Minutes from the Curriculum Committee Mini Retreat on 3/18/11
3/24/11
Topic
Attending:
Possible Major
Changes in the
Curriculum
Discussion
Byerley, Bynum, Cairns, Chuang, Cross, Darrow, Dent,
Dreesen, Enarson, Gilliland, Hobbs, Perry, Serra
Shaheen, Slatt, Steiner, Stone, Viera, White, Wood;
Newton - Chair
Brief descriptions of why:
1.
2.
3.
4.
5.
6.
7.
Action Items
Behavior/Development
a. A curriculum gap in the first two years is
normal development over the life cycle and
normal behavior. This is key context for many
clinical conditions.
Population Health
a. Combines the components of Medicine &
Society, Clin. Epi. and some of the clinical uses
of population health (i.e., new material) such
as advanced access or clinical care. This could
be achieved in a number of ways (e.g., via a
thread that introduces all diseases in the
second year, or moving Clin. Epi. to the first
year and expanding it).
Ambulatory Care Exposure
a. The core of this is the ability to see more
patients longitudinally in the first year to
underscore the clinical framework for
knowledge.
Normal (year 1) and Abnormal (year 2) Simultaneously
– (an “integrate preclinical curriculum”)
a. Argument for this is: 1) more efficient
learning opportunity to reduce redundancy
and 2) easy to integrate clinicals.
Electives in the Third Year
a. There are substantial numbers of students
with a desire to explore different career
electives earlier. There’s also increasing
pressure to enter residency selection earlier.
Preparation for Residency Focus
a. Follows on lead of Pediatrics and in the setting
of increasing information that students
coming out of medical school do not have the
experience that they have had in the past. The
widespread inclusion of Capstone type courses
also supports this trend.
Calendar
a. The calendar moving forward includes many
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specific options. The case for earlier electives
is noted above.
8. The calendar moving forward for intersession weeks
a. Allow reflection, focused attention to specific
skills that cross disciplines and time back in
Chapel Hill.
9. Assessment
a. As our review indicates, our emphasis is on
narrowly multiple choice questions but
broader assessment is important.
Possible Major Changes – Priorities
(timeframe 3-5 years)
Pre
Topics
More
3
behavior/development in
first year
More population health
9
in first year
More ambulatory
8
exposure in first year
Combining normal and
13
abnormal in MSI/MSII
years
More opportunities for
5
electives in the third year
New/more developed
1
focus on specialty
preparation in year 4
Calendar changes: move
14
clinical year forward for
elective time
Calendar changes: add
9
intersessions third year
More robust assessment:
12
across all competencies
and also end of first year
Integrated clinical
--curriculum
Post
1
12
8
1
5
2
23*
8
9
12**
*Note that the language changed the second time to not
specify elective time.
**Note that this was a new topic generated after
discussion.
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Key Points of Discussion:

NP schools emphasis on symptoms as
architectonic principle:
o A key issue is changing our learning
program, reducing passive learning and
less lectures, “Teach less, Learn more” –
Dreesen.
o TBL allows a great framework for
addressing both normal and abnormal
science at the same time.
o As we think about major changes,
however, we need to think about what’s
broke. What do we want to fix? There are
trade offs no matter which way we
organize the curriculum – what are the
consequences?
o As a partial answer to this part, health
care is changing. Do we need to change
our approach to education to fit or drive
that? How do we train future
researchers? One option is the Duke
approach of inserting a year of science in
the third year. Is this something we want
to do, at least in some part? One virtue of
it is that it does provide and makes sure
the department provides support for
student research.
o Another approach is to emphasize the
actual student comfort in use of data
moving forward. What do we give up if we
move the calendar forward? Is it really
reducing the first two years? It’s
important not to give up the summer
research and service opportunities which
really add distinctiveness. Could we move
some of the second year rotations into the
first year?
o Straw vote – evolution (tweaking here and
there, gradually combining things and
making more clinically relevant) vs.
revolution (doing normal and abnormal at
the same time), completely redesigning
the curriculum with an emphasis on
symptoms, combining normal and
abnormal. Straw vote – 60% vs. 40%.
o A key enabling strategy may be the
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recruitment of teaching specialists who
teach in a number of different courses
across disciplines.
Suggested Priorities Discussion:

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Move clinical calendar forward.
More population health in the first year.
More ambulatory exposure in the first year.
Move Integrated clinical curriculum up to number
2.
Move more robust assessment above
intersessions.
Calendar changes: added intersessions
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The Curriculum
Committee will review
next steps regarding
moving clinical
calendar forward,
population health and
the integrated
curriculum with
attention to
specifically what the
proposal will be as
well as timing
pre/post LCME.
The Curriculum Ops
Committee as well as
task forces will give
recommendations
within the general
framework
established by the
Curriculum
Committee.
Other possible
changes (behavior and
development, can be
put in place through
normal course
evolutionary
mechanisms).
There will be a task
force on assessment
that will address the
assessment issues and
integrate them into
individual courses.
The Curriculum
Committee’s
assessment was that
assessment needed to
be broader and that
significant changes in
the first year needed
to be considered.
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Educational
Strategies
Educational philosophy and resources were sent out
electronically and in person. Both are works in progress.
Of note, philosophy emphasizes active learning,
developmental learning styles and resources emphasizes
both engaged students and learners.

Kurt Gilliland reviewed small group teaching activities,
underscoring that there was a fair amount of small group
activities currently and they were often independent
activities; there was variation in whether new material
was introduced.
Initially at issue were the two proposals. A first proposal
for discussion was the role of small groups and active
learning in the first couple of years.
Discussion:

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Didactics in Clinical
Clerkships

Almost complete consensus about support for pushing
as much curriculum as possible to small groups and
active learning.
Our philosophy says that active learning is the
cornerstone of our education – we should take out the
phrase “as much as possible”.
We should appreciate that there are substantial
organizational challenges that will arise both in terms
of people to teach in small groups and perhaps some
other resources.
TBL provides some opportunity to extend faculty. UVA
has begun to do this.
Small group tactics are important – we mostly teach in
the first two years in the 32 down to 8 but 8 may be a
little bit large. Moreover, we need to have more
continuity of small groups but also the ability to
reform small groups as we move forward.
Perhaps another core issue as was discussed before is
the element of developing a core group of teachers as
we move across. A key element or strategy is this –
having faculty who can teach in more than one course
and more experience.
Finish Line Surveys document great variation across
clerkships and need for prep. in advance as well as
small group activities. What should we set as an
educational policy for the school for clinical clerkship
didactics?
o Overall impression is that there is some
problem among these lines but also a number


Consensus that we
should emphasize
active learning
including the use of
small groups, TBL and
others’ approach.
There is not one
template nor a best
way to practice.
Rather in typical UNC
fashion, we’ll develop
different approaches
and share best
practices, while
grappling with the
substantial resources
and organizational
constraints.
Consensus to reduce
the number of
lectures and use more
small groups.
Consensus – as much
as possible didactics in
the third year should
be driven towards
small group sessions
in which there’s
required preparation
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Next Steps

of good solutions.
o We should spread best practices of preserving
didactics. Different specialties have done
differently.
o We need to underscore the importance of
preparatory and group work.
o The broader issue is continuity of teaching.
This is key and needs to be underscored. It’s
part of the argument for longitudinal
curriculum but is also true for who does the
didactics.
o Intersessions could be very useful here,
allowing a focus on content that goes across
disciplines and special procedures and others.
o What’s the role of podcasts for delivering
lectures? There’s a tension between podcasts
and active learning – perhaps the total
amount of lecture time could be dropped and
the time together could be spent on group
cases or other things that require active
learning. Can they provide an opportunity to
push technology out?
o A broader issue is the locus of practice in the
environment. Hospital care and hospital
experience has changed dramatically over the
years with much shorter length of stay and a
much less comprehensive approach – not as
good for students. Structurally, of course,
much less care is taking place in hospitals. Do
we have the right balance of hospital vs. nonhospital experience? Twenty years ago, we
had virtually no ambulatory experience. Now,
we have many months. What’s the right
balance? Response: We need to be selective
about where we put people. The hospital may
be too much for many things.
o We need to be mindful that requiring prework and testing on it will increase the
number of hours of preparation in the study
for students, while it may cut down on the
amount of time in the classroom. This is
appropriate but we need to be mindful.
Assessment Committee - What are the questions that
the Assessment Task Force needs to ask?
o Should there be a comprehensive assessment
at the end of the year first year? If so, how
and when should that be done?
o How should we broaden assessments
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and interactive small
group activities,
ideally built around
cases.
As much as possible,
there should be
continuity of teaching
for preceptors and
small group leaders.
We should explore
technologies such as
podcasting as much as
possible in the third
year as well as spread
best practices around
reducing the tension
between ongoing
clinical care. We want
students to be
engaged in clinical
care. Technology can
help with that.
After review by
Curriculum Ops,
Newton will empanel
task forces to move
forward.
Newton and CC
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throughout the curriculum?
o Coordinating with the CC3/4 Committee, how
can our extended evaluation forms include all
of the core competencies?
o How can we build this into mid-course
feedback?
o Groups are key strategies for us. How do we
assess the function of the group and develop a
system for peer evaluation?
Task Forces – The key task forces at this stage are on
assessment, professionalism and population health –
volunteers taken.
Clinical Skills will reconvene once ICM sets plan.
For small focused topics such as medical
jurisprudence, occupational medicine, end of life, the
recommendation is to have one person head up a
small group to review the curriculum like we’ve done
with CTSA. A good first step would be to send notes to
the various curriculum committees to ask what’s being
done in each year. These things may be addressed in
some ways.
Core courses will have to integrate the new
competencies and assessments by the beginning of
the next year. How do we accomplish that? Judgment
was that many of the courses had made good progress
in this effort and are already doing this. Expectations
greater; needs to be followed at the level of the year
Curriculum Committees.


Leaders will set
expectations about
integration of
competencies and
assessments so that
can be done.
The Office of Medical
Education will set up
the processes to
review the very
specific LCME hot
topic curricula.
Newton to follow-up
with Lisa Slatt and
bring results back to
SOM Curriculum
Committee.
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