February 28, 2002

1. Clinical Rotation Development Council (CRDC) Update:  No structural changes for Year III for the upcoming 2002-2003 academic year; an August deadline for determining whether any third year changes will be made during 2003-2004.  The two one-week Psychiatry rotations continue to be a challenge.
    

2. Curriculum Leadership Council (CLC) Update:  To engage hard-pressed clinical faculty in the subject committee leadership role, a suggestion has been made to form a “Junior CRDC,” whereby a clinical representative from each hospital campus would act as a co-chair.  Thus, each co-chair would sit in on about one-third of the subject committee.
    

3. Results of an Outcome Assessment Study that determined the Level of Performance of the School’s Year 2000 Graduates as Interns – Dr. Richard Aach, Associate Dean for Residency and Career Planning
   In June 2001, a survey form was sent to the program director of each of the 135 graduates from the Class of 2000 who entered a residency training program.  The grading scale ranged from 1 (poor) to 5 (outstanding).  Program directors were also asked to evaluate the Dean’s Letter.  Responses were received for 99 (73%) of the 135 students who graduated and entered residency programs in July 2000.  This is equivalent to between 45 to 49 residency programs.  In the majority of the approximately 14 skills assessed, the mean ranking of resident performance fell in the 4.0 range.  The Dean’s Letter was of value for 84% of the 99 students.  Program directors indicated that the Dean’s Letter was not helpful for 5%; most indicated that they already knew the student.  The survey indicated that the Dean’s Letter was judged to accurately reflect the student’s attributes; the mean assessment for accuracy was 3.8.
    

4. Use of Personal Digital Assistants (PDAs) in Medical Education – Dr. Tom Nosek, Associate Dean for Biomedical Information Technologies
   Last year Dr. Smith and Dr. Nosek worked together with Dr. Jason Chao and Dr. Jay Wish on the course direction of PDAs and core clerkships.  They tried to put together a core group of programs that would be used from clerkship to clerkship.  This year, Pharmacology faculty who teach in the Year I subject committee Fundamentals of Therapeutic Agents (FTA) and the Year II subject committee Drug Action and Biodisposition (DAB) wanted the students to use the pharmacological database “ePocrates” that can be downloaded free of charge on all PDAs with the Palm Operating System (OS).  The PDAs allow easy access and portability.  The course directors, Dr. Smith, and Dr. Nosek wrote a memo to the first year students recommending that they buy a PalmOS-based PDA so that they would have access to ePocrates. 
   Dr. Jason Chao, co-director of the Family Medicine clerkship, will be using PDAs in the Family Medicine clerkship.  Dr. Chao obtained a three-year grant starting in July 2001.  The planning and programming year runs from July 2001 through June 2002.  July 2002 through June 2003 will be the implementation year for the Family Medicine clerkship.  Students who do not have PDAs will be provided with one, and students already having a PDA will have the recommended software loaded onto their own PDA.  Family Medicine plans include loading the following applications on the PDA:  1) ePocrates, 2) a medical textbook, such as 5-Minute Clinical Consult, Merck Manual, or abbreviated Harrison’s, 3) a calculator for analyzing medical formulas such as blood gases or BMI, and 4) a tracking program, which will identify the software programs that are the most useful to the students.  Dr. Chao will give an orientation session on the use of PDAs to the students this July.  He estimates that he will buy only between 15 and 20 PDAs; that is all he needs for each month-long Family Medicine rotation, which runs 12 times a year.  PDA logs will indicate the number of patients and diagnoses; this instant access enables a skewed patient distribution to be addressed before the clerkship is over.

March 21, 2002

1. LCME Site Visit (March 10 – 13)
   As of now, the LCME self-study culminating in the site visit takes place every 7 years.  The group coordinating the self-study consisted of Dr. Marcia Wile, Ms. Minoo Golestaneh, Dr. Murray Altose, and Dr. Kent Smith.  The reviewers were highly complimentary.  No major concerns were cited.  Reviewers “recommend” but do not make the official decision.
    

2. March 21, 2002 Match Results – Dr. Richard Aach, Associate Dean for Residency and Career Planning
   As in the past, our match results were excellent.  CWRU students have matched in virtually all of the most outstanding residency programs in the country.  Ninety-six percent (96%) of CWRU students matched, and, based on discussions with a number of students at this point in time, many students got one of their top three choices.  Dr. Aach cited some trends:  i) A larger number of our graduates will be entering the competitive Anesthesia, Emergency Medicine, and Orthopedic training programs.  ii) The 18 students going into Family Medicine this year represent a striking increase over the four who opted for this specialty last year.  iii) The number of students going into Pediatric residencies nationally decreased significantly this year—more residency slots available yet few applicants.  iv) We are only slightly under the targeted goal of 25% of our graduating class going into CWRU-affiliated residencies.  v) Geographic trends:  47 of our students are entering Ohio residency programs, 13 are going to California, 9 each are going to Pennsylvania and Illinois, and 5 each to Michigan and New York.
    

3. Teaching Incentives Subcommittee Update – Dr. Terry Wolpaw, Chair
   The Committee is continuing with plans to hold a major workshop in October for faculty development.  Dr. Wolpaw will approach the different department chairs to find out their opinions of the upcoming workshop and what they would like to see included.  Dr. LaManna suggested having each department chair identify a liaison from his/her department for faculty development.  The question has arisen as to how long the Teaching Incentives subcommittee of the CME needs to exist.  Committee members decided from the beginning that they wanted to be a working, active committee.  The CME subcommittee could transition to a committee of the Faculty and Learner Development Program, co-directed by Drs. Clint Snyder and Terry Wolpaw.  The Teaching Incentives subcommittee wants to go beyond merely producing a report; members want to have a hand in implementing their recommendations.
    

4. Significant progress is being made toward going wireless in the School of Medicine.  All students will have free access next year.  Currently, our streaming of audio lectures is enjoying great popularity with the students and is expected to improve.  Video streaming is done upon request.  Faculty will be able to purchase wireless access via relatively inexpensive cards.

April 11, 2002

1. Clinical Rotation Development Council (CRDC) Update
   Steering committee is holding a retreat later in May.  Recruiting of third and fourth year students for focus groups meeting May 1 is underway.
    

2. Flexible Program Update
   Dr. Tarvez Tucker and Dr. Charles Malemud, Co-Coordinators
   The Flexible Program Advisory Committee (FPAC) presented a proposal comparing current policy with suggested changes.  Proposed changes, once endorsed, would start with the Class of 2006, entering in August 2002.  The FPAC has started by focusing on the Type A electives component that occurs during the first and second years.  The proposal suggests reducing the total number of required Type A electives from 13 to 10.  The decision was also made to allow Year I students to begin taking Type A electives in Period 1.  The proposal suggests changing the required distribution to 5 Type A electives in Basic Science, Research, or Graduate and 5 Type A electives in Clinical.  Under the proposal, the total of Type A electives required for students choosing an Area of Concentration would be the same as for Diversified students:  10.  With regard to grading system, the current “satisfactory” and “unsatisfactory” would be replaced by “pass” and “no record.”  No “fails” would appear on the transcript.  The FPAC discussed the benefits of proposing a two-tiered electives system (where students would have to take a certain number of stringent electives) and decided against it.  The idea was to elevate every elective to a higher standard.  The proposal stipulated that the faculty sponsor will decide:

• To which category the elective belongs, i.e. basic science or clinical science

• The criteria for successful completion of the elective—i.e., whether attendance-based or requiring an end product such as a paper, oral presentation, examination, reading requirement, etc.

• How the individual student met the educational objectives of the elective as outlined in the Type A Catalog (This means more than 200 faculty sponsors must have specified their criteria for successful completion of their elective prior to July 1.)

After much discussion, there still exists divergence in what is perceived as the purpose of the electives program.  Issues—such as rigor, scholarship, objectives—were raised that will be revisited by the Flexible Program Advisory Committee and in turn brought back before the CME.

April 25, 2002

1. Announcements from the Vice Dean

• CWRU Board of Trustees approved five new degree programs affiliated with the M.P.H.

• Effort to include more ophthalmology in the curriculum underway

• Plans for putting together a group to look at professionalism throughout all four years of the curriculum in the works.  Dr. Terry Wolpaw and Dr. Clint Snyder were awarded $175,000 from the Provost Opportunity Fund for their project, “Scholars’ Collaboration in Teaching and Learning.”

• New surgery core clerkship at the Cleveland Clinic accepting two students per each eight-week rotation

2. Highlights of the March 6, 2002 Curriculum Leadership Council Meeting – Dr. William Merrick, CLC Chair

• Distribution of the 2002-03 Core Academic Program final schedule includes switching of the two 5-hour mornings to two different days that have small group activities in an effort to avoid lecture overload

• Evaluation in the Patient-Based Program

• Dr. Merrick’s goal:  Within five-to-seven years, to be able to identify a correlation in performance using all or part of the patient-based evaluations in the Patient-Based Program and the USMLE Step 2½ clinical skills licensure exam, similar to the predictive value of the Year I comprehensive examination in the Core Academic Program and the USMLE Step 1 performance

• Student electronic note service

• Not wishing to assume responsibility for verifying authenticity and total correctness, the CLC decided not to sanction the electronic student notes as part of the e-curriculum.  The tool, however, is recognized as an excellent resource, and students can still put the electronic notes on their own CDs.

• Student feedback sessions and the student evaluations of committees Methods to be explored for gaining timely feedback on Physical Diagnosis and ICM (Introduction to Clinical Medicine) and on the longitudinal committees of Histology, Gross Anatomy, and Pathology

• Agenda Items for June 7, 2002 CLC Retreat

1. To generate a CLC constitution

2. To put in place a timely record-keeping system to ensure that student evaluations arrive at the Office of the Registrar in enough time for the Committee on Students to have the results and for the Office of Student Affairs to work with students so that they do not fall too far behind

3. Whether to require attendance in the practical committees of Histology, Gross Anatomy, and Pathology

• Highlights of discussion following Dr. Merrick’s presentation included

1. Virtual simulations as learning tools—enhancements or replacements?

2. Only the subject committee chair sees the online questionnaire that the entire class fills out after a subject committee’s conclusion.  The issue of professionalism recurs, since there are many inappropriate comments from students about faculty lecturers contained in their online responses.  The concept of standardizing the online evaluation arose along with the suggestion to create a committee to review the online questionnaire evaluating each subject committee.

3. Plans to use Mount Sinai as a clinical teaching site that could prove useful in preparing students for the USMLE Step 2½

May 9, 2002

1. Discussion of significant decrease occurring over the years in the number of faculty marching at graduation
    

2. Student CME Report:  “Project Standards,” student syllabus initiative, a preliminary list of examples
   Dr. LaManna requested that the Student CME make a formal report to the CME next year and prepare a common electronic format—a template that would enable the faculty to fill in a PDF file on the browser.
    

3. CLICS (Contemporary Learning in Clinical Settings) Program Update – Co-Directors Dr. Linda Lewin and Ms. Kathy Cole-Kelly
   Background
   Mission and goals
   First year of the grant (1998-1999) – planning year
   Second year of the grant (1999-2000) – pilot program for third year students in the Primary Care Track
   Third year of the grant (2000-2001) – expansion of the CLICS program to the entire third year class
   Post-grant year one (2001-2002) – revision and continuation of course
   Evaluation
   Summary
   The CME voted unanimously to strongly endorse the continuation of the CLICS program as a valuable part of the curriculum.

May 23, 2002

1. Dean Berger’s question-and-answer session regarding two recent announcements:

1. Creation of the Cleveland Clinic College of Medicine of CWRU
   The CCF College of Medicine is meant to be a four-year curriculum to train 40 students per class to be clinical investigators, enrolling its first class in the fall of 2004.  Curriculum details will be developed; there is no distinct plan for the CCF College of Medicine curriculum at present.

2. Appointment of Lindsey C. Henson, M.D., Ph.D., as CWRU Vice Dean for Medical Education and Academic Affairs

2. ICM (Introduction to Clinical Medicine) Annual Report for 2001-2002 –
   Co-Directors Ms. Kathy Cole-Kelly and Dr. Ted Parran (Co-Director Dr. Elizabeth Patterson unable to be present)
   ICM consists of the following components:  1) Tuesday morning small groups, 2) Interviewing Skills Program, and 3) Family Clinic.  Small groups have been running smoothly and are well integrated with the core curriculum.  Preceptors have improved their facilitating skills in both the Problem-Based Learning and Clinical Science components.
   Presentation of immediate and long range plans
   Conclusion:  Confidence that our students will be well prepared to meet the USMLE Step 2½ clinical skills licensure exam.
    

3. Flexible Program Annual Report for 2001-2002 –
   Co-Coordinator Dr. Charles Malemud (Co-Coordinator Dr. Tarvez Tucker unable to be present)
   The Flexible Program Advisory Committee (FPAC) was an outgrowth of the afternoon Flexible Program breakout session led by Dr. Tarvez Tucker and Dr. Malemud during the November 28, 2001 Medical Education Retreat.  The FPAC met four times during 2002.
   Enumeration of topics comprising the FPAC’s focus for the coming year
   Dr. LaManna acknowledged the greater level of complexity inherent in the Flexible Program (containing over 320 electives) than we all anticipated.
    

4. PDA (Personal Digital Assistant) Update
   Dr. Tom Nosek, Associate Dean for Biomedical Technologies
   Students were greatly encouraged to use the ePocrates pharmacology database on their PDAs by the Pharmacology teaching faculty in the Year I Fundamentals of Therapeutic Agents (FTA) subject committee.  Dr. Nosek will provide more information when the results of the student evaluations of using PDAs and ePocrates are tabulated.  Dr. Jason Chao is establishing a prototype for other clerkships with his grant integrating PDA use in the Family Medicine core clerkship.  July 2002 is the start date of the implementation phase of his grant.  Dr. Chao is getting PDAs for use in the whole eight-week block of Family Medicine and Ambulatory Medicine.  After going through a few complete cycles, Dr. Chao plans to report back to the CME in January 2003.  Dr. Nosek foresees a strong need for PDAs in the third year.  The success of PDA use will depend on whether or not faculty promote its use to the students.

June 6, 2002

1. Special Meeting called by the Dean to introduce Lindsey Henson, M.D., Ph.D., Vice Dean Designate for Education and Academic Affairs           
   Dr. Henson described some of the factors influencing her decision to accept the Vice Dean position and certain pathways she would like to see developed at the medical school.  She briefly explained the responsibilities of her role as Vice Dean for Education and Academic Affairs.  She spoke briefly about the revised agreement signed three weeks ago between the Cleveland Clinic Foundation and CWRU to form the Cleveland Clinic College of Medicine of CWRU, which is intended to produce physician investigators.  She cited key differences of the more flexible revised agreement signed in May compared with the October 2001 version.  In explaining what the agreement says, Dr. Henson used the terms “the College” and “CCCM” to refer to the Cleveland Clinic College of Medicine of CWRU.  It is a “distinct entity” within the CWRU School of Medicine.  Its goal is to train M.D. investigators and not duplicate the existing M.D. programs already established at CWRU.  Optimal class size for this clinical investigator track is targeted at 30 students per year, allowing for up to a maximum of 40 students per year.  The goal is to have approximately 150-160 students in the 5-year program.  All CCCM students will be trained in research methods and complete a thesis, which may be a clinical research project as well as a basic science laboratory project.  The program will be designed to grant the M.D. degree, but a subset of the students may wish to pursue a Master’s or Ph.D. degree in addition.  The Vice Dean (Dr. Henson) reports to the Dean, but is also accountable to the Cleveland Clinic for responsible management of CCF resources for the College program.  Dr. Andrew Fishleder has been the Chairman of the Division of Education at the Cleveland Clinic Foundation for 11 years.  He is the “Executive Dean” at the College and also continues in his previously established responsibilities at the Clinic.  The Executive Dean at the College is responsible for academic functions of the College and reports to the Vice Dean.  Relevant CWRU committees will have CCCM representation, and relevant CCCM committees will have CWRU-SOM representation.  Dr. Henson invites you to nominate yourself or someone else whom you think would be interested in serving in this capacity. 
    

2. With the completion of Dr. Henson’s presentation, the meeting was opened to discussion.  Given the early stages of planning, Dr. Henson addressed as best she could individual concerns raised.  Concern over the limited amount of time to achieve such a comprehensive endeavor prompted Dr. LaManna to advocate an “April Fool’s” April 1, 2003 deadline for designing the CCCM, as the literature and application forms must be mailed by May 2003.  This gives us less than one year to prepare for the class entering in August 2004.  Dr. Henson concluded the discussion by describing the goal as integration of the CWRU and CCF faculties and the exciting new research collaboratives that will result.

June 13, 2002

1. Introduction of Dr. Murray Altose as the next CME chair
    

2. No formal Student CME report—a brief description of the diverse summer activities of the Class of 2005
    

3. The majority of the meeting consisted of the remaining annual report presentations.  The unanimous conclusion reached was that this had been a good year on many levels.
    

4. Curriculum Leadership Council Report for 2001-2002—CLC Chair Dr. William Merrick
   New CLC developments:

• The proposal of Drs. Miller and Tomashefski to include a glass slide histology/histopathology practical as part of the Year I Comprehensive Examination was approved by the CLC by a vote of 14 in favor and 5 opposed.  This proposal has now been forwarded to Drs. Wile and Malemud, Co-Chairs of the Year I Comprehensive Examination Committee.

• New CLC constitution now exists in draft form.

• Experimentation with the “carrots” (where bonus points are added) and “sticks” (where points are subtracted) policies on interim exams resulted in keeping students more current and small groups becoming more dynamic.

• Student performance relative to previous first, second, and third years as well as USMLE performance is “positive on all fronts” [Year I Comprehensive Examination, USMLE Step 1, NBME subject (shelf) exams].

• According to student evaluations and the LCME report, our students are happy here!

• Faculty were highly appreciative of efforts by the professional Audio Visual staff—consistency of having the same person in the lecture hall.

• Student end-of-year attendance:  1) remained strong in Year I, 2) precipitous fall-off during the third- and second-to-last committees of Year II

• A future plan to measure clinical skills and professionalism in quantitative fashion for ICM (Introduction to Clinical Medicine); discussion of faculty and professionalism

5. Patient-Based Program Annual Report for 2001-2002—Patient-Based Program Coordinator Dr. Jay Wish
   Major changes:  1) the continued “evolution” of the CWRU relationship with the Cleveland Clinic, and 2) the “de-evolution” of our affiliation with Henry Ford
   Outcome parameters:

• Student online clerkship evaluations

• Student-initiated self-study of the curriculum for the LCME accreditation review, which included an evaluation of CLICS (Contemporary Learning in Clinical Settings)

• NBME subject exam performance for Cleveland sites for the Classes of 2003, 2002, 2001, and 2000

6. Macy Initiative in Healthcare Communication Update—Ms. Kathy Cole-Kelly
   Communication issues are in the forefront of medical education.  Topics with “scenarios” for each of the six core clerkships and a sample set of pocket-sized laminated “cue cards”—each card containing key points for that particular scenario—were circulated.  Students learn their communication skills from the role modeling of their clerkship directors demonstrating the skill, from the standardized patients, and from their peers’ feedback.  Every workshop happens during every clerkship cycle, and everyone has all six experiences. 

There is a new initiative being explored that would involve a collaboration between the medical school and the teaching hospitals.  With the ACGME (Accreditation Council for Graduate Medical Education) now requiring residencies to demonstrate how they are teaching and evaluating interpersonal and communication skills as well as professionalism skills (as two of the six ACGME competencies), it makes sense to protect the investment of teaching these skills to our third years, to improve the skills of the teachers of the third years (interns and other residents most often), and to meet the ACGME requirements by offering a series of workshops for interns in the hospitals.  Using the expertise of those involved in Macy, as well as collaborating with other interested parties at each hospital, Ms. Cole-Kelly would like to start such an initiative.

7. Clinical Rotation Development Council Annual Report for 2001-2002- CRDC Chair Dr. Chris Brandt
   This year’s focus:  to review and assess the Year III curriculum, implemented in its revised form in the 2000-2001 academic year.  We are in good shape, as evidenced particularly by student evaluations and examination scores and Dr. Aach’s survey on CWRU graduates’ performance as residents.  The CRDC endorses continuing support of the Macy and CLICS programs.

CRDC concerns:

• One-week rotations interspersed throughout Year III

• Psychiatry configuration rotation

• Current Year III 12-month core curriculum allots only limited exposure to such areas as otolaryngology, ophthalmology, dermatology, and anesthesia, from a career standpoint.  Students can currently go through the Patient-Based Program Coordinator to postpone the Neurosciences core clerkship until the fourth year to participate in the aforementioned fields.  Students need a letter of reference by July or August prior to the fourth year for certain specialties in the Early Match.

CRDC’s desire for an end-of-third-year OSCE for all students
Other future plans:

• Establishment of continuity clinics for all Year III students

• Enhancement of the electronic and PDA-based curriculum

• Collaboration with the Cleveland Clinic faculty to form the clinical curriculum of the Cleveland Clinic College of Medicine (CCCM) of CWRU

8. Remarks from outgoing CME Chair Dr. Joseph LaManna
   Belief that our medical school is better now than it was six years ago.  Our overriding concern has always been the betterment of the students.  Two items remain for the CME as “unfinished business:”  1) the “vertical” themes, and 2) the Flexible Program revision.  Dr. LaManna strongly encouraged the CME to take as proactive a stance as possible in the CCCM initiative so that it becomes a collaborative effort for students and faculty of both institutions.  We have the potential to provide the best medical education possible in the city of Cleveland.  We have succeeded in establishing an infrastructure that enables us to adapt our curriculum whenever necessary.

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