MEC Course Review

1st Year Renal and Endocrine Physiology

Review of Renal/Endocrine Physiology course

•

Course occurs in the 2nd term of Year 1

•

Course Director – Geza Fejes-Toth (Renal) and Valerie Galton (Endo)

•

Course has 72 curricular hours

•

Course was last reviewed in May 2, 2012

Action Plan from Prior Review-Renal

• • • • • • • • Review sessions to become more similar to conferences, by introducing case discussions and relying on active class participation Formative quizzes to be introduced Add a 5 th small-group conference to discuss clinical correlations, analyze and interpret data Small groups will be subdivided into teams of 3-4 students to promote active participation Student performances in the small-group conferences will be graded based on preparedness, team-work and professionalism Failing grade will be 2 SD below the mean value; The final grade will be less weighted on final exam, now coming 55% from the final exam and 45% from quizzes and conference grades Meet with students to get input on formative assessment questions Faculty development to conference leaders to improve consistency and pedagogy of sessions

Action Plan from Prior Review-Endocrine

• • • • • • • Consider the feasibility of providing narrative feedback to students with regard to their small group participation Revisit the grading policy to consider reducing the weight of the final exam Faculty provide a list of objectives and/or key concepts with each set of lecture notes, and to remove unnecessary information that is beyond the level of Year 1 learners Evaluate the suitability of new course resources including texts or modules that are available online Introduce content that demonstrates the clinical application of the material prior to assessment activities Meet with a focus group of students for the purpose of examining the clarity and correlation of assessment questions Increasing active learning activities in the course (e.g. reducing lectures)

Course Objectives

1 2 3 4 5 6 7

Objective

Describe the various fluid compartment of the body, the determinants of their sizes and the forces that drive fluid movement between them.

Explain the unique aspects of the renal circulation and the relationship between renal hemodynamics and the regulation of blood pressure.

Describe the transport mechanisms that mediate tubular reabsorption and secretion in the different nephron segments Explain the role of the kidneys in the regulation of cell volume and the mechanisms that regulate water balance.

Describe the mechanisms involved in the regulation of sodium balance and the relationship between sodium balance and the long-term regulation of blood pressure.

Explain why the regulation of red blood cell production is vested in the kidney.

Explain the mechanisms that regulate internal and external potassium balance.

Link to Program Objective

1a

Number of Session Objectives Mapping to Course Objective

81 1a 1a 1a 1a 1a 1a 68 135 83 78 56 72

Course Objectives

8 9 10 11 12 13 14 15

Objective

Describe the mechanisms that maintain acid-base balance and discuss the role of the kidney, lung and liver in this process.

Describe the mechanisms of renal Ca, P and Mg transport and their hormonal regulation.

To communicate effectively with colleagues To communicate and interact with colleagues collegially To behave respectfully and responsibly towards colleagues and faculty at all times.

To meet professional responsibilities fully, including being punctual, present, and engaged educational activities, and being reliable in commitments to tasks To accept responsibility for his/her own actions. Receive constructive criticism and feedback well. Demonstrate the desire to learn and improve.

Take responsibility for his/her own medical education, and take initiative in optimizing his/her personal education plan.

Link to Program Objective

1a

Number of Session Objectives Mapping to Course Objective

81 1a 3e 3g 4b 4c 4g 4i 24 45 45 45 50 50 50

Course Objectives

16 17 18 19 20 21 22 23

Objective

Develop the habit of, and strong commitment to, continuous inquiry and lifelong learning.

To explain the roles of the endocrine system in maintaining homeostasis, integrating growth and development, responding to environmental insults and promoting successful reproduction To discuss the definition of a hormone in terms of its general properties To differentiate among endocrine, paracrine and autocrine systems.

To describe the different classes and chemical structures of hormone To identify the glands, organs, tissues and cells that synthesize and secrete hormones, hormone precursors and associated compounds.

To describe the synthesis and modes of secretion of hormones

Link to Program Objective

5f

Number of Session Objectives Mapping to Course Objective

50 1a 1a 1a 1a 1a 1a 17 2 5 32 31 50 To explain how the secretion of hormones is regulated, including the principles of negative and positive feedback mechanisms 1a 57

Course Objectives

24 25 26 27 28 29 30

Objective

To explain the importance of patterns of hormone secretion such as pulsatile, diurnal and cyclicle.

To explain how hormones are transported in the blood and the consequences of the reversible binding of many hormones by plasma proteins To explain the basis of hormone assays and assessment of biological activity To describe how hormones are metabolized in blood and tissues and the importance of hormone activation and degradation To discuss the clearance and excretion of hormones and their metabolic derivatives To define and discuss the physiological actions of hormones relating them whenever possible to human disorders To explain the consequences of under- and overproduction of hormones

Link to Program Objective

1a

Number of Session Objectives Mapping to Course Objective

21 1a 1a 1a 1a 1a 1a 17 10 24 22 101 54

Course Objectives

Objective

31 32 33 34 35 36 37 To describe and discuss the roles of hormone receptors in hormone action including their location, type and signaling pathways To compare and contrast the different mechanisms of action of hormones: i.e. those exerted by modulation of gene expression; those achieved by changes in protein activity.

To identify and discuss the integration of the endocrine system in general with focus on specific interactions.

To apply the above information to determine the pathophysiological basis of specific endocrine disorders.

To communicate effectively with peers and faculty in conferences and to evaluate, assess, discuss and/or present relevant scientific literature.

To discuss the physiological distribution and the control of turnover and utilization of critically important elements and substances such as calcium, phosphorus and energy-rich compounds.

To discuss the molecular, biochemical and physiological effects of hormone on cells and tissues.

Link to Program Objective

1a

Number of Session Objectives Mapping to Course Objective

37 1a 1a 1a, 1c 3e 1a 1a 29 59 56 7 36 58

Course Objectives – Geisel Competencies

There are 37 course objectives that fulfill Geisel competencies as follows: • • • • 29 address specific knowledge domain, and seem appropriate in the preclinical 3 address communication skills 4 address components of professionalism 1 address personal improvement Currently no course objectives are mapped to Geisel competencies 2 (clinical skills) and 6 (health care systems).

Course Objectives – Geisel Program Objectives

The course objectives fulfill the program objectives as follows: • • • • • • Course objectives address 2 competency 1 of the 6 program objectives for Geisel Course objectives address 0 competency 2 of the 9 program objectives for Geisel Course objectives address 2 competency 3 of the 8 program objectives for Geisel Course objectives address 4 Geisel competency 4 of the 12 program objectives for Course objectives address 1 competency 5 of the 6 program objectives for Geisel Course objectives address 0 Geisel competency 6 of the 10 program objectives for

Course Objectives – Geisel Program Objectives

• • Objectives will need to map to new Geisel Program Objectives Medical Science – – Objectives are comprehensive and detailed, perhaps many can be combined together and specifics can be used as session objectives Have objectives cover broader spectrum of the Medical Science Program Objectives domains (which I think are accomplished in this course) Clinical Care– not covered but this is appropriate for this course – Perhaps can use “Identify and interpret the results of frequently ordered laboratory, imaging, and other diagnostic studies.”

Course Objectives – Geisel Program Objectives

• • • • • • Objectives will need to map to new Geisel Program Objectives Population Health—not covered, seems appropriate Communication Skills—Some domains covered, in particular communicating with colleagues and faculty Personal, Professional, Leadership Development – Should have a number of domains covered from this competency: self assessment, constructive feedback, active discussion, lead effectively ones’ self & ones’ team Evaluation and Improvement in Medicine – Might cover first objective: assess balance between risk/benefit Professionalism– will definitely have some of these domains covered Collaboration and Teamwork– similarly, current objectives have a number of these domains covered

Course Objectives – Format/Distribution

• • Course objectives are prominently displayed on Canvas and are written in correct format Most course objectives on Canvas match the ones in Ilios Not present on Canvas: – Describe transport mechanisms that mediate tubular reabsorption and secretion in the different nephron segments – Describe the mechanisms of renal Ca, P and Mg transport and their hormonal regulation – Discuss the definition of a hormone in terms of its general properties – Differentiate among endocrine, paracrine and autocrine systems – Discuss the physiological distribution and the control of turnover and utilization of critically important elements and substances such as calcium, phosphorus and energy-rich compounds.

– Communicate effectively with peers and faculty in conferences and to evaluate, assess, discuss and/or present relevant scientific literature.

Not present on Ilios: – Practice and demonstrate critical thinking and problem solving skills – Practice team skills and demonstrate the ability to work constructively with others

Course Objectives – USMLE Brochure

• • On USMLE Brochure for Step I – Embryonic development, fetal maturation, perinatal changes – – Organ Structure and function Cell/tissues structure and function, including hormone synthesis, secretion, action, metabolism – Repair, regeneration, and changes associated with stage of life – Electrolyte and water metabolism Course focuses on function – Course objectives go in much more depth than topics on USMLE Brochure

Session Objectives – Format/Distribution

• • • All sessions have objectives with rare exception – – Some sessions have 15-20 objectives per session Suggest combining and summarizing many together to achieve sessions with 4-8 objectives per session (makes more accessible, and easier to evaluate) – No objectives • • “Hormones of Adrenal Cortex” All Endocrine Conferences need objectives– (conference 1– no objectives posted on Canvas—probably simply an oversight) They are all written in the correct format Session objectives on Canvas do not match what is listed in Ilios

Session Objectives - Redundancy

• • • • Insulin– purposeful repetition – Comes up in multiple courses at session level in Biochem, Renal and Endo Phys, Year 2 and 4 Pharmacology, SBM Endo and FEK – Comes up as course objective in SBM Endo Pheochromocytoma – Only in SBM Endo; no longer redundancy here Vasopressin – Renal and Endo Phys, SBM FEK, SBM Endo, CTO Sodium or Water– purposeful reinforcement – Renal Phys, SBM FEK, Cardio Phys, Endo Phys, Neurosci, Micro, Path, SBM Cardio, SBM Neuro, Pharm (Yr 2 and 4), SBM ID, Surgery Clerkship, Advanced Medical Science (Yr 4)

Session Objectives - Redundancy

• • • Acidosis – – SBM FEK and SBM Endo and SBM Resp Renal Phys – Clin Pharm Thyroid – – Endo Phys SBM Endo, 2 nd – Clin Pharm year Pharm, CTO, HAE, On Doctoring, Pathology Potassium – SBM FEK, SBM GI, SBM Cardio – – Renal Phys, Cardio Phys, Neuroscience 2 nd year Pharm – 4 th year AMS and Clin Pharm

Summary regarding Objectives

• • • • • Course and Session Objectives are present and written in correct format They cover a nice spectrum of program objectives and the content suggested by USMLE Both sets can be more summarized– very detailed and can be rewritten at a more general comprehensive level – Make them more accessible – More easily evaluated Course Objectives nearly match between Ilios and Canvas – Should be mapped to new Geisel Program Objectives Session Objectives are significantly different between Ilios and Canvas

Course Learning Opportunities

Renal • Lecture 16 hrs (49%) • • • Conferences 10 hrs (31%) Reviews 4 hrs (12%) Assessment: 2 quizzes, final exam (8%) Endocrine • • • • Lecture 14 hrs (46%) Conferences 10 hrs (33%) Reviews 4 hrs (13%) Assessment: 2 quizzes, final exam (8%)

Course Learning Opportunities

• • • Both courses employ active learning through small group conferences to large extent – Students divided into teams – Student teams expected to prepare questions/answers ahead of time to teach/explain answers to the other team – In final endocrine small group conference, student pairs present a paper Interactive Large Group Review Sessions prior to Quizzes except for Quiz 3 (the first endocrine quiz) Lecture format used less than 50% of in-class learning time

Summary regarding Pedagogy

• • Uses a mixture of small group active learning, large group active learning, and lecture based formats Appears to be an appropriate spectrum of pedagogy, though as will be discussed later, faculty development for small group facilitators may still be needed

Assessment

• • • Written Quizzes (40% of grade) – – Four 20 multiple choice question Quizzes Practice Quiz made available for preparation – Each count 10% of grade, together 40% of grade Final Exam (40% of grade) – – 25 Renal and 25 Endocrine multiple choice questions Board format emphasizing key concepts rather than memorization Conference Performance (20% of grade) – Facilitators assign scores to each team, based on mastery of the material, ability to explain it to peers, and team’s professionalism – Each member of the team receives the same score

Assessment

• • • Additional Requirement for Passing Pass from your conference facilitator – Criteria based on mastery of the material, ability to explain it to peers, and team’s professionalism Any student receiving a grade of Fail from either the Renal or the Endocrine conference leader may take an oral examination conducted by a faculty member other than the student’s conference leader

Assessment – Quizzes

• • • All Quizzes are Multiple Choice Questions, Board style – No “negative” formats such as “all of the following EXCEPT” Questions that test application and understanding of knowledge, not simple memorization: – 12/20 for Quiz 1 – 13/20 for Quiz 2 – – 13/20 for Quiz 3 14/20 for Quiz 4 Questions correlate well with course objectives

Assessment – Final Exam

• • • All Questions are MCQs, Board style – There is ONE question written in “negative” format (“all of the following EXCEPT”) • #45: In a child entering puberty, which of the following hormones does NOT promote chondrogenesis and/or osteogenesis with accompanying linear growth?

Questions that test application and understanding of knowledge, not simple memorization: – Renal questions (16/25) – Endocrine questions (18/25) Questions correlate well with course objectives

Assessment

• • Students are not provided with narrative feedback in the renal portion of the course In endocrine, small group facilitators provide narrative feedback

Summary regarding Assessment

• • Questions are MCQs and formatted properly – – The one “negative” MCQ on final exam should be revised Questions cover the course objectives broadly and appropriately – Close to two-thirds test application and understanding of knowledge, rather than simple memorization Conference performance comprises a fairly significant portion of the assessment – Evaluates additional program objectives such as collaboration and teamwork, communication, professionalism, personal/professional/leadership development

Measures of Quality – AAMC GQ

“Indicate how well you think that instruction in Renal and Endocrine Physiology prepared you for clinical clerkships and electives.” [1=poor; 2=fair; 3=good; 4=excellent]

Geisel mean 2010 Geisel mean 2011 Geisel mean 2012 Geisel mean 2013

Measur

mean 2014

2.8

All schools means 2014

2.7

Biochemistry 2.7

2.5

2.6

2.6

Biostatistics/Epidemiology Genetics Gross anatomy/Embryology Immunology Intro to Clin Med/On Doc Microanatomy/Histology Microbiology Neuroscience Pathology Pharmacology Physiology Behavioral Science Pathophysiology of Disease 2.9

2.9

3.6

2.9

3.5

2.8

3.1

3.2

3.2

3.4

3.6

3.2

3.5

3.2

2.8

3.5

3.0

3.4

2.9

3.2

3.0

3.1

3.1

3.6

3.3

3.5

3.2

2.8

3.6

3.1

3.5

3.1

3.3

3.0

3.4

3.1

3.5

3.3

3.5

2.9

2.6

3.4

2.7

3.0

2.8

3.0

3.0

2.8

2.6

3.1

3.0

3.3

3.3

3.1

GQ

3.1

3.2

3.1

3.1

3.4

3.2

3.5

2.9

3.1

3.5

2.9

3.2

3.2

3.3

3.1

3.4

3.2

3.5

Measures of Quality – Step I

2012* 2013* 0.20

0.40

2014* 0.22

N/A Means 12-14 0.24

N/A 0.28

0.33

0.37

0.31

0.26

0.22

0.18

0.26

0.26

0.47

0.24

0.22

0.08

0.25

0.24

0.29

0.39

0.23

Measures of Quality – Step I

SYSTEMS-BASED TOPICS

Behavioral sciences Biostatistics, Epidemiology, Pop Health Cardiovascular system Endocrine system Gastrointestinal system General Principles of Found Sciences Hematopoietic/lymph systems Immune system Multisystem Processes & Disorders Musculoskeletal, skin, CT systems Nervous system Nervous system and Behavioral Health Nutrition Renal/urinary system Reproductive/endocrine systems Reproductive system Respiratory system 2012* 0.43

0.20

0.32

0.14

0.22

0.24

0.25

0.56

0.42

0.42

0.29

2013* 0.26

0.47

0.59

0.18

0.53

0.34

0.21

0.39

0.21

0.39

0.31

2014* 0.15

0.01

0.02

0.39

0.54

0.25

0.09

0.16

0.23

-0.02

N/A 0.06

0.22

0.23

N/A 0.39

0.18

Means 12-14 0.28

0.01

0.23

0.39

0.48

0.25

0.14

0.30

0.23

0.19

0.06

0.39

0.29

0.39

0.26

*values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Measures of Quality – Course Evaluation

Year 1 courses (fall, winter)

Human Anatomy and Embryology II Human Anatomy and Embryology I Metabolic Basis of Disease Biochemical and Genetic Basis of Medicine Physiology-Renal CTO Virology Physiology-Endocrine Immunology Physiology-Respiration Physiology-Cardiovascular

Overall Satisfaction AY 2014-2015

4.57

4.35

4.35

4.34

4.19

4.07

3.77

3.76

3.67

3.34

3.23

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

Prior year

4.57

4.33

4.23

3.97

4.32

3.79

3.71

3.81

2.35

3.38

3.45

Measures of Quality – Course Evaluation

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

Overall satisfaction of course Clarity of learning objectives

Renal Physiology 2012 (95.5%)*

4.53

Renal Physiology 2013 (87.2%)* Renal Physiology 2014 (93.5%)*

4.32

4.19

not available 4.35

Organization of the course How well the course introduced me to this discipline Congruence of assessment questions to material emphasized in course not available *student participation rate on course evaluation 4.55

4.55

4.40

not available 4.32

4.19

4.10

4.24

4.01

Measures of Quality – Course Evaluation

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

Overall satisfaction of course Clarity of learning objectives

Endocrine Physiology 2012 (95.5%)*

3.78

Endocrine Physiology 2013 (87.2%)* Endocrine Physiology 2014 (93.5%)*

3.81

3.76

not available 3.85

Organization of the course How well the course introduced me to this discipline Congruence of assessment questions to material emphasized in course not available *student participation rate on course evaluation 3.93

4.07

3.83

not available 3.85

3.84

3.66

3.99

3.62

Measures of Quality – Course Evaluation Renal Physiology - Summary of Student Comments

Particularly Well Done

• Clear expectations and consistency • Integration of the lecture, small groups, iBook, and course materials • Organization and timely posting of materials

Could Have Been Better

• Difficult to read iBook • Clarity of conference grades • Canvas app does not work for course

Measures of Quality – Course Evaluation Renal Physiology

Suggestions

• Remove hyperlinks from iBooks and integrate the slides directly into the text • Provide a clear grading rubric for small group • Check with tech support to make sure things are uploaded to Canvas correctly

Summary regarding Measures of Quality

• • • •

Renal Physiology

This course is consistently well-received by students and rated in the “very good” to “excellent” range – the course director and his faculty are to be commended for their efforts Students do very well on Step I in this discipline Students suggest minor adjustments to make the course even better The major issues are presentation of the iBook and transparency in small group evaluation

Measures of Quality – Student Comments Endocrine Physiology - Summary of Student Comments

Particularly Well Done

• Small group discussions • Clinical correlation • Sensitivity to certain subjects

Could Have Been Better

• • • Student presentations Consistency and clarity of materials (i.e. notes, iBooks) Unnecessary removal of ‘controversial’ medical pictures

Measures of Quality – Course Evaluation Endocrine Physiology

Suggestions

• Create consistent format for supplemental lecture materials • Reevaluate group presentations • Re-insert any removed medical photographs into appropriate lectures • Provide a clear grading rubric for small group

Summary regarding Measures of Quality

• • • •

Endocrine Physiology

This course is consistently well-received by students and rated in the “very good” range – the course director and her faculty are to be commended for their efforts Students do very well on Step I in this discipline Students suggest minor adjustments to make the course even better The major issues are consistency of material and small group presentations

Vertical Integration topics

• • • Fluid and Electrolyte Disorders Diabetes and Insulin Prostaglandins – – 2 nd year Pharm Gen Pathology – Endo Phys

Recommendations

• • • • Keep up the good work! Overall the course is very well received.

Course Objectives – Combine/summarize, make more general such that there are 15-20 overarching objectives (rather than a course objective for each lecture session) – Map to the new Geisel Program Objectives Session Objectives – Similarly, combine/summarize into 3-5 objectives and make more general so the goals/objectives of a session are easy to take in Make sure the Course and Session Objectives on Canvas match what is on Ilios; communicate with Brian Reid to rectify any inconsistencies

Recommendations

• • • Small Group Conferences – Add in a self-directed learning objective for the small groups (to deliberately call this out– since this is the expectation anyway) – Consider the grading; the “score” caused much angst • Make Pass Fail, but have everyone who passes get a “100%” so it still counts towards overall grade percentage • (having everyone get 100% is same effect as everyone getting 80%, but it goes over better and serves same purpose– they pass conferences) Sessions – Renal– subdivide ibook into chapters and sections/paragraphs so there are clear subdivisions and easier to visualize – Endo– consistency of materials for each session – Canvas ipad app didn’t work; troubleshoot this technological glitch Endo small group presentation – Find a way to make it more active and engaging for audience (listening and being attentive for two straight hours was challenging for the students) – Ideas: Do the students need to present in person? Can they prepare and post on Canvas for all the read through? Can they present it on a video uploaded to Canvas? Make sure the goal of the session is being accomplished (is it to learn material or do a presentation?)

Action Plan--Renal

• • • Dr. Fejes-Toth agrees with the Recommendations of our MEC Sub-Committee He may not be directing the course next year so he wanted to address the specifics of the Action Plan once the new course director is identified then can propose the Plan at a later date to the MEC

Action Plan--Endocrine

• • • • As suggested the course objectives have been rewritten – by eliminating unnecessary detail/combining some of them, there are now only 10 – These have been mapped to the new Geisel program objectives – The session objectives have been or will be reduced to fewer than eight objectives.

Conferences will be graded on a pass/fail basis and a grade of pass in the conferences will be required to pass the course. – The decision not to give a number grade is based on the fact that over almost 30 years we have not found a way to do this that is satisfactory to both faculty and students – The issue is compounded by the fact that the student groups will increase from 12 to 16 The final exam grade and the mean of the quiz grades will likely have an equal weight in the overall class grade; waiting for announcement of new Renal course director Thus there will be two components to passing the course – A pass in the conferences and a pass in the test scores.

Action Plan--Endocrine

• • •

Create consistent format for supplemental lecture materials

– The lecture materials are prepared individually by six lecturers each with their own style. I will provide a template and suggestions to all of them and ask them to conform as best they can.

Reevaluate paper presentations – We feel that this is an important part of the course – We give them papers mostly on clinical topics that are highly relevant to the course material – It is an excellent exercise for them and in my experience the students do this very well – It does require some work but it also introduces another important component in their academic development Re-insert any removed medical photographs into appropriate lecture – I will make a decision on this issue when I am preparing my 2016 lecture next winter