Review of Year 2 Patients Populations course Course

Review of Year 2 Patients & Populations course • Course occurs in the second and third terms of Year 2. • Course Director – Brenda Sirovich, MD, MS – Lisa Adams, MD • Course has 8 curricular hours • Course was approved in May 2016 Date of this review: April 2017

Action Plan from Prior Review The course was given for the first time during AY 16 -17. (no prior plan)

Course Objectives 1 Describe the common methods of measurement in clinical medicine and research and how they are used. 2 Explain the role and use of statistics in addressing questions in health and medicine. 3 Explain the findings of a research study reported in the medical or health care literature. 4 Apply the findings of a research study to a clinical scenario. 5 Interpret the roles of probability, variability, and uncertainty in clinical decision making, including diagnostic testing and screening. 6 Explain how the quality of medical research may be affected by a study's design and execution, confounding, and bias. 7 Identify and compare strategies for the care of a population or community, or subgroups within it, based on your interpretation of patterns of disease and health care. 8 Explain the impact of social, behavioral, environmental, economic, cultural and personal factors on the health of individuals and populations. 9 Illustrate the relationships between the health care system and other societal systems and entities that impact population health. 10 Describe variation in how health care is delivered and financed across different U. S. regions and countries. 11 Discuss the context (financial, political, ethical, e. g. ) in which medicine is practiced in the United States, and how it influences health care delivery. 12 Evaluate a patient's and family's experiences within multiple levels of the health care system. 13 Analyze a local clinical front line health care microsystem.

Course Objectives - Continued 14 Analyze, measure, and perform tests of change? to demonstrate measurable improvement. 15 Demonstrate appropriate behaviors while working effectively in interprofessional teams. 16 Apply core patient safety concepts while recognizing the physician's role in monitoring and creating safe systems of care. 17 Demonstrate self-awareness and discovery through ongoing self reflection and assessment. 18 Demonstrate awareness of effective teams through observation and assessment. 19 Analyze leadership challenges at the personal and health care (clinical, educational, research, policy, or community service) team level. 20 Develop and execute a strategic action plan to create meaningful and measurable change at the personal and team level. 21 Practice clear and concise communication with individuals or larger audiences, using writing, speech or visual elements. 22 Demonstrate active, perceptive, and respectful listening. 23 Formulate effective communication to articulate vision, develop relationships, and effect change. 24 Evaluate a real world problem by effectively organizing, prioritizing, and synthesizing information into a plan for action.

Mapping of Course Objectives to Geisel Competencies • Course directors will review current mapping (to new Geisel competencies) and forward updates to Brian Reid

Course Objectives – Comments • Course and session objectives are written properly • Course objectives listed in Ilios are the same as those for Y 1 P&P • Course objectives do not appear in the syllabus • In the ilios system, session objectives map to only course objectives 3, 4, 9, 10, 11, 21 and 24, but probably should map to more – For example, course objectives 15 and 16 would seem to relate to the IPE session, which currently does not have any objectives in Ilios.

Format of Course & Session Objectives • Course objectives are not provided in the syllabus • Course objectives are written in the correct format • Session objectives are provided in the course materials • Session objectives are written in the correct format

Issues of Redundancy • Are there major issues of redundancy with other courses? – Opiate crisis – “Vaccine wars” – Ethical issues in international health research • These topics each appear other places in the curriculum, but this course presents them in a way different from how they are presented elsewhere. – Effective repetition

Health and Values Goals Ethics – “Identify key concepts in health care ethics and demonstrate an ability to recognize ethical issues arising in patient care and population health and to think critically and systematically in applying an ethical analysis” Cultural Awareness – “Demonstrate an understanding and skill in managing patient care of people of diverse cultures, social, economic standing and belief systems” Health Equity – “Identify the root causes and approaches for addressing health disparities locally and globally” Resilience – Demonstrate knowledge of skills and practices to prevent and address stress and maintain resilience in caring for patients and oneself Compassion and Empathy – “Demonstrate abilities to understand each patient’s experience of illness, adapt scientifically appropriate care to conform to that patient’s needs, and communicate in terms that each patient can understand” There also are synergies to health law, communication skills, professionalism (as LCME requires).

Health and Values Content • International research ethics session • Session on vaccines explores issues of rights of parents and children within the healthcare context and potential clashes of values versus objective measure in vulnerable populations • Students appreciate the possibility to evaluate these timely issues

Summary regarding Objectives • Course objective are not included in the syllabus • The Objectives listed on Ilios are the same as those of the first year course • Linkages of session objectives to course objectives and of course objectives to institutional competencies need to be reviewed. • Good health and values content

Course Learning Opportunities • This was a new course • Four 2 -hour experiences – Three Interactive Large Group sessions 6 hrs. (75%) – Interprofessional Education Exposure 2 hrs. (25%)

Course Learning Opportunities • Pedagogy is based around 3 articles and an IPE simulation experience • The IPE exercise has a readiness exercise and 3 simulated patient safety/communication vignettes • The 3 “cases” involve: – Pre-work, involving focused review of one of three individual aspects of the case, with a short written report. – Group discussion of the article from all three perspectives – Each student writes an “Executive summary” of the discussion • All of the activities would be classified as engaged learning

Summary regarding Pedagogy • The pedagogy is appropriate. • “Engaged Learning” approaches including: – “Flipped” sessions (w/ pre-work that contributes to engagement during the session – Independent investigation of aspects of a case – Interactive, student-led case discussions – Preparation of summaries of case discussions – IPE Simulation

Assessment (from syllabus) • Completion of pre-course survey: 5% • Completion of four course assignments (one for each case and one for IPE): 75% • Participation & Professionalism: 20% • Student participation and professionalism also contribute to a student’s grade. Each student is expected to attend and fully participate in all required sessions and exercises, and to maintain the highest values in: – Personal behavior that fosters respect, innovation, and growth, – Collaborative teamwork that supports discussion, sets clear expectations, and holds each student accountable, – Fostering a learning environment that is engaging, supportive, and sustainable – Providing and being receptive to feedback that is timely, constructive, and promotes positive change

Assessment for Course Objectives • Assessments include: – Readiness exercise for IPE session. – Attendance, timely completion of assignments and adherence to strict requirements for assignments. – Individual grading of written pre-session assignments and of the executive summary for each student on each of the three case sessions.

Summary regarding Assessment • Assessment of written reports is rigorous • The course evaluates whether students are meeting professional responsibilities (i. e. , timeliness, attendance, adherence to requirements). – The course syllabus emphasizes the many other aspects of professionalism incorporated in “Exams and Grading”, while there is no mechanisms for these other dimensions of performance to contribute to formative or summative assessment.

Measures of Quality – Step I 2014* 2015* 2016* Means 14 -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 Gross Anatomy/Embryology 0. 14 0. 16 -0. 12 0. 06 Histology/Cell Biology 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. 03 Physiology 0. 25 0. 11 0. 06 0. 14 TRADITIONAL CORE DISCIPLINES *values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Measures of Quality – Step I 2014* 2015* 2016* Means 14 -16 Behavioral sciences 0. 15 -0. 1 -0. 43 -0. 13 Behavioral Health and Nervous system 0. 06 -0. 10 -0. 18 -0. 07 Biostatistics, Epidemiology, Pop Health 0. 01 0. 22 N/A 0. 12 (14 -15) Cardiovascular system 0. 02 0. 16 -0. 1 0. 03 Endocrine system 0. 39 0. 24 0. 09 0. 24 Gastrointestinal system 0. 54 0. 2 0. 06 0. 27 Hematopoietic/lymph systems 0. 09 0. 10 -0. 15 0. 01 Immune system 0. 16 -0. 07 -0. 02 Musculoskeletal, skin, CT systems -0. 02 0. 22 0. 15 0. 12 Nutrition 0. 22 -0. 08 -0. 15 -0. 003 Renal/urinary system 0. 23 0. 02 -0. 27 -0. 007 Reproductive system 0. 39 -0. 03 -0. 04 0. 11 Respiratory system 0. 18 0. 27 -0. 22 0. 08 SYSTEMS-BASED TOPICS *values reported for core disciplines are SD above the US/Can mean for Geisel mean scores

Measures of Quality – Course Evaluation IPE session The IPE session was well received overall Quality of pre-work readings Content of the information during the session Relevance to your curriculum Quality of your interaction with interprofessional student colleagues This activity increased my appreciation that breakdowns in communication exist in healthcare and that these can adversely impact patient safety. This session has increased my confidence in applying communication strategies to convey an unsafe patient situation. 3. 31/5 3. 52/5 3. 61/5 4. 03/5 4. 13/5 3. 86. 5 Overall, how effectively did your team work together during this activity? Poorly 1. 11%; Adequately 3. 33%; Well 52. 22%; Extremely Well 43. 33% There were some suggestions about scheduling (which is challenging given the need for multiple session in the Sim Center) and content (particularly the pre-work and the large group debrief session) that should be reviewed by the course directors.

Measures of Quality – Course Evaluation scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent] MDED 218 AY 16 -17 (55. 7%)* Overall satisfaction of course 3. 89 Clarity of learning objectives 3. 9 Organization of the course 3. 96 How well the course introduced me to this discipline 3. 83 Congruence of assessment questions to material emphasized in course 4. 2 *student participation rate on course evaluation

Measures of Quality – Student Comments Strengths: • Topics chosen were of interest to students – “Loved the 3 topics chosen for the sessions - very relevant!” • Panelists brought expertise, unique perspectives – “I think the panelists were knowledgeable and engaging. ” – “The vaccine panel was particularly great -- each speaker provided a unique and very valuable perspective. ” – I thought the last session we had about the ethics of research studies and how to conduct a research study was very effective. ” • Group work involved team members with different roles – “The splitting up of the work load and working as a team facilitated really nice discussion and learning. ”

Measures of Quality – Student Comments Opportunities for Improvement: • Pre-session assignments focused too much on word count – “I did feel [constrained] by the number of questions we were expected to answer for our pre-class essay. I wish there had just been one question that we could have responded to thoroughly in 200 -400 words. ” – “…I think the assignment asked for too many pieces to go into a very short amount of writing. ” – “Emphasis on word count was extreme…and I feel like the emphasis detracted from the content of the course. ” • Consider removing the post-session executive summary – “Not sure what the executive summary provided. Good way to frame discussion but often felt like it was constraining a full discussion. ” – “The executive summary turned into one person having to do all they work. Didn't really seem to do anything purposeful. ”

Measures of Quality – Student Comments Suggestions for future course expansion: • Students liked the current number of case-based sessions – “I thought that the sessions were of sufficient length that I think adding in more cases would be overwhelming. ” – “[I thought] the longitudinal case on communication and adverse events last year was far too redundant. It would require new perspectives to do a longitudinal case and not feel like busy work. This year felt like the perfect sweet spot. ” • Students requested biostatistics/epidemiology material – “[This] would be extremely helpful…especially in the winter/spring as a Boards refresher. ” – “I think this could be helpful…maybe even just a problem set so that we can keep looking at it, or having it more integrated with the cases can be helpful…[or perhaps] adjusting the data group…to answer biostats questions pertaining to the case!”

Summary regarding Measures of Quality • The IPE session is rated “Very Good” by students – There are many individual students comments that should be reviewed before next year • Overall, students have rated the course is in the “Very Good” range • Since this was the first iteration of the course, there are no external metrics (e. g. , USMLE performance) on which to base quality assessment.

Recommendations • Overall, the Y 2 P&P course is appreciated by students and uses appropriate pedagogy and evaluations. • There areas for improvement in objectives, assessment and structure: • Objectives – Determine which of the course objectives are relevant to the Y 2 P&P content – Assure that course objectives are listed on Canvas – Assure that all session objectives are represented in one or more course objectives – Evaluate linkage of course objectives to institutional competencies

Recommendations • Assessment – Consider the methods of evaluation of professionalism beyond attendance and timeliness • Structure – Evaluate the need for, and appropriateness of, the strict 200 -400 word limits on the pre-work for case assignments – Examine the purpose, importance and structure of the “Executive Summary”

Action Plan for 2017 -18 1. Overall: Ø What will stay the same: Ø Ø Ø Course objectives Overall course structure Assessment methods Ø What will change: Ø Increase # of hours (8 13)

Action Plan for 2017 -18 2. Case Series: Ø What will stay the same: Ø Ø Ø Objectives, structure, content of dominant component = Case Series (currently 6 h/8 h) Each session = the opportunity to apply course competencies to specific topics (cases) in pop health, healthcare, and medicine Survey students at start of year re: topical interests Ø What will change: Ø Ø Add one case – likely related to Nutrition / Obesity Add one capability domain – likely splitting Data/Evidence into Data and Evidence Revise summary assignment requirement and structure Biomedical librarian workshop will now be required (floating)

Action Plan for 2017 -18 3. Other course elements: Ø What will stay the same Ø Ø IPE Session (Patient Safety) Ma. D Elective Canvas interface Faculty / staff Ø What will change Ø Ø Added Sim/IPE type session (IV) likely Pilot student teaching opportunities (Year 4, Ph. D, and or MD/MPH or MS)