Clinical Education Committee June 3, 2011 Minutes Committee members: Robert Acton Sharon Allen Leslie Anderson Sally Berryman Holly Boyer Kathy Brooks Elke Eckert Paul Gleich Cullen Hegarty Alan Johns Michael Kim Cornelius Lam Betsy Murray James Nixon James Pacala Edward Santos Linda Perkowski David Power Ted Thompson Yasuko Yamamura David Walk Kathy Watson Majka Woods 7:30‐8:30
7:30‐8:40
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Students:
J Brintnall
A Carrow
N Cole
K Norby
A Nord
S Pleasants
B Varda
X X X X X Guests: Patti Mulcahy
Whitney Donigan
Ali Hemphill
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8:50‐9:00
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7:30‐8:45
7:30‐8:40
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Attendance: Dr Ted Thompson will lead the meeting in Dr Hegarty’s absence. Student Council has been advised that we need new elections for student representatives – more MS4s and MS3s. Introduction: Dr Edward Santos from Orthopaedic Surgery has taken over for Fernando Pena as representative to CEC. Minutes‐ May 6, 2011 – Please let Brooke know of any requested changes. Information‐ Dress Code: Questions had arisen through the ECM course as well as some clerkships regarding the dress code for medical students. There is a Dress Code published for students that was passed in 2001 for students in years three and four. The question is whether or not this applies to first and second year students in the ECM course and whether or not the medical school has a dress code for trainees on clinical rotations. Most hospitals have dress codes for residents and fellows; these codes would surpass anything that the medical school would pass, however it may be prudent to have general guidelines. Recent examples of questionable dress code include: cutoff jeans, t‐shirts, sandals, etc. There is a possibility that the students in this case (surgery) were planning to change into scrubs later, but needed to pass through major clinical setting areas and should have been appropriately dressed. The major guidelines should also reference OSHA guidelines (closed‐toed shoes) and infectious hazards (ties). Betsy Murray also suggested a possible standardized procedure for preceptors observing inappropriate dress. Dr Watson indicated that appropriate dress is part of the overall evaluation for clerkships (professionalism). Dr Murray would like to know what to respond to preceptors when they alert her that a student was inappropriately dressed. Is there follow‐up from the medical school? Dr Brooks asked the question as to whether this was a central decision or a local (preceptor) decision? D r Thompson indicated the likelihood that this is a local decision when there are violations, but the medical school could rely on the faculty advisors to track any longitudinal problems with dress. Ali Hemphill (ECM Course Manager) indicated that for many rotations, there is a step in orientation where new students are reminded/instructed to follow professional dress guidelines. Dr Brooks would also like the UMMS dress code guidelines with our community preceptors. Dr Thompson asked for endorsement of current guidelines as printed; Dr Kim asked for an additional line regarding general OSHA rules and an additional line referring students to follow the specific dress code of the system. Dr Watson motioned for these guidelines to be promoted to a policy that applies to all four years and Duluth (Rural Health Scholars). LCME Independent Student Analysis Report: More information will be discussed at the Curriculum Committee meeting next week. Major issues discussed in report include scheduling (capacity, distribution, timing) and mistreatment/harassment. But overall there were few surprises, according to Dr Watson. Level 1 Recommendations from LCME Years 3 & 4 Subcommittee: Dr Murray was asked to bring back the recommendations that the LCME subcommittee created for implementation of the clinical learning objectives. Level 1 recommendations are those that are most urgent. Please refer to attachment… Disseminate programmatic learning objectives‐ This has occurred; document was distributed to all clerkship directors and coordinators with the request to disseminate to sites, students, and teaching faculty (including residents). Map clinical learning objectives‐ Will be mapped to the curriculum of the first two years by medical school staff. Review course‐specific learning objectives to verify consistency with clinical learning objectives – Responsibility of individual clerkship directors to make this reconciliation. Develop a plan for updating and maintaining clinical learning objectives annually – Dr Hegarty (CEC chair) has proposed that each year in January the CEC reviews the set of clinical learning objectives and proposed any changes, with sufficient time for implementation of changes. Dr Murray asked whether or not there should be a subcommittee to preview the document prior to the group review each year. Dr Kim added that when the clerkships present their reviews, the review form should ask if the clerkship objectives are correlated to the clinical learning objectives. Annual review of clinical learning objectives should also include a conversation of which clerkship “owns” each objective or is matching their clerkship‐specific objectives to individual clinical learning objectives. Dr Brooks questioned the dissemination of the clinical learning objectives to all 400 RPAP preceptors; she was advised to send the URL of the clinical learning objectives to indicate that they exist. Dr Watson would like each clerkship website to link to the clinical learning objectives site. To move forward, Dr Murray suggests that a subset of members is created late fall (November) to review this document. Dr Murray can chair this subset committee. Require each clerkship to explicitly state online the criteria to pass course – responsibility of each clerkship to implement in timely manner. This was one item mentioned on LCME Student Report. Dr Murray proposed that a template for course sites (assessment grid) would help students to find same information across clerkships. Template used for basic science courses could be modified for use in clerkships. Dr Boyer has been a champion of this initiative in the past and could be a resource, at minimum. Dr Kim would also like, in addition to minimum standards, the standards required for honors. Standardize repeat examinations – Dr Murray wants to know if committee is comfortable with the recommendation of repeat occurring within 3 months of failed exam and coordinated with another proctored examination. Dr Watson added a concern of the grading process of fail/repeat exams and consistency of tracking the pattern of fail/repeats. Dr Acton suggested a change to the “3‐month” modifier to a unit of measurement like “3 periods” with exemptions for students who are on specific following rotations (another clerkship) or away rotations, but there must be limits to these exemptions that must be cleared with clerkship director, faculty advisor, and medical school administration. Add disclaimer that it cannot be within three months of graduation. Dr Murray promotes some automatic recommended responses to an exam fail, such as meet with faculty advisor, meet with Marilyn Becker, schedule retake, etc. to make sure that students are receiving guidance that they need. Consequence of not doing retake within time frame is to meet with Dr Watson. Dr Watson would like for herself, faculty advisor, Dr Thompson, and Dr Marilyn Becker to be notified via email of students who’ve failed exam, need retake, etc. Dr Eckert asked for clarification of connection to other incompletes, such as papers – yes. Students request that this information be posted on MedEd website and individual clerkship sites. Dr Thompson posed question of whether or not this should be a specific policy – Dr Watson states that it falls under the overall grade policy, but this would simply be a procedure for disseminating and tracking. Dr Watson urged that there must be delineation between failures and incompletes due to not taking the exam. Dr Thompson will lead initiative to draft procedure for group to review. Set minimum standards for educator development – processes in place across clerkships, but all programs seem to be doing something to reach residents and faculty. Could also be documented on clerkship web sites. Discussion‐ Annual Clerkship Review – Pediatrics Please refer to handout from Dr Murray. ECM Update – James Pacala: ECM has two weeks left in Block A. Putting out daily fires. Ongoing issues include:  Preceptors – Brooke and Ted continuing recruitment of preceptors for upcoming blocks based on hospital‐systems.  Coordination – multiple medical school course managers covering aspects of coordination; turnover has created confusion.  Assessment – course directors feel strongly that course should be pass/fail not pass/fail/honors. This has raised some problems because assessment items are subjective to preceptor’s assessment of completion. Do the required elements = pass. Miss a required element = fail. But inclusion of honors factor requires there to be points for each assessment item. Portfolio: theory was to have students complete portfolio items in each block across all POCCs and complete the course with a complete documented portfolio as a ticket forward. Original idea was to pilot in inpatient medicine, but effort was implemented across all POCCs. But without buy‐in from all sections, the portfolios are not being completed in all POCCs.  Next year – both years of ECM will be running simultaneously for the first time. ECM facilitators for Year one are being recruited. FIPCC (AHC inter‐professional course) will reoccur and facilitators are 
being recruited. Major change in year one for parts one and two = increase and maximize small group time to provide enough time for completion of small group learning objectives. Based on student response, the Moodle sites are complex and unclear, so initiative this summer will be to clean up the web site and better organize course materials. Students are benefitting from being in clinical settings during year one for the first time. Dr Kim reaffirms this from his personal experience as a preceptor. Dr Watson has spoken with many students who are thrilled about this experience; feel welcome in the community, etc. NEXT MEETINGS: Full Curriculum Committee: June 10, 2011 @ 7:30‐9:00am in B646 Mayo. No CEC meeting for JULY.