Curriculum Committee meeting July 25, 2006
Members present: Bhavin Adhyaru, Dr. David Caro, Dr. Richard Davidson, Dr. Kyle Rarey, Dr. Lynn Romrell, Dr. Cari Hernandez, Linda Butson, Cynthia Karle, Dr. Robert Watson, Dr. Heather Harrell, Dr. Maureen Novak, Dr. John Meuleman, Dr. Louis Ritz, and Dr. Mike Chen
Student announcements: Bhavin stated they have finished second year and some of them are waiting to get their Step 1 scores back. He stated that he thinks half of his class is relieved, but the other half will be having palpitations until 1:00 tomorrow. Everyone is really enjoying third year and having fun and they’re really happy to be here.
Announcements: Dr. Romrell stated that with regard to 1:00 tomorrow, two weeks ago he opened the file to see how well this class has done on the Step 1; the scores that have come in are remarkably strong. They are keeping up with a very strong tradition of excellent performance. His anxiety, just like Bhavin’s, is going for tomorrow at noon when the scores are released again. The class has done well as they finished off the second year and the PBE performance was really solid. They are planning towards the new class entering. There will be a class of 131 students because they will have 4 oral surgeons joining the class in the second year.
Dr. Watson stated that this year is the first time that students are required to have a laptop. Room C-15 will be supplied with power so they can keep their laptops charged up. He stated that later today the Dean Search Committee member list will be coming out. He appreciates Doug Barrett’s seeking advice about members of the committee. It will be chaired by Kathy Long and vice-chaired by Win Phillips. Other members include Mavis McKenna, Ken Berns, Ed Block, Kendall Campbell, Fonda Eyler, Bill Friedman, Susan Frost, Heather Harrell, Richard Johnson, Lucia Notterpeck, Bob Nuss, Marco Pahor, Johannes Vieweg, Charlie Wood, Karl Altenberger, Tom Fortner, Marge Kovacevic, Karen Bodnar and Tim Goldfarb. They say that they plan to select the new dean by late spring to be in place by next summer. Dr. Watson congratulated Dr. Harrell for representing us and says we are fortunate Dr. Harrell will be on the committee. Dr. Hernandez stated this is a very diverse group and she’s excited about some of the names he mentioned.
Dr. Davidson stated that at the Executive Faculty Retreat the strengths and weaknesses of all of the LCME sections were presented and a final list of strengths and weaknesses was developed. Dr. Rarey and Dr. Romrell are going to discuss how this was done and look at the final list of the strengths and weaknesses, which is an important aspect that everyone in the Curriculum Committee needs to be aware of because each member will be meeting with the LCME visitors at the site visit. Dr. Davidson will then present an initial discussion about a joint MD/MPH program that will begin soon and he’ll talk about the subcommittees, about the rationale for them and what we hope will come out of those.
Dr. Romrell stated there is too much detail to give all the numbers, but he’ll give a flavor of what went on. Data was gathered from a number of sources. A faculty survey was compiled. They did a student survey of the curriculum and the school and the services provided. All of that data was compiled and then each one of the five subcommittees of the LCME Taskforce prepared summary reports and from that created a list of strengths and weaknesses. The three groups, the LCME various teams, the students and the faculty surveys were all compiled and presented to the Executive Committee. The file of the faculty survey data will be put online. Dr. Romrell color-coded statements in green when 90% or more people agreed with that particular question so the strengths could easily been seen. The faculty in general was very pleased with the functioning of the dean and his administration to the school. When support in terms of positive response to statements started to get lower, he used yellow as a kind of warning and red when there was a concern. When the question was asked if the institution fosters collegiality among the faculty and if there is there a commitment of faculty to education, the support was a little less strong. In regards to the education programs, the whole section was very positive that faculty feels like the educational program is extremely strong. There was some concern about the integration between Jacksonville and Gainesville, although it was still on the positive side. There were also very strong numbers in support of clinical resources. Areas where more than half of the faculty had concern were adequate financial support for education. This is the faculty’s perspective on it and we should be concerned about this declining state support for education. If we especially got tuition back instead of it being taken by the campus and put into general revenue, we could easily pay the cost of education with tuition state funding. The perception of the faculty about the library was extremely positive. Even though the library may struggle with funding, the faculty is very satisfied with the library. Each member can go online and look at this data further, but in general the faculty is pretty pleased about the programs here and there are very few concerns.
In terms of the functioning of various committees, they identified on every single committee a series of strengths and weaknesses and they answered specific questions required in the LCME report. The first section was a committee that worked on institutional setting. This was presented to the Executive Committee, they looked at each strength and weakness, they heard reports from the committee chairs and then the Executive Committee voted on how significant they thought that concern or strength was. That information went to the Steering Committee for the LCME process and that committee which includes Dr. Romrell, Dr. Watson, Dr. Pauly and is comprised of about 15 members, looked at this prioritized listing of strengths and concerns. These will also be put online so they can each be individually reviewed. It was asked how many people were on the Executive Committee and Dr. Romrell stated there are about 40 people who voted on these items. All of this data went to the Steering Committee after the items had been ranked by the Executive Committee and they came up with that list.
The item that had the absolute strongest support was the strong leadership provided by the deans and that tied over into the educational administration in other areas too. They decided to rewrite that into a combination of dean and the administration of the school. It was ironic that the Executive Committee voted that this is absolutely the strongest support for any statement in this report and the dean announced at the end of the meeting that he was going to step down.
We have a good budget system and model of management of educational money through mission-based budgeting has been picked up by the AAMC and is being promoted around the United States. There is innovation in how we made our agreement with Shands to share the profits from Shands. The compensation plan, although there are areas of concern, overall is well written and the faculty voted on it. It has been endorsed and is now in its second edition and is considered a strength. We have a strong research program and the program in basic sciences is in itself really large. The interdisciplinary program and the graduate program was cited. There is good institutional support for the graduate program. There is a lot of breadth in GME many different specialty programs are represented. There is going to be an expansion of the residency program. The chairs thought that is a very important step for the college to expand those programs. The diversity of research programs here is looked upon as a strength. The president says we need to be in the top 10 and our faculty in the basic science part is a third of the size of the major institutions that have the big funding. The president wants to see our research programs grow and we have to put some money into faculty. The current research space is adequate, but there is concern that even though we have built new buildings that we still can’t expand the research without expanding the space. The program in medical student research track is looked upon as a real strength.
The MD/PhD program is undergoing some revision and there was support for that. Our MD/PhD program is basically phasing out. Dr. Romrell states he believes there are only 7 students who are currently in the PhD portion of the track; we maxed out a few years ago with 23. It was noted that there is strong departmental leadership and a large and growing clinical faculty on the two campuses. There is a real concern that we essentially don’t have the capacity on the clinical side to go beyond where we are right now so there is a need to grow our clinical enterprise. Those were looked at and the Steering Committee as they looked at those decided they could capture what is in all of those strengths and concerns and put that into a more organized list. They hope to come up with about 10-15 strengths. The weaknesses that were identified were much fewer numbers so they thought they’d end up about 3-5 weaknesses. He stated they went through a very systematic process. First they did their self-study, then they had their subcommittees for each one of the areas on the report write an extensive report and each one of those subcommittees identified strengths and weaknesses. They reviewed that with the Steering Committee and then the Executive Committee.
1. Dr. Rarey presents a follow-up on strengths and concerns of the educational program (LCME).
Dr. Rarey began his presentation and reported that 5 task forces reported and came up with 100 strengths and 26 concerns that were reviewed at the retreat. The Steering Committee summarized the information into the following 8 strengths and 3 concerns.
Strengths:
Strong solid administrative leadership.
Concerns:
Dr. Watson asked if everyone completely understood the LCME accreditation site visit. Dr. Ritz asked what information the LCME committee actually sees and Dr. Davidson stated they see the entire database. They are going to pay most attention to the summary which is being written now. Dr. Watson stated it is very intense when they come through. They listen carefully to what faculty says and they listen more than anything to what students say. The students get a good education and appreciate their education. All of the other information determines whether or not it adversely impacts the educational program. Dr. Watson stated that the Health Study Summary is so important; every member of the team reads that.
2. Dr. Davidson presented his initial discussion about the joint MD/MPH degree program.
Dr. Davidson stated he has been working for several months on the MD/MPH program. He wanted to present this now because we may be able to begin this a year from now. Dr. Davidson stated he was told that Bob Marsden, when he was president of the university, was offered to have the school of public health here and turned it down, which is in his opinion a major mistake. The school of public health ended up in Tampa and having been a faculty member at a place that had good collaboration and interaction between a school of public health and a college of medicine, he thinks is a great detriment of this institution. Dr. Ken Berns was interested in developing a joint program at USF and appointed Dr. Davidson to work them. At the same time they were starting to do that, Bob Frank proposed that there be a joint program here that should be jointly administered by three colleges, Medicine, Health Professions and Health and Human Performance, which is up on campus. This was approved by the university, approved by the state and the students were entered in 1999-2000. He was the College of Medicine representative to that and there were representatives from the other colleges as well. The administration was to rotate among the three colleges. They admitted 35 students per year until 2002 when they actually had 48 students. Dr. Bob Frank stepped in and he negotiated funding from the provost and the program became part of the College of Health Professions, which then changed its name to Public Health and Health Professions. Mary Sheps was appointed to head the program in 2004; her husband is on faculty in Cardiology at the VA. The current program is maturing well and is on its way to accreditation and has obtained approval to have a separate department of Epidemiology, which is required for their accreditation. The current MPH program has the following departments in it: Epidemiology headed by Elena Andresen, Biostatistics headed by Linda Young, Social and Behavioral Sciences headed by Barbara Curbow, Environmental Health headed by Steve Roberts, and Health Services Research, Management and Policy headed by Paul Duncan. The current requirement for the MPH program is as follows: 48 semester credits of study at the master's level, which usually takes two years, 15 credits in the core public health courses required of all students which is required in all public health programs, 21-27 hours of specialty core courses and electives in the student's chosen area of interest, up to 6 credits of general electives and 6-9 credits of a final special project and seminar which is crucial because Dr. Davidson is working on this now. All students must complete a comprehensive exam; there is no master’s thesis. Students are admitted into one of five concentration areas, including Biostatistics, Environmental Health, Epidemiololgy, Public Health Management and Policy, and Social and Behavioral Sciences. There are plans for international health at some point; so far one faculty member has been interested in that. Students may specialize in more than one area if approved by their committee.
There are two options that we are working on for medical students.
Option 1: Begin as a joint MD/MPH student and complete both degrees in four years. This is actually based on the structure that had been present for a long time.
Option 2: This option may be a little more realistic because in order to begin option 1 the student would have to be able to decide this before beginning medical school. Through option 2, students may take one year out of medical school and complete both degrees in five years, which ordinarily would take six years, so essentially they could save a year by going with option 2.
With option 1, students begin in summer session prior to their first year and would be required to take six credits of public health core courses during Summer C. This is one of the things that needs to be updated because as of right now those credits are not available during summer C, but they will be for next year. College of Medicine coursework would count toward 12 credits, and students would need 9 credits of online core courses whenever they can take them, which would currently be in the fall or spring. They would also be required to have 15 credits of concentration core courses between first and second year or in the fourth year. Students would work at the Duval County Health Department during their Family Medicine clerkship in their third year. They would have one or two clinics per week to meet the requirement for the Family Medicine clerkship and the remainder of the time they would work on projects at the Duval County Health Department. This would count as their internship that they have to do to meet the requirements for the MPH program.
For option 2, the College of Medicine coursework would count for 12 credits and the 6 credits during the Family Medicine Clerkship, then there would be 6 credits of core content between taken years one and two, and then 24 credits during an extra year, less however much coursework was done in the fourth year. 24 credits is half the requirement, so that is usually a one year MPH training load. If students did additional coursework in the fourth year, during that extra year they wouldn’t need to get 24 credits.
Dr. Romrell suggested that what they ought to do with the credit in the fourth year is that the 12 credits done during medical school such as Epidemiology and Evidence-based Medicine should count towards this degree, but he thinks for fourth year they should double count up to three of the elective periods so it counts towards medicine (?and) it counts towards this other degree. He would make sure to change the phrasing for that. He thinks that option 1 would be impossible and it would be cruel and unusual punishment to come in the summer before, work hard, start medical school, and be blown away by the pace of it. In the 10 week block they have off between years one and two, and it would be an overwhelming load to put 15 credits into that crammed time. He thinks a year off is a better way to do it. For option 2, dual counting credits in the fourth year is routinely done on campus as well; that’s what you do with joint programs. Dr. Davidson stated that they have discussed that and for example, there is a managed care elective and if they took that it could easily be justified as counting towards their Health Policy and Management hours; those could easily be joint. Dr. Davidson said to remember that much of the coursework will be online and therefore learning can be done asynchronously so it’s not that they have to go to two lectures, etc. The thing that surprises Dr. Davidson is that so many students have done this at Tulane with this exact kind of structure where you start early. Tulane has a well recognized School of Public Health and is one of the strongest training programs for that in the country. Dr. Hernandez asked that if they went with the second option and had the fifth year if they would incur an additional year of debt. Dr. Davidson stated they hadn’t discussed tuition yet, right now they are talking hours. Dr. Romrell stated that usually what happens with joint programs is that the student would drop down to the lower tuition, so they’d be in a master’s level program and would pay master’s level instead of medical school level credit. You’ll save quite a bit of money on tuition, but you are accumulating more debt. You have to defer the debt while in medical school so you have to work with your financial aid officer, but in the end they end up accumulating probably $25,000 more in debt to pick up this year. They’d have to weigh if it was worth having the extra initials at the end of your name. Dr. Davidson stated that we’ve had a number of students go away and do this and he feels it would be nice to have the option here. In terms of tuition, their college is very different from ours because the tuition does go to them and they are deficit funding their entire MPH program. Tuition monies are very important to their college’s survival.
Dr. Watson asked that if a student was always at Equal Access Clinic if that could somehow be fashioned into a course where they could get credit in the MPH. Dr. Davidson stated that in a way they can get credit for it in Equal Access now in the community service elective that he oversees. He stated that would certainly be something he could discuss with them because they would rather have it done at the Public Health Department as opposed to Equal Access. He thinks those are all things that can be discussed as we get further along. Until they get their online coursework ready, this is going to be theoretical anyway.
Dr. Ritz asked how you gauge the interest amongst the incoming students. Dr. Davidson stated they have not done a survey, but he would say we have about 5-6 students out of every class that ask us about various public health careers and what the future might hold. He thinks very few students will sign up for this under option 1. He stated that things are different now than they were 10 years ago in terms of the intensity of the first year and they are probably very different here than they are at Tulane. He thinks it would be a challenge and would require a very mature student who really has a clear career path and we do have some of them. Dr. Novak questioned whether or not we lose students because of not having an MPH degree available during training. Dr. Hernandez stated that starting this track will change the sort of students we attract and that we will attract students who have interest in public health careers, especially because at the other end there is now a renewed interest now that the country is aware that our public health infrastructure is a mess and there is funding. Dr. Davidson stated that Bill Livingood came and presented the Institute of Medicine report that he was involved in that had to do with increasing training in public health. Dr. Davidson stated that Dentistry and the Vet School are working concurrently with us on developing almost identical programs. Dr. Davidson stated he’ll keep everyone apprised as we get further into this and if he can negotiate fewer hours required for our students, he’ll do that.
3. Dr. Davidson discussed the Clinical Skills Continuum Subcommittees.
Dr. Davidson said he and others think its time that we assess the developmental process of clinical skills, which he considers to be one of the strengths of our educational program. We evaluate in a developmental fashion using PBE’s, although we’ve not really had that much organized material in the clinical years, not nearly as much as we’ve had in the pre-clinical years. He wants to look at this and see how this continuum actually holds up. He has subsequently appointed two subcommittees. The first is a Pre-clinical Continuum Subcommittee. The overriding goal for this subcommittee is to review the continuum and clinical skills instruction of the first two years for consistency of content and evaluation. There are several cards he is interested in to include the fact that we have a lot of clinical faculty that give clinical correlation sessions in basic science courses. He would like to make sure that those clinical discussions are guised in some way in which they can interest the students and begin to teach the students about clinical decision making and developing differential diagnosis. There needs to be some kind of organized way to look at the clinical correlations in the basic science courses so that they can fit in with this longitudinal clinical skills instruction. He also wants to verify ways to strengthen the EPC continuum. One of the ways we may be able to do this is instead of relying on inpatient which is always a challenge to get and then students go up and they’re not there, maybe we can find some way to do this using the ambulatory setting so that the students can see patients in the ambulatory setting and possibly have the faculty’s time covered by educational research funds. We should also consider creative uses for simulation within the preclinical curriculum, and appraise the correlation of the evaluation system (PBE’s) with the instruction. This is for the pre-clinical years and the subcommittee that is going to approach that will be chaired by Dr. Whit Curry, Rebecca Pauly, Melanie Hagen, Cari Hernandez, Bill Winter because he’s the chair of the Course Director’s Committee, Dan Rubin who is a faculty member in Family Medicine who teaches in EPC and would probably have a good perspective, Janice Ho who is one of our graduates, Maureen Novak who is a clerkship director, Doug Arnold, Rana Yehia, and several as ex-officio members. The clinical subcommittee will determine new ways of integrating and assessing advanced clinical skills, such as clinical decision-making and patient management into a defined curriculum, which currently doesn’t exist longitudinally across all clerkships. We should consider ways to include involvement by each third year clerkship and each subinternship. There are a variety of different ways that this could be done to include making sure that case-based discussions occur in small groups, for example the Doc-in-the-Box sessions that Dr. Lynch and Dr. Harrell do in Medicine, individual oral examinations to discern clinical thought processes, the use of simulation, or CPC’s. Dr. Davidson went to a medical school that had CPC’s and he still remembers a number of them that occurred. For those that aren’t familiar with traditional CPC’s, they include taking a patient that has an unknown disease, usually that died, and getting someone that is unaware of their diagnosis to discuss how they would approach making the diagnosis of this person.. They can be a great method of learning how a very smart person approaches a clinical presentation and how to put things together, even if they don’t get it right. You also have students vote as to what they think the person had, and then the person says what they think they had, and then the pathologist gets up and says you’re an idiot. But the point is not whether or not you get it right, it’s really how you approach it. Continuing with the presentation, he stated we should consider the following concepts and how they can improve clinical decision making: algorithms and evidence-based medicine, reducing cognitive errors, and the use of decision rules. These concepts might be implemented in group didactic sessions. He thinks maybe we should have a continuous didactic session during the third year in which we can enhance the education of the students with regards to these topics. We should also develop ways of evaluating these skills as part of the PBE continuum. He states that the problem is that we assume that students pick this up by working with us on wards and when working with students on wards he can tell that they might and they might not pick things up. When looking at PBE3’s and the PBE3 results it is clear that some students don’t have a track that they follow as to how to reach correct conclusions. He thinks we can help them and can develop something that will enhance their ability to use at least a hypothetical deductive method of problem solving where they would develop a series of possibilities in their mind and then exclude them either on history, physical or lab tests. Everyone ought to be able to do that, but looking at some of the PBE3 performances, he is not sure that the students grasp that. Dr. Davidson is going to chair the subcommittee and the members are: Dr. Heather Harrell, Dr. Rob Hatch, Dr. Shireen Madani, Dr. Bayard Miller, Dr. Juan Cendan, Dr. David Caro, Dr. Paulette Hahn, Dr. Bryan Prine, Karen Bodnar, and Dean Chapman. Dr. Watson stated for the second committee he thinks Linda Butson should be on the committee or anyone from the library and maybe as an ex-officio on both committees because of the ability to go and be able to search. Dr. Harrell thought that was a great idea. She mentioned Up-to-date and says that’s all anyone knows how to do anymore. Dr. Davidson stated that the searching workshop in his course has traditionally been one of the lowest ranked parts of his course and this year it is much better and the students seemed to appreciate it more. Dr. Davidson stated that one of the topics listed was Evidence-based Medicine and he doesn’t think you can divorce the use of the internet and the use of those services from that and he thinks it is a great suggestion as well.
Dr. Davidson said the committees will begin meeting during the summer and the presentations to the Curriculum Committee will take place after the LCME visit.
Linda Butson mentioned that Pam Newman, the Director of the Library, will be retiring as of Thursday and they are looking for a new director for the library. The new person will hopefully be able to start right after Christmas.
The meeting was adjourned at 9am.