Curriculum Committee meeting

January 9, 2007

Members present:  Dr. Richard Davidson, Dr. Kyle Rarey, Vee Gosein, Dr. Maureen Novak, Dr. Heather Harrell, Dr. John Meuleman, Dr. Sigurd Normann, Dr. Louis Ritz, Dr. Beverly Vidauretta, Dr. Rob Averbuch, Dr. Judy Bowers, Dr. David Caro, Dr. Mike Chen, Dr. William Winter, Linda Butson, Karen Bodnar, Dr. Robert Watson, Dr. Frank Genuardi, and Wayne Bottom

Dr. Davidson wanted to briefly discuss an issue that came up at the last Curriculum Committee meeting that had to do with the clerkship directors and course directors and whether or not various policies that they wanted to implement for their courses and clerkships needed to be brought before the Curriculum Committee to be voted on.  This is a policy that is described at the beginning of each year in the general administrative structure of how medical education works.  It states that the Curriculum Committee is involved in developing and evaluating new curriculum, but not the logistics and management of the courses and clerkships, which is why there are course and clerkship director committees.  Dr. Romrell is the implementation arm; therefore decisions about when students should get time off and how early they need to contact clerkship or course directors about when they’re going to miss class are decisions that should be decided by the appropriate course or clerkship director’s committee and brought to Dr. Romrell for implementation as opposed to the Curriculum Committee.  Dr. Davidson stated that one of the reasons they have these reports at the beginning is that when he asks the course and clerkship directors what they’ve been doing, this would be an appropriate place to mention the issues that were raised and the decisions that were made.

Announcements: 

Dr. Genuardi stated that the residency program directors in Jacksonville are working on developing a Standardized Patient program. 

The clerkship directors have made a decision to move the clerkship orientation back to July, which is right before the students start on the clerkship. 

1.   An LCME update by Dr. Rarey.

Dr. Rarey stated that there are 41 days until the LCME site team is here.  There has been contact over the last three weeks with the secretary of the LCME site team, Phillip McHale.  He has received all of the materials and they are working on the final schedule, which will be sent out at the end of this week or beginning of next week for the site team members.  The agenda is also being finalized.  Dr. Watson stated that so far the team is going to focus on Jacksonville, the VA and here.  They don’t actually want to visit Shands at AGH, but he suggested that Dr. Novak be ready anyway. 

Dr. Rarey stated that next week we will hold a mock site visit.  Members of the Steering Committee to include Drs. Watson, Romrell, Pauly and Rarey will meet with different groups for 7 days in preparation for the February site visit.  They will go over the script of questions that may be asked.  He passed out a guide that he’s given to all of the department chairs that they have to follow in terms of gathering data.  Dr. Watson stated that what happens in general is that one member of the team has been assigned to a certain clerkship.  He feels that ED2 will be a topic of interest due to the past concerns about residents as teachers.  

Dr. Rarey showed four large books that were sent to each member of the site team.  The books consisted of the summary report, the outcome data about our educational program in terms of how our students feel, everything about our educational objectives, our competency-based curriculum and evaluation systems, everything about our courses and clerkships and electives, appendices, and information from the medical student committee in which they assessed everything about the curriculum including the resources of the different offices, etc., and the AAMC questionnaire from last spring.  The survey team will look at all of that data and see how congruent it is with the data from the faculty. 

Dr. Rarey stated that Dr. Robert Rich, the dean at Alabama, will chair the LCME Committee.  He showed the template that is typically used at each LCME site visit.  He emphasized that every director has to know what the educational objectives of the program are, which they will go through at the individual course and clerkship meetings.  The team decided not to meet with the residents as they did in 2000. 

Dr. Watson stated that in the Student Self-Summary report, one of their concerns was lack of formative feedback during the first two years.  The course directors have discussed that numerous times, but because it came up in the Student Self-Summary report, he recommends that all of the course directors give some thought as to how they might respond. 

Dr. Rarey continued discussing the schedule and stated that even though the Geriatric clerkship has only been going for six months, the site team asked that Dr. John Meuleman be present so that they can learn about the geriatric portion of the curriculum due to the concerns about geriatrics during the prior LCME visit.

Everyone will be notified in terms of what the strengths were and how the accreditation went.  They will give us verbal feedback, but the actual site team will probably not meet until June and we won’t receive the final papers until sometime in the fall. 

Dr. Ritz asked if each clerkship director should be aware of what the students said about their particular course.  Dr. Rarey stated that they definitely should and directed everyone to the online student data for each course.  Dr. Watson stated that the students did a phenomenal job presenting all of the data.

Dr. Vidauretta suggested including tours of the Office of Financial Aid, Student Counseling and the Student Health Office here in Shands to show that we have in-house resources that are helpful and Dr. Watson agreed.

2.   A description of fourth year programs by Dr. Harrell.

She showed an organization chart which had Dr. Watson and the Curriculum Committee as the head, Dr. Romrell as having oversight of the preclinical years, Dr. Duff as having oversight of the clinical years/career advisement, and her as having oversight of the fourth year curriculum/academic advisement.   Dr. Watson stated that in Jacksonville Dr. Genuardi fulfills the duties of what Drs. Duff and Romrell do in Gainesville.  She briefly reviewed the current fourth year structure, which shows that there are three months of required courses in the fourth year.  Almost every student takes the allowed interview month, which is usually in December.  In May, the month they graduate, there is also Internship 101.  Although that is currently an elective, she thinks that Dr. Duff is planning to make that a requirement.  She states that leaves six months of electives.  She states that also during the fourth year are the USLME Step 2 Clinical Skills and Clinical Knowledge.  She states that students are studying more for these exams and the scores are improving as a result of that.  This is now factoring into their decision-making of the fourth year electives.  Students who are the on Research Track have to finish that and any students who may have incompletes finish those, so it’s a surprisingly packed year for the students. 

She stated she is about halfway through interviewing all of the program directors to get their input on how they use the fourth year, what advice they’re giving students, and any ways that we can help them provide a better product so to speak.  She stated she has been pretty involved in remediation planning, which we may be using the fourth year more and more for now that we have ED2 data. 

She reviewed the electives offered in the course catalog that the students can take in Gainesville, Jacksonville and Orlando.  The three most popular courses that students take are Special Topics in Medical Ethics, Radiology Diagnostic Imaging and Lecture Series in Gastroenterology.  She mentioned the Chapman Center and the Narrative Medicine and Reflective Writing electives that Nina Stoyan-Rosenzweig has taken on.  She also mentioned other popular courses and noted that these are not very clinical oriented courses, which may or may not be a good thing. 

Dr. Davidson’s Community Service course was one of the popular ones and he explained that it is based on the general concept that 80 hours of work in a month is sufficient for one month’s credit.  They developed a list of criteria for student community service activities, which the students log in over four years beginning their first year.   He stated there are certain limitations; at least half of the 80 hours that they have to collect have to be done in Alachua County.  The maximum that they can get for going on a trip for a spring break trip is 20 hours.  There is a student advisory board composed of representatives of each class who decide whether or not an activity should count.  They do accept things that are not purely medical if they are community service based.  If students get credit for an activity it doesn’t count towards this. 

Dr. Harrell stated it has been very interesting interviewing the Program Directors and that overall our Program Directors are very satisfied with UF students.  Dr. Pat Duff has basically assigned all of the Program Directors to be the student’s fourth year advisors, although the involvement that the advisors take is highly variable.  Some didn’t even seem to know that they were the official advisor of the students; however, others give thoughtful advice and are very engaged in the student’s advisement. 

Dr. Harrell also asked the Program Directors if there were any courses that they thought would be helpful for fourth year students.  An idea that came up several times was some type of Clinical Physiology or bringing back basic science into the clinical years and putting it into perspective of what really was important during the first two years.  Another idea that came up several times was some type of introduction to research so that students understand the process of it even if they aren’t going to be a researcher.  An advanced version of Evidence-based Medicine was also suggested because there is a concern that residents in general don’t know how to read their literature critically.  Another suggestion was a longitudinal operative care elective, which basically starts in the pre-op clinic, in the OR, following them after surgery, and continuing as they go to a rehab hospital.  Another suggestion was something in advanced procedures, which also may end up being a remediation procedure as we are doing a better job tracking and making availability for students to go to the Simulation Center. 

Dr. Davidson stated that there has not been a whole lot of participation by Program Directors and by Residency Programs in developing Evidence-based Medicine competencies.  To think that having an extra month or two weeks in the fourth year is going to make a difference for their residents is missing the point.  They need to develop their own Evidence-based Medicine efforts within residency training. 

Dr. Harrell went through what has been accomplished so far.  They are going through the course catalog and have purged out courses that have not been used.  The course information was updated and they are trying to enhance the catalog.  The independent study proposals have been cracked down on and the form that the students use has even been changed.   The students need to have some product in mind whether it’s curriculum, a video, a reflection, something to let us know what they have been doing for that month and that has to be turned in to get credit.  She stated that she sends them back if they don’t make sense or if she doesn’t understand what it is they’re doing or if it sounds like a completely unrealistic research project.  Dr. Harrell stated that they have created new courses.  She has been reviewing individual student schedules, normally interviewing the bottom third of the class.  The only ones where there has been some issues are some students with unrealistic career expectations.  Dr. Harrell stated that she and Dr. Duff have been working together trying to advise the students. 

Dr. Normann asked how the bottom third of the class are assigned their advisors and suggested some structure of assigning them the top advisors.  Dr. Harrell stated that her attention is primarily on the bottom third because she can’t give them the type of career advice their program director can.  The bottom third of the class has not necessarily earned the same freedom of scheduling. 

Dr. Novak suggested having faculty development.  Dr. Caro stated it would be very helpful to him if he knew where they are in their class so he could tell a student if they should, for instance, aim for a topflight program or middle of the road program.  Dr. Harrell stated there is quite a bit she can do to help the Program Directors and that there is going to be some continuous remediation planning and oversight.

Dr. Harrell then mentioned new courses that have been offered that they are trying to advertise a bit more.  The classes include Becoming a Resident Teacher, Community Service, Art of Physical Diagnosis and Clinical Reasoning, Role of Psychological Testing in Healthcare, and Health Care Economics.  She stated that in her department there were some concerns that they’ve seen the drop-off in clinical electives being taken. 

With regards to ED-2, Dr. Harrell stated that this year we are finally having the students keep an accurate log of their experiences, which we can use to help guide their fourth year.  Students are going to be required to review their patient logs as they are coming through their third year, looking at what their experiences are, and using that as one of the things that will form their fourth year schedule.  They are trying to improve the catalog so they can better see where they might meet those requirements. 

Dr. Harrell discussed the future challenges and stated the core experiences they all think every student needs to see before they graduate.  She listed the challenges to include clarifying graduation competencies and making them transparent and pervasive, balancing flexibility in the fourth with enough rigors, defining and eliminating “fluff”, and balancing career needs with academic needs. 

Dr. Davidson stated that nobody has really done anything quite like this and that this is the opportunity for something unique.  The target was the fourth year and to direct it for individual students who could use more guidance.  Drs. Davidson, Watson, Romrell and Rarey had talked at one point about starting medical school earlier so that it ended with the match because essentially there’s a lot of time that’s dysfunctional in the fourth year.  He thinks that this has a great future in providing and expanding the educational process for all of the students. 

The meeting adjourned at 9:07am.