Curriculum Committee Minutes 2/19/18

March 1, 2018 by blm8e@virginia.edu

University of Virginia School of Medicine

Curriculum Committee

Minutes – 2.19.18

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 12, 2018 meeting.

System Review: Pulmonary – Dr. Elizabeth Bradley. Dr. Bradley presented this review and submitted a formal report on the Pulmonary System to the Curriculum Committee.

Conclusions/Recommendations 2017.

  • Organization and logistics: This year, the students were quite vocal about the organizational difficulties in the Pulmonary System. The issues included both logistical hiccups such as not providing the PowerPoints or resources for sessions in a timely manner, and content concerns such as students feeling they have not received/mastered basic concepts before moving on to more complex content. It is recommended that the System Leaders consider the students concerns to determine what adjustments could be made to the System next year.
  • Clinically oriented engagement sessions: For the second year in a row, the students raved about 2 highly integrated, engaging and meaningful learning sessions in the Pulmonary System. The first is the Integrated Multidisciplinary Case Conference (IMCC). This experience is often described by students as “the best learning experience we’ve ever had/had in medical school,” as it allows students to think and act clinically as they learn from real patients and their families. It has left some faculty and students in tears as they are reminded of why they are in medical school through this powerful session. The second session is the Clinical Anatomy and Imaging Lab (CAIL), which was introduced last year in the Cardiovascular System, and has now been adopted by GI and Pulm. The students find this lab to be incredibility effective in helping them solidify their understanding of Anatomy in a highly relevant clinical context.
  • Learning objectives: Again, this year, criticism of the learning objectives continued and focused on how they are organized and linked to the class content and assessments. The students feel the learning objectives and their linkages to resources and sessions can be substantially improved. It is recommended a significant effort is put forth to address the concerns.
  • Instructors and teaching assistants: The students felt that Drs. LeGallo, Moyer, Bloodgood, and Littlewood were excellent instructors, providing material in a way that they could understand and digest. The fourth-year teaching assistants provided important support to the students, providing review sessions, answering questions, and giving of them time in a manner in which the students truly appreciated.

Practice opportunities: The students feel that this System can benefit from more practice opportunities either in class (through small group discussions, problem sets etc.) or through better aligned practice questions associated with he weekly content in the System.

Clerkship Reviews.

Surgery.

Reviewers: Megan J. Bray, MD

Clerkship Director: Eugene McGahren, MD

Assistant Director: Anneke Schroen, MD

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

Strengths of the Clerkship (essentially the same over several years).

  • Many faculty felt to be excellent teachers:
    • Drs. McGahren, Friel, Tribble, Smith, Weeds
  • Outstanding faculty who are recipients of numerous awards this academic year.
    • Drs. Schroen, McGahren, Showalter, Rasmussen, & Rustin
  • Variety of experiences for students to participate in: OR, ED, Clinics, wards, ICUs, and the variety of clinical scenarios seen
  • Consistent didactic experience for all students
  • Enthusiastic teaching by residents and dedicated rotation directors
  • Suturing/gowning & gloving/scrubbing/OR etiquette workshops during orientation
  • Weekly sessions with Dr. Friel regarding critical thinking with case based scenarios
  • Students are encouraged to feel part of the team and get lots of opportunities for H&Ps, notes & rounding.

Unique Challenges.

The unique challenges the Surgery clerkship has faced:

  • Assuring a unified general surgery experience across multiple educational settings/services.
  • Assuring a professional environment across multiple educational settings/services.
  • Lack of responsibility/oversight of nursing interactions with students.
  • Multiple learners on specific services that limit active engagement- M3/M4’s; NP students; visiting students.

Update on Actions Required from Prior Year (2016).

  • Teaching
      • Implement schedule change to improve student exposure
      • Implement ‘No Room for Error’ mock OR sim – Done, awaiting feedback on it.
      • Finalize the students ‘didactic map.’

    Consider identifying high yield internet educational resources student could as efficient resources when their clinical activities are at a lull. Still a desire to accomplish. Jeff Gander has voiced desire to complete.

  • LOs/Expectations
    • Continue to work on improving the LOs, when possible better define specifics- Will have Vera Chen review.
    • Continue to work to integrate EPA assessment- training faculty and residents next month (Feb 2018). Will be entering the current pilot program.
    • Consider adding LOs directed towards sterile technique and informed consent- Have done. Students now participate and lead one time out while on service.
    • Define student expectation for MS3 vs MS4- working on
    • Monitor success of grade and evaluation changes to the clerkship- working on unify grades across clerkships.
  • Duty Hours
    • Continue to target DH violations should be aggressively targeted- duty hour violations now recorded as only student driven- their desire to stay late and participate in interesting case. Not feeling pressure from resident or faculty to stay. All violations taken very seriously. Dr. McGahren getting notices from OASIS directly now and following up on each one.
  • Professionalism
    • Unprofessional behaviors and student mistreatment must be aggressively targeted at the resident and faculty level- Gene has targeted this within the department and surgical environment.
    • Faculty should be continually reminded to serve as role models for behavior and student treatment to their peers and learners.
    • Monitor Site Specific data – i.e., Salem
  • Reinforcing Student Value to the Team
    • The resident’s role in facilitating/assuring the ongoing (daily) integration and value of the student to the healthcare team should continually be emphasized and monitored to assure an optimal learning environment. Continued commitment to this.

Actions Required for the Upcoming Year.

  • Monitor the change of leadership within the clerkship. Associate Dean of Curriculum meeting with new directors to help on board and review expectations as well as explain new curricular initiatives.
    • New Directors should join their national surgery educational organization and participate in clerkship directors school at next available conference.
  • Expand role in the EPA pilot program as it converts to fully executed initiative.
  • Review and edit existing Learning Objectives as well as create new general LO’s that encompass all surgical services.
  • Consider creating high yield educational resources and uploading to website so that students could review and learn from. Potential topics we reviewed: primer on chest tube placement and management; fluid resuscitation, Pre-op work up, post op care, incision considerations, wound closure considerations, etc.
  • Address extra learners on certain services that limit exposure of our MS3/MS4s to patient care.
  • Create and train core faculty/senior residents to provide mid-clerkship feedback in a consistent fashion using the agreed upon form already in use.
  • Align grading process with other clerkships across third year. Give input to and help assess the newly proposed end of clerkship student evaluation.
  • Continue to monitor and address unprofessional behaviors and student mistreatment at resident and faculty level as needed.

Urology.

Reviewers: Teresa Schlager, MD and Gretchen Arnold

Clerkship Director: Ryan Smith, MD

A formal report on the Urology portion of the Subspecialty Surgical Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Strengths of the Clerkship.

  • High marks from students on exposure to a variety of areas in Urology which including clinic, ward, lab for urodynamics as well as OR.
  • Daily rounds with oral presentations and write-ups. Excellent teaching marks given to faculty and residents.
  • There is a required formal presentation for each student that is evaluated.
  • There is daily feedback per the students from faculty and residents. The clerkship director provides formal feedback as well.
  • During orientation the students are provided with “What you really need to know” with specific instruction on how to navigate the clerkship.
  • A senior urology resident is assigned to each student.

Unique Challenges.

  • Regarding the number of students on rotation at one time – 3rd and 4th year student numbers including 4th year students on away rotation will be CAPPED this is a change and should improve the 3rd year experience.
  •  The single clerkship coordinator is highly tasked: this person is the residency coordinator, the ACE coordinator and the clerkship coordinator. At times the administration of the clerkship can be less than ideal. In the future it would be beneficial to have one coordinator for the ACE and clerkship and a separate coordinator as the residency director.
  • All attendings teach however student entering of orders and scripts is variable between attendings.
  • Regarding EPAs – entering orders and scripts are a challenge. Students obtaining informed consent would be against hospital policy. Procedures as mentioned above – no bag mask or CPR.
  • To further EPAs, Dr. Smith will need to take a more active role in observing students taking history and performing a PE during clinic hours. Dr. Nora Kern, Pediatric Urology has volunteered to assist but his is in planning stages. 

Actions Required for the Upcoming Year.

  • Continue excellent rotation experiences and teaching for students
  • Continue to unify experiences across the 6 subspecialty surgical clerkships- implement uniform LO’s and clinical requirements created by new overall course Directors- Dr. Black and Asthkari.
  • More focused administration assistance for this subspecialty service.
  • Continue integration of EPAs into clerkship.
  • Continue to evaluate student feedback and communicate these evaluations to the attendings and residents

Orthopaedic Surgery.

Reviewers: Mark Moody and Juliana Bueno, MD

Clerkship Director: Aaron Freilich, MD

A formal report on the Orthopaedic portion of the Subspecialty Surgical Clerkship was submitted to the Curriculum Committee. The highlights are listed below.

Strengths of the Clerkship.

  • The clerkship offers a varied and customizable experience.
  • A large number of faculty & residents who are interested and dedicated to teaching students. Several have been recognized in the past for their teaching with awards.

Unique Challenges.

Not particularly unique to this surgical subspecialty.

  • Concerns regarding ordering and notes on EPIC remain a concern with faculty.
  • The variety of experiences make it challenging to completely standardize the curriculum across the six surgical subspecialties. Continuing to work on.

Update on Actions Required from Prior Year (2016).

    • Formalized didactic sessions for students by faculty – under development.
    • Limit preceptors to those faculty interested in teaching – completed.
  • Implement more formalized feedback at end of rotation – completed. Note that mid-clerkship feedback now being given in the first 2 week subspecialty surgical service so that students can implement any changes during their second 2week subspecialty service.

Actions Required for the Upcoming Year.

  • Work with Medical Education Technology (Mark Moody’s group) to review and update of the course’s web pages – references to prior leadership, consistency.
  • Continue to seek consistency across the six surgical subspecialties clerkship: some learning objectives and EPAs can be shared among subspecialties to ensure completion and optimization of learning experience.

 

Note: The next Curriculum Committee meeting will be held on Monday, March 5, 2018 in MCBR, #2700.

Filed Under: 2018, Curriculum Committee Minutes