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Review of Y2 SBM/CT and MS Course PreClinical Subcommittee November, 2013 Chris Rees (Geisel 2), Steve Benson MD, Dave Nierenberg MD  Course learning.

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Presentation on theme: "Review of Y2 SBM/CT and MS Course PreClinical Subcommittee November, 2013 Chris Rees (Geisel 2), Steve Benson MD, Dave Nierenberg MD  Course learning."— Presentation transcript:

1 Review of Y2 SBM/CT and MS Course PreClinical Subcommittee November, 2013 Chris Rees (Geisel 2), Steve Benson MD, Dave Nierenberg MD  Course learning objectives  Course learning opportunities  Learning assessments for students  Measures of overall quality for the course  Specific suggestions for improving course

2 Course Learning Objectives #ObjectiveMaps to 1Apply current knowledge in MS Medicine to Dx and Rx decisions1a 2Apply current clinical and translational science to Dx and Rx questions1b,c,d 3Apply knowledge of prevention, risk factor modification, substance abuse, pain management, medical ethics, and medical-legal issues to clinical problem solving 1e 4Apply knowledge of impact of social, economic, cultural and personal factors on health to clinical problems in MS medicine 1f 5Establish mutually respectful student-patient and student-family interactions with diverse patients 2a,c, 3a,b 6Interview patients skillfully, using a MS-focused history2b,2c 7Examine patients with MS conditions skillfully, with attention to cleanliness, infection control, and patient comfort 2c 8Generate an appropriate differential Dx for patients with MS disorders2d,e 9Explain the indications, complications, and performance of diagnostic tests (e.g. CT, MRI, EMG, NC, tissue biopsy) 2f,g 10Identify common abnormal findings on plain radiographs, CT scans, and MRI scans2h 11Communicate effectively with patients and families especially when special barriers to communication exist (eg. Cultural, socioeconomic, linguistic, etc) 3c

3 ILIOS Course Objectives (cont’d) #ObjectiveMaps to 12Assist patients in understanding their treatment options and prognosis3d 13Communicate collegially and effectively, verbally and in writing, with physician colleagues and other members of the HC team 3e,f,g,h 14Behave respectfully and responsibly towards patients, families, colleagues, and other members of the HC team, and remain aware of different concerns, opinions, and cultural perspectives 4a,e 15Meet professional responsibilities fully4b 16Adhere to high ethical and moral standards,, accept constructive criticism, and respect patient confidentiality 4d,f,g 17Take responsibility for one’s own medical education, and develop habits of mindfulness and reflection 4h,j 18Describe barriers to access basic health services, and its effect on vulnerable populations 4k 19Contribute constructive feedback during peer review4l 20Identify and critically evaluate evidence-based and cost-conscious strategies for patients with MS diseases, and apply these approaches to patient care 5a,b,e,f 21Assess the effect of social environment on clinical care and patient outcomes5c 22Identify appropriate resources to support patient care, and collaborate effectively with all members of the inter-professional team 6a,b

4 1a. Learning Objectives (Dave) In the course syllabus 2013, the course objectives are listed as follows: To provide a thorough and detailed introduction to rheumatologic conditions and musculoskeletal medicine To know the important historical features, physical findings, laboratory and radiographic findings that help differentiate one connective tissue disease from another To develop a structured approach to the patient with musculoskeletal symptoms in order to construct an appropriate differential diagnosis and develop rational diagnostic and therapeutic plans. Students are not provided with the ILIOS course objectives Important to have one shared set of core learning objectives, presented right at the beginning of the course

5 Continued (Dave) From the lecture topics, and also the categories on the final exam, we can see the core topics of the course include: Overview of course, and the approach to the patient Elements of the joint and MS exam Osteoarthritis Rheumatoid arthritis Pediatric conditions and JRA Lyme disease Other types of arthritis: seronegative, crystal, infectious Muscle conditions, myositis and myofascial pain Vasculitis, SLE, and scleroderma Lab testing Soft tissue problems and injuries Bone diseases, fractures, and tumors DJD and other Diseases of the spine Congenital and developmental problems Imaging the MS and CT systems Common genetic conditions

6 1. Topics in national textbook (Cecil Essentials of Medicine, 2013) Approach to patient with rheumatic disease (Yes) Rheumatoid arthritis (Yes) Spondyloarthropathies (Yes) SLE (Yes) Antiphospholipid antibody syndrome (yes) Systemic sclerosis (Yes) and Sjogren’s syndrome Idiopathic inflammatory myopathies (Yes) Sjogren syndrome (no in 2013, yes in 2014) Systemic vasculitis (Yes) Crystal arthropathies (Yes) Osteoarthritis (Yes) Non-articular soft tissue disorders (Yes) Rheumatic manifestations of systemic disorders (Yes )

7 1f. Learning objectives addressing additional specific LCME topics (with Nicole) Health of populations: Senior epidemic of OA, and how obesity contributes to the clinical progression Chronic pain syndromes, e.g. fibromyalgia Basic and ethical principles of clinical and translational research: How the intricate process of basic and translational immunology research is changing the way we approach pts with RA (William Rigby) Gender and cultural biases in students themselves: Not at this time Instruction in medical ethics and human values In 2014 will be their first Hearts and Minds session about a patient with fibromyalgia (chronic pain syndrome) and her long-term use of opioids for pain management

8 1g. Overlap/ILIOS word search: “Vasculitis” Does not appear in any course objectives Appears in one session title (SBM/MS) Appears in 3 sessions in 3 different courses

9 1g. Overlap/ILIOS word search: “Rheumatoid Arthritis” Does not appear in any course objectives Appears in one session title (SBM/MS) Appears in 5 sessions in 3 different courses

10 1g. Overlap/ILIOS word search: “uric acid” (note: there are other “hits” when “gout” is searched) Does not appear in any course objectives Does not appear in any session title Appears in 4 sessions in 4 different courses

11 1. Learning Objectives: Summary IssueProposed Fix Learning objectives in ILIOS are vague Learning objectives in ILIOS differ from those posted in the course Group learning objectives by major competency domain, and map to specific competency tasks Current course objectives in ILIOS do not contain the key words of the major diseases and conditions Make sure that exam topics track nicely to new learning objectives List learning objectives for each session at the beginning of each session

12 2. Course Learning Opportunities (Dave) Total hours: 39 h  Traditional lectures = 29 h (74% of total hours)  Large group discussion/review = 0 h  Lab (classical) = 0  Small groups/conferences = 6  PBL groups = 3  Direct patient contact or PE session = 1 (2 groups)  Panel discussion (Hearts and Minds) = 0  Other formats = 0

13 2. Learning Opportunities Summary IssueProposed Fix Over-reliance on standard lectures (29/39=74%) Not enough engaged large group sessions (0) Only 6 h of conference groups Didn’t have Hearts and Minds panel discussion in 2013 Current 1 h PE demonstration clinic is excellent

14 3. Content of Final exam (current topics 2013) Topic# # Acute soft tissue6Myositis3 Bone pathology3Osteoarthritis7 Bone tumors1Pediatric topics3 Development1Physical dx4 DJD of spine2Imaging1 Fibromyalgia4Rheumatoid arthritis11 Fractures1Scleroderma5 Genetics1Seronegative arthritis3 Gout7SLE10 Infectious arthritis4Testing2 JRA3Vasculitis5 Lyme disease5Pharmacology6

15 Exam items sorted by current course learning objectives (Steve) #ObjectiveMaps to# items 1Apply current knowledge in MS Medicine to Dx and Rx decisions1a70 2Apply current clinical and translational science to Dx and Rx questions1b,c,d1 3Apply knowledge of prevention, risk factor modification, substance abuse, pain management, medical ethics, and medical-legal issues to clinical problem solving 1e2 4Apply knowledge of impact of social, economic, cultural and personal factors on health to clinical problems in MS medicine 1f0 5Establish mutually respectful student-patient and student-family interactions with diverse patients 2a,c, 3a,b 0 6Interview patients skillfully, using a MS-focused history2b,2c0 7Examine patients with MS conditions skillfully, with attention to cleanliness, infection control, and patient comfort 2c7 PE findings 8Generate an appropriate differential Dx for patients with MS disorders2d,e1 9Explain the indications, complications, and performance of diagnostic tests (e.g. CT, MRI, EMG, NC, tissue biopsy) 2f,g2 10Identify common abnormal findings on plain radiographs, CT scans, and MRI scans 2h9 11Communicate effectively with patients and families especially when special barriers to communication exist (eg. Cultural, socioeconomic, linguistic, etc) 3c0

16 Exam items (cont’d) #ObjectiveMaps to# items 12Assist patients in understanding their treatment options and prognosis3d0 13Communicate collegially and effectively, verbally and in writing, with physician colleagues and other members of the HC team 3e,f,g,h0 14Behave respectfully and responsibly towards patients, families, colleagues, and other members of the HC team, and remain aware of different concerns, opinions, and cultural perspectives 4a,e0 15Meet professional responsibilities fully4b0 16Adhere to high ethical and moral standards,, accept constructive criticism, and respect patient confidentiality 4d,f,g0 17Take responsibility for one’s own medical education, and develop habits of mindfulness and reflection 4h,j0 18Describe barriers to access basic health services, and its effect on vulnerable populations 4k0 19Contribute constructive feedback during peer review4l0 20Identify and critically evaluate evidence-based and cost-conscious strategies for patients with MS diseases, and apply these approaches to patient care 5a,b,e,f0 21Assess the effect of social environment on clinical care and patient outcomes5c0 22Identify appropriate resources to support patient care, and collaborate effectively with all members of the inter-professional team 6a,b0

17 3. Exam content (MS final exam) Question style # Factual only, test recognition/memorization Important concepts, avoid test fatigue15 Clinical vignette with reasoning Excellent, well written, pertinent59 Application of knowledge Interpret findings, data7 Photos of PE findings8 Negative stem 2 (only!) Multiple T/F format1 (only!) Pharmacology questions6 4 were simple recall, 2 clinical vignettes

18 3. Evaluating Students, Summary IssueProposed Fix Learning issues need to be granular enough that major exam areas map well to them Learning objectives not assessed on written final exam must be assessed in some other way Conference leaders may not know students well enough to assess their competency in multiple areas Conference size may be too large to enable faculty to get to know each student Written final exam made good use of vignettes, fewer factoid questions, very few negative stem

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

20 4. Feedback about course from March 2012 AAMC GQ How well did each of the following sciences basic to medicine prepare you for clinical clerkships and electives? All Year 1 disciplines (n=9): mean = 3.1 All Year 2 disciplines (n=4): mean = 3.4 (3.3) Renal course was not broken out

21 4. Feedback about course: Student survey scores (Dave)

22 Results from recent student course reviews Data from evaluations: Strongest areas: “Overall usefulness of attending laboratory sessions or simulated laboratory sessions.” 4.22 “How well this course provided me with a useful and appropriate introduction to this field of discipline.” 4.05 “Overall quality of the entire course” 4.00 Among the questions asked on the course review pertaining to the “usefulness” of course elements, none scored below at All faculty were rated at a 3.16 or higher, with 16 of 20 lecturers receiving a score of 3.70 or higher.

23 Results from recent student course reviews Representative comments (strengths): Many students commented on the fairness and congruence of the final exam. “The clinic visit was fantastic. This should be standard for all courses.” “The best part of the course was the conferences.” The majority of faculty received overwhelmingly positive scores from the students.

24 Results from recent student course reviews Representative comments (weaknesses): Several students commented that the clinical experience would be more useful later in the term. (done for 2014) “Perhaps one or two more conference groups would be helpful.” (done for 2014) “The organization of the course could be a little better. The arthritis lectures could be grouped together and the bone lectures could be grouped together.” (done for 2014) Some students commented that the required paper felt like “busywork.”(replaced in 2014 by off-line quizzes)

25 4. Global measures of quality IssueProposed Fix Shift clinical experience (PDX session) later into term Having one or two more conference group meetings would be helpful (highlight of course) Improve course organization by better grouping of topics (e.g. arthritis material, bone material) Required written paper (analyzing a journal article) felt like “busywork” to a few students

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

27 1. Learning Objectives: Summary IssueProposed Fix Learning objectives in ILIOS are vague Rewrite new set of course learning objectives Learning objectives in ILIOS differ from those posted in the course Post the new ILIOS objectives in syllabus on first day of course Group learning objectives by major competency domain, and map to specific competency tasks Done in new version Have enough detail in new course learning objectives to permit ILIOS word searches Done in new objectives Make sure that exam topics track to new learning objectives Done in new objectives List learning objectives for each session at the beginning of each session Will do next cycle

28 DRAFT New Course Learning Objectives for Each student should demonstrate an appropriate level of understanding of the pathophysiology of the musculoskeletal/connective tissues system, such that the student is prepared to recognize, diagnose, and describe effective treatment options for the most common and severe diseases and disorders of this organ/system that may be encountered during the clinical clerkships or in clinical practice.

29 Possible Course Learning Objectives #ObjectiveDomainAssessment 1Describe the pathophysiology, diagnosis, and treatment options for osteoarthritis1abcdeConference, PBL, exam 2Describe the pathophysiology, diagnosis, and treatment options for rheumatoid arthritis (including juvenile rheumatoid arthritis) 1abcdeConference, PBL, exam 3Describe the pathophysiology, diagnosis, and treatment options for less common types of arthritis (e.g. sero-negative, psoriatic, etc) 1abcdConference, PBL, exam 4Describe the pathophysiology, diagnosis, and treatment options for diseases of the lumbar and cervical spine (including DJD, ankylosing spondylitis, disc disease, low back pain,etc) 1abcdConference, PBL, exam 5Describe the pathophysiology, diagnosis, and treatment options for complications of uric acid and other crystals (including gout, pseudogout) 1abcdConference, PBL, exam 6Describe the pathophysiology, diagnosis, and treatment options for common infections of the MS system (e.g. Lyme disease, septic arthritis) 1abcdConference, PBL, exam 7Describe the pathophysiology, diagnosis, and treatment options for diseases of skeletal muscle (e.g. myositis, polymyositis, etc.) 1abcdConference, PBL, exam 8Describe the pathophysiology, diagnosis, and treatment options for connective tissue diseases (eg. systemic lupus erythematosus, scleroderma, mixed CT disease, Sjogren’s syndrome) 1abcdConference, PBL, exam 9Describe the pathophysiology, diagnosis and treatment options for the various types of vasculitis (eg. Polymyalgia rheumatica, giant cell arteritis, granulomatosis with polyangiitis, polyarteritis) 1abcdConference, PBL, exam 10Describe the pathophysiology, diagnosis, and treatment options for bone and soft tissue diseases (e.g. tumors, fractures, sprains) 1abcdConference, PBL, exam 11Describe the pathophysiology, diagnosis, and treatment options for common pediatric and developmental diseases (e.g. juvenile rheumatoid arthritis, genetic conditions) 1abcdConference, PBL, exam 12Describe the advantages and disadvantages of major diagnostic testing modalities for the MS system (e.g. radiography, CT, MRI, ultrasound, serologic testing, etc.) 2fghConference, PBL, exam

30 Possible Course Learning Objectives #ObjectiveDomainAssessment 13Describe the most common symptoms of rheumatic and musculoskeletal diseases, and use that knowledge to help develop a differential diagnosis 2abConferences, PBL 14Explain how patients with MS/CT disorders can be skillfully and respectfully examined, with appropriate attention to cleanliness and privacy 2acRheumatology clinic 15Explain the indications, complications, and limitations of common diagnostic modalities including imaging studies, EMG, NCS, and tissue biopsies 2fgExam 16Correctly identify common abnormalities seen on plain radiographs, CT scans, and MRI’s of the MS system 2ghConference, PBL, exam 17Communicate effectively, verbally and in writing, with colleagues and physicians3efgConference, PBL 18Demonstrate how to assist patients in understanding their treatment options, and prognosis of their diseases 3abcdConference, PBL 19Meet professional responsibilities (meetings, assignments, etc) in a timely and professional manner 4bdfhConference, PBL 20Demonstrate the ability to take responsibility for one’s own medical education4hConference, PBL 21Describe how barriers to access for care of MS/CT problems adversely effects the health of vulnerable populations 4kConference, PBL 22Demonstrate the ability to identify and evaluate information about evidence-based and cost- conscious strategies in managing MS/CT disorders 5abceConference, PBL, exam 23Identify appropriate resources to help support patients with MS/CT disorders, and describe the rolls of all members of the inter-professional HC team 6abefConference, PBL 24Describe the appropriate role of rehabilitation (physiatry) and related services (OT, PT, etc) in the care of patients with MS/CT diseases 6abceConference, PBL

31 2. Learning Opportunities Summary IssueProposed Fix Over-reliance on standard lectures (29/39=74%) In 2014, will reduce to 23/39 (59%) Not enough engaged large group sessions Will increase from 0 to 3 in 2014 Only 6 h of conference groupsWill increase to 8 h in 2014 Don’t have Hearts and Minds panel discussion in 2013 Will introduce new 1h session in 2014 Current 1 h demonstration clinic is excellent This will be continued in 2014

32 3. Evaluating Students Summary IssueProposed Fix Learning issues need to be granular enough that major exam areas map well to them Fixed with new course learning objectives Learning objectives not assessed on written final exam must be assessed in some other way Assigned in new course learning objectives to observation of students in conference, PBL groups Conference leaders may not know students well enough to assess their competency in multiple areas Increase hours spent with same conference leader Conference size may be too large to enable faculty to get to know each student Increase number of faculty-led conference groups Written final exam made good use of vignettes, fewer factoid questions, very few negative stem Continue to develop new items for final exam

33 4. Feedback from Students IssueProposed Fix Shift clinical experience (PDX session) later into term Fixed for 2014 Having one or two more conference group meetings would be helpful (highlight of course) Fixed for 2014 Improve course organization by better grouping of topics (e.g. arthritis material, bone material) Done for 2014 Required written paper (analyzing a journal article) felt like “busywork” to a few students Re-evaluate goals of this exercise: consider asking for a shorter paper, earlier in the course, that will help students develop the skills to translate translational research findings into language patients can understand


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