March 2008 Town Hall Meeting Georgetown University School of Medicine Georgetown University

Georgetown University School of Medicine Town Hall Meeting Update of First Year Curriculum Reform, Part 2 March 3, 2008 Georgetown University School of Medicine Town Hall Meeting on Curriculum Reform, Part 2 March 3, 2008 - 4:30 – 7:30 AGENDA Welcome/Introduction Evolution of the GU Medical Curriculum: The Goal and The Vision *Dinner Curriculum Proposals Office of Medical Education Support Credit Hours/Registrar Issues Assessment Next Steps: Syllabi Standards NBME Workshop Q&A Session Georgetown University School of Medicine Sistrunk Federoff Mitchell/Crooke Gwinn Walther Weissinger Moderator: Jeanne Walther Georgetown University School of Medicine First Year Mission Statement After completing the first year curriculum, the Georgetown medical student will have:  an easily retrievable, multidisciplinary corpus of biomedical knowledge about the organization, function, and systems of the human body in health;  a “beginners” ability to integrate, synthesize, apply, and communicate that knowledge in clinical contexts; and  the capability to retrieve this knowledge accurately and systematically, apply it appropriately in understanding both normal and abnormal human biological processes, and demonstrate the ability to think critically about these processes and the problems of patients. Georgetown University School of Medicine Molecular and Cellular Physiology  This course focuses on understanding the mechanisms by which cells receive and process extracellular signals, regulate gene expression, control organelle biogenesis, and divide or differentiate. It also explores the fundamentals of cellular metabolism. The relationship of these processes to human disease is emphasized as an underlying theme throughout the course. Georgetown University School of Medicine Metabolism and Signal Transduction  This course reviews general endocrine physiology and explains the pathophysiology of endocrine diseases such as diabetes mellitus, osteoporosis, thyroid diseases, and other disorders of hypo- and hyper- function of various endocrine tissues. Students become familiar with the signs and symptoms of endocrine diseases and learn to formulate a differential diagnosis and a diagnostic workup to rule in or rule out endocrine disorders in patients. In addition it provides an overview of diseases affecting all components of the digestive system. Emphasis is placed on understanding the mechanistic basis of digestive diseases and how diseases of the gastrointestinal tract and liver interface with other systemic conditions. Georgetown University School of Medicine Development Molecular and Human Genetics  Medical genetics is one of the most rapidly advancing fields of medicine, and understanding of its principles is now integral to all basic concepts and some major topics in human genetic medicine including cytogenetics, molecular genetics, biochemical genetics, pharmacogenetics, genetic testing and screening, developmental genetics, and dysmorphology. Georgetown University School of Medicine Cardiopulmonary  This course provides students with a comprehensive review of anatomy, hemodynamic function, and electrophysiology of the normal cardiovascular and respiratory system, and indepth study of the pathophysiology of cardiovascular diseases including cardiomyopathies, valvular heart disease, ischemic heart disease, vascular diseases, and congenital heart disease in addition to an understanding of basic respiratory pathophysiology and its application to patient care. Georgetown University School of Medicine Renal  This module addresses the structural, functional and integrative aspects of the kidney and urinary system. The goal is to facilitate student learning of the basic physiologic mechanisms that underpin renal function and understand the role the kidney plays in fluid and electrolyte homeostasis, including acid-base balance. Georgetown University School of Medicine Sexual Development and Reproduction  This module will provide the students with a good grasp of the cellular and anatomical components of reproduction and early development. These components include the development of the reproductive track, development of gametes, fertilization, and formation of the germ layers. Georgetown University School of Medicine The Limbs  This module introduces students to a series of diseases that overlap the disciplines of Radiology, Orthopedics, and Rheumatology. It affords students the opportunity to learn the clinical and functional correlates of structure first hand. It begins to bridge the gap between basic science and clinical applications for the diagnosis and treatment of connective tissue diseases. By the end of the course, students will have developed a rational, clinical approach to the patient with musculoskeletal complaints. Georgetown University School of Medicine Head, Neck and Special Senses  The head, neck and special senses module will present a series of coordinated lectures to describe first the development (i.e., embryology) of the head, neck, eyes and ears followed by comprehensive lectures and coordinated laboratories detailing the gross and microscopic (i.e., histological) anatomy of the head, neck and special senses. These lectures and laboratories will be integrated with clinical topics in order to provide a meaningful clinical perspective of the head, neck and special senses. Finally, this module will provide the necessary background for future neuroscience lectures and laboratories dealing with the neuroanatomy and neurophysiology of the head, neck and special senses. Georgetown University School of Medicine Medical Neuroscience  This course addresses structural, functional, and biochemical aspects of the nervous system, and introduces students to neurologic illnesses commonly encountered in clinical practice. It helps students gain insight into the scientific basis for evaluation and treatment of clinical phenomena such as pain, weakness and stroke…etc. The goal is to enable each student to reach a basic understanding through which normal and abnormal nervous system functioning can be interpreted. Georgetown University School of Medicine Seventeen Objectives of the Georgetown University School of Medicine Approved by Georgetown University School of Medicine Committee on Medical Education (COME), January 2002.  Knowledge-Related Competencies  Skill-Related Competencies  Values and Attitudes-Related Competencies Georgetown University School of Medicine KNOWLEDGE MCP DMHG MST LMB CP RNL SDR HNSS MNS Ethics PPB AC EBM I HC COMPET ENCI ES: 1 ) a know ledge of biom edical science and the ability to acqu ir e, m anage, integr ate, and apply this know ledge to the car e of patients 2 ) the ability to ev alu ate cr itically new know ledge and to deter m ine its r elev ance to the clinical pr oblem s and challenges pr esented by the indiv idu al patient 3 ) an u nder standing of the psy chological, socioeconom ic, cu ltu r al, and spir itu al dim ensions of hu m an health and illness 4 ) an u nder standing of cu r r ent and pr oposed str ategies for the or ganization, financing and deliv er y of health car e 5) an u nder standing and know ledge of Georgetown oneself, inclu ding the scope and lim its of University one’s know ledge, School of skills, and v alu es X X X X X X X X X X X X X X X X X X X X X X X X X X Medicine SKILL COMPET ENCIES: 6) the ability to take a comprehensive history and to perform a comprehensive physical examination 7 ) the ability to perform basic clinical procedures 8) the ability to solve and reason through clinical problems, from developing a differential diagnosis to formulating an appropriate plan of care 9) the ability to interpret, assess, integrate, and apply data and information from diagnostic tests in the process of clinical problem solving, reasoning, and decision making 10) the ability to implement and manage the plan of care in an appropriate and professional fashion with sensitivity to patient diversity and values 11) the ability to communicate and collaborate effectively with patients and colleagues MCP DMHG MST LMB CP RNL SDR HNSS MNS Ethics PPB AC IHC X X X X X X X X X X X X X X X X X X X Georgetown University School of Medicine 12) the ability to learn independently with a critical awareness of the scope and limits of one’s knowledge, skills, and values X X X X VALUES AND AT T IT UDES COMPET ENCIES: 13) an understanding of the ethical dimensions of the physician-patient relationship and of the ethical dilemmas encountered in health care, at the bedside as well as in the formulation of health care policy 14) an understanding of the obligations to patients, the profession, and society inherent in the practice of medicine 15) the clinical virtues of fidelity to trust, respect for others, excellence, duty, honor and integrity, humility and accountability, and compassion 16) altruism through a commitment to service, especially service to the disadvantaged 17 ) an awareness of the importance of maintaining one’s own well-being and of Georgetown balancing the demands of University School of professional and personal life Medicine MCP DMHG MST LMB CP RNL SDR HNSS MNS Ethics PPB AC IHC X X X X X X X X X X X X X X X X X X X X X X Virtual Gross Anatomy Module for Abdomen/Pelvis The virtual gross anatomy course would include three currently available web resources through the Dahlgren Medical Library (self-directed learning) for students to use to supplement their knowledge: 1) Dissection videos generated internally 2) Primal anatomy – a virtual dissection program 3) NetAnatomy – a web based anatomy program Georgetown University School of Medicine Virtual Gross Anatomy Module for Cardiopulmonary The virtual gross anatomy course would include three currently available web resources through the Dahlgren Medical Library (self-directed learning) for students to use to supplement their knowledge: 1) Anatomy videos, entitled The Thorax 2) Net Anatomy – Radiographic exam of the thorax Although self-directed, there is faculty input via the syllabus* – Gross Anatomy of the thorax 3) Primal Pictures – Interactive review of thorax and abdomen *the unique “virtual” syllabus Georgetown University School of Medicine Georgetown University School of Medicine Georgetown University School of Medicine First Year Curriclum Matrix 2 First Year Curriculum Matrix (v2 1-29-08) Molecular & Cellular Physiology (MCP) Metabolism & Signal Transduction/ Nutrition (MST) Development Molecular & Human Genetics (DMHG) Limbs (LMB) Cardio Pulmonary (CP) Renal (RNL) Sexual Development & Reproduction (SDR) Head/Neck & Special Senses (HNSS) Medical Neuroscience (MNSc) Discipline Liaison Biochemistry Microanatomy Gross Anatomy Endocrinology Genetics Embryology Physiology Neuroscience MCP MODULE FINAL GRADE MST MODULE FINAL GRADE DMHG MODULE FINAL GRADE LIMBS MODULE FINAL GRADE CP MODULE FINAL GRADE RNL MODULE FINAL GRADE SDR MODULE FINAL GRADE HNSS MODULE FINAL GRADE MNSc MODULE FINAL GRADE Module MCP MST DEV LMB Georgetown University School of Medicine CDP REN SDR HNS MNS Director Elliott Crooke, PhD Hiroshi Nakai, PhD Wai-Yee Chan, PhD John Delahay, MD Carlos Suarez-Quian, PhD Daisy Lazarous, MD Aviad Haramati, PhD Ian Gallicano, PhD Peter Andrews, PhD Michael Ullman, PhD Director Contact 202-687 1644 202-687-1442 202-687-7068 202-444-8766 202-687-1282 202-444-8843 202-687-1021 202-687-0228 202-687-1228 202-687-0492 Coordinator Essie Thompson Tanya Naguit Judy Blooms Valerie Johnson Essie Thompson Tanya Naguit Essie Thompson Valerie Johnson Tanya Naguit Coordinator Contact 202-687-5885 202-687-0194 202-687-5917 202-687-5873 202-687-5885 202-687-0194 202-687-5885 202-687-5873 202-687-0194 First Year Curriculum Matrix 3 First Year Curriculum Matrix (v. 3 2-29-08) Molecular & Cellular Physiology (MCP) Metabolism & Signal Transduction/ Nutrition (MST) Development Molecular & Human Genetics (DMHG) Cardio Pulmonary (CP) GastroIntestinal (GI) Renal (RNL) Sexual Development & Reproduction (SDR) Limbs (LMB) Medical Neuroscience (MNSc) Head/Neck & Special Senses (HNSS) Discipline Liaison Biochemistry Microanatomy Gross Anatomy Endocrinology Genetics Embryology Physiology Neuroscience MCP MODULE FINAL GRADE Module MCP MST DEV LMB CDP REN SDR HNS MNS GI MST MODULE FINAL GRADE DMHG MODULE FINAL GRADE CP MODULE FINAL GRADE GI MODULE FINAL GRADE RNL MODULE FINAL GRADE SDR MODULE FINAL GRADE LIMBS MODULE FINAL GRADE MNSc MODULE FINAL GRADE HNSS MODULE FINAL GRADE Coordinator Contact 202-687-5885 202-687-0194 202-687-5917 202-687-5873 202-687-5885 202-687-0194 202-687-5885 202-687-5873 202-687-0194 202-687-1017 Georgetown University School of Medicine Director Elliott Crooke, PhD Hiroshi Nakai, PhD Wai-Yee Chan, PhD John Delahay, MD Carlos Suarez-Quian, PhD Daisy Lazarous, MD Aviad Haramati, PhD Ian Gallicano, PhD Peter Andrews, PhD Michael Ullman, PhD Sue Mulroney, PhD Director Contact 202-687 1644 202-687-1442 202-687-7068 202-444-8767 202-687-1283 202-444-8844 202-687-1021 202-687-0228 202-687-1228 202-687-0492 TBA Coordinator Essie Thompson Tanya Naguit Judy Blooms Valerie Johnson Essie Thompson Tanya Naguit Essie Thompson Valerie Johnson Tanya Naguit Coordinator Contact 202-687-5885 202-687-0194 202-687-5917 202-687-5873 202-687-5885 202-687-0194 202-687-5885 202-687-5873 202-687-0194 Educational Support/Office of Medical Education  Current Plan (may change to reflect module sequence change)  MCP - Molecular & Cellular Physiology: Essie Thompson MST - Metabolism and Signal Transduction: Tanya Naguit DEV - Dev and Molecular & Human Genetics: Judy Blooms LMB - Motion and the Skeleton: Valerie Johnson CDP - Cardiopulmonary: Essie Thompson REN - Renal: Tanya Naguit SDR - Sexual Development and Reproduction: Essie Thompson HNS - Head Neck and Special Senses: Valerie Johnson MNS - Medical Neuroscience: Tanya Naguit  Educational Coordinator Responsibilities include: -scheduling - lectures, labs, small group experiences -syllabus material organization; copying, distribution -preparation and scoring of exam materials.  Centralized educational support; cross-coverage as needed  Standardization in the format, procedures, and syllabi among the Georgetown University School of Medicine various modules.  Support of modules, utilizing BlackBoard, and other available technology. Module Lead MCP PPB ECC IHC MST DEV LMB E. Crooke M. Donnelly C. Taylor S. Schwartz H. Nakai FALL 2008 TOTAL SEMESTER CREDITS Molecular & Cellular Physiology (plus Lab) Intro to Patient, Physician & Behavior Ethics and Cultural Competency Intro to Health Care, Part 1 Metabolism, Signal Transduction & Nutrition (No lab) Development Molecular & Human Genetics (No Lab) Limbs (Plus Lab) Grand Rounds Credits 23 6 2 1 2 3 5 3 0.5 Credit Hours Medical Students Version 2 W. Chan J. Delahay Topal Rounds /Hernandez Module Lead CDP PDx PD IHC SG SPRING 2009 TOTAL CREDITS D. Lazarous Cardio Pulmonary (Plus Lab) M. Donnelly Physical Diagnosis I M. Donnelly A. Haramati I. Gallicano P. Andrews M. Ullman J. Weinfeld PDx Intro to Health Care/Small Group Renal (Plus Lab) Sexual Development & Reproduction (plus Lab) Credits 25 5 1 2 3 3 3 5 1 2 1 0.5 4 0 0 0 0 RNL SDR HNS MNS EBM Head/Neck & Special Senses (Plus Lab) Medical Neurosciences Evidence Based Medicine Intro to Health Care, Service Learning Ambulatory Care Grand Rounds Former Physios to take labs (P/F) if excepted from the courses (CDP, SDR, MNS,RNL) IHC SL S. Schwartz AC M. Donnelly Topol Rounds /Hernandez LAB3 OSCE Shelf Shelf Shelf Suarez S. Sistrunk MedEd MedEd MedEd Georgetown University School of Medicine Observed Structured Clinical Exam Physio Gross Anatomy Biochemistry Module Lead FALL 2008 TOTAL SEMESTER CREDITS Molecular & Cellular Physiology (plus Lab) Intro to Patient, Physician & Behavior Ethics and Cultural Competency Intro to Health Care, Part 1 Metabolism, Signal Transduction & Nutrition (No lab) Development Molecular & Human Genetics (No Lab) Cardio Pulmonary (Plus Lab) Grand Rounds Credits 22.0 5.0 2.0 1.0 2.0 2.5 4.0 5.0 0.5 MCP PPB ECC IHC MST DEV CDP E. Crooke M. Donnelly C. Taylor S. Schwartz H. Nakai Credit Hours Medical Students Version 3 W. Chan D. Lazarous Topal Rounds /Hernandez Module Lead credits) SPRING 2009 TOTAL CREDITS (does not include former physio Physical Diagnosis I Limbs (Plus Lab) PDx Intro to Health Care/Small Group Renal (Plus Lab) Sexual Development & Reproduction (plus Lab) Credits 28.0 1.0 3.0 2.0 3.0 4.0 3.0 5.0 2.5 1.0 2.0 1.0 0.5 4.0 0.0 0.0 0.0 0.0 PDx LMB PD IHC SG M. Donnelly J. Delahay M. Donnelly A. Haramati I. Gallicano P. Andrews A. Faden S. Mulroney J. Weinfeld RNL SDR HNS MNS GI EBM IHC SL AC Head/Neck & Special Senses (Plus Lab) Medical Neurosciences Gastrointestinal Evidence Based Medicine Intro to Health Care, Service Learning Ambulatory Care Grand Rounds Former Physios to take labs (P/F) if excepted from the courses (CDP, SDR, MNS,RNL) S. Schwartz M. Donnelly Topol Rounds /Hernandez LAB3 OSCE Shelf Shelf Shelf Suarez S. Sistrunk MedEd MedEd MedEd Georgetown University School of Medicine Observed Structured Clinical Exam Physio Gross Anatomy Biochemistry Cardiovascular/Pulmonary Module Georgetown University School of Medicine Sexual Development & Reproduction Georgetown University School of Medicine Molecular & Cellular Physiology Georgetown University School of Medicine Georgetown University School of Medicine Comprehensive Assessment Plan “Medical education, like medicine itself, cannot afford to proceed in the dark, and the better we understand the results we are achieving, the more effectively we can align our programs with our objectives” Kern, Thomas, Howard, and Bass. (1998). Curriculum Development for Medical Education: A Six-step Approach. p. 93). Georgetown University School of Medicine Georgetown University School of Medicine First Year Curriculum Assessment Plan Professional Practice Residency Individual Students Individual Modules First Year Experience Undergraduate Program Georgetown University School of Medicine 1/02/08 Draft Comprehensive Assessment Plan Competencies Activities Georgetown University School of Medicine Assessment Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Competencies By the end of the program, what should the students know? What should they be able to do? Activities Georgetown University School of Medicine Assessment Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Competencies What type of instructional and experiential activities will promote and develop this knowledge? What will help students achieve the competencies? Activities Georgetown University School of Medicine Assessment Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Competencies How will we know that they have achieved the competencies? Activities Georgetown University School of Medicine Assessment Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Competencies Activities Georgetown University School of Medicine Assessment Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Assessment should be  appropriate and dynamic. Georgetown University School of Medicine Congruence! Ability to solve and reason through clinical problems Lecture Georgetown University School of Medicine Recall-level MCQ exam Adapted from Felder & Brent ( 1991) Congruence! Ability to solve and reason through clinical problems Lecture Georgetown University School of Medicine Recall-level MCQ exam Adapted from Felder & Brent ( 1991) Congruence! Ability to solve and reason through clinical problems Georgetown University School of Medicine Small Group Problem-solving experience Formative – response system Summative – scenario-based MCQ exam Adapted from Felder & Brent ( 1991) Comprehensive Assessment Plan Assessment should be  appropriate and dynamic.  balanced. Georgetown University School of Medicine New Strategies Internal Monitoring Formative Module level Program level External Review Summative MCQ exams Georgetown University School of Medicine Examples – Ungraded Learning checks  Peer feedback in small group teaching  situation collected anonymously in online form. Students reflect and respond to a video patient encounter streamed in Bb. Create graphic representation (diagram, flow chart) of steps and decisions used to address a clinical case. Complete an internet, web safari researching an underserved population. Successful completion of online selfchecking quizzes.    Georgetown University School of Medicine Georgetown University School of Medicine Examples – Graded  Create a two-page memo to a hospital administrator summarizing the issue and making a recommendation.  MCQ Exam (with higher level scenariobased prediction, estimation, & interpretation-type questions) Georgetown University School of Medicine MCQs – Recall In mathematics and statistics, the arithmetic average is equivalent to a. frequency distribution b. mode c. central tendency d. mean e. median Georgetown University School of Medicine MCQs - Comprehension A patient seen in the emergency department does not know which “heart drug” he is taking. His heart rate is greater than 80/min, and the PR and QRS intervals on an ECG are prolonged. The patient reports ringing in his ears. He most likely is taking a. digoxin b. lidocaine c. phenytoin d. propranolol e. quinidine Reference: Case & Swanson (NBME) Constructing Written Test Questions, p. 49 Georgetown University School of Medicine MCQs – Attitudes and Ethics An 8-year-old boy with acute lymphablastic leukemia has experienced three relapses in the past 2 years. The only available treatment is experimental chemotherapy. Without treatment, the child is unlikely to survive for more than 6 weeks; with treatment, his prognosis is unknown. The parents do not want further treatment for their son and wish to take him home; the child also says he wants to go home. Which of the following is the most appropriate course of action? a. b. c. d. Discharge the child against medical advice. Discharge the child routinely Petition the court for an order for treatment Report the parents to social services for medical neglect. Georgetown University School of Medicine Examples – Graded  Create a two-page memo to a hospital administrator summarizing the issue and making a recommendation.  MCQ Exam (with higher level scenariobased prediction, estimation, & interpretation-type questions)  Use Rubric to guide grading of non-exam assessment (e.g. literature review) Georgetown University School of Medicine Rubric – SDR Literature Review Georgetown University School of Medicine Comprehensive Assessment Plan Assessment should be  appropriate and dynamic.  balanced.  way to measure intellectual growth and value-added of programs. Georgetown University School of Medicine Georgetown University School of Medicine Comprehensive Assessment Plan Assessment should be  appropriate and dynamic.  balanced.  way to measure intellectual growth and value-added of programs.  cyclical. Georgetown University School of Medicine Comprehensive Assessment Plan Gather Data Interpret Data Ethics Foundational Knowledge Improve Program Identify assessment strategies & instructional methods Clinical Application Georgetown University School of Medicine Establish Program Goals Objectives Competencies Comprehensive Assessment Plan Assessment should be  appropriate and dynamic.  balanced.  way to measure intellectual growth and value-added of programs.  cyclical.  our process. Georgetown University School of Medicine Comprehensive Assessment Plan Looking for a few good volunteers! Please contact me if you would be interested in serving on an on-going program assessment subcommittee. paw33@georgetown.edu 202-68704556 Georgetown University School of Medicine