Medical Education Committee Minutes

December 18, 2001

I) Dave reported the results of his circulation of the planned changes to the Year 3 schedule:

None of the committee members polled suggested amendments to the following proposed motion:

Motion (12/10/01) for improving Years 3 and 4. Here are the key points, based on multiple meetings of the MEC, meetings with clerkship directors, clinical chairs, etc.

1. The 16-week integrated blocks would be discontinued.

2. Each clerkship will be scheduled in the lottery independently as part of an 8-week block.

3. Medicine and Surgery will each run for 7 weeks plus two days. When time is added for their orientations (the Friday before the 8-week block) and content in the "Core

Clinical Knowledge and Skills course", they would each receive 8 weeks nominal credit on the transcript (rounding to nearest week). Each would need to be scheduled and completed by August of the fourth year.

4. Pediatrics, which will be made up of several smaller blocks or rotations, covering both inpatient and outpatient activities, and will also run for 7 weeks plus two days. Orientation would be the Friday preceding the clerkship. It would receive 8 weeks nominal credit on the transcript (rounding to nearest week).

5. Family Medicine and Psych will each run for a total of 7 weeks. They have agreed to take the "normal" run of 7 weeks and two days, and to provide a long weekend break of 4 full days at the end of each clerkship. They are able to do this because their entire block is spent at the same location, making it easier to provide one or two break days at the end of the block. They each handle the location of that long weekend a little differently. They have orientation the Friday preceding the clerkship. They would each receive 7 weeks nominal credit on the transcript (rounding to nearest week), but would be viewed as co-equal with other major clerkships.

6. Inpatient Ob-Gyn and Ambulatory Medicine would each run for a full 4 weeks, with orientation the Friday preceding.

7. A new course called something like "Core Clinical Knowledge and Skills" or "Dartmouth Days" will be held every 8 weeks on the mornings of the final Wed, Thursday, and Friday for 4 hours per day (mornings), for a total of 72 contact hours. There would be some sort of periodic assessment of knowledge, based partially on student preference for the timing of such evaluation. This may take the form of a self-study web-based open book quiz after each 3-day cycle. The course will be pass-fail, and will carry 1 weeks credit on the transcript. Students will be "expected" to attend all sessions (same rules as for Years 1 and 2), except when they were completing a four-week required clerkship (e.g. ambulatory medicine, ob-gyn, etc). In those cases, students will catch up by watching videos of the sessions.

8. OSCE sessions will occur three times per year, on Tue, Wed, or Thursday evenings. Students will be assigned to one of 6-7 different OSCE cases depending on the clerkships they had completed over the previous 16 weeks. Feedback will go to students (areas of strength and weakness) and clerkship directors (so they can see how well their clerkships were covering necessary skills, etc). OSCE performance will be assessed on a pass-fail basis. A student would need to pass both the knowledge portion (see #7 above) and the skills (OSCE) portion of the new course to receive the full 1 week credit. In the rare situation when a student fails either portion of this pass-fail course, Dr. Shirley will develop a pathway for remediation that could be developed early in Year 4.

9. Most students would be expected to complete 47 weeks credit during Year 3 (as outlined above, all traditional Year 3 clerkships). All students MUST complete at least 43 weeks of required clerkships during year 3 (except for the few students on an 8-week staggered start).

10. Vacation or rest time during Year 3 will increase from the current 4 weeks (1 week fall, 2 weeks Holiday, and 1 week spring) to 4 weeks plus 8 days (two 4-day long weekends). Thus, students would have short or longer breaks after most clerkships.

11. The Dept of Ob-Gyn will be invited to present a plan to the MEC if they wish to attempt to design a new 7-week clerkship to combine the current 4 weeks of inpatient Ob-Gyn and ambulatory Women's Health. If the MEC votes to approve such a plan, in terms of its educational features and its logistical features, then it will be incorporated into the new design of the clinical years.

12. Students who feel the need to take an elective in Year 3 (or move a Year 4 clerkship like Neuro or Women's Health into Year 3) will have an increased chance of doing so. We estimate that the number of students who can do this will increase from the current 8 students per year to as high as 30 students per year, now without disrupting a 16-week block. Taking an elective in Year 3 will require displacing a 4-week or 8-week clerkship into Year 4, subject to the availability of such clerkships. A few slots will be reserved for Year 4 students to take different Year 3 clerkships in Year 4, and these slots will be clearly identified during the lottery. 8-week clerkships will need to be completed in Year 4 by December, while 4-week clerkships can be completed through May of Year 4. Exact availability of these slots will depend in part on the size of the Year 3 class that comes the following year, due to clerkship capacity issues.

2) Dave reported on the status of the absentee ballot regarding the proposed changes:

The students and faculty that voted via blitz-mail were enthusiastically and unanimously in favor of the proposed motion.

3) Dave opened a discussion regarding the motion:

Members expressed concerns or questions over the issues of timely integration of OB/Gyn clerkships into the system; the effects of restructuring on the quality of the OB/Gyn program; required planning time for ³Dartmouth Days;² student time conflicts between Dartmouth Days and clerkships, especially in December when students are interviewing; creating ground rules so students don¹t take advantage of unforeseen loopholes; and student time conflicts when vacation time abuts clerkships in other parts of the country.

4) Dave conducted a roll-call vote on the proposed changes to Year 3

The motion to make the above listed changes to Year 3 passed as follows:

Out of 18 possible total votes, including pre-meeting absentee ballots, and recalling that each class (2 students) receives one total vote:

Three people did not attend and did not submit an absentee ballot.

Agenda for next MEC meeting on January 15, 2002 in Borwell 758W:

As time permits, there will be a discussion of the AAMC Graduate Survey, taken last March.