Curriculum Committee meeting
October 9, 2007
Members present: Dr. Richard Davidson, Dr. Robert Watson, Dr. Margaret Duerson, Cynthia Karle, Dr. Peggy Wallace, Dr. Sigurd Normann, Dr. Kyle Rarey, Sarah Smith-Vaniz, Dr. Frank Genuardi, Dr. Maureen Novak, Chris Bucciarelli, Dr. John Meuleman, Dr. Beverly Vidauretta, Dr. Judy Bowers, Dr. William Winter, Dr. Heather Harrell, Dr. Juan Cendan, Dr. Rob Averbuch, and Dr. Bob Cook
Announcements: Dr. Winter stated that last month at the Course Director’s meeting they talked about students being on time for lectures and exams and the potential for a paperless first and second year. They will be continuing that discussion today along with some other issues. The majority of students are on time, but for those who are not there is a concern that it reflects a lack of professionalism.
Dr. Genuardi noted the transition that is going on in Jacksonville in terms of leadership in Emergency Medicine. Andy Godwin, who was Clerkship Director years ago, has been Program Director and will now be the new Director of the Simulation Center. Dave Caro who was the Associate Program Director will now become the Program Director. Tom Morrissey who is now the Clerkship Director will become the Associate Program Director and Jeff Garrin, who has been participating in a lot of the clerkship activities will become the new Clerkship Director for Emergency Medicine; he and Tom Morrissey are in a transitioning phase for the next six months. It was noted that Jeff Garrin will need to obtain the Clerkship Director’s handbook.
Dr. Genuardi stated that he and Dr. Duff have been working on addressing the LCME’s concern about healthcare issues for students. There is now a policy in place both in Jacksonville and Gainesville that allows for students to see physicians who are not involved in educating or evaluating them for their healthcare. This was also posted on the website. Students will continue to be allowed to see the doctor of their choice.
Dr. Watson stated that we are facing a four percent cut from the state, although none of the cuts will be from education funding. There will be another cut in the spring.
Dr. Watson stated that he has communicated with the chief financial people in the Board of Governors regarding the cost of medical student education. Based on our database we’ve collected since 1992, we’re probably the only place in the country that knows the true cost of medical student education. He has presented the mission-based budget information and it seems they agree that this is the way all medical schools and universities should do it. He is optimistic for the first time that this may happen.
Dr. Watson noted another important event, which was the conference in Amelia Island he attended from September 26th-28th entitled “The Caring Community Conference” that was held to plan the future of healthcare, health research, and health education in Jacksonville. Topics included needing more medical residencies that the community can help pay for, needing a regional medical school campus in Jacksonville, and needing a Bioscience corridor running between Gainesville and Jacksonville.
He mentioned that the kick-off for the Capital Campaign for the Health Science Center where the new education building was the highlight issue went really well. We are starting to make firm plans on how to raise money and get the building built.
1. Changes in the Performance Based Examination series – Dr. Davidson.
Dr. Davidson stated that the changes to be made in the PBE Series are ready for final discussion and approval from the Curriculum Committee. These changes were instituted essentially based on extensive email conversations between Drs. Duerson, Cendan, Watson, Davidson and others regarding the quality and makeup of the Performance Based Exam series and their concern about the fact that we’ve been using some stations for many years which have not been updated. It wasn’t clear with changes in course directors and courses that the PBE’s were actually measuring what was being taught in the EPC course. It was also felt that content from the Clinical Diagnosis course, because it includes important clinical aspects, should be included as part of the clinical skills exams. That led to a number of meetings and an ad hoc group that included course directors for the EPC continuum and Dr. Hernandez who is the course director for Clinical Diagnosis and Drs. Duerson, Cendan, Watson, Davidson and Harrell because this will also impact the fourth year.
The major points are that we are changing the name to reflect what the students are doing for their national exams, which is that they now have to take a clinical skills exam as part of Step 2. These are clinical skills exams; therefore we would like to be congruent with them in terms of naming what we’re doing.
Another motivation for this is the fact that we had multiple students come back to us and say that they hadn’t realized how important Essentials of Patient Care was and that because they are pass/fail courses they didn’t put as much time into them. Subsequently, they didn’t feel as well prepared as they might have been when they got on the wards.
There was discussion about students who fail the second year CSE being put on academic probation. It was clarified that remediation has been done in the past, although haphazardly, and that students were allowed to proceed to the third year even if they did fail the second year PBE’s. It will definitely get students attention if they fail and are placed on academic probation. It will not be counted as part of their grade, but they have to pass it in order to go onto the third year. CSE 2 will serve as the capstone examination of the first two years of instruction in clinical skills.
Dr. Duerson stated that Dr. Hernandez feels more comfortable having it as pass/fail and not part of the grade. They haven’t gotten far in deciding what the content is going to be because they’re still planning their course. Dr. Winter stated that he thinks in a sense it is included in the grade because they can’t pass unless they pass the exam; it’s just not a numerical score. There was discussion about what would be done if a student failed the USLME and the CSE at the same time and it was clarified that the Academic Status Committee would make recommendations in that kind of situation. Dr. Normann asked what the rationale is for having students receive credit for the remediation. Dr. Davidson stated it has to be that way because the students wouldn’t have enough credits to graduate if they didn’t receive credit for the six weeks of remediation. Dr. Harell stated that the remediation is very much like a fourth year elective anyway. Dr. Davidson also stated that the students would be required to double-up a lot in the fourth year, which isn’t what we’d want for these particular students. They are working in a clinical setting on a day-to-day basis and they are closely observed and are working one-on-one. Dr. Harrell moved that we approve the plan and Dr. Winter seconded it. All members were in favor of the approval.
2. Brief update on MD/MPH program – Drs. Davidson and Cook.
This is a preliminary informational presentation and Dr. Davidson still has to meet with the dean about it. If Dr. Kone approves it, it will go to the Executive Committee then back to the Curriculum Committee for approval.
This combined degree program is a 5 year combined MD/MPH program. Students tend to prefer leaving after the second year of medical school to obtain their MPH degree and then come back to finish medical school. Dr. Davidson is opposed to students leaving after their second year for a year and then coming back and starting their clerkships in the same way that he doesn’t think the MD/MPH program benefits students by having them leave at the same time and then having them come back and immediately start on the wards. For that and for other structural reasons having to do with scheduling, this proposal means that the students will go for one year to get most of their MPH coursework done after their third year after they’ve completed their clerkships and more specifically after they’ve completed their clerkships and done two months of their fourth year during the summer after their clerkships here. Then they will begin a year of MPH coursework and then resume their fourth year of medical school.
There are some crucial aspects of this that impact on our student’s schedule and financial issues as well. In order for this to be a joint program, both colleges have to accept 12 hours of credits from the other college for the degree, which means that 12 hours of medical school coursework will count towards the MPH program and 12 hours of MPH program content will count towards the MD degree. One of the things that translates into has to do with tuition. We don’t charge by the hour; we have block tuition. However, we will need to calculate on a per hour charge because our students will be taking 12 hours fewer of medical school courses, so their tuition will be less. Their tuition will also be less for the MPH degree because 12 hours of our credit will go towards their degree. Because so many of students have financial aid, this will also require integration between the financial aid offices in both colleges as well. The other thing that the 12 hours of credit translates into in terms of our students is that if they take two months of their fourth year at the end of their clerkship year, they then get 12 credits of the MPH coursework, which is three months of credit. They will have three months of credit plus two months that they’ve taken, which is five months of their fourth year completed when they start in fall of their fifth year, which would be their last year of medical school. Dr. Davidson feels that would allow students a great deal of flexibility in terms of the kinds of electives that they can take during their fourth year. Some students may also look at it as being done three months earlier with their fourth year. Dr. Cook stated that a required component of the MPH degree is that the students have to do a public health internship, which is at least 5 credit hours at 48 real hours per credit hour, so they need to spend at least 250 hours in a public health agency such as a health department, etc. Students will probably have to do that internship in the fifth year of the combined degree, so they won’t be able to completely take off. Dr. Davidson stated that could be a disadvantage in terms of limiting the amount of medical school electives that they can take in their last year.
Students would complete their clerkships in the third year and then apply to the program early in the third year or before that. There is currently one student interested in the program who hasn’t yet begun his first year of medical school and there’s one other student that Dr. Davidson knows of who is interested. In order to start this in the fall of 2008 which is our tentative aim pending everyone’s approval, we would like to get this approved and start recruiting students for this early next year. It was clarified that the students will have two months, July and August after their clerkship, to take two months credit of their fourth year. Then they’ll start one year of MPH coursework and then in the fall they’ll start the remainder of their fourth year but will be responsible for doing their internship, which actually could overlap with their MPH content as well. Dr. Cook stated they’re still trying to work that out, but that the traditional way to do it would be to block out several months to do it. He stated it may be to people’s advantage to establish their internship early and be able to spend more time with less intense experience, which might allow them to produce a research paper. A goal with being an MPH student would be to try and get them to complete a publication based on their work and it’s hard to do that if they wait until the very end to actually start.
Dr. Davidson anticipates approximately two students a year signing up for this program. It was estimated that medical students would pay $10,000 of the $15,000 tuition for an MPH degree in addition to the tuition for medical school, although there will also be a discount in medical school tuition because of the decreased credit hours they’ll be taking.
With the MPH degree, there are concentrations that are similar to a major category that is selected to get an MPH in. Those include content areas such as Epidemiology and Biostatistics or Health Administration, Environmental Science, or Social Behavioral Sciences. Students may choose any of those concentrations; however, with the way that the credits are set-up, every student that gets an MPH has to take core courses in each of those disciplines, which is a requirement and is for 16 credits. Then depending on the concentration they select, there are required concentration core courses that vary from 12 – 15 credits depending on the concentration. Those are the courses that would count towards the MD degree. There is one concentration called Public Health Practice that we would recommend medical students take because that allows them to take different types of courses and allows them to have much more varied experience during their MPH year. However, they can do any of the other concentrations that are available. Dr. Cook stated that there is not a concentration in maternal and child health, although there is an elective. He thinks the next concentration will be related to International Health because there is a lot of interest in that.
The question was raised about a resident wanting to obtain an MPH degree and Dr. Davidson stated that may be feasible in the future after this program becomes successful. He stated that all of the core courses are now available online, although because they have few faculty members, classes may be offered only one time per year and so there are issues about having to take one course before being able to take another course.
Dr. Cook stated the reason it is feasible for medical students to get an MPH degree in one year is because of the 12 credits from medical school that they get. Residents may not be able to have medical school credits transferred and will then have to take 48 credit hours, which is almost a two year program. There is a formal certificate program that can be taken that is 15-16 hours and they are working to make that more prestigious. After the initial program is established, they will begin looking at residents and fellows being able to obtain an MPH. Dr. Cook stated that in his experience, it is rare for residents to have time to get an MPH, but it is common for fellows and it is common for the fellowship program to pay for the MPH. That is the financial advantage of waiting to get an MPH until they’re a fellow.
Dr. Davidson thinks this is good thing for us that offers our students an option, but he prefers that students not get their MPH during medical school or residency. He prefers that they get it after residency because he’s seen a number of students that get their MPH during medical school that do use the degree. There are various reasons why they want to get their MPH, but many of them do not have a clear picture of what their career path is going to be.
Dr. Cook stated that there is a Preventative Medicine residency that actually includes an MPH. For students that aren’t clear whether or not they want to do clinical medicine, most preventative medicine residencies include one year of an internship, one year of research and getting an MPH, and another year that is sub-clinical. It was stated that there are approximately 15-20 preventative medicine residencies around the country.
Dr. Cook stated that we will set-up an advising system that will try to help students make the best decisions for them. Dr. Davidson stated that we will be hearing more about this.
The meeting was adjourned at 8:45am.