November 11, 2004 CME
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 teams. The 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
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
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
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
and presented by Dr. Claire Doerschuk.
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
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.
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
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.
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
One CME member
questioned the role of the CME in hearing the subject committee reports.
Are 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
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.
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:
committees can maintain their autonomy yet be accountable to the CME.
Quality control is within the purview of the CME, which can review
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
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.)
advocates that the medical school should play a more central role in
clinical education. This involvement should also include the basic
- 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
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
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.
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.
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
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.
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.
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.
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,
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
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.” (http://www.nih.gov/about/publicaccess)
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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