Curriculum Committee Meeting Minutes
March 28th, 2006
Members present: Dr. Kyle Rarey, Dr. Robert Watson, Dr. Richard Davidson, Omayra Marrero, Dr. Sigurd Normann, Dr. William Winter, Cynthia Karle, Dr. Lynn Romrell, Dr. Richard Rathe, Dr. Andrew Kaunitz, Dr. Louis Ritz, Dr. David Caro, Dr. Heather Harrell, Dr. John Meuleman, Dr. Maureen Novak, Dr. Robert Averbuch, and Dr. Robert Hatch
Student announcements: Omayra says they’re staying focused-due north.
Announcements: Dr. Romrell stated that the National Board just released the final summative data for the Step 1 Exam for last June and this will be the data that they are going to report. The results showed that on average only about 16% of the class was below the national mean in any subject area. The main point is that we have reached the point where almost all the class is solidly above the national mean and no one is failing. He stated that our programs by this measure continue to do better and better each year.
Dr. Winter stated that last month Dr. Romrell informed course directors about reviewing the EDs and their goal as course directors is to review all 125+ pages of those and report to Dr. Romrell their feedback and score them as to whether their ED objectives are met. They will continue that at their next meeting as well. Dr. Davidson stated that the same task has been given to the clerkship directors to review all the EDs and to respond, even those who are not directly involved. When those are collected they will be presented to the Steering Committee along with the entire report and will then be presented at the Executive Faculty meeting on June 15th for their approval.
Dr. Watson stated that we had delegation from the AMA visit us approximately 6-7 years ago and states that Baligh Yehia is spearheading another visit that will occur this Thursday. Baligh is the only medical student in the country who serves on the AMA council, which interestingly enough is a more powerful position in the AMA than any of our faculty hold. He thinks the LCME process is going very well. He stated that Carol Aschenbrener is the secretary for the AAMC and will be here as the secretary for our site visit. He and Dr. Rarey talked with her about the Office of Program Evaluation and Faculty Development and the way we approach the LCME. She has asked Dr. Rarey if he would be on the panel at the at the AAMC meeting this fall, which is a panel that will educate people who are going to have LCME visits about the LCME process. He thought that was a great feather in our cap that they would ask us to teach others when our visit is only a few months away. He said it is good for Dr. Rarey and he will do a great job; they are pleased with that. He told her that having this office has been interesting and that in fact he thinks they are having more LCME meetings this year than they were 7 years ago, but the meetings are higher quality and deeper.
Dr. Winter mentioned to Dr. Watson that the Florida Publication talked about the dream of having a new education building and asked if there was any information with the PICO money about that. Dr. Watson said that his dream is to have new Medical Education building and they have promised a location where they would house that. He stated that it would have 5 floors and the plan is that the first floor would be sort of an entryway based on the Art of Medicine, the Maren Room and archives and things like that. The second floor would be for standardized patients, simulators, and information technology floor. The third floor would be for the first year students and the fourth floor would be for the second year students. The fifth floor would be all education and administration offices. Dr. Tisher has the Foundation Development Office raising funds for the education building. Dr. Watson pointed out the Medical Education Building was built in 1972 for 90 students and that it is outdated technologically; we now have 135 students. He stated that we are working very hard to raise private funding for this building.
Dr. Davidson stated that at the next Curriculum Committee meeting Baligh Yehia will give the Curriculum Committee feedback about our performance with regard to his education and his classmate’s education using our 12 educational principles as the basis for this discussion. He will be working on a Power Point presentation and will collect information from his class and get back to us. This is a longstanding tradition for the Committee. Insightful students may give us a fresh perspective and new motivations. He feels there will be good feedback and stated that Baligh is a very discerning observer.
1. Continuation of the Evaluation Subcommittee’s report on courses and clerkships.
Dr. Rarey stated that overall in years one through four the results were as we expected. There is not an individual course in which the students felt they were overwhelmed. The goal is to assure that students are given enough information that they are not overwhelmed or under whelmed. Family Medicine and Psychiatry were given the lowest score by students in terms of the workload. It was stated that the Family Medicine clerkship has been arranged to represent how an actual Family Practice Medicine practice would be. OB/GYN and Neurology were rated the highest in terms of workload, although the scores reflect that the amount of work is just right and that they do not feel overloaded. It was stated that there is a whole different culture in the third and fourth years and that it is much less intensive. It was mentioned that one of the EDs states that the clinical responsibilities are to be aligned with their workload. The results show that the students’ objective perception is that the workload is just about right in all of the courses. Dr. Romrell stated that in the past the sequence of courses has been arranged to decrease conflict. Dr. Watson stated that two senior medical students related that they have heard the GME competencies all throughout medical school and are very familiar with them. Clinical Radiology is one second year course that can be improved upon. It was stated that as an overview, the courses are aligned with the Curriculum Committee policies and are congruent with the LCME standards. It was stated that the Emergency Medicine Clerkship currently has two different versions of their syllabus, and that is being corrected.
He stated that the infrastructure of the Surgery Clerkship was evaluated by the subcommittee and that while the information about the General Surgery component is aligned with policies and standards, it is the subspecialties that are not in the syllabus. He states that we have no idea of how they are being evaluated in the sub-specialties when they go to, for example, orthopedics, ENT and ophthalmology. Dr. Mike Chen is aware of that and has met with the Evaluation Subcommittee. He identified in the written report that he has six subspecialties that he is accountable for, although the College of Medicine is offering the clerkship in terms of Surgery. That is a management-type issue that he has to deal with in terms of making sure there is alignment of what the expectations are from the students in the Surgery Clerkship, as well as the subspecialties that they go into every two weeks and keeping that aligned will be a challenge. The members of this committee should realize that this will be a challenge for Dr. Chen and it is something we should monitor. Dr. Romrell stated that there are 23 options for subspecialties, which he feels is great. The clerkship director, Dr. Chen, has a very difficult task at getting every one of those disciplines to write goals and objectives that are specific for their portion of the clerkship. He has the General Surgery ones, but the sub-specialties include about six different departments including Anesthesiology. He wants to assure everyone that we are getting feedback and that the departments are evaluating students, they just haven’t written the goals and objectives. Dr. Rathe questioned whether there could be some type of generic form and Dr. Romrell stated that it should be somewhat templated by Dr. Chen. Dr. Romrell stated that what they are supposed to do is learn the principles of General Surgery even though they are on ENT or Orthopedics. They are still emphasizing the basics; they are not being trained to be residents. Dr. Rarey stated that Dr. Chen will address that and will notify them in terms of the status.
Dr. Rarey stated that this is the first time they have also reviewed the SubI’s that are required. He stated that the Evaluation Subcommittee determined we ought to be looking at those if they are going to be required and that they had previously focused on years one through three. He stated that last year Dr. Harrell, Dr. Novak and Dr. Karen Hall, along with Dr. Hatch, submitted the required clerkship reports, which was the first time feedback was given in terms of various sub-internship syllabi. The syllabus for Family Medicine is currently not online, but will be put online to meet the overall policy of the Curriculum Committee. He stated that it is interesting that in 2004-2005 there were four students who took Family Medicine and 16 that took Pediatrics and 100 students who took Internal Medicine. He pointed-out the great range in how many students took SubI’s. He stated that overall the student’s evaluations are glowing in terms of what they are learning in these SubI’s. The results show that overall students feel like they are being well prepared to go into residency.
Overall, the courses in all four years are quite dynamic in response to the student evaluations along with the policies of the committee. He thinks that this committee ought to monitor the compliance of Clinical Radiology in the second year and monitor how Dr. Chen is doing in Surgery. He thinks we are doing well and are about ready for the LCME site visit in February. He stated that these descriptors could be reviewed and different aspects may be enhanced during the retreat that this committee and the Evaluation Subcommittee will attend. Dr. Rarey pointed out that with Dr. Juan Cendan now being the Medical Director of the Harrell Center, as well as the chair of the PBE Oversight Committee, he will now report the results of the PBE’s and how the clerkships are doing in terms of how they design the cases. He will assure that they are compliant with testing the students on the PBE’s to the competencies, which we have been unable to monitor before. Thus, in addition to external measures such as Step 1 data and Step 2 data or national board exams to assess the quality of the clerkship reports, to the Evaluation Subcommittee will have PBE data as well. He also stated that beginning in July there is a policy that we will begin using item analysis data in terms of the course and clerkship’s use of multiple choice examinations. We would be looking at the quality of those exam questions because the reliability and validity is something that the LCME is always looking at in terms of any type of evaluation. We will begin asking the Clerkship Directors their perspective in terms of what this item analysis data suggests about the quality of their exam.
Dr. Hatch made an appeal to possibly delay discussions about the item analysis because they have so much new ED-2 data that as Clerkship Directors they have to address. He stated that Dr. Harrell has to deal with different services and he has to deal with different sites. In order to deal with that well and to deal with item analysis where he has his own internal exam, it would help him a lot if we could put off item analysis until next year and focus on the big key issue now, which is ED2. Dr. Hatch stated he would propose a formal motion to have this delayed until next year if need be. Dr. Davidson stated that he has been thinking about that as well because he knows that has been going on. He stated that the item analysis issue is one that he has mixed feelings about, although it is a good tool to look at. He feels that you cannot make determinations based solely on numbers looking at item analysis; you have to look at what purpose the examination serves; all are not designed for the same purpose. He has a few problems with setting cutoff points for item analysis; in fact he thinks it is wrong statistically. At the same time it should give course directors especially, feedback as to the kinds of questions they are developing. If they choose to want to use the questions that 90% of the class gets correct, he has no problem with that, in fact he could justify doing that with a great deal of validity in his opinion. Setting a cutoff point and saying your questions aren’t any good because it’s too easy or because they are too hard or because several of them have a bad point biserial may not be an appropriate approach. He thinks that they are a tool that should be looked at because he thinks that the course directors look at them and understand them, although he does not see them as being a big issue with clerkship directors. Dr. Hatch stated that clerkships are using them a lot. Dr. Davidson said he thinks there are very few clerkship directors that have their own internal multiple choice tests. Dr. Rarey thinks that the Evaluation Subcommittee would be interested in knowing how many of the multiple choice questions in the clerkships are being used and re-used versus if they are being modified because we need to address test security issues. Dr. Romrell stated that he feels the real issue is the quality of assessments and what are we doing to assure we have good instruments to assess student’s performance. He doesn’t think specific measures such as the point biserial should be made such a big issue. He feels that the real question that clerkship directors should address is “Do you set goals and objectives? Do you have adequate ways to measure that with the exams and things that you give?” He states that this is just one part of the evaluation of your assessment and doesn’t think it should bog anybody down. He suggested having a year when people look at it, but then the following year have them add it as a component of their report. He stated that Dr. Hatch has an interstation as part of the assessment in Family Medicine. He questioned whether we get great discrimination on those questions on the PBE and expect to create questions with a range of scores that have great validity. He does not think so; he thinks it is the kind of exam where this is criterion-referenced. What he expects is that the clerkship directors should assure that “every student meets my standards”. He stated that it is a whole different question than point biserial.
Dr. Davidson stated that he thinks to some extent that may be a central theme of this retreat when we have it, which is flexibility in how courses and clerkships are evaluated in terms of what their goal is for what they are doing. He has, for instance, a great deal of problem with using Board of Regents questions, which he thinks statistically we have shown are useless largely and redundant. He thinks that we can move beyond that now to look more specifically at courses and clerkships and what they do and what they provide based on things like LCME standards and our educational principles, which we will be discussing at the next meeting. The Evaluation Subcommittee has done a fantastic job at marking off something that he is not sure any other place has, which is really defining a baseline evaluation. As Dr. Watson said in a meeting, he thinks at this point, dynamic is a great word that Dr. Rarey used. He suggested we look at this and see how we can fine tune it so that it is more responsive to courses that might not fit in a traditional realm or that have different relevant objectives for the students. Geriatrics clerkship, he can tell by listening to it, is going to have a lot of interdisciplinary training and that is one of our educational principles. There are very few other courses or clerkships that emphasize that. It is an option on the Medicine clerkship and many students do it and like it a great deal, but it is something that is required in our educational principles and they ought to get credit for providing that kind of experience. It is an example and he feels that this can be a really useful, progressive forward-moving retreat when we have it whenever that will be. He and Dr. Rarey will be getting together and trying to outline an agenda and hopefully will back with everyone with the date.
Dr. Rathe stated that in reference to the item analysis, if you are giving multiple choice tests and if you are using that as a significant mechanism to decide A, B, C, or D grading, that is the only thing that item analysis that is generated by the online system is really relevant to, so that is clearly not all evaluations, but it fits a lot of evaluations. In those cases, the course directors ought to care that their items are good and obviously their real intention is to get better over time. He sees it as a foundation of quality improvement for that kind of assessment. Dr. Davidson’s response to that was that it depends somewhat on what the grade distribution is in the course. Regardless of item analysis, if you are talking about a basic science course that has largely multiple choice tests, which Dr. Rathe says are used to develop A, B, C and D, etc., if the grade distribution falls within the realm of what we recently decided would be appropriate, then he still sees item analysis as a great tool for feedback to the course director in terms of developing questions. He stated that ideally they will use that information to develop better questions, depending on what the goal is of them seeing the question. He offered to talk with Dr. Rathe individually to give examples of when someone may design a test for a specific reason, and that reason might be setting a baseline of determining the students in the class who do not know simple questions for instance and identifying those early in the course, which Dr. Rathe agreed with and said would be something other than trying to assign an A, B, C or D grade.
Dr. Kaunitz stated that he doesn’t have history in this committee and doesn’t know the origins of how the Sub Internships were chosen, and doesn’t really know much about the Sub Internships in general. He questioned what the basis was for choosing the three clinical disciplines for SubI’s and if going forward that should be re-examined. Dr. Davidson stated that historically Internal Medicine was the only required SubI and based on requests from students it was decided that we could offer a few students additional options for their SubI. That was relatively few students primarily because those particular requests to do Pediatrics and Family Medicine could not handle very many students and give them the intensity of a one month SubI experience that was felt to be appropriate. He was not chair of the Curriculum Committee at that time. Dr. Romrell stated that the alternatives began after looking at the overall distribution of time and assignment of time being too disciplined within the College of Medicine. The Curriculum Committee did that some time ago. If you look at Medicine for example, typically around the country 12 weeks is not an unusual assignment of time for Medicine. It is a national standard to have most students do sub-internships, generally in Internal Medicine, so we retained four more weeks of Medicine in the fourth year and that Medicine fourth year ended up being a higher level; i.e. the assignment is to function like an intern on a team and really get them ready to take on the next level of the training as an intern. There is the same argument in Family Medicine which has a broad scope of training. We experimented with it for a couple of years and allowed Pediatrics and Family Medicine to be an option for people who are tracking towards those disciplines to have that be the Sub Internship under the umbrella of Medicine. Medicine was still the controlling discipline for that and it has evolved to the point where it can be Medicine, Pediatrics or Family Medicine. We put a cap on it because we didn’t people thinking “Well, I’ll take Family Medicine because I’m going into Surgery and it’ll be easier”. We put a cap on how many people could do it, and the maximum number of students that he has seen was about 18 students who took Family Medicine as an option. Almost all of them are taking that as their career choice. Pediatrics has a total of 30 and is in fact is usually around 20, but that is the number of people who are tracking into residency in Pediatrics and in Pediatrics we gave different options they could do within that. Dr. Kaunitz questioned if these are largely inpatient based or strictly inpatient based and was told it is totally inpatient based. Dr. Kaunitz questioned if those are really entirely core areas for representing medical practice in the United States. He would suggest that ED for instance is very broad-based and represents a big chunk of clinical services as delivered in the country that is not inpatient, but ambulatory. He would suggest that a much more ambulatory-based clinical experience in the fourth year might be representative of how a lot of our graduates are going to be spending their entire careers these days. He doesn’t want to be guilty of vested interest, but he noticed that OB/GYN is not included there. He questioned whether that might be an attractive option for people who might want to elect that different kind of direction. Dr. Watson stated that what is going to happen is that right now we there is a lot of concern nationwide that we are too focused on the inpatient experience of medical student education and so that is a very good point. We try to stick with this general professional education. Dr. Davidson stated that to some extent the purpose of the SubI in most institutions and also here is to prepare people for PGY1. If they are doing a largely ambulatory PGY1, which is very unusual even in Family Medicine, then an ambulatory SubI may not really be that helpful. What he would rather do is increase the ambulatory time in the curriculum, which is what we have done. He thinks the SubI’s serve an important purpose and as anyone who has ever worked with a fourth year student knows, that’s an excellent way to ascertain their skills. He states that most of them are superb and you know that they are going to succeed during their PGY1 year by observing them actually acting as an intern. He stated that when we did switch Surgery, one of the reasons surgery didn’t want to be involved is because it’s a procedural specialty and they did not feel they could provide operating room time comparable to their PGY1 for their externs. Dr. Romrell stated that when you look at student’s assessment through the curriculum, the SubI for years was a time when you really could figure out is a student progressed enough in their education to really take on responsibility because they won’t graduate now to be an intern. Almost every year they would identify one or two students based on that experience who really hadn’t mastered the skills. He thinks that whatever we choose to be that SubI, we should maintain a high standard in terms of performance expectance and really give that final approval for it to be ready to go on. Dr. Kaunitz stated that they have very strong educators in Emergency Department for instance in Jacksonville and he questioned whether an appropriate SubI experience could be made possible in Jacksonville in the Emergency Department. Dr. Davidson stated that we actually discussed that in this committee; ED has a required clerkship in the fourth year. They recently proposed to this committee that they be allowed to offer an advanced rotation for students particularly interested in ED in terms of training. He stated that trying to integrate a separate SubI for ED, when there is already a required clerkship in the same year, would probably be logistically complex. Dr. Caro said that what they run into is that the fact that there is a rotation in fourth year would make it difficult to do a first rotation and then a second SubI rotation down the road, so that is what they are thinking. They are going to do a practice track. Dr. Kaunitz stated that Surgery has already suggested that there might be some constraints there in terms of the technical issues. He questioned whether OB/GYN had a current required rotation in the fourth year. Dr. Hatch stated that essentially everyone who wants to do OB does Internal and Fetal Medicine and they can accommodate just about everyone that wants to do it, so that’s sort of like the fourth year OB experience for OB bound people. It’s very popular and a great course.
Dr. Harrell says she thinks this speaks to the need of what the SubI Directors were trying to address, but that nationally this is a difficult topic as well of defining the fourth year SubI curriculum. She stated that part of the difficulty is that the students really like the autonomy and for most students that is a wonderful experience. She thinks on the GQ survey this is one of the highest rated “what best prepared me for my internship”. Some of what we are trying to work towards defining is a curriculum in the SubI. She stated that there are certain emergency situations that any type of intern needs to know and feels that students typically would not see those types of problems in OB/GYN rotation. The philosophy of what the SubI tries to emphasize are those types of situations, which the third year students don’t see as much. She thinks the students want to have that experience under their belt prior to any internship other than perhaps Pathology. She feels that is why nationally the SubI’s tend to fall more within departments of Medicine and Pediatrics. Dr. Watson stated that the other thing is that the flipside of what she’s saying is the value of maintaining, as long as we have the current structure and we are not cutting a year of medical school, just maintaining the value of sufficient elective time. He stated that as Dr. Hatch said, if someone is going into OB/GYN you’d better believe that they want to be able to pick and choose and talk with the program director. Not only do they have a high level OB/GYN or high level Neonatal Intensive Care Unit, but he bets every single one of them does pelvic anatomy with Dr. Romrell as an elective and learns the real details. We try to keep a good blend. Dr. Romrell says it is also interesting to look at the advising of the course and seeing what’s recommended for, as an example, OB; they’ll have one or two OB courses they recommend, but then they want them to have pulmonary medicine and basic anatomy. It is really pretty nice advisement and they are getting more broadly trained before they go on at the advice of their advisor.
Dr. Meuleman stated that he will give a brief summary of next year’s geriatrics clerkship expansion and then move into the topic of trying to work on their assessment. He stated he had e-mailed Dr. Davidson a couple of months ago about changing their assessment form and was told to bring it up in this month’s Curriculum Committee meeting. He stated that for several years they had two weeks in the third year, which they split into one week of outpatient Geriatrics and one week of inpatient. The decision was to go to two weeks in the fourth year and go to one week in the third year. The extra week in the third year allowed Neurology to expand to three weeks, so they retained the outpatient Geriatrics week which actually works well because it is part of Family Medicine which is mainly an outpatient rotation. This is a counterpoint to the other outpatient rotation that they are doing in the third year. In the fourth year, starting with this coming class in July, there will be 6-8 students every two weeks on mandatory rotation. There will be two students at the Shands Rehab Hospital and two students at the VA Geriatric Ward, which is kind of a rehab ward or transitional care ward. This ward is where people come after being in the hospital and who are debilitated and don’t really want to go to a nursing home, so they usually remain there for about a month. Two or three students will be in Jacksonville which has two sites, Shands Jax which has had a transitional care unit for several years with a Geriatrician as the attending, and River Garden which is a life care community where they used to have students when they had the two weeks in the third year. Some of the one week inpatient was done at River Garden with Dr. Gianinni who was a Family Practice attending over there. He thinks that is going to be the basic site structure. They are developing a web-based teaching curriculum and have been doing an ongoing development of teaching cases based on depression and dementia case-based teaching with a small section regarding delirium. There is another unit about falls and gait abnormalities and working with rehab staff, which is done online. In terms of structured teaching, every Friday afternoon there will be a small group teaching session where everybody who is in Gainesville will get together with Dr. Mihou Baltista who is one of their young faculty members. Those in Jacksonville will do it with their preceptors the first Friday, and on the second Friday they will come back and join Mihou and the Gainesville students. Therefore, the second Friday afternoon will be all the students together. There will be a debriefing so they’ll have some standardization of teaching through the web-based cases and through Dr. Batista doing her teaching. He thinks everything is coming together nicely. He stated that the only thing they are a little worried about is that River Garden has had a turnover in their attending staff. Dr. Giannini has been there for years and when Dr. Meuleman contacted them in the fall to remind them about the fourth year students coming every two weeks, Dr. Giannini was gone. Dr. Reeder was there for a short while and is now gone as well. Dr. Ober is currently there, but has made it clear that he is temporary. The whole medical leadership in River Garden is in flux, which he and Dr. Hatch think may be related to the whole flux of the Family Practice program and faculty over there. He said that is something they’ll work through and that they’ll go over and visit every few weeks and see how it’s going to work out. Dr. Kaunitz asked Dr. Meulman if Dr. Skip Wilson had contacted him because all of the physicians report to him. Dr. Meuleman stated he had contact with him by e-mail in November. Dr. Kaunitz stated that the good news is both Vince and Harold are both full time teachers and that they have stayed involved as full time faculty in outpatient Family Medicine program for decades and are good teachers. He agreed that the lack of stability is certainly a challenge. He hoped that Skip could over time resolve that, but stated that the closing of the residency program has put the Family Medicine program in flux. Dr. Meuleman stated that what they are going to emphasize is that each of these sites uses an interdisciplinary approach. They have housestaff at the rehab hospital and geriatric fellows up there and mid-levels with residents or fellows and attendings and rehab staff. He states there is more or less a formal team structure at all of the four sites. He thinks that it addresses that need for the curriculum and also dealing with more chronic care patients, not patients where the length of stay is 3.2 days. He thinks it is a different angle on things and they go into more depth on issues. They have had medical residents for 20 years in their VA unit and they go into depth that they don’t even entertain when they’re on the Medicine ward. When there are 20 patients turning one after the other there are secondary problems that just never get addressed and somehow in the outpatient clinic they don’t get addressed either. Consequently, he thinks the students will see things they haven’t seen on the wards.
The discussion that Dr. Meuleman wanted to bring up that he e-mailed Dr. Davidson about was about the evaluation system. He also got the e-mail about a month ago about the LCME standards, ED2, etc. He went through them and thought he should look at them in terms of the Geriatric Clerkship and there were 2-3 that seemed to pertain to evaluation. He tried to determine how to evaluate students and stated that there was a standard form, which looks similar to the 4th year Medicine form, as well as the 3rd year. He stated that Peggy Smith pulled this form and stated he could us another one. She obtained this from the Senior Medicine Clerkship at Alachua General and stated that they have different bullets. He stated that he would like to write his own anchors and Dr. Davidson advised him to discuss it initially with the Curriculum Committee. Dr. Davidson informed him that this question has come up now and then and we should talk about it. Depending on the discussion, we may need to take a vote in this committee to support that people can rewrite their anchors and then allowing in the future directors of clerkships to present their proposals for new anchors to the Evaluation Subcommittee, which can then make recommendations about those revised forms. Dr. Harrell stated that she was informed years ago in a Curriculum Committee that she could rewrite her anchors and that the message was you must use the six competencies. She stated that there was some general wording at the very top, but beyond that it made sense that you needed to individualize it. Dr. Meuleman questioned whether Pediatrics uses different anchors and Cynthia Karle said they’re very similar, but are not all identical and do have customization. Dr. Romrell stated that this is a constant topic of discussion among the Clerkship Directors. He said they don’t have to be identical, but there had to be consistency. He stated that there has been good cooperation among the Clerkship Directors. Dr. Rarey stated that he felt that the new clerkships that are coming onboard would need to present their anchors to this committee to check the consistency. Dr. Davidson asked if it would be reasonable to have Dr. Meuleman, who actually helped write the original document, submit that to Dr. Rarey’s office. Dr. Harrell asked if that would need to be done every time the document was edited because she does it year to year. Dr. Davidson said that would be fine and said he wanted to discuss it because it is something that comes up frequently in terms of how much it can be changed and how similar the wording should be. He took by everyone’s comments that Dr. Meuleman can develop his own bullets. Dr. Meuleman stated that when he had written these ED’s that it does state that you should evaluate student’s performance to make sure it’s appropriate based on clerkship-specific objectives, so he e-mailed Dr. Davidson after he read that. He thought that if wanted to have an evaluation that reflected clerkship-specific objectives, the generic form is a little too generic. Dr. Rarey stated that there are other aspect guidelines put forth by this committee that should be followed and stated that they are online. Dr. Meuleman asked Dr. Rarey to forward him the other guidelines because he’d like to see them before he begins working on his anchors. Dr. Hatch stated that the other issue with this is that every once in a while the topic comes up that states the descriptors are still a little too demanding, that the highest categories are still too hard for people to obtain and they say that it needs to be revised periodically. He is not sure that this will need to be done 9 months before our LCME visit, but stated that maybe in the future Dr. Meuleman could be the leader. Dr. Meuleman stated that maybe people should just start tailoring it for themselves. He stated that he originally did it for the Medicine Clerkship and then they were asked to try to generalize it. Dr. Harrell pointed out that it is analogous to the Shelf Exam, it is an evaluation tool and they don’t all use the same Shelf Exam but it has the same basic format and everyone knows what to expect.
Dr. Davidson stated that brings up the point that he and Dr. Rarey have been discussing for a while the possibility of having a retreat that would include the Evaluation Subcommittee and possibly all of the Curriculum Committee to discuss various issues in terms of evaluation and possibly moving on from the baseline that we’re at now to maybe making the evaluation system more flexible. He stated that this is an opportune time even with LCME coming. He thinks that if anything that would demonstrate to LCME that they are moving forward and are trying to advance as opposed to doing the same thing they’ve been doing for three or four years. Dr. Rathe stated that when the competencies were originally implemented, back when there were 11, there was a notion that there would be a longitudinal view and that there would be another parameter that we would follow over a period of time. What he thinks has happened is that the competencies are now very specific to individual courses. Dr. Watson agreed with Dr. Hatch’s statement about the descriptors being too demanding and that each of us want to give the students the best, but that nobody is that good. He states that the evaluation forms for the staff are the same exact way. Dr. Romrell stated that they give feedback to Course and Clerkship Directors every year on how they are doing and may even begin doing it twice yearly. Dr. Davidson stated that these are great topics for our retreat.
The meeting was adjourned at 8:52am.