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Summary of December 12, 2002 CME Minutes

 

1.                  Comments from the Chair

The search for a Dean for the School of Medicine is well underway, and an appointment is expected in the near future.

 

 2.                  Comments from the Vice Dean for Education and Academic Affairs

·        On Wednesday, January 8, and Thursday, January 9, 2003, Visiting Professor and family physician Dr. Ronald Epstein will speak on communication skills and assessment of professional competency skills of medical students.  On January 8, from 4:00 to 5:30 p.m., he will speak at CWRU, and on January 9, he will deliver the same talk at the Cleveland Clinic Foundation.

·        On Friday, February 21, or Saturday, February 22, (definite dates to be determined) Dr. Peter Scoles and Dr. Rich Hawkins of the National Board of Medical Examiners will both participate in two separate forums—one for faculty and one for students—on the USMLE Step 2½.

Dr. Altose suggested that student CME representatives communicate their recommendations for the format of this forum to Dr. Henson (lch14@po.cwru.edu).

 

3.                  Report from the CCLCM Curriculum Steering Council – Dr. Andrew Fishleder, Executive Dean of the Cleveland Clinic Lerner College of Medicine of CWRU

Dr. Fishleder explained that the CCLCM Curriculum Steering Council, which he co-chairs along with Dr. Henson, is comprised of 11 members in total, including three CWRU faculty members, and is responsible for oversight of the five-year program.  The Curriculum Development Task Force, a group comprised of over 30 CCF faculty, has been meeting for the past six months and has developed goals and objectives for the program and a curriculum structure.  A series of retreats and faculty development programs was held this fall.  Many of the faculty development programs have been collaborative efforts involving both CCF and CWRU faculty.

 

Dr. Fishleder provided an update on CCLCM curriculum development.

 

The curriculum consists of a five-year problem-based learning program to train physician investigators.  A research thesis is required for graduation.  While Years III, IV, and V were briefly described, the main focus of his presentation was on Years I (2004-2005) and II (2005-2006).  Documents were presented showing a block schedule with the development/exposition of vertical organ system blocks and accompanying horizontal disciplinary threads crossing the curriculum of the first two years.  Learning objectives for both organ systems and disciplinary threads were specified.  Year I focuses on the normal, and Year II focuses on the pathophysiology.  Year I starts with a ten-week basic and translational research summer block followed by six organ system blocks.  Year II starts with a nine-week clinical research summer block followed by five organ system blocks.  Effort has been made to avoid duplication of material where the same organ systems are covered in both Years I and II.  Additionally, a concerted effort has been made to integrate basic and clinical sciences.

 

All blocks begin on a Monday and end on a Friday.  Students will not come back to exams after holidays.  ICM (Introduction to Clinical Medicine) is a horizontal thread running throughout the first two years.  A time period following the final block of Year II has been dedicated to preparation for the USMLE Step 1.  A side-by-side comparison of the schedules for Years I and II of both the CCLCM and the traditional CWRU curricula was shown to demonstrate the intent to coordinate breaks as close to each other as possible.  Latitude in the program’s composition allows for individual tailoring of the research project/thesis to suit each CCLCM student’s needs.  The research project is due in preliminary form by January 1 of Year V and in final form by March 1 of Year V.  Core clinical clerkships will be completed by August 1 of Year V.

 

Prototypical week schedules of Years I and II indicate 3 days of problem-based learning for 2 hours per day amid labs, small group exercises, and seminars.  Approximately 20 of the 40 hours per week are spent in independent study.  Significant amounts of dedicated time are provided to prepare for PBL, graduate seminars, and graduate level courses.  (Graduate courses would be taken at CWRU.)  Four hours per day in the afternoon are reserved for independent study.  (One half-day per week is reserved for the Clinical Program during midweek independent study time slots.)  CCLCM students will have access to the CWRU eCurriculum.

 

A question-and-answer period followed.  There is an express desire not to have content experts as facilitators.  Content expertise is being taken into consideration in selection of the core of case writers who will prepare this case-based curriculum.  There will be 8 students per PBL group.  There are 3 two-hour PBL sessions for the 32 students per week in both Years I and II, which require a total of 8 faculty.  Four faculty will be needed for Year I and four faculty for Year II during each course.  There will be no lectures.  The clinical research block would include 1) a core clinical research curriculum, and 2) participation in an activity with a research investigator.  Curriculum planners intended that the summer experience at the beginning of Year II would provide students with a strong orientation to clinical research.

 

4.                  Overview of the Cardiovascular Animal Laboratories – Dr. John Mieyal and Dr. John Nilson

Dr. Altose welcomed the following Pharmacology faculty:  Dr. John Mieyal, Co-Chair, Year I Fundamentals of Therapeutic Agents (FTA) committee; Dr. John Nilson, Chair, Department of Pharmacology; Dr. Amy Wilson-Delfosse, Co-Chair Fundamentals of Therapeutic Agents (FTA) committee; Dr. Monica Montano, Co-Leader of Cardiovascular Pharmacology Lab; Dr. Ruth Siegel, Co-Leader of Cardiovascular Pharmacology Lab; Dr. W. John Durfee, Director of Veterinary Services; and Dr. Stephen Rudolph, cardiologist participating in the FTA  committee.

 

The CME invited members of the Pharmacology Department to address the CME, when the question arose in discussion whether the School of Medicine has an obligation to provide alternatives to those students who choose not to participate in the animal lab.  During presentation and discussion at today’s meeting, the theme of the animal lab as a critical educational activity was examined.

 

Dr. John Mieyal explained the context of the animal lab in the FTA committee, which he co-chairs.  A series of lectures on how all drugs are used precedes the Cardiovascular Animal Lab.  Variation in drug response among individuals is of primary concern.  This lab is the student’s first hands-on experience with a living being.  Dr. Jeff Blumer of Pharmacology delivers a clinical correlation lecture after the lab.  Dr. Mieyal explained that a simulation will be attached to the eCurriculum as a supplement, but he emphasized that, in his opinion, a simulation is not an equivalent substitute for the actual experience.  The Department of Pharmacology respects students’ sensitivities and offers the Cardiovascular Animal Lab on a sign-up basis.  Typically, more than 75% of the class sign up.  The lab emphasizes the importance of treating animals humanely and instilling a sense of responsibility for the proper care of the experimental animals.

 

Year II student representative Mr. Brian Chow presented results of the Class of 2005 Survey on Animal Lab Alternatives.  Of the 143 members of the Year II class, 37 responded to the survey.  Of the 37, 27 students attended the animal lab held during the FTA committee.  When asked should there be an alternative experience to the animal lab, 24 (64% of the 37) said “yes,” 5 (14%) said “no,” and 8 (22%) were “undecided.”  Suggested alternatives and selected comments from the surveys were included.

 

Dr. John Nilson, Chairman, Department of Pharmacology, supported the animal lab as an essential component in the training of a physician.  A proponent of hands-on animal experiences, Dr. Nilson personally favors making the cardiovascular animal lab a requirement rather than a voluntary activity.  He cited reasons and proposed re-thinking philosophical biases:

·        There is a national need for scientists and clinicians well trained with animal models.

·        Faculty need to re-educate themselves about the importance of hands-on experience with animals in providing the best medical education possible.

·        There is a need to reverse the lack of support in the School of Medicine for an activity whose faculty are equally as sensitive to animals as opponents and who invest themselves in a time-consuming, emotional project.  He welcomed the suggested involvement of bio-ethicists in the animal lab activity.

·        Pharmacology is the study of the effect of a drug in a living organism and not in a test tube.  There is no way to duplicate the former.  There are people who plan to discover new drugs and come up with new therapeutic agents, yet lack training in working with animals.

 

Dr. Henson wished to go on record that the School of Medicine will not force students to take the animal lab.

 

Cardiologist Dr. Stephen Rudolph, who has been involved in the animal laboratory for 25 years, believes that physicians and scientists need experience with animals.  He feels that a computer simulation lacks genuine emotional involvement.  The student has nothing at stake when no living being is involved.

 

One discussant referred to the graduate course “Surgical Anatomy,” ANAT 513, where students review gross anatomy on a cadaver and, with a surgeon, apply those surgical techniques on a dog.  Groups of students perform surgeries on dogs that were going to be euthanized by Cuyahoga County.  Cadaver-based information takes on a new perspective as seen in a living organism.

 

Dr. John Durfee, Director of Veterinary Services, believes in the value of animals in medical research.  He regards the Cardiovascular Animal Lab as a real way for the student to experience interaction with a living organism early on before he/she is taken to a human patient setting.

 

Dr. Rudolph explained that ten different drugs are administered and the results observed, such as changes in heart rate and blood pressure, in the cardiovascular ferret lab.  All animals respond to the drugs used, although the responses vary widely.

 

One CME member felt that technology has made incredible advances so that we can create models where students could see the effects on heart rate and blood pressure and also be affected emotionally.  Dr. Mieyal did not agree that a simulation can create the same emotional intensity as an experience with a live being.

 

The cardiovascular animal lab, like all CWRU courses, has always been voluntary.  In the late 1970’s, about 90% of the students signed up and attended the lab and the feedback was positive.  As opposition to use of animals became more vocal and animal rights became a political issue, participation/attendance decreased.  Now, there is about a 75% sign up rate, and that figure correlates with Mr. Chow’s data based on the number of responses from his survey of second year students.

 

Dr. Nilson expressed concern for the future of what he considers to be a very valuable activity.  If we do not have better organization of using animals and only stick to two isolated animal labs—the cardiovascular ferret lab and the dog surgeries—he foresees their disappearance within five years.  In his opinion, it is impossible to separate out the emotional experience.  He requested CME support for expanding animal labs.

 

When questioned whether there is anything we cannot simulate, Dr. Mieyal referred to the doctor-patient relationship response.  In his opinion, that emotional experience cannot be simulated.

 

Dr. Altose felt that the issues raised by the CME with regard to the animal lab had been addressed:  1) the educational value of the cardiovascular animal lab, and 2) whether we have supplementary, supportive material for those students who do not participate.

 

5.                  Vertical Themes

Dr. Altose recommended that we invite each “champion” representing a vertical theme to the CME to provide a general overview, or proposal, of how the particular vertical theme would fit into the CWRU curriculum.  The CME would then discuss and prioritize the vertical themes and recommend the top priorities to the Dean’s Office for support.  Dr. Altose had in mind supporting one vertical theme for further development at this time.  Money would be used for implementation purposes, not for planning.  The following vertical themes were mentioned:  1) Aging and Geriatrics, 2) Nutrition, and 3) Cancer Genetics.  Dr. Altose anticipated a decision by the CME as to which vertical theme to support within two months.  All suggestions for vertical themes are welcome; there are no restrictions based on prior presentations/recommendations made at the CME.

 

There are two ways of sustaining vertical themes:  1) by obtaining a grant, and 2) by identifying what we think are important themes and asking the School of Medicine to support them whether or not they receive a grant or after their grant ends.  As implementation of a vertical theme is very expensive, the CME has to decide how the vertical theme fits into the curriculum before approaching the Dean.  The “champion” of the vertical theme has the responsibility of meeting with every course director to locate gaps and duplications in the curriculum and to negotiate allotment of hours.

 

See Curriculum Revision Update section.

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