Present: Dr. Richard Davidson, Chair; Drs. Rob Averbuch, Judy Bowers, Heather Harrell, Robert Hatch, John Meuleman, Sigurd Normann, Maureen Novak, Mohan Raizada, Louis Ritz, Frank Genuardi, Cari Hernandez, Kyle Rarey, Stephen Hsu, Richard Rathe, Margaret Wallace, Lynn Romrell, Maureen Novak, Colin Sumners, Louis Ritz, William Winter, Bruce Kone, Beverly Vidauretta; Wayne Bottom, Robyn Sheppard, George Heck, Cynthia Karle, Students: Sarah Smith-Vaniz, MS4
Members not present: Students: Bhavin Adhyaru, MS4, Chris Bucciarelli, MS1, Omayra Marrero, MS3, Nitesh Paryani, MS2; Drs. David Caro, Mike Chen
Dr. Davidson began the meeting by stating there are significant changes in the educational Program; Dr. Watson stepped down as Senior Associate Dean for Educational Affairs and last week, Dr. Romrell stepped down as Associate Dean for Medical Education. He wanted to personally thank them for their efforts and wish them the very best in their future endeavors. Dr. Kone has appointed Dr. Rarey as the Interim Senior Associate Dean for Educational Affairs and has charged him and the committee to move forward with the curriculum as in the past. Dr. Kone intends to have a national search for a replacement for Dr. Watson. There will be a reorganization and the position will be one geared specifically toward medical education. The office will no longer be the reporting end point for CME and GME, which will report to other parts of the administration. The position will be Senior Associate Dean for Medical Education. Dr. Davidson said that Dr. Kone is interested in a curriculum revision and hopefully, when there is a permanent person in the position, that revision will proceed.
Dr. Davidson asked Dr. Rarey to make comments. Dr. Rarey stated that Drs. Watson and Romrell are leaving the education program at a high level and we need to take good care of it during this period of time and to look forward. Dr. Rarey said he is humbled to have the opportunity to serve during this transition period and will do the best he can in terms of listening and helping to resolve issues as they come forward. He stated that he has been here since 1984 as a faculty member in the College of Medicine. He said he has remained here because of the learning environment and that it has a compassion and dedication that all of the teaching faculty have to provide learning for our students. Dr. Rarey ended his comments by saying, "I feel fortunate to work with you during this period of time of transition; I hope to look at the learning environment and about how we can give our students the windows of opportunities to help them continue to become good resident physicians as they graduate, but also looking down the road at how they can be awesome practicing physicians." Dr. Davidson said he has offered to be available to Dr. Rarey to assist him in whatever we possible and is asking the clerkship and course directors to be available to make this transition period a lot easier.
Reports:
Dr. Genuardi reported that Jacksonville has hired a Chairman for Psychiatry that will be starting in April. They have already had some preliminary conversations and have started recruiting additional faculty so they can reconstitute the Psychiatry Department and start to offer that student course again.
Sarah Smith-Vaniz, MS4 – AAMC Rep, reported that in the student body, they are working on nominating the AAMC Humanism Award for the year. As a group, they are making travel arrangements for the spring SGEA conference. The fourth year students are just returning from their interviews.
Reports from Course Directors:
Dr. Winter mentioned that back in December there were two topics discussed. Dr. Rathe gave a presentation on the status of the current stages of putting materials on the web and its state of confusion. The second topic was that the students heard rumors that there was talk about going paperless. They presented a survey of all four classes that said the students would like hard copies and notes on the web. If they had to choose between the two, it would be hard copies. Dr. Winter said there would be a meeting today that would cover a couple of topics. Dr. Davidson said they would cover an update on patient safety curriculum and some student behavioral issues. Dr. Winter added they would also cover making sure the faculty end their lectures on time. On February 12th, the Dean will speak to the Basic Science Course Directors.
Dr. Hatch stated that at the last meeting, there was a discussion about the on-line logging system's efficiency to conform to LCME and to provide the clerkship directors with all the information they need. Dr. Rathe has made some recent changes that have improved the system. There has been follow-up on an article that Dr. Kellner brought to their attention regarding student and faculty transitions. They're looking on making changes both on a clerkship and a third year level to better orient students to the third year and to each individual clerkship, as well as relying more on students to get information to students.
Dr. Davidson said that in reviewing the curriculum, it was brought to his attention that our tobacco cessation training session could be improved. The Area Health Education Center is a recipient of state funding for tobacco cessation efforts. He invited Lisa Merlo, who is a clinical psychologist in the Department of Psychiatry, who is working with AHEC on second hand smoke efforts. Dr. Davidson has asked her to review our curriculum.
Lisa Merlo said she is working on two separate projects. The AHEC coordinators have asked her to come on board as a trainer, potentially throughout the State of Florida. The second project is that she has a grant related to tobacco smoke with the primary purpose to fund research into second hand smoke. Her project is looking at ways to improve medical student education in relation to second hand smoke cessation. She said she will be evaluating our program and looking at ways that we can become a model program for other medical schools around the country.
Dr. Davidson thanked Lisa Merlo and said we can look forward to her report around June or July.
Dr. Ritz said the Evaluation Subcommittee had talked about Sub-I's a couple of months ago that didn't result in a solution but passed guidelines for a grade distribution in all required courses. He said the Evaluation Subcommittee thought that discussion should be had by the Curriculum Committee regarding the large number of A's for these courses, which exceed the recommended percentage of 50%.
Dr. Davidson gave some background, which he said that when this was implemented, some people called, "The Davidson Doctrine," and as part of that it was decided that all 4th year electives would be Pass/Fail and would not be graded. Through Dr. Winter's leadership, general guidelines were made for grade distribution that are not quite being met. For any regular course if there are over 50% A's for more than two years, it will need to be justified to the Evaluation Subcommittee or go to a Pass/Fail course because of not really providing discriminating information that helps our students.
Dr. Harrell said that because we are not a Pass/Fail medical school, she does not feel the right course of the Sub-I's is Pass/Fail because it does a disservice to our students, at least for Medicine. There's a subset of students who didn't do as well on their 3rd year clerkship, we tell them to take the Sub-I early, work hard, and if they do well, that's going to help in their interview process. It would do a disservice to our students by making this required course that really is important to program directors Pass/Fail. She said she agrees there are problems. The Sub-I's are a sort of experiential rotation that has a real lack of valid assessment and that on their Sub-I, she is extremely unhappy about how the assessment is, as it is one team's evaluation. She said she doesn't believe it is objective. There is work going on with the national clerkships directors organizations to develop a Sub-I exam that we'll pilot here. Dr. Harrell said that in the Internal Medicine community there has been a lot of progress in the Sub-I in developing an actual curriculum that had been lacking prior to about 2002. There are a lot of unique issues with the Sub-I. She said she would not expect the Sub-I in any area to have the same grade distribution as the clerkships because you are sub-selecting students who are more interested and more motivated.
Dr. Novak agreed with what Dr. Harrell said.
Dr. Winter asked if the Dean's letter includes the distribution because he knows for basic science courses it does. Dr. Romrell said that those grades are not included in the Dean's letter.
Dr. Genuardi added that because he is a contributor to the grade inflation in Pediatrics, he agrees with the things that Drs. Harrell and Novak said and wants it to be stated that he takes those grades very seriously and does a very careful evaluation of the students on the Sub-I. He doesn't believe anyone is frivolously getting an A in the course.
Dr. Davidson said that from a medical student's standpoint, he probably learned more on his 4th year Sub-I's than he did on any other rotation about how to succeed as a PGY-1 and that this was years ago when they had no curriculum whatsoever. He stated that one possibility is to exempt the Sub-I's from this required criteria because it may be important for some students.
Dr. Harrell said for this Curriculum Committee, she believes the Sub-I's are doing a great job grading their students on their work ethic and thinks that the students that are working hard, are great team players and that are dedicated to their patients are getting good grades. She further said that she believes the Curriculum Committee could have the role to improve the quality and hopefully then could motivate better or broader assessment because even though she doesn't support going to Pass/Fail, she thinks that what Dr. Ritz is bringing up is unmasking another issue of the Sub-I. As there is a national interest, there is a chance for us to be a real leader in this.
Dr. Kone said that in Houston, when he was Medicine Chair, they interviewed all of the attendings and asked them very candidly what they were evaluating and what did they see that made them a star or not. It was always about work ethic and their personal skills, if they had a great sense of humor, and that kind of thing. They added in things like a differential diagnosis that they all had to get regardless of where they were and a few other things like, bringing literature in, discussing cases, and trying to use that to differentiate people that would give the evaluators a better idea of what to look for and what to talk to students about. He said that regardless of what form they had, what they were really doing is what we all do – we liked them and they worked hard.
Dr. Davidson said that over the years Dr. Harrell has developed a great way of evaluating both the 3rd year and 4th year using ACGME competencies which include practice-based learning, but instead of being filled out by an individual person, by one attending, it is actually filled out by the entire team at one sitting, so they share information about their impression of the student.
Dr. Kone said that they did that, too, and it was fixed in the curriculum specific examples of what practice-based learning was and what they had to show.
Dr. Genuardi said they do collect information about some of these – knowledge, particularly. He said there's a lot of information that he tries to gather when he talks to the person who worked with the student that has to do with their knowledge level and whether it was what you expect from a 4th year student. He said a lot of times he gets unsolicited comments about how it compares to the knowledge level of the interns on that team who we expect to have a higher level. He also looks at information like how a 4th year student did in terms of the teacher role and junior students, and part of that is whether they were effective in that effort. He agrees it is probably not as structured and effective as they would like it to be.
Sarah Smith-Vaniz, MS4 said it is important for students to succeed in their Sub-I and that having grades on a Sub-I are important for motivating seniors and for their overall feeling of what they are going into.
Dr. Hatch said that it sounds to him that our policy says that unless the clerkship director can justify the distribution, they have to go Pass/Fail. He said it sounds like we have pretty much justified it based on self-selection and putting their best forward.
Dr. Davidson said there could be emails sessions between Drs. Frank Genuardi, Karen Hall, Maureen Novak and Heather Harrell and if they could meet and bring back some recommendations concentrating on the Sub-I's.
Further discussion was made by Wayne Bottom, Drs. Novak and Winter regarding Pass/Fail's affect on admissions to residencies and the timing of students doing their Sub-I's.
Dr. Davidson told the Committee that each year he asks Colin Sumners, Medical Student Research Program Director, for an update on the options for our medical students in terms of medical student research activities. This year he has also asked Steve Hsu, in regard to the M.D./Ph.D. program which is now being revitalized.
Dr. Sumners gave a PowerPoint presentation: What we do now and what we should be doing if we want to develop an effective Research Track; What we do now regarding summer research opportunities, the Research Honors track and "Research Year programs;" and discussed, What should we be doing? Dr. Sumners also discussed the Physician Scientist Track (Junior Honors Program entry). Download Presentation (PDF)
There was discussion on recruiting efforts. Dr. Kone said that while he was a student here, he was an English major and had never had a research experience. He said it was on his 3rd year Medicine clerkship that he had had some experience in the lab. He said he thinks the thing that we miss in the program is offering really inspirational experiences for the students that go beyond the mentorship. These students should have face-to-face, one-on-one exposure, with a wide variety of super stars to see what really inspirational science is like. Dr. Kone said he thinks we have very energized junior mentors and other energetic people who are inspired about their research with great passion. He believes it is really a key thing and once people get identified or started in the program that we keep in touch with them, set up a luncheon, have them do a tour, or whatever we can do to keep them connected, with people remembering who they are, keeping track of them. Dr. Kone said it is a rare and precious commodity and something we should be building and growing. He really wants to emphasize developing the next leaders and scholars, and investigators and health policy experts, and the most outstanding physicians we can have.
Dr. Hernandez mentioned that when she started medical school, her medical school had a pre-matriculation research program which she participated in. They were put in labs of people who were the superstars and they were a group of minority students that were recruited, so she believes that excitement is really important to convey, and with the junior faculty who are mentoring and interacting with the students and giving the majority of the lectures.
Dr. Hsu, Director of the M.D./Ph.D. Program, discussed the interview process and his involvement in the Friday admissions interview day, by giving a ten-minute talk. He said he tells the students how important it is to have research experiences and offers all of the opportunities we have here. He tells the students that as they read journals and look at the knowledge that is being generated and the information that is coming out regarding health care policy, screening and the types of tests that need to be ordered, they're going to need the language and ability to interpret that kind of information actively incorporated into their clinical practice. He said we need to let them know that researchers have an integral part in their education because it is going to be very important for how they are able to utilize all of the information that is being generated. Dr. Hsu said we are going to need a lot of help from the Curriculum Committee regarding the curriculum content and program structure, the expansion of the areas of concentration so that they can go beyond the traditional categories. He further discussed concerns in the program and things that must be prioritized; Why the attrition rate has been especially high? Why do we only have 14 trainees when we should have about 28 spread over the 7 years? He believes the students don't feel they have a unique designation, particularly their transition from medical school into the IDP Program and then back to medical school.
Dr. Hsu said his office is now coordinating with three different offices; the Registrar's Office, Office of Financial Aid, and the Clerkship Program. Next year there will be an Advisory Board that will help to formally work in a much more structured way in order to have true dual interview processes from the medical school and the M.D./Ph.D. programs. With this Advisory Board, the students will get a good transition with everything from the admissions process through helping the students choose mentors, monitoring them, and make sure that that is a good fit and making sure they get a good transition. Download Presentation (PDF)
The meeting was adjourned at 9:00 AM.