Curriculum Committee meeting

April 10, 2007

Members present:  Dr. Rob Averbuch, Dr. Judy Bowers, Dr. David Caro, Dr. Richard Davidson, Dr. Heather Harrell, Dr. Robert Hatch, Tiffany Lacross, Omayra Marrero, Dr. Sig Normann, Dr. Maureen Novak, Nitesh Paryani, Dr. Mohan Raizada, Dr. Louis Ritz, Dr. Peggy Wallace, Dr. Robert Watson, Linda Butson, Dr. Richard Rathe, Dr. William Winter, Cynthia Karle, Dr. Kyle Rarey, Dr. Lynn Romrell, Dr. Tim Flynn, and Dr. Bill Cook

Student announcements:  Omarya stated that the second year class is doing great.  They just had Fungus Ball a week and a half ago and she stated there was excellent faculty turnout.  They have six weeks left before the White Coat Ceremony and already have their Step 1 date.  Nitesh stated that the first year class is also doing great. 

Tiffany stated that they are taking four students to the AAMC conference this weekend in Little Rock, Arkansas.  They have five posters being presented and Nina will be doing a presentation on humanism.  She will give a report next month on how the meeting went. 

Announcements:  Dr. Davidson stated that one of the things on the Course Directors’ plate is to get a survey completed that he and Dr. Winter worked on that surveys the clinical correlation sessions for the Basic Science courses in an effort to collect some information about those.  They had an interesting discussion yesterday in the PBE Advisory Board meeting about some possible ways we might be able to use those clinical correlations in conjunction with PBE’s to see if clinical correlations actually exist in the retention of content compared to cases for which there has not been a clinical correlation.  Dr. Davidson stated that he and Dr. Harrell discussed the fact that there’s content that we’re sure the students know, but when it comes up in the context of a patient they suddenly have no memory of it.  Dr. Davidson stated that if you believe in adult-learning theory, the reason for that would be that it’s not taught in the context of something that they would use at a later date.  That raises the question that if it were learned during a clinical correlation if it would be more easily accessible.  

Linda Butson stated that Friday is the day they need the Gideon database trials results.  There are several other electronic book packages they are looking at in conjunction with Smathers Library that has some medical components to it.  She’ll eventually be sending those out for review to everyone as well. 

Dr. Rarey stated that they are waiting patiently for the written feedback from the LCME.  They will review that and should be able to discuss it at the June meeting.  He stated that the LCME gives oral feedback and we’re now waiting on written feedback that looks at all aspects of the programs including write-ups on the various courses and clerkships.  We’ll need to review that and make sure it’s what we think is appropriate.  We have the opportunity to submit a rebuttal if there is a problem.

Dr. Watson stated that it’s nice that Dr. Kone is going to be our new dean. Dr. Kone graduated from UF in 1982 and was a very good, serious student.  He’s had a distinguished career and is a nephrologist.  He’s really excited about coming home to Gainesville as is his wife who graduated from UF and is an architect.  Dr. Watson stated he seems to be an extraordinarily hard working, great guy who wants to be here.  He thinks he will be personable and decisive.  He stated that Dr. Kone asks and he listens and Dr. Watson feels he is a good choice for dean. 

Dr. Harrell stated that at the Clerkship Directors meeting they spent most of the meeting trying to finalize the list of clinical presentations, procedures, skills, etc. that every graduating medical student should possess prior to graduation.  The idea behind this is to use that data since our students are doing a great job collecting for us to help fill in any gaps in their fourth year and make sure that everyone uses that year appropriately.  Dr. Watson stated that this links in with ED2; they want the students from day one in going through EPC or anything else to be able to start recording their patient care experiences.  Dr. Harrell stated that it’s very important that we do get this out to the students as soon as possible so that they understand the rationale because she and Dr. Romrell met with the first group of students to teach them how to access their own patient logs and it was a huge eye-opener for them to see why they did it in the first place.  The students said they would have filled it out differently had they known the purpose. 

Dr. Watson wanted to congratulate Dr. Ritz for the Golden Apple in Neuroscience; OB/GYN also came back with the Golden Apple.  Dr. Rarey was the senior class’s Teacher of the Year of Basic Science.  Angie Kruger won the Hugh Hill Award.

Dr. Flynn asked if the list that has been derived by also looking at some of the PGY1 prerequisite information some of the specialties have.  He stated that in Surgery there is a list of things they expect PGY1’s to do.  Dr. Harrell stated that they have not, but that she would like to see that list. 

1.  Certificate program in international health (Dr. Davidson).  Dr. Davidson presented a program to the deans last week that he and Dr. Romrell have been working on.  This is something that Dr. Davidson and Rob Lawrence submitted as a grant to the UF International Center for which was funded.  Their goal behind this is to give students who take international spring break trips some education in a formal fashion about these areas they’re going to somewhat in advance of the time that they arrive there.  Since there are trips by each of the six colleges and since part of his office has developed interdisciplinary (?programs), they thought it might make sense to develop an optional certificate program in International Health.  In this program, any student in any of the Health Science Center colleges could take it and at the end of the course receive a certificate from the University of Florida.  This presents a number of logistical obstacles because he would prefer that the course not be located in any one college and there are multiple reasons for doing that.  Unfortunately, to take a course for credit in a different college you have to get waivers.  In general, what they want to have is a course for all Health Science Center students, restricted to the HSC colleges that would be an overview in international health issues in Latin America and the Caribbean with a focus on those countries where the students usually go.  It will be presented through interdisciplinary faculty participants from all the colleges who choose to participate.  This will be the first step toward probably a more vigorous program in the future.  Trying to decide how we’re going to interact with what the other colleges already have in place is an interesting challenge.  Some of the proposed objectives are to identify key determinates of health and health disparities, add to the student development of awareness and necessary skills for providing ethnically and culturally appropriate healthcare, and develop interdisciplinary health promotion projects.  The topics will also include animal and human disease transmission and prevention, pharmacy issues and challenges, and cultural understanding and competency, which is a variety of content areas that would be valuable for students prior to going on their trips.  One of the primary goals is to make it more than just a spring break trip.  The first meeting will be in about 10 days and there will be representatives from each of the colleges.  They are going to start small with about 3-6 students from each of the HSC colleges with student selection by faculty from their college.  They want students who are planning on going on trips, so this may initially involve the trip leaders.  There will be evening classes, maybe two a month.  Dr. Hatch came up with some guidelines to include completion of two short papers, preparation and presentation of an interdisciplinary health intervention plan, and evaluations by their fellow students and by the faculty involved.  This will take place at night and is totally elective and optional for students that want to take it.  We would like to start this in the fall with the goal being to have much of the course completed prior to the Spring Break trips.  The details of that will be worked out by the Faculty Advisory Group.

Dr. Normann stated that one of the things he has observed in Pathology is that sometimes the students who are having academic difficulty are the students that are overcommitted to these extracurricular activities.  He has concerns here about perhaps the time involved and the selection of the students.  He doesn’t think we want to compromise their core curriculum.  Dr. Davidson stated at the same time he doesn’t want to deny the opportunity to increase education in international health for students that are particularly interested in it.  He thinks that advisors should be involved in this.  The selection will probably be made by the faculty in each of the colleges and if a student is not in good standing he thinks it is perfectly reasonable to make that a requirement for participation in the elective.  Dr. Davidson stated when they have something more formal he’ll present it to the Curriculum Committee for a vote.  There are all kinds of waivers and fee issues and tuition issues that have to be worked out on this, but he wanted to let people know they’re working on this in advance and that when there’s something more formal it will be presented to this group.  He pointed-out that although this will be offered as an elective and ordinarily electives are not something that are brought before the Curriculum Committee, he thinks this represents enough of a different opportunity that he would want the Curriculum Committee to discuss it. 

2.  Tracks or Concentration Areas (Drs. Davidson and Watson). Dr. Davidson stated that there are a number of institutions including Vanderbilt and UCSF in which students have concentration areas that they can select.  We already have this in place so that students can elect to participate in the Research Track.  They have a curriculum that’s outlined for them and they graduate with honors in research if they complete the requirements of the research track.  He stated that the question is if we should have additional opportunities in tracks for students to choose that.  Some of the ones that have been discussed have been international health, narrative medicine or humanities, community health or population health. 

Dr. Watson stated that the idea is that while students get their general professional education and we make sure that they’ve seen all the kinds of patients and done all of the kinds of procedures they need to do, we want to have some kind of structure in place that those students with special interests might be able to find a curriculum, a four-year developmental process where they can pursue special areas of interest.  The first of these was the Research Track.  Whether or not it will go to a default Master’s degree or whatever remains to be seen.  He stated if you step back and look at it broadly you can almost say we’ll end up with two fundamental concentrations, Research and Ethics/Humanism.  They may be called tracks or concentrations, although he’d like to come up with a more unique name.  Some students actually will, during their fourth year, be able to more heavily emphasize their special area interests.  It will be done only with a lot of supervision and help from their advisors and Dr. Harrell and others.  He guessed that we’ll end up with about 20% or so in a Research Track and about 40% in a broad Humanities/Ethics/Service track and then there will be those who won’t do either.

Dr.  Novak stated that the personal development aspect of this is great, but she doesn’t want us to create the culture that it’s another hoop that the students feel they have to jump through.  Dr. Watson stated that students are getting mixed messages about how important research is in applying for a residency. 

Dr. Harrell stated that she interviewed every single program director here except for Ophthalmology, Pathology and ER.  The directors said that the students don’t need to go off and do an externship, maybe one although no more than that, and they don’t need to do any research.  It doesn’t help them unless it’s substantial and if it is they better be able to discuss it in the interview; beyond that they think its fluff.  The only exception is Radiation Oncology who has a very structured fourth year plan they want the students to do which involved almost a mini-internship in Radiation Oncology and a research project.  A concern was raised that they think students are taking too much fluff in the fourth year and there’s not enough clinical experience. 

As far as the tracks are concerned, Dr. Davidson doesn’t want everyone that’s going on an international trip to do a track in international health.  The tracks are for people that possibly have a long-term interest in this field.  The certificate program would serve for students that are going on a trip.  He feels it would be insane for a student to do a four year curriculum in international health unless they really see this as a future interest.  There are at least four or five students that he can name personally who have a long-term career interest in international health.

Dr. Flynn asked if that’s good enough for us to put out the amount of work and effort it will take to create this.  He asked if this would be diverting resources from something else.  Dr. Davidson said it depends on where the resources come from.   Dr. Caro asked if most of the courses will be in MPH anyways.  Dr. Davidson stated that right now there is no International Health concentration in the UF Public Health program, but they do have plans for that.  It will be some time before they get accredited and get more things completed.  He’s spoken with the director of the Public Health program about this also because there’s no sense in our doing this if they are going to be putting together a new program in International Health.

Dr. Novak stated that it would be difficult if we did this and didn’t have the support at the GME level for their people to go on international trips.  Dr. Flynn stated there’s also no credit because the ACGME and the RORC recognize none of that foreign training.  Dr. Harrell asked how other institutions who have a more formal international programs in their residencies do it.  It was stated they have a formal affiliation with an institution, which is how they get it past the RORC’s. 

Dr. Rathe asked if the current out-of-the-country trips are officially sanctioned by UF.  Dr. Davidson stated they have been overseen by UF as of last year.  They are still student-run, student-organized and student-fundraised, but we felt it is important to have some oversight and some decisions need to be made.  Dr. Davidson’s office handles paperwork, handles insurance, helps them with their funding, and maintains bank accounts if the groups choose to do so.  Dr. Watson stated that there are certain issues that we had to be involved in, for example, he sent a letter to make sure Sovereign Immunity is all in place for faculty and students.  It was made clear that it is part of a faculty member’s assignment and that if they want to go with students as a mentor they do not have to take vacation.   Dr. Rathe stated that many of the students who go on these trips and don’t necessarily want to make it a long-term interest may do it for the pure sake of being immersed in a totally different culture.  He stated that there might be a danger of over-organization here and that maybe the unstructured nature is part of the experience.  Dr. Davidson doesn’t like that because it is up-taking and giving very little in return.  One thing that was important to Dr. Davidson before he even agreed to become involved in this at all was to have the goal of having some kind of sustainability.  There are some formal faculty members who argue vehemently that it’s a life-changing event for students and that that’s the most important thing.  He thinks it is an important thing, but he also feels that we have a responsibility to the countries that we’re going to, which is to educate the students about them and to make it more than a junket.  He thinks we can still provide a wonderful experience for the students by possibly organizing it so that it provides more sustainability to the effort in the local communities. 

Dr. Winter asked if an international track in the MPH program would supersede this.  Dr. Davidson stated that one of the major efforts here is to make this largely fourth year. 

Dr. Flynn stated that we should try not to use the term mission trips.  Dr. Davidson stated he has done everything in his power to keep people from using that term.  He stated we should call them the Spring Break International Trips. 

Tiffany stated that she has been on two international health trips and she thinks they’re absolutely phenomenal experiences.  She doesn’t foresee that being a basis of her medical practice or see herself working for the WHO, but it’s definitely a perspective she’ll always have. 

Nitesh stated that he shares some of Dr. Novak’s concerns in the way that this is brought up.  He thinks its great to have another track and have it available, but he thinks there is some danger in making it a hoop for students to jump through, especially the first years when they come in because they may not know the details about these tracks.  He stated there may be some students who feel they need to be in some kind of track because it’s better than being in nothing.  He feels we need to very carefully introduce it to students so that it doesn’t become something they feel they need to be in just to be in the top tier of the class rather than only doing it if it’s something they’re interested in. 

Dr. Winter asked, outside the clinics in Jacksonville and Gainesville, what activities students have in the underprivileged areas within the state.  Dr. Davidson stated that’s an excellent question and one of his pet topics.  We do have a community service elective and one of Dr. Davidson’s requirements for that was that half the hours need to be done in Alachua County, although students do get some credit for international trips.  There are two electives that are run out of his office that are specifically geared toward exposing students to underserved populations without the student doing an elective right now.  Jacksonville has rotations through the Sulzbacher Center, which is a homeless center.  We have a stipend from AHEC.  This summer, Grant  Harrell is going to be working on developing an alternative clinic system possibly at Gainesville Community Ministries, which is right down the street from the Equal Access Clinic.  Equal Access Clinic cuts off the number of people that they can see at a relatively small number.  We have students that want to do more, so why not try to arrange something for overflow. 

3.  Surgery Clerkship (Dr. Davidson).  Surgery has discussed some possible alterations in their clerkship.  They’re having a meeting with them next week to discuss this in more detail and it has to do with changes within their clerkship.  If these changes are to take place they would need approval by the Curriculum Committee.  Until we have more details, Dr. Romrell and Dr. Davidson are collecting information from debriefings and meetings with the students about the Surgery clerkship.

4.  Elective in procedures (Dr. Harrell).  Dr. Harrell stated that this is the third of wonderful fourth year electives that were fairly recently developed that she thinks Program Directors will be happy to have.  One is Dr. Paulette Hahn’s Advanced Clinical Diagnosis and Clinical Reasoning and Physical Exam Skills.  Dr. Kyle Rarey has a course in Becoming a Resident Teacher, which is a very practical skill.  As we’re now improving our tracking system and we’ve got the clinical presentations nailed down, we’ve focused more on procedures and what we should be doing.  The first priority is that students will learn and demonstrate competence in the core few procedures that we as a college have decided that every graduate needs to be proficient in.  We now have nice simulators here and particularly in Jacksonville that can aid us in that.  The second goal is to allow students somewhat based on their career interests to be taught how to do more advanced procedures that would be beyond the scope of a normal medical school education.  Thirdly, we also want to provide them opportunities to observe more complicated things they might not be doing but would be referring their patients to a lot so they understand what’s involved in that, as well as informed consent and other issues.  She spoke with Jocelyn Gravely about whether she wants to take this on because she thinks this will be a very popular elective.  She has not given Dr. Harrell her final answer yet; she’s mulling it over.  The idea would be do to a similar thing to what we did with Dr. Hahn’s course last year, which is to pilot it in the spring to a limited number of students.  One other discussion that they’re having is two week vs. four week versions.  Dr. Harrell’s opinion is that she would like for there to be a two week version offered that really emphasizes the core basics so that the maximum number of students can have that exposure and then if they wanted to take the four week version that would be the more advanced procedures.  Students who already come into the fourth year having demonstrated competence in all those core things can move right to the advanced and what interests them. 

Dr. Rathe asked that with the things that are considered to be core, is there any part of this that will involve assessment?  Dr. Harrell answered yes and stated that one of the things that they’re thinking about is having the first day of the elective be a pretest. 

Dr. Romrell stated that we may be able to do this with anatomy cadaver experience.  Dr. Bowers stated that is a good idea because she worries that if there are fourth year students doing core procedures, if it would take away from the third year students trying to get those core procedures.  Dr. Harrell stated that the core procedures are not that advanced.  For many of them there are ample opportunities with ancillary services.  They also talked about how to integrate the Simulator Center, whether by field trips there to spend some intensive time or whether it needs to be rotation time.  She believes that Dr. Rathe developed, in the current patient log system, the ability for people that have turned that on to get signed off.  That’s in the future if at some point we wanted to have that for the core procedures where the student actually has to get signed off that they’re competent.

Dr. Davidson asked Dr. Caro if he wanted to discuss this because when it came up his first thought was that it ought to be located in Jacksonville.  Dr. Caro stated that they have had discussions with other medical schools that have done this through their Simulation facilities.  They’ve been opening the Simulator Center up to the students on an every-other-month basis, although it hasn’t been this formal.  Dr. Watson stated that when he talked to Dr. Gravely, one of the requirements for being able to do this is her availability to travel to Jacksonville and carefully interact with and utilize the resources.  They felt it would be better to have it at both locations and have a generalist overseeing it. 

Dr. Harrell stated that her number one role is to make sure every student gets a general professional education, although she is supportive of all of the tracks and international trips and reflective writing. 

5.  Brief reports by Clinical-Decision making Subcommittees (Drs. Davidson and Curry).  Dr. Davidson decided to delay the subcommittee reports until next month when Dr. Curry will be here.   

Dr. Watson stated there is a lot of discussion going on behind the scenes right now about the surgical clerkship.  The Surgery Department now has expressed an interest in making sure the students who go through the Surgery clerkship are not allowed to do surgery outside of the Department of Surgery.  We’re gathering that data now and some of the worst educational experiences and worst role models are in General Surgery services. 

Dr. Davidson stated that he did a survey of approximately half of the fourth year class in verbal feedback with Dr. Hatch present for both of those sessions.  In neither case did the students know why he was asking about this, although the second time apparently the Department of Surgery has made this well-known among the students what they want to do.  He stated that the student’s perspective about this is 180 degrees from what we hear from the Department of Surgery in terms of the relative educational experience on subspecialties vs. General surgery, etc.  At the same time, there is no excuse any surgical subspecialty to have students rotating through their service and not be responsive to the Department of Surgery in terms of submitting things in a timely fashion; if they can’t do that they should not have students on their rotations. 

Tiffany stated she thought it was a huge benefit that they were able to do their electives during Surgery within the different departments.  Although she doesn’t personally have an interest in Surgery, she had one of her best learning experiences during the subspecialty service in Anesthesia. 

Dr. Davidson stated that Surgery’s response is that their goal is not to train people in surgical specialties; their goal is to give people a core knowledge basis in general surgery.  The unfortunate thing from the feedback that he gets is that he can’t tell that they are actually transmitting that core knowledge of general surgery and the student concern is that next year the number of students on Surgery will go up dramatically.  The feedback that he gets is that this past year there were not enough slots and not enough space on General Surgery for the students that were there.  Expanding that just with the class size and then expanding it by doing away with the subspecialties strikes him as being a real challenge in terms of personnel and instruction. 

The meeting adjourned at 9am.