review of year 2 respiration course - geisel school … · review of year 2 respiration course ......
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ReviewofYear2Respirationcourse
• CourseoccursinthefirsttermofYear2
• CourseDirector– HaroldManning,MD
• Coursehas46.5curricularhours(plus6hoursofPBL)
• CoursewaslastreviewedinMarch2012
ActionPlanfromPriorReview• Improve the images on the final exam(done)• Provideafewmorepracticequestionspriortotheexam
(done,althoughstudentscontinuetorequestmore)• Continue trend to a few more active, “interactive” large le
arning conferences (done)• Considerreducingtimespentinthe8hoursofpathologylab
exercises,whichstudentsreportedasnotbeingveryuseful,withpoorstudentattendance(pathologysessionshavebeenreducedby1hour)
• DomorewiththePFTlab,forexample,studyinghowvariousPFTs(e.g.FVCX,FEV1,MIP,etc.)varywithstudentheight,weight,gender,etc. (done)
CourseObjectives1. Correlatepathologicalchangesintherespiratorysystemwiththeaccompanyingphysiological
abnormalities2. Correlatethepathologicalandphysiologicalchangeswiththeclinicalmanifestationsoflung
disease3. Explainthepathophysiologyandtreatmentofcommonrespiratorysymptoms,suchascough
andshortnessofbreath4. Interpretavarietyofdifferenttypesofpulmonaryfunctiontests5. Describehowpatternsofabnormallungfunctioncharacterizedifferentrespiratorydisorders6. Measureone'slungfunction,predicthowavarietyoffactorswillaffecttheresultsof
pulmonaryfunctiontesting,anddescribesomeofthedifficultiesandlimitationsofpulmonaryfunctiontesting
7. Describebasicradiographicfindingsincommonrespiratorydisorders8. Explainhowthephysiologicalandpathologicalabnormalitiesthatoccurinpatientswith
respiratorydiseasegiverisetothesymptomsexperiencedbypatientsandthephysicalfindings(signs)thatcanbeobserved
9. Describetheroleplayedbygeneticfactorsincommonrespiratorydiseases10. Describetheroleplayedbyenvironmentalfactorsincommonrespiratorydisorders11. Describecommondevelopmentalabnormalitiesoftherespiratorysystem
CourseObjectives12. Explainthepharmacologicalandnon-pharmacologicaltreatmentsforabroadrangeof
respiratorydiseasesandwhenpossiblecorrelatewiththeunderlyingpathobiology13. Describethechangesinlungfunctionthatoccurduringfetaldevelopmentandduringthe
transitionfromuterinetoextrauterine life14. Explainthebasicprinciplesofscreeningandclinicalepidemiology15. Describefactorsthatmaylimittheadoptionand/orslowtheimplementationofnewscience
topatientcareorthatlimitpatientcompliancewithrecommendedtreatments16. Demonstratetheabilitytopiecetogetherpiecesofinformationfromthehistory,physical
examination,pulmonaryfunctiontests,andimagingstudiestoarriveatalistofthemostlikelydiagnosticpossibilities
17. Communicatewithfellowstudentsandfacultyaboutpatientswithrespiratorydisease18. Demonstratetheteamskillsbyparticipatinginsmallgroupconferences19. Demonstratetheresponsibilityforself-education20. Educatepatientsandfamiliesaboutillness21. Describetheimpactofchronicrespiratorydiseaseuponpatientsandtheirfamilies
CourseObjectives– Comments• Objectivescapturethecoursecontentwell• Itcouldbeusefultospecifythe“commonlungdiseases”
coveredinthecourseinordertocapturethiscontentinILIOS• USMLEcontent:
http://www.usmle.org/pdfs/usmlecontentoutline.pdf– CoursecoversmajorityofUSMLEcontent,althoughsomespecific,
obscureconditionsmaynotbeaddressedindetail(e.g.bagassosis,juvenilepapillomatosis,DIP,byssinosis,BOOP,pulmonaryalveolarproteinosis)
– Someoftheseclinicalconditionsaremorelikelytoappearonstep2CKorstep3ratherthanstep1andmaybeencounteredbystudentsinclerkshipsorelectives
FormatofCourse&SessionObjectives• Courseobjectivesareprovidedinthesyllabus• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesareprovidedinthecoursematerials
• Afewsessionobjectivesarenotwritteninthecorrectformat– Someusetheverb“understand”(e.g.ReviewofGasExchangeandBloodGasTransport),whichshouldbeupdatedtoindicatewhatstudentsshouldbeableto“do”
IssuesofRedundancy• Studentscommentedthatsomeintentionalredundancywithinthecourseandwithyear1physiologywashelpfulandastrengthofthecourse
• Nomajorredundancyidentifiedwithothercourses
ExplorationofEthics• InteractiveEthicslargegroupdiscussionsessionwithTimLahey andBillNelsonfocusedonissuesrelatedtowithdrawalofmechanicalventilation
• Sessionhasbeenaddedsincelastcoursereview
• Feedbackfromstudentshasbeenpositive
SummaryregardingObjectives• Overallcourseobjectivesmatchcoursecontentwellandarewrittenincorrectlanguage
• Werecommendconsideringspecifyingthe“commonlungdiseases”referredtoinobjectivesinordertoassistwithcurriculummapping
• Somesessionobjectivesarewritteninoutdatedlanguage(e.g.“understand”)andneedtoberevised
CourseLearningOpportunities• Lecture28.5hrs.(54%),however:– 4hourslistedas“lecture”inILIOSareactuallypatientpresentations(7%)
– 1hourislargegroupethicsdiscussion(2%)– Thisreducestotallecturetimeto45%oftotal– Manyofthelargegroupsessionsareinteractive(PFTs,“TyingitTogether”)
• Conferences9hrs.(17%)• Laboratory9hrs.(17%)• PBL6hrs.(11%)• E-lecture(2%)
CourseLearningOpportunities• Caseconferencesareveryhighlyreviewedbystudents– Somestudentscommentedthatexamquestionsweremoredifficultthanconferencequestions
• RequiredPulmonaryFunctionTestingatDHMCalsoverywell-received
• Somestudentssuggestedthatlabsshouldnotberequiredsinceslideswereavailableonline
SummaryregardingPedagogy• Courseusesabalanceoflearningapproaches
• SmallgroupconferencesandPFTlabwereespeciallywell-received
• Somestudentsrequestedadditionalsessionstohelpwithintegratingcomplexmaterialattheendofthecourse
Assessment• WrittenQuizzes(Noquizzes)• FinalExam• Conferencesandshortethicsessay
– Conferencegradebasedonattendance,participation– 9conferencestotal.Eachconferenceworth2points.(total– 18
points)– Shortethicsessayworth2points.– Studentsmustearn16of20possiblepointstopass
• SelfAssessmentExamsavailableonCanvaswithanswersprovidedmid-term.
SummaryregardingAssessment• Assessmentstructureisclear
• Allobjectivesareassessed– Questionaroseaboutobjective20(Educatepatientsandfamiliesaboutillness);thisisassessedinasthmaPBL
• Self-assessmentisprovidedduringcourse
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 0.14
Immunesystem 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
*valuesreportedforcoredisciplinesareSDabovetheUS/CanmeanforGeiselmeanscores
Measuresof
Quality–AAMCGQ
Year2courses OverallSatisfactionAY2014-2015
GI 4.47
Hematology 4.44
Infectiousdiseases 4.40
Respiration 4.38
Cardiology 4.27
Psychiatry 4.20
FEK 4.19
Pharmacology 4.15
Dermatology 4.11
Endocrine 4.09
CT&Bone 3.62
Nervous system 3.46
Reproduction 3.29
MeasuresofQuality– CourseEvaluation
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
MeasuresofQuality– CourseEvaluation
SBMRespiration
2012(98.9%)*
SBMRespiration
2013(97.7%)*
SBMRespiration
2014(98.8%)*
SBMRespiration2015(92.5%)*
Overallsatisfactionofcourse 4.25 4.39 4.38 4.08
Clarity oflearningobjectives 4.11 4.41 4.34 4.01
Organizationofthecourse 4.48 4.23 4.00
Howwellthecourseintroducedmetothisdiscipline 4.35 4.41 4.07
Congruence ofassessmentquestionstomaterialemphasizedincourse
3.58 3.88 3.92 3.55
*studentparticipationrateoncourseevaluation
MeasuresofQuality– StudentComments
Strengths:- ConferencesItwasgoodthatwehadsomanyconferences.Theywerealotofworktopreparefor,buttheykeptmeontopofthinkingaboutdiseases,someofwhicharequitecomplex.
- ProvidednotesThetypednotes(Worddocuments)werefantastic.IpersonallylearnbestfromwrittennotesandIappreciatethatfacultytooktimetoputthemtogether.Smallgroupreinforcedimportantmaterials.
- Dr.Manning,faculty’swillingnesstohelp- OrganizationofcourseandmaterialsVerywellorganized,reviewmaterialssuccinctandrelevanttofinalexamination,Dr.Manningwasveryhelpfulinansweringquestionsforourunderstanding.
MeasuresofQuality– StudentComments
Strengths:- LabsIreallyenjoyedthepathologylabs.IfeltlikeIwalkedoutofeachlabknowingwhatIneededtoknow.
GoingtotheSpirometry labwasveryhelpfulinunderstandingdiagnostictesting
- PatientpresentationsThepatientpresentationswerereallywonderful.Itisalwaysinterestingandmorememorabletoseeadiseaseinthecontextofaperson'slife/journey.
MeasuresofQuality– StudentComments
SuggestionsforImprovement:- PracticequestionsforeachlectureIfpracticequestionsweregivenforeachlecture,thatwouldhavebeenveryuseful.
- Practicequestionsrelevanttoexamstyle(moreclinical)Itreallywould'vebeenhelpful…tohavegivenusproblemsorworksets thatweremorerelevanttotheexamstyle,especiallyinrelationshiptothecomplexityandminutiaofperipheralpathologicsymptoms.
…ithinkwewouldonlybebettereducatedifthequestionswepracticedwithatthesmallgroupsessionshadthesamelevelofdifficulty/clinicalreasoningastheexam.Wedidn'tgetenoughpracticewithclinicalreasoning.
- SomepartsofexamnottaughtincoursePracticefinalexamtaughtmeanimmenseamountofmaterialIdidnotlearninotherpartsofthecourse.Especiallytheparaplegicvs.quadriplegicvs.diaphragmparalysisproblems.PerhapsstudentsshouldberemindedtoreallylearntheskillsduringOnDoctolearnthephysicalexamcuesfordisease.
MeasuresofQuality– StudentComments
SuggestionsforImprovement:- CondensedoutlineofcourseAcondensedoutlineofthecourse,includingalistofdiagnosesweareresponsibleforknowing,mighthavebeenhelpful.
- NeonatologylectureIthinktheneonatologylectureshouldbesplitintotwoseparatelectures- onereviewingfetalcirculationandtheotherthepathophysiology…alsobeokayifthereviewissimplytherecordingfromyear1'slectureorane-lecturerecordedatthelecturer'sconvenience.
- ConceptintegrationatendofcourseIthoughttherecouldhavebeenalittlemoretimespentonintegratingalltheinformationattheend,eitherinsmallgrouporlargegroupformat.
OptionalreviewsIwishtherewasanoptionalrevieworclassgearedtohelpingthoseofuswhoarenotasstrongintermsofphysics.
MeasuresofQuality– StudentComments
SuggestionsforImprovement:- AlignmentoffacultywithcoursegoalsIthinkthattheculminationofthecourse,asconstructedbyDr.Manning,insomewayswasoneanalyticalstepabovethelevelthatthematerialhadbeenpresentedatthroughouttheterm.Forinstance,understandingthetheorybehindmechanismsofhypoxemiaandhypercapnia inthemajorlungdiseaseswassomethingthatseemedtosortofpopoutofnowhere.It'snottosaythatwedidn'tlearnitattheend,butmyonlyissueisthatitwasunsettlingtofeellikemyownpassesthroughthematerial(and,frankly,theoriginallecturers'presentations)lackedthatcomponent--whichlargely,theydid.Squeezingthosetheoreticalframeworksinattheendunfortunatelycutshortmytimegoingbackthroughandmemorizingtheittybittydetails,despitethefactthatItookplentyoftimetoprepare(themosttimeofallmyfinals).IthinkthereshouldbediscussionbetweenDr.ManningandthefacultywhoteachCOPD,etc.abouthowtostartteachingtothoseobjectivesearlieron.
Someoftheindividualclinicianscominginarenotveryalignedwiththerestofthecourse.WouldhavebeenniceforDr.Manningtogetacopyofeachlecturer'spowerpoint atthebeginningofthecourse,andmodifythemtomakethemallcongruent..
MeasuresofQuality– StudentCommentsDidthefacultyinthiscourseprovidearespectfulenvironmentforlearning?
Absolutely.Questionswerewelcomedandfacultydidawonderfuljobteaching.
Howwelldidthecourseexploretheseareasofculturallycompetentmedicalcarewhenithadtheopportunitytodoso?
WehadasessioninPBLwithanasthmapatientatafreeclinic,butthentheyproceededtopullstringstogetherfreeexpensivetests.IthinkasmallgroupsessionondiagnosiswithoutPFTdatawouldhavebeenreallyuseful.
WhatrecommendationswouldyousuggesttoimprovetheCanvassiteforthiscourse?
Netpath materialsshouldbemoreprominentlyadvertised.
SummaryregardingStudentFeedback• Studentsfeltexamquestionsweremoreclinicalthanpracticequestionsorsmallgroupconferencequestions– Requestedmorepracticequestions
• Studentsfeltfacultywereengagedandapproachable,whichwasimportantforlearningdifficultconcepts
• Studentsfeltthataccesstosomee-lecturestoreviewcomplexyear1materialbeforecorrespondingsessionsinyear2wouldbehelpful
SummaryregardingMeasuresofQuality• CourseperformswellonGeiselstudentevaluationsandgraduationquestionnaire
• StudentsconsistentlyscoreabovethenationalaverageonrespiratorytopicsonUSMLEstep1
Recommendations• Addexamplesofcommonrespiratorydiseasestocourseobjectives
• Ensurethatallsessionobjectivesarewrittenincorrectformat
• Consideraddingmorepracticeexamquestions• Consideraddinge-lecturetoreviewdifficultyear1materialpriortocorrespondingyear2sessions
• Discussstudentconcerns(desirenottohavetheseberequired)aboutpathologylabswithrelevantfaculty
RevisedCourseObjectives1. Correlatepathologicalchangesintherespiratorysystemwiththeaccompanyingphysiological
abnormalitiesindiseasessuchasasthma,COPD,cysticfibrosis,interstitiallungdisease,andARDS.
2. Correlatethepathologicalandphysiologicalchangeswiththeclinicalmanifestationsoflungdiseases,suchasCOPD,interstitiallungdisease,asthma,pleuraldisease,andsleepapnea
3. Explainthepathophysiologyandtreatmentofcommonrespiratorysymptoms,suchascoughandshortnessofbreath
4. Interpretavarietyofdifferenttypesofpulmonaryfunctiontests,includingspirometry,diffusingcapacity,lungvolumes,bronchoprovocation challenge,andMIPandMEP
5. Describehowpatternsofabnormallungfunctioncharacterizedifferentrespiratorydisorders6. Measureone'slungfunction,predicthowavarietyoffactorswillaffecttheresultsof
pulmonaryfunctiontesting,anddescribesomeofthedifficultiesandlimitationsofpulmonaryfunctiontesting
7. Describebasicradiographicfindingsincommonrespiratorydisorders,suchasemphysema,interstitiallungdisease,lungcancer,ARDS,pleuraleffusion,pneumonia,andpneumothorax
8. Explainhowthephysiologicalandpathologicalabnormalitiesthatoccurinpatientswithrespiratorydiseasegiverisetothesymptomsexperiencedbypatientsandthephysicalfindings(signs)thatcanbeobserved
RevisedCourseObjectives9. Describetheroleplayedbygeneticfactorsincommonrespiratorydiseases,suchas
emphysema,asthma,andcysticfibrosis.10. Describetheroleplayedbyenvironmentalfactorsincommonrespiratorydisorders,suchas
COPD,asthma,interstitiallungdisease,andlungcancer.11. Describecommondevelopmentalabnormalitiesoftherespiratorysystem,suchascongenital
diaphragmatichernia,tracheoesophageal fistula,pulmonarysequestration,andvascularrings.
12. Explainthepharmacologicalandnon-pharmacologicaltreatmentsforabroadrangeofrespiratorydiseases,suchasCOPD,asthma,interstitiallungdisease,sleepapnea,lungcancer,andrespiratoryfailure, andwhenpossiblecorrelatethetreatmentwiththeunderlyingpathobiology
13. Describethechangesinlungfunctionthatoccurduringfetaldevelopmentandduringthetransitionfromuterinetoextrauterine life
14. Explainthebasicprinciplesofscreeningandclinicalepidemiology,particularlyappliedtolungcancer
15. Describefactorsthatmaylimittheadoptionand/orslowtheimplementationofnewsciencetopatientcareorthatlimitpatientcompliancewithrecommendedtreatments
RevisedCourseObjectives
16. Demonstratetheabilitytopiecetogetherpiecesofinformationfromthehistory,physicalexamination,pulmonaryfunctiontests,andimagingstudiestoarriveatalistofthemostlikelydiagnosticpossibilities
17. Describebasicethicalprinciplesinmedicineandapplythemtodecisionmakinginpatientswithadvancedlungdiseaseorpatientsonventilatory support
18. Demonstratetheteamskillsbyparticipatinginsmallgroupconferences19. Demonstratetheresponsibilityforself-education20. Educatepatientsandfamiliesaboutillness21. Describetheimpactofchronicrespiratorydiseaseuponpatientsandtheirfamilies