Curriculum Committee Minutes 2/12/18

University of Virginia School of Medicine

Curriculum Committee

Minutes – 2.12.18

MCBR, #2700 -4:00 p.m.

Present (underlined) were:

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

Voting: Juliana Bueno, Donna Chen, Aaron Freilich, Barry Hinton, Rachel Kon, Robin LeGallo, Keith Littlewood, Vishal Madaan, Juan Olazagasti, Margaret Plews-Ogan, Steven Powell, Theresa Schlager, Neeral Shah, Ryan Smith, Carlos Tache-Leon, Stephen Wolf

Students: John Hickman, Elizabeth Hoang, Ory Streeter, Rick Vavolizza

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

Staff: Bobbi May

Guests: None

Minutes Reviewed/Accepted. The Committee unanimously approved the minutes from the February 5, 2018 meeting.

Nomination: Assistant Clerkship Director, Geriatrics – Dr. Justin Mutter. Dr. Mohan Nadkarni, Division Chief of Geriatric Medicine, submitted his nomination for Dr. Justin Mutter as Assistant Clerkship Director. Dr. Mutter ‘s CV had been circulated electronically for review prior to meeting. Dr. Mutter is a former UVA medical student and resident and is well recognized as an enthusiastic teacher in his career thus far.  In 2017 he received the Mulholland Teaching award which students present to exceptional Fellows for their teaching accomplishments.

Vote: The Committee voted unanimously to approve Dr. Justin Mutter as the Assistant Clerkship Director for Geriatrics.

 

Clerkship Reviews.

Neurology.

Reviewers: Juan Olazagasti and Donna Chen

A formal report on the Neurology Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Clerkship Director: Guillermo Solorzano

Assistant Director: Binit Shah
Strengths of the Clerkship.

  • Very detailed evaluations with precise feedback of the rotating MS, with easy to act upon areas for improvement, highlights of student’s strengths as well as areas for improvement.
  • Active Student involvement on services. – Students play integral role on the stroke inpatient service. Additionally- the inpatient neurology rotation allows frequent practice of exam skills and certain degree of autonomy.
  • Strong leadership and administration.

Unique Challenges.

  • The outpt clinic seems to be too busy, understaffed and disorganized, making the rotation for the MS not as valuable/engaging and educational as it should be. Leadership is invested in improving.

Update on Actions Required from Prior Year (2016).

  • Assess the student experience after restructuring the outpatient clinic so that students are assigned to faculty rather than clinic locations. The outpatient clinic continues to be problematic with this change which prompted more changes as described below. Attempts will be made to have students work with a single attending more than once; this is difficult administratively, so will monitor closely for effect and ways to improve.
  • Continue to find and implement ways that students can have increased engagement and responsibility with patients, especially in the outpatient clinic. Suggestions would include the possibility of scribing, giving students clinic schedules in advance so they can read up on the patients, finding time/room for students to interact with patients independently and perform focused observed examinations. Having students work with a single attending more than once will also give attendings a sense of the students abilities and pave the way for allowing increased responsibility during subsequent sessions.
  • Increase faculty development on giving feedback and stress its importance. Students may be getting feedback but they are not recognizing it as such. There is continuous attention to this for faculty and residents. If OASIS comments about students correlate with level of feedback given to students, then it would likely be excellent. We discussed continuing to remind teachers to “tag” feedback as such when given in real-time.
  • Assess the value of newly implemented SDLs (multiple sclerosis series) There are many comments from students praising the quality of the curriculum overall. Nothing specific either way about the multiple sclerosis series.
  • Work with MBB to include more pediatric neurology. Continue to look at learning objectives and level of detail of which content is taught. Dr. Solorzano has reviewed MBB LOs with the system leaders. They have included some more pediatric neurology and will continue to look for places to include more.
  • Continue to improve the instructions for student expectations of the OSCE. Few student complaints about OSCE in OASIS, so looks like this has improved.
  • Integrate activities and faculty development towards the EPAs as recommendations come from committees. This will continue to be a priority as recommendations about EPAs come forward.

Actions Required for the Upcoming Year.

  • New Clerkship Director as of March 1st, Dr. Binit Shah –Dr. Solorzano will still be there to assist and support. We agree with and endorse their plan also to look for some new to begin to help out as Associate CD.
  • Curriculum (initially purchased from U of F/Miller SOM) is being continuously revised and updated. This curriculum has been shared and discussed with INOVA counterparts during preliminary meetings. Sharing curriculum will ensure comparability across sites.
  • Addition of basic imaging discussions to help students get more out of the Stroke and General Neurology conferences they attend while on rotation.
  • Outpatient clinic continues to garner the biggest concerns. Leadership has offered the following plan for next year.
  • Directly matching faculty with medical students 1:1 with defined goals and expectations for both parties.
  • Most faculty will then at least see a MS twice in ½ day workdays, so hopefully they  will feel more comfortable allowing the students to actively participate.   Should help with EPA implementation.
  • Continue to give “focused” handouts with specific questions for subspecialty clinics in order to facilitate obtaining an appropriate clinical history prior to the faculty doing the exam.
  • Leadership has a plan to introduce formal mid rotation feedback with clear instructions as well as remind faculty and residents to verbally tag real-time “feedback” when it is being given. Having students work 1:1 with attendings should help allow for more meaningful feedback as well.
  • Continue to work to integrate EPA’s into the clerkships.
  • Once the INOVA site opens there will be 2-3 medical students less per 4 week block rotation. This decompression should help improve the student experience at Charlottesville.

Emergency Medicine.

Reviewers: Ryan Smith and Barry Hinton

A formal report on the Neurology Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Clerkship Director: Amita Sudhir

Assistant Director:  Heather Streich

Strengths of the Clerkship.

  • Workshop, scheduled lectures and simulation activities. Dr. Sudhir has done a great job of ensuring students have a core set of predictable experiences and exposures given the variety and unpredictable nature of the ED. Students report high satisfaction.
  • Organization of the clerkship. This is a highly organized clerkship which is challenging given the frequency of changing shifts, the large volume of students and variability of attendings. Students continue to report that it is well run.
  • Student feedback: Each student had feedback at mid-clerkship and also moderate-length Oasis comments with some constructive criticism when appropriate. Students also noted changing their practice based on feedback. 

Unique Challenges.

The discontinuous assignments, both in terms of activities and supervising educators, remain a challenge for this clerkship. This is common to EM experiences nationally.  Students desire more shifts, but are limited due to student volume. Perhaps this will be alleviated with additional students at Inova.

Update on Actions Required from Prior Year (2016).

  • Dr. Sudhir has continued to provide mid-rotation feedback (generally via email) given the constraints of meeting each student during the rotation. Students reported changing their practice based on comments and are highly satisfied.
  • The clerkship checklist continues to be utilized but may receive modifications given forthcoming EPA’s.

Actions Required for the Upcoming Year.

  • Adjust clerkship checklist to reflect EPA’s.
  • Dr. Sudhir needs an assistant director to offset some of the administrative and logistical burden of the clerkship since the current assistant is taking on other responsibilities in the SOM.

Psychiatric Medicine.

Reviewers: Margaret Plews-Ogan, and William Wilson

A formal report on the Psychiatry Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Clerkship Director: Dr. Pamela Herrington

Assistant Clerkship Director: Dr. Meredith Lee

Strengths of the clerkship.

  • Students are exposed to a variety of psychopathologies in a number of clinical settings where they participate in a multidisciplinary approach to care. They have attending and resident physicians who are inclusive of students and motivated to mentor/teach. Students often comment that they like being an active member of the treatment team and that they have an adequate opportunity to engage with patients.
  • There is a teaching curriculum for residents that has been well received and useful.
  • Current chief resident, Dr. Rosen, was the recipient of the Mulholland Award for 2016-2017. Dr. Merkel was honored with the Master Educator Award. One of the chiefs who is particularly interested in teaching is planning to stay on as faculty and to continue to develop the teaching curriculum for residents.
  • To enhance the outpatient exposure, leadership first incorporated the Bridge clinic as a required part of the clerkship. They then started to have the WSH students spend time at the Northridge outpatient clinic. This year, they have added a list of elective clinic opportunities that a student may choose from. Included on this list are: Child clinic, Geriatric clinic, Nursing home visits, MAT clinic, Refractory mood disorder clinic, and Refugee clinic to name a few. Students feel that they have a good mix of inpatient and outpatient experiences. (85% inpatient 15% outpatient) as the inpatient experience gives students much more exposure to pathology and a more clear role in care.
  • The department has had several residents who are very interested in teaching and have worked to allow them to be actively involved with the clerkship. Chief Resident, Dr. Rosen, meets with students on a weekly basis for a clinical teaching session.
  • For the past couple of years, the students have been presenting a researched topic that counts as 15% of their final grade. In the past, the Clerkship Director (CD) had general guidelines for how this was graded, but now there is a structured assessment tool that is used at all sites. CD is considering incorporating a self- assessment and/or peer assessment portion to this exercise as well.
  • Starting in December 2017, the department has a new Child Psychiatrist, Dr. Meghan Gaare (a graduate of UVA SOM) who will serve as the Chief of Child and Adolescent CL and Emergency Psychiatry.   CD’s have not yet sorted out how students will be involved with this service, but the plan is to have students do some child psychiatry CL rounds.
  • At WSH, Dr. Walling has been in the role of site-director for the past couple of years.

Unique Challenges.

  • The primary challenge is related to the student numbers and a limited amount of space. The clerkship has the majority of students rotating at the UVA site as WSH has asked to reduce their numbers and there has been a reduction of the numbers at Salem. The GME work space is shared by residents and students and can be overcrowded when there is more than 6-7 students.  There have been 8-9 students on occasion.
  • It does not appear that there are any problematic holes in the curriculum as evidenced by how well students perform on the SHELF exam and also the behavioral medicine portion of the Step Exam. The current clerkship is only 4 weeks as compared to 6 weeks in the past. The teaching focuses on the more common psychiatric pathologies.   Students interested in more subspecialized topics can elect extra clinic time during the clerkship month or they might do a 4th year elective. Having the students chose a topic to research and present has been beneficial as it allows students to learn more about something they might not have come across in the clinical setting or have learned in one of our didactics.
  • There may be challenges implementing the EPAs particularly at WSH.
  • There are challenges re WSH wanting fewer students. They have also voiced concern with feeling that the UVA students are “entitled” and not motivated to participate.
  • Salem student housing is a challenge- lack of reliable wifi and other issues. It limits the number of student sent there. The clinical experience in psychiatry is excellent though.

Update on Actions Required from Prior Year (2016).

  • As of November 2017, Dr. Meredith Lee has been named as the Assistant Clerkship Director
  • Some podcasts have been completed.
  • They have incorporated more pharmacology.

Actions Required for the Upcoming Year:

  • Integration of the new Assistant Program Director.
  • Continue to produce core medical education materials for the various sites to use.
  • Suggest review of WSH complaints of professionalism issues toward students (5/34 is a meaningful % of students). It is possible that the general attitude toward students is creating a culture that needs to be addressed. Will be highlighted to CD’s and departmental Chair.
  • Assure that all professionalism concerns are addressed in a timely fashion.

Family Medicine.

Reviewers: Vishal Madaan and Robin LeGallo

A formal report on the Family Practice Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Clerkship Director: Catherine Casey, MD

 Strengths of the clerkship.

Strengths as reported by students and self-study include breadth and depth of experiences, excellent preceptor teachers, independence and one-on-one time with faculty, student participation in history taking, physical exam and medical record documentation. Direct contact with attendings at almost all sites. Some sites seem to offer more participation in procedures. Mid-clerkship feedback is consistent and continued feedback seems to be common.  The workshops are highly regarded. There are 60 preceptor sites, and they provide rich, hands-on exposure to real-world outpatient family medicine. The clerkship is organized and well-structured and despite the variety of placements, the goals and learning objective as well as the educational resources provide structure.

 Unique Challenges.

The number of placements and preceptors, spanning Virginia is unique to this clerkship. Dr. Casey does an amazing job of creating a structured program despite the variety of experiences.  De-centralization may lend itself to the potential for events of non-professional behavior and this should be continued to be monitored and addressed.

Update on Actions Required from Prior Year (2016).

Recommendations from last year’s actions plans were addressed. There is an ongoing search for an assistant system leader, several new preceptors have been recruited, the website has been revamped and suggested adjustments in OASIS gradebook and checklists have been made.

Actions Required for the Upcoming Year.

  • Identify an assistant clerkship director.
  • Fix the link to the 12 competencies on the website page
  • Also, other links related to Professionalism, Cultural Competency etc. on this page need to be fixed.
  • Continue faculty development in the areas allowing students to participate in documentation and procedures as well as giving feedback to them on their student narrative evaluations.
  • Continue with plan for site visits for all new preceptors.
  • Continue to weigh pros and cons of bringing students back mid-clerkship or consider alternatives for those that are farthest away.
  • Consider adding information on over the counter medications in pre-clerkship curriculum
  • Continue to work with Lynchburg in training residents as educators. Consider a site visit or professional development sessions for the residents.
  • Continue to work with leaders of the EPA initiatives to devise a plan for EPA assessments with the family medicine clerkship and determine how preceptors will be part of this.
  • Continue to monitor and address any reports of unprofessional behavior.

 

Note: The next Curriculum Committee meeting will be held on Monday, February 19, 2018 in MCBR, #2700.