Shield of the SOM Committee on Medical Education
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Summary of 10-25-01 CME Minutes 

  1. Question and Answer Session with Andrew Fishleder, M.D., Chairman, Division of Education, Cleveland Clinic Foundation, regarding the initiative to establish a College of Medicine at the Cleveland Clinic

Purpose of today’s meeting:  to initiate a continuing dialogue on some of the philosophical issues involved
Specifics are presented as intended at this particular point in time.  In-depth, finely-detailed planning has not yet taken place.  It is fair to assume that there is some degree of flexibility and that what follows does not represent an inalterable finality.  Random remarks making up the dialogue have been organized into broad categories here in an attempt to make it easier for the reader to digest the material.)

Background for the College of Medicine initiative provided by Dr. Fishleder:

  • Clinic’s desire for a cadre of 30-40 students—admitted in addition to the number of regular CWRU students—to receive the majority of their training at the Clinic

  • Goal of the Clinic Track:  to produce clinical investigators, clinical scientists

  • Intended Clinic Track curriculum format: Problem-Based Learning

  • Clinic Track students would do their first year at CWRU within the parameters of the standard CWRU curriculum.  The second year, however, would be done at the Clinic.

  • Task:  to develop a framework addressing the goals and objectives of producing clinical investigators in the context of Problem-Based Learning.

Clarifications, suggestions, concerns arising from ensuing discussion:

  • CWRU would be the degree-granting institution for the Clinic Track; the Clinic is not seeking to be degree-granting in the long term—it wants a long-term collaboration with CWRU.

  • Research activities—involving basic science, clinical science, Master’s degree or Ph.D. degree—in addition to the M.D. degree are variables needing to be worked out in the future.  The Clinic Track would include the standard four years, but students might need to stay longer for additive research training which could lead to a Master’s or Ph.D.  The Cleveland Clinic would offer Master’s and Ph.D. programs through CWRU.  Currently, Cleveland Clinic personnel already participate in Ph.D. programs at CWRU.  When asked if the Clinic were interested in developing graduate programs that are not found on the CWRU campus, Dr. Fishleder specified programs leading to the M.D./Ph.D. and M.D./Masters in these two main areas:  1) clinical investigation and 2) molecular medicine.  The intent was not to duplicate existing programs at CWRU.  There will be a core research training component to the entire Clinic Track.  There will be a clinical investigation component along with the standard medical school curriculum. 

  • The admissions process would be coordinated through CWRU. The first entering class would be admitted in 2003.  Clinic Track students would have to meet all CWRU credentialing standards.  Applicants would have options; they could apply for only the CWRU curriculum, for only the Clinic Track, or for both programs.  The tuition would be the same across the board. There has been talk of “overlapping” admissions/process but students would choose the Clinic’s program before admissions.  The Clinic Track students may differ from the full group of students.  The Clinic students will need guaranteed entry to the Clinic program.  Another issue for consideration is that some students thrive and others do not in PBL format.  CME discussants favored selecting Clinic Track students from a whole undifferentiated class rather than establishing a Cleveland Clinic subset right from the start.  Discussants supported unified entrance into CWRU with the option to choose a separate track—like our existing Primary Care Track—afterward.  However, it was acknowledged that the Clinic Track requires a certain type of student.  The Clinic Track offering should add to our overall attractiveness, and the quality of our applicant pool should improve.  Should there be a group of students admitted right from the start into the Clinic Track, it was hoped there would be an opportunity for some additional students to be able to enter later.
  • Decision to start the Clinic Track at CWRU for Year I and move to the Clinic in Year II:  Why after envisioning a full four-year program, did the Clinic decide to change, starting it in the second year?  In early discussions with the Dean, it was preferred to have some integration.  Since Year I focuses on what is normal and Year II focuses on pathophysiology, it seemed natural to make the cut after the first year.  Why not make the break after the first two years?  The third year—the clinical year—is the usual transition year in the “teaching hospital model” used by both CWRU and Ohio State University.  The Clinic wanted a distinct program that integrates basic science and clinical activity.

  • Exams
    Would the Clinic Track students be taking CWRU exams?  Dr. Fishleder does not know.  First year Clinic Track students would be in the same track as the standard CWRU students during the first year.  However, in the second year, if the PBL group were supposedly going toward the same goals and objectives as the standard CWRU students yet not attending the same lectures, they might be at a disadvantage.  The Clinic has already encountered the problem of Cleveland students not being in the same lectures with Columbus students during their experience with Ohio State University students.
    NBME subject exams in the third year are a requirement at CWRU.  The LCME requires “comparable objectives and equivalent evaluations” across all clerkship sites.  CWRU already has clerkship sites at different hospitals and in different cities.  We need to continue to demonstrate equivalency.

  • Electives program
    It was hoped that the Clinic Track students would take advantage of our electives program during the first year.  Research-oriented electives could be set up.  An Area of Concentration (AoC) allows the student to choose one area of study and pursue it in depth.  There are 39 Areas of Concentration.  The AoC program is particularly well-suited to the potential Clinic Track student.  Something could be set up to substitute for an Area of Concentration:  e.g., a Masters in Anatomy is an acceptable substitute for an Area of Concentration.

  • Clerkships
    Will the Clinic Track third year rotation sites be limited to the Clinic’s umbrella, or would they be open?  Would CWRU standard track students be able to participate in Clinic sites?  This has not been discussed.  Probably, most Clinic Track students would do their rotations at Clinic sites, but there would be opportunities for flexibility. Currently, CWRU students participate in OB, Family Medicine, and Neuro clerkships at the Clinic.
    Dr. Fishleder mentioned that the “distance” issue posed the greatest problem in terms of having tests and evaluations demonstrate comparability in its 10 years of experience with Ohio State University.  Dr. Fishleder recognized the importance of communication between clerkship directors if they have students being evaluated in one fashion.  This is a top priority for students.

  • Co-mingling of students
    Dr. Fishleder welcomed the students’ advice.  The Clinic plans to provide the majority of clinical training for students in the Clinic Track.  Year II will be tricky, because the day-to-day teaching sites in the Clinic Track will be different from the CWRU campus.  However, there will be integration on the third year rotations at the Clinic.  Two second year course offerings could maintain student contacts, if only for a few hours per week.  Year II Introduction to Clinical Medicine (ICM) maintains continuity by meeting once a month in the very same small group of the previous year.  The Year II Core Physician Development Program (CPDP), which meets for a two-hour session per week, focuses on Physical Diagnosis and clinical reasoning skills in PBL format.  The Patient-Based Program would also blend students.  The Family Clinic Program offers a two-year longitudinal experience where a student follows a patient.  This early patient exposure/continuity experience (Years I and II) characterizes the CWRU student.

  • Recruitment of faculty
    The Clinic already has a group of faculty in place to teach.  The Clinic now deals with 25 third year full-time Ohio State University students.  Penn State also sends students to do core clerkships at the Clinic.  There are also fourth year elective offerings at the Clinic.  Cleveland Clinic faculty already participate in Year I CWRU teaching.  The Clinic Track would afford faculty at both institutions the opportunity to work together toward equivalence.  Dr. Terry Wolpaw, Medicine Clerkship Director, invited a Clinic representative to contact her regarding the Medicine Clerkship.  She also suggested that someone at the Clinic contact the chairman of the CRDC (Clinical Rotation Development Council), which represents all the specialties and sites of the third year clerkships.  Faculty collegiality would benefit the students.

  • Facilities
    Currently, CWRU does not have the facilities to handle an additional 40 students.  However, Dean Berger has promised that if the Cleveland Clinic College of Medicine is approved, we will have the facilities available.

  • Teaching in a PBL curriculum
    As the first entering class would be admitted in 2003, the Clinic Track curriculum would need to be ready the following year in 2004.  Dr. Fishleder has visited McMaster University, Harvard, and the University of Rochester.  Faculty development would need to focus on 1) curriculum material, and, equally important, 2) mentoring and facilitating in a PBL format.  Provisions would have to be made for first-year CWRU “carry-overs” to Year II, such as Head and Neck Anatomy.  Dr. Fishleder suggested the possibility of PBL cases based on Neuro Anatomy in the second year Clinic Track.  Cases would be developed to satisfy the LCME equivalency requirement.

  • Comparison to the Harvard-MIT Division of Health, Sciences, and Technology (HST) Medical Sciences M.D. Program
    When asked if the Clinic Track was going to be similar to the HST program, Dr. Fishleder described the HST program as dealing with two degree-granting organizations with a track within Harvard but otherwise there is similarity.

  • Stipends
    When asked what he had in mind with respect to stipends, Dr. Fishleder referred to the summer research experience, where the stipend would liken it to a paying job.  As for the rest of the Clinic Track, scholarships/stipends have not yet been investigated.
    The example of the Harvard-MIT HST, which offers a one-half tuition benefit since many students go more than four years, was mentioned for consideration.

  • Does Ohio have too many medical schools?
    Are we training too many physicians?  Are we diluting our applicant pool?  The residency programs (not the medical schools) serve as the “gatekeeper.”  Currently, one-half of our residencies are filled with foreign residents.  A large proportion of our students leave Ohio after graduating from CWRU.

  • The Cleveland Clinic’s Ohio State University affiliation was officially discontinued and is being transitioned out over the next two years.  Dr. Fishleder clarified that the Ohio State University School of Medicine has three tracks:

    • Modular computer-based independent study involving over 30 students—This is the only second year track in which the Clinic is involved.

    • The traditional track

    • The Problem-Based Learning Track, consisting of between 30 and 35 students, which operates solely in Columbus, not in Cleveland.

  • Benefits for students not interested in the Clinic Track
    What will be the compensation for stretching faculty and facilities even thinner?  Dr. Fishleder envisioned greater opportunity for interchange with the clinical faculty during the first two years, a broadening of faculty.  There are already some electives and core rotations open to CWRU students at the Clinic.  These offerings could be expanded.
    The advent of the 12-month core clerkship third year at CWRU brought about the “forced” collaboration between Psychiatry, Internal Medicine, and Family Medicine in a new 16-week consolidated block.  The end result was a much better educational opportunity.

Perceived consensus from today’s meeting:  Keep CWRU students integrated without losing the unique identity of the different tracks.  Dr. Fishleder acknowledged that we need to work toward achieving a balance, but it is important for the Clinic Track to have a distinct identity within the School of Medicine.  The Clinic Track is doable, although it will involve a significant amount of work.  Critical areas needing attention and beneficial results have been identified.  There is a desire for the dialogue to continue.  Dr. Fishleder was extended an open invitation to the CME so that he can be on the agenda anytime he wants and attend whatever meetings are of interest to him.

See Curriculum Revision Update

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This page was last updated on 10/31/01 by John Graham.

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