Curriculum Committee Meeting Minutes 11/22/05

Members present: Dr. Richard Davidson, Omayra Marrero, Dr. Wayne Bottom, Dr. Kyle Rarey, Dr. Sigurd Normann, Dr. Louis Ritz, Dr. Robert Watson, Dr. Peggy Wallace, Dr. Vidauretta, Dr. Cendan, Bhavin Adhyaru, Dr. John Meuleman, Dr. Maureen Novak, Linda Butson, Dr. Lynn Romrell, Dr. Robert Hatch, Dr. Heather Harrell, Dr. Robert Averbuch, and Suki Subbiah

Announcements: Dr. Davidson welcomed Dr. Juan Cendan who is taking over as Medical Director of the Harrell Center. Dr. Davidson announced that Dr. Rarey, who has served as regional chair for the last year, was elected to be the National Chair of the RIME Committee next year. He congratulated Dr. Watson for receiving the Robert J. Glaser Award, an award he describes as a huge honor and the most prestigious AAMC award that can be presented.

Student announcements: 1st year student, Omayra Marrero, announced that the semester will soon be wrapped up. She states that the commemorative ceremony will be held Monday Dec 5th and says it will be nice having closure before going on to the next semester. 4th year student, Suki Subbiah, reported they are interviewing right now and planning Skit Night in which many faculty will be called to participate.

1.Brief comments about the AAMC meeting from participants.

Dr. Rarey commented on the LCME standards sessions, stating that they talked about the best practices. He stated that in 19 site visits by the secretariats, 8-9 schools have been cited for non-compliance in ED-2 standards. It was stated that resident teachers in both courses and clerkships need a written hardcopy of the syllabus, goals and objectives. Dr. Davidson was surprised of the number of schools that had already been cited with the relatively recent onset of ED-2 standards. Dr. Davidson stated that we are definitely addressing the issue and Dr. Rarey stated that those involved are doing a great job and are on the right track.

Dr. Davidson noted there were a number of interesting discussions that addressed the Institute on Improving Medical Education. Dr. Vidauretta stated that she attended the group on Student affairs meetings. She stated it was interesting to hear from the New Orleans schools, Tulane in particular, who lost all of their student records. The student affairs office had to call the AAMC for a list of their students and how to contact them. She said that fortunately, the other campuses faired better than that. One of the things that came from that discussion is that the OSR is putting forth recommendations for disaster recovery plans; for instance, which students had cars or which did not, etc. and what they would do in an emergency. The OSR also stated that some schools ordered their students to stay and recommendations will be discussed in that regard.

Dr. Vidauretta stated that the other main topic was criminal background checks of medical students, which she contributes to us now living in the post-911 era. There is now going to be a centralized service within the AAMC and this data is intended to be aside from the admissions process; in other words, any positive findings should not be part of a decision that is made-it is simply something that a separate office will follow-up on if any of these students are admitted. This will be handled on a case-by-case basis. It was approved by the Executive Committee in June and she believes it will begin in 2007. It was asked if drug testing was discussed, which she and Dr. Watson reported that it was not. Dr. Watson reported that it was asked if minority students would be handled differently. Dr. Watson reported that as soon as he returned from the meeting, he wrote Dr. Pat Duff a letter and appointed him the chair of a committee so far made up of Susan Collingwood, Ira Gessner, and Frank Genuardi. He stated that if anyone else is interested in joining the committee, they are to contact Dr. Pat Duff. Dr. Duff is going to establish our policies and procedures now so it will be in place when the information from the background checks is obtained.

Dr. Watson stated that he and Dr. Romrell are part of an FMA Pre-disaster Planning Committee for the state’s medical schools. One of the things that Dr. Romrell suggested is that there needs to be a central repository database secure and safe in a place such as Orlando where all the state schools have downloaded all the information about their students and residents. After listening to the speakers from the medical schools who had been involved in the hurricane, Dr. Watson wrote a letter to the president of FMA, Troy Tippett, and suggested that these people come in and offer advice to other medical schools, as they had learned a lot through their ordeal.

Dr. Watson also mentioned his interest in hearing that in the last decade, there has been a 23% increase in the number of medical schools that are all for profit, the majority of which are in the Caribbean. He said that California is the only state in the country that has a system in place that has some reasonable assessment of the quality of these people that are applying for residency positions; other than that this country does not have a system. He also noted that he was amazed and encouraged at how dominant the Institute for Improving Medical Education conferences were, that they included GME, CME and UME. He states that there is actually a big push for reform of GME and CME and then blending pre-med and medical school into GME.

2.Continuation of discussion about Dr. Ritz’s presentation regarding grading criteria.

Dr. Davidson stated the need to complete the discussion about the proposal made by the Evaluation Subcommittee. The latest version, after comments were added from Dr. Romrell, was handed out.

Dr. Ritz reminded everyone that last month’s meeting ended with discussion of the proposal that suggests there be a distribution of A’s (approximately between 17-34%) of the class; these students would be seen as exemplary students. Percentages of B’s and C’s are not discussed in the proposal. He stated that if someone was assigned a C there would be some remediation, but they would not have to repeat the course. If they were assigned an E, they would have to repeat the course. Dr. Ritz reviewed information that Dr. Romrell provided in regard to grades. He reported that there was a dramatic change in the percentage of C’s assigned from 1st year through 4th year. What he wanted to discuss is whether we would have uniform standards across the entire four years or have one standard for 1st and 2nd years and another for 3rd and 4th years. This implies that a C is a passing grade with no remediation required. It was noted that some C’s were given in the 3rd year clerkships, which was of concern to Dr. Meuleman in last month’s meeting. Dr. Meuleman stated that he felt if a clerkship had not given any C’s in a two-year period, the Evaluation Subcommittee would need to sit down with them and ask how they are critically identifying students who may need improvement. It was brought up that it was probable that the widest spread of grades would naturally occur in the 1st year and that by the 2nd year, the students who needed remediation should already have been recognized.

Dr. Harrell agreed that there are probably up to 5% of students yearly that may need improvement, but that the problem with the clerkship is trying to capture that because there is not a centralized grading system; that is, the clerkship director does not work directly with most students, in spite of the fact that they provide the final grade. She said if there is nothing solid from faculty that are critical of a student, her hands are tied and she thinks that is the case for most clerkship directors. Dr. Novak agreed that it is very hard without having a centralized grading system.

Dr. Romrell stated that if he meets with a student who is not performing as well as the rest of their class, in most cases those are not the students that they have any concern about. There are lots of students who are in the lower third of the class that anyone in the room would say “That’s the student who I want as my physician one day”. Taking a high achieving group of students who were performing at a level probably in the top 5% of their university class, suddenly in medical school are put in an environment where again we are going to test them on their abilities and some of are going to be in the lower third of their class. He asks if that means we have concern about those students who may earn a C or B and is a lower third student. He states that it is a rare event that a student graduates and we think “Why did we let him go”? Every year there may be one or two we look at and sometimes they’re in the top of the class, but they have poor judgment, they have inflated egos and are arrogant.

Dr. Davidson asked if we even need to address the fact that there is a different distribution of C’s in the first two years. The proposal suggests a percentage of A’s. Is this necessary that we address a percentage of C’s?

Dr. Hatch stated that one of his colleagues decided not to assign any C’s because it generated too much work because students complained too much and came back too much and it was just too hard. His colleague went to an A-B-B+ system.

Dr. Harrell stated that the clerkship knew if they were giving C’s or not and that they struggle a lot over grades. If it is suggested they are being thoughtless about the grades, it could potentially be the straw that breaks their back if they’re getting overwhelmed and having to meet deadlines and are then told that they’re not giving enough C’s. She thinks we have a group of people that are thoughtful about that. Dr. Hatch feels that by focusing attention on it we could get better at doing it and if we don’t focus attention on it, it is going to stay the same. Dr. Harrell doesn’t feel that anything would be accomplished by meeting about assignment of C’s. Dr. Romrell feels that assigning C’s would send a strong message to the students, but that they don’t need to remediate. He thinks we are doing that and points out that for the final grade, the students have already been remediated and the D’s and E’s disappear or the student has been dismissed. Dr. Normann expressed concern about Dr. Hatch’s statement that his colleague wouldn’t give C’s because it was too much work and feels that is wrong. He says it may mean more work, but states that you just have to “belly-up” to it. Dr. Watson agreed that if we are letting students get through about whom we have concerns, then there is something wrong, although he does not feel that we are doing that. He states that once ED-2 is in place and we have Dr. Juan Cendan looking at the continuum of all the all the PBE’s, at the end of the 3rd year we are going to take a look at each individual student and then Dr. Harrell and their advisor is going to help structure their 4th year so that if there are any deficiencies they will be remediated and will be fully prepared for graduation. We have great students and bright people and our job is to remediate them, not kick them out. We should not use a certain percentage of B’s and C’s in a punitive fashion. He thinks we are going to have the things in place that will make it even better than it is now. He agrees that there are so many different things that go into the grade by someone on the clerkship that he is not opposed to the electives being pass/fail, and stated he’d like the first year to be pass/fail as well.

50% A’s for two consecutive years: Dr. Novak questioned what happens when someone receives a U. Dr. Romrell stated that U is an unsatisfactory grade and said that Dr. Davidson would have to give recommendations on whether they intend to use the full-repeat of the course or some kind of remediation. The rules of the Curriculum Committee and the rules of the university are that any course can be s/u, but that the College of Medicine requires approval of the Curriculum Committee. Therefore, any 1st or 2nd year course can switch to an s/u. Clerkships typically do not want that to occur and feel that it is not in the best interest of the student to have s/u for a clerkship grade. The Curriculum Committee makes the decision as to who will be s/u (has been in the rules for years). Dr. Davidson said that the way it was envisioned in the Subcommittee was that it would start with an incoming first year class and then require two years for a course to have greater than 50%. Dr. Ritz stated the two-year waiting period is too long and is not in the spirit of what we’re trying to accomplish. Dr. Davidson said it is reasonable to allow course directors some knowledge of this before they are told that their course must be pass/fail. It was stated that it is confusing for a program director looking at a Histogram with regards to pass/fail courses. It was stated that there is no Histogram for pass/fail courses. Dr. Watson stated that he believes in criterion-referenced grading versus norm-referenced grading. Dr. Davidson agrees and said that would therefore make sense for a pass/fail course. Dr. Watson states that he has a lot of faith in course and clerkship directors and that small problems come up from time to time, but for the most part he is a believer in criterion-referenced grading. Dr. Romrell stated that the intent of waiting two years is that the standard for letter grades will be set higher each year and that the students will be informed beforehand. He states to have a two-year scale will give the chance for the course director the chance to say “Well, I set the level on the bar and they’ve learned to jump 6 feet and next year they’ll have to jump 7 feet to get that A”. That’s the way it is; every student knows the standard and they can all try for it. Dr. Harrell said that what you’re saying is not exactly criterion-referenced; you’re trying to be criterion-referenced, but you’re not. Dr. Romrell said that if we really are being criterion-referenced, we are not discriminating and we shouldn’t try to mix the two. Dr. Harrell says if you say one year this is what you need to know, the knowledge should not vary the next year. Dr. Romrell said then we should simply go to pass/fail. He agrees that we do have above average students.

NBME subject slide: Dr. Ritz discussed the 75th percentile and Dr. Romrell said that is a high standard, but to realize that is the average of the class. It was stated that at that time a clerkship director could make his case to his peers and then it would be presented to the Evaluation Subcommittee. It was of concern that this would be cumbersome and that the students would have to wait for their grades, which could take a month or longer to work out. Dr. Davidson stated that the reason the proposal says “there could be other justifications for this allowance, including high performance” is that some coursework is not evaluated using national subject exams. He thinks that if you teach a course for which the performance of the students is well above the national average even though it is not a Step exam, he thinks that ought to be considered the same as a Step exam would be considered if we agree to have this petition. Dr. Normann said he actually finds the second part to be more acceptable than the automatic assignment of pass/fail. It seems to him that we should go to this step first and then you could always petition the Curriculum Committee for the changing of the pass/fail. So he would be in favor of leaving this one and deleting the prior one. He states that this would be an example of how you could raise the standard. It was suggested that we could meet periodically to review the grades that are on the subject exam. It was stated that for the last 40 years we have been over the 75th percentile and we don’t need to come next year and state the same thing; the grades will reflect it. Dr. Harrell suggested that Dr. Pat Duff may be able to put something in the letters to explain in the Histogram that our students are in the 90th percentile so that people will have a sense that it is not grade inflation, the students are just absolutely outstanding. It was agreed that it could be a footnote on Histogram and would be good advertisement for the students. Dr. Davidson asked for comments regarding Dr. Normann’s suggestion to amend this proposal and eliminate the automatic pass/fail and have the right to increase the number of A’s based on performance on the subject exam or whatever argument you want to make and justify your A’s - bottom line. Dr. Watson stated that he felt it should go directly to the Evaluation Subcommittee for assessment rather than the two-step process. Dr. Davidson said that was the initial proposal, but it was suggested that peer pressure would be beneficial. The two-step process was intended to take the pressure off the course and clerkship directors so that they would not feel awkward. It was pointed-out that this could be an informal process and the course and clerkship directors could simply be asked for feedback before the matter was brought to the Evaluation Subcommittee.

All electives to be graded on s/u scale: Dr. Romrell noted that this does not include the required courses in 4th year. He stated that 85% of the grades in the real electives are A’s. Dr. Harrell sent out an e-mail to all Elective Course Directors a few days ago that included a comment that we’re considering this and asked people if they had feedback on that to get in touch with either Dr. Davidson or Dr. Harrell and there were no responses. Dr. Harrell is trying to make sure that all electives are evaluated based on competencies and have some type of method there, because most don’t and she feels this will take a lot of time to occur. Dr. Watson asked if performance on electives ever really changed a student’s class rank by one spot. Dr. Romrell stated that electives have changed a student’s rank. He stated that at the end of the year when the top 10 in the class are picked, there is always someone who gets knocked off the ladder right at the end. He is not sure that is fair because of the difference in the choice of electives, which can be from one extreme to another.

Valid instruments: Dr. Rarey stated the importance of having reliable and valid instruments for course evaluation and feels that Dr. Rathe has provided ways to monitor and use these analyses that will enhance the overall quality of the course and clerkship directors to use these instruments. For that reason, statistics regarding the difficulty and discrimination of MCQs will be a part of each future course and clerkship report. Dr. Davidson agreed, but felt that the defined percentages needed to be removed. He felt this showed misunderstanding of how to put a test together. Dr. Rarey pointed out that the numbers would be monitored.

Dr. Watson stated that it is important to put the Evaluation Subcommittee evermore firmly in the position that it makes the assessment and then makes recommendations to the Curriculum Committee.

Dr. Davidson brought up that the percentage of A’s was discussed in the courses, but not in the clerkships and whether or not that could result in a clerkship being pass/fail. It was determined that this would apply to courses and clerkships.

Dr. Davidson stated that the other thing that was not mentioned in the proposal was the competencies and that the competencies were addressed by the Subcommittee. He stated that when Dr. Romrell presented the results of the competency distributions, they fall very much in line with what is recommended in the letter grades in terms of the approximate percentage of the core category or the top category. So we are already meeting those criteria in terms of the competencies, we just may not be doing in terms of the grades. Dr. Rarey recommended that the Evaluation Subcommittee present competency data annually to the Curriculum Committee.

Dr. Harrell moved that the proposal put forth by the Evaluation Subcommittee be approved contingent upon removal of the statement stating that a course/clerkship in which more than 50% of the grades assigned are A’s for two consecutive years will be deemed as not being discriminatory and will be changed to the S/U (satisfactory/unsatisfactory) grading scale and Dr. Novak seconded it.

Before the motion was voted on, there was further discussion about the competency grades of D and E and if remediation would be needed. After some discussion, it was stated that the sentence should read “Unsatisfactory performances will be designated by any competency score of “needs remediation” or an assigned letter grade of D or E”. It was clarified that a C grade is not a failing grade, but it is a warning that a student is starting to show a low level of performance; it would not require action by the Academic Status Committee. A few members expressed concern of how to supply adequate remediation. It was also stated that the specific dean should be identified in regards to the presentation to the Curriculum Committee.

It was voted on to approve the proposal put forth by the Evaluation Subcommittee with the above-mentioned changes. All members and ex-officio members present were in favor of the proposal, none were opposed. The motion was passed.

The meeting was adjourned at 9:00.