Discussion Items

1. Minutes

The February 12 minutes were unanimously approved as submitted, with the following correction: Dr. Shea provided the Year 1 report in Dr. Wade’s absence.

The March 12 minutes were unanimously approved as submitted.

2. Announcements

There were no announcements.

3. Review of Operating Paper

This discussion was postponed until the April meeting.

4. Class of 2000 Graduation Questionnaire

Dr. Kruse presented the two options previously discussed by the EPC for handling of graduation questionnaire responses from the curriculum committee: 1) review the data prior to distribution to curriculum committees to develop a list of issues for response from the committees; or 2) distribute the data to the curriculum committees for response and determine at that time if there are overriding issues that the EPC should monitor. Dr. Resch made a motion, seconded by Dr. Caspary, that the curriculum committees review the graduation questionnaire data and report back to the EPC, and that the EPC review those responses and then determine if further action is necessary. Dr. Constance reminded the Council that the graduation questionnaire is only one piece of information, and that it is used only by the LCME and AAMC. The motion passed unanimously.

5. New EPC Subcommittees:

Dr. Kruse explained that only one additional Council member had volunteered to serve on one of the subcommittees. He will plan to distribute a full list of members for each subcommittee at the next EPC meeting.

He also reported that he had received suggestions since the last meeting regarding the Program Evaluation Subcommittee. In particular, it has been recommended that: 1) the EPC should review all raw data, and 2) the EPC should review all forms currently in use and planned for future use. There was consensus that these two recommendations would be followed by the subcommittee, and there was a further suggestion that membership be structured to ensure four-year representation.

6. Update of Curriculum

6.1 Mentored Professional Enrichment Experience (MPEE)

Dr. Shea provided the following overview of the Mentored Professional Enrichment Experience:

The Mentored Professional Enrichment Experience was designed to provide students with a research opportunity at the end of the first year of the curriculum. Dr. Kevin Dorsey is the coordinator for the project. Faculty in Carbondale and Springfield provided summaries of research projects and students could contact them for additional information and to work out proposals. Alternatively, students could pursue research opportunities outside the SIU-SOM structure. These projects had to be research oriented, whether the question was founded in basic science or clinical medicine. Activities such as shadowing a physician were not accepted. Applications were submitted in early February.

Application Process and Results

All projects were read by a committee of 10 SIU faculty drawn from the Carbondale and Springfield campuses and from the basic and clinical sciences. All faculty read all the applications except those for which they had been asked to serve as mentors.

Number of Applicants: 28 (39% of the first year class); 16 females, 12 males.

Number funded: 13

Number of funded students who accepted: 13

Number approved (summer fees only): 10

Number of approved students who accepted: 6

Undecided 1

Number of alternates (summer fees only): 4

Number of alternate students who have accepted: 3

Undecided 1

Number not approved: 1

Number of Carbondale SOM faculty mentoring projects: 5 mentoring 12 projects

Number of Springfield SOM faculty mentoring projects: 9 mentoring 9 projects

Number of non-SIU SOM faculty mentoring projects: 3 mentoring 3 projects

Total 17 mentors, 24 projects

Sample Titles of Approved Projects:

· Centrosome Hyper Expression in Acute Leukemia

· Complementary & Alt. Med. Research Project

· Cortical development in the pre-term infant

· Creating a Behavioral Model of Chronic Tinnitus in Lab Animals

· Cross Cultural Healing in the Lakota Tradition

· Effect of Pre-op Medications on Post-op Bleeding

· Effects of Genistein and Estrogen

· Limb-Girdle Muscular Dystrophy, Paget Disease & Alzheimer's

· NexGen Complete Knee Device Outcome Study

· Patient Compliance in Southern Illinois

· Statewide Study of the Uninsured

· Studies of Viral Replication

When MPEE is complete students will present their work in a session, possibly a day-long meeting, in Springfield, either in the form of papers or posters.

Follow-up survey

After the award determinations were made, a survey was conducted to find out why some students did apply, why some did not, and to gather suggestions about how to improve the program.

Of the 44 students (61% of the class) who did not apply to MPEE, 24 (55% of the subgroup) responded to the survey. What they will do instead of MPEE:

· other research (2)

· IAFP externship (6)

· relax (2)

· volunteer work (1)

· other clinical shadowing (5)

· paying job (4)

· MECO (2)

· travel (2)

Reasons students did not apply to MPEE:

· anticipated academic difficulties (0)

· not interested in research (2)

· need a break, for example, going home (4)

· had another opportunity (3)

· wanted to be with my significant other/spouse (0)

· other (6) – deadline date, prefer clinical experience over research, financial (2), too much – would affect other academic work, other responsibilities (family)

Of the 28 students (39% of the class) who did apply to MPEE, 21 (75% of the subgroup) responded to the survey. The single most important reason they applied was:

· wanted to explore a field of study (11)

· needed the money (2)

· had nothing better to do this summer (1)

· wanted to be located near significant other/spouse (0)

· would look good on my Dean’s letter (3)

· wanted to work with a specific faculty mentor (1)

· other (3) – wanted research experience, finish masters, enroll for insurance purposes

When asked what could be done better, replies centered on more information, esp. in terms of having more information earlier in the year, more guidelines on the applications, or wanting more money or more information about the money (this was the most frequent comment).

Dr. Shea reported that Dr. Dorsey anticipates some changes for next year, including putting MPEE information on the web early in the year. He will also post some of this year’s successful applications as samples for next year’s students.

There was a brief discussion as to why projects in which students wished to participate in clinical activities with a mentor were not considered eligible, since that was one of the projects listed in early promotional materials and because they were supported and endorsed by the Steering Committee. Since these activities were not included as MPEE activities this year, organizational oversight will need to be provided for those students who will be working with mentors outside the MPEE process. Dr. Shea will follow up on this issue and report back to the EPC.

The EPC applauded the effort of the faculty involved in the MPEE process for such a successful implementation.

7. Update of Curriculum Implementation Process

7.1 Educational Value Unit Task Force Update

Dr. Kruse reported that a questionnaire is being distributed this week, and data will be evaluated and reported back to the EPC.

8. EPC Faculty Development

Dr. Kruse explained that, in a continuing effort to bring all EPC members up-to-date on the Curriculum 2000 process, abbreviated versions of the faculty development workshops offered to faculty last summer are being presented at the next few EPC meetings.

8.1 Curriculum Philosophy

Dr. Tomkowiak provided the following overview of the curriculum developed during the Curriculum 2000 process:

Curriculum 2000 Background

C2000 was initiated by Dr. Carl Getto in response to requests by Basic Science faculty, Clinical Chairs, and students to move toward a unified curriculum with a more clinical context.

Curriculum 2000 Recommendations

The Curriculum 2000 Task Force submitted its recommendations to the Dean in September 1998:

Students should be encouraged to become self-directed, lifelong learners.

Medical school should model the behavior expected of the trained physician. The student should be encouraged to take responsibility for their continuing educational development.

Students should be exposed to a variety of clinical settings throughout their entire undergraduate education and should be expected to show progressive development of skills and professional behaviors.

Students will be assigned to a variety of clinical preceptors throughout their undergraduate career. In these settings they will develop their clinical skills, their socialization into the profession, their appreciation of the roles of a diversity of health care professionals, their understanding of the economics of health care delivery, and the nature of the physician-patient relationship. Students will be expected to show developing levels of patient care and responsibility as they move toward their residency training.

Learning of basic and clinical sciences shall be integrated.

The basic sciences shall extend beyond the "classic eight" (Anatomy, Biochemistry, Physiology, Behavioral Sciences, Pharmacology, Microbiology, Immunology, and Pathology) to include Ethics, Humanities, Epidemiology, Nutrition, and Biostatistics. Wherever possible the basic sciences should be learned and evaluated in the context of solving patient problems.

Active learning in small group settings should be encouraged.

Wherever possible, learning should occur in small groups with active participation by all members. Not only is this deemed to be educationally effective, but it will also develop those interpersonal skills necessary to function as members of multidisciplinary teams in health care delivery.

The curriculum shall develop the flexibility necessary for students to function in the rapidly evolving health care delivery system, and in a variety of roles such as individual patient care, community health, and preventive medicine.

Students should develop the skills to respond to evolving societal needs, practice patterns and scientific developments.

All curricular events should be evaluated; such evaluations should be diverse in style and performance-based.

Given the variety of skills, knowledge and attributes expected of our graduates, we anticipate that they will be evaluated in a diversity of ways, including self-evaluation. All such evaluations should be performance-based (defined as assessing the application of knowledge and skills in settings approximating actual clinical situations).

The following content areas should receive emphasis in the new curriculum: history and physical examination skills, medical practice management, health policies, evidence based medicine, resource acquisition and medical informatics, and opportunities to explore diverse career choices.

Where appropriate, management of the curriculum should be by interdisciplinary teams which cross geographical and calendar barriers.

Based on the C2000 Task Force Recommendations, the Dean appointed a Steering Committee:

Chair of the EPC

Chair of the C2000 Task Force

A clinical department chair

A basic science chair

Dean

Associate Dean for Education and Curriculum

Chair of the Clerkships and Electives Committee

Two clinical faculty involved in teaching in the first two years of the curriculum were subsequently added

The Steering Committee created 12 study groups who produced white papers in May 1999 related to the following content areas:

Active Learning in Small Groups

Administrative Oversight of the Curriculum

Alternative Delivery Systems/Distributed Learning/Informatics

Alternative Pathways and Remediations for At-Risk Students

Clinical Skills and Professional Behaviors

Faculty Development

Integration of Basic Science and Clinical Medicine

Medical School Outcome Objectives

Performance-Based Evaluation

Program Evaluation

Resources for the Curriculum

Mentored Professional Enrichment Project

Based on the white papers produced by these groups, work began toward developing a curriculum based on small-group, case-based learning, using patient problems as a stimulus for learning (see Newsletters 6, 7, and 8) in a clinical context. To enhance the clinical basis of the curriculum, segment-related clinical skills sessions were developed to ensure that the clinical skills students are expected to learn during the segment allow them to apply the knowledge they are building through their case-based learning.

Doctoring (peer/self assessment, Physicians Attitudes and Conduct, Medical Humanities, clinical skills)

The Clinical Skills and Professional Behaviors Group recommendations were applied to the curriculum by integrating various components of the existing curriculum that emphasized professional behaviors into a Doctoring Streamer across all four years. The streamer concept allowed the faculty working on the Doctoring Group to carefully review the clinical skills and professional behaviors expected of students by graduation and develop a plan for introducing and reinforcing those skills throughout the four years. Mentoring and continuity clinics are also built into this experience.

Clinical activities from year to year

The focus of the first year of the curriculum is on normal pathophysiology, and the clinical activities planned for that year are an introduction to the physician-patient relationship and history and physical exam development.

In the second year, the focus changes to abnormal pathophysiology, and the clinical activities planned to support this focus would include reviewing radiographs and pathology slides as they relate to patients seen in clinical settings, learning how physician offices operate (learning how medical records are organized and processed, dealing with patient's families, dealing with patients who cannot afford prescriptions, etc.), and following patients from physician offices to community-based support activities. Students will also continue to develop history and physical exam skills by working with mentors in their clinics every other week.

In the third year, students will have greater responsibility, and will work closely with assigned physicians in clinical settings on a daily basis.

In the fourth year, student responsibility for patient care increases, and teaching responsibilities for first and second-year students are introduced.

Integrated Clerkship Experiences

A major innovation in Curriculum 2000 is the movement toward the concept of team care of patients. While core curriculum concepts in the major clerkships will continue to be taught in Family and Community Medicine, Internal Medicine, Neurology, Obstetrics and Gynecology, Pediatrics, Psychiatry, and Surgery, integrated activities that begin to allow students to work as an interdisciplinary team will be introduced. The basic sciences will be re-emphasized and integrated as part of the integrated clerkship experience, as well.

Curriculu2000 Performance-Based Assessment

There will be three major assessments in each of the first and second years. These assessments will be performance-based, using standardized patients and clinical skills stations to determine whether students can apply the knowledge and skills covered in each year. The integrated clerkships are still developing their assessment plan. In the fourth year, all electives will include an assessment. An online self-assessment system will allow students to determine whether they are mastering the knowledge and skills faculty expect of them in each curriculum segment (see Newsletter 12).

Administrative Oversight (year directors)

Due to the highly integrated nature of Curriculum 2000, a Curriculum Year Director will be appointed by the Dean to work with the Associate Dean for Education and Curriculum to keep the curriculum running smoothly. Curriculum Year Directors will meet regularly with the Curriculum Segment Chairs and Curriculum Development Specialists to ensure that the curriculum is implemented as planned. Curriculum Year Directors will also be responsible for ensuring both horizontal and vertical integration.

Curriculum 2000 Implementation

The curriculum developed based on these recommendations will be implemented concurrently across all four years in the summer of 2000 (Years 3 and 4 in July; Years 1 and 2 in August).

Curriculum 2000 Overview

Year 1 is composed of three curriculum segments:

Cardiovascular/Respiratory/Renal

Sensorimotor Systems and Behavior

Endocrinology/Reproduction/Gastrointestinal

These curriculum segments are followed by a 12-week Mentored Professional Enrichment Project that will allow students to work with faculty to research a basic science or clinical issue (see Newsletter 11).

The weeks of each segment are divided among tutor group sessions, anatomy labs, resource sessions, Doctoring activities, mini-case discussions, journal clubs, and tutor group assessments.

Year 2 is composed of six rotating units:

Circulation

Infection and Host Defenses

Neoplasia

Population Health and Preventive Medicine

Neuromuscular

Behavior and Medicine

At any given time during the year, there will be two tutor groups (12 students) involved in each segment. By reducing the number of students who require segment-related clinical experiences at any one time, clinical and community facilities are not overwhelmed.

The weeks of each segment are divided among tutor group sessions, resource sessions, Doctoring activities, segment-related clinical skills activities (2 half-days per week), mini case discussions, journal clubs, tutor group assessments, and the Basic Science Streamer. The Basic Science Streamer brings all 72 students together every Wednesday morning for multidisciplinary conferences on a variety of basic science issues.

Year 3 is composed of three multidisciplinary clerkships:

22-week Internal Medicine/Surgery Clerkship

12-week Family and Community Medicine/Psychiatry/Neurology Clerkship

12-week Obstetrics and Gynecology/Pediatrics Clerkship

The Doctoring Streamer has a two-week segment given to half the class just before the holidays and the other half just after the holidays, in addition to activities that will be integrated into the clerkships.

Year 4

The philosophy of the fourth year is to allow students to develop expertise in their chosen field, while having an opportunity to broaden their horizons. Application of basic science knowledge will continue to be a major component of the fourth year, and students will be required to choose a least one basic science elective from a menu of courses. The Clinical Competency Examination is given early in the fourth year to provide students and faculty the opportunity to determine whether students have adequately mastered the knowledge and skills expected of graduates. In the 46-week year, 31 weeks are available for elective courses that are worked around the half-week Clinical Competency Exam, a two-week Anesthesiology clerkship, and a two-week Doctoring experience. Nearly 11 weeks are available for residency interviews, vacations, etc.

Assessment in the Curriculum

Three components of assessment in each curriculum segment:

Small Group Interactions

Knowledge and Skills

End-of-Segment(s) Performance-Based Examination

8.2 Student Assessment

Dr. Lower provided the following overview of the assessment process developed during the Curriculum 2000 process:

The Assessment Workshop was held three times, with an overall attendance of 32 faculty. The workshop included four 30 minute. Presentations included:

· Introduction and Philosophy of assessment

· On-line Self Assessment

· CCX/DXR Record Utilities

· Tutor Group Assessment

There were three 30-minute Mock Exam Stations:

· DXR

· OSCE

· CCX

Purpose of Assessment

· Measuring academic achievement

· Setting standards

· Diagnosing student problems

· Encouraging good approaches to learning

· Demonstrating course and teacher effectiveness

· Predicting future performance

Principles of Assessment

· It drives learning

· It shapes the curriculum

· It shapes student learning

· Expertise is greater than the sum of competencies

· Expertise requires self-reflection and feedback from experts

· Multiple assessment methods ensure all dimensions are assessed

· Assessment should reflect future practice

Methods of Assessment

· Standardized patients

· OSCE

· Evaluation of written reports

· Faculty observations

· Clinical encounter assessment

· Oral exams

· Tutor assessment

· Peer assessment

· Self assessment

· Written questions (essay, short answer, MCQ, T/F)

Recommendations for Assessment

· Specify assessment goals and link to course objectives.

· Sample content broadly.

· Include assessment of knowledge, clinical skills, and professional behaviors

· Include a variety of measures.

· Assessment should be as performance based as possible

· Use formative assessments to shape student behavior

· Use summative assessments to record student progress

· Use anonymous testing

· Use assessments for curriculum feedback

9. Committee Reports

9.1 Year 1 Curriculum Committee

Dr. Wade reported that students are in the Endocrine/Reproduction/Gastrointestinal (ERG). The Student Progress System document has been updated and ratified by the Student Progress Committee. Several students will be expected to remediate certain aspects of the Year 1 Curriculum over the summer, and the Year 1 Committee is in the process of developing activities for the remediation period.

9.2 Year 2 Curriculum Committee

Dr. Borgia reported that the Year 2 Committee has been focusing on three priorities: 1) the recently finished Block 2 exams, each of which included four CCX cases with additional basic science questions added and eight OSCE stations. Students performed at a higher level than on the previous end-of-block exam, probably based on greater student and faculty familiarity with the process. Performance reports were distributed to students in just over a week. There are faculty concerns about sustaining this amount of effort. 2) Planning for the April 19 retreat. Drs. Borgia, Distlehorst, Kruse and Tomkowiak met with Dr. Getto to discuss plans for the retreat, and he has reiterated the importance of the Curriculum Guidelines and stated that all changes made to Year 2 should fall within the guidelines. 3) Development of the remediation exam; which is scheduled for the week of June 11. There was a brief discussion about assessment software limitations present in the current Year 2 exam, with the consensus being that changes are in process that will ensure that the remediation exam and future iterations of the Year 2 exam will not have those limitations.

9.3 Year 3 Curriculum Committee

Dr. Kovach reported that the Year 3 calendar, as endorsed by the EPC at its March 12 meeting, is being distributed to faculty and students. All clerkships except Obstetrics and Gynecology have curriculum changes to make before implementation on July 9. The Online Forms Subcommittee continues to review forms developed for use across the curriculum to determine how they can be implemented in Year 3.

9.4 Year 4 Curriculum Committee

Dr. Lower reported that Year 4 Orientation was held on March 22. The Doctoring Curriculum Streamer in Year 4 was distributed at orientation, and there were no significant concerns. Course and student evaluation forms are being put online, and guidelines for electives advisors are being developed and posted to the Year 4 web site. Students are in the process of choosing electives advisors and planning their courses for the year.

9.5 Four-Year Doctoring Streamer

Dr. Hingle reported that the Doctoring Committee had held a retreat and developed an overview of the Year 4 Doctoring Streamer.

10. Other Business

Dr. Constance distributed a report from the NBME regarding the Class of 2002 performance on USMLE Step 1 (administered in Summer 2000) for review by the EPC. This report will be discussed at a future EPC meeting.

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

	Minutes