Review of Year 1 Biochemical and Genetic Basis of Medicine Course occurs in the Fall term of Year 1 Course Director – Larry Myers, PhD Course has 47 curricular hours Course was last reviewed in March 2012

Action Plan from Prior Review revise course objectives in the accepted format (i.e. using measureable verbs) ✓ revise the series of lectures on recombinant DNA to more clearly present the material to the students ✓ consider additional roles in the course for Dr. Ahmed since she is a skilled educator with much to contribute ✓ continue to encourage faculty to use tools such as the ARS that facilitate active learning ✓ evaluate the current content in the course to determine if it is meeting the students’ needs regarding clinical relevance ✓ investigate more active modes of learning or new methods of pedagogy that could be incorporated into the course ✓

Course Objectives

Course Objectives – Geisel Competencies There are 17 course objectives that fulfill Geisel competencies as follows: 14 address medical science knowledge and its application (MS) 2 address clinical care (CC) 0 address population health (PH) 1 addresses communication skills (CS) 1 addresses personal, professional and leadership development (PPLD) 0 address evaluation and improvement in medicine (EIM) 1 addresses components of professionalism (P) 0 address collaboration and teamwork (CT)

Course Objectives – Geisel Competencies Although the course objectives currently do not map to three competencies (PH, EIM, CT), there are likely opportunities in the course to map to these objectives: – On the course evaluation, one student mentions “The course did a good job at explaining how genetic traits can be different for different groups of people.” Thus the course does cover some aspects of population health. – Collaboration and teamwork is occurring in some of the conferences, so this could be emphasized in an objective

Course Objectives – Geisel Program Objectives The course objectives address the program objectives as follows: 3 of the 9 program objectives for the MS competency (39.6 hours) 2 of the 17 program objectives for the CC competency (2.3 hours) 0 of the 5 program objectives for the PH competency (0 hours) 2 of the 7 program objectives for the CS competency (1.9 hours) 1 of the 7 program objectives for the PPLD competency (2.8 hours) 0 of the 5 program objectives for the EIM competency (0 hours) 1 of the 8 program objectives for the P competency (1.4 hours) 0 of the 5 program objectives for the CT competency (0 hours)

Course Objectives – Format/Distribution Course objectives are provided in the syllabus Course objectives are written in the correct format Course objectives distributed on Canvas match the objectives in Ilios The number of course objectives seems appropriate

Course Objectives – Comments Objective #2: Memorize several basic physical chemical properties of biomolecules that govern their function. Although “memorize” is listed in Bloom’s Taxonomy, it does not seem like the best verb to use in the current educational climate (one that emphasizes application of knowledge). Consider using something like “list or name” to clarify what students are expected to do – or even better, rewrite using a higher order verb. Why do the students need to know these properties – what are they going to do with the information?

Course Objectives – USMLE Brochure The USMLE Brochure for Step I includes the following topics for Biochemistry: Gene expression: DNA structure, replication, exchange, and epigenetics (eg, imprinting, X- activation, DNA methylation) Gene expression: transcription Gene expression: translation, post-translational processing, modifications, and disposition of proteins (degradation), including protein/glycoprotein synthesis, intra-extracellular sorting, and processes/functions related to Golgi complex and rough endoplasmic reticulum Structure and function of proteins and enzymes (e.g., enzyme kinetics and structural/regulatory proteins) Energy metabolism (e.g., ATP generation, transport chain) These topics are covered well in BIOC110/BIOC112.

Objectives: National organization The Association of Biochemistry Course Directors (ABCD) has published a recommended curriculum for Biochemistry entitled “Biochemistry Learning Objectives & Competencies” Course and session objectives for the Geisel course correlate well with the recommendations in this national document

Session Objectives – Format/Distribution Session objectives are provided in the course materials on Canvas Almost all session objectives are written in the correct format: – Gene mapping, Epigenetics and Genetic testing sessions each have two objectives that start with the word “understand” and need to be rewritten Session objectives all map to at least one course objectives in Ilios Session objectives match the objectives in Ilios

Session Objectives - Redundancy The keywords used to search for redundancy were: protein synthesis DNA transcription translation mitosis molecular genetics cytogenetics epigenetics genetic testing apoptosis cell cycle signal transduction cancer

Session Objectives - Redundancy Searches using the terms “protein synthesis”, “mitosis”, “apoptosis” and “cell cycle” revealed some overlap in Biochemistry and CTO; course directors should meet to ensure redundancy is planned and complementary A search for “genetic testing” revealed overlap with the Y2 Themes course that seemed appropriate A search for “cancer” revealed numerous instances of overlap with SBM courses regarding specific types of cancer, however these seemed appropriate

Summary regarding Objectives Course objectives help fulfill 5 of the 8 Geisel competencies. There may be opportunities to make connections between existing course material and the other 3 competencies that are not currently represented Course and session objectives are well-written, correlate well with objectives published by national organizations, and match the objectives in Ilios Issues of redundancy were found with the CTO course; the course directors should ensure that this redundancy is planned and complementary

Course Learning Opportunities Lecture 30 hrs. (64%)* – one lecture is a Clinical Correlation Flipped classroom sessions 3 hrs. (6%) Conferences 14 hrs. (30%)* *In the prior review, these percentages were 76 and 24, respectively There is an optional session on Nucleic Acid Structure for students who are not familiar with the material. There are 2 hrs. of optional review to assist students with their final exam preparation.

Course Learning Opportunities Although lectures are well-received in this course, the number of course hours devoted to lectures is too high according to LCME guidelines. Lecture hours have been gradually reduced over the past 5 years: – 40 lecture hours (AY 10-11) – 38 lecture hours (AY 11-12) – 34 lecture hours (AY 12-13) – 34 lecture hours (AY 13-14) – 30 lecture hours (AY 14-15) Small group conferences allow students to apply the material they learned in lecture The course provides self-assessment materials on Canvas that are useful to students

Summary regarding Pedagogy The dominant form of pedagogy in the course is large group lectures; the course should continue its commitment to reduce the number of lecture hours in the course and introduce forms of pedagogy that allow self-directed learning experiences Students value the opportunity to apply the material in small group conferences, and self-assess their progress with practice materials

Assessment 5 Written Quizzes (56 % of course grade) Final Exam (36 % of course grade) Article discussion study guides (8% of course grade)

Assessment – Quizzes The content of the quizzes correlated well with the session objectives Quiz questions use three primary formats: MCQ, fill in the blank, and short answer essays Essay questions allow the course director to assess the students’ ability to solve problems and apply their knowledge; this information is useful to identify students who are struggling with the material early in the course There were several questions with clinical vignettes on Quiz 4, however vignettes are rarely used

Assessment – Quizzes Almost all quiz questions avoid “negative” formats; the one exception that needs to be revised is Question # 8 on Quiz 5 (“Which of the following statements are false”) One question on Quiz 3 (#2b) used “none of the above” as an answer choice, which is not recommended by the NBME Most MCQs used true/false formats rather than the one-best-answer format (NBME does not recommend the true/false format for MCQs)

Assessment – Final Exam The emphasis of the final exam appears balanced regarding the major content in the course The final exam used the same three formats as quizzes: MCQ, fill in the blank, and short answer essays The proportion of clinical vignettes was higher on the final than the quizzes

Assessment – Other Activities 8% of the course grade is based on Article Discussion Study Guides on the following topics: – Hemoglobinopathies – Mendelian Inheritance – Genetics – Cancer Students complete questions about the article in advance to demonstrate their preparation for the conference

Summary regarding Assessment The content on both quizzes and the final exam correlates well with the session objectives and the material covered in the course A mix of USMLE board-format and other formats are used for assessment questions in this course The questions that are written in USMLE board format (MCQ) primarily belong to the true/false family; clinical vignettes are not routinely used Assignments related to article discussions allow students to earn course points outside of the quizzes/final exam

Measur es of Quality – AAMC GQ Geisel mean 2010 Geisel mean 2011 Geisel mean 2012 Geisel mean 2013 Geisel mean 2014 All schools means 2014 Biochemistry Biostatistics/Epidemiology Genetics Gross anatomy/Embryology Immunology Intro to Clin Med/On Doc Microanatomy/Histology Microbiology Neuroscience Pathology Pharmacology Physiology Behavioral Science Pathophysiology of Disease Measures of Quality – AAMC GQ “Indicate how well you think that instruction in [basic science topic] prepared you for clinical clerkships and electives.” [1=poor; 2=fair; 3=good; 4=excellent]

Measures of Quality – Step I TRADITIONAL CORE DISCIPLINES 2012*2013*2014*Means Biochemistry Biostatistics/Epidemiology N/A Biostatistics0.08 Genetics Gross anatomy/Embryology Histology/Cell Biology Microbiology/Immunology Pathology Pharmacology Physiology *values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Year 1 courses (fall, winter) Overall Satisfaction AY Human Anatomy and Embryology II 4.57 Human Anatomy and Embryology I 4.35 Metabolic Basis of Disease 4.35 Biochemical and Genetic Basis of Medicine 4.34 Physiology-Renal 4.19 CTO 4.07 Virology 3.77 Physiology-Endocrine 3.76 Immunology 3.67 Physiology-Respiration 3.34 Physiology-Cardiovascular 3.23 Measures of Quality – Course Reviews scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]

Measures of Quality – Course Evaluation Biochemistry 2012 (100%)* Biochemistry 2013 (94%)* Biochemistry 2014 (87%)* Overall satisfaction of course Clarity of learning objectivesnot available Organization of the coursenot available How well the course introduced me to this discipline 3.90not available4.14 Congruence of assessment questions to material emphasized in course *student participation rate on course evaluation

Measures of Quality – Student Comments Summary of Student Comments Particularly Well Done Overall organization, relevance, and clarity of course Course notes clearly lay out expectations Small group sessions Most lecturers Could Have Been Better Expectations on understanding laboratory techniques Congruence of material throughout the semester Clinical application

Measures of Quality – Student Comments Suggestions Highlight notes to further clarify expectations (some faculty currently do this) Emphasize how the concepts from each lecture tie together throughout the semester Introduce more clinical relevance into the course, e.g. “Patient of the Day” Fewer lecturers during middle part of the course Devote a small group to lab testing techniques Re-evaluate Cancer lecture structure

Summary regarding Measures of Quality This course is consistently well-received by students and rated in the “very good” to “excellent” range – the course director and his faculty are to be commended for their efforts Students do moderately well on Step I in this discipline Students suggest minor adjustments to make the course even better The major issues are a need for more clinical correlations and better integration between topics

Recommendations Look for opportunities to represent course material in Population Health, Evaluation/Improvement and Collaboration/Teamwork in the Course Objectives Revise the one course objective and six session objectives that are not written in the best format Discuss issues of redundancy with the CTO course director to ensure redundancy is planned and complementary Continue to reduce traditional lectures in the course and incorporate activities that allow self-directed learning (e.g. PBL)

Recommendations Revise or replace the two quiz questions that had problems with correct language Gradually replace MCQs that are in the true/false format with questions in the one-best-answer format that is recommended by the NBME; incorporate more clinical vignettes where possible Incorporate more clinical relevance in sessions when possible, e.g. suggest revising the cancer sessions to include a patient scenario and information about laboratory tests

Action Plan Speak with faculty members whose quiz/exam questions or session objectives are not consistent with Geisel guidelines and assist in the correction of these inconsistencies. Include a PBL on sickle cell disease (planned for Fall 2015), in collaboration with Dr. David Nirenberg, to illuminate the connection between basic biochemistry/genetics and clinical practice. Eliminate large group session on ‘Mitosis/Meiosis’ to address redundancy with CTO.

Action Plan Cut down number of contact hours in large group sessions by streamlining Eukaryotic Transcription and Molecular Genetics sessions from 2 contact hours apiece to 1 contact hour apiece. Revise the interactive ‘Cancer’ sessions that build on Dr. Compton’s video lectures by changing the three ‘Q & A’ sessions used last year to a single ‘mini-PBL’ in which we address the application of laboratory methods discussed in the course to a cancer case study.