Curriculum Committee meeting
March 13, 2007
Members present: Dr. Richard Davidson, Cynthia Karle, Dr. Lynn Romrell, Dr. Tim Flynn, Nitesh Paryani, Dr. Peggy Wallace, Dr. Sigurd Normann, Dr. Frank Genuardi, Dr. Beverly Vidauretta, Dr. Bob Cook, Dr. Rob Averbuch, Dr. Richard Rathe, Dr. Robert Watson, Dr. William Winter, Dr. Lou Ritz, Dr. John Meuleman, Dr. Heather Harrell, Dr. Judy Bowers, Linda Butson, Dr. Robert Hatch, Dr. Caridad Hernandez, Dr. Kyle Rarey, and Dr. Margaret Duerson
Student announcements:
Nitesh stated most of the first year class is off on sunny beaches, as well as mission trips across and out of the country and he’s here enjoying the Curriculum Committee meeting. The first year class just finished their first block exams and are planning for the incoming class of 2011’s orientation
Announcements:
Dr. Genuardi stated that the big emphasis now is taking a deep breath after the LCME site visit. Now the ACGME visit will occur and they’re gearing up to prepare for that.
Dr. Winter stated that the Course Director’s Committee will meet this afternoon. One of the topics is from Dr. Ritz who wants to define a reasonable burden of reading assignments for first and second year medical students. They will also discuss the issue of the data that Dr. Davidson wanted them to collect on their clinical correlations. Dr. Winter asked all of the members of the Basic Science committee to send responses to what they think should be collected. It will be decided today and there should be lists provided that will give more specific data. Dr. Davidson stated that the purpose for that is for the two subcommittees of the Curriculum Committee that are looking at developing a longitudinal curriculum in clinical problem solving and clinical decision making.
1. Follow-up to the LCME visit: Drs. Rarey and Watson.
Dr. Watson stated that he felt the LCME visit went incredibly well. Dr. Watson stated that the Curriculum Committee should be particularly pleased that there wasn’t a single ding on the educational standards and felt it was quite an honor. He stated that the LCME site team was extraordinarily impressed.
Dr. Davidson thanked everyone on the committee who participated because we clearly did an outstanding job from their perspective. He especially thanked Dr. Rarey for the year and a half’s worth of intense work he’s put in for this visit.
Dr. Rarey stated that the last site visit was March 5th-9th, 2000 in which we were told that we had one of the best medical schools in the United States. He stated that from March 10th, 2000 on, each of us on a daily basis have continued to refine and realign our competency based curriculum and evaluation system and have interacted with our students as we think we should. He thinks we have good common sense in terms of how we should interact and how we should teach and provide opportunities for our students to learn. There are no guarantees, but we provide optimal learning environments. He stated that we all provided the opportunity for us to have a great site visit.
Dr. Watson thanked the Steering Committee, which consists of Drs. Rarey, Romrell and Pauly. Dr. Davidson stated that he thinks the mock site visit was one of the best things we did and it helped him feel more prepared. Dr. Watson stated it worked extremely well. Dr. Watson stated that Dr. Rarey met personally with anyone that was not able to make the mock site visit, although Dr. Watson decided it wasn’t necessary to meet with the students that were unable to make the mock site visit. It turns out at the luncheon that a couple of the students who weren’t at the mock site visit told anecdotal stories, which turned out to be rumors and not true. That’s the one thing you don’t want to do, so in retrospect we should have checked our list and met with students individually.
2. Update on MPH/MD joint degree: Dr. Bob Cook.
Dr. Davidson introduced Dr. Bob Cook who is a new faculty member here. He is in a very unusual situation because he is part time in the College of Public Health and Health Professions and works with the Medicaid Assessment Group. He is also 20% time in the Department of Medicine in the Division of Internal Medicine and is attending on the wards now. Because of his joint membership in both the College of Public Health and the College of Medicine, it was reasonable to ask him to become involved in MD/MPH program. Dr. Cook has come up with a pretty good tentative plan. He will also serve as an ex-officio member of the Curriculum Committee at least for the rest of this year.
Dr. Cook wanted first to acknowledge Dr. Davidson and Mary Peoples Shepps from the College of Public Health who really got this started. He stated that they have done a lot of the initial legwork and deserve a lot of the credit. The following is a tentative plan of how he thinks it could work pretty well. It would be a five year combined degree that meets full requirements for both the MD and the MPH degrees, so students would have to meet all the criteria that they would normally meet.
The way he feels it can work is that for the first three years of medical school it would be essentially the same thing. Students in year three would finish their third year clerkships and at some time they would be required to apply to be accepted to the College of Public Health. In year four, the way it is currently structured, is that in the summer they would do one or two fourth year electives, which would give them a chance to try a surgical subspecialty or take whatever requirements for any course they wanted to take. In the fall of year four they would go back to a traditional academic calendar and become a full time MPH student. They would take, over the fall, spring and second summer at the beginning of year five, for example 12-15 credits, which would be 4-5 classes in the fall, 4-5 classes in the spring, and then 1-2 classes in the summer. After they finish the summer, in year five, they would go back and do 7 or 8 more fourth year electives. Some of those fourth year electives might be public health related and they can get credit towards the MPH degree and MD degree with the same course. Students in the MPH program are supposed to complete a special project which would be between 6-9 credits. He thinks if students start early on then it would be a reasonable expectation that they could actually do a first authored paper or even more than that. The special project could be something that they collaborate with a faculty member of the College of Medicine.
Dr. Rathe asked if they were in with the other MPH students during that time and Dr. Cook stated that they are. Dr. Cook stated that a lot of MPH students actually start in the summer of year four. Dr. Davidson stated that our problem is the scheduling because the MPH courses are on the university calendar which means that they start Summer C which is the same start date as Summer A in mid-May. Our students are not available until June or July so there’s no way that they could start that summer. That’s why Dr. Cook came up with the concept of them actually going ahead and doing several fourth year rotations during the summer until the fall starts and they can then matriculate. Dr. Cook stated that they would finish their third year with their initial peers and could possibly take their Board Exam. He stated that students are required 48 credits for an MPH degree and pointed-out that12 credits from the College of Medicine can count towards those 48 credits, which he thinks is what would allow it to happen. There are several categories of degrees to go for within the MPH and several of those would work with this to be able to do it in a 12 month block.
Dr. Ritz mentioned other ideas that have been presented and asked if this is the only option on the table. Dr. Davidson stated that the issue with starting it early is that very few students are positive that they want to pursue a joint degree when they start medical school. He stated that this does not force them to make a decision about getting an MPH until after they’ve been here for a year or two. He thinks there are tremendous advantages to this over having them start the summer before med school.
Dr. Watson asked when the students in this program would get enough credits in to receive the MD degree. Dr. Cook stated it would be the end of the fifth year. Dr. Watson suggested Dr. Cook sit down with Dr. Summers who runs the Research Track and is now in charge of the Junior Honors program, which will be targeted at people who think they’re interested in some kind of research career. It is clear that the way he is moving is to link it to a master’s degree. If this is one of those options because it’s a research track, it is essential that Dr. Sumners and Dr. Cook are looking at the same sort of timeline.
Dr. Cook thinks that philosophically the students that might want to do an MD/MPH have basically two potential career paths they might take. Some of them may want to work in public health by becoming the director of a county health department or running a health clinic on an Indian reservation or getting involved in national government health policy. Others want to do a research-type track. Environmental health or world health might be different, for example, than a Master of Science degree that’s really more focused specifically on clinical research methods. For the residents and fellows there is a Training in Clinical Research Methods that focuses on how to do clinical research and how to write grants, which has its own merits. He stated that some students doing this MPH will be doing research and will be writing original papers and publishing papers. It would be great for those students who want to pursue that to be perceived of in the same research vein as the students who are doing the more traditional basic science research. He thinks it would be great if the students who do this degree could also have the opportunity to be viewed as researchers.
Dr. Hatch stated that he did a joint program at UCLA and stated this looks like a great plan to him. He encouraged Dr. Cook to be flexible. He stated that one of the biggest strengths about the program he did is that they were on a quarter system there. The Public Health courses would be about 11 weeks long. That program started in the middle of the third year, which he’s not sure would work here. He would do med school for a while and take one quarter of public health and go back to med school, then take another quarter of public health and go back to med school. The incredible strength of that was that it forced him to integrate what he was learning in Public Health with what he was seeing clinically. He would learn about health systems and caring for people in poverty and then he would go work in a county hospital. He stated that if we could allow for that somehow that it would be a tremendous strength.
Dr. Cook stated that one limitation is that because we are brand new, when comparing our MPH program to some of the bigger schools, many of our courses are only offered in sequences and are offered once a year, whereas other schools may be able to offer it year round. As our MPH program and course offers grow here he thinks there will be more flexibility.
Dr. Cook stated that to get an MPH degree students are required to have 48 credit hours. Up to 12 credits are possible from Medicine coursework, which could include some eligible fourth year Medicine electives. He stated that right now Dr. Davidson has already mentioned two or three courses that students already take in the first and second years that might qualify towards this. They will also get 6-8 credits towards their special projects, which could be completed over two years. That would be a project that they would work on with their advisors that would traditionally involve original data collection, writing of a paper or giving an oral presentation. That leaves only 30 credits that they would actually have to get through coursework. There are 16 credits of required public health courses. Depending on which concentration they choose, they would have to take 9-15 credits of required electives. If 15 credits of electives were required there would be less flexibility.
The core courses they would have to take are Statistical Methods either in Public Health or Research, the Research course being the most intense, a choice of two versions of Principles of Epidemiology and Public Health, one of which is more focused, Introduction to Public Health Administrative Systems, Environmental Health Concepts in Public Health, Psychological, Behavioral, and Social Issues in Public Health, and Seminar in Contemporary Public Health Issues which is a one credit course in which students are required to attend 4 or 5 seminars and a talk. All five of these courses are available online, which will allow students more flexibility.
The five concentrations in the UF College of Public Health are Biostatistics, Epidemiology, Public Health Management and Policy, Public Health Practice, and Social and Behavioral Health. Public Health Practice right now is basically designed to be the most flexible. It only has 9 required electives beyond the initial 16 credits and those can be taken in two or three of the other disciplines. Epidemiology is the more traditional thing that people do, but it is full of core requirements. Public Health Management and Policy is also popular among medical students who are interested in the policy side, which also has a lot of required concentration electives. The student in this current vision could choose one of these concentrations and meet the requirements of that concentration and be part of the rest of the students in that concentration.
Dr. Davidson stated that from an outside perspective, they want to get accredited and they are putting forth a lot of effort into making sure that they have enough adequate courses in the core concentrations so that they can get accredited. In the future, he would suspect there will be a Global or International Health concentration and a Maternal and Child Health concentration. They have correctly identified their primary goal as a new school to become accredited. They want to get enough faculty in the core areas to make sure that they can do that.
Nitesh asked if there is any talk about making scholarships available for medical students who want to pursue this degree or if it would mean obtaining more financial aid. Dr. Cook said he was actually going to make a slide about that question that said “To be discussed”. Dr. Cook stated that for people who do the MPH as part of a fellowship it actually is often worked into the fellowship and it is a bargain to wait and do it as a fellow. As a medical student there is sometimes a financial disincentive to try to do it because not only is it more tuition, but it’s now five years of tuition as opposed to four. He thinks that it would be a tremendous opportunity for us to explore. He thinks it would be unrealistic that this would happen this fall. He and Dr. Davidson agreed that it will most likely be the fall of 2008.
Dr. Ritz asked if the accreditations were separate and Dr. Romrell stated that they are. Dr. Cook stated that at this time, the College of Public Health is not accredited. It is now in its third year and everything is in line that it should be accredited by the fifth year. Dr. Davidson stated that accreditation of a college of public health is not the same as accreditation of a medical school. Most of the MPH degree programs in this state are not accredited and there are several of them, but this one will be.
3. Patient log data: Dr. Romrell.
Dr. Romrell stated that he is going to show how the data is collected, but more what we’re doing is analyzing the data and showing how we’re going to use that. He stated that a patient log is a requirement for the Educational Standard 2 which says we must have a way to track the student’s educational experiences in terms of patient contact. We’ve been doing that for three years and each year we continue to refine it. He stated that the big thing is that we want to be able to use the data we collect, not just simply meet the minimum requirements.
Dr. Rathe wrote the software that collects this data and there are ways to look at it in that system, but there’s the more comprehensive way to look at this data if we go to our medical student database. He showed how they look at the data through the medical student database Comptrac.
To go into it in a more comprehensive way we can do a drilldown report. This sets a filter so we can go through and define exactly what we want to look at. The program shows that there were 49,000 records that are in 2006-2007, which demonstrates how much data is being collected.
Cynthia Karle stated that you can look at the data in the Comptrac system and see many different ways of analyzing the data. An advantage of downloading the data into a spreadsheet is that it lets you do more comparisons such as looking across all clerkships, looking across all students, comparing locations, etc.
Dr. Romrell stated you can also look down the list of presentations and know that some of those are common things that you’d expect all students to do and some are relatively rare to deal with, which differentiates the ones you won’t expect every student to encounter. Globally the clerkship directors have to look at the list and decide what should be on our list as required types of encounters and what students would be expected to do with respect to that.
Cynthia showed how to look at individual students and their performance across all clerkships. Dr. Romrell stated that this kind of data can be used by the director of the fourth year, Dr. Harrell, to look at the students and decide whether they have had the kinds of experiences you expect them to have during their three years of medical school, which will help define a fourth year to fill in the gaps.
Dr. Flynn asked if there’s a minimum number that students are required to report and Dr. Romrell stated that is not defined yet. Dr. Flynn stated that what they have discovered in ACGME is that when they set minimum requirements, the students quit logging after that. They’re not capturing the total experience because all they do is the minimum requirements, which is very frustrating to the faculty.
Dr. Rathe asked if they also included the category of “Other”, which Cynthia stated they did. The student has the option of writing in the details of the actual encounter. Dr. Romrell stated that last year there were about 100,000 patient encounters logged and in 54,000 of those encounters the students chose “Other” because it’s the easy way to do it. Dr. Harrell stated that in Medicine the students actually thought they were being helpful by inputting the whole patient encounter, which was actually more work for them to do. Dr. Hatch stated that an example was that students didn’t understand that appendicitis could be included in the category of abdominal pain. Dr. Harrell stated that students don’t understand what our purpose of collecting this data is, which Dr. Romrell stated is definitely a factor. Dr. Romrell stated we need to have the students understand why we’re trying to do this, which will eliminate a lot of the confusion.
Dr. Davidson stated that he’s always interpreted that the reason for this in the first place is that the LCME wants clerkship directors to be able to define what kinds of patients, not numbers of patients, should be seen. For instance, there may be tertiary care institutions where students never see common types of patients, but have seen rare cases. They also wanted to know what happens when the students don’t see those types of patients, which is a good question. They want to know if the information is actually used in the method in which it was intended.
Dr. Harrell stated that Dr. Duerson mentioned that the next step is to look at the PBE’s to see if there is a correlation between the numbers of exposures they actually have to how they perform on that, which would be interesting.
Dr. Rathe stated that when thinking ahead to the issue of defining expectations, he thinks that course directors could begin adding some type of grading system as they go and as the data collection moves through time we could then do that relative to the total number of submissions. This could tell them directly if they were tracking something essential or that a certain procedure is clearly lagging behind the things that are considered not essential. It would be a qualitative, not quantitative, feel of how they’re doing.
Dr. Flynn stated that’s the same approach they took. They have a whole list of things they collect from residents to decide which 30 procedures are the ones that we didn’t think they should take the boards with unless they’d done that.
Dr. Harrell would like to teach the students to be doing their own self-assessments as well so they can keep up with it. If we make clear what the expectations are, they’ll be knocking on the clerkship directors’ doors and letting them know what they haven’t yet gotten.
The meeting was adjourned at 8:55am.