10-25-01 CME Minutes
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
today’s meeting: to
initiate a continuing dialogue on some of the philosophical issues
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.)
the College of Medicine initiative provided by Dr. Fishleder:
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
of the Clinic Track: to
produce clinical investigators, clinical scientists
Clinic Track curriculum format: Problem-Based Learning
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.
to develop a framework addressing the goals and objectives of
producing clinical investigators in the context of Problem-Based
arising from ensuing discussion:
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.
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.
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
Would the Clinic Track students be taking CWRU
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
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.
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.
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.
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
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.
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
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
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.
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.
of the Harvard-MIT HST, which offers a one-half tuition benefit
since many students go more than four years, was mentioned for
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
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:
computer-based independent study involving over 30
students—This is the only second year track in which the
Clinic is involved.
The traditional track
Problem-Based Learning Track, consisting of between 30 and 35
students, which operates solely in Columbus, not in Cleveland.
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.
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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