Review of Year 2 Patients & Populations - PowerPoint Presentation

Slide1

Review of Year 2 Patients & Populations course

Course occurs in the second and third terms of Year 2.

Course Director – Brenda Sirovich, MD, MS

Lisa Adams, MD

Course has 8 curricular hours

Course was approved in May 2016

Date

of this review:

April 2017

Slide2

Action Plan from Prior Review

The course was given for the first time during AY16-17.

(no prior plan)

Slide3

Course Objectives

1

Describe the common methods of measurement in clinical medicine and research and how they are used.

2

Explain the role and use of statistics in addressing questions in health and medicine.

3

Explain the findings of a research study reported in the medical or health care literature.

4

Apply the findings of a research study to a clinical scenario.

5

Interpret the roles of probability, variability, and uncertainty in clinical decision making, including diagnostic testing and screening.

6

Explain how the quality of medical research may be affected by a study's design and execution, confounding, and bias.

7

Identify and compare strategies for the care of a population or community, or subgroups within it, based on your interpretation of patterns of disease and health care.

8

Explain the impact of social, behavioral, environmental, economic, cultural and personal factors on the health of individuals and populations.

9

Illustrate the relationships between the health care system and other societal systems and entities that impact population health.

10

Describe variation in how health care is delivered and financed across different U.S. regions and countries.

11

Discuss the context (financial, political, ethical, e.g.) in which medicine is practiced in the United States, and how it influences health care delivery.

12

Evaluate a patient's and family's experiences within multiple levels of the health care system.

13

Analyze a local clinical front line health care microsystem.

Slide4

Course Objectives - Continued

14

Analyze, measure, and perform

tests of change?

to demonstrate measurable improvement.

15

Demonstrate appropriate behaviors while working effectively in

interprofessional

teams.

16

Apply core patient safety concepts while recognizing the physician's role in monitoring and creating safe systems of care.

17

Demonstrate self-awareness and discovery through ongoing self reflection and assessment.

18

Demonstrate awareness of effective teams through observation and assessment.

19

Analyze leadership challenges at the personal and health care (clinical, educational, research, policy, or community service) team level.

20

Develop and execute a strategic action plan to create meaningful and measurable change at the personal and team level.

21

Practice clear and concise communication with individuals or larger audiences, using writing, speech or visual elements.

22

Demonstrate active, perceptive, and respectful listening.

23

Formulate effective communication to articulate vision, develop relationships, and effect change.

24

Evaluate a real world problem by effectively organizing, prioritizing, and synthesizing information into a plan for action.

Slide5

Course directors will review current mapping (to new Geisel competencies) and forward updates to Brian Reid

Mapping of Course Objectives to Geisel Competencies

Slide6

Course and session objectives are written properlyCourse objectives listed in Ilios are the same as those for Y1P&PCourse objectives do not appear in the syllabusIn the

ilios

system, session objectives map to only course objectives 3, 4, 9, 10, 11, 21 and 24, but probably should map to more

For example, course objectives 15 and 16 would seem to relate to the IPE session, which currently does not have any objectives in

Ilios

.

Course Objectives – Comments

Slide7

Course objectives are not provided in the syllabus Course objectives are written in the correct format

Session objectives

are

provided in the course materials

Session objectives

are

written in the correct format

Format of Course & Session Objectives

Slide8

Are there major issues of redundancy with other courses? Opiate crisis“Vaccine wars”Ethical issues in international health researchThese topics each appear other places in the curriculum, but this course presents them in a way different from how they are presented elsewhere.

Effective repetition

Issues of Redundancy

Slide9

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).

Health and Values Goals

Slide10

International research ethics sessionSession on vaccines explores issues of rights of parents and children within the healthcare context and and potential clashes of values versus objective measure in vulnerable populations Students appreciate the possibility to evaluate these timely issues

Health and Values Content

Slide11

Summary regarding Objectives

Course objective are not included in the syllabus

The Objectives listed on

Ilios

are the same as those of the first year course

Linkages of session objectives to course objectives and of course objectives to institutional competencies need to be reviewed.

Good health and values content

Slide12

This was a new courseFour 2-hour experiencesThree Interactive Large Group sessions 6 hrs. (75%)Interprofessional Education Exposure 2 hrs. (25%)

Course Learning Opportunities

Slide13

Pedagogy is based around 3 articles and an IPE simulation experienceThe IPE exercise has a readiness exercise and 3 simulated patient safety/communication vignettes The 3 “cases” involve:

Pre-work, involving focused review of one of three individual aspects of the case, with a short written report.

Group discussion of the article from all three perspectives

Each student writes an “Executive summary” of the discussion

All of the activities would be classified as engaged learning

Course Learning Opportunities

Slide14

Summary regarding PedagogyThe pedagogy is appropriate.

“Engaged Learning” approaches including:

“Flipped” sessions (w/ pre-work that contributes to engagement during the session

Independent investigation of aspects of a case

Interactive, student-led case discussions

Preparation of summaries of case discussions

IPE Simulation

Slide15

Completion of pre-course survey: 5%Completion of four course assignments (one for each case and one for IPE): 75%Participation

& Professionalism: 20

%

Student participation and professionalism also contribute to a student’s grade. Each student is expected to attend and fully participate in all required sessions and exercises, and to maintain the highest values in:

Personal

behavior that fosters respect, innovation, and growth,

Collaborative

teamwork that supports discussion, sets clear expectations, and holds each student accountable,

Fostering

a learning environment that is engaging, supportive, and sustainable

Providing

and being receptive to feedback that is timely, constructive, and promotes positive change

Assessment (from syllabus)

Slide16

Assessments include:Readiness exercise for IPE session.Attendance, timely completion of assignments and adherence to strict requirements for assignments.

Individual grading of written pre

-session

assignments and of the executive summary for each student on each of the three case sessions.

Assessment for Course Objectives

Slide17

Summary regarding AssessmentAssessment of written reports is rigorous

The course evaluates whether students are meeting professional responsibilities (i.e., timeliness, attendance, adherence to requirements).

The course syllabus emphasizes the many other aspects of professionalism incorporated in “Exams and Grading”, while there is no mechanisms for these other dimensions of performance to contribute to formative or summative assessment.

Slide18

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

0.07

-0.09

0.07

Microbiology/Immunology

0.39

0.02

-0.01

0.13Pathology0.200.12-0.100.07Pharmacology0.12-0.020.00.03Physiology0.250.110.060.14

Measures of Quality – Step I

*

values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Slide19

Measures of Quality – Step I

SYSTEMS-BASED TOPICS

2014*

2015*

2016*

Means 14-16

Behavioral sciences

0.15

-0.1

-0.43

-0.13

Behavioral

Health and

Nervous system

0.06

-0.10

-0.18

-0.07

Biostatistics, Epidemiology, Pop Health

0.01

0.22

N/A

0.12 (14-15)

Cardiovascular system

0.02

0.16

-0.1

0.03

Endocrine system

0.39

0.24

0.09

0.24

Gastrointestinal system

0.540.20.060.27Hematopoietic/lymph systems0.090.10-0.150.01Immune system0.16-0.07-0.02

0.02

Musculoskeletal

, skin, CT systems

-0.020.220.150.12Nutrition0.22-0.08-0.15-0.003Renal/urinary system0.230.02-0.27-0.007Reproductive system0.39-0.03-0.040.11Respiratory system0.180.27-0.220.08

*

values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Slide20

IPE session

The IPE session was well received overall

Measures of Quality – Course Evaluation

Quality

of pre-work

readings 3.31/5

Content of the information

during the session 3.52/5

Relevance to your

curriculum 3.61/5

Quality of your interaction

with

interprofessional

student

colleagues 4.03/5

This activity increased my appreciation that breakdowns in

communication 4.13/5

exist in healthcare and that these can adversely impact patient safety

.

This session has increased my confidence in applying communication

strategies 3.86.5

to convey an unsafe patient situation.

Overall, how effectively did your team work together during this activity

?

Poorly 1.11%; Adequately 3.33%; Well 52.22%; Extremely Well 43.33%

There were some suggestions about scheduling (which is challenging given the need for multiple session in the

Sim

Center) and content (particularly the pre-work and the large group debrief session) that should be reviewed by the course directors.

Slide21

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

Measures of Quality – Course Evaluation

MDED 218

AY

16-17

(55.7%)*

Overall satisfaction of course

3.89

Clarity

of learning objectives

3.9

Organizatio

n of the course

3.96

How well the course introduced

me to this discipline

3.83

Congruence

of assessment questions to material emphasized in course

4.2

*

student participation rate on course evaluation

Slide22

Strengths:Topics chosen were of interest to students“Loved the 3 topics chosen for the sessions - very relevant

!”

Panelists brought expertise, unique perspectives

“I think the panelists were knowledgeable and engaging.”

“The

vaccine panel was particularly great -- each speaker provided a unique and very valuable perspective

.”

I thought the last session we had about the ethics of research studies and how to conduct a research study was

very effective.”

Group work involved team members with different roles

“

The splitting up of the work load and working as a team facilitated really nice discussion and learning

.”

Measures of Quality – Student Comments

Slide23

Opportunities for Improvement:Pre-session assignments focused too much on word count

“I did feel

[constrained] by

the number of questions we were expected to answer for our pre-class essay. I wish there had just been one question that we could have responded to thoroughly in 200-400 words

.”

“…I

think the assignment asked for too many pieces to go into a very short amount of writing

.”

“

Emphasis on word count was

extreme…and

I feel like the emphasis detracted from the content of the

course.”

Consider

removing the post-session executive summary

“Not

sure what the executive summary provided. Good way to frame discussion but often felt like it was constraining a full discussion.”“The executive summary turned into one person having to do all they work. Didn't really seem to do anything purposeful.”Measures of Quality – Student Comments

Slide24

Suggestions for future course expansion:Students liked the current number of case-based sessions“I thought that the sessions were of sufficient length that I think adding in more cases would be

overwhelming.”

“[I thought] the

longitudinal case on communication and adverse events last year was far too redundant. It

would require

new perspectives to do a longitudinal case and not feel like busy work. This year felt like the perfect sweet spot

.”

Students requested biostatistics/epidemiology material

“[This] would be extremely helpful…especially in the winter/spring as a Boards refresher.”

“I think this could be

helpful…maybe

even just

a problem

set so that we can keep looking at it, or having it more integrated with the cases can be

helpful…[or perhaps] adjusting

the

data group…to answer biostats questions pertaining to the case!”Measures of Quality – Student Comments

Slide25

Summary regarding Measures of Quality

The IPE session is rated “Very Good” by students

There are many individual students comments that should be reviewed before next year

Overall, students have rated the course is in the “Very Good” range

Since this was the first iteration of the course, there are no external metrics (e.g., USMLE performance) on which to base quality assessment.

Slide26

RecommendationsOverall, the Y2 P&P course is appreciated by students and uses appropriate pedagogy and evaluations.

There are areas for improvement in objectives, assessment and structure:

Objectives

Determine which of the course objectives are relevant to the Y2 P&P

content

Assure that course objectives are listed on Canvas

Assure that all session objectives are represented in

one or more course

objectives

Evaluate linkage of course objectives to institutional

competencies

Slide27

RecommendationsAssessmentConsider the methods of evaluation of professionalism beyond attendance and timeliness

Structure

Evaluate the need for, and appropriateness of, the strict 200-400 word limits on the pre-work for case assignments

Examine the purpose, importance and structure of the “Executive Summary”

Slide28

Action Plan for 2017-18

Overall:

What will stay the same:

Course objectives

Overall course structure

Assessment methods

What will

change:

Increase # of hours (8



13)

Slide29

Action Plan for 2017-18

Case Series:

What will stay the same:

Objectives, structure, content of dominant component = Case Series (currently 6h/8h)

Each session = the opportunity to apply course competencies to specific topics (cases) in pop health, healthcare, and medicine

Survey students at start of year re: topical interests

What will

change:

Add one case – likely related to Nutrition / Obesity

Add one capability domain – likely splitting Data/Evidence into Data and Evidence

Revise summary assignment requirement and structure

Biomedical librarian workshop will now be required (floating)

Slide30

Action Plan for 2017-18

Other course elements:

What will stay the same

IPE Session (Patient Safety)

MaD Elective

Canvas interface

Faculty / staff

What will

change

Added

Sim

/IPE type session (IV) likely

Pilot student teaching opportunities (Year 4, PhD, and or MD/MPH or MS)