Curriculum Committee meeting
November 14, 2006
Members present: Dr. Richard Davidson, Dr. Rob Averbuch, Dr. Juan Cendan, Dr. Robert Watson, Dr. Kyle Rarey, Dr. Frank Genuardi, Dr. Maureen Novak, Dr. Heather Harrell, Nitesh Paryani, Doug Arnold, Dr. Judy Bowers, Tiffany Lacross, Dr. William Winter, Linda Butson, Dr. Lynn Romrell, Cynthia Karle, Dr. Louis Ritz, Dr. Mike Chen, Dr. Cari Hernandez, Dr. Robert Hatch, and Dr. Tim Flynn
Student Announcements: Nitesh Paryani stated that the first year class is winding-up their semester. They are preparing for their Shelf Exams. They’ll ship off for their preceptorships in December.
Doug Arnold stated that fourth year students are now getting into their rotations and their interviews. Most of their events are getting established for the upcoming graduation season. Dr. Jordan Cohen will be their graduation speaker.
Tiffany Lacross stated that regarding the AAMC, they had 3 of their 5 representatives go to the conference at the end of October. Dr. Davidson stated that we will have reports from the AAMC at the next meeting and asked Tiffany if she would continue her report at that time.
Announcements: Dr. Winter stated that there will be a Course Directors meeting today at noon. They are going to talk about a perplexing topic concerning the university’s scheduling of classes and exams and quizzes.
Dr. Hatch stated that they had a very productive joint meeting with the program directors to talk about a lot of things, many of which had to do with the upcoming LCME visit. They have a joint meeting coming up with the folks in Jacksonville to help get prepared for the LCME.
Dr. Davidson announced that on January 18th the Jacksonville faculty will come here for a joint clerkship directors meeting that will include a mock LCME visit that Dr. Rarey will run in the morning to help everyone prepare. The goals of this are for the Jacksonville faculty to familiarize them with the new additions to the learning environment in Gainesville in preparation for the LCME visit. They will visit the expanded Harrell Center and the testing center and will see the simulation effort we have here.
Dr. Winter stated that the Society of Teaching Scholars held a workshop in October on the difficult learner that was attended by 20-30 faculty members. It was hosted by the College of Medicine and Dr. Rarey’s office, as well as the Society of Teaching Scholars. It presented problem residents and students; they actually had a fourth year medical student come and play a resident that was having issues with professionalism. He stated it was a very successful workshop that will be repeated next year. He stated that Jacksonville will be holding a similar workshop in April.
Dr. Genuardi stated that in Jacksonville they are doing a lot of preparation for the LCME visit. He has been meeting with various residents and folks that are involved.
Dr. Rarey stated that the LCME database documents are being prepared and copies have been made. They will be sent to the LCME site team members tomorrow. We now know the five members of the site team: Chair: Robert Rich, M.D., Senior Vice President for Medicine and Dean of the School of Medicine, University of Alabama at Birmingham, Secretary: Phillip McHale, PhD, Associate Professor of Physiology, University of Oklahoma Health Science Center, Team Member: Gary Rosenfeld, PhD, Assistant Dean for Curriculum, University of Texas Health Science Center at Houston, Team Member: Georgette Dent, M.D., Associate Dean for Student Affairs, University of North Carolina at Chapel Hill, and Faculty Fellow: Craig Cheifetz, M.D., Assistant Dean for Medical Education, Inova Fairfax Hospital Campus of Virginia Commonwealth University. They are putting together a proposed schedule for the team to follow from February 18th-21st and Dr. Rarey will let us know when he hears back from them that it’s acceptable. Dr. Rarey should be able to give an update at next month’s meeting.
Dr. Davidson stated that the program for the next meeting will include discussion about the AAMC meeting and the LCME updates. He stated that in January, Dr. Harrell will talk about the fourth year and how it integrates and who it integrates with. He stated that we will probably continue to have the meetings on the second Tuesday of each month in the second half of the year.
Dr. Watson stated that the students from all four years have selected the basic science and clinical science teachers of the year, which is part of a university-wide recognition. It was hosted at Dr. Machen’s home and was written-up in the Alligator. He announced that Dr. Maureen Novak was selected as the Clinical Teacher of the Year and Dr. Sigurd Normann was selected as the Basic Science Teacher of the Year.
Dr. Watson stated that he is really pleased that Rana Yehia was selected as chair of the National AMA-Medical Student Section in Las Vegas. He supports Rana and knows she will do a great job.
Dr. Watson mentioned that this upcoming weekend is the Alumni Weekend, which includes the barbeque before the football game.
Dr. Rarey mentioned the meeting last week between the clerkship directors and the residency directors. He stated that was an important meeting and was an opportunity for them to talk about the residency’s input and the roles of residents in the teaching of our medical students. Dr. Watson stated that the meeting was called in part to develop a more functional usage of student evaluations of residents. A plan has been developed by Mike Mahla which will form a template form that will go in to every resident’s six month evaluation. Dr. Flynn stated that the clerkship directors and program directors have a great need to communicate regularly and favors regular joint meetings.
Dr. Davidson stated he is still working on the MPH program. One of the odd things that has come up with that is the timing because their summer courses start in May before their year ends. That will be a challenge which has to do with our calendar being somewhat different than everyone else’s on campus.
Dr. Davidson stated that with regards to the main presentation today, he feels it is important to know the teaching effort that goes into the Harrell Center. Dr. Cendan and Dr. Duerson will give an overview. Dr. Cendan has recently taken over as Medical Director of the Harrell Center and has brought some fresh ideas and new ways of approaching things.
Dr. Cendan stated he wants to cover how the Harrell Center interfaces with the rest of the clerkships, relate the experiences that the students have, as well as demystify the PBE’s. He stated that most people in this meeting are familiar with this, but that it is different in that they are not a course unto themselves. They are an evaluation place, but they also serve a feedback position in the whole scheme. He wants everyone to be on the same page and is open to any suggestions as to what they can do better.
Dr. Cendan presented a general outline of the educational continuum and how it fits into the PBE scheme. He stated that as the students progress from the first year through fourth year they develop higher levels of thought and the ability to evaluate patients. The very first thing is the normal history, normal person and so forth. As they go through, they will eventually graduate being able to generate a differential diagnosis and treatment plan and catch all of the abnormal things.
They currently have PBE 1, 2 and 3. They do not have PBE 4, although they may have that in the future for residents or medical students who are about to graduate. PBE 1 is at the end of the first year, PBE 2 is at the end of the second year and PBE 3 is done at both the middle and end of the third medical school year. The competencies in PBE 1 are medical history taking and simple, normal examination. PBE 2 starts to incorporate the history and physical as they relate to each other, not just isolated issues. They also start to trickle in the idea of professional behavior. PBE 3 is the pinnacle of what eventually becomes part of the clinical skills testing for licensing. There is focused history taking, which is not just asking as many questions as possible, but asking the correct questions. Patient education and counseling are also incorporated at that time.
In PBE 1 they assess the mastery of the components of the clinical encounter, medical history, physical exam, and the interview process. In all of the PBE’s they have a checklist that the simulated patient marks off. Those checklists are generated by the folks who created that station, generally a clinician or someone in charge of the coursework that student has taken. For PBE 2, it becomes more sophisticated and is on complicated focused encounters and again there are checklists. Post-encounter notes are incorporated both in the first and second PBE’s, which are stations where the student relates what they felt they saw in between stations. PBE 3 is much more complicated. Professional behavior comes into play and the student is asked to generate more critical plans for diagnostic workups between the patient stations.
PBE 1 tests the material that is taught in the first year basic science courses that consists specifically of eight 6-minute single skill stations and 8 computer stations in between those clinical stations. Those are staffed by standardized patients or the Physical Exam Teaching Associates (PETAs). The format of the computer stations is a multiple choice or a queued answer type situation where they have to pick, from 10 different possible answers, the 3 that are best. The scoring system is basically pass/fail. The students have to demonstrate a minimal competency in the exam stations before they can go onto the second year.
PBE 2 has eight 10-minute standardized patient stations with a pass/fail scoring system. Competency has to be demonstrated to move into the clerkship year.
PBE 3 is more complicated and harder to be orchestrated because they wanted to match the coursework that the student has done to the clerkships that they’ve rotated on; therefore they have form A and form B of the test. Form A represents the students that have done the Medicine, Surgery, and Pediatrics blocks and the form B represents the students that have done the Family Medicine, OB/GYN, Psychiatry, and Neurology blocks. Students do PBE3 twice by doing form A and form B and basically repeat administrations of the same test. The professionalism component is added, as well as the more complicated and more realistic critically ill patient scenarios.
He stated that from an intervention standpoint, there is little for them to do with the data when the students pass. If the students pass every room and do well on everything, they do not normally intervene. If a student performs poorly in one particular room, they may pull the student aside and remediate on that one topic. They also pull any student that makes less than the cutoff grade on the overall experience. Those students would be remediated and if the individual section is the lowest standard deviation of the mean, then they are remediated on that one thing. Generally, Dr. Duerson speaks to students on the communication efforts and the PBE 1 questions and Dr. Cendan speaks to the students when they are in clinical situations. They both do that by having looked at videos of those interactions, so they have something they can talk to the students about very specifically. If the students do poorly they speak about them at the Oversight Committee and they may be referred to the Academic Status Committee for further action. They are trying to refine the process of bringing information back through the Evaluation Subcommittee and Curriculum Committee and getting feedback to course and clerkship directors.
He showed last year’s results of PBE 1 which covered physical examinations of the abdomen, eyes, heart, cranial nerves, and the upper and lower extremities. On the history side of the equation there were scenarios where a patient complained of shortness of breath, someone with high blood pressure, and a social/sexual history in a young woman coming for a routine annual pelvic exam. Computer stations then had multiple choice type questions relating to those scenarios in between. On that series of exams, 20 students failed the heart exam, 6 students failed examination of the cranial nerves, and 2 students failed overall. That is the general data that they review at the end of that situation. That reporting went to Dr. Romrell and those students have to come back and redo those sections for PBE1. The data on the parts of the physical exam and history that more people failed than they expected went back to the director of EPC 1 and EPC 2. That is the general model for all of these.
For PBE 2 the questions were general age-appropriate questions for second year students such as wrist pain, back pain from renal calculus, chest pain, heartburn, and painful rash. The physical exam was clinical breast exam. In the communication component of it, there was a situation where the patient needed education in cardiac risk factors. The student was expected to recommend behavioral changes; breaking bad news to an Alzheimer’s patient was another scenario. He mentioned the post-encounter notes again. He stated that they have not been able to systematize the evaluation of some of the post-encounter notes and they haven’t been as prominent a part of their evaluation process as they probably should be. They have had a hard time coming to grips with the volume of data generated by these. Major problems in the PBE 2 were, for example, that many students failed the wrist exam. There were also problems with the painful rash scenario. Several students scored poorly on the patient education and the painful rash scenario. That information went back to the courses where they anticipated that the students learned that or where they knew the person that wrote the scenario. They know that students get this information in multiple different sites and they don’t have a clear cut way to get information back to everyone who, for example, speaks to the student about wrist pain during their four years there. There isn’t a clear cut mechanism to get that information back to all of the different sources, but they can get it back to one source. Dr. Cendan used breast mass as an example of a confusing topic and pointed-out that it could be taught in Family Practice, Surgery, or Gynecology. The scenario came out of Surgery so they took the information there. Potentially, many different sites are responsible for the data being given to the student and he stated that tracking that all the way through is not as clear cut as people think.
PBE 3 cases in form A included standard cases such as ear pain in an infant, palpitations and different shortness of breath cases. In Form B the cases included very standard clinical scenarios that students would run into during their rotations such as right lower quadrant pain, diarrhea, and contraceptive counseling,. They saw problems here with the breast mass case, the ear pain case, and a number of students scored poorly in the palpitations and shortness of breath/tired. In the B component there was trouble with the contraceptive counseling case and the stroke. They have given this information back to the clerkships from whence these scenarios came as best as they could identify.
They have different methods for reporting performance. They have generally looked internally at how students perform at the Harrell Center. The software allows them to manipulate that data such that reports or data can be queried either according to student or according to scenario or according to a component of the exam. The software holds a lot of information; they just have to come up with what clusters of data need to go out to whom. That data generates the background for reporting to course and clerkship directors. The issues that they want to identify are both the individual student that has a problem and places where they find a possible curricular issue where they are just not getting the information, even though the question was generated by someone in a position to have given them the information. This provides an interesting center point for both the students and the courses. Dr. Cendan states that, depending on which course covers the objectives, it gets harder as the student goes along. In the first year it is easier in that they simply have not had as many courses and you know where the information came from. As they progress through, they could get bits and pieces of clinical data or examination data from many different courses and it’s harder to isolate.
Dr. Meuleman asked if any students had failed PBE 2 or PBE 3 and if there are a similar amount of failures per year. Dr. Cendan stated that during the last PBE, there were 17 students that were required to remediate and based on their remediation and after discussion with the Oversight Committee, there were approximately 2-3 people that were passed onto the Academic Status Committee, which is a typical figure in each class. There are usually 15-20 out of 100 who really have a problem and they need to be addressed somehow, either very specifically or more generally. A few of those students have had to go on and do an extra month of a particular rotation somewhere, which has happened within this past year.
Dr. Romrell stated that with respect to the Academic Status Committee and what they do with the results, within recent years they pay more attention to the PBE’s and have occasionally taken action where appropriate based solely on PBE performance. He stated that within the last three years they have had two students who were not allowed to go onto their clerkships. It was also a trigger for students who had to repeat the second year in its entirety because they looked at their overall performance. There was one student who had to do significant remediation, but then was allowed to go on and will graduate this year. They have used a student’s performance in PBE’s during the third year to reschedule the student’s fourth year. He has spoken to a faculty member who had significant remediation as a student that told him that the most significant education he got was remediation by working in the infirmary. In many cases they have changed the fourth year curriculum to include going back to the basics and identifying problems to help develop their skills. That will be an issue that will be addressed more carefully in the future as they look at the data they’re gathering now on ED2 and with Dr. Harrell’s oversight in the fourth year. The planning of the fourth year will be looked at much more critically. He thinks we are getting better scrutiny of all students’ fourth year schedules and are looking very carefully at defining the fourth year.
Dr. Meuleman asked Dr. Cendan what happens to students who have good grades, but do poorly on the PBE’s. Dr. Cendan stated that they are only one component of what the students are expected to learn and that if the student has done poorly in the PBE’s as well as other classes they are often passed onto the Academic Status Committee; however, if they are doing well in other areas and do poorly on the PBE’s, they can be remediated and will move ahead. Dr. Hatch stated that they don’t often have people do poorly on the PBE that do well on clerkships. He stated it used to come up a lot because they didn’t take the exam seriously, but the culture has changed and they take it more seriously now. Dr. Davidson stated that he’s not sure if it’s the Clinical Skills exam or the fact that it’s now understood that this counts for something, but you don’t see as many top 10 students not performing as well as used to happen in the past. Dr. Davidson stated that students who sometimes do poorly in the PBE’s are good students who make an error in judgment; it’s not usually their knowledge base per se. Dr. Cendan agreed and stated that these are not bad medical students who won’t become good clinicians; they just needed one more dot of feedback before they go on and that’s a way to catch it before they have to go to Atlanta and fail there.
Dr. Romrell stated that with respect to the USLME, with the class that graduated in 2005, there is a requirement for students that require licensure to pass the clinical skills exam. We’re now in the third year of that exam. Dr. Duerson is one of the leading experts in the nation on the use of standardized patient assessment. We were in on the development of the clinical skills exam, being one of the first two schools to take the exam and remaining throughout the pilot testing of that exam. The faculty here at UF helped them see that you can computerize the collecting of data. Our students are well prepared for that exam and are among the 40 schools that have extremely high pass rates. The national pass rate on the exam is 96%, which is about the same pass rate as Step 2 Clinical Knowledge. If you go through this continuum, you shouldn’t have most of your students failing out. He stated that at the AAMC meeting they did release some information that there is a subset of schools that have high fail rates. He feels that those are the schools that have no standardized patient program, which is a disadvantage for those students. Our student’s performance has really been outstanding; the first year we had two failures and no failures last year or this year. When they got their feedback on the exam it showed that our students scored high in the data gathering category, but our communication skills show room for improvement.
Dr. Hernandez brought up that someone had mentioned adding a PBE 4. She stated that while at a AAMC meeting, she saw an interesting presentation from a group in Pittsburgh. They evaluated students in the middle of the fourth year to assess their procedural skills. There was a consensus from the medical students at the MSLP outcomes project in terms of what procedural skills students should master and know by the end of the fourth year. It was a multi-institutional setting and the skill performance was extremely poor across the board. She wondered when they thought about adding PBE 4 if they would be evaluating procedural skills.
Dr. Cendan stated that in regards to creating a PBE 4, the next step is to present the student with not just the exercises such as putting a stethoscope up to the heart, but seeing if the student actually heard what you wanted them to hear. They want to make sure students can identify the abnormals. As they move down this continuum, their next challenge in the Harrell Center is to develop clinical scenarios that actually have fixed abnormals that are hard to do on patients. For instance, it’s hard to have a patient that has a fixed focal deficit or fixed severe cardiac murmur; you can’t have those people lying around, but they need to be able to test the student to see if they can identify those situations. He states that this is where he sees the simulation component of this coming into play and within that would be procedural. He’s sure we wouldn’t find anybody who will let 100 students stick a central line in them. Their next batch of clinical scenarios that they are developing will incorporate those things, so they are currently working on four clinical scenarios that incorporate abnormal physical findings with the use of simulators. He stated that the next thing would be obtaining a permit and doing a procedure. They have decided their first procedure will be a lumbar puncture because they have a simulator for it and it can be within this gigantic spectrum of clinical presentation all the way through to diagnosis by procedure and then clinical management, so it will be a much more graduate level of PBE. Dr. Watson stated that PBE 4 could be easily utilized by any residency program. He also stated that Dr. Cendan and Dr. Duerson are working now with colleagues in Jacksonville to help develop a standardized patient component for the fantastic simulation center they have in Jacksonville. He feels the PBE 4 is a great idea.
There is now an elective in Advanced Physical Diagnosis/Clinical Decision Making taught by Dr. Hahn, and Dr. Watson stated that Tiffany Lacross suggested having a pediatric component of that. He stated that in Jacksonville there are many more pediatric simulators and they can make that step. Dr. Caro stated that the question that is coming up all over the country is what the metric is and what the gold standard is.
Dr. Flynn stated that the right answer and the differential diagnosis change over time and what you really want to know is whether or not they can determine what skill is necessary and to be able to perform it. He stated that they are doing the same project for Surgery Boards and the great diversity they see in performance on the boards. They started with a grid that listed the diseases we expect them to know something about and the procedures we expect them to be sufficient in. They then worked back from that to create what it was they wanted the program to teach. He asked if there has been some type of grid created or are these things a product of an individual clerkship director’s desires and interests. Dr. Cendan said it is a little of both, but there is a list in the works of the things that they would expect a medical student to have either been exposed to with a real patient or in a situation in a simulation type of environment. Dr. Davidson stated that the clerkship directors passed a list several years ago of procedural skills that are supposed to be taught by each clerkship. They have never really evaluated the efficacy of that because they haven’t had anyway to evaluate it, but that should likewise be a part of this fourth year. Dr. Flynn stated that that was his point. The data from the surgery world is looked at and people are appalled at the variation that they see amongst the training programs in the country. Here at least we should learn how to control that better. Dr. Watson stated that is precisely what we are trying to do with ED2. There is a procedure list that identifies those at the end of their third year that have not filled in the grid competently who will then make it up during the fourth year.
Dr. Hatch stated that when he became the clerkship director for Family Medicine they had a very big PBE part in their exam so he went in and took the exam cold just as if he was a student. He stated it was very instructive and he felt it validated that. The other thing that validated the exam is that for UF Cares they probably ran 50-60 people through it and they all did multiple stations. He stated that these were people who were referred by the Board of Medicine because of concerns about their quality in practice. He stated that about half of the time they found legitimate concerns about their quality of practice. Almost to a person, their scores were below our student scores. There were a few people who really did excellent jobs, but virtually everyone had big gaps. A really interesting thing that came from that is the ones that don’t do something but then record in their note that they did, which they saw often.
Dr. Flynn said that the point about thought processes was a good one. He stated that this exam lends itself to the rules-based idea of checking boxes, etc., whereas in their practice they take shortcuts and use pattern recognition. Dr. Davidson stated that the goals are different because the goal of seeing a real patient is to get to the right answer, but the goal of seeing a standardized patient is to see if you are able to approach an unknown case in a comprehensive manner without missing anything. He stated that the common pathway for both is to know what the students are thinking. He stated that the things about the checklists is that students can go in there and do as many things as they possibly can in 8 minutes and get a great score and not have a clue as to whether or not they are approaching this in a reasonable fashion or not. He stated that Surgery has been doing oral exams more than anyone else and that everyone has problems with it. Dr. Cendan said they had problems with it in Surgery because they have generated a checklist and at the end you may give the student a better grade than you really think they deserve or the opposite because they match the things on the checklist but they may not know where they were going with it.
Dr. Genuardi stated that those that score lower receive remediation, but questioned what students who scored just above the cutoff received. Dr. Cendan stated that right now they simply receive a note that say they’ve passed because there’s nothing else they can do at this time. He stated that reviewing the videos of the 15 students out of 120 that did poorly is a gigantic feat, much less trying to review all 120 students’ videos. He stated it would be optimal to give feedback to all of them; they could begin having the simulated patients tell the students what they may have missed, but that brings up the issue of giving up the key at the time of the test. They haven’t decided if that would be the right way to do it either. Right now the effort is concentrated on the ones that do poorly.
Someone asked if students are able request reviewing their own video. Dr. Cendan stated they have offered that in the past, but the interest was zero. Dr. Davidson stated that one of the things that used to be done for PBE 3 was to take one of the videos of a student who had done very well and have the entire class view it so they could compare their own performance to that student’s video. Someone mentioned the concern over students who ask as many questions as possible as a way of passing and Dr. Cendan stressed that clerkships will be responsible for halting that behavior. Someone suggested maybe PBE 4 could catch that. Dr. Duerson stated that students are limited in the amount of time they have, so they can’t ask a million questions. She stated that in addition they are doing the post-encounter notes and she thinks that is where they will be able to determine whether students who ask so many questions actually knew what the important questions were because that’s what they have to put in the post-encounter notes. She feels they are making headway towards utilizing that by collecting data. Dr. Rathe has agreed to work with them on the January PBE’s to pilot test a program he’s developing for the national board on scoring these post-encounters. If we can get to that level she thinks we can see the problem-solving aspect of this, what is really what we want to get to.
Dr. Romrell stated that with the national boards in the clinical skills exam, outpatient encounters and all other scores but standardized patients requires that physicians read the post-encounter notes so they can understand what the student’s reasoning is. The scoring of that exam is delayed five months because it takes so much time to have physicians read somewhere between 15,000-30,000 examinees for both stations. He stated that we need to have a lot of people to look at our post-encounter notes and do something with them. He worries that the computer may find the phrase, but it won’t show what logic is going on in the student’s head. Dr. Cendan stated that the problem with the computer is that it will recognize the different possible same answers, but you wind up having a queued list and then it’s really not reality anymore.
Dr. Ritz asked if there is systematic feedback from the students on this evaluation such as debriefings and Dr. Cendan replied that no, there is not. He stated that he is sure they can do it somehow. Dr. Romrell stated that they have had senior students and graduates go over the questions and give us feedback. Dr. Harrell stated that students complain about not getting feedback; but that when you give them the opportunity to voluntarily meet with someone they don’t usually take advantage of it.
Dr. Caro asked if some students may have stage-fright or anxiety about their performance and asked if they have the opportunity to do a trial run before they do the exam. Dr. Duerson stated that students are videotaped from the first week they are here so they have time to get comfortable with environment. She doesn’t feel poor performances are typically related to stage-fright. Doug Arnold stated that the students do have difficulty with what they feel is an artificial environment. Dr. Cendan stated that everyone knows these people are actors, but that this is a high stakes important part of their testing so the students basically have to come to grips with that. He mentioned that as a student he struggled with it as well.
Dr. Davidson asked Dr. Cendan how he envisions the feedback loop to faculty. Dr. Cendan stated that a lot of critical folks are on the Oversight Committee so they receive information at those meetings. He stated that last year Dr. Rarey orchestrated a series of meetings with Dr. Cendan and the Clerkship Directors where they gave the information, which he felt was very helpful and should be formalized. They have also sent out letters of the PBE 3 results with summary statements to clerkship directors with the questions where performance was below par. Dr. Cendan will be making a presentation to the Evaluation Subcommittee where they will look at it in terms of the feedback as they do other learning efforts.
Dr. Harrell stated that she saw a certain checklist that had many more items on it than needed and stated that if the students were being taught that way for the entire third year it’s not surprising that they may not do well. She mentioned it may be a faculty development issue where they could meet and decide which items are pertinent on which list. Dr. Cendan stated that this comes back to what Dr. Davidson was saying about asking different faculty the same question and each of them coming to the answer in a different way, including the physical exam. He doesn’t think that faculty members have an agreed core of what a certain exam should consist of. They haven’t been able to come up with an overarching exam and the people who develop the questions are sensitive to having things removed or added. Dr. Duerson and Dr. Harrell agreed that there should be a more evidence-based checklist so they could support what it is they think is important in the scenario. Dr. Harrell stated that she is not sure the checklist part is as validated as the content of the scenarios themselves. While doing ED2 and other courses, she has seen that there are clearly core things that are taught that are always the same. She suggested creating a checklist from those and make certain that every student knows each of those things before they graduate. Dr. Cendan stated that incorporating that into the questions is probably easier than incorporating it into where they are hearing it and seeing it. Dr. Bowers stated that we will need an evaluation from the students. Dr. Hernandez suggested looking not only at the content, but also how it is delivered.
The meeting adjourned at 8:56am.