Curriculum Committee Minutes

October 9, 2020 Page 1 of 3

Curriculum Committee Minutes

Date October 5, 2020

Time 4:00 – 5:30PM

Location & Zoom Info

Zoom: https://uw-phi.zoom.us/j/414136379 Telephone: +1 669-900-6833 or +1 646-558-8656

Co-Chairs Mark Whipple, Sherilyn Smith

Attendees ☒ QUORUM REACHED (> 50%: 9; > 60%: 11)

Academic CoChair: Sherilyn Smith; Executive Chair: Mark Whipple Voting Members: Brenna Ostertag, Kris Calhoun, Peter Fuerst, Laura Goodell, Ruth Lewinski, John Willford, Leanne Rousseau, Zach Gallaher, Eric LaMotte, Sherilyn Smith, Amanda Kost Guests: Linh Ngo, Sarah Wood, Nick Cheung, Tim Robinson, Edith Wang, Tonja Brown, Jenny Jensen, Rachel Palfini, Kathy Young, Darryl Potyk, Parker Blekkenk, Emily Cox, Meghan Kiefer, Jeff Segmiller, Maya Sardesai, Heidi Combs, Gerald Tolbert, Jaime Fitch, Matt Cunningham, Tara Gates, Kelley Goetz, Rebekah Smith, Cynthia Sprenger, Raye Maestas, Devin Sawyer, Marilyn Cope, Kellie Engle

Regrets Voting members: Mara Rendi, John Scott, Malika Hale

Agenda

ITEM LEAD TIME ATTACHMENTS ACTION

1 September minutes Mark Whipple 5 min Attachment A Decision

2 Elentra Introduction Nick Cheung 15 min

3 Student Foundations Education Priorities Workgroup

Isabela Coveli/Haya Jamali 30 min

4 Step 1 Prior to entering Patient Care Phase

MSA student representatives 45 min Discussion/

Decision

Next Meeting: November 2, 2020

September meeting minutes Discussion: The September minutes were reviewed.

☒ DECISION REQUIRED? [11] VOTES FOR [0] VOTES AGAINST Decision: The committee approves the September minutes Elentra Introduction (Nick Cheung) Discussion:Elentra ([email protected]) is the new Curriculum Management System for the SOM. A curriculum management system is required by AAMC and LCME to capture and report the curriculum

https://uw-phi.zoom.us/j/414136379

mailto:[email protected]


and learning objectives and learning events for the school. All UWSOM students, faculty and staff are now active and entered in Elentra. Students will see whatever learning and assessment events subscribed to them. A dashboard calendar shows student learning events. Learning events are loaded block by block, one month before the block starts. WWAMI Time zones are built into Elentra. The first priority was to initiate the calendar and learning events and the next priority is to tag block level and program level objectives and add content level descriptors to allow key word search which will pull up all learning events with topics in the title. The Curriculum Explorer function will also pull up learning objectives across the four-year curriculum and a matrix function will tag objectives by blocks and clerkships. Tutorials will be developed as Elentra is built. DECISION REQUIRED? [] VOTES FOR [0] VOTES AGAINST Decision: Foundations Educational Priorities Elective (Meghan Kiefer, Isabela Coveli and Haya Jamali) Discussion: During spring 2020 when students were engaged in electives during COVID19 a group of 16 students (10 in Seattle and 6 from WWAMI) participated in an elective. The three focus areas and subcommittees were: assessments in Step 1; schedule for 2022; and curriculum delivery, which will present at the November Curriculum Committee meeting.

Foundations Curriculum Assessment (see slide deck): A schedule with a different order of content is presented. The working group also thought about the Threads. The group thought that physiology and EHM should be added as threads. A recommendation that student performance by threads should be tracked. Expanded time for anatomy is recommended. A Consolidation and Transition time frame that is focused on questions rather than review sessions is suggested.

Assessment: Recommendations: Implement cumulative final exams in all blocks longer than three weeks; designate additional time for students to review in class exams; increase exposure to board style questions and; implement comprehensive, cumulative quarterly CAS assessments; incorporate more time for consolidation and review of foundations content in review weeks. Compile a list of commercial products and; rethink timing and rethink moving Step 1 to Patient Care Phase with new Pass/Fail.

Next step is for work group for Foundations 2022 content group to hear the presentation from students. By December 2020 or January 2021 the content and schedule for Foundations 2022 will be confirmed.

Action: Student group to provide the Curriculum Committee with the more detailed report and presentation. DECISION REQUIRED? [] VOTES FOR [0] VOTES AGAINST Decision: Step 1 prior to entering patient care phase (Students:Brenna Ostertag, Jenny Jensen, Emily Cox, Parker Blekkenk) Discussion: Proposal to remove requirement to take Step 1 exam prior to patient care phase for students whom this would benefit.

Motion: removal of requirement for Step 1 prior to entering patient care phase for the E19 Patient Care phase. The E19 class was surveyed and 68/165 did say agree with the proposal, which is 41% of


respondents. Top reasons are increased benefit to my education and performance on exam; I will be more prepared for exam; factors related to COVID-19; increased changes to matching in desired specialty; and more equitable in my cohort to opt-in to taking exam Pass/Fail.

It is understood that Step 1 may be Pass/Fail in January 2022. It is important for students to understand the caveats and that competitive residencies may look at students with a numeric score versus a pass/fail score and the entire cohort will have a mixture of numeric versus pass/fail score and the possibility of needing to expand may exist.

To address from a curriculum standpoint- there would not be an overlap in curriculum and students would be on the same clerkship schedule and would be studying for step at the same time as clerkships if this proposal is enacted. A working group was established in 2019 was working on the question of whether Step 1 should be moved and approaches to timing and now that the test is moving to Pass/Fail and NBME is moving in October 2020 to higher foundational principles on Step 1 and higher management principles on Step 2 the recommendations which the workgroup made are on shifting sands.

It is important for students to discuss a decision with someone to explore the impacts to Explore and Focus curriculum and Step 2 and residency applications and important that students have all the information they need to make a good decision for themselves. Who and when would support be provided to students? Student Affairs supports the proposal with resources which are currently available.

Students could resubmit poll to students who would opt in and understand the scale needed for students and try to send to Curriculum by October 9, 2020.

Next steps: Bring forward to EVOTE on October 12: Motion: waive step 1 for E19 class to enter 2021-2022 patient care phase. Include with EVOTE: Foundation deans needs time to understand what resources are needed from the region. Sherilyn Smith to include point person and process for resources.

Foundations Curriculum AssessmentStudent Perspective

IntroductionWith changes needed to the Foundations curriculum as a result of the Department of Education guidelines, we are excited by the unique opportunity this presents to evaluate and make improvements to all aspects of the Foundations experience.

Our team identified the following 3 areas to assess and provide recommendations for:

1. Foundations Schedule2. Knowledge Assessment and Step 1 Preparation3. Curriculum Materials

Foundations Schedule

ApproachIn evaluating and developing recommendations for the the Foundations schedule, our team kept the following scope in mind:

● Ensured compliance with the Department of Education Guidelines ● Reviewed length and order of blocks● Evaluated existing threads● Highlighted need to incorporate structured opportunities for students to review

and integrate material throughout Foundations (specific suggestions on how integration and review should occur in addition to step 1 preparation are are covered in the Assessment section of the report)

Supporting Evidence UsedAs supporting evidence for our recommendations, we used the following information:

● Student Feedback ● End of Block Reports ● AAMC Y2Q Report● Foundations Educational Priority Survey (6/17/2020; Results provided as

separate document and relevant results included below)● Foundations 2022 Faculty Survey● USMLE Content Specification for Step 1

Proposed Foundations Schedule● Presentation provides

high-level overview of proposed schedule

● Full reports includes details of proposed changes, supporting evidence, and ideas for week-by-week schedules for each block

Threads● The concept of threads should be maintained in the Foundations curriculum.

In addition to the existing threads (anatomy, path, and pharm), physiology and EHM content should be added as a new threads

● Student performance by thread should be tracked so that students better understand strengths and areas for improvement

● If student performance by thread will require a minimum passing grade, it is important that questions be evenly distributed throughout blocks and quarters and that students be notified at the start of each quarter the number of questions that will be assigned to each thread by exam

Year 1: Immersion & Orientation● Integrate foundational EHM content with the goal to level set across regions,

and set expectations around discussions of topics such as racism, sexism, ableism, transphobia

● Increase the number of class bonding activities to promote class cohesion

● Consider moving content from FCM on introduction to the physical exam to the last week of I&O so that students can become more familiar with each other before beginning physical exam practice on each other

Year 1: Fall Quarter (1 of 2)Foundational Anatomy● Expanded time for Anatomy, taught early to serve as a foundation for the rest of medical school● Taught in the style of a thread in each block, but with less time dedicated to dissection and more to prosections,

review, and integrating clinical correlates● The goal would be to at minimum keep the proportion of anatomy the same (14-15%), and ideally increase it through

integrated review throughout blocks● Start to incorporate MSK anatomy into this block to decompress MSK block

Musculoskeletal Physiology and Pathology ● Course needs to be expanded● This course should be moved earlier in the curriculum to prepare students for PCP, Hospital Mornings, and RUOP,

and provide an opportunity to refine physical exam skills over Term 1

Year 1: Fall Quarter (2 of 2)Molecular and Cellular Basis of Disease● Reduce the length of this block in favor of integrating more MCBD content into exams during the subsequent blocks● One model that would be effective for this is 1 week of each Cell biology, Metabolism, Histology/Pathology, and

Principles of Pharmacology and Genetics

Endocrine ● The length of this block, 2 weeks, was felt to be sufficient by faculty and staff● Many students felt endocrine should be taught earlier as it is touched on in almost all organ systems

Integration and Review● As stated in the introduction, the goal is to integrate different systems/disciplines, and begin Step 1 preparation with

practice questions. See recommendations in Assessment section

Year 1: Quarter 2Blood and Cancer Block ● The block will be lengthened by 1 week● The cancer portion of the block needs to be a general overview and focus on hematologic malignancy, with other

cancers being presented with their organ systems (Eg Testicular cancer should be discussed in the lifecycle block)

Immunology ● Focus exclusively on immunology material and autoimmune diseases● Dermatology taught later in the curriculum - as part of multisystem block

Infectious Disease ● Focus on big picture items such as gram stains, pharmacology, and important “bugs”● Infectious disease will recur throughout the other blocks in the pertinent organ systems.

Cardiology● Much anatomy will have already been presented and focus should be placed on pathology

Pulm● Keep pulm at 3 weeks, making sure that lung cancer & ID content are covered

Renal ● Extend to 4 weeks and shift to earlier in the quarter● Renal contains difficult concepts that are essential for both Step 1 and clinical rotations, and students have

historically felt that it is too compressed to learn well. Moving it earlier will also help mitigate some of the mental fatigue that has made the block more challenging when scheduled at the end of a rigorous quarter

GI● Separated from endo and streamlined to 2 weeks

Multisystem ● There are several disease processes in particular that require an understanding of each relevant organ system and

the interactions between them (e.g. SLE, DM, cirrhosis, rheumatoid conditions). Learning these from a multisystem perspective at the end of MS1 incorporates spaced repetition into the curriculum while helping students prepare for Step 1 and clinical rotations

● Include dermatology content

Year 1: Quarter 3

Year 2: Quarter 5Lifecycles● Lifecycles is felt to contain a lot of important information for clerkships but not a lot relevant to Step 1, with this in

mind, we recommend moving MBB to be last so that it is fresh in the mind of students prior to taking step 1● Reduce by 2 days - with movement of HFF to anatomy block, one prosection anatomy day to be included, time is

given for additional content on pathology, and continued focus on pediatrics. Recommend geriatrics curriculum to cut redundant FCM material

Neuro● Shorten Neurology portion of MBB by 2-3 weeks● With the movement of HFF to an anatomy block at the beginning, this will reduce the course by several days, we

would also recommend removing redundant anatomy lectures without clinical relevance, team based assessment sessions and debate.

Psych ● Content & length to remain the same

Year 2: Quarter 6 Integrated Step 1 Review with focus on Step 1 questions (x 2 weeks, <20 hours remote):● Current consolidation capstone is burdensome without giving students time to develop their own study habits or

adding useful test taking strategies. We recommend a remote course consisting entirely of question sessions & review, in a solid block of time (ie 1 several hour session per day), during this time a CBSR style course could be added in addition for these students

Dedicated Step 1 Time (Reduced to 4-5 weeks):● With the move of Step 1 to pass/fail and integration of test taking strategies, more boards-style questions, and review

weeks into the schedule, we feel that students will feel more prepared for Step 1 and require less dedicated time

Remaining 4-6 weeks:● Can be used for more encompassing Transition to Clerkships Course (incorporating professionalism content from

EHM, procedures, etc)● Can also be used for a condensed 3 week EHM-like course, which we feel would benefit from consolidation &

streamlining● Finally, this time can be used to incorporate and add more Foundational teaching, at this time some blocks may

require more time and we can utilize these weeks if certain blocks do not fit elsewhere

Assessment

Approach

To develop recommendations to improve assessments in Foundations, we considered the delivery and content of block exams as well as their utility as preparation for Step 1.

We also considered alternative methods of integrating Step 1 preparation, given the new and expanded timeline for Foundations as proposed by the schedule team.

The following proposed changes aim to address student concerns about assessments, highlighted by the results of the Foundations Educational Priority Survey (6/17/2020)

Approach




Approach




Recommendation 1: Implement cumulative final exams in all blocks longer than 3 weeks.

With a few exceptions, the majority of Foundations block final exams are noncumulative, disincentivizing long-term retention of the material.

A majority of surveyed students (n=232) agree that cumulative exams would improve their overall retention of Foundations content.


With a few exceptions, the majority of Foundations block final exams are noncumulative, disincentivizing long-term retention of the material.

A majority of surveyed students (n=232) agree that cumulative exams would improve their overall retention of Foundations content.

Recommendation 2: Designate additional time for students to review their in-class exams.

Students currently review exams largely immediately following the assessment. For further review, they must make an individual appointment with a faculty member or proctor. Despite this option, most surveyed students would like more time to review their exams:

In order to truly utilize assessments as a learning opportunity, a different model is preferred.


Students currently review exams largely immediately following the assessment. For further review, they must make an individual appointment with a faculty member or proctor. Despite this option, most surveyed students would like more time to review their exams:

In order to truly utilize assessments as a learning opportunity, a different model is preferred.


We suggest a different model:

● Designation of a single, optional exam review session following each exam● Ideally, the sessions would be proctored by course professors or TAs● Note-taking is allowed, but all paper is subject to review by the proctors

Advantages to this approach include less demand of faculty time for individual exam review and a less intimidating environment for students to review their missed questions.


We suggest a different model:

Advantages to this approach include less demand of faculty time for individual exam review and a less intimidating environment for students to review their missed questions.

● Designation of a single, optional exam review session following each exam● Ideally, the sessions would be proctored by course professors or TAs● Note-taking is allowed, but all paper is subject to review by the proctors

Recommendation 3: Increase student exposure to boards-style questions early in the Foundations phase.

and

Recommendation 4: Implement comprehensive, cumulative, quarterly CAS assessments.

Only a minority of students believe Foundations block exams resemble or prepare them adequately for Step 1:

Recommendations 3 and 4: Increase student exposure to boards-style questions early in the Foundations phase; implement comprehensive, cumulative, quarterly CAS assessments.

Recommendation 3: Increase student exposure to boards-style questions early in the Foundations phase.

UWSOM currently provides a 180-day subscription to UWorld for the purposes of Step 1 preparation, but students need longer-term exposure to boards-style questions. We suggest:

● Provision of a subscription to another question bank (USMLE Rx, or AMBOSS) to students during the majority of the Foundations Phase

● Require the completion (self-reported) of weekly questions● With sufficient integration of NBME-style questions, support for UWorld could

be reduced to a 90-day subscription


We suggest the regular use of CAS examinations within the Foundations curriculum to increase familiarity with the format, depth, and breadth of the Step 1 exam.

● Performance on CAS exams should not be a part of the Foundations grade● These exams should be free of cost to students● We suggest a “ramp-up” strategy: Three “blocks” at the end of Term 1; four at

the end of Term 2, and so on.


We suggest the regular use of CAS examinations within the Foundations curriculum to increase familiarity with the format, depth, and breadth of the Step 1 exam.

● Performance on CAS exams should not be a part of the Foundations grade● These exams should be free of cost to students● We suggest a “ramp-up” strategy: Three “blocks” at the end of Term 1; four at

the end of Term 2, and so on.

Recommendation 5: Incorporate more time for consolidation and review of Foundations content.

In collaboration with the schedule subcommittee, we recommend the implementation of Integration and Review weeks with the following elements:

● Informational sessions● Faculty-led consolidation (inspired by the Foundations Capstone)● Pre-assigned Step 1-style questions followed by small group review ● Time for independent study● CAS exam

Recommendation 5: Incorporate more time for consolidation and review of Foundations content.

a In Term 1. b Step1 - style questions, e.g. from a question bank, should be pre-assigned to students. This session will serve as an in-depth review of the assigned questions after students have had time to try them on their own. c The number of sections should be ramped up throughout the year, beginning with 3 in Q1 and gradually reaching 6 sections by Q4.

Monday Tuesday Wednesday Thursday Friday

AM: Learning specialist presentationa

+PM: Faculty-led consolidation

PM: Faculty-led consolidation

+Small groups: assigned

question reviewb

Faculty-led consolidation

+Mock block

off CAS Exam(3-6 sections)c

Recommendation 6: Compile a matched list of commercial resources for each block and display the list on Canvas.

Mapping lecture topics and SLOs to the most popular commercial resources supports the supplementation of lecture materials with boards content.

● The E19 student block partners have created a simple, effective template:

Recommendation 7: Revisit the discussion regarding the timing of Step 1 to after the PCP in light of new P/F Step 1 scoring.

We hope that an extended Foundations Phase and integrated Step 1 preparation will decrease the proportion of students who defer Step 1 past the deadlines that UWSOM sets for taking Step 1

Studying for Step 1 is an important step in consolidating information from Foundations and preparing for clerkships

We anticipate that residency applications will begin to place a larger emphasis on Step 2 scores; Step 2 will therefore likely demand a more intensive study period than students have previously required

Recommendation 7: Revisit the discussion regarding the timing of Step 1 to after the PCP in light of new P/F Step 1 scoring.

A majority of surveyed students believe that Step 1 should not be moved:

Assessment Committee

Cameron Wallace

Haya Jamali

Kelsie Delaney

Samantha Kropp

Zannah Herridge-Meyer

Allison Rollins

Alyssa Hutchinson

Hailey Gunningham

Isabela Covelli

Madelyn Peha

MaKenna Siebenaler

Schedule Committee

UWSOM Foundations Curriculum Student Workgroup Foundations Schedule Subcommittee Compiled by Allison Rollins, Alyssa Hutchinson, Hailey Gunningham, Isabela Covelli, Madelyn Peha, MaKenna Siebenaler With changes needed to the Foundations curriculum as a result of the Department of Education guidelines, we are excited by the unique opportunity this presents to evaluate and make improvements to all aspects of the Foundations experience. As a group of students, our goal has been to evaluate the Foundation schedule experience - what is working well and what needs improvement. In evaluating and developing recommendations for the the Foundations schedule, our team kept the following scope in mind:

● Ensured compliance with the Department of Education Guidelines ● Reviewed length and order of blocks ● Evaluated existing threads ● Highlighted need to incorporate structured opportunities for students to review and

integrate material throughout Foundations (specific suggestions on how integration and review should occur in addition to step 1 preparation are are covered in the Assessment Subcommittee report)

As supporting evidence for our recommendations, we used the following information:

● Student Feedback ○ End of Block Reports ○ AAMC Y2Q Report ○ Foundations Educational Priority Survey (6/17/2020; Results provided as

separate document and relevant results included below) ● Foundations 2022 Faculty Survey ● USMLE Content Specification for Step 1

Illustrated below is our recommendation for the Foundations curriculum schedule. The sections that follow include details of proposed changes, supporting evidence, and ideas for week-by-week schedules for each block.

Threads

● The concept of threads should be maintained in the Foundations curriculum. In addition to the existing threads (anatomy, path, and pharm), physiology and EHM content should be added as a new threads

● Student performance by thread should be tracked so that students better understand strengths and areas for improvement

● If student performance by thread will require a minimum passing grade, it is important that questions be evenly distributed throughout blocks and quarters and that students be notified at the start of each quarter the number of questions that will be assigned to each thread by exam

○ For instance, E18 students provided feedback that in Lifecycles, a majority of questions for the pathology thread were assigned in the last exam. This made it stressful for all students because a single exam largely determined the ability to pass the thread for the entire term

Immersion and Orientation

● 3 weeks starting in early September ● Keep as a mandatory experience before official coursework begins

● Integrate some foundational EHM content with the goal to level set across regions, and set expectations around discussions of topics such as racism, sexism, ableism, transphobia

● Increase the number of class bonding activities to promote class cohesion ● Consider moving content from FCM on introduction to the physical exam to the last week

of I&O so that students can become more familiar with each other before beginning physical exam practice on each other

Quarter 1 - Fall MS1 Year Week 1-3: Anatomy Week 4-5: MSK Week 6-9: MCBD Week 10-11: Endocrine Week 12: Integration and Review Holidays:

● Veterans Day ● Thanksgiving

Other Considerations:

● Overlap with MS2 has implications for both small group activities and anatomy lab timing ● PCP generally does not start until Winter quarter, allowing more flexibility for FCM, EHM

or other longitudinal content if desired Recommendations:

● Fall quarter starts with several weeks of Foundational Anatomy ○ Faculty and students recognize the need for expanded time for Anatomy, and it

should be taught early to serve as a foundation for the rest of medical school ■ Student satisfaction with Anatomy decreased during the switch to the

current Foundations curriculum. In 2019 only 31% of graduating students felt that the preclinical anatomy was “excellent” preparation for clerkships, compared to 63.6% in the 2018 UW graduating class, and 52% nationally

● Many students express dissatisfaction with front-loading anatomy in each block, which hopefully would be alleviated by teaching foundational concepts first and then returning to content in the block

■ Faculty survey suggested increased use of prosections and online learning resources in HFF

○ Anatomy taught in the Foundational Anatomy course will be more focused on dissection. In addition, anatomy should also be taught in the style of a thread in

each block, with a focus on prosections, review, and integration of clinical correlates for that block

○ If the Foundations course is further expanded, we suggest adding an additional week of anatomy review during the week before MS2 Fall quarter, or at some point during Fall/Winter quarter before clerkships

○ The goal would be to at minimum keep the proportion of anatomy the same (14-15%), and ideally increase it through integrated review throughout blocks

○ Start to incorporate MSK anatomy into this block to decompress MSK block ○ Consider including anatomy as a prerequisite for admittance in future classes

given time constraints placed on teaching anatomy during Foundations Phase

● Musculoskeletal Physiology and Pathology ○ Given student and faculty feedback, this course needs to be expanded

■ 67% of surveyed students felt that MSK was too short ■ Faculty survey reiterated need to increase time for MSK

○ This course should be moved earlier in the curriculum to prepare students for PCP, Hospital Mornings, and RUOP, and provide an opportunity to refine physical exam skills over Term 1

○ By starting with foundational Anatomy, 2 weeks may be sufficient to teach MSK pathophysiology in its own block, or may require 3. Expanding time for MSK and Anatomy, and dedicating more time to pathophysiology provides more opportunity for integration and understanding rather than memorization

○ Some MSK-related content should also be included/reviewed in future blocks and FCM (eg arthritis during rheumatology)

● Molecular and Cellular Basis of Disease ○ We recommend reducing the length of this block in favor of integrating more

MCBD content into exams during the subsequent blocks ○ The overall goal would be to build a foundation of basic principles and avoid

focusing too much on examples and detailed memorization of pathways that will be forgotten before Step 1 occur

○ One model that would be effective for this is teaching 1 week of each: Cell biology, Metabolism, Histology/Pathology, and Principles of Pharmacology and Genetics

■ While 60% of students felt MCBD was the right length, and 33% felt it was too long, students provided the following key feedback:

● Additional feedback included grouping topics (eg genetics) rather than spreading across days

● Several students also suggested shortening MCBD in favor of incorporating content into relevant organ systems.

● Students called out need for focused discussion of Genetics and Cell Bio without trying to cram content that would need to be rememorized later for Step 1

■ Similarly, faculty survey provided the following feedback: ● Emphasized the importance of MCBD content, and potential for

integration into other blocks to improve retention and understanding

● Also noted time between MCBD and MS2 year and Step 1 is detrimental

● Potentially disband MCBD and add 1 week of foundational content to each block instead

● Endocrine

○ The length of this block, 2 weeks, was felt to be sufficient by faculty and staff ○ When surveyed on block order, several students proposed placing the

Endocrinology content with MCBD or Lifecycles, and moving it earlier ■ We chose to place it with MCBD with an aim to build foundational

knowledge in the first 2 quarters before moving into organ systems ○ 64% of students felt it was the right length

● The last week of the quarter would be the first week of Integration and Review

○ As stated in the introduction, the goal is to integrate different systems/disciplines, and begin Step 1 preparation with practice questions. Please see Assessment Subcommittee report for details

MCBD Proposed Changes: This is a mock-up of how you could reorganize the current foundational MCBD topics into themed weeks, and eliminate content that is covered in other blocks. Week 1: D1: Veterans Day D2: Nucleic Acids/Proteins, DNA/RNA/Protein Synthesis, Cytoskeleton D3: Membranes, Secretory/Endocytic Pathways, Membrane Channels D4: Signal Transduction, GPCR, RTKs, Steroid Hormone Intro Week 2: D5: TCA Cycle, PPP, ETC D6: Gluconeogenesis, Glycogen Metabolism, Practice Cases D7: Lipid Structure, Transport, metabolism, Nitrogen Cycle D8: B12, SAM, Folate, Iron metabolism Week 3: D9: Cell adaptation, injury, necrosis/apoptosis D10: Principles of Neoplasia, Cancer Histology, Inflammation D11: Thanksgiving D12: Thanksgiving

Week 4: D13: Intro Genetics, Epigenetics, Chromosomal Abnormalities, Practice Cases D14: Cancer Genetics, Carrier Testing, Pharmacogenetics D15: Drug Tolerance/Quantal Dose, Drug Metabolism, Quantitative Pharmacology, Pharm calculations D16: Final exam Content to integrate/already covered in future blocks: Cystic Fibrosis in Pulmonology Diabetes in Endocrine and GI DNA Repair Disorders in Blood and Cancer, and Dermatology Hemoglobinopathies in Blood and Cancer HFF Principles of Embryology, Imaging, Nervous System, ANS, and Cranial Nerves in HFF Foundational block Histology of Nervous System in Neuro Histology of Muscle in MSK Physiology of Sensory Receptors in Dermatology and/or Neuro Quarter 2- Winter of MS1 Year Weeks 1-4: Blood and Cancer Weeks 5-7.5: Immunology Weeks 7.5-9: Infectious Disease Weeks 10-12: Cardiology

Holidays and Scheduling Conflicts:

● Winter Quarter runs from Early January through Mid-March (12 Weeks) ● Officially University holidays during this quarter include:

○ Martin Luther King Day - Occurs during Blood and Cancer (week 3) ○ President’s Day - Occurs during Infectious Disease (week 7)

● There will not be any overlap with the MS2 class during this term Recommendations:

● This quarter will conclude the basic science/foundational curriculum that was started in Quarter 1. It will then jump into the first organ system.

● Blood and Cancer ○ Move block up in the curriculum to occur directly after endocrinology and before

immunology. The block will be lengthened by 1 week. The cancer material needs to be better distributed across the blocks so that it is integrated within the specific organ systems

■ This is being done to give a foundation of blood cells and cancer before 1) immunology is discussed, 2) before the cardiac material, 3) before cancer is taught in the organ systems

■ The cancer portion of the block needs to be a general overview and focus on hematologic malignancy, with other cancers being presented with their organ systems (ie., testicular cancer should be discussed in the Lifecycles block)

○ The student survey provided the following supporting data: ■ 59.9% of students stated that Blood was the right length, and 69.4% of

students stated that Cancer was too short ■ Several students expressed a need for blood and cancer to be longer to

get through the material (blood and cancer was the block that had the most individual comments)

■ Many students stated that blood and cancer needs to be presented earlier in the curriculum/with the immunology material/before CPR. Others also shared it should be closer to endocrine and not combined with MSK

■ Several students stated that the cancer material needs to be better distributed throughout the blocks -

● “I’m sick of hearing ‘you will hear about it in blood and cancer’ only to get there and be told ‘you should have already discussed that cancer with the organ system’”

● “Cancer does not need to be its own block, but a foundation week/basic sciences given at the beginning and the rest of the material distributed within the blocks”

● “Cancer is a part of every organ system and should be included in every block”

○ Faculty survey included the following key supporting points: ■ Move the Blood and Cancer Block - before CPR, with I&D, earlier in the

curriculum ■ Lengthen/give more time to the Blood and Cancer Block

● Immunology

○ Immunology could be taught in 2 ½ weeks, focusing exclusively on immunology material and autoimmune diseases

■ 69.5% of students stated that I&D was the right length, 22.6% stated that it was too long

■ However, the shortened time frame for this material is due to the prior exposure of some of the material in the blood and cancer block

○ In the student survey, students felt that the Immunology block should come before the Infectious Disease block, and that they should be separate and not integrated

○ Faculty also expressed I&D content retention is low

■ A possible explanation for this is that the material is presented before an understanding of blood cells, and that it is organized poorly due to its integration with infectious disease. By rearranging the blocks and pulling out infectious disease we hope to improve content delivery and retention

○ Additionally, faculty reported the need to move Dermatology somewhere other than I&D. In response, we suggest Dermatology be moved to the Multisystems Block in quarter 3

● Infectious Disease

○ Block would directly follow immunology for 2 ½ weeks. This material will no longer be interspersed with the immunology curriculum

○ These weeks should be focused on big picture items such as gram stains, pharmacology, and important “bugs”. Infectious disease should be readdressed throughout the other blocks in the pertinent organ systems

● Cardiology

○ Recommendation for 3-week cardiology block ○ The cardiology block currently has 3.75 weeks of teaching (including a holiday).

By having anatomy pulled out at the beginning of foundations, there is less needed time for that material. Additionally, by having the hematology material before cardio, this will allow streamlining of some of the instruction.

○ 74.6% of students stated that Cardio was the right length (3 week block) and this recommendation would have minimal effect on the block length

○ From the faculty survey, faculty included the need to split CPR. This is being done by separating cardiology and including it in the second quarter

Blood and Cancer Proposed Changes (largely kept the same but added more time): D1: Basics of Oncology D2: Basics of Oncology D3: Oncology Pharm D4: More cancer topics not in the curriculum now D5: More cancer topics not in the curriculum now D6: Stem Cells and Hematopoiesis (+ cancer only portion exam?) D7: RBC D8: WBC D9: HOLIDAY DAY OFF D10: Review of Diseases/Multisite Day D11: Hemostasis and Thrombosis D12: Hemostasis and Thrombosis D13: VTE and Transfusion D14: Hematologic Malignancy D15: Hematologic Malignancy D16: Exam

I&D Proposed Changes: Immunology Portion D1: Intro to Immune (innate vs adaptive, review of WBC’s, organs involved) D2: Anatomy (Lymphatic, Nasal Cavity, Middle Ear) D3: Pathology/Histology (inflammation and wound healing) D4: Antibodies, Compliment, T/B-cell development and interactions D5: Immune memory, Vaccines, cytokines D6: Autoimmunity Overview, Drug Overview, Organ Transplants/Rejection D7: Hypersensitivity and Autoantibodies D8: Immunodeficiencies D9: Rheumatology Day10: Exam Infectious Disease Portion D1: Microbiology Lab, General Overview, Organization (give students a framework of how to group/think about this material) D2: Bacteria and Antibiotics D3: Bacteria and Antibiotics D4: HOLIDAY AT SOME POINT D5: Viruses and Antivirals D6: Viruses and Antivirals D7: Fungi and Antifungals D8: Parasites and Antiparasitics D9: Review and “EHM” Material/connect to other blocks D10: Exam Cardiology Proposed Changes: D1: Anatomy Review D2: Anatomy, Embryology, Imaging D3: Pathology/Histology D4: Heart Mechanics and ECG D5: Heart Mechanics and ECG D6: Heart Failure and Shock (including pharm) D7: Arrhythmias (including pharm) D8: Valves, Coronary Blood Flow, Angina (including pharm and dx workup) D9: Acute Coronary Syndromes, MI D10: Circulation (atherosclerosis, claudication, peripheral vascular disease, vasculitis) Day11: Congenital Heart Disease, Cancer, Other things not already included Day12: Exam

Quarter 3 - Spring of MS1 Year Week 1: Integration & Review Week Weeks 2-4: Pulmonology Weeks 5-8: Renal Weeks 9-10: GI Weeks 11-12: Multisystem Content

Holidays:

● Memorial Day Recommendations:

● Quarter would begin with an Integration and Review Week

● Pulmonology ○ Keep length of pulmonology at 3 weeks, making sure that lung cancer & ID

content are covered during this block ■ Historically well-taught in this much time, even more likely to be

well-received as the first block back from winter break. Proposed changes to B&C and I&D will make it essential to integrate this material into each organ system, and pulm is one where neither have been emphasized proportional to Step and clinical importance

■ 72% of students indicated that 3 weeks is the right length for pulmonology

● Renal ○ Extending renal to 4 weeks and shifting it to earlier in the quarter

■ Renal contains difficult concepts that are essential for both Step 1 and clinical rotations. Students have historically felt that it is too compressed to learn well. Moving it earlier will also help mitigate some of the mental fatigue that has made the block more challenging when scheduled at the end of a rigorous quarter

■ 50% of students indicated that renal was too short at 3 weeks ■ 9 independent comments suggesting that CPR be broken up and/or

placing renal closer to the beginning of a term ■ Students comments from survey:

● “It would be helpful if renal was parsed out or expanded from CPR - by the end of the block fatigue is real, and it feels like renal is rushed through compared to CV/Pulm”

● “Renal was far too short, especially given its critical importance in human physiology...Allocating more time to renal and then a final week overview of CPR would ensure that students have integrated the material well”

■ Similarly, faculty shared the following thoughts: ● “It appears that students become extremely tired near the end of

longer blocks. Likely impacts their learning outcomes” ● “I think long blocks are really challenging, for both students and

faculty. When possible, I’d like to see some of the very long ones (i.e. CPR) made slightly shorter”

● GI

○ GI separated from endocrine and streamlined to 2 weeks ■ GI content can be adequately taught in less time than is currently allotted.

Typically, It is also an easier block for students. Even with pulm and renal prior to GI, students should still be able to engage with the material

● Students comments: ○ “I think we could take a week or a few days from GI and

give it to Endo...I felt it could have been slightly condensed”

● Faculty comments: ○ “E&H is a relatively easy course for students with several

days not using the entire 4 hours. We could consider condensing the material and adding 1 week of content to MSK”

● Multisystem Block ○ Adding 2 weeks of multisystem content to finish the quarter ○ There are several disease processes in particular that require an understanding

of each relevant organ system and the interactions between them (e.g. SLE, DM, cirrhosis, rheumatoid conditions). Learning these from a multisystem perspective at the end of MS1 incorporates spaced repetition into the curriculum while helping students prepare for Step 1 and clinical rotations

■ Supporting student comments: ● “Ending with a refresher course that delves into major pathways

and complicated diagnoses like nephrotic vs nephritic with board-style questions could be helpful for Step 1”

● “It would be cool to have a common disease block at the end of CPR just for diabetes and HTN. They were both placed at the end of renal and EnH and glossed over and were not given the time that they need, seeing as they are so prevalent in every specialty”

■ 14/74 (19%) in the faculty survey specifically mentioned importance of integration throughout the curriculum

Renal Proposed Changes: ● Increase length from 10 → 15 days (16th day is for exam), 39 → 60 hours ● D1 for anatomy review & embryology ● Expand time for normal physiology ● Integrate pharm, path, and histo into lecture ● Keep or increase emphasis on small group

D1: Anatomy & embryology D2-5: Normal physiology – fluids, glomerular phys, RAAS D6-10: Electrolytes & acid-base (incl HTN + pharm, RTA/tubular disorders, & stones) D11-12: Glomerular disorders (nephritic & nephrotic) D13: Acute disease: AKI, renal infections, ATN D14: CKD D15: Cancer D16: Exam GI Proposed Changes:

● Shorten from 15 → 7 days (8th day for exam), 60 → 28 hours of instruction ● D1 for anatomy review & embryology ● Remove nutrition as full day topic – vitamins and metabolism taught in other blocks and

integrated into other GI topics ● Keep integration of pharm & path/histo

D1: Anatomy D2: Normal phys - Digestive hormones & enzymes, Absorption, Bile & bilirubin D3: Esophagus & stomach disorders D4: Pancreas & biliary disorders D5-6: Liver disorders D7: Bowel disorders D8: Exam Quarter 4 - Summer of MS2 Year

● Keep Triple III & add option of CBSR-like course for students needing extra help preparing for Step 1

● Alternatively, could move Quarter 5 schedule here if summer teaching is approved

Quarter 5 - Fall of MS2 Year Week 1: Integration & Review Week 2-5: Lifecycles Week 6-10: Neurology Week 11-12: Psychiatry Holidays:

● Independence Day ● Labor Day

Recommendations:

● Lifecycles ○ Lifecycles will largely remain the same, but will be moved prior to MBB

■ Lifecycles is felt to contain a lot of important information for clerkships but not a lot relevant to Step 1. With this in mind, we recommend moving MBB to be last so that it is fresh in the mind of students prior to taking step 1

■ While 76% of students felt Lifecycles was the right length, we recommend reduction of Lifecycles by 2 days. This can be accomplished by moving a significant portion of anatomy to the introductory anatomy block and limiting anatomy time to prosections. Additionally, we recommend elimination of geriatrics content that is redundant with FCM material. Gained time should be for additional pathology review as well as pediatric

● MBB ○ 27% of students felt that neurology was too long, while most (80%) thought

psychiatry was the right length at two weeks ○ Shorten Neurology portion of MBB by 2-3 weeks

■ With the movement of HFF to an anatomy block at the beginning, this will reduce the course by several days. We would also recommend removing redundant anatomy lectures without clinical relevance, team based assessment sessions and debate. Neurology is highly tested on Step 1 and should be the last block before dedicated time

■ Student comments: ● Several students suggested the time duration of this block should

be reduced by at least 1-2 weeks. ● Some individuals did not appreciate the spiral learning structure.

They claimed it was repetitive and counter-productive. ● Many students were concerned when the major principles of

neurology weren’t established until the third week of the block. They would have liked this content to be covered earlier.

● Students said it was challenging to learn anatomy without also covering the functions of structures. Students would have liked to see the integration of anatomy and functions earlier.

● Some students disliked the repetition and redundancy of the content in this block and thought the content was not presented in chronological order.

■ MBB was also cited by faculty as being too long - needing to be reduced by 1-2 weeks

○ Psychiatry content & length to remain the same ■ Additional recommendations: Continued improvement of lecture quality,

retain patient interview/lectures, continue integration and organization of pharmacology

Lifecycles Proposed Changes: D1: 1-2 hours Embryology lecture, 2-3 hours Prosection Lab D2: Intro to HPG Axis, Physiology of Menstrual Cycle, Intro to Life Cycles Pharm, Aneuploidy & Early Pregnancy D3: Cases: Early Pregnancy, Lecture: Pregnancy Physiology & Complications Independence Day D4: Cases: Pregnancy Physiology & Complications, Lecture: L&D & Maternal Mortality D5: Cases: L&D & Maternal Mortality, Lecture: Lactation & Infancy D6: Cases: Lactation & Infancy, Lecture: Childhood & Adolescence D7: Cases: Childhood & Adolescence, Lecture: Sexual Development and Puberty, Differences and Disorders of Sexual Development D8: Exam 1 (Morning) Afternoon- Cases: Sexual Development, Lecture: Male Reproductive Physiology, Infertility & Pathology D9: Cases: Male Reproductive Physiology, Infertility and Pathology, Lecture: Benign Female Reproductive Physiology & Infertility D10: Cases: Female Reproductive Physiology & Infertility, Lecture: Contraception, Pharmacology and Abortion D11: Family Planning, Lecture: Human Sexuality, Transgender Medicine D12: Cases: Sexuality, Lecture: Gynecological Pathology and Oncology D13: Cases: Gynecological Pathology and Oncology, Lecture: Menopause, Aging Physiology D14: Being Mortal Patient Panel, Lecture: Geriatric syndromes and delirium, Palliative Care, Geriatric syndromes, Geriatric Polypharmacy and Palliative Care (No Cases only lecture- remove age simulation- 5 hours total) D15: Final Exam

Neurology Proposed Changes: D1: Intro to Neuroradiology, 3 hours Neuro Prosection Review (External & Internal) D2: Review of Ventricles, CSF, & ICP (1 hour), Cranium, Meninges & Major Arteries (1 hour), Internal Brain Morphology (1 hour), Sleep-Case Based (1 hour)

https://canvas.uw.edu/courses/1322923/modules/items/9929055











D3: Brainstem Prosection (2 hours), Cranial Nerves Lecture + Cases (2 hours) D4: Coma & Loss of Consciousness (1 hour), Motor & Sensory Tracts + Drawing (3 hours) D5: Neurotransmitters (1 hour), Somatosensory Cases (1 hour), Histology of Nervous System (1 hour), Lesion Localization Small Group (1 hour) D6: Histology of Special Senses, Hearing, Vestibular System + Dizziness, Eye Movement Control D7: Ophthalmology (2 hours lecture + 2 hours small group) D8: Visual Pathway (2 hours), Neural Development (1 hour), Neural Exam in Children/Cerebral Palsy (1 hour) D9: Exam 1 (Morning) Afternoon- CNS Infections (1 hour), Stroke (1 hour), Stroke & Hemorrhage Neuroradiology (1 hour), Stroke Pathology (0.5 hour), Repair of Neural System (0.5 hour) D10: Higher Cortical Function/Language- Case Based Discussion (1 hour), Neuromuscular Disease (Patient+Lecture-2 hours) D11: Cerebellar Cases (1 hour), Movement Disorders Path (1 hour), Stroke & NM Disease Cases (2 hours) D12: Movement Patient + Case-based Lecture (2 hours), Multiple Sclerosis (1 hour), MS Pathology + Neuroradiology of Spine (1 hour) D13: Spinal Cord Injury Lecture (1 hour), Gait & Dysarthria (1 hour), Movement Disorders & Spinal Cord Cases (2 hours) D14: Anesthesiology (2 hours), Anti-epileptics Pharmacology (1 hour), Headache (1 hour) D15: Epilepsy Patient & Lecture (2 hours), TBI (1 hour), Brain Tumors Neuroradiology (1 hour) D16: CNS Tumors & Neurocutaneous Disease (1 hour), Dementia Pathology (1 hour), Epilepsy & Headache Small Groups (2 hours) D17: Dementia Patient & Lecture (2 hours), Understanding & Assessing Pain (1 hour), Pharmacology of Analgesic System (1 hour) D18: Opioids & anti-inflammatories Review (Pharm-1 hour), Pain Cases (1 hour), Pain & Dementia Small Group + Ethics of Brain Death (2 hours) D19: Study Day D20: Final Exam Quarter 6- Winter of MS2 Year Week 1-2: Integrated Step 1 Review Week 3-8: Dedicated Step 1 Time Week 9-12: Break, Expanded Transition to Clerkships Integrated Step 1 Review with focus on Step 1 questions (x 2 weeks, <20 hours remote):

○ Current consolidation capstone is burdensome without giving students time to develop their own study habits or adding useful test taking strategies. We recommend a remote course consisting entirely of question sessions & review, in a solid block of time (ie 1

several hour session per day), during this time a CBSR style course could be added in addition for these students

Dedicated Step 1 Time (Reduced to 4-5 weeks):

● With the move of Step 1 to pass/fail and integration of test taking strategies, more boards-style questions, and review weeks into the schedule, we feel that students will feel more prepared for Step 1 and require less dedicated time

Remaining 4-6 weeks:

● Can be used for more encompassing Transition to Clerkships Course (incorporating professionalism content from EHM, procedures, etc)

● Can also be used for a condensed 3 week EHM-like course, which we feel would benefit from consolidation & streamlining

● Finally, this time can be used to incorporate and add more Foundational teaching, at this time some blocks may require more time and we can utilize these weeks if certain blocks do not fit elsewhere

UWSOM Foundations Curriculum Priorities Student Workgroup Assessment Subcommittee

Compiled by

Kelsie Delaney, Zannah Herridge-Meyer, Haya Jamali, Samantha Kropp, and Cameron Wallace


In accordance with the PEAC workgroup recommendation #2, we agree that standardization related to a cumulative final exam would allow for improved consolidation throughout the curriculum. There must be a minimum of one unscheduled day provided for final exam preparation as per PEAC recommendation #3. The majority of surveyed students (n=232) agree that cumulative exams would improve their overall retention of Foundations content.


Much of dedicated Step 1 preparatory time revolves around doing practice questions and reviewing the answers in depth. In-class exams should be approached in the same way. Reviewing exams immediately following the assessment is not an ideal time because students are often exhausted, unwilling to stay after they have completed the exam, and cannot take notes on the material they have learned. Although students are currently able to meet with course professors on a one-on-one basis to review their exams, this option is underutilized by most students.

Students understand the desire to protect the integrity of exams but have a suggestion to mitigate this concern: designate a single, proctored exam review session (ideally, with course professors or TAs present) for each exam. Each student would be permitted to take notes but could be asked to show those notes to a proctor prior to leaving, allowing proctors to ensure that no information specific to test questions is copied and later distributed. Although students currently may ask to review exam questions individually with an instructor, our model here would be less demanding of individual faculty time (a set review for all students, rather than requiring separate coordination to set up individual meetings) and is less intimidating for some students, some of whom may just wish to review their missed question(s) but not require additional faculty attention. Recommendation 3: Implement comprehensive, cumulative, quarterly CAS assessments.

A minority of students agree that Foundations block exams effectively prepare them for Step 1. In accordance with the PEAC workgroup recommendation #4, we agree that CAS examinations should be given to students on a more regular basis to increase familiarity with the format and depth and breadth of the Step 1 examination. These should not be part of the block grade. These exams should be given at regular intervals on a quarterly basis, on campus, free of cost, and used as an opportunity to both build stamina and increase exposure to questions. The CAS exams should be tailored to include material focused on the preceding blocks. We recommend that the CAS exam at the end of quarter 1 consist of three 40-question blocks, gradually ramping up to a six-block CAS exam at the end of quarter 4. Recommendation 4: Increase student exposure to boards-style questions early in the Foundations phase. In addition to regular CAS exams, we recommend that a subscription to a question bank (i.e. USMLE Rx, AMBOSS, etc.) be provided to students during the Foundations Phase with a requirement to complete a minimum number of questions per week (self-reported, additional credit towards block given) as a way to incentivize and promote early application of material to questions in a Step 1 format. We recommend 10 questions/week minimum, but feel that block leads should have the freedom to recommend as many questions as they see appropriate. We recommend that UWSOM pay for both AMBOSS and UWorld. Our group has reached out to AMBOSS and they have offered an estimated quote of $250/student for an 18-month subscription, which we recommend begin with the first block. With an AMBOSS subscription provided by UWSOM, students may receive a 90-day subscription to UWorld in the dedicated Step 1 preparation period (as opposed to the current 180-day subscription.)

Additionally, we have provided recommendations regarding the incorporation of a specific percentage of Step- style questions on course exams.

We recommend that 25-50% of questions used in block assessment of students follow NBME guidelines on difficulty, clarity, and content per the “Conducting Written Test Questions for the Basic and Clinical Science” book developed by the NBME. This book has been linked here.

Recommendation 5: Incorporate more time for consolidation and review of the Foundations content. In agreement with our colleagues in the Schedule subcommittee, we recommend the quarterly implementation of Integration and Review weeks. This is in line with the PEAC recommendation #3. We envision these weeks as a combination of mandatory sessions, required mock blocks, and time for independent review. The mandatory sessions would resemble/draw upon content from the current Foundations Capstone course. In addition, Step 1-style questions should be pre-assigned and reviewed in small-group sessions, with an emphasis on problem-solving and test-taking strategies. Mock blocks should be required, and time should be given for students to consolidate content individually prior to a CAS exam on the final day of the week. A sample schedule is provided below:

Sample Integration and Review Week Schedule

Monday Tuesday Wednesday Thursday Friday

Learning specialist presentationa

+ Faculty-led consolidation


+ Assigned question

reviewb


+ Mock block

off CAS Exam (3-6

sections)c

a In Term 1. b Step1 - style questions, e.g. from a question bank, should be pre-assigned to students. This session will serve as an in-depth review of the assigned questions after students have had time to try them on their own. c The number of sections should be ramped up throughout the year, beginning with 3 in Q1 and gradually reaching 6 sections by Q4.

https://www.nbme.org/sites/default/files/2020-01/IWW_Gold_Book.pdf

Recommendation 6: Compile a matched list of commercial resources for each block and display the list on Canvas. The incorporation of commercial resources into the Foundations curriculum is constantly suggested by students as a way to increase student exposure to Step 1-related content and provide additional preparatory material that fits diverse learning styles. However, commercial resources are not vetted by UWSOM faculty and may contain errors. As such, although these materials may not be appropriate for pre-class preparation, we recommend the compilation of daily lecture content matched to the most popular commercial resources (Boards and Beyond, Sketchy Pharm, Sketchy Micro, Pathoma, and First Aid). The purpose of this is not to supplant faculty-selected materials, but to organize related and matched content. Disclaimers within this document would emphasize that these resources are meant as supplemental material for board preparation and that questions for the block exams would still come from the syllabi, lectures, and small group content. We recommend this document be posted on the home page on each block’s Canvas site to allow for ease of access. A sample of an effective content map for Invaders and Defenders was compiled by the E19 student block partners and is attached. This format is simple and clean. We recommend the same template be used for each block and could be compiled by the student block partners during the 2020-2021 academic year and beyond. Recommendation 7: Revisit the discussion regarding moving Step 1 to after the Patient Case Phase in light of Step 1 scoring moving to Pass/Fail.

Of students who responded to our survey (n = 232), a majority felt that Step 1 should remain before clerkships. We recognize that moving Step 1 to the end of third year may help students who do not feel prepared to take Step 1 by the March deadline. However, we feel that our other recommendations regarding integration of Step 1 material into Foundations will help students feel more prepared. Our concerns regarding moving Step 1 include the overwhelming nature of taking Step 1 and Step 2 close together after the challenges and intensity of the Patient Care Phase. In addition, with the move of Step 1 scoring to pass/fail, we anticipate that a larger emphasis will be placed on Step 2 scores by residency programs; therefore, Step 2 will require more intensive studying than students may have required in the past. Finally, we view the time spent studying to take Step 1 as an important step in consolidating information from Foundations and preparing for clerkships. Without the pressure of Step 1, we are concerned this consolidation will be de-emphasized and disincentivized. Additionally, the process of learning to answer NBME-style questions is important for success on shelf exams, which will also have increasing importance as residencies will place higher value on clerkship grades and shelf exams with the change in Step 1 scoring.

Documents

Curriculum Committee Minutes