review of year 2 respiration course - geisel school … · review of year 2 respiration course ......

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.


Strengths:- LabsIreallyenjoyedthepathologylabs.IfeltlikeIwalkedoutofeachlabknowingwhatIneededtoknow.

GoingtotheSpirometry labwasveryhelpfulinunderstandingdiagnostictesting

- PatientpresentationsThepatientpresentationswerereallywonderful.Itisalwaysinterestingandmorememorabletoseeadiseaseinthecontextofaperson'slife/journey.


SuggestionsforImprovement:- PracticequestionsforeachlectureIfpracticequestionsweregivenforeachlecture,thatwouldhavebeenveryuseful.

- Practicequestionsrelevanttoexamstyle(moreclinical)Itreallywould'vebeenhelpful…tohavegivenusproblemsorworksets thatweremorerelevanttotheexamstyle,especiallyinrelationshiptothecomplexityandminutiaofperipheralpathologicsymptoms.

…ithinkwewouldonlybebettereducatedifthequestionswepracticedwithatthesmallgroupsessionshadthesamelevelofdifficulty/clinicalreasoningastheexam.Wedidn'tgetenoughpracticewithclinicalreasoning.

- SomepartsofexamnottaughtincoursePracticefinalexamtaughtmeanimmenseamountofmaterialIdidnotlearninotherpartsofthecourse.Especiallytheparaplegicvs.quadriplegicvs.diaphragmparalysisproblems.PerhapsstudentsshouldberemindedtoreallylearntheskillsduringOnDoctolearnthephysicalexamcuesfordisease.


SuggestionsforImprovement:- CondensedoutlineofcourseAcondensedoutlineofthecourse,includingalistofdiagnosesweareresponsibleforknowing,mighthavebeenhelpful.

- NeonatologylectureIthinktheneonatologylectureshouldbesplitintotwoseparatelectures- onereviewingfetalcirculationandtheotherthepathophysiology…alsobeokayifthereviewissimplytherecordingfromyear1'slectureorane-lecturerecordedatthelecturer'sconvenience.

- ConceptintegrationatendofcourseIthoughttherecouldhavebeenalittlemoretimespentonintegratingalltheinformationattheend,eitherinsmallgrouporlargegroupformat.

OptionalreviewsIwishtherewasanoptionalrevieworclassgearedtohelpingthoseofuswhoarenotasstrongintermsofphysics.


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

ActionPlan

• Courseobjectivesrevised

• Willensurethatsessionobjectivesareallwritteninthecorrectformat

• Willaddadditionalpracticequestionsinresponsetoinsatiabledemandformorepracticequestions

• Willreviewtimeallottedtopathologysessions(MECpolicyisthatlabsarerequiredsessions)

review of year 2 respiration course - geisel school … · review of year 2 respiration course ......

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