June 12th, 2007
Members present: Dr. Richard Davidson, Dr. Kyle Rarey, Dr. Rob Averbuch, Dr. Frank Genuardi, Dr. David Caro, Dr. Judy Bowers, Dr. Richard Rathe, Linda Butson, Dr. William Winter, Dr. John Meuleman, Dr. Heather Harrell, Dr. Lou Ritz, Dr. Maureen Novak, and Dr. Cari Hernandez
Announcements: Dr. Genuardi stated that Bhavin asked him to give his report. He stated that once again the third year students are making some noise about wanting more feedback on the PBE. He thinks they’re mainly concerned for the people who pass and do reasonably well and don’t get any feedback other than that. Dr. Harrell stated that in the past any student who wanted feedback could set up a time to go to the Harrell Center and someone would meet with them, although very few did. Dr. Davidson stated that they did something creative a few years ago. The class was divided into Form A and Form B and they showed videos for each station in which a student had gotten 100% to show them how they did without giving them their specific scores. He thinks there is a concern about the security of the stations and suggested bringing it up with Dr. Cendan who is the medical director. It was clarified that the feedback the students now receive is that either they pass all of the stations or find out which particular stations they may have failed. Dr. Cendan looks at every failure and meets with each one who has trouble. Dr. Davidson stated if a student fails just one of the three sections, which are history, physical and communication, they just about have to fail two of those to fail overall, although one person scored so low on communication that he failed overall. Dr. Harrell stated that Dr. Cendan knows the pattern people follow and realizes that they may just run out of time and not get to the physical exam. He then knows what to retest and if it’s not a fatal flaw problem he lets them retest to demonstrate that they’re able. If it’s a problem with approach or technique, he and Dr. Duerson work out remediation for them. Dr. Harrell works with them with the fourth year if it really looks like they need even more remediation. Dr. Davidson stated that according to Dr. Cendan who looked at the tapes, most of the time when the really good students fail it’s because they make an assumption about what the diagnosis is and they tend to be incomplete in terms of looking around for other possibilities; in other words, they act like real doctors.
Dr. Harrell stated that the other thing that came up is on the communication skills Students may have wonderful interpersonal skills, but the communication section is really examining their ability to counsel a patient in a systematic way. What we uncovered a couple of years ago with one of the students who is now doing an internship here is that in looking at her video, the problem is that they had never actually been taught an approach as to how to do this. That student, as an independent study, created a piece of curriculum to teach a systematic approach to counseling which has now been incorporated into EPC. Dr. Rathe suggesting renaming it counseling, which Dr. Davidson said we can consider. Dr. Rathe suggested having Dr. Cendan present to the Curriculum Committee about the PBE’s. Dr. Davidson stated he did earlier this year, but he thinks these are good topics to bring up and we can have him do that. Dr. Cendan can possibly present it at the July or September meeting.
Dr. Harrell stated that the Clerkship Directors met and discussed the orientation which this year has been moved up to right before when the clerkship starts rather than this month because they often don’t remember anything when it’s done too soon. They talked a little about the patient safety issue which was left off and that may end up being a Curriculum Committee issue at some point. The last thing they discussed is the ever-increasing student requests for time off for things during the third year because they really don’t understand the transition to clinical care. If they are not actually presenting at the meeting or in a leadership role there will be no special allowances. Dr. Hatch has allowed students, if they do Family Medicine during the spring break, to go on an international trip during Family Medicine because that is providing some outpatient primary care type experiences for them. He is going to make that very clear to the students that the only way they can do that is if they arrange it with Family Medicine at that time to try and have more consistency so that they’re not playing one clerkship director against the other.
Dr. Rathe stated that he and Dr. Romrell have collaboratively arranged to reassign one of the lines in his office to a new position that has a person to fill it now as Head Chief Proctor. The head proctor will be the executive in charge of individual test administrations.
Dr. Winter gave a report from last month’s Course Directors’ meeting. One of the things they talked about was the international medical trips. Dr. Davidson provided the background on this stating that there was concern about students going on trips and getting in academic difficulty. He stated from the viewpoint of the first and second year course directors they would advise students that if they had either a final or an ongoing grade in a course that is lower than B, they should reconsider their commitment.
Dr. Hernandez stated that there will be a workshop called QPR, which is a suicide prevention program that is put on by the University Counseling Center by Dr. Wayne Griffin. Our first session is this Thursday and they will have monthly sessions now through January. It is targeted at staff, faculty, students and residents to help identify people in distress and to direct them where to refer them.
1. Annual report of the Evaluation Subcommittee: Courses and Clerkships by Dr. Rarey.
Dr. Rarey stated that the objective of this meeting is to provide feedback from the Evaluation Subcommittee, which is a standing committee of the Curriculum Committee, on an annual basis the quality of courses and clerkships in our four year curriculum to the best parameters that we have. The objective this morning is to go over the data that has been compiled from participation of course and clerkship directors input, as well as to look at student evaluation data, etc. This is the sixth time that the data has been presented to the Curriculum Committee. The data is identified on the website. In that body of data is the assessment of the syllabi, as well as the director’s analysis report. There is an addendum, which is what he will go through this morning. The addendum is broken into courses and clerkships A through D. In each of the sections is the LCME Summary Report of every course and clerkship. Also included are the composites of student evaluation data and the assessment by the Evaluation Subcommittee, which provides different bodies of evidence in terms of how the courses and clerkships look from internal and external reviews.
Dr. Rarey clarified that the student evaluation is a composite of 15 points. The students evaluate the course overall, they evaluate the faculty instruction, and they evaluate the management and organization of the course, all of which count for 5 points.
He stated that most of the members are Course and Clerkship Directors and have already received the information regarding their course, but he wanted to give comparative data to reveal how other courses were reviewed by the LCME site team. He briefly discussed several departments including Biochemistry, Clinical Human Anatomy, Essentials of Patient Care I and II, and Human Behavior. IFH was identified as one of the major strengths of our educational program. They were commended for being an interdisciplinary course among the other colleges of the Health Science Center. Medical Neuroscience was written up very well. There isn’t anything to identify a concern either by LCME or student evaluations.
He presented composites of data taken from four parameters of the syllabi and four parameters of the director’s report plus the student evaluation of the course instruction, etc.
Dr. Genuardi asked what they do with the outliers on these composites. Dr. Rarey stated they have asked the course directors to meet with the members of the Evaluation Subcommittee.
It was stated that the Evaluation Subcommittee does both the assessment of the syllabus and the assessment of the directors’ analysis report, so there are two points of data that come from the Evaluation Subcommittee and one from the students.
In the second year in the Clinical Diagnosis course, the LCME report identified that the course director, Dr. Cari Hernandez, is doing well and is making great organizational moves that have strengthened the course. EPC III and IV are strong courses now. Ethics went above the mean this year with Dr. Bill Allen in charge of that course.
He encouraged members to look at each course themselves. He stated there is congruency in part with LCME and student evaluations.
He moved onto the third year and noted a good write-up about Anesthesiology. Surgery has gone a little lower from the Evaluation Subcommittee perspective and it is still because of all the subspecialties involved in that course that the learning objectives and methods of instruction are not clear. Dr. Davidson stated that Surgery will likely be presenting their plans for changes to the Curriculum Committee next year.
In the fourth year courses, for the LCME we identified that there is one sub-internship and that the students could choose between Medicine, Pediatrics, or Family Medicine. During this last year, 64% of the fourth year students chose the Medicine Sub-I, 22% chose the Pediatrics Sub-I and 14% chose Family Medicine, which is common. They thought there were solid Sub-I’s for each of the three departments. We’ve only done this for the Sub-I’s for two years. Next year Geriatrics will also be included.
The Evaluation Subcommittee did review every course and clerkship in the curriculum using the parameters that were approved by the Curriculum Committee over time and those data are identified on the website, as well as the addendum. As we look at going into the next academic year, members of the Evaluation Subcommittee met with Dr. Davidson who asked them to look at other ways to gather data that would be just as relevant as or more relevant than what we have. One of the things being promoted now is that we’re trying to develop a faculty assessment so that we can ask members of the teaching faculty within a course or clerkship for their input in terms of the strengths or areas of concern from their viewpoint.
Dr. Winter motioned that we accept this report, it was seconded and all were in favor.
Dr. Davidson stated that many of us met with a visiting medical educator from Portugal. She is heavily involved in evaluation of courses and she said one of the main things that they pay attention to is the faculty evaluations of the courses, which is something we haven’t done until this coming year. If a course is taught in small groups such as IFH or EPC or EBM, it is important to get the feedback from the teaching faculty about the course and what could be done to improve it. In IFH one of the things they did this past year was to ask the faculty and the students the same questions worded specifically and those answers were matched up to see how much agreement there was between their observations about the course. Interestingly there was more agreement than Dr. Davidson would have thought, but not on all questions. On some questions the faculty saw the experience as much more valuable than the students did. There are creative and interesting ways to further evaluate the courses beyond the Board of Regents questions and looking at the syllabus.
Dr. Rarey stated that if there are other things that the members of the Curriculum Committee feel should be looked at as far as the quality of the courses and clerkships, they’re open for that. Right now by external measures we seem to be achieving the goals for our educational program.
Dr. Davidson stated that he thinks what Dr. Hernandez is referring to in terms of changes may be, for instance, the idea that we’ll have basic science clinical correlation Grand Rounds issues. Dr. Cendan will be working on some way to specifically evaluate, for instance, differential diagnosis/diagnostic thinking as part of the PBE not with what exists right now. He thinks by assessing faculty that are teaching the students, we may be able to get that.
Dr. Davidson stated that for the Family Medicine clerkship they do a sit-down debriefing at the end of the rotation with him, Dr. Bayard Miller, Dr. Rob Hatch, and sometimes Dr. Meuleman. They have a free discussion about various aspects of the clerkship. There is such inconsistency among student opinions. It really makes him question using student evaluations in any kind of serious fashion when sitting in one of those sessions. Over a period of time, after listening to the whole class, issues and areas that need improvement can be pinpointed. Dr. Rarey stated that’s why we look at more than one set of data because there are limitations.
Dr. Hernandez stated she is very relieved at the way Clinical Diagnosis went this year. She thinks what was really critical to becoming successful was having mentoring and she thanked Dr. Davidson and Dr. Rarey for getting her help and finding someone to mentor her. She thinks we should keep in mind the importance of mentoring as new course and clerkship directors come on.
Dr. Davidson stated that we’re lucky because we don’t have a lot of turnover, but we’re facing an issue especially in the basic sciences. He thinks every course and clerkship director, no matter what their age, should be thinking about the future and if there’s someone that could take their place and what the best way is to mentor them to be able to do that.
Dr. Winter thinks another problem in the future is for any faculty that have significant clinical practices. Dr. Davidson stated that hopefully we will maintain the mission based budgeting that can impact that. With that in place, there is at least an argument with the chairs to allow someone the freedom. If we’re paying 20% of their salary and it’s going to the department, that person’s time should be protected.
The meeting was adjourned at 8:45.