Case Change Process: Overview The CICBC clinical cases, like clinical medicine, are in a state of continual evolution. The health care problems themselves were initially reviewed and substantially altered prior to their introduction into the UCB/UCSF JMP curriculum. To understand the case-change process, it is important to recognize that the cases are evaluated at 2 levels: (1) Their INDIVIDUAL integrity (i.e., do the treatment scenarios described and the treatments rendered continue to reflect medical care currently provided to persons or communities presenting with these specific problems?). (2) Their COLLECTIVE contribution to the overall curriculum, given the priorities articulated by the program’s faculty. Because of the considerable variation which exists within each JMP class (life experiences, individual expertise, group interests etc.,) more significant case changes are considered after a case has been used for 2 consecutive years. This is not true for changes which are indicated to improve the clarity or clinical accuracy of the case. Figure 1 provides a graphic representation of case changes as they are collected and directed to the Case Development Committee (CDC). Figure 2 provides a graphic representation of the work of the CDC in evaluating changes proposed by case stewards and brought to the faculty as a whole for discussion and approval. Figure 3 provides a graphic representation of the sequence of CDC meetings which permit the methodic review of 3 CICBC units every 4 months. Key Components of the Case Change Process (1) On Friday of each week, at the completion of day 3 of the case, tutors meet with the Unit Steward (Unit Stewards are the ‘owners’ of the 7 cases in their unit and are charged with maintaining their Individual integrity (see #1 above). It is at the tutor meeting that students’ and tutors’ perceptions of case changes are first identified. These discussions and data from the previous year assist the Unit Steward in deciding if and how the case might be modified. Low-level changes (involving text clarification, image enhancement, etc) are entered into the case-change database and generally approved for change prior to the case’s next use. (2) Changes which are recommended by the Unit Steward, but which have larger curricular implications (Level 3 and 4 changes – involving the introduction of new content or the removal of specific lines of inquiry) are reviewed with the CICBC curriculum director and then prepared for presentation at a subsequent CDC meeting.. Membership of the CDC The interrelated nature of the CICBC cases require that more substantive changes be understood in terms of their implications for students in all 3 years of the curriculum. For this reason, meetings of the CICBC are attended by JMP core content experts, Unit Stewards and 2 JMP 4^th year students, one of whom also sits on the JMP Curriculum Committee.