Curriculum Committee Minutes - April 13, 2004

Present: Rarey, Merani, Douglas, Ragan, Butson, Feree, Monahan-Estes, Davidson, Normann, Genuardi, Watson, Arnold, Kaunitz, Caro, Margie, Tina Wright, Ritz, Lawson, Hatch, Karle, Romrell, Harrell, Pauly, Sumners, Gold, Burchfield, Wallace, Gulig, Davidson,Vidaurreta, Chen (Margie McGarva recording)

Guest: George Hack, Educational Coordinator for HSC Library

Announcements
Students:

Doug Arnold - first-years just had class elections.

Lorena Merani - second years finishing up rotations; exams are coming up, and the class is looking forward to the White Coat on May 16.

Sara Monahan-Estes - 3 rd years are doing well and starting to choose electives.

Matt Lawson - Match went well last month; majority of students happy about where they will end up in their residency; they are busy planning end-of-year events and the senior faculty awards will be April 23. Skit night is earmarked for May 7 and the Hippocratic Awards is May 3 this year.

Dr. Romrell: Most students are on task.

Dr. Rarey: SGEA meeting is this week; College of Medicine well represented

Dr. Davidson - Curriculum Committee meeting for May will be held during Medical Education week; the course and clerkship directors will be invited to this special presentation by Alice Speer from Galveston, who will be speaking on grade inflation.

Dr. Watson: The Chapman Society was held on Friday night; Matt Lawson and Janice Ho were inducted.

Dr. Duff will present to Executive Committee about who will receive the various honors and awards.

Dr. Hatch gave an updated report on the Subcommittee on Public Health and Prevention with recommended curriculum changes.
The NBME performance of first takers on the 2000 USMLE Step 1 and the NBME performance of first takers on 2000-01 USMLE Step 2.

Survey of Current Curriculum on Public Health and Prevention Content Areas:

• Epidemiology/Biostatistics
• Occupational Diseases
• Environmental Health
• Prevention
• Patient Education
• Health Policy
• Health Care Delivery

Summary of Content Survey:

• Total time years 1 and 2: approximately 80 hours
• Total time years 3 and 4: approximately 25 hours plus significant clinical prevention during patient care
• First 2 years cover much of the key content, but weaknesses exist
• 3rd and 4th year spend little time on Public Health/Prevention issues, and weaknesses are more marked

Recommended Changes in 3rd Year from task force:

• Add Public Health experience to Family Medicine clerkship
• Every student to spend a full day in a health department for introduction to traditional public health activities
  • Monitoring/control of reportable diseases
  • Environmental health
  • Sanitation
  • Need 4 Jax slots and 4 Gainesville slots per 3 weeks
• Add didactic/small group content (distributed between several clerkships)
  • Add EBM exercise with small group discussion to Family Medicine (currently only included in OB and Medicine Clerkships)
  • Add EBM< exercise another clerkship as well?
  • Environmental Health Issues - 1 hour
  • Occupational Health Issues - 1 hour
  • Primary Prevention - 1 or 2 hours
    • Discuss a range of conditions for which there are interventions with demonstrated efficacy
    • Cover the data supporting the intervention
    • Teach students how to conduct the intervention
    • Example: Second-hand smoke (Drs. Gold and Watson)

Does This Address Our Weaknesses? Years 3 and 4

• Study Design/EBM Techniques
• Biostatistics
• Occupational Illnesses
• Environmental Issues
• +/- Toxins (Bioterrorism and Environmental will cover some)

Will the 3rd Year Changes Address Weaknesses in Years 1 and 2?

• Administrative Issues - No
• Environment Health *
• Occupational Health *
• +/- Health Policy System/Community Issues
• Primary Prevention *
• Public Health Infrastructure (Bioterrorism will cover to some extreme as well) *

Recommendations:

• Add one day Public Health experience to Family Medicine clerkship (not health department clinic)
• Add EBM exercise/discussion to Family Medicine
• Add EBM exercise to another clerkship also
• Add additional didactic sessions to 3rd year
  • Environmental Health Issues - 1 hour
  • Occupational Health Issues - 1 hour
  • Primary Prevention - 1 or 2 hours

Current Curriculum Years 1 and 2

• EBM - 14 weeks, 2-3 hours per week (key coverage of biostatistics, EPI, EDBM)
• Ethical and Legal Issues - 6-8 weeks, 3 hours per week (key coverage of health system and policy issues)
• PIPSA project (middle school tobacco prevention)
• Keeping Families Healthy (self-directed application)
• Smattering of coverage in many other courses (e.g., pre-natal screening in Genetics, Financing Health Care in Preceptorship, silicosis and asbestosis in Pathology, plus small parts of many lectures)

Current Curriculum Years 3 and 4

• About 15 didactic sessions totally devoted to Public Health/Prevention, such as:
  • Nosocomial infections (Surgery)
  • Pre-conception care (OB)
  • Adolescent Issues (Peds)
  • Managed Care (FP and Ger)
  • Domestic ABuse (Psych)
• EBM thesis (OB)
• Touched on in numerous talks (e.g., epistemology of acute MI in Med, etc.)

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Suggestions/Comments from members:

Dr. Watson indicated that there should be reading materials for each group.
Dr. Kaunitz suggested to have students see a case, such as an outbreak of cholera and how local issues are being dealt with. Dr. Vidaurreta inquired about an opportunity to followup and talk about the students' observations in a formal debriefing, and any readings, and have students discuss what they read and saw. Dr. Burchfield agreed that the exposure for a day is very good; probably not change the variables, but just knowing how public health is set up would be very valuable information to the students. Dr. Kaunitz thinks that you can probably identify more possibilities after this has been off the ground for a year. Dr. Romrell believes that the format is really good; three-week intervals is good, but not overwhelming for faculty; you could still give small group session; should probably monitor how people at public health feel about this. Maybe think about some sort of compensation for their activity (appointed as a courtesy faculty member?).

The members agreed that refreshers are important. Dr. Vidaurreta thought this could be possible at orientation. Dr. Harrell believes that you could get a sense of what should have a handle on and what they don't. Dr. Burchfield stated that faculty in clinics should know that teaching primary prevention is important to the curriculum. Dr. Kaunitz would like to ask the clerkship directors to identify within the CBC's, which components of specific CBC's include public health prevention.

Dr. Gold made a motion for the Curriculum Committee to support recommendations and principles to allow these types of discussions to go on, and Dr. Harrell seconded it. Motion passed and accepted by the committee. Dr. Hatch was asked to pass this information on to the clerkship directors as chair of the clerkship directors committee.

Dr. Davidson gave a summary of the AAMC Council of Dean's report. He announced that the June meeting will be student-run on the principles of our education system with a summary from some of the 4th year students.

Davidson to send out PGY2 student training they received here, about their internship year here to members of the committee.