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Summary of December 9, 2004 CME Minutes

  1. Minutes from the Previous Meeting
    Dr. David Katz wished to refer back to the discussion of the determination of the reduction of the two-year preclinical curriculum to accommodate the 16-week thesis requirement as reflected in the CME minutes for November 11. Dr. Katz established that he spoke as a strong supporter of the thesis requirement and believer that the 18-month pre-clerkship block is workable, given that the students will have additional opportunities for basic science learning throughout the rest of the curriculum. Dr. Katz was now seeking clarification regarding what has been approved, and by whom, regarding how the curriculum would be restructured to accommodate the thesis requirement. The CME minutes of April 8, 2004 indicate that Dr. Doerschuk had presented several options, including designating time in the pre-clerkship curriculum, summer, and Year III for the thesis requirement. Since that time, there had been no further discussion and no approval by the CME of any specific implementation plan. However, in recent weeks, statements have been made that the CME and/or Faculty Council had voted to shorten the pre-clerkship curriculum to accommodate the thesis research block. Given that, in matters relating to educational policy, the Faculty Council votes on recommendations forwarded from the CME, Dr. Katz asked that the CME find out precisely what had been forwarded to Faculty Council and what they had voted on regarding the thesis requirement. Dr. Katz was seeking clarity on this issue, because the CME cannot exercise its oversight role if it does not know what policies have been approved, and 2) because the historical record pertaining to the evolution of the new curriculum needs to be accurate.

    Dr. Murray Altose acknowledged that while consensual approval for the thesis requirement was expressed during discussion, no vote had been taken by the CME regarding implementation of the thesis requirement and that during Dr. Doerschuk’s April 8 visit to the CME, there was no clear understanding of where the thesis requirement would fit into the curriculum. At that meeting, the CME discussed the required 16-week research and thesis block, which was subsequently approved by the Faculty Council.

    Dr. Katz requested that the CME minutes contain an accurate accounting of how the proposed new structure for the curriculum has evolved.

    Dr. Altose responded by explaining the year and two-thirds preclinical curriculum is regarded as a model in this early developmental stage of the new curriculum. Timing and placement are open to discussion and review by the CME. Should this model prove unsatisfactory and unworkable, we can go back to the drawing board. Dr. Altose explained the need to have a model to begin work. Also, the desire is to have as few constraints as possible during the creation of a new curriculum. Dr. Altose explained the process that gave rise to the reduced preclinical curriculum. The Dean established a Policy Advisory Committee that developed this model. This model will be revisited and reviewed. The intent is to generate a new curriculum by forming working groups to create models, which will come before the CME.

    With the focus in designing the new curriculum on what we think the students need to know, we can figure out the goals first, and the time factor (allocation of hours) then becomes more flexible.

    In answer to questions by other discussants, Dr. Altose confirmed that any new curricular models will not become operational before they are sanctioned by the CME. Plans will be presented to the CME for a vote and then, if endorsed, will proceed to the Faculty Council.

    One member suggested that rather than starting from scratch, we might save time by examining the curricula of those medical schools already using the 18-month preclinical block. Dr. Terry Wolpaw and a group of six other faculty recently visited McMaster University, which has an 18-month integrated normal and abnormal preclinical curriculum. Dr. Wolpaw mentioned that she also has other information about the existing 18-month curricula at Penn, Stanford, and Duke. However, Case is unique in its endeavor to integrate population medicine (leadership, civic professionalism, and scholarship).

  2. Comments from the Chair
    Dr. Murray Altose provided an update on curricular revision. Dean Horwitz held a Town Hall meeting with the faculty, which resulted in many good suggestions. He held a meeting for third and fourth year students, who expressed concern for the well-being of the faculty and took a rather conservative approach to curriculum revision. Tomorrow Dean Horwitz will meet with the Year II students. While none of these classes will be affected by the curriculum revision, Dean Horwitz hopes nevertheless to engage them, and he invites their feedback and participation in the curriculum renewal. Plans to date for the new curriculum were presented at the Basic Science Curriculum Retreat and will be presented at this evening’s Clinical Curriculum Retreat.

    Dr. Altose appreciated the efforts of Year IV student representative Mr. Brian Chow, who, “as promised,” forwarded his observations on taking the 7-hour USMLE Step 2 CS (Clinical Skills) Examination November 30, 2004, at the Atlanta site. Mr. Chow addressed the following issues: scheduling problems—lack of sufficient testing slots available in Chicago, Philadelphia, and Atlanta; format of the exam with time allotments; curiosity pertaining to evaluation of U.S. graduates alongside international medical graduates (IMGs); straightforward primary care and Emergency Department nature of the cases; personal observations; and a cost analysis.

  3. Report from the Basic Science Curriculum Council
    Dr. Amy Wilson-Delfosse, Basic Science Curriculum Council Chair, mentioned that the Basic Science Curriculum Retreat took place yesterday. This was the first time that a large group of basic science faculty had the opportunity to get together at the same time for curriculum revision, and the retreat included people who do not belong to the Basic Science Curriculum Council. Multiple goals for the retreat included:
    • Delineating core concepts
    • Examining what is taught in Year I (normal) and Year II (abnormal) to reduce redundancy while still allowing for some intentional, meaningful repetition
    • Engaging our diverse, talented faculty.

Follow-up work will be done in small group format. As not every basic science group was represented at the retreat, it was hoped these faculty will become involved via a small group.

Dr. Wilson-Delfosse distributed the Basic Science Academic Schedule from 2005-2007, which was presented by Dr. Daroff at the last Basic Science Curriculum Council meeting on November 15. The transition year begins with the class entering in Fall 2005 (the Class of 2009). This is the first class to have the thesis requirement. Orientation takes place August 11-12, 2005. The new curriculum is targeted to take effect during the 2006-2007 academic year. Whereas we now have a rather artificial separation between the first two basic science years and the last two clinical years, in the new curriculum, the front part of the continuum will be weighted more heavily on basic science and the back part will be weighted more heavily on the clinical. Meaningful and substantial basic science activities such as seminars are planned for the third year. Some noteworthy dates follow:

  • Date of final basic science interim exam: 1/31/07
  • Board study and USMLE Step 1 exam: 2/1/07-2/28/07
  • Option to begin thesis or core clerkships 3/1/07 (approximate)

As there will be more emphasis on self-directed learning and preparedness of students when they come to class, time must be dedicated for students to accomplish this.

Mr. Utz requested whether a change of primary resources was planned—would there be a recommended reference document for information gathering—syllabus, research articles, etc.? Dr. Wilson-Delfosse answered that students would need to be directed to the resources. Mr. Utz expressed concern since the new curriculum is significantly shorter yet requires the student to accomplish more. For example, reading many research articles is often necessary to reach the desired degree of preparedness. Dr. Wilson-Delfosse replied that there would be a balanced combination of “unloading” the curriculum (reducing in-class course hours) plus self-directed learning.

Students will be synchronized to do their thesis in a four-month (16-week) block. The first thesis opportunity for the Class of 2009 occurs March – June 2007. These students may also choose to start core clerkships during this four-month block and delay the thesis until a later four-month block. Students can also use the summer break to start their thesis, although this does not preclude or shorten the required four-month thesis block that will occur later.

The issue of exemption from the thesis requirement for the dual degree students needs further investigation. At the moment, the M.S.T.P. (Medical Scientist Training Program) students are the only group explicitly discussed and exempted. They will go directly into their clerkships. With regard to scheduling, it was also pointed out that the Masters in Anatomy program continues into Year II. This could prevent those students from starting their clerkships in the new curriculum. It was added that the Masters in Public Health thesis has also been approved to fulfill the M.D. thesis requirement.

One member brought up the scenario where students have a longitudinal research project requiring more than four months to collect data. Will there be enough flexibility to accommodate this situation? Dr. Altose replied that the Dean has emphasized flexibility in the new curriculum and that the third and fourth years will allow ample opportunity for such circumstances.

Will there be clinical opportunities available to students during their four-month thesis block? The Dean has indicated that he does not want any clear “distraction” from the research block. Will one half-day per week in a clinical setting be permitted? Dr. Altose suggested inviting Dr. Claire Doerschuk, Associate Dean of Medical Student Research of the Office of Medical Student Research, who is responsible for organization of the thesis requirement, to a future CME meeting to respond to these issues.

One member reminded that currently, the USMLE Step 1 must be taken before beginning the clerkships. Will this hold true in the new curriculum? The USMLE Step 1 is important to the students. The CME may need to discuss the timing of this policy for the new curriculum. Dr. Altose replied that we have a commitment to prepare our students for the USMLE Step 1. At some medical schools, some students take the USMLE Step 1 after their clerkship experience. Dean Horwitz would like the USMLE Step 1 completed prior to the research block, so that the student has no distractions. After taking the USMLE Step 1, the student would proceed to either the clinical rotations or research.

  1. While the minutes indicate that we are still technically in the Basic Science Curriculum Council Report category, what follows encompasses the Flexible Program Council Report as well.

Dr. Wilson-Delfosse mentioned that there is concern even for the transition year of freeing up enough time for the students. She and Dr. Kent Smith, Flexible Program Coordinator, have been discussing the Type A electives program and would like the CME to place the role of the Flexible Program on a future agenda.

Dr. Altose mentioned that the elective options are valuable, but now our electives have ceased to be “elective.” How can we make Type A electives (in Years I and II) totally elective?

Dr. Smith wanted to consider requiring a small number (4, 5, or 6) of Type A electives during the first two years instead of the current 13. Type A electives provide the opportunity for all departments to be represented in the curriculum and encourage students to work with various basic science and clinical faculty.

Dr. Altose’s questioning the value of “requiring” electives was met by some members with a rationale in favor of requiring electives. By requiring electives, students see their benefits and this encourages them to take more. Mr. Utz, speaking from the student perspective, agreed. Some students will not take a course that is not required. Currently, students take electives in fields that interest them. Mr. Utz does not feel that the current number of required electives is a concern.

Dr. Altose saw as contradictory the pairing of self-directed learning and the rather prosaic “high school” requirement approach.

While the Cleveland Clinic Lerner College of Medicine has no elective requirement, its students asked for an elective program similar to that of the University program. Electives offer direction and a different perspective.

One member mentioned that in his personal experience Case offers the student the best clinical exposure of any medical school where he has been. Electives are many-faceted. They can promote better understanding of basic science. They foster appreciation for clinical context. They offer exposure to ethics.

Mr. Utz offered the following suggestion should the decision to make the Flexible Program truly elective be implemented: Invite Year II students to speak to Year I students and encourage them to take electives.

The need to bring faculty together in collaborative curriculum efforts was also raised. It is felt that the lines of communication are open between the basic science and clinical faculty. Currently, the Basic Science Curriculum Council chair and the Clinical Curriculum Council chair attend each other’s meetings. Specific members of each related discipline need to sit down together to plan an integrated longitudinal four-year curriculum. For example, Nervous System Committee/Mind subject committee chairs, the neurology and psychiatry clerkship directors, working together can create an integrated learning experience. Dr. Altose interjected that this is the concept behind the planned multiple design teams. Once the shape of Year III in the new curriculum has been established, we will have design teams. Case is very fortune in the willingness and enthusiasm of its basic science faculty to become involved in Years III and IV.

  1. Clinical Curriculum Council Report
    Dr. Dan Wolpaw, Clinical Curriculum Council Chair, mentioned the similarity between the Clinical Curriculum Council and the Basic Science Curriculum Council in their pursuit of developing the new curriculum. Using a process parallel to that of the Basic Science Curriculum Council, the CCC is focusing on:
    • What students need to learn, rather than time allotments – Identifying core topics/areas students need
    • How can all the stakeholders collaborate?

Because both the basic science and clinical curricula are equally “on the table,” that makes for a level playing field and a congenial working collaboration.

Dr. Wolpaw pointed out that medical schools have traditionally abdicated their educational role during the clinical years to the hospitals. The curriculum has been characterized by random exposure to clinical experiences and has been subject to the service and throughput needs of the hospitals. A new curriculum needs to address these issues and will likely require additional resources. The Dean has expressed his commitment to support the education of medical students. It is the faculty’s responsibility to come up with the curriculum. Dr. Wolpaw based his own optimism on 1) the pervasive sense that changes in the clinical curriculum are necessary, and 2) the partnership and shared interest of the University and College programs.

  1. Health Sciences Library Update
    Mrs. Virginia Saha, Cleveland Health Sciences Library Director, announced that approximately 2500 users participated in the eMedicine trial conducted in November. She will recommend purchasing a site license for 3 simultaneous users. Mrs. Saha opted for the PubMed feature that will provide links to full text journals available to Case. As a point of information, Mrs. Saha noted that the coveted Up-to-Date database is increasing its prices by 30%. Mrs. Saha announced a future trial for First Consult, the point of care product from MD Consult.
  1. Update from the Office of Biomedical Information Technologies
    Dr. Thomas Nosek
    , Associate Dean of Biomedical Information Technologies, encouraged faculty to make use of the license we have with the DXR Development Group to create original Virtual Clinical Cases.

See Curriculum Revision Update section.

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