Curriculum Committee Meeting June 27, 2006
Members present: Dr. Richard Davidson, Dr. Kyle Rarey, Dr. Margaret Duerson, Dr. Robert Watson, Wayne Bottom, Cynthia Karle, Beth Layton, Dr. Maureen Novak, Dr. Andrew Kaunitz, Dr. Lynn Romrell, Dr. William Winter, Dr. John Meuleman, Dr. Louis Ritz, Dr. Cari Hernandez, and Dr. Robert Averbuch
Announcements: Dr. Davidson announced that Dr. Andrew Kaunitz from Jacksonville and Dr. Colin Sumners are both resigning to provide other contributions to the university. He thanked them very much for their contributions to the committee. He stated that Dr. Sumners will give yearly presentations to the committee regarding updates on how the Research Track is progressing.
Dr. Romrell stated that the students are in the process of taking the Step 1 exam. He says there’s no reason to think this class won’t do well because in fact they have credentials going in from their Subject Exams which put them the strongest yet to take that exam.
Dr. Watson stated that the rising 3rd year class is going through criminal background checks and substance abuse testing. The AAMC is currently working on a national program for criminal background checks; substance abuse is going to be more local and we are going to try to begin working with other medical schools in the state to have some common ground. PRN has recommended four random drug screens per year which seems excessive.
Dr. Watson stated that Dr. Tisher announced his resignation at the LCME retreat. A search will soon be started although there is no word on who will be the chair of this committee or who will be on the committee.
Dr. Watson stated that the library will be provided an additional $100,000 per year which will help with the funding. He stated that there are two issues that are going on with the library. The library in the eyes of faculty and students provides excellent service, but the funding is problematic. There will be ongoing conversation linked to exactly who or what the Health Science Center Library reports to, i.e. the Vice President’s Office or the Head of Libraries on campus, and they will try to find a stable funding source.
Dr. Winter will give an update from the Course Directors at the next meeting, as their meeting this month was cancelled due to Hurricane Alberto.
Dr. Davidson stated that although we may not have a Curriculum Committee meeting in August, we probably will have a retreat. This retreat will be a joint retreat with the Curriculum Committee and the Evaluation Subcommittee. He stated that while writing for the LCME report, the most frequent term he has used has been the Evaluation Subcommittee. When it comes to making sure the courses are evaluated, he couldn’t imagine not having the Evaluation Subcommittee there; it is incredibly important and has done its job very well and very appropriately. Now that almost all of the courses and clerkships are online in terms of their syllabi and everything else, we’d like to move onto the next phase at looking critically at what’s evaluated in course and clerkship evaluations; for instance, is content something that should be addressed, how should things be weighted in different courses and clerkships, and what ideas can we come up with for the future to have it expand and move forward with the Evaluation Subcommittee course and clerkship evaluations? He and Dr. Rarey will come up with some kind of agenda and a date.
Another thing that Dr. Davidson discussed was the need to begin looking beyond the LCME visit and review our Clinical Skills continuum, which he has been interested in for the last two years in terms of clinical decision making and how we teach it and how we evaluate it. He is going to appoint two subcommittees of the Curriculum Committee to essentially review the clinical skills curriculum and make sure that it’s a continuum and to think of new and creative ways that we can improve it. One subcommittee will look at the first two years and included in the first two years is not just the EPC continuum and clinical diagnosis, but it is also, for instance, what are the ways that the clinical aspects of the basic science courses can be used to teach introductory clinical decision making. We have a great opportunity with some of our finest clinicians being involved in the basic science courses and providing clinical correlation and is there a way that these clinical correlations can be used to begin to get students to think critically and to think in terms of how to put a differential diagnosis together. The subcommittee looking at the first two years will be chaired by Dr. Whit Curry and the subcommittee looking at the last two years will be chaired by Dr. Davidson. Many of the members of the Curriculum Committee will be appointed to participate in these. He is not sure what date they’ll be looking for final presentation to the Curriculum Committee, but we will start this summer, Those members that are clerkship directors are more likely to be involved in the second subcommittee and some course directors will be involved in the first subcommittee along with course directors in the involved courses. We will aim to put it all together at some point and have a clear vision of a developmental process for teaching clinical skills throughout the four years. His tentative lists includes residents and students in each of the subcommittees. The residents are all residents that have gone through our training program so they have a pretty good longitudinal vision of what they need and what could have been improved. We will have a brief meeting in July to outline what will happen in the retreat, which is yet to be determined and will announce the makeup of the subcommittees at that time and come up with a timeline for them at that meeting. There won’t be a meeting in August.
Dr. Watson stated that they had asked the Board of Trustees for a 10% decrease in tuition for out of state students. In response, they increased the out of state tuition less than they would have if they wouldn’t have made the request. It is now $51,000 for tuition and fees for residents. The in-state tuition also went up 5%. Dr. Watson and Dr. Romrell have been working very hard to get a tuition waiver of some sort for the out of state students; it was actually signed by Dr. Tisher and Dr. Barrett who will then forward it although no formal word has been heard about knocking about $15,000 off of the out of state tuition. Dr. Kaunitz asked how the $51,000 compared to private facilities. Dr. Watson stated it is approximately $15,000 more; Duke University is about $34,000-35,000. Miami gets $30,000 a year per student from the state, so Miami is clearly underbidding us in tuition because a lot of the applicants have told him and others that Miami tells them they’ll pay less tuition there than at UF. It definitely puts us at a competitive disadvantage for out of state students, especially for MD/PhD and minority students. He stated that hopefully if we can get the $15,000 decrease on tuition and then provide them with scholarship money from the Research Track foundation funds we can become a little more competitive. Dr. Romrell stated that the average tuition right now for private schools is $35,400 and with the $15,000 waiver we would come right in at the level of the average of private schools; it wasn’t an arbitrary number, it was carefully thought out. Dr. Watson stated that there are two things that are going through with the Board of Governors. One is a tuition parity, which is that all state public schools should be getting the same per student as Miami, which for us would be about six and a half million dollars more in state funding. The second thing, which may be a little more far fetched, but the Board of Governors has it in a letter to (?Gardener), is 100 million dollars to increase the size of facilities of the existing medical schools, which would be key for our new building. He was very disappointed with the tuition increase.
Beth Layton stated in regards to the library, they are going to have a national exhibit starting at the end of August, which will be the “Changing the Pace of Medicine Exhibit” that will be in the library for six weeks. That space is going to be used for the exhibit and after that they will recapture that for study areas and will get new carpeting and painting, etc. so that the first floor will look a lot nicer. In regards to the collections, even with another $100,000, they are looking at cutting some of the titles. They do take into account the input that people give them very seriously and stated that the more response they receive the better they can support everyone’s needs.
Dr. Davidson said that when the LCME visits our school they will be meeting with members of the Curriculum Committee. Dr. Rarey will lead us through what happened at the Executive Committee Retreat. Dr. Davidson will do the presentation that he, Dr. Romrell and Dr. Genuardi did with regard to the educational program because that’s the most important for this committee to be aware of. He will present the strengths and concerns that our subcommittee came up with and Dr. Rarey will present the strengths and concerns after they were voted upon by the Executive Committee.
Dr. Rarey stated that the Executive Committee Retreat was held on June 15th and lasted about 4-5 hours. The idea was for the members of the Executive Committee to hear the committee reports with regards to the status of our educational program and how we are in terms of our educational resources, facilities, etc. As being the movers and shakers of this educational program as members of the Curriculum Committee, it is important to be aware of what was stated in terms of its strengths and concerns with regards to those areas. He reiterated that the accreditation process is where we are involved in identifying the strengths of the educational program and the LCME visitors will be here February 18th, 2007. In preparation for that we have to do a thorough self- evaluation, therefore there are various surveys that have been done by the students and faculty, and materials have been presented to members of this group and the Executive Committee, which satisfies their efforts to obtain 100% input from a variety of people. The three basic questions are:
Dr. Rarey stated that in 2000 there were 11 sections of the database. However, for the 2007 site visit, the LCME requested that each medical school facing accreditation consolidate down into five areas. These include the institutional setting, the educational program, the medical students, faculty, and educational resources. The databases are focused on those particular five areas and Dr. Rarey will present the overview of each of those five areas this morning, although he’ll go into more detail about the educational resources. The site team will come in February and they will tell the LCME Committee where our strengths are for the educational program and if we are compliant or partially compliant or if we are in various stages of transition. Starting in July of last year, various members including members of the Curriculum Committee were involved in Task Force. There have been 129 faculty, staff and students involved in creating this database, which is representative of both the faculty in Jacksonville and Gainesville. The LCME visitors in February will be Robert Rich, M.D. who will chair the site team and is the Dean at the University of Alabama in Birmingham, Gary Rosenfelt, Ph.D. who is the Associate Dean of Curriculum, a pharmacologist, Georgette Dentz from North Carolina who is the Associate Dean of Student Affairs, Craig Chevitz who is the Assistant Dean of Medical Education at Virginia, and we are unsure of the secretary at this time. Carol Aschenbrener was the former LCME secretary but she is now going to become the medical education head person in the AAMC. The LCME site visit in 2000 identified 10 strengths to include good leadership from the very top, strong leadership in our educational areas, Dr. Vidaurreta’s counseling was considered a strength, strong curriculum, great technology with the state of the art Harrell Assessment Center, good feedback mechanisms, a great student body, strong fiscal resources, and good collaboration between the Dean and the Vice President. There were concerns which when they come back are going to be the number one priorities they’re going to look at. These include changing focus and lack of coordination with EPC, Keeping Families Healthy was a concern, inconsistent applications and formative evaluations in some clinical clerkships, variable preparation for residents for roles as teachers and evaluators, and lack of funding for the Health Science Library. They wanted us to monitor the Shands Jacksonville area, they wanted us to make sure that we are making progress in the implementation and evaluation of our curricular objectives which is our competency-based program as well as our evaluation system, they wanted to make sure that we had proper facilities, and there was concern about the student housing. Over the past seven years we have had multiple correspondence and progress reports to the LCME, and with the letters they sent back it seemed they are satisfied what we have done over the past six or seven years to address all of those areas. The site team coming in February will confirm we’ve done what we’ve said; we have to provide the evidence.
Mike Good and Colin Sumners were co-chairs of the institutional setting, which is one of the five areas of the database group. It deals with the governors and administration, the graduate education program, our GME, etc. Through their database fact-finding endeavors, they have come up with strengths and concerns. In governance administration they found that we have strong leadership by the deans, effective planning, effective budgets and financial management processes, and a good innovative academic affiliation agreement with Shands. There are many strengths that have been found with regards to our educational program and our supportive areas. There were approximately 100 strengths found across all five sections and there were 26 concerns. There was a concern that while adequate financial support is available from the institution in instrumental support, the IDP, the graduate interdisciplinary program, would be enhanced by pre-doctoral training groups. This is not a major concern as to how it impacts our educational program. The strengths that are found with Graduate Medical Education and research is that there are a large number of faculty are engaged in a diverse array of research activities, great strength in terms of our collaborative research, and strength in terms of the amount of extramural funding in national and international representation of our faculty. A concern again, which seems to be a theme here, is space. While the current research space is adequate and new facilities will come online in 2006 like the Genetics Institute, it is clear that more space will be needed to accommodate the continuing expansion of our research enterprise. With regards to students that perform research, there were strengths in terms of our programs; however, there is a concern with the low level of activity within the current MD/PhD program. Dr. Romrell stated there are currently 14 students in the PhD track. Dr. Watson stated that the MD/PhD program is in transition because of Research Track, but it is still alive and needs specific support. He stated that the cost had begun exceeding the benefits, so we are rethinking it. The composite of the institutional setting identification was that our clinical and basic science departments are strong, there is a strength in our clinical departments in terms of good leadership overall, we have large growing clinical faculty in the two campuses, and significant participation is accomplished in research and education for our faculty. That is the synopsis that Dr. Mike Good and Dr. Colin Summers came up with for our institutional setting.
In regards to faculty, Dr. Charlie Wood and Dr. Jim Crawford are the co-chairs of the faculty section of the taskforce. There are 14 standards that they had to find evidence that we are compliant or not. All of the Task Force Chairs identified that we are compliant with all 126 standards. They found that we have a sufficient number of faculty to meet our educational program goals with regards to the number of faculty and diversity that we have on our campuses. The strength is that we recruit and maintain a diverse faculty largely reflective of the diversity of the general population of the state of Florida. The concern is that while the Jacksonville campus has a diverse faculty, the diversity of the Gainesville campus does not yet match the general population of the state. The rank of the senior faculty is under-populated by women although specific attention is given to mentoring and retaining senior women faculty. With regards to seeing the quality and productivity of our faculty, the strength was that the faculty is of high quality, their professional accomplishments are commissioned with their academic rank, and quality is continuingly improved by the institution via the faculty compensation plan. The concerns that came out of that particular section was that though the quality of faculty is excellent, we see room for improvement in faculty productivity.
With regard to educational resources, Dr. Ken Berns, who was the dean when the last site team was here, is the co-chair of along with Wayne Tharp. of the educational resources in our database. The strengths included developing a budget using principles of mission-based budgeting, mission-based funding, an excellent relationship between the two campuses, the overall financial state of the College of Medicine is robust, and there has been significant expansion of the facilities including the Harrell Center, the Simulation Laboratory, the Testing Center and the Cancer and Genetics Research Complex. In addition, the library provides superb information and informational resources; the staff is knowledgeable about scientific matter and plays a major role in educating medical students. An area of consideration is that the clinical facilities in Gainesville are constrained; in particular the hospital at times is running greater than 100% capacity. This implies that the clinical programs in the College of Medicine could be enhanced if more clinical facilities were available. In spite of the excellence of the library system, funding has been constrained and the number of positions has been held constant for a number of years.
Dr. Meuleman said there have been rumblings amongst the educators that are concerned that the whole reimbursement package for faculty undervalues teaching. He thinks it is mostly in regards to the bonus system. Bonuses were assigned primarily to clinical and research faculty. It is necessary for people to apply every year and put together a package stating why they deserve an educational bonus. He asks how people are supposed to sustain a system where the educational bonuses are undervalued as well as having an awkward system to begin with. Dr. Watson stated that in the faculty section, in a much broader sense, concerns came up about the compensation plan. The general idea is that the faculty compensation plan drove people more towards generating money than it did towards things less likely to generate money. Dr. Davidson stated that it also came up in his section. Dr. Tisher has stated that he will put more money into it this year and Dr. Watson suspects more people will be applying. He stated that some of the chairs didn’t bother to nominate some of their deserving faculty.
Dr. Rarey stated that with regard to the medical students in general there are different areas that had to be looked at. Dr. Duff was the chair of that task force and Dr. Romrell presented the data from this at the retreat. In regard to admissions, the incoming MCAT scores for the students for the class of 2009 were slightly higher. With regard to GPA, the average pre-med GPA for first year students was 3.71. With regard to the number of admissions, there were over 2100 applicants for last year which is the class of 2009, and there were over 350 candidates interviewed, 208 of which were accepted and 132 which matriculated. The entire student body was 491 when this report was made. Since 2000 there has been a crossover so that now there are more female students entering medical school than males. Dr. Duff’s group found four strengths to include broad-based representation on the Selection Committee, active participation of students in the selection process, a high caliber of students being selected, and great career options for incoming members of the class. The one concern noted was difficulty in tracking selected minority students because of limited scholarship dollars. The percentage of students who historically have been dismissed or who withdraw was listed, which is very low. Dr. Kaunitz went back to the concern of limited scholarship dollars as a restraint in terms of attracting selected minority students. He stated that earlier it was mentioned that faculty diversity isn’t as high as it could be and a strong experience in his department has been that they weren’t effective in recruiting quality minority residents until they had faculty diversity in the department and once they did it became much easier.
The tuition fees were again discussed as mentioned earlier. The amount of graduating medical student’s debt was discussed, which was an average of $107,000 for the class of 2006. The number of graduates with debts over $100,000 was 54% of the graduating class. The strengths were that we have great services, strong academic advising, excellent financial counseling, and excellent mental health counseling. There were no concerns with regards to our student services. The residency program directors were asked to score our recent graduates with regards to the five competencies categories. All of our graduates were rated in the high categories with only a few in the middle and none in the needs improvement category. Dr. Romrell found the data of how they were scored when they were students here with us and the scoring was comparable. He wanted to assure that the members know we do resident surveys based on the competency based system and this is evident in terms of the quality of our program.
Dr. Rarey quoted the following numbers: we have 491 medical students with us, 135 entering class size, 94 seats in the testing center and Dr. Watson says we are getting more as of today, 68 total number of exams that our students take during year one and year two, and a total number of 16 buckets in the hallway in the Communicore when it rains. The only concern is that the infrastructure of our clinical facilities is old and merits refurbishing and we need more space if we are going to increase the class size.
Dr. Davidson followed Dr. Rarey’s presentation of the summary of the other sections with the education database section. He stated there are two sections of the education database: one is the summary data, which the course and clerkship directors are familiar with because they completed and handed those in, and section two which is a report on Part A Key Quantitative Indicators and Part B the specific responses. Unlike having 16 or 20 educational standards, this section has 48 educational standards, by far the largest section in the report. The five sections are: educational objectives, structure, general design and content, teaching and evaluation, curriculum, management, both roles and responsibilities and geographically separated programs, and evaluation of the program effectiveness. They wanted to set the stage and have everyone understand at what a high level our students perform. Our students score higher than the national average and the number of weeks of our curriculum is 164 compared to the national standard of a minimum of 130 weeks. Data from the Graduation Questionnaire stated that the percentage of graduating students who agree or strongly agree with the statement that overall they are satisfied with the quality of their medical education is 96%, which is significantly better than the national mean.
Dr. Davidson said that with regards to the educational objectives, he thinks it is important for the Curriculum Committee to understand the difference between educational principles and the competencies because there has been some confusion about that. The educational principles were approved by the Curriculum Committee in 1997 and they serve as the philosophical underpinnings and basis for the curriculum. They are not a blueprint, but they include those content areas that the Curriculum Committee feels are important to include in our curriculum. He stated that everyone has seen them at some point because he usually shows them at the beginning of each year. The curriculum is based on the six competency categories, so we use the ACGME general categories as a blueprint or as a way of developing and evaluating the curriculum. He states everyone is well aware of the graduation competencies, which reflect the ACGME competencies. They are used for the development of core education objectives in every course and clerkship, all courses and clerkships are evaluated annually, and the evaluation includes data on student mastery of the defined graduation competencies, teaching effectiveness and quality of learning objectives. He states it is important to point out that the evaluation includes much more than just student evaluations. He emphasizes that it is an important difference because in many institutions, courses and clerkships are evaluated based on student feedback and evaluation, which is not ideal. With regards to performance, there are many items that ask about performance and our students do very well. He states that it is interesting that 2-4% of graduates enter academic medicine careers compared to 12% of UF graduates. 2/3 of our graduates have served as chief residents; we need to correct that for surgery training programs, but nonetheless it is still a very impressive number.
Dr. Duerson asked if there was any Step 2 CS Exam data on our graduates . Dr. Romrell stated that we had a 2% fail rate in the Class of 2005, the first year it was introduced; the national rate was 96%. In the current class, the national board is slowly giving us the data; it has been delayed this year due to a computer issue. We now have 99 of 116, which all passed. The students go into that exam feeling very confident. Students have to take this Step 2 exam to graduate and we don’t know the scores, we just know they took the test. However, it has been discussed over the past three or four years that residency programs will begin to stop accepting students that didn’t pass the Step 2 Exam.
Dr. Davidson reviewed the educational objectives section of the presentation: well defined learning objectives in courses and clerkships, combined clinical education in Jacksonville and Gainesville with a variety of different clinical experiences, Humanities in Medicine and community service electives and Maren Reading Room and support of international trips, and extensive interdisciplinary education involving other health science center colleges. There is an item about self-directed learning; the structure was changed about five or six years ago to decrease the number of lecture hours and direct contact time and increased self-directed learning. The use of web-based instruction in many of the courses was developed, there was an emphasis on evidence-based medicine in both the second year and during the clerkships, there was an online portfolio in the medicine clerkship and simulator use in Physiology, Anesthesiology, and Emergency Medicine, all of which are aspects of self-directed learning. There is consistency of quality at alternative sites, (the collaborative arrangement we have for clerkship leadership), the use of an internet-based patient logging system which we’re still fine tuning, performance on national boards and USMLE exams is carefully monitored to assure quality, as well as getting feedback from students regarding that quality. Ambulatory and inpatient balance is another item that was brought up by the LCME in this list, specifically the percentage of time inpatient and percentage of time outpatient in the required clerkships. Someone asked if we compare to the national norm in this instance and Dr. Davidson stated there was no national norm. Dr. Romrell stated that we present this data every year in our clinical report. Dr. Watson stated when you go on LCME visits they look for approximately 50/50 and Dr. Davidson confirmed that (our balance of inpatient/outpatient is 47/52, so we are clearly mainstream.
Dr. Davidson stated that regarding teaching sites, we have a variety of different teaching sites which provide our students with a broad range of patient settings and patient socioeconomics status, etc. On the structure section, the committee thought that there were strong models for clinical and pre-clinical science integration, early clinical experience with the preceptorship, EPC and IFH in the first year of medical school, a large percentage of students participated in Equal Access Clinic, a developmental process in clinical skills education including the performance-based exams and Essentials of Patient Care, a large number of satellite ambulatory clinical sites, collaborative clerkship organizations, and Jacksonville provides exposure to underserved populations including an urban population with multi-cultural socioeconomic learning opportunities. The concerns in this section: tendency towards too many lectures in some courses, difficulty in identifying redundancy in the curriculum, aging classrooms at full capacity, and the need for small group teaching space. Teaching and evaluation: supervision of students is carried out by resident fellows and faculty, there are Resident-as-Educators workshops at both campuses, faculty development activities are available;, in terms of outcome measures, there are structured written oral examinations in courses and clerkships and we observe students in the clinical setting, we use subject exams Steps 1 and 2, there is a graded developmentally appropriate performance-based evaluation program, and we look at performance on the match and in residency training. Timely feedback is another item identified by the LCME in this section that is explicitly required of all courses. It is assessed as part of evaluation in every course and clerkship by the Evaluation Subcommittee. Additional clinical evaluation includes the use of the Harrell Center, assessment of skills by a developmental series of PBE’s, and an online patient logging system. The strengths in the teaching and evaluation section: team teaching taking advantage of individual faculty members’ strengths, systematic use of the competencies which was a true strength that every course and every clerkship uses the same competency evaluation forms although they vary depending on the decision of the course or clerkship director, but a similar competency-based blueprint is used in all courses and clerkships. There is extensive annual evaluation of each course and clerkship, dedicated innovative teaching faculty with financial support for teaching effort, highly qualified housestaff,, teaching skills training is offered to residents through the RAE program, the Harrell Professional Development and Assessment Center, a comprehensive program for faculty development, and the Society of Teaching Scholars provides educational scholarships and workshops. The concerns in this section included inflation of grades especially at the lower end of the grade distribution. Earlier this year, this committee addressed issues at the top end of the grade distribution, but not at the bottom end and the main thing that he would say about this concern is that it was promptly dismissed by several of the chairs because our performance was so good on national measures he thinks it is a reasonable comment that maybe we should not worry about grade inflation, maybe it is appropriate. Another concern is that all residents are not required to participate in the Residency as Educators program. Dr. Hernandez discussed the RAE program and stated it is in its second year. The first year they really focused on the core clerkships and this past year they did more subspecialty residents. They did two workshops, focusing on leadership and team dynamics, a lot of the skills particularly geared for the first year interns as they are transitioning to residents and teaching them leadership roles. Dr. Novak asked if graduate students do much teaching and questioned whether or not they should be part of this program. Dr. Rarey stated that was a good question and that they were supposed to have their goals and objectives out of every course and if they are involved in teaching there ought to be something directed towards them.
Dr. Davidson moved onto curriculum management, which directly relates to this committee. He stated that the Curriculum Committee consists of general faculty members and students, there is participation by Jacksonville, and monitors the curriculum via the Evaluation Subcommittee. The committee reports to the Senior Associate Dean for Education and the Dean, the Evaluation Subcommittee reviews every course and clerkship and presents it to us, which with the approval of Senior Associate Dean and the Dean have the authority to correct any deficiencies in the curriculum. He showed a slide of one structure of curriculum management that the LCME requests, which is a list of the Curriculum Committee including Jacksonville faculty and non-voting members and there are other additional ex-officio members who are not mentioned in here such as Medical Director of the Harrell Center and other assistant and associate deans.
Workload is another issue. There are guidelines established in pre-clinical years with an average of 25 hours of contact hours per week. Dr. Romrell has carefully done the math and in fact, there is an average of about 25 hours of contact hours per week. During the clinical years, duty hours are similar to resident duty hours policy and students are routinely surveyed regarding duty hours. Dr. Davidson continued, stating that we have geographically separate campuses, students are surveyed with regard to teaching quality feedback, patient care experiences, administrative and student service issues, students on the Jacksonville campus spend on an average of 25% of their third year in Jacksonville, which Dr. Romrell states is amazing that the students accept this so well and go there with very little complaint or concern. The students in their own groups decide who goes and people who have children tend to be all based in Gainesville and some people are based more frequently in Jacksonville. He stated that says something about the program when few complaints are heard when there is that kind of disruption. There are clerkship directors appointed in Jacksonville, the collaboration between Jacksonville and Gainesville, the annual retreat, clerkship directors work collaboratively together and there is ongoing contact between them, and we have a patient log system that will detail clinical exposures in all settings.
Strengths for curriculum management include strong administrative leadership, effective administrative support from the Office of Medical Education and Student Affairs, student leadership, empowered Curriculum Committee, very effective curriculum planning and evaluation and includes participation of faculty from Jacksonville, continuous curriculum renewal plans that the Evaluation Subcommittee provides for us, strong leadership in areas of informatics, protected compensated time for educational administration, Jacksonville clinical sites well suited to the provision of the general professional education, the diversity of Jacksonville faculty, and a large well-designed simulation and patient safety center in Jacksonville. There is limited dormitory housing in Jacksonville which is a true concern, faculty assignment and compensation plan may interfere with faculty commitment to teaching, low levels of state funding for educational programs in Jacksonville, and some UF Jacksonville faculty still feel isolated from UF Gainesville faculty and this is based in part on a faculty survey. Dr. Kaunitz stated that the disruption that Dr. Romrell was referring to and the dormitory challenge would both be addressed and potentially resolved if they ever get to the point of a subgroup of UF students spending their entire third and fourth year in Jacksonville. He stated that both of those concerns would become non-concerns immediately with that change. Dr. Watson stated that the big concern then comes up in our student surveys is that if 25% of our students stay in Jacksonville the third and fourth years, the remaining 75% would be concerned that they will not have the value of educational experience over at Jacksonville.
Strengths of evaluation of effectiveness include using multiple measures to include surveys of the residency program directors and the graduation questionnaire. He states we have seen the graphs many times before that show how our students outperform what one would predict based on their admission MCAT’s on Step 1. He thinks it is worth noting on Step 2 that while Step 2 has somewhat lagged behind Step 1 in performance, there is more evidence that it is improving. There is an improvement on a regular basis in clinical subject exams across all subject exams. Other strengths include our developmental series of PBE’s, rewards of teaching efforts, exceptionally high scores on the USMLE, positive evaluation of the educational program on the GQ, and while above the national average, the Step 2 scores are not correlated with the extremely high performance on Step 1. Someone asked why the Step 1 and Step 2 scores don’t correlate and Dr. Davidson stated that the obvious reason is that there is no requirement for graduation. He thinks if we required it for graduation the pass rate would much greater. It is true in most institutions that it is not required for graduation.
Dr. Rarey presented the survey findings that students Rana Yehia and Doug Arnold presented at the retreat that included responses from 427 of our 487 students during this current academic year. Strengths overall included a positive and warm learning environment, dedicated faculty, multiple teaching modalities, innovative group activities that foster teamwork, and emphasis on interdisciplinary interaction. They found that there are great strengths with our humanism and compassion that we have demonstrated throughout the curriculum, we have consistent emphasis on professionalism in medicine, there has been an emphasis on student input throughout the curriculum, and the students feel very prepared for Step 1 and Step 2. The concerns are that there needs to be more exercises in the clinical reasoning in our curriculum specifically during the basic science years, students felt that there is still insufficient formative feedback during our basic science courses and they have a solution in terms of giving more mid-course feedback that we as the Curriculum Committee would fully endorse. Dr. Rarey stated that on the Graduation Questionnaire we are okay on nutrition, although on this student survey all of the classes felt they didn’t have enough. Dr. Watson stated that the answer to that is that the GQ compares to the average students all over the medical schools and all students perceive nutrition as not adequate, so Dr. Davidson stated it is relative and even worse at other places. Dr. Rarey stated that with regards to year one specifically, student input about strengths included good faculty, innovative methods to utilize and teach and evaluate, exceptional accessibility of faculty, immediate emphasis on clinical skills and communication through our EPC1 and EPC2, and clinical oriented medical curriculum. They expressed some concern with regards to EPC1 and EPC2 didactic teaching format, they’d rather there be more small groups and less lectures, they’d like to have more feedback on their clinical skills as they are being taught during the first year and at one time they talked about having more time in at the Harrell Center to practice their clinical skills. In addition, they felt that the IFH program was a little early in their curriculum for which they gave a possible solution of moving the course to a later point in the curriculum somewhere, insufficient use of STAN and other simulators, inconsistency in the quality of lectures and materials in the Principles of Physiology course, and a decrease in the number of lectures. With regards to year two, the strengths are dedicated faculty, they think that the General Systemic Pathology courses are the backbone of year two, continued emphasis on clinical skills through EPC3 and EPC4, Evidence-based Medicine provides students with critical skills to find, assess and apply information and there is emphasis on Medical Ethics. Concerns included insufficient active learning methods utilized during lectures- they would like more active learning, lack of consistency between the sections of Clinical Diagnosis course and insufficient emphasis on presentations and clinical reasoning skills, lack of adequate online radiology resources, and insufficient amount of independent study time. Strengths with regards to years three and four include a wide variety of clinical teaching sites with diverse patient populations, numerous attendings and housestaff members with exceptional teaching skills and dedication to their learning, excellent conferences and small group sessions in all clerkships, the Doc-in-the-box clinical reasoning sessions, our competency-based curriculum, formative feedback, significant student autonomy throughout the fourth year and the broad range of electives that they can take. Concerns for years three and four from the student body include variability in the teaching of residents and attendings, very limited time some felt during the fourth year for electives and some felt that there was inadequate information about the scheduling and how you apply for externships.
Overall with regards to the question “I am pleased with my level of knowledge skills and behavior required to date in the competency-based curriculum” with 5 being the highest, all four classes are very pleased with the competency-based curriculum. They also gave input in terms of support staff, etc., the faculty is sensitive to race, gender and cultural differences, there is exceptional staff in the different offices, there is strength with regard to Dr. Vidauretta’s office, strength with provided information about financial affairs, and orientation they found as a strength. Also considered strengths were Family and Friends Day and the White Coat Ceremony that is held at the end of the second year as they move into their third year of the curriculum. Additional strengths are accessibility of the Health Science Center, satellite clinics, a wide variety of student interest groups, faculty administration on the international medical outreach trips, faculty administration’s support of Equal Access Clinic, narratives, reflective writing, the Maren Reading Room, and our emphasis on humanism and compassion and the overall working environment by our students. There were only two concerns to include inadequate student health insurance coverage and cost and some students are concerned about the safety on campus at night even though we have SPARK and others. The only concerns at one time were insufficient library access hours, although he thinks that has been addressed, inadequate quality of Health Science Center student lounge which is being addressed by getting new floors and new equipment, insufficient number of power outlets in the lecture halls, security outside the Jacksonville dormitories, and they’d like to have hot water more consistently which has been corrected. Dr. Rarey stated that the bottom line is overall the students are very positive about the environment that is provided for them for their training to receive their MD degree.
The last question was how all four classes felt about the overall rating of their education strengths this year and they all scored that they are receiving an exceptional education here. Dr. Rarey wanted to make sure that the members of the Curriculum Committee knew exactly what was said at the retreat and that we got a feeling, from the five sections of these areas that will be looked at in February, that we have many strengths and few areas that are in need of improvement.
Dr. Watson stated that what he said at the dean’s staff meeting and his overview of it was facilities and space, which seemed to be the recurring theme. The compensation plan seemed to be somewhat of a concern and he couldn’t help but worry somewhat about the lines of communication between the dean and the president’s office.
Dr. Davidson stated that we have a great program, great students, we’re turning out great doctors; we just need to make sure the LCME knows about that. Dr. (Ritz) asked whether the LCME would be looking at all 7 years or if they’ll focus the last 3 years or a snapshot of where we’re at right now, just a general idea of how they’ll approach this visit. Dr. Watson stated that they will look at all 126 standards and each of the five members of the site visit team will be assigned specific standards in advance to cover. They will look carefully at the database in relation to the specific standards that they covered, they will all have read carefully the sub-study summary, and will literally look at the evidence to support our compliance with all 126 standards. The data we just reviewed, the USMLE report and the GQ, will be the data they will receive for the accreditation visit. They will meet with every course director and every clerkship director, a group of faculty and a group of students, program directors and all of the chairs, and the hospital CEO.
Dr. Kaunitz asked Dr. Romrell to provide the match update. Dr. Romrell stated that it is interesting data that shows how well our students do in the match and the distribution of students as they go into the match in the various programs. He thinks we’ll be amazed. Dr. Davidson gave an example stating that he has always had this opinion that if a student went into Neurosurgery or Dermatology or Ophthalmology, they would always be in the top five or ten in the class, which is actually far from being true. In Orthopedics we have had people rank as low as being in the bottom half of the class matching in Orthopedics.
The meeting was adjourned at 9:10am.