ReviewofYearYear2SBM/Dermatologycourse
• Spring2016versionofcoursereviewed• Version9/27/16• MECSubcommitteeGroupconsistedof:– DaveNierenberg,MD(SBMco-director)– DeniseAaron,MD(coursedirector)– RichComi,MD(ex-coursedirector,ex-co-directorofSBM)– ChristianRees,MD/PhDstudentwhotookthecoursein2015
ReviewofYearYear2SBM/Dermatologycourse
• CourseoccursinthefourthtermofYear(mid-FebruarythroughlateMarch);courselastofferedTerm4,2016
• CourseDirector:Dr.DeniseAaron(forpast3years)
• Coursehas24.5curricularhours• CoursewaslastreviewedbyMECin2012(wethink,don’thavecopyofreview)
• CDhasreceivedannuallettersofreviewfromDr.Nierenbergeachyear
ActionPlanfromPriorReview• Webelievelastreviewwasin2012• Recommendations(andresponses)included:– Decreasenumber/%ofstandardlectures(droppedfrom86%downtoabout75%,nowabout72%)
– Ensurethatcourseobjectivesaremadeclearforstudents(nowpostedonCanvassite,andincoursenotes)
– Ensurethatsessionobjectivesarepostedwithineachsession,e.g.powerpoint (onreviewvastmajoritycomply;2lecturersneedtoaddobjectivestotheirmaterials)
– Increasethenumber/percentofquestionsthatincludeaclinicalvignettewithinthestem,vssimplyrecognizingavisualimage(currently8questionsidentifyimage/diseaseonlyand35identifyimageandintegratewithcase)
ActionPlanfromPriorReview• In2016,Dr.Nierenbergsuggestedinhisletter:
– IncreaseemphasisonunderstandingPathophysiology ofskindiseases– Decreaseemphasisonsimplevisualrecognitionofskindiseaseson
finalexam(about50%ofexamitems)– Increasecontentoffinalexamquestionsaboutpathophysiology,
management,diagnosis,orprognosisofskindiseases
• In2015,Dr.Nierenbergsuggested:– Worktoreduceunintendedoverlapofcontentbetweencourse
lecturers– CurrentMECsubcommitteeidentifiedseveraltopicsofpotential
overlapesp.ininfectiousdisease.However,concludedthatthematerialwascomplimentarynotrepetitive,ie,derm focusingonidentificationandphysicalfindingsofskininfectionsandIDfocusingontreatment,resistance,etc.
CourseObjectivesusedSpring2016# OBJECTIVE EXAM
2016 #
1 Learnandapplyusefulknowledgeofthemostcurrentbasicsciencethathelptoexplainnormalskinandadnexal,hair,nailsandmucousmembranestructureandfunction,health,andthepathophysiologyofdisease,suchthatthisknowledgecanbeusedtoimprovepatientcare.
10
2 Definetermsrelevantandcommontothediscussionofpatientswithdisordersoftheskin,hair,nailsandmucousmembranes.
3
3 Correlate cutaneous symptoms andsigns withdermatologicdiseases. 35
4 Explaintheapproachtothediagnosisandevaluationofcommonandimportantcutaneousdiseasessuchaseczemaandcontactdermatitis,papulosquamous disorders,majorbullousdisorders,folliculardisorderssuchasacne,diseasesaffectingthehairandnails,cutaneousinfections,connectivetissuediseasesandskincancer.
13
5 Listandexplainthetypicalfindings,presentation,clinicalcourse,naturalhistoryandcomplications ofcommonandimportantcutaneousdisordersasinnumber4.
22
6 Listandexplainhowenvironmentalchallengestotheskinaffectcutaneoushealthresultingindiseasestates(e.g.UVradiation,chemicalcontactants)
5
CourseObjectivesusedSpring2016
# OBJECTIVE EXAM2016#
7 Explainthebasisforpharmacologicalandnon-pharmacologicalinterventionsforcutaneousdiseases.
14
8 Describethepathophysiologyandmajorpathologicfeaturesaswellastheepidemiologyofcommonandimportantcutaneousdiseasesincludingneoplasms,cutaneousmanifestationsofinfection,cutaneousmanifestationsofconnectivetissuedisease,disordersofthehairandnails,cutaneousmanifestationsofsystemicdisease.
8
9 Comparethepediatricskinexaminationtotheadultcompleteskinexamandtolistcommonbenigncutaneousneoplasmsofchildrenandadults.
0??
10 Explainhowtheexpressionofpediatriccutaneousdisease andnormalcutaneousfindingsmaydifferfromadult.
0??
11 Practiceanddemonstratesystematicskillsofphysicaldiagnosistodescribefindingsofpatientswithcutaneousdisease.
PEsession
12 Communicatewithfellowstudentsandfacultyaboutpatientswithcutaneousdisease.
PEsession
CourseObjectivesusedSpring2016
# OBJECTIVE EXAM2016#
13 Demonstrateteamskillsbyparticipatinginphysicaldiagnosissession. PEsession
14 Examinepatientsskillfullyandrespectfully,withappropriateattentiontostudentcleanliness,infectioncontrol,andpatientcomfortandprivacy.
PEsession
15 Generateanappropriatedifferentialdiagnosis,basedonlogicalclinicalassessmentandguidedbyappropriatestatisticalreasoning.
?Rewordobjective
16 Communicateeffectivelywithphysiciancolleaguesverballyrelatingthefindingsofacutaneousphysicalexaminationinconciseandaccurateterms.
PEsession
17 Takeresponsibilityforhisorherownmedicaleducation Delete
18 Recognizetheimportanceofethnicandculturaldiversityintreatingtheskin
18
CourseObjectives– Comments• Shortenandclarifyseveraloftheobjectives(1,4,5,8
especially);Objective1needstobeupdatedperDr.Aaron• Overall,theygiveanexcellentsenseabouttheemphasisof
thecourse• Havingabout18isanappropriatenumberforamajor
requiredcourse• Makesurethatseveral(11,12,13,14,16)areactuallyassessed
duringPEsessioninsomewaythatcanbedocumented(evenifnotgradedperse)- YES
• Identifyhowtwo(15,17)areactuallyassessed
• Objectivechangesproposedin“Recommendations”atend
FormatofCourse&SessionObjectives• CourseobjectivesareprovidedinthesyllabusandonCanvassite
• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesareprovidedinthecoursematerials(earlyineachppt file)
• Sessionobjectivesarewritteninthecorrectformat[reviewedbyDenise]
IssuesofRedundancy• Aretheremajorissuesofredundancywithothercourses?• Derm courseincludes:
– Viralskininfectionsandviralexanthem (e.g.warts,molluscum contagiosium,erythemainfectiosum,hand-foot-mouthdeisease,HSV,VZV,eczemaherpeticum)
– Bacterialskininfections(e.g.impetigo,folliculitis,cellulitis,erysipelas,necrotizingfasciitis)
– Infestations(e.g.scabies,lice)– AcneandRosacea
• TheSBMIDcourseincludesamajormoduletitled “Skinandsofttissueinfections”,withpotentialforoverlap,withfocuson:– Strepskininfections(impetigo,erysipelas)– Boilsetc duetoStaphaureus– Catbitesandhumanbites– Water-carriedskininfections(fresh,salt)– Miscl:Anthrax,sporotrichosis
IssuesofRedundancy• CurrentMECsubcommitteeconcludedthatthematerialwascomplementarynotunintentionallyrepetitive,ie,derm focusingonidentificationandphysicalfindingsofskininfectionsandIDfocusingontreatment,resistance,etc.
Explorationof[VIGtopic]• Thispastyear,onthethirddayofthecourse,therewasaonehour“HeartsandMinds”sessionrunbyDr.O’DonnellandDr.McDaniel,thatdealtwith“psychologyofillness”issuesinpatientswithchronicskindisease
• Thissessionisbeingre-workedbecauselastyear(2016),patientwasunabletoattend(livedtoofaraway,etc.)
• Sessionpresentsalivedermatologypatientandcareteam(doctor,nurse,etc.)andexploresthepatient’sexperienceofdiseaseandhealthcare.ModeratedbyDrs.O’DonnellandMcDaniel.
ArtofClinicalObservation• Studentsareofferedopportunitiestoparticipateinelectiveandnon-graded“ArtofClinicalObservation”experienceatHoodMuseummoderatedbymuseumeducationconsultant,VivianLadd
• BasedontheworkofDr.IrwinBraverman atYale– JacquelineC.Dolev MD,LindaKrohner Friedlaender MS,IrwinMBraverman MD,UseofFineArttoEnhanceDiagnosticSkills.JAMA286:1020-1,2001.
– Carefullyobservingartenhancesabilitytoobserveanddiagnosepatients.
ArtofClinicalObservation
.
CourseLearningOpportunities• Totalscheduledhours:24.5(percoursedirector)• StandardLectureformat:17.5h(72%)• E-lecturemodule(IntrotocoursebyCD):0.5h(2%)• Interactivelectures,reviewwithARS:3.5h(14%)• Conferences:0h(0%)• Laboratory:0h(0%)• PsychologyofIllnesssessionwithpatient:1h(4%)• PhysicalDiagnosisClinicwithpatients:2h(8%)
CourseLearningOpportunities• Coursereliesheavilyonstandardlecture(72%)– Derm isveryvisualandacornerstoneoflearningtodiagnosederm conditionsisrepetitivevisualizationofdifferentpresentationsofthesamecondition.Thekeyistodrawattentiontosalientdetailsthathelpcementthediagnosisanddifferentiateitfromsimilarconditions
• Conferencesweretried2yearsagoandwerenotwellreceived.
• SinglePEsessionisverywelldoneandwellreceivedbystudents
Assessment• WrittenQuizzesforgrading:none(butmanyself-assessmentquizzesoffered,oneforeachlecture)
• FinalExam:countedfor100%offinalscore• Other:Eachstudentwasrequiredtoattendandparticipateinthephysicaldiagnosissession(withoutformalassessment)
• Skillsassessedonthefinalexam(allMCQ):– Identifyimage/diseaseonly:31– Identifyimageandintegratewithshortcase:30– Applicationofknowledgetonewcase/vignette:18– Recallinformation:19– Other:9
Assessment• Finalexamhad92items• Percoursedirector,divisionasfollows:• 43itemsincludedclinicalphotos:– 8hadstudentssimplyidentifytheimageordisease– 35hadstudentsidentifytheimageandintegratewithcase(vignette)
• 49itemsdidnotincludephotos:– 23itemstestedsimplerecallofinformation– 5werematchingitems– 21testedapplicationofknowledgethroughclinicalvignette
AssessmentforCourseObjectives• Finalexamquestionsseemtorelysomewhaton“simple”recognitionofanimage,butalmostalwaysanewimagenotshownduringclass
• Finalexamquestionsseemtorelysomewhatonrecallofinformationonly
• Needtoincreasenumberofquestionsinvignetteform,thatrelyonaccessingknowledgeandthenapplyingthatknowledgetoanewclinicalsituation
• Moretestingaboutdiseasepathophysiology(andimplicationsfortreatment)wouldbehelpful
MeasuresofQuality– StepI
*valuesreportedforcoredisciplinesareSDabovetheUS/CanmeanforGeiselmeanscores
2013 2014 2015
Mean last 3 year (2013-15)
Pass rate 100.0% 98.8% 96.3% 98.4%Mean score 236 235 232 234.3SYSTEM-BASED TOPICS** (similar to SBM)Behavioral sciences 0.26 0.15 -0.1 0.10Cardiovascular system 0.47 0.02 0.16 0.22Gastrointestinal system 0.59 0.54 0.24 0.46Hematopoietic/lymph systems 0.18 0.09 0.08 0.12Immune system 0.53 0.16 -0.06 0.21Musculoskeletal, skin, CT systems 0.34 -0.02 0.25 0.19Nervous system 0.21 na na naNervous system & Behavioral health (2014) na 0.06 -0.09 -0.02Nutrition 0.39 0.22 -0.07 0.18Renal/urinary system 0.21 0.23 0.04 0.16Reproductive/endocrine systems 0.39 na na naReproductive system (2014) na 0.39 -0.01 0.19Endocrine system (2014) na 0.39 0.26 0.33Respiratory system 0.31 0.18 0.29 0.26General Principles of Found Sciences (2014) na 0.25 0.11 0.18Biostatistics, Epidemiology, Pop Health (2014) na 0.01 0.21 0.11Multisystem processes & disorders (2014) na 0.23 -0.15 0.04
mean 0.19 0.08 0.18
Measuresof
Quality–AAMCGQ
MeasuresofQuality– CourseEvaluation
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
Year 2 Courses 2015-16
The clarity of the learning objectives for the overall course.
Congruence of quiz (if applicable) and exam questions to the learning objectives.
Your assessment of the effectiveness of the organization of the course.
How well the course provided me with a useful and relevant introduction to this field or discipline.
The overall quality of this course.
Mean Lecturer/Large Group Instruction Score
Mean Small Group Leader Score
This year overall mean
score
Term 1-Pharm Intro. 3.88 3.80 3.62 3.99 3.74 3.56 4.17 3.82
Term 1-Cardiology 3.75 3.34 3.64 3.85 3.69 3.78 4.26 3.76
Term 1-Respiration 4.01 3.55 4.00 4.07 4.08 3.96 4.57 4.03
Term 2-Neurology 3.31 2.88 2.98 3.37 3.06 4.07 4.36 3.43
Term 2-Psychiatry 4.08 3.87 4.02 4.18 4.16 4.06 4.45 4.12
Term 2-Hematology4.14 3.79 4.17 4.44 4.26
4.22 4.13 4.16
Term 3-Endocrine 3.95 3.50 3.83 4.10 3.88 4.02 4.61 3.98
Term 3-FEK 3.93 3.70 3.78 3.98 3.85 4.08 4.21 3.93
Term 4-CT&Bone 3.33 3.01 3.16 3.56 3.23 3.90 4.39 3.51
Term 4-Dermatology3.98 4.00 3.91 4.07 3.89 4.02
n/a 3.98
Term 4-GI 4.28 4.22 4.21 4.37 4.31 4.07 4.43 4.27
Term 5-ID 3.91 4.01 3.93 4.09 4.02 4.18 4.45 4.08Term 5-Reproduction
3.26 2.84 3.00 3.35 3.053.87 4.25 3.37
2015/16 MEAN 3.83 3.58 3.71 3.96 3.79 3.98 4.36 3.88
scale[1=poor;2=fair;3=good;4=verygood;5=excellent]
MeasuresofQuality– CourseEvaluation
2014 2015 2016
Overallqualityofcourse 4.11 3.89
Clarity oflearningobjectives 4.18 3.98
Organizationofthecourse 4.10 3.91
Howwellthecourseintroduced metothisdiscipline 4.23 4.07
Congruence ofassessmentquestionstomaterialemphasizedincourse 3.83 4.00
Meanlecturerscore 4.30 4.02
Overallmeanscore 4.13 3.98
MeasuresofQuality– StudentComments• Coursewaswellorganized– “GoodorganizationandgreatresourcesforstudyavailableonCanvas.”
– “Ithoughtcoursewasreallywellrun.”
• Dermatologyclinicwasterrific– “Theclinicsessionattheendwasfantastic.Itwassowellorganizedanditwasveryhelpfultoseethepatients.Eventhenon-patientstationswereveryhelpfulforreview.Veryimpressivetobeabletodothiswith90students!”
• Practicequestionsandquizzeswerehelpful– “Iappreciatedthatyouprovidedsomanypracticequestionsthatgenerallyrepresentedthematerialonthefinalexam.”
MeasuresofQuality– StudentComments
SuggestionsforImprovement:• “Therewaslittleemphasisonpathologyorotherboardstestableinformation.”
• “Someofthelectureswereconfusingbecausethepathophysiologywassometimesnotdiscussed.”
• “Sometimesitfeltthattherewasn’tmuchofadialoguebetweendifferentlecturers,orbetweenlecturersandthecoursedirector.”
• “Thephysiologybehindcertaindermatologicdiseaseswasnotcovered.”
Recommendationsfor2017• CourseObjectives– RewordObjective#1
• Current:“Learnandapplyusefulknowledgeofthemostcurrentbasicsciencethathelptoexplainnormalskinandadnexal,hair,nailsandmucousmembranestructureandfunction,health,andthepathophysiologyofdisease,suchthatthisknowledgecanbeusedtoimprovepatientcare.”
• Splitthisobjectiveintotwomorefocusedobjectives,asbelow• Proposed:“Explain structureofnormalskinandadnexalstructures.”
• Proposed:“Recognizeandidentifycommonphysicalfindings,anddescribepathophysiology(whenknown),ofcommondermatologicaldisorders”
Recommendations– DeleteObjectives#9,#10,#17.Notaddressedortested.– SimplifyObjectives#4.
• Current:– 4:“Explaintheapproachtothediagnosisandevaluationofcommonandimportantcutaneousdiseasessuchaseczemaandcontactdermatitis,papulosquamous disorders,majorbullousdisorders,folliculardisorderssuchasacne,diseasesaffectingthehairandnails,cutaneousinfections,connectivetissuediseasesandskincancer.“
– 15:“Generateanappropriatedifferentialdiagnosis,basedonlogicalclinicalassessmentandguidedbyappropriatestatisticalreasoning.“
• Proposed:“Generateadifferentialdiagnosisforskinrashesbasedondistributionandmorphologyofrash.”
• Proposed:“Recognizecommonbenignandmalignantskingrowths”
•
Recommendations– RewordObjective#5
• Current:“Listandexplainthetypicalfindings,presentation,clinicalcourse,naturalhistoryandcomplications ofcommonandimportantcutaneousdisordersasinnumber4.“
• Proposed:“Explainthetypicalpresentation,clinicalcourse,andnaturalhistory ofcommoncutaneousdisorders“
– AddnewObjectivere:treatment• “Listfirstlinetreatmentsforcommondermatologicrashesandgrowths”
– DeleteObjective#8– Redundantwith#1• Current:“Describethepathophysiologyandmajorpathologicfeaturesaswellastheepidemiologyofcommonandimportantcutaneousdiseasesincludingneoplasms,cutaneousmanifestationsofinfection,cutaneousmanifestationsofconnectivetissuedisease,disordersofthehairandnails,cutaneousmanifestationsofsystemicdisease.“
ActionPlan• Ensure2lecturersthatdonotcurrentlyhavesessionobjectivesinmaterialsaddthem
• Inmanyskindiseasespathophysiologyisnotwellunderstood.Wherepathophysiologyofskindiseaseisknown,suchasbullousdiseases,addvignette-styleexamquestions.
ActionPlan• Reviewexamlookingforopportunitiestoreplacequestionsofidentificationorsimplerecallwithvignette-stylequestions.– Currentexamcontent:
• Forquestionswithphotos:– Identifyimage/diseaseonly:8– Identifyimageandintegratewithcase:35
• Forwrittenquestionswithoutphotos– Recallinformation:23– Matching:5– Applicationofknowledgetonewcase/vignette:21
