Curriculum Committee meeting
September 11th, 2007
Present: Dr. Richard Davidson, Dr. Rob Averbuch, Bhavin Adhyaru, Cynthia Karle, Chris Buciarelli, Omayra Marrero, Dr. Maureen Novak, Nitesh Paryani, Sarah Smith-Vaniz, Dr. Peggy Wallace, Dr. Kyle Rarey, Dr. Robert Watson, Linda Butson, Dr. Heather Harrell, Dr. John Meuleman, Dr. Lou Ritz, Dr. William Winter, Dr. Mike Chen, Dr. Mohan Raizada, Dr. Rob Hatch, Dr. Cari Hernandez, Dr. Bruce Kone, Dr. David Caro, and Dr. Richard Rathe
Dr. Davidson introduced the members of the Curriculum Committee. He reiterated that we aim for a diverse group of members and noted the academic chairs for each class and AAMC representative for the fourth year who are also members.
Student announcements: Bhavin Adharyu, fourth year academic chair, stated that their class is doing fantastic. They are doing applications and interviews and are looking forward to finishing up the year. Omayra Marrero, third year academic chair, stated that while they’re not doing quite as good as the fourth year, they are doing better than they were last year. She stated that eight additional class members joined after Step 1. They are in their second rotation now and she stated that it’s obvious the quality of education students receive here by the fact that they’re ahead of most other people from day one of the clerkships. They really appreciate all they’ve learned in the first two years. Nitesh Paryani, second year academic chair, stated that their class is excited to be back and that they just finished their first Pathology exam yesterday. Chris Buciarelli, first year representative, stated they are anxious and excited about their first exercise. He stated that everyone is doing pretty well in terms of transitioning. Sarah Smith-Vaniz, the AAMC representative, stated they are getting ready for the national meeting coming up in November. They are meeting with the new first year representative later today to talk about their goals for the year.
Announcements: Dr. Winter stated not too much is going on with the course directors right now. Dr. Hatch stated the clerkship directors had a pretty quiet summer. They’re getting the new groups rolling and there’s not much to report.
Dr. Genuardi was going to be the new dean of student affairs at the University of Central Florida, but Dr. Watson stated that he changed his mind about doing that; he’s going to stay in Jacksonville. Everyone was pleased to hear that.
Dr. Rarey stated that since this group last met we’ve gotten the final letter from the LCME and as indicated there were no citations about our educational program; they thought our program was outstanding. There were three citations that they want progress reports on. Two were about educational space. Dr. Romrell’s office is going to work on getting lockers in the sleeping areas for our third and fourth year students. The other policy for which there was a concern was regarding individuals who do counseling or interact with our medical students in the mental health centers, etc. They stated that students shouldn’t have interaction with those people who could potentially evaluate them later on. There will be a policy put in place to take care of that. He stated that the visit went outstanding and that the next visit won’t be until 2014. Dr. Davidson stated that all of the work of the course and clerkship directors was greatly appreciated and that it paid off by getting as good review as we could possibly get. Dr. Winter stated that Dr. Rarey also deserved kudos.
Dr. Watson stated that the budgets are in flux right now. He stated that what we definitely know is that there will be a 4% cut, although he’s not sure how much it will affect the Health Science Center.
Dr. Watson stated that Dr. Rarey and his committee have been working on deciding eligibility for educational incentives this year. Dr. Watson is working with the dean to try and get the money available for an educational incentives increase.
As was noted by the LCME, our biggest need is space. The Capital Campaign kicks off on September 28.
There is going to be a retreat at Amelia Island from September 26th-28th. The purpose is to plan the future of healthcare, health research, and health education in North Florida. Drs. Watson, Barrett and Kone will all be there.
1. Review of policies and procedures and introduction of new members - Dr/ Davidson.
Members of this committee are the faculty decision-making body regarding all aspects of the curriculum. Through the Evaluation Subcommittee, which is chaired by Dr. Rarey, we make decisions about the efficacy of existing courses and clerkships and retain the ability to make changes within those as necessary. Dr. Romrell is the implementation arm of the decisions made by the Curriculum Committee. This committee’s job is not to necessarily worry about the logistics or implementation, but to approve the very best curriculum possible. Dr. Romrell will then implement it working with Drs. Watson and Kone. There are a minimum of 11 people on this committee and we strive to get individuals who are without parochial, political or departmental influences. The academic chairs for the third and fourth years are voting members of the committee. The first and second year academic chairs are ex-officio members. Members are expected to be prepared for and attend the meetings, as well as participate when asked to serve on task forces or subcommittees. There is money set aside to reimburse members for their time on this committee. There are a number of ex-officio members. It is at Dr. Davidson’s discretion that they may or may not be allowed to vote on certain issues. Members include faculty from Jacksonville, as well as from both clinical and basic sciences. The curriculum is based on 12 educational principles that were approved by the committee in 1997. The learning objectives are developed through each principle and students are evaluated by using a competency-based curriculum.
This year we are going to update continuous programs that we’re working on and which are currently in effect including the Research Track, the MD/PhD and MD/MPH programs. There will be a meeting next week about the MD/MPH program to hopefully come up with something to present to the Curriculum Committee before the first of the year. There will be reports concerning refinement and reorganization of the Performance-based Examination series and review of the Clinical Skills developmental continuum, which are the two subcommittees appointed last year to develop a longitudinal, developmental curriculum in clinical decision making and clinical thought processes. Many of the recommendations have already been implemented. There is also an effort from Drs. Hernandez, Cooper and Rarey to improve the utility of student evaluations of faculty and courses. This is a very important aspect of the evaluation system that needs attention given the increasing importance of student evaluations of faculty for promotion and tenure. We have a trial waiting to attempt to improve those evaluations.
2. Current events and brief updates on the PBE Series and COM finances.
This has been reviewed over the last several months and there were several reasons why this was done. It was based in part on emails between Drs. Watson, Duerson, Cendan and Davidson about concerns that the Harrell Center had about the PBE continuum. Concerns included the appropriateness of the stations and whether or not those stations are actually measuring the content of the courses and clerkships for which they are intended to. There have been discussions for years about the EPC continuum. Historically there was a reason why the PBE series was independent of the EPC continuum, but those reasons are no longer in effect. At one point the EPC course included a lot of non-clinical material, but it has become much more clinical over the past five years or so. The goal is to more closely link the PBE’s with the EPC continuum. There have always been problems with remediation and what to do with students who fail one of the Performance-based exams. How do we remediate in a timely fashion? Do we have a structure in place for remediation? In the past it has been haphazard, but it has worked because we rarely have to remediate more than one student per year. Another question that came up frequently is what happens to students who fail Performance-based Exams. Should they be brought to the Academic Status Committee? Should they be put on academic probation? What exactly are the stakes for the Performance-based exams? These points will be discussed tomorrow morning at another meeting and will be brought before the Curriculum Committee next month. These include fairly controversial and significant changes in the Performance-based Exams, which are now going to be called Clinical Skills Exams so that the nomenclature is appropriate for the national clinical skills exam which takes place as part of Step 2. The decisions that have been forth by this group so far are:
The Clinical Skills Exams will serve as a final examination for EPC 2 and that will be the Clinical Skills Exam in EPC 4 and Clinical Diagnosis and that will be Clinical Skills Exam 2. They will take place in approximately the same period of time that they currently do. In the past, the PBE’s were entirely independent in terms of grading and everything else from the EPC continuum. That will no longer be the case, although EPC will continue to be pass/fail. Clinical Diagnosis is a graded course and students must pass the Clinical Skills Exam at the end of the second year in order to pass Clinical Diagnosis. The implications of that are significant because if they fail Clinical Skills Exam 2 they are failing 9 hours of coursework. That has implications in terms of academic probation.
Because the Clinical Skills Exam will be tied to the EPC continuum, the EPC course directors and the Clinical Diagnosis course directors will be responsible for making sure that the content of the exam reflects the learning and the education that takes place in the EPC courses and the Clinical Diagnosis course. They will be responsible for reviewing the stations and suggesting new stations, which will then be developed by the Case Development Committee of the Harrell Center. They will also determine who passes and who fails whereas in the past that was done the Advisory Committee in the Harrell Center. However, although they determine who passes or fails, their recommendations then go to the Harrell Center Advisory Board. The Harrell Center Advisory Board has information that may not be known by the EPC course directors such as how the students have performed on prior clinical skills exams. The Harrell Center Advisory Board will review these. Dr. Cendan will review each one and discuss it with the Advisory Board. The Advisory Board will refer students to the Academic Status Committee. Students that fail the first year clinical skills exam can remediate relatively easily. They can remediate in the Harrell Center over summer. They may also participate in a condensed clinical skills course which has been put together for the entering oral surgery students. Oral surgery students don’t do their first year; they start with the second year. In the past the oral surgery students have performed very poorly on the clinical skills exams because they haven’t had any clinical skills education. There has been a short course put together for them at the beginning of the second year and our assumption is that students who fail the first year clinical skills exams will, in addition to doing other remediation in the Harrell Center, also participate in that course then will retake the first year exam.
The Clinical Skills Exam 2 has been much more complicated and actually served as the reason for this long discussion because it takes place near the time of Step 1. The decision must be made immediately because our requirement has always been that the students must pass that in order to go onto the clerkships. There is really never enough time to think about this to remediate. Drs. Duff and Hatch have devised remediation for Clinical Skills Exam 2. Students who fail the Clinical Skills Exam 2 will remediate during a special clerkship. That clerkship will replace their first scheduled clerkship of the third year. It is unresolved if the clerkship is a six-week rotation rather than an eight week rotation. Dr. Hatch suggested if it’s an eight week rotation the students will do six weeks of remediation and then take a two week elective of their choice to make-up the other two weeks. He stated that they want to identify the best third year teachers and hold them in reserve so that anytime we have someone that needs remediation we’ll assign them to one of those students. These will be people who have been successful remediating other students. If they’re not needed, we put the regular clerkship students there and if they are needed they’re held aside and are ready to take remediation students. The individuals are Dr. Kendall Campbell, Dr. Dan Rubin, and Dr. Ron Berry. At the end of that rotation the students will then re-take their Clinical Skills Exam 2 and must pass it. Because of the lost contact hours, students will get academic credit for that remediation portion. If they don’t do that it could cause major havoc with their fourth year. This also means that one of their clerkships will be deferred until one of the first two rotations of the fourth year. Dr. Harrell will be involved in helping determine that. It will also be helpful in determining schedules for those students who performed poorly even if they pass the Clinical Skills Exam 2. We are making this a very important high stakes test. One of the reasons is that we keep hearing students say that in hindsight they don’t realize how important the EPC continuum is. The students in the first two years do not appear to grasp that. This will emphasize the importance of the EPC continuum for their success in the third year. If they fail CSE 2 they will be put on academic probation because they will have failed two courses in the process of doing that.
The third year Clinical Skills Exams will be reviewed and evaluated by the clerkship directors who will be responsible for updating and reviewing the stations and making sure that they reflect current thought processes and current diagnostic issues in their particular clerkships. Remediation for that would be determined by the Oversight Committee.
It was clarified that this will be implemented this year. Dr. Novak asked if this would include Pediatrics as well. Dr. Davidson stated that it is the responsibility of Dr. Hernandez as the course director for Clinical Diagnosis and Dr. Pauly as course director for EPC 4 to make sure that the learning content reflects the general professional education of our students.
Bhav asked if we plan to incorporate Doc-in-the-Box sessions during those two courses. Dr. Davidson stated that is part of the Clinical Decision Making Subcommittee’s report that will come out sometime before January. They reviewed the clerkships and had recommendations about having those kinds of conferences within each clerkship. The same thing holds true for the clinical courses in the first couple of years. Some of the implementations have already been made such as Basic Grand Rounds that are going to run throughout the first and second years. They are approaching this clinical thinking and clinical thought process curriculum as one of their major efforts.
It was clarified that students will be working one on one with a faculty member. Dr. Hatch stated that it turns out that there are pretty much universal problems these students have and that it is mainly a lack of a structured approach. Dr. Watson suggested utilizing the Jacksonville clinical faculty to help with this if possible.
Dr. Davidson mentioned a new procedures course which Jocelyn Gravely is developing that will involve the use of simulation and a variety of other things.
3. Review of student performance on Step exams – Dr. Romrell (presented by Cynthia Karle). The assessment methods used by faculty include the competencies, grades, clinical skills exams, external exams such as Steps 1 and 2, peer evaluations done by the students, and tracking of the clinical experiences. In January, the students will also be able to denote whether their patients were real, standardized or simulated. She pointed-out that they do keep track of both competencies and grades for the students. The class rankings are based solely on grades, but Dr. Duff uses both competencies and grades equally in his Dean’s Letters, which are crucially important to each student.
Our student’s scores on the external exams are consistently above the national mean. There was a brief discussion about our admission policies. According to the Graduation Questionnaire, 99% of our students were satisfied with the quality of their medical education at UF. As to how these high scores translate into residency, 90% of our graduates get one of their first three choices, 98% match in the residency of their choice, 60% stay in Florida, and 35% come back to UF for their residency program. About 75% of our graduates become chief residents regardless of where they go.
Dr. Kone stated that he went to Emory University who has a spectacular new education building and has also undergone what they consider revolutionary changes in their curriculum at the same time. He asked their dean which process informed which; did they develop their curriculum and then decide what building would fit that curriculum or the other way around? He said it was informing both, but that the curricular structure that they had was how they designed the building. He stated that when we think about the type of medical education building we want in 2010 and beyond and while we’re making decisions about curriculum, we can keep that in mind.
He also stated that one of the things he would like the faculty in the College of Medicine to do is to start to look beyond how our students are doing in medical school and try to determine how many future leaders in medicine we are going to have and how many future leaders in our community we are going to have. He is positive we have terrific doctors. Our goal as we move forward now that we have this terrific population of students is to nourish them to become these types of people and help to select those types of people. He hopes that we would be remembered for the contributions of our students to healthcare in general and to the communities as national leaders.
Dr. Watson discussed the cost of medical student education. Almost 65% of our budget is based on clinical dollars. The state provides only 5.3% of our budget and tuition and fees are 1.3%. Research is 27%, which is important when you look at how the money is spent. Research dollars are pretty much a wash. Whereas the clinical dollars represent about 65% of the incoming, it only represents 55% of the outgoing, which means it’s a subsidizer. Education is also being subsidized, but the overwhelming part of that subsidy is subsidizing resident education and not medical student education. That money is spent on graduate student education, PA student education and medical student education, but the biggest piece of subsidy is in resident education because we don’t get funded for faculty effort in resident teaching. He said we run a pretty thin bottom line between what comes in and what goes out. Faculty education effort is a big cost. The direct cost per student is $53,690 and the total direct and indirect cost per student is $77,851. Because we invented mission-based budgeting, we have the best data on the true cost of medical student education. Tuition covers about 22% of a student’s education; 78% is covered by other funds. We’ve not been happy by the increase in tuition, although we have absolutely control over it. A significant amount of the increase in tuition has been greater than the rate of inflation. With the graduating debt of our students approaching $100,000, Dr. Watson feels that is an influence on what students choose to do with their lives, not only the specialty they choose to go into, but whether they can afford to be future leaders, future academic clinicians and future clinical scientists. He questions whether the market exists to support them being able to pay off those kinds of debts. It’s even worse for the out-of-state students who pay $51,500 per year, which puts us easily in the top ten.
We will discuss the clinical skills exam continuum at the next meeting. The meeting was adjourned at 9am.