Clinical Education Committee February 3, 2012 Minutes MEMBERS: Cullen Hegarty DEPARTMENT and/or Clerkship
Emergency Medicine ATTENDANCE
X
David Power Family Medicine James Nixon David Walk Cornelius Lam Yasuko Yamamura Holly Boyer Edward RG Santos Betsy Murray Elke Eckert James Pacala Sally Berryman Michael Kim Robert Acton Paul Gleich Kathy Brooks Jacob Prunuske Erin Maddy Travis Fahrenkamp Ashley Nord Kiersten Norby Majka Woods Kathy Watson Ted Thompson Patti Mulcahy GUESTS: Linda Reilly Brad Clarke Medicine I/ II & Essentials of Clinical Medicine
Neurology Neurosurgery Obstetrics & Gynecology
Otolaryngology Orthopaedic Surgery Pediatrics Psychiatry Primary Care Selective – FMed & Essentials of Clinical Medicine
Primary Care Selective – Medicine
Primary Care Selectives – Medicine/Pediatrics & Pediatrics
Surgery Urology RPAP Duluth MS3 MS3 MS4 MS4 Med Ed Administration Med Ed Administration Med Ed Administration Med Ed Administration DEPARTMENT and/or Clerkship
Med Ed Administration Med Ed Administration X
X
X
X
X
X
X
X
X
X
X
X
X
ATTENDANCE
X
X
Minutes  December 2, 2011 – were not reviewed at January meeting so included here.  January 6, 2012 – minutes from combined SFC/CEC meeting Information  LCME Site Visit Prep – o Site Visit ‐ all clerkship directors and coordinators should have received message from Linda Reilly regarding what date/time they are needed to meet with site visitors. Please come 15 minutes early for briefing; there will also be a post‐meeting debrief. More information to come… o BlackBag – you can get a preview of the features when you go in to system to do objective mapping (that is ONLY requirement at this time for clerkships). If you’d like additional info/views now, please contact Mark Hilliard. OME’s focus is to do year one and two courses first (cannot move to Moodle), but if clerkships desire to move, OME may be able to accommodate. ALL courses and clerkships will use BlackBag by fall 2013.  Governance Scenarios – Discussion regarding if I want to make change with course/clerkship, what is the process given the new committee structure. Current format for clerkships is that individual CD’s can make changes within clerkship if needed. Incomplete Grades – o Started process last month of checking delayed grades and sending out notification letters to clerkships who were out of compliance. Additional reminder will now be sent at week 3 post‐period as trigger to prepare for entering grades. o Latest grade delay report shows only one clerkship potentially still out of compliance o Cooperation from clerkship directors and department chairs, but much angst and confusion from coordinators about notification of lack of compliance. There was significant surprise in some clerkships about amount of delayed grades; must discuss communication between all parties for transparency and process o K grade – if delay is due to clerkship, not student. Waiting on site directors meeting, need evaluations in, etc. To be used sparingly; several clerkships have considerable number of K grades. Used appropriately to not be counted as delayed grade, but cannot be used exorbitantly or as placeholder. o I grade – student has not completed their portion of the course (family illness, personal illness, etc.) Student has some assignment or hours to make‐up. Must be agreement between clerkship director and student – should be written and filed (email OK). This document is often needed for evidence in COSSS to prove deadlines. o Both grades (I and K) come off of transcript once final grade entered. o Gleich – what is best mechanism to use if students have missing documents/time – how to put heat on student? Fail them? Allow for one deadline, then fail if not met? What about lack of evaluations? Is that cause for failure?  Pacala – Just finished this situation for ECM:POCC. Sent letter to students with list of missing documents and deadlines, plus consequences for failing to meet deadline. Ask them to acknowledge receipt of email. VERY painful and time consuming. Dr Acton confirmed that Surgery uses similar process and emphasized using paper trail.  Nixon – would like to revisit policy on assigning failure grade. Lot of wording in policy that makes it hard to meet every single component of policy. Dr Woods confirms that this would be a good discussion, to ensure that clerkships are compliant with accreditation standards, University standards, and any internal medical school standards. Use of technology may support and assist with policy. o If you have additional concerns or suggestions, please contact Dr Hegarty or OME as procedure continues to be improved to clean up straggling late grades. o

Discussion  Annual Clerkship Review presentations o Neurology – please see attached handout  Objectives taken from national clerkship directors committee  Shelf exam scores continue to be slightly above national average  Student evaluations, including ISA, indicate some dissatisfaction which has guided some suggested improvements  Direct teaching by faculty is biggest value in this clerkship.  Areas of concern – consistency: in order to place all students, currently using 10 sites in TC and Duluth. Tutorial content – adequate to prompt discussions, but a little “blah” and could be improved. 
o
Intended changes: improve tutorial content with some new education materials from clerkship director. Improve consistency by meeting with site directors to ensure communication to students and consistent expectations. Shadowing – working with sites to ensure capable students have appropriate opportunities to do H&P’s. Meeting with residents to help instruct them how to teach medical students. Also re‐implementing group orientation so that all students get consistent information. Will survey students after next session to determine if changes were beneficial.  Questions: Boyer – in regards to orientation, clerkships directors should take advantage of technology and use videos, etc. to limit CD time and provide consistency. Dr Walk agrees, but adds that face‐time each session helps promote connectedness and encourage question/answer. In‐person orientation guarantees that students receive information. Dr Acton adds that a mix of both methods could work – use video for standard info, but face‐time to reinforce and answer questions. Dr Nixon would like video for students who are absent at orientation or simply fail to take in all the information on the first day. Dr Pacala encourages that all clerkships would need to buy‐in to video/online (Breeze) so that culture changes and it becomes standard expectation. IN‐person portion could be optional addition. Dr Eckert adds that video could be for standard information, since students then get individual site orientation once they split up and go to sites. Ashley Nord MS4 comments that online/video would be great for shorter clerkships or and/or for students who are not scheduled on campus to not have to come. Dr Hegarty cautions that it would be hard to check for understanding of orientation information if its just online. Dr Yamamura indicates the OB orientation is in SimPORTAL so would still need didactic info too. Further discussion warranted for orientations…  Questions: Santos – consistency across sites. Neurosurgery has less control over what is done at some of their sites, esp. Duluth. Neurology has even more sites, how is consistency managed? Dr Walk shared that they sites meet yearly, but attendance is low. Switching to “GoToMeeting” (online meeting software) to increase attendance and increase frequency. Individual visits to sites have also occurred. High number of sites allows students some flexibility and tailoring of experience.  Question: Is shadowing related to productivity? Yes…neurology clinics often have long waiting list, so productivity must stay high…may limit experiences of medical students. One option is for medical students to see patients in the resident’s continuity clinic: student gets to do H&P, resident doesn’t mind, and all three debrief after the patient visit.  Question: Has HCMC increased their number of physicians in neurology? Yes.  Question: Mid‐clerkship feedback? Seeking advice…how is this achieved? Surgery created simple template (introduced at orientation) that students print off and ask for feedback from resident, chief, or attending. Psych has had problems that their template was not same as e‐value so is making changes to match documents. Dr Nixon will share Medicine’s form and process. OB/GYN – please see attached handout  Objectives also taken from national group  Evidence of success include shelf exam scores and evaluations  Going well…broad range of sites and subspecialties; integrating simulations 

Concerns…a lot of variability between sites due to productivity and patient variety. Recruitment of additional sites…have exhausted all options for gaining new preceptors and simulators  Changes…Large number of lectures/materials provided online for students, but many materials need to be updated. Hoping to increase experiences in simulation. Want to expand experiences from North Memorial site in Robbinsdale to Maple Grove Hospital.  Question: Dr Walk asks how many students have difficulty getting to remote sites? Ashley notes that students choose sites when they register so can plan accordingly. Acton notes that outlying sites often provide free parking which is of interest to students.  Question: Dr Pacala asks about objectives, in that most objectives relate to medical knowledge, rather than performance. Is this intentional? Dr Yamamura indicates that it is somewhat intentional. Though there are procedures and experiences that are valuable; exposure to some opportunities is minimal and proficiency is not standard. Knowledge objectives are the ones that can be tracked consistently across all students, but using performance objectives for students would be difficult to achieve for all students due to variety of exposure. Only J is the only objective that involves patient care/interaction, but goal paragraph includes more performance‐
based items.  Dr Thompson compliments Dr Yamamura on improving the rotation on Riverside. Question: Why are there so few failures now compared to in the past? Dr Yamamura indicates that grading scale has not changed, but could be due to improved attention to orientation. Ashley notes that ACOG questions online helped her to prepare for the shelf exam. Dr Y notes that mean score on shelf exams has increased. o Primary Care Selectives  Combination of four courses: Pediatrics/Medicine‐Pediatrics/Family Medicine/Medicine. Students choose which area to register for and are assigned a primary care clinic in that discipline.  Four days of clinic per week and one day for online didactic material  Objectives similar for all four areas, but specific to specialty.  Going well…Clinical experience receives highest rating of experiences. Flexibility within schedule (which day off?). Course website is clearly organized.  Concerns…finding preceptors is biggest challenge due to clinic’s switch to EMR (affects productivity), resident placements , lack of work space for students, general productivity demands of faculty  Note: Dr Pacala indicates that EMR switch is wide‐spread; unknown variable now is that once clinic settles into new EMR system , they haven’t learned how to incorporate student into that process. Another problem is also that students are not used to hand‐writing their notes which has negatively affected some education.  Changes…need to formalize mid‐clerkship feedback, need to implement diagnosis and procedure log. Hope that BlackBag will help combining some information that is currently on four separate Moodle sites. Grade Standardization Re‐visit – NOTE HANDOUT IN PACKET/ON MOODLE. Will be sent as consent item to Education Council. Student Questions/Concerns – none at this time Meeting adjourned at 9:04am Next CEC meeting: March 2, 2012 – 7:30‐9am in B620 Mayo/179 Duluth Presentations: Family Medicine