September 21, 2009:
Due to the overwhelming attendance at the "Health Care Reform 101" panel last week, we wanted to advertise another event that may be of interest. Dr. Warren Newton, Executive Associate Dean for Education and Chair of the Department of Family Medicine, will be speaking this Wednesday, September 23rd from 12-1 in the Aycock Family Medicine Building auditorium. The title of his presentation will be "Health Care Reform and the Patient Centered Medical Home." There is a shuttle that runs to the Family Medicine bulding from the front of UNC Hospitals every 15 minutes, and there are also buses that run there from the stop in front of Thurston Bowles. We hope to see you there!
Ali and Anshu
September 16, 2009:
Check out our new Health Care Reform section. We will regularly update this page with links to local articles as well as videos and pictures from the Forums.
August 19, 2009:
It is my pleasure to invite you to the School of Medicine’s 2009 Richard H. Whitehead Lecture on Wednesday, August 19, 2009 at 12:00 P.M. in 2204 Medical Biomolecular Research Building. This year’s lecturer will be Dr. Arrel D. Toews, Professor, Department of Biochemistry and Biophysics.
The title of his lecture will be, "To Make the Best Better-Farm Stories, Deep Thinkers, Good Doctors." Awards to faculty and students will be presented following the lecture and a reception will follow the awards.
I hope you can make a special effort to attend this year’s Whitehead Lecture, awards ceremony, and reception. I look forward to seeing you there.
Georgette A. Dent, M.D.
Associate Dean for Student Affairs
August 11, 2009
The Whitehead Medical Society has been invited to speak during orientation. This will happen on Wednesday, August 11, 2009 from 12 – 1 PM and lunch will be provided.
Town Hall Meeting Summary
April 24, 2009
1. Study Space for Step 1
· Dr. Newton has acquired permission for the medical students to have access to Bondurant after-hours, hopefully permanently (not just for this summer). Details are still being worked out.
· FYI, there are showers in the basement of Bondurant for those who were interested.
· The 4th and 5th floors of Berryhill will be renovated in time for boards studying.
2. Match Outcomes
· This year, there were 5 seniors that did not match (all were able to scramble). This puts UNCSOM in the top 25% of medical schools in terms of success in the match.
· Factors in non-matching:
o step 1/step 2 failure
o mismatched expectations
o geographic restrictions
· It is our hope that with better advising, these pitfalls can be avoided in the future. This is of special concern because the match will only get more competitive, with the number of US medical and DO grads increasing faster than the number of residency spots.
· The 4th and 5th floors will be completed fairly soon.
· The first floor will be addressed in 2 phases:
· Current lounge will become a "quiet lounge."
· Osler will be significantly redesigned and should be completed by the end of December, with a kitchen, TV's, a social area, and a wellness center.
4. Lecture Capture
· This has been a huge success this year. Through surveys, it seems that most students using the lecture capture use it for individualized targeted review.
· We are now looking at technical improvements, and some ideas that have been brought up include Podcasts, downloadable format, transcription of lectures, faster speeds, improved synching, and concerns about length of access.
· We would also like to expand the use of lecture capture to the clinical curriculum, especially for consistency among AHEC sites.
5. Asheville Pilot
· The idea of the Asheville pilot is to emphasize a continuity experience vs a rotational experience, with each student following a set of patients throughout the year. This approach has been experimented with at Cambridge and has been quite successful there.
· Four incoming third years have been selected to pilot this program in the coming year. The program will exist on a year-to-year basis, depending on whether funding is available (~ $50,000/student/year).
6. AHEC Housing
· There has been concern that there will be a daily fee for AHEC housing in the coming year. This will NOT be the case THIS YEAR.
· After this coming year, there will be a consistent fee charged to each student (i.e. not daily per use, but one flat fee charged to everyone). This fee will be covered by financial aid.
Updated PDA Guidelines
Dr. Dent has issuedfor PDA recommendations.
January 18th, 2008
Student Position Statement Regarding the Clinical Curriculum Proposal
1. Questionable motivation behind the need for change
- In our opinion there were inadequate data (n = one class) to support changing the curriculum. The decision was based primarily on expert opinions of Clerkship Directors and department chairs. Preliminary data of current curriculum suggests at least equal and possible upward trend on USMLE Step 2CK. There may have been a slight decrease in individual shelf scores, but, again, this was based on data from only one class. Courses which were restructured in previous clinical curriculum redesign failed to adequately adapt to their new format; teaching and exposure to patient care did not change with shortening of clerkships from 6 to 4 weeks. Student feedback revealed that students felt OB/Gyn did need more time to relay their stated course objectives, but Family Medicine and Psychiatry did not.
2. If implemented adequately, this proposal likely will be neutral for students.
- What we mean by “neutral is that all students would receive a solid foundation of medical education in this curriculum not significantly better or worse that what students are currently experiencing.
- Our rationale: this proposal allows for 1) an experience in core fields equivalent to what exists currently, 2) exposure to any medical specialty through electives and selective opportunities, 3) adequate unscheduled/flexible time to study for and take board exams, go on away rotations, receive letters of recommendations, life events, and interview for residencies, and 4) no advisor or faculty member we have talked with believe that it will truly hurt students beyond the increased anxiety the change will cause.
3. Phase 1 versus Phase 2
- In order to produce a proposal in time for it to be implemented in the 2008/09 academic year, the Clinical Curriculum Committee (CC ¾), the group that created the proposal, chose to split the process of curriculum redesign into two phases: Phase 1 (this current proposal) would be focused on the number of weeks assigned each clerkship. Phase 2 would be focused on key content changes.
- Daniel and I along with your other student representatives have been outspoken that weeks DO NOT equal educational value. Therefore any process centered on weeks (i.e. Phase 1) WILL NOT lead to true curricular improvement. It was the students’ desire from the beginning to focus more heavily on the content-driven Phase 2, but do to time constraints and political realities, committee members produced this proposal and gave a verbal commitment to work on Phase 2 in the future.
4. Room for improvement
- As stated above, only by focusing on content can the curriculum be truly improved. Fundamental areas in need of improvement are not addressed by this proposal Daniel and I believe work in these following three categories would lead to the greatest improvement of student learning:
- Integration of content across curriculum will lead to more efficient use of time and deeper learning experience.
- Longitudinal experience to both patients and clinical mentors is absent from UNC’s curriculum. A commitment to the introduction of a longitudinal experience would directly address a large curricular gap.
- Increased medical student responsibility: The medical student is no longer a helpful part of the treatment team. This lack of responsibility is apparent in three key arenas:
- Medical students’ H&P’s and Progress Notes do not “count”. Notes usually go unread by attending physicians and residents, and students rarely receive constructive feedback on performance.
- Medical students cannot write meaningful orders. The CPOE, medical student version which residents can cosign is sloppy and does not represent the full range of order sets which residents frequently use.
- Medical students are not given ample opportunities to perform procedures. IV’s, line placements, ABG’s, etc. are rarely, if ever, performed by 3rd year clerks.
- In summary, the medical student’s responsibility on the treatment team has slowly eroded, weakening the educational experience once gained by taking ownership of a patient’s care. Improvement is possible: institutions, like Cincinnati Children’s Hospital, offer systems that allow and encourage medical students participation in patients’ care. So far UNC has failed to institute the necessary elements to reverse this trend of decreasing student responsibility. This needs to change.
- Aside from the above goals, students have offered many valuable comments and recommendations for improving this proposal and the clinical curriculum in general. A few of the more pertinent and insightful ones follow:
- The items listed by the CC3/4 in their proposal as “essential” currently do not exist and need to be developed. These include advising, two week electives, better communication across courses, and an electronic scheduling system. Currently, there is no advising system in place, 2 week career exploration elective opportunities courses do not exist, minimal cross-clerkship or cross-departmental communication has occurred to reduce unneeded redundancy, and an electronic scheduling system may not be ready for scheduling this year. Without these structural support components in place, successful rollout of the consensus plan by July 2008 appears challenging.
- The proposal does not meet the stated goals of Dr. Pisano’s charge to “fill curricular gaps and reduce unneeded redundancy”.
- Expansion from 4 to 6 weeks of Family Medicine, OB/GYN, and Psychiatry has led to concurrent reduction in possible elective opportunities.
- As adult learners, students feel their ability to talor their curriculum to their individual needs is being reduced.
- To minimize the effects of reduced elective time, selective prerequisites must stay to a minimum and the spectrum of specialties in which a student may do a selective must be much broader then currently available.
- In response to many faculties’ opinion that the MS4 year is “soft”, students have responded that increasing the robustness of the MS4 curriculum is not solely accomplished by adding months to curriculum. Rather, restructuring clinical rotations to maximize responsibility and learning efficiency is a more responsible and constructive answer.
- The content delivered in the two weeks of Capstone should be evaluated for its usefulness. Depending on the results of the evaluation, the course should either be reduced to its original one week length or eliminated while incorporating its objectives into other places in the curriculum.
- FAC should be deconstructed into its base elements—Basic Life Support, training in simple procedures, Anesthesia exposure, and Advanced Life Support. BLS and the training in procedures should be accomplished before starting clinical duties. Anesthesia exposure should be incorporated into the core experience either as a structured part of the Surgery clerkship and/or as a new, two week elective. And ACLS training should take place within one year of graduation to fulfill the residency requirements and to eliminate the need for renewal in the fourth year.
- Students need increased accountability of course directors for their use of student time.
- Time is a limited and precious commodity for students and clinicians alike. Wasting students’ time with poorly organized, badly taught material cannot be tolerated. Students need a robust system to deliver feedback to course directors and administrators. Transparent cooperation of course directors to fix flaws must be gained, and students with the support of the Office of Medical Education must have the authority to demand improvement if adequate steps are not taken.
- Standardization across the state’s AHEC system must improve. AHEC experiences vary widely between location and between specialties. Concrete steps must be taken to identify and remediate outliers.
Letter from the Whitehead Medical Society Co-Presidents
Town Hall Meeting
We hope that this letter finds you all well. For those of you that were unable to make the meeting, Kyle and I have drafted a quick summary for your perusal. Included in this summary are the key topics discussed during the meeting. As always, if you have specific questions or concerns, or if you would like to sit down over a cup of coffee to discuss these further, just send us an email. The administration present today included Dr. Cheryl McCartney, Dr. Georgette Dent, Dr. Robyn Stewart, Dr. Julie Byerley (leader of Curriculum Committee for 3rd and 4th years) and Dr. James Yankaskas (leader of Curriculum Committee for 3rd and 4th years).
1. Berryhill Reopening- Dr. McCartney informed the class that as of today Berryhill is scheduled to reopen in January 2008. A final, definitive date for reopen should be available prior to everyone’s departure for the Holiday. As soon as this is known an email from will follow. The limited reopening will include access to the 1st, 4th, and 5th floors. The student lounge is on the first floor and lab spaces will be available on the 4th and 5th floors for the MS2’s and MS1’s respectively.
2. Clinical Curriculum Reform- This topic was the primary thrust of our meeting today… A brief summary of the key questions/comments is reflected below.
- Why is the clinical curriculum being reviewed so urgently? First, the school of medicine curriculum is constantly under review and in evolution. The administration continues to work towards a better, more refined experience for the students. Over the last two years changes were made in the MS3/MS4 years to address two perceived gaps in the curriculum: 1) Flexibility for time off/electives in MS3 year and 2) a weakness in Neurology. To get these both into the third year the OB/GYN, Family Medicine, and Psychiatry clerkships were shortened from 6 to 4 weeks in length. There has been some concern that shortening these clerkships in length has weakened the clinical experience and may be adversely affecting test scores.
- What is the process by which a decision will be made regarding next year’s clinical curriculum? With this as a background, Dr. Pisano charged the Clinical Curriculum Committee for MS3/MS4 (CC ¾) to readdress the current design of the clinical years and to present options that may address these concerns to her by January 8, 2008. There are 5 MS4 student representatives on this committee. Dr. Pisano will make a decision regarding the curriculum at that time. Any changes will go into effect beginning July 08 for entering MS3’s. Again, any changes will continue to be reviewed and the clinical curriculum will continue to evolve, as has been the norm for many years.
- What are the student representatives’ goals for the clinical curriculum redesign? There are three key goals that the student leadership is trying to achieve in the curriculum redesign. (1) Maintain unrestricted flexibility for elective time/time off as an option for the MS3 year. (2) For July-September of the MS4 year to remain as flexible as possible so that students will have adequate time to complete Step 2 study, Acting Internships, Away Rotations, etc. It is the students’ preference that the “core” MS3 calendar not be extended into the beginning of the MS4 year. (3) Teaching that occurs across MS3/MS4 years should be integrated and informed. Planned redundancy is acceptable and should build on previous experience, but unplanned redundancy due to a lack of knowledge of what is taught in other clerkships is not desirable.
- Why is elective time important in the third year? Having the option do an elective in the MS3 calendar year is very valuable for many students. The core curriculum includes surgery, internal medicine, family medicine, psychiatry, pediatrics, ob/gyn, and neurology. Approximately 1/5 of each UNC graduating class chooses a specialty not represented within the “core” of the MS3 curriculum (Anesthesiology, Radiation Oncology, Dermatology, Emergency Medicine, Radiology, Pathology). Elective time in the MS3 year allows students considering these fields to gain early exposure to the fields, which helps guide the career decision making process.
- How have student test scores been affected by recent curricular changes? The verdict is still out, although preliminary data suggests that performance on national shelf exams and Step 2CK is comparable, and perhaps better, than in previous years. Currently, the graduating class of 2008 has a cumulative average of 6 points greater than last year’s national average on Step 2 CK and is the second highest that it has been during the last 8 years.
- How will any curricular changes affect student’s time spent away from Chapel Hill? Currently students do an average of 5 months away from UNC Hospitals. This is unlikely to change with any curriculum redesign. As Dr. Dent stated, UNC is the state’s flagship medical school and unlike private medical schools in our area, our mission is to serve the people of North Carolina. As such, part of UNC’s mission will always be to serve people throughout the state. The administration will attempt to do a better job of letting students know where they will be doing clerkships further in advance. There will be much more to come on this topic after the first of the year.
- What are the different clinical curriculum options currently being considered by the CC ¾? There have been approximately 7 different proposals presented at these committee meetings. They range in scope from increasing the “core” MS3 year to 15 months to reverting to a clinical curriculum from 2002 to changing our clinical curriculum to large integrated blocks in the spirit of the MS1 and MS2 years. At this point in the deliberations it is unclear exactly what the proposals that are presented to Dean Pisano will look like. As soon as additional information becomes available it will be communicated.
- What is the timeline for career decision-making in the MS4 year? As a general rule it is important to know what your specialty of choice is going to be by September 1 of your MS4 year. Residency applications, personal statements, and letters of recommendation are completed in the Fall and interviews begin for most specialties between November and January. Match day occurs in March of the MS4 year. In general, knowing what you want to do earlier, rather than later, is preferable as this allows students to design their MS4 schedules, electives, and away rotations to cater to their specific needs.
3. Why do MS2’s pay Summer Tuition and Fees when all they are doing is studying for Step 2?
- Dr. Dent addressed this in great detail. In short, all medical students currently must have the same schedule and thus the same financial aid package. In previous years when students were not “enrolled” during boards study time there were students that had to get jobs to support themselves because financial aid was not available during this time. By having students “enrolled” when studying, financial aid is available to all students.
4. Career Goal Advising for MS1’s and MS2’s
- Dr. Robyn Stewart, Assistant Dean for Student Affairs, is currently in the process of meeting with all MS1’s individually. In the Spring semester Dr. Stewart will be meeting with MS2’s in small groups. During these meetings she will be addressing any questions and concerns, as well as offering some “what you should look for in a clerkship” pointers.
These were the main points discussed today during our meeting. Again, feel free to email if you have specific questions or comments. Additional information will be disseminated regarding both Berryhill and the Clinical Curriculum Redesign as soon as it becomes available. Thanks again for you interest and we look forward to our next Town Hall meeting after the first of the year.
Daniel Fox and Kyle Knierim