universityofvirginiaschoolofmedicine* curriculumcommittee ... ·...

University of Virginia School of Medicine Curriculum Committee Minutes 01/10/08

Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Gene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) Guests: Jeff Young, Darci Lieb 1. Announcements. The Committee welcomed new member, Thomas Gampper. Dr. Mohan Nadkarni

will also be joining the group later in 2008. Anatomy Access Policy and Rules of Behavior. A policy for anatomy acess and rules

of behavior has been finalized by the subcommittee. The policy has now been submitted to the Dean for final approval. When approved, it will be placed on the web along for students to read and sign electronically. [A NetLearning session has been devised to assure that all students have read and understand the policies. – 01.30.08 DJI]

Anatomy Curriculum Group. The group met this week to continue the discussion

regarding the anatomy curriculum revision. Some progress has been made. Melanie McCollum, Anatomy Course Director, and Don Innes are to draft a curriculum proposal and circulate to the Anatomy Curriculum group for input.

Card Scanners in the Anatomy Labs. Card scanners have been installed on the doors

to the Anatomy Labs. All students will have access to the labs. Faculty and others will need to be added to the list of allowed visitors.

2. Integrating War Games into Transition from 2nd Year to 3rd Year of Medical School.

Jeff Young met with the Committee to outline his proposal for integrating war games into the School of Medicine curriculum.

PROPOSAL: The War Games program (low fidelity simulation) has been in place since 2003. Over 1000 case

simulations have been completed in over 340 individual students and residents. Four peer reviewed publications and multiple presentations at national meetings [1-‐4] have come from this effort. The results have demonstrated that the cognitive performance of individuals can be improved in simulated clinical situations through deliberate practice as created by the War Games process.

Process The War Games take urgent clinical situations and break them into their component actions. The

subjects is presented with data as they ask for it, and must stabilize the patient by describing what actions they would take, and what labs and studies they would obtain (please see email attachment

for sample evaluation sheets). Feedback from students has been consistently positive, and has centered around the fact that this training is unique to their medical school experience.

Proposal We wish to use the War Games to prepare second year medical students for the realities of their

ward rotations, and to provide them with a framework for the types of clinical decisions they will encounter. Many students relate that the ward experience is so different from their previous encounters that it is difficult for them to keep pace with the clinical work, and to know how to separate essential from frivolous information. We believe that a “curriculum” of War Games involving second year medical students that take place at the second half of their second year will enhance their clinical experience in their third year.

Method We have developed a curriculum of clinical encounters that we believe provides a continuum of care

from the simplest to the most complex. Inherent in these simulations are condensation of information and patient presentations. In addition to helping them understand the process of clinical care, this will enhance the student’s ability to put together concise and effective clinical presentations during their third year.

The proposed mandatory case curriculum includes: Patient Risk Assessment Simple pre-‐operative surgical patient screening Simple medicine admissions screening Cardiac, Pulmonary, Metabolic, Infectious Routine Hospital Admission Post-‐operative surgical patient, Routine medicine admission, Pediatric admission Emergent Changes in Patient Condition and Stabilization Somnolence -‐ Drugs, CVA, Hypotension, Hypoxia, Cardiovascular -‐ Hemorrhagic shock, Cardiogenic shock, Congestive heart failure, Rapid arrhythmia,

Bradycardia Pulmonary -‐ Aspiration, Pneumonia, Pulmonary embolism, Pulmonary contusion, Pain

(atelectasis) Renal – Oliguria-‐-‐Preload, ATN Metabolic -‐ Hypoglycemia, Hyperkalemia Infectious -‐ Rigors and fever, UTI, Sepsis of unknown origin, Severe wound infection/dehiscence Progression of Care -‐ Medical discharge process, Surgical discharge process, Pediatric discharge

process Optional Critical Care Medicine Curriculum Respiratory failure and ventilator management – ARDS, Pleural effusion, Mucous plugging, Lost airway -‐ Lost trache, Inability to ventilate Cardiovascular -‐ Severe MI, Hypotension, Hypertensive crisis Sepsis -‐ Routine therapy, Refractory hypotension with multiple organ failure Erroneous data from equipment CNS -‐ Blown pupil, Severe agitation Oliguria We propose that groups of ten students are assigned two one-‐hour sessions weekly. At those

sessions we will proceed through the cases in the curriculum. Every student will not perform each case, but they will encounter every case since they will be present at the session when the case is presented to another student and critiqued. Each student should attend six sessions at minimum. Our lab can accommodate six sessions weekly. Each student can track their performance if they wish through our evaluation scheme, but all records will be de-‐identified after the student has completed their sessions. All information is confidential unless the medical school administration wished to use it in some manner. At the termination of all sessions, we ask the students by email if they would allow us to use their anonymous responses for research purposes. If they decline their responses are

deleted from our database. This work is approved by the SBS-‐IRB. The sessions are either conducted by myself or my lab coordinator who has witnessed or participated in every session since the inception of the project.

Logistics Obviously scheduling all of the students would be complex so we would need as much lead time, and

help as possible from the administration of the second year class. Dr. Young provided the following citations for published articles regarding War Games. 1. Young, J., et al., “The Use of “War Games” to Evaluate Performance of Students and Residents

in Basic Clinical Scenarios: A Disturbing Analysis. Journal of Trauma, 2007. 63(3): p. 556-‐565.

2. Young, J., R. Smith, and S. Guerlain, Resident Cognitive Performance in Surgical Critical Care: The Basic Science of Medical Errors. American Surgeon, 2006. 73(6): p. 548-‐555.

3. Young, J., et al., Proactive versus reactive: the effect of experience on performance in a critical care simulator. American Journal of Surgery, 2007. 193(1): p. 100-‐104.

4. Young, J. and T. Hedrick, The Use of "War Games" to Enhance Clinical Decision Making in Students and Resident American Journal of Surgery, 2007. In press.

Sample grading sheets and transcripts from War Games completed by third year students in the past

were also distributed. The cases that have already been developed are divided into three levels of difficulty. Level 1 and

even 2 may be appropriate for medical students. Level 3 is geared more toward the intern or resident. The Committee discussed the “debriefing” session with Dr. Young. The Committee noted that the lack of discussion of the case with an attending or resident after the sessions was a major weakness. The Committee briefly discussed when and where in the curriculum these exercises might be valuable. Cases might be placed in PoM2 and even PoM1. Inclusion in the transition course, the Life Saving Techniques Workshop and the clerkships was also mentioned. The possibility of a pilot program was briefly discussed. It was suggested that this might also be useful as a computer based timed exercise. Dr. Young was asked to provide a video of a War Games session to the Committee and electronic copies of the publications.

The Committee will discuss this proposal at an upcoming meeting and respond to

Dr. Young’s proposal after that discussion. Donald Innes dmr


Pediatric Conference Room, 4:00 p.m.

Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) 1. Announcements. a) Two news articles from Dartmouth Medical School: Dartmouth Medical School Begins Bi-‐coastal Teaching Partnership With San

Francisco's California Pacific Medical Center

Fixing Health Care: More Doctors Are Not the Solution b) News article from the AAMC

Changes Possible for Medical Licensing Exam

c) Anatomy Curriculum Group – Members of the Study Group (Kristy Davis, Spencer Gay, Don Innes, Melanie McCollum and Brad Bradenham) met on 1/24/08. The group has begun to tackle formalin vapor issues, cadaver selection and preparation, need for down draft tables. They will begin discussion of deeper curriculum issues after immediate issues have been resolved. It was noted that USMLE Step 1 Anatomy scores for UVA, while rising are not rising as fast as the national average. The group will seek to determine if our teaching methods can be improved and made more clinically relevant. Cases being developed by Spencer Gay to correspond to individual gross disections is thought to be a step toward this goal.

d) Notes from recent Dean’s Town Meeting (01.10.08) Please see attachment. 2. PoM-‐2 Requests Guidance. Brian Wispelwey requested that the Curriculum Committee review the POM2 exam

policy.

POM II has four examinations, each of which stands alone with regard to the subject matter that is covered and must therefore be mastered. In the Brave New World of Pass /Fail a cumulative passing grade for this course does not imply mastery of each individual data set. We had proposed that a passing grade of at least 70 on each exam would be required to pass the course and this has created a stir. I still believe this is important and Darci and I favor making those who do not attain this score repeat the exam until they do. We need the curriculum committees approval or alternative suggestions. After intense discussion, including proposals for a cummulative final examination, a minimum score on all exams, and a minimum score for the final grade, the Committee agreed that exams should not be considered optional.

The Curriculum Committee unanimously approved a motion that all formal course examinations are required activities. Failure to take seriously the understanding and mastery of a body of knowledge necessary for patient care should be recorded in the student’s file as a breach of professionalism.

3. Clinical Skills Educator Program. The Committee discussed the curriculum for the Clinical Skills Educator Program.

While the program pilot in Internal Medicine is very well received by the students, there is some concern that the experience may not be equivocal for all students participating. Cases vary week to week and preceptor to preceptor. Whether a standard set of cases should be established or even could be established was discussed. The Committee decided to recommend that the Program Director(s) meet regularly with the instructors in the program to outline expectations and course requirements.

4. War Games. The Curriculum Committee agreed that the “War Games” outlined by Jeff Young at a

previous meeting could be an asset to the curriculum. Possible insertion points include during a proposed selective anesthesiology experience or elsewhere in the Surgery Clerkship. The Committee would like to see the experience spread over all of the surgery subspecialties so that no one subspecialty is burdened by the “War Games” experience. Addition of “War Games” scenarios to the Clinical Connection sessions (Reid Adams, Director) also seems appropriate. These suggestions will be communicated to Jeff Young.

5. Curriculum Committee Agenda: Elective time in the fourth year will be discussed at

a future meeting. Members were asked to suggest future agenda topics to Don Innes by e-‐mail. [Success in residency placement; Course reviews (Neuroscience; Anatomy; PoM-‐1), course director description, year-‐one comprehensive exam]

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary)

1. Announcements. a) Dr. Robert Bloodgood has reserved human study approval for his research

into whether student admission criteria and MCAT scores correlates to class attendance.

b) Two published articles were distributed to the Committee

“What Did the Professor Say? Check your iPod” – from the NY Times

http://www.nytimes.com/2007/12/09/business/09novel.html?_r=2&ref=business&oref=slogin&oref=slogin

“Application of Boom’s Toxonomy Debunks the “MCAT Myth” – Science,

319:414-‐415, 2008 http://www.sciencemag.org/cgi/content/full/319/5862/414

2. Combined Degree Program: M.D./M.P.H. A two page outline of a proposal for a

combined degree program was distributed to the Committee. It outlines the criteria for admission, enrollment, tuition and financial aid, tracking credit, effect on the transcript, and awarding of degrees. The Committee voted unanimously to support this combined M.D./M.P.H. degree program.

3. Measuring success in residency placement (Dr. Robert Bloodgood)

Bob Bloodgood presented his efforts to find a quantitative measure for determining the success that UVa medical students have in matching into high quality residency programs. This effort was driven, in part, by the desire to ask the question whether our change in the grading system in the 1st two years of our medical curriculum from letter grades to pass/fail had any deleterious effect on residency placement success. Three measures were examined: 1) US News and World Report overall rankings for medical schools. Each medical

school in the top 65 is assigned a quantitative score reflecting a number of factors. The scores for the schools containing the residency programs to which our students matched were averaged. There was no statistically significant difference in the means for the Classes of 2006 (graded) and 2007 (pass/fail). Members of the curriculum committee felt that this was not a meaningful measure of residency program quality; because the best residency programs in a particular field are not necessarily found at the top rated medical schools.

2) Use of just one of the measures (called “Assessment score by residency directors”) from the US News and World Report ranking system for medical schools. Dr. Bill Wilson pointed out that, in this measure, the residency directors were asked to rank the quality of the undergraduate medical training at various medical schools and not the Residency training programs. This measure again

showed no statistically significant difference between the graded and pass/fail classes. The members of the Curriculum Committee were, once again, not convinced that this was a valid measure of residency program quality.

3) Use of Board certification exam pass rates for Internal Medicine, Family Medicine, Pediatrics and Surgery residency programs (available on the web sites of the ABIM, ABFM, ABP and ABS) as a measure of residency program success, Again the scores for the Residency programs to which our students matched were averaged. The data are shown in the Figure below. There is no significant difference in the means for the graded and pass/fail classes. The Curriculum Committee felt that this was, by far, the most valid measure (of the three) for estimating residency placement “success” of our medical students. The data below suggest that the change in our grading system in the first two years of medical school from letter grades to pass/fail did not have any deleterious effect on our medical students in terms of residency placement.

4. Course Reviews – 2008 The Committee discussed which courses should be reviewed spring 2008. Neuroscience, Anatomy, PoM1, and Medical and Molecular Genetics were selected

for review. All of these courses have experienced recent changes in directorship or curriculum. The Course Directors of these courses will be contacted to set up dates for their reviews. The Committee hopes to complete the review process by the end of April so that recommendations might be helpful in planning the 08-‐09 academic year.

5. Extension of Clerkships. The Committee was briefed by Don Innes on the unusual

number of MSTP students returning to this year’s clerkship class. This influx could potentially raise the total number of students in the clerkship year by as much as 14 or 15. One possibility to address this issue might be to have the 10 month core clerkships spread over a 12 month period with selectives/electives interspersed with the clerkships. The

electives that are interspersed into the core clerkships would have to be carefully chosen and approved so that students were adequately prepared for them, i.e. plastic surgery after the surgery clerkship. The Committee will continue the discussion of this proposal and other ways this issue might be addressed at the next meeting. A decision must be on this made soon to help the 09-10 clerkship year.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) 1. Announcements. 1) Fern Hauck is working on the cultural competency portion of the School of Medicine’s

response to the LCME. Dr. Hauck is developing a new line item for each of the clerkship passports addressing cultural competency. Funding for videotapes, etc. for teaching and evaluation in the clerkships is being sought by the Cultural Competency Committee.

2) Course Reviews have been arranged for Neuroscience on 5/22/08 and Medical and

Molecular Genetics on 3/13/08. Anatomy and Practice of Medicine I course directors will be scheduled for sometime in April-May, 2008. Bob Bloodgood was asked to recommend any other courses that might need to have Curriculum Committee review after the Principles of Medicine Committee completes their annual course assessments.

3) Mo Nadkani, elected from the faculty at large will become an active member of the

Curriculum Committee in the summer of 2008. 4) Bob Bloodgood reported on the Principles of Medicine Committee meeting held on

2/13/08. Sixtine Valdelievre reported to the Committee on the USMLE Step 1 review course. The review of the fall courses was begun. Minutes of the meeting will be placed on the website.

5) The Academy of Distinguished Educators 4th Medical Education Poster Session will be held on Wednesday, February 20, 5-7 p.m. (with remarks by Dr. Sharon Hostler at 5:30 p.m.) outside the Claude Moore Health Sciences Library.

The posters will be presented outside the library for the entire week of February 18-22. At the Medical Center Hour talk on February 20th at 12:30 p.m., Janet Hafler from Tufts University, will speak on "Beyond, not by, the numbers: qualitative research in medical education."

2. Consideration of an Extended Clerkship Period. The Committee continued last week’s

discussion of the expected increase in students for the coming clerkship years. While talks are ongoing with other outside institutions to develop more alternative clerkship sites, this will not solve the immediate needs of the next few years. Next year for instance, there are nearly 15 students returning to the third year class from the MD PhD program and or after taking a year off. This has created a problem in scheduling the clerkship positions. The Committee agreed that the proposal to extend the 10 months of clerkship over a 12 period including some electives/selectives in the clerkship year might be the best solution. Scheduling issues such as elective prerequisites were discussed. Some electives that have no prerequisites such as Emergency Medical Techniques/Anesthesiology, Dermatology, Pathology, and Radiology could be offered in the first and second clerkship period. The possibility that students who take these first and second period electives during their third year be given preference in the fourth year elective selection was discussed. Students concerns about the elective selection/assignment process were noted.

The Committee voted to develop this proposal. Don Innes will draft the proposal;

circulate it to all members of the Curriculum Committee for comment, and then present to Dean Hostler for approval.

3. Core Clerkship Elements. The Committee began work on developing a list of core

elements for all clerkships. 1) One-to-one experience with faculty and/or resident allowing for discussion 2) Rounds with resident/fellow/attending physicians on inpatient services (daily) 3) Medical student performance/presentation of patient history and physical examination

to supervising resident/fellow/attending physicians – full initial and regular daily updates on patient course

4) Clerkship Director (or Designee) rounds, e.g. Medical Director’s Report, Ethics Rounds

5) Clerkship designated learning events, e.g. radiology rounds, patient based didactic sessions

The Committee discussed the differences between the clerkships and the elements all

should have in common. These Core Elements will be discussed at a future meeting, expanded and refined.

4. Next meeting is February 21 to continue discussion of core clerkship elements.

Remember that the committee meets the first, second, and third Thursdays of each month during the year.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary)

1. Announcements. All of the 2008-‐09 Clerkship Passports will be amended to include an evaluation of cultural competency. The statement will read: "Student managed a patient effectively within the context of the patient's cultural beliefs, practices and needs."

2. Fern Hauck, Chair of the Cultural Competency Committee has asked that the

Curriculum Committee amend the document “Comptencies Required of the Contemporary Physician” to include a cultural competency component. The Committee voted to include the component “Cultural competency in clinical practice and professional relations” in Competency #1. The new Competency #1 will read: 1. The development and practice of a set of personal and professional attributes that enable the independent performance of the responsibilities of a physician and the ability to adapt to the evolving practice of medicine. These include an attitude of:

a) Humanism, compassion and empathy, b) Collegiality and interdisciplinary collaboration, c) Continuing and lifelong self education, d) Awareness of a Personal response to one's personal and profession limits, e) Community and social service, f) Ethical personal and professional conduct, g) Legal standards and conduct, h) Economic awareness in clinical practice; i) Cultural competency in clinical practice and professional relations.

This change should be noted at the February 29, 2008 Clinical Connections session on Cultural Competency.

Communication from Dr. Corbett – February 24, 2008 [Thanks for this note. I had intended to let you know that this was a nice and needed amendment when I read last weeks curr comm. minutes. I also plan to mention this to colleagues at the AAMC when we meet in June. We are currently putting finishing touches on the next AAMC clinical skills monograph focused upon the preclerkship curriculum. It will be interesting to see if they elect to do same! - Eugene C. Corbett, Jr., MD, FACP]

3. Anatomy specific objectives for the anatomy work group The charge of the "Medical Anatomy Curriculum Group" is to assess the need for anatomic knowledge, skills, and attitudes in the contemporary practice of medicine and to define a program that ensures their delivery within the context of our educational structure and resources, including faculty and physical facilities. The specific objectives of this group are as follows: • Define the educational objectives of the core course in Gross and Developmental Anatomy. • Identify the most effective and efficient learning environments for students to acquire anatomic knowledge and develop critical-‐thinking skills. • Develop a temporary core course program, to be in place from the 2008-‐2009 academic year through to the opening of the new Medical Education building, that achieves the educational objectives of the course, and that also minimizes student and faculty exposure to formalin vapors. • Create a vision of a permanent core course program and identify the facilities upgrades and new equipment necessary for implementation. • Identify areas for elective studies and propose potential methods of course design.

It was suggested that someone from the Health Sciences Library (i.e. Ellen Ramsey) who is aware of the library’s anatomy resources be added to the working group.

4. Nutrition, professionalism, disaster medicine, environmental health, cultural

competency in the curriculum. The office of the Dean for Curriculum has provided limited budget support for initiatives in some of these curriculum elements. Although funding is limited the Committee would like to see these areas supported as much as possible to ensure that oversight and updating of the programs is maintained. Fern Hauck requested approximately $1000 to evaluate videos and materials regarding cultural competency for use in the clerkships. Funds will be made available for this. Gretchen Arnold mentioned that Patient and Family Services

Representative, Cindy Westley and Kelly Near in the Health Sciences Library may have similar materials for the Cultural Competency Committee to evaluate.

5. Clinical Practice Exam Issues. Brian Wispelway, Course Director for the PoM2

course, has asked the Committee for guidance since a significant number of PoM2 students have failed to complete and/or pass their CPX examination. The Committee agreed that to have the students repeat these exercises before the final exam period and the ULMLE exam would increase stress levels.

The Committee recommends that the students remediate the CPX examinations following the final exam period and USMLE exams, but before the “transition” course. The student should remediate only the failed portions of the exam. The Committee discussed the formation of a subcommittee to include input from PoM directors Brian Wispelwey, Walt Davis, and Seki Balogun, and the clerkship directors to review the “UVA H&P” examination, how and when it is taught, and revise if necessary. A faculty development program for faculty and residents on the UVA H&P will be necessary. The Committee will continue this discussion at a future meeting. The Working Group on Clinical Skills Education (Chair, Gene Corbett) has been working on Clinical Skills Education in the curriculum. The Working Group has been asked to develop methods for clinical skills education for incorporation into the curriculum by September 2008. They will continue work on the development of a required list of clinical skills, and research into implementation and outcomes.

6. Basic Science for Careers Program. It appears that the program will be ready for it’s March implementation, however, the program has morphed from the original design. Evaluation and feedback from this inauguration year will be used to plan next year’s program well in advance. Re-‐examination of the original design may be helpful. Chris Peterson suggested linking this program with the Cells to Society Program and their use of diabetes as a theme. In the future, the Committee wants more faculty/department involvement in the individual programs.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard

Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) 1. Clerkship Web Site Template. The Committee reviewed the Clerkship web site

template which will be implemented by 4/28/08. All clerkship websites will be updated to conform to a common structure and required elements. The Committee discussed the list of required elements as well as the list of elements which “should” be on the websites. The Committee suggests that “A statement of the attending and resident physician’s roles and expectations” move from “should have” to “required.” The Committee also suggests that there be a place for clerkship specific resources available to students regardless of their clerkship site location. Clerkship goals and expectations should be broad enough to be applicable at all clerkship sites. Please see attachment A at end of document.

2. Admissions Survey of Matriculants. The 2007 Admissions Survey of the 143

members of the first year class two months after matriculation was distributed. Forty-‐eight students responded (34% of the class). Of the respondents 50% were Virginia residents and 40% were from out of state. Results of questions regarding satisfaction with the admissions process, importance of diversity of the patient population and teaching facilities in decision to matriculate, student perception of the School’s greatest strengths and weaknesses, and integrated curriculum were discussed.

4. MR5 Scheduling Difficulties. An e-‐mail from Mary Kate Worden of the Neuroscience course regarding a recent difficulty with one of the conference rooms in MR5 was discussed. The School of Medicine has priority in the MR5 rooms only in the afternoon. Individual departments in the building have priority in the mornings. On the morning in question, there was a scheduling snafu and Neuroscience was unable to use the room for a small group discussion even though it had been scheduled in advance. The Neuroscience class was forced to move to C1 which is suboptimal for their needs. Jerry Short noted that this has happened in the past but only on rare occasions (approximately 5 times since the building opened). He also noted that the size of the small group (approximately 30) creates the most difficulties because there are few rooms available that seat this number of students comfortably. The MR5 rooms will now be reserved through the departments.

4. Defining the Core Clerkship Elements. Some of the members of the Committee have

made suggestions regarding the draft of the Core Clerkship Elements. These suggestions have now been incorporated. The Committee suggested changes be made to “Rounds with resident/fellow/attending physicians (daily)” so that it would apply to all clerkships, ambulatory as well as in-patient. Suggestions included changing “Rounds” to “Supervised direct patient contact” or “Patient based discussions…” The committee was again asked to submit suggestions to Don Innes by e-mail. Please see attachment B at end of document.

5. Update on Comprehensive Review of USMLE. The Committee to Evaluate the USMLE Program (CEUP) reported that it has completed its review of information gathered during the early phases of the CRU process and has set a target of mid-March, 2008 to complete final recommendations. It is likely that the previously reported themes that were emerging in the CEUP discussions will e reflected in the final report. In brief, these include A) provision of assessments that are intended to inform the state licensing authorities in making decisions at two “Gateway” points: 1) entry into supervised practice and 2) entry into unsupervised practice; B) redesign of USMLE to better reflect the competencies important to medical practice; C) reconsideration of the current, independent assessment of the basic sciences in favor of an integrative approach.

The Committee discussed whether an in-house comprehensive exam might be purchased

or created to help prepare UVA SOM students for the USMLE comprehensive basic exam. MCV does have such as exam. Howard Kutchai has a basic science contact at MCV that he will put Jerry Short in touch with to see how this is done there.

6. Clerkship 2008 Increased Size. The Committee continued discussion of an extension of

the Clerkship period to accommodate the increase in students for the coming clerkship years. OBGYN and Internal Medicine are experience the biggest difficulties in dealing with the approximately15 extra students in next years class. Pros and cons of extending the clerkship were debated. The Committee has been asked to act on this so planning can begin for the 200-2010 clerkship period. Discussion will continue at next week’s meeting.

Donald Innes Dmr

Attachment A

Clerkship Web Site Template Implementation What: Update all clerkship web sites to conform to common structure and required elements When: Draft web site review: April 1, 2008. Final deadline April 28, 2008 (Start of first rotation of 2008-2009 year) Where: http://staging.healthsystem.virginia.edu/ How: Required Elements

All Clerkship websites must have clearly stated: Overview and list of student expectations and responsibilities * Goals and objectives * Evaluation and grading standards * Access to the online course evaluations – OASIS Access to the clerkship patient log Orientation materials for each site Housing information for away sites

* Basic expectations and expectations, goals and objectives, and evaluation and grading standards must be common to all instructional sites within a discipline.

Access to clerkship specific resources, e.g. syllabus, clinical problem sets

A statement of the attending and resident physician’s roles and expectations.

All Clerkship websites should have: Access to clerkship site specific schedule information , e.g. lecture and workshop

schedules, rotation schedules Site Layout:

Home page: overview, goals, and objectives Menu Items:

• Logistics: Orientation, Housing, Contacts, Guides for each site, Passports • Schedules: Attendance, Lecture Schedule, Workshops • Learning Materials: Textbooks, Workshops, Ward Conduct/Activities,

Readings, Library link for away sites, Online Resources • Grading and Evaluation: Grading and Evaluation Policies, Problems and

Feedback, Oasis, Patient logs, • For Educators: Expectations, Orientation Guide, Library Resources,

Residents as Educators • Links: Your department, Student Source, Professional organizations

For Reference: Medicine Clerkship draft web site at: http://staging.healthsystem.virginia.edu/internet/MedicineClerkship/

Attachment B A core clerkship is a required one to two month academic period of instruction based in clinical experience in which the medical student learns and participates in patient care broadly, but is generally focused on a single medical discipline. The experience grows out of a set of knowledge, skills, and attitudes based on the Twelve Competencies Expected of the UVA Physician. Elements Expected of All Clerkships 1. Orientation 2. Direct participation in and observation of patient care with

resident/fellow/attending [including discussion of evaluation, differential diagnosis, treatment, and follow-‐up]. (daily)

3. Daily medical student presentation of patient history & physical examination (or follow-‐up) to supervising resident/fellow/attending

4. Patient-‐based formal teaching at least weekly, such as Clerkship Directors (or Designee) Rounds, student morning, report or Ethics Rounds

5. Teaching conferences at least weekly, e.g. Grand Rounds, Clinical Pathologic Conferences

6. Clinical Skills Passports 7. Self-‐learning: student should review patient's medical history and physical

examination, imaging and pathology laboratory studies, and read about the patient's disorder and read about diagnostic and treatment options. Reading may include relevant basic science, anatomy and procedures.

8. Complete an on-‐line patient exposure log 9. Direct teaching time with attending at least three days a week 10. Evaluation of knowledge, skills, and attitudes relating to the clerkship Other elements of clerkships (not required for all): 1. Clerkship designated learning events, e.g. radiology rounds 2. Exercises in Clinical Problem Solving, e.g. CLIPP Cases, Virtual Patient 3. New patient admission opportunities, e.g. night call, night float 4. In ward rotations, student should experience the life of a resident. 5. Workshops for clinical skill learning.



Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Sixtine Valdelievre, Debra Reed (secretary) 1. Announcement: The agenda for next weeks CC meeting (3/20/08) will include a discussion with

Melanie McCollum and Bobby Chhabra from the Education Task Force. 2. Medical and Molecular Genetics Course Review. Wendy Golden presented an

excellent self-‐assessment report on the Medical and Molecular Genetics Course. The report outlined the course goals, content, objectives, grading policies, and future plans. The primary goal of the course is to provide an overview of basic and clinical aspects of the rapidly changing field of medical genetics. Objectives for Medical and Molecular Genetics

• DNA • Chromosomes • Single gene disorders • Complex diseases • Ethical issues • Application of knowledge • Effective written and oral communication skills

The course uses many and varied teaching tools to ensure that the students learn and understand the material – Lectures, In Class Activities/Questions, Small Group Conferences, Clinical Correlations, Patient Presentations, Critical Review, Directed Clinical Letter, and Exams. Practice Problems. practice exams, tutorials, workshops and one on one tutoring sessions are also used. Analysis of new initiatives tried in the course during the previous year and outcome data was presented. Assessment data from student evaluations was provided. The course is the highest rated by students in the first year. Since 2006, the course has been taught during the three weeks between Thanksgiving and the winter and is the only course taught during this period other than PoM1. This “immersion version” of the course has been well received by the students. Suggestions for improvement from both students and faculty after the first year were successfully implemented in 2007. Proposed new initiative for 2008 include using the Audience Response System in the Workshop setting, making minor adjustments to scheduling and topics, looking for ways to increase active learning and addressing concerns such as the addition of

some detailed information concerning diseases combining basic science and clinical application. Example: Gleevec in patients with the bcr/abl fusion protein. Inquiries about linkages to other courses were made. Links to PoM-‐1 and SIM were suggested. [Links to Ethics, Pathology, PoM-‐2, Intro to Psychiatry, and Pharmacology may be of value.] Concern was raised as to adjustments for MSTP students. The Curriculum Committee thanked Dr. Golden for an excellent presentation and commends the course directors and faculty for producing and maintaining an excellent course. A letter will be sent to Dr. Golden.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Brad Bradenham, Emily Clarke, Kira Mayo, Sixtine Valdelievre, Debra Reed (secretary) Guests: Melanie McCollum, Bobby Chhabra, Juliet Trail 1. Education Task Force. The Co-‐Chairs of the Education Task Force, Melanie

McCollum and Bobby Chhabra met with the Committee to discuss curriculum issues. The charge to the Education Task Force was to look at the curriculum and how to best utilize the features of the new Medical Education Building. The Task Force is looking at the GME, CME, Simulation Center, Preclinical and clerkship programs seeking ways to make the buildings assets an integral part of the curriculum. Dr. McCollum noted that the preclinical years seem to be the most difficult and in order for the preclinical courses to make use of the learning studio, much faculty development will be necessary. Using the learning studio may necessitate a decrease in lecture time and an increase in the free time students will need to prepare for the sessions.

Dr. McCollum noted that in a paper published in 2000 Academic Medicine,

http://www.healthsystem.virginia.edu/internet/med-‐curriculum/acadmed/acadmed2020.cfm the goals and objectives for curriculum design and management reflect many of the

same goals the Task Force has today. She asked if there were Task Force recommendations that might accelerate the process described in this document. The Committee explained some of the extenuating circumstances that prevented full implementation of the goals outlined in the paper.

The size of the Curriculum Committee, course oversight, integration of the preclinical courses, flexibility of scheduled student contact hours, decrease in lecture hours, faculty needs for increased small group activities, and a decrease in individual course hours to accommodate the time required for student preparation for learning studio activities were discussed. It was suggested that perhaps a yearly preclinical retreat might foster more integration.

Dr. McCollum stated that one of the goals of the learning studio teaching method is

to go from just teaching knowledge to teaching the students a new way of learning. Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Reid Adams, Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak Debra Reed (secretary) Guest: Melanie McCollum 1. Announcements: Joint Clinical Clerkship Committee Meeting 4/2/08. Don Innes reported on the Joint

Clinical Medicine Clerkship Committee meeting held at UVA on 4/2/08. Clerkship faculty from UVA, Salem VA, Roanoke Carilion, and Fairfax were in attendance. The new medical education building plan was reviewed with the group along with the recent addition to the University of Virginia School of Medicine Competencies Required of the Contemporary Physician “cultural competency in clinical practice and professional relations.” A statement assessing this competency - "Student managed a patient effectively within the context of the patient's cultural beliefs, practices and needs", has been added to the Passports. Allison Innes outlined the 2008 Match Results for the group. Bill Wilson and Allison Innes provided an Electives and Selectives Assessment. Melanie McCollum gave a report from the Education Task Force. The group was introduced to the new Clerkship website format by Veronica Michaelsen. Gene Corbett talked to the group about the Clinical Skills Working Group and their efforts to enhance teaching of clinical skills in the clerkships. The Committee discussed how to best prepare the students for the USMLE-2CS exam. During lunch, the clerkship leaders met and were asked to discuss methods to enhance clinical skills education. The SMEC representative, Animesh Jain, spoke to the group with suggestions from SMEC to improve the student’s clerkship experience. Before the group adjourned, they visited the Simulation Center for a demonstration of UVA’s simulation technology.

Kira Mayo and Jason Franasiak were welcomed to the Curriculum Committee as the new 08-09 student members. Surgery Proposal. The Surgery Clerkship Directors met after the April 2nd Joint Clerkship Committee meeting to discuss Eugene McGahren’s proposal for the Surgery Clerkship. Ashley Shilling of the Department of Anesthesia was present and had worked out the appropriate arrangements for the anesthesia component. The Surgery group strongly supported the proposal and came away from the meeting “very excited by the potential for this format”. It will be implemented in 2008-‐09. Surgery -‐ week 1 (introduction, all surgery lectures and workshops, 2-‐day anesthesiology experience), weeks 2-‐4 (Surgery team: general, cardiac, vascular, colorectal, hepatobiliary, pediatric, trauma, transplant, thoracic, oncology), weeks 5-‐7 (Surgery team: general, cardiac, vascular, colorectal, hepatobiliary, pediatric, trauma, transplant, thoracic, oncology), week 8 (wrap-‐up lectures, orals, exam)

2. Anatomy Course Review. Melanie McCollum, Anatomy Course Director, updated

the Committee on the recent changes to the Anatomy course. The embryology section of the course has been enhanced. The grading system has been revised. Exams now include more problem solving types of questions and the number of questions have increased from 50 to 75 per exam. Multiple quizzes and use the ARS system have also been added. The course is being taught with far more “active” learning now than in the past. This type of learning does require substantially more student preparation time prior to and after the weekly labs.

The group discussed the appropriate allotment of “study hours” to each of the first

year courses. The group reviewed and discussed the recent student evaluations of the course. The course will make further revisions this year based on what they learned last

year, e.g. learning objectives have been pared down and made more specific. The issue of memorization was discussed at length. Some of the Committee members felt that while memorization is not the ideal learning method, some memorization such as terminology is absolutely necessary.

Specific outcome data on the effects of the new teaching method are not available at

this time. The Committee suggested that ways to evaluate cause and effect of the method should be found and data collected. The Committee strongly suggests that the first year course directors meet as soon as possible to discuss timing of their course activities to both integrate material and lessen student overload whenever possible.

The Committee also suggests that quizzes be timed to not interfere with other courses.

3. Response to the Medical Molecular Genetics Course Review. The Committee

discussed a response to the Medical Molecular Genetics Course review. A letter will be sent to the Course Director, Wendy Golden, with the Committee’s comments.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak Debra Reed (secretary) 1. USMLE Response to Pathology Chairs. Portions of a letter from Peter Scoles of the

USMLE in response to inquiries made by a group of Pathology Chairs regarding the future of the Step 1 and Step 2 examinations were read. There is a misconception that the recommendations under consideration involve either the elimination of Step 1, or the combination of the current Step 1 and Step 2 examinations into a single one day test, and the subsequent administration of the current Step 3 examination. This is not the case. Instead, we anticipate building new test items that measure not only mastery of clinically relevant basic science information, but also the ability to deal with emerging concepts which may have relevance in the future for the practice of medicine. Both "gateways" in the new examination would contain these materials. Conjunctive scoring models could be applied, with minimum requirements in basic sciences and clinical materials in both gateways as a condition of passage. Although some current USMLE test materials may be appropriate for the purpose, it is certain that new blueprints, test materials, and test formats will be required. One of the more disconcerting findings has been that curriculum officers at nearly all US medical schools report that students engage in “binge and purge” behavior with regard to basic science knowledge in the several months surrounding the transition from preclinical studies to clinical rotations, regardless of the nature of the curriculum at their medical schools. Most believe that Step 1 of the USMLE interferes with their ability to achieve horizontal and vertical integration of basic science across the curriculum, and encourages this approach on the part of students. NBME basic science retention studies are not encouraging, and frankly, the popularity of USMLE review courses and the volume of sales of USMLE Step 1 preparation books support these conclusions.

2. Combined Degree Program: M.D./M.B.A. A proposal for a combined M.D. and M.B.A.

degree program was submitted to the Curriculum Committee for approval. After discussion, the Committee voted to approve the proposal.

Proposal: Combined Degree Program: M.D./M.B.A Admission

Students must be admitted to each career/degree program (M.D. and M.B.A.) by the respective schools, the School of Medicine and Darden). Admission is first to the M.D. program and then to the M.B.A. Enrollment, Tuition and Financial Aid A student enrolled in the M.D./M.B.A. degree program will have access to the financial aid office in the school of enrollment. The student will spend the first 3 years in the School of Medicine, the fourth year in Darden, the subsequent summer semester in the School of Medicine, and the final year registered in Darden. In total the student will pay a total of 7 semesters of tuition to the School of Medicine 4 semester to Darden. Darden will reimburse the School of Medicine for 0.5 semester of tuition for the Spring Semester of the final year. Registration, tuition and fees will be as follows: Year 1 SOM Fall and Spring Year 2 SOM Fall and Spring Year 3 SOM Fall and Spring Year 4 Darden Fall and Spring; SOM Summer Session Year 5 Darden Fall and Spring (tuition to be divided evenly with the SOM) Students will be required to meet the degree requirements of the School of Medicine with the exception that the total number of elective credits will be reduced by 8 provided that they successfully complete four quarter long health-‐related courses in Darden to be designated by the Darden faculty. Tracking Credit Documentation of successful completion of the 4 Darden courses will be required from Darden in order for students to receive the M.D. degree. Documentation must be received at least 3 weeks before the graduation date. Effect on the Transcript The UVA academic transcript will include separate entries for each career/School (Medicine/Darden-‐). Credits or coursework taken while enrolled within a particular career will appear on the page of the transcript affiliated with that career. The following courses will have to be manually entered by the School of Medicine: MED 665 Selectives Program MED 670 Electives Program MED 680 DxRx: Health Care Policy MED 682 Basic Science for Careers Awarding of Degrees Both the M.D. and M.B.A. degrees, providing requirements have been met for both career plans, can be awarded on a UVA graduation date.

3. Cultural Competency. The Committee agreed to ask the PoM-‐2 course director to

revise two of the tutorial cases to include a component of cultural sensitivity [competency] for 2008-‐09. Guidance in revising the cases may be available through Fern Hauck and the Cultural Competency Committee.

4. CPX and Cultural Competency. The Committee requests that beginning in 2009 the

CPX include at least one case evaluating the student’s ability to work with a patient in a competent, culturally sensitive way.

5. Anatomy Course Review. The Curriculum Committee discussed the Anatomy Course

Review of 4/3/08. The Committee began the review and will recommend that more

image analysis be integrated into the course. The discussion will continue at the April 24th meeting.

6. Cumulative End of First Year USMLE Examination. The Committee began

exploration of a summative examination after the first year. The Committee had a lengthy discussion on whether such an exam is a good learning tool, whether it is good preparation for the case based questions of Step 1, timing of exam, whether there would be increased stress to students with addition of the exam, appropriateness of questions on the exam and difficulties course directors face in not knowing what topics are covered on the exam. Input is requested from the Principles of Medicine Committee. Medical Education is investigating the nature and composition of an examination containing a specific subset of questions concentrating on our first year courses.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary) 1. Gross and Developmental Anatomy Course Review. The Curriculum Committee

continued discussion of the Gross and Developmental (embryology) Anatomy] Course Review of 4/3/08.

Concerns about the impact of changes to the Anatomy course on the over all

learning environment were of primary concern. When any course intends to make major changes to their curriculum, fellow course directors should be made aware of the proposed changes – not in any way to discourage changes or usurp course director’s authority – but rather to avoid conflicts and to foster a good learning environment for students to do well in all courses. In particular concerned was raised about the amount of time anatomy requires outside their scheduled time and the impact that has on the other first year courses, shifting study time for students to Anatomy.

The student evaluations of the anatomy course were lower than previous years – comments regarding anatomy’s new teaching method were highly variable with most of the negative comments expressing concern about the lack of specific objectives and the time required for the post-‐lab were. Anatomy has written new and more specific objectives for 08-‐09.

It was noted that anatomy groups are self-‐selected unlike any other medical school

course (all other courses use a random, alphabetical, or director selected system. Some students noted in their evaluations of the course that they found this difficult. It is best if Anatomy used an assigned method.

Difficulties in obtaining cadavers with low levels of formaldehyde from the State of

Virginia were discussed. It appears that action at the state level is needed to revise the way bodies are embalmed before formaldehyde levels can be corrected. Correspondence between the new Dean and the new State Chief Medical Examiner should be initiated.

Anatomy Working Group Report, now it the final stages, was reviewed. The charge

of the Medical Anatomy Curriculum Group was to assess the need for anatomic knowledge, skills, and attitudes in the contemporary practice of medicine and to define a program that ensures their delivery within the context of our educational structure and resources, including faculty and physical facilities. The specific objectives of this group are as follows:

• Define the educational objectives of the core course in gross anatomy. • Identify the most effective and efficient learning environments for students to

acquire anatomic knowledge and develop critical-‐thinking skills. • Develop a temporary core course program, to be in place from 2008-‐2009

academic year through the renovation of the Gross Anatomy Facility, that achieves the educational objectives of the course, and that also minimizes student and faculty formaldehyde exposure.

• Create a vision of a permanent core course program and identify the facilities upgrades and new equipment necessary for implementation.

• Identify areas for elective studies and propose potential methods of course design.

The group’s final report will recommend that the course be renamed “Clinical

Anatomy & Medical Imaging;” that the course design incorporate and integrate principles of medical imaging with the study of the cadaver in situ; that Fourth Year Anatomy Electives be enhanced; that objectives be rewritten to be more specific; and that formaldehyde exposure in the laboratory be reduced. Environmental Health (Kristy Davis) will monitor student exposure.

2. Options to Accommodate More Students (~20) Per Year on Clerkship Rotations

Option 1 -‐ expand the number of clinical sites available for rotations at UVA and nearby hospitals, e.g. Roanoke Carilon Hospital, Salem Veterans Hospital, Fairfax Inova Hospital, Martha Jefferson Hospital, Augusta Medical Center, Culpeper Regional Hospital, Rockingham Memorial Hospital, Richmond area hospitals. Responsibility for securing clinical training sites is primarily administrative; these decisions should be made in consultation with the Curriculum Committee. -‐ If Virginia is to graduate additional physicians training sites must be made available by those communities and their hospitals that will eventually employ these physicians. The hospitals above, especially Martha Jefferson Hospital, Augusta Medical Center, Culpeper Regional Hospital, and Rockingham Memorial Hospital have a moral, community, and regional obligation to contribute to the education and training of physicians serving their respective communities and the region. Additional sites are crucial in OB-‐GYN if the class size is to be expanded. Option 2 -‐ extend the current 10-‐month clerkship rotation period to 12 months with two months of elective time -‐ effectively adds 30 additional students to rotate per year -‐ does grave damage to the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas. -‐ forces at least 30 to as many as 120 students to take electives before experiencing all or some of their core clerkships; this weakens the elective experience for those students. -‐ shortens the time available for students to experience a variety of medical specialties and make thoughtful reasoned career decisions Option 3 -‐ expand the current 10-‐month clerkship rotation period to 12 months with two months of required clinical training -‐ effectively adds 30 additional students to rotate per year -‐ standardizes basic clinical experience -‐ adds an important dimension to the required "core clerkship" curriculum, that of geriatrics -‐ preserves the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas. -‐ shortens the time available for students to experience a variety of medical specialties and make thoughtful reasoned career decisions

The Committee endorses exploration of an opportunity to work with the current president of the Albemarle County Medical Society, Dr. Sam Caughron to increasing ties/communication between community doctors and the School of Medicine. He was thinking of a system where private practitioners would approach UVA departments or doctors to arrange student rotations. The Committee noted that outside sites would need to be monitored carefully to assure comparable experiences at all sites. And that some form of a centralized "clearing house" through the Dean's office would likely be needed.

Donald Innes dmr



Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Guest: Anne Chapin, Debra Reed (secretary) 1. Announcements. The Committee welcomed Megan Bray, M.D., as a new member of

the Curriculum Committee. 2. CSTAP (Clinical Skills Training and Assessment Program) Report. Anne Chapin met

with the Committee to discuss the CPX program. The CSTAP program has three components. During the PoM1 course, small groups

participate in clinical exercises involving primarily history taking, physical examination, and cultural sensitivity. During the PoM2 course, H&Ps in the UTA and GTA portions of the course involve history taking, physical examination, patient note, and invasive procedures. The CPX during the clerkship year is a performance exam with a focused PE and patient note.

What is going well?

• Over past 10 years, case means and ranges have remained relatively consistent. • Many students report that the CPX is a great learning experience. • Students report that it is a good opportunity to practice the format of the USMLE

Step 2 CS. Problems • Consistent with past years, physical exam scores are lowest. • Done incorrectly because students listen to heart and lungs through gown. • Many critical PE items overlooked. • Students do not incorporate patient education smoothly.

When the PE was not done or done incorrectly, errors were made in the following: • Anxiety Case: lungs 25%, heart 35%, thyroid 90%. • Appendicitis Case: abdomen 23%, percussed 71%, heart 40%, lungs 50%, raise leg

75%. • Hypertension Case: BP one arm 52%, BP two arms 98%. • Chest pain Case: BP 60%, lungs 35%, heart 58%, pulses 85%, one side of neck

lying down 77%. Other problem areas:

• Students do not wash their hands before the PE 10-25% of the time. • SPs performing chest pain role noticed that students went through motion of listening

to heart in 4 places, but not accurately in aortic, pulmonic, tricspid and mitral areas. • Several cases reported that 30% of students did not drape them. • Lowest scoring case was contraceptive counseling.

In the 2007 USMLE CS examination 8 students did not pass. Possible reasons for this might be: • Students casual: assumed showing up and speaking English = pass. (no review) • In clerkships speed and diagnostic efficiency are valued ≠ quality focused PE +

patient education of performance exam format. • Students failing CS difficult to predict: Low performing CPX students generally pass

CS exam. Students who fail CS exam perform just below average in CPX. • Students have little practice or feedback in performance exam format. What has the CSTAP Program done? • Offered practice sessions after CPX with SP feedback on checklist. • Invited low scoring students to practice sessions. • Offered individual coaching to all CPX students. • Advised all students to review First Aid book to prepare for CS exam • Raised passing score for POM 2 H&P assessment. • Remediated all POM 2 low-scoring students.

What should be done?

• Review checklist items for importance, revise if needed. • Propose adding CPX type activity (2 cases) at beginning of clerkship with feedback

so students understand nuance of performance exam (Hx, focused PE, patient ed.). • Urge faculty to more closely observe and monitor clerkship student PE skill

development. • Model excellence, students do what they see.

Committee Recommendations:

• Preparation of a web video of the “ideal” H&P for student review prior to the CPX (an attending do a full or appropriate PE on a patient)

• Addition of one or two SP cases to the beginning of the clerkship year (providing the student with perspective as they go through the clerkships)

• Expand the CSE program to more clerkships • Increase use of proctored simulated cases in the Simulation Center, e.g. breast

exam Questions regarding time constraints of the CPX versus those of the USMLE-CS were

raised. From student comments, time does not appear to be a major issue. Students who have been on the wards are already in the mindset of completing tasks in a time delineated fashion.

The Committee noted that if the Clerkship Passports were used as intended, many of the

issues raised in the CPX would not be a problem. The CSTAP provides a detailed report to the Clerkship Directors on each year’s CPX results.

• The Clinical Medicine Committee is asked to review the report and develop an “action plan” to address these issues. PoM1 and PoM2 directors should be involved in the Clinical Medicine Committee discussion.

• A short focused report (1-2 pages) should be provided to the Clerkship Directors with instructions that the information should be shared with all the Clerkship sites and teaching faculty and housestaff. This focused report should be broad and perhaps not clerkship specific.

Donald Innes dmr Note to Curriculum Committee: USMLE Site [Posted April 14, 2008] A small number of multiple-‐choice items with associated audio and/or video clips will be introduced into the USMLE Step 1 Examination beginning in mid-‐ to late May 2008. No more than 5 items with associated media clips will appear in a single examination. The 2008 USMLE Orientation Materials include a small number of multiple-‐choice items that contain exhibits involving audio and/or video clips. Instructions for practicing with items with associated media clips on Step 1, Step 2 CK, and Step 3 are provided in the Tutorials for each Step examination in the orientation materials. Items with associated media were introduced into Step 2 CK in 2007, and into Step 3 in March of 2008. As of May 2008 all three multiple-‐choice question components of the USMLE examination will include items with associated audio and/or video.


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Guests: Seki Balogun, Walt Davis, Debra Reed (secretary) 1. PoM-‐1 2007-‐2008 Review (Seki Balogun, Walt Davis)

Dr. Balogun outlined the PoM-‐1 course themes:

Patient interviewing -‐ basic and advanced Physical examination Ethics Medical humanism -‐ cultural competency, sensitive topics (sexuality,

substance abuse, breaking bad news & dying), geriatrics, narratives in medicine

Self-‐learning Accessing medical information; pofessionalism -‐ written and oral

communication, problem solving The Course has achieved consistently high ratings on the student evaluations. In

2007-‐2008, 100% of the students gave the course a “B” or higher (62% “A” and 38% “B”).

Students were also asked to evaluate organization and content of the course and

scores remained high. While the “challenging content” score was slightly lower overall, Dr. Balogun believes that this reflects that the material is being well taught and is not especially difficult to learn.

0%10%20%30%40%50%60%70%80%90%100%

ObjectivesClear

Wellorganized

Solidunderstanding

Challengingcontent

Learningeasier

2007-20082006-20072005-20062003-20042002-2003

Significant strides have been made to achieve integration with other courses. Greater than 90% of students self-‐report being comfortable or very comfortable with most skills learned in PoM-‐1. Application of basic science skills was slightly lower at 84%. New Initiatives 2007 -‐2008 (Based on student feedback from 06-‐07) Lectures made more interactive: automated audience response units Accessibility of information POM-‐1 website has been updated and expanded to include all course information Printed handout was provided 1st semester CDROM only handout provided for the 2nd semester) Addition of session on review of systems Addition of faculty retreat Teaching different course components Group dynamics Course Strengths Small groups Mentors Patient contact activities Hospital Interviews Interviewing practice with SPs 4th year H and P Clinical Correlations Physical examination OSCE Physical Exam modules/videos Putting it all together session where the mentor demosntrates a full H&P In group demonstration with 4th year student as patient Course Weaknesses Lectures were the least favored part of the course even when made more interactive (45%: excellent or good). However, high grades were received in lectures with clinical correlation (Mean 3.5/4 and above). Teaching of ethical issues in medicine in the traditional lecture format, ethics case presentations and ethics case discussions were not well received. Students panned the course for the accessibility of course information via the POM website, the CDROM and the printed material. Future improvements Move away from lectures or large group sessions and include more clinical correlations with actual/SP demonstrations. Integrate more lecture material into the small groups. Further enhance use of the audience response system. Introduce ethical principles with clinical cases rather than lecture applying principles to real life clinical situations. This “case of the week” might correspond to one of the other Basic Science courses. While first year students have limited knowledge of disease processes, clinical cases must be selected carefully for content so as not to overwhelm or frustrate the student.

Course directors will attempt to incorporate the 12-‐item AAMC model for clinical competency in all PoM-‐1 activities. Professionalism Engagement & communication skill Scientific understanding and application Clinical history-‐taking Mental & physical examination Differential diagnosis Clinical procedures and testing Information management Plan of care Clinical intervention Prognosis Care in context (personal, family, ethical, social, cultural, etc) The Curriculum Committee applauded the course for it’s consistently high evaluations and the course directors’ commitment to further improving the course. PoM-‐1 has had no problems with availability of mentors for the course; however, non-‐physician mentors sometimes feel less “useful” in the second semester of the course as the exercises become predominantly clinical. Course directors have made suggestions for better use of the mentors during this time period. Difficulty in finding patients for the student to interview on the floors was discussed. Some units provide a daily list of patients who are appropriate for interviews to the PoM-‐1 office. Others are not able to provide the list anymore due to time constraints and the noon discharge, which leaves the mentors searching for patients instead of observing the students during the beginning of the history taking exercise. They should consider using patients at Health South, outpatients who are waiting during long testing procedures, outpatients who are willing to take the time to talk to a medical student in the PCC clinics and possibly patients in the ER who are waiting for admission for the PoM-‐1 H&P exercise. Other suggestions were to use the Teaching Resource Center to develop more interactive teaching exercises; inviting someone from the Center to speak at the next faculty retreat. Dr. Balogun and Dr. Davis were congratulated on running an excellent course and providing a thorough course review to the Curriculum Committee. Donald Innes dmr



Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary) 1. PoM1 Course Assessment. Discussion of the PoM1 Course Assessment of 5/8/08

was continued with the suggestion that the search for appropriate patients for H&P exercises include the post-‐partum ward, the ER and the renal dialysis unit. Planned changes to the ethics portion of the course seem warranted and beneficial to the course. The Committee will review student evaluation data after the changes. The Committee agreed that while most of the students’ ethics education takes place in the clerkship/elective years, the groundwork must be laid in the preclinical years. Recommendations and proposals for the coming year were reviewed. A communication to the course director will be formulated.

2. 2009-‐2010 Clerkship/Elective Calendar. The Clerkship/Elective calendar for 09-‐10

will be adjusted by one week so that the beginning of each clerkship and elective period is in sync. The Committee reviewed the modifications and approved the change.

3. Comprehensive Exam Proposal. A proposal to develop a comprehensive exam after

the first year was discussed. 1. Currently, medical students take the following comprehensive exams during the four years of medical

school and after their first year of residency. Year 1 Year 2 Year 3 Year 4 PGY 1

USMLE Step 1 USMLE Step 2CK (Clinical Knowledge)

USMLE Step 3

USMLE Step 2CS (Clinical Skills)

UVA Clinical Performance Exam

2. Initial reports indicate that the USMLE is planning to discontinue Steps 1, 2, and 3 and replace them with

two Gateway exams using the following schedule: Year 1 Year 2 Year 3 Year 4 PGY 1 Gateway 1: Licensure for

the supervised practice of medicine

Gateway 2 Licensure for the unsupervised practice of medicine

Final approval of the new licensing design is scheduled for consideration by the full boards of the FSMB and NBME no earlier than Spring 2009. As noted by the USMLE, “If changes are approved, it will take at least two additional years to work out the details for a reasonable transition to the new design, structure, and to begin implementation.”

2. In order to plan for the new design, a new sequence of comprehensive tests is proposed that would give students more experience with comprehensive tests before taking Gateway 1.

Year 1 Year 2 Year 3 Year 4 PGY 1 NBME/UVA Foundation of Medicine Exam

NBME Comprehensive Basic Science Exam

Gateway 1: Licensure for the supervised practice of medicine

Gateway 2 Licensure for the unsupervised practice of medicine

UVA Clinical Performance Exam

3. The NBME/UVA Foundation of Medicine Exam could be constructed in 2008-‐2009 using NBME’s

Customized Assessment Service and offered to students in Spring 2009.

In order to construct this test, a committee of faculty would identify the topics to be included on the test. Next, the NBME would provide questions from the NBME test item bank related to the topics. Twice as many questions would be provided as would appear on the completed test. The faculty committee would select the questions to be included on the test. The test would probably consist of 150 questions and require three hours to administer. The test would be administered by computer to two groups of 70 students each in the Health Sciences Library on a Saturday in the spring. The NBME charge for 140 students would be

Administrative Fee $1,500 Exam Fee ($40 per student x 140 students) $5,600 Total $7,100

The process of constructing the exam should be a useful faculty development project. The review of first year course material and the experience of taking an NBME-‐type exam should be useful to students. It is recommended that taking the exam be required of students, but that no passing score be set until UVA has several years experience with the exam. Since this is an exam based on the UVA curriculum, there would be no national norms comparing UVA students to a national norm group.

4. When Step 1 is discontinued in the future, the NBME Comprehensive Basic Science Subject Exam could be

substituted for it and offered at the end of Year 2. This is a standardized exam given at some other medical schools. It would provide national norms for comparison purposes. .The cost of this exam is currently $42 per student.

The Committee discussed the reasons this proposal was developed - preparing the student better for USMLE Step 1 thus improving scores, identifying students who may need remediation, and consideration of test scores by the promotions committee were noted. Standardized testing at other US medical schools was outlined. NBME/UVA Foundation of Medicine Exam - the examination should cover anatomy, biochemistry, histology, genetics, physiology, and neuroscience - all students (starting with the Class of 2012) must take the examination and the results used for formative (not part of a grade) self-assessment (helping the students to understand criteria by which they will be measured on USMLE; measure of what they are learning relative to their peers) - provides practice in USMLE format and computerized testing environment - review of material – synthesis and integration of basic science material before using the normal to study abnormal function - identify students who may need remediation for mentoring - feedback to faculty – familiarize faculty with USMLE style questions - could serve as a measure of remediation, by a successful end-of-year examination The primary hypothesis is that the students with this new practice and self-assessment tool will improve their performance on USMLE-1 as measured by the class mean compared to historical controls.

Lecture- Basic sci Lecture- Clinical Active learning- large group discussion (148 per group) Active learning- lab dissections (5 per group) Active learning- small group discussions (30 per group) Active learning- problem sets (6 per group) Active learning- patient presentations (148 per group)

2.44%2.44%

9.76%

4.88%7.32%

21.95%

51.22%

The Committee was appraised of the availability of appropriate testing facilities, cost of the tests. Student stress levels, the timing of implementation, and the need to gather outcome data were considered.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson (Acting Chair), Kira Mayo, Jason Franasiak, Debra Reed (secretary) Guests: Kevin Lee, Mary K. Worden 1. Medical Neuroscience Course Self Assessment. Mary K. Worden, Director of the

Medical Neuroscience, course updated the Committee on course content objectives, time distribution, and the various types of learning activities in the course with examples. The Clinical Course Director is Myla Goldman, M.D., M.S. and the lab directors are Serena Liu, Ph.D. and Scott Zeitlin, Ph.D.

Course content objectives:

• Understand the functional neuroanatomy of each level of the nervous system. At each level students will identify key structures and pathways, understand their normal physiological functions, and predict the neurological consequences if these structures are damaged.

• Understand the anatomy and physiology of sensory, motor, and integrative systems that extend over several levels of the nervous system.

Specific learning goals of the Medical Neuroscience (in Fink’s taxonomy) as

determined from answering the question “A year or more after this course is over, I want and hope students will ________” were distributed to the Committee. There are 82 total contact hours in the course. For 2008, there were approximately 148 students including graduate students from Neuroscience Graduate Program, Biology, Psychology, Sports Medicine. Senior NGP students (6-‐8 per year) assist in labs and problem solving sessions Faculty from Neuroscience, Anesthesiology, Radiology, Physical Medicine and Rehab, Opthalmology, Neurology, Cell Biology, Neurosurgery and Pathology teach in the Neuroscience course.

The 2008 distribution of instructional time in the various activities is outlined in the following table:

A total of 73.2% of time is designated lecture time. Lecture (Basic science/clinical) -‐ sometimes includes ARS questions Lectures impart foundational knowledge in the following subject areas: 1. Introduction to the CNS 2. Sensorimotor integration 3. CNS injury 4. Special Senses 5. Brainstem 6. Cortical and subcortical systems The lectures are designed to: Have students value basic science as the foundation of therapies for

neurological disorders Get students excited about the recent scientific and medical advances that

increase our understanding of health and disease in the mind and brain. Help students appreciate how neurological disorders can impact a patient’s

quality of life. Clinical problem discussion sessions (8 hrs) -‐ two hour small (n=30) group discussions of clinical scenarios mediated by a clinician/scientist team

1. Pre-‐session meeting of all faculty to review learning objectives and encourage faculty to run interactive sessions

2. Handouts (written by Worden & Goldman): Pre-‐lab exercises (schematics, vocabulary, questions) Learning objectives 3 to 4 Case scenarios (+/-‐ CT/MRI accessed on course website) Specific discussion questions for the case Bridging questions that span two or more cases 3. Post-‐discussion online quiz (2.5% of course grade: written by Worden &

Goldman) This exercise is designed to: Levelize, lateralize, localize, and integrating anatomy and physiology

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Help students recognize patterns of symptoms associated with lesions Help students recognize abnormal signs on the neurological exam. Sylvius Challenges (2 hrs) This is a new activity -‐ a one hour large group discussions of structure/function questions based on neuroanatomy slides, and mediated by ARS clickers (MK Worden).

1. Show the question slide, call for vote, display the answer histogram. 2. Discuss the right/wrong answers or ask for re-‐vote. Answer any questions

students raise. 3. Ask two more questions about the same slide and have students volunteer

the answers and discuss. This exercise is designed to give the students practice at: Recognizing major nervous system landmarks Integrating anatomy and physiology Recognizing patterns of symptoms associated with lesions Recognizing abnormal signs on the neurological exam.


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Localizing Neurological Lesions (2 hrs) -‐ Two hour large group discussion mediated by Dr. Fred Wooten

1. Handout has 10 case scenarios, no images. 2. Dr. Wooten directs a Socratic method discussion of how to localize the lesion. 3. Dr. Wooten displays the relevant anatomy slides and confirms the

localization. Be excited about neurology (and related specialties) This exercise is designed to help the student:

levelize, localize, lateralize integrating anatomy and physiology recognizing patterns of symptoms associated with lesions recognizing abnormal signs on the neurological exam.

Problem-‐solving Sets (2 hrs) – This is a new activity -‐ One hour small group (n=6) discussion of structure/function questions associated with online images. (Spinal Cord Wiki; CT/MRI images)

1. Log into website and review the image and associated questions (one problem set is adapted from U.Mass, the other was created by Worden & Goldman)

2. Discuss and agree on a group answer. 3. Check answer against the correct answer posted after the session (not

graded) 4. Be more interested in neurology and neuroradiology.

This exercise is designed to help the student: Interact with other students to solve problems Recognize major nervous system landmarks Integrate anatomy and physiology Recognize patterns of symptoms associated with lesions Levelize, localize, lateralize

Lab dissections (4 hrs) -‐ two hour lab sessions mediated by scientists and clinicians (surface anatomy, deep brain structures and cerebellum)

1. Pre-‐lab review session with graduate student teaching assistants and new faculty

2. Handout written by Dept. Neuroscience faculty Pre-‐lab exercises (schematics, tables, questions) Dissection protocol Post-‐lab exercises (using neuroanatomy software) 3. Material subsequently appears in lectures, clinical problem sessions, and

Sylvius challenges. This exercise is designed to help the student:

Interact with other students to solve problems Recognize major nervous system landmarks Integrate anatomy and physiology


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Patient presentation (2 hrs + Brad Worrall, M.D.) One hour session mediated by a clinican who invites a patient. Students wear white coats

1. Clinician interviews patient. 2. Clinician does neurological exam on the patient. 3. Students ask questions of patient.

This exercise is designed to help the student: Appreciate how neurological disorders affect a patient’s quality of life Value basic science as a foundation of therapies. Be more interested in neurology and related specialties. Practice at recognizing patterns of symptoms associated with lesions.

Time distribution in 2009 will be reallocated to make lectures (clinical and basic science no more than 65.7% of the total time (down from 73.2% of the total class time). The Neuroscience Course evaluation scores have increased dramatically in the last two years. The scores are now on a par with the rest of the first year courses. Some students did complain that the course seemed disjointed – this will be addressed by Dr. Worden in the introduction of the course and by providing more clearly delineated outlines of course content. One student noted that all the students wearing white coats during the patient interview seemed to overwhelm the patient. Students wearing white coats during this exercise was initiated to increase professionalism of the students during the interview session and the patient did not note any discomfort from the practice. The Curriculum Committee thanked Dr. Worden for her in depth course self-‐assessment and review and applauded both Dr. Worden and the rest of the course faculty on the recent improvements in the Neuroscience course.

Bill Wilson dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary) Guest: James Click


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1. Clinical Clerkship Report – June, 2006-‐June, 2007 – Mulholland Report. James Click, current Editor, reviewed the Executive Summary results of the 2006-‐2007 report, the most recent period. Overall average mean ratings for the clerkships dropped slightly from 3.69 to 3.52 in 06-‐07. The breakdown of individual clerkship ratings for the Class of 2008 was discussed as well as trends of the past five years. Family Medicine and AIM retain their position as the top two rated clerkships by students. Other clerkships retained their positions from last year except for OBGYN which has shown marked improvement. Individual clerkship sites (in and outside of UVA) often receive quite different scores. Psychiatric Medicine rotation at Roanoke remains the highest scoring clerkship – when asked why the students like this site so much – it was noted that one faculty member does all the teaching at this site and students’ work day is over at noon.

Teaching. The consequences from the shortened resident work hours has been

noticed by the students in many rotations. Students complain that often lectures are canceled without notice on clerkships. Teaching, generally, was one of the highest scoring categories of the questions asked for most clerkships.

Feedback. Feedback from residents and attendings is deemed adequate. Students are reminded that it is just as important for them to ask for feedback as it is for the attendings to provide it. The LCME requires that midpoint evaluation be assured.

H&P Skills and Presentations. Overall students believe that are given adequate opportunities to practice H&P skills and presentations.

Patient Diversity. Diversity varies from site to site with the Salem VA rotations having the most limited patient population. However, Salem rotations are lauded for giving the students much autonomy for patient responsibility.

Procedure Training. This remains the lowest rated area this year. Students compete with residents who need to fulfill their own requirements for residency. The use of passports has helped but the limited availability of procedures is noted by the students on some rotations. Active procedure training seems to be somewhat site specific. It has been suggested that more simulation models be added to the clerkships whenever possible. Students suggest increasing the number of surgical and life-‐saving skills workshops.

Outpatient Exposure. Students feel adequate outpatient exposure is provided in most clerkships. Due to the shortened (4 week) curriculum in Neurology and Psychiatry, course directors suggest outpatient experiences in these services would best be gained in selectives/elective time in the fourth year.

Living Conditions. Students continue to have multiple complaints about the living

conditions at the Salem VA including lack of internet access in each room, unhealthy food selection and unsanitary room conditions.

Professionalism. The results were unchanged from previous years. When students are exposed to incidents of unprofesssional behavior, they are encouraged to consult with the Student Advocacy Committee.

Conclusions. Overall, the students tend to be satisfied with their third year clerkship experience. The rotations were as an important part of their education as it bridges the classroom to the clinical setting. However, there are many improvements that

an be potentially made, and it is strongly suggested that the recommendations provided for each section be taken with much consideration for change.

SMEC will work closely with the Mulholland Society to develop the next Clerkship

report. It is hoped that SMEC data will allow for more “near time” response to evaluations.

Factors that may have helped improve OBGYN’s scores include the development of a

full day orientation, adjustment of the lecture schedule, an edited orientation packet, and redefining end of clerkship practicum.

The Curriculum Committee is urged to consider individual clerkship sites and make

recommendations to the Clerkships for improvements. The Committee discussed expansion of the Clinical Skills Educator program into the

other clerkships. Each clerkship director may be asked to develop a proposal as to how to use available funds to increase clinical skills education in their clerkship.

Dan Becker noted that Mark Williams of Geriatrics just received a stellar review in

JAMA for his book Geriatric Physical Diagnosis: A Guide to Observation and Assessment. http://jama.ama-‐assn.org/cgi/content/full/299/15/1838

2. Admissions/MCAT/ULMLE Outcome Data, AAMC Graduation Questionnaire, Course

Evaluations. Jerry Short updated the Committee on recent data – MCAT /USMLE scores, AAMC Graduation questionnaire, and course evaluations.

MCAT scores remain consistently higher for UVA than the national mean in verbal,

physical science and biology. Overall USMLE scores for UVA SOM students for both Step 1 and 2CK remain above the national mean but the gap seems to be growing slightly narrower. Data on the number of failures of UVA SOM students taking USMLE Step 1 the first time was reviewed. Comparative course evaluation scores from the first and second year courses was also reviewed.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus

Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary) Guests: Darci Lieb, Jonathan Evans, Elizabeth Bradley 1. Basic Science For Careers (BS4C) Report, March 10 – 28, 2008 Darci Lieb

presented a review of the BS4C program held March 10 – 28, 2008. Darci Lieb, Debra Perina, Jerry Short, Don Innes, and students Doug Clark and Animesh Jain reviewed the course in May. BS4C was generally well received by students with mean ratings well above 3 on a 4-‐point scale. The main criticism was that the 3-‐week program was too spread out and that the days/hours should be consolidated. Students used this time to study for USMLE-‐2CK and simply well deserved downtime following the intense clerkship period. The attendance policy was too strict and the large sessions were not judged as valuable as the small group sessions. Pairing of a basic scientist with a clinician did not occur in the majority of sessions, some presenters were unprepared, some sessions were judged to be at too basic a level, and finally some students felt the program did not prepare them for the boards (note the survey was prior to USMLE). Logistical planning for the program needs to be redesigned.

A set of revisions to the BS4C program were proposed. a. Concentrate the program within two identical weeks followed by DxRx b. Require 24 hours of BS4C short sessions. Generally this would be 12 two-‐hour

sessions. c. Balance students between the two weeks (~70 @) according to student

preference d. Three sessions daily, Monday – Thursday 9-‐11, 11-‐1, and 2-‐4 e. Designated clerkships would be responsible for providing concurrent groups

(~10-‐12). This will ease administration and allow a wide range of choices for students.

f. Provide a basic template for formatting a session -‐ brief case based interactive session with co-‐teaching with basic science faculty where appropriate. Encourage experimentation with active experiential learning.

g. Administrative timelines appeared reasonable. Discussion centered on discontinuing the program entirely versus adopting the

proposed revision for 2009 and working to further improve it considering the coming change in USMLE – “Gateway A”. The consensus was to approve the revision for 2009 and to refocus the program on the original objectives with the added objective of board preparation.

2. Proposal for a 2-‐Week Geriatric Clerkship. Earlier discussions at the Curriculum

Committee recognized the need for geriatrics education and training. Furthermore, one of the stated reasons for increasing the class size was to produce more physicians to care for the growing elderly population. Bill Wilson and Don Innes met with Jonathan Evans and Elizabeth Bradley to learn more of what might be included in a required geriatrics curriculum. A proposal for a UVA geriatrics program was requested.

Jonathan Evans and Elizabeth Bradley presented their proposal to the committee.

During the proposed 2-‐week Geriatrics Clerkship, students will actively participate in the ongoing, daily care of older patients who have a wide variety of acute and chronic illnesses and abnormal physical findings. Each student will be paired with a primary geriatric physician mentor who will provide clinical teaching and ongoing feedback to the student. Additionally, each student will be responsible for his or her own panel of patients at a skilled nursing facility. Throughout the clerkship students will work with a variety of geriatric focused health professionals as part of the interdisciplinary care team. This includes nurse practitioners, therapists, certified nursing assistants, and social workers. It is expected that throughout the course of the 2-‐week clerkship students will be involved with and responsible for admission assessment, discharge planning, ongoing care and management, writing orders, and working with families.

Student will also actively participate in a series of case based clinical skills

workshops. These sessions will provide students with needed instruction and practice of skills pertinent to the care of older adults. The timing of the workshops will also allow ample time for students to practice their developing skills at their clinical sites. As with all other clerkships, students and faculty will use a Clinical Skill Passport to assist teaching and learning of several geriatric focused skills. Faculty will use this tool to guide teaching and feedback to students, and students will use the Passport to track their learning needs more effectively.

Curriculum Topics for Geriatric Clerkship: The following topics form the foundation of information students will learn

regarding the care of older patients. These topics are foundational regardless of chosen career specialty, because they are basic and necessary for providing quality patient-‐centered care to older adults.

1. Population aging and the impact on health care delivery, the economy, and

society. 2. Important age-‐related changes in anatomy and physiology and the

implications for drug prescribing. 3. Atypical presentations of illness—what and why? 4. Evaluation and diagnosis of common geriatric syndromes:

a. Delirium b. Dementia c. Falls d. Incontinence e. Failure to Thrive

5. Roles and responsibility of working on an interdisciplinary care team. The Geriatrics proposal was enthusiastically received. A two-‐week Geriatrics

experience should fit well into an “Expansion” proposal to accommodate as many as 20 additional medical students per year on clerkship rotations (142 -‐> 160). This

“Expansion” proposal extends the current 10-‐month clerkship rotation period to 12 months with two months focused on acquisition of concepts and skills that are generally useful to all physicians, that address un-‐met educational needs, and/or allow for selectives not requiring core clerkship experiences. The knowledge, skills, and attitudes to be included in this expansion must derive from the “ Twelve Competencies Required of the Contemporary Physician” and should whenever possible actively engage learners.

Donald Innes Animesh Jain [email protected]


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Eve Bargmann, Megan Bray, Dan Becker, Robert Bloodgood, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Howard Kutchai, Marcus Martin, Mohan Nadkarni, Chris Peterson, Jerry Short, Bill Wilson, Kira Mayo, Jason Franasiak, Debra Reed (secretary) Guest: Brian Wispelwey

1. Clinical Skills Education It has come to the attention of the Committee that restrictions have been placed on the teaching activities for certain faculty in Medicine resulting in a shortage of faculty available for teaching the History & Physical Examination portion of PoM-‐2. Some physicians have also been restricted from serving as tutorial leaders for first or second year students. Apparently, this is an effort to increase the time protection of Medicine junior faculty who are working to develop successful research careers; who require more focus on their research efforts and thus need to be relieved of some of their obligations as clinical educators. Such a restriction involves approximately 22 junior faculty or about 10% of all Medicine faculty.

Brian Wispelwey, PoM-‐2 course director, agreed to explain the situation to the Committee. The H&P course requires ~145 attending physicians to achieve a student to faculty ratio of 1:1. The H&P program includes 3 H&Ps with faculty and one with a trained fourth year student. After the 22 and certain other “ineligible” faculty are excluded, about 128 faculty remain available for teaching H&Ps. Doubling up stresses the Department of Medicine faculty. Surgery, Family Medicine, and Pediatric faculty could serve, but generally do not present the student with the more complex problems and physical findings associated with typical Medicine patients.

Teaching the full H&P has traditionally been the forte of the Department of Medicine. The Curriculum Committee urges the Department of Medicine to continue supporting the H&P program allowing time to consider a restructuring of how the H&P should be learned and evaluated. The Committee recognizes the need to devote time to research and deeply appreciates the teaching efforts of Medicine. Small group teaching in tutorials or problem solving sessions and one-‐on-‐one teaching (as in the H&Ps) represent as much of an important component of the UME teaching effort as does lecturing and should be evaluated as such for P&T.

2. Proposal to Accommodate Expansion of Class from 142 to 160. Recent discussions of the Curriculum Committee have led us to explore expansion of the current 10-‐month clerkship rotation period to 12 months with two months of required additional clinical training. The School of Medicine decision to increase class size from 142 students to 160 students requires accommodation of at least 18 additional students per class. In addition to obtaining new sites for clinical training, extension of the 10-‐month clerkship rotation to 12 months will be required to accommodate the expanded class. How can this be done while preserving the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas? Can a solution to this expansion problem also solve the Anesthesia/Surgery issues explored in 2007, certain complaints about the timing of the surgical specialties, and the need to place Geriatrics into the curriculum? The November 2007 Anesthesia Clerkship Task Force [Chris Peterson] report and the related Ashley Shilling proposal for a Medical Student Anesthesia and Basic Skills Clerkship [experience]. The task force principles served as guides.

Additions to the required clinical curriculum should meet the following guidelines:

• The experience must meet high standards with respect to evidence that the added material is necessary for every physician

• The required experience meets educational needs not being addressed in other clerkships or required experiences,

• The objectives derive from the UVa Competencies Required of the Contemporary Physician • Explicit links between clinical content and the basic sciences are included, • The teaching methods are sound and consistent with principles of adult learning • Measurable behavioral objectives for medical students that relate to the “Competencies Required

of the Contemporary Physician” are specified, and • Evaluation methods are suitable for the content and level of expected competence.

The Shilling proposal for a Medical Student Anesthesia and Basic Skills

[experience] (December 6, 2007) was recognized as a needed element of medical education and was enthusiastically endorsed (with minor modifications); however, placement as a required fourth year experience was a problem.

The Geriatrics proposal (June 12, 2008) was enthusiastically received. A two-‐week

Geriatrics experience should fit well into an “Expansion” proposal to accommodate as many as 20 additional medical students per year on clerkship rotations (142 -‐> 160). This “Expansion” proposal extends the current 10-‐month clerkship rotation period to 12 months with two months focused on acquisition of concepts and skills that are generally useful to all physicians, that address un-‐met educational needs, and/or allow for selectives not requiring core clerkship experiences. The knowledge, skills, and attitudes to be included in this expansion must derive from the “ Twelve Competencies Required of the Contemporary Physician” and should whenever possible actively engage learners.

Surgical subspecialties have indicated an interest in offering their selectives

interspersed in the clerkship year. There is general agreement that using a 1-day orientation and back-to-back surgical subspecialty selectives (Ophthalmology, Neurosurgery, Orthopedics, Urology, Otolaryngology, and Plastic Surgery) could be successful without a prerequisite of a general surgical experience. Early Surgical subspecialties selectives may be of particular benefit to students interested in Ophthalmology and Otolaryngology as both have early matches.

Expansion of the clerkship rotation period to 12 months with two months of required additional clinical training might appear as follows.

Medicine Psych Neuro Pediatrics Surgery FamM Obgyn Exp1 Exp2 Gen 4 AIM 4 4 4 4 + 2 + 1 + 1 1 +3 +3 +1 4 4

• The Medicine, Surgery, Pediatric, Family Medicine, Neurology, Psychiatry, and Obstetrics

and Gynecology clerkship rotations would remain unchanged. • Two new experiences of one month each would be added to the rotation schedule. These

would be subdivided. • The addition of the two-month session effectively allows as many as 30 additional students to

rotate per year.

Experience 1 (4 weeks) Experience 2 (4 weeks) Anesthesia/Life

Saving/Clinical Skills Geriatrics Surgery Selective 1 Surgery Selective 2

Anesthesia/Life Saving/Clinical Skills

Geriatrics Medicine Selective 1 Medicine Selective 2

Geriatrics as a 4-week experience Anesthesia/Life Saving/Clinical Skills

Radiology/Laboratory Diagnosis

This preserves the principle of the "core clerkship" concept in which students are exposed to a set of basic clinical knowledge, skills, and attitudes in core areas of medicine, e.g. internal medicine, surgery, pediatrics, etc. before exploring subspecialty areas.

We considered geriatric medicine, anesthesia/life-saving skills, radiology/laboratory diagnosis, clinical skills workshops, and the two-week surgical and medicine subspecialty selectives. - Standardizes basic clinical experience - Adds an important dimension to the required "core clerkship" curriculum, that of geriatrics and Anesthesia/Life Saving/Clinical Skills - Other topics that could be folded into the Anesthesia/Life Saving/Clinical Skills are Emergency care of elderly, the J. Young “War Games”, and clinical skills workshops -‐ A geriatrics program offers experience with age appropriate care – drugs, nutrition, social, family centered and numerous interdisciplinary opportunities for human development and behavior, enhanced physical diagnosis training, cognitive function assessment, rehabilitative medicine, and psychiatric care of elderly - The necessity of the geriatric and anesthesia experiences in light of the new USMLE Gateway Exam proposal - All experiences, including Geriatrics would be Pass/Fail - A negative is that certain subspecialty selectives are not all offered 12 months out of the year so that might limit student choice In summary, accepting the several proposals (Shilling Anesthesia proposal with modification, Geriatrics Experience, and the restricted Surgical subspecialty offerings) to form a unit allows introduction of several needed elements into the curriculum in a workable format. The Committee members present were in favor of this combination. The opinions of the absent members will be solicited and reported. 3. First Year Schedule 2008 -‐ 2009 Bob Bloodgood presented a first year schedule

proposal to include the required End-‐of-‐Year 1-‐Self-‐Assessment at the end of the April exam week. This will take no time from the summer vacation/research period and allows for two study days before the first exam (Physiol/C&TS) and a one-‐day interval between each exam and before the self-‐assessment. The Committee approved the schedule although concerns were expressed that this self-‐assessment would increase stress on the students and that they might reduce their attendance at class more than is seen already.

4. Adjourn for summer … Items for the fall will include a proposal for the 2009 DxRx

course, a proposal from the Working Group on Clinical Skills, and exploring ways to more fully integrate our curriculum and incorporate active learning principles.

Donald Innes

University of Virginia School of Medicine

Curriculum Committee Minutes 09/04/08


Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Debra Reed (secretary) 1. The Committee welcomed back its returning members as well as the newest

members, Keith Littlewood, Mohan Nadkarni, Linda Waggoner-Fountain, and Mary Kate Worden. Membership criteria and the names and e-mail addresses of all members of the Committee are posted on the Curriculum website:

http://www.healthsystem.virginia.edu/internet/med-curriculum/members.cfm 2. Education Task Force Report Focus. Don Innes outlined the parts of the Education

Task Force report that pertain to the Curriculum Committee. The Education Task Force was charged by the Dean with assessment of technology and

personnel needs for the new Medical Education Building. This charge was expanded to include how best to utilize all the facilities in the School of Medicine. GME (Graduate Medical Education), Undergraduate Medical Education and Continuing Medical Education were all considered in the report, but the Curriculum Committee will concentrate on the recommendations regarding UME.

Specific recommendations of the Task Force in regard to UME:

A) Accelerate pursuit of the goals for the curriculum outlined in the 2020 report

http://www.healthsystem.virginia.edu/internet/med-‐curriculum/intro00.cfm

1. Integrate and coordinate basic science and clinical experiences.

2. Create time in the early years for regular and frequent patient contact, integrating and coordinating patient experiences with the learning of the clinical sciences, professional attitudes, and information management skills necessary to function as a physician.

3. Achieve a balance of lecture, problem based learning, patient experiences and blocks of open study time to improve the learning environment. Encourage a problem solving approach to learning.

4. Create a time to encourage imaginative and creative expression of medical students in the basic sciences and clinical medicine.

B) Further integrate clinical and basic science material. The Committee will develop an integrated curriculum built on a plan of 1) learning objectives, 2) assessment and feedback, and 3) appropriate learning activities and teaching methods.

C) Create vision of the UVA educated physician.

D) Create two subcommittees either made up of members of the Curriculum Committee and/or outside of the Committee to review the curriculum content for integration.

E) Work of the Working Group on Clinical Skills Education (WGCSE) to continue. The Curriculum Committee will meet with this Committee on 9/18/08 to discuss their progress.

F) Review student independent study time

G) Identify learning methods to best take advantage of the facilities in the new Medical Education Building.

H) Adapt the Curriculum to prepare the students for the new USMLE exam schedule which is likely to begin in 2012-2013

I) Determine student learning methods and how best to accommodate the individual learning style of each studentThe Committee will discuss how best to impart clinical information early in the Curriculum.

J) Plans to increase interactive teaching time and decrease static teaching time (lecture time) will be developed. The Committee discussed the pros and cons of the pre-lecture preparations already in use by the Anatomy Course with the students present.

K) The Committee will continue the discussion of integration at the next Curriculum Committee meeting, Thursday, September 11, 2008.

“support greater efficiency and a tighter focus on science that "matters" to medicine. In addition, because of the growing commonality of language among scientific disciplines, and because human beings are complex organisms whose discrete systems are linked intricately and elaborately within the body and modified profoundly by external influences, we need to teach in ways that reflect this complexity and that stimulate students to synthesize information across disciplines. Unfortunately, asking faculty members to undertake such synthesis defies the long-sacred compartmentalization of disciplines into departmental silos. Such isolation among disciplines has already begun to change, and many medical schools have added new departments of systems biology, which focus on this complexity and the interdependence and interaction among different body systems. A sick patient does not represent a biochemistry problem, an anatomy problem, a genetics problem, or an immunology problem; rather, each person is the product of myriad molecular, cellular, genetic, environmental, and social influences that interact in complex ways to determine health and disease. Our teaching, in both college and medical school, ought to echo this conceptual framework and cut across disciplines.” - Jules L. Dienstag, M.D. NEngJMed 359:221-224

3. There will be a Special Joint Curriculum Meeting with members of the Curriculum, Principles, and Clinical Medicine Committees on Saturday, 9/20/08 in the Jordan Hall Conference Center. The agenda will include discussions on ways to advance curriculum integration and how to more actively engage the student across

disciplines. Donald Innes dmr



Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Debra Reed (secretary) 1. A Special Joint Curriculum Meeting with members of the Curriculum, Principles,

and Clinical Medicine Committees will be held on Saturday, 9/20/08 in the Jordan Hall Conference Center. The agenda will include discussions on ways to advance curriculum integration and how to engage the student in active learning across

disciplines. Small groups will be formed to work on curriculum integration throughout the basic science and clinical curriculum.

2. The discussion of curriculum integration was continued from the 9/4/08 meeting. An article entitled “The Integration Ladder: A Tool for Curriculum Planning and

Evaluation” by Robert Harden, Medical Education 34:551-‐557, 2000 was distributed to the Committee in preparation for the 9/20 meeting. Don Innes outlined the 11 steps outlined in this article’s integration ladder.

1) Isolation (no consideration of other disciplines) 2) Awareness (aware of other disciplines) 3) Harmonization (consultations between courses) 4) Nesting (infusion of information – teacher targets, within a subject-‐based

course, skills related to other subjects) 5) Temporal Co-‐ordination (parallel or concurrent teaching) 6) Sharing – (Joint teaching -‐ two or more disciplines plan and jointly organize a

program) 7) Correlation (concomitant program) 8) Complementary programs (mixed programs) 9) Multi-‐disciplinary (Webbed, contributory – moves toward organ system

approach) 10) Inter-‐disciplinary (Monolithic – shift to themes are focus of learning – little

individual discipline identity) 11) Trans-‐disciplinary (total fusion – real life learning) While much of the curriculum could not function at Step 11 enhanced integration

over and above the current level is needed. The curriculum development groups (Saturday, 9/20/08) will try to match

appropriate levels with the information from all the basic science and clinical courses and aim for highest integration levels whenever possible.

We must search for ways to fuse basic science to clinical practice in the basic science

courses and in the clerkship/selective programs. Jason Franasiak suggested that lectures not be designated basic science or clinical and that the information should be confined to the “one hour” lecture period ~40 minutes lecture ~10 minutes clinical correlation. The opposite, that of ~40 minutes clinical and ~10 minutes basic science, might be appropriate during the clerkships.

iPod technology developed in-house and outside UVA might also be a way to enhance

coordination. Library resources could also be helpful – Google scholar was mentioned. Courses with the help of the library might develop integration web links between their course and relevant basic science or clinical material. A list of coordinating basic science or clinical principles might be considered for all courses.

3. Clerkship Expansion to 12 months. The Committee reviewed the expansion of the

Clerkship program to a 12-month program. Please see minutes from the June 19, 2008 meeting. http://www.healthsystem.virginia.edu/internet/med-curriculum/minutes/061908.cfm

Two additional two-week clerkships, Geriatrics and Anesthesiology/Acute Care would be

added as well as one more month of required selectives. This proposal is to mitigate the impact of increased numbers of students due to returning MD/PhD students as well as future class size increases. The benefits, disadvantages, and trade-offs of this proposal were discussed. Electives would be decreased from 32 weeks to 28 weeks. The Committee voted to approve the proposal and encourage a May, 2009 start date. If this is not possible the program would begin in May, 2010.

Donald Innes dmr


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Guest: Darci Lieb, Debra Reed (secretary) 1. Action ideas for enhancing clinical skills education: a) Implementation of specific skills curriculum experiences, b) Creation of early student clinical exposure, c) Enhance and

systematize clinical skills assessment, d) Expand and emphasize faculty (and resident) development and support, and e) Educational design. Please see attachment for ideas. 2. Recommendations to enhance clinical performance education were presented by the Working Group on Clinical Skills Education (Gene Corbett). The recommendations are intended to reaffirm and focus upon the educational mission in the UVA School of Medicine and Health Science Center at a time when, comparatively speaking, our clinical and research missions are expanding and well supported financially. The mechanisms described below, which reflect the concerns of faculty and students alike, are intended to preserve the integrity of essential medical education activities. Implementing these recommendations will enable us to adhere to the highest medical education outcome standard: that each graduate of the UVA School of Medicine achieves clinical performance excellence. Please see attachment. A. Clinical Performance Teaching Culture: implement specific changes designed to

advance clinical performance teaching in the School of Medicine.

This recommendation addresses the challenge of securing faculty availability and accountability for student teaching. It is intended to minimize the influence of an institutional silo effect in the conduct of UME curricular responsibilities. Action Items:

a. Create a formal, integrated system for the development, implementation and evaluation of all clinical performance education programs.

b. Establish a clinician leadership position in the School of Medicine to oversee clinical performance education.

c. Designate and support faculty committed to clinical performance education. Evaluate and support these faculty based upon explicit criteria.

d. Phase in an integrated basic science / clinical science teaching paradigm. This includes comprehensive coordination between basic science and clinical faculty for all courses and clerkships, and implementation of a clinically-‐oriented organ-‐system curriculum design throughout the preclerkship years5.

e. Develop an implementation plan for migration to a learning community / college system within the SOM.6

f. Create mechanisms for enhancing and rewarding resident and student participation in clinical performance teaching.

g. Expand and integrate UME and GME faculty development efforts related to clinical performance education.

B. Clinical Performance Learning Culture: implement specific changes designed to advance clinical performance learning.

This recommendation addresses impediments to students’ active participation in clinical learning experiences as well as the need for a more permissive and effective clinical learning environment. Both student-centered and institutionally-centered educational expectations are paramount in this process.

Action Items: a. Create a four year faculty and student mentorship program. b. Create formal student, resident, and faculty development processes that explain and

assure adherence to the 12 UVA objectives of medical education7, and the role that each teacher has in achieving fulfillment of this goal on the part of every graduate of the SOM.

c. Identify and remove both student-‐centered and institutionally-‐centered barriers to student participation in clinical care learning opportunities.

C. Continuous Clinical Performance Assessment: create an integrated clinical skills

assessment, feedback, and improvement process that supports the achievement of students’ basic clinical competency.

This recommendation addresses the need for a developmental and coordinated assessment process for clinical performance education that specifies and enforces standards for students’ clinical performance achievement. Action Items:

a. Centrally coordinate and improve the system of clinical skills assessments. b. Create additional web-‐based assessments for selected clinical skills. c. Create a comprehensive plan for utilizing simulation in skills assessment. d. Create skill improvement programs individualized to each learner and competency.

D. Specific Clinical Skills Curricular Recommendations.

This recommendation gives specific emphasis to selected clinical skill development elements in the UVA curriculum.

Action Items:

a. Adopt the Working Group modified set of the AAMC recommended clinical skills and incorporate their learning and assessment into the UME curriculum.

b. Integrate and enhance physical examination skill learning in years 1 through 4. c. Expand the clinical skills educator program to all clerkships. d. Review and expand the clinical skills passport concept. e. Establish a procedural skills course in the clerkship year. f. Create a unified and expanded plan for utilizing simulation and CSTAP for clinical

skills teaching throughout the curriculum. 3. The next Curriculum Committee meeting will be October 2, 2008. Donald Innes


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Guest: Darci Lieb, Steven Heim, Greg Hayden, Debra Reed (secretary)

1. HRSA Grant: Enhancing the Culturally Competent Care of Vulnerable Populations - Global Health in Your Own Back Yard. Steven Heim, Gregory Hayden and Eugene Corbett met with the Curriculum Committee to discuss the project’s goals and objectives, how the project will help to address LCME findings, potential synergies between this project and current curriculum plans and to ask for feedback from the Committee.

This HRSA Predoctoral Training Grant is a 3-year proposal (Year 1 currently funded)

with a collaborative effort between Department of Family Medicine, Division of General Medicine, Geriatrics, and Palliative Medicine and the Division of General Pediatrics. Steven Heim, Gene Corbett, Greg Hayden, Preston Reynolds, Lisa Rollins, and Elizabeth Bradley are the steering committee members. The purpose of the grant is to create a longitudinal predoctoral curriculum, enhancing knowledge, skills, and attitudes; helping to provide culturally competent care, with a focus on vulnerable populations such as immigrants and refugees, the elderly, patients with HIV/AIDS and vulnerable children.

The grant seeks to develop new and enhance existing classroom and experiential curricula, develop new and integrate current clinical opportunities, expand opportunities in the MSSRP, and provide faculty development to improve knowledge and skills both in providing and teaching. Dr. Heim noted that socio-cultural differences influence communication, clinical decision-making, patient satisfaction, patient adherence to treatment and overall quality of care.

Dr. Heim presented various definitions of cultural competency including the LCME

Standards ED21, 22 and 26.

• “Cultural competence in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs“(Betancourt et al., 2002)

• “Cross-cultural education can be divided into three conceptual approaches focusing on attitudes (cultural sensitivity/ awareness approach), knowledge (multicultural/ categorical approach), and skills (cross-cultural approach), and has been taught using a variety of interactive and experiential methodologies” Institute of Medicine. Washington, DC: The National Academies Press; 2002. Unequal Treatment:

Confronting Racial and Ethnic Disparities in Health Care.

The Cultural Competency Advisory Committee led by Fern Hauck defined Cultural Competency as: Functioning effectively as an individual or organization within the context of the cultural beliefs, practices, and needs presented by patients and their communities. This includes demonstrating sensitivity and responsiveness to patients’ and colleagues’ gender, age, culture, religion, disability, physical appearance, ethnicity, gender identification, and/or sexual orientation. Specific activities of the grant: Project Goal #1: Develop new and enhance existing classroom and experiential curricula that prepare students to provide culturally competent care to vulnerable populations.

a) Link explicitly the cultural competence objectives taught in the four-year curriculum to the recommended AAMC objectives.

b) Review and enhance course specific learning content regarding cultural competency in the first-year POM I course.

c) Expand the existing Social Issues in Medicine (SIM) course in year one and two. d) Develop and implement a new workshop in the Family Medicine Clerkship e) Develop and implement new workshops in the Ambulatory Internal Medicine

Clerkship f) Develop and implement new workshops in the Pediatrics Clerkship g) Expansion of student evaluation and assessment activities specific to cultural

competence in the third-year. h) Provide five new fourth-year experiential electives

Project Goal #2: Develop clinical opportunities that prepare students to provide culturally competent care to vulnerable populations. a) Expand the Summer Preceptorship for students that have finished their first year of

preclinical course work b) Place third-year students with an interest in caring for vulnerable populations in

community-based practices that serve such patients c) Expand clinical elective offerings focusing on the care of vulnerable populations in the

fourth year

Project Goal #3: Provide rising second year students seven-week summer research opportunities with faculty who work with vulnerable populations in Family Medicine, General Internal Medicine, and Pediatrics. a) Provide additional Medical Summer Research Project (MSSRP) slots within Family

Medicine, General Internal Medicine and General Pediatrics with projects focused on the respective vulnerable populations.

b) Facilitate lunch-time meetings for participating summer students to discuss their projects with each other, and with faculty facilitators

c) Coordinate student presentations at end of the summer to describe their work, with participation of faculty and residents from each participating Department/Division

Project Goal #4: Provide faculty development to improve faculty members’ own knowledge and skills in providing culturally competent care to vulnerable populations and their teaching of these concepts and skills to students under their supervision. a) Survey faculty to determine level of cultural awareness/sensitivity b) Provide faculty development sessions to the three participating departments on specific

topics related to teaching students how to provide culturally competent care to vulnerable populations

Steve Heim asked the Committee for additional suggestions of ways to enhance Cultural Competency education. He also noted that the purpose this grant is not designed to interfere with Course Directors’ control over their curriculums but rather to encourage course directors to look for ways to incorporate cultural competency education whenever possible. Faculty development will also be an important part of the grant’s goals. Students note that often they feel more culturally competent than the professors who teach them. “Ethics” Rounds in the medicine clerkship with Walt Davis often deals with cultural issues. Family Medicine is already working on a similar type of rounds and other clerkships will be encouraged to do likewise. The standardized patient program will also seek to include a cultural competency component in some of their cases. The steering committee is working to add a cultural competency component to other current activities such as PoM1 and 2 tutorials.

2. Curriculum, Principles of Medicine and Clinical Medicine Committee retreat on September 20, 2008. The Collaboration site for the SOM Curriculum Renewal is up and running at:

https://collab.itc.virginia.edu/portal The site has resources from the September 20th retreat including powerpoints,

relevant journal links, and group reports. The committee was asked to review the material on the Collaboration site and

be prepared to discuss at the next Curriculum Committee meeting. It was noted by Bob Bloodgood that while the groups at the meeting did draft these

proposals in response to a specific request, they might not be heartily endorsed by the Principles of Medicine and Clinical Medicine Committees. Timetable:

September 2008 -‐ Present Working Parameters; Curriculum Workshops October -‐ January 2009 -‐ Curriculum Design Workshops (final) June 2009 -‐ Final Organizational Plan for Curriculum September 2009 -‐ Form organizational units November 2009 -‐ Complete unit curriculum detailed learning plans for Foundations

& Systems January 2010 -‐ Critique & Correction of learning plans for Foundations & Systems March 2010 -‐ Complete unit learning materials, e.g. selected readings, handouts,

laboratory arrangements, and curriculum support needs, e.g. classrooms August 2010 -‐ phased beginning of Next Generation curriculum for Class of 2014

Rationale for a Fully Integrated Curriculum: The design of the UVA curriculum

should attract, motivate and guide outstanding people by nurturing the dreams of those embarking on a career in medicine, engage the creative abilities of people to generate new knowledge and improve the quality of life, and foster excellence in medical education by blending compassion, technical ability and thirst for knowledge.

Modern education practice has demonstrated the value of active and experiential

learning, e.g. problem-‐based learning, simulation, case studies, small group earning, assessment as learning, and service learning. Such learner-‐centered education has been successfully applied in many medical schools. We must take advantage of this new knowledge and capability.

The learning of medicine should occur within a clinical context or framework to

energize students and improve retention of knowledge, skills, and attitudes. It should be competency based with early and regular clinical experiences. A new learning space and Clinical Performance Education Center will allow for more simulation and practice. Learning then becomes more efficient and meaningful.

The new USMLE assessment tools for measuring a “physician's ability to apply

knowledge, concepts, and principles, and to demonstrate fundamental patient-‐centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care.” Emphasis is placed on “the importance of the scientific foundations of medicine in all components of the assessment process. The assessment of these foundations should occur within a clinical context or framework, to the greatest extent possible.” Assessment should “explore means of enhancing the assessment of clinical skills important to medical practice” and to focus “on the doctor’s ability to access relevant information, evaluate its quality, and apply it to solving clinical problems.”

It was noted that active learning and traditional learning are not mutually exclusive learning styles and that both are necessary for a well-‐balanced curriculum. Finally, in our current curriculum the components are lodged so tightly in place that attempts to adjust even one piece are often blocked by the lack of plasticity. Moving to an integrated curriculum requires rethinking all aspects of the curriculum.

Donald Innes


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Animesh Jain, Ashley Shilling, Chris Ghaemmaghami, Veronica Michaelsen, Debra Reed (secretary) 1. Acute Care Medicine. Ashley Shilling (Anesthesiology), Chris Ghaemmaghami

(Emergency Department), and Keith Littlewood (Anesthesiology), detailed the curriculum for the new Acute Care Medicine clerkship. The two week long course is divided into one week of perioperative care and one week of basic acute care principles and procedures. The committee approved of the content, but recognized that the proposed schedule of 12 sessions per year did not match the Geriatric and Surgical Specialty rotations. [In the week following the October 9, 2008 meeting the schedule was reexamined and adjusted to retain the knowledge and skill content.] The adjusted composition of the two-‐month expansion of the clerkship period starting May 2009 will include: 2-weeks of Geriatric Medicine, 2-‐weeks of Perioperative & Acute Care Medicine, and 4-weeks of Surgical Specialties all run continuously throughout the year.

The Department of Anesthesiology and the Emergency Department will be responsible for 24 sessions of the two-week perioperative and acute care requirement each year. The Life-Saving Skills Workshop program will move to a day provided by Surgery in each of the Surgery clerkship rotations. This will likely be in the last week of the rotation with the day to be arranged by Drs. Littlewood and McGahren. The current anesthesia experience nested within the Surgery clerkship will be eliminated.

The Department of Medicine will be responsible for the 24 two-week Geriatric requirement. The specialty departments of Neurosurgery, Ophthalmology, Orthopaedics, Otolaryngology, Plastic Surgery, and Urology will be responsible for offering a steady number of two-‐week sessions throughout the 12 months of the year as a stand-‐alone rotation. Perioperative and Acute Care Medicine Clerkship: This two-week course will teach medical students basic clinical concepts and skills through direct patient exposure, focused didactics, problem-based learning sessions, and programmed procedural training. Focus will be placed on perioperative medicine, pharmacology and physiology, crisis management, and cardiac resuscitation, as well as essential clinical skills including airway management, wound care, ECG and radiograph interpretation and intravenous

access. Passport-directed objectives and competencies will be mastered within the high-yield specialties of Anesthesiology and Emergency Medicine.

2. Next Generation Medical Education Discussion.

Goals for change: Fully Integrated Curriculum: Active and experiential learning, Learner-centered within a clinical context or framework to energize students and improve retention of knowledge, skills, and attitudes. Prepare for new USMLE assessments measuring a "physician's ability to apply knowledge, concepts, and principles, and to demonstrate fundamental patient-centered skills, that are important in health and disease and that constitute the basis of safe and effective patient care" occurring within a clinical context or framework, and focusing "on the ability to access relevant information, evaluate its quality, and apply it to solving clinical problems." Veronica Michaelsen, M.D., a curriculum designer, will be joining us regularly to help us with the design and implementation of the new medical curriculum. Elizabeth Bradley, Ph.D., will be helping with evaluation of the curriculum. Everyone is asked to prepare a “model” of the most likely curricular format based on their vision of the tables (5) and mystery (1) proposals from the September 20 workshop.

Donald Innes


Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Animesh Jain, Debra Reed (secretary) 1. Competency Based Curriculum. The system developed by John Jackson and company

has been expanded and refined since last demonstrated to the Curriculum Committee (12.13.07). We will arrange a demonstration of the latest version for possible use in developing the new curriculum.

2. Yearly Review of Data 2007-08. Jerry Short presented the latest statistical data including

incoming GPAs, USMLE/MCAT scores and exit questionnaires.

Input data included • MCAT Verbal • MCAT Physical Science • MCAT Biological Science • GPA

Output data included:

• USMLE Step 1 Basic Science • USMLE Step 2CK Clinical Knowledge • USMLE Step 2CS Clinical Skills • AAMC Graduation Questionnaire • Student Evaluations of Courses

Summary • Strengths

– Faculty – Academic preparation – Residents – Students – Support Staff

• Weaknesses – Clinical experience – Clinical relevance of some basic science courses.

The Committee discussed the data presented and what might be inferred from the data. Dr. Short noted that follow up data from matriculated students is difficult to get and even though residency programs have been surveyed only about 25% of those querried for information responded. Confidentiality issues may be partially to blame for the low response rate. Selected graphic presentations follow.

3. Continuation of Next Generation Medical Education Discussion. Don Innes

presented information from SMEC on the development of the new curriculum.

SMEC: Thoughts on a new curriculum

Based on SMEC Executive committee meeting, 10/15/08.

• Caution – make sure changes are well thought out and planned

• Commitment – need a commitment to getting teachers, including clinicians o This must come from “top-‐down” and be backed by

appropriate financial support.

• Curriculum design o Not a strong desire for one particular system. An

organ-‐system like approach (e.g, UNC curriculum) was favored by most students. We also feel that this is really just an extension of what is being already attempted in the 2nd year course.

o Opposed to radical changes, as in proposals B or anonymous proposal

• Learning styles – need a mix of lecture and case based learning

o Time/Burden – make sure not too place too much of the learning burden of the new curriculum on students or attendings

• Mentorship – beneficial overall, need faculty support o Issues with mentoring – individual students will

utilize the mentors to differing degrees. Also, finding 1:1 mentors is exceptionally difficult.

o Strong support for a college system. This allows for a supportive community early on. Colleges could have several faculty members with students from all 4 years. This would provide mentoring from upperclass students as well as several faculty members. Students would have a variety of mentors to work with.

o Clinical teaching -‐ need to teach more clinical material early on if you will be testing with clinical vignettes on exams and on USMLE Gateway.

4. A model for an integrated (systems based) curriculum matrix and an example

of one representative system was put forth for discussion. The varying degree of undergraduate preparation for medical students was discussed and how this will impact a new integrated curriculum. More clinical skills should be taught and evaluated in the first two years of medical school – it was suggested that the use of a passport-‐like form might be useful. Coordination between the various disciplines in a system as well as coordination at a higher level between the systems is deemed very important and development plan will need to include both. Each system would be tested individually with one exam covering the various disciplines covered. Veronica Michaelsen has been provided a copy of the “Content in Color” developed a few years ago. She will actively monitor the new curriculum to make sure pertinent topics do not fall through the cracks.

Donald Innes dmr



Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes, Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson (Chair), Mary Kate Worden, Jason Franasiak, Kira Mayo, Animesh Jain, Guest: Elizabeth Bradley, Debra Reed (secretary) 1. Curriculum Evaluation. Elizabeth Bradley updated the Committee on early plans for

evaluating the new curriculum. The evaluation process should answer the question “Did our hard work make a difference?”

Some basic considerations as we embark upon the process of curriculum reform:

1. Create the evaluation plan as the curriculum is being developed 2. Clearly define the problem to be addressed 3. Clearly define curriculum goals and objectives to be achieved 4. Consider how the information will/should be used 5. Stakeholder driven process 6. Remain transparent 7. Remain flexible/create a process responsive to change 8. Develop infrastructure to support the evaluation process

Curriculum Objectives are required as the template for curriculum evaluation and the

Committee agreed that the objectives already in place for the curriculum of the School of Medicine are well thought out and specific.

The types of questions a comprehensive evaluation might ask:

1. Is the planned curriculum “good” and “appropriate”? (Intrinsic value) 2. Will what is planned address the stated goals and objectives, and who is the

intended audience? (Instrumental value) 3. Is the new program better than the old one? (Comparative value) 4. How can the new program be improved? (Idealization value) 5. Will the evaluation process provide the evidence needed to determine whether It

should be kept, changed, or eliminated? (Decision value) Dr. Bradley provided a few more thoughts on the evaluation process and asked for

feedback from the Committee.

There are as many approaches to evaluation as there are programs to be evaluated. From WKKF: “ we believe that good evaluation is nothing more than good thinking.” From Will Rogers: “Even if you are on the right track, you will get run over if you just

sit there.”

She also offered suggestions as to what the next steps in developing the evaluation

process might be such as appointing a subcommittee to begin developing an evaluation plan; continued literature review and monthly progress reports to Curriculum Committee.

The Committee agreed that changes to the curriculum should be monitored carefully.

The lack of good outcome data was discussed. Residency programs and matriculated students are reluctant to provide information. It has been suggested that students be asked to sign a waiver prior to graduation that their residency program can be contacted for information on their progress.

Strategies for proceeding with curricular change were discussed. Chris Peterson provided information on pertinent books on curriculum evaluation that the

Committee might read. Practical Guide to the Evaluation of Clinical Competence by Eric S. Holmboe and

Richard E. Hawkins (Authors) The Royal College of Physicians and Surgeons of Canada: The CanMeds Assessment

Tool Handbook by Bandiera (Author) 2. Approval of Clerkship Directors. Drs. Ashley Shilling and Claire Plautz have been

nominated to be the clerkship directors for the new Acute Care and Perioperative Clerkship. Dr. Aval-Na'Ree S. Green has been nominated to be the clerkship director for the new Geriatrics Clerkship. The Committee discussed the nominations and enthusiastically voted to approve all of these appointments.

Donald Innes dmr

University of Virginia School of Medicine Curriculum Committee

Minutes 11/06/08 Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Animesh Jain, Debra Reed (secretary) 1. Basic Science for Careers Update. Jerry Short apprised the Committee of the plans for

the March, 2009 BSCS course. The 2009 course is condensed into one week and the Clerkship Directors are providing the programs for this year. Thus far this has worked well. At present, 12 slots are open but the course could proceed without filling these if

necessary. The two new clerkships, Acute Care and Geriatrics will be asked to participate. The suggestion was made to offer “addiction” as a topic in the Psychiatric Medicine offerings. A lottery in early December will order topics such that students will attend three 2-hour sessions each day. This course will continue to evolve over the next few years.

2. Next Generation Medical Education Discussion. Don Innes responded to questions

from the Committee about the need for the changes, the commitment of the SOM to make the changes, and the role of the Curriculum Committee in the development of a new curriculum.

The reasons for a new “integrated” curriculum were again outlined – the change in

the USMLE exams, the nature of the millennial generation of students and the way these students expect to be taught, and the need for more active learning. The relative lack of published literature on curriculum change and outcomes in medical education was discussed. The systems approach is thought to be more conducive to student retention of material than the “silo” approach of individual course work with little or no integration or clinical relevance. The Curriculum Committee is to review the scenarios developed at the September 20 Curriculum Retreat and lay out a plan for the new curriculum from these scenarios.

Concern was expressed that faculty and other resources will not be available to staff

small group active learning activities or to accommodate the increased class size due to budget cuts.

The Curriculum Committee is interested in meeting with the Senior Associate Dean

for Education or Dean before beginning the massive effort to modernize the curriculum.

Once the Curriculum Committee develops a plan, it will be presented to the Deans

for approval. It will then need to be detailed by the reorganized teaching groups. It is expected that all of the current course directors will play an active role.

Donald Innes dmr


Minutes 11/13/08 Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Debra Reed (secretary) Guests: Animesh Jain, John Jackson, John Voss

1. ACT Curriculum Development Tool. John Jackson and John Voss met with the

Committee to demonstrate the progress in the ACT curriculum development tool and how it might be useful in developing the “Next Generation” School of Medicine undergraduate curriculum. ACT was originally designed with funding from a Robert Wood Johnson grant to be used by residency programs for curriculum development. The program helps to develop competency based curricula. The system was not originally designed to deliver content to the learner but with further development might be adapted for such use. It is designed to share resources and enhance collaboration among curriculum developers. The system helps to see redundancy or omissions in a curriculum through detailed reports. For further information about the ACT program, please contact John Jackson [email protected] or John Voss [email protected].

2. “Next Generation” Medical Education Discussion. A subgroup of the Curriculum Committee met last week to discuss how to proceed with development of the new integrated curriculum. Members present at the first meeting were Dan Becker, Wendy Golden, Linda Waggoner-‐Fountain, Bill Wilson, and Veronica Michaelsen. A second meeting with Mo Nadkarni and Don Innes was held.

The Committee developed principles on how to proceed:

1. TAM should be responsible for development of appropriate teaching methods to be applied to the new curriculum - case-based, lecture, small group, team-based, etc. Thus we have divided our work into two parts – 1) determining the best structure for the curriculum, and 2) determining the appropriate learning/teaching methods to be applied - case-based, lecture, small group, team-based, etc.

2. Current curriculum content is generally appropriate as assessed by the USMLE

Content Outline. Minor adjustments – increases/decreases in depth and breadth; additions and subtractions – are needed.

3. The issue is not what students are learning as it is when and how it is learned.

4. A systems based structure allows high level integration

5. There must be weekly patient (or in some cases simulated/standardized patient)

encounters

6. There should be an introduction - a foundations course - Principles of Medicine (including human behavior, the doctor/patient relationship, decision sciences, principles of biochemistry, genetics, histology, physiology, anatomy, immunology, microbio/viro-logy, pathology, pharmacology, and epidemiology) and should be completed by winter of the first year.

7. The Systems are: Musculoskeletal, Nervous, GI, CV/Pulm/Renal, Endocrine/Reproductive, and Heme

8. Each system includes representatives from Anatomy & Medical Imaging,

Epidemiology, Cell & Tissue, Decision Sciences, Ethics, Physiology, Biochemistry, Human Behavior/Psychiatry, Pharmacology, Genetics, Immunology & Microbiology, Pathology, History & Physical Exam, Cultural & Social Issues, Neuroscience, and Public Health Policy & Practice.

9. In parallel and integrated with the Systems is a Practice of Medicine weekly

session with patient encounters. [Here interviewing skills and physical exam skills are introduced and practiced.]

10. There must be a continuum of the science, clinical skills, and professionalism

from the Principles of Medicine into Practice of Medicine and clerkships and advanced clinical training. The student should be presented within and across each period with multiple examples of knowledge, skills, professionalism, and decision making.

11. The amount of “structured” time should be limited to allow preparation for

learning teams, small group work, etc.

An illustration of the interconnectedness of the systems approach in which students learn by building connections of knowledge, skills, and attitudes from different areas of medicine. Development of the new integrated curriculum will begin with the following draft. Number of weeks and participants in each section will be adjusted as the curriculum is developed.

Next Generation Cells to Society Curriculum

Weeks Cells to Society Intro Biochemistry Human Behavior Genetics Physiology/C&TS Immunology Epidemiology Microbiology: Bacteria/Viruses General Pathology General Pharmacology PoM (Interviewing/Patient Stories) Social Issues in Medicine/Exploratory Public Health Systems Musculoskeletal System (e.g. Anatomy, Physiology, Biochemistry, Immunopathology, Genetics, PM&R, Pathology, Pharmacology) PoM (Sports-medicine; musculoskeletal exam) Social Issues in Medicine/Exploratory Nervous System (e.g.Anatomy, Physiology, Biochemistry Genetics, Pathology, Pharmacology Toxicology) Intro Psychiatric Medicine PoM (add Neurological & Psychiatry exam) Social Issues in Medicine/Exploratory Gastrointestinal System (e.g. Anatomy, Physiology, Biochemistry, Genetics, Microbiology, Pathology, Pharmacology, Parasitology) POM (add GI/abdominal exam) Social Issues in Medicine/Exploratory

Cardiovascular/Pulmonary/Renal (e.g. Anatomy, Physiology, Microbiology Immunopathology, Biochemistry, Genetics, Pathology, Pharmacology) PoM (add CV, Pulm, & UT exams) Social Issues in Medicine/Exploratory Hematology (e.g. Biochemistry, Physiology, Genetics Pathology, Pharmacology) PoM (add Heme components) Social Issues in Medicine/Exploratory Endocrine & Reproductive (e.g. Anatomy, Physiology, Biochemistry, Genetics, Pathology, Pharmacology) PoM (add Reproductive & Social Issues in Medicine/Exploratory Systems Synthesis Study and take Foundations & Systems Comprehensive Basic Patient Care Skills? Weeks Thanksgiving Break Winter Break Summer Break (research and/or vacation)

There was general agreement on the principles outlined above and the discussion

centered on: 1) What parts of the curriculum might need to be “front loaded” into the Intro

section? 2) The knowledge, skills, and attitudes learned seem to be generally

appropriate, but that first we must repackage for better integration and then determine what learning methodology is most effective.

Donald Innes dmr


Minutes 11/20/08 Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Franasiak, Kira Mayo, Debra Reed (secretary) Guests: Randolph Canterbury, Animesh Jain 1. Next Generation Medical Education. Randolph Canterbury, Senior Associate

Dean for Medical Education, met with the Committee to outline the impetus for the impending curriculum changes and answer questions from members of the Curriculum Committee regarding the Curriculum Committee charge and support from the Dean’s office. In addition he addressed lingering topics such as class size and procedural issues.

Dr. Canterbury outlined the reasons for developing a more integrated

curriculum. These include the change in the USMLE exams, the nature of the millennial generation of students and the way these students expect to be taught, and the developments in education, especially the need for more integrated and active learning. Our competitors for qualified medical students are moving along this pathway.

The Education Task Force Report has been well received by the School of

Medicine administration. Suggestions made in this report have been prioritized. Initial funding priorities include curriculum integration, the simulation/clinical performance evaluation center and increased faculty development.

Funding available for implementation of the new curriculum was discussed. The Committee agreed that developing the “ideal” curriculum for UVA should not be limited by funding issues; however, the implementation may have to be staggered to compensate for funding issues.

The concept of “continuous curriculum improvement” and the need for

leadership by individuals from the Curriculum Committee was described. Individual faculty from all instructional areas will soon be taking active parts in the design of the new curriculum.

A group of faculty including Veronica Michaelsen and Elizabeth Bradley are working on developing evaluation techniques for assessing the new curriculum.

The need for a systems engineer to be hired early to aid in the development

of applications for the facilities in the new medical education building was emphasized.

The principles on proceeding with the “Next” curriculum from the November

13 meeting with some further outline of a preliminary organizational structure and teams will be presented to the chairs for comment.

Donald Innes dmr


Minutes 12/11/08 Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Woods for Jason Franasiak, Kira Mayo, Debra Reed (secretary) 1. Next Generation Cells to Society Curriculum. A proposed structure for the Next

Generation Cells to Society Curriculum was presented in a schematic form. The Committee discussed the proposal and offered input.

1) Cardiovascular, Pulmonary, and Renal systems should be separated, but

sequenced or placed adjacent to one another, e.g. Cardiovascular, then Pulmonary, and then Renal.

2) The target for the beginning of the clerkships would be January of the second year but is subject to change as curriculum develops.

3) The length of a system unit will be determined by the content and learning

methods required and will be adjusted as the curriculum plan develops. 4) Simultaneous development of Foundation and Systems curricula is

necessary with continuous crosstalk between all components. [Veronica Michaelsen will be coordinating this. The ACT curriculum development tool (Please see November 13 minutes.) should be used for the development and tracking of the curriculum.]

5) Learning/teaching methods for each component will need to be developed

as part of the work of the systems development teams. 6) A development team will be formed for the Foundations, the Clinical

Performance Development program, and each of the Systems. The Curriculum Committee will provide input as to the composition of each development team and in particular those who should lead. As the pre-clerkship phase of curriculum is developed the clerkship directors will be informed and their input sought.

7) A time line for the development of the curriculum was outlined. By

February 2009 development teams should complete a draft plan for each system. April-March 2009, the Curriculum Committee and development teams will refine the plans (content, assessment, and learning methods) with a final plan in June 2009. By August/September 2009, Foundations, Clinical Performance Development program, and Systems educators will be identified (many may be from the development teams) and start work on constructing the day-to-day educational materials to meet the stated objectives, assessment, and learning methods. Implementation is planned for August 2010.

Donald Innes dmr


Minutes 12/18/08 Pediatric Conference Room, 4:00 p.m. Present (underlined) were: Gretchen Arnold, Dan Becker, Robert Bloodgood, Megan Bray, Eugene Corbett, Thomas Gampper, Wendy Golden, Donald Innes (Chair), Keith Littlewood, Veronica Michaelsen, Mohan Nadkarni, Chris Peterson, Jerry Short, Linda

Waggoner-Fountain, Bill Wilson, Mary Kate Worden, Jason Woods for Jason Franasiak, Kira Mayo, Debra Reed (secretary) 1. NBME Examiner articles distributed: USMLE Moves to Next Step in Design Review Assessment of Professional Behaviors Prepares for 2009 Scale- Up "This process will be evolutionary… The entire process (of redesigning the USMLE tests) will

likely take a minimum of four years -- and quite possibly longer -- before it will impact any test-taker." --NBME Examiner, Fall/Winter 2008, Volume 55, Number 2

2. Clinical Service Work Hours. The following statement is posted in the

“Policies” section of the Medical Student Handbook website. The Committee will amend the policy to include the “red underlined” text below.

Medical students rotating on clinical services (clerkships, selectives and electives) should be subject to the same principles that govern the 80-hour work week for residents. Clerkship, electives and selectives directors are responsible for monitoring and ensuring that duty hours are adjusted as necessary. Student duty hours should be set taking into account the effects of fatigue and sleep deprivation on learning and patient care. In general, medical students should not be required to work longer hours than residents*. (Curriculum Committee 9/9/2004)

3. MD/MBA Program. It is proposed by Meg Keeley that several Law School and Graduate Arts and Sciences courses be included in the MD MBA Program. The original agreement was only between Medicine and Darden. It was agreed earlier that 4 courses would be equivalent to the 8 weeks of 4th year medical school credit that I had approved. The following list of choices seem appropriate: GBUS 8435 Emerging Medical Technologies Seminar GBUS 8402 Survey of the Health Care Sector GBUS 884 Innovation GBUS 895 Darden Business Projects: Venturing GBUS 895 Darden Business Projects: Case Development GBUS 895 Darden Business Projects: Consulting

The Curriculum Committee agreed that the courses offerings should be expanded to include those from the Law and Graduate Arts and Sciences programs upon approval of the School of Medicine Director of Electives (Meg Keeley).

Meg Keeley is also plans to limit the number of weeks that these students can take non-clinical courses (Humanities/Ethics, Public Policy, Finance) when they return to medical school. This would be at the director’s discretion, but should follow general guidelines used for other student elective time. The Curriculum Committee supports this decision.

4. ADE Teacher Coaching Program Mandatory Training Session. Marva Barnett has been scheduled for a mandatory training session for coaches in that program at 4 on Thursday (Feb 12). It may be worthwhile to have the entire Curriculum

Committee attend that training session? The Committee will decide whether to attend this session as a group at a January meeting.

5. Next Generation Cells to Society Curriculum. A copy of the updated Powerpoint presentation from last week was distributed. E-mailed suggestions received from members of the Committee were incorporated. Preliminary guidelines were formed. More work is needed on these.

• Mix of learning activities - case based learning, problem based learning, small group, lecture, laboratory

• Cumulative sessions within each system for multi-system conditions and diseases (e.g. physiologic changes in pregnancy, multi-system autoimmune conditions, or the manifestations of multiple system failure before death from cancer, or hepatic failure, etc.)

• Carefully manage the interface between Foundations and CPD and SIM/EX • Learning Environment must be learner centered • Objectives, Assessment, and Methods must be aligned • Formative assessments are essential for both teachers and students to monitor progress. • Context and connections to other knowledge, skills, and attitudes

And

1. Teachers must connect to and work with existing knowledge skills and attitudes of students. 2. Some subject matter must be taught in depth, providing many examples in which the same concept is at work and providing a firm foundation of factual knowledge. 3. Teaching of metacognitive skills should be integrated into the curriculum in all subject areas.

The Committee then identified individuals for leadership roles in the development of the Systems and the proposed Foundations course. Please see attachment. Certain participants should be included in all Systems Community planning groups.

Systems Community (participants): Physicians -‐ General Medicine, Specialty, Geriatric, and Pediatric

Pathology Medical Imaging Basic Scientist(s) Immunology Biochemistry Genetics Pharmacology Histology/Physiology Librarian (decision sciences) Public Health Nurse and/or therapist Professionalism/Ethics/Cultural Social Issues 4th Yr Student Resident physician(s) Other

Each planning group will be charged with drafting a curriculum for a system using guiding principles. Suggestions of other people to include on the Systems Communities will be forwarded.

Donald Innes dmr

List of Suggestions w/e-mails…

Foundations “Nancy Payne” <[email protected]> “Brian Wispelwey” <[email protected]> “Bob Bloodgood” <[email protected]> “Selina Noramly” <[email protected]> “Howard Kutchai” <[email protected]> “Joel Hockensmith” <[email protected]> “Wendy Golden” <[email protected]> “Melanie McCollum” <[email protected]> Musculoskeletal “Mary Bryant” <[email protected]> "Bobby Chhabra, *HS" [email protected] “Melanie McCollum” <[email protected]> “Janet Lewis” <[email protected]> Nervous System “Mary Kate Worden” <[email protected]> “Myla Goldman” <[email protected]> “Bruce Cohen” <[email protected]> “Bill Hobbs” <[email protected]> “Jason Sheehan” <[email protected]> or “Jeff Elias” <[email protected]> neurosurgeons GI “Carl Berg” <[email protected]> “Sheila Crowe” <[email protected]> “Howard Kutchai” <[email protected]> “Chris Moskaluk” <[email protected]> or “Henry Frierson” <[email protected]> “Stephen Borowitz” <[email protected]> “Charles Friel” <[email protected]> CV “Eugene Corbett” <[email protected]> “Brian Annex” <[email protected]> “Brian Duling” <[email protected]> “Alan Binder” <[email protected]> Pediatrician CV Surgeon “Gary Owens” <[email protected]> “Lewis Lipson” <[email protected]> “Karen Rheuban” “Robin LeGallo”

Pulm “Gary Owens” <[email protected]> “Ajeet Vinayak” <[email protected]> “Stuart Lowson” <[email protected]> /“Charles Durbin” [email protected] (anesthesiologists) Renal “Mitch Rosner” <[email protected]> “Kambiz Kalantarinia” <[email protected]> “Rasheed Balogun” <[email protected]> “Bill Steers” <[email protected]> – (someone from urology) Heme/Oncology? “Don Innes” <[email protected]> “Gail Macik” <[email protected]> “Pam Clark” [email protected] Oncologist? Endo/Reproductive “Bob Carey” < [email protected]> “Alan Dalkin” <[email protected]> “Christine Burt” <[email protected]> “Meagan Bray” <[email protected]> “Chris Peterson” <[email protected]> “Joann Pinkerton” <[email protected]> “Craig Peters” <[email protected]> (urology)

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