SBM cardiology Review Jan 2017 - Geisel School of Medicine...SBM Cardiology –Course Review. Review...

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)


• ApproachlearningaboutECGsinanewway,possiblyadifferentcombinationofreadingthetext,usinganinteractivecomputerprogram,andfewerhoursoflecture

• Decidehowtoreducetimeslightlydevotedtopathologymaterial,anddiscusschangeofmain

• DecidehowbesttocovertwohoursoflecturecurrentlycoveredbyDr.Katz,inordertomakeitmoreaccessibletoY2medicalstudents


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– 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”


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)”


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

SBM cardiology Review Jan 2017 - Geisel School of Medicine...SBM Cardiology –Course Review. Review...

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