ReviewofYear1Biochemistrycourse

• CourseoccursintheFalltermofYear1

• CourseDirector– LarryMyers,PhD

• Coursehas45curricularhours

• CoursewaslastreviewedinMay2015

ReviewpresentedtoMECJanuary2017

• Speakwithfacultymemberswhosequiz/examquestionsorsessionobjectivesarenotconsistentwithGeiselguidelinesandassistinthecorrectionoftheseinconsistencies.✓ (alsostillworkingonforassessmentquestions- ongoingprocess)

• IncludeaPBLonsicklecelldisease(plannedforFall2015),incollaborationwithDr.DavidNirenberg,toilluminatetheconnectionbetweenbasicbiochemistry/geneticsandclinicalpractice.✓

• Eliminatelargegroupsessionon‘Mitosis/Meiosis’toaddressredundancywithCTO.✓

ActionPlanfromPriorReview

• CutdownnumberofcontacthoursinlargegroupsessionsbystreamliningEukaryoticTranscriptionandMolecularGeneticssessionsfrom2contacthoursapieceto1contacthourapiece.✓

• Revisetheinteractive‘Cancer’sessionsthatbuildonDr.Compton’svideolecturesbychangingthethree‘Q&A’sessionsusedlastyeartoasingle‘mini-PBL’inwhichweaddresstheapplicationoflaboratorymethodsdiscussedinthecoursetoacancercasestudy.✓

ActionPlanfromPriorReview

CourseObjectives

• ThenumberofcourseobjectivesseemsappropriateandcoursecontentcorrelateswellwithBiochemistrycontentintheStepIBrochure(seenextslide)

• Onlythreesessionobjectivesmaptocourseobjective#10,thusitmaybebettersuitedasasessionobjective

• ThemappingofcourseobjectivestotheGeiselcompetenciesinIlios wasreviewedbythecoursedirectorandcheckedforaccuracy

CourseObjectives– Comments

RelevantContentinStepIBrochure

}CTOcourse

}CTOcourse

• Courseobjectivesareprovidedinthesyllabus• Courseobjectivesarewritteninthecorrectformat• Sessionobjectivesareprovidedinthecoursematerials

• Sessionobjectivesarewritteninthecorrectformatwiththeexceptionof#1forSignalTransductionsession(needsameasurableverb)

FormatofCourse&SessionObjectives

• Multiplewordsandtermswereusedtosearchforredundancy(e.g.protein,DNAreplication,inheritance,signaltransduction,etc.)

• MinorrepetitionwithinY1coursesseemedappropriate(e.g.chromatininBiochemistryfocusesonfunctionwhereaschromatininCells,Tissues,andOrgansfocusesonstructure).Otherexamplesinclude:– CellcycleinCTOandGeneralPathology(Biochem focusesoncontrolby

proteinkinases;CTOonstructuralchangesinthecell;Pathologyonitsroleinwoundhealing)

– TranscriptioninNeuroscience(Biochem introducesconcept;Neurosciencediscusseditinthecontextofhowcircadianrhythmsareestablished)

– CancerinGeneralPathology,ImmunologyandVirologyaswellasmultipleY2courses(manydifferentareasoffocus)

• Unnecessaryredundancywasnotdetected

IssuesofRedundancy

Ethics – “Identifykeyconceptsinhealthcareethicsanddemonstrateanabilitytorecognizeethicalissuesarisinginpatientcareandpopulationhealthandtothinkcriticallyandsystematicallyinapplyinganethicalanalysis”

CulturalAwareness – “Demonstrateanunderstandingandskillinmanagingpatientcareofpeopleofdiversecultures,social,economicstandingandbeliefsystems”

HealthEquity– “Identifytherootcausesandapproachesforaddressinghealthdisparitieslocallyandglobally”

Resilience – Demonstrateknowledgeofskillsandpracticestopreventandaddressstressandmaintainresilienceincaringforpatientsandoneself

CompassionandEmpathy – “Demonstrateabilitiestounderstandeachpatient’sexperienceofillness,adaptscientificallyappropriatecaretoconformtothatpatient’sneeds,andcommunicateintermsthateachpatientcanunderstand”

Therealsoaresynergiestohealthlaw,communicationskills, professionalism(asLCMErequires).

HealthandValuesGoals

HealthandValuesContent

• WhatHealthandValuesProgrammaterial(healthcareethics,culturalawareness,healthequity,resilience,compassionatecare)ispresentedinthecourse? ThePBLsessionsonsicklecellandTay-Sachsverysuccessfullyaddressedthesetopics.

• AretheHealthandValuestopicsnotedinthecourseandsessionobjectives?Notexplicitly

• WhatdothestudentevaluationsindicateregardingHealthandValuesteaching?Manystudentsacknowledgethedifficultyinincorporatingtheseelements.Somespecificsuggestionsforwheretoincorporatetheminlectureare:cytogenetics,Mendeliangenetics,cancers.Otheropportunitieswouldbeforguestlecturerswithrarediseasestotalktotheclass,andforincorporationofthesetopicsinthediscussionsections.

HealthandValuesContent

SummaryregardingObjectives/Content

• Courseobjectivesaredistributedtostudents,arewell-writtenandseemappropriateforthecoursecontent;onecourseobjectivemaybebettersuitedasasessionobjective

• SessionobjectivesaredistributedonCanvas,arewell-writtenandclearlydefineexpectations

• Unplannedredundancywasnotidentifiedinthiscourse

• Severalsessionsincludehealthandvaluescontent,howeverthesessionobjectivesdonotmakethisexplicit

• Livelectures24hrs.(53%)• Videolectures3hrs.(7%)• SmallGroupConferences*12hrs.(27%)• PBL4hrs.(9%)• Largegroupdiscussions(“miniPBL”)2hrs.(4%)

*Eachsmallgroupsconsistsof23students,thusisclassifiedasa“largegroup”onIlios (>12students)

Thecourseoffersself-assessmentmaterialsandoptionalreviewsessionspriortoquizzesandthefinalexam.

CourseLearningOpportunities

• Overthelast6yearsthecoursehasgraduallyreducedthenumberoflecturesfrom76%ofcontacthoursto53%ofcontacthours

• Duringthelasttwoyears,thecourseaddedaPBLcaseandmodifiedtwoclinicalcorrelationsinto“miniPBL”cases(case-basedlargegroupdiscussions)

• Thesmallgroupdiscussionscontainapplicationexercises(“problemsets”)thatareverypopularwithstudents

CourseLearningOpportunities

SummaryregardingPedagogy

• Thesubcommitteeappreciatesthecoursedirector’seffortsinreducingthepercentageoftraditionallectureinthecourse;thecurrentvalueiswithinrangeofGeisel’srecommendedtargetof40-50%ofcontacthours

• Thecourseoffersavarietyofpedagogiesforlearning.Onestudentcommentsumsitupwell:“Thecoursehadanicemixoflectures,smallgroups,andPBLsessions,andIenjoyedthisvariety.”

• 5WrittenQuizzes(~59%ofcoursegrade)• FinalExam(~33%ofcoursegrade)• ArticleDiscussionstudyguides(~6%ofcoursegrade)• ReadinessQuizzes(~2%ofcoursegrade)

Assessment

• Objectives1-11arerelatedtomedicalknowledgeandareassessedonquizzesandexams

• Objective12involvesproblem-solvingskillsandisassessedwithquestionsonquizzesandexamsthatrequireapplicationofknowledge

• Objectives13and17involvesearchingwithinandcriticallyevaluatingscientificliterature;theseskillsarenotcurrentlyassessed

AssessmentforCourseObjectives

• Objectives14-16involveteamandcommunicationskills,andprofessionalbehavior(beingpunctual,presentandengaged).Theseskillsareassessedformally(attendancesheets)andinformally(facultyobservation)duringsmallgroups,howeverstudentsarenotcurrentlyprovidedfeedbackregardingtheseskills.

AssessmentforCourseObjectives

SummaryregardingAssessment

• Quizzesandexamsassessknowledgeobjectivesandproblem-solvingskills;incorporationofthelatterpromotescriticalthinkingskills

• Severalobjectivesrelatingtoscientificliteraturearenotassessed,andstudents’teamskillsareassessedinformally

• Studentscurrentlydonotreceivefeedbackregardingprofessionalismandteamskills

MeasuresofQuality– GraduationQuestionnaire

DatafromAAMCGraduationQuestionnaire

MeasuresofQuality– GraduationQuestionnaire

DatafromAAMCGraduationQuestionnaire

TRADITIONALCOREDISCIPLINES2014* 2015* 2016* Means14-16

Biochemistry 0.22 0.03 -0.04 0.07

Biostatistics 0.08 0.29 N/A 0.185(14-15)

Genetics 0.28 0.09 -0.36 0.003

GrossAnatomy/Embryology 0.14 0.16 -0.12 0.06

Histology/CellBiology 0.23 0.07 -0.09 0.07

Microbiology/Immunology 0.39 0.02 -0.01 0.13

Pathology 0.20 0.12 -0.10 0.07

Pharmacology 0.12 -0.02 0.0 0.03

Physiology 0.25 0.11 0.06 0.14

MeasuresofQuality– StepI

*valuesreportedforcoredisciplinesareSDabovetheUS/CanmeanforGeiselmeanscores

OverallQuality - Year1courses AY14-15 AY15-16 AY16-17

Basic ScienceofMicrobialDisease 3.94 4.10

BiochemicalandGeneticBasisofMedicine 4.34 4.40 4.54

Cells, TissuesandOrgans 4.07 4.06 4.21

HumanAnatomyandEmbryologyI 4.35 4.04 4.61

HumanAnatomyandEmbryologyII 4.57 4.43

Immunology 3.67 3.94

MetabolicBasisofDisease 4.35 4.48

Neuroscience 3.59 3.32

OnDoctoring 3.74 4.10

Pathology 3.22 3.06

PatientsandPopulations N/A 2.77

Physiology-Cardiovascular 3.23 3.41 3.88

Physiology-Endocrine 3.76 3.52

Physiology-Renal 4.19 3.63

Physiology-Respiration 3.34 3.41 3.80

Virology 3.77 3.83

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluationMeasuresofQuality– CourseEvaluation

scale[1=poor;2=fair;3=good;4=verygood;5=excellent]

MeasuresofQuality– CourseEvaluation

BiochemAY 14-15(87%)*

BiochemAY15-16(95%)*

BiochemAY16-17(95%)*

Overallsatisfactionofcourse 4.34 4.40 4.54

Clarity oflearningobjectives 4.32 4.24 4.55

Organizationofthecourse 4.27 4.41 4.40

Howwellthecourseintroduced metothisdiscipline 4.14 4.34 4.54

Congruence ofassessmentquestionstomaterialemphasizedincourse 4.25 4.15 4.46

*studentparticipationrateoncourseevaluation

Strengths:• Engaging,InteractiveLectureStyle– “Dr.Myersisextremelyengaging.Heisapleasuretolearnfrom.”

– “Hisclasswasmyfavoritethisterm:[hepresented]materialclearly,inaninterestingmanor,andincorporatesalotofcriticalthinkingintothecourse.”

– “WhileImightpreferavideoonlyformattosomecourses,IfindDr.MeyerssuchagreatteacherthatIthinktheclasswouldbenefitmorefromanin-personlecture.”

– “ThelecturesinthisclassarefantasticsoIwouldnotliketoseeamovetoallvideolectures.”

MeasuresofQuality– StudentComments

Strengths:• WrittenlecturenotesprovidedbyDr.Myerswereanexcellentresourcefor

students.– “Havingwrittennotestorefertowasextremelyhelpful.”– “Thenotesthatwereprovidedtoaccompanythelectureswereabsolutelypositively

amazing.Veryclearandverysuccinct,anditmadethewholecoursefeelmoreorganizedandcompact.WhenIdidn'tunderstandsomethinginlecture,Iwouldalwaysreadthenotesandthathelpedmeunderstand9/10times.”

• Classprovidedawelcomedvarietyofteachingapproaches,andfocusedonrelevantconceptsandcurrentevents,ratherthanmemorization.– “Verymuchappreciatethatthecoursewasmoreconceptualthanmemorization-based.”– “Ireallyappreciatedtherelevanceoftheselearningopportunities,astheycreateda

stronglinkbetweentheoftenminute,detailedpathwaysthatwelearnedinclass,andclinicalcases.Istartedtofeellikeadoctor!”

– “Thecoursehadanicemixoflectures,smallgroups,andPBLsessions,andIenjoyedthisvariety.”

– “Ialsolikereadingrelevantpapersthatusethetechniqueswehavelearned--itmakesthecourseseemmorerelevanttoourfuturesasdoctors.”

MeasuresofQuality– StudentComments

SuggestionsforImprovement:• WhilemanystudentsvaluedthePBLandsmallgroupsessions,some

studentshadsuggestionstomakethembetter:– “IthinkthePBLformatscouldbechangedabit,butI'mnotsurewhatthatwouldlook

like.Ilikethestudentdrivenlearningcomponents,butthelongpowerpointslidesoftextsortofweighedthesessionsdown.Maybethrowinmorepicturesforthevisuallearners?”

– “PerhapsmakethePBLabitmorestructured,i.e.don'tgivestudentsasmuchautonomytodictatethetestablematerialastheyweregivenwiththegroup-editedwikipage.Aconsiderableportionofthestudent-generatedmaterialendedupbeingsomewhatunrelatedtothecoreobjectivesoftheblock.”

– “ThePBLWikipage didnotworkwellontheiPad,andIdidnotfinditparticularlyeffectivetostudyfrom.”

– “IsatinonadifferentsectiononceandIreallylikedthewaytheywentthroughtheproblemset.Itwasdifferentthanmyownsection,butIlikedbothalot.However,Ihaveheardclassmatessaythattheirsmallgroupsdon'trunassmoothlyasoursortheotheronethatIsatinon.Maybewecouldworktomakethesmallgroupsessionsmoreconsistent?”

MeasuresofQuality– StudentComments

SuggestionsforImprovement:• Somestudentswouldlikemoreofafocusonethicswithinthecourse,ratherthan

somuchemphasisonthebasicscienceaspectofbiochemistry– particularlyconcerningthegeneticsunit.– “Ithinktherearemanyopportunitiesinthiscoursetoincludematerialfromthehealth

andvaluescurriculum(ontopicssuchascytogenetics,mendelian genetics,andcancerinparticular).Wecouldhavepatientscometoclasswithraregeneticdisorderstolearnfromtheirstories,wecanhavesmallbreakoutsessionstodiscusstheethicssurroundinggenetictestingandtreatmentofincurablegeneticdisease.ManyopportunitiesherewhichIwillrelaytothehealthandvaluesworkinggroup.”

• Somestudentsfeltthatpracticequestions/quizzesshouldalignmorewiththerealquizcontent, andthatmorepracticequestionsshouldbeprovided.– “Practicequizzesandquestionsandproblemsetsshouldalignmorecloselywiththe

actualquizzes.”– “ThepracticequizzesonCanvaswerehelpful,butIthinkthatitwouldbebettertohave

evenmorepracticeproblemstoprepforthequizzes.”– “Ithinkthatthediscussionproblemsetsweredisproportionatelydifficult,convoluted,

andtime-consumingwhencomparedtowhatwastaughtandwhatwasactuallytested.”

MeasuresofQuality– StudentComments

Othercomments:• Onestudentspokeonbehalfofthosewhohavelimited

backgroundknowledgeinbiochemistry,requestingmoredemonstrations.– “Ican'tspeakforeverystudentintheclass,butforsomeonelikemewholacksa

backgroundinbasicscienceresearch,Ithinkthatlabdemonstrationswouldbeveryhelpfulforunderstandingthevarioustechniqueswearelearninginbiochemistry.WhileweinvestalotoftimeinanatomylaborphysiologysimulationsatDH,IbelievewearetotallyoverlookinganopportunitytoshowstudentswhatthePCRorWesternBlotprocessislikeinperson.Thatseemstomelikeitwouldfacilitatelong-termretentionofthesetechniquesmuchbetterbymakingthemmoretangibleratherthanabstractconcepts.”

• Studentsunanimouslyagreedthatthecoursefacultycreatedapositivelearningenvironmentandtreatedallstudentsrespectfully.

MeasuresofQuality– StudentComments

SummaryregardingMeasuresofQuality

• TheBiochemicalandGeneticBasisofMedicinecourseisanexemplarycourseintheY1curriculumthatisconsistentlyratedinthe“verygoodtoexcellent”range

• Thecoursewasverywellreceivedbystudents,withparticularappreciationforthevarietyofengagingpedagogiesandhighqualitycoursematerials

• Suggestionsforimprovementwereminor;thesemainlyinvolvedthePBLsession,ethicscontentandpracticequestions

Recommendations

• Reflectontheappropriatelocationforcourseobjective#10(coursevs.sessionobjective)

• ReviseobjectivesforthesessionsonsicklecelldiseaseandTay-Sachstomakehealthandvaluescontentmoreexplicit(i.e.visiblewithanIlios search)

• Considerwaystoassessandprovidefeedbackregardingobjectives13-17

• ConsidersuggestionstoimprovethePBLsession,theamountofethicscontentinthecourseandthenumber/formatofthepracticequestions

ActionPlan• Addressinconsistencybetweenquizquestionsandpracticequizquestionsbyaddingmoremultiplechoicequestionsandconvertingsomeoftheexistingpracticequestionstomultiplechoice.

• Incorporateexplicithealthandvaluesobjectivestoexistingsessionsthatincorporatethistypeofcontent(sessionsonTay-Sachsdisease,SickleCelldisease,andCytogenetics).

• WorkwithEthicsexpertsandGeneticCounselorstoseeifthehealthandvaluescontent(above)canbeconnectedtoexistingethicscontentortocreatenewhealthandvaluescontentwithinourcourse.

ActionPlan• FindamechanismwherestudentscangeneratecontentforPBLsessionssuchthatit’sfinalformisconsistentandequitablewithothercontentpresentedinthecourse.Theaimofthisactionistoprovidethestudentsaclearerviewofwhatwillbeassessedonquizzesandexams.