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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