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Summary of October 23, 2003 CME Minutes

See Curriculum Revision Update section.

  1. Comments from the Chair

Dr. Murray Altose introduced the two newly elected student representatives:  Mr. Jason Garnreiter (Year II) and Mr. Christopher Utz (Year I).         

Dr. Altose invited follow-up discussion on Dean Horwitz’s presentation of his vision at the last CME meeting.  There was consensus that the emphasis on public health, research and scholarship, clinical skills, leadership, and civic professionalism was relevant and timely and touched on important priorities for a new curriculum.  Concern focused on the challenges and impediments to the development and implementation of a new curriculum.  There will be a need to embrace a new curricular structure with significant content changes, a new learning culture, and to engage faculty with limited protected time.  There was strong support for the concepts of basic science and clinical integration and continuity over the full four years of the curriculum.  Clinicians welcomed the idea of having basic scientists join the students on rotations during rounds, in small groups, etc.  The use of 1) M.D./Ph.D.s who are not currently teaching, and/or 2) graduate students working on Ph.D.s who desire teaching experience and interaction with medical students was suggested.  The possibility of working with Dr. Alison Hall, Director of Graduate Education at the School of Medicine, was also raised.  The CCLCM is currently exploring utilizing the basic scientist in the clinical setting.  Accommodating large numbers of students spread out over many diverse sites during the clerkship years makes this a challenge for the university program.

Dr. Henson mentioned the overall goal:  creating a diminished basic core curriculum (applying to both basic science and clinical science components) and adding a required, “selective” advanced core curriculum.  This format would afford students the opportunity to “focus” and pursue different learning objectives in depth.  Dr. Henson cited two different models under consideration for incorporating basic science into the clinical years:  1) integrating basic science back into the curriculum, and 2) pulling people out for a short time, two weeks, for example, to return to the classroom and focus on basic science.  Dr. Henson referred to the practical advantage in implementing the second model.  She reminded that incorporating the leadership skills promoted by Dean Horwitz in public health and service learning (“civic professionalism”) necessitates paring down existing curriculum components.

Due to conflicting commitments, Dr. David Katz has decided not to take on leadership of the Basic Science Curriculum Council.  Dr. Henson and Dr. Altose are working on identifying another candidate for the position of Basic Science Curriculum Council chair.  For the time being, the individual subject committee chairs will bring their reports to the CME.

  1. Report from the Student CME

Students expressed satisfaction with the way both Year I and Year II are progressing.

  1. Update on the Clinical Curriculum Council

Dr. Linda Lewin, Clinical Curriculum Council Chair, provided an update on structuring the CCC.  This committee’s curricular oversight extends from Year I through a potential Year V and membership encompasses ICM (Introduction to Clinical Medicine) as well as the clerkships.  It does not include the clinical electives, although representatives are welcome to attend.  Acknowledging the impossibility of getting everyone on such a large committee to attend meetings, Dr. Lewin favors the “convener” concept, previously used in the clerkships, where one person is designated to represent all sites of that particular clerkship at council meetings and report back.  This insures that all curricular components are regularly included and informed.  The CCC intends to meet monthly.  In addition to CCC members, the Associate Dean for Biomedical Technologies, the society deans, and clinical elective sponsors are welcome to attend CCC meetings.  Dr. Lewin outlined specific goals:

  • To improve communication between all the various parts of the clinical curriculum to eliminate redundancy and to share information

  • To provide feedback to any faculty member wishing to present a project in progress

  • To discuss issues relevant to everyone, for example, evaluation and tracking of clinical skills across four years.

Dr. Lewin is currently meeting separately with the clerkship directors and ICM directors

Dr. Altose and Dr. Henson complimented Dr. Lewin on her approach to organizing the expanded clinical council.

  1. Report from the Flexible Program Council

Dr. Altose mentioned the drive to re-conceptualize the “elective selectives,” in addition to reorganizing the curriculum council structure.  Integrating clinical science and basic science in an experience can occur in a Type A elective during the first and second years and in a Type B elective during the fourth year.

Dr. Kent Smith, Flexible Program Coordinator, mentioned that one of the most popular Type B electives is the reading elective taken in preparation for the USMLE Step 2.  He and Dr. Haynie have sponsored approximately 100 students so far this year.  Dr. Smith recognized Dr. Wile for her help in this undertaking, also.

Referring back to discussion about the integration of basic science and clinical science earlier in the meeting, Dr. Smith recalled our prior experience with the CPC (Clinical-Pathologic Conference).  During the 1998-1999 academic year, under the leadership of Dr. Jay Wish, then the Patient-Based Program Coordinator, three whole-school CPC’s were held.  The CPC was broadcast from E301 to students and faculty in other areas of the School of Medicine, University Hospitals, MetroHealth Medical Center, and Henry Ford.  While the CPC’s were well done, the number of students participating was disappointing.  Dr. Altose suggested offering CPC electives on a much smaller scale.  For example, a clinician, a pathologist, and a biochemist could mentor the CPC for a small group of students, who could present their cases to each other.

  1. Report from the Cleveland Clinic Lerner College of Medicine of CWRU Curriculum Steering Council

Dr. Andrew Fishleder, Co-Chair of the CCLCM Curriculum Steering Council, listed target dates:

  • Mid-December:  Year I Summer Research and Physical Diagnosis courses and all Year I organ-based courses will be completed.

  • End of March:  Syllabus for these courses will be completed.

  • Mid-December:  Report on assessment model will be brought before the CME.

Dr. Fishleder distributed two handouts of model weekly medical school schedules—one, a generic format, the other, a sample format completed for Year II Renal.  The theme defines the PBL case and the clinical activity.  The sample Renal week contains a listing of theme, case, lab, and seminar topics.

  1. Report from the Office of Biomedical Information Technologies

Dr. Thomas Nosek, Associate Dean for Biomedical Information Technologies, mentioned current projects involving his staff.  The Office is helping to compile posters for presentation at the upcoming AAMC meeting:

  • Poster on Preventive Medicine and Health Promotion:  This poster describes the Year IV Type B online elective that has been developed by Drs. Haynie, Smith, Nosek, and Litaker.

  • Poster on wireless technology and PDAs:  This poster describes how the students are using the wireless web access in the first two years of the medical curriculum and PDAs during the Family Medicine Year III clerkship.  Dr. Chao is continuing his study on the ways in which our students use PDAs.  The issue under consideration is to determine whether every clerkship should have PDAs to track the cases seen by students.

Cancer Genetics:  Grant funding has begun on the creation of the “Essentials of Cancer Genetics,” an online multimedia learning resource to support our vertical theme on this topic.  Dr. Georgia Wiesner and Dr. Anne Matthews have produced a unique learning resource accessible to our students anywhere.  Dr. Nosek hopes to find funding for the Preventive Medicine project so that another innovative eCurriculum site can be developed.

The BIT office has also created a student information system that is being used by the four society deans.

Dr. Nosek advised the CME that Dr. Henson and Dr. Wile have requested access to the electronic question bank to generate Year I quiz questions for the CCLCM and raised the matter of granting access to the electronic question bank used to generate our secure exams.  The issue of security was pointed out and the importance of precautions to ensure security was emphasized.  Another issue was whether the examination questions were considered the intellectual property of the authors or rather the property of the School of Medicine.  The School of Medicine has several different secure databases, and Dr. Nosek stated that he has always regarded subject committee chairs as owners of their examination question database and has deferred to the “owner” of the database in deciding who is allowed access.

Dr. Altose felt that the examination question bank belongs to the Dean or the Dean’s designate (the Vice Dean for Education and Academic Affairs).  So long as we are sharing material internally and not using it for financial profit, he did not foresee a problem in accessing the material.  Dr. Katz mentioned that we have always regarded syllabus material as belonging to the author and that we should adopt this same approach with respect to the examination question bank.  Dr. Nosek acknowledged that “legally” the university owns the databases.  However, his actions have been predicated on the assumption that the subject committee chair is the owner of the exam questions pertaining to his/her own committee.  Every question contains the faculty author’s name.  Dr. Nosek does not open any database without first asking the owner’s permission.  Dr. Katz suggested informing the faculty upon submission of their exam questions as follows:

  • The questions become university property.

  • The questions will only be used internally as a communal resource for the faculty.

  • The faculty member accepts this arrangement when he/she signs on.

Dr. Nosek stated that his informal policy for accessing databases has worked well for the past six years.  He acknowledged, however, that there have been a few faculty who have refused to contribute to the database due to issues of trust.  Less concerned about legal charges of expropriating intellectual property, Dr. Nosek is interested in maintaining the established rapport and not alienating faculty.  Currently, Dr. Nosek personally handles each case on a one-to-one basis.  An ad hoc solution was suggested by the CME in regard to the situation at hand.  For now, Dr. Nosek will e-mail the few parties involved in allowing access to the examination question database.  Dr. Nosek volunteered to draft a document later on for Dr. Dan Anker to review regarding a comprehensive policy pertaining to the use of the database and then to bring it before the CME.  The consensus among discussants supported the sharing of a collaborative effort.

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