Shield of the SOM Committee on Medical Education
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Summary of 5-10-01 CME Minutes 

  1. Dr. LaManna announced a proposal seeking CME endorsement that would require all Year IV students to take the USMLE Step 2 by January 15 of the year in which they expect to graduate.  It is currently required that all students must pass the USMLE Step 2 in order to graduate.  When the NBME converted to online examinations, the individual student became responsible for his/her scheduling of exams.  We never formulated a definite policy regarding the latest date a student could take the exam and still have time to retake it in case of failure.

Associate Dean of Students Dr. Robert Haynie mentioned the significant amount of work caused this academic year by students who had not taken the USMLE Step 2 as of December.  This amounted to four rounds of e-mailings and a registered letter for each student where necessary.  He does not want to see this situation repeated.

The following proposal passed unanimously:

Because all students must pass the USMLE Step 2 in order to graduate, students will be required to take the USMLE Step 2 by January 15 in the year in which they expect to graduate.

This way affords students who do not pass the USMLE Step 2 the opportunity to retake the exam and graduate with their class.  This also eliminates the situation where a CWRU match student has to drop out of a residency program, because he/she did not pass the USMLE Step 2.  The new policy requirement will meet the needs of both the students and the residency.  Implications of how best to implement the policy are currently under discussion.

  1. Dr. LaManna next brought up an idea that arose from a Physiology department meeting this morning that he attended.  Dr. LaManna clarified that the Department of Physiology did not make any specific request of the CME.  It was Dr. LaManna who suggested that the CME might play a useful role.  Dr. Ulrich Hopfer mentioned that a significant number of students have not mastered some of the very basic principles when they come to take an exam.  He is referring to basic entry level information that students may have learned in high school or at another time but have not retained.  Dr. LaManna suggested that, in this case, the Physiology faculty identify a list of fundamental content concepts that could be brought to the CME, and perhaps Dr. Nosek could post this list on the electronic curriculum.  Dr. LaManna reiterated that the CME does not deal with content; it deals with policy.  We would be looking at the concepts on the list.  Content would have to be judged by the content group.  Any interested committee could submit a list of basic concepts.  However, we would not require it of any committee.  One discussant mentioned that tracking the percentage of wrong answers to exam questions has revealed a steady increase over the years.  Dr. Joe Miller supported the creation of an outline/database of primary fundamental information needed at the entry of medical school and considered important all the way through.

  2. Dr. Charles Malemud, Associate Coordinator for the Flexible Program, presented the “Report on the Flexible Program:  2000-2001 Academic Year.”

Dr. Malemud acknowledged the Registrar, Mr. Joseph Corrao, for his help in preparing the annual report.

One hundred sixty-five Type A electives were listed in the 1999-2000 CWRU School of Medicine Flexible Program Catalog.  Dr. Malemud’s table listing Type A electives reflects only those where ten or more students were enrolled.  Heavily subscribed Type A electives include Basics of Critical Care Medicine, Primary Care Track Seminar, Medical Apprenticeship, Introduction to Emergency Medicine, The Internist’s Top Ten, Clinical Correlation:  MSI, and Psychiatry Noon Option.

Dr. Malemud mentioned that he and Dr. Tarvez Tucker, Coordinator for the Flexible Program, are aware that there is no formal strategy to assess the quality of electives.  They are looking into selectively monitoring the electives.  However, since electives are offered in the afternoon, physicians busy in practice cannot come to the medical school to assess the electives.  There currently exist student evaluations of electives; however, their return is erratic.  Dr. Malemud explained that most of elective registration depends on word of mouth.  We do not have a system in place to help faculty improve in those electives that are not heavily subscribed.  We need more quantitative data so that we can decide whether or not to keep the undersubscribed electives in the catalog.

Type B electives are offered during the third and fourth years.  With the exception of the 63 students who are enrolled in the Radiology elective at University Hospitals, students are broadly distributed for the remaining Type B electives at University Hospitals, MetroHealth Medical Center, and the Cleveland VA.  The largest enrollment in Type B electives is among the “unlisted electives,” which are offered exclusively at other places, where we have no quality control.  We approve these electives offered by other LCME-approved medical schools.  Third and fourth year elective offerings at Henry Ford are also currently lumped together under the “unlisted” category.  At the present time, as reflected on our list, we have not differentiated between electives at unaffiliated LCME-approved medical schools and at our Henry Ford affiliate.  Dr. Malemud explained that students use the fourth year to take advantage of opportunities that are not offered here.

Thirty-nine Areas of Concentration are listed in the Registrar’s report, dated May 5, 2001, and include the number of students enrolled for the four classes (2001-2004).  The Area of Concentration is a strong tool for Admissions.  Students enrolled in the Primary Care Track and Family Medicine represent a duplication in numbers.  A few AoCs have no students enrolled at all.  While the majority of students are not enrolled in more than one Area of Concentration, some students are enrolled in more than one AoC.  Approximately one-half of our students are in AoCs.  In addition, about 60 students are enrolled in the dual degree programs.  Five heavily subscribed Areas of Concentration are Emergency Medicine-Clinical Care, Family Medicine, Neuroscience, Primary Care Track, and Internal Medicine.  These numbers tell us what our students are doing.  Student interest in the Alternative Medicine AoC indicates their awareness that they will need to know about this area in their practice despite its omission from our core curriculum.  Realization that alternative medicine is coming into the mainstream should cause us to rethink whether it should be offered as a combination of core and elective material.  The “flexible” nature of the electives program allows students to “customize” their medical education.  Customized Areas of Concentration are found under the category of “Student-Initiated AoCs.”  Faculty in successful AoCs actively recruit to spur student enrollment in their offerings.  Departments cannot simply wait to have students come to them.

Dr. Malemud explained that the Dual Degree statistics presented in the handout are taken from the CME chart presented in the fall of 2000.  For example, the 11 students enrolled in the M.S. in Applied Anatomy have increased to 20, according to Dr. LaManna.  One discussant suggested getting dual degree figures at the same time each year.

Dr. Malemud referred to Dr. Tucker’s announcement at the February 2001 Medical Education Retreat at Landerhaven of translational research opportunities for first year students during the summer preceding their second year under the sponsorship of the University Hospitals Research Institute.  This is an ideal way to combine fundamental science with application.

Dr. LaManna mentioned that a program renovation is needed for the fourth year, where we define 1) the goals of the enrichment program, 2) the program, and 3) its evaluation.  He would like concrete data on how many medical students take graduate courses.  Students earn Flexible Program credit for these graduate courses.  In Dr. LaManna’s opinion, more formal structure is needed in the electives program across all four years.  Dr. LaManna welcomed a CME subcommittee plan for the fall to revise the Flexible Program.  Discussion brought up the perception of the Flexible Program as an “enhancement” program.  However, students not in good standing are now using “remediation electives” when they want.  We do not have remediation in Year I.  Students in academic difficulty are required to complete electives in Year I.  This is a policy issue.  Should first year students in academic difficulty have to complete their electives requirement?  Dr. LaManna raised the question:  Do electives always have to be enhancing?  We have a formal policy regarding the dual degree program:  Students not in good academic standing are not allowed in the dual degree program.  However, we need a policy regarding students not in good standing and the electives program.

See Curriculum Revision Update

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This page was last updated on 6/4/01 by John Graham.

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