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Course learning objectives Course learning opportunities Learning assessments for students

Review of Y2 SBM Repro Course Preclinical Subcommittee January, 2014 Aaron Barnes (Geisel 2), Rich Comi MD, Hal Manning MD. Course learning objectives Course learning opportunities Learning assessments for students Measures of overall quality for the course

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Course learning objectives Course learning opportunities Learning assessments for students

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  1. Review of Y2 SBM Repro CoursePreclinical SubcommitteeJanuary, 2014Aaron Barnes (Geisel 2), Rich Comi MD, Hal Manning MD • Course learning objectives • Course learning opportunities • Learning assessments for students • Measures of overall quality for the course • Specific suggestions for improving course

  2. SBM Reproductive Endocrinology Review of Objectives Rich Comi, MD

  3. Course Objectives from Ilios • Define terms common to the discussion of patients with disorders in repro system (RS) • Describe the normal structure and physiology of RS • Describes normal stages of maturation and involution of RS • Describe processes of normal pregnancy, labor, delivery and issues in family planning • Explain signs, sx, processes of dx of common disorders of male and female RS • Explain signs, sx, processes of male RS • Describe disorders of male and female RS in early and late life • Describe appropriate use of dx testing in patients with disorders of RS • Discuss epidemiology and population health aspects of disorders of the RS • Discuss public health and ethical issues of disorders of the RS

  4. Course Objectives from Ilios (cont’d) • Describe the pathology and pathophysiology of disorders of the RS • Explain the basis for pharm and nonpharm interventions for common repro disease • Describe how various medical disciplines are integrated in disorders of the RS • Utilize the results of outcome and cost utility studies to evaluate pt care, prevention and screening in disorders of the RS • Describe how operations and processes in a complex healthcare system have an impact in disorders of the RS • Practice and demonstrate systematic problem solving skills in disorders of the RS • Explain ethical issues involved in mgmt of patients with disorders of the RS • Communicate with fellow students an faculty about disorders of the RS • Discuss methods of communication with pts and families about disorders of the RS • Demonstrate team skills by participating in team exercises

  5. Course Objectives from Ilios (continued) 21) Take responsibility for your own education 22) Read critically , evaluate and assess information about disorders of RS 23) Search efficiently for high quality relevant info about disorders of the RS Review of Objectives: Objectives 5 and 6 are redundant Objective 11 seems too broad Objective 12 is vague Objectives 20 , 21 and 23 are not specific to this course but seem reasonable There are several typos # 23 is mislabeled as 22 and always paired with 22 – “22,22”

  6. Session mapping to course objectives 100 50 20 10 F R E Q U E N C y 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 This shows that all course objectives are addressed multiple times in the sessions, but that #11 may be too broad

  7. Mapping Geisel to the NBME Step 1 curriculum 1-4 • Normal processes • embryonic development, fetal maturation, and perinatal changes, including gametogenesis • organ structure and function • female structure, including breast • female function • male structure • male function • intercourse, orgasm • pregnancy, including ovulation, fertilization, implantation, labor and delivery, the puerperium, lactation, gestational uterus, placenta • cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis, sex steroids, and gestational hormones • reproductive system defense mechanisms and normal flora 1-4 1-3 ?

  8. Abnormal processes • infectious, inflammatory, and immunologic disorders (female and male) • traumatic and mechanical disorders (female and male) • neoplastic disorders (including female reproductive, male reproductive, breast [including fibrocystic changes], trophoblastic disease) • metabolic and regulatory processes (female and male) • prenatal and perinatal counseling and screening • systemic disorders affecting reproductive function • disorders relating to pregnancy, the puerperium, and the postpartum period • obstetric problems • complications affecting other organ systems • disorders associated with the puerperium • antepartum, intrapartum, postpartum disorders of the fetus • idiopathic disorders • drug-induced adverse effects on the reproductive system • degenerative disorders • congenital and genetic disorders affecting the reproductive system 5-7,11 ? 10, 17,19 ? 5,11 5-7, 11

  9. Principles of therapeutics • mechanisms of action and use of drugs for treatment of disorders of the reproductive system and management of normal reproductive function • female reproductive tract • fertility drugs • oral contraception, other methods of contraception • estrogen, progesterone replacement, treatment of menopause • stimulants and inhibitors of labor • estrogen and progesterone antagonists • stimulators and inhibitors of lactation • male reproductive tract • fertility drugs • androgen replacement and antagonists • gonadotropin-releasing hormone and gonadotropin replacement, including all gonadotropin-releasing hormone antagonists • abortifacients • antimicrobial and antiparasitic agents • antineoplastics • restoration of potency • other therapeutic modalities affecting the reproductive system 12

  10. Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmental emotional and behavioral factors influence on person, family, and society occupational and other environmental risk factors family planning and pregnancy gender identity, sexual orientation, sexuality, libido effects of traumatic stress syndrome, violence, rape, child abus 9,10,14, 15, 17,19, In excess of NBME 1: 8 (diagnostics), 13 (team integration), 16 (problem solving skills), 18 (communicate with professionals), 20 )team skills), 22( read literature), 23 (search literature)

  11. Mapping Geisel to the LCME Content Emphases ED-10. The curriculum of a medical education program must include behavioral and socioeconomic subjects in addition to basic science and clinical disciplines. ED-11. The curriculum of a medical education program must include content from the biomedical sciences that supports students' mastery of the contemporary scientific knowledge, concepts, and methods fundamental to acquiring and applying science to the health of individuals and populations and to the contemporary practice of medicine. ED-12. The curriculum of a medical education program should include laboratory or other practical opportunities for the direct application of the scientific method, accurate observation of biomedical phenomena, and critical analysis of data. ED-13. The curriculum of a medical education program must cover all organ systems, and include the important aspects of preventive, acute, chronic, continuing, rehabilitative, and end-of-life care. ED-14. The curriculum of a medical education program must include clinical experience in primary care. 14, 15 5,6,16,22,23 ? ? n/a

  12. ED-15. The curriculum of a medical education program must prepare students to enter any field of graduate medical education and include content and clinical experiences related to each phase of the human life cycle that will prepare students to recognize wellness, determinants of health, and opportunities for health promotion; recognize and interpret symptoms and signs of disease; develop differential diagnoses and treatment plans; and assist patients in addressing health-related issues involving all organ systems. ED-16. The clinical experiences provided to medical students by a medical education program must utilize both outpatient and inpatient settings. ED-17. Educational opportunities must be available in a medical education program in multidisciplinary content areas (e.g., emergency medicine, geriatrics) and in the disciplines that support general medical practice (e.g., diagnostic imaging, clinical pathology). ED-17-A. The curriculum of a medical education program must introduce medical students to the basic scientific and ethical principles of clinical and translational research, including the ways in which such research is conducted, evaluated, explained to patients, and applied to patient care. ED-18. The curriculum of a medical education program must include elective opportunities to supplement required courses and clerkships (or, in Canada, clerkship rotations). 7,9,10,14,16, 17 n/a n/a ? n/a

  13. ED-19. The curriculum of a medical education program must include specific instruction in communication skills as they relate to physician responsibilities, including communication with patients and their families, colleagues, and other health professionals. ED-19-A. The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include health professionals from other disciplines as they provide coordinated services to patients. These curricular experiences include practitioners and/or students from other health professions. ED-20. The curriculum of a medical education program must prepare medical students for their role in addressing the medical consequences of common societal problems (e.g., provide instruction in the diagnosis, prevention, appropriate reporting, and treatment of violence and abuse). ED-21. The faculty and medical students of a medical education program must demonstrate an understanding of the manner in which people of diverse cultures and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments. ED-22. Medical students in a medical education program must learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the process of health care delivery. ED-23. A medical education program must include instruction in medical ethics and human values and require its medical students to exhibit scrupulous ethical principles in caring for patients and in relating to patients' families and to others involved in patient care. 18, 19 13 10,14,15 ? ? 17, 19

  14. In sum, There are minor typos to be fixed Objective 11 is too broad The objectives do a nice job of covering the NBME curriculum and LCME emphases but there are a few areas that could be improved (yellow boxes with “?” NBME topics: metabolic, systemic disorders and “protective systems ( bacterial biome?) LCME topics: diversity gender and cultural biases translational research observation/measurement of biophenomena rehab medicine

  15. 1g. Overlap/ILIOS word search: “Estrogen” • Does not appear in any course objectives • Appears in 2 course-level MeSH (Pharm 217) • Appears in 9 sessions in 5 different courses

  16. 1g. Overlap/ILIOS word search: “Eclampsia” • Does not appear in any course objectives • Does not appear in any session title • Appears in 5 sessions in 2 different courses

  17. 2. Course Learning Opportunities 2012-13 (Hal) • Total hours: 55.5 h • Traditional lectures = 23.5 h (42% of total hrs) • Large group discussion/review = 12 h • Lab (classical) = 2 • Small groups/conferences = 3 • PBL groups = 7 • Panel discussion (Hearts and Minds) = 5 • “Other formats” = 3

  18. Assessment of Student Performance • Final exam: 85% • Small group “speed” dating: 6% • Team-based learning: 6% • Breast exam session: 1% • Self-directed learning exercise: 2%

  19. 3. Content of Final exam (current topics 2013) – 85% of grade

  20. 3. 2012-2013 Exam items sorted by current course learning objectives (Hal)

  21. 2012-2013 Exam items (cont’d)

  22. 3. Exam content (Repro final exam) Question style # Factual only, test recognition/memorization 17 Important concepts, avoid test fatigue Clinical vignette with reasoning 27 Application of knowledge: 17 --Interpret findings, data 14 --Photos of pathology 3 Negative stem 0 Multiple T/F format 3 Pharmacology questions 5

  23. 3. Exam content (cont’d) Question style# Short answer/essay 3 -- Facts (list some of the…..) 1 -- Comment on brief clinical vignette 2 “Multiple Matching) 9 “Use each item once, more than once, or not at all”.

  24. 4. Performance on USMLE Step 1 over last 3 years

  25. 4. Performance on USMLE Step 1 over last 3 years

  26. 4. Feedback about course:Student survey scores (Aaron)

  27. Results from recent student course reviews Data from 2012-2013 evaluations: Strongest areas: • “Overall usefulness of reading Text(s).” 3.95 • “How well this course provided me with a useful and appropriate introduction to this field of discipline.” 3.85 • “Overall clarity of the learning objectives for the entire course and for each individual learning session.” 3.81 Among the questions asked on the course review pertaining to the “usefulness” of course elements, none scored below a 3.12. All faculty were rated at a 3.26 or higher, with 19 of 28 lecturers receiving a score of 3.70 or higher.

  28. Results from recent student course reviews Representative comments (strengths): • Many students commented on the strength and quality of the lecturers. • “The course focused on principals that I will probably retain rather than memorizing facts that I definitely won’t.” • “TBL was helpful for emphasizing key points.” • “I also really appreciated the books and the correlation between the book chapters and what was taught.”

  29. Results from recent student course reviews Representative comments (weaknesses): • Several students commented that lecture notes should be given for every lecture in order to more clearly communicate important points and remedy the incongruence between lectures and the textbook. • “I think there was a lot of ambiguity in what we needed to know, despite the fact that we were supposed to be using our textbook as a guide.” • The number of TBL cases was overwhelming early on in the conceptually heavy portion of the course • Some students felt that greater coordination between clinician lecturers and pathologist lecturers would increase the clarity and effectiveness of their lectures. • “Combining multiple topics into one session, or having multiple speakers at one lecture, sometimes felt overwhelming. The flow of these sessions should be practiced.”

  30. PLANS FOR ADDRESSING CONCERNS AND ISSUES FOR NEXT CYCLE, TERM 4, 2014

  31. 1. Learning Objectives: Summary

  32. 2. Learning Opportunities Summary • Good use of non-lecture formats (58% in 2013, projected to be > 60% in 2014) • Outside of PBL, limited opportunities to observe (and evaluate) individual students

  33. 3. Evaluating Students, Summary

  34. 4. Feedback from Students

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