Whats Been Going on in Undergraduate Medical Education

1
Whats Been Going on in Undergraduate Medical
Education

• Michael F. Rein, M.D.
• Jordan Professor of Epidemiology in Internal
  Medicine
• Associate Chair for Undergraduate Medical
  Education

2
Starting 100 Years Ago

• 1906 The foundation of the Department of
  Medicine at UVa
• 1910 The Flexner report ranks UVa SOM as a
  Class A medical school
• One of only 22 so ranked in the country
• Post hoc ergo propter hoc??
• We are still Class A
• 2006 UVa School of Medicine Achieves Its Highest
  Ever Ranking (23) In U.S. News World Report
• Coincidence? I think not!

3
Site of UVA Medicine Clerkship 1911
4
Recent Improvements in the Clerkship
5
Ambulatory Internal Medicine

• One month of the Medicine Clerkship is now held
  in a practitioners office in Virginia
• Much of internal medicine is certainly ambulatory
• More diagnosis
• Spectrum of disease
• Preventive Medicine
• Patient Centered Medical Home
• Experience with some of the business of
  internal medicine

6
Student Morning Report

• The Clerkship Director Meets with the students at
  UVA each weekday morning.
• Students present cases, and the Clerkship
  Director guides the discussion.
• Emphasis is on approach to general problems,
  differential diagnosis, and interpretation of
  clinical information.

7
Ethics Rounds

• Twice each month during Student Morning Report
• Students meet with the Director of the Ethics
  Consultation Service and present and discuss
  cases with ethical components

8
Clinical Skills Educator Program

• Funded by the Dean
• Students on General Medicine at UVA
• Students meet in groups of 4 with an individual
  faculty member
• Twice weekly for 2 hours each
• Bedside teaching emphasizing physical diagnosis

9
Chief Residents Rounds

• Twice weekly, 1 hour
• Discussion with a Chief Resident of a topic of
  interest
• Extremely highly rated portion of the clerkship

10
OUTCOMES
11
Internal Medicine Subject Examination, Yearly
Means, Standard Deviations vs. National Mean
12
Equivalence Among Inpatient Sites 06-07 Data

• 80 complete
• Subject Exam Score Means
• UVA 78.7
• Roanoke 75.5
• Salem 77.4
• P 0.25
• Subject Exam Score Medians
• UVA 77.5
• Roanoke 77.5
• Salem 76.0
• Letter grade distribution P 0.66

13
Number of UVA Students Choosing Internal Medicine
Residencies
14
Where our students matched this year (Class of
2007)

• Baylor College of Medicine
• Boston University
• Cambridge Hospital, Tufts
• Duke University
• Georgetown University Hospital
• Johns Hopkins University
• Johns Hopkins, Bayview
• Massachusetts General Hospital
  
• Mayo Medical School
• McGraw, Northwestern
• National Naval Med Centerr

• Thomas Jefferson University
• U of California, San Francisco
• University of Maryland
• University of North Carolina
• University of Pittsburgh
• University of Rochester, Strong
• University of Utah
• University of Virginia
• Wake Forest University
• New England Medical Center

15
Mulholland Society/Class of 1988Departmental
Teaching Award

• In recognition of the department which has
  contributed the most to the clinical education of
  the next graduating class of the School of
  Medicine.
• The Department of Medicine has won this award 11
  (out of 19) years 1991, 1992, 1993, 1994, 1995,
  1997, 2002, 2003, 2004, 2006, 2007

16
University of Virginia School of Medicine Award
for Excellence in Teaching (The Deans Teaching
Award) 2003-2006

• Recognized by students and faculty as an
  outstanding teacher
• 2006
• John D. Voss, General Medicine, Geriatrics and
  Palliative Care
• 2005
• Mitchell H. Rosner, Nephrology
• Lawrence W. Gimple, Cardiovascular Medicine
• 2004
• Margaret Plews-Ogan, General Medicine, Geriatrics
  and Palliative Care
• Brian Wispelwey, Infectious Diseases and
  International Health
• 2003
• Mohan M. Nadkarni, General Medicine, Geriatrics
  and Palliative Care
• Gregory C. Townsend, Infectious Diseases and
  International Health

17
All-University Teaching Award

• In recognition of notable teaching and
  considerable skill in motivating and inspiring
  students at the University of Virginia
• 2006 Brian Wispelwey, Infectious Diseases and
  International Health
• 2005 Mitchell Rosner, Nephrology
• 2004 Eugene C. Corbett, Jr., General Medicine,
  Geriatrics and Palliative Care

18
David C. Harrison Distinguished Educator

• This is the highest teaching award given by the
  School of Medicine. It recognzes a lifetime of
  teaching excellence.
• 2005 Brian Wispelwey, Infectious Diseases and
  International Health

19
Robley Dunglison Award2003-2007

• The award was established by a gift from the
  Class of 1964 in honor of the first faculty
  member of the School of Medicine. It is given by
  the graduating class to a member of the faculty
  in recognition of outstanding teaching efforts
  and personal contributions toward arousing
  interest and inspiring the endeavors of students
• 2007 Steven M. Koenig, Pulmonary and Critical
  Care Medicine
• 2006 Michael F. Rein, Infectious Diseases and
  International Health
• 2005 Michael F. Rein, Infectious Diseases and
  International Health
• 2003 Eugene C. Corbett, Jr., General Medicine,
  Geriatrics and Palliative Care

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Medicine Faculty Nominated as Excellent Teachers
in 2007 Poll

• Seki Balogun
• Eugene Barrett
• Daniel Becker
• Jim Bergin
• Alan Binder
• Stephen Caldwell
• Robert Carey
• Eugene Corbett
• Rebecca Dillingham
• Gerald Donowitz
• Matthew Goodman
• William Grosh
• Molly Hughes
• Kambiz Kalantarinia
• Steven Koenig
• Anthony McCall
• Mary McMasters
• Christopher Moore
• Randall Moorman

• Mohan Nadkarni
• Christopher Parsons
• Richard Pearson
• Michael Rein
• Mitchell Rosner
• William Scheld
• Vanessa Shami
• Costi Sifri
• Steven Taylor
• Tyler Taigen
• Gregory Townsend
• Ajeet Vinayak
• Amy West
• Mark Williams
• Brian Wispelwey
• And from our affiliates
• Michael Wiid
• Jon Sweet

21
Curriculum Reform
22
IM Clerkship Under New Curriculum

• 8 weeks duration in third year
• 4 weeks Ambulatory Internal Medicine
• 4 weeks Inpatient General Internal Medicine
• 4 weeks required selectives in fourth year
• 2 selectives of 2 weeks each
• Standard inpatient rotations (MICU, CCU,
  Cardiology, Digestive Health, Hematology/Oncology
• 2 weeks of rigorous or shortened elective
• Cardiovascular Emergencies interdisciplinary

23
Subject Exam Performance with Shortened Clerkship

• Mean
• 12 week clerkship (04-05) 78.5
• Transition Year (05-06) 79.1
• 8 week clerkship (06-07) 77.6
• 80 complete
• Missing last (best) group
• P 0.39

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IM Clerkship Under New Curriculum

• Required Advanced Clinical Elective (ACE)
• Acting Internship
• General Medicine
• Acute Cardiology
• Digestive Health
• Hematology/Oncology
• New Hospitalist AI
• Planned Geriatrics/Palliative Care

25
After 100 years, undergraduate medical education
in the DOM survives, prospers, and evolves.

• The DOM has always been an environment in which
  teaching is respected and supported.