Review of Y2 SBM Repro Course
Preclinical Subcommittee
January, 2014
Aaron Barnes (Geisel 2), Rich Comi MD, Hal Manning MD
1. Course learning objectives
2. Course learning opportunities
3. Learning assessments for students
4. Measures of overall quality for the course
5. Specific suggestions for improving course
SBM Reproductive Endocrinology
Review of Objectives
Rich Comi, MD
Course Objectives from Ilios
1) Define terms common to the discussion of patients with disorders in
repro system (RS)
2) Describe the normal structure and physiology of RS
3) Describes normal stages of maturation and involution of RS
4) Describe processes of normal pregnancy, labor, delivery and issues in
family planning
5) Explain signs, sx, processes of dx of common disorders of male and
female RS
6) Explain signs, sx, processes of male RS
7) Describe disorders of male and female RS in early and late life
8) Describe appropriate use of dx testing in patients with disorders of RS
9) Discuss epidemiology and population health aspects of disorders of the
RS
10)Discuss public health and ethical issues of disorders of the RS
Course Objectives from Ilios (cont’d)
11) Describe the pathology and pathophysiology of disorders of the RS
12) Explain the basis for pharm and nonpharm interventions for common
repro disease
13) Describe how various medical disciplines are integrated in disorders of
the RS
14) Utilize the results of outcome and cost utility studies to evaluate pt care,
prevention and screening in disorders of the RS
15) Describe how operations and processes in a complex healthcare system
have an impact in disorders of the RS
16) Practice and demonstrate systematic problem solving skills in disorders of
the RS
17) Explain ethical issues involved in mgmt of patients with disorders of the
RS
18) Communicate with fellow students an faculty about disorders of the RS
19) Discuss methods of communication with pts and families about disorders
of the RS
20) Demonstrate team skills by participating in team exercises
Course Objectives from Ilios (continued)
21) Take responsibility for your own education
22) Read critically , evaluate and assess information about disorders of RS
23) Search efficiently for high quality relevant info about disorders of the RS
Review of Objectives:
Objectives 5 and 6 are redundant
Objective 11 seems too broad
Objective 12 is vague
Objectives 20 , 21 and 23 are not specific to this course but seem
reasonable
There are several typos
# 23 is mislabeled as 22 and always paired with 22 – “22,22”
Session mapping to course objectives
100
F
R
E
Q
U
E
N
C
y
50
20
10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
This shows that all course objectives are addressed multiple times in the
sessions, but that #11 may be too broad
Mapping Geisel to the NBME Step 1 curriculum
1-4
Normal processes
embryonic development, fetal maturation, and perinatal changes, including
gametogenesis
1-4
organ structure and function
female structure, including breast
female function
male structure
male function
intercourse, orgasm
pregnancy, including ovulation, fertilization, implantation, labor and delivery,
the puerperium, lactation, gestational uterus, placenta
1-3
?
cell/tissue structure and function, including hypothalamic-pituitary-gonadal axis,
sex steroids, and gestational hormones
reproductive system defense mechanisms and normal flora
57,11
Abnormal processes
infectious, inflammatory, and immunologic disorders (female and male)
traumatic and mechanical disorders (female and male)
neoplastic disorders (including female reproductive, male reproductive, breast
[including fibrocystic changes], trophoblastic disease)
?
metabolic and regulatory processes (female and male)
10, prenatal and perinatal counseling and screening
17,19
? systemic disorders affecting reproductive function
5,11
5-7,
11
disorders relating to pregnancy, the puerperium, and the postpartum period
obstetric problems
complications affecting other organ systems
disorders associated with the puerperium
antepartum, intrapartum, postpartum disorders of the fetus
idiopathic disorders
drug-induced adverse effects on the reproductive system
degenerative disorders
congenital and genetic disorders affecting the reproductive system
12
Principles of therapeutics
mechanisms of action and use of drugs for treatment of disorders of the
reproductive system and management of normal reproductive function
female reproductive tract
fertility drugs
oral contraception, other methods of contraception
estrogen, progesterone replacement, treatment of menopause
stimulants and inhibitors of labor
estrogen and progesterone antagonists
stimulators and inhibitors of lactation
male reproductive tract
fertility drugs
androgen replacement and antagonists
gonadotropin-releasing hormone and gonadotropin replacement, including
all gonadotropin-releasing hormone antagonists
abortifacients
antimicrobial and antiparasitic agents
antineoplastics
restoration of potency
other therapeutic modalities affecting the reproductive system
Gender, ethnic, and behavioral considerations affecting disease treatment
9,10,14,
and prevention, including psychosocial, cultural, occupational, and
15, 17,19,
environmental
emotional and behavioral factors
influence on person, family, and society
occupational and other environmental risk factors
family planning and pregnancy
gender identity, sexual orientation, sexuality, libido
effects of traumatic stress syndrome, violence, rape, child abus
In excess of NBME 1:
8 (diagnostics), 13 (team integration), 16 (problem solving skills), 18
(communicate with professionals), 20 )team skills), 22( read literature),
23 (search literature)
Mapping Geisel to the LCME Content Emphases
14,
15
ED-10. The curriculum of a medical education program must include behavioral
and socioeconomic subjects in addition to basic science and clinical disciplines.
5,6,
16,
22,
23
ED-11. The curriculum of a medical education program must include content from
the biomedical sciences that supports students' mastery of the contemporary
scientific knowledge, concepts, and methods fundamental to acquiring and
applying science to the health of individuals and populations and to the
contemporary practice of medicine.
?
ED-12. The curriculum of a medical education program should include laboratory
or other practical opportunities for the direct application of the scientific method,
accurate observation of biomedical phenomena, and critical analysis of data.
?
ED-13. The curriculum of a medical education program must cover all organ
systems, and include the important aspects of preventive, acute, chronic,
continuing, rehabilitative, and end-of-life care.
n/a
ED-14. The curriculum of a medical education program must include clinical
experience in primary care.
7,9,10,
14,16,
17
ED-15. The curriculum of a medical education program must prepare students to
enter any field of graduate medical education and include content and clinical
experiences related to each phase of the human life cycle that will prepare students
to recognize wellness, determinants of health, and opportunities for health
promotion; recognize and interpret symptoms and signs of disease; develop
differential diagnoses and treatment plans; and assist patients in addressing healthrelated issues involving all organ systems.
n/a
ED-16. The clinical experiences provided to medical students by a medical
education program must utilize both outpatient and inpatient settings.
n/a
ED-17. Educational opportunities must be available in a medical education program
in multidisciplinary content areas (e.g., emergency medicine, geriatrics) and in the
disciplines that support general medical practice (e.g., diagnostic imaging, clinical
pathology).
?
ED-17-A. The curriculum of a medical education program must introduce medical
students to the basic scientific and ethical principles of clinical and translational
research, including the ways in which such research is conducted, evaluated,
explained to patients, and applied to patient care.
n/a
ED-18. The curriculum of a medical education program must include elective
opportunities to supplement required courses and clerkships (or, in Canada,
clerkship rotations).
18,
19
13
ED-19. The curriculum of a medical education program must include specific instruction in
communication skills as they relate to physician responsibilities, including communication
with patients and their families, colleagues, and other health professionals.
ED-19-A. The core curriculum of a medical education program must prepare medical
students to function collaboratively on health care teams that include health professionals
from other disciplines as they provide coordinated services to patients. These curricular
experiences include practitioners and/or students from other health professions.
ED-20. The curriculum of a medical education program must prepare medical students for
their role in addressing the medical consequences of common societal problems (e.g.,
10,14,
provide instruction in the diagnosis, prevention, appropriate reporting, and treatment of
15
violence and abuse).
?
ED-21. The faculty and medical students of a medical education program must demonstrate
an understanding of the manner in which people of diverse cultures and belief systems
perceive health and illness and respond to various symptoms, diseases, and treatments.
?
ED-22. Medical students in a medical education program must learn to recognize and
appropriately address gender and cultural biases in themselves, in others, and in the
process of health care delivery.
17,
19
ED-23. A medical education program must include instruction in medical ethics and human
values and require its medical students to exhibit scrupulous ethical principles in caring for
patients and in relating to patients' families and to others involved in patient care.
In sum,
1) There are minor typos to be fixed
2) Objective 11 is too broad
3) The objectives do a nice job of covering the NBME curriculum and
LCME emphases but there are a few areas that could be improved
(yellow boxes with “?”
NBME topics: metabolic, systemic disorders
and “protective systems ( bacterial biome?)
LCME topics:
diversity
gender and cultural biases
translational research
observation/measurement of biophenomena
rehab medicine
1g. Overlap/ILIOS word search: “Estrogen”



Does not appear in any course objectives
Appears in 2 course-level MeSH (Pharm 217)
Appears in 9 sessions in 5 different courses
Course
Session
Session Objective
Neuroscience (MDED 115)
Hypothalamus
Describe the HPG axis (GnRH, FSH, LH) and how gonadal steroids
(estrogens, progestins, androgens) and other environmental factors (e.g.,
leptin) influence GnRH neurons (through presynaptic afferents such as
kisspeptin neurons).
Endocrine Physiology (PHSL 120 Endo)
The Male and Female Reproductive System
To explain how estrogens, progestins and androgens regulate nonreproductive tract tissues, including their mechanism(s) of action.
Endocrine Physiology (PHSL 120 Endo)
Conference 2:
To recall the sources of estrogen in pre- and postmenopausal women and
to consider ways in which tumor growth might be slowed in the two groups
of individuals.
Endocrine Physiology (PHSL 120 Endo)
Endocrine control of growth
To describe interactive roles of key hormones HGH, thyroid hormones,
androgens/estrogens, insulin, PTH, Vit.D, cortisol, somatomedins, in
skeletal growth
Organ Based Pharmacology (PHAR 217)
F-7 Kinlaw - Bone/Calcium Pharmacology 2-Feb 11:15am
Recognize medications used in treating disorders of calcium metabolism
(including: diuretics, bisphosphonates; calcium salts; vitamin D;
calcimimetics; estrogen replacement therapy; selective estrogen receptor
modulator (SERM); parathyroid hormone; and monoclonal antibodies).
Organ Based Pharmacology (PHAR 217)
H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors
Review the physiologic role of estrogen and progesterone in the female
reproductive cycle.
Organ Based Pharmacology (PHAR 217)
H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors
Describe the basics of the biosynthesis of estrogen and progesterone.
Organ Based Pharmacology (PHAR 217)
H-3 Craig/DiRenzo - Gonadal Hormones and Inhibitors
Discuss the effect of tamoxifen on estrogen receptors.
Reproduction (SBM 206)
Contraception
Compare and contrast pregnancy rates and efficacy between unprotected
coital activity, estrogen containing contraceptives, IUDs,
medroxyprogesterone acetate contraception, withdrawal, and condoms.
Reproduction (SBM 206)
Contraception
Recognize the "absolute" contraindications to estrogen containing
hormonal contraceptives in clinical patient cases.
Reproduction (SBM 206)
The Menopause Transition
Describe the common short- and long-term effects of estrogen deficiency.
Reproduction (SBM 206)
PBL - Breast Cancer
Discuss the role of estrogens in breast cancer.
Clinical Pharmacology and Therapeutics
(PHAR 405)
Using glucocorticoids wisely
Explain the common structures of glucocorticoids, mineralocorticoids,
androgens, progestins, and estrogens
1g. Overlap/ILIOS word search: “Eclampsia”
 Does not appear in any course objectives
 Does not appear in any session title
 Appears in 5 sessions in 2 different courses
Course
Session
Session Objective
Reproduction (SBM 206)
Small Groups/Speed Dating
Format
Discuss potential
mechanisms in the
pathogenesis of
preeclampsia.
Reproduction (SBM 206)
Small Groups/Speed Dating
Format
List the physical
manifestations and risks of
preeclampsia.
Reproduction (SBM 206)
Small Groups/Speed Dating
Format
Discuss the risk factors for the
development of preeclampsia.
The Kidney in Pregnancy
Discuss vascular endothelial
growth factor (VGEF) and
sFIT-1 in pre-eclampsia.
Review with Faculty
Describe kidney function and
dysfunction in pregnancy,
including pre-eclampsia.
Kidney and Urinary System
(SBM 212)
Kidney and Urinary System
(SBM 212)
2. Course Learning Opportunities 2012-13 (Hal)
 Total hours: 55.5 h
 Traditional lectures = 23.5 h (42% of total hrs)
 Large group discussion/review = 12 h
 Lab (classical) = 2
 Small groups/conferences = 3
 PBL groups = 7
 Panel discussion (Hearts and Minds) = 5
 “Other formats” = 3
Assessment of Student Performance
 Final exam: 85%
 Small group “speed” dating: 6%
 Team-based learning: 6%
 Breast exam session: 1%
 Self-directed learning exercise: 2%
3. Content of Final exam (current topics 2013) – 85% of grade
Topic
#
Topic
#
Abortion
1
Male pathology
1
Adolescent sexuality
1
Male sexual dysfunction
2
Breast disease
5
Menopause
1
Cervical dysplasia
1
Menstrual cycle
2
Complications of pregnancy
3
Ovarian
4
Endo/Pregnancy
2
Placenta
4
Erectile dysfunction
2
Pregnancy
5
Genetics
2.5
Prostate
1
HPG axis
1
Puberty
6
Imaging
2
Reproduction pharmacology
5
Incontinence
1
Sex differentiation
2
Infertility
3
Sexual abuse
1
Labor/Delivery
2
Uterus/fallopian
1
Lactation
1
Vulva/uterus
2
3. 2012-2013 Exam items sorted by current course learning
objectives (Hal)
#
Objective
Maps
to
# items
1
Define terms common to the discussion of patients with disorders of the reproductive system.
1a,1c
0
2
Describe the normal structure and physiology of the reproductive system.
1a
1
3
Describe normal stages of maturation and involution of the reproductive system.
1a
3
4
Describe the processes involved in normal pregnancy, labor and delivery and issues in family
planning/contraception.
1a
8
5
Explain signs, symptoms and process of diagnosis of common disorders of the male and female
reproductive system, including: benign and malignant neoplasms; infections; menstrual disorders;
sexual dysfunction; disorders of sexual differentiation; abnormal pregnancy, infertility; pubertal
disorders; urinary tract disorders.
1c
36
6
Explain signs, symptoms and process of diagnosis of common disorders of the male reproductive
tract, including: benign and malignant neoplasms; infections; sexual dysfunction; disorders of sexual
differentiation; infertility; urinary tract (including prostate) disorders.
1c
9
7
Describe the disorders of the reproductive system that affect patients early and late in life.
1c
5
8
Describe the appropriate use of diagnostic testing in patients with disorders of the reproductive
system.
1c, 2g
3
9
Discuss the epidemiology and population health implications of disorders of the reproductive system.
1c
1
10
Discuss the public health and ethical issues involved with reproductive health, including sexual abuse,
sexually transmitted diseases, and unintended pregnancy.
1e
0
11
Describe the pathology and pathophysiology of disorders of the reproductive system
1c
3
12
Explain the basis for pharmacological and non-pharmacological interventions for common
reproductive diseases.
1c
4
2012-2013 Exam items (cont’d)
#
Objective
Maps to
# items
13
Describe how various medical disciplines are integrated and involved with the care,
research and prevention of the disorders of the reproductive system (OB/GYN. urology,
radiology, pathology, pediatrics, psychology, social work, etc)
1c
0
14
Utilize the results of outcome and cost utility studies to evaluate the effectiveness of
patient care, disease prevention and screening in regards to the reproductive system.
5c,6h
0
15
Describe how operations and processes that occur within a complex healthcare system
have an impact on cost and quality of effective care of reproductive system diseases
1f,6d,6e
0
16
Practice and demonstrate systematic problem-solving skills with regard to patients with
reproductive disease.
1c
0
17
Explain ethical issues involved in management of patients with disorders of the
reproductive system.
1e,4d
0
18
Communicate with fellow students and faculty about patients with reproductive system
disease.
3e,3g
0
19
Discuss methods of communication with patients and patient families about reproductive
diseases.
2a,3a,3b,3d
1
20
Demonstrate team skills by participating in team exercises.
4a,4b
0
21
Take responsibility for his- or her-own medical education.
4h
0
22
Read critically, evaluate, and assess medical information and scientific literature about
important reproduction topics and questions.
1b,5b
0
23
Search efficiently for and obtain recent, high quality, relevant medical information and
scientific literature about important clinical topics and questions.
5a
0
3. Exam content (Repro final exam)
Question style
#
Factual only, test recognition/memorization
Important concepts, avoid test fatigue
17
Clinical vignette with reasoning
27
Application of knowledge:
--Interpret findings, data
--Photos of pathology
17
14
3
Negative stem
0
Multiple T/F format
3
Pharmacology questions
5
3. Exam content (cont’d)
Question style
#
Short answer/essay
-- Facts (list some of the…..)
-- Comment on brief clinical vignette
3
1
2
“Multiple Matching)
“Use each item once, more than once,
or not at all”.
9
4. Performance on USMLE Step 1 over last
3 years
4. Performance on USMLE Step 1 over last
3 years
4. Feedback about course:
Student survey scores (Aaron)
Results from recent student course reviews
Data from 2012-2013 evaluations:
Strongest areas:
• “Overall usefulness of reading Text(s).” 3.95
• “How well this course provided me with a useful and appropriate
introduction to this field of discipline.” 3.85
 “Overall clarity of the learning objectives for the entire course and
for each individual learning session.” 3.81
Among the questions asked on the course review pertaining to the
“usefulness” of course elements, none scored below a 3.12.
All faculty were rated at a 3.26 or higher, with 19 of 28 lecturers
receiving a score of 3.70 or higher.
Results from recent student course reviews
Representative comments (strengths):
 Many students commented on the strength and quality of
the lecturers.
 “The course focused on principals that I will probably retain
rather than memorizing facts that I definitely won’t.”
 “TBL was helpful for emphasizing key points.”
 “I also really appreciated the books and the correlation
between the book chapters and what was taught.”
Results from recent student course reviews
Representative comments (weaknesses):
 Several students commented that lecture notes should be given for every
lecture in order to more clearly communicate important points and remedy
the incongruence between lectures and the textbook.
 “I think there was a lot of ambiguity in what we needed to know, despite the
fact that we were supposed to be using our textbook as a guide.”
 The number of TBL cases was overwhelming early on in the conceptually
heavy portion of the course
 Some students felt that greater coordination between clinician lecturers and
pathologist lecturers would increase the clarity and effectiveness of their
lectures.

“Combining multiple topics into one session, or having multiple speakers at one lecture,
sometimes felt overwhelming. The flow of these sessions should be practiced.”
PLANS FOR ADDRESSING
CONCERNS AND ISSUES
FOR NEXT CYCLE, TERM 4,
2014
1. Learning Objectives: Summary
Issue
Proposed Fix
Some of learning objectives too broad See new set of course learning
(e.g. 11); some redundancy among
objectives
obejctives (e.g. 5 and 6)
Group learning objectives by major
competency domain, and map to
specific competency tasks
Done
Make sure that exam topics track to
new learning objectives
In progress for current exam cycle
Consider enhanced coverage of
topics with LCME emphasis (e.g
gender and cultural biases, diversity,
etc.)
Introducing material this year in both
small group sessions and a panel
discussion
2. Learning Opportunities Summary
 Good use of non-lecture formats (58% in
2013, projected to be > 60% in 2014)
 Outside of PBL, limited opportunities to
observe (and evaluate) individual students
3. Evaluating Students, Summary
Issue
Proposed Fix
Learning objectives need to be
granular enough that major exam
areas map well to them
Learning objectives revised for 2014
Learning objectives not assessed on
written final exam must be assessed
in some other way
Some objectives are assessed in
small groups, team based learning,
and self directed learning
Conference leaders may not know
students well enough to assess their
competency in multiple areas
Format was changed to improve
continuity. Faculty have more
longitudinal exposure to students
Written final exam made good use of
vignettes, no negative stems! Need
to eliminate matching questions.
Will be eliminated
4. Feedback from Students
Issue
Proposed Fix
Consider providing lecture notes to
helpful in identifying important points;
lecture notes may be more congruent
with the course than a textbook
Some lecture notes are provided in
the event the text is not congruent.
Powerpoint presentations are posted
as a resource
Clarifying objectives would make it
easier to prepare for the exam
Objective have been revised
Consider decreasing the amount of
TBL sessions early on in the course
and/or using TBL session in a
directed manner to assist in the
learning of particularly confusing
topics
TBL session topics revised
Sessions given by both pathologists
and clinicians could be better
organized and orchestrated
Feedback given to these dyads for
2014