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
