1. Review of Year 1 Metabolism course
Course occurs in the winter term of Year 1
Course Director – Larry Myers
Course has 50.5 curricular hours
Course was last reviewed in July 2015
Review presented to MEC July 2017

2. Action Plan from Prior Review
Explore opportunity to revise section on Lipoproteins and Atherogenesis to reduce from 8 to 6 hrs. ✓ [actually reduced to 4 hrs]
Work with SBM faculty to develop a PBL module on alcoholic liver disease or acetaminophen toxicity to replace lectures (4 hrs) on Hepatic Function. ✓
Optimize literature discussion groups. Faculty and some students find discussion of current literature valuable for training as life long learners, other students feel time could be better utilized. ✓ [Working to make a format that spans Bioc110 to 112, increasing degrees of self-directed learning]
Organize a meeting with course directors to optimize coverage (minimize unintended redundancy) of topics including diabetes, FH, and obesity ✓ [coordinated with Endo]

3. Course Objectives
Course objective #11 does not have any session objectives mapping to it

4. Course Objectives – Comments
The number of course objectives seems appropriate and course content correlates well with Metabolism content in the Step I Brochure (see next two slides)
Suggest removing the word “To” from objectives to match current style in Ilios for other courses
The mapping of course objectives to the Geisel competencies in Ilios was reviewed by the course director and checked for accuracy; changes were conveyed to Geisel computing and the issue with course objective #11 was fixed (PBL and TBL exercises map to this objective, they were just not formally stated)

5. Relevant Content in Step I Brochure
covered in HAE & CTO
covered in Metabolism, CTO, Endocrine & Renal Physiology, SBM GI

6. Relevant Content in Step I Brochure
covered in HAE & CTO
covered in Metabolism, CTO and Endocrine Physiology

7. Format of Course & Session Objectives
Course objectives are provided in the syllabus.
Course objectives are written in the correct format.
Session objectives are provided in the course materials
Note: Objectives for Diabetes case part I and II are the same; rather that having two separate pages with the objectives listed only on the first page, suggest having one page that both sessions link to
Session objectives are written in the correct format with the exception of objectives for the session titled “Clinical Correlation: Engaging in the Obesity Epidemic”

8. Issues of Redundancy
Multiple words and terms were used to search for redundancy (e.g. glucose metabolism, lipoproteins, cholesterol, obesity, etc.)
Some terms match to two year one courses - Metabolism and Endocrine Physiology – however the course directors of these courses have discussed their content to avoid unplanned redundancy
Some clinical topics are also covered in SBM and clerkships (e.g. diabetes, obesity), however a meeting occurred after the prior review to coordinate this content across courses

9. Health and Values Goals
Ethics – “Identify key concepts in health care ethics and demonstrate an ability to recognize ethical issues arising in patient care and population health and to think critically and systematically in applying an ethical analysis”
Cultural Awareness – “Demonstrate an understanding and skill in managing patient care of people of diverse cultures, social, economic standing and belief systems”
Health Equity – “Identify the root causes and approaches for addressing health disparities locally and globally”
Resilience – Demonstrate knowledge of skills and practices to prevent and address stress and maintain resilience in caring for patients and oneself
Compassion and Empathy – “Demonstrate abilities to understand each patient’s experience of illness, adapt scientifically appropriate care to conform to that patient’s needs, and communicate in terms that each patient can understand”
There also are synergies to health law, communication skills, professionalism (as LCME requires).

10. Health and Values Content
What Health and Values Program material (healthcare ethics, cultural awareness, health equity, resilience, compassionate care) is presented in the course?
alcoholic liver disease in Iraq war veteran
lead poisoning
eating disorders
Are the Health and Values topics noted in the course and session objectives?
Objectives currently don’t mention these topics because the content is not directly assessed; this material is used to illustrate clinical application and foster discussion – students felt it was effective in helping to contextualize the basic science

11. Health and Values Content
What do the student evaluations indicate regarding Health and Values teaching?

12. Health and Values Content
Student comments:
“I feel like most talks about health and values in our course came from Dr. Myers slipping asides into his lectures... It would have been cool to hear more stuff about socioeconomic status, food deserts, and nutrition in the part of the course where we started to tie everything together.”
“I think that the patient presentation, clinical correlation, PBL sessions, and the cases included in the lectures helped to integrate the health & values curriculum nicely.”
“We talked about AZT with regards to nucleotide metabolism; sharing the brief story of this drug's development during the AIDS crisis through fierce activism would illustrate a lot these points (beyond what is meant by a thymidine analogue).”

13. Nutrition Objectives Medical Science Clinical Care Population Health
Describe core nutrition science concepts, such as nutritional biochemistry and metabolism, digestion, endocrinology, and adverse effects of malnutrition on human health.
Explain the links between nutrition science and other sciences, including those of the environment, exercise, toxicology, and pharmacology.
Apply core nutrition science knowledge to understand and manage human health and disease through the lifespan.
Clinical Care
Perform a nutrition assessment and accurately measure anthropometrics.
Perform a complete nutritional exam to assess for presence of malnutrition.
Interpret, develop, and implement a nutrition plan for treatment, including nutritional additions or restrictions, culinary skill development, artificial nutrition support, and supplementation.
Population Health
Explain the impact of nutrition on individual and population health and disease.
Assess the impact of social, environmental, behavioral, economic, cultural, and personal factors on the nutritional health of individuals, and the incidence and burden of disease in populations.
Explain and exemplify the physician’s role for promoting nutrition in public health.

14. Personal, Professional, and Leadership Development
Communication Skills
Demonstrate empathy for individuals’ concerns, and be respectful of others’ perspectives and personal, cultural, and religious dietary restrictions and beliefs, and communicate nutrition advice respectfully and without judgment.
Promote positive behavioral change through nutrition-specific motivational interviewing and cognitive behavioral therapy.
Translate nutrition science concepts in to useful information to educate patients, families, peers, and others.
Personal, Professional, and Leadership Development
Engage in lifelong learning to improve one’s performance in the application of nutrition science.
Apply nutrition science and culinary competency to enhance resiliency and physician self-care.
Advocate for environments that promote healthy nutritional lifestyles in the community, while removing any existing barriers.
Evaluation and Improvement
Identify and utilize healthcare and community resources to provide nutrition care and improve patient outcomes and patient satisfaction.
Identify credible, evidence-based sources of nutrition information and apply knowledge gained from the literature to clinical care, teaching, research, and population health.
Collaboration and Teamwork
Recognize and capitalize on different roles and strengths of team members, including the clinical dietitian, to develop and address shared goals, and foster a working relationship with all team members built on mutual respect and trust.
Demonstrate the ability to share and allocate responsibilities among team members.

15. Nutrition Content
The metabolism course satisfies components of objectives:
MS1 - Describe core nutrition science concepts, such as nutritional biochemistry and metabolism, digestion, endocrinology, and adverse effects of malnutrition on human health.
MS2 - Explain the links between nutrition science and other sciences, including those of the environment, exercise, toxicology and pharmacology.
MS3 - Apply core nutrition science knowledge to understand and manage human health and disease through the lifespan.
CC1 - Perform a nutrition assessment and accurately measure anthropometrics.
PH1 - Explain the impact of nutrition on individual and population health and disease.

16. Nutrition Content What nutrition content is presented in the course?
carbohydrate metabolism
obesity epidemic, metabolism in obesity
starvation and diabetes
lipid metabolism, cholesterol metabolism, atherosclerosis
amino acid/protein metabolism, purine metabolism, nucleotide metabolism, gout case study
water soluble and fat soluble vitamins
fuel sources, sprint vs. marathon
energy balance

17. Nutrition Content
Are the nutrition topics noted in the course and session objectives?
Yes in both course and session objectives, however it was noted that the word “nutrition” does not actually appear in one of the course objectives (thus would not be detected by an Ilios search)

18. Summary of Objectives/Course Content
The content of course and session objectives is appropriate and correlates well with the metabolism content in the Step I Brochure
Minor formatting issues need to be addressed with some objectives, e.g. objectives for the “Clinical Correlation: Engaging in the Obesity Epidemic” session
The course discusses numerous nutrition topics and these are evident in the course and session objectives. Health and values content is also present, although not explicit in the objectives

19. Course Learning Opportunities
Lecture 27 hrs. (53%)
Discussion Large Group 8 hrs. (16%)
Discussion Small Group 4 hrs. (8%)
PBL 4 hrs. (8%)
Case-Based Instruction/Learning 2 hours (4%)
Assessment events 5.5 hrs. (11%)

20. Course Learning Opportunities
Over the last 5 years the course has gradually reduced the number of lectures from 79% of contact hours to 60% of contact hours
The course added a PBL case this year that was well- received by the students
The course provides optional review sessions to prepare for quizzes and the final exam

21. Summary regarding Pedagogy
Percentage of lecture hours is higher than the percentage recommended by the MEC (40-50% of course hours)
The course includes opportunities to discuss material with peers and faculty, and apply knowledge to case-based scenarios
The PBL session provides an opportunity for self-directed learning (LCME Standard 6.3)

22. Assessment Final Exam = ~40% of course grade (264 pts)
Written Quizzes = ~50% of course grade (330 pts)
Quiz 2: 150 pts
Quiz 3: 100 pts
Quiz 4: 80 pts
Article Discussions = ~10% of course grade (66 pts)
Article Discussion 1: 33 pts
Article Discussion 2: 33 pts

23. Assessment for Course Objectives
Objectives 1-10 are related to medical knowledge and are assessed on quizzes and exams
Objectives 11 and 12 involve problem-solving skills and are assessed with questions on quizzes and exams that require application of knowledge
Objective 13 involves evaluating and discussing scientific literature; this is assessed during the two literature discussion exercises

24. Summary regarding Assessment
All of the course objectives are being assessed in the course
Some assessments evaluate the students’ ability to apply their knowledge, thus promoting critical thinking and problem solving skills (LCME Standard 7.4)
Literature discussion sessions foster the spirit of inquiry and develop skills of critical judgment (LCME Standards 3.2, 7.4)

25. Measures of Quality – Graduation Questionnaire
Data from AAMC Graduation Questionnaire

26. Measures of Quality – Step I
TRADITIONAL CORE DISCIPLINES
2014*
2015*
2016*
Means 14-16
Biochemistry
0.22
0.03
-0.04
0.07
Biostatistics
0.08
0.29
N/A
0.185 (14-15)
Genetics
0.28
0.09
-0.36
0.003
Gross Anatomy/Embryology
0.14
0.16
-0.12
0.06
Histology/Cell Biology
0.23
-0.09
Microbiology/Immunology
0.39
0.02
-0.01
0.13
Pathology
0.20
0.12
-0.10
Pharmacology
-0.02
0.0
Physiology
0.25
0.11
*values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

27. Measures of Quality – Course Evaluation
Overall Quality - Year 1 courses
AY 14-15
AY 15-16
AY 16-17
Basic Science of Microbial Disease
3.94
4.10
4.73
  Biochemical and Genetic Basis of Medicine
4.34
4.40
4.54
  Cells, Tissues and Organs
4.07
4.06
4.21
  Human Anatomy and Embryology I
4.35
4.04
4.61
  Human Anatomy and Embryology II
4.57
4.43
4.74
Immunology and Virology
3.67/3.77
3.94/3.83
4.70
  Metabolic Basis of Disease
4.48
4.25
  Neuroscience
3.59
3.32
2.93
On Doctoring
3.74
Pathology
3.22
3.06
2.61
  Patients and Populations
N/A
2.77
2.79
  Physiology-Cardiovascular
3.23
3.41
3.88
  Physiology-Endocrine
3.76
3.52
3.63
  Physiology-Renal
4.19
3.46
  Physiology-Respiration
3.34
3.80
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]

28. Measures of Quality – Course Evaluation
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
BIOC 112
AY (92%)*
AY (89%)*
AY (70%)*
Overall satisfaction of course
4.35
4.48
4.25
Clarity of learning objectives
4.6
4.3
Organization of the course
4.31
4.46
4.08
How well the course introduced me to this discipline
4.32
4.49
4.38
Congruence of assessment questions to material emphasized in course
4.36
4.51
4.19
*student participation rate on course evaluation

29. Measures of Quality – Student Comments
Strengths:
Course materials
“The notes from all the professors were a great resource and it made learning less stressful.”
“Great practice problems with explanations! I wish every course used this style of prep, review questions with thorough explanations of the answers (and why others choices are incorrect).”
Review slides for quizzes and final exam seen as extremely helpful and high-yield

30. Measures of Quality – Student Comments
Strengths:
Pedagogy
“The article discussions were great - the articles chosen were very relevant to the course material and our group had great discussions.”
“The PBL was very good for reinforcing material and applying it to an interesting clinical case.”
“Overall great course. It was a challenging amount of material, but by the end of the course, I felt that I understood the connectedness and clinical relevance of the metabolic pathways. I appreciated the variety of lecturers and variety in teaching format (lecture, PBL, lit discussions, etc).”

31. Measures of Quality – Student Comments
Strengths:
Course design and faculty
“I think the learning objectives were were well written to target what was important in class.”
“…availability/willingness of faculty to help students grasp the material”
“I liked hearing patients and doctors speak - the gout presentation and the obesity presentation were quite interesting. The faculty were great.”

32. Measures of Quality – Student Comments
Suggestions for Improvement:
Scheduling*
“The first quiz for this course was overloaded and rushed, making for a flimsy foundation on which to build the rest of the course. I would hope that in future years, the compressed nature of that first quiz could be reevaluated.”
“I'd organize is so that large concepts are taught earlier on before details”
“The material for the first metabolism quiz was overwhelming. I wish we could have had half that material on quiz 1 (prior to winter break) and then the second half of the material on the following quiz. This would require restructuring of the endocrinology course, but I think that is necessary as well.”
*Note: Prior to AY 16-17, the metabolism course was spread out over the entire winter term. This year due to scheduling issues with Endocrine Physiology, Metabolism was compressed in the later part of the term. This change had a negative effect on Metabolism and will be remedied for AY

33. Measures of Quality – Student Comments
Suggestions for Improvement:
Course materials/pedagogy
Of the five sections of the course, one was taught in a different format than the others (section B, Lipoproteins and Atherogenesis). Students requested that this section be revised to better correlate with the other sections: “The material done [in section B] was difficult because it was a different format. It’s helpful to have uniform notes and resources for the course.”

34. Summary regarding Measures of Quality
The Metabolism course is consistently rated in the “very good to excellent” range
Students commended faculty for their teaching, the variety of effective pedagogies and their support of student learning – “…general willingness to engage with students and provide assistance both in and out of class is commendable.”
Suggestions for improvement focused on the scheduling of the first part of the course and the format of the material on lipoproteins and atherogenesis

35. Recommendations
Fix minor formatting issues with objectives; add the word “nutrition” to a course objective to make the nutrition content more explicit
Continue the trend of incorporating more active pedagogies in the course
Work with the leadership of Year 1 to remedy the scheduling problem for the material on Quiz 1
Revise the material on lipoproteins and atherogenesis to correlate better with the format of the other sections of the course

36. Action Plan
The W2018 course will begin after Thanksgiving (as opposed to the aberration last year when it began after Christmas) so the material on the W2017 First Quiz can be spread out over two quizzes.
Work with Nutrition and Health/Values VIGs to explicitly connect the basic science to broader issues in nutrition and health/values (processed food, alcohol use, food deserts,…..)
The presentation of the second block of the course on lipid metabolism will be re-organized to be consistent with the rest of the course.

37. Action Plan
Session objectives will be matched with course objective lacking session objectives