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Summary of December 11, 2003 CME Minutes

  1. Comments from the Acting Chair

Dr. Louis Binder, Acting Chair, presented highlights regarding medical education from the AMA Section on Medical Schools winter meeting recently held in Hawaii.  His report mentioned a) new approved LCME standards and potential standards under discussion, b) workforce data and trends toward a physician shortage, c) reducing student debt and reauthorization of the Higher Education Authorization Act, d) elimination of politicization from the NIH grant approval process.

  1. Report from the Vice Dean of Education and Academic Affairs

Dr. Lindsey Henson urged submission of nominations for the Glennan Fellowship Program awards.  Be sure to consult the Web site, URL is, for specifics.  The (University Center for Innovation in Teaching and Education) UCITE-administered Glennan Fellows Program was established in honor of T. Keith Glennan, former President of Case Institute of Technology, by the Glennan family.  The program is designed to reward excellence in teaching to faculty members in the tenure track who are not yet tenured.  Five stipends of $6,500 each are awarded.  The deadline for letters of nomination is January 22, 2004, and the deadline for the nominee’s proposal is February 19, 2004.

Our policy on the USMLE—Effective with the Class of 2005—was presented for clarification:

Case School of Medicine students must pass the United States Medical Licensing Examination (USMLE) Step 1 at the end of the second year to advance to the third year.  Students are also required to take the USMLE Step 2 Clinical Knowledge (CK) by January 31 in the year they intend to graduate.  To be eligible for graduation from the school, students must obtain at least the minimum passing score on the USMLE Step 2 CK as established by the USMLE Composite Committee.  In addition to passing the USMLE Step 1 and USMLE Step 2 CK, students must sit for the USMLE Step 2 Clinical Skills (CS) prior to graduation.

The decision to make “taking” the Clinical Skills exam, which costs approximately $1,000, a graduation requirement enables the student to qualify for financial aid.

The decision not to make “passing” the Clinical Skills exam a graduation requirement is based on the following factors:

  • Approximately 10% of a pool of strong candidates failed the exam in the pilot.  We do not know enough now about how our students will perform.  We need more data before deciding whether passing the exam should become a graduation requirement.

  • Logistically, the timeframe is difficult for those who fail to re-take the exam in time to graduate.

  • A medical school diploma is needed in order to begin an internship.

The Clinical Skills exam starts in June 2004, and the expected turnaround time for reporting score results is about three months.

Case is revamping its OSCE (Objective Structured Clinical Examination) program in order to better prepare our students for the Clinical Skills component.  Two “long” stations, patterned after the CS exam, were incorporated into the Medicine/Family Medicine OSCE in October this year.  They were graded by standardized patients and physicians.  Students not performing up to standards were sent a note to meet with Dr. Marcia Wile or Dr. Klara Papp for follow-up.  Dr. Henson mentioned plans to expand the two stations to four for a mock Clinical Skills Examination during the first six months of Year IV.  The intent is for students to 1) get experience using clinical skills, and 2) receive feedback on their performance.  Students should become comfortable enough with the clinical skills evaluation process so that they are able to demonstrate their clinical abilities.  They should have resource people with whom they can remediate.  They should know their own strengths and weaknesses.  It is anticipated that Year II Physical Diagnosis will also add at least one or two more stations to their OSCE.

It was reiterated that the Clinical Skills exam will be graded Pass/Not Pass on three scales:  clinical skills, interpersonal skills, and English proficiency.  A candidate must pass all three scales at the same examination in order to pass this exam.

Dr. Henson responded to an inquiry about Dean Horwitz’s proposal to create the “Case School of Medicine and Health.”  Dean Horwitz has produced a white paper describing his vision to create an educational program for medical students at the University dealing with both disease and health, which will require us to design a new basic science and clinical curriculum.  The start date of the new curriculum is 2006.  The Vice Dean’s Advisory Committee on the Curriculum, an executive committee currently consisting of the Vice Dean for Education, the Associate Dean for Curricular Affairs, the Clinical Curriculum Council Chair, the as-yet-to-be-named Basic Science Curriculum Council Chair, the Committee on Medical Education Chair, and the Associate Dean for Medical School Research, will be expanded.  This executive committee usually meets weekly and will 1) coordinate communications and planning among the councils, the curricular affairs office, other key groups of faculty, and the CME, and 2) ensure that the new curriculum adheres to the Dean’s vision.  Dean Horwitz has been contacting foundations to pursue support for his vision.  The year 2006 will also mark the start date of the new Year III and Year IV clinical curriculum that will accommodate both the College and University students.  Developments will take place before 2006 to accomplish a smooth transition between the preclinical ICM (Introduction to Clinical Medicine) curriculum and Year III.  We are also already looking at innovative ways to teach in the basic science curriculum.

The next of the sequential Year III and Year IV clinical curriculum retreats will take place January 7, 2004, at Healthspace Cleveland.

  1. Report from the Student CME

Year III student representative, Mr. Brian Chow mentioned his classmates’ concern about the disparity in evaluation among different sites of the same clerkship, where similar performance did not earn similar final grades.  Students would like clerkship grading standards to be published in a catalog for all students to see before the clerkship starts so that they know what is expected of them.  The student perception is that only the clerkship directors know how students are being graded.  When asked whether this problem was global across all clerkships or specific, Mr. Chow replied that there appeared to be a significant disparity between the Metro and Cleveland Clinic OB sites, even though the same residents were doing the grading, using similar evaluation forms and criteria.  Students perceive clerkship grades as having huge impact, since Case’s first two years are ungraded.  Clerkship grades play a significant role in the competitive residency selection process, their evaluative comments are quoted in the Dean’s Letter, and they determine eligibility for the AOA honor society.

Approximately between 66% and 75% of our students receive “commendable” or “honor” grades.  The problem is variability in grading between sites and also between time blocks.  The Clinical Curriculum Council chair is interested in obtaining the data on variability of grades.  The Registrar has site-by-site data.  The Director for Residency and Career Planning can provide trends.

A reference to our Dean’s Letter as a letter of recommendation rather than a letter of evaluation invited some background explanation.  Case clerkships had a long history of Pass/Honors grading.  When the “commendable” category was added, the intent was for our top quartile of students to be awarded “honors,” and the next highest quartile awarded “commendable.”  What actually resulted was more than the originally intended percent of students earned high marks.  Since 1) Case students were getting good residencies in the match, and 2) a survey of residency program directors indicated our Dean’s Letter adequately fulfilled their needs, it was decided to leave the grading system as it was.

The Dean’s Letter format was discussed and it was recommended by one CME member that it be changed to more authentically represent student performance.  The Clinical Curriculum Council Chair responded that before such a recommendation could be made, all of the complex issues that affect clerkship evaluations would need to be addressed.  The Director for Residency and Career Planning added that the Dean’s Letter currently contains the number of honors the student receives as well as a final paragraph summarizing overall performance as “outstanding,” “excellent,” “very good,” etc.

Dr. Henson felt that we can remedy our current problem of unreliable grading across sites by training people to be reliable evaluators of student performance.  She referred to a Provost’s grant written by Dr. Terry Wolpaw for this type of assessment training.

When asked about subjectivity and variability in clerkship grading, Mr. Chow felt students would like answers to these three questions:

  • What are the grading criteria?

  • How do we get to the final criteria?

  • Even if there are the same evaluators, why are there better grades at one site than another?

To satisfactorily address out students’ concerns, we will need clerkship grading data 1) by site and 2) by (time) block.  CCC Chair Dr. Lewin will contact the Registrar, bring the matter before the CCC in February, and report back to the CME.

Year II student representative, Mr. Jason Garnreiter mentioned that he and the Year I representative, Mr. Chris Utz, will meet with Dean Horwitz on January 5, regarding clarification of the Dean’s vision.  January 19 is the tentative date set for Dean Horwitz to address the students about his vision for the future.  Mr. Garnreiter has started the process to find a temporary replacement for Year IV CME voting member Mr. Jim Lan.  By posting a description of the responsibilities of the student representative and the role and make-up of the CME on the Year IV ListServ December 10, Mr. Garnreiter invited responses from students interested in representing the concerns of the Class of 2004 until Mr. Lan’s return.  CME members agreed to Mr. Garnreiter’s discretion in selecting one of the respondents and asking the CSR (Committee on Student Representatives) to agree to the appointment.

  1. Report from the Clinical Curriculum Council

Dr. Linda Lewin, Clinical Curriculum Council Chair, mentioned that approximately 20 people attended the first meeting of the CCC held November 25.  All disciplines but one were represented.  The meeting focused on goals, how to run the CCC, what issues to address.  Discussions about formulating a charge brought up the following questions:  Should the CCC serve in 1) a decision-making, or 2) an advisory capacity?  Should the CCC be empowered to choose one pathway over another?  Would the CCC provide feedback?  Based on personal experience with the CCC’s predecessor, the CRDC (Clinical Rotation Development Council), majority opinion favored having input regarding curriculum issues but not having to make the big decisions themselves.  One of the issues that the CCC will address concerns the clinical transaction portfolios, and many members had not heard about the clinical transaction skills grant awarded Case.  A primary role of the CCC was perceived as communication, keeping members informed as to what is going on.  CCC meetings are scheduled for the second Friday of the month, from 7:30 to 9:00 a.m., probably in room T501 of the School of Medicine.  Each clinical clerkship has chosen a convener as its representative.  There are also representatives from the pre-clinical programs of ICM.  However, anyone is welcome to attend CCC meetings.

When questioned how the CCC would make decisions and resolve issues raised, Dr. Lewin replied that it has not yet been determined whether the CCC reports to the Vice Dean for Education and the CME or whether its function is that of an advisory committee.  This needs to be decided before the CCC can tackle any big decisions.

  1. Report from the Flexible Program Council

Dr. Kent Smith, Flexible Program Coordinator, announced that a Micromolecular Biology graduate course taught by Dr. Jonathan Karn and Dr. Michael Lederman will be offered as a Type A elective.  There are plans to bring in local and outside experts for the summer research.

  1. Report from the Molecular Biology, Developmental Biology, and Genetics Subject Committee

Dr. Matt Warman, Molecular Biology, Developmental Biology, and Genetics subject committee co-chair, mentioned that major organizational changes occurred in the committee this year.  Dr. Warman felt that the committee successfully integrated all four disparate disciplines—histology, molecular biology, embryology, and genetics.  More clinical correlation conferences were added, as students indicated their appreciation for this kind of learning activity.  This year there were five clinical correlations, and patients were brought in.  Frustration for the teaching faculty stems from the committee’s early scheduling block in Year I before students have had enough exposure to truly appreciate the committee.  While approximately 20% of the students divide evenly at either end of a “love-hate” relationship in rating the committee, the other 80% of students rate the committee as “good” to “very good.”  Plans for next year include updating the syllabus in a more timely fashion and increasing the number of clinical correlations.  Dr. Warman’s own preference would be to videotape all the lectures and do the clinical correlations during class time.  This, however, would require students’ watching the lectures on their own time to prepare for the in-class activity.

Dr. Warman would prefer to let the students self-select the small groups that they choose to attend.  For example, a student who is strong in molecular biology could choose not to attend that small group.  Faculty could push the very knowledgeable students by offering some extremely challenging small groups, and, at the same time, offer some groups for those students encountering the material for the first time.  Also on the subject committee’s agenda for next year is making a decision whether to update the syllabus or to issue a statement supporting textbooks as the better resource.

This last issue—whether the syllabus is the “Bible” or the primary resource should be textbooks—evoked much response from discussants.  The consensus, regardless of the position taken, was that this is an important issue that needs to be addressed.  In an age of evidence-based medicine and information technology, students need to know how to evaluate and synthesize the material for themselves.  Dr. Warman felt that it is the faculty’s duty to promote primary material or other sources as being more important than the syllabus.  Dr. Nosek mentioned a company that offers a full range of unabridged medical texts in digital format, with updates appearing as each new edition is published.  In his opinion, the high quality of our syllabus deters students from spending money on texts.  From the student viewpoint, deterrents to buying texts include 1) the failure of the bookstore to order enough books for the entire class, 2) the high cost of a textbook ($150) for a course lasting only a few weeks, and 3) announcements from subject committee chairs the first day of the committee that everything the students need to know is found in the syllabus.  Students recommended that prior to beginning the course, subject committee chairs should indicate to the students whether or not they should buy specific texts.

  1. Information Technology Update

Dr. Thomas Nosek, Associate Dean for Biomedical Information Technologies, described the new ePortfolio system.  The new system will allow students to upload information to share, at their discretion, with classmates, faculty, or only with their advisers.  The ePortfolio offers a venue for them to include their research work.  Dr. Lynda Montgomery and Dr. Klara Papp are in charge of the Year III clinical transaction ePortfolios, and Dr. Aach will handle the ePortfolios in Year IV.

  1. Update from the Office for Curricular Affairs

Dr. Terry Wolpaw, Associate Dean for the Office for Curricular Affairs, mentioned that she, Dr. Nick Ziats, Ms. Minoo Golestaneh, and Mr. Craig Hull have been working on a faculty needs assessment and have identified a brief but effective intervention.  Two or three focus groups of subject committee chairs indicated the desire for a “one shot deal,” which may be conducted by UCITE in the spring.  Topics for consideration include large and small group teaching and feedback.  Once developed, a concise series could be offered several times.

  1. Health Sciences Library Update

Mrs. Virginia Saha, Cleveland Health Sciences Library Director, announced that Case Western Reserve University has joined BioMed Central through OhioLINK’s consortial membership.  BioMed Central is an Open Access publishing enterprise and covers a large range of basic science and clinical disciplines.  Because Case is now a member, faculty no longer have to pay significant amounts to publish in the BMC titles.  Case now has access to BioMed Central journals via the libraries’ Electronic Journals website ( and through the special PubMed link on the library’s home page ( 

See Curriculum Revision Update section.

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