Minutes from the Curriculum Committee Mini Retreat on 6/30/11
7/1/11
Topic
Attending:
Introduction – Where
We Are in the LCME
Process/Role of the
Committee
Specific Policy Issues
– Plans for Next Year
Discussion
Bacon, Cairns, Chuang, Cross, Dent, Farrell, Felix, Gilliland,
Hobbs, Emily Holmes, Marks, Rao, Steiner, Stone, Viera,
Dan Wurzelman; Newton - Chair
 Over the last year and a half, we have made dramatic
progress in addressing the 48 potential citations we
identified in review 13 months ago. With respect to
the curriculum, our major effort has been to identify
our core competencies and milestones, define the
UNC96 and core procedures, map the curriculum and
now to put these in place.
 This committee represents the institutional oversight
required by LCME standard ED2: we have
responsibility for ongoing review of the program. The
purpose of today’s retreat is to do an evaluation of the
overall program and make suggestions for next year.
 Timeliness of Grades – the attached data suggest that
for all the clerkships, grades are now timely.

Duty Hours Review - Data reveal roughly the same
pattern as last year. Years 3 & 4 have no problems
with duty hours, as measured by the 80 hour criterion.
Inpatient rotations are roughly 60-75 hours/week and
outpatient rotations are 45-55 hours/week.
Regarding the 10 hour rule, members supported
collection of data but wanted to make sure optional
unscheduled activities were not excluded by the rule.
Action Items
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Duty Hours – CC1 and CC2 report no concerns from
students about duty hours/overall work in the first
two years. There have been occasional comments that
preparation for boards is stressful but no evidence
that it is overwhelming. How should we monitor? The

Proposal: We are in
compliance.
Henceforward, OME
will monitor regularly,
using one45, and
intervene as
appropriate. There
needs to be no further
action on the part of
the Curriculum
Committee unless
problems arise.
We are in compliance.
For next year, we will
continue to monitor
via one45 with the
inclusion of a specific
question regarding 10
hours of rest between
scheduled activities.
We, therefore, will
continue to monitor.
Consensus was that
there was not a
problem with duty
hours in years 1 & 2.
We will continue to
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group’s sense was that an ongoing focus group with
students would be appropriate. We need to ensure
that as we switch to more team based and selfdirected learning, total hours (inside and outside) of
the classroom do not expand. We need to track this.
Midcourse Formative Reviews – Students report that
experience with getting midcourse clerkship reviews is
quite variable across departments. Ob/Gyn is
excellent but others are not; similarly, the use of
clinical logs is variable across rotations. One45 data
confirms this.
There is consensus that midcourse reviews are
valuable for monitoring both the student experience
and the clinical log. There was discussion about what
constitutes the appropriate midcourse review. Key
elements were that it be simple, use one45 and
include some student self-assessment.
Proposal – that we document midcourse review
through a short form in one45.
Midcourse Review in Years 1 & 2 – The pilot of year 1
block IV formative review demonstrated feasibility.
Faculty, however, felt uncomfortable giving judgments
about midcourse aptitude across competencies –
underscored by the choppy nature of that block.
There was disagreement as to the value of broad
midcourse review in the first year. The group affirmed
the importance of feedback with information about
standard deviation in each of the first year courses but
wondered whether it was appropriate to try to judge
all competencies in each block. One lesson is that
different blocks might emphasize different
competencies – for example, block II highlights the
communications competencies. This could be the
focus of assessments and midcourse feedback.
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monitor with our
course focus groups
and CC1 and CC2
ongoing review, and
bring back any issues
that emerge.
Will clerkship
directors to develop
and implement this
year a midcourse
review form in one45
that is simple and
includes a studentgenerated
component. The
CC3/4 clerkship
meeting next week
will finalize the form.
Year 1 & 2 long
courses such as
Medicine & Society,
Clin. Epi. and CSD/CSI
will have midcourse
feedback across
competencies.
Midcourse review in
the first year will
include specific
feedback around
medical knowledge
and student standing
within the class. We’ll
pilot the use of
midcourse feedback
for competencies that
are addressed in a
specific block,.
Another possibility is using peer assessment
selectively. This could provide excellent assessment of
some of the competencies (e.g., communication skills)
and might stand as a proxy for this sort of midcourse
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review. This would be good to pilot next year.

Common Assessment Forms – Over the last two weeks
a draft common assessment form for the core
clerkships has been created. It includes behavioral
anchors across all seven competencies and assessment
of the learner’s mastery. The assessment task force
acknowledged that there are substantial differences in
what clerkships want in the common assessment
forms as well as how they will be used. Accordingly,

they have created a process for piloting different
versions of the form, with a goal of having a common
assessment form across the clerkships in place by mid
fall.
Review of the professionalism forms reveals a variety
of different forms being used relatively rarely.

Academic Comparability Across Sites – A key issue is
grade rates. Following up last year’s discussion, the
rates of Honors grades have come down, but there is
some concern that the rate of High Pass needs some
attention. In some clerkships, the rate of High Pass
and Honors together is as high as 95%. The
assessment task force discovered variation in who fills
out the assessment form. Early data suggest that there
is not much variation in clinical assessment – faculty
development is necessary. They proposed specific
proportions for Honors, High Pass and Pass. These
would need to be seen in the context of increasing
competition for residencies nationally – and the
importance of the shifts in grades from one year to the
next with respect to the match. The consensus of the
Curriculum Committee was that we need to extend
our concerns about grade inflation to High Pass but
not to have a rigid formula yet. We also need further
exploratory work and probably faculty development
regarding clinical assessment and the consistency of
the evaluation process from site to site.

The Curriculum
Committee approved
development and
implementation of a
common assessment
form this year. It will
include all
competencies,
behavioral grounding
and identification of
students at risk. In
addition, the current
professionalism forms
will not be used
routinely; specific
professionalism items
will be included in the
common assessment
form.
CC3,4 assessment task
force will recommend
thresholds for Honors
and High Pass, and
give
recommendations for
collection of
information.
There are cases in which there is clearly variation in
grading across sites. A preliminary look at the strength
of students across clerkships suggests that this is not
an adequate explanation for grade variability. The
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consensus of the committee was that we need to
improve the consistency of grading across sites. We
will intervene in the various elements of variance,
including faculty development over the next year.
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Program Review

Mistreatment – Newton summarized the current
status of mistreatment. The key issues are:
o 29% of the students report experiencing or
observing mistreatment; of those experiencing
it, only 31% reported it to anyone in a position
of authority.
o Mistreatment is not nurse vs. student nor
what happens when we ask students to do
things for patients, and only rarely is it
physical abuse, unwanted sexual advances or
racial slurs. Most mistreatment falls into two
buckets: a) specialty bashing including not
giving people going into a certain discipline
experience in the discipline’s clerkship, and b)
lack of respect for patients or for the student’s
role.
The plan for this year includes:
o Development of an institutional positive
learning environment statement
o Explicit involvement of department chairs in
clerkships, with an emphasis on Surgery and
Ob/Gyn
o Orientation to the issue for rising third years
and residents
o Continuing real time surveillance via the
survey of fourth-year students in September.
o AHEC campus ombudsmen for confidential
reporting and investigation; zero tolerance
policy addressing safety issue
Comments included:
o Grade issues are sometimes part of the
complaints.
o Faculty development is a challenge. They need
to learn to ask about specialty plans in a way
that students don’t find threatening.
This is an overall review of the medical student
education program.
Please note that some of the elements of the review
that we envisioned last October are not available – the
residency program director data, a competency-based
roll up across the curriculum with outcomes at student
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OME will follow up.
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The overall
assessment is very
good.
We plan a more
systematic use of data
to admissions process
– outliers and process.
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and course level, as well as long-term outcomes from
licensure data. In addition, data we’ve reviewed over
the course of the year were not reproduced (e.g.,
board part III scores, CPX scores, clinical log scores and
the like).
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Comments:
o
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Please note that there has been a dip in
interviews and acceptances among minority
candidates, although an increase of
acceptance rates. African Americans/Indians
are among the best in country; the Hispanics
one of the worst. The rate of MED alumni
acceptances increased.
o The cohort experience is typical except that in
this year, the number of MD-PhDs ended up
fewer.
o A question was raised about leave of absence
– what happens to those people. The majority
of leaves of absence are for research and
enrichment purposes. They almost all come
back. Of the ones that do it for academic
challenges, about 50% come back. Consensus
was that it would be valuable to have further
information.
The year committees reported out. CC1 raised a
number of issues for next year – integrating CAC into
CSD, the development of a cumulative end of year
exam, the use of small groups and TBL and
acknowledging the departure of Alan Cross. CC1 hopes
to integrate social sciences more definitively into the
curriculum via a new grant. Of note, the first year
curriculum has gone from 17 to 4 courses in 10 years.
CC2 – The multi-phased mapping has gotten course
directors to rewrite their objectives and sometimes
their exams and course content. In some cases, it has
identified redundant material or gaps. The major issue
that should be a focus for next year is prepping for
Step I. It’s loud and clear from the GQ as well as
discussion that some of effort needs to be made. Of
note, there’s less time than there used to be to
prepare for Step I. There has been some turnover in
CC2 leaders, some of which is intentional.
CC3/4 – There’s also been some turnover in CC3/4 and
there’s been a lot of work related to LCME as noted
above. Key issues include the importance of mapping
and comparability across clerkships with an emphasis

Also, tuition increase
will support new
efforts for Hispanics.
OME will bring
analysis of LOA data
back to committee.
Leave of absence
follow-up in
Curriculum
Committee.
The Curriculum
Committee and OME
will work with
students to develop
options for board
prep.
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on grading, competencies and the like.
Other Comments:
 Assessment (how we assess, what we’re assessing,
broadening assessment) needs to be a major focus
next year.
 A key idea arrived at today is that we can have
individual blocks (in the first two years) and individual
clerkships focus on different competencies and fit
together as a whole. We need to have GME formally
represented on this group.

Future Items
o There was a proposal to change the name of
this committee to the Education Committee. It
is a better descriptor of our authority over not
just curriculum but also admissions and longterm outcomes, and it eliminates confusion
with the year committees.
o Newton introduced the strategic planning
process which is about to kick off. We will
likely have a focus on the needs of the state of
NC and the curriculum. More to come as
charges are defined and people on
committees are finalized.

Continue to broaden
assessment.

OME will engage new
DIO.
Approved
unanimously.
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