ReviewofYear2IntroductiontoThemescourse

• CourseoccursasthefirstweekofTerm1inYear2

• CourseDirector– DavidNierenberg,MD

• Coursehas22.5curricularhoursandtakesplaceoveroneweek(fivedays)

• Courseisrelativelynew(about4years)andhasnotpreviouslybeenformallyreviewed– Itwasdesignedtoreplaceseveralotherofficialcoursesthatwere

“outside”ofSBM,andwerenotsuccessfulintheirpreviousform(PediatricGrowthandDevelopment,Oncology,Nutrition,etc.)

ActionPlanfromPriorReview• N/A(coursehasnotbeenformallyreviewed)

CourseObjectives(forAug2015)• MEDICALKNOWLEDGE

1. Describeseveraluniquefeaturesofpediatrichealthcarecomparedtoadulthealthcare

2. Listthetypicalelementsthatdeterminethestageofacancer3. Listtypicalhistologicfeaturesofcancerfoundinapathology

specimen4. Summarizethemechanismsofactionofchemotherapyandradiation

therapyincancercare5. Defineimportantfeaturesofscreening,treatmentandsurvival

statistics6. Listthemostcommontypesofimagingusedinhealthcareandtheir

attendantrisksandadvantages7. Describehowandwhysomepatientsdevelopelementsof

malnutritionwhilebeingcaredforinthehospital

CourseObjectives• SKILLSFORDELIVERINGEXCELLENTCLINICALCARE

8. Explaintheimpactofageandstageofdevelopment onthedifferentialdiagnosisofpresentationsofdiseaseinchildhood

9. Summarizetheusefulnessofclinicalstagingandprinciplesofcancercare10. Summarizetheprinciplesofgeneticcounseling11. Describethespecialchallengesinvolved infollowingapediatriccancer

survivor12. Describetheadvantagesofdifferent imagingmodalitiesforhelping to

establishtheoriginofamediastinalmass,oramassoftheupperarm13. Describetheadvantagesanddisadvantagesoforal,enteral,andparenteral

nutritional supplementation14. Listseveralspecificapproachesthatathletestaketooptimizetheir

nutritionalpreparation foroptimizing theirperformanceatvarioustypesofathleticevents

CourseObjectives• INTERPERSONALANDCOMMUNICATIONSKILLS

15. Explainhowyoumightcounseltheparentsofapediatriccancersurvivorintermsoflongtermrisksandoptimalfollow-upplans

• FORMATIONOFYOURPROFESSIONALIDENTITY16. Demonstratepersonalresponsibilityforyourowneducationbyattendingallrequired

classes,andbycompletingessentialcomponents ofthecourseinatimelyfashion

• HABITSOFLIFELONGLEARNINGANDIMPROVEMENT17. Demonstrateyourabilitytofindrecentandreliablesourcesofinformationtoanswer

focusedclinicalquestions18. Identifyyourownstyleoflearningthatworksbestforyouwhenspecificlearningissues

areraisedindirectlybycases,ratherthandirectlybyateacher

• SYSTEMS-BASEDPRACTICEANDTHESCIENCEOFHEATHCAREDELIVERY19. DescribethecomponentsofthePDSAcycleinimprovementworkingeneral,and

relatedtoimprovingthecomplianceofstudents andotherswithhandwashinginparticular

20. Demonstratehowasystemofhealthcaredeliverycanbeanalyzedbydividingitintoaseriesofdiscreteprocesses

CourseObjectives– Comments• Courseisdesignedtointroducestudentstothe“majorcurricular themes”ofyear2– Pathology(buildsonY1course)– Pediatrics– Pharmacology– Imaging(buildsonY1materialinAnatomy)– ImprovingtheHCSystem(buildsonY1course)– Nutrition– Neoplasia (genetics,staging,vocabulary,statistics,etc.)– MedicalGenetics(buildsonY1material)– RehabilitationMedicine(newtwoyearsago)– Newest:Medicalethics,socialjustice,Psychologyofdisease

CourseObjectives– Comments• Courseobjectivescapturethemainideasofthecourse

• ObjectivesaddresssomeUSMLE“interdisciplinary”contentareasthatmaynotbespecificallyaddressedinothercourseobjectives(e.g.nutrition)

• CoursecurrentlyaddressesUSMLEobjectivesrelatedto“Biostatistics,Epidemiology/PopulationHealth,&InterpretationoftheMedicalLiterature”– Someofthismaterialmayeventuallybecoveredinthe“PatientsandPopulations:ImprovingHealthandHealthcare”courseinYear2

FormatofCourse&SessionObjectives• Courseobjectivesareprovidedinthesyllabus

• Courseobjectivesarewritteninthecorrectformat

• Sessionobjectivesareprovidedinthecoursematerialsformost(butnotall)individualsessions

• Sessionobjectives,whenpresent,aregenerallywritteninthecorrectformat

IssuesofRedundancy• Aretheremajorissuesofredundancywithothercourses?– NutritionappearsinnoothercoursesaseitheracourseobjectiveorsessionobjectiveinILIOS

– Manyotherthemesaredesignedtobedeliberatelylongitudinal(pediatrics,imaging,neoplasia)

– WillneedtowatchforredundancywithnewPatientsandPopulationscourseandcoordinatematerialcarefully

– Studentsfelttherewassomeredundancywithyear1coursesbyanewY2facultymemberinNutritionunawareofwhatstudentshadpreviouslylearned(e.g.ATPproduction)andintheareaofbiostats

ExplorationofEthicsandHumanities• EthicalissuesareexploredaspartofCPCcasediscussionsandarediscussedspecificallyinsessionson:– Screeningforcancer– Providingpalliativecareforcancerpatients– Rehabilitationmedicine:focusonfunction

• Studentsareencouragedtoexploreethicalissuesintheiressayassignmentforthecourse

SummaryregardingObjectives• Objectivescorrelatewellwithcoursecontentandfillimportantgapsinthecurriculum

• Afewsessionsaremissingsessionobjectives

• Course’semphasisonworkingthroughacomplexCPCcase (adaptedfromarealcasepresentedina2000NEJMCPC)asaclasslendsitselftodiscussionofethicalissues

CourseLearningOpportunities• Courseisframedbyasingleextendedcaseofachildwitha

malignancy– Therearetwo1-hourCPCsessionswithfullclassparticipation

– Therearethree1-hour“paneldiscussions”withfullclassparticipationthatarestructuredwithspecificquestionsrelevanttothecase

• Lectures15hrs.(67%)• Largegroupdiscussions7 hrs.(31%)– Casepresentation/discussionsandpaneldiscussions

• TourofRadiationTherapyUnit0.5hrs.(2%)– Tourwasnotrequired,butwaswellreceivedbystudentswhoattended

SummaryregardingPedagogy• Courseisdeliveredinlargegroupformat,whichincludesanumberof“standard”lectures– Mostlargegroupsessionswerecase-basedandinteractive

• CPCsessionsandPaneldiscussionsofferadditionalopportunityforstudentengagementandactiveparticipation

Assessment• WrittenQuizzes

– Ashortquiz(3items,5minutes)isprovidedfollowingmostofthecourselectures

– Totalofapproximately45questionsacrossallquizzes– StandardSBMgradingpoliciesapply(failingscoreis> 2.5SDbelow

themean,andanoutlierfromtheclassandbelow70%)• FinalExam

– Nofinalexamisofferedinthiscourse• Other

– Studentsarerequiredtowritea3pageessayaddressingoneofthetopicsofthecourse(orarelatedtopicchosenbystudent)

– Specificessayquestionsareprovided;studentsmaychoosewhichtoanswer

– Studentsareexpectedtoincorporateandproperlycitequalityreferencesfromthemedicalliterature

AssessmentforCourseObjectives• Objectivesareassessedinquizzes,classdiscussionsandinthefinalessay

• Studentschoosewhichessayquestiontoanswer,somayspendmoretimeonparticularobjectivesthanothers

• SBMDirectorsgradethefinalessays(1-5scale)andprovidewrittencommentstostudents– Asmallminorityofstudentsareaskedtore-writetheiressays

incorporatingthisfeedback,iftheiressaydoesnotmeetminimalpassingstandards

– Thisyear,3studentsoutoftheclassofabout94studentswereaskedtore-writeinordertoreceivecredit

SummaryregardingAssessment• Courseeffectivelyassesseslearningobjectives,withmostbeingassessedinquizzes,andseveralbeingassessedindepthwithafinalessay

• CourseallowsstudentstobeassessedinbothMCQandnon-MCQformats– Studentsarerarelyaskedtoproducearesearchpaperwithreferencesoverthecourseofyear1andyear2

– Studentsreceiveagradefrom1-5(scoreof3requiredtopass)aswellaswrittenfeedbackontheiressays

– Studentswritingunacceptableessaysaregivenagradeofincompletewiththeopportunitytore-writebasedonfeedback

Measuresof

Quality–AAMCGQ

Year2courses OverallSatisfactionAY2014-2015

SBMThemes 3.54(2014-2015)3.35(2015-2016)

GI 4.47

Hematology 4.44

Infectiousdiseases 4.40

Respiration 4.38

Cardiology 4.27

Psychiatry 4.20

FEK 4.19

Pharmacology 4.15

Dermatology 4.11

Endocrine 4.09

CT&Bone 3.62

Nervous system 3.46

Reproduction 3.29

MeasuresofQuality– CourseEvaluation

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluation

Themes2014(55%)*

Themes2015(21%)*

Overallsatisfactionofcourse 3.54 3.35

Clarity oflearningobjectives+ NA NA

Organizationofthecourse+ NA NA

Howwellthecourseintroduced metothisdiscipline+ NA NA

Congruence ofassessmentquestions tomaterialemphasizedincourse+ NA NA

Overallmeanscoreforcourseevaluation -- 3.83

*studentparticipation rateoncourseevaluation+thesequestionswerenotaskedonThemescourseevaluation

MeasuresofQuality– StudentComments

Strengths:• CPCcaseworkedwelltoframethecourse• Paneldiscussionswerehelpful forputtingmaterialintocontextandwerehighlyinteractive

• “DiscussionsweremyfavoritepartofThemes”

MeasuresofQuality– StudentCommentsSuggestionsforImprovement:• Studentsfeltcoursecouldhavebeencondensedandthatsomesessionswereredundant– Somenutritionmaterialwasredundant toyear1,andfacultymemberdidnotseemawarethatstudentshadalreadylearnedmetabolism

– Otherredundancywashelpful(e.g.inimagingsessions)– Screeningsessioncoveredsomematerialpreviouslytaughtinbiostats (somestudentsmayhavefoundthishelpful,butothersfounditrepetitive)

• Studentswouldappreciateacommentindicatingthatthefacultymemberisawarematerialhasalreadybeentaught

MeasuresofQuality– StudentComments

• Studentsfeltsportsmedicinesessionwasnotrelatedtotheremainderofthecourseandmightbebetterplacedelsewhere(suchasYear1Metabolism)

• Studentswouldlikeforallquizquestionstobevisibleatonce(navigation wasdifficultinCanvas–formattingissue)

• Studentsfeltnomorethanafewminutesshouldbespentbyfacultyinpresentingtheircareer/specialty

• Somestudentsdidnotfeeltherelationshipofthecourseto“Themes”ofSBM/year2wasclear

SummaryregardingMeasuresofQuality• Courseevaluationresponseratewasonly21%ofclass(comparedto55%in2014-2015)

• Courseevaluationdidnotincludeallquestionsaskedinothercourseevaluations

• StudentsfeltCPCcaseworkedwelltoframethecourse

• Studentsrecommendedthatfacultybefamiliarwithwhathasalreadybeencoveredinyear1andacknowledgeany“review”materialassuch

Recommendations• Ensureallsessionshavesessionobjectives• ReformatquizzesonCanvastoimprovenavigation• AddquestionstostudentcourseevaluationtomatchevaluationsforotherSBMcourses(clarityoflearningobjectives,organizationofcourse,etc.)andallowfreetextforcommentsattheendofevaluation

• Ensurefacultyareawareofwhathasbeencoveredinyear1andacknowledgeplannedredundancyorreview

• ConsidermovingSportsNutritionsessiontoyear1metabolismcourse

Actionplanfromcoursedirector(1)• Ensureallsessionshavesessionobjectives– Continuetorequirethisfromalllecturers

• ReformatquizzesonCanvastoimprovenavigation– Thisisasimpleformattingissue– MakesurethatallquestionsdisplayatthesametimeinCanvasoncequizisopened

• AddquestionstostudentcourseevaluationtomatchevaluationsforotherSBMcourses(clarityoflearningobjectives,organizationofcourse,etc.)andallowfreetextforcommentsattheendofevaluation– ThiscanbeeasilyarrangedwithDianeGrollman,andwillmakeiteasiertocomparethiscoursetootherY2courses

Actionplanfromcoursedirector(2)• EnsurefacultyareawareofwhathasbeencoveredinYear1andacknowledgeplannedredundancyorreview– ThiswasaproblemwithanewlecturerinNutrition(Ms.Al-Nimr),

whoarrivedoncampusthedaybeforethecoursebegan.– Dr.Nierenbergwillmeetwiththisfacultymember,andreviewthe

areasofunintendedoverlap(e.g.ATPproduction)presentinY1curriculum

– ThisproblemofunintentionalredundancywasalsoanissuewithsomescreeningandstatisticstopicsinthelecturebyDr.Arrick aboutscreeningforcancer;

– Dr.NierenbergwilldiscussthisissuewithDr.Arrick aswellfornextyear

– Whilesomestudentsmayfindthisuseful,atleastitspresenceinYear1shouldberecognized

Actionplanfromcoursedirector(3)• ConsidermovingSportsNutritionsessiontoYear1metabolismcourse– Mayfitbetterinthatslot– WillarrangeconversationbetweenlecturerandY1coursedirector

• WilldiscusswithournewNutritionfacultymemberadifferentthirdtopictodiscussinthisY2courses,tofurtherstrengthenthisintroductiontoNutritionatthispointinYear2