Minutes from the Curriculum Committee Meeting
10/5/09
Topic
Attending:
Information
Curriculum Evolution
Discussion
Gilliland, Rao, Byerley, Farrell, Dreesen, Bacon, Perry, Felix,
Stone, Chhotani, Verma, Stewart, Steiner
 Curriculum Committee meetings have been set for the
rest of the year and include the November 12th
meeting. Curriculum Operations meetings with the
leaders of the CC1, CC2 and CC3/4 have also been set
up and are monthly. I’ll meet individually with CC3/4
chairs and Academy of Educators chairs on a regular
basis as well.
 Berryhill small group teaching spaces – the addition of
five small groups and two mid-sized groups has been
useful but there are still some small groups being
taught in Berryhill that should not be taught in
Berryhill. Some faculty like Berryhill. Moving Clinical
Epidemiology from spring to fall has had an impact.
We are exploring new space and will need to look at
the schedule to try to maximize use of space.
 Budget: There’s been a 5.5% cut to the Office of
Medical Education. This has meant some layoffs of
personnel, which are proceeding this week, as well as
changes in the level of OME salary support to some
teaching faculty.
 We’ve started Health Care Reform informational
sessions every 6-8 weeks for the students at the
students’ request.
 MS1 Blocks 3 and 4 have new Block Directors.
 CC3/4 is starting an integrated course review which
will allow systematic addressing competencies, active
learning, duty hours and other issues. Clerkship
Directors will also do peer review.
 The residents as teachers task force has met and given
recommendations. We plan a joint strategy building
on strong departmental models and developing some
course support for residents as teachers.
 I have begun talking with Basic Science Chairs about
an evolution of some of the Basic Science teaching to
emphasize more critical thinking and ongoing science.
 We start a Dean’s seminar in medical education on
11/13. We’ll invite members of the leadership and the
Block Directors. The focus of the seminar on 11/13 is
teaching patient safety.
 We’ve begun systematic outreach to alumni, parents
Action Items
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LCME
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Clinical Skills in ICM
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ICM Task Force
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and the Council on Faculty Excellence on campus in
addition to the internal work with the Basic Science
and Clinical Chairs.
We’ve developed an Excel spreadsheet with each of
the 44 possible citations. We will track who’s
responsible for what. Lisa Slatt will manage that and
will be involved in each of the Curriculum Committees.
Context: With respect to CPX, 45 out of 143 failed,
essentially the same test as previously. The failures are
all in the history and physical exam and assessment. A
discussion at CC3/4 raised a number of possible
hypotheses, including ICM teaching, clinical clerkship
experience, quality of exam.
With respect to ICM, Newton proposes a task force to
look at the fundamental design of the course. ICM is a
large and complex course that has had challenges over
the years and great variability in quality. The task
force would address goals and objectives for ICM,
whether ICM should continue as one course or be split
into components, how should the community
experience be changed and give recommendations for
improving clinical skills training.

Newton asked for advice regarding process.
 Ana Felix speaking as a member of the leadership of
ICM welcomes the review. She said that we’re at the
stage that it would be useful. They added a lot of
enhancements in the last year and learned a lot about
how best to teach this.
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 One of the features of many CPX failures was
examining over gowns – this had been a major focus of
the teaching over the last couple of years and they had
made the decision to emphasize it. Of note, they’ve
had success with hand washing!
 The variability of the community experience is striking.
Some are phenomenal experiences and others are
quite weak. This raises an issue of comparability that
is important.
 Getting at the goals would be very valuable.
 What’s the role of simulated patients? Students tire of
simulated patients - although National Medical Boards
now include simulated patients, so they are going to
have to get used to them.
 Improving clinical skills training is one of the
overarching themes – important to integrate ICM and to understand the clinical clerkships can’t do
Newton will call a task
force to meet once
and sort out causes
and initial solutions
and will report back.
Newton will also
empanel ICM review
to report back to this
Curriculum
Committee. The
understanding is that
potentially major
changes may be
merited.
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Setting Competencies
for the School
Looking at Long Term
Outcomes
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everything.
Newton briefly described the current UNC list of
competencies and Duke set of competencies. The
Mapping Committee (Longitudinal Clinical Skills
Faculty) had looked at competencies from a variety of
medical schools and decided that this was the best
model.
Comments included:
 The Duke set of competencies is robust. The value of
this will be to help course directors know where they
fit and what they have to do.
 At least from a genetics point of view, an attraction of
the Duke system is that it allows addressing
competencies across a number of different areas, not
just medical knowledge.
 Level of detail feels actionable. Ultimately, we’re
going to need to measure and assess whether or not
we’ve achieved these competencies.
 Who are the customers of this? Clearly, the course
directors will know where they fit in but also the
students whom we can tell (for example) on the first
day of class what we want them to do by the end.
 The Duke system is much more nuanced than current
UNC. There are 12 categories to begin with as opposed
to 3 and it’s more detailed at the next level.
 The Appendices (procedures, signs and symptoms,
core diseases) are key. They represent a nice
consensus and interestingly are simpler than what we
came up with for Asheville.
 It will be important to get course director input on
specifics – indeed, this needs to be something that the
faculty as a whole owns.
 We need to make sure that USMLE estimates of
what’s necessary in each course are consistent with
these. Likewise, with the GQ elements.
 Of note, people with experience at Duke report that
there’s been at least in their department no faculty
involvement in the document after it was produced.
We need to think about how to make this document
and this process living.
 A key issue is keeping it simple and workable. One of
the lessons that we’ve learned from Asheville is that
we can be too complex and the cost of measurement
becomes great.
 The list that we began to develop at our kick off
retreat was a start but clearly there is more that needs
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Newton requests
feedback within a
week, particularly
about overall
categories, anything
missing, anything that
can be grouped,
anything that can be
deleted.
CC1 and CC2 leaders
should consider
addressing USMLE
requirements for Basic
Science.
CC3/4 leaders should
particularly look at the
Appendices and see
whether the
procedures and
disease lists seem
appropriate – what
they would add and
what they would
subtract.
Newton will take the
next draft and
reframe as a draft of
the UNC set of core
competencies.
Newton will circulate
Appendices A & B
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to be added.
Organization of
Retreat
Comments:
 One person identified an identity crisis – are we
training generalists or researching subspecialists? One
of the ways out of this has been to think about it from
the point of view of bimodal products.
 We need leaders and leadership to be reflected in our
long-term outcomes, understanding that it needs to
be defined broadly - it’s leadership in communities or
in professional associations or whatever.
 Looking through the “what we are doing when we are
doing our best” list, it’s clear that values are critical.
We need to make sure that these long-term outcomes
deal with values as well.
 Newton described possible strands: 1) the core
competencies and the further definition with perhaps
groups looking at them, 2) vertical integration with
priorities chosen from last year – Neuroscience,
Evidence Based Medicine, Clinical Skills, Pediatrics &
Embryology.
electronically and
request feedback and
comments about what
our long-term
outcomes should be.
He’ll then take this
document and
develop it further,
putting in parallel to
the core
competencies and get
feedback.
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Other Comments & Suggestions:
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GQ
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We need some place to talk as a group about our
achievements in the last year in addition to the things
that we need to do better.
What about Asheville? What are we learning from
Asheville?
Small groups can have input on the documents.
Comparability would be good to address, given that
we are beginning to look at that across clerkships.
Who will attend? Include course directors, advisors,
representatives of key programs. Consider including
some residents, community preceptors and small
group teachers.
Another good question is the impact of first year
curriculum reorganization.
What about cultural competency? What does that
mean? How well are we doing from it? Should this be
another track that we look at?
Academy of Educators has indicated that they’d like to
have some input onto topics for faculty development.
What should we focus on from GQ? Varied opinion.
Look at only those things that this source of data will
be helpful to us (e.g., mistreatment because GQ is

Newton will draft a
“straw man” proposal
ASAP and submit it to
the committee for
their input.
Newton will work with
leadership of ICM,
Humanities, core
clerkships with
outpatient preceptors
and AHEC Directors to
identify preceptors for
their interest and
involvement and
submit an invitation to
them as soon as
possible.
Subsequently, we’ll
find a way to make
this Curriculum
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anonymous).
GQ is one of the benchmarks for the LCME review. We
need to be aware of it, although we haven’t been
reviewing it regularly.
It probably should not go to all faculty, rather, it
should be summarized in some way.
Note that there are parts of the GQ that are important
but not necessarily directly relevant to curriculum –
Student Affairs and the like. More people than this
committee need to know it exists.
Committee aware of
the GQ and perhaps
some key elements of
it and to summarize to
the core teaching
faculty, perhaps at the
fall retreat.
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