ReviewofYearPathology course

• CourseoccursinthespringtermofYear1

• CourseDirector– BillHickey,MD

• Coursehas63curricularhours

• CoursewaslastreviewedinFeb2013andpresentedtotheMECinApril2013

ActionPlanfromPriorReview• Duringthediscussionofthecoursein2013,theMECrequestedthatDr.Hickeysubmitinwritinganactionplantoaddressissuesraisedduringthereview

• Thedocumentwasneverreceived,thusitisnotpossibletoassesswhethertheactionplanwasimplemented

• ManyoftheissuesraisedbystudentsduringAY2011-2012werealsomentionedinAY2014-2015

CourseObjectives

1. Describethegeneralfieldofpathologyanddiscussitsrelationtoothermedicaldisciplins andregulatorybodies.

2. Defineatleastsixdistinctpathogenetic processesbywhichhumandiseasecanoccur.3. Giveatleasttwoexamplesofdiseasesthatfitintoeachpathogenetic category.4. Discussdevelopmentaldiseasesinthecontextofnormalandabnormalembryogenesis.5. Discussthefeaturesoflethalandsublethal cellinjury.6. Identifyanddiscusscellularatrophy,hyperplasia,dysplasiaandneoplasia7. Discussdisordersofthebloodandcircularory systemincludingedema,arteriosclerosis

andtheevolutionofischemicinjuryandinfarction8. Diagramthecoagulationcascadeanddiscussclottingandbleedingdisorders.9. Describetheprocessesintheevolutionofacuteandchronicinflammationaswell asthe

significanceandconsequences.10. Namefourcomplicationsofchronicinflammation.11. Detailinastep-by-stepmannertheprocessofnormalwoundhealing.12. Describethepathogenesis,pathologyandresistancefactorsassociatedwithvarious

diseasescausedbybacteria.

*Note:typoswerefoundintheobjectivesonCanvas;thesearehighlightedinred

CourseObjectives(cont.)13. Definethepathogenicmechanismsandgiveexamplesofchronicandopportunistic

pathogens.14. Discussthepathologicaleventsinviralinfections.15. Define,distinguishandexplainhypersensitivitydiseasestypesIthroughIV.16. Explaintoleranceintheimmunesystemandhowautoimmunediseasescoulddevelop,

givingexamplesofthree.17. Discussthepathophysiologyofimmunodeficiencyandthefourprimary

immunodeficiencydisordersanddetailwhattheyinvolve.18. DiscussthepathogenesisofHIVinfectionintermsoftheHIVgenome.19. Listthemostcommonneoplasticconditionsandthefourfeaturessharedbyall.20. Describethepatholigic featuresofneoplasmsanddistinguish[objectivecutoffon

Canvas]21. ExplaintheprocessofgradingatumorandtheTMNstagingsystemfortumors.22. Describemalignanttransformationandthreegeneticabnormalitiesthatgiveriseto

cancersyndromes.23. Discussepigeneticinfluencesinthemaintenanceofnormalcellularhomeostasis.24. Describemechanismsbywhichneoplasmsevadeimmunologicalelimination.

CourseObjectives(cont.)25. Explaintheroleofthemedicalexaminerinmedicineandjurisprudenceandwhenadeathorillness

mustbeinvestigatedbythemedicalexaminer..26. Explaintheimportanceofautopsiesandtheprocessesofobtainingandconductingthem.27. Explainthemechanismandgiveexamplesofenvironmentalexposures,toxin,poisonsand

medicationscausingillness.28. Discussthepathogenesisofdiseasescausedbyalcoholandcigarettesmoking.29. Correlatesigns,symptoms,clinicalpresentationsandtreatmentswithunderlyingpathological,

pathophysilogical andepidemiologicalcharacteristics.30. Discussclinicallaboratorystudiesandclinicalpathologyprinciples,includingsourcesoferror,in

medicalpractice.31. Tocommunicateeffectivelyandcollegiallywithcolleaguesandfacultyinsmallgroupexercisesand

labs.32. Tobehaverespectfullyandresponsiblytowardscolleaguesandfacultyinsmallgroupexercisesand

labs.33. Tomeetprofessionalresponsibilitiesfully.34. Toadheretohighethicalandmoralstandards,acceptresponsibilityforpersonalactionsandaccept

constructivecriticisminsmallgroupexercisesandlabs.35. Takeresponsibilityforhis- orher-ownmedicaleducationbypreparationforsmallgroupexercises

andlabs.36. Tosetup,useandtroubleshootamicroscope.

MappingofCourseObjectives(1of2)

MappingofCourseObjectives(2of2)

CourseObjectives– Comments• ThereisnospecificsectionintheNBMEStepIbrochureforPathology,howeversessionobjectivescovercontentinmanysectionsofthebrochureincluding:

BiologyoftheCellsBiologyoftissueresponsetodiseaseHemopoietic andLymphoreticular SystemsCentralandPeripheralNervousSystemsCardiovascularSystemsImmuneSystemRespiratorysystem

ObjectivesSuggestions• Therearetoomanycourseobjectives– 8to15objectivesis

standardpractice;someofthecurrentobjectivesaremoreappropriateforsessionobjectives.

• Currentlytherearetoomanyobjectiveswithout“searchable”wordsincluded.Thisprohibitssearchesforredundancyandshouldbechanged.

• ManyobjectivesmaptoCompetency1c.Afewofthesecanbecombinedandwrittenwithmoresearchwords.– ExampleObjectives2-24shouldbere-writtentoinclude~2objectives

fromeachoftheeightmainsectionsoftheclass:Cellularpathology,Circulation,Inflammation,Infectiousdisease,ThePracticeofPathology,Immunopathology,Neoplasms,PhysicalAgents,Trauma,Forensics.

ObjectivesSuggestions– con’t

• Objectives1and25shouldbemappedtocompetency6– Healthcaresystems

• Objective36shouldbedeletedasslidesarenowvirtual.Additionally,severalsessionobjectivesfortheLaboratorySessionsmentionusingamicroscopeandglassslides– theseshouldbeupdated

ObjectivesSuggestions– con’t• ItispossiblethattheForensicsLectureistoonuancedforaFundamentalPathologyCourse.TheAutopsyLecturebyDrWellscouldexplaintheroleoftheMedicalExaminerandthatcouldbesufficientforafirstyearstudent.

• Objective28– Itisunclearwherethisinformationisdiscussedasnosessionsmaptoit.ThecoursedirectorclarifiedthatitistaughtintheEnvironmentalPathologysession– keywordsneedtobeaddedtothesessionobjectivessothemappingisclear

FormatofCourse&SessionObjectives• Courseobjectivesareprovidedinthesyllabus,however

therearetyposonCanvasthatshouldbecorrected• Courseobjectivesarewritteninthecorrectformat,

however31-36usetheIlios format(startingwiththeword“To”)andtheotherobjectivesdonot– shouldbeconsistent

• Sessionobjectivesareprovidedinthecoursematerials• Sessionobjectivesarewritteninthecorrectformat,

howeverthesameissuewithformatispresent(someusingtheword“to”,othersnot)

IssuesofRedundancy• Thereareseveralissueswithredundancybothwithinthe

Pathologycourseitself,andbetweenPathologyandothercourses:“Thecoursehasmultipleredundancieswithmicrobio,biochemistry,CTO,immunologyandvirology.Iwouldestimatethatcloseto50%ofthelectureswereanexactrepeatofpreviousmaterialwithnothingadded.”

• Oneexamplewithinthecoursewasmentionedmultipletimesbystudents- the2sessionsonenvironmentalpathology,alectureandasmallgroup,werefelttobeverysimilar: “Theenvironmentalsmallgroupwasbasicallyjustarecapitulationofthelecturewehadattendedrightbefore.”[Accordingtothecoursedirector,thiswasamixup forthisparticularyear]

IssuesofRedundancyExamplesofredundancycitedbystudents:• “Allofthelecturesonneoplasia andcanceroverlappedalot.

Nottomentionthatwehadalreadylearnedmanyoftheseconceptsinbiochem andimmunology.”

• “Theimmunologysectionofthecourseoverlappedalmostentirelywiththecontentpresentedintheimmunologycourse-- thereforeitwasveryredundant.SimilarlytheEpigeneticslecturewasnearly100%reviewfromthebiochemistrylectureonthetopic.”

• “Theentiresectiononimmunopathology(especiallythefirst5videosegments)wereexactlysimilartoimmunology.”

• “ThemodulesonInfectiousDiseasealsooverlappedheavilywithmicrobiology…

IssuesofRedundancyIlios wasusedtoaccessthetopicOncogene• OncogenesarediscussedinCTO(nucleusandmitosis),inBiochem andGenetics(CancerI,IIandIII,problemset10anddiscussionarticle)andinMed.Pharm.(Year2noveltreatmentsforcancers).

• ItappearsthatunplannedredundancyispresentinCTO,Biochem andPathology.Thecoverageinyear2buildsuponwhatisdiscussedinyear1andseemsappropriate.

IssuesofRedundancyIlios wasusedtoaccessthetopicAutoimmunity anditappearedinmultiplecourses:• ImmunologyandVirology:Autoimmunity,tumor

immunology,TBLIandII• GeneralPathology:Autoimmunity,ImmunopathologyIII,

ImmunopathologylabsBandC• GastrointestinalSystem:Autoimmunityandtheliver• Boneandconnectivetissue:rheumatoidarthritis• Endocrinology:incourseobjective(diabetes,Gravesetc)

UnplannedredundancyseemstobeoccurringwiththeImmunology/Virologycourse;Y2sessionsseemappropriate

IssuesofRedundancyIlios wasusedtoaccessthetopicStreptococcusPneumoniaanditappearedinGeneralPathologyandBasicScienceofMicrobialDisease• PathologyObjective:Describetheevolutionof

StreptococcusPneumoniaPneumonitis.• MicrobiologyObjectives:TodistinguishStreptococcus

PneumoniafromStreptococcusPyogenes;TounderstandthespectrumofdiseasecausedbyStreptococcusPneumonia

Thecoursedirectormentionedthatthesamefacultymembergivesthesesessions,soredundancymaynotbepresent

IssuesofRedundancyIlios wasusedtoaccessthetopicofHIV,anditappearedintwoYear1coursesand4othercourses• ImmunologyandVirology:AIDSandHIV/AIDs• GeneralPathology:ImmunopathologyIVHIV-1• ID:SmallgroupHIV/AIDS,Introtoinfectiousdiseases,

IndependentstudyHIV,IntroductiontoHIV,PBLpneumonia• Organ-basedpharmacology:HIVdrugs• Neurology:neuropathologyinfectiousdiseases• Clinicalpharmacologyandtherapeutics:UpdateonHIVand

AIDSmanagementSomeunplannedredundancymaybepresentinthePathologyandImmunology/Virologycourses

ExplorationofHealthandValues• Ilios wasusedtoevaluateHealthandValuescurriculum

contentinthecourse,howevernothingwasrevealed• Thereisapotentialtointroducesomecontentinthecase

studies(CPC).[Thecoursedirectormentionedthatthey haveasessionthatdiscussesthedifferencesinaskindiseaseforlightvs.darkerskintones]

• Therewasanincidentwherestudentswereoffendedaboutthetreatmentofmaterialconcerninggaymenandblooddonation.Handledappropriately,thiscouldbeareallygoodplacetodiscusshealthcaredisparitiesexperiencedbythispopulation.Additionally,withtherecentchangesinFDAlegislationonthistopic,itwouldallowsomediscussionofethicsandhealthpolicy.

SummaryregardingObjectives• Currentlytherearetoomanycourseobjectives,andmanyaretoodetailed(theyaremorelikesessionobjectives)

• SomeobjectivesdonotcontainkeywordsthatwouldallowIlios todetectmajorthemesinthecourse

• Therearesomeformattingissues/typosthatneedtobecorrectedintheobjectives

• SearchesusingIlios andstudentfeedbackbothindicatethatthereissignificantunplannedredundancyinthePathologycourse

CourseLearningOpportunities• Lecture30hrs.(47.6%)• Smallgroupconferences5hrs.(7.9%)– althoughthese

sessionsarelabeledassmallgroups,thecoursedirectorstatesthatthesesessionsareusedtointroduceparticularlychallengingmaterialinalectureformat;thestudentrepagreedthatsmallgroupsarelectures giventoasmallernumberofstudents

• Laboratory19hrs.(30.2%)

• CPC[clinicalpathologycorrelation]– interactivesessionsinvolvingclinicalproblemsolvinginalargegroup6hrs.(9.5%)

• OnlineRecordedLectures3hrs.(4.8%)

CourseLearningOpportunities

• Accordingtothesyllabus,smallgroupsessionsandCPCswererequired,whilelabsessionsandlectureswerenot;althoughallsmallgroupsarerequiredviatheMECattendancepolicy,sincethesesessionsarebeingusedforlecturetheyshouldnotberequiredinthepathologycourse

• Thepercentageoflecturesinthecourseis60.3%,whichishigherthantheLCMEguidelines.Lecturesaregiveninthreeformats:largegrouplivelectures,pre-recordedonlinelecturesandlecturesinsmallgroups

• ThecourseprovidesanonlineresourcecalledNetpath forindividualstudy.Netpath hasmodulesforsomeofthetopicsinthecourse(e.g.“AcuteInflammation”)thatincludetutorialslidesfollowedbyself-assessmentquestions.Whilestudentsappreciatedthisresource,manycommentedthattheycouldnotaccessitoffcampusasyoumustbeontheDartmouthnetworktouseit(andapparentlytheywereunabletousetheVPN);additionallyitwasnotavailableforalltopics

SummaryregardingPedagogy• Thecourseneedstoreducethenumberoflecturesinthecourse.ThecurrentpercentagedoesnotmeettheGeiselpolicyonActiveLearning/LectureTimeorLCMErecommendations.

• Thecourseshouldreevaluateitsuseofsmallgroupconferences;ifconferencesareusedforlectures,thereisnopurposeinbringingstudentstogetherinasmallgroup

• Thecoursedoeshave6interactivesessions(CPCs);thesubcommitteeencouragesmoresessionsofthistype

Assessment

• WrittenQuizzes(3,30%ofcoursegrade)

• FinalExam(50%ofcoursegrade)

• Histopathologyquizzes(best2outof3count20%ofcoursegrade)

AssessmentofCourseObjectives• Thefirst28objectivesareknowledgeobjectivesthatareassessedonquizzesandexams

• Objectives29-35relatetopreparation,problem-solvingskillsandperformanceinlaboratoryandsmallgroupactivities;thesearecurrentlynotassessedinthecourse[thecoursedirectormentionsthatoralfeedbackmightbegivenregardingstudents’understandingofthematerial,butnotregardingcommunicationskills,preparation,problem-solvingskills,etc.]

• Objective36,“Tosetup,useandtroubleshootamicroscope”,isnotassessedandshouldberemovedsincethecourseusesvirtualslides

SummaryregardingAssessment• Formalassessmentinthecourseoccursviaquizzesandexams

• Therearecurrentlyobjectivesinthecourse(#29-36)thatarenotbeingassessed

Measuresof

Quality–AAMCGQ

Geiselmean2010

Geiselmean2011

Geiselmean2012

Geiselmean2013

Geiselmean2014

Allschoolsmeans2014

Biochemistry 2.7 2.5 2.6 2.6 2.8 2.7

Biostatistics/Epidemiology 2.9 3.2 3.2 2.9 3.2 2.8

Genetics 2.9 2.8 2.8 2.6 2.8 2.9

Grossanatomy/Embryology 3.6 3.5 3.6 3.4 3.6 3.4

Immunology 2.9 3.0 3.1 2.7 2.7 3.1

IntrotoClin Med/OnDoc 3.5 3.4 3.5 3.0 3.3 3.5

Microanatomy/Histology 2.8 2.9 3.1 2.8 3.1 2.9

Microbiology 3.1 3.2 3.3 3.0 3.1 3.2

Neuroscience 3.2 3.0 3.0 3.0 3.2 3.2

Pathology 3.2 3.1 3.4 2.8 3.1 3.3

Pharmacology 3.4 3.1 3.1 2.6 3.1 3.1

Physiology 3.6 3.6 3.5 3.1 3.4 3.4

BehavioralScience 3.2 3.3 3.3 3.0 3.2 3.2

PathophysiologyofDisease 3.5 3.5 3.5 3.3 3.5 3.5

MeasuresofQuality– AAMCGQ“IndicatehowwellyouthinkthatinstructioninPathology preparedyouforclinicalclerkshipsandelectives.”[1=poor;2=fair;3=good;4=excellent]

MeasuresofQuality– StepI

TRADITIONALCOREDISCIPLINES2012* 2013* 2014* Means12-14

Biochemistry 0.30 0.20 0.22 0.24

Biostatistics/Epidemiology 0.43 0.40 N/A N/A

Biostatistics 0.08 0.08

Genetics 0.28 0.18 0.28 0.25

Grossanatomy/Embryology 0.33 0.26 0.14 0.24

Histology/CellBiology 0.37 0.26 0.23 0.29

Microbiology/Immunology 0.31 0.47 0.39 0.39

Pathology 0.26 0.24 0.20 0.23

Pharmacology 0.22 0.22 0.12 0.19

Physiology 0.38 0.35 0.25 0.33

*valuesreportedforcoredisciplinesareSDabovetheUS/CanmeanforGeiselmeanscores

Year1courses OverallSatisfactionAY2014-2015

HumanAnatomyandEmbryologyII 4.57

HumanAnatomyandEmbryologyI 4.35

MetabolicBasisofDisease 4.35

BiochemicalandGeneticBasisofMedicine 4.34

Biostatistics andEpidemiology 4.23

Physiology-Renal 4.19

CTO 4.07

Basic ScienceofMicrobialDisease 3.94

Virology 3.77

Physiology-Endocrine 3.76

Immunology 3.67

Neuroscience 3.59

Physiology-Respiration 3.34

Physiology-Cardiovascular 3.23

Pathology 3.22

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

Pathology2012(90.8%)*

Pathology2013(67.1%)*

Pathology2014(91.2%)*

Overallsatisfactionofcourse 3.62 3.46 3.22

Clarity oflearningobjectives notavailable 3.50 3.21

Organizationofthecourse notavailable 3.39 3.18

Howwellthecourseintroduced metothisdiscipline 3.56 notavailable 3.46

Congruence ofassessmentquestionstomaterialemphasizedincourse 3.68 3.45 3.04

*studentparticipationrateoncourseevaluation

MeasuresofQuality– StudentComments

Strengths:• RelatingthecoursematerialtoRobbinstext• Goodclinicalcorrelations• ParticularlyenjoyedInfectiousDiseaselectures

MeasuresofQuality– StudentComments

SuggestionsforImprovement:• Removeextensiveredundanciesorclarifyplannedrepetitionof

material• QuestionsnotinNBMEformat

[afewquestionsusednegativeformats]

• BetteraccesstoNetpath[beingontheDartmouthNetworkwasnecessarytouse]

• Providesupplementarymaterial(i.e.practicequestions,notes,etc.)[thestudentsfeeltherecommendedtextistoocomprehensive,tooexpensiveanddoesn’thavemanypracticequestions– thesubcommitteefounda“basic”versionofthetextbookbythesameauthor– couldthisbeconsideredforthecoursetext?]

• Feedbacktolecturerstoimprovelecturequality(specificlectureslistedinstudentreviewcomments,e.g.atherosclerosis)[studentscommentedthatsomelecturersjustreadtheirslidesanddidn’tseemtowanttoteach]

MeasuresofQuality– StudentComments

SuggestionsforImprovement(cont.):• Shownormalimagesnexttodiseasestateinlab• Bettercommunicationandresponsewhenlecturersfailto

showup• Smallgroupswereoftenjustcontinuedlecturesor

unnecessary• Changestooverallorganizationofthecourse

[topicsseemtobein“randomorder”;bettercoordinationwiththeMicrobiologycoursewouldbeidealsotheylearnaboutthediseasefirstthenthePathologicalcharacteristics]

MeasuresofQuality– StudentComments

Otherissuesfromstudentcomments• Sensitivitytoparticularsubjectswasanissue:– StudentswereparticularlyoffendedbyDr.Dunbar’slectureontransfusionandLGBTinsensitiveremarks

– Studentsalsocommentedonthegraphicnatureoftheforensicpathologylecturematerial

– Innetpath,thereareinsensitivecommentsaboutamanwhocommittedsuicide• PhysicalinjuresandhemorrhagesFig.2

SummaryregardingMeasuresofQuality• Thiscourseisnotconsistentlywell-receivedbystudentsandratedaroundthe“good”range– thecoursedirectorandhisfacultyshouldconsideradjustmentstothecourse

• StudentsdomoderatelywellonStepIinthisdiscipline

• Studentshavesuggestedminoradjustmentstomakeimprovementstothecourse

• ThemajorissueisunplannedredundancywithotherY1coursesandoverallorganizationissues

Recommendations• Thenumberofcourseobjectivesneedstobereduced;

someobjectivesneedtoberewritten/combined,andformattingissues/typosonCanvasneedtobecorrected

• Thereisasignificantamountofunplannedredundancyinthecourse.ThecoursedirectorshouldmeetwithotherY1coursedirectorsintheImmunology,BiochemistryandMicrobiologycoursestoremedythis;alternativelytopicscouldberemovedfromthecourse.Asthecurriculumreorganizationmovesforward,thereispotentialtointegratethecontentofthiscourseintoothercoursesratherthanhavingaseparatecourse

Recommendations• Thecourseneedstoreducethenumberoflecturesinthecourse.ThecurrentpercentagedoesnotmeettheGeiselpolicyonActiveLearning/LectureTimeorLCMErecommendations.

• Thecourseshouldreevaluateitsuseofsmallgroupconferences;ifconferencesareusedforlectures,thereisnopurposeinbringingstudentstogetherinasmallgroup

• Thecourseneedstoremedythefactthat8courseobjectivesarenotassessed(eitherremovethem,orassessthem)

Recommendations• Inadditiontoremovingredundancy,thecourseshouldconsiderreorganizingthecontenttocorrelatebetterwiththeMicrobiologycourseandhaveamorecohesiveflow

• Thecourseneedstoremoveallquizandexamquestionsthatusenegativestems

• Thecourseshouldremedythevarious“offensivematerials/remarks”mentionedinthecourseevaluation.Forparticularlygraphiccontent,anadvancewarningwouldbeappreciatedbystudents

RecommendationsSomeadditionalminorrecommendationsthatwouldincreasestudentsatisfaction:• Thecourseshouldconsiderprovidingguidancetostudents

regardingaccesstoNetpath (e.g.perhapsITstaffcoulddraftatutorialforthesyllabustoexplainhowtousetheVPNtogetoff-campusaccess)

• Thecourseshouldhaveacontingencyplanforwhenlecturers/smallgroupfacilitatorscannotmakeit;ataminimumthereshouldbesomecommunicationtotheclassaboutthesituation

• Studentswouldgreatlyappreciatetheuseofnormalimagesinthelaboratorytocomparetothepathologicalimages(i.e.areminderofthenormalstructurewouldhelpthemseethedifferencesinthepathologicalstate)

ActionPlan

ActionPlan