Overview of 2000-01 CME Meetings

Arranged Chronologically by Meeting Date and Issues Discussed
(Detailed Digest Available Upon Request)

September 14, 2000

1. Announcement of new CME members:  1) Dr. G. David McCoy, 2) Dr. James Arnold, 3) Dr. Robert Harvey
   

2. Dr. Linda Lewin, Co-Director of the CLICS (Contemporary Learning in Clinical Settings) Program, presented the results of a 1999-2000 pilot program for third year medical students.

• CLICS program originated as a HRSA (Health Resources and Services Administration) grant focusing on “undergraduate Medical Education for the 21^st Century” (UME-21) by introducing third year students to topics relevant to medical practice but not included in the curriculum

• Four individual cases introduced as four separate discussion sessions in the Primary Care Track (PCT) small group format spread over the year at the three sites:  Henry Ford, University Hospitals, and Metro

• Students give high ratings to cases via questionnaires; student performance evaluated through OSCE stations at the end of the third year, when all PCT students take a Generalist OSCE

• PCT students who attended CLICS sessions outscored non-PCT volunteers who did not attend CLICS sessions on the OSCE stations linked to the CLICS sessions.

• Interest generated in a Year III whole-class comprehensive OSCE, requiring approximately 50 stations (competencies that could be designated as “learning objectives”) and 40 faculty to evaluate and grade the students

The following motion passed unanimously:  that the CME get input from the Clerkship Directors and the Clinical Rotation Development Council on the idea of establishing a third year whole-class comprehensive OSCE.  This input is to evaluate the potential behind the idea, not to recommend implementation.

3. Setting agenda items for the coming year:  The CME is responsible for evaluation of the curriculum.
   

4. Student perception of the need for change in the current examination system

Prior to last year—when an error in Xeroxing led to release of some secure exams and resulted in a decision to shred all exams once the exam is over— students could approach the Dean of Students and review the actual secure exam with him to see exactly where mistakes were made.  This is no longer possible; students can never see the questions they missed on the exam.  First- and second-year students believe that assessment in its current form is impeding the educational mission and needs to be changed.  Delineation of desired student changes follows:

1. Students must have the right to review their exams after receiving their scores and to discuss the exam and specific questions with the relevant Committee Chairperson or other appropriate and knowledgeable instructor.

2. The mean and standard deviation for several previous years should be reported along with each score and the current class aggregate data, so that students may make informed judgments about the relative adequacy of their knowledge base.

3. Each Committee should schedule a formal (post-)review session and print the date and time of such a review in the official printed syllabus.

4. Any time it is determined that the process of examination can be reasonably modified so as to increase the educational value of the examination without detracting from its assessment value, such modifications should be urged and adopted.

Students are seeking the endorsement of the conditions stated above from both the Committee on Medical Education and the Curriculum Leadership Council. 

In general, discussants expressed a desire to reinstate the arrangement whereby students could make provision to review their exam performance and see what they missed without, however, the release of the exams for students to keep.  Benefits of secure exams were cited.  Input from the Curriculum Leadership Council and the Committee on Students is needed before further action can be taken with regard to the student desire for change in the secure exam system as it exists today.

September 28, 2000

1. Results of the USMLE Step 1

The most recent CWRU Year II class to take the USMLE Step 1 scored the highest mean since the implementation of the USMLE Step 1 in 1992.  Dr. Wile mentioned that 1999 was the first year of the electronic version of both the USMLE Step 1 and USMLE Step 2.  The USMLE Step 1 and Step 2 are now one-day exams, and each examinee’s test is different.  As of September 13, 2000, 96.5% of the 142 first-time test-takers in the CWRU Class of 2002 passed the USMLE Step 1.

2. Mr. Joseph Corrao, Registrar, presented an update on dual degree students.

A look at formalized enrichment—via the joint degree programs offered and the number of students enrolled in each according to class as of fall 2000.  CWRU currently offers these certificate/degree programs in combination with the M.D. degree:

• M.B.A.

• J.D.

• Ph.D. (offering a Ph.D. in Health Policy Research, or other Ph.D. where students are independently seeking a Ph.D.)

• Medical Scientist Training Program (M.S.T.P., a long-standing fully funded program offering both the M.D. and Ph.D.)

• M.S. in Applied Anatomy

• Certificate in Health Care Management (awarded by Weatherhead)

• M.P.H. (awaiting university approval before it can be offered as a dual degree to medical students)

• M.A. in Bioethics

• M.S. in Exercise Physiology

• M.Ed. in Medical Education (in collaboration with John Carroll University)

CWRU medical students also have the option of enrolling in a degree program at another school, although, currently, there exists no formal approval process for doing this.  Dr. LaManna expressed the desire to have the dual degree program under the umbrella of the Flexible Program, which deals with enrichment.  The Committee on Students seeks assurance that the dual degree students are in good academic standing, and, currently, there is no established mechanism in place for this.

Mr. Corrao’s handout listed graduate courses and the number of first- and second-year students collectively signed up for them prior to the fall of 2000.  Figures in this section did not include the M.S.T.P. students or any other medical student currently enrolled solely in the Graduate School.  Each of the four years of medical school counts as 9 credits.  There are 9 students—all in the dual degree program—who are carrying over 15 credit hours.

Discussion included soliciting student input for specific interests in adding to the dual degree offerings, recruiting for the dual degree program, tracking percentages of identified dual degree students, tracking the residencies where dual degree students match, collecting data to determine if, indeed, enrichment provided via a dual degree program merits choosing CWRU over other medical schools. 

October 12, 2000

1. Introduction of newly elected Year I student representative Jim Lan and suggestion to investigate possibility of online listing of MAPs (Medical Apprenticeship Programs)
   

2. Discussion of 1) facility problems in lecture halls and 2) computer problems impeding release of Histology exam scores as interfering with the educational mission
   

3. Student accountability for mastery of the three longitudinal committees:  Gross Anatomy, Histology, and Pathology
   

4. Update on secure exam issue
   Year II student representative Scott Walker met with principals involved for an honest exchange of views.  The faculty emphasized that secure exams are a necessity.  However, the faculty are always looking for new ways to evaluate.  Mr. Walker will attend the upcoming Curriculum Leadership Council meeting.
   In an effort not to violate the secure exam process currently under discussion, faculty exercised extreme caution in reviewing exams.  This resulted in students getting the runaround when trying to find people to answer their questions.  The issue of post-exam review must be finalized so that a decision can be made on what can and cannot be reviewed with students.
   

5. The medical education retreat will take place Friday, February 23, 2001, at Landerhaven.

 October 26, 2000

1. Discussion of the AAMC (Association of American Medical Colleges) exit survey (“Medical School Graduation Questionnaire Report”)
   This extensive questionnaire compares responses from CWRU fourth-year graduates with a nationwide sample of all fourth-year graduates from U.S. medical schools.  The survey indicates percent of responses to approximately 39 categories of questions.  School-specific data are provided for three years:  2000, 1999, and 1998.  The sample size, however, at CWRU consisted of less than half the graduating seniors.  Less than 50% of CWRU graduating seniors filled out the survey, whereas on the national level, approximately 15,000 responses were received out of 16,500.

November 16, 2000

1. Overview of the Medical Scientist Training Program (M.S.T.P.) – Dr. John Nilson, Director, and Chairman, Department of Pharmacology
   As CME is tracking dual degree programs, we were interested in learning more about the Medical Scientist Training Program in hopes of determining ways in which we might be of help to the M.S.T.P.  Dr. Nilson elaborated on the following areas:  Program Mission, Program Features, Typical Student Accomplishment, New Students, 1999 Ph.D.s, 1999 Program Graduates, and 2000 Program Graduates.  The CWRU M.S.T.P. has been NIH-funded for over 20 years.  It received an outstanding review at its last site visit.  It is currently funded for 30 slots.  The program mission is to “endow students with the skills necessary for a lifetime of scholarly accomplishment in medical science.”  The M.S.T.P. student chooses to spend an extra four years acquiring a Ph.D. along with earning an M.D.  Approximately 80% of M.S.T.P. graduates remain in academic medicine.  Areas of focus included:  mentors, transition from medical school to Ph.D. program labs to medical school wards, research recognition and publications, residency match, and recruitment.  “Detractors” in recruiting:  need to 1) elevate our graduate program, and 2) improve our physical facilities.  Positive factors attracting students here:  1) our openness and 2) our commitment to medical education.  CWRU is still the leader in integrating basic and clinical education.
   

2. Review of CWRU USMLE Step 1 and USMLE Step 2 Performance – Dr. Marcia Wile, Director of Curricular Evaluation
   Dr. Wile provided a brief history about the roles that the NBME Part I and Part II examinations took on, beginning with implementation of the innovative 1952 Case Western Reserve University curriculum.  With the implementation of the USMLE Step 1 in 1992, passage of the USMLE Step 1 became a CWRU requirement, effective with the Class of 1994. The USMLE Steps 1, 2, and 3 became the only way to obtain licensure.  Passage of the USMLE Step 2 became a prerequisite for graduation.  Dr. Wile distributed two separate charts providing data for the past ten years on CWRU first-time test-takers’ performance on the USMLE Step 1 and the USMLE Step 2.  The USMLE Step 1 was a paper/pencil exam from 1992 to 1998.  The electronic format replaced the paper/pencil exam in 1999.  Differences in the paper/pencil version and the electronic format were noted.  Students must pass the USMLE Step 1 to stay in the clerkships.  Electronic administration of the USMLE Step 2 also began in 1999.  A student can only take the USMLE Step 1 or Step 2 three times in one year.

December 14, 2000

1. Introduction of new fourth year student representative Eric Baden, who replaces Sarah Dorsey currently in her residency in the 3 + 3 Internal Medicine program.
   

2. Presentation on the Clinical Research Scholars Program (CRSPs) at CWRU – Dr. E.R. McFadden, Jr., Director of the General Clinical Research Center UH/CWRU
   Two components of the program:  1) CRSP Jr., a program for medical students, is currently in development with promise of support by the Dean, and 2) CRSP Sr., a program for fellows, is currently a K30 funded program.  CRSP Jr. is looking for 1) first- and second-year medical students to spend one year in the laboratory of a successful clinical research team with a designated mentor, and 2) house staff to spend a research year.  CRSP Jr. can be taken by medical students as an extra year between the second and third years of medical school or between the third and fourth.  Students can earn a combined M.S./M.D. degree.  However, students interested in clinical research opportunities but not wishing to take a year off from their medical school studies can still have access to a list of clinical research opportunities and related courses.  CRSP Sr. is at the level of a fellowship.  Current emphasis is on developing the CRSP Sr. program and getting a Master’s.  CRSP Sr. (K30) is a funded program.  It is a didactic program to teach clinical investigation to those who have completed their training in Medicine, Dentistry, or Nursing and want a career in clinical investigation.  While CRSP Sr. is geared to postdoctoral applications, we can put medical students into the summer two-week Introduction to Clinical Research Seminar Series and one or two courses.  For further information, contact Dr. E.R. McFadden, Jr. at (216) 844-8669 or erm2@po.cwru.edu.  Dr. LaManna sought and received a CME endorsement for the Clinical Research Scholars Program at CWRU to go forward and to report back to the CME on its progress.  The CME views CRSP as beneficial to medical students and enriching the curriculum.
   

3. Trends in Nine Years of Admissions Data (1992-2000) – Dr. Albert Kirby, Associate Dean for Admissions, and Dr. G. David McCoy, member of the Admissions Committee Data presented began with the Class of 1996 entering in 1992 and ended with the current first year class, the Class of 2004 entering in 2000.  Snapshots of the selection process furnished data on GPAs and MCAT scores.  Bar graphs compared performance of 1) all national applicants to U.S. medical schools, all accepts to national medical schools, and 3) all accepts to CWRU School of Medicine.  Overall, GPA for all students tends to be increasing.  CWRU MCAT scores are getting higher.  The increase in scores is coming from our funded programs—the Dean’s Scholars program and the Medical Scientist Training Program (M.S.T.P.).  The largest number of our medical students comes from CWRU.  The next largest number of students comes from the Ohio State University, University of Michigan, this year Berkley, and the Ivy League, and near-Ivy League schools.  With respect to the Ohio population represented in our medical school make-up, 60% of the first year class must be Ohio residents, since we receive Ohio funding.  CWRU is doing well with regard to the Ohio applicant pool.  CWRU would incur a $4 million loss if we were to drop the Ohio subsidy.  The pool of underrepresented minorities is declining at a faster rate nationally than at CWRU.  One of the “top-ten” rankings that we consistently qualify for is “most expensive” medical schools.  This year, for the first time, we offered students in Michigan the opportunity to interview at Henry Ford.  Two-thirds of Michigan applicants took advantage of the opportunity to interview at Henry Ford instead of coming to CWRU.

January 11, 2001

Midterm Update of the Core Academic Program Curriculum

1. Electronic Testing – Dr. Tom Nosek recognized Ms. Irene Medvedev for the online testing system that she has designed.  An optional online version of the last Year II interim was offered to interested students in the computer classroom, which could accommodate up to 23 students, as the first phase, or “pilot” step, in implementation of electronic testing.  Only four students chose the online version over the paper copy.  The system enables both output to a computer and the ability to make a paper version of the interim.  There will always be a paper backup.  One of Dr. Nosek’s goals is to open online exams to the faculty so that they could edit their questions directly.  Online exams can be kept secure.  It was decided to implement computer-based interim exams on a whole-class basis with the Year I class, if the Subject Committee Chair agreed to do so.  Dr. Ulrich Hopfer of the Renal-Gastrointestinal subject committee of the Homeostasis I section will offer five online quizzes before the next interim in Homeostasis I.  Prior to the first of the five quizzes, all Year I students will take a practice quiz.  Dr. Nosek highlighted the benefits of the online quizzes:

• Immediate feedback since the quiz/exam is graded instantly once the student presses a button indicating that he/she has finished

• Since the quizzes are not secure, the exam comes up and links with the electronic curriculum for review purposes.

• An analytical printout of the quiz goes to the subject committee chair, Dr. Hopfer, within fifteen minutes.

There will be five online quizzes preceding the actual February online interim.  Rationale for the quizzes was explained:

• Since there is a tendency for students not to perform strongly on Renal Committee test questions on both the interim and on the Year I Comprehensive Examination, this is a concerted effort to improve the knowledge base in this area.

• Dr. Hopfer is using the “public” quizzes (they are not secure) to encourage students to work steadily and not to cram at the last minute.  The quizzes will also serve as a learning experience.

2. Brief update on Histology
   Histology will still give its own practical and multiple-choice-question format exam.  Histology test results have been relatively consistent.  There is an effort to integrate one or two questions on Histology and Physiology on each interim exam.  Recognition expressed for:  1) Excellent visual material work by faculty, and 2) Strong group of tutors that supports second year commitment to the first year students in Anatomy and Histology.
   

3. Brief update on Pathology
   Like Histology and Human Gross Anatomy in Year I, practical exam scores are the only scores considered for Pathology.  To date, four subject committees have had Pathology exams.  Students received their cumulative weighted Pathology percent scores based upon their performance on the Pathology practical examination administered in the four subject committees.  The cumulative score is calculated on the basis of the total number of Pathology hours in each committee.  The cumulative Pathology score represents the student’s performance on approximately 40% of the Pathology teaching in the 2000-01 academic year.

February 8, 2001

1. Year II students strongly urged to take the Comprehensive Basic Science Examination on March 22, which is highly representative of the USMLE Step 1
   

2. Cleveland Health Sciences Library recipient of $1 million grant for refurbishing from the Elisabeth Severance Prentiss Foundation.  The Library already has funding from the Firman Foundation to transform two small rooms into one large high-tech room for interactive video and Web-based technology.
   

3. Student CME

• Student frustration that there are not enough hours dedicated to Anatomy, particularly in lecture—lab hours are okay.
  

• The Office of Student Affairs has started a research binder.
  The CME endorsed adoption of a document denoting individual student research to be used in preparation of the Dean’s Letter.  The CME further recommended that this document be handled through the Office of Student Affairs.

4. Update on Genetics vertical theme – Dr. Matthew Warman, Assistant Professor of Genetics and Pediatrics
   Plans for Year I

• Desire for all students to have the same minimum font of knowledge containing the vocabulary and tools that Genetics uses to study human disease, mostly basic science

• Introduce how to take a genetic family history in Year I Physical Diagnosis

Plans for Year II

• Introduce key concepts of Genetics (an example:  common disease-predisposing alleles exist within the population) and thinking relevant to practice in Year III

Plans for Year III

• Genetic differential diagnosis

• Core teaching

• Invitation to case conference management, given a realistic time frame

Plans for Year IV

• If we can assure that all Year III students can be reached during their rotations and exposed to key Genetics concepts, then the Year IV elective should remain enrichment for those particularly interested in genetics.

• If we are not able to reach all Year III students, important concepts could be reinforced in Year IV by having special events, such as a weekend symposium where a common disease or problem would be discussed from several perspectives, including genetics, and students would be strongly encouraged to attend.

Summary of Genetics mission:  Accustom the medical student within his/her four years of undergraduate medical education to think of Genetics predispositions with equal importance and ease as deciding which antibiotic to prescribe for a patient.  Every family has a family tree to consider.  The student should also be familiar with diagnostic and prognostic tests.

March 22, 2001

1. Dr. Richard Aach, who chairs the search committee for a Vice Dean for Education, mentioned that candidates represent a range in expertise and possess formal education backgrounds.  Pamela B. Davis, M.D., Ph.D., Professor of Pediatrics and Director of the Cystic Fibrosis Center, is heading the search for a Vice Dean for Research.
   

2. Match Day Results:  Approximately 95% of our students matched.  Ninety-two and one-half percent of our students matched in one of their top three choices.
   

3. Update on Bioinformatics Initiatives in Medical Education (Part I)—Dr. Tom Nosek, Associate Dean for Biomedical Information Technologies (BIT)
   Dr. Nosek explained the vision of the CWRU electronic curriculum, accessed it, and showed examples of all the electronic resources that he mentioned.  Faculty are encouraged to use links to their teaching, such as original text, multiple color illustrations, and specific electronic articles.
   The School of Medicine collaborates with the Cleveland Institute of Art-sponsored program run by David Aldrich, where one student is matched up with a CWRU faculty member for the purposes of enhancing the electronic curriculum multimedia resources.  Faculty have access to the following enhancements:  video, slide collections, PowerPoint presentations, animations, three-D reconstructions, and sound files.
   Dr. Nosek’s BIT office has spent three years developing the electronic exam system.  The main problem/drain is making sure that exams taken on the student’s computer are secure.  Dr. Nosek is targeting fall 2001 as the time to initiate whole-class electronic exams for both Year I and II.  From two to 11 (allowing for a maximum of 20) students currently use the online option via the computers in room E324.  The streamlining advantages of the online exam system include Question Database combining all the questions from many files, Exam Delivery allowing for both paper and online versions, Grading allowing for immediate flagging of questions, analysis, and distribution of grades, Question Database Update and Student Notification.  The new grading system has been tested successfully for the last five online interim exams.  While it ensures quick grading, it allows you to decide when you want to report grades to the students.  Dr. Nosek walked us through a mock exam.
   Dr. LaManna asked whether it was the sense of the CME to see a specific report on the performance of the online test exams before going ahead with the mandatory whole-class implementation for fall 2001.  The CME consensus was that was not necessary.
   Dr. Nosek highlighted the increased interest in the electronic curriculum by tracking screen hits per month.  Starting at approximately 1,500 hits per month on digitized texts in 1997, usage peaked at 120,000 on the multimedia format of the Biological Basis of Disease committee after implementation of the electronic curriculum in 1998.  In 1999, hits averaged about 50,000 per month.  The BIT office is making the electronic curriculum available in a portable format on CD-ROM.  Popularity of Dr. Kaiserman-Abramof’s Histology CD-ROM subsequently reduces the number of hits, so that interest in using digitized materials may not be adequately measured by just looking at the number of hits to the Web-based electronic curriculum.

April 12, 2001

1. Discussion of scheduling conflicts despite the electronic calendar
   

2. Student CME

1. Year II students initially given a list of items to complete by end of second year with deadline dates lacking.  Frustration over too many due dates and too few time slots left.

2. Administration is working to find a solution for the 15 students who signed up for Year III slots at Henry Ford next year while room for only 13 is currently available.

3. Conclusion of Bioinformatics Initiatives in Medical Education (Part II)—Dr. Tom Nosek, Associate Dean for Biomedical Information Technologies (BIT)
   Integrated Electronic Curriculum as the official curriculum (in Dr. Nosek’s opinion)
   Explanation of remaining software applications:

• Review of screen hits per month to measure use of the electronic curriculum

• Popularity of Dr. Ita’s eHistology (Web-based and on CD-ROM)

• Year II Semester II CPDP digitalization of Frank Carson problem-based learning case

• Alumni sampler of electronic curriculum

• Streaming of lectures experiment in E301 – video captured, streamed live to the Internet, and archived for viewing at any time in the future

• Wireless Project for three first year students in E301 that allows access to the electronic curriculum during class

• Use of E324 (the electronic classroom) with 23 computers for training of faculty, staff, and students; Evidence-Based Medicine; and Family Medicine

• PalmPilots or Visors for third year students to track patients

• Mandatory computer-based subject committee and rotation evaluation questionnaires completed by students—Dr. LaManna requested CME access to data from mandatory electronic student questionnaires for subject committees and rotations to help the CME evaluate the curriculum.

• Development of School of Medicine Web site:

• New Home page design to make the Web site more functional

• Attractive new School of Medicine Admissions Office Web site with beautiful graphics

• Streaming video for virtual tour of the School of Medicine to be added

• “Portals” for faculty, students, and staff

• Computer resources in E401:  one brand new multimedia projector, a new projection screen, a faculty computer workstation with built-in monitor and keyboard, and a new faculty podium

• Online HelpDesk for students and staff requiring that all service requests be made online

Dr. Nosek’s references to the future:  We are using data-warehousing techniques throughout the School of Medicine.  We are progressing with electronic examinations.  We want to put resources where people will use them.
Dr. Nosek’s summary:

• “If the faculty send them, students will go.”

• Faculty development is needed to provide training in the use of new technology.

• Facilities must be updated to implement use of the new technology.

Topics of discussion raised throughout the meeting:

• Appropriateness of sharing “unfiltered” as opposed to “filtered” data from student questionnaires due to the personal nature of some of the students’ remarks about individual teaching faculty.  Reliability of “mandatory” student responses that are required in order for students to receive grades when, in effect, they may not have attended the lecture.

• Problem of lack of delegated monies for maintenance of complex equipment installed during renovations

• Dilemma of whether to replace actual lab procedures with fine online programs that mimic them

• Need to emphasize value-added feature of student interaction with outstanding CWRU faculty

• Dr. Nosek’s role—to demonstrate the electronic capability; faculty’s role as that of the gatekeeper

April 26, 2001

1. Amendment to April 12 minutes (added words are underlined):  Dr. Nosek said, “The official curriculum is the electronic curriculum.”  There remains contention over this issue, and it was pointed out that neither the Committee on Medical Education nor the Curriculum Leadership Council voted to endorse this stance.

2. Report from the Committee to Review the Standing Committees presented at the April 23, 2001 Faculty Council Meeting
   Presentation by Dr. LaManna of some of the salient points of the report:  criticisms of the CME for “soft” agendas and unregulated discussion yet conclusion that there needs to be a CME to ensure that the faculty is still running the curriculum.  Suggestion that the chairs of the Curriculum Leadership Council (CLC), the Clinical Rotation Development Council (CRDC), and the electives program be added to the CME as voting members and that the CME expand the number of its elected members.
   Dr. LaManna presented his own DRAFT of the Proposed Plan for 2001-2002 for the CME, containing an organizational chart and text proposal.  The CME is depicted as a policy board as opposed to an operations or administrative branch.  The CME reports to the Faculty Council, which reports to the general faculty of the School of Medicine.  Dr. LaManna presented the format of a regular CME agenda, a list of reports the CME would hear over the academic year, and a list of potential subcommittees dealing with topics as focused narrowly within CME interests.  He called for feedback/suggestions and approval of his two-page draft at the upcoming May 10 CME meeting so that it could be submitted to the Faculty Council at its June 11 meeting, which is immediately followed by a meeting of the general faculty of the School of Medicine.

May 10, 2001

1. 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.  Implications of how best to implement the policy are currently under discussion.

2. A significant number of students have not mastered some of the very basic entry-level principles when they come to take an exam.  Department faculty could identify a list of fundamental content concepts that could be brought to the CME, and perhaps Dr. Nosek could post them on the electronic curriculum.  The CME, which deals with policy, would look 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.  In general, there was support for the creation of an outline/database of primary fundamental information needed at the entry of medical school and considered important all the way through.

3. “Report on the Flexible Program:  2000-2001 Academic Year”—Dr. Charles Malemud, Associate Coordinator for the Flexible Program
   Dr. Malemud acknowledged the Registrar, Mr. Joseph Corrao, for his help in preparing the annual report and also Dr. Tarvez Tucker, Coordinator for the Flexible Program.  Dr. Malemud discussed Type A electives, potential selective monitoring of electives, Type B electives, Areas of Concentration (approximately one-half of our students are in AoCs), dual degrees (approximately 60 students are enrolled in dual degree programs), and research opportunities.
   Dr. LaManna mentioned that a program renovation is needed for the fourth year, where we define goals of the enrichment program, the program itself, and its evaluation.  Desire for concrete data on how many medical students take graduate courses.  Need for more formal structure in the electives program across all four years.  Dr. LaManna welcomed a CME subcommittee plan for the fall to revise the Flexible Program.  Perception of the Flexible Program as an “enhancement” program, yet students not in good standing are 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.  Do electives always have to be enhancing?  Furthermore, we have no formal policy regarding students not in good standing and completion of the electives program.

May 24, 2001

1. End-of-year report by Mr. Scott Walker, Year II student representative, delineating the following issues as requiring attention:

• The “zero tolerance” policy requiring all Year II students to pass or remediate every subject committee before advancing to Year II was instituted for the first time this year.  As a mechanism to increase attendance at lectures, it did not succeed.

• Need to work on the collegial attitude of cooperative education that should exist between students and faculty

• Student frustration with secure exams and desire for faculty to reconsider this arrangement

• Need to refocus on producing outstanding physicians rather than improving multiple-choice-question test performance

2. End-of-year report by Dr. David Katz, Curriculum Leadership Council Chairman, listing the policy issues undertaken by the CLC:

• Advancing from Year II to Year III requires passing all Year II interim exams.  The policy offers the student the opportunity to remediate within the academic year (Year II).  If the student is not successful, he/she delays entering Year III and remediates during the summer.

• Implementation of cumulative yearlong scoring of Pathology, integrated across Year II.  The previous year, in Year I, students became accountable for Gross Anatomy and Histology, integrated across Year I.

• Discussion of the merits of the Scoles/Ravdin Policy (also known as the Policy on Evaluation and Standards), which 1) set a prospective pass score for each subjective committee, and 2) implemented remediation for failure of an interim.

• Reconsideration of the secure exam policy given the input and data brought before the CLC by year two CME student representative Scott Walker

• New strategies for raising the intellectual level of the learning environment

• Instituting of standardized online course evaluation forms completed by students after each subject committee

• Evaluation of proposals for vertical themes, such as genetics, preventive medicine, and sexual health

• Completion of a detailed report for the LCME on support and infrastructure for medical education

Brief discussion of student attendance problem.  Delineation by Dr. Katz of issues needing attention in the first two years.  Dr. Bill Merrick to replace Dr. Katz as CLC chair during his sabbatical.

3. “Analyses of Residency Programs Matched by CWRU School of Medicine Graduates and Comparison with Other 13 Consortium Medical Schools”—Dr. Richard Aach, Associate Dean for Residency and Career Planning
   Data on the post-graduate experience of our students is one outcome measure of how well we prepare our students.  Data were used to answer two main questions:  1) What proportion of our graduates go to CWRU-affiliated residency programs? and 2) What proportion of our students go to top-rated residency programs?  Three sets of criteria were used in rating “top” residency programs for the CWRU medical school classes graduating, for the most part, from 1996 through 2001:

• The top 10 and top 20 programs for each specialty ranked in each year’s July issue of U.S. News and World Report, which rank-orders medical schools, academic departments, and clinical departments each year.

• Responses to the annual survey that Dr. Aach sends out to program directors and the clinical department chairs of CWRU-affiliated residencies to indicate what they believe are the top 10 and the top 20 programs of each specialty.

• Number of students matching at any university (medical school) residency program

• Guidelines derived from data:

• Retaining 25% ± 5% of our graduates in affiliated residencies was a good number, with cause to look into the situation should a deviation occur

• Tendency for our students to get into the better residency programs—CWRU students match their first, second, and third choices, and they aim high.  50% should be our minimum standard in the “top 20 category that includes CWRU students matching CWRU-affiliated programs.”

• One-third of the CWRU medical school graduating class go to the top 20 residencies in their specialty, when not counting CWRU-affiliated programs.

• 90% of our graduates this year matched at university-affiliated programs when CWRU-affiliated programs were included.

June 28, 2001

1. Announcement of newly elected CME members:  Dr. Hue-Lee Kaung and Dr. Terry Wolpaw
   

2. Distribution of the following documents:

• CME Schedule for the 2001-2002 academic year.  Since the LCME site visit is taking place March 10-14, the CME March meeting date has been changed to March 21.

• The new CME Charge (approved by the Faculty of Medicine 6/13/01)

• Patient-Based Program Annual Report 2000-2001 – Dr. Jay Wish, Patient-Based Program Coordinator

• Introduction to Clinical Medicine 2000-2001 Executive Summary – Ms. Kathy Cole-Kelly, Dr. Ted Parran, Dr. Elizabeth Patterson, ICM Co-Directors

• Physical Diagnosis Course Summary 2000-2001 – Dr. Baha Arafah, Physical Diagnosis Director

3. The wording of the CME resolution concerning scheduling of the USMLE Step 2 that was passed at the May 10 CME meeting had been modified once and was again “fine-tuned” for the Student Handbook.  As of June 29, the resolution for this coming year’s Student Handbook now reads:
   Students are required to take the USMLE Step 2 by January 15^th in the year they expect to graduate.  A passing score on the USMLE Step 2 is one of the graduation requirements.  Passing scores on the USMLE Step 2 must be received by the Registrar no later than May 10, 2002, for all students who intend to graduate on May 19, 2002.

4. Desire to resolve problem arising when fourth year students wish to drop the one-month Acting Internship (AI) at Rainbow Babies & Childrens Hospital
   Dilemma:  1) Student frustration over not being allowed to drop when they had given notice greater than 30 days prior to the onset of the AI and had found student replacements, and 2) RB&C’s reluctance to consider non-CWRU students due to uncertainty of their quality.  Suggestion:  that the Student CME write a letter to Dr. Nieder requesting working toward a solution for the future and adding a cc: to Dr. Wish

5. The new CME Charge was created by the Committee to Review the Standing Committees, which incorporated elements of the Resnick Report and the previous CME charge.  The document was modified at the Faculty Council on June 11, 2001 and approved by the general faculty on June 13, 2001.
   Dr. LaManna reviewed noteworthy segments of the new charge, which include:

• CME’s exclusion from operational responsibilities

• Explicit rather than implicit need for teaching experience to serve as a CME member and/or CME chair

• Increase from 7 elected faculty members to 9 elected faculty members in order to balance voting privilege given to 3 appointed curriculum leadership council chairs (Core Academic Program Council, Clinical Rotation Development Council, and Flexible Program Council) now members of the CME

• Due to increased difficulty in recruiting department chairs to serve, dropping of requirement that at least 3 of the elected or appointed faculty CME members be department chairs

• Addition of Appendix I that describes role of the three curriculum leadership councils and their chairs, who are to report periodically to the CME “regarding operational matters” and to provide “an annual summary and report of actions jointly to the CME and Faculty Council.”

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