Curriculum Committee meeting

November 13^th, 2007

Members present:  Dr. Richard Davidson, Wayne Bottom, Dr. Kyle Rarey, Dr. Frank Genuardi, Dr. Beverly Vidauretta, Dhipthi Mulligan, George Hack, Omayra Marrero, Dr. Sigurd Normann, Dr. Peggy Wallace, Dr. Lou Ritz, Dr. Bob Cook, Chris Buciarelli, Dr. Mike Chen, Dr. Maureen Novak, Cynthia Karle, Dr. John Meuleman, Dr. Heather Harrell, Dr. Robert Watson, Dr. Robert Hatch, Dr. Dave Caro, and Dr. Richard Rathe

Student announcements:  Chris Buciarelli stated that they are getting ready for their third exam.  He heard that they did pretty well on their last Anatomy quiz.  They are beginning to set up for Family Day, which will be next semester.  Omayra stated that the third year class is 5 ½ weeks from finishing this semester.  She wanted to say once again that she feels it’s a privilege to be here.

Announcements:  Dr. Davidson welcomed George Hack who will be replacing Linda Butson on the Curriculum Committee as a result of some reorganization; he represents the Health Science Center Library.  Dr. Davidson encouraged everyone go to the regional and national AAMC meetings because there’s such a vast amount of great content at those meetings. 

Dr. Hatch stated that the Clerkship Director committee has been trying to have joint meetings with other groups they have common interests with, so they have been meeting with the program directors once a year for the last couple of years and they just added a joint meeting with the course directors.  He thinks it’s a big step towards better collaboration.  Their focus was on the clinical skills exams and PBE’s for a more common approach to those and a more seamless education across all four years. 

Dr. Davidson stated that one of the major emphasis aspects of the AAMC meeting was transitions from the second year to the third year i.e., transitions from UME to GME and from GME to CME.   

1.  Patient safety:  Drs. Kone, Davidson, and Dewar.  Dr. Davidson stated that about a month ago he and Dr. Rosenberg were reviewing the evaluations for some of the patient safety talks they’ve done and decided that they were not being well received by students and that we needed a different way to do things.  He has put together a subcommittee of the Curriculum Committee to review the patient safety curriculum as it exists that will then make suggestions to the Curriculum Committee.  He stated that he talked to Dr. Kone who stated that he has a long-term strong interest in patient safety.  He was very involved in it in Houston and has very strong and committed feelings towards developing a longitudinal patient safety curriculum.  Dr .Marvin Dewar agreed to chair that subcommittee because he’s a recognized expert in patient safety.  The subcommittee includes Dr. Heather Harrell, Dr. Eric Rosenberg, Dr. Amy Stevens, Dr. Tim Flynn and Dr. Bob Wears from Jacksonville.  We are aiming for a transitional program that can be used for medical students and then expanded to GME and CME at a later date.  Dr. Dewar wants this to begin in the first year of medical school using tools such as video tapes, interviews and cases.  Dr. Kone has very strong feelings about this and very strong ideas about how the curriculum should be accomplished.  Dr. Dewar and the subcommittee will be working closely with him to help develop this and will find places in the curriculum where it can go.  This will include during clerkships, as well as during the fourth year and preclinical years.   Dr. Harrell suggested calling the committee a Task Force of the Dean’s Office and feels that we need to agree on common language about patient safety between the housestaff and faculty as well.  Dr. Kone suggested to Dr. Dewar that this curriculum should be presented to the Executive Committee, to the clinical chairs and to Dr. Mike Good for their input and approval.  Dr. Davidson wants a significant portion of this to take place in the third year because he feels that teaching anything in the first two years will suffer because students don’t have any idea of what being on the wards is like prior to that.  He thinks it will be much more highly valued if this content comes during the clinical years because at that point the hospital is also involved in this.  The clinical chairs will get the message from the dean that this is something that the faculty needs to be involved in, committed to and role modeled for the students.  Dr. Dewar submitted a tentative curriculum to Dr. Kone who made some updates. 

Dr. Harrell expressed concern that the patient safety and quality issue has to be longitudinal across the continuum so that students are seeing done on all levels what they are being taught to do.  Dr. Kone seems to be particularly interested in the medical student curriculum aspect of it.  Dr. Davidson received a patient safety book that he’ll donate to the subcommittee to decide if it should be used as a textbook. 

Dr. Davidson stated that this will be a major initiative for everyone including courses and clerkships and faculty.  Omayra asked if there will be a nursing representative on the committee.  Dr. Davidson stated that because he is so dedicated to interdisciplinary learning he proposed that early on, but it was agreed that the curriculum would be developed first and then others would become involved at a later date.  Dr. Dewar travels around the state and country talking about patient safety and he knows well that you cannot implement any kind patient safety and quality of care issues if you just look at doctors and medical students.  Communication issues and handoffs and a variety of other things are essential and there really needs to be an interdisciplinary focus at some point.  Dr. Davidson thinks at some point this will have to be a Health Science Center issue.  Omayra stated that nurses are more than willing to teach the students and she mentioned Rose Rivers, the Director of Nursing, who Dr. Davidson agreed would be a great addition to that committee.  Dr. Davidson stated that this is not only about patient safety, but also about quality and that the link between these two will be clarified in the educational efforts that we come up with. 

2.  Final approval:  Joint MD/MPH Program:  Dr. Davidson.  The proposal for the joint MD/MPH program has been approved by both deans and both executive committees and now needs approval from each respective Curriculum Committee at which point it can go to the graduate school for approval.  This does not have to go to Tallahassee.  Because they’ve recently had a joint program approved with the College of Veterinary Medicine we assume that this will go through with no problems.  There are only a few changes that were made from what we initially discussed.  Dr. Davidson stated that he has interviewed two people so far and he has an appointment with another student later on this week who is interested.  So far, many of the students he has interviewed are interested in International Health, which we don’t have yet.  He has arranged the possibility of some international health experiences for the internship for these students with a variety of people, primarily Mike Lazardo.  He will send this out in an email to the students once it is approved.  Our aim is to start it next fall for current third year students.

Dr. Davidson feels that the best time for students to complete the MPH program is after they’ve completed their clerkship year.  Students will complete their clerkship year in June.  They will then have two months during the summer of what would be their fourth year to take electives or required fourth year coursework in July and August and then start the program in September.  They would then be in the MPH program from September until the next June.  Then they would complete their fifth year, which would be their last year of medical school from July on. 

There will be 12 hours of credit of medical school coursework that counts toward the MPH degree.  There will be 6 hours of MPH credit that counts toward MD degree.   One of the reasons for that is that it will decrease the medical student’s tuition because they will be taking 6 less hours from the College of Medicine toward their degree.  48 hours are required for an MPH degree and with the 12 hours that can be applied from medical school, medical students are able to get the MPH degree in one year instead of two.  There are some issues because the medical school is not on the university calendar.  Dr. Hatch suggested that the schedules be as flexible as possible and Drs. Davidson and Cook said it should be.  There was a vote of approval on this program and all were in favor so it was approved.

Dr. Ritz stated that at a recent Evaluation Subcommittee meeting, they were looking at the three SubI’s offered in the fourth year.  It became apparent to some of the members that there are no grade distributions; approximately 70-90% of the students get A’s in the SubI’s.  The Curriculum Committee has a policy that there should be a grade distribution so they discussed the possibility of the SubI’s going pass/fail.  Dr. Harrell stated that there is a concern nationally about the evaluation of students during SubI’s and that nationally the grade inflation is huge.  The National Board has been interested in developing a traditional knowledge-based exam, which we feel very strongly that we don’t want to measure as much during the SubI’s as skills.  Right now all the grades are based on is the faculty evaluation, which can be extremely variable.  Dr. Davidson stated we will talk about this at next Curriculum Committee meeting.  

3.  Report from the AAMC meeting:  Dr. Watson, Dr. Harrell, Dr. Davidson, Sarah Smith-Vaniz, MSIV, and others. 

Dr. Davidson felt this was an excellent meeting and he was very impressed with Darrell Kirsch, the new president of the AAMC.  The name of the talk was “Culture and the Courage to Change”.  Dr. Watson stated that what Darrell Kirsch basically said is that the organizational structure is not aligned with function very well.  He said that the way that we have traditionally been recognized was by individual accomplishments, whereas that doesn’t lead to a culture of teamwork and interdisciplinary behavior.  It was therefore recommended to change the criteria so that they recognize the accomplishment of teams and not individuals, which would include changing promotion and tenure guidelines and changing the way people are compensated.  He thinks that would be more aligned with 21^st century healthcare, education and research, which Dr. Watson agrees with.   It was clarified that he was talking specifically about academic medicine.

Dr. Harrell stated that she also liked Darrell Kirsch’s talk and that she’s really excited with how he’s trying to move the academic organizations to think completely differently about how we’re preparing 21^st century doctors because it’s different than the last century with information technology, etc.  She also stated that he mentioned the premedical requirements in curriculum preparation, which is where it starts.  Dr. Novak asked who determines the premedical curriculum and Dr. Watson stated that he feels it is the MCAT.  Dr. Novak feels we should be the ones driving that, but Dr. Watson stated that is difficult because it has constituencies.  He stated it is a complicated issue and he thinks it should start no later than premed or earlier.  Dr. Rathe stated that Liberal Arts may be what we’re talking about.  Dr. Davidson stated that our country is the minority of how medical students are typically trained.  The vast majority of other countries train their medical students in baccalaureate programs in which they essentially start medical school right out of high school. There are also schools like that in the United States and each has its advantages and disadvantages. 

Dr. Harrell stated that she had a very productive meeting with a variety of members of the Southern Group on Educational Affairs at the AAMC meeting.  Their meeting is in April this year in Nashville.  She stated that the SGEA is a very productive group who are doing a lot in terms of educational research.  She stated that they accept works-in-progress which can be submitted in order to try it out and collaborate it.  One idea of collaboration that she got involved in was with a fourth year group in which Gary Rosenfeld, one of our LCME site reviewers, spoke about how much basic science is being taught in the clinical years.  He put together a study years ago of how to look at that on the wards, which was interesting.   He had gotten discouraged about it, but Dr. Harrell as a Clerkship Director was able to see how to operationalize his study.  He left very excited about it.

Another topic was at the Generalist meeting right before the AAMC meeting.  Dr. Harrell stated that Dr. Hagen in particular was very excited about something that the Anatomy Department at Einstein does.  They have the EPC faculty come the first day of the cadavers and go over observation with them as a way to integrate those courses.  She feels there are many possibilities to have the clinical and non-clinical faculty members in better collaboration to optimize the pre-clinical and clinical years.  Much of the discussion surrounded this at the AAMC meeting. 

Dr. Harrell was on a panel called ACE (Alliance of Clinical Educators) on portfolio-use longitudinally.  She stated that portfolios are here to stay; they are coming to GME with 2008-2009 as tentative pilot dates with some things they are working on.  Consequently, just like when competencies came to GME it trickled into medical school.  There is very little precedence in medical school for longitudinally using portfolios in the clinical years.  There are quite a few longitudinal portfolios in the pre-clinical years which are pretty much professionalism portfolios.  There was a lot of interest and it was very well received.

Dhipthi stated that the AAMC meeting was a wonderful opportunity for students to go and learn about what is happening in other medical schools.  She noted that a lot of things that were presented are already being done at UF.  The students who went got together and picked four sessions that they felt were most important to present:

• The first one was from the first year representative entitled “Emergency Medicine Procedure Experience” for first and second year students. They spend 10-15 hours learning how to do procedures and volunteer at the emergency department for 4 hour shifts to practice these skills. They felt this would be a great way for first and second year students to get into the patient care state-of- mind before they actually get to do it in the third year. This is being done at the University of Rochester.
• Another topic was the USMLE changes. There was a panel and the director spoke to the students about this. Students were able to express their opinions and a lot of students were against it because they felt that making it pass/fail or putting it in the third or fourth year would take away from them if they went to a less than brand-name school. They did suggest using a portfolio as a means of assessment if the USLME became pass/fail as a good way to help separate students out from each other.
• Another topic talked about was assessing professionalism and ways that schools do it differently and ways that work and don’t work. A consensus among the students is that a lot of it is very inconsistent between attendings and between clerkships. Another problem is that there is an unclear definition of what professionalism is. They suggested using letters of commendation or concern that would go into a portfolio for specific events where students may or may not have demonstrated professionalism. She stated that it’s easier to model a concrete example than it is to base future behavior on a 1 to 4 scale. Another idea was students evaluating students. They suggested having a consistent list of adjectives to pick from and each student picks some of these adjectives to describe other students. It would then be consistent throughout and everyone would be included. They also talked about an Early Concern Policy where students in the first two years can complete a form to express concern over certain students’ professionalism, etc. It would not go in front of a dean. The school that presented it has a Humanities Committee and she thought that possibly the Chapman Society could deal with it. It would therefore be a learning experience for the student about what they’re doing wrong and how to improve it so they’ll know more about what is expected when they get to their third year. Dr. Rathe stated that there was a speaker from a school who described a Citizenship Grade Point, which today could be a Professionalism Grade Point that was tracked as a completely separate thing. For instance, a student could be first in their class grade point-wise, but on professionalism scale they might not be as stellar. Also, a student who grade point-wise was more middle-of-the-road might be more stellar on this separate grade point. Dhipthi stated it wasn’t something they really assigned a grade point to; it was more something that could be included in their dean’s letter.
• The fourth topic that Dhipthi mentioned was presented by a physician at Howard University on cultural competence in teaching within the medical curriculum. This is the first person she has heard who described cultural competency in ways she could understand and in ways that she can put to practice. He talked about how cultural competence or incompetence affects the clinical decisions that are made. He mentioned the online AAMC Tact Assessment, which is a survey that can be taken by course and clerkship directors and deans. It lists ways to teach cultural competency and important factors of cultural competency. They can check off what aspects they teach in their course. It allows them to see their weak and strong points and allows them to change their curriculum accordingly. Dr. Caro stated that is an area where simulation comes in beautifully. He has seen some very interesting simulations on death and dying and family notification when you have for instance, an African American family vs. an Asian Family. It’s very interesting to watch and have some stereotypical roles played out and some not. He feels there is real power there especially with very emotional interchanges like that. Dr. Davidson stated that Dr. Hernandez is aware of the Tact Questionnaire.

Dr. Rarey and Dr. Davidson will continue their AAMC update during the next meeting.  Dr. Rarey will discuss the RIME sessions and LCME and Dr. Davidson will talk about how doctors think. 

The meeting was adjourned at 9am.