MEDICAL EDUCATION COMMITTEE MINUTES: MEETING OF MAY 14, 2014 Members Present: Dr. Daphne Calmes Stephanie Cham, MSIII Dr. Wendy Coates Dr. Tom Drake (co-chair) Dr. Ronald Edelstein Dr. Esteban Dell’Angelica Dr. Iljie Fitzgerald Dr. Ed Ha Dr. Lee Miller Dr. Mark Noah (co-chair) Rikke Ogawa (ex-oficio) MacLean Sellars, MSI Maya Smolarek, MSII Dr. Carl Stevens (ex-oficio) James Weinberger, MSI Dr. LuAnn Wilkerson Guests: Dr. Clarence Braddock Joyce Fried Dr. Gary Holland Dr. Chris O’Neal Dr. Robert Oye Laura Pescatore Margaret Govea Zachary Terrell Staff: Time Called to Order: 4:38PM Time Adjourned: 6:27PM AGENDA/NAME Review & Approval of December Minutes – Dr. Mark Noah DISCUSSION/RECOMMENDATION Dr. Noah asked MEC members to review the April minutes and send revisions to Zachary by the end of the week. Past MEC meeting minutes are posted on the website, http://www.medsch.ucla.edu/mec/Minutes.htm ACTION Minutes were approved. Announcements New Appointments Informational • • • • Class of 2017 Student Reps: MacLean Sellars & James Weinburger Class of 2016 Student Reps: Michael Klein, Maya Smolarek, & Michelle Sun Academic Medicine College Chair: Gerald Lipshutz (Surgery) who is a clinician active in research. Academic Medicine College Co-Chair: Dr. Alison Moore from the Division of Geriatrics in the Department of Medicine. She has been active in research with medical students nationally. Ultrasound Curriculum Task Force • • Dr. Braddock appointed Dr. Carl Stevens and Dr. Randy Steadman to head a taskforce exploring ultrasound curriculum in other medical schools. The taskforce will propose a four-year ultrasound curriculum for DGSOM in the next 30 days for review for budget implications by Dr. Braddock. The MEC co-chairs asked that the recommendation then be presented to the MEC. Currently, DGSOM has ultrasound curricula in the first year anatomy lab. There are opportunities to use ultrasound in the Ob/Gyn, Medicine, and Surgery clerkships, and Emergency Medicine and ICU electives. AGENDA/NAME DISCUSSION/RECOMMENDATION • • ACTION Cost of equipment is the biggest challenge but portable machines are somewhat affordable. The taskforce will also recommend how to monitor and assess the resulting ultrasound curriculum. Open Access Textbooks Initiative– Rikke Ogawa, Biomedical Library • • • 2013 Graduation Questionnaire – Dr. LuAnn Wilkerson To help students incur less debt, the biomedical library is working to leverage the resources the library is already purchasing for the benefit of the students. Students would have access whether on or off campus. We need to educate the HB&D block chairs of this change. The librarians can teach the faculty how to use the new e-book format. Dr. Wilkerson reported on the AAMC Graduation Questionnaire (GQ) results for the Class of 2013 (75% response rate) compared to national means. • • • The basic science content is evaluated on clear objectives, integration, aligned examinations, clinical relevance, preparation for clerkships, and inclusion in clinical experiences. (% Strongly Agree & Agree) o We are at or above the national mean on all items. o Objectives being aligned with exams if 5% higher than the national. o Students’ comments suggest the need for more clinical relevance and biochemistry content. o Novices may have trouble making the connection to clinical content in the HB&D years so Block Chairs should help make it clearer. o We should see improvements in this area next year as we have added more clinical vignettes in the HB&D block assessments and exams. o For the past two years, students have been getting a keyword report on their Block exam performance based on Step 1 content topics. This should help the students see the relevance. Preparation for clerkships is rated in terms of major basic science content areas. (% Excellent & Good) o Biochemistry has the lowest rating and is well below the national average. o Immunology and genetics are rated lower than the national mean. Discussion: o Are these ratings reflective of the actual curriculum or how students are preparing for Step 1? o We should consider adding biochemistry content to year 2 and Discussion Recommended actions: 1. Form a consortium and pool our data for comparison. 2. Organize focus groups with the class of 2014 with an outside facilitator. Participants will be selected randomly and the groups will meet the week of graduation (last week of May). AGENDA/NAME DISCUSSION/RECOMMENDATION explore its application during clerkships. o The MEC recently appointed a Biochemistry thread chair whose work in organizing and strengthening biochemistry should be reflected in the GQ responses for the Class of 2018. • • • • • • • Students report on volunteer or elective activities during medical school. o Free Clinic experience with an underserved population: 80% o Research with a faculty mentor: over 95% o Between 50 and 75% report experiences with cultural competence, health disparities, use of an interpreter, and health education. o In the narrative comments, several students commented on the lack of help in finding mentors. Only STTP has this policy. Other summer research programs help students find mentors. Discussion: o Will this change when the grading system takes effect? With our current Pass/Fail system, students sometimes look for research opportunities to distinguish themselves for residency. Student rate their preparedness for residency in 4 areas: clinical skills, communication skills, evidence-based practice, and care for patients unlike themselves. (% Strongly Agree & Agree) o Clinical Skills: 85% o Other 3 readiness areas: 90% Fourth year components are rated at or much higher than the national means: o Guidance in selection of electives: 65% (same as national) o Elective time: 82% o Value in preparing for residency: 85% o Importance of the final year: 85% Students indicate expected career intentions. o Full Time University Faculty 40% (compared to 35% nationally) o Full Time Non Academic Clinical Practice: 30% Average amount of medical school debt of those with debt ($122,000) is low compared to the national average of $161,000. The mean “Overall satisfaction with the quality of my medical education” at DGSOM is 4.2 compared to the national mean of 4.4. o In 2013, the percent of Strongly Agree & Agree is 87.3 (compared to 89.2 nationally). In 2009 this was a90% (compared to 86.6 nationally). o Nationally, the trend has shifted to more satisfaction, but DGSOM has shifted lower. ACTION AGENDA/NAME DISCUSSION/RECOMMENDATION • Discussion: o Overall satisfaction decline is of concern. Possible causes were suggested: match results, setting students’ expectations too high, issues with Step 1 vs curriculum. ACTION Ophthalmology Clinical Requirement for Year 2 - Dr. Gary Holland Ophthalmology has five afternoon sessions scheduled throughout the second year curriculum. In past years, they tried to schedule clinical experiences for a class of over 160 students over a 2 week period. This proved logistically difficult and some students had poor experiences. In 2013-14 academic year, Dr. Holland piloted an optional ophthalmology clinical visit for second year students. Students could select from a list of dates spanning the second year. By using only two sites (the West LA VA and Jules Stein), he was able to monitor quality. Those students who took advantage of this opportunity valued the experience and suggested that it be required. Ophthalmology is offered as a Surgery subspecialty in third year but it is in high demand so they cannot accommodate all the students who request it. Action Clinical Immersion Week Presentation – Drs. Robert Oye and LuAnn Wilkerson Considerations raised in discussion: • What are our Ophthalmology graduation competencies? • What is the best ways for students to become competent: clinical sessions, labs, simulation…? • What are the Ophthalmology objectives of each Block and in anatomy? • Should we add an ophthalmology exam in HB&D? • Dr. Oye and Dr. Wilkerson presented objectives, activities and assessment plans for the proposed Clinical Immersion Week for the incoming class of 2018. The experience is scheduled October 6 – 10, 2014, between blocks 1 and 2. Dr. Oye is working with Dr. Michael Lazarus, Dr. Magdalena Ptaszny, and Dr. Carl Stevens to plan, schedule, and implement the activities. The request from the Clinical Skills planning team is to make participation a requirement. Objectives: Link basic pathologic mechanisms to clinical conditions observed in both inpatient and ambulatory settings. Describe irregular heart sounds commonly heard during the cardiac exam. Identify specific ways to improve skills in making a meaningful connection to the patient and eliciting the patient’s chief complaint. Reflect on the team-based nature of health care delivery. Demonstrate basic Heart Saver procedures. Motion: Dr. Noah moved to require an Ophthalmology clinical visit during the second year. This will take the place of one of the currently required afternoon ophthalmology sessions. The motion passed. Action Motion: Dr. Drake moved to approve a required Clinical Immersion course for one year. Dr. Calmes seconded the motion. The motion passed and will be forwarded to the FEC. AGENDA/NAME DISCUSSION/RECOMMENDATION Activities: Lecture on the health care delivery systems and the ACA – Stevens Lecture on Ethics and Professionalism in medicine – Hynds Shadowing for 2 to 3 hours in an ambulatory setting preferably linked to the preceptorship that begins in January. Shadowing for 2 to 3 hours with an inpatient team. Cardiac exam with heart sounds workshop using the Harvey simulator. Formative OSCE with immediate feedback from the SP and checklist Heart Saver certification HIPAA online certification ACTION Assessment: Reflective essay on a patient’s experience with a health care delivery team Multiple-choice exam (10-20 items) Discussion Several additional objectives and activities were suggested: • Add Electronic Health Record concept to the week • Use electronic Blaufuss pads when teaching heart sounds. • Add real patients with pathology to the course. • If approved by MEC, the motion needs FEC approval. Update from Drew – Drs. Daphne Calmes and Ronald Edelstein • • • The ribbon cutting ceremony for the Martin Luther King Jr. Outpatient Center is May 28, 2014. This year MLK took five students for 1st year preceptorship. 2014 is the 30th anniversary of the first Drew/UCLA Medical Education Program graduating class. Informational