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Monday, November 3

3:00 - 4:30p

GEA/GFA Small Group Discussion
How Can We Help Faculty Succeed as Educators and Recap the Reward of Academic Promotion?

Moderator:
Nancy Searle, Ed.D.
Faculty Development Program Director
Baylor College of Medicine

Discussants:
Larry D. Gruppen, Ph.D.
Josiah Macy, Jr. Professor of Medical Education
Director, Office of Medical Education Research
Director, Medical Education Scholars Program
Chair, Department of Medical Education
University of Michigan Medical School

Deborah "Deb" Simpson, Ph.D.
Associate Dean, Educational Support and Evaluation
Director, Office of Educational Services
Co-Chair, Society of Teaching Scholars
Medical College of Wisconsin

Thomas R. Viggiano, M.D., M.Ed.
Associate Dean, Faculty Affairs
Mayo Medical School
Professor of Medicine
Mayo Clinic College of Medicine

Description of Topic and Rationale: The word "doctor" is derived from the Latin word "doctor" which means "to teach." Since the beginnings of civilization there have been people whose job it was to take care of the sick. In so doing, they instructed the sick person, their caretakers, and others learning the "doctoring" trade. From these early days until now, all physicians are teachers, but those involved in academic medicine spend much more time teaching than those in other types of medical practice.

Until the latter part of the 20th Century, academic physicians were researchers, clinicians, and teachers. Many physicians chose academic medicine because of the opportunity to spend time in at least two if not three of these activities. By the mid 1980s, research dominance in some medical schools as well as dependence on clinical revenue for operating budgets changed the academic environment. Many academic physicians began to "specialize" in research, patient care, and/or teaching while the gold standards for promotion were still defined by numbers of peer reviewed research papers published and grants received.

Although some degree of teaching was expected as part of academic citizenship, it certainly did not count as scholarship, and it counted little if any towards promotion and tenure. In response, physicians began to teach less and instead engaged in the revenue generating activities of clinical care and grant chasing sometimes at the direction of their department chairs. There were no "rewards" for teaching and sometimes there were even financial disincentives for teaching.

In 1990, Boyer's Scholarship Reconsidered: Priorities of the Professorate, sponsored by the Carnegie Foundation for the Advancement of Teaching, suggested that the academic world of medicine should examine teaching as a scholarly work rather than minimizing it because everyone is "expected to teach" and everyone can "see one, do one, teach one." Teaching awards and academies, sometimes with tangible benefits like money or time, were also established to recognize outstanding educational effort.

By 2000 Glassick added to the discussion of educational activities as scholarship by stating the requirements for any type of scholarship: (1) clear, realistic goals, (2) adequate preparation, (3) appropriate methods, (4) meaningful results, (5) effective presentation of results, and (6) reflective critique. Whitcomb added that medical schools should be "cognizant that faculty appointment, promotion, and tenure policies must reflect the changing roles and responsibilities of medical school faculty" through greater recognition of education.

In response to the teaching dilemma mentioned above, some medical schools provided faculty development opportunities for their faculty members in the form of teaching skills development workshops and educational fellowships with the hope of improving teaching and fostering educational scholarship.

Some schools' promotion and tenure committees have embraced new ideas concerning the advancement of educators through the recognition of education as a viable career track, the use of educator portfolios for promotion, the expectations of accrediting bodies, and the expansion of teaching fellowships and academies. Many other medical schools' promotion and tenure committees have not advanced past "teaching has little value towards promotion. It is either publish or perish."

Here lies the problem: How can we help medical faculty succeed as educators and reap the reward of academic promotion?

The purpose of this small group discussion is to bring together people who are involved in faculty development, faculty affairs, promotion and tenure committees, medical education, mentoring, leading departments, and peer evaluation, to learn from those who have had and from those who have not had success in what works and what does not work in reaping the reward of academic promotion for their education faculty.

210 B

3:00 - 4:30p

GEA/GSA Small Group Discussion
Sustaining and Improving Your Career Advising Program: Maximizing Outcomes with Minimal Resources

Moderator:
Hilit F. Mechaber, M.D., F.A.C.P.
Assistant Dean for Student Services
Director, Office of Professional Development and Career Guidance
University of Miami Miller School of Medicine

Discussants:
Dorothy Andriole M.D., F.A.C.S.
Assistant Dean for Medical Education
Washington University School of Medicine

Robert Hernandez, M.D.
Senior Associate Dean for Medical Student Administration
University of Miami Miller School of Medicine

Shalini T. Reddy, M.D., F.A.C.P.
Assistant Dean Of Student Programs
University Of Chicago Prtizker School of Medicine

Description of Topic and Rationale: Career advising has become an integral part of medical student programming, and an essential function of many offices of student affairs and student services at all medical schools. Given the changing demographics of medical students, as well as the notable predictions for the future physician workforce, we must continue to support students in their quest to select the specialty and career path beyond medical school graduation which optimally "fits" their aspirations and professional goals. Career advising has grown in past years to encompass much more than a few meetings with an advising dean and student. Many schools have created robust programs that begin early in the first year, and extend longitudinally throughout all four years. Schools across the country are also adapting, for their institutional use and to varying degrees, elements of the AAMC Careers in Medicine program.

While each school may approach career advising in some unique way, there are themes and issues that are pertinent to all. Lack of fiscal support for programming, faculty development, or for faculty effort in a role of advisor or mentor, has plagued many institutions' attempts to improve their programs. Some institutions have resorted to using innovative approaches to overcome this often under supported endeavor. In this discussion group, discussants will share examples of institutional successes with career advising programs and practical approaches to overcoming obstacles in meeting their students' needs. Participants will gain an appreciation for ways in which medical school deans of students and administrators can enhance their career advising curricula within their current frameworks of institutional resource and support.

Discussants will elaborate on models that have included:

1. A variety of advisor: peer-to-peer student advising, student interest groups, alumni advisors, community faculty, institutional faculty invested in the process
2. Web-based resources
3. Student and faculty development programs

209

3:00 - 4:30p

GEA/GSA Small Group Discussion
Stakeholder Perspectives about the Step 2 Clinical Skills Examination: What Now? What Next?

Moderator:
Ann Jobe, M.D., M.S.N.
Executive Director, Clinical Skills Evaluation Collaboration (CSEC)
Educational Commission for Foreign Medical Graduates
National Board of Medical Examiners

Discussants:
Brian Hurley, M.D., M.B.A.
President
American Medical Student Association

Peter Nalin, M.D.
Associate Dean for Graduate Medical Education
Indiana University School of Medicine

Thomas Rebbecchi, M.D.
Medical Director, Clinical Skills Evaluation Collaboration (CSEC)
Educational Commission for Foreign Medical Graduates
National Board of Medical Examiners

Description of Topic and Rationale: The step 2CS Examination has been in existence for over four years. This examination is one in a series of four examinations that are required for a physician to obtain a license to practice medicine in the US. This examination is considered a "minimal standards exam" and is meant to assess readiness for graduate education training. The addition of this exam has forced changes in clinical education in many institutes across the country. While all US medical school had clinical teaching as part of the core curriculum, the post Step 2CS environment has encouraged a more standardized manner in which this clinical education is taught. In fact, many US medical schools have created Clinical Skills teaching centers utilizing standardized patients and other forms of health/disease simulators.

Now, four years later, the Step 2CS exam is evaluating more than 34,000 examinees per year. There has been a generalized acceptance in the medical community that assessing clinical skills is important. Prior to this examination, there was no standardized method to assess what was being taught in clinical education. The Step 2CS examination fulfills that standardized evaluation which was often lacking in teaching institutions.

After all of these standardized assessments, many wonder if what the examination is assessing needs new scrutiny. The panel will give their insights into this question. This is a discussion that will move beyond whether or not the Step 2CS exam should be part of the licensing series and expense issues.

211

3:00 - 4:30p

GEA/GSA Small Group Discussion
Transforming the Medical Education Learning Environment

Moderator:
Barbara Barzansky, Ph.D.
Secretary, Liaison Committee on Medical Education
American Medical Association

Discussants:
Louise M. Arnold, Ph.D.
Associate Dean, Medical Education
University of Missouri Kansas City School of Medicine

Kelly Caverzagie, M.D.
Evaluation Research Specialist, Internal Medicine Residency Program
Henry Ford Hospital, Detroit, Michigan

Carl A. Sirio, M.D.
Professor of Critical Care Medicine
University of Pittsburgh School of Medicine

Description of Topic and Rationale: The goal of this session is to engage participants to reflect upon, refine, and further expand upon a set of recommendations that were a product of an ITME working conference on transformation of the medical education learning environment. The aim of that multi-disciplinary working conference was to develop recommendations for further research and action, including implementation strategies that would promote a learning environment that contributes to the acquisition of appropriate professional attitudes, values, and behaviors in medical students and residents. The ITME working conference was held in December 2007 and the participants included approximately 40 medical education researchers, faculty and administrators from medical schools and residency programs, representatives from medical education accrediting bodies, medical students, and residents.

A core goal of medical education is to promote learners' acquisition of professional attitudes, values, and behaviors. It is clear that medical students and residents gain in knowledge and skills as they proceed through training. However, there is evidence that the period of training may have negative effects on certain professionally-relevant attitudes and values, resulting, for example, in declining empathy and increasing cynicism.

This undesirable outcome may be related to the direct and indirect effects of various factors that together shape the learning environment in which trainees function. These factors include the hidden/informal curriculum (for example, the explicit or implicit attitudes and values displayed by supervisors and peers); the organizational values manifest in policies related to students, faculty, and patients; and the societal values inherent in such things as payment and reimbursement policies and professional standards. While the effects of some, but not all, of these factors on learner outcomes have been studied, research has often focused narrowly on a specific factor.

There is a need to understand in a more holistic way how to shape the learning environment in order to ensure that it has positive, rather than negative, effects on learner outcomes.

212 A

3:00 - 4:30p

GEA/GSA Small Group Discussion
Approaches to Achieving Culture Change in Academic Medical Institutions

Moderator:
Linda Pololi, M.B.B.S., M.R.C.P.
Principal Investigator
The National Initiative on Gender, Culture and Leadership in Medicine
Senior Scientist and Resident Scholar
Brandeis University

Discussants:
Thomas Inui, Sc.M., M.D.
President and CEO, Regenstrief Institute, Inc.
Principal Investigator
The Relationship-Centered Care Initiative
Associate Dean for Health Care Research
Indiana University School of Medicine

David E. Kern, M.D., M.P.H.
Director, Division of General Internal Medicine
Professor of Medicine
Johns Hopkins University School of Medicine

Description of Topic and Rationale: Adverse aspects of the dominant culture of academic medicine and academic medical centers have been linked to lack of diversity, including women and under-represented minority faculty in leadership, waning professionalism, and overemphasis on competition and individual accomplishment hampering the success of multidisciplinary and collaborative work. This discussion group will focus on culture change within medical school organizations, address why important issues facing academic medicine relate to culture, and discuss approaches to culture change.

Two U.S. initiatives focused on culture change in medical schools will be integrated into the discussion. The National Initiative on Gender, Culture, and Leadership in Medicine: C - Change is an action-research partnership of five U.S. medical schools (Duke; George Washington; Tufts; University of Minnesota, and University of New Mexico). The Relationship-Centered Care Initiative, is a longer-standing culture change initiative that has been in operation at Indiana University School of Medicine since 2002. During the session, an overview of the strategies, processes of research, interventions, and outcomes will be presented and discussed in an interactive fashion.

212 B

3:00 - 4:30p

GEA/GSA Small Group Discussion
IQ+: Integrating Medical Sciences and Patient Care in a Core Clerkship Curriculum

Moderator:
Daniel Wolpaw, M.D.
Chair, Clinical Curriculum Council
Case Western Reserve University School of Medicine

Discussants:
James P. Bruzik, Ph.D.
Associate Professor
Case Western Reserve University School of Medicine

Amy Wilson-Delfosse, Ph.D.
Chair, Basic Science Curriculum Council
Case Western Reserve University School of Medicine

Peter Scoles, M.D.
Vice President, Assessment Programs
National Board of Medical Examiners

Terry Wolpaw, M.D., M.H.P.E.
Associate Dean for Curricular Affairs
Case Western Reserve University School of Medicine

Description of Topic and Rationale: While the promotion of clinical experiences in the first years of medical school has continued to progress since the introduction of the "Family Clinic" at Case Western Reserve University School of Medicine in 1953, the meaningful integration of sciences basic to medicine into the clinical (clerkship) curriculum has remained a difficult challenge. Traditionally, months of classroom and weeks of intensive review culminate for students in the USMLE Step1 exam, after which they walk or run off to clerkships without a look back. This landscape is beginning to change. Some schools are choosing to delay Step 1 until after clinical rotations, and the National Board of Medical Examiners (NBME) is considering a change in the USMLE exam format to reconfigure Steps 1 and 2 as a flexible "gateway" exam. These trends have the potential to create real incentive for ongoing attention to science and underlying path o-physiology during the Clerkships - but how to actually accomplish this goal remains problematic. The challenges include: 1) making basic science relevant for students focusing on learning and excelling on their Clerkships, 2) creating a learner-centered environment that is consistent with and supportive of professional growth in clinical settings, 3) maintaining, solidifying, and advancing student learning in sciences basic to medicine in such a way that it will help to prepare them for board exams, and 4) aligning assessment in this undertaking with Clerkships to maintain consistent incentives for performance.

As part of the new learner-centered Western Reserve2 (WR2) curriculum at CWRU, a group of faculty and students worked over 3 months in 2007 to design and implement a weekly case-based program during core clerkships that features interactive, self-directed learning in a small-group format building on the problem-based Case Inquiry (IQ) groups that these students have used since entering the WR2 curriculum. The four hour sessions are designed to be entirely self-contained with integrated time for reflection, clinical problem solving, research, expert consultation and didactics, and related simulation exercises. Facilitation by faculty and senior students provides guidance, perspective, and an assessment component to the sessions.

213 A

3:00 - 4:30p

GEA/GSA Small Group Discussion
Basic Public Health Training in Population-Based Preventive Approaches: Where Are We Now?

Moderator:
Jay Glasser, Ph.D., M.S.
Professor of Biostatistics
The University of Texas School of Public Health at Houston

Discussants:
Anne Gill, Dr.PH., M.S.
Assistant Professor
Baylor College of Medicine

Allison Ownby, Ph.D.
Director of Educational Programs
The University of Texas Medical School at Houston

Elisabeth Wilson, M.D., M.P.H.
Assistant Clinical Professor
The University of California San Francisco

Description of Topic and Rationale: The 2007 AAMC Graduation Questionnaire indicates that nationally, 35% of students report inadequate instruction in public health and 25% report inadequate instruction in population health training. Historically, medicine and public health have been overlapping areas of interest dedicated to the improved health and well-being of humankind. The last ten years has witnessed a renewed interest in increased collaboration and exposure among trainees. This collaboration has resulted in new medicine and public health educational initiatives such as: 1) The AAMC and CDC cooperative agreement to create 11 Regional Medicine-Public Health Education Centers (RMPHEC); 2) The 2003 Institute of Medicine (IOM) recommendation that "All medical students receive basic public health training in population-based preventive approaches to health;" and 3) The AAMC sponsored, "Clinical Prevention and Population Health Curriculum Framework" which includes Evidence base of practice, Clinical Preventive Services-Health Promotion, Health Systems and Health Policy, and Community Aspects of Practice.

Not only have authoritative bodies such as the AAMC and IOM endorsed increased public health curriculum in medical education, but a clear need is recognized by students as evidenced by their responses on the AAMC Graduation Questionnaire. Therefore, medical educators must determine not only what constitutes "basic public health training" but also determine how, when, and where prevention and population curriculum should be taught and evaluated. Using a diffusion model as a conceptual framework, this small group discussion offers an opportunity to create a "virtual community" of like-minded educators to network and share innovative educational initiatives for training learners in population health.

213 B

Tuesday, November 4

1:00 - 2:30p

GEA/GSA Small Group Discussion
Implications of the New ACCME Criteria for CME and Clinical Practice in the Academic Medical Center: Blending Quality, Patient Care, and Education

Moderator:
George Mejicano, M.D., M.S.
Associate Dean for Continuing Professional Development
University of Wisconsin School of Medicine and Public Health

Discussants:
Mark Albanese, Ph.D.
Professor
University of Wisconsin School of Medicine and Public Health

Dave Davis, M.D.
Senior Director, Continuing Education and Improvement
Association of American Medical Colleges
Adjunct Professor of Medicine
University of Toronto

Valerie Parisi, M.D., M.P.H., M.B.A.
Vice Dean, Hospital Relations and Clinical Affairs
Senior Advisor to Chairman/CEO of the University Physician Group
Wayne State University School of Medicine

Description of Topic and Rationale: In 2008, the Accreditation Council for Continuing Medical Education (ACCME) will start to utilize new criteria to determine the accreditation status of CME providers. The new criteria have significant implications for the design, delivery, and evaluation of individual CME activities (as well as entire CME programs) because they strongly embrace the notion that the purpose of CME is to improve physician competence, physician performance, or patient outcomes. As a result, CME providers will now be expected to measure the impact of educational interventions in terms of competence, performance, or patient outcomes. Simultaneously, health care systems, including academic medical centers and teaching hospitals, constantly strive to demonstrate and improve quality of care measures.

CME units associated with academic medical centers will need to change their operations as a result of these new criteria. For example, staff will need to learn about performance measures and ACGME competencies. Connections will need to be forged between CME offices and the quality improvement initiatives of faculty practice plans and teaching hospitals. CME personnel will need to add to their role as meeting planner by taking on the role of educational consultant. Instructors will likely need to undergo faculty development related to educational methods that are more likely to change the behavior of physician learners. Evaluation and needs assessment methods will move from "happiness" scores and towards data registries linked to dashboards used for Maintenance of Certification, Pay for Performance, and Joint Commission surveys. This session will explore these and other issues in an effort to help CME units within medical schools prepare for the challenges just around the bend.

Dr. Mejicano, will provide an opening 15 minute presentation on the ACCME Updated Criteria and Implications for a CME Unit and the academic medical center. Three five minute presentations will follow, broken by short periods of interactive discussion. Dr. Albanese will present the implications of the updated criteria for the continuum of education (UME, GME, CME) focusing on quality improvement expectations. Dr. Parisi, will then discuss the clinical quest for quality and its ties to funding, education and mission. Dr. Davis will discuss the topic of CME as a strategic asset of academic medical centers in improving quality of care.

006 D

1:00 - 2:30p

GEA/GSA Small Group Discussion
Interdisciplinary Education Using Simulation: How Can it be Cultivated?

Moderator:
Carol Hasbrouck, M.S.
Assistant Dean
Director for Clinical Skills and Medical Education
Ohio State University College of Medicine

Discussants:
Daniel Clinchot, M.D.
Associate Dean for Medical Education
Ohio State University College of Medicine

Sherri Harkless, B.S.N., R.N.-B.C.
Nursing Staff Development Coordinator
Ohio State University College of Medicine

Daniel J. Scherzer, M.D.
Clinical Assistant Professor
Medical Director, Patient Safety and Simulation Center
Nationwide Children's Hospital, Columbus, Ohio

Description of Topic and Rationale: Two growing topics of interest in medical education are simulation and interdisciplinary education. These issues are of interest at all levels of medical training, as well as in nursing and other health professions. There is growing awareness of the need for simulation to enhance skills acquisition that will hopefully impact patient outcomes. Numerous annual interdisciplinary conferences (e.g., International Meeting on Simulation in Healthcare, Northwestern's Simulation Technology in Medical Education, and METI's HPSN) are held to foster the use of simulation and attract attendees from a broad range of professions and specialties. The Agency for Healthcare Research and Quality (AHRQ) commissioned a report on medical teamwork and patient safety which reviews the literature and addresses the history and evolution of teamwork in medicine and other fields and AHRQ has been a catalyst for funding patient safety projects. Although team training is not a novel concept in many fields, medicine has lacked an interdisciplinary focus. Interdisciplinary team training is an area in which surgical and medical specialties, as well as nursing and allied health professions, could take an active role.

007 A

1:00 - 2:30p

GEA/GSA Small Group Discussion
Reflection in Learning: Can We Know It When We See It?

Moderator:
Britta M. Thompson, Ph.D., M.S.
Director, Evaluation and Assessment
Assistant Professor
Baylor College of Medicine

Discussants:
Michael J. Devlin, M.D.
Associate Professor of Clinical Psychiatry
Clinical Co-Director, Eating Disorders Research Unit
Columbia University College of Physicians and Surgeons

Paul Haidet, M.D., M.P.H.
Associate Professor of Medicine
Baylor College of Medicine

Andrew Mutnick, M.D.
Assistant Clinical Professor
Director, Medical Student Education in Pediatrics
Columbia University College of Physicians and Surgeons

Description and Rationale: Within medical education, there is continued emphasis to promote reflection. Reflection has been purported to improve attitudes and abilities in areas such as professionalism, cultural competence, and self-directed learning. Although many conceptual models exist that emphasize the why, when, and what of reflection, these models are limited in terms of how to promote learner reflection within educational activities, especially in medical education. This session acknowledges this deficit and provides a forum for beginning to address 'best practices' and for building a conceptual understanding of how to create educational activities that promote reflection.

Our two groups have been working to develop a conceptual understanding of the inner processes and elements of reflection in an effort to assess the quality of students' reflections, the success of interventions intended to create reflection, and to study the outcomes of student reflection. The Baylor group has been formally analyzing qualitative focus group transcripts of students' discussions about occurrences of self-reflection in classroom and clinical settings in order to understand the important elements of educational activities that foster self-reflection. Based on a model of reflective practice originally developed for teacher training, the Columbia group is working toward developing a reliable and valid instrument to assess reflective essays along several independent dimensions and to guide feedback to promote growth of reflective skill. We will draw upon the experiences of these groups to deepen the discussion during this session.

007 B

1:00 - 2:30p

GEA/GSA Small Group Discussion
Medical Education Outcomes: Utilizing Specialty Board Certification Data

Moderator:
Dorothy A. Andriole, M.D.
Assistant Dean for Medical Education
Associate Professor of Surgery
Washington University School of Medicine in St. Louis

Discussants:
Heather L. Hageman, M.B.A.
Director of Educational Planning and Program Assessment
Washington University School of Medicine in St. Louis

Sheldon D. Horowitz, M.D.
Special Advisor to the President
American Board of Medical Specialties

J. Jon Veloski, M.S.
Director, Medical Education Research
Thomas Jefferson Medical College

Description of Topic and Rationale: A program of outcomes assessment, required for accreditation by the Liaison Committee on Medical Education, provides information to the medical school faculty and administration regarding curricular strengths and weaknesses as well as students' achievements during and after medical school. National Board of Medical Examiners (NBME) United States Medical Licensing Examination (USMLE) performance, medical-licensure status, program-director surveys and periodic surveys of graduates themselves can all provide relevant outcomes data for medical schools to track their graduates' progress.

Achievement of American Board of Medical Specialties (ABMS) - member board certification, as a long-term outcome of the medical education process, is an additional measure of growing importance: specialty-board certification by one of the ABMS member boards is emerging as an evidence-based measure in the Quality-of-Care movement and is increasingly used by health maintenance organizations, hospitals, and health-insurance plans in evaluating physicians who wish to obtain privileges or join provider organizations. Achievement of ABMS-member board certification is also a relevant outcome measure of the graduate medical education (GME) process itself, as trainee performance on ABMS-member board qualifying and certifying examinations are among the data considered by specialty-specific Residency Review Committees in assessing residency training programs seeking accreditation by the Accreditation Council of Graduate Medical Education (ACGME). Finally, analysis of ABMS-member board certification data, among other outcomes measures, may inform applicant-selection efforts of both medical-school admissions committees and residency-training program directors as they seek to identify and select candidates whose career paths will most likely be well-aligned with programmatic educational missions and goals of undergraduate and graduate medical education.

There are many approaches that can be taken to the acquisition, utilization and dissemination of board certification data. Approaches can vary considerably among medical schools and GME programs, reflecting differences in program-specific missions and educational cultures. The small-group discussion format will provide an optimal forum for a discussion of different approaches to utilization of ABMS data which can be adopted by a range of medical education programs. While there may be no single template for acquisition or utilization of ABMS data that will optimally "fit" every institution, there are common issues and logistical challenges faced by all medical education programs in acquiring and utilizing these data. The discussion format will foster an exchange of ideas about different approaches to these issues and challenges among participants from a wide range of educational settings.

This discussion topic is particularly timely in the current medical education environment as many undergraduate and GME programs are implementing systematic approaches to outcomes assessment, with an emphasis on measurable benchmarks of achievement by their program graduates. At the same time, issues of data ownership and the potentially sensitive nature of these types of information mandate a deliberate, thoughtful approach to acquisition and utilization of board-certification data in educational outcomes assessment.

007 C

1:00 - 2:30p

GEA/GSA Small Group Discussion
Creating a Multi-Institutional Research Collaborative in Medical Education:
ISTEP (Innovative Strategies for Transforming the Education of Physicians)

Moderator:
Audiey C. Kao, M.D., Ph.D.
Vice President, Ethics Standards Group
American Medical Association

Discussants:
Larry D. Gruppen, Ph.D.
Josiah Macy, Jr. Professor of Medical Education
Director, Office of Medical Education Research
Director, Medical Education Scholars Program
Chair, Department of Medical Education
University of Michigan Medical School

Paul N. Lanken, M.D.
Associate Dean for Professionalism and Humanism
University of Pennsylvania School of Medicine

Win May, M.D., Ph.D.
Associate Professor of Clinical Medicine
Director, Standardized Patient Program
University of Southern California Keck School of Medicine

Description of Topic and Rationale: This proposed topic will examine ISTEP, a new multi-institutional research initiative in medical education that has evolved as collaboration between the American Medical Association (AMA) and a group of 27 medical schools. We will focus our discussion on the potential strengths and challenges of engaging in multi-institutional curriculum development and medical education research projects. We will also discuss several ongoing research projects that utilize ISTEP's unique resources, including a new prospective, longitudinal cohort study of physician-learners and the learning environment in medicine.

Often overlooked amidst the call for increased translational research in medicine is an understanding of how physicians acquire and maintain the knowledge, skills, and judgment they need to deliver good "bench to bedside" patient care. At present, it takes nearly 17 years for newly published clinical research findings to be widely adopted in medical practice. A multitude of editorial commentaries, journal articles, and blue ribbon reports published over the past decade have argued that substantial changes must be made in the way physicians are educated if we hope to guarantee "the best of science and the best of caring" for future patients. But first, we need to know - quite simply - what works in medical education and what does not. A concerted, organized effort by a large national collaborative, such as ISTEP, to advance outcomes-based medical education research will be critical to establishing a solid evidence base in medical education.

This discussion will be valuable on a practical level to those looking to engage in collaborative, multi-institutional projects in curriculum development and medical education research. This presentation and the subsequent discussion will also provide attendees with a practical grounding in the experiences and decisions critical to both the creation and continuing activities of ISTEP. We will share with attendees ISTEP's plans for launching a major new effort in medical education research - a large, prospective, longitudinal cohort of physician learners. One of the key goals of the cohort study will be to characterize and quantify the educational experiences of physicians as well as the learning environment in medicine. This discussion should therefore also appeal to those who are interested in sharing their own ideas about how such a cohort study might be designed to capture the education and professional development of physicians and, in a general sense, how a large multi-institutional collaboration like ISTEP could be used to advance the field of medical education research.

007 D

1:00 - 2:30p

GEA/GSA Small Group Discussion
The Promotions Committee Challenge:
Making Decisions and Creating Remediation Plans that Fit the Deficits

Moderator:
Laurie Brown, M.A.
Director, Student Affairs
Mount Sinai School of Medicine

Discussants:
Angela Nuzzarello, M.D.
Associate Dean, Student Programs and Career Development
Northwestern University Feinberg School of Medicine

Suzanne "Suzi" Rose, M.D, M.S.Ed.
Associate Dean, Academic and Student Affairs
Mount Sinai School of Medicine

W. Scott Schroth, M.D., M.P.H.
Senior Associate Dean for Academic Affairs
The George Washington University School of Medicine

Description of Topic and Rationale: In recent years, there has been an explosion in the literature of articles on all aspects of professionalism in medicine and professionalism as a competency. Lawrence Smith, MD in his "Generations" keynote at the national GSA meeting in the spring of 2006 discussed this phenomenon, noting that in the 1980's there were less than 40 articles per year on the general topic of professionalism; in 2000, there were approximately 100 articles on this topic and then in 2003, there were around 170 articles on this topic. In 2003 at the AAMC annual meeting, there were 15 sessions dedicated to professionalism in medicine. The following year, there were 35 sessions on that same topic.

In response, many schools now employ incident reports, physician-ship, or other forms to assess professional behaviors. With systems in place to collect the data on unprofessional behaviors, we have entered the next phase of the process: what do we do when students have multiple or egregious incidents of unprofessional behavior? Recently, at both MSSM and GW there has been a concerning increases in cases of unprofessional behavior and dismissals related to such behavior. This increase presents challenges to school promotions committees. At FSOM the trend is not quite the same. In addition, establishing appropriate remediation plans for such students requires new and complex collaborations between educational and student affairs administrators.

008 A

1:00 - 2:30p

GEA/GSA Small Group Discussion
Integrating Career Planning into the Formal Curriculum:
Achieving Dual Goals of Meeting Educational Objectives and Helping Students Plan Their Future

Moderator:
Toni M. Ganzel, M.D., M.B.A.
Senior Associate Dean for Students
University of Louisville School of Medicine

Discussants:
Isaac "Ike" Wood, M.D.
Senior Associate Dean of Medical Education and Student Affairs
Virginia Commonwealth University School of Medicine

Peggy Dupey, Ph.D.
Assistant Dean for Student Affairs
University of Nevada School of Medicine

Leon "Lee" Jones, M.D.
Associate Dean for Student Affairs
Professor of Psychiatry
University of Texas Health Science Center San Antonio

Description of Topic and Rationale: Choosing a medical specialty is one of the most important, yet daunting, decisions students make during medical school. This challenge is compounded by the lack of available time to thoroughly explore career options and interests. It is difficult for students to carve out time in the crowded preclinical curricula for structured career planning activities and there is little elective time in the third year for them to experience specialties outside their core clinical clerkships. Since students are forced to make a career choice at the start of their fourth year, the need to integrate career planning activities effectively and efficiently into the formal curriculum is more important than ever. The purpose of this Small Group Discussion is to share ideas on how schools are implementing high yield career planning tools and activities into the formal curriculum to achieve the dual purpose of meeting educational goals and objectives and helping students plan for the future.

215

1:00 - 2:30p

GEA/GSA Small Group Discussion
How Kotter's Model Can Effect Curricular Change:
A Multi-Institutional Perspective

Moderator:
Molly Osborne, M.D., Ph.D.
Associate Dean, Student Affairs
Oregon Health & Science University

Discussants:
Paul Bascom, M.D.
Associate Professor
Oregon Health & Science University

Ursula Braun, M.D., M.P.H.
Assistant Professor of Medicine and Medical Ethics
Baylor College of Medicine

Barbara Palmisano, M.A.
Director, Offices of Geriatric Medicine/Gerontology and Palliative Care
Northeastern Ohio Universities Colleges of Medicine and Pharmacy

Jamie Von Roenn, M.D.
Professor of Medicine
Medical Director, Palliative Care and Hospice Program
Northwestern University Feinberg School of Medicine

Description of Topic and Rationale: Medical education is in the midst of major reform across the United States and abroad. Despite clear directives as to what is needed to prepare future physicians for contemporary medical practices, significant hurdles must be overcome to implement fundamental change. It is a daunting task to reform long-standing conventional pedagogical practices and to sustain curricular change.

The discussants propose that having a systematic approach to gaining "buy-in" is essential for successful curricular change. "Buy-in" is necessary at all levels, not only hierarchically, from top-down, but collegially, from bottom-up. This small group discussion will focus on John Kotter's eight -step model for change, which has been embraced in the world of business for many years and more recently introduced into academic settings.

Kotter's Eight-Step Model For Change:

Step One: Creating a Sense of Urgency for Change
Step Two: Pulling Together a Guiding Team and Identifying Champions
Step Three: Developing a Change Vision and Strategy
Step Four: Communicating the Vision
Step Five: Empower Others to Act/Build Broad Base Support
Step Six: Produce Short-Term Wins
Step Seven: Don't Let Up/Stimulate More Change
Step Eight: Anchor Change in Institution/ Sustainability

Kotter's model has proven to be a useful tool for curricular change within institutions. However, as we move towards more multi-institutional, collaborative change efforts in targeted curriculum areas, we must ask critical questions. Will Kotter's model provide guidance on how to obtain and sustain "buy-in" for special topic/content integration across multiple years of the curriculum? Can the model promote cross-departmental and cross-institutional dialogue by providing a common language for curriculum change steps? How effective is Kotter's model in rural and community-based schools as compared to traditional university-based institutions?

These questions will be answered by providing the perspectives from six schools, Robert Wood Johnson Foundation award recipients of the Medical School Palliative Care Education Project (MSPECP) developed by the Medical College of Wisconsin. The experiences of these six schools in integrating palliative care into the clinical years of medical education will serve as a template. Palliative care is generalizable because it crosses many disciplines and clinical departments.

008 B

1:00 - 2:30p

GEA/GSA Small Group Discussion
Local Efforts to Promote Educational Scholarship: Perspectives from Three Universities

Moderator:
Karen Szauter, M.D.
Medical Director, Standardized Patient Center
The University of Texas Medical Branch at Galveston

Discussants:
Ann Frye, Ph.D.
Director, Office of Educational Development
The University of Texas Medical Branch

Caridad Hernandez, M.D.
Associate Director, Faculty Development
University of Florida College of Medicine

Patricia O'Sullivan, Ed.D.
Associate Director, Educational Research
University of California San Francisco

Description of Topic and Rationale: The 2006 Consensus Conference on Educational Scholarship brought together medical educators and medical school administrators to address the importance of scholarship as a part of the educational process. In the subsequent publications related to this conference, recommendations for the documentation of scholarship by individual faculty members were made. In addition to the focus on faculty activities, the importance of the institutional infrastructure to support scholarship by educators was highlighted. The lattermost concept will be the focus of this presentation.

This small group discussion will engage the audience in conversation about local efforts to promote scholarship among medical educators. The session will begin with a brief discussion of three programs at North American medical schools, highlighting processes each school uses to advance scholarship among their faculty. Audience members will then engage in conversation about how faculty's educational work can be enhanced with a focus on scholarship, and how the institution can support and promote such activity. Issues of faculty development, resource requirements, professional satisfaction, and promotion will be addressed.

217 C

1:00 - 2:30p

GEA/GSA Small Group Discussion
Addressing Diversity in Graduate Medical Education: Challenges and Perspectives

Moderator:
Donald W. Brady, M.D.
Associate Dean, Graduate Medical Education
Vanderbilt University School of Medicine

Discussants:
Andre Churchwell, M.D.
Associate Dean for Diversity in Graduate Medical Education and Faculty
Vanderbilt University School of Medicine

David Gordon, M.D.
Associate Dean for Diversity and Career Development
University of Michigan School of Medicine

Richard Sims, M.D.
Associate Dean for Diversity
University of Alabama School of Medicine

Description of Topic and Rationale: The AAMC, through it many publications and initiatives, has emphasized the need for diversity at all levels of medical education, beginning at the student level. However, diversity among the medical student population does not ensure diversity at the graduate medical education level, whether one is talking about within an individual residency program or across a university's entire GME enterprise. Many factors affect what field a student chooses, including the presence of role models, appropriate mentoring, and other influences. The recent AAMC publications, Roadmap to Diversity: Key Legal and Educational Policy Foundations for Medical Schools and Minority Student Opportunities in United States Medical Schools, address many of the institutional issues related to achieving underrepresented minority goals in the medical student population, but there is an equal need to simultaneously focus on the opportunities and needs for those students upon graduation when they enter their residency training.

Given this need, many schools have begun to expand their diversity efforts to focus specifically on the need to diversify their house staff programs and to address the factors that influence the success of such diversity efforts. Some have even appointed Associate Deans of Diversity specifically to address house staff and faculty needs. All house staff, including minority residents and fellows, seeks career guidance in choosing what type of practice to enter or what specialty or subspecialty to pursue. Underrepresented minority house staff has the additional need to find role models like themselves who have found success as minority physicians. Academic medical centers, however, can find their efforts in this area hampered by a lack of diversity among its faculty as a whole or within certain departments, by the institution's real or perceived lack of emphasis on diversity efforts, and even by the diversity (or lack thereof) of the community within which the medical center resides.

This small group forum will provide an opportunity for medical school leaders to discuss the opportunity and challenges of diversity efforts at the graduate medical education level. Three different Associate Deans for Diversity, representing both private and state universities as well as geographic diversity, briefly will present how their institutions are addressing diversity efforts in their graduate medical education programs and why they assumed the roles they did. These short presentations will serve as a platform for a broad discussion among all present about the need for diversity at the house staff level, the challenges faced, and strategies for achieving successful diversity throughout all levels of graduate medical education.

218

3:00 - 4:30p

GEA/GSA Small Group Discussion
Assisting Students in Developing Rational Residency Application and Match Strategies

Moderator:
Michael D. Prislin, M.D.
Associate Dean, Student Affairs
University of California Irvine School of Medicine

Discussants:
Donna Elliott, M.D., Ed.D.
Associate Dean of Student Affairs
University of Southern California Keck School of Medicine

Neil Parker, M.D.
Senior Associate Dean of Admissions and Student/Resident Affairs
University of California Los Angeles David Geffen School of Medicine

Description of Topic and Rationale: Applying for residency training has become a progressively more complex process in terms of addressing the mutual expectations of students and residency programs. Further the increasing competitive for obtaining residency positions in a number of specialties, and the "black box" nature of the match are often-times highly anxiety provoking for students. As a consequence, students look to their student or educational affairs offices to provide increasingly detailed advice and guidance on how best to navigate through this process. The discussion in this session will address how best to provide such advice and guidance to our students.

218

3:00 - 4:30p

GEA/GSA Small Group Discussion
Faculty Development to Teach Professionalism in Three Settings:
University, Community Teaching Hospital, and Academic Society

Moderator:
Ellen M. Cosgrove, M.D., F.A.C.P.
Senior Associate Dean, Education
University of New Mexico School of Medicine

Discussants:
Louise Arnold, Ph.D.
Associate Dean, Medical Education and Research
University of Missouri Kansas City School of Medicine

Alden H. Harken, M.D., F.A.C.S.
Professor and Chairman, Department of Surgery
University of California San Francisco, East Bay

Ajit K. Sachdeva, M.D.
Director, Division of Education
American College of Surgeons

Description of Topic and Rationale: The issue of this discussion is how to enable faculty to go beyond merely using implicit role modeling in their "teaching" of professional values and behaviors (professionalism). One of the discussants will spend 10 minutes defining the rationale & key issues in faculty development to teach professionalism. We will show a 5 minute video vignette of a professionalism dilemma involving a resident and a faculty member caring for a patient. Each of the discussants will briefly describe their experience using the video vignette in developing faculty to teach professionalism in one of the three settings: medical school, teaching hospital, and academic society. Their brief talks (5 minutes) will emphasize effective techniques to engage faculty, promote self-reflection, and move toward consensus on expected behaviors. The didactic portion of the session will conclude with a 5 minute description of two different approaches to a comprehensive model of faculty development in professionalism.

This discussion group will focus on the need for faculty development in professionalism education and assessment across the continuum. It will highlight the usefulness of the case model, explicit role modeling, and appreciative inquiry as the basis for the faculty development in which faculty acknowledge the competing interests and values, thoughtfully consider alternative courses of action, and consider the effect of the context of the care environment with their students and residents.

006 D

3:00 - 4:30p

GEA/GSA Small Group Discussion
Immersion in Authentic Patient-Centered Care:
Learning Effective Clinical Skills and Effective Inter-Professional Teamwork by Actually Taking Care of Patients

Moderator:
Lynn Cleary, M.D.
Senior Associate Dean for Education
Vice President for Academic Affairs
State University of New York Upstate Medical University

Discussants:
Debra Buchan, M.D.
Associate Professor of Medicine
State University of New York Upstate Medical University

Susan Flewelling, M.S.
Course Administrator
State University of New York Upstate Medical University

Ruth Hoppe, M.D.
Professor of Medicine
Associate Dean Emeritus
Michigan State University College of Human Medicine

Topic of Discussion and Rationale: This small group discussion is designed to engage participants in a conversation about two major challenges and opportunities in health professions education:

1. Providing authentic clinical immersion opportunities in teaching and learning core clinical skills
2. Providing effective opportunities to learn principles of teamwork by working together to deliver high-quality patient care.

Providing authentic, patient-centered experiences for students in health professions education is a major challenge for educators. The pace and intensity of inpatient and outpatient clinical care makes it more difficulty to identify settings where and preceptors with whom students can learn key communication and hands-on skills. This challenge exists across the spectrum of professions: medicine, nursing, physicians' assistants, allied health professionals, etc. In many programs, the use of standardized patients and other simulations have supplemented and sometimes replaced direct bedside patient care. These opportunities are excellent but present different challenges, including delays in acquiring comfort interacting with real patients, sick patients, and the bedside clinical skills required to fully engage in the later clinical phases of training.

Another challenge facing health professions educators is designing and delivering educational experiences that provide authentic opportunities to learn principles of teamwork in providing effective patient-centered, high quality care. This need has been highlighted by the Institute of Medicine, by the Accreditation Council for Graduate Medical Education, by the AAMC Medical Schools Objectives Project, and others. Some efforts at designing and delivering inter-professional health education have had limited success. Didactic lectures can only go so far in addressing the need. Other efforts have resulted in high satisfaction among learners and teachers, and resulted in actual benefits to patients. Learners may benefit most from engaging together in real patient care, identifying needs and actually contributing to improving the care and outcomes for individual patients and populations of patients.

The discussants will set the stage for discussion by briefly describing their experience in designing and delivering successful examples of authentic clinical immersion experiences for students and teachers from various health disciplines, including colleges of medicine, nursing, and health professions. The presentations will identify the need, the stars that were aligned to identify the solution, and the outcomes and remaining challenges.

007 A

3:00 - 4:30p

GEA/GSA Small Group Discussion
Medical School Career Development Professionals:
Why Aren't We Researching and Writing about Our Best Practices?

Moderator:
Anita M. Navarro, M.Ed.
Assistant Professor
Curriculum Consultant
Virginia Commonwealth University School of Medicine

Discussants:
Nicole J. Borges, Ph.D.
Director of Medical Education Research
Associate Professor
Wright State University Boonshoft School of Medicine

George Richard, Ph.D.
Director, Careers in Medicine
Association of American Medical Colleges

Anita D. Taylor, M.A.Ed.
Director of Career Advising
Associate Professor
Oregon Health & Science University School of Medicine

Description of Topic and Rationale: In writing a paper on medical student career development programs, two of this proposal's authors have found very little evidence that schools are publishing on their career development efforts. In the course of our literature search, we found 10 potentially relevant articles; however, once reviewed, we determined their foci were only tangentially related the types of career programs and courses offered by medical schools. There were no entries in MedEdPORTAL for courses or workshops related to student career choice, and in CurrMIT, there were approximately seven schools that had identified courses or workshops that were not part of a discipline-specific course. This has lead us to question why there is not more current literature on medial student career development and the specific programs that work to facilitate their career decisions. We are curious as to the reasons medical student affairs practitioners are not publishing on this and perhaps other topics around medical student and even resident and physician career development.

We believe there are a myriad of answers and would like to investigate these and related questions at a national level to understand this void in the literature and to discover potential solutions for closing the gap. By working with workshop participants we would like to define the current state of research on medical student career development, including the lack of models for implementing career development activities. We would like to explore issues around conducting research on this topic, find strategies to address the issues, and offer networking to facilitate collaboration on investigating best practices in programming for medical student career development concerns.

007 B

3:00 - 4:30p

GEA/GSA Small Group Discussion
Everything You Always Wanted to Know About M.D./M.B.A. Dual-Degree Programs But Were Afraid to Ask

Moderator:
Dorothy A. Andriole, M.D.
Assistant Dean for Medical Education
Associate Professor of Surgery
Washington University School of Medicine in St. Louis

Discussants:
Maria Chandler, M.D., M.B.A.
Associate Professor, Pediatrics
Associate Professor, Business
University of California Irvine School of Medicine
University of California Irvine Paul Merage School of Business

Angela Nuzzarello, M.D.
Associate Dean, Student Programs and Career Development
Northwestern University Feinberg School of Medicine

Brian Hurley, M.D., M.B.A.
President
American Medical Student Association

Description of Topic and Rationale: In recent years, there has been a steady expansion in the number of dual-advanced degree MD/MBA programs offered by US allopathic medical schools. As of March, 2008 the AAMC Curriculum Directory listed 49 U.S. allopathic medical schools that offer MD/MBA programs.

As any single medical school likely has only small numbers of students participating in this type of dual-degree program, a discussion of this topic will be of value as a forum for participants from many different medical schools to compare their institutional programs, experiences and perspectives. While the focus of our session will be primarily on MD/MBA programs already in place, the discussion should also be of interest to participants from schools that may not currently offer MD/MBA programs but are considering doing so in the near future or have students enrolled in their medical schools who are interested in this dual-degree program option.

This topic is timely as medical schools are currently seeking to recruit and educate an increasingly diverse student body, both to meet the health care needs of the population at large and to participate in effectively addressing a multitude of health policy issues facing our country. Medical schools are also challenged to develop and implement individualized career counseling programs, tailored to meet the needs and professional aspirations of the contemporary medical student population. A discussion of student options for participation in these MD/MBA programs, and particular issues relevant to career counseling for students enrolled in these programs, can inform the efforts of session attendees to optimally address their medical students' career-counseling and advising needs.

A discussion of this topic will also be of value in the context of medical school educational outcomes programs. Educational-outcomes measures currently employed by most medical schools may not fully capture relevant data pertaining to dual-advanced degree program graduates, who may make important contributions to the field of medicine through career pathways in a wide range of domains, such as innovations in health-care financing or health care administration. Identification of educational-outcomes measures which can quantify the achievements and accomplishments of these MD/MBA program graduates can inform the efforts of medical schools offering any of these programs to more comprehensively meet the LCME standard for accreditation that stipulates a program of outcomes assessments for each school's graduates.

Finally, the steady expansion of MD/MBA degree programs is an important topic in the context of the projected physician shortage in the U.S. Medical schools throughout the U.S. are striving to improve the efficiency of the educational process and increase the numbers of medical students they enroll and graduate. Dual advanced-degree programs, by definition, add to the duration of the undergraduate medical education process and program graduates can consider a remarkably wide range of endeavors that extend well beyond the traditional professional activities for physicians of direct patient care, teaching and biomedical research

007 C

3:00 - 4:30p

GEA/GSA Small Group Discussion
Quality Improvement Processes: Authentic Involvement of Students During Medical School

Moderator:
Summers Kalishman, Ph.D.
Director, Program Evaluation, Research and Education
University of New Mexico School of Medicine

Discussants:
Greg Ogrinc, M.D., M.S.
Director, Office of Research and Innovation in Medical Education
Dartmouth Medical School

Craig Timm, M.D.
Associate Dean, Undergraduate Medical Education
University of New Mexico School of Medicine

Thomas R. Viggiano, M.D., M.Ed.
Associate Dean, Faculty Affairs
Mayo Medical School Mayo Clinic College of Medicine

Description of Topic and Rationale: In 2001, the AAMC issued the Medical School Objectives Project Report V, Contemporary Issues in Medicine: Quality of Care. In that report, they posed two key questions to medical school faculty and staff. What should medical students learn about quality improvement? What kinds of educational experiences allow students to achieve those learning objectives? While the report also included guidelines about what should be learned and possibilities about how to achieve it, since 2001, medical school faculty have responded to those questions with adaptive and interesting educational approaches. During this session, we plan to explore the panelists' approaches as well as those of the audience participants. In addition, since the report was issued, two additional questions seem relevant to this discussion and will be added to the discussion. What is meant by quality improvement? Can a competency based framework be applied to quality improvement objectives? Quality improvement traditionally focuses on changing performance in patient care, adopting and monitoring safety practices, and influencing the system of care and improving systems based practice. Quality improvement has also been used as a framework to engage students authentically in practice based learning and improvement practices and in development of professionalism through systematic review of curricula. While each approach involves a different competency, each is similar in some underlying characteristics. In each, students must review evidence, consider gaps between prevailing practice and "best" or better practices, synthesize information, support recommendations, and participate as a member of QI team.

The overall goal of this small group discussion is to describe quality improvement theory and its evolution in medical curricula, explore the application of a competency based framework to quality improvement in medical student education, and elicit from the panel and the audience the quality improvement educational knowledge needed by medical students and the kinds of educational experiences that allow students to achieve that learning. In addition, during the discussion, we will seek to identify the application of quality improvement to student educational curricular experiences. With the audience, we will identify learning concepts that support authentic application of quality improvement concepts within medical student educational environments, benefits and barriers associated with the process, and the needed organizational factors to support different types of quality improvement interventions with medical students.

007 D

3:00 - 4:30p

GEA/GSA Small Group Discussion
Integrating Meaningful Learning Activities Relevant to Practice-based Learning and Improvement and Systems-based Practice into a Busy Residency Program

Moderator:
John Littlefield, Ph.D.
Director, Academic Center for Excellence in Teaching
University of Texas Health Science Center at San Antonio

Discussants:
Deb DaRosa, Ph.D.
Vice Chair, Education Professor of Surgery
Northwestern University Feinberg School of Medicine

Pat Wathen, M.D.
Clinical Professor of Medicine
Associate Program Director, Internal Medicine Residency Program
University of Texas Health Science Center at San Antonio

Description of Topic and Rationale: It is difficult to meaningfully integrate learning activities relevant to the ACGME competencies Practice-Based Learning and Improvement (PBL&I) and Systems-Based Practice (SBP) into a busy residency program. The emphasis on patient safety and continuous quality improvement seems to grow each year. Few faculty realize that resident learning activities relevant to PBL&I and SBP often overlap with the Scholarship of Clinical Teaching (SCT) and Quality Assurance (QA). A carefully planned project can simultaneously benefit residents as PBL&I or SBP, benefit faculty as SCT, and benefit the institution as QA. SCT should produce discovery of new knowledge about teaching and learning, integration of knowledge about teaching across disciplines, or application of knowledge to solve practical teaching problems. SCT must produce a tangible or electronic product presented in a form that can be reviewed by peers for quality, and publicly disseminated for others to learn from and build upon. QA scholars have recognized the overlap between QA and more traditional forms of scholarship while ethicists have noted a paradox exists in that IRBs monitor traditional research, but not QA studies. This session will describe strategies for altering current resident learning activities or developing new ones that address PBL&I or SBP competencies, but also promote SCT and QA. A project to improve the quality of Patient Discharge Summaries will be used as an exemplar for simultaneously achieving benefits for residents, clinical faculty, and the hospital. Residents learned about PBL&I, the faculty member studied peer assisted learning, and the hospital received data showing improvement in the quality of patient care.

008 A

3:00 - 4:30p

GEA/GSA Small Group Discussion
A Hitchhiker's Guide to the Graduation Questionnaire: What you need for Program Evaluation

Moderator:
Thomas W. Koenig, M.D.
Associate Dean for Student Affairs
Johns Hopkins University School of Medicine

Discussants:
Heather F. Hageman, M.B.A.
Director of Educational Planning and Program Assessment
Washington University in St. Louis

Michele Pugnaire, M.D.
Vice Dean for Undergraduate Medical Education
University of Massachusetts Medical School

Kenneth B. Simons, M.D.
Senior Associate Dean for Academic Affairs
Medical College of Wisconsin

Description of Topic and Rationale: The Medical School Graduation Questionnaire (GQ) is a web-based data collection tool administered annually to fourth-year medical students. Since its inception, the results of the GQ have assisted the association and medical schools in setting priorities and program and policy development. It has been administered annually since 1978 to US graduating medical students. The focus of this session will be to discuss current and future research with the GQ and the Medical School Questionnaire, as well as providing an update on how one school in particular utilizes the GQ for setting their policies for medical education.

T B D

3:00 - 4:30p

GEA/GSA Small Group Discussion
The Nature of Teaching Awards at Medical Schools: A Discussion About Intended and Unintended Consequences

Moderator:
Ruth Greenberg, Ph.D.
Associate Dean of Medical Education
University of Louisville School of Medicine

Discussants:
Boyd Richards, Ph.D.
Director, Office of Curricular Affairs
Columbia University Medical Center

Lynne Robins, Ph.D.
Associate Professor
University of Washington School of Medicine

Deborah Simpson, Ph.D.
Associate Dean, Educational Support and Evaluation
Director, Office of Educational Services
Co-Chair, Society of Teaching Scholars
Medical College of Wisconsin

Description of Topic and Rationale: Awards that honor exemplary teaching have grown in number in higher education over the past twenty years. In 1993, seven in ten institutions reported giving an annual teaching award, an increase from 1987, when the proportion was about half. Medical schools also honor and recognize teaching excellence through teaching awards, and we suspect that it would be difficult to identify even one medical school today that does not have at least one teaching award; in fact, our collective experience suggests that most medical schools bestow several teaching awards annually, both at the department and school level, and that these awards vary quite substantially in terms of criteria for receiving the award, how the winners are determined, and the actual awards themselves. Our collective experience indicates too that recipients appreciate receiving those awards.

The literature provides little insight into this topic. The literature that exists outside of medicine is modest, focusing mostly on the type, criteria and relative impact of different types of awards. In medical education the literature provides some insights regarding the key features and impact of teaching awards. Interestingly in medicine, one of the most recent studies, by Brawer, Steinert et al at McGill University, reveals that department chairs are more likely to perceive prestigious, peer reviewed college-wide teaching awards as contributing to the recipient's stature than did the awardees!

Despite this limited data set, we in medical education have experienced the growth of the teaching academy movement. This movement, in turn, has given birth to a new type of teaching award, the "project" award. In addition, the GEA Consensus Conference on Educational Scholarship has raised national awareness of the importance of defining and documenting faculty activities in the area of education, highlighting teaching awards as a strong form of documentation.

In an effort to understand better the nature of teaching awards, their features, consequences, and impact on the current national discussion about educational scholarship, a group drawn from the Society of Directors of Research in Medical Education (SDRME) members began a conversation at the 2007 AAMC annual meeting about the nature and role of teaching awards. Since then, the discussion has expanded to include a group of approximately 15 medical educators representing an array of medical schools across the country (private/public; research intensive), who now "meet" monthly via telephone. Initially, we conducted a literature review and expanded the discussion through accepted sessions at each of the GEA's four regional meetings. In preparation for these small group discussions, we designed a web-based survey to learn more about the nature of the teaching awards at medical schools. We administered the survey to all SDRME members in February 2008 and summarized results for use at the four regional GEA meetings. We also produced a brief annotated bibliography, which we distributed at the regional meetings.

Building on our literature search results, survey findings, and themes emerging from the GEA's four regional meetings on teaching awards, the next step is to share more broadly the results and identify strategic directions for future work.

217 C

3:00 - 4:30p

GEA/GSA Small Group Discussion
Helping the Older Student Survive the Challenges of Medical School

Moderator:
Alan Kent, Ph.D.
Director, Medical Student Counseling Service
Clinical Associate Professor
University of Washington School of Medicine

Discussants:
Scott Rodgers, M.D.
Associate Dean for Medical Student Affairs
Assistant Professor of Psychiatry
Assistant Professor of Medical Education and Administration
Vanderbilt University School of Medicine

Mark Wicks, Ph.D., LICSW
Medical Student Counselor
University of Washington School of Medicine

Karen Cross
Fourth Year Medical Student and Mother
University of Washington School of Medicine

Description of Topic and Rationale: Non-traditional or older students enter medical school with a wealth of maturity and experience which often enhances their applications. On the other hand, their age and life circumstances often present them with a set of challenges that are not experienced by the younger, more traditional student who may be entering school directly from college. There is very little literature in the field of medical education that explores this issue. Anecdotal discussions with Student Affairs Deans and medical student counselors suggest that many bright, promising older students run into difficulties balancing the demands of medical school with other challenges in their lives. This panel discussion is designed to elucidate some of the unique challenges of the older student and to identify possible supports and resources to help such students achieve success.

008 B

Wednesday, November 5

8:00 - 9:30a

GEA/GSA Small Group Discussion
Affiliate Agreements: Finding a Common Solution

Moderator:
Marilyn London, Ed.D.
Assistant Dean for Medical Education
State University of New York Stony Brook School of Medicine

Discussants:
David Irby, M.D.
Vice Dean for Education
University of California San Francisco School of Medicine

Vicki Fields
Assistant Dean for Medical Education
Oregon Health and Science University School of Medicine

Description of Topic and Rationale: In a recent GSA listserv discussion, several medical schools identified issues related to affiliate agreements requested for visiting student electives. Some members could not understand why the agreements are needed. Others had reasons related to state law, liability insurance activation, and inflexibility of administrators and legal counsels. Some roadblocks were identified which were related to the inability to indemnify the host site, and the time it takes a legal office to review an agreement. Each school has its own agreement with unique legal verbiage, necessitating a new review each time a different student applies for an elective. In most cases, students are not permitted to start a visiting rotation without having an agreement in place.

In January 2008, the GSA Student Records and Student Affairs groups met and passed a recommendation to establish a national committee which will work on solving the problems created by the perceived and real needs for affiliate agreements. A small group discussion session will be held at the NEGSA in April to identify reasons why schools want the agreements as well as the roadblocks they encounter in creating them. The ultimate goal of the NEGEA session is to begin work on a universal agreement to propose for use across US medical schools. This goal is in synchrony with the January recommendation passed by the GSA. The reason a meeting at the AAMC is both timely and useful is to bring a template of a universal agreement, created as a result of the January recommendation and the April NEGSA meeting, to the larger group for consideration and further development.

007 B

8:00 - 9:30a

GEA/GSA Small Group Discussion
The Pre-Clerkship Clinical Skills Taskforce: Discussing the Publication

Moderator:
Eugene "Gene" C. Corbett, Jr., M.D.
Professor of Medicine and Nursing
University of Virginia Health Science Center

Discussants:
TBD

Description of Topic and Rationale: AAMC Project on the Clinical Education of Medical Students: Preclerkship Clinical Skills Education. For several years the AAMC has been developing a focused effort to better understand and improve the clinical education of medical students, an essential educational mission that is particularly vulnerable to the economic, institutional and productivity forces that pervade the contemporary academic medical environment. In November 2005, the AAMC published a monograph providing an overview and recommendations for clinical skills curricula for undergraduate medical education. This session will provide an opportunity for medical educators to discuss clinical skills education specific to the preclerkship experience, the focus of a second monograph by the AAMC Task Force on Clinical Skills Education. The discussants represent the major disciplines that are involved in the leadership of preclerkship professional development courses and those working to develop a national consensus on this core element of clinical education.

007 C

8:00 - 9:30a

GEA/GSA Small Group Discussion
Curricular Response to Proposed USMLE Revisions: A Challenging Opportunity

Moderator:
John F. Mahoney, M.D.
Associate Dean for Medical Education
University of Pittsburgh School of Medicine

Discussants:
Ruth-Marie E. Fincher, M.D., MACP
Vice Dean for Academic Affairs
Medical College of Georgia School of Medicine

Alison Whelan, M.D.
Associate Dean for Medical Student Education
Washington University School of Medicine

Description of Topic and Rationale: The USMLE Composite Committee is conducting a comprehensive review of the USMLE Program and its examinations, and is preparing a plan for possible changes to these examinations. Any changes to the existing examination scheme, including adjustments to content and timing of the examination, have the potential for significant impact on how medical schools conduct curricula and how students prepare for these examinations. Significant advanced planning efforts will be essential for optimizing curricula and maximizing student success in the wake of any USMLE changes.

In this session, faculty from three schools will lead a discussion of the issues related to curricular change that may be necessary or desirable as a consequence of changes to the USMLE Program. A brief introductory topic review will facilitate communication among an audience with varying degrees of awareness of the proposed USMLE revisions. The remainder of this session will be a dialog among participants and panelists, focusing on the challenges introduced by these changes and on the spectrum of opportunities for curricular innovation that may stem from these changes. Participants will be challenged to identify potential opportunities in their institutions and in undergraduate medical education in general.

By attending this session, participants will develop: 1) familiarity with the issues raised by modification of the USMLE program and 2) insight into the opportunities that exist in their curricula to maximize benefit and minimize adverse consequences stemming from this change. As a result of this session, participants will develop new perspectives on how this potentially disruptive innovation can be a vehicle for positive change in their own curriculum. It will also provide diverse perspectives for continuation of this dialog upon return to their institutions.

It is anticipated that there will be an announcement about the nature of the proposed changes in November 2008, along with the timeline for implementation. This timely session will be especially valuable to undergraduate medical educators, who will need to begin to formulate a response as soon as these changes are announced. To optimize the success of the discussions, we have assembled a panel of highly skilled educators with substantial experience in curriculum development, innovation and assessment.

007 D

8:00 - 9:30a

GEA/GRMC Small Group Discussion
Meeting the Needs of Faculty Development for Community Physician Preceptors: A Discussion of Varying Methods to Achieve Success for Recruitment, Education and Retention of Community Faculty

Moderator:
Rosemarie Cannarella, M.D., M.P.H.
Assistant Dean of Student Services
Professor Family Medicine
West Virginia University Medical School - Eastern Division

Discussants:
Jane Gair, Ph.D.
Faculty Development Coordinator - Senior Instructor
Division of Medical Sciences - Island Medical Program
University of Victoria, British Columbia

Desiree Lie, M.D., M.S.Ed.
Director, Division of Faculty Development and Research
Clinical Professor, Department of Family Medicine
University of California Irvine School of Medicine

Adela Valdez, M.D.
Assistant Dean of Education -Regional Academic Health Center
Clinical Associate Professor, Department of Family Medicine
University of Texas School of Medicine at San Antonio

Description of Topic and Rationale: The utilization of community physicians as preceptors for students in a myriad of clerkships and clinical experiences is increasing, and is often associated with a lack of direct compensation for their teaching services. More medical schools are forming regional clinical campuses to meet the needs for community healthcare, and the demand for increased class sizes. Regional campuses are characteristically smaller and yield more community-based experiences than primary campuses. Distinctions between primary and regional campuses move beyond geography and include differences in educational processes. Also, more medical schools are using community preceptors in the education of pre-clinical medical students as well. One of the most challenging aspects on both primary and regional campuses is to equip community-based faculty with the necessary skills to maximize medical student learning, deliver appropriate evaluation and feedback and foster professionalism. Innovative ways of enlisting, educating and keeping these preceptors becomes a priority for medical schools.

We present a panel with diverse experience in community preceptor faculty development, which will bring into focus issues of recruitment, retention, training and differences in needs for faculty development. The literature in faculty development suggests that a mixed methods model that addresses local factors with a strong needs assessment component is most likely to be successful. We will communicate various perspectives on community preceptor faculty development, initiate a discussion to highlight the issues of motivation to teach, building skills to meet the course objectives for students and maintaining interest and commitment among community faculty to continue teaching our students, and share views via the "questions for discussion."

214 A

8:00 - 9:30a

GEA/GIR Small Group Discussion
Internet Tools to Support Collaboration

Moderator:
Carol Kamin, M.S., Ed.D.
Director of Pediatric Medical Education Research and Development
University of Colorado School of Medicine

Discussants:
Kevin Souza, M.S.
Director, Office of Educational Technology
Associate Director, Office of Medical Education
University of California San Francisco School of Medicine

Brian Tobin, M.A.
Education Technologist
Stanford University School of Medicine

Description of Topic and Rationale: Because of increased interest in multi-site research collaborations in medical education, this session was organized to describe the variety of Internet tools available to support collaborative activities. This discussion is organized around typical multi-site research activities with tools demonstrated to support those activities. The moderator and the discussants have used an array of Internet tools to complete multi-site projects and published research studies. The conceptual framework of the research process is highlighted as follow:

Communication: In the early stages of a project, brainstorming serves an important function of getting all of the participants to agree upon project goals. Project planning and decision making will continue through the life of the project and it is critical to have optimal communication tools and strategies. Documentation of action plans and group decisions keep the group on task and minimize misunderstandings among the participants.

Creating and Sharing Documents: There may be shared instruments developed and implemented by the participating sites. Having these in a shared location to avoid different versions of the instrument is preferable. Each site will have to go through their local IRB, but sites can share their applications and consent forms to simplify work for the group. IRB approval for each sites can be documented in a shared space.

Literature Reviews: The ability to build a shared repository of literature is important for reviewing, discussing and documenting up-to-the-minute publications relevant to the research topic. The repository can also facilitate writing of publications across different authors.

Data Analysis and Sharing of Datasets: Having datasets in a shared location with documentation of checks and other processes to clean data before analysis is important to avoid multiple versions of files. A shared space for looking at the data analysis would serve as another communication device about findings.

Writing: At various points in the project, there are opportunities to collaborate on the writing of grant proposals, conference abstracts and manuscripts.

Project Management: In a multi-site collaborative project, using standard project management tools, such as timelines, implementation plans and resource allocations are critical. These should be accessible to everyone on the team to clarify expectations of the members.

214 B

8:00 - 9:30a

GEA/GSA Small Group Discussion
Innovative Curriculum and Assessment Models at the Edge of Chaos

Moderator:
Nehad El-Sawi, Ph.D.
Associate Dean for Curriculum and Faculty Enrichment
A.T. Still University School of Osteopathic Medicine in Arizona

Discussants:
Alan Neville, M.D.
Assistant Dean of Undergraduate Medical Education
McMaster University, Hamilton, Canada

Klara Papp, Ph.D.
Educational Psychologist
Case Western Reserve University School of Medicine

Rachel Yudkowsky, M.D., M.H.P.E.
Director, Allan L. and Mary L. Graham Clinical Performance Center
University at Illinois at Chicago College of Medicine

Description of Topic and Rationale: Medical education programs may be viewed as a complex adaptive system (CAS). A complex adaptive system, by definition consists of a large number of agents, each of which behaves according to its own principles of local interaction. No individual agent, or group of agents, determines the patterns of behavior that the system as a whole displays, or how these patterns evolve, and neither does anything outside the system. Medical education programs exhibit CAS properties where they consist of human agents who make choices about their actions, have hierarchical structures and networks, have patterned and unpredictable behavior, exist within wider systems which they both influence and influenced by, and no individual or group determines the systems' pattern of behavior.

Planning and evaluation of curricular interventions exhibits the CAS unpredictability with unintended consequences. A brief overview of the conceptual framework for curriculum evaluation and change, with the complexity theory perspective will be provided at the beginning of the small group session. Faculty at four medical schools will provide examples of unintended consequences of innovative curricular/assessment approaches at their respective institutions.

214 C

9:30 - 11:00a

GEA/GSA Small Group Discussion
A Blueprint for Medical Education on Violence and Abuse

Moderator:
F. David Schneider, M.D., M.S.P.H
Professor and Vice Chair
University of Texas Health Science Center at San Antonio

Discussants:
Tasneem Ismailji, M.D., M.P.H.
Educator and Researcher
Academy on Violence and Abuse

Connie Mitchell, M.D., M.P.H.
Director, Domestic Violence Education
California Department of Public Health

David McCollum, M.D.
President
Academy on Violence and Abuse

Description of Topic and Rationale: In 2002 the Institute of Medicine released, Confronting Chronic Neglect, the Education and Training of Health Professionals on Family Violence. This report outlined the magnitude of the effect of victimization, and called for the development of significant research infrastructure and a cadre of experts to better care for these patients. Since that time, little progress has been achieved. In 2007, the Academy on Violence and Abuse convened a summit to explore the current status of health professions education in this area, and the potential development of a new medical specialty on violence and abuse. This session will present the results of the summit and explore in greater detail the development of expertise needed to care for these patients in this area.

007 B

9:30 - 11:00a

GEA/GSA Small Group Discussion
Transforming Clinical Clerkships: Are Social and Behavioral Sciences the Answer?

Moderator:
Jason M. Satterfield, Ph.D.
Associate Professor of Clinical Medicine
Director, Behavioral Medicine
Attending Psychologist
University of California San Francisco School of Medicine

Discussants:
Shobhina Chheda, M.D., M.P.H.
Associate Professor of Medicine
University of Wisconsin School of Medicine and Public Health

Eric Green, M.D., MS.c.
Assistant Professor of Medicine
Albert Einstein College of Medicine

Description of Topic and Rationale: The basic structure and pedagogy of the third year clinical clerkship has remained essentially unchanged since the turn of the 20th century. Its philosophy is deeply rooted in an experiential learning, apprenticeship model saturated in the hierarchical culture and subcultures of Western medicine. Although sometimes surgically precise in its delivery of knowledge and promotion of procedural competence, a large body of "doctoring skills" - i.e. communication, professionalism, empathy, advocacy, behavioral change, cultural sensitivity - are inconsistently taught and sometimes actively devalued. For many students, a "hidden curriculum" insidiously erodes the humanistic attitudes, values, and skills they may have possessed before the clerkships began. As many medical schools have begun to discover, now is the time for radical reconsiderations of clerkship and ambulatory training.

This small group discussion presents examples of both incremental and radical changes to the clerkship curricula of 3 contrasting medical schools. Although structural and financial challenges are key pieces of this complex puzzle, the described clerkship changes focus on change management strategies and pedagogical innovations to introduce, reinforce, and promote the integration of the social and behavioral sciences (SBS) in clinical care. Each of the presenting schools is part of the larger NIH Social and Behavioral Sciences Curriculum Consortium funded under the auspices of the Office of Behavioral and Social Science Research.

007 C

9:30 - 11:00a

GEA/GSA Small Group Discussion
Adjudicating Student Professionalism Lapses: Who Should Take the Lead?

Moderator:
Carol Hasbrouck, M.S.
Assistant Dean and Director for Clinical Skills and Medical Education
Ohio State University College of Medicine

Discussants:
Joanne Lynn, M.D.
Associate Professor
Ohio State University College of Medicine

Polly Moss, M.Ed.
Assistant Dean for Student Affairs and Admissions
Northeastern Ohio Universities Colleges of Medicine and Pharmacy

Constance Shriner, Ph.D.
Associate Dean for Curriculum Evaluation and Faculty Development
University of Toledo College of Medicine

Description of Topic and Rationale: Professionalism as a construct in medicine goes well beyond the doctor-patient relationship. It should be evident in classrooms, laboratories, hallways, and patient areas. Likewise, lapses of professionalism can occur anywhere. The profession of medicine has historically been expected to police itself. But who should take the lead when student lapses in professionalism occur? Recent literature highlights the continuing importance of professionalism, although not much has been written on Student Honor Boards/Councils. Efforts have been undertaken to define standards starting with the American Board of Internal Medicine's efforts in the 1980s to identify, define and assess "humanistic qualities" and their Project Professionalism in the early 1990s. Other organizations engaged in defining characteristics and standards are: AAMC, 1998; ACGME, 1999; LCME, 2005; NBME, 2003. Much literature exists (most recently Academic Medicine November 2007) regarding all aspects of professionalism: the assessment of professionalism; efforts to develop assessment tools; establishing cultures of professionalism; identifying and addressing unprofessional behaviors; and identifying predictors of future "unprofessional" behavior. But how does an institution address the goal defined by Michael Whitcomb "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." Who should take the lead in establishing professionalism norms and in adjudicating professionalism lapses in students - faculty or students? Many medical schools have developed student honor councils charged with promoting professionalism education, as well as adjudicating professionalism lapses. Their structures and functions vary.

007 D

9:30 - 11:00a

GEA/GSA Small Group Discussion
Faculty's Professional Behavior Lapses: How to Address Them

Moderator:
Ruth Rademacher, M.D.
Assistant Professor
Medical College of Wisconsin

Discussants:
Louise Arnold, Ph.D.
Associate Dean, Medical Education
University of Missouri Kansas City School of Medicine

Catherine Lucey, M.D., F.A.C.P.
Vice Dean for Education
Associate Vice President for Health Sciences Education
Ohio State University College of Medicine

Karen Marcdante, M.D.
Vice Chair, Pediatrics
Medical College of Wisconsin

Description of Topic and Rationale: Accrediting bodies, such as the ACGME, require that faculty assess the professionalism of medical students and residents and remediate them, if necessary. In academic medical centers, learning by example is the most frequent way that medical students and residents come to understand the accepted behaviors and culture. They observe many faculty behaviors, both the good and the bad. In order to create a culture in which learners feel comfortable and supported, the faculty must conduct themselves as professionals and demonstrate appropriate behaviors for learners to model. However, not all faculty behavior is seen as professional. Observing professional behavior lapses may actually promote modeling of those unprofessional behaviors in learners. Therefore, medical schools and residency programs need appropriate and effective ways of addressing faculty's professional behavior lapses. Some institutions have processes already established, some do not, and many most likely struggle with the issue.

This small group discussion will identify and critique ways to respond to faculty's professional behavior lapses. Multiple strategies implemented at several institutions--discipline, therapy, root cause analysis, and prevention through appreciative inquiry-will be briefly described, and other approaches will be identified through group discussion. Participants will then attempt to apply the approaches to scenarios of faculty's professional lapses to determine strengths, weaknesses, and suitability of different strategies to the various situations. Finally, the barriers to addressing faculty's unprofessional behavior as well as possible solutions to overcoming the barriers will be discussed. .

214 A

9:30 - 11:00a

GEA/GIP/GIR Small Group Discussion
Learning Spaces for Health Care Education: Best Practices in Design

Moderator:
Kevin Souza, M.S.
Director, Office of Educational Technology
Associate Director, Office of Medical Education
University of California San Francisco School of Medicine

Discussants:
Deborah "Deb" Simpson, Ph.D.
Associate Dean, Educational Support and Evaluation
Director, Office of Educational Services
Co-Chair, Society of Teaching Scholars
Medical College of Wisconsin

Jennifer Stringer, M.S.
Director, Educational Technology
Stanford University School of Medicine

Aggie Manwell-Jackson, Ph.D.
Manager, Online Teaching and Learning
Manager, Learning Technologies
University of Texas Health Science Center at San Antonio

Horace Bomar
Director of Facilities Management and Planning
University of Michigan

Description of Topic and Rationale: Medical schools have seen an increase in the design and development of learning spaces during the past 5 years. Part of this increase in development is due to creation of simulation and clinical skills training facilities. In California, a state proposition is funding the development of high tech educational facilities to teach telemedicine skills at the UC medical schools, and many of these centers include new technology enhanced classrooms, simulation and clinical skills centers and high definition videoconferencing and video capture tools.

Successful facilities require collaboration between educators, educational technology and IT professionals to meet the demands of innovative curricula and tech savvy learners.

The moderator will set the stage for discussion by presenting a brief overview of why learning spaces are a hot topic for educators; examples of interesting projects in learning spaces; and why learning spaces are important to the medical education community.

Panel members will highlight the three primary perspectives required to develop successful learning spaces in medical education, these include an educator, educational technologist and a CIO.

Participants will work as a group to create a large wall sized map detailing the current landscape of learning spaces in medical education. The map will document customer needs, current trends, political and financial factors, as well uncertainties. The map will be used to identify topics for further discussion and documentation by AAMC constituents.

214 B

1:00 - 2:30p

GEA/GSA Small Group Discussion
Moral Distress in Medical Students and Residents: The Impact of Reflective Writing and Small Group Discussions

Moderator:
Bonnie M. Miller, M.D.
Associate Dean for Undergraduate Medical Education
Vanderbilt University School of Medicine

Discussants:
Jeffrey Bishop, M.D.
Associate Professor of Medicine
Director, Clinical Ethics Service
Associate Program Director, Internal Medicine
Vanderbilt University School of Medicine

Donald Brady, M.D.
Associate Dean for Graduate Medial Education
Vanderbilt University School of Medicine

Kim Lomis, M.D.
Assistant Professor of Surgery
Surgery Clerkship Director
Third Year Intersession Director
Vanderbilt University School of Medicine

Description of Topic and Rationale: Moral distress is defined as the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of hierarchical or institutional constraints. This phenomenon has been very well-described in the nursing literature and numerous studies have linked it to burnout, cynicism, and withdrawal from patient care. After meeting with medical students on a monthly basis for seven years to discuss their clinical experiences, we suspected that medical students experienced moral distress as well, and have subsequently documented this with survey studies. Using the same instrument, we have also found that residents experience moral distress. The most common inciting factors for our learners are lack of professional behaviors on the part of team members, systems that impede the delivery of high quality care to all patients, and situations of medical futility.

We have used both reflective writing and small group sessions to help trainees process morally challenging situations. While we have no data that proves these exercises mitigate the potentially negative impacts of moral distress, both student and faculty participants have responded positively to these sessions. Students report a sense of moral support and faculty feel better connected to the lived experiences of their trainees. The goals of this session will be: to reflect on personal experiences with moral distress, to discuss the potential impact of moral distress on the professional growth of physicians-in-training, and consider whether reflective writing, small group discussions and/or other activities might provide benefit.

006 A

1:00 - 2:30p

GEA/GSA Small Group Discussion
Developing a Competency-Based Curriculum: Are We Meeting the Needs of Medical Students in the Areas of Practice-Based Learning and System-Based Practice?

Moderator:
Lynn Cleary, M.D.
Senior Associate Dean, Education
Vice President, Academic Affairs
State University of New York Upstate Medical University

Discussants:
Elza Mylona, Ph.D.
Associate Dean, Educational Development and Evaluation
Associate Professor, Clinical Preventive and Internal Medicine

Suzanne "Suzi" Rose, M.D, M.S.Ed.
Associate Dean, Academic and Student Affairs
Mount Sinai School of Medicine

Norma Saks, Ed.D.
Assistant Dean for Educational Programs
Director, Cognitive Skills Program
University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School

Description of Topic and Rationale: In 2006, AAMC published the response of the Group on Educational Affairs to the 2004 IIME Dean's Committee Report, "Educating Doctors to Provide High-Quality Medical Care: A Vision for Medical Education in the United States." Prior to the publication of this report, various GEA constituents identified what was working best in medical education. One of these best practices was "a recognition that the separate 'silos' of UGME, GME and CME are barriers to systems change" and stated that, "The primary way in which this goal can be achieved is through enabling learners at all levels to develop and exhibit many elements of professional competence, such as acquisition of a strong and broad knowledge base, a wide array of clinical and professional skills, and exemplary professional and humanistic behaviors." Among the most frequently cited areas to improve was "increased integration across the medical education continuum (to include development of assessment measures that provide a comprehensive view of physician performance from UGME to GME to CME)."

The ACGME competencies in the areas of Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice have been adopted widely for training medical residents. More recently these same competencies, modified appropriately, have been recognized as beneficial for training across the medical education continuum, including undergraduate medical students. Many medical schools have adopted modified ACGME competencies to guide undergraduate education.

Some of the ACGME competencies have traditionally been taught at the undergraduate level (e.g. Patient Care and Medical Knowledge), and other competencies have been included in curricula in more recent years (e.g., Communication Skills and Professionalism). But Practice-Based Learning and Improvement and Systems-Based Practice are newer to the undergraduate medical education curricula; medical schools are exploring how to best teach topics, which include, patient safety, and economics of health care delivery, health literacy, access to health care/health care disparities, and the challenges and impact of a team approach to patient care.

The focus of this session will be to explore how medical schools are integrating the teaching of practice-based learning and improvement and systems-based practice into the undergraduate curriculum. By attending this session, participants will participate in an interactive discussion to learn more about the successes and challenges of teaching and evaluating these concepts in the preclinical curriculum.

006 B

1:00 - 2:30p

GEA/GSA Small Group Discussion
Using Distributed Learning to Enhance the Experience of Clerkship Students and Support the Development of Clinical Skills

Moderator:
Dina Kurzweil, M.A.M.S.
Deputy Director
Uniformed Services University of the Health Sciences

Discussants:
Jeffrey Goodies, Ph.D., A.B.P.P.
Assistant Professor
Uniformed Services University of the Health Sciences

Beth Marcellas, Ph.D.
Senior Instructional Designer
Uniformed Services University of the Health Sciences

Dale C. Smith, Ph.D.
Senior Vice President
Uniformed Services University of the Health Sciences

Description of Topic and Rationale: Clerkships begin to bridge medical students' transition from classroom learning to medical practice. During clinical clerkships, students spend a significant amount of time away from their medical schools, observing medical staff at other locations and participating with them in patient care activities. Clerkship sites can vary in the types of providers and skill level those providers have for teaching different skills.

While distance from the medical school's faculty and other students can be a problem during the clerkship, students do not have to lose touch with their schools and the medical specialists there. Distributed Learning (DL) uses technology to enable students to access course materials and communicate with faculty members and other students at any time, "providing students with greater flexibility and eliminating time [and distance] as a barrier to learning." DL is used to reach widely-dispersed audiences, and it has been a subject of great interest to healthcare professions.

This session will open with a discussion of how administrators, faculty members and educational technology specialists worked together to use DL tools to integrate behavioral science training into the Family Medicine clerkship. It will then open out into a wider discussion of DL tools, how they can be used to enhance the clerkship experience in a variety of different types of clerkships, and how administrators can support these types of curricular enhancements.

As students are exposed to a variety of medical problems and preceptors, the DL site can serve as a medical home for students where they can retrieve information and converse with faculty and other students as questions arise.

006 C

1:00 - 2:30p

GEA/GSA Small Group Discussion
Increased Medical School Class Size: Implications for the Clinical Clerkships

Moderator:
Philip A. Masters, M.D.
Clerkship Director, Internal Medicine
Vice Chair, Education
Pennsylvania State College of Medicine

Discussants:
Kristy Barnes-Le, M.D.
Associate Clerkship Director, Internal Medicine
Pennsylvania State College of Medicine

Cynthia H. Ledford, M.D.
Clerkship Director, Internal Medicine
Associate Program Director
Ohio State University College of Medicine

Description of Topic and Rationale: Following the June, 2006 AAMC call for a thirty-percent increase in medical school class size, many Colleges of Medicine nationwide have planned and subsequently increased enrollment, compelling educators to confront issues of classroom and clinic space, faculty availability, and financial limitations. Schools that have increased class size have already seen the effects of the first wave of students within the classrooms, most of whom are still in, or just completing, their pre-clinical training. Substantial educational challenges are anticipated as this student cohort moves into the clinical clerkship years, with possible impacts on students, faculty, and the educational experience. Specifically, concerns have been raised regarding identification of an adequate number of appropriate teaching sites and difficulty recruiting and retaining faculty. Furthermore, there are concerns about aligning clinical training with other changes in the overall medical school experience, particularly with appropriate resources allocation.

Because issues associated with increased class size span departmental boundaries, the intention of this Small Group Discussion is to bring forward the challenges, benefits and potential solutions derived from the experiences of medical student educators, with an emphasis on problem-solving for the clinical training of medical students. The discussion will also be applicable to the broader audience of medical educators, including pre-clinical teachers, medical school administrators and deans. It is hoped that the discussion will thus engage the pertinent stakeholders and help consolidate efforts to adjust to educating larger numbers of future U.S. physicians.

006 D

1:00 - 2:30p

GEA/GSA Small Group Discussion
Think Big!: USMLE Changes Open the Door for New Models of Medical Education

Moderator:
Aaron Michelfelder, M.D.
Chair, Curriculum Committee
Loyola University Chicago Stritch School of Medicine

Discussants:
Gregory Gruener, M.D., M.B.A.
Associate Dean, Educational Affairs
Loyola University Chicago Stritch School of Medicine

Michael Koller, M.D.
Loyola University Chicago Stritch School of Medicine

Patricia McNally, Ed.D.
Director, Faculty Development
Loyola University Chicago Stritch School of Medicine

Description of Topic and Rationale: The NBME has announced that USMLE steps 1 and 2 will likely be collapsed into one licensing exam given to the medical students 36 months after matriculation. This change would require that students be prepared to remember and integrate the knowledge from both the clinical basic sciences. Therefore, the door is open to rethink medical education, since the old model of the two basic science and two clinical years will be obsolete. This session will provide both a rational framework for thinking about changing the medical school curriculum, while allowing opportunity to share ideas. Come prepared to "blow up" the traditional curriculum and think outside of the box. In the end, you'll be expected to take home some very practical points to apply to your own curricular change.

In 2007, the National Board of Medical Examiners announced that the United States Licensing Exams Steps 1 and 2 will likely be given as a single exam 36 months after matriculation. The NBME expressed the idea that two preclinical and two clinical years in medical education is currently being driven by USMLE step 1 and 2, and the NBME wants to create the opportunity for curricular innovation at medical schools. This change in testing will have a major impact on how medical students are taught, as students will need to remember and integrate both basic and clinical sciences to pass the exam. This change is a significant opportunity to improve medical education throughout the world, and schools should be beginning to prepare for the change. Instead of every school reinventing the wheel, the community of medical educators should collaborate to create optimized curricula for adult learning. This session is designed to present the rational framework to consider curricular change based on adult learning theories, and then to begin the dialogue of sharing ideas for future curricular change.

007 A

1:00 - 2:30p

GEA/GSA Small Group Discussion
Developing, Implementing, and Maintaining a Professionalism Program: Lessons Learned at Three Medical Schools

Moderator:
Karen Szauter, M.D.
Medical Director, Standardized Patient Center
The University of Texas Medical Branch Galveston

Discussants:
Kate Fallon, M.D.
Dean, Student Affairs and Admissions
Texas A&M Health Science Center College of Medicine

Anne Gill, Dr.PH., M.S.
Assistant Professor
Professionalism Appraisal and Competency Evaluation Chair
Baylor College of Medicine

Julie Kutac, M.A.
Graduate Student
The University of Texas Medical Branch Galveston

Description of Topic and Rationale: The last ten years has brought about a sea change in the way society, faculty, and learners think about and define medical professionalism. The American Board of Internal Medicine's Project Professionalism, the Physician Charter, the General Medical Council's Duties of a Doctor are but a few of the many new initiatives developed to address the growing concerns about medical professionalism. Medical educators are responding to this national call by reviewing and reassessing the teaching and evaluation of medical professionalism. As such, professionalism is being transformed from a "white coat ceremony" into a core competency.

Determining how to model, teach, and evaluate professionalism has led to the development of new programs and initiatives nationwide. Indeed, the entire November 2007 edition of Academic Medicine is devoted to the issue of professionalism. These three Texas medical schools represent institutions in different stages of developing, implementing, and maintaining professionalism initiatives. Using Appreciative Inquiry as a conceptual framework, this small group discussion is designed to address common concerns related to the development, implementation, and management of professionalism programs. Lessons learned from the discussants and other participants may offer insight into potential problems common to all.

007 B

3:00 - 4:30p

GEA/GSA Small Group Discussion
Preparation for Residency: Are We Optimizing the Sub-Internship?

Moderator:
Meenakshy Aiyer, M.D.
Clerkship Director, Internal Medicine
University of Illinois College of Medicine at Peoria

Discussants:
Keith Armitage, M.D.
Internal Medicine Program Director
President, Association of Program Directors of Internal Medicine
Case Western Reserve University School of Medicine

Michael Fitz, M.D.
Clerkship Director, Internal Medicine
Loyola University Chicago Stritch School of Medicine

Heather Harrell, M.D.
Clerkship Director, Internal Medicine
University of Florida College of Medicine

Description of Topic and Rationale: As residency programs face increasing demands to balance patient care with duty hours, the transition from medical school to residency is garnering much attention. Program Directors want PGY1 residents who can be highly functional at the beginning of residency while medical schools want to ensure that their learners will be optimally prepared with the unique skills needed to be a successful PGY1. The exponential increase in work load and autonomy begins immediately on the first day of residency and so it is important that students are adequately prepared to meet this challenge. Currently, over 75% of medical schools require a sub-internship and 75% of all medical students opt to take an internal medicine sub-internship. Within Internal Medicine, most Clerkship Directors serve the dual role of Sub-internship Director. Thus the Clerkship Directors of Internal Medicine created a Task Force to address specific issues and needs related to the sub-internship. This multi-institutional group of educators has developed a sub-internship curriculum and guidelines on the roles and responsibilities of sub-internship directors. The Task Force anticipates completing an Internal Medicine Sub-internship Primer for preparation for the internal medicine internship and is actively collaborating with the NBME to develop assessment tools tailored to the sub-internship. Despite these advances, there remains significant variability between institutions as to the expectations, requirements, curriculum and evaluation of the sub-internship.

006 A

3:00 - 4:30p

GEA/GSA Small Group Discussion
The Winds of Change: Best Practices and Learning from Our "Failures"

Moderator:
Karen Marcdante, M.D.
Vice Chair, Pediatrics
Medical College of Wisconsin

Discussants:
Molly Cook, M.D.
Professor of Medicine
Director, Academy of Medical Educators
University of San Francisco School of Medicine

Deborah "Deb" Simpson, Ph.D.
Associate Dean, Educational Support and Evaluation
Director, Office of Educational Services
Co-Chair, Society of Teaching Scholars
Medical College of Wisconsin

John X. Thomas, Ph.D.
Senior Associate Dean, Medical Education
Northwestern University Feinberg School of Medicine

Description of Topic and Rationale: Changing any organization can be difficult. Changing a medical school embedded in an Academic Medical Center (AMC), with its multiple missions and faculty who prefer autonomy, is often daunting. Fortunately, there are success stories and learning opportunities from the less successful tries. Many faculty members are searching for a way to change the curriculum, improve the teaching environment, recognize and reward educators or just finding a way to provide colleagues with constructive feedback on their teaching. The business literature offers multiple models and possible strategies, but do they work in our medical schools/AMCs?

Our panelists will provide a brief description of how they have approached projects that require change, identifying strategies that have worked for them. Common scenarios requiring change within a medical school/AMC will then be presented to the audience. Using an audience response system, audience members will identify their initial approach from a series of options drawn live from the audience. Building on those answers, the panelists and audience members will interactively discuss the risks and benefits of the various approaches, focusing on the intended and unintended consequences of various change projects on the organization and the key stakeholders. Explicit links between the strategy and change models will be drawn. The moderator will then facilitate a debriefing to identify themes and issues. A reference list will be provided at the end of the session.

006 B

3:00 - 4:30p

GEA/GSA Small Group Discussion
Millennial Students, Medical Education, and Mental Health - An Oxymoron?

Moderator:
Caroline P. Haynes, M.D., Ph.D.
Associate Dean for Medical Education
Duke University School of Medicine

Discussants:
Kathleen Franco, M.D.
Associate Dean of Admissions and Student Affairs
Case Western University College of Medicine

Lisa Mellman, M.D.
Senior Associate Dean for Student Affairs
Columbia University College of Physicians and Surgeons

Nancy E. Oriol, M.D.
Dean of Students
Harvard Medical School

Description of Topic and Rationale: The majority of the students coming to medical school today are members of the "Millennial" generation, born roughly between 1982 and 2002. Millennials have been characterized as optimistic, generous, community-minded, and sheltered. Most of their teaching faculty and residents are members of the "Baby Boom" generation, known for the value its members place on success and prosperity, or of "Gen-X", known for the tendency of its members to be independent, comfortable with confrontation and skepticism, and focused on self-actualization and personal success. Much is being written and discussed about generational differences in the workforce in general, and there is increasing recognition of those differences in the medical education setting. At the same time, there are system-wide changes occurring in medical education due to increasing financial pressures within academic medical centers and stress on faculty and residents to demonstrate productivity, increased emphasis on regulation and compliance that sometimes limits the experiences of medical students, and erosion of teaching time due to multiple factors, including restrictions on resident and student duty hours in the clinical setting and shorter hospital stays for patients. Simultaneously, more students are entering higher educational settings with diagnosed mental health conditions and already using psychotropic medication, and university mental health services nationwide are struggling to cope with the frequency and acuity of students' mental health needs. This combination of factors should be of concern to medical educators, and may represent a "perfect storm" of factors that put medical students at higher risk for mental health issues such as depression, anxiety disorders, and substance use disorders. The focus of this discussion group will be on examining the ways in which medical educators can become aware of how these factors are interacting to contribute to student mental health concerns at their institutions, how they can alert teachers and students to these concerns, and how the medical education system and student support services can be designed to best develop our current students in their adaptation to the current medical environment.

006 C

3:00 - 4:30p

GEA/GSA Small Group Discussion
An Approach to the Administration's Response to Medical Student Stress and the Use and Abuse of Alcohol, Prescription Medications, and Illicit Drugs: Three Schools' Experiences

Moderator:
Gerald Sterling, Ph.D.
Associate Dean, Medical Education
Temple University School of Medicine

Discussants:
Samuel Parrish, M.D.
Associate Dean of Student Affairs
Drexel University School of Medicine

Charles Pohl, Ph.D.
Associate Dean, Student Affairs
Thomas Jefferson Medical College

Kathleen Reeves, M.D.
Associate Dean, Student Affairs
Temple University School of Medicine

Description of Topic and Rationale: Mental wellness and mental illness are important issues that must be addressed by medical school educators. A significant number of medical students suffer from stress and depression-associated illness during medical school. 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. This discussion group will focus on one mental health issue, alcohol and other drug use and abuse, affecting medical students. The discussion, though specific to this issue, will also address more global issues pertaining to medical student mental health. With many students at risk for suffering from stress, medical students are also at high risk for suffering the effects of alcohol and other substance abuse. Many students use alcohol and other drugs on a regular basis to deal with the stressors associated with medical school. The personal and professional consequences of this behavior are significant for the student, the patients and the school.

006 D

GEA/GSA Small Group Discussion
28 Years of Experience with an Alternative to the Traditional MD Curriculum
The Ohio State University College of Medicine

Moderator:
Bruce A. Biagi, Ph.D.
Associate Professor, Phsyiology and Cell Biology
Ohio State University College of Medicine

Discussants:
Philip F. Binkley, M.D., M.P.H.
Professor Department of Internal Medicine
Ohio State University College of Medicine

Holly Cronau, M.D.
Associate Professor-Clinical Department of Family Medicine
Ohio State University College of Medicine

Thomas F. Mauger, M.D.
Associate Professor of Ophthalmology
Ohio State University College of Medicine

Philip F. Binkley, M.D., M.P.H.
Professor
Ohio State University College of Medicine

Description of Topic and Rationale: Following a brief description of the ISP, its structure, student evaluation and strengths for students, faculty and curriculum the discussants and moderator will lead a discussion of interested participants based on some of the following questions. Questions for Discussion:

• Potential isolation and not much student group work/interaction.
• How to best screen students for the ISP program. Student self-selection generally works well but not always. It is difficult to determine who will struggle in this type of program.
• Time commitment of ISP module leaders and administration to assure success.
• LCME accreditation concerns in knowing if the traditional and ISP programs are comparable and cover the same content. There are differences in content covered, as well as time devoted to content; however, students from both programs have typically performed well and comparably on USMLE Step 1.
• Sources of good text books?
• How to address critical analysis and clinical problem solving knowledge and skills.
• How to integrate Anatomy, psychosocial, behavioral and physical exam competencies in a self-study format?

With the recent calls from the AAMC and others for increased medical school capacity and numbers of physicians combined with flat or marginally increasing medical school funding, alternative programs that produce high quality gradates with limited resources should be reviewed and considered. (1., 2.) The Ohio State University College of Medicine Independent Study Program (ISP) is a proven alternative to the traditional MD lecture discussion type program. It provides an optional educational pathway that meets the needs of students with a different learning style and/or different lifestyle. The program has produced good results that have been measured against fair and appropriate norms (see table 1). This program has a long-standing history and was considered truly innovative when it was first implemented in 1970 to increase the number of physicians with no new resources. With the goal for medical schools to increase their class sizes, the ISP could serve as a model for other institutions to emulate. The U.S. Department of Health and Human Services released a report in 2006, projecting a shortfall of approximately 55,000 physicians in 2020. "If current trends continue, the full time equivalent (FTE) physician supply is projected to grow to 866,400 by 2020, while demand for physicians will increase to 921,500 due to the growth and aging of the U.S. population. The report projects shortages will be in greatest in non-primary care specialties.' (3.) In the January 2005 Council on Graduate Medical Education report, "Physician Workforce Policy Guidelines for the United States, 2000-2020" recommended an increase of 3,000 medical school graduates by 2015 in order to meet rising demand. "Only under the most optimistic of various supply and demand scenarios outlined in the report would the nation have an adequate supply to meet demand in the year 2020. It further predicted a projected shortage of about 85,000 physicians in 2020. (4.) In the 2004, Merritt, Hawkins & Associates, a health care staffing and consulting firm, publication, "Will the Last Physician in America Please Turn off the Lights? A Look at America's Looming Doctor Shortage." predicted there will be a shortage of 90,000 to 200,000 physicians. 95.)