Minutes from the Curriculum Committee Meeting
7/19/10
Topic
Attending:
Minutes
Information Items
Discussion
Bacon, Bynum, Colford (guest), Cross, Dreesen, Gilliland,
Newton, Serra, Shaheen , Stone, Wood; by phone: Felix,
Fields, White
 Minutes were reviewed. The only significant addition
from the first draft was inclusion of the discussion
around standards for Honors – 25%, not more than
35% with a review of data regularly during the year.
Please see agenda. Points of emphasis include:
Action Items

Consent Agenda
Kurt Gilliland has been appointed as Interim Director
of Curriculum. He’ll be working on improving small
group teaching effectiveness, improving quality of
examinations and a teaching certificate.
 The Asheville shelf exams have come out and the
students have done quite well. The numbers are small
but in aggregate, they had tested at approximately 2530th percentile of UNC students on Step I and at the
end of their third year tested well above average for
UNC students – a greater than expected jump. While
the numbers are too small to be definitive, it is
certainly reassuring.
 Conference room Scheduling – We are trying to
develop a systematic solution for conference rooms
across the school.
 The LCME Task Force is being set up. The kick off and
charge will be August 24th – 7:30-8:30am with a LCME
consultant to kick off the subcommittees on
September 17th . An announcement will come out.
A couple of comments in the aggregate:
1. Peer review system developed in the third year,
CC3/4 is very positive; will be extending this to
CC1 and CC2 in the next year.
2. Occasional comments about “threatening” in
transition and in Surgery. What does this mean?
Where does it go? The comments in the
Transition course were actually quite rare. In
Surgery, it may be valuable to bring up again to
GME and other settings. We have in place a super
structure including the new undergraduate
medical directors which we’ll be adding to this in
this coming year. We’ll review all of this plus the
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latest data on mistreatment on an annual basis.
Core Competencies
Tracking Curricular
Outcomes
The first draft of the milestones were reviewed. We’ve
established overarching and enabling competencies. Now,
we want to focus on the transitions and year by year
outcomes. Issues raised included:
1. In general, the committee reaffirmed pushing as
much clinical reasoning into the first and second
year as possible. This needs to be made more
consistent across competencies. An example is
procedures – of which perhaps, more should be
done in the first year and which later.
2. A second issue is Pediatrics. Again, the committee
affirmed the sense that as much can be done with
first and second years as possible but the logistics
might be appropriate. It’s difficult to get
competence in all aspects of the physical
examination and clinical examination of children
but the more the better: this would allow further
development in the clinical clerkship. Cam
mentioned that other schools had used family
physicians for this also.
3. Question: There are huge holes in the curriculum
– human development, population management.
How will those be dealt with? Indeed, this is the
process by which we identify and fill huge holes.
The overall timeframe is that once we establish
what we think students at the end of each year
should know, then each year we will review the
core competencies and say what they can and
can’t do – what courses are doing and what needs
to be different. Finding the gaps will be critical.
4. As a general comment, many of the competencies
use the same language to get from 3 to 4 without
a sense of the progression of the skills. This
program needs to be explicit. In some cases, it can
be reframed in terms of kind of patients.
Review the draft email. General points were made:
1. We need to think about what metrics we need to
use in order to evaluate particular outcomes at
the curriculum and student level.
2. In addition, we need to talk about the process and
the infrastructure necessary.
3. We need to be careful about building too much
infrastructure. We need to be pragmatic about
what we do.

The committee will
give specific line by
line feedback to Cam
and Lisa by the end of
the week. They will
revise and bring to the
Curriculum
Committees for their
input over the course
of the month of
August. Then, we’ll
revise and in this
group and review in
advance of the
discussion in
September.

Newton will send out
the email asking for
volunteers to
participate in the
curriculum outcomes
session, have a single
meeting and then
report back at the
retreat.
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Improving
Comparability Across
Sites
Introduction to
Clinical Medicine
4. At the same time, much of what we do in terms of
competencies isn’t really targeted on
competencies. We can improve the efficiency of
the process.
Please see summary. This represents a collection of
various policy items that we’ve put in place to underscore
comparability across sites. The only addition at this point
is incorporation of the Campus Directors in Charlotte and
Asheville on this group, which affects a LCME standard.
Deb Bynum and Cristin Colford presented briefly what
they are trying to do. Comments included:
1. Wonderful to open up tutors broadly – impressive
that there are many people who want to do this
course; we need to figure out a way of
incorporating Obstetricians and Pediatricians into
it in some way.
2. Students reported that they very much
appreciated putting more clinical skills including
chest x-rays and EKGs into the first year and that
better integration within the ICM blocks is
desirable.
3. It’s important to try to push smaller groups and
experiments in next year.
4. Better integration of community weeks if possible.
The group encouraged new thinking about
community weeks, both in better integration of
other first year materials but also whether or not
they are accomplishing the purpose. A major
challenge is the variability; the added value is the
continuity of teaching and some of the individual
settings.
5. Another issue is the opportunity for actual clinical
experience in the first two years. It’s quite
variable according to ICM. In some of the tutor
groups, there isn’t enough direct clinical
experience.
6. For the next year, ICM will use the current title
and will be changing the name in 2011-2012 as
they pilot other pieces.




There was broad
consensus that all of
these were
appropriate.
Newton will invite
White and Heck to
participate in the
Curriculum
Committee and set up
the technical support
for doing that. They’ve
already been invited
to the Curriculum
Retreat in September.
The Curriculum
Committee endorsed
the general direction
of the new course
leaders for ICM –
including the
standardization
approach of recruiting
and hiring tutors, the
general direction of
getting more clinical
reasoning in the first
year and many of the
pilots. The committee
supported more
sweeping redesign of
the course including
smaller group size and
seeing what is
possible with ongoing
clinical work.
The course will bring
the proposal back for
further input from the
Curriculum
Committee in the
early fall.
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MD-PhD Changes
Newton and Shaheen gave context for the specific
proposal. This represents the last piece of a series of
changes in the curriculum designed to improve the quality
of the MD-PhD curriculum as well as shorten the overall
program. The proposal acknowledges that the MD-PhD
program satisfies the Integration Selective. The current
proposal is a new mechanism for a longitudinal clerkship,
patterned on the successful experience at Asheville, in
which students will continue to have clinical experience
during their MD-PhD program. The initial 40 week
segment will take the place of the APS. Students can also
get ongoing additional credit for 40 weeks at a time. The
40 week rotations like other clinical rotations will have
evaluation of clinical skills and mid-course feedback.

The committee voted
unanimously to
support the current
proposals with the
added proviso of
limiting the number of
lecture credits that
can be fulfilled.
In addition, we will try to make available clerkships right
before graduate school starts.
The committee was supportive of these changes.


Remediation
There are capacity limitations in the summer.
It is important to maintain breadth while students are
in the MD-PhD program (i.e., no more than the APS
being fulfilled by working with the MD-PhD mentor).
The Office of Medical Education has engaged Arrel Toews, 
Teacher of the Year from last year, to help with two
specific issues: 1) remediation with students failing a
course and 2) the development of common basic science
teachers. We’d like input and guidance about directions of
putting this in place.

Several people have observed that a challenge in the
first two years is that the individual course directors
may feel hesitant about failing somebody giving the
complexity of what remediation is. The goal is for
Arrel to work with individual course directors and the
year directors to develop a system. The goal is not to
replace the early warning and tracking process; in
addition, this is complementary to the discussion
about standards for failure in the first and second
years. Nevertheless, we need to pull together the
area of activities into a more consistent process.
Kurt and Arrel will
work with CC1, CC2,
Debbie Ingersoll and
others to clarify the
issues and develop
consensus about a
comprehensive plan
around remediation.
Comments on this issue included:

There’s a strong sense that this was indeed a problem
and this is in part because of the variation in what
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Common Basic
Science Teachers
Berryhill
Curriculum Retreat
people do. Lecture Capture is new and may make
remediation easier technically and a little bit different.
 We also will need to personalize. Some students have
a particular area of weakness that needs remediation
– this is the basis for some conditional grades. Others
are skimming along at the borderline level throughout
the course.
 It will be valuable to get Al Parker’s perspective on this
from promotion.
 Another barrier here is the stigma associated with
failure.
 There will be some value of facilitating the process.
 The tone of the interaction with the Block Directors is
important. It needs to be helping them rather than
imposing it at the Dean’s level.
 Focus should be competency, not punishing the
students.
 It’s important to set consistent standards for
remediation across courses. One element of this
might be what kinds of exams we’re going to use and
the like.
Brief discussion – there was unanimous support among
the Curriculum Committee for trying to develop core basic
science teachers across disciplines. There is a question of
how broadly people can teach – using a visible spectrum
analogy, some people will be able to do red, yellow and
orange and others will be at the other end of the spectrum
but more breadth is possible. TBL emphasizes facilitation
of information, not just personal knowledge.
Space continues. We will continue to push for
improvements and space. The biggest issue is getting
appropriate space for clinical exams.
The retreat will be on September 3rd. We will be focusing
heavily on outcomes data and the curriculum
competencies.

Newton will be
following up with the
Basic Science Chairs in
September. The trick
will be to come up
with a financial
mechanism that they
will endorse.
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