Third and Fourth Year Curriculum Committee Meeting
Julie Byerley, M.D., James Yankaskas, M.D., and Timothy Farrell, M.D., Co-Chairs
March 31, 2009, 7:30 – 8:30 A.M, 238 MacNider
In Attendance:
Julie Byerley
James Yankaskas
Timothy Farrell
Tony Lindsey
Georgette Dent
Deb Bynum
Mike Meyers
Cam Enarson
Ellen Roberts
Robert Gwyther
Karen Stone
Jim Barrick
Cheryl McNeil
Beat Steiner
Christopher Klipstein
Frances Smith
Announcements:
o
Communication Skills Survey
 Erin Malloy is doing a survey that was e-mailed to everyone March 30 about how
communication skills are acquired through the curriculum.
 A comment was made that there was difficulty with the survey being able to
select more than one choice on some questions.
o
Asheville Pilot
 The student selections have been made for the Asheville projects, but their
names are not ready to be released.
o
Transition Course Update
 Active in recruiting for participation. It will be June 29 through July 2. Dr.
Klipstein will be sending out e-mails in the next couple of weeks asking for
participation.
o
Uniform Faculty Evaluation Form
 Many course directors have commented that students are not in a position to
assess faculty’s medical knowledge and clinical competence.
 A recommendation was made that these specific questions be taken off of the
evaluation form and the form should be sent back to the committee for review.
 The sub-committee recommended that they pilot this form with a couple of
programs before rolling out to the whole group.
o
Goal Setting for CC34
 Want to set up for what we want to do with the clinical curriculum -- a set of
proposed goals which we’d like to do in subcommittee, by e-mail, and say here is
what our draft is and have a session of brain storming and then a multi-vote to
pick out where we really ought to be going.
 In line what we’ve been doing over the last five years.
 Make sure that everyone has the basics (3rd year) and have advanced curriculum
(4th year) more robust.
 Will send an organized email to everyone with recommended feedback and have
concise session meeting in April. One round of brainstorming. This is where we
think we ought to be going and are we prepared.
o
Procedures Across Clerkships
 Will be done in One 45 and working on a pilot and will bring back for feedback
from the group.
 Procedures vs. diagnosis. The sub-committee would like to bring the discussion
on diagnosis back to the group. Should it be presenting complaints or final
diagnosis?
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Integration of FAC Curricular Material into Clerkships
o There is approximately 40 hours of material to cover.
o BLS will be covered in the Transition Course (4 hours) and a small portion of BLS will
need to be covered with ACLS as required by American Heart Association.
o ACLS will take two consistent days. Most of the material will fit best with Internal
Medicine and must be taught by an American Heart Association qualified instructor.
o Airway management.
 Currently done in piecemeal through Clinical Skills Center;
 The mannequin portion and 2 hours of lecture are needed.
 Hands on patient in OR
o Respiratory failure would go best with Internal Medicine.
o Shock/trauma assessment
o EKG – needs to be early in 3rd year
o How to proceed?
 Prioritize material and then decide where it fits. ACLS is the priority.
 Subcommittee to address this issue – Frances Smith, Christopher Klipstein,
Renae Stafford, Tim Farrell, Ana Felix

Late Grades
o The pressure is on 4th year late grades because they will be graduating in five weeks.
o There may be some grades that have been provided to Leanne Shook but that are not in
One45 and are not indicated on this list.
o The late grade report will be updated and provided at this meeting at the end of every
month.
o A lot of the problem is due to the fact that we don’t know who the person is to contact.
o According to the LCME they want scores in within six weeks which begins with the last
day of their clerkship.
o Students deserve timely feedback and time for remediation.

LCME Review
o
LCME Review Committee: Carol Tresolini, Tom Bacon, Cam Enarson, Lisa Slatt

Overall clerkship objectives: How do we use them to determine content?
Institutional Competencies/Outcome Objectives: How do we use them to
determine content? Overall clerkship objectives – how do they relate to the full
set of medical objectives?
 Most of us their national curriculum from national organizations.
 When they were reviewed they were in line with overall School of
Medicine objectives for the clinical clerkships
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How do they relate to the medical school objectives?
 We reviewed the objectives during the last LCME site visit.
 Those objectives were established in 2002 and framed in the same way
ACGME objectives – six core competencies with specific objectives
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How do you communicate those to students?
 They are communicated during the first session with students and let
them know that this is how they will be evaluated and assessed.
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How do you define the type of patients the students must encounter?
 All clerkships have a card or list and many of those list line of with
national standards and a few may have used expert opinion.
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Outcome data: How do you use in further developing the clerkships?
 We use our card data, broad list of skills and patient types and then
review and adjust our curriculum based on deficiencies.
 At the combined at the 3rd/4th year level, objectives and develop 4th year
advanced courses aimed at specific ally students achieved
competencies in more complex ACGME competencies.
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NBME scores: Do you look at that data and from CPX or Step 2?
 The data is presented to us but we do not have a formal mechanism
where we factor in the potential outcome measures that we have access
to and then look back at our curriculum.
 It is sent to everyone on the committee to use as a reference.
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Student evaluations: How do you use student comments?
 We provide feedback to instructors and address performance issues as
needed.
 Feedback on didactic materials is used to adjust format and content of
the course.
 If there is some type of theme we are seeing from the comments we
adjust the courses to improve the course.
 A lot of changes are made due to student feedback; Student feedback is
a large driver. We provide feedback to instructors and address
performance
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What is the role and responsibility of your committee? In respect to CMPC? In
respect to planning and evaluation?
 Our work is done by sub-committees and then presented here for
approval by this committee and then presented to CMPC and generally
approved.
 Approvals made by this committee are more or less endorsed by the
CMPC. We don’t do anything hidden from CMPC.
 We consider this committee to be advisory to CMPC
 The role of this committee can vary based on the dean. Warren Newton
is new in his role.
 The committee co-chairs make sure that the course evaluations are
completed each year.
 Course directors have a lot of input on what they do with own courses.
 If there are any issues in a clerkship are identified we work together to
provide support to that director.
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Student evaluations: How do you assure students get formal, appropriate and
timely feedback?
 Students receive mid-point evaluations during their clerkships. Some are
more formal and others not as formal.
 One45 indicates whether students received feedback.
 There is variability among the clerkships on the timing of the grades, but
we are currently working on these issues.
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How do you assure that students have comparable experiences and that
there are common methods and evaluations across all sites?
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Are there common objectives and methods of evaluation used across the sites?
Does this committee review the data on comparability of educational
equivalences of evaluation across the sites?
 Through the course review process.
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Assessment
ED2 cards – patient experiences
Sites meet on a regular basis to review the clinical and didactic
experiences, and although they might vary by site, we try to assure the
whole breath of experience is comparable.
How do you as a committee assure that there is appropriate horizontal
and vertical integration across the 3rd and 4th year curriculum??
We are currently working with Family Medicine and Outpatient Medicine
to assure that there is integration among those courses.
There is a lot of student feedback if there are unnecessary redundancies
among the clerkships.
Vertical integration is more challenging. There are efforts going on
among some clerkships are trying to establishing some type of linear
organization to make sure that all of their objectives are made in the end.
How do you assess student’s clinical knowledge skills, behaviors and attitudes?
How much of that evaluation comes out of direct observation by faculty? How
are the students problem-solving and communication skills assessed?
 Direct observations varies by course director – more difficult
 Some attendings are more present, others are not.
 Varies by clerkship
 Some clerkships use oral exams to determine clinical reasoning.
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How are residents prepared to teach medical students?
The Academy of Educators has a sub-committee working to address this
issue and hoping to improve this process. They should have a more
concise answer by July 1.
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What support is available to assist faculty in curriculum design, selection of
appropriate teaching methods and design of student evaluation?
 This committee works with each other (peer support).
 Clerkship directors do get some salary support.
 Variable based on the department and the department chairs.
 The need for more administrative support or financial support for
clerkship directors and coordinators is a top need.
 Protected time for the course directors.
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Who would you go to for assistance in finding new ways to evaluation?
 A national group or OED.
 The new leadership has been working to restructure OED to make it
more integrative with this committee. We are working together to
develop tools that are available and usable by us and administered by
them.
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How do you monitor student workflow? What is the process? How do you know
if it is effective?
 Students do a great job of providing feedback.
 We create a structure for students so the can self-monitor their hours.
 How does this committee reviewing student harassment and
mistreatment?
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We have an ombudsman, but it is only utilized once or twice a year.
Code of Conduct
Advertise School of Medicine and school-wide policy on mistreatment
Guarantee anonymous nature of reporting of complaints
Student evaluations
Graduation questionnaire
REMINDER
Next meeting will be held on April 28th from 7:30 – 8:30 am in 133 MacNider