Curriculum Committee Meeting Minutes for May 9th, 2006
Members present: Dr. Richard Davidson, Dr. Robert Watson, Baligh Yehia, Linda Butson, Dr. Peggy Wallace, Dr. Sigurd Normann, Dr. Kyle Rarey, Dr. Beverly Vidauretta, Dr. Bill Winter, Dr. Heather Harrell, Dr. Mike Chen, Dr. Lynn Romrell, Cynthia Karle, Dr. John Meuleman, Wayne Bottom, Suki Subbiah, Dr. Lou Ritz, Dr. Robert Hatch, Dr. Cari Hernandez and Dr. Richard Rathe
Student announcements: Suki Subbiah stated that graduation is 11 days away. They are in the middle of internship 101 and the lectures are excellent.
Announcements: Dr. Rarey gave an LCME update and stated that the five subcommittees are preparing the reports for the retreat to present to the Executive Committee on June 15th. Databases are being compiled and reviewed, reports are being prepared and areas for improvement are being worked on and they are on track. He stated that this past weekend they had the Southern Regional meeting for educational affairs (SGEA) in Galveston, Texas. There were 18 members of the University of Florida there. There were 18 presentations, and 12 of the 18 master educators were there to present. He stated it was a very good meeting and the University of Florida faculty presence was noticed.
Dr. Rarey stated that the Society of Teaching Scholars had their Medical Education Banquet two weeks ago. Dr. Lou Ritz and Dr. Heather Harrell were inducted into the Society of Teaching Scholars along with Dr. Ken Burns. He stated that remarkably we had 230 members and staff, faculty and students present and 125 members of our community were recognized. It was an outstanding meeting.
Dr. Davidson stated that next week several of us are going to Richmond, as one of six invited academic health centers, to AAMC to see if we can’t cure all the GME ills that exist on earth, which is not likely to happen in two days.
Linda Butson stated that she sent out an email yesterday to the Curriculum Committee that stated the library is looking at major cuts in the journal budget this next year. There was an email sent out in March asking people what their favorite journals were. They received lots of responses from the basic sciences, although there were not as many responses from the clinical people. They are putting together a list of potential cancellations which will be disseminated to the faculty in June. She needs the members of the Curriculum Committee to be responsive and to let them know when they are cutting something that we really need. They are looking at also cutting MD Consult and some databases. She stated that they need us to be responsive about the things we need because that is how they will make the decisions, which have to be made by September in order to be activated in January.
Dr. Watson wanted to assure that everyone was aware that Dr. Robert Hatch received the Hippocratic Award.
Dr. Romrell announced that graduation is May 20th and the White Coat Ceremony is on the 21st, so it is a big weekend coming up. The talent show is also on the same day as graduation.
Baligh thanked everyone for having him back and stated that there was a lot of positive feedback from the first half of his presentation and he hopes to be as helpful during the second part of his presentation. He doesn’t have as many slides as last time because the last couple of principles are not as strenuous as the first couple. That should allow us to get through the remaining principles and discuss the entire 12 principles.
Principle 6 states that effective healthcare delivery requires the consideration of family and community contacts. The goal of this principle is that our learning experiences should focus on family and community. In the objectives it discusses maintaining the IFH class in the preclinical years and maintaining the Family Medicine clerkship, as well as having the knowledge about community resources that can be used to help inpatient care. When he was looking at this principle and thinking about what we do in terms of community and family and public health at large, he pointed-out that during our first two years the ones that stick out in his mind are obviously IFH and the preceptorship in Introduction to Clinical Medicine. He states they also get some introduction to Public Health during Evidence-based Medicine. Those are the main ones that they get in the preclinical years. He states that many clerkships have some sort of outreach with the community or the Health Department. Family Medicine would fit under there because a lot of time is spent in the community. In Pediatrics they have to do two weeks of outpatient Pediatrics and when they’re in Jacksonville they actually do it at the Health Department. In OB/GYN they have to spend at least one day with an A.R.N.P. in a Health Department and in Psychiatry, and depending on where they get paired-up, they might spend some time in the community. There is some sort of component in a lot of the clerkships which allows students to get out from the Health Science Center and go to a community and work with patients in that setting. When he was considering the whole concept of family and community, he thought there are some things we can do to improve where we’re at right now. One of the good things that we can do is to have more public health exposure. They get a little public health during EBM and occasional things here and there, but there really isn’t anything that is consistently focused throughout their four years. One of the ways to increase the content would be to incorporate that with the preclinical courses such as Microbiology or Clinical Diagnosis, which are dealing with the spread of disease, especially now with bird flu, for instance. There are many different things with which you can have some sort of clinical correlation or a small group or presentation that links these preclinical courses to a public health issue. He doesn’t remember having a lot of public health exposure in Microbiology and it seems that would be such a natural fit to start introducing some of these clinical principles during the first two years. He states that another way we can do it is instead of having it incorporated to specific courses, there could be some sort of annual symposium or workshop day similar to Healthcare Issues Day where public health issues would be presented. He suggested bringing in speakers from across the state or nation that could do different presentations and have an intense focus for one day where students attend different workshops and lectures to get exposure on how to deal with patients and how to deal with the population. The last two that he mentioned are to encourage public health research and offer an option to complete an MPH. The reason he put those in is because it is great to have a mix of a class where there are many different types of people, for instance, people that are interested in academics, people that are interested in research, or people that are interested in public health or international medicine. Inside their classroom when they are having small groups, each of these people bring a different perspective to the discussion and then outside of class they are chatting with their friends, which are indirect ways to learn about things mainly through your colleagues. Although it is currently an option to get an MPH and students are told during the admission process that we are flexible and that they can take a year off, during medical school these options are not really publicized. He would expect that with classes as large as ours there would be 1-2 students each year getting an MPH. He saw the Department of Epidemiology while on the UF website and is not sure if it is under the Department of Medicine or if it is its own department and that’s what they deal with. Dr. Davidson addressed that and stated that there are actually, as of last Friday, two departments of Epidemiology and it has been very controversial. He has been discussing a joint MD/MPH degree program for about three or four years and explained that what they have been waiting for is for the public health program to get online so that our medical students can actually integrate it into what they are doing. He is meeting again with Mary Sheps the week after next to firm this up. He states that as they make their materials accessible so that our students can participate without impacting significantly on their on-call and a variety of other things, this will definitely be an option within probably a year to a year and a half. Baligh thinks that is great especially now since we have a College of Public Health that will allow us to start working with those other health professionals. He reiterated that we are creating an environment with people that are coming with these principles and backgrounds, which will bring a new perspective to their small group sessions and increase their awareness in general about these public health and community issues.
Principle 7 states that appropriate faculty and appropriate clinical settings are essential to students acquiring the mastery of competencies. In essence, in the objectives it highlights the difference between ambulatory and inpatient training and also the use of other clinical sites such as our Jacksonville site and other health settings. It also includes AHEC and emphasizes how we should continue that strong relationship that we have. The last one says that faculty should serve as facilitators of learning and sources of information to help students learn to retrieve information, evaluate literature, solve problems and then make clinical decisions. He considered all the different places that they rotate and went through the strengths and weaknesses. He feels that here at Shands in Gainesville they have excellent subspecialty care and are exposed to tertiary and quaternary care, as well as a lot of basic science and clinical research. Another really good aspect about rotating at Shands is that the clinical team composite is different than other places. This is one of the rare places where you will have pharmacy residents rotating with you, as well as a case manager, social worker and many other people working as a team to take care of patients. He stated that Jacksonville is also a very effective component for education. He listed some of the standout rotations to include Obstetrics, Pediatrics, Emergency Medicine, and Psychiatry that allow students to learn basic medicine and get their hands dirty. When students are in Jacksonville they feel needed, they help out in the care of patients and it is beneficial, especially in the procedural specialties and clerkships, because they get to participate and get to have a role in the surgery. The last point is regarding continuing to develop residency program and teaching. He states that although you are going to come across various standout faculty and residents, when you compare numbers, the quality of teachers you are going to get when you are at Gainesville, from your residents or from the small group and the lecture format of the faculty, is different than what you get at Jacksonville and that would be the only weakness. To continue developing the GME programs is only going to strengthen our rotations up there. Dr. Rarey asked for an example. Baligh stated that a lot of them have residency programs, but the difference is when he is rotating in Jacksonville he is not going to have as many conferences as he normally does in Gainesville. A lot of times their core faculty is less in terms of the number they have up there. Your normal everyday interaction with residents is not the same. He doesn’t want to compare people, but if you take your average Jacksonville resident versus your average Gainesville resident in most specialties, the one in Gainesville will probably be able to refer you to an article or give you a little insight about a problem that you have versus a Jacksonville resident.
Wayne Bottom asked Baligh if his particular rotation adequately exposed him to working with Physician Assistants. Baligh stated that they do work with PA’s and stated that sometimes they take the place of the second medical student on the team. Throughout all of his third year, not so much during fourth year, it was during his clinical rotations during third year that sometimes it would be you and a PA instead of you and another medical student. He knows a lot of them by name and stated that you end up running across them; they go to your lectures. He had a PA working with him in OB and he was in Jacksonville and it was his second rotation. There they have a lot of knowledge that we don’t have when you start off right away in terms of practical knowledge and how to get things done and how to write things. He learned a lot from the PA that he was working with in terms of this how the note should be or little aspects of how to get things done. It was clarified that he is referring to PA students. Mr. Bottom wanted to see if Baligh saw places where the PA program could better bring the two together. He stated that PA’s are becoming a big number in the healthcare team and he thinks no one should be graduated until they understand how these two professionals work together. Baligh stated that they get exposed to a lot of PA’s and ARNP’s because many of the services have PA’s and ARNP’s doing the work, so you run across them one way or another. He states that medical students have a good working relationship with the PA’s.
Baligh stated that there are standout rotations in Jacksonville and that if you’re doing ER in Jacksonville, their residents up there are fantastic and they are top notch residents and they know what they’re talking about. There is a different caliber in some of other specialties and the discussions you can have about a certain topic is not on the same level. Overall there is a different tenor than Gainesville. Dr. Watson stated they are well aware of that in Jacksonville and are working hard to improve.
Baligh stated that the next site they rotate at is the VA, which he thinks is wonderful. Not a lot of medical schools have a VA and the fact they can rotate through the VA and learn about medical informatics, the way that they do their online patient records and really just understand that healthcare system, where a lot of people when they transition to residency might work at a VA, is very helpful. Everyone says if you have worked in one VA you’ve worked in all of them so there’s a running joke that once you’ve seen one you’ve seen them all and you know how the system works. It is really great to be able to relate to what they mean when they say “Oh we have a VA here, so you know how that is”.
Other clinical sites they rotate at are health departments, like we mentioned before, especially when you’re in Jacksonville where he spent two weeks at the Health Department, which is a pretty good chunk of time in comparison where he spent working there. He knows that in your fourth year you take different electives such as ID you have some time where you go to the Health Department and in OB/GYN you spent a day at the Health Department. Other than that, those are the only ones that he could think of and when you think of the Health Department you think about underserved, uninsured and disparity of medicine issues and he thought it was a very valuable experience to treat that sort of patient population. He doesn’t think the students get enough of that and he doesn’t know if there are joint appointments between faculty members and the health department or what sort of relationship we have with them, but he thought that if there was an opportunity for a medical student to go and rotate at a health department instead of one or two weeks somewhere else it would be beneficial to get that perspective. One of his comments is to forge a closer relationship with the health department and allow more students to rotate through there.
The next one is nursing home and rehab. We utilize this to a certain extent in Family Medicine. He spent about a week in Family Medicine and of that maybe two days where he went to a nursing home. It was something that was very beneficial to him. He had been to a nursing home before and was familiar with the environment, but a lot of people are not exposed to what happens in a nursing home or what kind of care people receive there. Besides learning good Geriatrics, which is something we want to have in our curriculum, and neurology and basic medicine of the elderly, it really helps you understand the system in general when you see a lot of our admissions come from nursing home patients. To have that perspective of knowing they are coming from a nursing home that means in a student’s mind that this is what happens there and when you are discharging there to a nursing home. Right now for a lot of students that don’t rotate through there, a nursing home is some entity in space and their perception might be completely skewed of what really goes on there. He thinks it is beneficial to allow students to have the opportunity to rotate there, to continue during Geriatrics and have the chance to go and work there. There are going to be a couple of students, as we are right now, that get a little exposure here and there, but it is not consistent. With our aging population, he thinks it is important at the minimum to grasp an idea of what sort of care happens in nursing homes, what they do there and what activities they have, and if your patients actually get out and walk around or are in their room all day. He thinks it is important to get those things and be able to conceptualize them.
The last thing is community physician offices. We do a good job of that in Family Medicine and Pediatrics where you really get a chance to see the day to day life of a private practice physician. He states they get that in their preceptorship as well.
The main ones as the clinical sites are the health department and nursing home and to strengthen the Jacksonville residency.
Moving from our sites to focusing on inpatient versus ambulatory care, right now where we currently stand is that we have two weeks of ambulatory medicine during our third year and six weeks of Family Medicine, which is outpatient. During various other clerkships, time was spent in the outpatient arena; two weeks in Pediatrics, half a day a week at a clinic in Internal Medicine, Surgery, Psychiatry and Obstetrics, and depending on what rotation it is, usually there is a clinic day. That is a total of 8 weeks and then there are 2 weeks in Pediatrics plus or minus two more weeks, so in general there are about 10-12 weeks during the third year. The third year is composed of 48 weeks, which means roughly 20% of the time during the third year is spent in the outpatient setting, which is a perspective for us to have as we begin this discussion. During fourth year, with the help of Dr. Romrell’s office, he was able to get an idea of what kind of electives his classmates are choosing. He took all the classes everyone signed up for and took out all required courses, externships and electives that didn’t have any patient interaction such as Ethics or Narrative Medicine and divided them into clinic, hospital and clinic/hospital. We had 94 people sign up for a clinic and 86 requests for hospitals, which does not include the 16 people that did Pathology and 75 that did Radiology, and then 79 people that had a balance of hospital and clinic. He didn’t individualize it so you knew how many people did one or the other. What this means is we are having a lot of people that on their own choose to do some ambulatory medicine during their fourth year, but if you add them up, out of our class of 120, there are still people that might not have any exposure to the ambulatory setting during their fourth year. This shows what different people are choosing and while they are choosing some clinics, it is not outstanding in number. He thinks we are doing a decent job; 20% of our required courses are in the outpatient setting with the opportunity to do an elective during the fourth year. He feels we should continue to stress the importance of the outpatient training in the clinical clerkships. Apart from actually being in the clinical environment, what point one stresses is more of how clerkship directors and faculty approach lectures and discussions with students. Students are less likely get a chance to learn how to approach a patient that comes in with a cough or how to approach a patient that comes in with shortness of breath (?and) mainly focusing on the outpatient setting. He states that most practitioners do not spend most of their time in hospitals; it is mostly in the outpatient setting. Shelf exams are not completely focused on inpatient topics, they also have outpatient curriculum. This brings into account the fact that we should create some sort of lecture series for each of the different clerkships because every single specialty that students rotate through has an outpatient curriculum, for instance, when you’re in Surgery you have to know how to take care of wounds. We should design a lecture series that is not only focused on inpatient topics, but also includes outpatient ambulatory topics. Students have the opportunity to go into the outpatient setting, and they do get exposure to ambulatory medicine, but he thinks once they’re in the hospital and once they’re in the classroom, most of the focus of their clerkships tends to be on inpatient topics and not so much on outpatient topics, with the exception of Family Medicine which mainly deals with outpatient topics. Baligh thinks students recognize that it is an important aspect of the training and so they seek it independently. It might be good and what he is stressing is not just spending time out there because we are having a good amount of time out there, but it is the nature of the environment that everything is focused on inpatient. Probably apart from Family Medicine, most of the lectures are how to deal with a hospitalized patient and there isn’t that exposure of how to approach a clinic patient that is coming in with these run-of-the-mill problems. Dr. Watson stated that he is sure that the clerkship directors who are sitting here are well aware of this and if we do ED-2 correctly, most of the things on ED-2 are those common problems that Baligh mentioned would be seen in an outpatient setting and he thinks we can blend these things and get a better balance. Dr. Davidson stated that traditionally when he was a resident they used to admit people to work them up and you don’t do that anymore. There are very few diagnoses made in the hospital; a lot fewer than there used to be. 10 or 12 years ago he and Dr. Meuleman did a study where he got a list of 10 admissions to the hospital and then he went back in old charts and got admissions to the hospital 15 years before that. He called several faculty and asked them, after all the identifiers were taken out so they couldn’t tell when they were from, to rate the vignettes on their educational value. The ones from 15 years before were much more educationally valuable to the faculty than the others, and this was 10-12 years ago. Now it is even less because patients have brief admissions for chemotherapy or for procedures and most of the diagnoses and diagnostic stuff takes place in the outpatient clinic. Dr. Watson stated that the other thing is that what Dr. Davidson said is right; the hospital environment is really not following anything from beginning to end. If you start thinking about important things like an aging population, prevention, public health, the kinds of things that blend themselves so much better into the ambulatory environment, the hospital is not acute episodic to the extreme. In general, everyone seems to agree that we have a good chunk of time right now, approximately 20% is pretty good, but it’s this whole environment of being so inpatient focused and lectures that tend to be on how to treat these types of patients and not necessarily outpatient. The clerkships should question “What are the things that we need to learn to do in an outpatient setting?” Pediatrics does a great job of this; students have to know how to do a well child exam for different age groups and know immunizations. They have a really good curriculum and that’s what they focus on and what they teach when in the outpatient setting. If the clerkships decided which are the important things for third year students to learn on this rotation in terms of ambulatory medicine and then designate people to teach and designate ways to evaluate it, this will create an environment change.
Principle 8 states that informatics is essential for effective acquisition and utilization of information by students. This deals with developing a curriculum that allows students to use informatics. Under the objectives it mentions internet-based learning and the work of the Office of Information Technology. He thinks we do a really good job here at UF with the amount of exposure we get to online material. Online exams and evaluations are very helpful; it’s hard for him to imagine taking a paper exam. Other than their Shelf exam, everything they do is online and he thinks that is great especially since their Step exams are online. They have a lot of tutorials primarily during the first half of the first year, for instance Anatomy, Histology, and Radiology. That’s how he used to learn during his first block; he looked at dissection online before he went through the Histology slides and prepped for Radiology. It was the same for Pathology; he told one of the professors that he really enjoyed the CD that came with the textbook that went through the clinical cases because it really tied in issues. Microbiology has a program where students learn about them and they stick in their mind just like patients do and they remember the stories. He used Clinical Skills, Dr. Rathe’s program, to prepare for his Step 2 Clinical Skills exam. He pointed out that we have many different resources to utilize. In terms of the clinical years, they have online evaluations, their medicine portfolio is mainly online, Psychiatry has quizzes that are taken online, Anesthesia has tutorials and quizzes, and in the ER lectures they use Blackboard. He stated we should continue working on this great foundation that we’ve laid to continue to emphasize informatics. He suggested we could develop tutorials for Physiology and Pharmacology. Physiology and Pharmacology are the main classes that they deal with when they’re in the second half of the first year. A lot of the different effects that are learned there might be counterintuitive; different doses of certain drugs might have different reactions in the body, there are a lot of different receptors and counter-receptors, which makes it hard to conceptualize. Physiology was very frustrating for his class; he thinks that was their lowest Shelf exam score that they had. One of the suggestions is to do STAN online. Dr. Rathe stated that there is currently a virtual anesthesia machine. Dr. Watson asked Baligh to contact Dr. Lampotang to see if he could take a look at the machine. The last suggestion is to develop online modules for clinical clerkships. Those go back a little to what he talked about in his first presentation of developing critical thinking skills. Those are most effectively used so far in Anesthesiology and Psychiatry, they give a presentation and go through online quizzes and aren’t necessarily for a grade. Students can pick out the core topics they want to cover and create a case and there would be a choice of what to do next. He thinks students enjoy learning by being asked questions and giving a response. If you look at what most third year students study, usually they have some sort of supplementary textbook, like blueprints, and then most of them have some sort of question and answer book. A lot of students like to, in between times, flip through those questions and answers; they like to be given a question and they give a quick response back. He thinks it is a good way for teaching because a lot of students enjoy learning that way of going through the question book. Most of his studying was done by having a question book and looking at the topic then answering the question and reviewing it in his textbook. He also stated it would be helpful to develop some case-based questions for different clerkships. Dr. Rathe stated that the serious thing that is being contemplated is that given the idea of general medical education and the fact that it is unlikely that every student is going to see every desired clinical presentation or diagnosis that these cases could actually act as an adjunct to that. For instance, if you have not seen a patient with an acute abdomen, you could at least go through the case material and get the core information related to that diagnosis. Dr. Romrell stated that Pediatrics has a program that they bought called Clips. Dr. Harrell stated that it is really popular and that a group got a grant to create this program and disseminate it. It has been widely used in Pediatric clerkships now and she knows the Medicine clerkship directors are looking at something similar, developing a bank of cases following a similar format. Dr. Watson stated that the big message here is that the future of educational evaluations is going to be simulators and information technology. This generation is very comfortable using computers. The first year students are already creating programs on their own for EPC and interviewing.
Principle 9 states that the educational program must be responsive to the emerging needs of society. This principle deals with focusing on different issues that are contemporary in nature and a lot of things that heard on the news and discussed in the news and things that are coming up and how our curriculum responds to that. He picked out a couple of things that are important, one of which is the business of medicine and he evaluated where they were taught that. We have Healthcare Issues Day where we sometimes bring in speakers. In Ethics and EBM we have different discussions about this. In Family Medicine we take a field trip to view a managed care plan such as Av Med. In Pediatrics, if a student does a rotation in Jacksonville, the chairman gives a medical economics lecture. Baligh suggested there be a stronger emphasis on medical economics, especially during the third and fourth years when they’re actually dealing with these issues. He felt a good way to do this was to develop a checklist by the committee of important topics that graduating students need to know. Once we know what they need to learn about the business of medicine, for instance, the difference between Medicaid and Medicare and what managed care is, we can develop basic principles that we feel that students need to know when they enter their residency and go into practice. He feels that right now it is very dependent on the lecturer. Dr. Chu, the Pediatrics Chair in Jacksonville, has an MBA and always does a medical economics lecture, so there are a couple of people that tend to do it, but to come up with a checklist would be helpful. He is sure that AAMC probably has a list of what graduating students need to know and if not, we’ll develop our own and say this is what we need graduating seniors to know. The other thing is to utilize student organizations and develop programs on these issues. We have the AMA, AMSA and Atkins Society, which is devoted to business. These are things that we go to as students during our lunch break and we get exposed to and we learn about it. That is what the Atkins Society deals with. He suggests really utilizing student organizations that are student driven initiatives and to start exposing them to all of these. Dr. Watson spoke to Tom Harris about what students actually take and he stated they can choose a Business of Medicine elective, which 26 students took this year. He was talking with Tom Harris and Jan Eller about the level of sophistication of Baligh’s classmates; they were quite impressed with the questions they asked and reading they did. Baligh stated there are a lot of people interested in this, especially now when they are getting to move and are dealing with things they were sheltered from while in medical school. Dr. Normann asked Baligh if he has had any exposure to the politics involved in reimbursement issues because this will probably emerge as the single most dominating factor affecting how medicine will be practiced in the future and it is a crisis. Baligh stated that he knows that from his involvement with the AMA and right now for students it is more of an independent, self-driven process. He remembers being told about RVU’s, the competition between Medicare setting the prices and how everything kind of referred to that and that they’re really low for certain things. He feels students have a general knowledge, but he thinks it is pockets of people who go out and seek it; it is not a standardized issue. He stated that these are issues that are affecting our profession and students should know about them. Dr. Hatch stated that he does one talk in the preceptorship on it and one talk in the third year clerkship. In the preceptorship three years ago they thought it was totally peripheral and now they see it as more germane and some of that is that he refined it by trial and error. Baligh stated that is a perfect point because when you go into your first year you are distanced from this, you’re not even thinking about it, but then you get a little exposure to it. Even in this Health Science Center it is vastly different than what the rest of the medical profession in the world does. These are academic physicians that students are working with, some of whom are very removed from this, which is why students tend to wonder why this is being discussed in medical school. Dr. Watson mentioned our mission trips and stated that this is a very unique society, which is what he thought about while reading Suki’s Narrative Medicine thesis based spending a month in her birthplace, India. When we made this principle we focused on the United States and he questioned whether we should we focus on the emerging needs of society in the world. Baligh stated that he thought about this when he was creating this presentation, but he didn’t know where to put it. He mentioned a little in the first half of the presentation the importance of international medicine and when he did (?it) he went through office of global health, but that doesn’t exist anymore although Dr. Watson stated that Dr. Davidson and Rob Lawrence are trying to pick up the pieces. The concept we have about standardized care is very important and there needs to be a home for these organizations. He asked Dr. Romrell how many of his classmates went to mission trips and it was slightly less than 50%, so about half of students throughout the four years will go somewhere and have an experience in another country. It is definitely valued. Most of these issues are conducive to group projects or presentations, something where you can sit down with a group, so it’s not a lecture that you get, it’s a discussion that you have. He suggested utilizing various media, movies, books, magazines, and articles to facilitate these discussions about teenage pregnancy or about AIDS in Africa. One of the best clerkships he thinks would be good to utilize it would be Family Medicine because it covers a lot of issues, children, adults and OB and it also tends to be a longer clerkship. In his mind he was envisioning that the clerkship group would be divided into different groups where students would work on a topic and then have a chance to sit down and present and discuss it. He also suggested having a faculty mentor and the group could all meet at someone’s house one evening, similar to a Journal Club where students read a prime magazine article about one of these things. Students could see how people who are not in the medical profession perceived these issues and then have a good discussion about it. He’s going to learn a lot from, not a lecture, but sitting and talking with Suki about her experience. Dr. Hernandez stated that some institutions have established a Social Medicine Department and she questioned if that had ever been a consideration at UF.
Principle 10 deals with research and discusses the emphasis of discovery and knowledge acquisition. For the sake of time he is not going to go through all of the research projects and programs that we have here at UF, but will move onto the suggestions. One of the first ones that he stated was to strengthen senior research course opportunities. What this means is not necessarily research times because right now we have options for research electives, but this would offer some of the courses that IDP students have in terms of Biostatistics and Epidemiology. There are some students that will end up doing a fellowship and during the residency will do research. He thinks it should actually have it written on their elective form where you can take a month on how to write a grant or a month in Biostatistics. He said the library and IDP would also be helpful for this. He suggested offering courses in which students would not necessarily do research, but that taught them how to approach it and how to do it and allow them to have that opportunity. His second point is to establish research mentors in the first year. Right now we have people paired up with clinical faculty. If students are really interested in research and this is something that they want to do, it would be great to have on the checklist for orientation. There could be someone that does clinical medicine and research and they fulfill those roles of being a mentor and research mentor. He stated we need to allow that opportunity for students who are taking that path. Dr. Sumners has said that more and more people are signing up in the research program and it is very heavily stressed when students are here for admissions, which shows that a lot of people are interested in this and are attracted to this program and they’re choosing UF over other schools for this opportunity. He is sure that not all of the class will participate, but it would benefit students that are really inclined about this. He also suggests strengthening the MD/PhD program and states that most strong academic programs have thriving MD/PhD program. For them, it was amazing as first year students when they had a class research project, they were the patient and they got to participate and their MD/PhD classmates were the PIs of the group. Other than bonding, it really helped them learn what they do; for instance, they have to get IRB approval and they have to sign consent forms.
Principle 11 talks about working in a team and how we should collaborate with other health science colleges to allow a multidisciplinary approach. He mentioned the different clerkships and different pre-clinical things that we do as a part of a team, for example in OB you shadow a nurse for a day, and in Surgery you get to work with TPN nurses or IV nurses. Baligh states that while in MM or while hearing a case he often wonders what the other team members would have thought, although usually they were discussed from a physician’s standpoint. Suggestions to improve Interdisciplinary Education include instead of shadowing or seeing what they do, it would be great to be able to sit with them in a group and have a case presented and then have the nurse’s perspective, the pharmacist’s perspective, the physician’s perspective, etc. Technically this is what should be going in the Department of Pediatrics when you’re on the wards. He’s not sure how we could do that, but he thinks it would be beneficial to sit down and have different people give their input as to how they’d approach it. The next one is MM/System Errors. He suggested bringing in people that were involved such as a scrub nurse so students will know their protocol rather than speculate. It would be beneficial, if we can’t do it in real time, to be able to study a case where something went wrong. He mentions the Pops groups that had when they were first year students where they had different people and they all had different roles; it’s kind of the same thing of bringing in different professionals with different expertise to get their perspective. The last thing is the third year when a student questions what they will do. He thinks it wasn’t until halfway through his third year that he realized “Oh, that’s what a PCRN is or what it stands for”. Many times they don’t get an introduction to all of these people and for the benefit of our patient it is helpful to know what a social worker does and what is in her capacity so they’ll know who to ask or who to approach with a problem. He suggests having a simple lecture during orientation in third year of the medical team’s roles. Dr. Meuleman stated that working on the Geriatric clerkships in the fourth year there is going to be a mandatory interdisciplinary case planning for the assigned patient where you actually put to paper what disciplines are doing on your patient. Baligh stated that it would be even more helpful to actually have the nurses, etc. in the room and have them tell the student what they would be doing for the patient at that time.
Principle 12 discusses fostering a learning environment, professional development and creating a humane environment that fosters respect, personal integrity and service. He stated when they start off medical school they have this amazing professionalism atmosphere that sets the stage throughout all of medical school. Dr. Vidauretta is amazing in her job and most people on the faculty are warm and responsive to students. The only thing he suggested is to designate some reflection time because while the majority of people are really amazing that they come in contact with, they are going to come in contact with some people that might not be as professional as we would like. Especially for third year students that may not know what is appropriate and inappropriate, it is good to have time to reflect. Debriefing sessions sometimes include these issues but not always and it is good to have an independent faculty member not associated with your grades to sit down and talk to about what you saw on the wards. The only thing he suggests is for all clerkships to designate some time for students to reflect on their experiences apart from the debriefing sessions so they can take what they saw and improve on it.
Dr. Winter asked if we are doing more and more within the same time, would we make medical school longer or what do we cut out or is there going to be more use of the fourth year. Baligh stated that for some issues that were mentioned it would be beneficial to use more of the fourth year in terms of ambulatory medicine. The first half of the presentation he mentioned taking out some things that could be served better by other courses or clerkships. He doesn’t feel that many of these ideas are extremely time consuming. We should provide resources, online modules, and create an environment change by attitudes and different presentations. Some of them will require time, but primarily it is creating a change in how we view things or how we approach things. Dr. Davidson stated that Case Western has announced that they will be going to five years. Dr. Harrell said what struck her is that most of what Baligh presented today is here and available. She stated that what we haven’t successfully done yet is to figure out what are the core parts of those things that every student needs and to what extent each student needs them. Maybe there are some core things that every student at some time needs to be responsible for getting. We have all of these opportunities there, but we have not well-defined, particularly in more of the peripheral topics, what we expect every student to get. Dr. Winter stated that education is a continuum and so much of what Baligh has talked about are things will come back in residency. Dr. Winter stated that his prejudice is that medical school is your opportunity initially in your third year to apply your basic science principles to solving real life problems and you better get that down before you worry about a lot of peripheral issues that are going to be ultimately terribly important, but he agrees with Dr. Harrell in that you really need your basic foundation. Baligh agrees with Dr. Winter but stated that the point is that we mostly focus on that. He stated that when Dr. Winter made the statement of “We should just focus on this”, that doesn’t mean that the other things are not important and it doesn’t mean that there shouldn’t be a plan of how to approach them because right now they are there, people are exposed to them. He stated that it is more than just having them available, but it is realizing as a group what is important. Instead of just leaving it on the periphery and not really addressing it and saying they’re just there and focusing on one thing, he doesn’t think is a good approach. Dr. Watson stated that the Curriculum Committee knows our goal is general professional education and the trick is to decide what a general professional education is and deciding what is necessary for every single medical student to know. The other trick is to recognize that it changes. The world is changing out there fast and we tend to sort of stick with the same general professional education even though things are changing. Dr. Harrell pointed-out that Baligh is one of our smartest and most motivated students to come through here, and feels that other students may find this overwhelming. She stated we have to keep that in mind that there are some core things that we’ll have these opportunities for students like Baligh that will run with it. Baligh stated that everyone has different experiences while in medical school. He thanked everyone for having him.
Dr. Davidson stated that while we will be taking the summer off for meetings, we will be appointing some task forces to work on several issues that have come up and several issues that have been raised in Baligh’s presentation.
The meeting adjourned at 9:12a.m.