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Monday, October 30

2:30-4:00p

GEA/GSA Group Discussion Session
Just-in-Time Learning: Does it Have Efficacy for Long-Term Practice Benefits?

Moderator:
Kimberly S. Ephgrave, MD
University of Iowa Roy J. and Lucille A. Carver College of Medicine

Discussants:
Mark H. Gelula, PhD
University of Illinois College of Medicine

Jess Mandel, MD
University of Iowa Roy J. and Lucille A. Carver College of Medicine

Description of Topic and Rationale: With the advent of the internet and its ubiquity, physician self-directed learning is often a product of "just-in-time" (JIT) learning.

There are good reasons why JIT learning is used by physicians. In the Emergency Room, the ICU or the physician's office, it provides immediacy to questions, it is efficient, and it short-circuits the need to find a colleague or consultant when time is of the essence. That physicians us JIT learning is no longer an issue: software such as UpToDate© and MDConsult© are available in many medical schools, hospitals and large clinics. Resident training programs and medical student clerkships now offer them and other similar digital assistant-based programs as an adjunct to the standard curriculum because the programs underscore the process of evidence-based medicine supporting a physician query.

Despite the potential of JIT learning, there is debate regarding the long-term benefit of this approach as an effective self-directed learning strategy. Traditional cognitive learning theory and associated instructional design strategies (Gagne, 1965; Gagne & Briggs, 1974, Kolb, 1984) would suggest that learning for long-term gain should have a developmental sequence. There should be time for iteration, reflection, doing and reinforcement. Further, there is significant meta-analytic evidence that effective CME requires multiple types of interventions over an extended period of time (Davis et al, 1999).

None-the-less, situated learning theory would suggest that the intensity and need wrapped within the context of learning can impact on the learning outcome (Brown, et. al, 1989). This is compounded by the strength of the individual's motivation in the moment. Motivation theory, self-efficacy theory and the theory of planned behavior each support JIT because the learning is completely intrinsic, driving learning based on the learner's immediate need, their beliefs in what they think they know, and their perceived control of the situation at hand. (Ajzen, 199, Bandura, 1986, Deci, & Ryan,) In this session, we will examine previous traditional approaches to CME against this framework of JIT learning as a model of useful and effective self-directed professional development. It is hoped that an outline of ideas and concepts with implications for physician learning will result from the discussions.

Seattle Convention Center - Room 617

2:30 - 4:00p

GEA/GSA Group Discussion Session
Organizational Infrastructure to Support Scholarship in Education

Moderator:
John Littlefield, PhD
University of Texas Health Science Center at San Antonio

Discussants:
Deborah Simpson, PhD
Medical College of Wisconsin

Debra DaRosa, PhD
Northwestern University Feinberg School of Medicine

Description of Topic and Rationale: In September 2000, the GEA project on scholarship used Bolman and Deal's four 'frames' to describe organizational infrastructure that supports scholarship in education: 1. Structural (e.g., education leadership positions listed on organization chart) 2. Human Resources (e.g., faculty development programs/workshops), 3. Political (e.g., educators in leadership positions), and 4. Symbolic (e.g., education emphasized in rituals, traditions, and ceremonies) . Since that time, a number of formal activities have been initiated by the AAMC and GEA to provide infrastructure support to medical educations. The GEA's Medical Education Research Certificate (MERC) Program was launched to provide the knowledge necessary to be effective collaborators in medical education research (human resources frame). The AAMC's MedEdPORTAL now provides a peer reviewed repository for educational materials and resources consistent with Glassick et al.'s criterion for scholarship (structural frame). Each of the GEA regions have also provided workshops (human resources frame) and recognitions/awards (symbolic frame).

As our national and regional organizations build the infrastructure, per Bolman and Deal's four frames, we must also critically exam how we can build and sustain the infrastructure at our home institutions. This small group discussion will present operational examples of organizational infrastructure to support scholarship in education in our departments, medical schools, and across the health sciences. The session will begin with a brief review of each Bolman and Deal's four frames and then each discussant will use the four 'infrastructure frames' to describe their home institution's efforts to encourage scholarship in education at one of three levels: 1. a single clinical department (Surgery), 2. a medical school, and 3. an academic health center. Participants will complete a worksheet using the four infrastructure frames to assess support for scholarship in education at an organization of their choice (i.e., department, school, or academic health center) Discussion will focus on how to increase scholarship in education by resolving organizational infrastructure deficiencies and to identify the key features/strategies that can be synthesize from across the formal presentations and the discussion.

Seattle Convention Center - Room 618

2:30 - 4:00p

GEA/GSA Group Discussion Session
The Evidence that Healthier Medical Students will Become Better Physicians, and How to (and how not to) Produce Healthy Medical Students at Your School

Moderator:
Erica Frank, MD, MPH
University of British Columbia

Discussants:
Cam Enarson, MD, MBA
Creighton School of Medicine

Linda Hyder Ferry, MD, MPHA
Loma Linda University School of Medicine

Description of Topic and Rationale: Our data show that promoting medical student health can produce medical students who are healthier and more interested in and capable of counseling their patients about prevention. Our presentations and discussions will help participants translate these facts into effective, testable programs at their medical schools.

Chronic disease is epidemic among North Americans, in large part because of inactivity, poor diets, obesity, and alcohol and tobacco abuse. While physician counseling is of variable efficacy, physician counseling can indeed improve many chronic disease-related patient behaviors, even ones as stubborn as tobacco use, diet and exercise, alcohol abuse, and weight loss. Despite this potentially enormous lever, physicians have traditionally had minimal training about patient counseling for primary prevention of CVD, and we have a limited menu of options for effective and appropriate ways to train and encourage them to do so. We must train a new generation of physicians who can address these critical and growing needs, and this presentation aims to help do so in a novel, efficient, and benevolent fashion.

This presentation will be based on the foundation we and others have built demonstrating the strong and consistent relationship between medical students' and physicians' personal health habits and their related patient counseling habits. The moderator published a summary in JAMA on this topic - this will be provided to the participants. In prior work supporting this foundation, Lewis et al (in a mail survey of 2,610 internists), found that respondents who exercised more were more likely to report counseling their patients about exercise, seat belt users to recommend seat belt use to patients, and non-smokers were more likely to report counseling their patients not to smoke. Our Women Physicians' Health Study examined separate models of 14 different counseling behaviors. Other than for being a primary care practitioner, practicing a healthful behavior oneself was the most consistent and powerful predictor of physicians' counseling a patient about related prevention issues. This was true for a wide range of habits. For example, significant associations were found between physicians' fat consumption and their likelihood to counsel patients about cholesterol-lowering through lifestyle changes, physicians' personal practices regarding breast self exams was strongly correlated with their performance of clinical breast examinations, and their personal sunscreen use and their providing skin cancer counseling were positively related. Significant associations were also found between personal and clinical practices about exercise, alcohol, tobacco, flu vaccine, and hormone replacement.

In the summer of 2003 we finished collecting four years of personal and clinical health-related data on the Class of 2003 at 17 U.S. medical schools. The moderator was the PI of this study, and the two co-presenters were site investigators/collaborators. All students were eligible to complete three questionnaire administrations (at freshman orientation, orientation to wards, and in their senior year). Our response rate overall for all years was 80.3 percent; item non-response rates were a median of 3 percent. Students were tracked through medical school with a confidential unique identifier; a total of 2316 individuals responded to our surveys, with 1658 of these responding at >1 timepoint. Our most important manuscript from this study (in review) confirms our primary hypothesis: the avidity with which medical schools encourage students to be healthy significantly influences students' patient counseling. Our models showed that both counseling frequency (p=0.002) and perceived relevance (p=0.0007) were positively affected by attending a school that encouraged healthy personal practices, and that frequency of exercise, nutrition, and weight counseling were also positively influenced by the health promotion environment in one's school. This same manuscript also confirms a major secondary hypothesis: as with practicing physicians, medical students' personal health practices are overall correlated with their counseling frequency (p < 0.0001) and perceived relevance (p=0.008).

By "growing healthy medical students", we can build on this relationship between personal and clinical practices, and could encourage physicians to do more, and more effective prevention counseling. All these data suggest that promoting medical student and physician health may be an effective, kind, and efficient way to improve patient outcomes.

Seattle Convention Center - Room 205

2:30 - 4:00p

GEA/GSA Group Discussion Session
The Role of Medical School Administration in Support of Medical Students with Mental Health Issues: A Discussion of Three Schools' Experiences

Moderator:
Gerald H. Sterling, PhD
Temple University School of Medicine

Discussants:
Kathleen A. Reeves, MD
Temple University School of Medicine

Samuel K. Parrish, MD
Drexel University School of Medicine

Diane R. Gottlieb, MD
Temple University School of Medicine

Brenda J. Butler, MD
Drexel University School of Medicine

Matthew Strickler, Esq
Temple University School of Medicine

Charles A. Pohl, MD
Jefferson Medical College

Ruth M. Lamdan, MD
Temple University School of Medicine

Description of Topic and Rationale: Mental wellness and mental illness are important issues that must be addressed by educators in medical schools.(1) A significant number of medical students suffer from stress and depression associated illness during their medical school career.(2) Some students go on to suffer from major depression or possibly psychosis related illnesses that are often diagnosed after they have matriculated in medical school.(3) It is very important for the well being of the students as well as for overall patient care that we as medical school educators are able to provide wellness care as it relates to mental health, identify medical students at risk for developing mental illness and provide appropriate counseling and medical care to students with illness.

Mental health wellness has long been overlooked in medical education. It is imperative that we provide young doctors-to-be with the skills they need to deal with stress, family and career pressures, depression, anxiety and substance abuse issues.(4) This must be done in a way that is not perceived as judgmental or punitive by the student. It must be easily accessible, effective and attractive enough for students to take advantage of what is offered.

Mental illness is not uncommon in medical students. We as medical educators must be adept not only at recognizing the signs of mental illness but also knowing how to support the student in a way that is most beneficial to the student as well as to society as a whole. (5)

Over the past 18 months, Associate Deans for Education and Student Affairs as well as faculty Psychiatrists who treat medical students at three medical schools in Philadelphia have formed a working group. These faculty from Temple University School of Medicine, Drexel University College of Medicine and the Jefferson Medical College have begun to tackle issues related to School specific policies, specific clinical problems, and shared challenges. We have found it to be extremely useful to combine resources as they relate to medical student mental health wellness and treatment. We have been specifically addressing the following goals:

1. The development of a wellness program for all medical students centered on mental health issues that can serve as a model for other medical schools to use in the development of school specific programs
2. To determine if there are risk factors for mental illness in medical students that can be identified during the admissions process or early on in a student's medical education
3. To develop a best practice as it relates to the structure and financial support needed in providing students with mental health wellness and treatment programs during medical school

This workshop will provide a forum for discussion about prevention, identification and treatment of medical students with mental health problems. The moderator will begin the workshop by providing an 10 minute overview of the prevalence of mental health issues in medical students, a review of the LCME requirements as they relate to mental illness during medical education, a review of pertinent case law as it relates to this issue and an overview of where our working group is with relation to the goals outlined above. We will then distribute cases from each of the medical schools that will help us address the following questions:

1. Are there tools or techniques that can be used to identify students at high-risk for developing mental illness prior to matriculation and during their medical education?
a. Should we specifically screen for mental illness?
b. What is the sensitivity/specificity of screening tools?
c. Should we identify students we think are at high risk at the time they matriculate?

2. What services should we have in place in our schools to support students and to protect patients when students are showing signs of significant mental health issues?
a. Do University wide services provide adequate mental health care for our students?
b. How do we keep evaluative faculty from becoming involved?
c. How do we/the students pay for the services?

3. How can schools in the same geographic area work together on issues of student mental health wellness, evaluation and treatment?

4. How should we approach issues involving students with mental health diagnoses who have promotional issues during their medical school career?

We will then divide the participants into small groups; each group to discuss a specific case. This will be limited to 15-20 minutes. We will then regroup as a whole. The moderator will introduce the three panelists. The panelists will be Assistant/Associate Deans of Student Affairs from Temple University School of Medicine, Drexel University School of Medicine and the Jefferson Medical College. Each panelist will take a case and lead the discussion. The small group that reviewed that case will be asked to comment on what was discussed in their group. At the end of each discussion the panelist will share how each school resolved the issue.

In addition to the panelists we will have faculty Pyschiatrists and University Counsel from the represented schools to help with questions that may arise during the discussion. At the conclusion of the discussion the moderator and panelists will review the important points and help develop some best practices as they relate to the questions outlined above. The moderator will then lead a discussion about how we can continue to work together to develop universal policies and tools as we handle the very difficult problems associated with student mental health wellness and illness in medical education.

Seattle Convention Center - Room 206

2:30 - 4:00p

GEA/GSA Group Discussion Session
Medical Education and Patient Outcomes: Where Are We Going?

Moderator:
Louise Arnold, PhD
University of Missouri, Kansas City School of Medicine

Discussants:
Gary Gaddis, MD, PhD
University of Missouri, Kansas City School of Medicine

Carol Thrush, EdD (candidate)
University of Arkansas for Medical Sciences

James A. Clardy, MD
University of Arkansas for Medical Sciences

Description of Topic and Rationale: Medical education researchers have been challenged to link medical education efforts to measurable patient outcomes.1-3 Toward that end, researchers have asked, "Which education-related patient outcomes could our current university and hospital systems permit us to measure?"

Perhaps the question should be, "What education-related patient outcomes should we be measuring, and how can we alter our current systems to allow us to do that?" A panel of medical education researchers, with varying university roles, will briefly present their unique perspectives on this issue. During the group discussion, participants will conceptually move beyond the restraints that their current systems put on associating patient outcomes with medical education. This will allow participants to conceptualize the outcomes that they would like to or should be measuring, without limitations.

Once participants have identified these outcome ideals, they will brainstorm ways to move from where they are now, to where they need to be to achieve these outcomes. Participants will leave with ideas for possible means to overcome their institutions' limitations which inhibit linkage of medical education with patient outcomes.

Seattle Convention Center - Room 204

2:30 - 4:00p

GEA/GSA Group Discussion Session
What Should We Ask On Our Graduate Follow-up Survey? "Three Medical Schools" Perspectives on the Methods and Processes

Moderator:
Dawn S. Bragg, PhD
Medical College of Wisconsin

Discussants:
Brian Mavis, PhD
Michigan State University

Summers Kalishman, PhD
University of New Mexico School of Medicine

Robert Treat, MS
Medical College of Wisconsin

Description of Topic and Rationale: Every medical school has experienced the daunting task of planning and implementing an outcome evaluation to inform curriculum changes and improvement as well as to meet LCME accreditation requirements (ED-47) and ACGME Outcome Project Expectations for Phase III. Educators are faced with the challenge of deciding what questions to ask that will yield information useful for informing curriculum decisions and program improvement.

Outcome evaluation strategies are many and varied; however, many schools use an annual survey of their graduates and their residency directors to garner information about the quality of their curriculum and to determine whether their objectives have been met. Many schools have been conducting such studies for at least 10 years. Analyses of these data frequently reveal that information is consistent over the years and provides evidence for medical schools to judge whether they do a good job preparing their graduates for internship and if their graduates are satisfied with their medical education. With these data, educators are also able to compare their perceptions to other data sets (e.g., parallel forms of questionnaires completed by the graduates' residency directors). Such results bode well for accreditation, recruiting efforts and other marketing activities.

Evaluation wisdom and the context of the changing health care landscape and expectations for physician competence demands that we continuously examine our curriculum and physician training programs to achieve our stated goals of excellence in medical education. Therefore, obtaining information that is most useful to course and clerkship directors, residency program faculty, other medical educators and deans for curriculum improvement should be a key purpose of graduate follow-up evaluation(s).

An in-depth examination of our graduate survey needs to be a priority for those who have been doing this for at least 5 years for three reasons. First, examination of the data gathered over the last 5 years should inform whether we are getting the information important to our school officials. Are we asking the right questions and are we asking the questions in a manner to elicit the responses that will give us valuable/useful data? Secondly, many schools have implemented some curricular change over this time and need to ensure that their graduate survey is responsive to these changes. Thirdly, this discussion will also help those schools that have yet to implement such surveys as part of their outcome evaluation plans.

Seattle Convention Center - Room 211

2:30 - 4:00p

GEA/GSA Group Discussion Session
The Making of Successful Advising and Mentoring Programs: A Discussion to Make it Happen

Moderator:
Maryellen Gusic, MD
Penn State College of Medicine

Discussants:
Dwight Davis, MD
Penn State College of Medicine

Ruth Marie Fincher, MD
Medical College of Georgia

Lewis R. First, MD
University of Vermont College of Medicine

Description of Topic and Rationale: Medical student advising and mentoring programs have notoriously been difficult to design, implement, and assess. This small group discussion is intended to bring together GEA and GSA faculty to discuss effective models for the design of advising and mentoring programs for students. The group will consider such issues as 1) similarities and differences between advising and mentoring, 2) the import of mandated involvement for faculty and for students, 3) measures of the effectiveness and impact of these programs, 4) faculty development needs to maintain these programs and, 5) time, effort and dollars needed to sustain them. Successful and unsuccessful models of advising and mentoring programs will serve as the basis for these discussions.

Seattle Convention Center - Room 307

2:30 - 4:00p

GEA/GSA Group Discussion Session
The Possibilities and Pitfalls of Developing and Sustaining a Faculty Medical Education Fellowship

Moderator:
Nancy Searle, EdD
Baylor College of Medicine

Discussants:
Charles Hatem, MD
Harvard Medical School

Larry D. Gruppen, PhD
University of Michigan Medical School

Lynn Robin, PhD
University of Washington Medical School

Description of Topic and Rationale: Expanding and refining the repertoire of teaching faculty is required by the current demands of medical education. To met this challenge, institutions have begun to establish programs aimed at improving the teaching skills of faculty as well as empowering them to assume leadership roles within the organizational and educational arenas. The development of educational fellowship programs designed to facilitate continuous improvement in the faculty and establish them as change agents is one such response that has emerged to meet these challenges. This session is designed to help those beginning educational fellowships and those who currently direct educational fellowships develop and sustain this type of program at their institutions. Four directors of long-standing medical education fellowships will lead a general discussion of their experiences with medical education fellowships as their programs have developed and changed with the needs of their individual institutions. Six directors of other medical education fellowships have been invited to attend to contribute to the discussion.

Seattle Convention Center - Room 310

2:30 - 4:00p

GEA/GSA Group Discussion Session
Using the Tool for Assessing Cultural Competence Training (TACCT) for Curricular Needs Assessment: The Experience at Four Medical Schools

Moderator:
Christopher Reznich, PhD
Michigan State University

Discussants:
Donna Elliott, MD, EdD
Keck School of Medicine of the University of Southern California

Monica L. Lypson, MD
University of Michigan

Nehad El-Sawi, PhD
Arizona School of Health Sciences at A. T. Still University

Description of Topic and Rationale: Faculty at four medical schools have recently used or are currently using AAMC's Tool for Assessing Cultural Competence Training, or TACCT as part of curriculum needs assessments to ascertain the penetration of cultural competence knowledge, skills and awareness in the curriculum and to identify curricular strengths and weaknesses. The moderator and three discussants will briefly describe how they and their institution used the TACCT for cultural competence curricular needs assessment. The following questions will be addressed during the discussion:

1. What did the TACCT reveal about the incorporation of cultural competence content in our curriculum? What strengths were revealed, and what weaknesses? 2. What were the strengths and weaknesses of the TACCT as part of a curricular needs assessment?
3. Is the TACCT the best resource for medical schools to use to assess their multicultural curriculum?
4. Can the TACCT be used to determine if there are differences between student and faculty perceptions of the cultural competence curriculum?
5. How can TACCT be used in planning new medical school curriculum?

Seattle Convention Center - Room 213

2:30 - 4:00p

GEA/GSA Group Discussion Session
Moving Beyond Assessment: Enhancing the Educational Value of Multi-Source Feedback

Moderator:
Joan Sargeant, MEd
Dalhousie University Faculty of Medicine

Discussants:
Karen Mann PhD
Dalhousie University Faculty of Medicine

Douglas Sinclair MD, CCFP (EM), FRCPC
Dalhousie University Faculty of Medicine

Jocelyn Lockyer, PhD
University of Calgary Faculty of Medicine

Description of Topic and Rationale: Multi-source feedback (MSF or 360-degree feedback) is a type of formative assessment used for physicians, residents and clinical clerks to assess performance and provide feedback. Medical schools, regulatory authorities, professional organizations, and healthcare organizations are adopting it in a growing number of countries. Domains of performance frequently assessed include patient communication, communication with colleagues and coworkers, professionalism, and practice management, domains difficult to assess by traditional performance measures. MSF uses questionnaires completed by groups of reviewers who work with the individual being assessed. In medicine these are usually medical colleagues and peers, coworkers, and/ or patients, and usually the recipient completes a self-assessment. Recipients receive an individualized feedback report providing their mean scores from each reviewer group, aggregate mean scores and self-assessment scores if applicable. Feedback may or may not be facilitated by a supervisor or other professional. The intent is that recipients through reviewing their own and aggregate scores will be able to identify learning and improvement needs and act to address these.

Research has confirmed the ability to design standardized MSF tools which will provide reliable data using appropriate numbers of reviewers and questionnaire items. Studies have also shown the feasibility of MSF use for various populations and, importantly, recipients report using their feedback for learning and improvement. But, not all MSF participants accept or use their feedback as intended. Research in the business environment shows that several factors influence MSF feedback acceptance and use, findings supported by recent studies in medical education. The purpose of this discussion group is to explore the factors which may influence the use of MSF for learning and improvement at all levels of the medical education curriculum.

Seattle Convention Center - Room 604

2:45-4:15p

GEA/GSA Group Discussion Session
Longitudinal Patient-Centered Experiences: How Students Can Learn Chronic Illness Care

Moderator:
Gail Morrison, MD
University of Pennsylvania

Discussants:
Paul N. Lanken, MD
University of Pennsylvania

Jane Turner, MD
Michigan State University

Maria A. Wamsley, MD
University of California, San Francisco

Description of Topic and Rationale: Teaching about chronic illness care on all levels (medical students, residents and practicing physicians) is increasingly being recognized as an important and critical mission of medical education. One argument for its importance and inclusion in medical education is based on the overwhelming numbers of the chronically ill and their health care costs. According to the program Improving Chronic Illness Care (ICIC) of the Robert Wood Johnson Foundation (RWJ Foundation), almost half of all Americans (~133 million) live with chronic health conditions (http://www.improvingchroniccare.org/change/index.html) currently and a projected total of 171 million by 2030. Furthermore, it is estimated that care of those with chronic illness consumes 75 percent of health care expenses in the U.S. (http://www.aamc.org/meded/iime/chronicillnessproposals.pdf).

Another argument for its inclusion is the recognition that chronic illness care currently suffers in quality. This is attributed, in large part, to the reactive nature of the current health care delivery system, in which a fragmented, uncoordinated system primarily responds to acute problems on an "as needed" basis rather than functioning on a pro-active and patient-empowering basis. Other models of health care, e.g., the Chronic Care Model (or an expanded version, the Care Model), have been proposed to provide a coordinated, evidence-based and patient-centered and patient-empowering approach (Wagner EH. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998;1:2-4 and http://www.improvingchroniccare.org/change/model/components.html). In recognition that the current system of health care is deficient, RWJ Foundation has established an extensive external and internal research program whose goals are to improve health care for those with chronic illnesses (http://www.improvingchroniccare.org/research/initiatives.html).

The traditional learning venues in undergraduate medical education about chronic illness care have been shaped, by and large, by the traditional system of health care delivery, i.e., a reactive, acute care-based, fragmented approach. This traditional educational approach has also utilized a student-centered approach in which students encounter patients for short periods of time in different inpatient or outpatient clinical environments. Many such "rotations" may last a month or less making it impossible to observe evolution of a chronic disease over time. Even outpatient or ambulatory care rotations may only be 4 to 6 weeks in duration during which time a student is unlikely to see the same patient twice. This creates a paradoxical educational paradigm in which students are trying to learn about chronic illness care over relatively short periods of time. What's missing in this paradigm is the "chronic" of chronic illness care.

That teaching about chronic illness care is a major challenge in current medical education and that new approaches are needed is emphasized by the recent "Request for Proposals" by the AAMC based on a grant from the Josiah Macy, Jr. Foundation, "Enhancing Education for Chronic Illness Care." This proposal is to provide funds for selected schools for a year of planning curricular interventions followed by a year for implementation and assessment.

In this proposed Small Group Discussion, Directors of three established longitudinal patient-centered learning experiences related to chronic illness care at three different medical schools will compare and contrast the goals and formats of their programs. Comparing and contrasting these distinctive experiences, as guided by the Discussion Questions listed below, should trigger considerable discussion. The presentations and ensuing discussion should provide a wealth of information relevant to educators who want to use a longitudinal experience to teach chronic illness care at their own schools or who currently direct existing longitudinal experiences relating to chronic diseases.

This Small Group Discussion should be of interest to educators from all medical schools who want new ideas and practical approaches to use in their institutions to meet the challenge about how to teach chronic illness care, whose importance can only be expected to grow for the foreseeable future.

Seattle Convention Center - Room 619/620

Tuesday. October 31

1:00 - 2:30p

GEA/GSA Group Discussion Session
The Surgeon in the Dean's Office: "Bull in a China Shop" or "Match Made in Heaven"?

Moderator:
Dorothy A. Andriole, MD
Washington University School of Medicine

Discussants:
Paul J. Jones, MD
Rush University

Kimberley Ephgrave, MD
University of Iowa Roy J. and Lucille A. Carver College of Medicine

Peter Deckers, MD
University of Connecticut Health Center

Description of Topic and Rationale: A panel of surgeons will lead a discussion about the challenges and opportunities in combining an academic surgical practice with administrative responsibilities in the dean's office. The discussion will serve as a forum for an exchange of ideas among physicians balancing their evolving academic, clinical and administrative responsibilities The discussion will be relevant for surgeons, as well as clinically active physicians in other medical specialties , who are considering (or already hold) positions in their medical schools' central administrative offices. The discussion will provide an opportunity for physicians to develop a greater awareness of the wide range of possibilities for involvement in central administrative activities within the medical school structure, to consider different approaches to combining clinical and administrative roles and to recognize potential departmental benefits of their involvement (or that of their departmental colleagues) in central administration roles.

The discussion should also be of interest, and value, to current medical school administrators involved in recruiting and supporting medical school faculty in dean's office activities. The discussion may also be relevant for current departmental leaders seeking to increase their departmental representation and involvement in medical school central administrative activities.

All the selected panelists are surgeons who have chosen a range of professional paths and routes to administrative careers in their school deans' offices. Each panelist has a different range of administrative responsibilities as well as ongoing surgical departmental involvement.

A recent report on the current status of US medical school education programs concluded that the responsibilities of the medical school dean have expanded in recent years to include many additional roles beyond that of chief academic officer of the medical school (Barzansky B, Etzel S. Educational programs in US medical schools, 2003 - 2004; JAMA 2004; 292: 1025 - 1031) With this expansion of roles assumed by medical school deans, the "dean's office" has evolved to encompass an increasingly broad scope of individuals , including those with direct responsibility for different aspects of educational program management. In recent years, rather than designating a single individual responsible for all aspects of educational programming, many medical schools have created separate, specific positions for broad educational program management responsibilities in undergraduate, graduate and continuing medical education domains. Furthermore, as the "dean's office" range of activities includes aspects of clinical activities and an expanding scope of other institutional administrative activities (such as strategic planning, information technology and research ) , there are additional opportunities for involvement in central administrative roles beyond those within the educational domain per se.

As the level and complexity of challenges faced in meeting expanding "dean's office" responsibilities has grown, there is a need for representation and input at the central administrative level from the full spectrum of perspectives and talents in the medical school community. In this context, there can be increasing opportunities for involvement by physicians whose clinical careers may not have been optimally aligned with the more limited choice of opportunities and options which historically characterized the nature of dean's office involvement for medical school faculty.

There is an increasingly close relationship between the dean's office and medical school departments in all educational domains due to requirements for faculty development in their roles as teachers, accompanied by efforts across all departments to develop structurally sound educational programs with broadly recognized objectives, teaching and learning strategies aligned with stated objectives, and methods to document achievement of these objectives by learners at all educational levels , particularly at the undergraduate and graduate levels.

Surgeons can bring their particular perspectives to a range of domains within the dean's office. For example, in the domain of graduate medical education, surgeons are essentially constantly "on service" and therefore spending very high percentages of their time teaching and working with residents. Surgical training programs have relatively small numbers of residents compared to numbers of faculty and these faculty members work for long durations of time with their residents. Surgeons are particularly aware of, and sensitive to, a number of current issues faced by Accreditation Council on Graduate Medical Education (ACGME) -members related to work hour limits, due process issues in resident retention and promotion and development of competency-based curricula in graduate medical education. In the domain of undergraduate medical education, as medical school curricula are progressively moving to encompass an increased emphasis on the acquisition of fundamental skills, there are growing opportunities for surgical involvement in curricular design, implementation and assessment extending beyond the required clinical clerkship rotation in surgery.

Seattle Convention Center - Room 615/616

1:00 - 2:30p

GEA/GSA Group Discussion Session
Developing Faculty Development Activities that Respond to the Needs of Community-based Preceptors

Moderator:
Janet M. Riddle, MD
University of Illinois, Chicago

Discussants:
Marcy Rosenbaum, PhD
University of Iowa Carver College of Medicine

James Shropshire, MD
University of Wisconsin School of Medicine and Public Health

Description of Topic and Rationale: Community-based health care settings are important sites for learners to practice key clinical skills and to become exposed to settings in which they are likely to work in the future. Community-based preceptors are often volunteers, who enjoy interacting with learners and find fulfillment in teaching. These preceptors are typically geographically dispersed, have little training in effective precepting skills and often face increasing clinical and non-clinical workloads. In order to provide support for volunteer community-based preceptors, faculty developers need to have strategies to assess and meet the needs of those preceptors. In this small group discussion, participants will discuss and critique preceptor needs assessment strategies. Participants will also apply the PRECEDE (predisposing-enabling-reinforcing) planning model as a framework for discussion of preceptor development programs that are likely to enhance the educational experience of the preceptors and their learners.

Seattle Convention Center - Room 611

1:00 - 2:30p

GEA/GSA Group Discussion Session
Simulation for Institutional Leaders: Outcomes from the Millennium Conference 2005 on Medical Simulation

Moderators:
Grace Huang, MD
Shapiro Institute and Harvard Medical School

Richard Schwartzstein, MD
Shapiro Institute and Harvard Medical School

Discussants:
Ruth Greenberg, PhD
University of Louisville School of Medicine

Richard J. Simons, MD
Pennsylvania State College of Medicine

Scott A. Engum, MD
Indiana University School of Medicine

Paul M. Wallach, MD
University of South Florida

Description of Topic and Rationale: Medical simulation holds the potential to transform medical education; however, simulation initiatives have to-date been relatively isolated in clinical departments or at select institutions. During this small group session, we will continue a dialogue initiated at the Millennium Conference (MC) 2005 on Medical Simulation about strategies to achieve implementation of broad-based simulation programs in medical education. Leaders from select medical schools who participated in the MC will speak about their experiences integrating simulation comprehensively into the curriculum. The large group discussion that follows will address issues universal to educational innovation, such as faculty buy-in, financial support, and curricular implementation.

Seattle Convention Center - Room 307

1:00 - 2:30p

GEA/GSA Group Discussion Session
At your own PACE (Programs for Advanced Curricular Enrichment for Medical Students) (An NEGEA-UGME Sponsored Discussion)

Moderator:
Suzanne Rose, MD
Mount Sinai School of Medicine

Discussants:
Norma S. Saks, EdD
UMDNJ, Robert Wood Johnson Medical School

Kathleen D. Ryan, PhD
University of Pittsburgh School of Medicine

Description of Topic and Rationale: At this year's spring Northeast GEA regional meeting, undergraduate section representatives came together to explore common interests and concerns. The group included basic science and clinical faculty, medical educators, and deans. One issue that was addressed was whether appropriate effort is being made for the advanced student, the student who may achieve educational goals and objectives at an accelerated rate. This discussion topic is relevant and applicable across the medical education continuum.

This session will provide an opportunity to discuss the important issue of providing educational enrichment programs for the advanced medical student. The discussion will allow participants to share creative programming and to consider this perceived need in the context of medical education across the continuum. Can students achieve milestones at personal paces and advance appropriately to a level of competency? The session will explore the feasibility of offering advanced courses or alternatives, exempting students from certain courses, options for "fast-tracking" students with advanced clinical skills, promoting self-directed learning, and teaching students to create their own educational opportunities to meet their goals. The intent of this discussion is to facilitate communication, collaboration, and relationships between and among medical educators, medical school faculty and deans.

Seattle Convention Center - Room 617

1:00 - 2:30p

GEA/GSA Group Discussion Session
Responding to Reports of Unprofessional Behavior at Community Sites

Moderator:
Michael R. Callaway, MS
University of Texas Medical Branch, Galveston

Discussants:
Alice Anne O'Donell, MD
University of Texas Medical Branch, Galveston

M. Zelime Ward, MS4
4th Year Medical Student
University of Texas Medical Branch, Galveston

Description of Topic and Rationale: Responding to reports of unprofessional behavior is an unpleasant but necessary responsibility of administrators and medical educators. In addition to the unprofessional behavior of students, the unprofessional behavior of community faculty may also need to be addressed. Dealing with the unprofessional behavior of community faculty is uniquely challenging and particularly sensitive when the unprofessional behavior is identified and reported by students. The panelists at this session will present selected reports of the unprofessional behavior of students and community faculty occurring away from the medical school campus. Audience participants will be challenged to suggest appropriate actions and responses. Panelists will provide additional information as requested by audience participants during discussion, and then share outcomes and lessons learned from each reported incident. All participants will be encouraged to share their own experiences and perspective during the discussions.

Seattle Convention Center - Room 603

1:00 - 2:30p

GEA/GSA Group Discussion Session
Meeting the ACGME Mandate for Program Improvement

Moderator:
Pamela Derstine, PhD
ACGME

Discussants:
Barbara Joyce, PhD
ACGME

Joseph Brocato, PhD
University of Minnesota

Description of Topic and Rationale: As of July, 2007, all resident training programs are expected to have fully integrated the competencies and their assessment with learning and clinical care. Programs are expected to use resident performance data as a basis for improvement and provide evidence for accreditation review. Programs are also expected to use external measures such as clinical quality indicators, patient surveys, and national or specialty standardized measures to verify resident and program performance levels. Using a data-based framework (internal evaluation; practice indicators; national specialty-specific benchmarks), examples for meeting this requirement will be presented and participants will be invited to discuss and share strategies for implementation of this mandate in their program.

Seattle Convention Center - Room 602

2:30 - 4:00p

GEA/GSA Group Discussion Session
Impaired Medical Student Policies… Crossing The Line…When A Personal Health Concern Becomes An Institutional Matter

Moderator:
Brenda D. Lee, MEd
University of Rochester School of Medicine and Dentistry

Discussants:
David R. Lambert, MD
University of Rochester School of Medicine and Dentistry

Lynn Bickley MD
Texas Tech University Health Sciences Center

Description of Topic and Rationale: For more than 15 years the University of Rochester School of Medicine and Dentistry has had a formal policy to respond to actual and suspected cases of medical student impairment due to alcohol and/or other substance abuse. The policy addressed solely, impairment due to alcohol and/or other substance abuse when a student's academic performance was impacted by the suspected impairment.

Given the narrow focus of the original policy, when the institution encountered other categories of medical student impairment or suspected impairment when there were not related academic performance deficits, there was not a formal pathway to respond to the suspected impairment, to mandate evaluation or treatment.

Faced with new and emerging categories of impairment due to issues other than alcohol and substance abuse, the University of Rochester participated in a nearly two-year institutional planning and review process to revise the impaired medical student policy. In 2004, a comprehensive impaired medical student policy was implemented. Prominent features of the revised policy include a mandated intervention when there is evidence of or suspected impairment and the authority to mandate an intervention even when the suspected impairment has not had an adverse impact on the student's academic performance.

The enhanced policy has facilitated the University of Rochester's ability to assist students who are suspected of being impaired due to eating disorders.

Seattle Convention Center - Room 611

2:30 - 4:00p

GEA/GSA Group Discussion Session
Teaching Behavioral and Social Sciences to Medical Students

Moderator:
Susan E. Skochelak, MD, MPH
University of Wisconsin

Discussants:
Rita Charon, MD, PhD
Columbia University

Alan W. Cross, MD
University of North Carolina, Chapel Hill

Margaret Stuber
University of California, Los Angeles

Description of Topic and Rationale: In 2004, the Institute of Medicine released the report "Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula." Six topics of high priority were identified for inclusion in medical school curricula: mind-body interaction in health and disease, patient behavior, physician role and behavior, physician-patient interactions, social and cultural issues in health care, and health policy and economics.

Responding to this report, the National Institutes for Health issued a RFA to support curriculum development in these topics at medical schools. Nine medical schools have been working with the NIH Office of Behavioral and Social Science Research to collaboratively develop new educational programs in these important topic areas.

Seattle Convention Center - Room 307

2:30 - 4:00p

GEA/GSA Group Discussion Session
Developing a System for Assessing Medical Student Professionalism

Moderator:
Hugh Stoddard, MEd, PhD
University Nebraska College of Medicine

Discussant:
Gerald F. Moore, MD
University of Nebraska College of Medicine

Description of Topic and Rationale: The Guide to the Preparation of the MSPE published by AAMC (2002) requests that medical schools indicate "student's performance, relative to his/her peers, in the area of professional attributes". In response to this and other societal forces, medical schools are renovating their models for how medical student professionalism is defined and assessed. This small group session will focus on discussing the dilemmas involved in assessing professionalism and will report on the decisions and rationales employed by one medical school that has built a professionalism assessment system.

Seattle Convention Center - Room 617

2:30 - 4:00p

GEA/GSA Group Discussion Session
So You Are Thinking About Starting a Learning Community: The Nuts and Bolts from 3 Medical Schools Who Have Done It

Moderator:
Joel A. Gordon, MD
University of Iowa Roy J. and Lucille A Carver College of Medicine

Discussant:
David Wooldridge, MD
University of Missouri, Kansas City

Anne-Marie Amies Oelschiager, MD
University of Washington, Seattle

Description of Topic and Rationale: Learning Communities in Medical School governance and management of student affairs and curriculum is of increasing interest to the Medical Education community. For those medical schools thinking of instituting Learning Communities at their institutions, this small group discussion will facilitate the exchange of information from three medical schools who have gone about this in three very different ways.

Seattle Convention Center - Room 602

2:30 - 4:00p

GEA/GSA Group Discussion Session
Comprehensive Faculty Development Programs: A Concept Whose Time Finally Has Come

Moderator:
Henry Pohl, MD
Albany Medical College

Discussants:
Sharon K. Krackov, EdD
Albany Medical College

Boyd Richards, PhD
Baylor College of Medicine

LuAnn Wilkerson, EdD
University of California, Los Angeles, School of Medicine

Description of Topic and Rationale: Faculty play a key role in the educational mission of the medical school. Medical educators have long stressed the importance of helping faculty develop educational and professional skills. Until relatively recently, however, many faculty development activities were limited to orientation sessions or workshops directed to faculty who are undertaking new teaching initiatives. Over the past several years, the concept of faculty development has become more formalized and comprehensive, with new formats, venues, and institutionally supported programs (1-4). These programs support faculty who see their careers as educators.

During this session, we will explore three faculty development formats that are part of a comprehensive program.

Seattle Convention Center - Room 603

2:30 - 4:00p

GEA/GSA Group Discussion Session
Use of Mind-Body Skills to Decrease Anxiety and Increase Self-Awareness, Self-Care and Empathy In Medical Students

Moderator:
Frank Vincenzi, PhD
University of Washington School of Medicine

Discussants:
Aviad Haramati, PhD
Georgetown University School of Medicine

Gina Paul, PhD
Southern Illinois University

Description of Topic and Rationale: A recent systematic review documented the prevalence of psychological distress in students attending US and Canadian medical schools (Dyrbye et al., 2006). Further research into causes and consequences of medical student distress was suggested. More importantly, it was noted that exploration of potential solutions for student distress is likely to benefit not only the students but as well the patients for whom they will provide care. This Small Group Discussion will focus on approaches to solutions currently underway in three different medical schools (Georgetown University, Southern Illinois University and University of Washington) and potential mechanisms by which such approaches may work. Similar approaches are in various states of evolution in several other institutions and a sharing of ideas would be valuable.

There is increasing evidence of important interrelationships between the state of mind of human beings and the wellness of the body. This is true not only in patients, but in health care providers. As noted, many medical students become more anxious during school and display progressively lessdeclining healthy lifestyle choices during their training. One of the outcomes of the increased interest and focus on complementary and alternative medicine (CAM) in allopathic medical schools is the introduction of mind-body (M-B) skills as both an educational and research exercise. A number of academic medical centers have adopted the use and study of mind-body methods as a part of their CAM education initiatives. An expanding base of experience in medical education demonstrates measurable reductions in anxiety, including test anxiety, and stress, in people who practice such skills. Likewise, improved self-awareness, self-care and empathy have been measured in people who practice meditation, mindfulness-based stress reduction (Shapiro et al., 1998), deep breathing, etc. Increased empathy of physicians is an implicit, if not explicit long-term benefit of suchM-B practices among medical students. Evolving research on the mirror neuron systems of primate and human brains has provided a unifying framework for understanding phenomena such as mind-body awareness and empathy (Gallese et al., 2004).

The presenters in this small group discussion have largely adopted a mix of M-Bmind-body methods that includes biofeedback, meditation, genograms, guided imagery, breath control, body movement and music. Introduction of these M-Bmind-body skills has been used to promote stress management, self-awareness, self-care, and personal growth. The individuals to whom these approaches were introduced were usually medical students, health professions students, and faculty.An expanding base of experience in medical education demonstrates measurable reductions in anxiety, including test anxiety, and stress, in people who practice such skills. Likewise, improved self-awareness, self-care and empathy have been measured in people who practice meditation, mindfulness-based stress reduction, deep breathing, etc. Increased empathy of physicians is an implicit, if not explicit long-term benefit of such practices among medical students. Evolving research on the mirror neuron systems of primate and human brains has provided a unifying framework for understanding phenomena such as mind-body awareness and empathy. Thus, it is important for medical schools to consider this complex issue as an integral component of the medical school curriculum.

Seattle Convention Center - Room 606

GEA/GRA Group Discussion Session
Transitioning from Medical Student to Resident: The Role of Capstone Courses?

Moderator:
John B. Coombs, MD
University of Washington School of Medicine

Discussants:
James C. Norton, PhD
University of Kentucky College of Medicine

Hugh M. Foy, MD
University of Washington School of Medicine

Karen A. McDonough, MD
University of Washington School of Medicine

4:00 - 6:00p

GEA/GSA Group Discussion Session
Critical Building Blocks: A Comprehensive Approach for Changing the Culture of Professionalism in a Medical Center

Moderator:
Carol S. Hasbrouck, MA
Ohio State University College of Medicine

Discussants:
Paul Weber, MD
Ohio State University College of Medicine

Linda C. Stone, MD
Ohio State University College of Medicine

Jon Henry
Second Year Medical Student
Ohio State University College of Medicine

Description of Topic and Rationale: The topic of professionalism in medicine, although not new, is a topic of continuing interest. Many national and international initiatives have addressed the issue of professionalism from multiple perspectives, including the American Board of Internal Medicine's efforts in the 1980's to identify, define and assess "humanistic qualities" and their Project Professionalism in the early 1990's (ABIM, 1997); published articles and literature reviews regarding the assessment of professionalism (Arnold, 2002; Ginsburg, 2000); conferences, like the ACGME/ABMS Conference on Fostering Professionalism: Challenges and Opportunities (ACGME, 2003); presentations at national meetings; and ultimately national standards as set forth by such groups as the Association of American Medical Colleges (AAMC, 1998), the Accreditation Council for Graduate Medical Education (ACGME, 1999), the Liaison Committee for Medical Education (LCME), and the National Board of Medical Examiners (NBME, 2003).

Although much has been written about professionalism in medicine, many at an institutional level are still grappling with how best to operationalize professionalism in our medical environments and to truly establish cultures of professionalism and respect. As Michael Whitcomb wrote, "The goal is clear - to create within medical schools and teaching hospitals an institutional culture that places value on commendable professional behaviors and that is intolerant of behaviors that do not conform to established standards. The leadership of academic medicine's institutions should be held responsible for seeing that this occurs." (Whitcomb, 2002: 474) This session will focus on a discussion of critical components needed to implement a comprehensive, medical center approach to addressing professionalism. There are many stakeholders, approaches and aspects (e.g., assessment, education, standard setting, advocacy, and accountability) to be considered. What differentiates our medical center's initiative from many others is the comprehensive and collaborative nature of the effort, the inclusiveness of multiple stakeholders, the student-driven efforts preceding and now integrated with the institution's activities, and the staged implementation. The initiative is truly a 360 degree approach to developing a culture of professionalism and respect across the entire Medical Center and across the three mission areas: education, patient care and research. The initiative includes physicians, residents, nurses, faculty, staff, students, medical center leadership, quality assurance employees, as well as representation from business and law. Two key efforts mark the beginning of the professionalism initiative: the student-run Project Professionalism and the Dean's Professionalism Task Force.

Project Professionalism is a multi-faceted, student-driven program which started in 2001 which has grown tremendously since that time. The student program thus preceded the Dean's project and is now complementary to it. Students involved in Project Professionalism work on almost everything involving the medical school, including didactic sessions, community projects, collaborations with other organizations like the Gold Foundation, and other special projects. Most recently, Project Professionalism has worked with the College to re-energize and reinstate the former Honor and Professionalism Council, which is the judicial arm of the student effort and provides the opportunity for students to have their cases heard by their peers.

The Professionalism Task Force was appointed in May 2003 by the Dean of the College of Medicine at Ohio State University. To demonstrate the priority of this effort, the Dean named the Vice Dean for Medical Education to head the Task Force and named 28 individuals from the Colleges of Medicine, Business, and Law and the School of Nursing to the Task Force. The Task Force was charged with formalizing the vision for addressing professionalism in the medical center and was given one year to explore avenues that would lead to best practice models for professionalism. The Task Force was expected to define issues and threats across the three mission areas of teaching, research and service (as applied to all members of the medical center), to recommend solutions for enhancing the level of professionalism, and to work toward achieving a true culture of professionalism and respect in the medical center. The Task Force worked diligently to outline its mission, vision, and values, which are embodied in the following statements: "We aspire to create and foster a professional, compassionate and humanistic environment in which to prepare healthcare professionals and to create a culture of respect, service and excellence. To this end, we will teach, model, assess and expect these characteristics of professionalism in our teachers and students: altruism, responsibility and accountability, excellence, scholarship, knowledge, skills, duty, honor and integrity, leadership, respect for others and compassion." (Ohio State University COMPH Professionalism Task Force, 2003).

One of the major recommendations resulting from the Task Force was to establish a standing "Professionalism Council" with broad representation from all mission areas, specialty services, and stakeholders. Based upon this recommendation, a Professionalism Council was appointed in July 2004. The work of the Council is under the direction of the Professionalism Executive Committee and is composed of five standing committees: Education, Evaluation and Assessment; Business Ethics; Research Ethics; Clinical Practice; and Communications. The work of the Council focuses on professionalism through understanding and evaluating the environment in which we function, promoting educational and informational venues concerning the tenets of professionalism, and by valuing and promoting professional and compassionate behaviors. The Professionalism Council's action plan focuses on advocacy/accountability, collaboration, communication and building trust. In every corner of the medical center we are working to create the culture of respect which will only happen through collaboration and meaningful communication in all areas of our mission: patient care, education and research.

Seattle Convention Center - Room 307

4:00 - 6:00p

GEA/GSA Group Discussion Session
Curriculum Reform: Evolution or Intelligent Design?

Moderator:
Kathryn N. Huggett, PhD
Creighton University School of Medicine

Discussants:
Giulia Bonaminio, PhD
University of Kansas School of Medicine

William B. Jeffries, PhD
Creighton University School of Medicine

Susan J. Pasquale, PhD, MT-BC, NMT
University of Massachusetts Medical School

Description of Topic and Rationale: Engaging in the curricular reform process requires navigating three complex stages of the change continuum: planning, implementation, and evaluation/revision. Successful management of each stage is integral to the overall success of curricular reform. Nowhere is this more apparent than in the efforts medical schools have made to increase the integration of disciplinary content, basic science principles and clinical medicine (1-3). To date, a CurrMIT search indicates that 101 medical schools use some form of the word 'integrate' (e.g., integrated, integrative, integration) in the name of a course title, course session (e.g., lab, lecture) and/or course topic. Of those 101 medical schools, 62 have courses with the words "integrated," "integrative" or "integration" in the course title. Of the 62, thirty-seven course titles were for year 1 or 2 year courses. Some medical schools have already made significant investments of time and resources to undertake these reforms, while other schools are poised to begin the process. In addition, some medical schools who implemented curricular changes in the pre-clinical years are now re-focusing curricular reform efforts to improve education in the clinical years. The Institute for Improving Medical Education, in its recent report to the AAMC, expressed concern about the clinical years and scope of traditional clerkships (4). Their influential report will likely spur new proposals for curricular reform. Despite these widespread reform efforts, discussion of the process is often limited to a single institution, and there are few opportunities to learn whether lessons can be generalized to other settings. This small group discussion will 1) provide a multi-institutional perspective on curricular reform; 2) describe the three stages of curricular change; and 3) offer participants a forum to discuss the process of curricular change.

Seattle Convention Center - Room 617

4:00 - 6:00p

GEA/GSA Group Discussion Session
Electronic Portfolios (ePortfolios) in Medical Education

Moderator:
James B. McGee, MD
University of Pittsburgh School of Medicine

Discussants:
Brian W. Tobin, MA
Stanford University School of Medicine

Gustavo Duque, MD, PhD
McGill University

Jorge G. Ruiz, MD
University of Miami Miller School of Medicine

Description of Topic and Rationale: Educational and professional portfolios document students', trainees', or clinicians' evidence of education and practice achievements [1]; electronic portfolios or "ePortfolios" use web-based technology to facilitate and enhance the portfolio-keeping process. Medical educators have used portfolios at the undergraduate, graduate, and continuing medical education levels across various medical specialties [2-6]. Medical education experts advocate the use of portfolios at each level of training to aid in the evaluation and documentation of competencies set forth by accrediting agencies such as the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) [2, 6]. Portfolios can be tailored to an individual trainee's learning needs, while accommodating a diverse collection of evidence of practice and academic achievement. They foster self-directed learning, lifelong learning, critical thinking, and self reflection [2, 3, 7].

Electronic portfolios (ePortfolios) can circumvent some of the difficulties associated with maintaining hardcopy portfolios. Portfolios in written form are more difficult to update, store, search, access, and distribute. ePortfolios enable program administrators to electronically gather and keep track of all the portfolio components that need to be submitted by students, residents, supervising faculty, and other contributors, especially when these persons are geographically dispersed. Trainees can access their ePortfolio at any time, enabling them to document their clinical training in a timely fashion and allowing their physician mentors and colleagues to review their progress.

Most ePortfolios are based on Internet technologies that offer multiple useful features such as accessibility, easy updating, learner control, distribution, standardization, tracking, and monitoring. Moreover, ePortfolios can be designed to include learner assessments to determine whether learning has occurred. Since documentation of outcomes is a new ACGME mandate for residency programs and can also enhance reporting to the LCME, ePortfolios will likely grow in popularity.

Seattle Convention Center - Room 602

4:00 - 6:00p

GEA/GSA Group Discussion Session
Diversity: A Compelling Interest in Medical Education for GSA, MAS, and GEA Members

Moderator:
LuAnn Wilkerson, EdD
University of California, Los Angeles, School of Medicine

Discussants:
David Acosta, MD
University of Washington School of Medicine

Lawrence H. Doyle, EdD
Drew University of Medicine and Science

Ana E. Núñez, MD
Drexel University School of Medicine

Description of Topic and Rationale: In his 2005 address to the AAMC, Dr. Jordan Cohen argued that racial and ethnic diversity in medical education is indispensable in helping future physicians achieve the cultural competencies needed to treat an increasingly diverse society. Empirical studies, mostly at the undergraduate college level, show that student body diversity influences students' attitudes toward the benefits of a diverse society and is associated with increased skills in critical thinking. Several recent studies suggest these same benefits occur in medical education as well. Analysis of responses to the 2004 AAMC Graduation Questionnaire suggests that these same benefits apply in medical education. However, to achieve a diverse student body within the current legal atmosphere, we need to better collaborate across student and educational affairs activities. In this session we hope to engage members of the Group on Student Affairs, the Minority Affairs Section, and the Group on Educational Affairs in the discussion of best practices and evaluation strategies for outreach and pipeline activities, admissions, and cultural competency education.

Seattle Convention Center - Room 603

4:30 - 6:00p

GEA/GSA Group Discussion Session
MedEdPORTAL - Providing Online Resources To Advance Learning

Moderator:
Robby J. Reynolds, MPA
Association of American Medical Colleges

Discussants:
Chris Candler, MD
Association of American Medical Colleges

Marian Taliaferro, MSLS
Association of American Medical Colleges

Cynthia A. Woodard
Association of American Medical Colleges

Description of Topic and Rationale: The Association of American Medical Colleges (AAMC) has developed MedEdPORTAL (http://www.aamc.org/mededportal) to serve as a prestigious publishing venue through which faculty might disseminate their educational works. MedEdPORTAL publishes materials such as tutorials, cases (PBL, SP, OSCE, etc), lab manuals, assessment instruments, faculty development materials, web sites, computer-based materials, virtual patients, etc. Submitted products undergo a rigorous peer review process comparable to that used by established print-based journals. Reviewers assess each submission using accepted standards of educational scholarship.

Publishing within MedEdPORTAL has several benefits for faculty including recognition of peer-reviewed work that may be considered by promotion & tenure committees, useful feedback for enhancement or expansion of the resource, and expanding the audience of potential users.

This session will provide an overview of the MedEdPORTAL system, including examples of various types of materials and the submission and peer review process. Participants will gain an understanding of how educators may receive scholarly recognition publishing resources in MedEdPORTAL. Attendees will also learn how published resources are cataloged and indexed. In addition, participants will be encouraged to consider their own educational resources and identify potential items which may be suitable for submission to MedEdPORTAL.

Seattle Convention Center - Room 618

Wednesday, November 1

8:00 - 9:30a

GEA/GSA Group Discussion Session
MedEdPORTAL Scholarship

Moderator:
Chris Candler, MD
Association of American Medical Colleges

Discussants:
Jorge G. Ruiz, MD
University of Miami Miller School of Medicine

Description of Topic and Rationale: New forms of digital publishing have provided unprecedented opportunities for publication of scholarly works online. The Association of American Medical Colleges has developed MedEdPORTAL to serve as a prestigious publishing venue through which faculty might disseminate their educational works. MedEdPORTAL was designed to promote collaboration and educational scholarship by facilitating the exchange of peer reviewed educational materials, knowledge, and solutions. Publishing within MedEdPORTAL has several benefits for faculty including recognition of peer-reviewed work that may be considered by promotion & tenure committees, useful feedback for enhancement or expansion of the resource, and expanding the audience of potential users.

Seattle Convention Center - Room 305

8:00 - 9:30a

GEA/GSA Group Discussion Session
Thinking Outside the Box: Using Social Capital to Examine the Pursuit of Medical Education within the Three-Pronged Mission

Moderator:
Allison R. Ownby, PhD, MEd
University of Texas Medical School at Houston

Discussants:
Linda C. Perkowski, PhD
University of Minnesota Medical School

Fred Hafferty, PhD
University of Minnesota Medical School

Description of Topic and Rationale: Since World War II, many medical insiders have concluded medical education has become a by-product of the operation of academic health centers [AHCs] and that the greatest challenge to achieving learner-centered medical education involves altering the long-held attitudes, values, and priorities that subordinate teaching to research and patient care (Ludmerer 2004). Fincher et al. (2000) suggest a variety of mechanisms to evaluate scholarship in education and teaching in order to elevate education to the same level as research or other scholarly activities. They also discuss the infrastructure including organizational structure, human resources, political, and symbolic that must evolve to support educational scholarship.

We suggest that the concept of social capital may be useful for exploring the challenges facing medical education and AHCs in the pursuit of the three-pronged mission (education, research, and patient care). James Coleman defines social capital as "a variety of entities having two characteristics in common: They all consist of some aspect of a social structure, and they facilitate certain actions of individuals who are within the structure. Unlike other forms of capital, social capital inheres in the structure of relations between persons and among persons. It is lodged neither in individuals nor in physical implements of production" (Coleman 1990:302 as cited by Edwards and Foley 2001). Social capital is a productive force that facilitates social activity and that exists within the structure of relations between actors. There are several forms of social capital including obligations and expectations of behavior, the acquisition of information, and norms and sanctions for behavior (Coleman 1990). Social capital is created through repeated interactions where norms of trust and reciprocity are established among the individuals interacting within a particular social structure. The concept of social capital has been utilized by a wide variety of disciplines including criminology, epidemiology, international development, economics, sociology, and political science (Edwards and Foley 2001). Edwards and Foley also indicate that social capital has been used both as an independent variable to explain outcomes such as civic engagement, volunteerism, mortality rates, and organizational effectiveness, and as a dependent variable focusing on the types of organizations or relationships that produce it.

Trust is inherent within social capital and is often used as a proxy measure of social capital. Coleman (1990) suggests that social capital is created through repeated interactions where obligations and expectations of behavior are established, the acquisition of information is facilitated, and norms and sanctions for behavior are created.

Trust is crucial within social capital as individuals operating within a particular institution or group must trust that if they perform an action that that action will be reciprocated at some future time and that their behavior has not been in vain. The trust literature suggests that states and groups can signal fairness to citizens or group members and those institutional factors such as internal organization, goals, and strategies may impact the ability of a state or group to signal fairness and promote trust (Levi 1998, Tyler and Degoey 1996). Accordingly, it is possible to apply these constructs analogously to the medical education environment. Specifically, are departments, medical schools, and AHCs structured in such a way as to promote the development of social capital and trust? Furthermore, can the construct of social capital help us understand the dynamics of pursuing a three-pronged mission when one part of that mission, education, may not necessarily be related to generating revenue or individual achievement? Essentially, medical education can be viewed as a type of collective action where rational, self-interested individuals will not choose to participate in collective action situations unless benefits outweigh costs. Medical schools have implemented relative value units, mission-based budgeting, and other initiatives to alleviate the burden facing clinical educators. Yet, as Ludmerer (2004) suggests, the greatest challenge facing medical education is the long-held subordination of teaching and educational activities to patient care and research.

The goal of this small group discussion is to explore whether social capital and the associated literatures on trust can inform our understanding of the challenges facing medical education and the pursuit of the three-pronged mission by medical schools and AHCs. We propose looking to the social sciences and the concept of social capital for strategies that will help inform current discussions surrounding the future of medical education. This topic is especially timely as medical schools and AHCs face the challenges associated with the pursuit of the three-pronged mission and should be of interest to medical educators and administrators alike.

Seattle Convention Center - Room 307

8:00 - 9:30a

GEA/GSA Group Discussion Session
Climbing the Ladder: Strategies to Help Medical Educators Advance in Academe

Moderator:
Carol Elam, EdD
University of Kentucky College of Medicine

Discussants:
Jo Ann Wood, MD
University of Louisville School of Medicine

C. William Balke, MD
University of Kentucky College of Medicine

Amy V. Blue, Ph D
Medical University of South Carolina

Description of Topic and Rationale: Faculty and staff at academic medical centers have a challenging set of job requirements that require competence in multiple areas related to the teaching, research, clinical, and administrative functions of their institutions. Using review of case studies to generate interaction, this small group discussion is designed to address career development issues such as productivity, time management, collaboration, negotiation, and stress, and will incorporate lessons learned from discussants in junior and senior level positions at their institutions.

Seattle Convention Center - Room 210

8:00 - 9:30a

GEA/GSA Group Discussion Session
Predictors and Implications of Medical Student who 'Extend'

Moderator:
Anne R. Nedrow, MD
Oregon Health & Science University

Discussants:
Molly L. Osborne, MD, PhD
Oregon Health & Science University

W. Scott Schroth, MD, MPH
Oregon Health & Science University

Anita Taylor, MA, EdD
Oregon Health & Science University

Description of Topic and Rationale: Medical educators have long appreciated that a small percentage of each medical school class does not graduate at the expected time. This small group of medical students, who take a 'leave of absence' during their medical education, is commonly referred to as 'extenders'. This delay in graduation can be a result of a wide range of circumstances, from family reasons (including pregnancy) to international experiences, academic difficulties, or health, emotional or legal reasons.

It is now recognized that this previously small percentage has increased over the past decade to include 15-20 percent of many medical school students. Little to none is known about predictions or implications of extension of medical school education.

To stimulate discussion, this small group discussion will share recent national data gathered at George Washington University on the increasing trend in medical student 'leave of absences', including the when and why 'leaves' occur (THE MACRO). This data reports on the total number of students now taking a 'leave of absence' during their medical education, gender differences and purposes and timing of these 'leaves of absences'. Tables 1-3 illustrate examples of this information.

Seattle Convention Center - Room 214

8:00 - 9:30a

GEA/GSA Group Discussion Session
Teaching Medical Students to Document Patient Encounters Using Electronic Health Records - When, How, Why, and Pitfalls to Avoid.

Moderator:
Paul J. Hemmer, MD, MPH
Uniformed Services University of the Health Sciences

Discussants:
Regina Kovach, MD
Southern Illinois University School of Medicine

Suma Pokala, MD
Texas A&M Health Sciences Center

David A. Resch, MD
Southern Illinois University School of Medicine

Description of Topic and Rationale: The advent of the electronic health record (EHR) has created new opportunities, challenges, and ethical dilemmas for medical students, and those who teach them clinical skills. Electronic templates -- either with free text entry or symptom driven documents with preformatted pick lists and automatic prompts -- allow for documenting Histories and Physical examinations, as well as daily notes, in a way that can improve efficiency and achieve consistency across multiple clinical sites. Although the EHR improves the legibility and availability of documents, there is concern that template use by students may inhibit problem solving, discourage directed inquiry, and lead to inattention to detail, inadequate updating of notes, and documentation of portions of the physical examination that are not accurate (e.g., documentation of gender specific portions of an exam in an opposite gender patient). EHRs will continue to proliferate and we must decide when and how to teach medical students to effectively document using an EHR.

This small group discussion is intended to generate discussion that not only addresses concerns about using electronic health records and templates, but seeks solutions, and ways to come to agreement on basic goals and expectations for students. We are seeking examples of best practices and are interested in possible research questions that might arise.

Seattle Convention Center - Room 304

10:00 - 11:30a

GEA/GSA Group Discussion Session
Using the TACCT to Effect Curriculum Change

Moderator:
C