Discussion Items

1.                   Minutes

2.                   Announcements

No announcements.

3.                   EPC Chair Election

Paul Feltovich withdrew his name from the nominations.  After much discussion, it was determined that only voting members of the EPC should participate in the election.  Dr. Kruse was elected as chair and directed the meeting from that point on.  He explained that his focus will be on the five issues he listed in his EPC nomination information:

·         Knowledge of educational systems of other medical schools

·         Knowledge of the role of community preceptors in medical student education

·         Understanding of the balance of medical student and resident education

·         Commitment to curricular excellence in evidence-based medicine and information technology

·         National perspective and vision

Dr. Kruse further suggested that the EPC should continue its efforts to develop and maintain the best education for medical students, emphasizing objective evaluations of the current curriculum and developing an overarching long-range vision for the school.  To do this, the EPC will need to work with everyone involved in developing the curriculum and view curriculum evaluation information critically.

4.                   EPC Operating Paper

A draft of an operating paper based on the former Educational Policy Committee Operating Paper and the C2000 Administrative Oversight Study Group reports was distributed and briefly reviewed. 

Dr. Caspary offered to convene a group of members to review the paper and make recommendations at the January meeting.  Dr. Borgia and Dr. Naritoku offered to serve on the group.

5.                   Overview of Curriculum Implementation Process

Dr. Distlehorst made a brief presentation, outlining the curriculum development efforts that culminated in the new curriculum being implemented in July and August:

Timeline

·         September 1997: EPC recommends a single curriculum for SIUSOM

·         January 1998: Dean Getto establishes C2000 Task Force

·         September 1998: C2000 Task Force submits recommendations and guidelines to Dean Getto

·         November 1998: Dean Getto and EPC accept C2000 Recommendations, including establishment of a Steering Committee to design and implement curriculum based on recommendations

·         January 1999: Steering Committee established

·         January – May 1999: Study Phase

·         May – July 1999: Vertical Integration Phase

·         July – September 1999: Design Phase

·         October 1999 – August 2000: Implementation Phase

·         July 2000: Years 3 and 4 are implemented

·         August 2000: Years 1 and 2 are implemented

·         November 2000: New EPC is seated

·         December 2000: Last meeting of Steering Committee

Statistics

Number of Segments

·         Year 1:  3 plus Doctoring Streamer and Mentored Professional Enrichment Project

·         Year 2: 6 plus Doctoring Streamer

·         Year 3: 7 plus Doctoring Streamer

·         Year 4: 1 plus Doctoring Streamer and 200+ Elective Courses

Year 1

·         Cardiovascular/Respiratory/Renal

·         Sensorimotor Systems and Behavior

·         Endocrinology/Reproduction/
Gastrointestinal

Year 2

·         Circulation

·         Infection and Host Defenses

·         Neoplasia

·         Population Health and Preventive Medicine

·         Neuromuscular

·         Behavior and Medicine

Year 3

·         Family and Community Medicine

·         Internal Medicine

·         Neurology

·         Obstetrics and Gynecology

·         Pediatrics

·         Psychiatry

·         Surgery

Year 4

·         Anesthesiology Clerkship

·         Elective Courses

Number of Cases

·         Year 1:  27

·         Year 2: 44

Number of tutors

·         Year 1: 48

·         Year 2: 72

Number of assessments:

·         Year 1: 3 (one following each segment for all 72 students)

o        One SP with an OSCE station (heart sounds), followed by Clinical Reasoning CCX (on computer), followed by 41case-related MCQ’s

o        2 other OSCE stations + 36 station Gross Anatomy practical + 36 station Histology practical.

o        7 written case scenarios with 93 case-related MCQ's

o        Total MCQ's 135, sampled student generated learning issues in Behavioral Sciences, Biochemistry, Genetics, Embryology, Cardiovascular Physiology, Respiratory Physiology, Renal Physiology, and Pharmacology

·         Year 2: 3 (one following each set of paired assessments)

o        4 CCX Cases with Standardized Patient Checklists and Questions built into case (~30 MCQ, T/F, and Short Answer Questions for each case)

o        8 OSCE Stations (~ 10 MCQ, T/F, and Short Answer Questions for each station, with some also including Standardized Patients and Checklists)

o        Year 2 Exam Breakouts:

§         Circulation/Neuromuscular: 242 Questions (25 students)

§         Infection/Neoplasia: 279 Questions (26 students)

§         Medicine&Behavior/Population Health: 196 Questions (26 students)

§         Content areas evaluated: Alternative Medicine, Behavioral Sciences, Biochemistry, Epidemiology/Biostatistics, Genetics, Geriatrics, Gross Anatomy, Histology, Immunology, Pathology, Pharmacology, Physiology, Microbiology, Nutrition, Radiology, Doctoring, Family and Community Medicine, Humanities, Internal Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Preventive Health, Psychosocial, Public Health, Surgery,

·         Year 3: 7 (one following each segment)

o        CCX Cases with Standardized Patient Checklists and Questions built into case (~30 MCQ, T/F, and Short Answer Questions)

o        OSCE Stations (some including Standardized Patients and Checklists)

o        NBME subject tests/in-house MCQ’s

o        Statistics

·         Year 4: 3+

o        CCX (15-stations)

o        Doctoring

o        Anesthesiology

o        One for each elective course

Number of Online Forms/Databases:

·         25+ Viewable at:

o        Year 1: http://www.siumed.edu/mrc/curriculum/Curriculum.html

o        Years 2 through 4: http://edaff.siumed.edu/Curriculum%20Resources/index.htm

New Initiatives

·         Doctoring Streamer

o        Clinical Skills, Physicians Attitudes and Conduct (PAC), Continuity Experience, Medical Humanities, Self and Peer Assessment)

·         Mentored Professional Enrichment Project

o        An optional experience between the first and second year that allows students to work with a mentor over the course of 12 weeks to complete a project that allows them to increase their knowledge in a wide variety of areas ranging from rural practice to population and/or community health to academic medicine to bench research.

·         Segment-Related Clinical Activities

o        Clinical activities specifically chosen for Year 1 and 2 students that broaden their understanding of patients as people and build on and illustrate basic science concepts being developed through students’ study and discussion of patient cases and learning issues.  Examples include time spent in dialysis units, pulmonary function lab, nutrition/weight support groups, social service centers, and support groups.

·         The Springfield PDL has been upgraded to 8 exam rooms.  Even with the expansion, the unit is in use an average of 4 days per week for instruction and assessment activities in 14 curriculum segments in Years 2 through 4 plus the CCX baseline and Senior exams in Years 2 through 4.  The audio and video qualities of the PDL observation room have been enhanced

·         The OEC Computer Lab was upgraded to 16 computer stations to accommodate the two new PDL rooms (2 computers per patient case).

·         12 tutor rooms were set up on each campus with a big screen TV for use as a whiteboard, for patient presentation, and software and web access

·         A skills lab has been established on the Springfield campus where students can practice clinical techniques, do self-directed learning or schedule a resource session with a Nurse Educator or faculty. The lab is also used by groups to open patient cases with a Standardized Patient and by Doctoring faculty working with students on specific skills

Faculty Participation

·         241 faculty participated in Study, Vertical Integration, Design, and Implementation Groups

·         76 faculty participate in monthly curriculum meetings (Years 1-4 Curriculum Coordinating Committees, Educational Policy Council, CCX)

Faculty Development

Workshop                      No. Iterations                 Attendance

Assessment                             3                                 32

Item Writing                              4                                 24

Philosophy                               7                                 108

Small Group Facilitation            18                                 77

Research/Publishing                  4                                 24

Technology                               4                                 24

Dr. Distlehorst ended the presentation by stressing the amount of work done in the past six months, designing and creating implementation plans for the new curriculum, while the former curriculum was still being implemented and maintained.  The Program Evaluation Working Group will begin to evaluate the data that has been collected to date and to review the new curriculum as it was implemented. 

6.                   Educational Value Unit Task Force

Dr. Kruse directed the attention of the Council to the memo from the Educational Value Unit (EVU) Task Force, the text of which follows:

The EVU Subcommittee was charged with determining a method to measure the educational activities and efforts of faculty across departments. The committee had three meetings, on June 16, 2000, July 21, 2000, and September 29, 2000.

The major activities of the committee included a review of the literature regarding efforts to measure faculty educational performance, including careful review of a series of papers from the AAMC about mission-based management. One of the AAMC papers had a specific focus on measurement of educational performance, and this paper served as a basis for most of our discussions.

The committee also requested that all department chairs provide the existing EVU method used to measure and evaluate their department’s faculty performance or develop one that could be used. Review of the responses from department chairs served as the major discussion point for our final meeting.

The EVU Subcommittee is, at this time, unable to recommend a system that places a “relative value” scale on specific educational activities performed by our faculty. Many departments and faculty feel that there is not a clear need for such a system at this time, and are not able, or not ready, to try to define clear “relative values” for the educational activities of their faculty. In addition, among those departments that either have, or were willing to develop, a point system for educational activities, there were significant discrepancies among the departments regarding the relative value of various specific activities. Thus, the EVU Subcommittee felt that while a point system could possibly be proposed, it is unlikely that it would be widely accepted by faculty or department chairs.

Assuming that development of an EVU system continues to be important to the School and the Educational Policy Committee, the EVU Subcommittee is willing to continue the work to develop such a system. We would suggest the process begin with assigning a relatively arbitrary “EVU” to one or two common educational activities that occur in all non-clinical and clinical departments for example, managing a tutor group might be assigned a value of one educational value unit per week; or, giving a lecture to the entire class might assume a value of one educational value unit.) Using this “anchor” value, all departments, the Faculty Council, and the Medical School administration could then be asked to establish educational value units for an additional group of educational activities that are common across departments, such as mentoring of students, serving on educational committees, serving as a course director, and others. The process should be as inclusive as possible, and include cross-departmental activities that would reduce the territorial nature of educational effort now in place. With such a systematic approach, and continued refinement of numbers and re-review by administration, faculty, and curriculum leaders, a reasonable system should be attainable. Such a process would be neither simple nor brief, but with perseverance it should result in a widely-accepted and usable educational value unit scale.

The Subcommittee felt that two other issues should be mentioned. First, the development of an EVU system should be developed in the context of including EVU measurements in the creation of faculty position descriptions.  Second, the subcommittee feels that an EVU system can only work in the context of an overall system that also provides equally precise measurements for research activity, clinical work, and service.  The process noted above will be more likely to be successful if there are simultaneous efforts underway to develop precise measures of all aspects of faculty performance.

Thank you for the opportunity to participate in this important subcommittee. At your direction, we stand ready to continue our efforts.

In response to questions from EPC members, Dr. Getto explained that the purpose of this process was to review where the School’s resources are being spent, and how those resources are being distributed among departments.  Unless there is some way to measure what is being done, there can be no appropriate assignment of resources.  The goal is to make sure that departments whose faculty are doing much of the curriculum effort are receiving the resources necessary to support that effort.  The first level of review is assignment of the appropriate resources to departments, but the process could move to the individual level at some point, if faculty believe that is the direction the process should go. 

Issues brought up in the discussion that followed include:

·         Inclusion of all educational responsibilities (graduate programs, undergraduate programs, residency programs)

·         Quality and appropriateness of effort cannot be ignored as quantity is evaluated.

·         It is difficult to separate educational value units from other measurements used at the School (e.g., RVUs).  One system should be developed to document all faculty activities, including clinical practice, education, research, service (including committee service), etc. 

·         As clinical, research, service and teaching activities become more multidisciplinary, the focus will shift to value to the institution as opposed to value to departments.

·         A well-developed system could be used for new faculty hires, budget allocations, faculty promotion and tenure, etc.

7.                   Committee Reports

7.1               Year 1 Curriculum Coordinating Committee

Dr. Wade reported that Year 1 faculty and students were having an interesting philosophical discussion regarding the directiveness vs. non-directiveness of the curriculum.  A minority of students are asking for additional information regarding faculty expectations.  It was noted that students in Year 2 have the same concerns.  Tutors in both years have reported that students are getting to the learning issues faculty expect them to achieve.  The Year 2 Directors are working with Year 2 tutors to ensure that all tutors understand the importance of ensuring that students develop the appropriate learning issues, and providing the appropriate amount of direction when that does not happen.  A consistent set of core learning issues has been developed for each segment, and tutors have been informed of those issues. 

There was much discussion about the importance of self-directed learning as a tool for preparing students for a career of life-long learning as opposed to the importance of being taught a core set of information that reflects everything students need to know to graduate.  It was pointed out that the EPC needs to fully understand the curriculum before decisions can be made.  It was also pointed out that much study of adult educational theory was done during the early stages of curriculum development, and that recommendations made during that phase are the underlying principles of the curriculum and its implementation. 

The philosophical issue is how to reassure students that they have attained the faculty learning objectives.  To ensure that students learn and value self-directed learning, it is important that faculty model the process students are expected to use, rather than giving students sheets of paper with learning objectives. 

Year 1 is less faculty-directed than Year 2, with strong faculty sentiment that it is not possible for students to learn everything and that they need to focus on core learning issues.

7.2               Year 2 Curriculum Coordinating Committee

Dr. Tomkowiak and Dr. Borgia reported that students have fully completed two of the six rotating segments in Year 2 and are mid-way through Rotation 3.  Students had their first block (two rotations) exam the week before Thanksgiving, and results were distributed the week of December 11.  Development, implementation, and reporting for the exam involved incredible time commitments by faculty and staff and was done in too short a time period.  Much evaluation of the exam is being done as it is being developed for the second block, but, overall, the segment chairs were supportive of the process and the tools used in the exam and believed that the exam was a good tool for assessing basic science knowledge, clinical reasoning and clinical skills.  The minimum pass levels were set lower for this exam than had been set for the same content areas in the previous Standard Curriculum, and that issue will continue to be monitored.  Doctoring was completely integrated into the exam.  There was much discussion regarding the length of time necessary to get results back to students.  It was noted that there were many components of exam (12 CCX cases and 20 OSCE stations across three separate exams) and much clinical data that required faculty review.  Pulling all of the data into one place and analyzing the results was extremely time-consuming, but the process provided a good level of detail regarding student acquisition of knowledge, reasoning and skills. 

7.3               Year 3 Curriculum Coordinating Committee

Dr. Kovach reported that the committee was in the process of hearing reports from clerkships regarding changes due to student feedback.  OB/GYN has had many changes, and preliminary feedback from students has been positive.  Neurology has also made substantial changes.  The calendar for the Class of 2003 has also been a major issue.  A subcommittee reviewed possible iterations and made recommendations at the November Y3CCC meeting that included a possible ER rotation.  The plan is to make decision at December meeting. 

7.4               Year 4 Curriculum Coordinating Committee

The call for electives has been distributed, with a major emphasis on increasing the number of Basic Science electives in Year 4 so that the new Basic Science requirement can be enforced.  The Committee is also developing a list of quality issues for future electives.

7.5               Four-Year Doctoring Streamer

Dr. Barnhart reported that the big pieces of the curriculum, particularly the mentor program, have been implemented.  Year 3 and 4 activities are scheduled for January and March. 

8.                   Other Business

It was suggested that the EPC compare the CCX clinical reasoning process to the clinical reasoning process in tutor groups at its next meeting.

It was also suggested that the curriculum development impetus needs to be maintained, and that the areas noted as needing continued follow-up on handout from the Steering Committee should be regularly reported on:

1)       Comparison of curriculum as implemented to curriculum as designed (review of cases, content, etc.)

2)       Clinical Skills in Year 2 and effect on students entering Year 3 and on Year 3 curriculum

3)       Continuity/Vertical Integration Across the Curriculum

a.       Case Content

b.       Case Format/Design

c.       Curriculum Resources

d.       Faculty Development

e.       Online Forms

f.         Pathology and Radiology resources in the curriculum

g.       Program Evaluation

h.       Small Group Process

i.         Student Assessment Process

                                                                                       i.      Clinical Knowledge and Skills

                                                                                     ii.      Small Group Assessment

                                                                                    iii.      Performance-Based Assessment

                                                                                    iv.      Progress Subcommittees

4)       Integration of Basic Sciences into Years 3 and 4

5)       Online Self-Assessment

6)       Mentored Professional Enrichment Experience

The Dean and Dr. Folse stressed the amount of involvement in the curriculum development process to date by a broad number of faculty and students that has made the curriculum successful and suggested that this effort needs to continue to keep the curriculum alive.  It is also Important to recognize that SIUSOM is only one year into a four-year curriculum implementation.  The EPC will need to review curriculum carefully and not move too quickly to make change until the curriculum is fully understood.  As the first year of feedback from each of the four years is received, there will be much data to review.  Vertical integration is an area that needs thorough, careful review.

The Steering Committee was thanked for its efforts and asked to continue to communicate with EPC.

9.                   Next Educational Policy Council Meeting:  Monday, January 8, 2001, 1:30 to 3 pm