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Summary of October 14, 2004 CME Minutes

  1. Report from the Student CME

Mr. Chris Utz, Year II student representative, mentioned that the mandatory Health Care Symposium held at the Cleveland Clinic October 4 was enthusiastically received by Year I and II students, with one request:  that both students and faculty be notified well in advance of required events for planning purposes.

Mr. Utz was unable to attend the September 23 CME meeting and wished to respond to several issues raised at that time.  Attendance at small groups is related to the “value-add” of the small group.  Some small groups are well attended.  Mr. Utz cited those of Hematology/Oncology as an example of a valuable learning experience.  In addition, individual preparation varies greatly among preceptors and this influences the “skewed” nature of student attendance at small groups.  Basic Science Curriculum Council Chair, Dr. Amy Wilson-Delfosse explained that Dr. Tim O’Brien’s small group conferences in the Heme/Onc committee were very poorly attended this year.  Dr. Wilson-Delfosse referred to the self-perpetuating “cycle”—students do not come causing preceptors not to invest much in their preparation for small group, etc.  Both Mr. Utz and Dr. Wilson-Delfosse agreed that both sides (students and faculty) have to come together.  One incentive to attending small groups raised at the last CME meeting was basing student assessment on the value-added component(s).  Mr. Utz cited the recent example of the Pathology lab/small group that requires a pre-lab quiz on the reading—the Individual Readiness Assurance Test (IRAT).  Everyone participated and seemed to enjoy that small group.  In addition, the quiz contributes to the student’s final Pathology grade.

Mr. Utz wished to revisit the syllabus vs. reference sources discussion.  Yes, it is true that most Case students regard the syllabus as pivotal.  Should the decision be made to diminish the role of the syllabus or to do away with the syllabus altogether, Mr. Utz urged these two recommendations be taken seriously: 1) Do this consistently across all subject committees, and 2) Improve the learning objectives for each lecture.  At the February 12, 2004 CME meeting, Dr. Nosek had mentioned the existence of a program containing all primary texts in electronic format. While expensive for the students, such an option, suggested Mr. Utz, might be cheaper in the long run than buying textbooks for two years.  Sections made available via a site license could be printed out in place of the syllabus.

With regard to research skills, Mr. Utz mentioned that many students are adept at using both PubMed and Google.  Cognizant of its limitations, Mr. Utz nevertheless described the “Google” database as “under-appreciated.”  More students would use eMedicine if they had a subscription to the site.  The Cleveland Health Sciences Library Director mentioned the advantage of a site license with regard to efficiency and the ability of the user to access it from anywhere.  Mr. Utz did not think many students were currently using MDConsult, even though the library has increased the number of simultaneous users eliminating a lockout problem.  Mr. Utz suggested that Foundations of Clinical Medicine might have students bring in a journal article related to a topic and then critique that article instead of having students only review one chosen article.  Finding an appropriate article is actually more challenging than critiquing it and could be a valuable learning experience.

Dr. Altose concluded the discussion by assuring that the curriculum renewal initiative recognizes the necessity for establishing “rock solid” learning objectives.  Additionally, Dr. Dan Wolpaw is aware of the importance of both search and critical appraisal skills and is incorporating that learning activity into the Foundations program.

  1. Comments from the Chair

Dr. Murray Altose welcomed Dr. Henri Brunengraber, one of the Dean’s newly appointed CME members.

Dr. Altose mentioned that with Dr. Nieder’s imminent relocation, a replacement for the Clinical Curriculum Council Chair was needed.  Dr. Altose and the Office of the Dean reviewed nominations submitted.  Dr. Altose has proposed Dr. Dan Wolpaw as the new Clinical Curriculum Council Chair.  Dr. Dan Wolpaw, an Associate Professor of Medicine, has a distinguished record in medical education.  Currently, he is Co-Director of the Foundations of Clinical Medicine course and a member of the Curriculum Steering Committee.  He was Director of Ambulatory Programs for the UH/VA Medicine Residency.  He chaired the “Best Contributions” teaching recognition initiative that designed a system already honoring recipients this year.  As a Visiting Professor in Medical Education at the University of Tokyo from November 2003 through January 2004, he evaluated the medical school curriculum and multiple faculty development courses.  Dr. Wolpaw is a Harvard Macy Scholar.  Twice he was named Department of Medicine Teacher of the Year.  He also received the first Humanism in Medicine Award.

The CME endorsed the appointment of Dr. Dan Wolpaw as Clinical Curriculum Council Chair.

Dr. Altose mentioned the Town Hall meeting with Dean Horwitz on the curriculum initiative that took place October 12.  Dean Horwitz elicited impressive responses from the audience.  Dr. Altose viewed the main goal before us as to “communicate” and “engage” faculty, students, the hospitals, and other stakeholders.  The first step will be a small retreat of primarily clinical faculty that will take place in the beginning of November to define a revised, or “renewed,” clinical curriculum.  In an effort to build solid communication, the results of this retreat will be disseminated to other workgroups, the Dean’s steering committee, the CME, and Faculty Council.  Everything will come before the CME and then move to Faculty Council.

  1. Report from the Flexible Program Council

Dr. Kent Smith, Flexible Program Coordinator, mentioned that there are a number of new Type B electives and an improved return of evaluations.  Students at the CCLCM have expressed interest in the University’s Type A electives program and would like to look into the prospects of whether our faculty would be willing to offer the electives again to conform to College schedules, or whether the Cleveland Clinic faculty could create a similar series of new electives.

Dr. Smith wanted the CME to be aware that currently there is no requirement for students to be on the Case campus during the fourth year so long as they are pursuing approved Type B electives elsewhere.  This has generally not created problems.  Almost all students take away-electives during their fourth year—usually for several months.  Students often take an AI (acting internship) in a competitive specialty where they are planning to apply for residency, and many take Medicine AI’s regardless of specialty choice.  Dr. Altose presented Dean Horwitz’s plans for the new curriculum with respect to flexibility and quality:  1) to ensure flexibility to accommodate the students’ needs and interests, and 2) to make our product so attractive that students will want to stay here instead of going elsewhere.

  1. Report from the Basic Science Curriculum Council

Dr. Amy Wilson-Delfosse, Basic Science Curriculum Council Chair, provided highlights of the council’s last meeting:

  • Continued exploration of efforts to improve student attendance

  • 2006 curriculum reform—Dr. Wilson-Delfosse will communicate the results to Dr. Altose’s curriculum working group.

  • Formation of a subcommittee to look into “mastery assistance” and revisit the issue of remediation.

  1. Guidelines for the New Curriculum

Dr. Altose led a discussion revisiting the “Guiding Principles for a New Curriculum,” developed by the Curriculum Working Group, which were presented at the last CME meeting.  Dr. Altose emphasized the following as key issues:

  • Medical education should be contextual and experiential.

  • There should be more active learning and less passive learning.

  • Reiteration of the Case philosophy:  students and faculty are mutually respectful partners.

  • There should be better continuity within basic science and within clinical science over the four years of the curriculum and better integration of basic science and clinical science throughout the entire curriculum.

  • There will be a research/thesis requirement.

  • Contained in the Dean’s white paper, the themes of public health, civic professionalism, and leadership will be incorporated into the new curriculum.

  • The new curriculum will include health care delivery issues (such as cost effectiveness) and patient safety (such as medical errors).

  • There will be clear learning objectives upon which a plan for student assessment and program evaluation will be based.

One discussant’s suggestion to make familiarity with medical informatics and the ability to use it effectively a goal of the new curriculum complemented the integration guideline.  Discussants differed on whether or not the new curriculum is trying to “residency-ize” medical school.  We learn different things at different times.  The emphasis seems to be more on a graduate-student-style learning experience than a “residency-ization” of medical school.  Dr. Altose added that training a physician encompasses more than four years of medical school.  There exists little continuity between medical school and residency, yet both are valuable. It is impractical to conceptualize a ten-year experience.  The current thrust of the curriculum initiative is the first four years of medical education while keeping an eye, however, on the whole continuum.

  1. Biomedical Information Technologies Update

Dr. Thomas Nosek, Associate Dean for Biomedical Information Technologies, mentioned that his staff are pursuing several ongoing initiatives mentioned at prior meetings.  He chose to focus on new endeavors for his update.

Deliberations are underway on whether to give entering medical students tablet computers instead of the usual notebook computers.  Tablet PC’s allow the user to take handwritten notes right on the electronic document, with an option for printing this out if desired.  The tablet computer is wireless—the user can access the Internet, do e-mail, etc.  The goal is “information on demand,” “information just in time.”  Dr. Nosek is considering a pilot of 10 students to compare use of the tablet computer with that of the notebook computer.

The existing Preventive Medicine and Cancer Genetics Web sites are being developed further.  Dr. Nosek is planning a three-dimensional eCurriculum for spring 2005.  Adobe Atmosphere, a program used for movie animations, creates a 3D environment with a feeling of gamesmanship and interaction that should appeal to the students.  Dr. Nosek also mentioned that we are changing our programming to “.net” to better accommodate students and faculty using the MacOS.

  1. Health Sciences Library Update

Mrs. Virginia Saha, Cleveland Health Sciences Library Director, had mentioned at the last meeting that the Library tries to go where there is a need rather than wait for people to contact the library.  Retention is much better when the learning experience takes place at the moment and in the context where it is needed.  Mrs. Saha mentioned one such recent example.  Following the discussion at the last meeting, Ms. Kathy Blazar was invited to deliver an instructional presentation to Masters of Public Health students who rewarded her with applause—and a tee shirt—for her efforts.  Student evaluations of the presentation reflected high ratings, also.

Mrs. Saha referred back to the varying level of search skills.  Most people are proficient using “key words.”  And, like Mr. Utz, she admitted her fondness for Google.  As to new developments, Mrs. Saha mentioned surprising trends in online usage.  The “trailing print” version of some journals, which can be accessed via OhioLINK, is being cancelled, and in the decision process, rankings, impact factors, and the number of downloads of the electronic versions are being examined.  Brain Research, once widely respected as the #1 journal in the field, is no longer that popular and has dropped below 20 in rank.  The current “heavy hitters” consist of Annual Reviews and other review journals, which may owe their popularity to 1) their unique position of providing a quick overview of highly specialized fields of study for those outside the discipline, and 2) their ability to consolidate bibliographic-references, eliminating the need to consult so many sources.

Dr. Altose concluded the discussion by urging everyone to use the resources available as enumerated in Mrs. Saha’s frequent updates.

 

See Curriculum Revision Update section.

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