Curriculum Committee Minutes 01/13/20

University of Virginia School of Medicine

Curriculum Committee

Minutes – 01.13.20

MCBR, #2700 – 4:00 p.m.

 

Present (underlined) were:

Chair (votes only to break a tie): Megan Bray

Voting: Juliana Bueno, Donna Chen, Katharine DeGeorge, Aaron Freilich, Fern Hauck, Barry Hinton, Paul Kunk, Robin LeGallo, Keith Littlewood, Vishal Madaan, Juan Olazagasti, Margaret Plews-Ogan, Steven Powell, Neeral Shah, Ryan Smith, Carlos Tache-Leon

Students: Sarah Dudley, Erin Adonnino, John Popovich, Monet Lane, Logan Shelnutt, Brett Whalen, Marc Vetter, Paranjay Patel, Abby Norwood

Non-voting: Gretchen Arnold, Elizabeth Bradley, Maryellen Gusic, Mark Moody, Selina Noramly, Bill Wilson

Staff: Bobbi May

Minutes Reviewed/Accepted. The Committee voted unanimously to approve the minutes from the January 6, 2020 meeting.

Calendar – SMD24. The Committee reviewed and briefly discussed the calendar for the incoming class.

VOTE: The Committee voted unanimously to approve the SMD24 calendar.

Residents as Teachers Training. Data on resident and fellow attendance was provided by Dr. Greg Trimble from Inova, Dr. Dan Harrington from Carilion, and Diane Farineau in our GME office to confirm that all incoming residents and fellows fulfilled their mandatory “Residents as Teachers” training requirements in 2019.

VOTE: The Committee voted unanimously to approve each of the reports from Inova, Carilion and UVA confirming that all incoming residents and fellows have completed their mandatory training requirements in 2019.

Proposal: Student Evaluation Modification (3rd Year). Analysis of the performance of the 2019-2020 end of clerkship/clinical elective student performance evaluation is ongoing.   In its current form, the professionalism component comprises 49% of the score while the clinical skills component comprises 51%.  This has led to an inflation of Phase 2 and Phase 3 course grades.  A proposal from the Assessment Committee was brought forth to the Curriculum Committee to modify the weighting of the professionalism component to 30% and the clinical skills component to 70%.  This aligns with the our 70% passing grade benchmark and allows for students who can’t pass the professionalism component of the course to appropriately be in jeopardy of not passing the clinical component of the student’s course grade.  Dr. Jim Martindale has done the mathematical modeling to support this modification and Dr. Elizabeth Bradley has confirmed that our OASIS system can handle calculating the resulting scores.  The Committee discussed the proposed changes in detail.

VOTE: The Committee voted unanimously to approve the 3rd year, student evaluation assessment percentages as described above.

ACE Reviews.

General Surgery, Red. Dr. Juliana Bueno presented the review. The highlights are listed here, a detailed report is on file.

Curriculum Committee Reviewers: Juliana Bueno, MD, Peggy Plews-Ogan, MD

Clerkship Directors: Philip Smith, MD

Strengths:

  • The ACE student functions at the level of the intern in clinic in terms of seeing patients, entering the post-operative and discharge orders for surgical cases, and performing any inpatient documentation not being performed by a third-year student. The ACE student participates as an assistant surgeon in the housestaff position for portions of cervical endocrine procedures, working directly with either the attending surgeon or chief resident and learning and demonstrating fundamental technical surgical skills.
  • OASIS student evaluations of the course are very high.
  • The single attending on the service allows a very in-depth experience and the opportunity to demonstrate ability and progress.
  • Despite returning to a single attending service, the total operative and clinic volume is greater than in prior years thus increasing the learning opportunity.
  • The specific operative opportunities are achievable and represent opportunities to learn and demonstrate truly fundamental surgical skills (tissue and instrument handling, dissection, recognition and exposure of surgical planes, management of bleeding vessels).

Challenges: Since this is a single attending service, when Dr. Smith is not clinically active, there is no clinical activity on the service. This is addressed by not having an ACE student during those times that Dr. Smith will be away or otherwise not clinically active, as well as facilitating the ACE spending time with other services for any days that there is no clinical activity on the service. The schedule for the month is out early enough for the students to plan alternative activities during those days Dr. Smith is away.

Action Items and status from last year’s review (2018):

Note writing and orders had been a challenge but over this past year completely addressed.  The ACE is far exceeding the threshold for one pre-op and one post-op note, and students are routinely now putting in orders.

Action Items for the upcoming academic year:

This ACE is very well-organized and seems to be highly valued and liked by students. The previous action items (note writing &documentation) were appropriately addressed and currently the students feel engaged in the rotation and most importantly, feel that they participate and contribute valuably as their notes are considered valuable for patient care.

The future continuity of the ACE seems to be safe right now, despite being a single attending-program. No new action items

Trauma Surgery/Critical Care. Dr. Ryan Smith presented the review. The highlights are listed here, a detailed report is on file.

Curriculum Committee Reviewers: Donna Chen, MD, Ryan Smith, MD

Clerkship Directors: Jeff Young, MD

Strengths:

There is an emphasis on algorithmic and protocol-based approach to critical care that is a benefit of student exposure. In addition, we agree that the current SOM curriculum provides limited critical care exposure for students prior to graduation and remains an active area of consideration for required rotation prior to graduation.

Challenges:

Trauma surgery and admissions are highly variable. Also, medico-legally students are limited in their involvement in critical care procedures. The director tries to ensure that students are exposed to procedures such as CVL’s, chest tubes, bronchoscopy and trach’s. Students are only able to first assist on these procedures as opposed to bronchoscopy. The opportunity to see/do these procedures is difficult to predict and standardize across the ACE. Also there are competing interests of the residents on the service who need these experiences. They are trying to increase the opportunity for simulation experience with these procedures.

Action Items and status from last year’s review (2018):

Trauma service volume is variable, if the student is on service during a slow period the focus is offering the student more OR time, participation in the care of non-trauma SICU patients along with research opportunities. The Friday didactic session has also become a formal part of the rotation where student give evidenced based presentation on trauma to attendings and residents. “We have no control over the variability of admissions. We have not yet implemented a simulation program, this is in progress. We have been somewhat successful in allowing the ACE students to scrub on more general surgery cases, but there are other learners who need these experiences as well. The Friday presentations have been in place with 4th year presentations for several years. “

Action Items for the upcoming academic year:

  • Add required clinical conditions for the rotation (e.g. Perform initial evaluation of 5 trauma patients)
  • Consider movement to 4th year elective status from ACE status
  • Enhance simulation experience for procedures

 

 

Note: The next Curriculum Committee meeting is scheduled Monday, January 27, 2020, MCBR, #2700.