ReviewofY2SBM/Heme course• 1.Contents• 2.Basicfactsaboutcourse• 3.Actionplanpriorreview2012• 4.Courseobjectives2014-15• 12.USMLEobjectives• 13.Sessionobjectives• 16.Pedagogy• 19.Assessment• 23.Proposednewcourselearningobjectives,2015• 27.Measuresofquality• 33.Proposedchangesandimprovements• 35.Responsefromcoursedirector

ReviewofY2SBM/Heme course

• Courseoccursinthe2nd termofYear2,oneof13SBMcourses(oneof16Y2courses)

• CourseDirector– ElizabethBengtson,MD– SectionofHematology,Dept.ofMedicine

• Coursehas37curricularhours(+4hexam)

• Coursewaslastreviewedinapprox 2012– Plusannuallongletter(review)fromDaveeveryyear

ActionPlanfromPriorReview• Summarizeactionplanfrompriorreview(MECc2012)• Dave’sannualletter2013• Thefinalexamwassometimesfrustrating tostudents(astheyreported)becauseit

sometimesfocusedonsmalldetailsinsteadofmoreimportant concepts• Alotofthematerialthatwasemphasized inclassdidnotevenappearonthe

exam• Offeringa“practiceexam”,notforcredit,wouldhelpstudentsanticipateexam

• Dave’sannualletter2014• Theprogression oftopicssometimesfeltabitoutoforder tostudents• Thelearningobjectivesforsomeofthesessionswerenotveryclear,andoftennot

postedwiththelectures.• Thefinalexamwasdifficult. Itwouldhelpstudentsalottohaveasmallpractice

exam,orpracticequizzes,prior totheactualfinalexam.

CourseObjectives(ILIOS2013-14)Objective Links Session

objectives1.Describeprocessofhematopoiesis 1a,2f 10

2.Explaintheevaluation ofdisordersofredbloodcells,andtheirmanagement 1a 54

3.Describepathophysiology,risks,issuesinvolvedintransfusion medicine 1ab,2g 10

4.Describecoagulationcascade andfactorsinvolvedinnormalhemostasis 1a 19

5.Describeevaluation,testing,andmanagementofdisordersofcoagulation 1a,2h 23

6.Listanddefinethedisordersofwhite cellnumberandfunction 1a 11

7.Explainevaluation andmanagementofdisordersofwhitecellnumberandfn 1a,2h 14

8.Explaintheevaluationandmanagementofhematopoieticneoplasias 1a,2h 109

9.DescribeMOA,complications,andresistanceforchemotherapeutic agents 1a,1b 8

10.Describeissuesinvolvedinbonemarrowtransplantation (includingmedical,psychosocial,andethical)

1a,1f 8

CourseObjectives(ILIOS2013-14)Objective Links Session

objectiv11.Communicate effectivelywithfellowstudents andfaculty(teaching,evaluation)

3efg 4

12.Communicateeffectivelywithstudentsandfaculty(aboutheme diseases) 3efg 4

13.Students takeresponsibilityfortheirownmedicaleducation 4h 4

14.Searchefficientlyforqualityandrelevantrecentinformationtohelpsolveproblems

4h,5ab 4

15.Readcritically,evaluate, assessmedicalinformation aboutimportanttopics 4h,5ab 4

16.Behaverespectfully andresponsiblytowardscolleaguesandfaculty 3efg 6

17.Discussphysical,social,financial,andpsychological impactofhavingahematologicmalignancyorblooddisorder

1ef,2a,4e

10

18. Interactwithpatientsandfamilies withcompassionandrespect 2ab,3abc 4

19.Identifyandanalyzeevidence-based,cost-conscious treatments 6c 2

20.Describecomplexitiesofcareforpatientswithsevereillness,howhealthcareisorganized,financed,anddelivered

6defj 3

CourseObjectives– GeiselCompetencies

Thereare20course-levelobjectivesthatfulfillGeiselcompetenciesasfollows:

• 11 addressspecificknowledge inthepreclinicaldomain,andseemappropriate(1)

• 6 addressspecificclinicalskillsnecessaryforpatientcare,andseemappropriate(2)

• 4 addressinterpersonalandcommunicationskills(3)• 4 addresscomponentsofprofessionalidentityformation(4)• 2 addressbuildinghabitsofinquiryandimprovement(5)• 2 address understandingandimprovingthehealthcaresystem

(6)

CourseObjectives– GeiselProgramObjectives

Thecourseobjectivesfulfilltheprogramobjectivesasfollows:

• Courseobjectivesaddress4ofthe6programobjectivesforGeiselcompetency1

• Courseobjectivesaddress5 ofthe9programobjectivesforGeiselcompetency2

• Courseobjectivesaddress6 ofthe8programobjectivesforGeiselcompetency3

• Courseobjectivesaddress3 ofthe12programobjectivesforGeiselcompetency4

• Courseobjectivesaddress2 ofthe6programobjectivesforGeiselcompetency5

• Courseobjectivesaddress5 ofthe10programobjectivesforGeiselcompetency6

CourseObjectives– GeiselProgramObjectives

Commenthereaboutinformationonpreviousslide.• Thereisanefforttohaveatleast2course objectivesmaptoeachofthesixmajorschooldomains

• Thereisappropriateemphasisinthiscourseonschooldomains1,2,and3

CourseObjectives– Format/Distribution

• Didnotseecourse-levellearningobjectivesprovidedatthefrontofthe2014syllabus;wouldbeusefultoshowthoserightupfront

• Sessionlevelobjectiveswerelistedrightatthetopofmanybutnotalllecturehandouts;formatcouldbeimproved

• Themostrecentcourse-levelobjectivesinILIOSarefromAY2013-14,notfromAY2014-15

• Ifchangesaremadetothecourseobjectivesnow(June2015),theyshouldbeupdatedinILIOS,intimeforthenextcourseinFall2015

CourseObjectives – USMLEBrochure• Forthe“BloodandLymphoreticular System”• The2014NBMEContentOutlineappliestoallthreestepexams,notjusttoStep1

• Itisquitevague,andlists“normalprocesses”and“abnormalprocesses”

• Itgenerallydoesnotmentionspecificdiseasesorconditions(e.g.vonWillebrand disease),butwillmentionmorebroadcategories(e.g.coagulationdisorders,orcongenitaldisorders)

CourseObjectives – USMLEBrochure• Normalprocesses

– Embryonicdevelopment,fetalmaturation,perinatalchanges– Organstructureandfunction– Cell/tissuestructureandfunction– Repair,regeneration,changesassociatedwithstagesoflife

• Abnormalprocesses(healthmaintenance,screening,diagnosis,management,risks,prognosis)– Infectiousandimmunologic– Neoplasms– Anemia,cytopenias,andpolycythemia– Coagulationdisorders(hypercoagulable andhypocoagulable conditions)– Traumatic,mechanical,andvasculardisorders– Congenitaldisorders– Adverseeffectsofdrugsonthehematologicandlymphoreticular systems

CourseObjectives– XOrganization• Wedidnotfindarecommendedsyllabuspublishedbyanationalprofessional/scientificorganization

SessionObjectives– Format/Distribution• Sessionobjectiveswereprovidedrightatthetopofmost,butnotall,

syllabusnotes• Notsureaboutpowerpoint files• Mostly,butnotalways,insuggestedformatwithclearactionverbsthat

aremeasurable• SessionobjectiveshavebeenmappedbacktocourseobjectivesinILIOS• Wecheckedthesessionobjectiveslistedforthe2014versionofthe

lectureaboutHematopoiesisbyDr.Lowrey,andcomparedthemtothesessionobjectiveslistedinILIOSforthe2013lecture.Thislecturein2013listed9sessionobjectives(inILIOS).For2014,thatsamelecturelisted6sessionobjectives,whichwerefewerbutbetterwritten.

• IwasunabletofindsessionobjectivesinILIOSfromthe2014course.

SessionObjectives- Redundancy• Welookedfortwoareas:leukemiaandlymphoma,whicharebothmajor

themesinthiscourse• Leukemia

– Didnotappearinanycoursesasacourseobjective– AppearedinoneSBM/Heme sessiontitle(PBLcase:AML)– Appearedinsessionobjectivesfor3SBM/Heme sessions(1PBLcase,

2lectures)• Lymphoma

– Didnotappearinanycoursesasacourseobjective– AppearedintwoSBM/Heme sessiontitles(1lecture,1smallgroup)– AppearedinsessionobjectivesfortwoSBM/Heme sessions(see

above)

SummaryregardingObjectives• Courseobjectiveslookappropriate(20),withappropriatedistributiontoGeisel6competencydomains,buttheyarenotoptimal(seebelow)

• NeedtobeupdatedinJune2015,andthenpostedtoILIOSforuseinFall2015

• Courseobjectivesneedtobepresentedinthesyllabusonday1,andalsoinCanvas

• Sessionobjectivesneedtobeupdated,putinsimilarformat,andshownineachppt file,andeachsyllabusworddocument,andupdatedtoILIOSinFall2015

CourseLearningOpportunities

Learningformat Hours %class time

Standardlecture 21 57%

Clinicallargegroup (e.g.patientpresentationordiscussion)

6 16%

PBLcases(AML,vonWillibrand)

6 16%

Clinicalconference,smallgroup

4 11%

Subtotal 37 100%

Finalexam 4

Totalhours 41

CourseLearningOpportunities• Activelearningisincludedinsmallgroupconferences,andPBLgroups

• Standardlecturestillconstituteahigherpercentage(57%)ofscheduledclasstimethanisoptimalalthoughingeneraltheyarewelldone

SummaryregardingPedagogy• Makeefforttoconvertafewhoursofscheduledclasstimefromstandardlecturestootherformatswithmoreactivelearning/involvement

Assessment• Thereisa4-hourfinalexamattheendofthecourse• ThereisarequiredessaycalledaPersonalreflection,baseduponthePatientPerspectiveofIllnesssession– Thisseemsworthwhiletomoststudents,butitwouldbehelpfultoreceiveessaysbackwithafewcommentsfromfacultyforfeedback

• Studentsmustearnatleast6pointsinthe6requiredactivities(smallgroupseminars,hemophiliasession,patientperspectivesession,lymphomasession,andALL/CLLsession)

Assessment– FinalExam• Finalexamdraftisassembledbythecoursedirector,thenreviewedbyDr.NierenbergorDr.Frew (SBMoffice)

• Wetrackcloselyquestionformat:vignette,factoid,imagerecognition,analysisofdata,etc.

• MultipleT/Fquestionsandnegativeleadinitemsarediscouraged,andreducedeachyear

• Numberofquestionsrelatedtomajortopicsofcoursearetrackedclosely,andareappropriate

• Breakdownofexamitemsbycourseobjectivesisshowninnexttwotables

Assessment– Currentcategories• Totalexam 83items• Anemia 16• Bleeding/thrombosis 13• Hematologicmalignancy 19• Hematopoeisis 02(shouldbeatleast3)• Pathology 08• Pharmacologyitems 13• Transfusion 07• Transplantation 01(shouldbeatleast3)• WBCbenign 04

Assessment– Itemtype(n=70)• Vignette 28• Factoid 21• MultipleT/F 16• Negativelead-in 0• Analyzedata 2• Recognizephoto 7• Matching 2• (Pharmacology 13)

CourseObjectives(proposedfor2015)Objective #onexam

1.Describeprocessofnormalhematopoiesisforrbc’s,wbc’s,andplatelets 4

2.Explaintheevaluationofbenigndisordersofredbloodcells,andtheirmanagement(e.g.anemia,polycythemia,hemolysis,etc.)

13

3.Describepathophysiology, risks,issuesinvolved intransfusionmedicine(e.g.indications,reactions,etc) 7

4.Describecoagulationcascade andfactorsinvolvedinnormalhemostasis 5

5.Describeevaluation,testing,andmanagementofdisordersofcoagulation(e.g.DIC) 9

6.Describebenigndisordersofwhite cellnumberandfunction, theirdiagnosisandmanagement(e.g.leukopenia,leukocytosis)

5

7.Describe benigndisordersofplateletnumberandfunction,theirdiagnosisandmanagement(e.g.thrombocytopenia, thrombocythemia)

4

8.Describethepathogenesis,diagnosis,andmanagementofleukemias andlymphomas 13(8+5)

9.Describethepathogenesis,diagnosis,andmanagementofotherpremalignantandmalignantdiseases(e.g.multiplemyeloma,MDS,polycythemia vera,etc)

5

10.DescribeMOA,complications,andresistanceforchemotherapeutic agents 10

11.Describeandidentifypathologicfindingsofcommondisorders oftherbc,wbc,platelet,andlymphomatissues

6

12.Describeissuesinvolved inbonemarrowtransplantation (includingmedical,psychosocial,andethical) 1

CourseObjectives(proposedfor2015)Objective Items on

exam13.Communicate effectivelywithfellowstudents andfacultyabouthematologicissues(teaching,evaluation)

Conf,PBL

14.Demonstratetheabilitytotakeresponsibility foryourowneducation Conf,PBL

15.Searchefficientlyforhighqualityandrelevantrecentinformationtohelpsolveproblems,andreadandassessitcritically

Conf,PBL

16.Behaverespectfully andresponsiblytowardscolleaguesandfaculty Conf,PBL

17.Discussphysical,social,financial,andpsychological impactofhavingahematologicmalignancyorblooddisorder(e.g.leukemia,hemophilia)

Essay

18. Interactwithpatientsandfamilies withcompassionandrespect Patientsessions

19. Identifyandanalyzeevidence-based,cost-conscious treatments Conf,PBL

20.Describecomplexitiesofcareforpatientswithseverehematologicillness,howhealthcareisorganized,financed,anddelivered

Essay

Assessment• Essaybaseduponpatientsession• Basicassessmentofstudentknowledge,participation,andappropriateinterpersonalskillsandcommunicationassessedinsmallgroupsandPBLgroups

• NarrativefeedbackisnotroutinelyprovidedinHemesmallgroupsessions,butitisinPBLgroups

SummaryregardingAssessment• EliminatemultipleT/Fitems• Makesurethereareatleast3itemspertopic• Alignexamtopicswithfirst12course-levellearningobjectives

• Reducenumberof“factoid”items(testingpurememorizationandrecall)

• Providepracticequizorpracticeexam• Reviewoveralllevelofdifficultyoftheexam,andhowwellitemsmatchtocourseobjectives

MeasuresofQuality– StepISYSTEMS-BASEDTOPICS 2012* 2013* 2014* Means 12-14

Behavioralsciences 0.43 0.26 0.15 0.28

Biostatistics,Epidemiology,PopHealth 0.01 0.01

Cardiovascularsystem 0.20 0.47 0.02 0.23

Endocrinesystem 0.39 0.39

Gastrointestinalsystem 0.32 0.59 0.54 0.48

GeneralPrinciplesofFoundSciences 0.25 0.25

Hematopoietic/lymphsystems 0.14 0.18 0.09 0.14Immunesystem 0.22 0.53 0.16 0.30

MultisystemProcesses &Disorders 0.23 0.23

Musculoskeletal,skin,CTsystems 0.24 0.34 -0.02 0.19

Nervous system 0.25 0.21 N/A

NervoussystemandBehavioral Health 0.06 0.06

Nutrition 0.56 0.39 0.22 0.39

Renal/urinarysystem 0.42 0.21 0.23 0.29

Reproductive/endocrinesystems 0.42 0.39 N/A

Reproductivesystem 0.39 0.39

Respiratory system 0.29 0.31 0.18 0.26*valuesreportedforcoredisciplines areSDabovetheUS/CanmeanforGeiselmeanscores

MeasuresofQuality– AAMCGQ

Year2courses OverallQualityAY2014-2015 Overallmeanscore14-15

Themes

Respiration 4.38 4.35

Cardiology 4.27 4.30

PharmacologyI 4.15 4.11

Hematology 4.44 4.33Nervous system 3.46 3.87

Psychiatry 4.20 4.28

Endocrine 4.09 4.07

FEK 4.19 4.14

CT&Bone 3.62 3.87

Dermatology 4.11 4.16

GI 4.47 4.40

Infectiousdis 4.40 4.38

Reproduction 3.29 3.52

MeasuresofQuality– CourseReviews

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

MeasuresofQuality– Heme Reviews

2013-14X%

2014-15X%

1.Clarityoflearningobjectives 4.24

2.Congruenceofexamitemstocourseobjectives 3.79

3.Effectivenessofcourseorganization 4.39

4.Courseprovided useful/relevantintroduction tofield 4.61

5. Overallcoursequality 4.44

6.Qualitylargegroup instruction (meanscore) 4.38

7.Qualitysmallgroup instruction (meanscore) 4.17

8.Overallmeanscore,allquestions 4.29

MeasuresofQuality– Studentcomments2015

• Courseoverallandlectureswereverywellorganized– Itwasallsowellorganizedandengaging—trulyapleasuretosit

through.BestruncourseIhaveseenthisyear.

• Clinicalvignette/pathologyduoteachingstyleworkedwell

• Studentslovedsessionswherecaseswerediscussedrightinclass– Ithoughtthesessionswithcaseswereverywelldoneandincredibly

helpfultoworkthrough.

• Facultywerearealstrengthofthecourse– TheinstructorsforthiscoursearePHENOMENAL!Theyaregreat

teachers!

MeasuresofQuality– Studentsuggestions

• Progressionoftopicssometimesfeltabitoutoforder.Thiswasnotedinboth2014and2015versions,soworthasecondlookatthis.

• Thelearningobjectivesforsomeofthesessionswerenotveryclear,andoftennotposted/includedforthelectures

• Thefinalexamwasdifficult.Itwouldhelpstudentsalottohaveasmallpracticeexam,orpractice,quizzes,priortotheactualfinalexam.

• Reviewexamitemstobesuretheyaretestingimportantconceptsfromsessions,ratherthanveryspecificdetails

SummaryregardingMeasuresofQuality• Asratedbystudents,thiswasaveryhighqualitycourse,withhighscores(top3-4)intermsofoverallqualityandmeanscore

• StudentsdoperformwellonStep1,butinthelowerthirdofallY2subjectstestedonStep1

Recommendations• Courseobjectives:

– Clarify,rewritefor2015(seeproposed wording inearliertwoslides)– Includekeywordslikeanemiarightineachcourseobjective(easiersearching

onILIOS)– Includeonfirstday

• Sessionobjectives– Updatefor2015,includeatheadofeachppt file

• Pedagogy:– Schedule fewerhoursoflecture,morehoursofothermoreactivelearning

sessions• Exam:

– Rebalancenumberofitems;alignwithcourseobjectives– Makesureeachareahasatleast3items(orasappropriateforclasshours)– Delete,rewriteitemsindiscouraged formats(e.g.multipleT/F)

• Student suggestions– Makeavailablepracticequizzesorpracticeexam

ActionPlanbyCourseDirectorElizabethBengtson,submitted9/8/15

• Courseobjectives:– Clarifyobjectivesandrewritefor2015(seeproposed inslides23-24above)– Includekeywordslikeanemiarightineachcourseobjective(easiersearching

onILIOS)– Includecourseobjectives insyllabus,Canvascoursepage,andpowerpoint

presentedonthefirstday– CourseobjectiveswillalsobeavailableonCanvas()coursehomepage)and

ILIOS• Sessionobjectives

– Updatefor2015,includeatheadofeachsessionpowerpoint fileandincoursesyllabus

• Pedagogy:– In2015theAML/MDS lecturewillbereplacedwithacasebasedformat.This

willbeclassinteractiveandattendancewillberequired.

ActionPlan(continued)• Finalexamandquizzesforcredit:

– Rebalancenumberoffinalexamitems;alignwithcourseobjectives– Makesureeachtopic/areahasanappropriatenumberofitems(basedon

timespentinclass)– Delete,rewriteitemsindiscouraged formats(e.g.multipleT/F)– Twoshortquizzeswillbeaddedin thecourse,oneafterredblood celltopics,

andoneaftercoagulation lectures.• Eachquizwillhave10items,20minutesallowed,oneattemptallowedonline• Similarstyleanddegreeofdifficultytofinalexamquestions• Deadlinewillbe11PMSundaynightsoasnottoconflictwithothercourses,etc.

– Havingtwoquizzescounttowardsthefinalgradewillserveseveralpurposes:• helpstudents knowwhattoexpectonthefinalexam• Forcestudents to“keepupwiththecurriculum”toaidinpacedlearningand

minimizeend- of-the- termcramming• Helptore-distributethegradingofthecoursesothat itisnotasweightedonlyon

thefinalexam– Not-for-creditpracticeexamquestionswillbemadeavailabletothestudents