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Summary of September 25, 2003 CME Minutes

  1. Comments from the Chair

Dr. Murray Altose presented the CME-endorsed nominations of Dr. Linda Lewin as Clinical Curriculum Council chair and Dr. David Katz as Basic Science Curriculum Council chair at the September 22 Faculty Council meeting. The CME in conjunction with the Vice Dean for Education and Academic Affairs will subsequently define the composition of the curriculum councils and develop an agenda for each curriculum council conducive to tracking progress over time. An executive or steering group, consisting of the Vice Dean for Education and Academic Affairs, the CME Chair, the Associate Dean for Curricular Affairs, and the curriculum council chairs, will be established. This group will meet regularly to ensure a common and consistent agenda and effective integration among the various curricular components.

  1. Report from the Student CME

Mr. Michael Buschur , Acting Year II student representative, mentioned the well-received project developed this summer by the Committee on Student Representatives (CSR)—the online exam feedback system that allows students to see their answers following an exam. After the test, students get a password from the committee chairs. They can then log on and access their test answers along with the correct answers to every question on the test. In addition, the committee chairs review the most frequently missed questions. This system has been incorporated into this year's exams and is working very well for both students and faulty.

  1. Update from the Director of Curricular Administration

    Ms. Minoo Golestaneh provided an update on the activities of the Office for Curricular Affairs (OCA) . The Office will be organizing the annual education retreat held at Landerhaven Friday, February 27, 2004 . A steering committee is being formed to determine agenda, speakers, and workshop leaders for the retreat. Please e-mail Ms. Golestaneh at mxg86@cwru.edu with any suggestions you may have. The OCA is trying to formalize a standardized support system protocol for subject committee chairs . While the OCA currently supports some subject committees, they would like to extend their services to all the subject committees. Ms. Golestaneh will continue to work with the Basic Science Curriculum Council members under the leadership of Dr. David Katz. A clinical counterpart to Ms. Golestaneh will be chosen to work with the Clinical Curriculum Council under the leadership of Dr. Linda Lewin.

  1. Update from the Registrar

    Mr. Joseph Corrao announced the revised School of Medicine transcript , designed to provide more information. Individual subject committees are now listed. Core clerkship grades will appear on the transcript for the first time starting with the Class of 2005.

  1. Report from the Clinical Curriculum Council

    Dr. Linda Lewin , Clinical Curriculum Council (CCC) chair, is in the process of determining how best to structure the diverse body comprised of Introduction to Clinical Medicine and Physical Diagnosis directors and core clerkship directors. At this stage, Dr. Lewin tends to view the purpose of the large group as sharing information across the entire curriculum in order to improve integration and continuity. She leans toward smaller working groups to do the actual work; these small groups will meet in between the large group meetings. Dr. Lewin welcomes student representation from all four classes, if possible, on the CCC. Please contact Dr. Lewin with any organizational structure suggestions at lol@cwru.edu .

  2. Report from the Flexible Program Council

    Dr. Kent Smith , Flexible Program Council Coordinator, presented a listing of the most popular Type B electives , the one-month electives taken in Year IV. Almost all students take the Readings in Medicine electives designed as preparation for the USMLE Step 2. Both Drs. Haynie and Smith have each sponsored multiple reading electives, which can be taken by the student anywhere in the United States .

    Dr. Smith next presented a request for the CME to endorse the procedural policy for Type B elective enrollment , seeking CME endorsement as the policy pertains to graduation requirements. Key points of revised Type B elective enrollment policy:

    • Effective January 1, 2004 , students may not retroactively receive credit for a course in which they were not properly registered. All schedules are to be finalized 30 days before the beginning of the elective. A default vacation month will automatically be scheduled should the course not appear on the schedule at the beginning of the elective.
    • Students awaiting consent from an away site are to notify the Office of the Registrar (Mrs. Antoinette Nethery via e-mail axn34@cwru.edu ) to reserve the right to receive Type B elective credit once confirmation is received. Failure to do so will result in the addition of a default vacation month on the student's schedule.
    • Students amending their schedules with fewer than 30 days' notice must contact the sponsor of the replacement/new elective and obtain permission to add the elective. Similarly, students dropping an elective with fewer than 30 days' notice must also contact the sponsor. Sponsors often require prerequisite work prior to the onset of an elective. A student's failure to meet all prerequisites may result in a denial of credit for the elective. Prearranged electives require permission of the sponsor at least 30 days prior to enrollment.

    Students are allowed two vacation months in Year IV. Seven and one-half Type B electives are required for graduation. The student cannot “double up” Type B electives, as a Type B elective represents a one-month commitment. The Office of the Registrar has tried to enforce elective enrollment policy but has lacked the necessary backup—thereby resulting in an appeal to the deans for this codification of policy. The revised Type B elective enrollment policy received a strong endorsement by the CME.

  3. Report from the Office of Biomedical Information Technologies

    Dr. Thomas Nosek , Associate Dean for Biomedical Information Technologies, mentioned current projects:

    • Conversion of the P4 (Portable Patient Problem Pack) PBL cases in Semester II CPDP to laptop format was well received last year by both faculty preceptors and students. Discussions with the Office of Technology Transfer are in progress to commercialize the project.
    • Creation of a template for real PBL cases exists and cases will be available for faculty use within a few months. Actors will portray patients in videos. Multi-media features such as videos, color illustrations, sonograms, lung sounds, and heart sounds can be incorporated.
    • For a number of years, we have had an online student information system. It is used by the Registrar and administrators who need student personal information. This system has been opened to the students so that they can see their personal information (including test scores) online. This system can be expanded to include student ePortfolios , where students can enter their clinical experiences, raise research and clinical questions, and submit reports on various topics. Some of this material can be made available to the society deans for their review or to faculty for evaluation. The system is ready once the faculty have decided what the content of the ePortfolio will be.
    • Using the student information system, a specialized reporting system was created for the society deans , which enables them to familiarize themselves with the students they are advising (see exam grades, some of the Registrar's information, etc.) and enter their own notes online.
    • Collaboration with the dental school to provide all the templates for the SOM eCurriculum so that the Dental School can begin developing a Dental School eCurriculum. Dr. Nosek's “dream” would be the creation of an integrated eCurriculum that includes learning resources for all the Health Sciences schools: the Schools of Medicine, Dental Medicine, and Nursing. A single password would provide access to all resources.

  4. Health Sciences Library Update

    Mrs. Virginia Saha , Cleveland Health Sciences Library Director, reported that the reception celebrating completion of the Health Center Library renovation is scheduled for Friday, October 24, from 4:00 to 7:00 p.m.

  5. Comments from the Vice Dean for Education and Academic Affairs

    Dr. Lindsey Henson recently attended a meeting with Dr. Lewin for all recipients of the clinical transaction skills grant funded by the Josiah Macy Foundation for the New York Academy of Medicine and AAMC . In addition to CWRU, Harvard, University of Washington , and SUNY (the State University of New York ) Upstate at Syracuse , two more schools were added to the list of recipients: SUNY at Stony Brook and Vanderbilt University . The first year of the grant is the planning year and consists of a $50,000 award. The amount awarded for the second and third years of the grant depends on what transpires during the first year. Focus is on how students learn and master three clinical transaction skills during their third and fourth years: 1) history taking, 2) performing a physical examination, and 3) clinical reasoning. Dr. Henson noted that four of the recipient schools plan to use the portfolio concept in assessing students' skills. Dr. Henson stated that 28 medical schools—roughly half the number of existing medical schools—applied for the grant.

    Dr. Lewin added that the consensus among grant recipients seems to be: While clinical transaction skills have always been a basic part of medical education, we need to find out why we are not doing as well as we had hoped. Dr. Lewin also noted the following trends in approaches among the funded schools: 1) use of portfolios for tracking student progress, and 2) use of mentors or advisers to follow students over a period of time.

  6. Comments from the Dean

    Dr. Ralph I. Horwitz , Dean of the School of Medicine and Vice President for Medical Affairs, mentioned his pleasure with faculty and leadership efforts focused on the curriculum and with Dr. Henson's organization of the medical school's educational activities. Dr. Horwitz would like to reinvigorate the curriculum—find a fresh way of continuing CWRU's tradition of innovative education that would move in directions needed for today's changing health care system. The integrated organ system approach, early clinical exposure, and independent graduate school style education conceived at Western Reserve in the 1950's are still valid. However, in order to “restore, recapture, and prioritize” some good things in our curriculum, we will need to streamline our curriculum to elevate research and scholarship to the status that they once enjoyed at this medical school. Dr. Horwitz's goal is to transform American medicine. He would like to unite clinical medicine and the practice of public health. He sees an urgent need for the integration of the public health infrastructure with the delivery of health care across the population. Dr. Horwitz would like to see the creation of a School of Medicine and Health at CWRU.

    Over the next 24 months with a target date of Fall 2005, Dr. Horwitz would like to see the development of a revised and enhanced curriculum to

    • Unite clinical medicine and public health
    • Emphasize research and scholarship with the expectation that each student demonstrate accomplishment in these areas
    • Emphasize mastery of clinical skills
    • Collaborate with Weatherhead to develop a curriculum in leadership as a core aspect of every student's training. Our students need to be familiar with the structure and behavior of organizations and know how to effect change in organizations. Medical school prepares the student for a diverse set of careers.
    • Promote civic professionalism as a “social contract” to counteract erosion of the public's trust in medicine.

    The perspective on health and health care is wide-ranging: from the individual's health to population medicine, from the biology of disease to the social determinants of illness. In order to accomplish such ambitious goals, it is necessary to protect the time of the student . Education occurs not only in classrooms, seminars, and small groups but through independent study , where the student pursues his/her own interests. Allotting more independent time for students means accepting that “nothing in the curriculum is sacred.” Dr. Horwitz envisions this enhanced education as “owned” by our faculty and anticipates their role as proponents of a curriculum that will be enthusiastically desired by our students.

    Dr. Horwitz addressed discussants' questions. When asked about maintaining CWRU's level of diversity , Dr. Horwitz mentioned his intent to maintain the significant enrollment levels of 1) underrepresented minorities, and 2) nontraditional students (those deviating from the high school-undergraduate college-medical school pathway). He would like to see the enrollment broadened to include larger national representation. When asked to expand his definition of civic professionalism , Dr. Horwitz cited “civic” as requiring an interface with broader society. There must be a support organization and financing for the uninsured and the underinsured to enhance health and health care. “Professionalism” is comprised of the values, attitudes, and behavior of the physician or the physician scientist. It entails putting the patient before self-interest. Dr. Horwitz recognized that we already teach professionalism. Professionalism is demonstrated by example, by behavior. The student will encounter both positive and negative models on the wards that will follow in the community. Right now, the students see a chaotic process, with no inventory, no sense of need, and no structural way of evaluating that need. Dr. Horwitz referred to the Primary Care system in the United Kingdom , where students are “embedded” in the system so that they are knowledgeable as to what community services are available for patients both with and without resources. When asked to expand on the fifth year , Dr. Horwitz stated he hopes that all students would elect a fifth year to take full advantage of all of the new academic and scholarly opportunities.

 

See Curriculum Revision Update section.

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