Shield of the SOM Committee on Medical Education
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Summary of November 11, 2004 CME Minutes

  1. Comments from the Chair

Dr. Murray Altose mentioned that the curriculum renovation renewal project is proceeding at a deliberate pace.  The current task is the organization of a series of design teamsThe model for the new curriculum curtails the first two years of the curriculum to allow room for the 16-week block dedicated to the research and thesis requirement before the third year.  The one and two/thirds year block replacing the current first two years is being constructed with a focus on experiential learning (learning “in context”), as students participate in clinical experiences, somewhat in depth, that are relevant to the basic science teaching.  The intent is to accomplish better integration of the clinical and basic sciences than currently exists.

At this point in the discussion, a member requested clarification as to how the decision to shorten the first two years came about.  Dr. Altose replied that the proposal for the 16-week thesis and research block had been brought to the CME for approval and then brought to Faculty Council and voted on.

The CME meeting continued with further questions as to the rationale to cut 16 weeks from Years I and II.  Was this time considered superfluous and not well used?  Or, was the intent to introduce/integrate the deleted content into Years III and IV?

Dr. Altose summarized some of the shortcomings of the current curriculum and the shift toward the new curriculum model:

  • Third and fourth year faculty felt that training received by students in the first two years was not retained by the students.

  • There could be better integration of basic science and clinical teaching over all four years.  Continuity could be improved.

  • The lecture-based approach has resulted in many students not coming to class.  We need a better way of doing things. 

  • The new curriculum favors a graduate-school style approach and more experiential learning.

  • Redundancy exists in the first two years.  Eliminating this redundancy allows for an increase in the depth of study.

One CME member remarked that he was not made aware by his department’s representative to the Faculty Council or his department head of the intention to reduce the first two years to a one and two/thirds year block to accommodate the thesis requirement.  Dr. Altose referred back to the concept of scholarly research both introduced early on in the Dean’s white paper:  Horwitz, Ralph I.  Case School of Medicine and Health:  A proposal for radical reform of medical education, and presented by Dr. Claire Doerschuk.

A discussant inquired as to whether all students would be doing the research requirement at the same time.  Dr. Altose explained that 2005-2006 will be a transition year.  The targeted date for the new curriculum is Fall 2006.  The new curriculum is to allow sufficient flexibility so that students can do their research and thesis at different times.  In terms of practicality, Dr. Doerschuk cannot handle 140 students at one time.  The Health Sciences Library would like to offer a “how to do research” orientation as a mini-block right before students will be using these skills.  This could be incorporated into the “Research Foundations” component that is being offered to the class entering in 2005.  Dr. Terry Wolpaw, Dr. Amy Wilson-Delfosse, and Ms. Minoo Darvish are currently working on the transition schedule.

  1. Report from the Student CME

Mr. Brian Chow, Year IV student representative, mentioned that he will be taking the USMLE Step 2 Clinical Skills (CS) in Atlanta before the December 9 CME meeting.  If unable to attend the December meeting, Mr. Chow will forward his observations.  While the USMLE Step 2 CS may be only a minimum competency exam, Dr. Terry Wolpaw emphasized that we need to prepare our students adequately by making them feel very comfortable in the 20-minute standardized-patient scenario.

Mr. Christopher Utz, Year II student representative, wished to commend Dr. Nosek and the BIT staff for solving problems that occurred during yesterday’s exam before it was over.  Students were appreciative.  In reply to an inquiry about future incoming classes receiving computers, it was announced that the class entering in fall 2005 is the last one to receive computers purchased by the Case School of Medicine.  Students will be encouraged to buy a recommended computer.  If they choose another option, they will need to see the BIT staff for standardization issues.  Examinations will continue to be given online.

  1. Report from the Basic Science Curriculum Council

Dr. Amy Wilson-Delfosse, Basic Science Curriculum Council Chair, announced that the second Basic Science Curriculum Council meeting will take place Monday, November 15.  The Mastery Assurance subcommittee has been reviewing remediation strategies and will have a report for the CME.

Dr. Altose recalled that last year, in the absence of a Basic Science Curriculum Council Chair, the CME invited subject committee chairs to present an overview of their committee focusing on strengths, areas requiring attention, and plans for improvement.  He asked discussants for their input on whether to continue this practice this year or whether it is sufficient to have the Basic Science Curriculum Council Chair keep us informed.  (The following discussion was not part of the Basic Science Curriculum Council Chair’s report but occurred with regard to basic science matters and so is included in this section.)

Two CME members commented they both enjoyed and valued the detail provided by the various subject committee chairs.  One cautioned that quality control should fall under the realm of the Basic Science Curriculum Council Chair, however, and he sought a balance so that the CME did not seem to be infringing on the Basic Science Curriculum Council Chair’s responsibility.

One CME member questioned the role of the CME in hearing the subject committee reportsAre we there to provide feedback to help them?  Is this solely an educational activity to inform us?  Does this activity lead to any outcome?  What is its value?

Dr. Terry Wolpaw, Associate Dean for Curricular Affairs, mentioned the evaluation cycle function of her office that specifically addresses this issue.  The process has been established, but the cycle needs to progress a bit further before the desired endpoint is reached.  The evaluation cycle works this way: 

  • At the end of each subject committee, the subject committee chair receives all the program evaluation data furnished by the students. 

  • The chair formulates an “action plan” addressing issues raised by the students, specifically, how to improve perceived weaknesses.

  • The action plan is distributed for all students to see—“closing the loop.”  Students have requested assurance that their feedback is taken into account.

  • The chair brings the action plan to the CME and reviews it with us—what changes were made and if things improved. 

The CPDP Course Director interjected later in the meeting that this process was carried out with CPDP.  Last year’s course evaluations, reflecting a 100% response rate by the students, led to the formulation of an action plan that was posted on the ListServ for the participating class last year and presented to the current CPDP students during the Course Director’s overview the first day of CPDP.

CME discussion explored whether the CME is the proper body to be reviewing outcomes.  The following are diverse, individual perceptions of the role of the CME that surfaced during the discussion:

  • The subject committees can maintain their autonomy yet be accountable to the CME.  Quality control is within the purview of the CME, which can review shortcomings.

  • The CME’s main function is that of a policy-making committee.

  • The CME is a hands-on committee giving feedback.

  • The CME is of limited value if it just listens to the subject committees and does not give them back very much.

  • There could be a value-added for dealing with the individual committees.

  • Involve students in this reviewing endeavor as they need to see that their feedback is taken seriously.

While it was acknowledged that accountability is a key issue, there was no clear consensus as to exactly who is accountable for what and to whom.  The bulleted points show the chronological evolution in the thinking based on discussants’ contributions.  (Thoughts of more than one discussant may be expressed within one bulleted point.)

  • Popular opinion advocates that the medical school should play a more central role in clinical education.  This involvement should also include the basic sciences. 

  • The CME has much important policy-level business.  It would be too much to have the CME hear from every subject committee.  The CME should concentrate on policy input. 
  • The evaluation and accountability piece should be handled through the Office of Curricular Affairs, which already is dealing with such matters as evaluation, faculty development, etc.

  • Create a quality improvement group.  Should it be out of the Dean’s office or a faculty group instead?

  • Consider one functional model already used successfully by the CME in the past:  creation of several subcommittees which carried out the work and reported to the CME, which made the final decisions.

  • The curricular councils could be more helpful than the CME with continuous quality improvement.  One member wished to replace “the curricular councils” with the Office of Curricular Affairs as having the responsibility for continuous quality improvement.

  • Evaluation and expectations for performance of the subject committees should be part of the curricular councils’ agenda.  The curricular councils would bring before the CME only those issues needing CME intervention.  The Office of Curricular Affairs already provides support to the curricular councils.  The councils have responsibility for the subject committees, clerkships, etc.  The CME, however, has the ultimate responsibility for evaluation, review, and making recommendations for policies of the educational program.

One CME member mentioned that it is difficult for a curricular council to evaluate itself—part of the function of the curricular council is to be supportive and friendly to its own members, the subject committee chairs.  Perhaps outside consultants could be of value, as self-evaluation has its limits.  The curricular council chair might be forced to “police” her colleagues by ensuring that they adhere to standards.  The Basic Science Curriculum Council Chair mentioned that she is trying to build a sense of community, cooperation, innovation, and integration.  She wants to avoid “policing” and would prefer to use the Office of Curricular Affairs, which is a neutral body.

Dr. Altose preferred to view the situation in a more positive light.  We are trying to make better what we are already doing well without any finger-pointing or blame.

The Office of Curricular Affairs is already charged with evaluating programs and continuous quality improvement.  Once the evaluations are received, how do you use those data and make things better?  We take it back to ourselves.

Dr. Altose summarized the mechanism in place.  The evaluation of programs is a function of the Office of Curricular Affairs.  The Basic Science Curriculum Council takes the feedback gathered by the Office of Curricular Affairs and looks for an opportunity for quality improvement via an “action plan” drawn up by the subject committee chair and reports back to the CME.  If there are special issues needing attention, the Council brings them to the attention of the CME.  One such example is that of remediation, which the Basic Science Curriculum Council Chair plans to bring before the CME.  One discussant reiterated that things must be brought back to the students as well.  This venue already exists, as the action plan is transparent and open and is communicated to all the students.

  1. Report from the Clinical Curriculum Council Chair

Dr. Daniel Wolpaw, Clinical Curriculum Council Chair, announced that he will chair his first meeting tomorrow, November 12.  He will be introducing a plan for regular reporting by the specialty clerkships, addressing curriculum, student assessment, and program evaluation in terms of strengths, weaknesses, and action plans.

Plans are to focus in particular on development, implementation, and evaluation of a clear curriculum for the clinical year.  The effort will be to eliminate the random nature of this experience and ground it in the educational needs of the students rather than the service needs of the hospitals.

A clinical retreat involving faculty of both the University and College programs took place November 1.  Focus of the retreat was where do we want our students to be in terms of competencies and content at the end of their clinical experiences, which is currently at the end of Year III, and where should the students be when they begin the clinical curriculum, or, in other words, our expectations for their preclinical Foundations of Clinical Medicine training.  Other retreat agenda items included the role of professionalism and revisiting certain skills to determine where they were learned in the curriculum.  How will re-designing our clinical experience impact our students?  Currently, the consensus is that we do not prepare out students well for the clinical curriculum.

Dr. Bruce Koeppen, of the University of Connecticut School of Medicine and an expert on clinical reform, will attend the December 9 follow-up retreat.  All core clerkships have been asked to list the diseases, life stages, etc. that are core to their area and to confine that number to twenty.  Significant overlap is anticipated, and this will be helpful in designing a new clinical curriculum.

Dr. Wolpaw views the Clinical Curriculum Council as taking on a leadership role in the new curriculum by representing the clerkship directors and the Foundations of Clinical Medicine leaders.

  1. Flexible Program Council Report

Dr. C. Kent Smith, Flexible Program Coordinator, mentioned that both Type A and Type B electives are going well.  A few Year I and Year II students have signed up for longitudinal research—in-depth exploration of areas—where they can earn up to four elective credits per year.

  1. Update from the Office of Biomedical Information Technologies

Dr. Thomas Nosek, Associate Dean of Biomedical Information Technologies, updated the CME on recent BIT projects.  Dr. Nosek referred to the previously mentioned immediate audience response system utilizing the student computers in the Year II Hematology/Oncology committee, where students take a mini-quiz at the end of a lecture and then discuss the results.  Both the E301 and E401 lecture rooms can be equipped with hand-held devices instead of the student notebook computers for approximately $75,000.

Dr. Nosek will have a Gateway Tablet PC on loan in his office next week.  He is very enthusiastic about the tablet computer.  Dr. Nosek would like to have 10 tablet computers in order to run a one-month trial for ten Year I and Year II students.  Microsoft could provide the students with training on how to use the tablet computer and specialized software.  After the trial, students would return to Dr. Nosek either the loaned tablet computer or their own notebook computer, based on their individual preferences.  That would be his voting system.  The top of the tablet computer pops down like a tablet and you can write on it.  The hand-written notes can be printed, if desired.

Recently, Dr. Nosek has attended EDUCAUSE and AAMC meetings that stress that Information Technology skills are essential for today’s students.  In designing the new curriculum, we need to consider what we want students to achieve with respect to IT skills, as this will affect the kinds of programs we need.  Dr. Nosek has written a white paper for the Vice Dean for Education on various options to provide computer technology to students.

The final version of the short, four-question lecture-by-lecture online student evaluation of the faculty lecturer is available.  Students should go to the eCurriculum where they will see all the lectures given up to that day with a check mark indicating those evaluations that have already been completed.  If the student clicks on the professor’s name, a list of all the lectures of that particular professor appears.  The evaluation form is also available to students via the committee schedule.

A brief discussion ensued regarding the number of lecture evaluation respondents.  If there are only 30 responses for one lecture, does that constitute a valid sampling of the class on which to base changes?  Thirty might represent the total number of students attending the lecture.  There is a “DNA”—“did not attend”—category on the evaluation.  In order for evaluation data to be valid, we need a 100% response, even if that includes many “did not attends.”  Without taking a stand either way, one CME member urged giving serious consideration to student classroom attendance when redoing the curriculum.  Clarification is needed regarding both medical school policy and faculty expectations for the new curriculum.

  1. Health Sciences Library Update

Mrs. Virginia Saha, Cleveland Health Sciences Library Director, called attention to the current clash between the NIH advocating a free electronic access policy for manuscripts supported by NIH funding and the publishers opposing it.  Specifically, “…the NIH public access policy proposal requests investigators to provide the NIH with electronic copies of all final version, peer-reviewed manuscripts upon acceptance for publication, if the research was supported in whole or in part by NIH funding.  …the NIH would archive these manuscripts in NIH’s digital repository for biomedical research, PubMed Central (PMC), which is fully searchable…  Six months after an NIH-supported research study’s publication—or sooner if the publisher agrees—the manuscript would be readily accessible to the public through PMC.” (  The six-month embargo was perceived as adequate not to jeopardize the publishers’ subscription sales.  NIH Director, Dr. Elias A. Zerhouni, gathered input from all stakeholders before the NIH compiled the proposed sharing mechanism, which was posted September 3, 2004.  The NIH is accepting comments in reference to the proposal through November 16 on its Web site.  Libraries strongly support the public access initiative, but commercial and society publishers oppose it.  It is estimated that the public access proposal would affect between 60,000 to 65,000 articles per year.  However, articles based on NIH research represent only a small fraction of the articles published in scientific journals.  Libraries and individuals involved in a field of study will continue to subscribe to the journals publishing important scientific findings.

Eleven hundred hits were tracked last week during the current eMedicine trial, which offers unlimited access.  Mrs. Saha encouraged users to try the PDA download.  If the library decides to buy a site license to eMedicine, we will get the PDA download free for the first year.  The library has planned more trials.


See Curriculum Revision Update section.

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