Download Review of SBM Psychiatry

Review of SBM Psychiatry
• Course occurs in the fall of Year 2
• Course Director – Julie Frew
• Course has 59 curricular hours (+ 6
hours PBL)
• Course was last reviewed Nov 2013
Action Plan from Prior Review
• Revisions to learning objectives (“The
course objectives need to be re-written
to line up better with the sessions”)
– Objectives extensively revised (see
appendix)
• Other course director-initiated changes:
– Addition of an ethics session
– Incorporation of live patients into more
sessions
Course Objectives
• 19 objectives
Program objective
Number of course objectives
1. Medical knowledge
12
2. Patient care
2
3. Interpersonal communication
2
4. Professional identity
4
5. Inquiry and reflection
2
6. Healthcare delivery
2
• All mapped to at least one session
Course Objectives
*
**
*
*
**
Final written exam
Final written exam plus interview groups
Course Objectives
*
**
**
^
*
^^
?
*
**
^
^^
Observation and written evaluation by the interview preceptor
Preceptor graded written case write-up after interview
Participation in ethics session, final exam
* + final exam
Course Objectives – Format/Distribution
• Do they provide course objectives in the
syllabus?
– All except the last one
• Are they written in the correct format?
– Objective 10 is quite vague: “Discuss the basic
principles of biological and psychosocial
treatments as they apply to specific disorders”
• Do the course objectives distributed in the
course match the ones in Ilios?
– Yes
Session Objectives – Format/Distribution
• Do they provide session objectives in the
course materials?
– Canvas says, “Session objectives, if the faculty member has
made them available, will be included on either the first
page of their handout or the second slide of their PPT file.”
o Some found in Word files (handouts), others in PowerPoint file
• Are they written in the correct format?
– Inconsistently. For example, “Students will learn the
diagnostic criteria for the major mood disorders” in
syllabus but Ilios says “Describe the diagnostic criteria for
the major mood disorders”
Session Objectives – Format/Distribution
• Does each session objective map back to a course
objective (Ilios)?
– Yes
• Do the session objectives match what is listed
in Ilios?
– Not always (see above)
Session Objectives - Redundancy
• Are there major issues of redundancy with
other courses?
– The PBL session session objectives touch on
spousal abuse, eating disorders and sexual abuse.
– Is content coordinated with sessions on
depression & eating disorders, and with SBM
Repro session on peripartum mood disorders?
– Is substance abuse-related teaching synced with
On Doc sessions on screening for it?
Summary regarding Objectives
• Appropriate number of course objectives mapped to
session objectives with reasonable distribution of
topics and good use of Bloom’s taxonomy
• Wording of objective 10 is pretty vague
• Session objectives not always in same location,
sometimes mismatched with those in Ilios, suspect
this is transitional issue
• Good opportunity to assure complementarity with
other coverage of topics such as eating disorders,
peripartum mood disorders, and substance abuse
screening
Course Learning Opportunities
• Lecture: 28 hours (43%)
• Small group sessions: 16 hours (25%)
• Large group session with patient
presentation: 14 hours (22%)
• PBL: 6 hours (9%)
• Panel discussion: 1 hour (1%)
Summary regarding Pedagogy
• Overall, there is a nice mix of different
types of learning sessions
• The percentage of time in lecture is very
slightly above the target of 40%, though
some of the lectures have an interactive
component
Assessment
• Medical knowledge:
– Final Written Exam
• Attendance, participation, and engagement:
– Attend at least 7/8 patient interview sessions
– Score at least 13.5/20 points in patient interview
sessions
• Students need to pass BOTH components to
pass the course
Summary regarding Assessment
• The grading system for the course seems
appropriate
• The course is currently assessing all of its
objectives
Measures of Quality – Step I
Pass rate
Mean score
SYSTEM-BASED TOPICS**
Behavioral sciences
Cardiovascular system
Gastrointestinal system
Hematopoietic/lymph systems
Immune system
Musculoskeletal, skin, CT systems
Nervous system
Nervous system & Behavioral health (2014)
Nutrition
Renal/urinary system
Reproductive/endocrine systems
Reproductive system (2014)
Endocrine system (2014)
Respiratory system
Multisystem processes & disorders (2014)
2013
98.8%
236
2014
98.8%
235
2015
97.5%
232
Mean last 3 years
98.4%
234.3
0.26
0.47
0.59
0.18
0.53
0.34
0.21
na
0.39
0.21
0.39
na
na
0.31
na
0.15
0.02
0.54
0.09
0.16
-0.02
na
0.06
0.22
0.23
na
0.39
0.39
0.18
0.23
-0.12
0.15
0.22
0.1
-0.07
0.23
na
-0.1
-0.09
0.02
na
-0.03
0.24
0.27
-0.18
mean
0.10
0.21
0.45
0.12
0.21
0.18
0.21
-0.02
0.17
0.15
0.39
0.18
0.32
0.25
0.03
0.20
*values reported for core disciplines are SD above the US/Can mean for Geisel mean scores
Measures of Quality – Course Evaluation
Year 2 courses
Overall Satisfaction AY 2014-2015
Measur
es of
Quality
– AAMC
GQ
GI
4.47
Hematology
4.44
Infectious diseases
4.40
Respiration
4.38
Cardiology
4.27
Psychiatry
4.20
FEK
4.19
Pharmacology
4.15
Dermatology
4.11
Endocrine
4.09
CT & Bone
3.62
Nervous system
3.46
Reproduction
3.29
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Measures of Quality – Course Evaluation
Year 2 Courses
2014/15
Clarity of Congruence Effectiveness How useful Overall
Mean
Mean Small
the learning of quiz and
of the
and relevant quality of Lecturer/Large Group Leader
objectives
exam
organization introduction this course
Group
Score
questions to of the course to this field
Instruction
the learning
or discipline
Score
objectives
Overall mean
score
SBM Psychiatry
4.08
3.87
4.02
4.18
4.16
4.06
4.45
4.12
2015/16 MEAN
3.88
3.55
3.76
4.00
3.84
4.21
4.48
3.81
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Measures of Quality – Student Comments
Strengths:
• Course director was very organized and
set clear expectations and provided
clear explanations
• Having “real patients”
• Small group interviewing sessions
Measures of Quality – Student Comments
Suggestions for Improvement:
•
Skill introduction for patient interviewing::
– Provide opportunity to observe an interview before doing on one’s own
•
More diversity in small group patient interviews:
– Some thought they did not see a diverse enough patient population
•
More differentiations between disorders:
– “There needs to be more focus on differentiating between like diagnoses
across lectures”
•
More visuals:
– Some lectures had almost all text-only slides; students found graphs helpful in
comparing/distinguishing different disorders
•
Redundancy
– Some repetition/redundancy between all the drug/opioid lectures and the
corresponding pharmacology lectures
•
More practice questions like those on the exam
Summary regarding Measures of Quality
• The course is rated in the very good to excellent range;
overall course rating was within a fraction of the point of
the highest rated SBM courses
• Students had high praise for the course director and for
the course overall
• Most consistent suggestions from students:
– Would be helpful to see a patient interview before doing one (a
demonstration interview is provided on the first day of the
course)
– Increasing diversity of patients in small group interviews
• Students perform at about the national average on
USMLE for psychiatry (behavioral science) content,
though the mean for Geisel students is above the
national average
Recommendations
• Course and session objectives require some
minor modifications
• Review a few content areas that overlap with
other courses to assure that there is
coordination of content and no unintended
redundancy
• Consider reducing the amount of lecture time
to get to target of ≤ 40%
• See if there is any practical way to assure
greater diversity of patients in the small group
sessions
Action Plan
• Objectives were revised and approved by MEC in
December 2015
– “Objective 10” (noted as vague) is no longer included and
has been subsumed under individual objectives related to
various major categories of psychiatric illness
– e.g. “Describe the signs and symptoms of Mood Disorders
and related conditions (including major depressive
disorder, bipolar disorders, and persistent depressive
disorder) along with current knowledge of risk factors,
pathophysiology, and management strategies including
both pharmacologic and nonpharmacologic treatments”
Action Plan
• Will continue to work with faculty to ensure
session objectives are easy to find, correlate
with course material, and are written in
appropriate form
• Will schedule meeting with On Doctoring
course directors to coordinate coverage of
substance abuse screening
• Will consider ways to achieve greater patient
diversity in small group interviewing sessions
• Will work towards offering a greater number
of practice exam questions
Appendix: Revised Course Objectives
#
1
2
3
4
5
Course learning objective, Y2 SBM/Psychiatry course
Maps to
Describe the signs and symptoms of Mood Disorders and related conditions
(including major depressive disorder, bipolar disorders, and persistent
depressive disorder) along with current knowledge of risk factors,
1a,1b,1c,1d,1e,1f
pathophysiology, and management strategies including both pharmacologic
and nonpharmacologic treatments
Describe the signs and symptoms of Psychotic Disorders and related
conditions (including schizophrenia, schizoaffective disorder, and delusional
disorder) along with current knowledge of risk factors, pathophysiology, and 1a,1b,1c,1d,1e,1f
management strategies including both pharmacologic and nonpharmacologic
treatments
Describe the signs and symptoms of Anxiety Disorders and related conditions
(including generalized anxiety disorder, panic disorder, OCD, and posttraumatic stress disorder) along with current knowledge of risk factors,
1a,1b,1c,1d,1e,1f
pathophysiology, and management strategies including both pharmacologic
and nonpharmacologic treatments
Describe the signs and symptoms of Substance Use Disorders and related
conditions (including alcohol, cannabis, opioid, and other substance use
disorders) along with current knowledge of risk factors, pathophysiology, and 1a,1b,1c,1d,1e,1f
management strategies including both pharmacologic and nonpharmacologic
treatments
Describe the signs and symptoms of Neurodevelopmental and
Neurocognitive Disorders and related conditions (including delirium, mild and
major neurocognitive disorders, ADHD, autism spectrum disorder, and
1a,1b,1c,1d,1e,1f
traumatic brain injury) along with current knowledge of risk factors,
pathophysiology, and management strategies including both pharmacologic
and nonpharmacologic treatments
Assessed by
Final written exam
Final written exam
Final written exam
Final written exam
Final written exam
Appendix: Revised Course Objectives
6
7
8
9
10
11
12
Describe the signs and symptoms of Somatoform Disorders and related
conditions (including somatic symptom disorder, illness anxiety disorder, and
functional neurologic symptom disorder) along with current knowledge of
risk factors, pathophysiology, and management strategies including both
pharmacologic and nonpharmacologic treatments
Describe the signs and symptoms of Eating Disorders and related conditions
(including anorexia nervosa, bulimia nervosa, and binge eating disorder) along
with current knowledge of risk factors, pathophysiology, and management
strategies including both pharmacologic and nonpharmacologic treatments
Describe the signs and symptoms of Sleep Disorders and related conditions
(including insomnia, narcolepsy, obstructive sleep apnea and circadian
rhythm disorders) along with current knowledge of risk factors,
pathophysiology, and management strategies including both pharmacologic
and nonpharmacologic treatments
Describe the signs and symptoms of Personality Disorders and related
conditions (including borderline personality disorder) along with current
knowledge of risk factors, pathophysiology, and management strategies
including both pharmacologic and nonpharmacologic treatments
Describe the elements of an emergency psychiatric assessment, suicide risk
assessment, and crisis intervention
Describe and recognize psychological landmarks, behaviors, and
developmental tasks typical of the various stages of the human life cycle
1a,1b,1c,1d,1e,1f Final written exam
1a,1b,1c,1d,1e,1f Final written exam
1a,1b,1c,1d,1e,1f Final written exam
1a,1b,1c,1d,1e,1f Final written exam
1c
Final written exam, Interview
groups
1a,1c
Final written exam
Observation and written
Conduct a basic psychiatric interview, including mental status exam,
2a,2b,3a,3b,3c,4a evaluation by the interview
conducting him or herself in a professional, sensitive, and respectful manner
preceptor
Appendix: Revised Course Objectives
#
Course learning objective, Y2 SBM/Psychiatry course
Maps to
Assessed by
13
Demonstrate ability to write-up a psychiatric case based on an
observed patient interview, including appropriate history, mental
status exam, and assessment
3e,2d,2e
Preceptor graded written
case write-up after
interview
14
Discuss ethical issues likely to occur in the care of patients with
psychiatric illness, specifically those related to confidentiality and
involuntary psychiatric treatment
4g,1e
Participation in ethics
session, final written exam
15
Search for recent, high quality, relevant medical literature; read it
critically; and use it to further your understanding of how the
5a,5b
patient is assessed and a diagnosis is selected
16
Discuss the advantages and inadequacies of the current mental
health care delivery system and how these may impact individuals
living with psychiatric illness
17
Explain the biological, psychological, and social factors that
contribute to risk of psychiatric illness, including the role of trauma 6i,1c,1e,1f
(effects of physical and sexual abuse)
Preceptor graded written
case write-up after
interview
Observation and written
evaluation by interview
6d,6e,6f,6g,4k,5d
preceptor, final written
exam
Final written exam,
observation and written
evaluation by interview
preceptor