Medical Education Committee Minutes

November 20, 2001

I) Dave reported on his meetings with Clerkship Directors, CCDC, Students, Student Government, Clinical Chairs, since the last MEC meeting:

Using the attached charts (A and B), Dave discussed the different constituencies and how they would be affected by changes in the Year 3 schedule:

2) Dave outlined the latest iteration of the proposed new structure for Year 3:

Using the attached chart (C), Dave explained the block schedule of the new Year 3 schedule, as opposed to the current schedule, to wit:

A series of eight week clerkships would be created to include Medicine, Pediatrics, possibly Ob/Gyn, Family Medicine, Psychiatry, and Surgery, and an additional 8-week block that could contain 4 weeks of an elective, plus 4 weeks of either ambulatory medicine, women's health, and/or neurology.

The blocks would consist of 7 weeks of clerkships, followed by one week of a mixture of activities including finishing up the clerkship; OSCEs; special classwide lectures; and orientation for the next block.

The system would require no additional time spent by students. There would be an average of 12 students per block, with a lottery system in place to assign students to blocks.

3) Eric Shirley further defined the new schedule

Eric reported on the desire of the Ob/Gyn Clerkship Directors to combine the two clerkships into one if we approve the new Year 3 architecture.

Using the following chart, he explained how "Dartmouth Days" would incorporate new materials into the curriculum.

4) Dave and Eric fielded questions about the new system of scheduling

(Dave Nierenberg and Eric Shirley left at 5:00. Patty Carney took over as chair.)

5) The remaining committee members discussed the schedule and voiced the following concerns and suggestions:

• Would it be possible to make the Friday of the 8th week a vacation for all students? (This would reduce the time spent in the "Dartmouth Days" portion of the curriculum.)
• How would the requirement of electives in Year 3 affect distribution of students? (Electives in Year 3 would not be required, but would be optional.)
• Travel time for away sites is already inadequate - how will the changes affect that? (Changes should result in more time to travel to and back from distant sites, since there would always be a weekend to travel.)
• How will the new schedule impact clerkship orientations for away sites? (Basic orientation would happen at DMS on Friday afternoons; any local orientations could happen on site on Monday mornings.)
• Will students be able to adjust to the change from a 7 week clerkship structure to the fragmented topics of "Dartmouth Days?" Will the topics be relevant to what the students learn in the preceeding clerkships? (Probable list of topics presented.)
• Is it possible to implement the new schedule within a six month time frame? Could the "Dartmouth Days" programs be completed on time? (Dr. Shirley believes that both could be done properly if given a lead time of 6 months, probably not if less.)
• Would it be possible to integrate students from different clerkships to participate in small sub-group topic areas?
• Would there be a problem with students cutting electives or Outpatient Medicine to attend "Dartmouth Days?" (Students would be expected to attend Dartmouth Days if they were on electives; they would be expected to complete all four weeks of any required 4-week clerkship, such as Ambulatory Medicine or Women's Health.)
• What, specifically, would be the format of "Dartmouth Days?"(Still being worked on, probably a mixture of lectures, conferences, computer-assisted instruction.)
• Can different "Dartmouth Days" topics be offered concurrently to provide choices for students? (Unclear.)
• Could a "Manual of Electives" be provided to students half-way through Year 2? (Yes, this is already available.)

Agenda for next MEC meeting on December 18, 2001 in Auditorium A:

Further discussion and vote regarding Year III issues and restructuring

Pass rate: This year, 57 of 61 seniors passed, for a pass rate of 93.4%. The pass rate for the 16,515 seniors from all US schools who took the exam (the comparison group) was 95.0%. Over the last four years, our average pass rate at DMS has been about 97.2% (while the national average for the same period has been 95.0%). I believe that the reason that more than the expected number of our student failed on their first attempt this past spring may be due to several factors: NBME raised the passing score; lack of specific preparation for Step 2 by some of our students; the stress caused by students being pressured by various state medical boards to take the exam earlier in the year; and the difficulty for some students to master the MCQ format of exams during Year 2, Step I, and the shelf exams during the clerkships.

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