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&#15.

• 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