Review of Y2 SBM Repro Course - PowerPoint Presentation

1. Review of Y2 SBM Repro CoursePreclinical SubcommitteeJanuary, 2014Aaron Barnes (Geisel 2), Rich Comi MD, Hal Manning MDCourse learning objectivesCourse learning opportunitiesLearning assessments for studentsMeasures of overall quality for the courseSpecific suggestions for improving course

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

3. Course Objectives from IliosDefine terms common to the discussion of patients with disorders in repro system (RS)Describe the normal structure and physiology of RSDescribes normal stages of maturation and involution of RSDescribe processes of normal pregnancy, labor, delivery and issues in family planningExplain signs, sx, processes of dx of common disorders of male and female RSExplain signs, sx, processes of male RSDescribe disorders of male and female RS in early and late life Describe appropriate use of dx testing in patients with disorders of RSDiscuss epidemiology and population health aspects of disorders of the RSDiscuss 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 RSExplain the basis for pharm and nonpharm interventions for common repro diseaseDescribe how various medical disciplines are integrated in disorders of the RSUtilize the results of outcome and cost utility studies to evaluate pt care, prevention and screening in disorders of the RSDescribe how operations and processes in a complex healthcare system have an impact in disorders of the RSPractice and demonstrate systematic problem solving skills in disorders of the RSExplain ethical issues involved in mgmt of patients with disorders of the RSCommunicate with fellow students an faculty about disorders of the RSDiscuss methods of communication with pts and families about disorders of the RSDemonstrate team skills by participating in team exercises

5. Course Objectives from Ilios (continued)21) Take responsibility for your own education22) Read critically , evaluate and assess information about disorders of RS23) Search efficiently for high quality relevant info about disorders of the RS Review of Objectives:Objectives 5 and 6 are redundantObjective 11 seems too broadObjective 12 is vagueObjectives 20 , 21 and 23 are not specific to this course but seem reasonableThere are several typos# 23 is mislabeled as 22 and always paired with 22 – “22,22”

6. Session mapping to course objectives1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23FREQUENCy100502010This 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 curriculumNormal processesembryonic 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 1-41-41-3 ?

8. Abnormal processesinfectious, 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 ?5,115-7, 11

9. Principles of therapeuticsmechanisms 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 antagonistsgonadotropin-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 system12

10. Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environmentalemotional 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 abus9,10,14, 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 EmphasesED-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. 14,155,6,16,22,23? ?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, 17n/an/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. 18,191310,14,15??17,19

14. In sum,There are minor typos to be fixedObjective 11 is too broadThe 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 objectivesAppears in 2 course-level MeSH (Pharm 217)Appears in 9 sessions in 5 different coursesCourseSessionSession ObjectiveNeuroscience (MDED 115)Hypothalamus Describe the HPG axis (GnRH, FSH, LH) and how gonadal steroids (estrogens, progestins, androgens) and other environmental factors (e.g., leptin) influence GnRH neurons (through presynaptic afferents such as kisspeptin neurons).Endocrine Physiology (PHSL 120 Endo)The Male and Female Reproductive SystemTo explain how estrogens, progestins and androgens regulate non-reproductive tract tissues, including their mechanism(s) of action.Endocrine Physiology (PHSL 120 Endo)Conference 2: To recall the sources of estrogen in pre- and postmenopausal women and to consider ways in which tumor growth might be slowed in the two groups of individuals.Endocrine Physiology (PHSL 120 Endo)Endocrine control of growthTo describe interactive roles of key hormones HGH, thyroid hormones, androgens/estrogens, insulin, PTH, Vit.D, cortisol, somatomedins, in skeletal growthOrgan Based Pharmacology (PHAR 217)F-7 Kinlaw - Bone/Calcium Pharmacology 2-Feb 11:15amRecognize medications used in treating disorders of calcium metabolism (including: diuretics, bisphosphonates; calcium salts; vitamin D; calcimimetics; estrogen replacement therapy; selective estrogen receptor modulator (SERM); parathyroid hormone; and monoclonal antibodies).Organ Based Pharmacology (PHAR 217)H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors Review the physiologic role of estrogen and progesterone in the female reproductive cycle.Organ Based Pharmacology (PHAR 217)H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors Describe the basics of the biosynthesis of estrogen and progesterone. Organ Based Pharmacology (PHAR 217)H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors Discuss the effect of tamoxifen on estrogen receptors.Reproduction (SBM 206)ContraceptionCompare and contrast pregnancy rates and efficacy between unprotected coital activity, estrogen containing contraceptives, IUDs, medroxyprogesterone acetate contraception, withdrawal, and condoms.Reproduction (SBM 206)ContraceptionRecognize the "absolute" contraindications to estrogen containing hormonal contraceptives in clinical patient cases.Reproduction (SBM 206)The Menopause TransitionDescribe the common short- and long-term effects of estrogen deficiency.Reproduction (SBM 206)PBL - Breast CancerDiscuss the role of estrogens in breast cancer.Clinical Pharmacology and Therapeutics (PHAR 405)Using glucocorticoids wisely Explain the common structures of glucocorticoids, mineralocorticoids, androgens, progestins, and estrogens

16. 1g. Overlap/ILIOS word search: “Eclampsia”Does not appear in any course objectivesDoes not appear in any session title Appears in 5 sessions in 2 different coursesCourseSessionSession ObjectiveReproduction (SBM 206)Small Groups/Speed Dating FormatDiscuss potential mechanisms in the pathogenesis of preeclampsia.Reproduction (SBM 206)Small Groups/Speed Dating FormatList the physical manifestations and risks of preeclampsia.Reproduction (SBM 206)Small Groups/Speed Dating FormatDiscuss the risk factors for the development of preeclampsia.Kidney and Urinary System (SBM 212)The Kidney in Pregnancy Discuss vascular endothelial growth factor (VGEF) and sFIT-1 in pre-eclampsia.Kidney and Urinary System (SBM 212)Review with FacultyDescribe kidney function and dysfunction in pregnancy, including pre-eclampsia.

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

18. Assessment of Student PerformanceFinal 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 gradeTopic#Topic#Abortion1Male pathology1Adolescent sexuality1Male sexual dysfunction2Breast disease5Menopause1Cervical dysplasia1Menstrual cycle2Complications of pregnancy3Ovarian4Endo/Pregnancy2Placenta4Erectile dysfunction2Pregnancy5Genetics2.5Prostate1HPG axis1Puberty6Imaging2Reproduction pharmacology5Incontinence1Sex differentiation2Infertility3Sexual abuse1Labor/Delivery2Uterus/fallopian1Lactation1Vulva/uterus2

20. 3. 2012-2013 Exam items sorted by current course learning objectives (Hal)#ObjectiveMaps to# items1Define terms common to the discussion of patients with disorders of the reproductive system. 1a,1c02Describe the normal structure and physiology of the reproductive system. 1a13Describe normal stages of maturation and involution of the reproductive system. 1a34Describe the processes involved in normal pregnancy, labor and delivery and issues in family planning/contraception. 1a85Explain signs, symptoms and process of diagnosis of common disorders of the male and female reproductive system, including: benign and malignant neoplasms; infections; menstrual disorders; sexual dysfunction; disorders of sexual differentiation; abnormal pregnancy, infertility; pubertal disorders; urinary tract disorders. 1c366Explain signs, symptoms and process of diagnosis of common disorders of the male reproductive tract, including: benign and malignant neoplasms; infections; sexual dysfunction; disorders of sexual differentiation; infertility; urinary tract (including prostate) disorders. 1c97Describe the disorders of the reproductive system that affect patients early and late in life. 1c58Describe the appropriate use of diagnostic testing in patients with disorders of the reproductive system. 1c, 2g39Discuss the epidemiology and population health implications of disorders of the reproductive system. 1c110Discuss the public health and ethical issues involved with reproductive health, including sexual abuse, sexually transmitted diseases, and unintended pregnancy. 1e011Describe the pathology and pathophysiology of disorders of the reproductive system 1c312Explain the basis for pharmacological and non-pharmacological interventions for common reproductive diseases.1c4

21. 2012-2013 Exam items (cont’d)#ObjectiveMaps to# items13Describe how various medical disciplines are integrated and involved with the care, research and prevention of the disorders of the reproductive system (OB/GYN. urology, radiology, pathology, pediatrics, psychology, social work, etc) 1c014Utilize the results of outcome and cost utility studies to evaluate the effectiveness of patient care, disease prevention and screening in regards to the reproductive system. 5c,6h015Describe how operations and processes that occur within a complex healthcare system have an impact on cost and quality of effective care of reproductive system diseases 1f,6d,6e016Practice and demonstrate systematic problem-solving skills with regard to patients with reproductive disease. 1c017Explain ethical issues involved in management of patients with disorders of the reproductive system. 1e,4d018Communicate with fellow students and faculty about patients with reproductive system disease. 3e,3g019Discuss methods of communication with patients and patient families about reproductive diseases. 2a,3a,3b,3d120Demonstrate team skills by participating in team exercises. 4a,4b021Take responsibility for his- or her-own medical education. 4h022Read critically, evaluate, and assess medical information and scientific literature about important reproduction topics and questions. 1b,5b023Search efficiently for and obtain recent, high quality, relevant medical information and scientific literature about important clinical topics and questions. 5a0

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 3Negative stem 0 Multiple T/F format 3Pharmacology 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 reviewsData 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 reviewsRepresentative 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 reviewsRepresentative 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 courseSome 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: SummaryIssueProposed FixSome of learning objectives too broad (e.g. 11); some redundancy among obejctives (e.g. 5 and 6)See new set of course learning objectivesGroup learning objectives by major competency domain, and map to specific competency tasksDoneMake sure that exam topics track to new learning objectivesIn progress for current exam cycleConsider enhanced coverage of topics with LCME emphasis (e.g gender and cultural biases, diversity, etc.)Introducing material this year in both small group sessions and a panel discussion

32. 2. Learning Opportunities SummaryGood 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, SummaryIssueProposed FixLearning objectives need to be granular enough that major exam areas map well to themLearning objectives revised for 2014Learning objectives not assessed on written final exam must be assessed in some other waySome objectives are assessed in small groups, team based learning, and self directed learningConference leaders may not know students well enough to assess their competency in multiple areasFormat was changed to improve continuity. Faculty have more longitudinal exposure to studentsWritten final exam made good use of vignettes, no negative stems! Need to eliminate matching questions.Will be eliminated

34. 4. Feedback from StudentsIssueProposed FixConsider providing lecture notes to helpful in identifying important points; lecture notes may be more congruent with the course than a textbookSome lecture notes are provided in the event the text is not congruent. Powerpoint presentations are posted as a resourceClarifying objectives would make it easier to prepare for the examObjective have been revisedConsider decreasing the amount of TBL sessions early on in the course and/or using TBL session in a directed manner to assist in the learning of particularly confusing topicsTBL session topics revisedSessions given by both pathologists and clinicians could be better organized and orchestrated Feedback given to these dyads for 2014