DO 2008 EFM-2 Requirement Modifications sign now


We, the undersigned members of the Western University of Health Sciences College of Osteopathic Medicine of the Pacifics (COMP) graduating class of 2008, petition that the following temporary changes be made to the Essentials of Family Medicine II (EFM-2 [DO8550]) course to be implemented for the spring semester of the 2007-2008 academic school year:

1. The requirement to submit a case report be removed.
2. The requirement to submit three logs over three rotations be decreased to a requirement to submit one log over the course of either one rotation or two two-week rotations.


On February 1st, 2008, the majority of the COMP Class of 2008 received an email from the EFM course coordinator informing us of the requirements to pass the EFM-2 course, which are due by April 1st or 15th of 2008. We were notified in this email that passing this course is a requirement for graduation, which is scheduled for May 16th, 2008.

The EFM-2 requirements include:
- Completion of 12-16 CME courses.
- Completion of 8 business modules
- Submission of a minimum of 3 logs (Patient, Procedure, Conference), 1 per rotation from January April, signed by a preceptor or other acceptable person.
- Write and Submit a Publishable Case Report with proof of receipt prior to April 15th.

The intention of the course, as outlined in the syllabus, is to help the student to be able to successfully transition into his or her post-graduate training program and future medical practice. We appreciate and respect the intent of the requirements of the EFM-2 course, and agree that they could serve to accent the clinical coursework students traditionally participate in during their 4th year of medical school.

Unfortunately, we feel that the timing of the presentation of these requirements, with 8.5-10.5 weeks from the date of the notification to the due date(s), does not leave us with enough time to complete the tasks in a manner which would accomplish the goal of actually learning from the experience. Instead, it appears to us that the timing creates for a crash course in life long learning. It is common knowledge that crash courses do not result in truly learned material, but rather utilize short term memory.

Although a lot of time and planning may have gone into the development of the EFM-2 course itself, it appears that the actual roll-out of the course requirements was a bit pre-mature. To better support our argument, we would like to share the following points of information:

1. CASE REPORT unreasonable timing:
According to Vandenbroucke JPs article In defense of case reports and case series (Ann Intern Med 2001;134(4):330-4), most case reports are on one of five topics:
An unexpected association between diseases or symptoms.
An unexpected event in the course of observing or treating a patient.
Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
Unique or rare features of a disease.
Unique therapeutic approaches.

Furthermore, the Journal of Medical Case Reports ( states that they welcome well described reports of cases that meet one of the following criteria:
1. Unreported or unusual side effects or adverse interactions involving medications
2. Unexpected or unusual presentations of a disease
3. New associations or variations in disease processes
4. Presentations, diagnoses and/or management of new and emerging diseases
5. An unexpected association between diseases or symptoms
6. An unexpected event in the course of observing or treating a patient
7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Case reports should include an up-to-date review of all previous cases in the field. Authors should seek written and signed consent to publish the information from the patients or their guardians prior to submission.

Considering the above information, it is unlikely that students will
a) come across a case that is unique or interesting enough to meet the commonly accepted guidelines for a case report in the next few weeks, or
b) research said case (if they were fortunate enough to come across one) in a manner that would result in a well written and PUBLISHABLE case report, or
c) find a preceptor who is willing to sign onto a case report that is rushed and thus likely sub-par.

Having said that, it is more likely that people will be forced to submit poor quality, unresearched and unorganized Case Reports that are on neither rare nor unique diseases/pathologies/cases. Consequently, this will not be the best training for writing a real case report in our future careers as physicians. In addition, this really wont look very good for COMP or the individual students. Is this the reputation that we want to set for our students and our school?

2. LOGS Unbalanced expectations:
The email was received on February 1st, yet the requirements indicate keeping patient logs over the course of 3 months from January through April. At this point, many students only have 2 months left of rotations as of the first week in February.

Also, there are some of our classmates who are in Ecuador starting this week for international rotations lasting through the next 4-6 weeks. This leaves them approx 2-4 weeks in the country with access to adequate internet services (as the email indicated Broadband would be best for the modules) to complete all the requirements. This does not include any other students who may be abroad. It should be noted that with proper notification, these logs could be kept manually even while abroad, but due to the late notice we received, that is not a reasonable option at this point.

The email did indicate an exception would be made for vacation months, but this actually seems to be an acknowledgement of requiring something from only a portion of the class in order to graduate. Shouldnt the entire class be given the same standards and requirements when it comes to evaluation for graduation?

If it is a known fact that the requirement is expecting more than most students will be able to provide, then maybe the requirement is unreasonable and should be reconsidered for this year. Otherwise, a portion of the class is required to complete what surmounts to busy work in order to graduate with their peers who are exempt from the same assignment(s).

Finally, with the Match around the corner (both AOA and ACGME), there may be some unfortunate people dealing with a scramble, and many others having to plan for moving (both in and out of state). In addition, it is not uncommon for medical students to save the end of their 4th year as a time for major life events such as international rotations, weddings, vacation travel, etc. Springing on these assignments with such late notice, and no acknowledgement of their unrealistic expectations, shows what could be perceived as a lack of respect for our time as professionals (and future colleagues).

3. INFORMATION Not accessible:
The email submitted to us contained the following statement:
If you find a broken link or a page that does not load in your browser, try it on another computer, brand or web program, as some sites may not be accessible with some programs, operating systems, etc. We did fairly rigorous testing prior to launch, but some OS, programs, browsers or other equipment simply may not work with yours. If this is the case, you will need to either find or use an appropriate alternate method to view the resource, but please let us know.

a. If the assignment is deemed important enough to develop a requirement with such late notice and in such a rush, then the documents which are intended to aid in the completion of the assignments (such as the log template), should be made available by any means necessary. In this case, there is actually the prior knowledge that the links do not work, yet no effort made to assist students in accessing the documents. Other ways in which the documents could have been made available to students include:
Email them as attachments (How to Write a Case Report and Patient/Procedure Log Template)
Put them on Blackboard (an entity we are familiar with using and have not had major problems accessing in the past)
Put them in the postal mail

b. There seems to be an implication made in the statement that students have access to multiple computers and operating systems. This is not a reasonable expectation. In addition, the problem is likely not the OS/Programs/Browsers, but rather the link to or format of the actual resources. This is something that should be cleared up before setting a deadline that requires access to these documents. Although the email indicated that a lot of beta testing went on before hand, it appears that a major problem was still not fixed before go-live.

c. Although it says let us know at the end of the statement, it should be noted that the email was sent on a Friday. Thus, by the time students got home from their rotations and checked their email, there was nobody working and able to address our concerns. With such late notice of the requirements and a limited time period for completing said requirements, this is a significant delay.

4. ALUMNI Relations Not a great start:
As most people at COMP know, we dont have the best track record for Alumni Relations. Ending a students academic career at COMP with this type of experience doesnt really bode for setting the stage for strong future relationships with the soon to be alumni from DO Class of 2008. This is in no means a threat, but rather a point of information. From students, and soon to be alumnis, point of view, these types of situations leave us feeling disrespected and create a general sense of frustration towards the college (even though this may be the result of the actions of one department).

As you can see, we feel that the timing of the announcement of this course and the associated due dates is poor, and does not allow for the academic learning goals of these assignments to be achieved, even if the tasks are completed. Early on in 4th year, when doing audition rotations and sub-internships, students are likely inundated with procedures and interesting cases more like a residency would be. If the goal is to prepare students for a true residency-like experience, maintaining case logs and looking for case report material would best be done at that time.

Based on the above arguments, with all due respect, we submit to you the aforementioned petition to adjust the EFM-2 course requirements for the COMP graduating class of 2008.

In the future, we hope that you will reconsider the presentation of this requirement for the future COMP classes. Consider presenting this information during the last two didactic weeks of the MSIII year, in order to ensure that all members of the class are made aware of and prepared for completing these requirements in advance of beginning their 4th year. In addition, this will allow for the sharing of sample logs, sample case reports and possibly a Q&A session for the students before they embark on completing these requirements. This type of format could optimize the students chances for learning from the assignments.

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Chad OneillBy:
Petition target:
Essentials of Family Medicine Department Coordinator(s)


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