MINUTES
CC34 Clinical Curriculum Committee – Feb 28, 2012; Burnett-Womack 1045, 7:15-8:30
Attendees: Alice Chuang, Tim Farrell, Robin Latessa, Christopher Klipstein, Beat Steiner, Meg Jordan, Cam
Enarson, Michel Branch, Dale Krams, Katie Smith, Lisa Slatt, Kurt Gilliland, Karen Stone, Mindy Roush, Anne
Mounsey, Rachel Quinto, Kenya McNeal-Trice, Cristin Colford, Amy Shaheen, Erin Malloy, Ana Felix, Georgette
Dent, Warren Newton
Topic
Discussion
Clinical
log
(Farrell
/Dale,
15 min)
The Clinical Log is a tool to assist our students in the attainment of competencies and in
preparation for residency. We have defined the types/settings/level of involvement for
our clinical log. We have systems in place for monitoring during each course and then
for monitoring at the end of third year with the assistance of their college advisors.
These include the midpoint evaluation, the end of clerkship evaluation and meetings
with College Advisors. These are opportunities for remediation during the course and
then during fourth year. The student experience as monitored by the log is routinely
discussed at CC34 and the data is systematically reviewed by course directors and at
CC34.
See attachment*
A suggestion was made that in future iterations, there could be more elements of
Problem Based Learning and Systems Based Practice, such as working with consultants
or communicating with consultants, incorporated into the scenarios.
CPX
Update
(Shelby
Marx,
10 min)
LCME
FINAL
PREP
Please prepare!
1) It is very important that we consistently report the same thing!
2) We must speak up in committee…be on the offensive instead of on the
defensive
3) In both sessions, we must discuss mistreatment.
Asheville Curriculum:
How does it interrelate formally with SOM?
Robin Latessa, as Campus Director, for the Asheville campus will attend CC34. There
will be a formal review regularly of Asheville track. Jeff Heck, as CEO of MAHEC and
Associate Dean of Asheville campus, will be responsible for all other aspects (Student
Affairs, Financial Aid, etc). Jeff also is on the Educational Committee.
What is the relationship between CD’s and Asheville track?
Ob/Gyn and Family Medicine are administered similarly to how the other off site
clerkships are run.
The other clerkships will report to Robin Latessa but also will communicate with
clerkship director’s at Chapel Hill.
The Asheville track was designed to be comparable to the UNC clerkships with the
added value of longitudinal experiences.
 Objectives/core experiences: Asheville curriculum was designed with same
objectives and same core experiences in mind, based on Core Competencies
 Grades: The grading criteria are pulled directly from our course websites! The
only difference is lack of resident evaluations. Asheville proposes grades, CD’s
here approve grade.
 Didactics: all available online or other comparable format
 Assessment: use same Common assessment Form
 Midrotation Feedback: They meet regularly with course director, more than
Action
Items
ALL:
Review
Tables and
return
feedback to
Lisa Slatt!
ALL:
Review
notes and
attachment
s and links
in
preparation
for LCME
visit.

one “midcourse” feedback because the course is so long.
UNC96/Clinical Log: The Asheville students use the same UNC 96 and Clinical
Log but have additional items on their clinical log as well.
How is the Asheville curriculum reviewed?
Special task force of the education committee has reviewed the program annually with
on-site visits, looking at outcomes, student services, etc. Standard course review
includes Asheville curriculum. The Asheville site directors report to the main course
directors at UNC-Chapel Hill and are then ultimately reviewed at the level of CC34.
There are two systems in place, one for the program which is via Education Committee
and one of the curriculum, which is via CC34.
Other issues:
 Class size: There will be an increase to 180 with no plans to increase further
until more resources are identified.
 Overlap between Family Medicine and Outpatient Medicine: These courses
have differential emphasis…OM emphasizes cardiovascular, respiratory, end of
life care. FM focus on musckuloskeletal, womens’ health, anxiety/fatigue,
population health. These courses were desgined with planned
duplication…complex topics that need repetition. Clinical log for both are
lengthy and overlaps can occur and should occur.
 Governance: The governing body which makes decisions about the curriculum
is the Education Committee. All the curriculum committees answer to the EC.
CC’s function to review individual courses, discuss issues with curricular content
and curricular structure but also review year as a whole. Policy in place for
review of electives and development of new electives by CC34.
 Learning Environment: *PLEASE be familiar with the data for learning
environment and mistreatment for your course over the past years! Please
read Graduation Questionnaire data! Give examples of our commitment to
positive learning environment. Includes mitigation of poor learning
environment and promotion of positive learning environment. This data is
regularly reviewed by course directors, curriculum committees. We have a
system to assess the learning environment and a mechanism for addressing
issues of the learning environment.
o Examples of promoting learning environment in surgery include: 1)
department ombudsman 2) Department code of conduct 3) recurring
Grand Rounds surrounding promoting Learning Environment 4) PhD
Educator with communications/professionalism expertise 5)
implemented work hours limitation and 6PM depart time 6) added
mistreatment and learning environment issue to midpoint feedback
plan.
o In Ob Charlotte, survey is used to assess resident’s idea of learning
environment followed by regular discussion of survey results compared
to student results.
o Also, information more prominent on websites. More daybacks have
promoted student communications and morale. This is discussed at
midrotation feedback. Resident awards/faculty awards help promote
learning environment.
http://www.med.unc.edu/www/education/mdprogram/governance/policies/additional
-policies/Enhancing%20Our%20Learning%20Environment.pdf

Duty Hours Policy Review: Clinical years duty hours are monitored regularly,
preclinical years academic calendar reviewed
http://www.med.unc.edu/www/education/mdprogram/governance/policies/files/Artic
le5ResponsibilitiesofMedicalStudents2012220.pdf
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Resources: There is departmental and SOM support for teaching, including
protected time and salary support. Budget cuts have forced us to be more
innovative and creative, including Asheville curriculum increasing capacity.
Teaching practices in FM, OM and Peds provide more clinical sites for teaching.
Mistreatment: We acknowledge this is an issue as indicated in our last LCME
review. We have taken steps. Data gathered each block from students,
reviewed quarterly by Karen Stone and Georgette Dent. Issues made known to
individual course directors. We will need to offensively discuss Surgery and
Peds/OB at Charlotte and describe the specific steps taken there and the
specific improvement in scores. There is an institutional policy on mistreatment
and ongoing education and faculty development surrounding this issue. Be
familiar with the example of the neurosurgery resident whose graduation was
delayed secondary to mistreatment issues.
http://www.med.unc.edu/www/education/mdprogram/governance/policies/mistreat
ment/NEW%20Appr%20Treatment%20Oct%2018%202011.pdf
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Competencies (ED-1, ED-1a): Driving force behind all course content, methods
of instruction, methods of assessment and curricular elements. They are also
used for ongoing review of the curriculum, decisions for promotion, outcomes
measures and curricular innovation. The operational level is the enabling
competencies.
UNC96/Clinical Log (ED-2): Function as the mechanisms for achieving our
competencies. Reviewed midcourse and then remediation plan made if student
is not on track to complete tasks/log. (Please think of specific examples to
share with site visitors.)
How are objectives made known to faculty/residents/teachers? (ED-3)All
courses have a mechanism in place, and this has been discussed frequently at
CC34 meetings so that we can share our best practices.
Comparabiity of experience/equivalence of assessments(ED-8): Our courses
have same grading structure, same assessment instruments and critieria, same
policies, same objectives, same core didactics, comparable clinical experiences,
same midrotation feedback. Site directors meet with course directors at least
2x/year
Of note, this standard states that we should review student experience at all sites and
ensure that the experiences are comparable…may need to address specifically
differences in sites for individual clerkships.

Residents as Teachers (ED-24): Institutionally, GME has always worked to
prepare residents to teach. AOE Task Force (years ago) catalogued all efforts.
This was followed by a half day program directors retreat to discuss this.
Residents are oriented upon arrival. As well, simple teaching skills card (both
electronic and pdf format) is distributed which addresses: 1) learning
environment 2) SOM competencies 3) each clerkship goals/objectives. Student
feedback on resident teachers is formally distributed. There is a formal
mechanism in place to ensure residents attest to receiving and reading UNC
SOM 1), 2) and learning environment and mistreatment policies, etc. Two new
initiatives include: 1) During rising chief residents workshop, with new curricula
addressing their roles as educational leaders on the team, specifically palliative
care counseling. 2) Required annual orientation for all new residents will have
formal session as Residents as Teachers.
http://www.med.unc.edu/aoe/resources/resources-for-residents-as-teachers1/resources-for-residents-as-teachers
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Each department also has systems in place to prepare residents for their
teaching role. Each department also has opportunities for residents who selfidentify as particularly interested in medical
Faculty appointments (ED-25): All faculty have faculty appointments
System of assessment (ED-26): System of assessment (i.e. common assessment
form) in place based on competencies. OSCE/CPX also included in our system
of assessment. The form was developed in CC34 with clerkship directors and
students. July –Dec form was piloted and found it was not optimal to assess
student competencies. The form was revised extensively and rolled out. It was
felt that it was important that it was implemented mid year.
Direct Observation (ED-27): We have OSCE’s and CPX. We query students
about this each block.
Timeliness of grades (ED-30): Most recent data show we are in compliance. We
discuss this routinely at CC34 in a systematic way. This is also discussed at
Education Committee. Shelf exam failures are informed immediately!
Midrotation Feedback (ED-31): Students meet face to face for “formal” and
their progress towards achievement of competencies is reviewed. We ensure
that this is happening by querying the students. As well, we have a form that is
filled out to document this.
Narrative evaluation (ED-32): Narrative description should be included as
component of assessment. Generally not a problem in MS3 and MS4 year.
Addendum Tables distributed to LCME (Lisa Slatt):
Educati
on
Commi
ttee
Update
Priorities for discussion per Dr. Newton
Areas needing attention/clarification/discussion this meeting.
CRITICAL ISSUES
Meeting Feb 20:
 Competencies Review: We need one clerkship director at each one. Still need:
o Practice Based Learning, Mar 2, 3-4:30, Bondurant 4052
o Systems Based Practice, Mar 27, 9-10:30, Bondurant 4052
ALL: Still
need one
clerkship
director to
attend SBP
session.
Please
contact
Alice if you
can attend.
* See Attached Document(s)
Next meeting: March 27, Location TBA
7:15 am-7:45, Course Directors only
7:45-8:30, Full Committee
Next Course Review:
Inpatient and Outpatient Clinical
Assignments (exposure to faculty,
Felix
Mar
ratio
27
Didactic Structure
Steiner
Chuang
Rake
Malloy
Rake/Wurzelmann