Medical Education Committee Minutes

September 18, 2001

Introduction by David Nierenberg, Associate Dean for Medical Education.

Dave gave a brief history and introduction about how our committee came to be.

We became the MEC (Medical Education Committee) about 5 years ago, replacing the New Directions Coordinating Committee, which had in turn replaced the earlier Curriculum Committee. The MEC was set up by the Associate Dean for Medical Education, and though we never received a formal written charge of what we should be doing, we've assumed the global responsibility for oversight of the content and quality of the medical school curriculum, as outlined and required by the LCME.

These are the members of our committee and each individual brings a different perspective and expertise to these meetings.

STANDING VOTING MEMBERS

Jim Bell (SBM Year II) (Electives)
Gene Nattie (Yr. I) (Electives)
Dave Nierenberg (Assoc Dean/SBM)
Eric A. Shirley (Assoc Dean)
Patty Carney (Evaluations/OSCE's)
Marlene Sachs (Community Preceptor Board Member and Representative of outside community)

INDIVIDUAL VOTING MEMBERS

Ethan Dmitrovsky '02 (Pharm/Tox)
(Leslie Fall) (Pediatrics)
Donald Kollisch '02 (C&FM)
Deborah Peltier '03 (C&FM)
Virginia Reed '03 (Education)
Martha McDaniel '03 (Surgery)
TBN '04
TBN '04
TBN '04

STUDENT VOTING MEMBERS

Alex Reyentovich '02 1/2 vote
Tim Killoran '02 1/2 vote
Katherine Bardzik '03 1/2 vote
Seth Crockett '03 1/2 vote
Kirsten Redborg '04 1/2 vote
Todd Burdette '04 1/2 vote
Ryan Knapp '05 1/2 vote (new)
Justin Wheeler '05 1/2 vote (new)

I. List of Potential Committee Members

Members of the MEC proposed the following people as possible new members on the MEC:

2. Discussion of Key Points About Undergraduate Medical Education, as Selected by Dave from the September '01 JAMA Educational Issue.

Faculty Issues

Worldwide, in the 2000-2001 academic year, there were 103,553 full-time faculty members in LCME-accredited US medical schools, a 1.1% increase from the number of full-time faculty in 1999-2000.

Student Issues: Applicants

"The 37,092 applicants for the class entering in 2000 represented a 3.7% decrease from the number of applicants in 1999."

General:

• Nationwide, a total of 17,538 individuals were accepted, and the ratio of applicants to accepted applicants was 2.1:1.0.
• At DMS, a total of 206 individuals were accepted. A total of 4,681 applied (roughly 23 applicants for every student accepted). 74 of the 206 students who were accepted eventually matriculated.

Women:

• Nationwide, a total of 17,274 women applied to medical school, a 0.9% decrease from 17,433 applicants in 1999. However, the percentage of women applicants increased from 45.2% in 1999 to 46.6% in 2000.
• At DMS for 2000, a total of 2,085 women applied to medical school (45% of all applicants).

Other minorities (Black, Native American, Mexican American, and Mainland Puerto Rican):

• Nationwide, the number of applicants to the 2000 entering class from underrepresented minority groups increased 2% from 1999, from 4,184 to 4,266. This is the first increase in the number of underrepresented minority applicants since 1996.
• At DMS, the number of applicants to the 2000 entering class from underrepresented minority groups was 276 out of 4,681 applicants (5.9% of all applicants).

• Student Issues: Enrollments

  Mean GPA:

  • Nationwide, the mean grade point average of students who matriculated in 2000 was 3.60, compared with 3.59 in 1999.
  • At DMS, the mean grade point average of students who matriculated in 2000 was 3.65, compared with 3.60 in 1999.

  Medical College Admission Test Scores (2000 Class):

  	Nationwide	DMS
  Verbal Reasoning	9.5	9.9
  Physical Sciences	10.0	10.6
  Biological Sciences	10.2	10.7

  Women:

  • Nationwide, 7,739 women matriculated in 2000, 46% of total first-year enrollment, an increase of 0.2% from the previous year.
  • At DMS in 2000, 101 (49% of total) were accepted, and 33 (45% of total) women matriculated.

  Other Minority Admissions:

  • Nationwide, of the first-year class in 2000, 1,862 (11.5% of the total) individuals were from underrepresented minority groups, including Blacks, Native Americans, Mexican Americans, and Mainland Puerto Ricans.
  • At DMS, of the first-year class in 2000, 23 out of 206 accepted, (11% of the total) individuals were from underrepresented minority groups including Black, Puerto Rican Mainlanders, and Mexican-Americans. 6 (8% of 74 total) matriculated.

  International Student Admissions:

  • Nationwide, of all first-year students in 2000, 193 (1.1%) were neither US citizens nor permanent residents.
  • At DMS in 2000 entering class, 7 (3%) of first-year students in 2000-2001 were neither US citizens nor permanent residents.

  Student Issues: Progress and Attrition

  • Nationwide, final data for the 1999-2000 academic year showed that 13,566 graduates (86.4% of total) had completed the medical education program in 4 years or less and that 2,132 (13.6%) had taken 5 years or longer to graduate.
  • At DMS, 49 students (77% of total) completed the program in 4 years; 12 students (19%) completed in 5 or more years.
  • Nationwide, during 1999-2000, 756 medical students (1.1% of total enrollment) left their original medical school.
  • During the same academic year, 3 DMS students (1%) left prior to graduation.

  The Medical School Curriculum

  Structure and Content

  • Nationwide, the majority of medical schools are currently involved in a process of curriculum review and change.
  • During the 2000-2001 school year, DMS has focused on curriculum enhancements in such programs as Geriatrics, Cultural Diversity and Competency, Technology in Medical Education, and Assessment and Planning Skills. Changes are also being considered and/or implemented in course scheduling, electives, and student progress evaluation systems.
  • Nationwide, during 2000-2001, there were an average of 38 scheduled weeks in the first year of the curriculum, 36 weeks in the second year, 47 weeks in the third year, and 35 weeks in the fourth year.
  • At DMS, there were an average of 39 scheduled weeks in the first year of the curriculum, 37 weeks in the second year, 48 weeks in the third year, and 32 to 44 weeks in the fourth year.
  • Nationwide, the average number of required hours was 827 in Year 1 and 754 in Year 2.
  • AT DMS, the average number of required hours was 901 in Year 1 and 876 in Year 2.

  The Medical School Curriculum: Structure and Content (Cont'd)

  Year 3 and Year 4 contain required clerkships and elective/selective time. The average total time devoted to separate required clerkships in the clinical disciplines and the modal (most common) total instructional time in these disciplines were as follows:

  Discipline	Nationwide Average in Weeks	Nationwide Mode in Weeks	DMS Average in Weeks
  Ambulatory Care	5.7	4	(16)
  Family Practice	6.1	4	8
  Internal Medicine	11.5	12	12
  Neurology	3.7	4	4
  OB/Gyn	6.8	6	8
  Pediatrics	7.3	8	8
  Psychiatry	6.9	6	8
  General Surgery	8.4	8	8
  Surgical Subs.	4.5	4	0

  Curriculum: Oversight

  • In order to evaluate educational program effectiveness and attainment of the schools educational objectives, the following methods were used:

  Method	Number of Schools
  Student Evaluation of Courses	123
  United States Medical Licensing Examination (USMLE) results	122
  Results of the AAMC Medical School Graduation Questionnaire	122
  Student advancement and graduation rates	115
  National Residency Matching Program results	112
  Performance based assessment of students' skills and abilities	102
  Specialty choice of graduates	95
  Residency performance of graduates	93
  Less common measurements	110

  • DMS used a combination of all of the above methods for curriculum oversight (plus many others!!)

  Curriculum: Evaluation of Student Performance

  • Nationwide, 115 schools required students to take Step I and 101 schools required students to take Step II of the USMLE. Students were required to take both examinations in 100 schools.
  • At DMS, students are required to take both Step I and Step II.
  • Nationwide, the following scores were required for advancement or graduation:

  Grade	Number of Schools
  Passing grade on Step 1	103
  Passing grade on Step 2	72
  Passing grade on Steps 1 and 2	72

  • DMS does not require students to pass either part.

  Resources

  Information Technology

  • Nationwide, medical students in 2000-2001 were required to own or rent individual personal computer equipment in 58 schools (46% of total).
  • DMS does not require any student to own a computer, but it encourages students to do so.

  Inpatient Teaching

  Sites for inpatient teaching are critical to an effective system of clinical education. Nationwide, in 2000-2001, a total of 120 reporting medical schools used a total of 883 hospitals as major inpatient sites for required clinical clerkships, compared with 936 hospitals used by 122 reporting schools in 1999-2000. This indicates a decrease in the number of hospitals used for teaching between 1999-2000 and 2000-2001.

  Clinical Teaching in the Ambulatory Setting

  In order to meet the students' education needs medical schools must maintain a sufficient number of community-based faculty members.

  Some of the challenges involved for US medical schools in the 2000-2001 academic year are listed below:

  • 40 schools reported that it was more difficult to recruit and retain volunteer faculty during 2000-2001, compared with the previous year.
  • 110 schools attributed the difficulty in recruitment and retention of community-based faculty to increased pressure for efficiency in practice that made community physicians less willing to participate in clinical teaching.
  • 41 schools reported competition from other medical schools and residency programs in the area for the available pool of community physicians.

  Nationwide, medical schools have attempted to meet the challenges in recruitment and retention of community-based faculty in the following ways:

  • 40 schools reported making a monetary payment to some or all volunteer faculty members.
  • 114 schools offered access to library services, including literature searching.
  • 102 schools held recognition dinners or provided certificates.
  • 85 schools provided free or discounted continuing medical education.
  • 36 schools supplied or discounted computers or software.
  • 35 schools offered access to athletic facilities or sports events.
  • DMS is working hard and continuously to meet the challenge to recruit and retain community-based faculty in all of the ways above.

  III. Possible Agenda Items for Future Meetings

  1. Diversity and Cultural Competency

  VIG 25 (Lori Alvord, Jim Bell, and Patty Carney) will report.

  2. Computers in Medical Education
  

  • Should DMS students be required to own a computer?
  • Should DMS student be required to own (and use) a PDA?
  • Should computers be provided for community faculty?

  3. Geriatrics

  John Wesson and Julie Paterson will give a progress report in May.

  4. Year 3 Issues

  Dave Nierenberg will meet with clerkship directors regarding the following issues and present findings in October or November.

  • Examination of electives for improved flexibility.
  • Examination of the system of ambulatory and inpatient pediatric rotations for improved adjacency.
  • How are students doing in OSCEs?
  • Anonymity of student evaluations - CCD (?) will report.

  5. Audience Response System (ARS)

  Contact Reed Datar regarding status.

  6. Pediatrics VIG

  Report due?

  7. New VIGs

  • Set up Sexual Medicine VIG
  • Set up Alcohol/Drug Abuse VIG

  IV. Agenda for next MEC meeting on October 16, DMS 1 E/W, 4 pm:

  • Possible changes to Year 3 structure
  • Summary of performance of DMS Year 4 students on Step II of the Boards

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