Curriculum Committee Minutes for October 10th, 2006
Members present: Doug Arnold, Dr. Rob Averbuch, Dr. Judy Bowers, Dr. Richard Davidson, Tiffany Lacross, Dr. Sigurd Normann, Dr. Maureen Novak, Dr. Bill Winter, Linda Butson, Dr. Frank Genuardi, Cynthia Karle, Dr. Robert Watson, Dr. Mohan Raizada, Dr. Heather Harrell, Dr. Cari Hernandez, and Beth Layton
Student Announcements: Bhavin Adharyu sent an email with the third year class updates. He says they are doing well and are enjoying the third year. Everyone has finished one rotation and they are learning so much and having fun at the same time. His class received their USMLE Step 1 scores and their average was 232. The class overall was happy with those scores and he thanked all of the faculty members that have taught and mentored them so well. Doug Arnold stated that the fourth year class is rolling along and people are getting their interviews and are excited about that. Things are going well and they are looking forward to the rest of the year. There are a few people who are still not 100% sure what they want to go into, but for the most part they are falling into where they want to go.
Announcements: Dr. Davidson congratulated Dr. Sigurd Normann for receiving the 2006 Distinguished Professor Award, which is a campus-wide award. There were four of these awards given and two of the recipients were given to faculty in the College of Medicine, the other one being Dr. Josepha Cheong.
Dr. Davidson introduced new member Dr. Mohan Raizada who is replacing Dr. Sumners and thanked him for serving on the committee.
Dr. Watson stated that Dr. Jordan Cohen agreed formally to be the speaker at graduation and they are happy about that. He stated that he is also now the Chair of the Board of Directors at the Gold Foundation. The Chapman Society is hoping that he’ll have time to come a day early and do something with them.
He stated that there are a couple of students going to the AAMC meeting in Seattle. Rana Yehia is running for the Chair of the AMA Medical Student Section. He hopes she will be successful because she would be a great chair.
He stated that several of our doctors went over to Alachua General Hospital and he stated that it looks really nice. He reiterated that the Curriculum Committee is responsible for several things; they oversee the entire curriculum including the method of learning, environment, etc. He would like for a few members of the Curriculum Committee to go over to Alachua General to see the changes that have been made. Dr. Davidson asked if there was learning space available now. Dr. Novak responded by saying that they have videoconferencing. She stated that the medical students are going to do most of their learning specific to medical student teaching here. Dr. Davidson stated that Dr. Rarey is the chair of the RIME section this year and he brought Dr. Davidson the response by the group on educational affairs for the IIME report. Dr. Watson described the IIME (Institute for Improving Medical Education) as a group that the AAMC put together that includes people across the continuum of medical education and includes hospital CEO’s and is chaired by Michael Johns. He stated that Mike Whitcomb has played a major role in it as well. They have had several meetings and their biggest focus is on GME because Mike Whitcomb believes that major changes need to be made in the GME, including accreditation. Dr. Davidson stated that their report elicited a response from each of the regional Group on Educational Affairs meetings and that response also developed a number of research items. As section chair of RIME, Dr. Rarey is responsible for trying to consolidate these items. There were 42 research items that were generated in response to the IIME report. The goal is to obtain funding sources for this kind of research and they are very important questions to be looked at. He thinks the issue is whether or not we can actually get the funding to approach those questions. Dr. Davidson stated that most of them seem to be directed at medical student education. Dr. Rarey stated that the idea is to have research projects that will include undergraduate medical education, graduate medical education, and continuing medical education.
Dr. Genuardi stated that everything is stable right now in Jacksonville. He stated that there has been a change in the Pediatric program. They have been running a two-site Pediatric program for a number of years now and have found that videoconferencing has worked very well and the technology has gotten better so they have residents and students at two different places a lot of times. It has worked well and feels it would work well here. He also mentioned the Proton Beam Dedication, which will happen Friday, October 13th.
Dr. Winter gave an update from the course directors. He states they are talking about a number of issues to include the faculty’s responsibilities to attend test reviews and their expectations for student behavior at these reviews. They are also going to have an update from Dr. Rarey today. Dr. Davidson stated at the next Curriculum Committee meeting we will have a submission from the course directors for us to discuss regarding test review and professionalism.
Dr. Hatch stated that they have a joint meeting coming up in November with the program directors; they are going to try and do that once or twice a year. They are hoping to set one up with the course directors soon to get a cross-exchange of ideas. He stated that ED2 seems to be going along fine. He states they are trying to get ED2 a little more individualized by clerkship and Cynthia Karle has been helping with that. He feels that they have a great system that just needs a little tweaking.
1. Current status of the MD/MPH Dual Degree Program.
Dr. Davidson stated that they have made a fair number of changes. They were offering two options, one of which involved the student starting the summer before. The more they thought about that and the more they talked to students about it, they realized that it is unrealistic to expect that students are going to know before they start that this is what they’re going to do. When they looked at what other programs are doing, they have begun focusing on a five year program. He states that ordinarily the MPH program here requires two full years or 48 credit hours. They have not discussed tuition, etc., but that will be discussed at some point. The current outline of how this will work is that in year one, the IFH course that has to do with community and family environment and health status is 4 hours credit. In the summer between first and second years, the students would need to take 6 hours of core coursework, which is unavailable online. That would be introductory Epidemiology and Health Administration courses. In year two, EBM will count for three hours toward the degree. Dr. Davidson stated that in his opinion the best year to take a year off would be between years three and four of medical school and would like input from others on that issue. This is also open for discussion with Dr. Hatch. He stated that during the Family Medicine clerkship, the idea is that the students would work primarily at Duval County Health Department who already has a relationship with the MPH program. They would have half day a week of clinic and would have their Fridays available to do the didactic part of the Family Medicine rotation. The remaining time would be spent working in a clinical setting doing a special project for which they would receive 6 hours credit. This means that they would have 19 hours of credits after years one, two and three. During their fourth year they would need to get a total of 25 hours, nine of which can be online. The interesting thing about that is that now that they have a new concentration in public health practice, it is conceivable that this could be completed prior to January of that year and the student could therefore start their fourth year six months later than their cohorts, assuming that it could be arranged for someone to start their fourth year in January. This has to do with whether or not they can get the online courses together. During the fifth year there would be 4-5 hours of electives taken that would fulfill the requirements for the degree, which would include things like International Health and Managed Care. There will be a fair amount of flexibility in terms of what we could count towards that. A university rule states that a total of 12 hours of credit can come from the College of Medicine coursework, which would include 4 hours of IFH, 3 hours of EBM and 5 hours of electives. That is the current rough draft of this and there is a possibility that we could even start this beginning next year for incoming students.
Dr. Meuleman stated that if year four can be done that quickly, he feels that we’d be short-shifting the Family Medicine clinical aspect. He asked if we could have them do a little more clinic time and add a few more hours to year four. Dr. Davidson stated that one of the nice things about this is that is really is flexible since they’ve got this new concentration because there it is not as rigorous in terms of the requirements. There still is a limit of 12 total hours from College of Medicine coursework. He stated it would depend on what sort of courses they could take, but is certainly something they could work on. He stated it is up to Dr. Hatch as to whether or not this would fit in his criteria. Dr. Hatch stated that depending on what they do there, he thinks they have quite a few primary care clinics. Dr. Davidson stated that they are getting a lot of Pediatrics, although there is not much adult contact. Dr. Hatch said we might have to find a way to supplement that because they may have a disadvantage on the exam for not having done adult clinical care. Dr. Davidson stated that it doesn’t even have to be done at Duval County if they could find an appropriate special project to do here. He stated that it does require approximately 248 hours that need to be dedicated to this special project/internship.
Dr. Hatch stated that he did a combined program and finished in January of his fifth year. He stated that for people who had an advanced degree they had a one year MPH program like Harvard and John Hopkins has. He asked if we could also do the one year program that other places offer. Dr. Genuardi said he did the same thing. Dr. Davidson stated that the problem is the university limitations on the number of hours and their requirement for 48 hours in order to get the degree. Dr. Davidson stated that if you have a doctorate degree it is different than being a medical student. He stated they probably would offer a one year program for someone who has a doctorate, but that is not a medical student. Dr. Davidson stated that they talked about this a number of years ago and that is another university rule that if you have a doctorate they can make significant changes in their requirements, but while you’re a student that is not the case. He states that leads to the question if it makes more sense to do four years of medical school and then get a one year MPH, but the timing of that may not be ideal in terms of starting residency. Dr. Hatch stated that our students have gone elsewhere and gotten an MPH in one year while they were in medical school. He stated that if he was advising someone he might have to say go to John’s Hopkins for year since they’ll let you do it in one year. Dr. Davidson agreed that those are good points that he needs to bring up.
Dr. Novak asked what students would do in terms of their residency in what is an economically-challenged time in their lives. She felt like that would turn her off if she were a student. Dr. Davidson stated ordinarily that might not happen, but what he’s saying is if a student wanted to increase the amount of hours that they took in their fourth year and could still get their requirements in during the fourth year, it would be feasible for them to do that, but that wasn’t the plan. The plan would be that they would take a whole year to do it.
Dr. Watson stated that one suggestion to transform medical education is to figure out a way to combine fourth year with PGY-1. He stated that if you had a student interested in obtaining the degree while training in Pediatrics, you could fashion the beginning of their residency so they could fit in the program. Dr. Davidson stated that there are several issues with this particular MPH program that put them in a bind with regards to what they can do. One is that they’re about to have their first accreditation visit; they are not accredited yet. Their financial structure is very complicated. Their situation is different than some established schools and it may not be to our student’s benefit to get it here, but it also would provide them a lot of flexibility if they don’t want to move. Dr. Davidson stated that he has been very impressed with their faculty. They have hired two new department chairs in the last two months and he thinks they will do fine. He stated he will transmit these issues to Dr. Sheps because he thinks they are good points, especially in comparison to Hopkins.
Dr. Genuardi stated that in Jacksonville, the University of North Florida agreed to waive the tuition for their residents and fellows for the MPH program, so they have some students that are doing that program for free. Dr. Davidson stated that Dr. Tim Flynn contacted him because he is interested in finding out the possibility of residents also participating in the Public Health program, so that is on their agenda to talk about. Dr. Genuardi stated that UNF did this because they really wanted to create bridges with the medical program.
Dr. Watson mentioned that he and Dr. Romrell have been working for about a year to reduce the high rate of out-of-state tuition. He stated that their request for a tuition waiver was approved. The concern regarding high out-of-state tuition will therefore be taken off the LCME concern list and will instead be shown as a problem that was identified and remedied.
2. Updates: Richmond Group, Clinical Education Grants.
Dr. Davidson stated that we were one of five institutions that were invited to go to Richmond in May of 2006. This was partially due to the results of the IIME report in which the AAMC was interested in looking at the effect of following practice outcomes and providing feedback to GME to see how that might affect the curriculum. They asked for five representatives from each institution to go, which were the program directors of Internal Medicine and Family Medicine, a medical education researcher, some health services researchers, and the head of the GME from each institution. The institutions were Indiana, Tufts, UCSF, Michigan and UF. UF faculty who went included Dr. Flynn who was in charge, Dr. Betsy Shenkman, Dr. Bruce Vogel, Dr. Davidson, Dr. Carolyn Stalvey, and Dr. Whit Curry. They spent a couple of intense days working on various kinds of proposals and each group presented a different proposal at the end. There will be a follow-up meeting later on this month with Drs. Stalvey, Curry, Flynn and Shenkman. This means one of two things; either they are going to have funds for us to do our own research project or they have got funds and have decided on some collaborative research project that can be done at each of the institutions.
Dr. Davidson gave a brief update on the Clinical Education Grant Awards, which are from the CME office. Dr. Dewar has done a great job with this. This is a new grant that is available to provide support for educational projects up to $20,000 that can last up 18 months or two cycles per year. All College of Medicine faculty in Gainesville and Jacksonville can apply; medical students and residents can co-apply with faculty mentors. These somewhat pertain to patient safety and quality, so they will tend to be clinical years kinds of projects. The projects must plan and implement educational issues designed to directly improve patient safety and/or clinical process improvement and some aspects of clinical care at any of the institutions. The priorities include processes or outcomes that have to do with quality or HEFA measures across the continuum including GME, UME, and CME. Reports, publication or poster presentations, educational scholarship activity, sustainable, further funded research and interdisciplinary would be priorities and supported in the review. There has been an email sent out announcing this.
Dr. Watson stated that Dr. Tim Flynn was just named to a Blue Ribbon VA Panel to look at VA Medical School affiliations. Dr. Winter reminded everyone about a workshop tomorrow about difficult learners that is sponsored by the College of Medicine. Three cases will be presented and there is an expert panel to include Dr. Ray Pomm, Dr. Pat Duff, Dr. Beverly Vidauretta and Dr. Cassissi. The contact person for this event is Jo Drumheller from Dr. Rarey’s office.
3. LCME Report to the Curriculum Committee-Dr. Rarey.
Dr. Rarey encouraged everyone to visit the LCME Accreditation webpage, which is found as an icon on the College of Medicine’s website. Your Gatorlink password will be required to access the webpage. The data that is included in this website will be the same data that will be sent out as a paper copy of in five months. All of the documentation that has been gathered for past 15 months is displayed. There is a summary report that is a synopsis (about 35 pages) that highlights all of the various self-study committee reports, as well as the database that has been collected since July of 2005. That database contains five areas that the survey members will ask us about when they’re here in February. The five LCME survey members are to find evidence that supports our conclusions in terms of our strengths and/or concerns about the quality of our educational program. They will want to know in terms of the institutional study database, both in Gainesville and Jacksonville, what our academic environment is like for our medical students and their opportunity to get involved in various research programs, information about our graduate basic education IDP program, and GME in general. He asked the members of the Curriculum Committee in particular to review the data found in Section II Educational Program under the database heading. He pointed out that 48 of the 126 LCME standards are in this particular section. Beneath that on the website are the required courses and clerkships; all four years of the courses and clerkships have been written up and are in this particular file. They have asked the clerkship directors to review that and sit with their departmental chairs and go over their specific reports. He is meeting today with the course directors and will have them do the same. He emphasizes that the department chairs will meet with the LCME survey team as well and will have to be very knowledgeable about what is “on paper” about the departmental course that they sponsor. Dr. Genuardi stated that the clerkship directors in Jacksonville are doing that as well. Dr. Rarey stated that he will be going to Jacksonville on January 18th to speak with the directors up there. Dr. Rarey went through the remaining sections of the database that are on the website to include Section III Medical Students, Section IV Faculty, and Section V Educational Resources. Beneath that on the website are the individual reports from each class. Doug Arnold is the co-chair of the Student Assessment Committee and they create a summary report that cut across all four classes, which is online as well. The Graduation Questionnaire from the Class of 2006 is also available. Dr. Rarey stated that when the LCME survey team is here, they will carry around a book that has the student summary report and the AAMC Graduation Questionnaire and they’ll look at responses from the students. Dr. Watson stated that everyone should read the Self-Summary report; it is now on its twelfth edition and has been looked over by Dr. Tisher. He said that is the one document that every single team member has read, underlined and check-marked in detail.
Dr. Rarey highlighted page 24 of the Self-Study Summary Report, which discusses the Curriculum Committee’s roles and responsibilities. Each member of the Curriculum Committee needs to carefully review this section, beginning on page 24. The LCME team wants to know what the roles of the Curriculum Committee are and they want to know how functional the committee is. They want to assure that this committee designs and sends things forward to be implemented and receives feedback about the quality of the programs across all four years. Dr. Watson suggested the members read the entire 35 pages of the summary.
Dr. Davidson suggested the Course and Clerkship Directors look over their particular course or clerkship under the required clerkship data in the database to make sure it is correct.
Dr. Rarey went to ED1 on page 2 of Section II of the database, which has the 48 objectives associated with the educational program. The LCME team may ask how the Curriculum Committee functions with regards to knowing the educational objectives in terms of the level of completion we’re at and if we meet those objectives.
ED2 on page 8 of Section II of the database and is the one in which Dr. Hatch reported on the number of patient encounters. We have to keep track of that not only in the third and fourth years, but in the first and second years through the Essentials of Patient Care 1-4 semesters. The responses that the members of the subcommittee came up with are there to review.
Dr. Rarey went on to ED33 on page 113 of Section II of the database, which the members of the Curriculum Committee will need to be aware of as they sit with members of the survey team. ED33 states that there must be integrated institutional responsibility for the overall design, management and evaluation of a coherent and coordinated curriculum. He briefly went through pages 113-130 and stated that these pages are specific to the Curriculum Committee. He encouraged the committee members to become especially familiar with these 13 pages because he wants the members to be comfortable in describing the role of the Curriculum Committee. We have five more weeks to take care of the data and then it has to be sent out to the survey team.
Dr. Genuardi pointed-out that the team members will want to meet with students who are rotating in Jacksonville.
Dr. Davidson asked Dr. Watson if there is a particular day when they most likely will want to meet with the Curriculum Committee. He stated that each member should keep their calendar completely free for the entire time the team is here.
The meeting was adjourned at 8:40 a.m.