective in
trying to search another database. Mrs. Saha emphasized that the library
staff would like to be more responsive in helping students and faculty
learn these skills at the time when such instruction will do the most
good, i.e., when there is a real need to use them.
The topic of critical
thinking and searching skills led to the following observations/responses
curriculum fosters over-reliance on the syllabus. Perhaps in the new
curriculum, we could mandate use of the primary scientific literature.
The new Foundations
course has integrated a mentored component on how to approach the
medical literature. Students will read a journal article and appraise
it the following week. Foundations seeks to address the past
inconsistency of expectations in critiquing the scientific
literature and lack of guidance.
The AAMC has
learning objectives on this topic. Perhaps we could integrate them into
the new curriculum or each of the subject committees.
- What are the expectations
for students in medical school? The BSTP (Biomedical Sciences Training
Program) has a course to teach its graduate students how to read and
dissect a manuscript. Mrs. Saha added that we are still talking
about how to equip our students to find the manuscript!
Dr. Altose summarized
a common theme that also occurred earlier in the meeting: How do we
promote the desire to go “beyond the syllabus” among our students? At
every student feedback lunch, students request that more material be
included in the syllabus. The expectation among Case students seems to be
that everything in the first two years should be included in the
syllabus. How do we change this culture?
One solution could
consist of explicit learning objectives including references to primary
program will give quizzes on the journal articles that students are to
read prior to coming to class.
multiple-choice-question examinations tend to focus on details contained
in the syllabus, essay examinations would not be as dependent on the
syllabus. “Assessment drives learning.”
The CCLCM summer
course requires students to use the literary search skills that they are
taught, as they go out and develop answers to the problem sets that they
A few years ago,
the Internal Medicine/Family Medicine clerkship had librarians teach the
students evidence-based learning skills for a year. Student input was
that they already knew these skills, and subsequently, this teaching
activity was dropped. Today, unlike a few years ago, Year III students
are not doing the required reading and are coming to class unprepared.
Dr. Altose summarized
the issues raised during discussion:
Do our students
have the skills necessary to find the appropriate material in a
reasonably efficient manner?
Students are not
using what they find. They are not “engaged.”
How do we structure
what we do to promote the students to look “beyond” the syllabus?
What steps do we take
between now and the curriculum renewal project? What are our plans for
immediate change and for long term change? One member suggested that the
CME could define values that should characterize the new curriculum. Dr.
Altose proposed that the CME revisit the “Guiding Principles for a New
Curriculum,” developed by the Curriculum Work Group, that he presented at
the September 9 CME meeting.
Update on Faculty
Dr. Terry Wolpaw,
Associate Dean for Curricular Affairs, announced the new
faculty development workshop series designed for this year and offered
under the auspices of the Office of Curricular Affairs. The initiative
began with an e-mail survey to CME, Basic Science Curriculum Council, and
Clinical Curriculum Council faculty, requesting individual preferences
with regard to day, time, and site for workshops offered as well as
preferences from among 20 suggested topics with a write-in option for
personal interests. The goal of the initiative is the encouragement of
personal growth via a substantial and scholarly effort that can be noted
on the curriculum vitae. Faculty participating in the program have four
To earn a
Certificate in Active Learning, a multi-session lecture
development series, led by Dr. Mark Gelula (visiting Case from the
Department of Medical Education at the University of Illinois at
To earn a
Certificate in Team Learning, application of a small group
technique to the large group setting via a multi-session series, led by
Dr. Dan Wolpaw
To earn a
Certificate in Teaching and Learning, individual choice to attend
any 6 of the 11 topics offered and selection of one teaching
intervention to use in actual teaching and evaluate, led by Dr. Terry
To attend on a
session-by-session basis with no certificate
The eleven different
theme sessions will be repeated and offered at various times, dates, and
See Curriculum Revision Update section.
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