Medical Education Committee Minutes

Tuesday, April 23, 2002

A. VIG REPORTS

• I. Dave explained the concept of Vertigal Integration Groups (VIG):
  • Every year the MEC picks one or two areas of curriculum that are lacking in DMS education, need improvement, or could be expanded, and a Vertigal Intergration Group is formed to study the options.
• II. Lori Alvord presented the progress report on implementation of the VIG on Cultural Diversity (approved last year):
• a) Below are listed, in brief, the actions recommended by the MEC (and resulting actions) with respect to the Vertical Integration Group Report #25 on Diversity Training and Cultural Competency for medical students at DMS. (For complete report, see attachment).
• 1. ADD an item on the survey of our graduates (at 8 years) on how well DMS prepared students to be culturally competent in their practice of medicine.
  **DONE..
• 2. KEEP the Cultural Competency exercise as part of the current Year 2 orientation. (This is already in place, and handled by the Office of Minority Affairs.)
• 3. RECOMMEND that Dr. Cochran seek to add a session on Cultural Competency issues and skills during Year I of On Doctoring. Also, RECOMMEND that Dr. Cochran seek to identify and recruit more minority faculty to serve as clinical preceptors and group facilitators in On Doctoring.
  ** Dr. Benita Walton, a black physician who will begin a psychiatry residency this summer, was hired (for this year only) to help with On Doctoring.
• 4. RECOMMEND that Drs. Nierenberg and Bell seek to include more healthcare issues related to patients of different ethnic and racial groups, as appropriate and feasible, in Year 2 PBL cases.
  **An asthma case was changed to make it a young Hispanic woman living in the inner city (Manchester, NH) with asthma brought on by cockroach allergy (and complicated by the difficulties of inner city living). Additional issues of access to healthcare and paying for expensive prescription drugs were also explored.
• 5. RECOMMEND that HSP in Year 4 develop some type of "culminating experience" in the Cultural Competency curriculum. This might take the form of a poster presentation, new case for discussion, etc. (Note: Ginny Reed agreed to work on this possibility with her course planning group.)
  ** One of the debate topics for the HSP curriculum indirectly addressed cross-cultural issues.
• 6. DISTRIBUTE to all faculty and course directors in Years 1-2 a summary of these recommendations, and ENCOURAGE them to work such issues into their teaching as they continue to evolve and improve their courses, lectures, etc.
  **DONE.
• 7. REQUEST that the Dean invite all faculty to attend a faculty workshop program designed to increase faculty sensitivity to these issues, developed by the Office of Minority Affairs expressly for medical school faculty. Further, encourage On Doctoring facilitators to be among the first to take this workshop program.
  ** The dean's office and the office of Multicultural Affairs sent a joint email to faculty/departments to let them know that we were planning to offer sessions related to diversity/cultural competency. This initiative has been on hold until a new Director of Multicultural Affairs has been hired.
• 8. ENCOURAGE the Admissions Office to develop a workshop or retreat to think about how to increase enrollment of under-represented minority students.
  **The admission office will incorporate this into their spring workshops. The multicultural affairs office, after consulting with admissions, attended six minority recruitment fairs at summer minority premed preparation courses. We will check with admissions to see if there has been an increase in applications from minority students.
• 9. ENCOURAGE the Associate Dean for Faculty Affairs to sponsor and organize a conference or workshop to brainstorm about ways to improve the recruitment of faculty members with more diverse backgrounds.
  **See the list of the eight new minority faculty members in the full text attached, and the dean's statements (Attachment A) about efforts to recruit minority faculty members through collaborative efforts with AA/EO and the Department Chairs.
• 10. RECOMMEND that faculty and students work together to expand extracurricular opportunities relative to culture and diversity.
  **I don't know if this was issued as a recommendation from the MEC. We have had four speakers in the past year who have addressed issues of cultural relevance sponsored through the dean's office and multicultural affairs:
  The Office of Multicultural Affairs also continues to send regular information to students about cultural events happening in the Dartmouth community.
• 11. REQUIRE that all medical students complete four weeks or more of a clinical experience at a site that offers patients who differ significantly cultural, ethnic, socioeconomic, or other backgrounds from patients more commonly seen in New Hampshire and Vermont. This experience is designed to be part of a much broader four-year curriculum in cultural competency.
  **This has been implemented, though I think the final language was "strongly recommended."
  For details, check the DIHG bulletin board in Student Affairs or their website www.cfhi.org
• 12. REQUEST that 2-3 members of the current VIG volunteer work over the coming year to move these recommendations forward through conversations with key faculty and committees, and prepare a progress report for the MEC in 12-18 months. (Note: Lori Alvord, Jim Bell, Patty Carney, and Jack Lyons have volunteered to do this.)
• **Members have worked independently toward achieving most of these goals.
• b) The MEC discussed the progress and lack of progress in several areas.
• III. Leslie Fall's Progress Report of the VIG on Pediatrics (not completed thus far) was distributed in her absense:
  • a) Below are listed, in brief, the major points of the report, which is still a work in progress: Click here for the work in progress.
    • 1. We have received and reviewed in depth much of the first and second year syllabus/curriculum.
    • 2. We have sent out to the pediatric faculty a survey that asks their opinion of the current 4-year curricular content in pediatrics, the "optimal" 4-year curricular content and an area for open suggestions.
      ** I have received all of these and just need to compile the data.
    • 3. I have met with Nan Cochran to review the pediatric content of On Doctoring.
      ** We both have agreed that there needs to be a permanent pediatric member of the OD curriculum committee.
    • 4. We have held quasi-focused interviews with 8-10 3d and 4th year medical students regarding their thoughts and experiences.
      ** About half of them went into pediatrics and half did not.
    • 5. We have reviewed the NBME and AAMC survey data related to pediatrics.
    • 6. I have spoken informally with many of my COMSEP colleagues regarding integration of a unified pediatric curriculum across all 4 years of the medical school curriculum.
  • b) A full report will be presented in Fall '02.
• IV. Report on Genetics VIG:
  • Jay Dunlop reported, through Dave Nierenberg, that many changes are currently taking place in the new Genetics Department. The MEC recommended that a formal VIG be formed in the fall of 2002.
• V. Report on Proposed VIG on Professionalism:
  • a) Joe O'Donnell's proposal for a new VIG on Professionalism was distributed to the committee. Below are listed, in brief, the proposed goals of the new VIG (the complete report is attached).
     
    The Professionalism VIG will:
    • 1) Define a profession and professionalism-use definitions of Creuss and Creuss, Swick, AAMC, and ABIM
    • 2) Review the formal, informal and hidden curriculum for instances in which these are currently taught/learned and or sabotaged (especially in the hidden curriculum) and seek opportunities to positively reinforce this subject and the attitudes about it.
    • 3) Obtain or develop curricular materials and references on this topic.
    • 4) Develop an evaluation plan similar to that at UCSF.
  • b) The committee discussed and determined:
    • 1) Now would be good time to initiate a VIG on Professionalism.
    • 2) The VIG should include an additional 3rd Year student, a nurse or nurse administrator, and Worth Parker (to represent GME concerns).
    • 3) Dave Nierenberg will write a letter (now completed)to inform Joe O'Donnell of the MEC's decision to have him move ahead on the project.
    • 4) The committee will expect a complete report of the VIG in the winter of the '02-'03 academic year.

B. REPORT OF THE COMMITTEE ON PHYSICIAN-SCIENTISTS

• I. The CPS Report, entitled "The Promotion of the Science of Medicine Within the DMS Curriculum" was distributed to the committee.
  • a) Below are listed, in brief, the major points of the report (the complete report is attached).
     
    In order to improve the post-matriculation atmosphere at Dartmouth Medical School such that it encourages the development of our medical students as scientists (irrespective of future career interests), the Committee on Physician-Scientists makes several recommendations to Dean John Baldwin. We urge:
    • 1) That changes be instituted in the grading, evaluation and course sequencing in Year One and Two that collectively will foster a curriculum with enhanced emphasis on concept-based and problem-solving approaches to the teaching of medical science and will increase student self-responsibility for their own education.
    • 2) The addition to the Year One and Two curricula of a required Medical Science Seminar Series (MSSS) that would create small groups of students linked to a faculty person with strong interests in the basic/clinical science interface.
    • 3) The addition to the Year One and Two curricula of a DMS Grand Rounds featuring presentations by select DMS faculty and visiting physician-scientists.
    • 4) The establishment of a Dartmouth Medical Education (DME) credit program, whereby all DMS students would be required to attend events that they would select from a list of scholarly meetings of interest throughout DMS and DHMC.
  • b. Dave Nierenberg expressed concern (and others of the committee agreed) that this report was never formally submitted to the MEC, given that it contains many suggestions that bear directly on the MD curriculum. The report was forwarded to Dr. Nierenberg informally last week by Ann Brisson in the Dean's office, for information only.
  • c. Dave reiterated that no significant changes in the broad MD curriculum (as opposed to within a specific course or clerkship) can be planned and implemented without approval by the MEC (a requirement of the LCME).
  • d. The committee agreed that, to their knowledge, there does not seem to be a parallel track elsewhere on these issues.
  • e. Student members of the MEC reported that Dr. Witters gave an oral presentation of a brief summary the report to students and solicited their support ­ but was not specific in how they were to support the proposal.
  • f. Dave Nierenberg suggested that the MEC might be willing to consider this report as an "unofficial" VIG, and begin formal discussion of these and related issues next fall. There was general support to do this.
  • g. Dave Nierenberg will circulate the report and several key questions to Year 1 course directors and student reps over the summer, so that their perspective on these issues will be known by the MEC prior to formal discussions by the MEC next fall.

Agenda for next MEC meeting on May 21, 2002 in Auditorium G:

Using Information Technology to Improve Medical Education at DMS

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