MEC Course Review
1st Year Renal and Endocrine Physiology
Review of Renal/Endocrine Physiology course
• Course occurs in the 2nd term of Year 1
• Course Director – Geza Fejes-Toth (Renal) and
Valerie Galton (Endo)
• Course has 72 curricular hours
• Course was last reviewed in May 2, 2012
Action Plan from Prior Review-Renal
• Review sessions to become more similar to conferences, by
introducing case discussions and relying on active class participation
• Formative quizzes to be introduced
• Add a 5th small-group conference to discuss clinical correlations,
analyze and interpret data
• Small groups will be subdivided into teams of 3-4 students to
promote active participation
• Student performances in the small-group conferences will be graded
based on preparedness, team-work and professionalism
• Failing grade will be 2 SD below the mean value; The final grade will
be less weighted on final exam, now coming 55% from the final exam
and 45% from quizzes and conference grades
• Meet with students to get input on formative assessment questions
• Faculty development to conference leaders to improve consistency
and pedagogy of sessions
Action Plan from Prior Review-Endocrine
• Consider the feasibility of providing narrative feedback to students
with regard to their small group participation
• Revisit the grading policy to consider reducing the weight of the
final exam
• Faculty provide a list of objectives and/or key concepts with each
set of lecture notes, and to remove unnecessary information that is
beyond the level of Year 1 learners
• Evaluate the suitability of new course resources including texts or
modules that are available online
• Introduce content that demonstrates the clinical application of the
material prior to assessment activities
• Meet with a focus group of students for the purpose of examining
the clarity and correlation of assessment questions
• Increasing active learning activities in the course (e.g. reducing
lectures)
Course Objectives
Objective
Link to Program Number of Session
Objectives Mapping
Objective
to Course Objective
1
Describe the various fluid compartment of the body, the
determinants of their sizes and the forces that drive fluid
movement between them.
1a
81
2
Explain the unique aspects of the renal circulation and the
relationship between renal hemodynamics and the regulation
of blood pressure.
1a
68
3
Describe the transport mechanisms that mediate tubular
reabsorption and secretion in the different nephron segments
1a
135
4
Explain the role of the kidneys in the regulation of cell volume
and the mechanisms that regulate water balance.
1a
83
5
Describe the mechanisms involved in the regulation of
sodium balance and the relationship between sodium balance
and the long-term regulation of blood pressure.
1a
78
6
Explain why the regulation of red blood cell production is
vested in the kidney.
1a
56
7
Explain the mechanisms that regulate internal and external
potassium balance.
1a
72
Course Objectives
Objective
Link to Program Number of Session
Objectives Mapping
Objective
to Course Objective
8
Describe the mechanisms that maintain acid-base balance and
discuss the role of the kidney, lung and liver in this process.
1a
81
9
Describe the mechanisms of renal Ca, P and Mg transport and
their hormonal regulation.
1a
24
10 To communicate effectively with colleagues
3e
45
11 To communicate and interact with colleagues collegially
3g
45
12 To behave respectfully and responsibly towards colleagues and
4b
45
4c
50
4g
50
4i
50
faculty at all times.
13 To meet professional responsibilities fully, including being
punctual, present, and engaged educational activities, and being
reliable in commitments to tasks
14 To accept responsibility for his/her own actions. Receive
constructive criticism and feedback well. Demonstrate the desire
to learn and improve.
15 Take responsibility for his/her own medical education, and take
initiative in optimizing his/her personal education plan.
Course Objectives
Objective
Link to Program Number of Session
Objectives Mapping
Objective
to Course Objective
16
Develop the habit of, and strong commitment to, continuous
inquiry and lifelong learning.
5f
50
17
To explain the roles of the endocrine system in maintaining
homeostasis, integrating growth and development, responding to
environmental insults and promoting successful reproduction
1a
17
18
To discuss the definition of a hormone in terms of its general
properties
1a
2
19
To differentiate among endocrine, paracrine and autocrine
systems.
1a
5
20
To describe the different classes and chemical structures of
hormone
1a
32
21
To identify the glands, organs, tissues and cells that synthesize and
secrete hormones, hormone precursors and associated
compounds.
1a
31
22
To describe the synthesis and modes of secretion of hormones
1a
50
23
To explain how the secretion of hormones is regulated, including
the principles of negative and positive feedback mechanisms
1a
57
Course Objectives
Objective
Link to Program
Objective
Number of Session
Objectives Mapping
to Course Objective
24
To explain the importance of patterns of hormone secretion
such as pulsatile, diurnal and cyclicle.
1a
21
25
To explain how hormones are transported in the blood and
the consequences of the reversible binding of many
hormones by plasma proteins
1a
17
26
To explain the basis of hormone assays and assessment of
biological activity
1a
10
27
To describe how hormones are metabolized in blood and
tissues and the importance of hormone activation and
degradation
1a
24
28
To discuss the clearance and excretion of hormones and their
metabolic derivatives
1a
22
29
To define and discuss the physiological actions of hormones
relating them whenever possible to human disorders
1a
101
30
To explain the consequences of under- and overproduction
of hormones
1a
54
Course Objectives
Objective
31 To describe and discuss the roles of hormone receptors in hormone
action including their location, type and signaling pathways
32 To compare and contrast the different mechanisms of action of
hormones: i.e. those exerted by modulation of gene expression;
those achieved by changes in protein activity.
33 To identify and discuss the integration of the endocrine system in
general with focus on specific interactions.
34 To apply the above information to determine the pathophysiological
basis of specific endocrine disorders.
35 To communicate effectively with peers and faculty in conferences
and to evaluate, assess, discuss and/or present relevant scientific
literature.
36 To discuss the physiological distribution and the control of turnover
and utilization of critically important elements and substances such
as calcium, phosphorus and energy-rich compounds.
37 To discuss the molecular, biochemical and physiological effects of
hormone on cells and tissues.
Link to Program
Objective
Number of Session
Objectives Mapping
to Course Objective
1a
37
1a
29
1a
59
1a, 1c
56
3e
7
1a
36
1a
58
Course Objectives – Geisel Competencies
There are 37 course objectives that fulfill Geisel
competencies as follows:
• 29 address specific knowledge in the preclinical
domain, and seem appropriate
• 3 address communication skills
• 4 address components of professionalism
• 1 address personal improvement
Currently no course objectives are mapped to Geisel
competencies 2 (clinical skills) and 6 (health care systems).
Course Objectives – Geisel Program Objectives
The course objectives fulfill the program objectives as follows:
• Course objectives address 2 of the 6 program objectives for Geisel
competency 1
• Course objectives address 0 of the 9 program objectives for Geisel
competency 2
• Course objectives address 2 of the 8 program objectives for Geisel
competency 3
• Course objectives address 4 of the 12 program objectives for
Geisel competency 4
• Course objectives address 1 of the 6 program objectives for Geisel
competency 5
• Course objectives address 0 of the 10 program objectives for
Geisel competency 6
Course Objectives – Geisel Program Objectives
Objectives will need to map to new Geisel Program Objectives
• Medical Science
– Objectives are comprehensive and detailed, perhaps many can be
combined together and specifics can be used as session objectives
– Have objectives cover broader spectrum of the Medical Science
Program Objectives domains (which I think are accomplished in
this course)
• Clinical Care– not covered but this is appropriate for this
course
– Perhaps can use “Identify and interpret the results of frequently
ordered laboratory, imaging, and other diagnostic studies.”
Course Objectives – Geisel Program Objectives
Objectives will need to map to new Geisel Program Objectives
• Population Health—not covered, seems appropriate
• Communication Skills—Some domains covered, in particular
communicating with colleagues and faculty
• Personal, Professional, Leadership Development
– Should have a number of domains covered from this competency: selfassessment, constructive feedback, active discussion, lead effectively
ones’ self & ones’ team
• Evaluation and Improvement in Medicine
– Might cover first objective: assess balance between risk/benefit
• Professionalism– will definitely have some of these domains
covered
• Collaboration and Teamwork– similarly, current objectives
have a number of these domains covered
Course Objectives – Format/Distribution
• Course objectives are prominently displayed on Canvas and are
written in correct format
• Most course objectives on Canvas match the ones in Ilios
Not present on Canvas:
– Describe transport mechanisms that mediate tubular reabsorption and
secretion in the different nephron segments
– Describe the mechanisms of renal Ca, P and Mg transport and their hormonal
regulation
– Discuss the definition of a hormone in terms of its general properties
– Differentiate among endocrine, paracrine and autocrine systems
– Discuss the physiological distribution and the control of turnover and
utilization of critically important elements and substances such as calcium,
phosphorus and energy-rich compounds.
– Communicate effectively with peers and faculty in conferences and to
evaluate, assess, discuss and/or present relevant scientific literature.
Not present on Ilios:
– Practice and demonstrate critical thinking and problem solving skills
– Practice team skills and demonstrate the ability to work constructively with
others
Course Objectives – USMLE Brochure
• On USMLE Brochure for Step I
– Embryonic development, fetal maturation, perinatal
changes
– Organ Structure and function
– Cell/tissues structure and function, including hormone
synthesis, secretion, action, metabolism
– Repair, regeneration, and changes associated with stage of
life
– Electrolyte and water metabolism
• Course focuses on function
– Course objectives go in much more depth than topics on
USMLE Brochure
Session Objectives – Format/Distribution
• All sessions have objectives with rare exception
– Some sessions have 15-20 objectives per session
– Suggest combining and summarizing many together to
achieve sessions with 4-8 objectives per session (makes
more accessible, and easier to evaluate)
– No objectives
• “Hormones of Adrenal Cortex”
• All Endocrine Conferences need objectives– (conference 1– no
objectives posted on Canvas—probably simply an oversight)
• They are all written in the correct format
• Session objectives on Canvas do not match what is
listed in Ilios
Session Objectives - Redundancy
• Insulin– purposeful repetition
– Comes up in multiple courses at session level in Biochem, Renal
and Endo Phys, Year 2 and 4 Pharmacology, SBM Endo and FEK
– Comes up as course objective in SBM Endo
• Pheochromocytoma
– Only in SBM Endo; no longer redundancy here
• Vasopressin
– Renal and Endo Phys, SBM FEK, SBM Endo, CTO
• Sodium or Water– purposeful reinforcement
– Renal Phys, SBM FEK, Cardio Phys, Endo Phys, Neurosci, Micro,
Path, SBM Cardio, SBM Neuro, Pharm (Yr 2 and 4), SBM ID,
Surgery Clerkship, Advanced Medical Science (Yr 4)
Session Objectives - Redundancy
• Acidosis
– SBM FEK and SBM Endo and SBM Resp
– Renal Phys
– Clin Pharm
• Thyroid
– Endo Phys
– SBM Endo, 2nd year Pharm, CTO, HAE, On Doctoring, Pathology
– Clin Pharm
• Potassium
–
–
–
–
SBM FEK, SBM GI, SBM Cardio
Renal Phys, Cardio Phys, Neuroscience
2nd year Pharm
4th year AMS and Clin Pharm
Summary regarding Objectives
• Course and Session Objectives are present and written in
correct format
• They cover a nice spectrum of program objectives and
the content suggested by USMLE
• Both sets can be more summarized– very detailed and
can be rewritten at a more general comprehensive level
– Make them more accessible
– More easily evaluated
• Course Objectives nearly match between Ilios and Canvas
– Should be mapped to new Geisel Program Objectives
• Session Objectives are significantly different between
Ilios and Canvas
Course Learning Opportunities
Renal
•
•
•
•
Lecture 16 hrs (49%)
Conferences 10 hrs (31%)
Reviews 4 hrs (12%)
Assessment: 2 quizzes, final exam (8%)
Endocrine
•
•
•
•
Lecture 14 hrs (46%)
Conferences 10 hrs (33%)
Reviews 4 hrs (13%)
Assessment: 2 quizzes, final exam (8%)
Course Learning Opportunities
• Both courses employ active learning through small
group conferences to large extent
– Students divided into teams
– Student teams expected to prepare questions/answers
ahead of time to teach/explain answers to the other team
– In final endocrine small group conference, student pairs
present a paper
• Interactive Large Group Review Sessions prior to
Quizzes except for Quiz 3 (the first endocrine quiz)
• Lecture format used less than 50% of in-class
learning time
Summary regarding Pedagogy
• Uses a mixture of small group active learning, large
group active learning, and lecture based formats
• Appears to be an appropriate spectrum of pedagogy,
though as will be discussed later, faculty
development for small group facilitators may still be
needed
Assessment
• Written Quizzes (40% of grade)
– Four 20 multiple choice question Quizzes
– Practice Quiz made available for preparation
– Each count 10% of grade, together 40% of grade
• Final Exam (40% of grade)
– 25 Renal and 25 Endocrine multiple choice questions
– Board format emphasizing key concepts rather than
memorization
• Conference Performance (20% of grade)
– Facilitators assign scores to each team, based on mastery of the
material, ability to explain it to peers, and team’s
professionalism
– Each member of the team receives the same score
Assessment
• Additional Requirement for Passing
• Pass from your conference facilitator
– Criteria based on mastery of the material, ability to explain
it to peers, and team’s professionalism
• Any student receiving a grade of Fail from either the
Renal or the Endocrine conference leader may take
an oral examination conducted by a faculty member
other than the student’s conference leader
Assessment – Quizzes
• All Quizzes are Multiple Choice Questions, Board
style
– No “negative” formats such as “all of the following
EXCEPT”
• Questions that test application and understanding of
knowledge, not simple memorization:
–
–
–
–
12/20 for Quiz 1
13/20 for Quiz 2
13/20 for Quiz 3
14/20 for Quiz 4
• Questions correlate well with course objectives
Assessment – Final Exam
• All Questions are MCQs, Board style
– There is ONE question written in “negative” format (“all of
the following EXCEPT”)
• #45: In a child entering puberty, which of the following hormones
does NOT promote chondrogenesis and/or osteogenesis with
accompanying linear growth?
• Questions that test application and understanding of
knowledge, not simple memorization:
– Renal questions (16/25)
– Endocrine questions (18/25)
• Questions correlate well with course objectives
Assessment
• Students are not provided with narrative feedback in
the renal portion of the course
• In endocrine, small group facilitators provide
narrative feedback
Summary regarding Assessment
• Questions are MCQs and formatted properly
– The one “negative” MCQ on final exam should be revised
– Questions cover the course objectives broadly and
appropriately
– Close to two-thirds test application and understanding of
knowledge, rather than simple memorization
• Conference performance comprises a fairly
significant portion of the assessment
– Evaluates additional program objectives such as
collaboration and teamwork, communication,
professionalism, personal/professional/leadership
development
Measures of Quality – AAMC GQ
“Indicate how well you think that instruction in Renal and Endocrine Physiology prepared
you for clinical clerkships and electives.” [1=poor; 2=fair; 3=good; 4=excellent]
Geisel
mean 2010
Geisel
mean 2011
Geisel
mean 2012
Geisel
mean 2013
Biochemistry
2.7
2.5
2.6
2.6
Biostatistics/Epidemiology
2.9
3.2
3.2
2.9
Genetics
2.9
2.8
2.8
2.6
Gross anatomy/Embryology
3.6
3.5
3.6
3.4
Immunology
2.9
3.0
3.1
2.7
Intro to Clin Med/On Doc
3.5
3.4
3.5
3.0
Microanatomy/Histology
2.8
2.9
3.1
2.8
Microbiology
3.1
3.2
3.3
3.0
Neuroscience
3.2
3.0
3.0
Pathology
3.2
3.1
Pharmacology
3.4
Physiology
Measur
es of
Quality
– AAMC
GQ
Geisel
mean 2014
All schools
means 2014
2.8
2.7
3.2
2.8
2.8
2.9
3.6
3.4
2.7
3.1
3.3
3.5
3.1
2.9
3.1
3.2
3.0
3.2
3.2
3.4
2.8
3.1
3.3
3.1
3.1
2.6
3.1
3.1
3.6
3.6
3.5
3.1
3.4
3.4
Behavioral Science
3.2
3.3
3.3
3.0
3.2
3.2
Pathophysiology of Disease
3.5
3.5
3.5
3.3
3.5
3.5
Measures of Quality – Step I
2012*
2013*
2014*
Means 12-14
Biochemistry
0.30
0.20
0.22
0.24
Biostatistics/Epidemiology
0.43
0.40
N/A
N/A
0.08
0.08
TRADITIONAL CORE DISCIPLINES
Biostatistics
Genetics
0.28
0.18
0.28
0.25
Gross anatomy/Embryology
0.33
0.26
0.14
0.24
Histology/Cell Biology
0.37
0.26
0.23
0.29
Microbiology/Immunology
0.31
0.47
0.39
0.39
Pathology
0.26
0.24
0.20
0.23
Pharmacology
0.22
0.22
0.12
0.19
Physiology
0.38
0.35
0.25
0.33
*values reported for core disciplines are SD above the US/Can mean for Geisel mean scores
Measures of Quality – Step I
SYSTEMS-BASED TOPICS
Behavioral sciences
2012*
2013*
2014*
Means 12-14
0.43
0.26
0.15
0.28
0.01
0.01
0.02
0.23
0.39
0.39
0.54
0.48
0.25
0.25
Biostatistics, Epidemiology, Pop Health
Cardiovascular system
0.20
0.47
Endocrine system
Gastrointestinal system
0.32
0.59
General Principles of Found Sciences
Hematopoietic/lymph systems
0.14
0.18
0.09
0.14
Immune system
0.22
0.53
0.16
0.30
0.23
0.23
0.19
Multisystem Processes & Disorders
Musculoskeletal, skin, CT systems
0.24
0.34
-0.02
Nervous system
0.25
0.21
N/A
Nervous system and Behavioral Health
0.06
0.06
Nutrition
0.56
0.39
0.22
0.39
Renal/urinary system
0.42
0.21
0.23
0.29
Reproductive/endocrine systems
0.42
0.39
N/A
Reproductive system
Respiratory system
0.29
0.31
0.39
0.39
0.18
0.26
*values reported for core disciplines are SD above the US/Can mean for Geisel mean scores
Measures of Quality – Course Evaluation
Overall Satisfaction
AY 2014-2015
Prior year
Human Anatomy and Embryology II
4.57
4.57
Human Anatomy and Embryology I
4.35
4.33
Metabolic Basis of Disease
4.35
4.23
Biochemical and Genetic Basis of Medicine
4.34
3.97
Physiology-Renal
4.19
4.32
CTO
4.07
3.79
Virology
3.77
3.71
Physiology-Endocrine
3.76
3.81
Immunology
3.67
2.35
Physiology-Respiration
3.34
3.38
Physiology-Cardiovascular
3.23
3.45
Year 1 courses (fall, winter)
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Measures of Quality – Course Evaluation
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Renal
Physiology
2012 (95.5%)*
Renal
Physiology
2013 (87.2%)*
Renal
Physiology
2014 (93.5%)*
Overall satisfaction of course
4.53
4.32
4.19
Clarity of learning objectives
not available
4.35
4.19
Organization of the course
not available
4.40
4.10
How well the course introduced me to
this discipline
4.55
not available
4.24
Congruence of assessment questions to
material emphasized in course
4.55
4.32
4.01
*student participation rate on course evaluation
Measures of Quality – Course Evaluation
scale [1=poor; 2=fair; 3=good; 4=very good; 5=excellent]
Endocrine
Physiology
2012 (95.5%)*
Endocrine
Physiology
2013 (87.2%)*
Endocrine
Physiology
2014 (93.5%)*
Overall satisfaction of course
3.78
3.81
3.76
Clarity of learning objectives
not available
3.85
3.84
Organization of the course
not available
3.83
3.66
How well the course introduced me to
this discipline
3.93
not available
3.99
Congruence of assessment questions to
material emphasized in course
4.07
3.85
3.62
*student participation rate on course evaluation
Measures of Quality – Course Evaluation
Renal Physiology - Summary of Student Comments
Particularly Well Done
• Clear expectations and consistency
• Integration of the lecture, small groups, iBook,
and course materials
• Organization and timely posting of materials
Could Have Been Better
• Difficult to read iBook
• Clarity of conference grades
• Canvas app does not work for course
Measures of Quality – Course Evaluation
Renal Physiology
Suggestions
• Remove hyperlinks from iBooks and integrate the
slides directly into the text
• Provide a clear grading rubric for small group
• Check with tech support to make sure things are
uploaded to Canvas correctly
Summary regarding Measures of Quality
Renal Physiology
• This course is consistently well-received by students
and rated in the “very good” to “excellent” range –
the course director and his faculty are to be
commended for their efforts
• Students do very well on Step I in this discipline
• Students suggest minor adjustments to make the
course even better
• The major issues are presentation of the iBook and
transparency in small group evaluation
Measures of Quality – Student Comments
Endocrine Physiology - Summary of Student Comments
Particularly Well Done
• Small group discussions
• Clinical correlation
• Sensitivity to certain subjects
Could Have Been Better
• Student presentations
• Consistency and clarity of materials (i.e. notes, iBooks)
• Unnecessary removal of ‘controversial’ medical pictures
Measures of Quality – Course Evaluation
Endocrine Physiology
Suggestions
• Create consistent format for supplemental
lecture materials
• Reevaluate group presentations
• Re-insert any removed medical photographs into
appropriate lectures
• Provide a clear grading rubric for small group
Summary regarding Measures of Quality
Endocrine Physiology
• This course is consistently well-received by students
and rated in the “very good” range – the course
director and her faculty are to be commended for
their efforts
• Students do very well on Step I in this discipline
• Students suggest minor adjustments to make the
course even better
• The major issues are consistency of material and
small group presentations
Vertical Integration topics
• Fluid and Electrolyte Disorders
• Diabetes and Insulin
• Prostaglandins
– 2nd year Pharm
– Gen Pathology
– Endo Phys
Recommendations
• Keep up the good work! Overall the course is very well
received.
• Course Objectives
– Combine/summarize, make more general such that there are 15-20
overarching objectives (rather than a course objective for each lecture
session)
– Map to the new Geisel Program Objectives
• Session Objectives
– Similarly, combine/summarize into 3-5 objectives and make more
general so the goals/objectives of a session are easy to take in
• Make sure the Course and Session Objectives on Canvas
match what is on Ilios; communicate with Brian Reid to rectify
any inconsistencies
Recommendations
• Small Group Conferences
– Add in a self-directed learning objective for the small groups (to deliberately
call this out– since this is the expectation anyway)
– Consider the grading; the “score” caused much angst
• Make Pass Fail, but have everyone who passes get a “100%” so it still counts towards overall
grade percentage
• (having everyone get 100% is same effect as everyone getting 80%, but it goes over better and
serves same purpose– they pass conferences)
• Sessions
– Renal– subdivide ibook into chapters and sections/paragraphs so there are
clear subdivisions and easier to visualize
– Endo– consistency of materials for each session
– Canvas ipad app didn’t work; troubleshoot this technological glitch
• Endo small group presentation
– Find a way to make it more active and engaging for audience (listening and
being attentive for two straight hours was challenging for the students)
– Ideas: Do the students need to present in person? Can they prepare and post
on Canvas for all the read through? Can they present it on a video uploaded
to Canvas? Make sure the goal of the session is being accomplished (is it to
learn material or do a presentation?)
Action Plan--Renal
• Dr. Fejes-Toth agrees with the Recommendations of
our MEC Sub-Committee
• He may not be directing the course next year so he
wanted to address the specifics of the Action Plan
once the new course director is identified
• then can propose the Plan at a later date to the MEC
Action Plan--Endocrine
• As suggested the course objectives have been rewritten
– by eliminating unnecessary detail/combining some of them, there are now
only 10
– These have been mapped to the new Geisel program objectives
– The session objectives have been or will be reduced to fewer than eight
objectives.
• Conferences will be graded on a pass/fail basis and a grade of pass
in the conferences will be required to pass the course.
– The decision not to give a number grade is based on the fact that over
almost 30 years we have not found a way to do this that is satisfactory to
both faculty and students
– The issue is compounded by the fact that the student groups will increase
from 12 to 16
• The final exam grade and the mean of the quiz grades will likely
have an equal weight in the overall class grade; waiting for
announcement of new Renal course director
• Thus there will be two components to passing the course
– A pass in the conferences and a pass in the test scores.
Action Plan--Endocrine
• Create consistent format for supplemental lecture materials
– The lecture materials are prepared individually by six lecturers each
with their own style. I will provide a template and suggestions to all of
them and ask them to conform as best they can.
•
Reevaluate paper presentations
– We feel that this is an important part of the course
– We give them papers mostly on clinical topics that are highly relevant
to the course material
– It is an excellent exercise for them and in my experience the students
do this very well
– It does require some work but it also introduces another important
component in their academic development
• Re-insert any removed medical photographs into appropriate
lecture
– I will make a decision on this issue when I am preparing my 2016
lecture next winter