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CourseReviewCommittee:
HalManningJonHuntingtonJoshRamos
SBMCardiology– CourseReview
ReviewofYear2SBMCardiology
• Courseoccursinthe1st termofYear2• CourseDirectors:– TonyGemignani– TerrenceWelch
• Coursehas62curricularhours• CoursewaslastreviewedinMarch2012
Dateofthisreview:Jan2017
• Actionplancannotbelocated…• Suggestionsfromlastreview:– Developacourseplanningcommittee,multidisciplinary,withrepresentationfromkeystakeholders(e.g.cardiology,cardiacsurgery,pathology,pharmacology,pediatrics,imaging,etc.)
– Createwrittennarrativeformativefeedback,mostlikelyfromhavingmoreconferencegroups(withcontinuityoffacultymember),andhopefullyabletoassesstheirskillsatmedicalproblemsolvingandcriticaljudgment(thisalreadyoccursinthePBLgroupsaswell).Thisfeedbackmaybemorehelpfultostudents,andlessthreatening,ifnotpartofthefinalgrade(e.g.formative,notsummative)
ActionPlanfromPriorReview
• Decreasehoursoflectureslightly,increasemoreactivelearningactivities;LCMEgoalappearstobe<40%timedevotedtolectures
• Developatleastonehourofcurriculumforstudentstoobserve,measure,andthinkaboutactualclinicalorscientificdata(e.g.rangeofMETSachievable(range,mean,SD,etc)ontreadmilltestformalevsfemalestudents)
• DevelopPhysicalDx clinicforpatientswithcardiacmurmurs,possiblyattheVAMCaswellsostudentscanbeintroducedtothatcenter
• Createnewlibraryofdigitizedimagesforuseonthefinalexam(path)
ActionPlanfromPriorReview
• ApproachlearningaboutECGsinanewway,possiblyadifferentcombinationofreadingthetext,usinganinteractivecomputerprogram,andfewerhoursoflecture
• Decidehowtoreducetimeslightlydevotedtopathologymaterial,anddiscusschangeofmain
• DecidehowbesttocovertwohoursoflecturecurrentlycoveredbyDr.Katz,inordertomakeitmoreaccessibletoY2medicalstudents
ActionPlanfromPriorReview
1. Describethepathophysiologyofcommonandmajordiseasesofthecardiovascularorgansystem.2. Recognizethemolecularbasisofcardiaccontractilityandelectrophysiology,anddescribehow
abnormalitiesofthesemechanismsproduceimportantcardiovasculardiseases.3. Describetheclinicalpresentations(symptomsandsigns)ofthemostcommondiseasesofthe
cardiovascularsystem.4. Explainthebasisforvariousapproachestothetreatmentofthecommoncardiovasculardisease,
includingbehavioral,pharmacological,andinterventionalstrategies.5. Examinelargeepidemiologicalandmulticenteroutcomesstudiesrelevanttothecommon
cardiovasculardisease,anddescribehowtheyhavealteredourapproachtothetreatmentofmajorcardiovasculardiseases.
6. Interviewapersonwithcoronaryriskfactors,counselthatindividualonhowtoreducetherisk,andwriteapaperdescribingandreflectingontheexperience.(CoronaryPreventionProject)
7. Describeandrecognizethecommonandimportantelectrocardiographicabnormalitiesandarrhythmias.
8. Comparethestrengthsandweaknessesofseveralimagingmodalitiesthatcanbeusefulintheidentificationandmanagementofcardiovasculardiseases.
9. Describethecommonfactorsthatleadtothedevelopmentofcommoncardiovasculardiseases(mostspecificallycoronaryarterydisease)andhowCVriskisassessedandmanaged.
10.Beabletoexplainandidentifyauscultatory findingsassociatedwithcommonvalvular andcongenitalheartabnormalities.
CourseObjectives
11.Describetheessentialpathologicalfeaturesofcommonandimportantcardiovasculardiseases,includinghypertension,cardiomyopathy,pericardialdisease,ischemicheartdisease,andvalvular heartdisease.
12.Recognizetheimportanceofgeneticfactorsintheproductionofcertaincardiovasculardiseases.
13.Find,read,evaluate,anddiscussrecentarticlesandothersourcesofinformationaboutcardiovasculardiseasesandtreatmentsforconferenceandPBLgroups.
14.Practiceanddemonstratesystematicproblem-solvingskillswithregardtopatientswithcardiovasculardisease.
15.Communicateeffectivelywithfellowstudentsandfacultyaboutpatientswithcardiovasculardisease.
16.Discusstheimplicationsofregionalvariationsindeliveryofhealthcareforimportantcardiovasculardiseasessuchasischemicheartdisease(e.g.asdescribedintheDartmouthAtlas).
17.Reflectonyourpersonalexperiencerelatingtopatientssufferingfromcardiovasculardisease.
18.Describethewaysinwhichaknowledgeofcardiovascularepidemiologycontributestothediagnosisandtreatmentofpatientswithcardiovasculardisease
19.Demonstrateabilitytocommunicatewithcardiacpatientsandpersonsatriskforthedevelopmentofcoronarydisease.
20.Discussimportantracial,genderandsocioeconomicdisparitiesinhealthcaredelivery.
CourseObjectives(continued…)
MappingofCourseObjectivestoGeiselCompetencies
LinkstoProgramObjectivesCountofSessionObjectivesMappingto
CourseObjectiveCourseObjectives1 MS.1,MS.2 1162 MS.1,MS.2 283 MS.5 994 MS.5 885 CC.13,CC.7,EIM.2,EIM.3,MS.5,PH.1 176 CC.1,CC.12,CC.13,CC.2,CS.1,CS.2,CS.4,CS.7,MS.5 37 CC.5,MS.2,MS.5 438 CC.13,CC.5,MS.5 179 MS.5,PH.2 110 CC.3 4411 MS.2 3612 MS.2,MS.5 613 MS.1,MS.2,MS.5 314 CC.6,CC.7 2015 CC.1,CC.8,CS.6,CT.3,P.2,P.7,PPLD.3 3516 EIM.5 1917 P.6,PPLD.1 418 CC.13,MS.5,PH.2 2319 CC.12,CC.2,CS.1,CS.2,CS.4,CS.7,P.6,PPLD.1 1520 P.5 2
• Overall,theygiveanexcellentsenseabouttheemphasisofthecourse
• Having20courseobjectivesisonthehigherendforamajorrequiredcourse
• Confirmhowobjective15isactuallyassessed(?PBL)
CourseObjectives– Comments
• Courseobjectivesare providedinthesyllabus• Courseobjectivesaregenerallywritteninthecorrectformat
withthefollowingexceptions:– Minorchangestowordingofobjectives10&15:
• remove“beableto”• ?useof“communicateeffectively”
• Sessionobjectivesare generallyprovidedinthecoursematerialsexceptinthesession:– “IssuesinHypertension”
• Sessionobjectivesaregenerallywritteninthecorrectformatwiththefollowingexceptions.– Pathology:VascularDisease:
• Severalexamplesof“beableto…”and“becomefamiliar”inanumberofdifferentsessions
FormatofCourse&SessionObjectives
• Aretheremajorissuesofredundancywithothercourses?
• Noneidentified
IssuesofRedundancy
Ethics – “Identifykeyconceptsinhealthcareethicsanddemonstrateanabilitytorecognizeethicalissuesarisinginpatientcareandpopulationhealthandtothinkcriticallyandsystematicallyinapplyinganethicalanalysis”
CulturalAwareness – “Demonstrateanunderstandingandskillinmanagingpatientcareofpeopleofdiversecultures,social,economicstandingandbeliefsystems”
HealthEquity– “Identifytherootcausesandapproachesforaddressinghealthdisparitieslocallyandglobally”
Resilience – Demonstrateknowledgeofskillsandpracticestopreventandaddressstressandmaintainresilienceincaringforpatientsandoneself
CompassionandEmpathy – “Demonstrateabilitiestounderstandeachpatient’sexperienceofillness,adaptscientificallyappropriatecaretoconformtothatpatient’sneeds,andcommunicateintermsthateachpatientcanunderstand”
Therealsoaresynergiestohealthlaw,communicationskills, professionalism(asLCMErequires).
HealthandValuesGoals
• 1.5hour“ConnectingHeartsandMinds”presentationwithpatient
• Courseobjective(#17):– Reflectonyourpersonalexperiencerelatingtopatientssufferingfromcardiovasculardisease
• Sessionobjectives:– Toconnectthescienceofmedicinewiththelivedexperienceandhumandimensionsofprovidingandreceivingmedicalcare
– Todevelopskillinformingeffectiveandpositiverelationshipswithpatients,theirfamilies,andcolleagues.
– Tolearnandpracticethecommunicativeskillsassociatedwithprofessionaleffectiveness.
HealthandValuesContent
• Sessionobjectives(cont’d):– Tomodelarangeofcompetenciesassociatedwithprofessionalism,includingpatient-centeredvalues,proficiencyinmedicalscience,abilitytocommunicateandcollaboratewithothers,andpersonalintegrity.
– Toassiststudentsinbeingemotionallypresentfortheircolleaguesandfuturepatients.
– Toembedaspiritofhumanismintoeverystepintheprovisionofhealthcare.
HealthandValuesContent– cont’d
• AretheHealthandValuestopicsnotedinthecourseandsessionobjectives?Yes– Objective17:Reflectonyourpersonalexperiencerelatingtopatientssufferingfromcardiovasculardisease
– Objective20:Discussimportantracial,genderandsocioeconomicdisparitiesinhealthcaredelivery.
• WhatdothestudentevaluationsindicateregardingHealthandValuesteaching?– Samplecomments:
• Ireallylikedthissession.Itwasreallypowerfulandeducationalandyoushould100%dothisagain.
• Reallyenjoyedthissession!
HealthandValuesContent
SummaryregardingObjectives
• Overall,theobjectivesarewellwrittenandthecontentseemsappropriate
• Minorrevisionsneededinasmallnumberofcourseobjectives
• Minorrevisionsneedtobemadetoasmallnumberofsessionobjectives
CourseLearningOpportunities
Hours %coursetime
Lecture 31.5 51eLecture 1 2Largegroup discussion 1.5 2Conference 15 24Lab 4 6PBL 9 15
Total 62
SummaryregardingPedagogy
• Lecturetime(51%)isstillalittleabovewhatisconsideredideal.
• Studentsreallyenjoyedthesmallgroupconferences:– Perhapssomecurrentlecturescouldbeconvertedtosmallgroups(e.g.shiftsomeofthe4hoursofvalvediseaselecturetosmallgroup?)ortoaninteractivelargegroupformat(e.g.finalsession“reviewofclinicalarrhythmias”)
• Topassthecourse,studentsmust:–Passthefinalexamination– Scoreaminimumof10pointsforconference(7conferences,2pointseachforattendanceandparticipation)–Completecoronarypreventionproject(aroughly2pagepaper)
Assessment
• ConfirmthatObjective#15isassessedbyPBLtutor(orothermeans)
AssessmentforCourseObjectives
SummaryregardingAssessment
• Thecourseemploysanappropriaterangeofassessmenttools.
MeasuresofQuality– GraduationQuestionnaire
DatafromAAMCGraduationQuestionnaire
MeasuresofQuality– GraduationQuestionnaire
DatafromAAMCGraduationQuestionnaire
MeasuresofQuality– GraduationQuestionnaire
DatafromAAMCGraduationQuestionnaire
MeasuresofQuality– GraduationQuestionnaire
DatafromAAMCGraduationQuestionnaire
MeasuresofQuality– StepI
SYSTEMS-BASEDTOPICS 2014* 2015* 2016* Means14-16
Behavioralsciences 0.15 -0.1 -0.43 -0.13
Behavioral HealthandNervoussystem 0.06 -0.10 -0.18 -0.07
Biostatistics,Epidemiology,PopHealth 0.01 0.22 N/A 0.12(14-15)
Cardiovascularsystem 0.02 0.16 -0.1 0.03
Endocrinesystem 0.39 0.24 0.09 0.24
Gastrointestinalsystem 0.54 0.2 0.06 0.27
Hematopoietic/lymphsystems 0.09 0.10 -0.15 0.01
Immunesystem 0.16 -0.07 -0.02 0.02
Musculoskeletal,skin,CTsystems -0.02 0.22 0.15 0.12
Nutrition 0.22 -0.08 -0.15 -0.003
Renal/urinarysystem 0.23 0.02 -0.27 -0.007
Reproductivesystem 0.39 -0.03 -0.04 0.11
Respiratory system 0.18 0.27 -0.22 0.08
*valuesreportedforcoredisciplinesareSDabovetheUS/CanmeanforGeiselmeanscores
MeasuresofQuality– AAMCGQ
Year2coursesOverallQualityAY
14-15OverallQualityAY
15-16OverallQualityAY
16-17Cardiology 4.27 3.69 3.90
CT&Bone 3.62 3.23
Dermatology 4.11 3.89
Endocrine 4.09 3.88
FEK 4.19 3.85
GI 4.47 4.31
Hematology 4.44 4.26
Infectiousdiseases 4.40 4.02
IntroductiontoPharmacology 4.15 3.74
Introduction toSBMThemes 3.54 3.35
Nervous system 3.46 3.06
OnDoctoring 3.58 3.60
Psychiatry 4.20 4.16
Reproduction 3.29 3.05
Respiration 4.38 4.08
MeasuresofQuality– CourseEvaluation
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
MeasuresofQuality– CourseEvaluation
SBMCardiologyAY15-16(98%)*
SBMCardiologyAY16-17(98%)*
Overallsatisfactionofcourse 3.69 3.90
Clarity oflearningobjectives 3.75 4.08
Organizationofthecourse 3.64 3.83
Howwellthecourseintroduced metothisdiscipline 3.85 4.16
Congruence ofassessmentquestionstomaterialemphasizedincourse 3.34 3.55
*studentparticipationrateoncourseevaluation
MeasuresofQuality– StudentComments
Strengths:• Smallgroupstructureandfacilitatorsreceivedhighpraise
– “SmallgroupswerethebestI'vehadinmedicalschool”– “Smallgroupcaseswerewrittenverywellandreallyhelpedme
understandwhatIknewanddidnotknow”• Patientpresentationsessionwaswellexecuted
– “IheardfromsomestudentswhonormallyarenotveryresponsivetoPOIsessionsthattheyparticularlyenjoyedthisone”
– “Patientperspectives[sessionwas]extremelyhelpful”• TimespentonEKGspreparedstudentsforclinicalencounters
– “IreallylikehowmuchwefocusedonreadingEKGsandwasabletoreadoneatpreceptor”
– “IthinkthatthecourseofferedlotsofgoodEKGexamplesthathelpedsolidifyourknowledge”
MeasuresofQuality– StudentComments
SuggestionsforImprovement:• Studentsrequestedapracticefinal
– “Ireallywishthereweresomepracticequestionstounderstandwhatkindofinformationtofocuson”
• SometopicsinStep1reviewmaterialsnotcovered– “UWorldpracticequestionsforboardspreparation[have]alotofquestions
thataskaboutgeneticconditionsandcongenitalheartdefects…asidefromMarfan Syndrome,noothergeneticdefectswerecovered”
• Lecturesonarrhythmiaswereconfusingtomanystudents– “Arrhythmias[lectures]coveredalargeamountofmaterialinverydaunting
detailwhichmadeitdifficultformetoabsorbkeyinsights/frameworks”• Pathologylectures/labswerepoorlyorganized
– “Amorestandardizedapproachtothelecturesandlabsshouldbeadopted(morelike[inSBMRespiration],inwhichthereisapre-lecturevideoonthematerialandthencase-basedlabworktodoinsmallgroups)”
MeasuresofQuality– StudentComments
OtherIssuesfromStudentComments:• UnlikeotherSBMcourses,SBMCardiologydoesnothavea
hands-onclinicalcorrelationcomponent– “UseSIMcentertoforceustothinkonfeetforachallengingcardiac
case”
• TwodifferentEKGreadingmethodologieswerediscussed,whichwasconfusingtostudents– “YoushouldalsomakeDubin requiredreadingandemphasizethattothe
class,becauseIdidnotunderstandEKGsuntilIwentthroughit”– “youtaughtusonemethodofEKGanalysisinlectureandthen
recommendedthatwereadtheDubin book,whichtaughtacompletelydifferentmethod”
SummaryregardingMeasuresofQuality
• StudentsperformatnationalmeanonUSMLEStep1cardiovascularcontent
• Virtuallyeverycomponentofstudentcourseratingshasimprovedcomparedwithlastyear
• Studentcommentsweregenerallyverypositive
Recommendations
• Makeminormodificationstocourseandsessionobjectives
• Attempttoreducetheamountof“traditional”lecturetime
• Providingpractice,exam-stylequestionswouldhelpstudentsprepareforthefinalexamandtheboards
• Assurethatwhatisemphasizedonexamcorrespondswithwhatisemphasizedduringthecourse
Recommendations
• Reviewcoverageofarrhythmias,atopicthatmanystudentsfoundconfusing
• Reviewthepathologycontent– helpstudentsidentifywhat’simportantfromthemtoknow
• Providepracticequestions
ActionPlan
• Makeappropriatemodificationstocourseandsessionlearningobjectives(andensurethattheyarecongruent)
• Reducelecturetimeandincreasenumberofsmallgrouplearningsessions– willaimfor40%lecturetime
• We’llreviewthequestionstoensurethatthefinalexaminationteststhemostimportantconceptsfromthecourse(andthatthesessionsfocusonthemostimportantconceptsfortheexamination)
ActionPlan
• Providepracticequestionsforfinalexamination• Considerinterimself-assessmentquizzestoensuremasteryofmaterialandinterruptthe“forgettingcurve”
• Revampthecurriculumforelectrocardiographyandarrhythmias.Dubin textwillbeassignedreading.
• Optimizepresentationofpathologymaterial,ideallywithtransitiontomoresmall-grouplearningandemphasisonthekeyconceptsfortheexaminationandclinicalpractice