course Course occurs in the winter term of Year 1 Course Director Larry Myers Course has 505 curricular hours Course was last reviewed in July 2015 Review presented to MEC July 2017 Action Plan from Prior Review ID: 774844
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Slide1
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
Slide2Action 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]
Slide3Course Objectives
C
ourse objective #11 does not have any session objectives mapping to it
Slide4The 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 coursesThe 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)
Course Objectives – Comments
Slide5Relevant Content in Step I Brochure
covered in HAE & CTO
covered in Metabolism,
CTO, Endocrine & Renal
Physiology, SBM GI
Slide6Relevant Content in Step I Brochure
covered in HAE
& CTO
covered in Metabolism, CTO and Endocrine Physiology
Slide7Course objectives are provided in the syllabus. Course objectives are written in the correct format.Session objectives are provided in the course materialsNote: 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 toSession objectives are written in the correct format with the exception of objectives for the session titled “Clinical Correlation: Engaging in the Obesity Epidemic”
Format of Course & Session Objectives
Slide8Multiple 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
Issues of Redundancy
Slide9Ethics – “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
Slide10What 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 veteranlead poisoningeating disordersAre 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
Health and Values Content
Slide11What do the student evaluations indicate regarding Health and Values teaching?
Health and Values Content
Slide12Student 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).”
Health and Values Content
Slide13Medical ScienceDescribe 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 CarePerform 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 HealthExplain 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.
Nutrition Objectives
Slide14Communication 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.
Slide15The 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.
Nutrition Content
Slide16What nutrition content is presented in the course? carbohydrate metabolismobesity epidemic, metabolism in obesitystarvation and diabeteslipid metabolism, cholesterol metabolism, atherosclerosisamino acid/protein metabolism, purine metabolism, nucleotide metabolism, gout case studywater soluble and fat soluble vitaminsfuel sources, sprint vs. marathonenergy balance
Nutrition Content
Slide17Are 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)
Nutrition Content
Slide18Summary 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
M
inor 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
Slide19Lecture 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%)
Course Learning Opportunities
Slide20Over the last 5 years the course has gradually reduced the number of lectures from 79% of contact hours to 60% of contact hoursThe course added a PBL case this year that was well- received by the studentsThe course provides optional review sessions to prepare for quizzes and the final exam
Course Learning Opportunities
Slide21Summary 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)
Slide22Final Exam = ~40% of course grade (264 pts)Written Quizzes = ~50% of course grade (330 pts)Quiz 2: 150 ptsQuiz 3: 100 ptsQuiz 4: 80 ptsArticle Discussions = ~10% of course grade (66 pts)Article Discussion 1: 33 ptsArticle Discussion 2: 33 pts
Assessment
Slide23Objectives 1-10 are related to medical knowledge and are assessed on quizzes and examsObjectives 11 and 12 involve problem-solving skills and are assessed with questions on quizzes and exams that require application of knowledgeObjective 13 involves evaluating and discussing scientific literature; this is assessed during the two literature discussion exercises
Assessment for Course Objectives
Slide24Summary 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)
Slide25Measures of Quality – Graduation Questionnaire
Data from AAMC Graduation Questionnaire
Slide26TRADITIONAL CORE DISCIPLINES2014*2015*2016*Means 14-16Biochemistry0.220.03-0.040.07Biostatistics0.080.29N/A0.185 (14-15)Genetics0.280.09-0.360.003Gross Anatomy/Embryology0.140.16-0.120.06Histology/Cell Biology0.230.07-0.090.07Microbiology/Immunology0.390.02-0.010.13Pathology0.200.12-0.100.07Pharmacology0.12-0.020.00.03Physiology0.250.110.060.14
Measures of Quality – Step I
*
values reported for core disciplines are SD above the US/Can mean for Geisel mean scores
Slide27Overall Quality - Year 1 coursesAY 14-15AY 15-16AY 16-17 Basic Science of Microbial Disease3.944.104.73 Biochemical and Genetic Basis of Medicine 4.344.404.54 Cells, Tissues and Organs 4.074.064.21 Human Anatomy and Embryology I 4.354.044.61 Human Anatomy and Embryology II 4.574.434.74 Immunology and Virology3.67/3.773.94/3.834.70 Metabolic Basis of Disease 4.354.484.25 Neuroscience3.593.322.93 On Doctoring3.744.104.07 Pathology3.223.062.61 Patients and PopulationsN/A2.772.79 Physiology-Cardiovascular 3.233.413.88 Physiology-Endocrine 3.763.523.63 Physiology-Renal 4.193.633.46 Physiology-Respiration 3.343.413.80
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Measures of Quality – Course Evaluation
Measures of Quality – Course Evaluation
Slide28scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Measures of Quality – Course Evaluation
BIOC 112AY 14-15 (92%)*BIOC 112 AY 15-16 (89%)*BIOC 112 AY 16-17 (70%)*Overall satisfaction of course4.354.484.25Clarity of learning objectives4.354.64.3Organization of the course4.314.464.08How well the course introduced me to this discipline4.324.494.38Congruence of assessment questions to material emphasized in course4.364.514.19
*
student participation rate on course evaluation
Slide29Strengths: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
Measures of Quality – Student Comments
Slide30Strengths: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).”
Measures of Quality – Student Comments
Slide31Strengths: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.”
Measures of Quality – Student Comments
Slide32Suggestions 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 17-18.
Measures of Quality – Student Comments
Slide33Suggestions for Improvement:Course materials/pedagogyOf 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.”
Measures of Quality – Student Comments
Slide34Summary 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
Slide35Recommendations
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
Slide36Action 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.
Slide37Action Plan
Session objectives will be matched with course objective lacking session objectives