2015/16

Undergraduate Medical Education

Oregon Health and Science University

2015/16

Foundations of Medicine Educational Leaders Handbook

Table of Contents Preface .......................................................................................................................................................... 1

Philosophy of the OHSU School of Medicine ................................................................................................ 1

Education Curriculum ................................................................................................................................... 1

Guiding Principles of the OHSU MD Curriculum ........................................................................................... 1

Student, Faculty, and Administrative Expectations ...................................................................................... 2

Structure ....................................................................................................................................................... 2

UME Curriculum Template ........................................................................................................................... 3

Evaluation of Student Performance .............................................................................................................. 4

Learning Goals/Objectives

Planning and Modifying Sessions Process ................................................................................................ 6

Sample Purpose Statement and Related Block Goals ............................................................................... 8

Blooms Taxonomy of Educational Objectives ........................................................................................... 9

OHSU UME Competencies ...................................................................................................................... 11

Instruction

Active Learning Assistance ...................................................................................................................... 19

Quick Guide- Active Learning Strategies ................................................................................................. 20

Session Planning Worksheet Process ...................................................................................................... 21

Course Material Deadlines ...................................................................................................................... 22

Using Copyrighted Materials in Your Teaching ....................................................................................... 26

Foundations of Medicine Course Numbers ............................................................................................ 27

Block Durations/Dates ............................................................................................................................ 28

Med18 Curriculum Case List ................................................................................................................... 29

Attendance and Live Streaming Policies ................................................................................................. 30

Exemplar Case Communication Preparation (Monday 8am session) ..................................................... 31

Exemplar Case Introduction (Monday 8am session) .............................................................................. 32

Weekly Schedule templates .................................................................................................................... 34

CSL Group Learning Contract .................................................................................................................. 36

Sample CSL Study Guide ......................................................................................................................... 37

Request for Time-Off from FOMA or CSL ................................................................................................ 40

Enrichment Week Deadlines ................................................................................................................... 42

Preceptorship .......................................................................................................................................... 43

Student Suggestions for Presentations ................................................................................................... 44

Tips for Effective Discussion Facilitation ................................................................................................. 78

Classroom Resources

AV Training materials .............................................................................................................................. 82

EPIC

EPIC Training Environments .................................................................................................................... 87

Library Resources

Library Reserves ...................................................................................................................................... 91

Assessment

Weekly Assessment Timeline.................................................................................................................. 93

Weekly Quiz Creation Process ................................................................................................................ 94

Writing Strong Multiple Choice Questions (MCQ’s) ............................................................................... 95

Writing Strong Matching Questions ....................................................................................................... 96

NBME Exam Creation and Editing Process .............................................................................................. 98

Assessment Analysis & Adjustment Process ......................................................................................... 100

Remediation Process............................................................................................................................. 104

Test Item Difficulty, Discrimination Index and Point Biserials .............................................................. 108

Grading Rubric for short answer assessments ...................................................................................... 111

Sample Clinical Skills Assessment Checklist .......................................................................................... 112

Request for Time-Off for Assessment ................................................................................................... 113

Teaching Evaluation & Quality Improvement

Teaching Evaluations of Sakai ............................................................................................................... 116

FoM Session Instruction Observation Rubric ........................................................................................ 117

UME Quality Dashboard ....................................................................................................................... 118

Educational Leaders

Duties and Responsibilities ................................................................................................................... 120

Meetings and meeting schedules ......................................................................................................... 120

FoM 2015/16 Organizational Chart ...................................................................................................... 122

FoM 2015/16 Director Team ................................................................................................................ 124

Foundations of Medicine Team (all inclusive) ...................................................................................... 127

Colleges Team ....................................................................................................................................... 128

Scholarly Projects Team ........................................................................................................................ 128

Clerkship/Clinical Experiences Director Team ...................................................................................... 129

Clinical Experience Development Team................................................................................................ 130

Appendix

Generic Syllabus .................................................................................................................................... 132

Scholarly Projects Syllabus .................................................................................................................... 142

Sample Session Planning Worksheet .................................................................................................... 151

Weekly Schedule Templates (plug in) ................................................................................................... 156

OHSU UME Curriculum Terminology .................................................................................................... 158

Educational Leaders Position Descriptions

Foundation of Medicine Lead ............................................................................................................... 161

Block Director ........................................................................................................................................ 163

Thread Director ..................................................................................................................................... 165

Prematriculation Block Director ........................................................................................................... 167

Director of Clinical Skills Lab Faculty Development .............................................................................. 169

Clinical Skills Lab Instructor ................................................................................................................... 171

Director of Narrative Medicine ............................................................................................................. 173

Preceptorship Director .......................................................................................................................... 175

CSL Recruitment Packet ........................................................................................................................ 177

Preface This handbook was created to assist you in understanding the yourMD processes and procedures to ensure the effective and efficient delivery of the Foundations of Medicine curriculum (9 blocks). It is to be used as a guide and items may be updated accordingly.

Philosophy of the OHSU School of Medicine Undergraduate Medical Education Curriculum The purpose of the undergraduate medical curriculum is to foster transformation of the learner into a physician. In addition to transferring information and skills, medical education should prepare the student for lifelong learning and scholarship; synthesis of information, critical reasoning and problem solving; self-assessment and reflection; and collaborative clinical practice. The OHSU School of Medicine curriculum explicitly integrates the scientific basis of medicine with relevant clinical experiences within and across each year of learning. It offers students progressive patient care responsibilities, fosters independent learning, and allows individualization of educational experiences. Students learn in an integrated system model, in which scientific principles of normal and abnormal human structure and function are woven throughout, and other important themes are incorporated as threads.

Guiding Principles of the OHSU MD Curriculum The curriculum is guided by the following tenets:

1. Integration of foundational and clinical sciences throughout the curriculum promotes comprehension and retention.

2. Learner-centered teaching modalities are selected according to the desired educational outcomes and may include: didactic presentations, team-based learning, problem-based learning, case discussions, simulation, online modules, service learning and clinical experiences.

3. Competency-based assessment evaluates student mastery of knowledge, skills and attitudes. 4. Training is aligned with the institutional missions addressing healthcare needs of the state and

region. 5. The curriculum embraces the principles of diversity and inclusion, scientific discovery and

innovation. 6. All physicians need a foundational core of knowledge, skills and attitudes, which the curriculum

provides while maintaining the flexibility to allow the development of expertise in specific areas of concentration.

7. Clinical experiences beginning in the first year and continuing throughout the medical curriculum reinforce integration and application of new knowledge, enhance clinical and communication skills, and foster development of professional identity.

8. Clinical experiences in rural, medically underserved, and other community settings provide perspective as well as exposure to the key role of social determinants of individual patient and population health. Carefully designed shared learning experiences foster the knowledge, skills and attitudes needed for practicing as part of an interprofessional care team that operates within a larger system of care.

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9. The curriculum effectively prepares the MD graduate for transition to the next phase of training as a resident.

Student, Faculty, and Administrative Expectations Students are expected to engage fully in all aspects of the medical education program, and to contribute to the learning of their classmates.

The faculty are responsible for defining the specific content and learning modalities of each course and clerkship. Faculty are expected to participate in and support the education mission of the School of Medicine. In recognition of the importance of this mission, achievement as an educator will be an important component for faculty academic advancement.

The Associate Dean for Undergraduate Medical Education, under the supervision of the Senior Associate Dean for Education, is responsible for maintaining the quality and effectiveness of the curriculum and all other aspects of the undergraduate medical education program. The Curriculum Committee and subcommittees assist with this work, and facilitate input of the faculty into the curriculum structure and function.

Structure

• An optional self-assessment and learning opportunity is offered prior to matriculation to help prepare students for success in the undergraduate medical curriculum.

• A required introductory block familiarizes the student with general concepts of the foundational sciences, and promotes the knowledge, skills and attitudes necessary for the professional development of the physician.

• The foundational science curriculum is organized into integrated, multidisciplinary units, relating normal and abnormal structure, function and behavior with the epidemiology, pathophysiology, prevention and treatment of disease, together with emerging disciplines such as informatics and quality improvement science.

• Required clinical clerkships follow the foundational science curriculum to provide a broad experience in clinical medicine.

• Electives, selectives, and mentored scholarly activity leading to a capstone project are provided to enhance the educational value of the curriculum, allow increased breadth and depth in specific areas, and permit individualization of each student’s educational experiences.

• Intersession courses are provided to facilitate the progression from undergraduate to professional school, from the foundational curriculum to the core clinical experiences, and from medical student to resident physician. They are also used to reinforce foundational sciences.

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UME Curriculum Template (without acceleration)

Funda- mentals

(7 weeks)

Foundations of Medicine Blood &

Host Defense

(5 weeks)

Skin, Bones & Musculature

(5 weeks)

Hormones &

Digestion (7 weeks)

Cardiopulmonary & Renal

(11 weeks)

Pre-

mat

ricul

atio

n Se

lf-As

sess

men

t and

Lea

rnin

g

Developing Human

(6 weeks)

Nervous System & Function (9 weeks)

USM

LE S

tep

2 CK

& C

S

August July January

Core

Sele

ctiv

es/

Elec

tives

Core

Inte

rses

sion

Inte

rses

sion

Inte

rses

sion

Inte

rses

sion

Scholarly Project, “deep dives”

Residency application/ interviews

First 12 months

Second 12 months

Third 12 months

Last 12 months

Capstone (finale, all

MS4s required)

Asse

ss

Optional, but encouraged for all, freely accessible

Selectives/Electives

Potential graduate student involvement

within blocks/ intersessions

Gra

duat

ion

Summative assessments

are integrated, multi-modal, competency-

based

Asse

ss

Asse

ss

Asse

ss

Asse

ss

Asse

ss

Asse

ss

Threads and Preceptorship

Threads and Preceptorship

Core

Sele

ctiv

es/

Elec

tives

Core

Core

Rural and Continuity Experiences Rural and Continuity Experiences

Rural and Continuity Experiences

Orie

ntat

ion

USM

LE S

tep

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Preceptorship: Early & Longitudinal Clinical Experience

Threads: • Professionalism • Ethics • Communication • Patient Interview,

Examination & Clinical Reasoning

• Epidemiology, EBM, Informatics

• Health Policy, Quality & Safety

• Anatomy • Embryology • Histology • Cell Biology • Genetics • Biochemistry • Nutrition • Physiology • Pathology • Pharmacology • Microbiology • Immunology

Intersessions: basic science--clinical science healthcare delivery science

integrated curricula

Threads

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Evaluation of Student Performance

• The evaluation of student performance includes the following core competencies: medical knowledge, patient care and procedural skills, professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice.

• The evaluation of student performance applies both traditional approaches and performance-based assessment of the acquisition of clinical skills, knowledge and attitudes.

• Evaluation of student performance is timely, includes formative and summative feedback, and is provided by faculty who are familiar with the performance of the student.

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Learning Goals/Objectives

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Planning and Modifying Sessions Process

You will soon receive one excel document and one link to an online form from Janet Wheeler, M.Ed., Curriculum Development Specialist. They are as follows:

1. Excel Document: Curriculum Spreadsheet (for existing sessions) The Curriculum Spreadsheet identifies the title, date and time of an existing session and the objectives for the session and may need to be edited.

2. Link: New Session Worksheet (for brand new sessions ONLY). The new session worksheet is an online form for the creation of a new session that does not currently exist in the block.

Curriculum Spreadsheet (for existing sessions) – To be completed by Block Directors • Make any changes to a session on the Curriculum Spreadsheet as indicated by the prompts below. • When referring to changes within the session(s) or to move a session, please identify the session by the alpha

numeric tag at the beginning of the session name (i.e. 04.1e:M - as circled below). • Email the edited Curriculum Spreadsheet to Janet to make modifications to an existing session.

Curriculum Spreadsheet Example (for existing sessions)

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New Session Worksheet (for new sessions ONLY) – Online form to be completed and submitted by Block Directors. Submit a separate form for EACH session.

• Use the New Session Worksheet link to create a new session in the block. • All information identifying the instructor, week, title, day/date and times are required. The form must be

completed in its entirety to submit. All fields are required to enter the new session into Curriculum. • When you have completed the form, click the “Submit my session” button or “Save my progress” to resume

later. • Once the new session is put into ilios it will show up on the Curriculum Spreadsheet and any further changes

can be made using the process listed above.

New Session Worksheet Example (for new sessions ONLY) – Online form

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Sample Purpose Statement and Related Block Goals This course is a multidisciplinary presentation of the basic anatomy, physiology, biochemistry, pharmacology and pathology of the nervous system. This course will link knowledge of the basic functioning of the nervous system with an understanding of the pathophysiology of major neurologic and psychiatric diseases. Knowledge gained in this course will serve as a foundation upon which you will build during clinical clerkships in Neurology, Neurosurgery and Psychiatry, as well as your other clerkships. The purpose of this course is to serve as an introduction applied basic science knowledge of the nervous system. At the end of this course, students should be able to use their knowledge of the anatomy of the nervous system to localize focal damage within the CNS, and to assemble a reasonable differential diagnosis starting with a set of archetypal neurological or neuropsychiatric signs.

1. Identify the anatomy of the various sensory functional systems within the CNS, (e.g., somatosensory systems, visual system, auditory system, vestibular system, etc.).

2. Identify the anatomy of the various parts of the nervous system that contribute to motor functions (e.g., motor cortex, basal ganglia, cerebellum).

3. Apply your knowledge of the anatomy of these various functional systems to localize focal damage within the CNS, including being able to predict the sidedness and location of focal damage within major subdivisions of the CNS.

4. Recognize the cardinal manifestations (i.e., syndromes) of common or archetypal neurological disorders.

5. Distinguish between various types of motor problems by observing patterns of weakness, coordination, reflexes and muscle tone.

6. Distinguish between various types of higher cognitive dysfunction, and to describe the cardinal manifestations of focal CNS damage that results in memory dysfunction, speech problems, spatial reasoning problems, and other aspects of higher cognition.

7. Appreciate how the various extra- axial tissues and spaces (e.g., meninges, ventricles, choroid plexus, subarachnoid space, etc.) contribute to normal neurological function, and how disturbances of these tissues and spaces can contribute to dysfunction.

8. Understand the biological basis of drugs (e.g., analgesics, antipsychotics, antiepileptics, antidepressants, anxiolytics, etc.) that are commonly used in the treatment of CNS pathologies, psychiatric disturbances, epilepsy, motor system pathologies, cortical pathologies, etc. To be able to recount their major side effects.

9. Recognize structures relevant to various neurological pathologies in CT and MR images through the brain. 10. Understand the biological basis of various pathologies of the CNS, including inflammatory and immune processes, ischemic

processes, neurodegenerative processes, metabolic disturbances, neoplastic disease, etc. 11. Understand how various congenital malformations of the nervous system occur and how they manifest themselves in

patients.

What is a Block Goal? Block goals should cover the big ideas and skills of a block. A block of typical length will likely have between 8 and 15 goals. All session objectives should tie (in some way) to a block goal though they may tie to several. Block goals should address two fundamental questions:

1. What impact will this block have on a student two or three years after this block is over?

2. What would differentiate a student who took this block from a student who did not?

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OHSU SoM UME Competencies YourMD

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Preamble: In August, 2014, Oregon Health & Science University (OHSU) School of Medicine (SoM)

launched a new curriculum for its entering medical school class. This curriculum transformation was

the result of several years of planning, widespread input from key stakeholders, and careful

deliberation in order to fundamentally change how we educate physicians-in-training so that we may

achieve our primary goal: to optimally prepare our graduates for 21st century residency education

and professional practice in order to meet the needs of society. The OHSU SoM Undergraduate

Medical Education (UME) competencies outlined below have evolved from the previous UME

Program Objectives from 2013, and are aligned with local and national perspectives for competency-

based education. Specifically, the OHSU SoM UME Competencies in this document were compiled

and devised using four primary sources:

OHSU SoM UME Program Objectives (2013)

OHSU Graduation Core Competencies (2013)

Clinical Informatics Competencies for UME (2014)

Association of American Medical Colleges (AAMC) General Physician Competencies

(https://members.aamc.org/eweb/upload/Core%20EPA%20Curriculum%20Dev%20Guide.pdf)

Each of the 43 numbered competencies listed herein is categorized under one of six Domains of

Competence (DOC) in bold. This is consistent with the Accreditation Council of Graduate Medical

Education (ACGME) competency nomenclature for residency education and because of the

continuum of medical education from UME to GME, and from GME to continuing professional

development and lifelong learning. Medical students at OHSU will obtain the M.D. degree once all

M.D. program graduation requirements have been met. This includes, but is not limited to, achieving

designated milestones associated with each competency below as evidenced by robust, multi-modal

competency-based assessments in classroom settings, as well as in both simulated and authentic

(actual) clinical environments.

As competency-based medical education and assessment evolves, so will the OHSU SoM UME

Competencies. In particular, as Entrustable Professional Activities (EPAs) and UME milestones are

defined across and within, respectively, the competencies listed herein, the language in this

document will be refined to best describe the desired learning outcomes for OHSU SoM medical

graduates. Periodic minor updates and revisions to this document will be presented first to the SoM

UME Curriculum Committee, and then to a smaller workgroup of the SoM Faculty Council for

approval, members of which will be named by the Dean. Larger, substantive changes to this

document will be presented first to the SoM UME Curriculum Committee before final approval by the

full Faculty Council and subsequently, the Dean of the SoM.

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OHSU SoM UME Competencies YourMD

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Patient Care and Procedures: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

1. Gather essential and accurate information about patients and their conditions through history taking, physical examination, review of prior data and health records, laboratory data, imaging and other tests.

2. Interpret and critically evaluate historical information, physical examination findings,

laboratory data, imaging studies, and other tests required for health screening and diagnosis. 3. Construct a prioritized differential diagnosis and make informed decisions about diagnostic

and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment.

4. Develop, implement, and revise as indicated, patient management plans.

5. Apply personalized healthcare services to patients, families, and communities aimed at preventing health problems and maintaining health.

6. Perform all medical, diagnostic, and surgical procedures considered essential for the specific clinical practice context.

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OHSU SoM UME Competencies YourMD

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Medical Knowledge (Knowledge for Practice): Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care.

1. Apply established and emerging bio-medical scientific principles fundamental to the

healthcare of patients and populations. 2. Apply established and emerging knowledge and principles of clinical sciences to

diagnostic and therapeutic decision-making, clinical problem-solving and other aspects of evidence-based healthcare.

3. Apply principles of epidemiological sciences to the identification of health risk factors,

prevention and treatment strategies, use of healthcare resources, and health promotion efforts for patients and populations.

4. Apply principles of social-behavioral sciences to assess the impact of psychosocial and

cultural influences on health, disease, care-seeking, care-adherence, barriers to and attitudes toward care.

5. Apply principles of performance improvement, systems science, and science of health care delivery to the care of patients and populations.

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OHSU SoM UME Competencies YourMD

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Practice-based Learning and Improvement: Demonstrate the ability to investigate and evaluate the care provided to patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on analysis of performance data, self-evaluation, and lifelong learning.

1. Demonstrate skills necessary to support independent lifelong learning and ongoing professional development by identifying one’s own strengths, deficiencies, and limits in knowledge and expertise, set learning and improvement goals, and perform learning activities that address gaps in knowledge, skills or attitudes.

2. Participate in the education of peers and other healthcare professionals, students and

trainees.

3. Use clinical decision support tools to improve the care of patients and populations.

4. Use information technology to search, identify, and apply knowledge-based information to healthcare for patients and populations.

5. Continually identify, analyze, and implement new knowledge, guidelines, practice standards,

technologies, products, and services that have been demonstrated to improve outcomes.

6. Analyze practice data using quality measurement tools and adjust clinical performance with the goal of improving patient outcomes and reducing errors.

7. Participate in scholarly activity thereby contributing to the creation, dissemination, application, and translation of new healthcare knowledge and practices.

8. Incorporate feedback received from clinical performance data, patients, mentors, teachers, and colleagues into clinical practice to improve health outcomes.

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OHSU SoM UME Competencies YourMD

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Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.

1. Communicate effectively with patients, families and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.

2. Counsel, educate and empower patients and their families to participate in their care and

improve their health; enable shared decision-making; and engage patients through personal health records and patient health information access systems.

3. Demonstrate insight and understanding about pain, emotions and human responses to disease states that allow one to develop rapport and manage interpersonal interactions.

4. Use health information exchanges (e.g., Care Everywhere within the EPIC electronic health

record) to identify and access patient information across clinical settings.

5. Effectively access, review, and contribute to the electronic health record for patient care and other clinical activities.

6. Effectively communicate with colleagues, other health professionals, and health related

agencies in a responsive and responsible manner that supports the maintenance of health and the treatment of disease in individual patients and populations.

7. Effectively communicate patient handoffs during transitions of care between providers or settings, and maintain continuity through follow-up on patient progress and outcomes.

8. Act in a consultative role, including participation in the provision of clinical care remotely via telemedicine or other technology.

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OHSU SoM UME Competencies YourMD

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Professionalism and Personal & Professional Development: Demonstrate a commitment to carrying out professional responsibilities, an adherence to ethical principles, and the qualities required to sustain lifelong personal and professional growth.

1. Demonstrate responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disability, socioeconomic status, and sexual orientation.

2. Demonstrate respect for protected health information and safeguard patient privacy,

security, and autonomy.

3. Demonstrate a commitment to ethical principles pertaining to provision, withholding or withdrawal of care, confidentiality, informed consent, and business practices, including conflicts of interest, compliance with relevant laws, policies, and regulations.

4. Demonstrate sensitivity, honesty, and compassion in difficult conversations about

issues such as death, end-of-life issues, adverse events, bad news, disclosure of errors, and other sensitive topics.

5. Adhere to professional standards when using information technology tools and electronic/social media.

6. Demonstrate responsiveness to patient needs that supersedes self-interest by mitigating conflict between personal and professional responsibilities.

7. Demonstrate awareness of one’s knowledge, skills, and emotional limitations and demonstrate healthy coping mechanisms and appropriate help-seeking behaviors.

8. Demonstrate integrity, establish oneself as a role model, and recognize and respond appropriately to unprofessional behavior or distress in professional colleagues.

9. Demonstrate accountability by completing academic and patient care responsibilities

in a comprehensive and timely manner.

10. Demonstrate trustworthiness that engenders trust in colleagues, patients, and society at large.

11. Recognize that ambiguity and uncertainty are part of clinical care and respond by demonstrating flexibility and an ability to modify one’s behavior.

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OHSU SoM UME Competencies YourMD

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System-based Practice and Interprofessional Collaboration: Demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to effectively call upon other resources in the system to provide optimal care, including engaging in interprofessional teams in a manner that optimizes safe, effective patient and population-centered care.

1. Participate in identifying system errors and implementing system solutions to improve patient safety.

2. Incorporate considerations of resource allocation, cost awareness and risk-benefit analysis in

patient and population-centered care.

3. Demonstrate accountability to patients, society and the profession by fully engaging in patient care activities, and maintaining a sense of duty in the professional role of a physician.

4. Effectively work with other healthcare professionals to establish and maintain a climate of

mutual respect, dignity, diversity, integrity, honesty, and trust.

5. Effectively work with other healthcare professionals as a member of an interprofessional team to provide patient care and population health management approaches that are coordinated, safe, timely, efficient, effective, and equitable.

Approvals:

SoM Curriculum Committee: September 11, 2014 SoM Faculty Council first read: December 4, 2014 SoM Faculty Council second read: February 5, 2015 SoM Dean: February 9, 2015

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Instruction

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Active Learning Assistance

As part of yourMD, faculty members teaching in the Undergraduate Medical Education curriculum are encouraged to utilize active learning techniques in the classroom to increase student engagement and content comprehension. Active learning in the classroom means that students engage in activities such as discussion or problem solving that promote analysis, synthesis, and evaluation of class content. Group discussions, think-pair-share, problem-based learning, the use of case methods and simulations are some approaches that promote active learning.

The Collaborative Life Sciences Building Learning studios and small group rooms include state-of-the-art instructional technology and lecture capture (Echo 360). Seasoned and new faculty alike are encouraged to leverage these resources as well as contact a teaching specialist in the OHSU Teaching and Learning Center for assistance in developing simple and effective active learning strategies.

Upon request, a Faculty Development Specialist is available will meet with you to help:

OHSU’s Teaching and Learning Center provides one-on-one and small group consultation and teaching skill support to all faculty to ensure a successful teaching and learning experience. Simply phone or email Sarah Jacobs, M.Ed., the TLC Faculty Development Specialist assigned to UME and set up an appointment to meet at the CLSB, your office, or wherever is convenient for you. Bring your PowerPoint, images, study guides and list of any pre-work that you expect the students to complete. For best results, it is recommended that you schedule your meeting a week or two prior to teaching so that you have plenty of time to implement any desired changes and to ensure that any extra materials you may need can be accessed.

Sarah Jacobs, M.Ed. Faculty Development Specialist

OHSU Teaching and Learning Center 503.494.2527 or meltonsa@ohsu.edu

• prioritize objectives and major concepts for your session(s) • create meaningful links between your session content and

the weekly exemplar case • identify easy and high yield methods for active learning

including the use of student response systems (“i-Clickers”) • learn how to use the available instructional technology (incl.

Sakai) to achieve the results you want • develop questions for use formative and summative

assessments

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Quick Guide - Active Learning Strategies LOW TIME REQUIREMENTS

• Pause (simply stop and ask students to review their notes with someone sitting nearby--1 minute) • Think/Pair/Share or Write/Pair/Share (ask the students to think/write and make a commitment to an answer, an

idea, a thought; share that with a partner and discuss similarities/differences; debrief with large group if needed depending on task.

• Clicker questions 1) present a question with 4 discrete answers--one correct, three as foils that focus on the common mistakes students make; 2) as them to make a choice and tell them that making a choice is the most important thing--get a commitment! 3) share answers with a partner nearby--if in agreement, then discuss the other choices and why those were less desirable answers; if not in agreement, try to convince the other your answer is better; 4) bring the class back together and show then the correct answer AND explain why the incorrect answers are incorrect. You can do this in 3 minutes.

MEDIUM TIME REQUIREMENTS

• Concept maps--have the students work in groups to create a picture of how main concepts related to each other with directional arrows and explanations (e.g. X causes Y, A necessary for B); OR show the students your concept map (big picture), point to the area of the map you will be exploring in this part of your session; then hide the map and ask the students to reproduce the section you just discussed--working in pairs, trios, small groups. If you do this, you need to be sure your concept map is NOT in your posted slides. 10 minutes

• Compare/contrast charts. In the first column of a Table you list the attributes you want the students to consider. At the top of the other columns (no more than 3 for early learners), list the concepts--one per column--that you want the students to compare and contrast. For example, mitosis and meiosis--how are they different, how are they the same? Give the students the labeled Table with the attributes and have them fill it out during your presentation. Then, use the "pause" principle for students to work together to make corrections or complete the chart. You can have them come up and use the projection camera to show their charts if you want. 3-5 minutes. Alternatively, have them work in groups to complete the whole chart at a break in the session to see what they remember or wrote down in notes. 5-7 minutes.

LARGE TIME REQUIREMENTS

• Team-based Learning (TBL--the "formal thing" we are doing on Monday mornings)--only the most ambitious of teachers should try this in year 1

Created by: J. Bowen Dec 2014

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Session Planning Worksheet Process Summary: The Session Planning Worksheet (SPW) collects the following valuable information:

1. Room set-up information 2. Course materials 3. Multiple Choice Questions (MCQs) * Secondary process- see Weekly MCQ Quiz Creation process

Each instructor will be sent a link to the SPW form for their block and asked to complete it in a timely manner by the deadlines identified (a listing of deadlines for AY 15/16 has been provided in this handbook). This information is essential for the operations team to facilitate the proper set up of classrooms, build the course site on Sakai and the timely creation of weekly assessments.

Process:

1. A member of TSO staff will send an email and a calendar appointment to each faculty member for each session they teach containing the SPW link. Block Directors are encouraged to send out the SPW link to faculty prior to this time if faculty wishes to work on their SPW earlier.

2. Instructors complete the SPW link and submit any accompanying documents (PowerPoints, pre-work/readings, study guides and other supplemental materials, ect.) by the due date listed on the SPW form

3. Completed SPWs are routed back to TSO 4. A member of the TSO staff will review the SPW for room set-up information, course materials, and MCQ’s.

They will contact the faculty directly if any information is unclear or missing 5. A member of the TSO staff will upload all accompanying documents into the appropriate Box folder (block &

thread directors will have viewing access to the box folders) 6. Every Tuesday, a member of the TSO staff will publish a weekly report of all SPW data received and upload to

the appropriate box folder for block and thread directors to review. Additional reports may be sent as needed or requested.

Please note: Missing or late materials will be added to reports the following Tuesday. Delays in submitting session materials will impact our ability to prepare for a session.

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Course Material Deadlines To facilitate the proper set up of the classroom, build out of the Sakai course sire and timely creation of weekly assessments, we ask that each instructor submit a Session Planning Worksheet (SPW) by the following dates. Deadlines are set for the Monday 2 weeks prior to the week of instruction. See the Session Planning Worksheet for more details.

MS2 Courses: Nervous System & Function

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in session title/date/time, please refer to the Outlook appointment Teresa Andersen has provided or email her at anderset@ohsu.edu

Due Date Week 1 8/10-8/14 27-Jul Week 2 8/17-8/21 3-Aug Week 3 8/24-8/28 10-Aug Week 4 8/31-9/4 17-Aug Week 5 9/7-9/11 24-Aug Week 6 9/14-9/18 31-Aug Week 7 9/28-10/2 14-Sep Week 8 10/5-10/9 21-Sep Week 9 10/12-10/16 28-Sep

Developing Human

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in session title/date/time, please refer to the Outlook appointment Teresa Andersen has provided or email her at anderset@ohsu.edu

Due Date Week 1 11/2-11/6 19-Oct Week 2 11/9-11/13 26-Oct Week 3 11/16-11/20 2-Nov Week 4 11/23-11/27 9-Nov Week 5 11/30-12/4 16-Nov Week 6 12/7-12/11 23-Nov

22

MS1 Courses: Fundamentals

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in

session title/date/time, please refer to the Outlook appointment you have received or email TSO

tso@ohsu.edu

Due Date Week 1 8/19-8/21 3-Aug Week 2 8/24-8/28 10-Aug Week 3 8/31-9/4 17-Aug Week 4 9/7-9/11 24-Aug Week 5 9/14-9/18 31-Aug Week 6 9/28-10/2 14-Sep Week 7 10/5-10/9 21-Sep Week 8 10/12-10/16 28-Sep

Blood & Host Defense

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in

session title/date/time, please refer to the Outlook appointment you have received or email TSO

tso@ohsu.edu

Due Date Week 1 11/2-11/6 19-Oct Week 2 11/9-11/13 26-Oct Week 3 11/16-11/20 2-Nov Week 4 11/23-11/27 9-Nov Week 5 11/30-12/4 16-Nov Week 6 12/7-12/11 23-Nov

23

Skin, Bone & Musculature

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in

session title/date/time, please refer to the Outlook appointment you have received or email TSO

tso@ohsu.edu Due Date

Week 1 1/4-1/8 14-Dec Week 2 1/11-1/15 21-Dec Week 3 1/18-1/22 4-Jan Week 4 1/25-1/29 11-Jan Week 5 2/1-2/5 18-Jan

Cardiopulmonary & Renal

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in

session title/date/time, please refer to the Outlook appointment you have received or email TSO

tso@ohsu.edu

Due Date Week 1 2/22-2/26 8-Feb Week 2 2/29-3/4 15-Feb Week 3 3/7-3/11 22-Feb Week 4 3/14-3/18 29-Feb Week 5 3/28-4/1 7-Mar Week 6 4/4-4/8 21-Mar Week 7 4/11-4/15 28-Mar Week 8 4/18-4/22 4-Apr Week 9 4/25-4/29 11-Apr

Week 10 5/2-5/6 18-Apr Week 11 5/9-5/13 25-Apr

24

Hormones & Digestion

Week of Instruction

Date of Instruction

This form is due by the date listed below. Deadlines are based on the week your session will take place. To fill in

session title/date/time, please refer to the Outlook appointment you have received or email TSO

tso@ohsu.edu

Due Date Week 1 5/30-6/3 16-May Week 2 6/6-6/10 23-May Week 3 6/13-6/17 30-May Week 4 6/27-7/1 13-Jun Week 5 7/4-7/8 20-Jun Week 6 7/11-7/15 27-Jun Week 7 7/18-7/22 5-Jul

25

Using Copyrighted Materials in Your Teaching Using copyrighted materials in your teaching is common, and the links below will help you understand what your obligations are when it comes to copyright and teaching. Stephanie Kerns, Associate University Librarian and UME Liaison Librarian, is available for all questions related to copyright, best practices for using copyrighted materials in your teaching and determining fair use, and how to request library resources for use in your courses. She can be reached at kernss@ohsu.edu and 503-494-3478. Best Practices Fair Use: What is it and how to determine if what you want to do is covered by it Fair Use is a provision in the U.S. Copyright Act that allows certain uses of copyrighted material without asking the copyright holder for permission. In order to determine whether you are within fair use when posting materials in Sakai or otherwise making materials available to your students, you must evaluate and apply the “four factors” to each use. The easiest thing to do is think about what you want to do and evaluate whether it falls under fair use or not using the links below. If your use does not fall under fair use, contact Stephanie and she can help you determine another resource that the Library might already license for your needs, find another resource freely available that might fit your needs, or help you determine how best to ask for permission to use the resource you want for your needs. Links to resources Fair Use and the Four Factors Explained: https://copyright.columbia.edu/basics/fair-use.html Fair Use Checklist: https://copyright.columbia.edu/content/dam/copyright/Precedent%20Docs/fairusechecklist.pdf Fair Use Examples and How to Ask for Permission: http://fairuse.stanford.edu/

26

Foundations of Medicine Course Numbers

Block and Thread Name SUBJ Number Term Transition to Medical School TRAN 702 Summer Fundamentals FUND 710 Summer- Fall Blood & Host Defense BLHD 710 Fall Skin, Bones & Musculature SBM 710 Winter Cardiopulmonary & Renal CPR 710 Winter - Spring Hormones & Digestion HODI 710 Spring - Summer Nervous System & Function NSF 710 Summer- Fall Developing Human DEVH 710 Fall Preceptorship PREC 721 Fall

Preceptorship PREC 722 Winter Preceptorship PREC 723 Spring Preceptorship PREC 724 Summer - Fall

27

Block Durations/Dates

Med18 Block # weeks Dates

Nervous System & Function 9 Aug 10- Oct 16, 2015 (+Fall break Sept 21-25)

Assessment/Enrichment 2 Oct 19-30, 2015

Developing Human 6 Nov 2-Dec 11, 2015

Assessment 2 Dec 14-18, 2015

Winter Break 2 Dec 21-Jan 1, 2015

MS2 USMLE Study 5 Jan 4-Feb 4, 2016

MS2 Transition to Clinical Experiences

1 Feb 5, 2016

Med19 Block # weeks Dates

Med19 Transition to Medical School

2 Aug 10-18, 2015

Fundamentals 7 Aug 19-Oct 16, 2015 (+Fall break Sept 21-25)

Assessment/Enrichment 2 Oct 19-30, 2015

Blood & Host Defense 5 Nov 2-Dec 9, 2015

Assessment/Enrichment 2 Dec 10-18, 2015

Winter Break 2 Dec 21-Jan 1, 2015

Skin, Bones & Musculature 5 Jan 4-Feb 5, 2016

Assessment/Enrichment 2 Feb 8-19, 2016

Cardiopulmonary & Renal 11 Feb 22-May 13, 2016 (+Spring break Mar 21-25)

Assessment/Enrichment 2 May 16-27, 2016

Hormones & Digestion 7 May 30- July 22, 2016 (+Summer break Jun 20-24)

Assessment/Enrichment 2 July 25-Aug 5, 2016

28

Med18 Curriculum Case List as of 8-6-15

Fundamentals Blood & Host Defense

Skin, Bones & Musculature

Cardiopulmonary & Renal

Hormones & Digestion

Nervous System & Function

Developing Human

Week 1 Healthy Physical Sickle Cell Disease Low Back and Leg Pain

Hemorrhage/Shock Ulcerative Colitis

Headache PID

Week 2 Sickle-cell trait Hemophilia Upper Extremity Weakness

Ventricular Septal Defect (neonate)

Celiac disease Meniere’s Disease Infertility

Week 3 Type 2 Diabetes Mellitus

Rheumatoid Arthritis

Inflammatory Arthritis

Myocardial Infarction GERD Stroke Twin Gestation

Week 4 Colon Cancer Acute Myelogenous Leukemia

Systemic Lupus Erythematosus

End Stage Renal Disease

HCV Cirrhosis Schizophrenia ADHD

Week 5 Type II Diabetes Mellitus revisited

HIV Atopic Dermatitis Vomiting Type II Diabetes Disruptive Behavior

Breast Cancer

Week 6 Torn Anterior Cruciate Ligament

Acute Kidney Injury Secondary Adrenal Insufficiency

Alcohol Use Disorder

Dementia

Week 7 Septic Arthritis Minimal Change Disease

Hyperthyroidism Parkinson’s Disease

Week 8 Asthma Multiple Sclerosis

Week 9 Respiratory Distress Syndrome

Post-traumatic Stress Disorder

Week 10 Lung Cancer/PE

Week 11 Obesity

Week 12 CHF/Mitral Stenosis

29

Attendance and Live Streaming Policies Attendance: Beginning in August, 2015 for the students in the entering class of 2015, attendance will be required and tracked for all Foundations of Medical Anatomy (FOMA) and Clinical Skills Lab (CSL) sessions. Students who are unable to attend will be required to complete the “Foundations of Medicine Request for Time Off- FOMA or CLS session” form prior to the absence and submit this to TSO for consideration of approval. A member of the TSO staff will forward the request to the appropriate Thread Director for review and decision. Students who miss a required session without the approval of the Thread Director will have a Professionalism Monitoring Form submitted for their unexcused absence. The accumulation of Professionalism Monitoring Forms may result in Medical Student Progress Board review. Live Streaming: Beginning in August, 2015, we will live stream (and archive) all sessions taking place in the Learning Studios for both classes held Monday – Friday with the exception of assessments. Sessions that take place outside the learning studios (e.g. FOMA, CSL, any session in a small group room on the second floor) will not be live streamed or recorded for archive purposes.

30

Exemplar Case Communication (Monday 8am session) Preparation Rationale: The Exemplar Case plays an important role for integrating basic science learning in the clinical context, in setting up the basic science concepts to be learned that week, and can trigger examples used in or the design of learning activities for the Science or Clinical Skills Labs. Clinical cases can also spiral forward within and across blocks, creating “return visits” to model longitudinal integration. Thus, many different individuals need to know about the Case-of-the-Week and provide appropriate input in case construction. Case Development Process As faculty responsible for the case introduction sessions the first morning of each week of the curriculum, the block directors are responsible for coordinating changes and communication. These changes will then be sent to the Foundations of Medicine lead. Once all changes have been finalized, the case goes to the Informatics Thread lead, and the EHR Informaticist for entry into the EHR. Stage 1: Case Development or Revision: At least 3 weeks prior to case session During this stage, the block directors will work with the faculty champion of the week and the Foundations of Medicine Director to be certain the proposed case is the best trigger for learning the important concepts of the week. Ideas for altering the case can and should come from anyone involved in that week’s instruction. NOMENCLATURE: Four letter Block name / underline / Week-X / underline / Date / underline / time / initials (e.g. FUND_Week-3_083114_1500JLB) NEED TO KNOW High Stakes – impacts curriculum build

FYI – Potential shift in curriculum build

FYI Only

Case Session Leaders EPIC/Informatics Ilios/Sakai Teachers of the week – Week’s Champion

Foundations of Medicine Director

Faculty Support

Block Directors Clinical Thread Directors Science Thread Directors UME Admin Stage 2: Case Finalization and Publication: At least 1 week prior to case session During this stage the Foundations of Medicine Director will complete final edits and coordinate with Informatics Thread Director, and EHR Informaticist for EPIC production and cloning, with Sakai staff for Ilios/Sakai posting and case naming. NOMENCLATURE: Four letter Block name / underline / Week-X / underline / Date of case presentation / dash FINAL (e.g. FUND_Week-3_090814-FINAL) NEED TO KNOW High Stakes – Build/Impact Case Session Leaders EPIC/Informatics Ilios/Sakai Foundation of Medicine Director Stage 3: Final Case Distribution: Wednesday prior to student case introduction Send ‘FINAL’ case to everyone above. Final version is stored X:\OHSU Shared\Restricted\SOM\Curriculum Transformation

31

FoM Exemplar Case Introduction (Monday 8am) Each exemplar case should be introduced to the class following a similar structure across all blocks. For the Academic Year 2015/2016 the goals for the session are:

1. Introduce the exemplar case of the week via Epic (see Exemplar Case Communication Preparation for more details) and in the Monday 8am session (or another day of the week if Monday falls on a holiday).

2. Generate curiosity questions- both basic science and clinical 3. Include an element of Clinical Reasoning that allows the students to hone their skills in this thread

Each block may choose to approach the goals in differently depending on how far along in the curriculum the block falls. To ensure the goals are incorporated in each case introduction the following members of the FoM team will work together:

1. Block Directors 2. Marc Gosselin 3. Paul Gorman and Gretchen Scholl 4. Pete Sullivan

Case Introduction Framework for Clinical Reasoning, Patient Interviewing & Examination History Physical LABS/Imaging Communication FUND Basic organization

present Chief complaint HPI Family History(genetics) Intro screening

Vital signs Diabetic exam Knee exam

Basic CBC Chem profile Glucose

Introductions

BLHD HPI ROS(confounding) Social history Sexual history/habits Intro Nutrition history

Vitals, esp fever Lymph node exam Joint exam

Immune profile CBC smears/diff Viral serology

Developing raport

SBM Neuro vs. muscle ROS(confounding)

Dermatomes Derm exam

Autoimmune testing Introduce imaging

Cost effectiveness?

CPR Nutrition history ROS(multiple& confounding) Family history Compare/contrast Screening discussion

Cardiac exam Lung exam Volume assessment

Cardiac tests Lipid profile Renal profile Acid base equations

Shared decision making History from family

HODI Symptoms-based HPI Epi Compare/contrast Screening discussion

Diabetic physical- foot Abdominal pain exam Cirrhosis- exam Endocrine- thyroid & adrenals

Liver profile Diabetes labs Endocrine testing

Public health discussions

NSF Symptoms-based Neuro history Psych history Compare/contrast

Neuro exam Eyes & ear exam

Spinal tap Imaging- Neuro

Cost effectiveness Prognosis discussions

DEVH Symptoms-based Pregnancy history Geriatric history Family history Vaccine history

Pediatric exam Geriatric exam

Pregnancy labs Screening- pregnancy

Empathy Talking with parents End of life decisions

32

Example of how the NSF block will organize their sessions:

Each week is organized around a cardinal symptom and a differential diagnosis of 3 possible etiologies for the symptom. All of the diagnoses are either covered during the week or have been discussed in earlier blocks. This format builds upon the team based learning the students have been doing since their first day of medical school.

Prior to Monday morning, the students will research the basic features of each of the 3 diagnoses and read the HPI of a case history. Then in class on Monday morning the students will discuss the presenting symptoms and determine what additional diagnostic information they require to determine which of the three potential diagnoses fit the case. The remaining information will be revealed during class. In addition to discussion, the students will share their “curiosity questions” – or unanswered questions about the diseases, diagnostic strategies, or symptoms. After class, the objective findings and diagnostic findings will be published for student review as well as the completed compare/contrast sheet.

This session is scheduled to last 45min. The goal is to have the students strengthen their clinical reasoning skills and teach each other.

*note that in earlier blocks the process may be more simplistic as students do not have the knowledge base to use EPIC or do in depth clinical reasoning etc.

33

8:00

9:00

10:00

11:00

12:00

12:00-1:00

1:00

2:00

3:00

4:00

5:00

NOTES:

Last updated 3/2/15

All students will be assigned to a group (A, B, or C) for Clinical Skills Lab, Preceptorship, and Independent Learning time.

Students will submit a request for the group they prefer. Students will be assigned a specific group by UME staff. Not all

requests can be accommodated.

Fridays: a portion of Friday can be utilized for review sessions or introduction of new material.

Monday Holiday Weeks: Monday clinical skills and preceptor groups will be distributed between 2 other Clinical Skills

Labs.

AY1516 Monday Holidays:

Sep 5, 2016 (5th week of NSF)

Clinical Skills Labs: 1/3 class in each weekly time slot. Clinical thread directors to determine content each block.

Preceptorship: 1/3 class in each time slot. There are 4 Preceptorship terms total for Foundations of Medicine: Fall term,

Winter term, Spring term, and Summer B + Fall term combined. No preceptorship during Summer A term, students have

an extra independent learning 1/2 day instead.

College Activities: Reserved for individual academic advising/coaching, career advising, service learning, student

wellness, academic opportunities and college spirit events

End-of-Week Assessments every Friday (ExamSoft quizzes, clinical skills, & science skills). Some weeks may only have

ExamSoft quizzes.

Thanksgiving Day and Day After: NO class (and no preceptorships the entire week)

Nov 26/27, 2015 (4th week of DEVH)

College Activities

Large group, Small

group or Science Lab

(All groups)

Assessments

Large group/small

group (All groups)

Clin

ical

Ski

lls L

ab

(Gro

up

A-

1/3

cla

ss)

Pre

cep

tors

hip

(Gro

up

B-

1/3

cla

ss)

Ind

epen

den

t Le

arn

ing

(Gro

up

C -

1/3

cla

ss)

Ind

epen

den

t Le

arn

ing

(Gro

up

A)

Clin

ical

Ski

lls L

ab (

Gro

up

B)

Pre

cep

tors

hip

(G

rou

p C

)

YourMD Foundations of Medicine Weekly Template - Med18

Monday Tuesday Wednesday Thursday Friday

Year 2 begins with Nervous System & Function block and concludes with Developing Human Block

AssessmentsLarge group, Small

group

(All groups)

10 min break per hour

Break Break Break Break Break

Case introduction

Large group, Small

group or Science Lab

(All groups)

Large group, Small

group or Science Lab

(All groups)

Pre

cep

tors

hip

(G

rou

p A

)

Ind

epen

den

t Le

arn

ing

(Gro

up

B)

Clin

cal S

kills

Lab

(G

rou

p C

)

34

8:00

9:00

10:00

11:00

12:00

12:00-1:00

1:00

2:00

3:00

4:00

5:00

NOTES:

Last updated 3/2/15

College Activities: Reserved for individual academic advising/coaching, career advising, service learning, student

wellness, academic opportunities and college spirit events

End-of-Week Assessments every Friday (ExamSoft quizzes, clinical skills, & science skills). Some weeks may only have

ExamSoft quizzes.

Thanksgiving Day and Day After: NO class (and no preceptorships the entire week)

Nov 26/27, 2015 (4th week of BLHD)

Monday Holiday Weeks: Monday clinical skills and preceptor groups will be distributed between 2 other Clinical Skills

Labs.

AY1516 Monday Holidays:

Sep. 7, 2015 (3rd week of FUND)

Jan 18, 2016 (3rd week of SBM)

May 30, 2016 (1st week of HODI)

Jul 4, 2016 (5th week of HODI)

Clin

cal S

kills

Lab

(G

rou

p C

)

Assessments

Clinical Skills Labs: 1/3 class in each weekly time slot. Clinical thread directors to determine content each block.

Case introduction

Ind

epen

den

t Le

arn

ing

(Gro

up

A)

Clin

ical

Ski

lls L

ab (

Gro

up

B)

Pre

cep

tors

hip

(G

rou

p C

)

Ind

epen

den

t Le

arn

ing

(Gro

up

C -

1/3

cla

ss)

Large group, Small

group or Science Lab

(All groups)

College Activities

Pre

cep

tors

hip

(G

rou

p A

)

Ind

epen

den

t Le

arn

ing

(Gro

up

B)

YourMD Foundations of Medicine Weekly Template - Med19

Monday Tuesday Wednesday Thursday Friday

Break

Fridays: a portion of Friday can be utilized for review sessions or introduction of new material.

Large group, Small

group or Science Lab

(All groups)

Year 1 begins with Fundamentals block and concludes with Hormones & Digestion block

All students will be assigned to a group (A, B, or C) for Clinical Skills Lab, Preceptorship, and Independent Learning time.

Students will submit a request for the group they prefer each term. Students will be assigned a specific group by UME

staff. Not all requests can be accommodated.

Assessments

Large group, Small

group

(All groups)

10 min break per hour Large group/small

group (All groups)

Break Break Break Break

Large group, Small

group or Science Lab

(All groups)

Preceptorship: 1/3 class in each time slot. There are 4 Preceptorship terms total for Foundations of Medicine: Fall term,

Winter term, Spring term, and Summer B + Fall term combined. No preceptorship during Summer A term, students have

an extra independent learning 1/2 day instead.

Clin

cal S

kills

Lab

(Gro

up

A-

1/3

cla

ss)

Pre

cep

tors

hip

(Gro

up

B-

1/3

cla

ss)

35

CSL Group Learning Contract Suggested Opening: “I’d like for us to start by talking about how we will do our work together.” Make a list of the key issues on the white board and suggest that someone volunteer to take notes of the contract decisions.

1. Group member participation: What expectations should we have of each other regarding listening, interrupting, building from each other's comments?

a. What do you expect of the facilitator? What do I expect of myself? What do we do about team members who are not prepared?

2. Late Students: What should we do about group members who arrive late? What about those who are

consistently late?

3. Dominant speakers: What should we do about group members who dominate the discussion? 4. Quiet Students: Although we want to respect individual differences in comfort level, learning styles, and

other factors that affect how we each contribute to the discussion, how should we address group members who are quiet or who appear to be non-participants?

5. Distractions:

a. Electronic devices: How should we handle use of smart phones, i-Pads, laptops when not used for group relevant tasks?

b. How shall we address unambiguously off-topic comments? c. What about side-bar conversations?

36

CSL student study guide provided as an example only- Information subject to change based on week

Session objectives:

1. Demonstrate how to greet and put a patient at ease, by applying elements of the AIDET (Acknowledgment, Introduction, Duration, Explanation, and Thanks), and PEARLS (Partnership, Empathy, Apology, Respect, Legitimization, and Support) models.

2. Demonstrate the ability to elicit a patient’s full list of concerns at the beginning of a medical encounter.

3. Demonstrate the ability to negotiate the agenda for a medical encounter.

Student’s Guide to Small Group Activity:

Title: The First 5 Minutes: Relationship-building and Agenda-setting – Patient-centered Habits #1 and 2.

Purpose: This skill-building session will give students an opportunity to practice two of the four core habits for patient-centered communication and care – Habit #1 (relationship-building), and Habit #2 (agenda-setting) – in preparation for what will be ongoing assessments of the four habits throughout the curriculum (e.g., during Clinical Skills Assessments, and end-of-block OSCEs).

Background: This session will give students the opportunity to take turns practicing the initial moments of the medical encounter, in which first impressions are made, relationships begin to develop, and the agenda for the visit is made (ideally). This relationship-building experience is based on material which was covered in Week 1 and Week 3 of the Fundamentals block. In addition, this session revisits and expands on information about agenda-setting, which was also introduced in Week 3 of Fundamentals. Relationship-building and agenda-setting represent the first two of OHSU’s new “4 Habits for Patient-centered Care” model. The other two habits (facilitating understanding and confirming understanding) will be introduced in the next block. Note: the four habits represent a core set of behaviors which we believe should be demonstrated in all medical encounters. Many other recommended communication behaviors are not included in the habits model. This does not mean they are necessarily less important. These other behaviors will be taught, emphasized, and assessed throughout the medical school curriculum in support of and in conjunction with the “four habits.” Many of the behaviors included in the four habits model will be familiar to faculty. Some, however, such as using a “teach-back” technique to confirm understanding, represent newer advances in health communication, and may be less familiar to some. All four habits and related behaviors represent best practices which are too often not practiced in real world clinical settings. We believe that students will likely see many examples of good physicians not demonstrating the desired behaviors when they get into clinical activities. Our hope is that by building strong habits early in their training, we can help “inoculate” students against this “hidden curriculum.” Over time, we anticipate that the four habits model will help change the culture of communication at OHSU as an institution, from a bottom-up approach. We expect students to develop and refine each of the four habits over the course of the curriculum. We will assess their demonstration of these habits at every possible opportunity, including during role-plays, weekly Clinical Skills Assessments (CSAs), and end-of-block Observed Structured Clinical Exams (OSCEs).

37

SMALL GROUP ACTIVITIES (to be done during the small group session):

1) 15 MINUTES. Brain-storming discussion of ways in which students can begin to develop rapport in the first 60 seconds of a medical encounter during their preceptorships.

a. Make a list of ideas. b. What are some counter-examples of ways to sabotage rapport early in the encounter? c. We have not taught this yet, but what are some ways you can work to build upon and/or maintain

rapport throughout the encounter?

2) 10 MINUTES. As a way of reviewing the material in the article on agenda-setting by Baker et al, as a group, create a list of ways in which agenda-setting benefits patients, and ways in which it benefits doctors. Who do you think has the most to gain from good agenda-setting? Why?

3) 30 MINUTES. Role-play exercise: In this activity, you will take turns playing the roles of a) medical student interviewer, c) patient, and c) patient’s friend/observer. Each student should play the role of the medical student interviewer once.

a. Your Faculty Facilitator will provide instructions and materials 4) 10 MINUTE BREAK. 5) 20 MINUTES. Debrief the role-play activity 6) 20 MINUTES. Discuss the Student Assessment Checklist (4 Habits of Patient-centered Care)

Readings:

1. Baker LH, O’Connell DO, Platt FW. “What Else?” Setting the Agenda for the Clinical Interview. Annals of Internal Medicine 2005;143(10):766-70.

2. (Review). Putnam JB. Teaching Physician-Patient Communication (AIDET) for Results in All Pillars. Available at http://www.studergroupmedia.com/WRIHC/presentations/teaching_physician_patient_ communication_(aidet)_for_results_in_all_pillars_vanderbilt_putnam_kennedy_0028.pdf. Accessed 5/28/14. Review the AIDET model from the 1st week of Fundamentals (pp 10-14).

3. (Review). Coleman C. PEARLS for relationship-building and Maintenance. Handout, 9/2/14. Review the PEARLS model for relationship-building from the 3rd week of Fundamentals.

4. (Review). Mauksch LB, Dugdale DC, Dodson S, Epstein R. Relationship, Communication, and Efficiency in the Medical Encounter: Creating a Clinical Model from a Literature Review. Archives of Internal Medicine 2008;168 (13):1387-95. Review Up-front, Collaborative Agenda Setting from the 3rd week of Fundamentals (pp 1390-1).

5. OHSU 4 Habits for Patient-centered Care Student Assessment Checklist. Familiarize yourself with this assessment tool, which you will use to assess each other during a role-play activity this week. In the Fundamentals Block you will only be assessed on the Habits #1 and #2. This tool will be used in multiple other assessments throughout the preclinical curriculum, including CSAs and OSCEs, and you will eventually be assessed on all four habits.

38

6. Fundamentals Week 7 – Agenda-setting – Student’s Guide 7. Optional video: Medical Interviewing: Agenda Setting and HPI. 7-minute video available

at http://www.youtube.com/watch?v=1VqY_62rUSk. This humorous example of agenda-setting also demonstrates examples of relationship-building, and the use of medical jargon as a barrier to patient-centered communication.

39

Foundations of Medicine Request for Time-Off from Foundations of Medical Anatomy or

Clinical Skills Lab Sessions

Students in the Foundations of Medicine curriculum are expected to attend and actively participate in all required learning sessions and assessment activities. Not only will your own learning be enhanced by attending all required sessions, but your classmates and instructors will count on your participation in large and small group activities to enrich their learning. This focus on being present is analogous to what will be expected of you during your clinical experiences, your residency training, and ultimately, your professional practice as a physician. Students should schedule personal activities during University breaks in the academic calendar (totaling 5 weeks per year), or during their Independent Learning session each week. The OHSU School of Medicine Undergraduate Medical Education (UME) program leaders have established attendance expectations for students in the Foundations of Medicine curriculum. Your attendance will not be tracked on a daily basis except for Foundations of Medical Anatomy (FOMA) or Clinical Skills Lab (CSL) sessions. Students wishing to request time-off from a required FOMA or CSL session are required to submit this form for approval. Request for Time-Off from a FOMA or CSL session Due To Emergency Absence/Personal or Immediate Family Illness: In most circumstances, requests from students with emergency absences due to personal or immediate family illness will be granted. Students are still required to submit this form to the Teaching Services Office (TSO) at tso@ohsu.edu once they know they will not be present at a FOMA or CSL session. TSO will forward your request on to the appropriate Thread Director or the Associate Dean for review. Request to Take Time Off from a FOMA or CSL session for Non-Emergency Personal Reason: Request for time off for non-emergency personal reasons may sometimes be approved by the Thread Director or the Associate Dean and can be considered if you submit this Request for Time Off form. As these types of absences can most always be anticipated, students are encouraged to provide as much advanced notice as possible. Not all of these requests will be approved, and students who submit a request that is denied by the Thread Director or the Associate Dean are expected to attend the FOMA or CSL session as scheduled or they will receive a Professionalism Monitoring Form (PMF). Steps for Requesting Time Off:

1. For emergency or anticipated absences, the student will submit this form to the Teaching Service Office (tso@oshu.edu) as soon as possible. TSO will forward your request on to the appropriate Thread Director or the Associate Dean for review.

2. The Thread Director or the Associate Dean will review the request and will approve or deny the

request. Approvals of Requests for Time Off from FOMA or CSL will include any requirements or conditions to be met by the student at the time of approval. The Thread Director or the Associate Dean may consult the Dean’s Office UME Teaching Services Manager to determine if previous days off have been granted to the student in the Foundations of Medicine curriculum. All requests, approved or denied are tracked but the Office of UME.

3. The Thread Director or the Associate Dean will forward the final decision and the signed Request

for Time Off form to the Dean’s Office Teaching Services Manager, Laura Foran (foranl@ohsu.edu), where the attendance records will be maintained for students in the Foundations of Medicine curriculum.

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*****************************************************************************

Completed By Student:

Student Name:

Block Name:

Today’s Date:

Requested Date(s) for Time Off

[ ] FOMA- Date:

[ ] CSL- Date:

Please Select One Category

[ ] Emergency Absence/Personal or Immediate Family Illness [ ] Non-Emergency Personal Reason Please Describe Circumstances and/or Details You Wish To Be Considered For This Request

Student Signature:

Date: *********************************************************************************

Completed By Thread Director:

Thread Director Signature:

Date: Action Taken By Thread Director:

[ ] Approved

Conditions or Requirements:

[ ] Denied 41

Enrichment Week Enrichment Week Session Deadlines class of 2018

Enrichment Block Week of Enrichment

Preliminary Session

Information* Sent to

Emily Larson

Calendar viewing open to students

Registration open

Due Date Due Date Due Date SBM 2/17-2/20 12-Jan 16-Jan 23-Jan

CARE 5/26-5/29 30-Mar 13-Apr 24-Apr

HODI 8/3-8/7 22-Jun 29-Jun 3-Jul

NSF 10/26-10/30 21-Sept 28-Sept 2-Oct

DH None - - -

Enrichment Week Session Deadlines class of 2019

Enrichment Block Week of Enrichment

Preliminary Session

Information* Sent to

Emily Larson

Calendar viewing open to students

Registration open

Due Date Due Date Due Date FUND 10/26-10/30 21-Sept 28-Sept 2-Oct

BLHD 12/14-12/18 9-Nov 16-Nov 20-Nov

SBM (2016) 2/16/16-2/19/16 11-Jan 15-Jan 22-Jan

CARE 5/23-5/27 4-Apr 15-Apr 22-Apr

HODI 8/1-8/5 27-Jun 1-Jul 8-Jul

NSF 10/24-10/28 26-Sept 30-Sept 3-Oct

DH None - - -

*Preliminary Session Information includes:

1. Day of week you wish to run your session 2. Start and end time of session 3. Number of students the session can accommodate (this will help is with room location scheduling) 4. Title and a brief description of the session so that students know what they are signing up for

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Preceptorship

Terms:

Med18

Summer-Fall: August 10 – December 11, 2015

Med 19

Fall: September 28 - December 11, 2015 Winter: January 4 - March 18, 2016 Spring: March 28 – June 17, 2016 Summer - Fall: August 8 - December 9, 2016

Program details: Students meet with their preceptor, once a week for 4 hours. The preceptorship is NOT a shadowing experience. It is expected that students work with their preceptors to integrate into the care team. While not explicitly evaluated, students will conduct patient histories and exams under the supervision of the preceptor.

The preceptorship is designed to familiarize students with working and learning in a clinical setting. The following are goals of the preceptorship:

1. To interact with patients as a student-doctor. 2. To become a member of a health-care team as a student-doctor. 3. To begin thinking as physicians in clinical interaction. 4. To act professionally in clinical settings

We have students participating in almost every specialty and preceptors from OHSU, Kaiser, Providence and Legacy, as well as private practices all over the greater Portland area and as far as Salem.

At the end of each term the Preceptor is asked to evaluate their student(s) using an evaluation from provided from the School of Medicine.

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Student Suggestions for PresentationsApril 2015

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Table of ContentsI Introduction II Slide Design Suggestions

A. Visual • Text Color• Bullet Points• Animations• Graphics• Graphic Color

B. Content • Volume of Text• Slide Numbering• Intro Concept Map / Flow Chart• Research

III Pre-Work Suggestions • Videos• Reading• Timing of Posted Material

IV Presentation Strategy Suggestions • Slide Order• Before / After Copy• 20 Minute “Timer”• iClicker Question Style• Questions During Lecture• Technical Tips

o iClicker Question Administrationo Document Camerao iPad

V Study Guide SuggestionsVI Examples of Effective Slides VII Example of an Effective Study Guide

Pages 3 - 5

Pages 10 - 15 Pages 16 - 34

Page 6

Pages 7 - 8

Page 9

Page 2

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I Introduction This document was created by Nicholas von Foerster (vonfoers@ohsu.edu) and Lucas

Student/Faculty Liaisons for the Class of 2018. To assist faculty with the transition to the new curriculum, we decided to create this document as a reference for some stylistic and presentation suggestions that enhance delivery and greatly help us take clear notes and learn the material. The suggestions are a synthesis of the feedback we have gleaned from our classmates and a response to some common questions from faculty. Particularly effective slides have been included to highlight certain points, as well as an example of a useful study guide. We hope that this document will serve as a useful resource both for new faculty building a presentation, as well as those who have been teaching for decades. Thank you for being receptive to our suggestions, and please feel free to contact us if you have any questions regarding this document.

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II Slide Design Suggestions A) Visual Suggestions

Text Color Works: Light background with dark text allows us to take notes directly on the slides. Doesn’t Work: Dark backgrounds tend to restrict notes to the page margins and make it difficult to write on or draw arrows into the slide.

Bullet Points Works: Points delivered sequentially on slides. This helps focus our attention to the point currently being made. Doesn’t Work: Every bullet point showing up at once. Animations Works: Animations that retain some sort of meaning on the printed copy. Sequential graphics (using sequential slides) are sometimes easier for us to incorporate into cohesive notes. Doesn’t Work: Animations that print with the graphics all jumbled together. It can be challenging to summarize graphic motion into writing fast enough during lecture. Graphics

Works: High contrast colors like black, dark blue, or dark red on white Doesn’t Work: Red text on blue graphics or yellow text on white graphics shows on a monitor but tends to project poorly.

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B) Content Suggestions Volume of Text Works: Limit text on slides to the essentials and include longer explanations in the study guide. Under 75 words on a slide seems to be a sweet spot. Doesn’t Work: Slides that require a lot of reading. Slide Numbering Works: Slide numbers that match both on your presented copy and our printed copy. This helps us quickly reorient ourselves if we zone out by seeing what slide number you’re on. Doesn’t Work: No slide numbers, or slide number only on our copy. If slides are omitted without placeholders the numbers between our copy and your copy cease to be aligned. Introduction Concept Map / Flow Chart Works: Simple and clean concept map at the beginning of lecture and repeated as we change topics so that the arrangement of topics within a group gets engrained in our memory. The following slide is a great example of this:

Doesn’t Work: Large, overly complex diagrams. Any more arrows on the above slide would be a bit much.

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Research Works: We really like to hear about particularly relevant or cutting edge research that directly illustrates an objective, a teaching point, or something useful for clinical practice. The study guide (See section V and VII) is a great place for longer explanations of other research topics. Doesn’t Work: Tangential research that may detract from the overall message and possibly obscure takeaway objectives / points.

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Works: Videos are great. It seems as though the sweet spot for time is under 30 minutes. YouTube, Khan Academy, and Echo360 all work.

Reading Works: PDFs of textbooks are great and easy for us to access on all our devices. UpToDate overviews or review articles can work too, provided they are directly applicable. Ten page volume, or identification of which pages are crucial and which are not as important. If possible, please also give both page number ranges and chapter/section heading titles in the reading assignment because the online versions occasionally omit page numbers. You could even reference parts of your study guide as pre-reading. Doesn’t work: Longer peer-reviewed articles (better to reference these in the study guide, see Section V and VII), or a large page volume for limited lecture time. Timing of Posted Material Works: Post everything early. This helps everyone come prepared, especially those with families or a long commute. We greatly appreciate having a copy of something to take notes on (digitally). This could be slides (without correct clicker answers shown), or a study guide with room for notes. Doesn’t work: Neither the study guide or slides posted prior to lecture. Material posted a day before the session.

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IV Presentation Strategy Suggestions

Slide Order Works: Consistent slide order between our copy and your copy Doesn’t Work: Mismatched slide order leads to frantic scrolling through the document to find the right slide to take notes on. Before/After Copy Works: The “before lecture” copy includes clicker questions with correct answer unidentified and includes tables. Also includes placeholder slides for information you don’t want us to see beforehand so that the numbering between copies remains intact. Big individual filled-out tables can be posted after class. Posting of withheld material immediately after class. Doesn’t Work: An entire second powerpoint with the full tables/info means we have two documents, one with our notes on it and one with the full info. This creates a organizational challenge for us. Please avoid posting the complete material days later.

20 Minute “Timer” Works: Breaking up the flow of things / prevent DVT’s by incorporating some sort of active learning activity every 20 minutes during a presentation has been well-received. This could be a “pair and share” for two minutes with someone nearby, a more involved 5 minute long clinical vignette clicker question, etc. Doesn’t Work: An hour of lecture with no interactivity. This is especially difficult in the afternoon.

iClicker Question Style Works: Questions that assess deeper understanding or application of the material that we just went over. A simple knowledge-based question immediately before could build up to more involved questions. Additionally, questions identified as being on par with test questions are always useful. Doesn’t Work: Questions on material you are about to present in the next section, or exclusively fact recall-based questions from previous slides.

Questions During Lecture Works: Let us know at the beginning if we can ask questions along the way, or if you plan to pause periodically for questions. Defer more obtuse questions with long answers for conversation after class. Doesn’t Work: Allowing obtuse questions to disrupt the flow of the presentation or take it significantly off topic.

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Technical Tips: We recommend trying out the following technology prior to your session so that you’re familiar with its operation. Some things less intuitive to operate than others. Please contact Nick Crampton (cramptni@ohsu.edu) or Laura Foran (foranl@ohsu.edu) in the Teaching Services Office to arrange a tutorial.

iClicker Question Administration Works: Let us read the questions at our own speed, and use a count up timer (rather than count down) and then stop when most of the class has voted. Doesn’t Work: Countdown timer, reading the question and all possible answers aloud. Document Camera Note: Located on the right side of the podium, this is an excellent resource for drawing out diagrams (like you would do on a whiteboard), except it will project to all the screen and will be captured on the recording. Tip: It takes some practice to work the zoom, focus, switch inputs between that and the powerpoint, etc. Works: Dark thick marker drawn large on white paper. Sharpies are great but be careful – they may go through a single sheet of paper onto the surface. Doesn’t Work: Ballpoint pen. iPad This will allow you to control the iClicker system, mouse pointer, and the powerpoint from anywhere in the room. Tip: Learning the “touch” of the finger mouse/pointer and getting it to project takes practice and is not intuitive. Works: Using the finger/mouse pointer while looking at the projection (rather than at the iPad). This will get onto the recording. Doesn’t Work: Slowly using the finger/mouse pointer. The software won’t pick it up and the pointer will not show on the screens.

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The study guide is where we turn when we want to make sure we have understood everything the way you intended and to revisit the material from another perspective. The study guide is also a place for the objectives to be answered clearly so that we can use our notes to supplement and reinforce the objectives, rather than exclusively rely on our notes. This allows us to spend more brainpower synthesizing the material. Additionally, the end of the study guide is a great place for stuff that didn’t quite make it into the powerpoint.

An example of a particularly useful study guide has been included as Section VII. Other study guides have been very useful as well, but for the sake of brevity of this document they have not been included. Feel free to contact us if you would like an example of another useful study guide.

Components of the Ideal Study Guide • Clearly state the objectives• Clearly explain concepts as they relate to the objectives at the level of detail that is

important for us to know• Include charts or tables that help us differentiate diseases / drugs / etc• Include flow charts and diagrams that assist in differentiating concepts• Include references to pertinent pages / sections in First Aid, Pathoma, BRS Review,

etc.• Include delineated sections with extra detail / resources for those who are particularly

interested in a topic• Include further references or supplemental reading for those who are particularly

interested in the topic

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VI Examples of Effective Slides

Many instructors have presented excellent slides, but for the sake of brevity of this document only six have been included. Please feel free to contact us if you would like additional examples of slides or have any questions about why we find these helpful.

Slide 1 – This slide was presented multiple times during the BLHD block and it allowed us to quickly orient ourselves to how the current lecture fit into grand scheme of things. This is an example of a great concept map for the various related malignancies. At first glance it’s a bit daunting with a lot of paths and arrows, but the arrows were added sequentially so that we didn’t have this full web during the first week. Additionally, we saw this concept map so many times that it became quite familiar and ended up being a very useful study resource.

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Slide 2 – This is an example of a slide that is extremely easy to come back to months after seeing it and immediately understanding what it was referring to. The graphics are simple, minimal, and labeled. For slides where the point is not quite as apparent, it’s helpful to have the “thesis” of the slide in the title (i.e. for the above slide, “G-6-PD analysis is used to evaluate tissue clonality”), or a little blurb on the side to help us interpret a complex chart or graph from some research.

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Slide 3 – The things we are expected to know on a visual slide are labeled clearly. This eliminates the guesswork when we come back to this slide later in the event that we didn’t write each one down if they were unlabeled. Even just an arrow pointing to which cell or histological feature we should direct our attention to is really helpful for the untrained eye. It is also helpful to be able to compare cell types / sizes right next to each other for maximum contrast.

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!!!

!

Slide 4 – This slide was used to illustrate the variation in the course of disease, specifically to the timeline with regards to involvement of different organ systems. It was extremely effective for driving the point home as a later slide. Great use of minimal text and simple graphics – this helps keep the slide clean and makes it very easy for us to take notes directly on the slide.

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Slide 5 – This slide is busy but the presenter spent a significant amount of time going through it to help us understand the logic and to have it make sense to us. Slides like these help us tease out the nuances between pathologies. We can clearly identify what we should know by the red boxes. It was very effective to come back to while studying. This is a good example of a slide that is effective when presented by only showing one disease / grouping on the slide at a time so that we don’t get overwhelmed with all of them at once.

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Slide 6 – It’s really clear to see what branches have what effects. This was very helpful come time to review and piece everything together. This slide is an example of another graphic that can be reused by instructors who are presenting on similar topics to help us quickly remember the original topic, reinforce a point, and anchor the theme between presentations.

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VII Example of an Effective Study Guide

We have included Dr. Dao’s study guide as an example of one that is clear and well organized with a useful balance of content. All subsequent pages of this document were created by Dr. Dao.

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MYELOPROLIFERATIVE NEOPLASMS Tuesday November 25, 2014 9:00-10:15am

Kim-Hien Dao, DO, PhD

OBJECTIVES

1. Name three Philadelphia chromosome-negative, classical myeloproliferative neoplasms and describe key pathophysiological features shared by these neoplasms.

2. Name the two key genes most often mutated in the Philadelphia chromosome-negative myeloproliferative neoplasms.

3. List five causes of reactive or secondary thrombocytosis.

4. Describe the clinical features, complications, and treatment of essential thrombocytosis.

5. List five causes of reactive or secondary polycythemia.

6. Describe the clinical features, complications, and treatment of polycythemia vera.

7. Describe the typical blood and bone marrow findings in patients with primary myelofibrosis and the role of JAK2 inhibition in clinical management.

8. Describe some clinical and genetic features typically associated with myeloproliferative

neoplasm disease progression or clonal evolution.

The relevant sections to review these objectives are expertly highlighted by Professor Owl:

#

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Table of Contents MYELOPROLIFERATIVE NEOPLASMS ............................................................................................... 1 OBJECTIVES ......................................................................................................................................... 1 INTRODUCTION .................................................................................................................................... 3 I. THE MYELOPROLIFERATIVE NEOPLASMS ................................................................................... 4 A. The MPN clones derive from somatic mutations in pluripotent stem cells .......................................... 4 B. Classification of MPNs ....................................................................................................................... 4 C. Molecular defects in Classical MPNs ................................................................................................. 5 D. MPN as a familial disease .................................................................................................................. 6 E. Key pathophysiological features in Philadelphia-negative MPNs ........................................................ 7 II. ESSENTIAL THROMBOCYTOSIS .................................................................................................... 9 Diagnosis ............................................................................................................................................... 9 Differential diagnoses ........................................................................................................................... 10 Prognosis, complications, and treatment .............................................................................................. 10 III. POLYCYTHEMIA VERA ................................................................................................................ 11 Diagnosis ............................................................................................................................................. 11 Differential diagnoses ........................................................................................................................... 12 Prognosis, complications, and treatment .............................................................................................. 12 IV. PRIMARY MYELOFIBROSIS ........................................................................................................ 14 Diagnosis ............................................................................................................................................. 14 Differential diagnoses ........................................................................................................................... 15 Prognosis, complications, and treatment .............................................................................................. 15 REFERENCES ..................................................................................................................................... 18

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INTRODUCTION

Myeloproliferative neoplasms (MPNs) are characterized by acquired somatic mutations at the level of the hematopoietic stem cell resulting in abnormal expansion of MATURE myeloid cells. Examples of classical chronic myeloproliferative neoplasms include chronic myeloid leukemia (CML), polycythemia vera (PV), essential thrombocytosis (ET), and primary myelofibrosis (PMF, also known as agnogenic myeloid metaplasia). The main clinical characteristics of these disorders include marrow hypercellularity, extramedullary hematopoiesis, a propensity toward thrombosis and hemorrhage, and increased risk for leukemic transformation. In contrast to the situation in acute leukemia (in which hematopoietic precursor cells do not undergo terminal differentiation), cellular differentiation from immature precursor cells to mature blood cells proceeds in a normal fashion. Consequently, there are simply too many cells (red cells in PV, or platelets in ET, or leukocytes in CML) being produced in patients with these diseases and generally at least one of the blood cell counts is high. Clinically, patients with MPN can present with seemingly trivial symptoms and in others the diagnosis is revealed by a severe life-threatening complication. Symptoms can include fatigue, fevers, weight loss, pruritus, drenching sweats, indigestion, abdominal pain, bone pain, burning feet, erythromelalgia, bleeding, or thrombosis. Some patients have no symptoms and the clinician is alerted to the disorder only by an abnormal screening blood count. At present, there are no curative options available for the vast majority of patients (the only curative option is a hematopoietic stem cell transplant). Current treatment goals focus on supportive care to manage cytopenias (low blood counts) and constitutional symptoms, decreasing the risk of life-threatening thromboses, modify or reduce risk for disease progression or leukemia development, and ideally, overall survival.

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I. THE MYELOPROLIFERATIVE NEOPLASMS A. The MPN clones derive from somatic mutations in pluripotent stem cells It is currently thought that MPN arises from the genetic alteration of a hematopoietic stem cell (HSC). Evidence that this is a clonal process was first suggested over 30 years ago in studies that characterized non-random inactivation of genes located on the X-chromosome (e.g., G6PD and HUMARA) in blood samples from patients with PV. The JAK2V617F mutation can be found in myeloid cells as well as lymphoid cells from patients with PV, suggesting that the disease originates in an early progenitor that retains pluripotent potential. Direct evidence came from isolating HSCs by fluorescence-activated cell sorting (FACS) from patients and proving that the cells carry the JAK2V617F mutation. Although the JAK2V617F mutation can be detected in lymphoid cells of patients with MPN, the disease clinically affects only the myeloid lineage. The reason for the lack of involvement in the lymphoid lineage has yet to be elucidated.

B. Classification of MPNs Using the 2008 WHO classification system, “atypical” MPNs are conditions that do not fit in the classical MPN group or in the myelodysplasia (MDS) group. These disorders tend to have features of both MDS and MPN. Other examples of “classical” MPN include chronic neutrophilic leukemia, chronic eosinophilic leukemia, and mast cell disease.

Philadelphia chromosome-

NEGATIVE MPN

Philadelphia chromosome-

POSITIVE MPN

Classification of MPNsMYELOPROLIFERATIVE NEOPLASMS

Chronic myelomonocytic leukemia (CMML)

Juvenile myelomonocytic leukemia (JMML)

Atypical chronic myeloid leukemia (aCML)

Atypical

Primary Myelofibrosis (PMF)

Essential Thrombocytosis (ET)

Classical

Polycythemia vera (PV)

Chronic myeloid leukemia (CML) Unclassifiable MDS/MPN

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C. Molecular defects in Classical MPNs The molecular defect in CML is BCR-ABL, an abnormal fusion protein that is formed as a result of the t(9;22) (Philadelphia) chromosomal translocation. This mutation leads to uncontrolled ABL tyrosine kinase activity. In 2005, mutation in the JAK2 tyrosine kinase (JAK2V617F) was found in practically all patients with PV and in approximately 50% of patients with PMF and ET. Current thinking holds that other mutations activate JAK2/STAT signaling in patients without JAK2V617F mutation. Indeed, in 2013 it was discovered that the majority of JAK2V617F-negative PMF and ET were found to have a mutation in CALR, a gene that encodes calreticulin. A number of co-existing mutations have been identified in various subsets of MPN and modify disease characteristics and overall prognosis.

Mutually exclusive mutations: Gene Genomic Location Frequency Pathophysiology ABL 9q34 (ABL1) CML 100%

Not present in other MPNs Translocation generates the BCR-ABL oncogene and activates ABL tyrosine kinase activity.

JAK2

(janus kinase 2) 9p24 PV 96%

ET 30-50% PMF 50%

Activating mutation of JAK2 tyrosine kinase (JAK2V617F) leading to JAK/STAT pathway activation. Increased cytokine production and proliferation of hematopoietic precursors.

Calreticulin 19p13.2 PV 0% ET 30%

PMF 30%

Calreticulin has a role in protein folding and calcium homeostasis. Frameshift mutations result in alternative stop codon usage and a novel C-terminal peptide in exon 9. Mutant calreticulin activates JAK/STAT signaling.

MPL (myeloproliferative

leukemia virus) 1p34

PV rare ET 3-5% PMF 10%

Encodes the thrombopoietin receptor. Mutation (W515L or W515K) activates thrombopoietin receptor and contributes to megakaryocyte proliferation.

Other co-existing mutations: Gene Genomic Location Frequency Pathophysiology TET2

(tet methylcytosine dioxygenase 2)

4q24

PV 16% ET 5%

PMF 17% Blast phase MPN 17%

Possible tumor suppressor gene May contribute to epigenetic modulation of transcription.

ASXL1 (additional Sex Combs-

Like 1) 20q11.1

PV 2-5% ET 5%

PMF 13-23% Blast phase MPN 19%

Possible tumor suppressor, aberrant retinoic acid receptor and MPL signaling.

CBL (casitas b-lineage lymphoma proto-

oncogene)

11q23.3

PV rare ET rare PMF 6%

Blast phase MPN ?

Blocks the regulatory function of wild-type CBL to inhibit kinase signaling.

IDH1/IDH2 (isocitrate dehydrogenase) 2q33.3/15q26.1

PV rare ET rare PMF 4%

Blast phase MPN 20%

Induces accumulation of 2-hydroxyglutarate, a possible oncoprotein.

IKZF1 (IKAROS family zinc

finger 1) 7p12

PV rare ET rare

PMF rare Blast phase MPN 19%

Alters tumor suppressor function of wild-type IKZF1.

The BCR-ABL translocation is believed to be the initiating event in CML. However the JAK2 V617F mutation (or other JAK2 mutations), is believed to be a secondary event in a “susceptible” hematopoietic stem cell. The JAK2V617F mutation occurs in the pseudokinase domain, a domain that has auto-inhibitory function. The mutation disrupts this regulation leading to constitutive JAK/STAT signaling (independent of ligand activation of receptor). The recently identified frameshift mutations in exon 9 of CALR occur most frequently as a type I (52bp deletion) or a type 2 (5bp insertion) mutant, both leading to the same open reading frame and novel C-terminal domain. The frameshift mutation disrupts a KDEL signal important for CALR’s role as an ER chaperone protein. CALR has important functions in the immune system and calcium homeostasis. The mutations lead to JAK/STAT activation by an unknown mechanism.

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The JAK2V617F mutation is commonly associated with three distinct MPNs: PV, ET, and PMF. How the same mutation can be responsible for three different clinical syndromes is not entirely clear. One explanation is differences in gene dosage of the V617F (ratio of V617F to WT JAK2) in the granulocytes amongst the various syndromes (Tiedt, et al.). In patients with high mutant ratios, the clinical phenotype is predominately erythrocytosis or PMF. In patients with lower mutant ratios, the clinical phenotype is predominately thrombocytosis. This effect of the mutant JAK2 allelic burden on hematologic phenotype is also seen in murine models of MPN. Other possible explanations for the association of JAK2 mutations with phenotypically different MPNs include the influence of genetic variations (both germline and somatic) on hematological phenotype as well as the possibility that the mutations may arise in slightly different stem/progenitor cell populations. Recently, evidence has emerged that preferential activation of downstream STAT signaling may play a role in the clinical emergence of PV versus ET (Chen, et al.). Erythroid colonies from PV patients have more intense activation of STAT5 whereas erythroid colonies from ET patients have more intense activation of STAT1.

Tiedt, R., et al. Blood 2008;111:3931-3940.

Chen, et al. Cancer Cell 2010; 18: 524-535.

D. MPN as a familial disease Familial clustering of MPN is well described. The familial tendency to acquire a specific somatic point mutation suggests the predisposing factor driving the selection of the JAK2V617Fmutation is a heritable factor. Studies aimed at identifying genetic variations that predispose to the development of MPN have revealed a haplotype in JAK2 itself ((termed 46/1, contains 4 polymorphic variations) which is associated with significantly increased frequency of MPN development compared to the general population without this haplotype.

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E. Key pathophysiological features in Philadelphia-negative MPNs JAK/STAT activation See section on “Molecular defects in Classical MPNs.” Clinical symptoms

• Constitutional symptoms – fatigue, inactivity, concentration problems, drenching sweats, itching, bone pain, fever, and weight loss. Many of these symptoms are related to the hypermetabolic state induced by inflammatory cytokines.

• Symptoms related to anemia (myelofibrosis) – dyspnea or shortness of breath with exertion, reduced exercise tolerance, fatigue, daytime sleepiness, mental and physical debility.

• Symptoms related to an enlarged spleen (due to extramedullary hematopoiesis) – indigestion, abdominal pain or discomfort, early satiety, and weight loss. Severe acute on chronic pain may indicate splenic infarction, splenic rupture, or perisplenitis.

• Vasomotor symptoms – headache, lightheadedness, syncope, atypical chest pain, acral paresthesia, livedo reticularis, erythromelalgia, transient visual disturbances.

• Thrombosis – thought to be due to abnormal activation of leukocytes, vascular endothelium, platelets, and the coagulation system. A young patient (<45 y/o) with an unprovoked, unusual, or splanchnic vein thrombosis (e.g., portal vein thrombosis) should be tested for an occult MPN. Sometimes the thrombotic event may precede the clinical onset of the disease. The highest incidence of arterial and venous thrombotic events occurs in PV patients (~5.5 per 100 patient-years) vs. ET and PMF patients (~2 per 100 patient-years).

• Hemorrhage – due to qualitative platelet defects and acquired von Willebrand disease. Cytokine abnormalities

Role of JAK2 signaling in the pathogenesis of splenomegaly, clinical manifestations, and constitutional symptoms in myelofibrosis. (A) mobilization/entrapment of CD34+/CXCR+ hematopoietic stem cells from bone marrow and autocrine-paracrine cytokine (e.g., IL-I5)/JAK2-mediated increased CD34+ cell numbers in spleen. (B) cytokine (eg, Epo, Tpo, granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor) induced expansion and differentiation of early progenitor cell lineages. (C) cytokine/JAK2-mediated trilineage hyperplasia resulting in (D) clinical sequelae including (E) cytokine-induced constitutional symptoms associated with myelofibrosis. PDGF, platelet-derived growth factor; TGF, transforming growth factor; TNF, tumor necrosis factor; INF, interferon; IL, interleukin. Source: S Verstovsek, Clinical Cancer Research 2010;16:1988.

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Laboratory and bone marrow findings Disease RBC WBC Platelet

Count Bone Marrow Molecular abnormality Splenomegaly

CML 0 ++++ 0 to +++ Increased granulopoiesis BCR-ABL 100% 90%

ET 0 0 to ++ ++ to ++++ Megakaryocytic hyperplasia JAK2 50%

Calreticulin 30% MPL 3-5%

40-50%

PV ++++ 0 to ++ 0 to ++ Erythroid hyperplasia JAK2 ~97% 75%

PMF ↓ 0 to ++ ++ to ↓ Fibrosis

Megakaryocytic hyperplasia Megakaryocytic atypia/dyspoeisis

JAK2 50% Calreticulin 30%

MPL10% >90%

Symbols: ↓ = decreased; 0 = normal range; ++++ = markedly increased. Marrow fibrosis may be observed in CML, ET, and PV, but is not usually a prominent feature. Fibrosis is visualized better with a silver stain (reticulin fibrosis) or a trichrome stain (collagen fibrosis). Reticulin fibrosis is thought to be reversible whereas collagen fibrosis is much less reversible. Fibrosis may be noted on magnetic resonance imaging (MRI) – the major source of MRI signal is from the fat and water content of bone marrow. Thus, an MRI may demonstrate conversion of fatty marrow (intense or bright signal) to the cellular and/or fibrotic marrow (markedly low intensity signal) associated with MPNs. Disease progression, clonal evolution (if suspected, evaluate the bone marrow!) Post-ET and post-PV myelofibrosis – An International Working Group for Myelofibrosis Research and Treatment has proposed this criteria:

Major (requires both) ●Documentation of a previous diagnosis of either PV or ET as defined by WHO criteria ●Presence of increased bone marrow fibrosis Minor criteria (requires at least two) ●Progressive anemia or loss of phlebotomy requirement ●Leukoerythroblastic blood smear ●Increasing degree of splenomegaly ●Development of constitutional symptoms (ie, weight loss, night sweats, unexplained fever) ●Increased serum lactate dehydrogenase (post-ET myelofibrosis only)

Myelodysplasia – Associated with progressive cytopenias, increased dyspoiesis, and myelodysplasia-associated chromosome changes e.g., loss of 5/5q, 7/7q, complex cytogenetics, i(17q), 17p loss, etc. Acute myeloid leukemia – There may be sudden development of severe low blood counts and non-specific, severe symptoms such as fevers, fatigue, bleeding, and infections. Risk is greater in patients treated with P32 and alkylating agents. AML transformed from MPN is resistant to conventional chemotherapy – estimated complete remission rate ranges from 0- 20% after standard “7+3” induction chemotherapy (very poor prognosis). In patients who achieve disease control and are fit for allogeneic stem cell transplant, long-term survival is still low - estimated around 20-30%.

Disease Risk for myelofibrosis transformation

Risk for AML transformation

CML Not applicable >90% ET <5% <5% PV 10% at 10 years; 25% at 25 years 10-25%

PMF Not applicable 20% Post-ET/Post-PV

MF Not applicable >20%

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PV, ET, PMF and AML can be related to each other by shared molecular defects and clonal evolution amongst these clinical entities.

II. ESSENTIAL THROMBOCYTOSIS Diagnosis Thrombocytosis is a common clinical problem. Increased platelet counts can occur as a primary/clonal disorder (essential thrombocytosis) or can be secondary to a number of conditions (reactive thrombocytosis). It is important to determine if thrombocytosis is primary or secondary because treatment is different and the risk of thrombosis is increased in patients with essential thrombocytosis but not in patients with reactive thrombocytosis. There are many causes of reactive thrombocytosis including:

• Trauma • Post-splenectomy • Post-operative • Iron deficiency • Malignancy • Connective tissue diseases (rheumatoid arthritis, SLE, etc.) • Acute infection • Chronic infection • MPL receptor agonists • Rebound after thrombocytopenia due to a specific cause (e.g. chemotherapy)

Differentiating primary from secondary thrombocytosis can be challenging. History and physical exam can give clues about infections, malignancies and other causes of reactive thrombocytosis. Historical findings suggestive of MPN include heat-induced pruritus, plethora, erythromelalgia, and thrombosis. Physical exam findings suggestive of MPN include plethora and splenomegaly. The incidence rate for ET is approximately 2.3 new cases/100,000 population per year. Median age at diagnosis is 60 y/o and as many as 20% of the patients may be <40 y/o. If ET occurs in children, consider the possibility that somatic mutations were acquired in utero. ET is a diagnosis of exclusion. There must be chronic thrombocytosis in the absence of reactive or secondary causes of thrombocytosis and the diagnostic criteria of another chronic myeloproliferative neoplasm are not fulfilled. ET is not a cytogenetically or morphologically defined neoplasm. The Polycythemia Vera Study Group came up with the initial formal diagnostic criteria, which has been modified to:

●A consistently elevated platelet count >450,000/uL. ●Megakaryocytic hyperplasia on bone marrow aspiration and biopsy. ●Absence of the Philadelphia chromosome on routine cytogenetic study and by PCR. ●Absence of causes for reactive or secondary thrombocytosis. ●Absence of peripheral blood, bone marrow, and karyotypic evidence for MDS and PMF. ●Normal iron stores (normal ferritin and mean corpuscular volume).

PV

ET

MF AML

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Higher white blood count, higher JAK2V617F allele burden, and presence of JAK2V617F in platelets and granulocytes were associated with a higher incidence of thrombosis. Patients with CALR mutations are younger, more frequently male, have higher platelet counts, lower hemoglobin and leukocyte counts, and a lower risk of thrombosis than those with the JAK2V617F mutation. There was no difference in the rate of transformation to post-ET myelofibrosis and overall survival when comparing CALR mutant vs. JAKV617F-postive ET. Differential diagnoses

• Reactive thrombocytosis • Other MPNs (CML, PV, PMF) • Rare myelodysplastic syndromes (5q minus syndrome, MDS with thrombocytosis, RARS with

thrombocytosis) • Familial essential thrombocythemia, also called hereditary thrombocythemia, is a rare

autosomal dominant disorder associated with activating mutations of thrombopoietin or its receptor c-Mpl. For example, mutations in the thrombopoietin gene can lead to a single point mutation in the splice donor site of intron 3 and result in a shortened 5' untranslated region that is more efficiently translated than normal thrombopoietin transcripts. The result is a higher steady state level of thrombopoietin protein.

Prognosis, complications, and treatment Patients with ET are expected to live a normal or near-normal life expectancy. A simple prognostic model includes only age and white blood cell count at the time of diagnosis:

●Low risk age <60 and WBC <15,000/uL median OS 25 years ●Intermediate risk age ≥60 or WBC ≥15,000/uL median OS 17 years ●High risk age ≥60 and WBC ≥15,000/uL median OS 10 years

Predictors of arterial thrombosis include age >60, prior history of thrombosis, presence of cardiac risk factors (eg, tobacco use, hypertension, diabetes mellitus), white blood cell count >11,000/microL, and presence of the JAK2 V617F mutation. The order of frequency of thrombotic events is stroke, myocardial infarction, peripheral arterial occlusion, and deep vein thrombosis or pulmonary embolism. Atypical thromboses can also occur, such as central abdominal vein thrombosis or Budd-Chiari syndrome. The 15-year cumulative risk is 20% for developing a thrombotic event. Erythromelalgia is a unique complication of the MPD’s and particularly of ET. It is painful, swollen, red digits caused by thromboxane-dependent platelet mediated endothelial injury leading to micro-vascular thrombosis in the hands (a rare anatomical site) and feet (a common site). Aspirin is very effective in preventing recurrent episodes of erythromelalgia. Miscarriages occur about 40-50% of the time and many occur in the first trimester. Increased risk of bleeding occurs when platelets are >1,000,000/uL. Extreme thrombocytosis may cause abnormal adsorption of large von Willebrand factor (VWF) multimers and result in a hemostatic defect. Patients should be screened for the presence of acquired von Willebrand disease – if ristocetin cofactor level is >30%, lose dose aspirin is safe if clinically indicated. The most common site of bleeding is the GI tract followed by cutaneous and mucosal bleeding.

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Treatment options, if treatment is indicated: • Low dose aspirin (40-100mg/day) for most patients • Cytoreductive therapy is indicated in these high-risk patients - age >60 years or history of prior

thrombosis. Goal platelet is <400,000/uL. In a head to head comparison, hydroxyurea is superior to anagrelide for reducing thrombotic and hemorrhagic events.

o Hydroxyurea is well-tolerated inhibitor of ribonucleotide reductase/S-phase inhibitor. Some side effects include oral ulcers, nausea, diarrhea, alopecia, hyperpigmentation, skin rash, nail changes, and leg ulcers. There has not been a randomized study showing increased leukemogenic potential, but in some retrospective studies the cumulative dose correlates with leukemogenic potential modestly.

o Anagrelide is an imidazoquinazoline derivative which inhibits platelet aggregation via anti-cyclic AMP phosphodiesterase activity and lowers platelet counts by an unknown mechanism but has been observed to interfere with megakaryocyte proliferation and maturation. The anti-platelet aggregation effects occur at much higher doses than that needed for the anti-proliferative effects. Toxicity of anagrelide is mainly related to the drug's direct vasodilatory and inotropic effects. Most common side effects include headache, palpitations and tachycardia, fluid retention, and diarrhea. Rarely, anagrelide can cause heart failure (acquired idiopathic cardiomyopathy). Increased fibrosis and MF transformation were noted in a clinical trial compared to hydroxyurea as cytoreductive therapy.

o Interferon alpha interferon or pegylated interferon alpha-2b and alpha-2a are good cytoreductive therapy alternatives in high-risk women of childbearing age, women who are pregnant, and for controlling thrombocytosis in patients failing treatment with hydroxyurea. Cost is prohibitive. Side effects and tolerability are improved with pegylated interferon formulation. Reduces JAK2V617F allele burden and the majority of patients achieve normalization of blood counts and spleen size.

Less commonly used or investigational strategies: o Alkylators – cyclophosphamide, melphalan. o Platelet pheresis (physical removal of platelets) is considered for severe or life-

threatening organ dysfunction (eg, stroke, pulmonary embolism, ischemic digital necrosis) or severe acute bleeding due to acquired von Willebrand disease. This is considered a temporary measure and must be coupled with another cytoreductive therapy (e.g., hydroxyurea) to provide sustained control.

o Ruxolitinib (JAK1/2 inhibitor) – under investigation. Longer duration of disease and transformation to post-ET MF are associated with higher risk for AML transformation. III. POLYCYTHEMIA VERA Diagnosis The incidence rate for PV is approximately 2.2 new cases/100,000 population per year. The median age at diagnosis was 71 years old. Originally, the diagnosis of PV was dependent on documenting elevated red blood cell mass by isotope dilution methodology. However, because the assay is not routinely done it is generally accepted that the majority of female patients with a hemoglobin concentration >16.5 g/dL (or hematocrit [Hct] above 50%) and all male patients with a hemoglobin concentration >18.5 g/dL (or Hct above 56%) have increased red cell mass. Nearly 100% of patients with PV have an exon 14 V617F JAK2 mutation (97 percent) or an exon 12 JAK2 mutation (3 percent). Very rarely, a PV patient will have a MPL mutation. Therefore, one should reconsider the diagnosis if a suspected PV patient does not have a mutation in JAK2 or MPL.

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Suspect a diagnosis of PV in cases of unexplained: ●Splenomegaly ●Thrombocytosis and/or leukocytosis ●Thrombotic complications ●Erythromelalgia or pruritus

The criteria for diagnosis of PV, revised WHO criteria requires the presence of both major criteria and one minor criterion, or the presence of the first major criterion together with two minor criteria.

Major criteria include • Increased hemoglobin level (>18.5 g/dL in men or >16.5 g/dL in women) or other

evidence of increased red cell volume • Presence of a JAK2 mutation

Minor criteria include • Bone marrow biopsy showing hypercellularity with prominent erythroid, granulocytic, and

megakaryocytic proliferation • A serum EPO level below the reference range for normal* • Growth factor independent erythroid colony growth in vitro

*While low EPO levels are highly specific for PV, levels above normal are unusual and suggest reactive or secondary polycythemia (specificity of 98%).

Differential diagnoses • Reactive or secondary polycythemia. Examples are hypoxia, familial polycythemic disorders, high-

affinity hemoglobins, truncated EPO receptor, illicit injection of EPO, and inappropriate EPO production by tumor.

• Patients may have bled-down or masked PV – patients meet the other criteria for PV but do not have elevated Hgb or HCT because of a concomitant issue such as active bleeding, portal HTN/hypersplenism, or increased plasma volume.

Prognosis, complications, and treatment Median survival of untreated PV has been estimated at 6-18 months from the time of diagnosis. Median survival of treated patients <65 or ≥65 years old at the time of diagnosis were 17.5 and 6.5 years, respectively. Generally, patients live shorter than the life expectancy of age and sex matched controls. Therefore, treatment is essential for optimizing long-term outcome. Media overall survival in multivariate analysis, a risk score is based on:

Age: ≥67 years: 5 points; 57 to 66 years: 2 points WBC: ≥15,000/uL: 1 point History of venous thrombosis: yes: 1 point

Median overall survival: 28 years (0 point, low risk), 19 years (1-2 points, intermediate risk), and 11 years (≥3 points, high risk). The most common causes of death included:

●Thrombosis (29%) ●Hematologic malignancies (23%) ●Non-hematologic malignancies (16%) ●Hemorrhage (7%) ●Post-PV myelofibrosis (3%)

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Disease duration correlated with increased risk for developing post-PV MF. Development of MDS or AML was associated with age >70y/o and use of cytoreductive agents other than hydroxyurea and interferon. Plasma levels of a number of cytokines are elevated in PV. Some correlations were seen:

IL-2 with hematocrit IL-1b, IL-2, IL-7, FGF-b, and HGF with leukocytosis IFN-alpha and IFN-gamma with thrombocytosis

The major abnormal findings on physical examination in PV include splenomegaly, facial plethora, and hepatomegaly. Symptoms associated with PV -Pruritus following a warm bath or shower (aquagenic pruritus) – vasoactive substances are released such as histamine, prostaglandins, and interleukin 31. -Thrombosis -Erythromelalgia, or burning pain in the feet or hands accompanied by erythema, pallor, or cyanosis due to microvascular thrombotic complications in PV and essential thrombocythemia. Symptoms respond dramatically to aspirin in low doses or to reduction of the platelet count to normal range. -Transient visual disturbance — eg, transient ocular blindness [amaurosis fugax], scintillating scotomata. -Major thrombotic events can occur in patients who otherwise have few clinical and laboratory features of PV. Examples include the Budd-Chiari syndrome, and portal, splenic, or mesenteric vein thrombosis. Portal hypertension and hypersplenism may mask the increase in blood cell counts. PV should be suspected in cases of splanchnic thrombosis and in young patients (<45 y/o) with any unprovoked thrombotic events. Treatment Treatment/supportive care for pruritus and gout. Phlebotomy goals – in low risk (age <60 AND no prior thrombosis), goal hematocrit is less than 45% in men and less than 42% in women. This should be combined with cytoreductive therapy (hydroxyurea or interferon alpha) in high risk PV patients (age >60 y/o AND prior thrombosis). For intermediate risk patients, this is individualized based on risk/benefit discussion. Interferon alpha (a very good first or second cytoreductive option) carries a high response rate and reduces JAK2V617F allele burden, but its cost, side effects are prohibitive in some patients. Anagrelide – see section II. Aspirin (75 to 100mg/day) is recommended in the absence of an acquired VWF disorder and significantly lowers the combined risk of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, pulmonary embolism, or major venous thrombosis.

Ruxolitinib – A phase II trial of the JAK1/JAK2 inhibitor ruxolitinib has shown clinical benefit for spleen volume reduction, symptom reduction, and reduced phlebotomy requirements. There are ongoing phase III trials of ruxolitinib and other JAK2 inhibitors to characterize the side effects, long-term safety, and efficacy of these agents.

Pregnancy – Keep hematocrit below 45%, continue low-dose aspirin throughout pregnancy, and, if myelosuppression is required, use interferon. The use of prophylactic anticoagulation with low molecular weight heparin (LMWH) for the first six weeks following delivery or during pregnancy for patients with active thrombosis is sometimes considered but there is no data to help formalize this recommendation.

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IV. PRIMARY MYELOFIBROSIS Diagnosis PMF is a hematologic disorder characterized by marked splenomegaly, leukoerythroblastosis, marrow fibrosis, megakaryocytic atypia/dyspoiesis, and trilineage extramedullary hematopoiesis. The incidence rate for PMF is approximately 1 new case/100,000 population per year. Leukoerythroblastic smear (can be caused by dense fibrosis or infiltration with tumor) classically shows teardrop-shaped RBCs, abundance of nucleated erythrocytes (nucleated reds) and granulocyte precursors (myelocytes, metamyelocytes, and blasts). Secondary causes of bone marrow fibrosis include chronic infections that involve bone marrow (mycobacterial and fungal), other malignancies (metastatic carcinoma, hairy cell leukemia, Hodgkin’s disease) and other forms of bone marrow injury that may reflect injury of the marrow microvasculature (lupus erythematosus). Using the history/clinical examination and a review of the peripheral blood smear (looking for a leukoerythroblastic smear), secondary myelofibrosis can be distinguished from patients with primary myelofibrosis. Another subtype of secondary myelofibrosis arises from patients who had PV or ET. Recently, this has been named post-ET or post-PV myelofibrosis to distinguish from those patients who are diagnosed with PMF and those patients who have reactive or secondary myelofibrosis. See section I.E for signs/symptoms of post-ET and post-PV MF development. The bone marrow in PMF is often difficult to aspirate, usually yielding a "dry" tap. In addition, the results of aspiration alone, if successful, are not always diagnostic. The most common findings are granulocytic and megakaryocytic hyperplasia. Granulocytes may show hyperlobation and erythroid precursors may be normal or increased. Megakaryocytes are often morphologically abnormal (displaying atypia or dyspoiesis):

• Small to large megakaryocytes with aberrant nuclear/cytoplasm ratio • Dense clustering • Hyperchromatic and irregularly folded nuclei

These morphologic changes in megakaryocytes (and finding a leukoerythroblastic blood smear) help to distinguish myelofibrosis (primary or post-ET or post-PV MF) from essential thrombocythemia. 2008 WHO criteria for PMF (diagnosis requires 3 major criteria and 2 minor criteria). Major criteria: 1. Presence of megakaryocytic proliferation and atypia, usually accompanied by either reticulin

and/or collagen fibrosis, or, in the absence of significant reticulin fibrosis, the megakaryocytic changes must be accompanied by an increased bone marrow cellularity characterized by granulocytic proliferation and often decreased erythropoiesis (i.e. pre-fibrotic cellular-phase disease).

2. Not meeting WHO criteria for PV, CML, MDS, or other myeloid neoplasm 3. Demonstration of JAK2 mutation or other clonal marker (e.g. MPL or calreticulin mutation), or in

the absence of a clonal marker, no evidence for secondary bone marrow fibrosis. Minor criteria: 1. Leukoerythroblastosis 2. Increase in serum LDH 3. Anemia 4. Palpable splenomegaly

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Differential diagnoses • If excess blasts are noted in the blood and bone marrow, consider MDS with fibrosis or two

types of AML - acute megakaryocytic leukemia, and acute myelofibrosis. • Secondary causes of bone marrow fibrosis (see above) • Post-ET and post-PV myelofibrosis • Other types of hematologic malignancies are associated with marrow fibrosis – e.g., CML, PV,

ET, CMML, mast cell disease • ITP patients treated with thrombopoiesis-stimulating agents • Secondary hyperparathyroidism with vitamin D deficiency or renal osteodystrophy

Prognosis, complications, and treatment More common clinical features associated with PMF or post-ET/post-PV MF (less common in ET/PV): -Marked splenomegaly -Hepatomegaly -Portal hypertension may develop from increased splanchnic flow due to splenomegaly and/or intrahepatic obstruction associated with extramedullary hematopoiesis. Complications include ascites, varices, and liver failure. -Other laboratory findings – prominent leukoerythroblastosis, elevated circulating CD34 cells, alkaline phosphatase (liver or bone), LDH, uric acid, leukocyte alkaline phosphatase, vitB12. -Marked extramedullary hematopoiesis -Osteosclerosis -Periostitis -Osteolytic sarcoma (AML) -Higher risk for marrow failure, MDS and AML -Worse overall prognosis Median overall survival is best for CALR mutated disease and worst for "triple negative" (JAK2, CALR, and MPL negative) disease – for JAK2-mutated, CALR-mutated, MPL-mutated, and "triple-negative" patients, median overall survival is 5.9, 15.9, 9.9, and 2.3 years, respectively. Pathogenesis of Marrow Fibrosis The current hypothesis is that ineffective clonal megakaryocytopoiesis results in the liberation of excessive amounts of growth factors that induce the growth of fibroblasts.These factors include transforming growth factor β, fibroblast growth factor, and platelet derived growth factor. This in turn leads to marrow fibroblast expansion and collagen synthesis. That marrow fibroblasts are not part of the malignant clone is compatible with this model of pathogenesis. Some 50% of patients carry the JAK2V617F mutation, 30% carry calreticulin mutation, and a small subset (5% or so) have an activating mutation in the thrombopoietin receptor (Mpl). Prognosis The prognosis for patients with myelofibrosis can be quite variable, ranging from an expected life-span of a few years to over ten years. The Dynamic International Prognostic Scoring System in MF (DIPSS) is a point-based system that can help prognosticate expected survival in MF patients. Importantly, this is a dynamic scoring system so can be obtained and reassessed at any time point during an MF patient’s course. Passamonti et al, Blood 2010: The DIPSS is calculated as follows:

●Age >65 years – 1 point ●Leukocyte count >25,000/uL – 1 point ●Hemoglobin <10 g/dL – 2 points ●Circulating blast cells ≥1 percent – 1 point ●Presence of constitutional symptoms – 1 point

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Subjects with zero, one to two, three to four, or five to six points were considered low, intermediate-1, intermediate-2, or high risk, respectively.

Poor prognostic factors include unfavorable karyotype (complex karyotype or sole or two abnormalities that include +8, -7/7q-, i(17q), -5/5q-, 12p-, inv(3), or 11q23 rearrangements), red cell transfusion dependence, and thrombocytopenia. Mutant ASXL1, IDH, SRSF2, or EZH2 predicted shortened survival. ASXL1 mutations were significant in the context of the International Prognostic Scoring System (IPSS). Treatment Therapy is indicated in patients with symptomatic anemia, painful splenomegaly, bleeding problems, thrombocytopenia, hyperuricemia, or portal hypertension. Newer agents include Thalidomide and Lenalidomide (immunomodulatory agents), which are thought to modulate the cytokine milieu, although their precise mechanism of action remains unknown. Overall response rate is approximately 20-25% for improvement of anemia and reduction of spleen volume. Bone marrow transplantation in PMF can be curative, and should be offered to suitable patients (especially intermediate-2 and high risk patients, see figure above). Interestingly, the marrow fibrosis typically resolves after transplantation. Long-term survival (at 5 years) is approximately 50-60% and reduce intensity is a good option for patients >60 y/o.

For anemia For splenomegaly and

For Potential Cure

pRBC transfusions Folate supplementation Iron supplementation

Anabolic steroids Steroids

Erythropoietin Immunomodulatory agents

Hydroxyurea Other cytotoxic chemotherapy

Splenic radiation Splenectomy

JAK2 inhibitors Steroids

Immunomodulatory agents Etanercept

Allogeneic stem cell transplant (intermediate-2 and high risk,

expected median overall survival of less than 5 years)

A number of JAK inhibitors have been tested in clinical studies. INCB01824 (ruxolitinib or jakafi) was the first JAK1/2 inhibitor to enter phase 3 clinical studies for patients with PMF and was FDA approved in November 2011 for the treatment of Intermediate-1 to high risk myelofibrosis on the DIPSS system. This drug has a fairly high rate of reducing splenomegaly (median 33% decrease in spleen volume at 6 months). Drug treatment leads to a significant decrease in pro-inflammatory cytokine levels (e.g. IL-1, TNF-alpha, IL-6), and angiogenic and fibrogenic factors (e.g. VEGF and basic-FGF). Rapid and durable improvements in systemic symptoms (fatigue, abdominal pain, pruritus, bone/muscle pain, and night sweats) were noted. However, only modest reductions in mutant JAK2 allele frequency were noted (13% marrow, 9% peripheral blood), suggesting that the clinical benefit of this drug may be related to

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Estimated long-term outcome after allogeneic stem cell transplant

0 points

1-2 points

3-4 points5-6 points

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the inhibition of aberrant JAK2 (and possibly JAK1) signaling, rather than elimination of mutant cells. Other JAK inhibitors are being tested in clinical studies. Special precautions- patients should be counseled about JAK inhibition withdrawal syndrome (sepsis-like symptoms). Steroids and a slow ruxolitinib taper may reduce the impact of the withdrawal syndrome, which occurs in a small subset of patients. The most common side effect is worsening of anemia and thrombocytopenia (the largest drop occurs in the first 3 months). Starting at a lower dose then going towards a higher dose of ruxolitnib is an effective strategy to lessen this issue. Serious bacterial, mycobacterial, fungal, and viral infections have been reported but the causality as a result of JAK inhibition has not been conclusively demonstrated. Splenectomy Splenectomy is indicated for painful spleen or transfusion-dependent anemia. Mortality risk is approximately 10% around the time of surgery and may rise to 20-25% at 3 months. Complications include bleeding, infection, thrombosis, and accelerated hepatomegaly. There is a component of splenic sequestration and ineffective erythropoiesis in a massively enlarged spleen. Patients should get immunizations to Haemophilus influenza, Strep pneumonia, and Neisseria meningitides. Post-splenectomy thrombocytosis is associated with postoperative thrombosis and decreased survival. The main causes of death not related to surgery are infection, cardiac or thrombotic events, bleeding, and leukemic transformation. Splenic irradiation — Splenic irradiation provides transient symptom control (3-6 months). This is a reasonable modality for primarily palliative considerations. Radiation therapy is extremely successful in the management of symptomatic extramedullary hematopoiesis of the CNS, peritoneal and pleural cavities, focal areas of bone pain, and whole-lung treatment for pulmonary hypertension.

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REFERENCES Up to Date Campbell PJ, Green AR. The myeloproliferative disorders. N Engl J Med. 2006 Dec 7;355(23):2452-66. Review. PubMed PMID: 17151367. Cleary C, Kralovics R. Molecular basis and clonal evolution of myeloproliferative neoplasms. Clin Chem Lab Med. 2013 Oct;51(10):1889-96. doi:10.1515/cclm-2013-0135. Review. PubMed PMID: 23729579. Odenike O. Beyond JAK inhibitor therapy in myelofibrosis. Hematology Am Soc Hematol Educ Program. 2013;2013:545-52. doi: 10.1182/asheducation-2013.1.545. Review. PubMed PMID: 24319230. Tefferi A. Primary myelofibrosis: 2014 update on diagnosis, risk-stratification, and management. Am J Hematol. 2014 Sep;89(9):915-25. doi: 10.1002/ajh.23703. PubMed PMID: 25124313.

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Tips for Effective Discussion Facilitation Excerpted from Fishman and Newman, Facilitator’s Guide for Leading a Session on Small Group Teaching, Harvard Medical School Open-ended Questions. It may help to explore different types of open-ended questions and how they affect students’ responses and engagement. Open-ended questions that have identifiable right answers can be considered “black or white” questions. These questions may lead to silence as the students search for the “ideal answer” or try to guess what the facilitator is thinking. They even may fear giving an incorrect answer and embarrassing themselves. An example of a “black and white” question might be, “What is the diagnosis?” Questions without a single, correct answer can be termed “blue or green” questions, such as asking the students if they like blue or green better. There is no single, right answer. These types of questions encourage more discussion. For example, the facilitator might introduce the session by asking the students, “Where would you like to start?” Learning Contract. Establish class expectations or an educational contract on the first day of a class. Late Students. It is advisable that teachers welcome late students and summarize or have another student give a one-minute orientation to the case discussion. Suggest that they wait until the conclusion of the session to check on the student’s well-being and inform/remind the student about the educational contract or class expectations. Off-topic Remarks. A successful facilitator is able to create a safe, relaxing environment and have a productive discussion about the case. You should feel comfortable entering into a social moment and still maintain enough control to be able to exit when appropriate. Doing so allows for a balance of freedom vs. discipline during the session. Quiet Students. You might engage the quiet student by: making frequent eye contact with him/her; speaking softly to the student to make the environment less threatening; or by asking the student to read the page aloud or to look up a fact. In addition you can use indirect hints such as, “We haven’t heard from this side of the room yet” or “There are multiple answers to this question; what’s your opinion? I want to hear from everyone,” or “I’d like to hear 2 different responses to that question.” If the quiet student does respond, but does so in a low voice or whisper, ask the person furthest from the student if he/she could hear the answer. Explain that you value all responses

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and would like to have everyone hear such good answers. After class you can talk to the quiet student to see if there are particular factors affecting his/her participation. Talking outside of class might make quiet students feel more comfortable explaining why they are less engaged or suggest what has worked for them in the past to become a more active participant. For example, some students like to be assigned a topic in advance or asked to read aloud. Others may prefer to choose their own moments to enter the conversation. General Tips. It’s generally best to assume that students are involved and interested in learning. By taking this positive, trusting point of view, students will rise to meet your expectations and re-focus on the case discussion or will feel comfortable voicing their questions or reveal their confusion about a discussion point. You might re-engage students by inviting them to share what they are discussing or offering your assistance: “Is there a question I can help answer?” or “What did you learn about the condition that everyone else should hear?” When multiple conversations happen at the same time, you can steer these side-bars back to the case by simply inviting people to re-join the group discussion. By doing so, you emphasize that all input is valued and should be shared to further the learning process. Try saying something such as, “Hold that thought. I am curious to hear what each of you is thinking. Let’s have Mary speak, and then hear from Bob and Mark.” An experienced facilitator might engage in what is called “reflection-in-action.” Reflection-in-action is the ability to “think on one’s feet” so that within any given teaching moment a facilitator connects with his/her emotions and prior experiences to attend to a situation directly. As a facilitator it is acceptable to admit a mistake or re-group and adjust the learning environment. Be transparent and provide reasons for the change. During a series of case discussions, it is ideal for you to change where you sit so that you will face different students. This allows you to view the room from various students’ perspectives. In addition, it is surprising to see how moving one position will affect the group dynamic. It is important to become conscious of the students’ comfort level and sense of safety. If you notice that none of the above-mentioned behaviors are happening, you may need to take a step back and assess/address what factors may be causing this discord. If the students are hesitant to contribute to the discussion or seem to be noticeably quiet and unwilling to engage as active participants, it may be helpful for you to state that the main

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priority is to understand their thought processes and help them reason through the case, rather than hear “right” answers. If you notice that the students avoid eye contact with you, try to look away when you ask your next question or make a comment. Direct eye contact can be threatening to some learners. Try writing something on the board or looking down at your papers.

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Classroom Resources

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Collaborative Life Sciences Building

Touch panel to wake up, then select:

Presentation Mode — or — Active Learning Mode

Select the desired screen(s)

Select desired source

Select the “Breakout” button to route local group

sources (HDMI or VGA) to local group screens.

Select between sources for main projector

Eyes forward presentation from the lectern utilizing

the main projector at the front of the room for a tra-

ditional lecture.

Utilizes five projectors and screens with computer

inputs to enhance discussion in small groups. Any

input can go to any or all displays in the room.

To operate touch panel:

Home Button: Select either “Presentation” mode or “Active Learning” mode.

Lighting Button: Adjust room lights and window shades. To exit this menu, push the lighting button again.

Audio Button: Adjust the volume or mute audio inputs. To exit, push the audio button again.

Help Button: Displays a phone number to dial if assistance is needed.

Power Button: Displays a dialog box asking if you want to turn the system off.

3A001 and 3A002

EdCOMM | 503-494-2222 (option 6)| edcomm@ohsu.edu

Lectern Computer

Lectern Laptop (VGA and HDMI inputs on lectern)

Document Camera

VGA and HDMI inputs are available on the lectern. HDMI will override VGA.

HDMI and VGA group inputs are located on the wall below each display. HDMI will override VGA.

Group numbers are clockwise, with number 1 to the left of the lectern.

Source audio is active when displayed on the main projector.

If laptop audio does not route to system, check playback devices in the sound menu of the laptop.

It can take several seconds for projector(s) to change inputs.

PowerPoint presentations will look best if the widescreen (16:9) aspect ratio is used.

The system will take a full two minutes to cool down before it can be restarted.

Please turn the system off after use by pressing the power button and confirming shut down.

Helpful Hints:

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Collaborative Life Sciences Building 3A001 and 3A002 User Instructions

EdCOMM | 503-494-2222 (option 6)| edcomm@ohsu.edu

Using the Touchscreen Controller

All of the room’s presentation controls can be accessed through the lectern touchscreen controller. The controller can make changes

to lighting, audio volume and presentation sources.

Home Button

The “Room Mode” page allows the presenter to choose “Presentation” or “Active Learning” mode as their presentation

style. Simply touch one of the modes to activate that mode.

o Presentation mode is designed to support the traditional lecture where all attention is directed towards the main

screen and the presenter in the front of the room.

o Active Learning mode is designed to dissect the classroom into smaller, collaborative groups where their ideas and

content can be shared across all of the displays in the room.

The “Room Mode” page is also the “Home” page for the menu. In the upper left corner of each menu, there is a home

icon. Pressing the home icon will return the presenter back to the “Room Mode” page.

Presentation Mode

Upon selecting “Presentation” mode, three source options will appear:

o Lectern Computer: Refers to the installed desktop PC inside of the lectern.

o Lectern Laptop: Refers to the presenter’s laptop computer which connects via VGA or HDMI to the connection box on

top of the lectern.

o Document Camera: Refers to the document camera located on the right side of the lectern.

o Center Laptop: Refers to the floor connection located in the center of the room. Contact EdCOMM for more

information.

Once selected, your chosen source button will be blue and will display on the screen.

“Projector Mute” will black out selected projector(s).

Active Learning Mode

Active learning allows the presenter to send different sources to different projectors.

Once the mode has been engaged, the menu page becomes divided into two categories: video destinations and video

sources. On the top of the panel, there is a selection of video destinations (projectors) to choose from. On the bottom of the

panel, there is a selection of sources to choose.

Video Destinations

o Main Projector: This button refers to the large projection screen in the front of the room.

o Group 1 through 5: These buttons refer to the projectors and screens located around the perimeter of the

room. They are numbered in a clockwise fashion from the perspective of a lectern-based presenter looking out

towards the class. The “Group 1” projector is to the left of the lectern, and the numbering of the groups follows in a

clockwise fashion.

Video Sources

o Lectern Computer: this button refers to the installed desktop PC inside the lectern.

o Lectern Laptop: this button refers to the presenter’s laptop that is plugged into the top of the lectern.

o Document Camera: this button refers to the document camera located at the lectern.

o Group 1 through 5: Still following the clockwise format, these buttons refer to the VGA and HDMI inputs for each of

the group projectors and screens in the room. Each group projector has an HDMI and VGA input connection on the

table near the group screen.

o Breakout: The “Breakout” button routes all of the group local inputs to the local projectors.

Sending Video Content to Multiple Projector(s)

o To send a source to a destination, first choose your intended projector(s) (i.e. “Group 1” projector and “Group 5”

projector). The video destination buttons will become blue once selected. Then, choose the source that you intend

to send to the projectors (i.e. Lectern Laptop). The content will now appear on all selected projectors.

o The “Select All” button selects all projectors in the room. Use this feature to place the content from one source onto

each screen in the room.

o Audio from these group inputs will only be amplified if the input is shared with the main projector.

Breakout Mode

o Pushing “Breakout” clears group projectors of all their presentation content, transforming each group table into its

own presentation space.

o Inputs for local groups are on the table, near each group screen. Class participants will connect their laptops to

these inputs and present to their local groups.

o NOTE: Local projectors will not play laptop audio. Group inputs will only be amplified if the input is shared with the

main projector.

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Collaborative Life Sciences Building 3A001 and 3A002 User Instructions

EdCOMM | 503-494-2222 (option 6)| edcomm@ohsu.edu

Other Functions

o The “Video Mute” button will black out selected projector(s). For example, if one were to select “Group 4” projector

on the touch panel and then press the “Video Mute” button, the group 4 projector would go black. To reactivate,

press the “Group 4” projector button and then press the appropriate source button that you wish to send.

Lighting Button

Lighting will bring up a menu with different settings for the room.

Lighting Settings:

o All On: Turns all the lights in the room on.

o Active Learning 1: Removes light from main projector screen; students are well lit.

o Active Learning 2: Removes lights from all projector screens; students are well lit.

o Active Learning 3: Removes lights from all projector screens; lights over students are brighter.

o Movie Mode: Darkens the class for detail specific graphics or movie content.

o All Off: Turns all lights in the room off.

Shades: Diffused light allowed into the room, controlled by pressing up and down arrows.

Pressing an arrow once fully engages the shades. Pressing the stop button will stop their movement at desired points.

Press the “Lighting” button again to exit the lighting menu.

Audio Control Button

For voice amplification, there is a lectern microphone labelled as “Front Lectern” and a wireless “Lapel” microphone.

“Program” is computer audio. It will control the volume for any computer in the room that is connected to the main projector.

“Room” is the overall master volume control of the room. The level will affect the volume of every other audio input.

“Middle Lectern” requires installation and is only usable if requested in advance.

For each input, the top button increases volume, the middle button decreases volume and the bottom button mutes the input.

When a microphone is muted, the “Mute” button will blink red.

Press the “Audio Control” button again to exit the audio menu.

Help Button

This will bring up the phone number to dial if assistance is needed. 503-494-2222 (option 6).

Press the “Help” button again to exit the help menu.

Power Button

The power button will turn the system off.

Once pressed, you will be prompted to confirm or cancel the power down process.

The system will take a full two minutes to cool down before it can be restarted.

Please turn the system off after use by pressing the power button and confirming shut down.

Helpful Hints

VGA and HDMI inputs are available on the lectern. HDMI will override VGA.

HDMI and VGA group inputs are located on the wall below each display. HDMI will override VGA.

Group numbers are clockwise, with number 1 to the left of the lectern.

Source audio is active when source is displayed on the main projector.

If laptop audio does not route to system, check playback devices in the sound menu of the laptop.

It can take several seconds for display(s) to change inputs.

PowerPoint presentations will look best if the widescreen (16:9) aspect ratio is used.

The system will take a full two minutes to cool down before it can be restarted.

Please turn the system off after use by pressing the “Power” button and “Confirming” shut down.

Echo 360 Lecture Capture System

This room is connected to the ECHO 360 lecture capture system, which can record both the physical lecture and the audio-video

content being sent to the projector.

To request this service, please visit: https://bridge.ohsu.edu/edu/edcomm/services/SitePages/Home.aspx

The display at the back of the room is for Echo 360 record camera reference only.

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Collaborative Life Sciences Building 3A001 and 3A002 User Instructions

EdCOMM | 503-494-2222 (option 6)| edcomm@ohsu.edu

There are some small differences on the touchscreen when the room is in combined mode.

Presentation Mode

Upon selecting “Presentation” mode, these video destinations and video sources will appear:

Video Destinations

o 3A001 Projector

o 3A002 Projector

Video Sources

o 3A001 Sources: Projector Mute, Lectern Computer, Lectern Laptop, Document Camera, Center Laptop.

o 3A002 Sources: Projector Mute, Lectern Computer, Lectern Laptop, Document Camera, Center Laptop.

Once selected, your chosen source will be blue and will display on the screen.

“Projector Mute” will black out selected projector(s).

Active Learning Mode

Video Destinations

o 3A001 Destinations: Main Projector and Group Projectors 1 through 5.

o 3A002 Destinations: Main Projector and Group Projectors 1 through 5.

o You can also select “All Projectors”. (Note: This will also engage the 4 screens in the middle of the rooms.)

Video Sources

o 3A001 Sources: Lectern Computer, Lectern Laptop, Document Camera, and Group 1 through 5.

o 3A002 Sources: Lectern Computer, Lectern Laptop, Document Camera, and Group 1 through 5.

o “Video Mute” will blackout selected projector(s).

o “Centers Off” will power down and retract the four screens in the middle of the two rooms. (3A001 group 4 and 5,

3A002 group 1 and 2.)

o “Breakout”: The breakout button transforms all of the group projectors into isolated, local screens that display only

the content being sent from their local connection.

Sending Video Content to Multiple Projector(s)

o To send a source to a destination, first choose your intended projector(s) (i.e. 3A001 Group 2 Projector and Group 3

Projector). The video destination buttons will become blue once selected. Then, choose the source that you intend

to send to those projectors (i.e. 3A002 Group 1). The content will now appear on all selected projectors.

o The “Select All” button selects all projectors in the room. Use this feature to place the content from one source onto

each screen in the room. Note that this will include the four projectors and screens in the middle of the room.

o Audio from these group inputs will only be amplified if the input is shared with the main projector.

Breakout Mode

o Pressing “Breakout” clears group projectors of all their presentation content, transforming each group table into its

own presentation space.

o Breakout inputs for local group projectors are on the table, next to each group screen. Class participants will connect

their laptops to these inputs and present to their local groups.

o NOTE: Local projectors will not play laptop audio. Group inputs will only be amplified if the input is shared with the

main projector.

Audio Control Button

There are three microphones available in combined mode: “Front Lectern”, “Lapel 3A001”, and “Lapel 3A002”.

“Program” is computer audio. It will control the volume for any computer in the room that is connected to the main projector.

“Room” is the overall master volume control of the room. The level will affect the volume of every other audio input.

“Middle Lectern” requires installation and is only usable if requested in advance.

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EPIC

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Page 1 of 3

This document will step you through accessing the Epic training environments remotely through Citrix, and login instructions for those training environments.

Overview You will access OHSU’s Epic training environments for both your instructor-led Epic training, and again throughout your course work.

What You Will See Once you access the OHSU network remotely, you will see multiple options.

Instructional Guide for Accessing the Epic Training environment To access the Epic environment for your case studies:

1. Access www.ohsu.edu/wts. Log in using your OHSU ID and password. On campus, from a networked computer – find My OHSU WTS Applications.

2. Once you have access OHSU network remotely, open the remote Access folder:

3. Open the green Epic Train icon: (not the Epic Train 2014)

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Page 2 of 3

4. Connect to the SOM environment:

5. Use your own network ID, and password. Department = The Practice

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Page 3 of 3

6. To find your patients, click the Schedule button at the top, and navigate to your Frances provider that is on your login sheet. (Note – your actual patient names will be different than the ones shown in the screenshot below.)

7. You can also click the Chart button in the top tool bar, and search for your patient using last name, first name. You will then be in a view-only mode in the chart.

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Library Resources

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Library Reserves: Using the Library to provide resources to your students The Library is available to request materials for your courses through the Reserves service. Physical books are placed on reserve at the Service Desk at the BICC, at the LRC, or both, based on your preference. Electronic books and other resources can also be licensed, if that is your preference. Please note that purchasing electronic books can take longer because the Library is licensing access to them, not purchasing a print book, so if you prefer that format, please give additional time for processing when making that request. Library staff will work with you to let you know of your options when making any reserve requests for your courses. To request materials for your course, please go to this page: http://www.ohsu.edu/xd/education/library/services/reserves/index.cfm

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Assessment

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Monday MCQ's submitted via

online SPW

(Instructors)

Monday

Draft Quiz in Word

(Block Directors)

Tuesday-Thursday

Edits/ improvements

(Block Directors &

TLC staff)

Monday-Thursday Audit sessions - Edit

quiz if needed

(Block Directors)

Thursday 4pm Final Quiz published

in Examsoft

(TSO)

Friday AM Administer Examsoft

quiz

(TSO)

2 weeks before test administration

1 week before test administration

Week of test administration

Friday PM

Post-test review process

(Tracy, TSO, Laura,

Block Dir, +/- owner of week or content expert if necessary)

Week after test

Monday Noon % correct scores and annotations

released to students by noon

*Annotations

withheld until all students have

completed quiz

(TSO)

Monday

Release of weekly quiz to instructors with psychometric

data

(TSO)

Weekly assessment cycle timeline ~4 weeks

Weekly Assessment Timeline

Tuesday Question bank

uploaded to Box (additional questions uploaded if in after

deadline)

(TSO)

Tuesday - Friday Review MCQ’s in

question bank

(Block Directors)

Thursday Noon Final Quiz sent to

TSO by noon

(Block Directors)

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Weekly Quiz Creation Process Instructors have been asked to submit a minimum of five questions (per hour taught), each with annotated answers that best represent the core concepts they have covered in their session(s). These questions will be used for weekly assessments (Fridays) and final block assessments (Assessment week). Questions that have been submitted may/may not be included on the final version of the weekly assessment (30-35 questions total) at the discretion of the Block and Thread Directors. Submitted questions may also be rewritten in an improved format by the block director prior to quiz creation. All questions submitted will become property of the SoM.

Process:

1. Instructors: a. Submit 5 questions (or more) via the online Session Planning Worksheet (SPW)- (see Session Planning Worksheet

process for details) by the Monday two weeks prior to instructional week i. Include rationale for correct and incorrect answers in annotation space provided for each questions on SPW

2. TSO:

a. Questions will be extracted from the SPW, copied into a Word document, and uploaded to an appropriate box folder titled “Question bank [date of quiz]”

b. Identify which instructor submitted the question Late submissions will be added to the bank as they are received

3. Block Directors:

a. Review questions in the Word document in box b. Create a new Word document titled “draft quiz [quiz date]” containing only questions selected for weekly quiz c. Include the following information in draft:

i. Identify the concept area (if applicable) ii. Identify the thread (select all that apply using the YourMD identified threads)

d. Email draft to designated member of the Teaching and Learning Center (TLC) staff for review of question construction

4. A member of the Teaching and Learning Center (TLC):* a. Reviews draft quiz questions for:

i. Question stems with “except” or “not”, all of the above or combination answers ii. Poor wording

iii. No or inadequate link to session objectives/concepts b. The draft will be emailed to Block directors with notes regarding questions that could benefit from editing

5. Block Directors:* a. Revise questions as needed to create the FINAL Quiz. b. Label new document “Final Quiz [quiz date]” c. Email FINAL Quiz to TSO and cc Thread directors no later than Thursday 12:00 p.m. day prior to exam

6. Teaching Services (TSO):*

a. Uploads questions to Examsoft b. Publishes FINAL exam on Thursday at 4pm

*Time sensitive- Quick turnaround

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Writing Strong Multiple choice Questions (MCQ’s) Instructors have been asked to submit a minimum of five MCQ questions, each with annotated answers (per hour taught), that best represent the core concepts per session(s). These questions will be used for weekly assessments (Fridays) and final block assessments (Assessment week). Questions that have been submitted may/may not be included on the final version of the weekly assessment (30-35 questions total) at the discretion of the Block Directors. Submitted questions may also be rewritten in an improved format and become property of the SoM.

CLARITY To create clear and reliable weekly assessments, please try to keep multiple choice questions as straightforward as possible. Make the question stem concise and content rich so that the answer choices are clear. When guessing, students often pick the longest choice (and it is frequently correct). The following criteria may be helpful as you design weekly assessment/quiz questions:

• Use positive stems only (no EXCEPT, NOT ) • Limit answer choices to A-D (including the correct answer) • All of the above, some of the above, or none of the above answers cannot be included • No True or False questions (or Correct and Incorrect)

CONTENT Questions should test the main concepts covered in class or in lab. Recycled questions from previous years are acceptable if they meet the above criteria and are relevant to the current year’s central session concepts.

• Overly detailed questions or testing on minor points do not enhance a quiz or test question’s reliability • Questions can reference central points in required reading

EXAMPLE “Aplastic anemia signals which of the following?”

A. Thrombin deficiency B. Prothrombin deficiency C. Platelet deficiency* D. A & C E. None of the above

A poor question that relies primarily on memorization can be rephrased into a better question that assesses the application of student knowledge not just the ability to memorize. “A 32 y/o woman is admitted to the ED with fatigue and generalized weakness. She reports excessive bleeding of the gums upon brushing teeth. A physical exam reveals small red dots over her trunk and bruising on her upper arms. You order a CBC and expect to find a deficiency of which blood component?”

A. Thrombin B. Prothrombin C. Platelets* D. Fibrinogen

For more resources on item writing please review the NBME web-based item writing instructional video: http://download.usmle.org/IWTutorial/intro.htm and Constructing Written Test Questions for the Basic and Clinical Sciences: http://www.nbme.org/PDF/ItemWriting_2003/2003IWGwhole.pdf

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Writing Strong Matching Questions The matching format provides a useful tool to measure a learner’s ability to identify the relationship or association between similar items. Matching is particularly effective when the content of study has many parallel concepts (e.g., causes and effects, objects/images and labels, scenarios and responses.)

Two Types of Matching Questions

1. SIMPLE MATCHING. Learners connect a word, sentence or phrase in the left column (premises) to a corresponding word, sentence or phrase in the right column (responses). Premises are numbered and responses are labeled with capital letters.

Tips for Writing Simple Matching Question Sets

• Provide clear instructions. For each question set, include instructions on how to make the match and the basis for matching the response with the premise.

• Parallel content. Within one question set, stay with a common approach, such as matching effects to causes or matching principles to scenarios.

• Plausible answers. All responses in Column B should be plausible answers to the premises in Column A. Otherwise, the test loses some of its reliability because some answers will be “give-aways.”

• Every premise should have only one correct response. This seems obvious but it’s a good idea make sure each response only works with one premise.

• Use a reasonable number of premises in the first column. Too many can overload even the best student’s working memory. (A reasonable number is between 5-7 premises.)

• More responses than premises helps to ensure the remaining responses don’t inadvertently act as hints to the correct answer. However, it’s not a great idea to list double the amount of responses needed. Again, be reasonable – a few extra responses are all you need.

• Watch out for unintentional hints through grammar (e.g., implying the answer must be plural) or hints from word choice (e.g., like using the term itself in a definition).

2. EXTENDED MATCHING: Extended matching items are frequently on the NBME. These questions are useful for discriminating between similar concepts or classes of information and consist of two parts. The first part provides instructions or a “lead-in” and may begin with a phrase such as, “For each of the following patients.”

EXAMPLE → Instructions: Match the virus with the disease and place the corresponding letter in the answer blank. (No items may be used more than once.) Answer:

____ 1. Coxsackievirus A A. Common cold ____ 2. Respiratory Syncytial Virus B. Herpes genitalis ____ 3. Echovirus C. Pharyngitis ____ 4. Rhinovirus D. Respiratory disease in kids ____ 5. Herpes Simplex 2 E. Aseptic meningitis F. Viral gastroenteritis in kids G. Shingles

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You may also want to organize a question set is around a chief complaint or some other factor with a more descriptive lead-in such as, “For each of the following patients with fatigue,” or “For each of the following patients with an enzyme deficiency.”

The second part of the lead-in describes the task and the option set: “select the most likely diagnosis”; “se protein that is most likely to be defective.”

Tips for Writing Extended Matching Question Sets

• Decide on a theme. A theme can be a chief complaint, a situation or a drug class. For example, if you want to write some questions related to the diagnosis of chest pain, you would begin by listing the diagnoses that might cause chest pain.

• Write the instructions or lead-in for the set (e.g., “For each patient described below, select the most likely diagnosis.”) The lead-in indicates the relationship between the stems and the matching options.

• Create list of options. The list of options should be single words or very short phrases. List the options in alphabetical order unless there is some other logical order.

• Write each item for the set. These should be similar in structure. (Patient vignettes often work well.) • Review and check to ensure that there is only a single “best” answer for each question and that there are

reasonable distractors for each item.

It’s a good idea to ask a colleague to review your quiz or test items (without the correct answer indicated). If your colleague has difficulty determining the correct answer, modify the option list or the item to eliminate the ambiguity.

EXAMPLE → Instructions: For each patient with fever, select the pathogen most likely to have caused his/her illness. Place the corresponding letter in the answer blank. (No items may be used more than once.)

A. Adenovirus D. Coxsackievirus B. Aspergillus fumigatus E. Streptococcus pyogenes (group A) C. Bacillus anthracis F. Epstein-Barr

1. A 6-year-old girl has a high fever and a sore throat. There is pharyngeal redness, a swollen right tonsil with creamy exudate, and painful right submandibular lymphadenopathy. Throat culture on blood agar yields numerous small hemolytic colonies that are inhibited by bacitracin. Answer ____

2. For the past week, an 18-year-old woman has had fever, sore throat, and malaise with bilaterally enlarged tonsils, tonsillar exudate, diffuse cervical lymphadenopathy, and splenomegaly. There is lymphocytosis with atypical lymphocytes. The patient tests positive for heterophil antibodies. Answer ____

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NBME Exam Creation and Editing Process

Access How to access website and NBME CAS page:

1. https://nsp.nbme.org/ 2. Use your login and password for the NBME website to login. 3. User ID: oregonhsu1 or oregonhsu2 (the number is taped on the RSA key) 4. Pin Number: itot123 5. RSA Token Code: refer to RSA Token Key 6. Click “Build Exam” 7. Click “here” under the Building Customized Assessment Exam

Platform and Brower that have been validated:

• Windows XP (IE7, IE8, Firefox 3); Windows Vista (IE7, IE8, Firefox 3) • Mac OSX (Safari 3, Firefox 3 but not 4), Chrome • The browser must be configured to enable JavaScript and accept session cookies, to allow pop-up from this

website NBME CAS Help Desk: 215-590-9259

Timeline Who What 8 weeks (9 weeks for FUND) prior to the first day of assessment week

Block Directors & Thread Directors (face-to-face mtg)

Create Blue Print (step 1) - 100 question items - Decide on content area - Decide on min/max numbers per content area

Click Step 2, select Create a New Test, select the test, then Generate test. NBME CAS will generate 200 questions for you to choose from.

7 days Block Directors Within an hour or so, you will receive email from NBME “Notice of Exam Construction Completion”

Review and edit a draft test (step 2). - Select the correct test - Item pacing: 90 seconds (except for NSF and DEVH: 72 seconds) - If you want an item, check a box under “On Test” - If you don’t want an item, check a box under “Drop” - If the item needs to be reviewed by thread director, put “review

needed by XXX” under the “Notes” section. Save the exam by clicking an icon “Save” Click Main Menu and select Step 3. Select “Replace Items.”

- Under Confirmation, edit the Test Description of New Version (you can use your initial). And check box “Save version” on current test.

- Click “Regenerate” Dropped items will be replaced. Replaced items will have numbering

starting 1000 level. The following replacement will give you at 2000 level, and so on.

You will receive email message, “Notice of Exam Construction Completion” from NBME approximately in an hour

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Go to Step 2 and review. Repeat the above procedures until you find items you want.

3 days Thread Director 1 Review and edit a draft test (step 2). Each thread director reviews contents in their areas. - Select the test, and click green arrow icon - If you want an item, check a box under “On Test” - If you don’t want an item, check a box under “Drop” - If the item needs to be reviewed by other thread director, put

“review needed by XXX” under the “Notes” section. Save the exam by clicking an icon “Save” Click Main Menu and select Step 3. Select “Replace Items.”

- Under Confirmation, edit the Test Description of New Version (you can use your initial and date). And check box “Save version” on current test.

- Click “Regenerate” Dropped items will be replaced. Replaced items will have item

number different from the original ones (i.e., the original items: 1, 2, 3, 4…; the first replacement items: 1000, 1001, 1002, 1003…; the third replacement items: 2000, 2001, 2002, 2003…).

You will receive email message, “Notice of Exam Construction Completion” from NBME approximately within an hour

Go to Step 2 and review. Repeat the above procedures until you find items you want.

3 days Thread Director 2

3 days Thread Director 3 3 days Thread Director 4 3 days Thread Director 5 3 days Thread Director 6 3 days Thread Director 7

7 days Block Directors Review the exam. Revise as needed. 1 to 2 weeks prior to assessment week

Block Directors and Thread Directors )face-to-face meeting)

Review the final draft. Drop and add questions as needed. Final test should contain 100 “On Test” question items.

Preview test (step 4) Return RSA key to Tomo

At least 3 days prior to assessment date

Tomo and Marcia Order exam online and assign students at least 3 days prior to the exam date.

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Assessment Analysis & Adjustment Process

Background The yourMD UME Foundations of Medicine curriculum uses five multi-modal block assessment categories:

1. Component 1- Weekly quiz given in ExamSoft 2. Component 2- Weekly Clinical and/or Science Lab Skills demonstration Assessments (some weeks may not have

any CSAs or SSAs; other weeks may have more than 1.) 3. Component 3 - Final Block exam given in ExamSoft 4. Component 4 - National Board of Medical Examiners (NBME) customized board exam 5. Component 5 - Final clinical and science skills/demonstration exams

These Components provide summative assessments of student learning for all major concepts in each block. In addition, final assessments are designed to:

• Allow students to identify areas of strength and weakness; • Help prepare students for the USMLE Step 1 exam; • Assist UME leadership with monitoring the performance of individual students; and • Help evaluation of the curriculum at large.

Timeframe: Components 1 and 2 will take place every Friday during the block. Components 3, 4 and 5 will take place during the designated assessment week in the end of each block. In the event that scheduling or other logistical constraints prevent an assessment from happening during the regularly schedule time, some or all of the assessment will be reschedule to another appropriate date/time. Students will be notified well in advance when this is necessary. Mode: Assessments will consist of multiple-choice questions (MCQs), clinical examinations using standardized patients or other simulation methods, identification, short answer questions, or matching questions as deemed appropriate. Content tested may come from any instructional session or instructional materials in the block, including clinical or science skill laboratories. Only content taught in the respective block will be included, but assessments may build on prior knowledge first introduced in previous blocks. Once students have completed these multi-modal assessments, performance statistics are generated.

Purpose The purpose of this process outline is to provide consistency across all blocks for the post-assessment analysis and adjustment process as well as the identification process for students who have not met the minimum passing threshold for all Components. This process will specifically:

1. Provide guidelines for evaluating the performance of assessments and making test item and/or whole assessment adjustments

2. Identify students requiring remediation for specific areas of deficiencies

Post-Assessment Analysis Team (for all components with the exception of #2) A post-assessment analysis team meeting will take place on each Friday of the block (including the final assessment week) to review the results of the Components assessed. Required attendees include:

1. Minimum 1 Block Director 2. Teaching & Learning Center (TLC) Director or delegate 3. Teaching Services Office (TSO) Manager 4. Assessment Project Coordinator 5. Director of Assessments or Associate Dean for Undergraduate Medical Education (UME) 6. Only for component 3 - additionally a minimum of 1 content expert for each main content area covered (Block

Director, Thread Director, or core instructional faculty as identified by the Block Director)

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Component 1 & 3- Examsoft Weekly Quiz and Final:

Post-Assessment Analysis Process • Statistical analysis of each test question’s performance will include % correct p-value, discrimination index, and point

biserial to determine whether a question is psychometrically valid. The statistical results help to identify problems with individual questions.

• TSO manager will send out the assessment analysis and student queries to individual questions to the Post-Assessment Analysis Team before the meeting.

• Team members review assessment results before the meeting, and all participants will flag questions they feel need further review/discussion.

• Student queries will be reviewed to determine if certain questions need further discussion by the team. • Team to review summative exam analysis together. • Block Director to lead question-by-question discussion for each question that was identified as potentially

problematic as outlined below. • Team to discuss each question of concern and decide if it meets criteria for post-assessment adjustment. • If a question meets criteria for adjustment, team to decide how best to adjust (which adjustment option to choose-

see below for details). • If needed, Block Director will contact Instructor who authored the question, to inform him/her of any question

adjustment and explain decision process. • TSO manager to adjust assessment results in real time. • TSO manager to release % correct scores to students after confirmation given from Block Director. Special Considerations: Unlike the weekly quizzes (Component 1), students are not given a complete copy of the Final Exam (Component 3) to keep. Rather, they are given an opportunity to review their examination and answers in a secure test review provided by the TSO Manager at a designated time after the block assessments have been completed.

Criteria for Post-Assessment Adjustment of Components 1 & 3 Exam Test Questions:

• Question is poorly worded or in an inappropriate format and/or not consistent with instructions provided for writing high-quality MCQs.

• Question’s content matter was not taught: a. Not a key concept tied to any session objective AND not addressed significantly in any learning session

over the course of the block b. Was an objective but NOT found in any pre-session instructional materials or learning session over the

course of the block

(Block or Thread Director may need additional information directly from the author of the question before determining if a particular test item meets criteria for post-assessment adjustment) Adjustment options once a question qualifies for adjustment:

1. Accept all test-takers’ answers as correct (preserves the original total number of questions in the assessment)

2. Accept several specific answers if there is more than one correct answer but other answer choices are clearly wrong

3. Remove the question (lowers the total number of questions in the assessment)

Remediation identification: • Component 1- any student who does not meet the overall passing threshold of <70% total average for all weekly

assessments (note: students can drop lowest weekly quiz for component 1) is required to remediate.

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• Component 3- Any student who does not meet the overall passing threshold of <70% or below passing threshold on final Examsoft assessment, whichever is lower is required to remediate.

• See Remediation Process for details.

Component 2 & 5- Clinical/Science Skills Assessments:

Post-Assessment Analysis Team

• Clinical Skills Assessments are the responsibility of the Clinical Thread Directors. Any CSA involving Standardized Patients (SP) will be graded and submitted by the SP following the encounter. Clinical Skills Directors will review grades for final analysis and reporting to UME assessment team.

• Science skills Assessments are the responsibility of the Science Thread Directors who will grade (along with faculty members when needed) and report all final grades to the UME assessment team.

Special Consideration: The CSAs are an opportunity both for practicing as well as assessing the skills learned in the CSLs. Standardized patients are given a script containing details of their presenting complaint as well as elements from the review of systems, past medical/social/family histories that the students then have to obtain during their 17 minute encounter for credit. They are assessed both via a check list containing elements that the students need to obtain in history taking as well as on the performance of physical examination maneuvers and patient centered communication. All of the encounters are videotaped so that if there are any discrepancies in grading the students may review their interactions after grades are posted and have any grading disputes resolved with the thread director.

Post-Assessment Analysis • Each of the skills/demonstration assessments that make up Component 2 and Component 5 will be reviewed

separately. • The percentage weight that each of the assessments carry for Component 5 will be known and communicated to

students in advance of the assessments. • Once an individual assessment grade has been assigned, TSO Manager will send out the assessment results to the

Post-Assessment Analysis Team for review. • Thread Directors to determine need, if any, for adjustment, and which adjustment option should be used. • If adjustments are deemed necessary, TSO manager will adjust student scores in real time.

Criteria for Adjustment of Skills/Demonstration Assessments

1. Block and/or Thread Director selected a test item for inclusion, but in retrospect, s/he realizes the content was not taught, or was not adequately taught.

2. The examination scores are unexpectedly low, suggesting the examination was more difficult than intended for all students in the class.

Remediation identification:

• Component 2- any student who does not meet the overall passing threshold of <70% total average for all weekly skills demonstration is required to remediate.

• Component 5- Any student who does not meet the overall passing threshold of <70% or below passing threshold on final skills demonstration, whichever is lower is required to remediate.

• See Remediation Process for details.

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Component 4- NBME Exam:

Post-Assessment Analysis Process • TSO Manager will receive the initial % correct distribution from the NBME (usually within a few hours after test

administration). Approximately 48-72 hours after the test is administered to students, the NBME will send detailed thread reports for all individual test takers, but typically these reports are not available prior to the Friday Post-Assessment Analysis team meeting.

• TSO manager will send out NBME % correct report to Post-Assessment Analysis team before the Friday meeting. • Team members will review assessment results before the meeting. • UME data coordinator will perform statistical analysis on NBME % correct scores to provide adjustment scenario

options below. • During the meeting, Block Director(s) to determine need, if any, for adjustment, and which adjustment option

should be used. Note: once the NBME test is created and administered, we do not have access to review how an individual student has performed on individual test items. Since each test item selected for inclusion has a thread category associated with it, we are only able to see student performance bars for all questions grouped together in a particular thread as part of their thread report.

• If adjustments are deemed necessary, team to decide which adjustment option to choose, and TSO manager to

adjust student assessment scores in real time. • TSO manager to release exam % correct scores to all students once confirmation given from Block director. • Once detailed thread reports are received from the NBME, TSO Manager releases individual reports to all students. Criteria for Adjustment of NBME Examination

1. Block and/or Thread Director inadvertently selected a test item for inclusion, but in retrospect, s/he realizes the content was not taught.

2. The examination scores are unexpectedly low, suggesting the examination was more difficult than intended for all students in the class.

Adjustment Options for NBME Examination

1. Adjust (curve) the % correct scores upward to set the maximum score (100%) equal to what the top scorer in the class achieved, but keep the passing threshold at 70%.

2. Lower the passing threshold to below 70%, and equal to 2 standard deviations below the mean. Remediation identification:

• Any student who does not meet the overall passing threshold of <70% or is below the passing threshold, whichever is lower, is required to remediate.

• See Remediation Process for details.

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Remediation Process

Background The yourMD UME Foundations of Medicine curriculum uses five multi-modal block assessment categories:

1. Component 1- Weekly quiz given in ExamSoft 2. Component 2- Weekly Clinical and/or Science Lab Skills demonstration Assessments (some weeks may not have

any CSAs or SSAs; other weeks may have more than 1.) 3. Component 3 - Final Block exam given in ExamSoft 4. Component 4 - National Board of Medical Examiners (NBME) customized board exam 5. Component 5 - Final clinical and science skills/demonstration exams

These Components provide summative assessments of student learning for all major concepts in each block. In addition, final assessments are designed to:

1) Allow students to identify areas of strength and weakness; 2) Help prepare students for the USMLE Step 1 exam; 3) Assist UME leadership with monitoring the performance of individual students; and 4) Help evaluation of the curriculum at large.

Once students have completed these multi-modal assessments, performance statistics are generated. The purpose of this process outline is to provide consistency across all blocks for the creation of both remediation activities and remediation re-testing for students who have not met the passing threshold for Components 1-5. This process will specifically:

1. Identify students requiring remediation for specific areas of deficiencies 2. Describe the process for remediation activities and re-testing 3. Outline the communication process for remediating students.

Identification of Students Requiring Remediation Students will qualify for remediation if any of the following are met: • Component 1 Weekly Quizzes: <70% total average of all quizzes (note: students can drop lowest weekly quiz) • Component 2 End-of-Week Clinical and/or Science Lab Skills demonstration assessments: <70% total average • Component 3 Final Block Exam: <70% or below passing threshold, whichever is lower • Component 4 NBME board exam: <70% or below the passing threshold, whichever is lower • Component 5 Clinical and Science Skills demonstration Exams: <70% total average

Development of Student Remediation Plan Identification of deficient areas: Given the student’s failed component(s), TLC and other members of the Post-Assessment Analysis Team as appropriate, will identify areas of deficiency down to the most granular level possible which will vary by component.

o Component 1 – remediation plan based on deficiencies of key concepts on failed weekly quizzes o Component 2 – remediation plan based on deficiencies in key clinical or science lab skills assessments o Component 3 – remediation plan based on deficiencies in key concepts in final exam results o Component 4 - remediation plan based on thread areas with lower performance as detailed on individual NBME

thread report. Members of the Post-Assessment Analysis Team will work together to narrow down main

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concepts to as granular and actionable remediation areas as possible. This may take the form of thread concepts, or week-by-week concepts from the Block

o Component 5 – remediation plan based on deficient areas of clinical and/or science skill assessment failed

Remediation Activities • Based on the deficiencies identified above, TLC will work with Block or Thread Directors in identifying the key

instructors with whom to develop remediation activities for all students requiring remediation. • All students required to remediate will receive a Component Remediation Information Sheet by the Block Director or

Associate Dean for UME. See “communication” section below. • All students will be encouraged to meet with the Student Learning Support Specialist for general tips and study

strategies prior to taking their remediation assessments. • The instructor, Thread and/or Block Directors will create a suggested list of topics and study materials (e.g., book

chapters, instructional materials, etc.) the student can review to focus their studying prior to their remediation re-testing.

• Instructors and/or Block and Thread Directors will work individually with the student as needed to aid in the comprehension of the student’s areas of deficiency in the form of group review sessions or individual office hours.

Remediation Assessment/Re-Testing Process

Components 1, 3 and 4: • The instructor and Thread and/or Block Director will create 1-2 short answer questions for each concept area to be

given in the final remediation exam, of which the Block Director may choose 1. • The author of the short answer remediation questions will also create an answer key ahead of time to include the

key elements of what a correct answer would be. • Short answer questions will be provided to the TSO Manager no later than 48 hours prior to administering the

remediation assessment on Friday morning of Enrichment week for the creation of individual student assessments. • Short answer questions will be administered in ExamSoft. • Students will have unlimited time to complete their remediation assessments. • Once completed, student answers to all remediation assessment questions will be sent by the TSO Manager to the

designated grader for that question. • All students completing a particular remediation assessment will have their answers graded using the standard

rubric (“UME Grading Rubric for Short Answer Questions”) by the same individual content expert, or in a consensus format of content experts to determine the student’s final score for each question.

• Grading for the component will be pass-no pass and students must achieve at least a 70% average of the points available for all remediation assessments for that component to meet the passing threshold.

• Grading will include: o Final level scored from rubric for each short answer question (i.e., 1-5) (See Appendix XX) o Total points earned for each short answer question o % of points achieved for each short answer question o Rationale for student score received from grader

• Once remediation re-testing grades have been determined for each component, this information will be communicated to the Block Director and the Associate Dean for UME, who will coordinate communication to the student.

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Components 2 and 5: • The skills instructor, Thread Director, or Block Director will create a remediation assessment for each of the skills

assessments in which a student requires re-testing. • The author of the remediation assessment will note the correct answers for each skills assessment when creating

the test. • All science skill remediation assessments will be administered on Friday morning of the Enrichment Week, and the

format will be similar to the original science skill assessment (e.g., in ExamSoft). • All clinical skill remediation assessments will be administered in the same format as the original clinical skill

assessment (i.e., in the simulation center with standardized patients, or learning studio as appropriate) • Students will have unlimited time to complete their remediation assessments. • Once completed, the TSO Manager will send the assessment results to the Block Director, appropriate Thread

Director, and the Associate Dean for UME. • Grading for the component will be pass-no pass and students must achieve at least a 70% average of the points

available for all remediation re-testing for that component to meet the passing threshold. • Grading will include the % correct for each of the clinical or science skill remediation assessments.

Communication 1. Identify students required to remediate any Component based on the Post-Assessment Analysis Team meeting 2. Identify each student’s designated Portfolio Coach 3. Identify student’s area(s) of deficiency 4. Thread Director (or Block Director if area of deficiency is not encompassed in a Thread) to identify key instructor

for each area of deficiency 5. Block Director to contact instructor/content expert (carbon copying Thread Director) with the following:

a. Notification of student who failed their identified concept b. Stating the process for remediation c. Requesting their assistance in helping the student improve their comprehension of the topic in group

setting or “office hours” approach 6. Block Director to email remediating students the following, and cc’ing the student’s Coach, Student Learning

Support Specialist, and Instructor(s) after the remediation plan is set above: a. Failure of identified component(s) with specific student score, and passing threshold score b. Key concept areas deficient in the component(s) c. Component Remediation Information sheet including the key areas to study, and if the

instructor/content expert will provide office hours or review session and date/time; remediation details such as date and time of remediation re-testing (typically will be Friday morning of Enrichment week), and expected communication following the re-testing.

d. Notice that student is strongly encouraged not to participate in previously scheduled enrichment activities so they may focus on the remediation task at hand. However, students will not be prevented from doing so

e. Refer students to the Block syllabus, which further outlines the Block grading and remediation procedures.

7. For students with required remediation of Component 4 NBME examination: a. Block Directors should email the students needing remediation once it is determined who has not met

the passing threshold, no later than the end-of-day of the Post-Assessment Analysis Team meeting. The communication will let the student know that once their individual NBME thread report is available, they will receive this along with further instructions regarding their remediation re-testing. Until this report is available, the student should be encouraged to review the Block material as a whole, focusing on areas of weaker performance based on the weekly quizzes.

b. Once the NBME thread reports are available, the Block Director will email this to the students requiring remediation and include information about what areas are deficient and therefore, what areas will be covered in the remediation assessment.

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8. After remediation re-testing is completed and as soon as remediation re-testing grades have been determined for each component, (including all assessments within a component) this information will be communicated to the student and their Coach by the Block Director or the Associate Dean for UME.

9. Students who pass their remediation re-testing for any originally failed component will have their final block grade posted as “Pass” on their official university transcript. Students who do not pass their remediation re-testing for any originally failed component will have their final block grade posted as “No Pass” on their official university transcript.

10. All original assessment student scores as well as remediation assessment student scores are tracked by the UME program and Associate Dean for UME. All communication to students regarding their overall progress/status in the MD program will come from the Associate Dean for UME to the student.

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Test Item Difficulty, Discrimination Index, and Point Biserial Explained by

Tom Boudrot, Ed.D.

The Point-biserial and discrimination index are almost identical (simply different calculations that

achieve the same purpose – not sure why ExamSoft displays both) and compare students in the top

27% in overall test performance from the bottom 27% (overall as well) on a specific test item. The

discrimination scores are useful measures of item quality whenever the purpose of a test is to produce a

spread of scores, reflecting differences in student achievement. If I’m not mistaken, the calculations for

point-biserial and discrimination index are slightly different in the ExamSoft system … I use them

interchangeably since they’re always very close.

I’ve taken a few slides from a workshop I do often that shows two important metrics:

P-value (item difficulty) and IDis (item discrimination or point-biserial). They’re both pretty basic and

easy to compute. The item discrimination slide shows the computation when five students in the upper

group and 2 students in the lower group got a specific exam item correct yielding a discrimination index

of .50 (a good discriminator).

I also included to slides that show the basic ranges of each value. For test items that aren’t written by

professional test developers. I give more wiggle room for item discrimination and consider anything

above .20 to be “in the ball park” and anything above .30 to be pretty good.

Tom

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Grading Rubric for Short Answer Assessments

Each question is graded by giving an overall level for the student’s response based upon the above rubric. There are 10 possible points for each question. Points are totaled in the following way:

Level 5 = 10 points = 100% Level 4 = 8 points = 80% Level 3 = 6 points = 60% Level 2 = 4 points = 40% Level 1 = 2 points = 20% Level 0 = 0 points = 0%

A student’s final score for the short answer assessment is calculated using the following:

Total points attained by student Total possible points

Students must attain an average of 70% or greater of the possible points on the assessment to meet the passing threshold.

LEVEL DESCRIPTION

5 Demonstrates complete understanding of the question. All requirements of the problem are included in the response. Medical terminology used accurate and student’s reasoning is clear and correct. Demonstrates excellent understanding of the material covered in lecture, reading and study guides.

4 Demonstrates considerable understanding of the question. All requirements of the problem are included in the response. Medical terminology used is mostly accurate and student’s reasoning is mostly clear and correct. Demonstrates competent understanding of the material covered in lecture, reading and study guides.

3 Demonstrates partial understanding of the question. Most requirements of the problem are included in the response. Medical terminology used is generally accurate and student’s reasoning is evident but is incorrect or unclear at times.

2 Demonstrates little understanding of the question. Many requirements of the problem are missing from the response. Medical terminology used is sometimes inaccurate and student’s reasoning is muddy or unclear.

1 Demonstrates no understanding of the question. Most requirements of the problem are missing from the response. Medical terminology is not used or used incorrectly. Student’s reason is missing or unstated.

0 No response attempted.

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Sample Clinical Skills Assessment Checklist

The checklist:

1. Did the student introduce themselves? 2. Did they clean their hands? 3. Did they speak clearly at a moderate pace? 4. Did they ask what makes your symptoms better? 5. Did they ask about past medical history? 6. Did they ask about your family history? 7. Did they ask about at least some social history? 8. Did they feel for any vibrations when you were speaking? 9. Did they percuss your lungs from behind? 10. Did they listen to your lungs in 3 areas on both sides? (1 point each)

a. Upper chest b. Sides underneath your arms c. Back

11. Did they elicit questions in a patient centered manner? 12. Comments/areas the student could improve?

The Honors checklist:

1. Did they ask about sputum? 2. Did they ask about pain? 3. Did they get the history that you went to Fresno? 4. Did they listen through the stethoscope and ask you to say “E”? 5. Did they tell you that they thought you might have a pneumonia that might not respond to the usual

antibiotics? (patients on dialysis are at risk for health care associated pneumonia) 6. Did they mention that your trip to Fresno suggests an infection called cocci (coccidiomycosis or valley fever) 7. Did they mention any antibiotic choices? 8. Did you feel confident in the student’s abilities?

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Foundations of Medicine Request for Time-Off From Assessment

Students in the Foundations of Medicine curriculum are expected to attend and actively participate in all required learning sessions and assessment activities. Students should schedule personal activities during University breaks in the academic calendar (totaling 5 weeks per year), or during their Independent Learning session each week. Students wishing to request time-off when a required assessment is scheduled are required to submit this form for approval. Request for Time-Off from an Assessment Due To Emergency Absence/Personal or Immediate Family Illness: In most circumstances, requests from students with emergency absences due to personal or immediate family illness will be granted and an alternate assessment will be rescheduled no later than one week after the initial assessment date. Students are still required to submit this form to the Block Director once they know they will not be present at a required assessment. Request to Take Time Off from an Assessment for Non-Emergency Personal Reason: Request for time off for non-emergency personal reasons such as weddings, reunions, etc. may sometimes be approved by the Block Director and can be considered if you submit this Request for Time Off from Assessment form. As these types of reasons can most always be anticipated, students are encouraged to provide as much advanced notice as possible. Not all of these requests will be approved, and students who submit a request that is denied by the Block Director are expected to take the assessment at the scheduled time or they will receive no credit for that assessment. Steps for Requesting Time Off:

1. For emergency absences, the student will submit this form as soon as possible once an absence becomes necessary. For absences that can be anticipated, the student submits this form to the Block Director as soon as possible in advance of the assessment date.

2. The Block Director will review the request and will approve or deny the request. Approvals of Requests for Time Off from Assessments will include any requirements or conditions to be met by the student at the time of approval. The Block Director may consult the Dean’s Office UME Teaching Services Manager to determine if previous days off from assessments have been granted to the student in the Foundations of Medicine curriculum.

3. The Block Director will forward the final decision and the signed Request for Time Off form to

the Dean’s Office Teaching Services Manager, Laura Foran (foranl@ohsu.edu), where the attendance records for assessments will be maintained for students in the Foundations of Medicine curriculum.

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*****************************************************************************

Completed By Student: Student Name: Block Name: Today’s Date: Requested Date(s) for Time Off:

Please Select One Category

[ ] Emergency Absence/Personal or Immediate Family Illness [ ] Non-Emergency Personal Reason

Please Describe Circumstances and/or Details You Wish To Be Considered For This Request

Student Signature: Date: *********************************************************************************

Completed By Block Director: Block Director Signature: Date:

Action Taken By Block Director: [ ] Approved

Conditions or Requirements for Make Up Assessment: [ ] Denied

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Teaching Evaluation & Quality Improvement

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Teaching Evaluations on Sakai

Individual teaching evaluations are stored on Sakai for Faculty to review. Each instructor should have access to Sakai and be able to review his/her student evaluation of each session taught. To access your teaching evaluations follow these easy steps:

1. Log into Sakai at https://sakai.ohsu.edu/

2. Locate the “Evaluation Reports” section on the main page and click on the “available here” link

3. Evaluations are listed by course

4. Choose the course you wish to review then choose the week to see your evaluations

5. If you do not see any evaluations and you have taught in a Foundations of Medicine block, please contact the Sakai help desk at 1-877-942-5249 or sakai@ohsu.edu

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Foundations of Medicine - Session Instruction Observation Rubric Instructor:

Week/Date/Time:

Block: Observed By:

Session Topic/Title:

The purpose of this form is to provide timely feedback on faculty sessions in Foundations of Medicine.

Session Observational Rubric 3 2 1 0

Ex

ceed

s ex

pect

atio

ns

Mee

ts

expe

ctat

ions

Insu

ffici

ent/

Nee

ds W

ork

Not

Pre

sent

Introduction Introduces topic and teaching goals, establishes context, offers preview Gains attention and motivates learning

Body of Teaching Clearly addresses session objectives (as stated in Ilios) Links class content to prior learning and/or weekly TBL case Provides time for student questions and demonstrates active listening Creates opportunities for higher order thinking (e.g., interpretation, synthesis, evaluation)

Demonstrates command of the subject Appropriately answers student questions Facilitates or otherwise encourages productive class discussion

Pedagogical Strategies More than one form of instruction is used Active learning is integrated into the instruction Provides clear instructions and adequate time for active learning activities Educational technology of the room is effectively utilized

Assessment Provides formative assessments to check for understanding (clicker questions, weekly quiz questions, discussion questions, etc.)

Explains rationale behind correct and incorrect answers post-assessment Summary

Ends session with brief review of major concepts covered Additional Comments:

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Educational Leaders

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Duties and Responsibilities The following positions have been hired to support the Foundations of Medicine curriculum. A listing of specific job description can be found in (Appendix):

Block Director

Clinical Skills Lab Instructor

Director of Narrative Medicine

Director of Clinical Skills Lab Faculty Development

Foundation of Medicine Lead

Preceptorship Director

Prematriculation Block Director

Thread Director

Meetings and meeting schedules The smooth operation of each block in the Foundation of Medicine curriculum requires a group effort. Members of the Foundations of Medicine leadership, operations and administrative teams are invited to take part in several meetings that occur at various times throughout the curriculum. A listing of the specific meetings and their purpose are listed below:

Pre-operations meetings- Beginning six weeks prior to the start of each block, this one hour weekly meeting is key in pulling together the final details of the block as well as resolving any unresolved issues. Areas of emphasis include: session objective finalization, Sakai site build out and schedule finalization, solidification of block assessment dates and syllabus finalization. Participants may include ADUME, FoM Lead, Block and Thread Directors, operations staff, members of the TLC and others. Meeting schedule is based on the availability of the block directors and varies per block. Location may vary.

Faculty Kickoff meetings- Scheduled approximately two months before the start of a block, this one time meeting is the kick into high gear for block organization involving teaching faculty, block and thread directors. Participants may include teaching faculty, ADUME, FoM Lead, Block and Thread Directors, operations staff, members of the TLC and others. Meeting schedule is based on the availability of the block directors and varies per block. Location may vary.

Operations meetings- Beginning with the first week of the block, this one hours weekly meeting serves as a check-in between the operations team and block and thread directors to ensure the block is running smoothly. Areas of emphasis include: state of the week, teaching materials update, weekly assessment creation, and discussing and areas of concern. Participants may include ADUME, FoM Lead,

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Block and Thread Directors, operations staff, members of the TLC and others. Meeting schedule is based on the availability of the block directors and varies per block (kept in the same timeslot as the pre-operations meeting when possible). Location may vary.

Post Assessment meetings- Scheduled each Friday following the weekly assessment (except when noted otherwise); this meeting is for the analysis and adjustment of the week’s assessment. Scores may be adjusted based on several factors (see Assessment Analysis & Adjustment Process for details- Pg XX). Participants include ADUME, at least 1 Block Director, TLC Director or delegate, TSO Manager, and Assessment Project Coordinator. Meetings are scheduled based on participant availability and may vary per week. Location may vary.

FoM Subcommittee meetings- Scheduled on the third Monday of each month, this one and a half hour meeting functions as a venue for all Foundations of Medicine leadership to meet and discuss larger matters concerning the overall curriculum, share ideas, discuss concerns, and participate in training as needed. Special topics can be submitted to the FoM Lead for incorporation. Participants may include ADUME, FoM Lead, Block and Thread Directors, operations staff, members of the TLC and others. Meeting schedule and location for AY 2015/16 is as follows:

Date Location July 20, 2015

CLSB 3A001

August 17, 2015 September 21, 2015 October 19, 2015 November 16, 2105 December 21, 2105 January 25, 2016 February 22, 2016 March 21, 2106 April 18, 2016 May 16, 2016 June 20, 2016

Faculty Town Hall meetings- Held at least once following the conclusion of each block (may be scheduled several times for longer blocks); this one hour meeting is a venue to gather important feedback from the teaching faculty regarding the block. Participants may include teaching faculty, select members of the student leadership team, ADUME, FoM Lead, Block and Thread Directors, operations staff, members of the TLC and others. Meeting schedule is based on the availability of the block directors and varies per block. Location may vary.

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Tracy Bumsted

Associate Dean, Undergraduate Medical Education Teaching Services staff Narrative

Medicine & Preceptorship

Block Directors

Thread Directors

Deans Office staff

Faculty Development

UME Advising, Colleges and Outreach

Laura Foran Administrative Manager, UME Teaching Services

Marc Gosselin Lead,

Foundations of Medicine

Tomo Ito Administrative Manager,

UME Curriculum and Student Affairs

David Pollack Director, Clinical Skills Faculty Development

Nicole Deiorio Director, Colleges

Teresa Andersen Program Tech, FoM Block support

Emily Larson Program Tech, Clinical Skills support

Elizabeth Lahti Director, Narrative Medicine

Cezary Wojcik & Steve Planck Co-Directors, FUND Block

Erin Bonura Director, Microbiology & Immunology

Leslie Haedinger Assessment Coordinator, Curriculum Transformation

Gretchen Scholl Informaticist, Electronic Health Records Educational

Carolyn Zook Program Manager, UME Advising, Colleges and Outreach

Tamara Khachaturian Program Tach, FoM Block support

Olivia Buscho Admin. Asst., UME Teaching Services

Mark Kinzie Director, Preceptorship

Gabrielle Meyers & Evan Shereck Co-Directors, BLHD Block

Sylvia Nelsen Director, Anatomy Embryology & Histology

Kaitlin Seymore Admin. Assistant, Curriculum and Student Affairs

All College Coaches and Leads (~44)

Nick Crampton Lab Tech, Technical Assistance

Lyndsay Dinino Preceptorship Coordinator

Lynne Morrison & Nels Carlson Co-Directors, SBM Block

David Farrell Director, Physiology, Pathology & Pharmacology

Sandra Iragorri

& Bart Moulton Co-Directors, CPR Block

Peter Mayinger Director, Cell Biology, Genetics, Biochemistry & Nutrition

Amy Garcia & Jessica Castle Co-Directors, HODI Block

Cliff Coleman Director, Communication, Ethics & Professionalism

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Meg Cary & Suzanne Mitchell Co-Directors, NSF Block

Paul Gorman Director, Epi, EBM, Informatics, Health Policy, Quality & Safety

Diane Stadler & Amy Stenson Co-Directors, DVH Block

Pete Sullivan Director, Patient Interview, Exam & Clinical Reasoning

All Block specific faculty instructors

All Clinical Skills Instructors (~40)

Teaching and Learning Center Staff in conjunction with FoM

Alex Shuford Interim Director,

Teaching & Learning Center

Program facilitation and Evaluations

Faculty consultations

Ilios/Sakai Student learning support & tutoring

Sarah Jacobs Faculty Development Specialist

Janet Wheeler Educational

Development Specialist

Shoshana Zeisman-Pereyo Student Learning Support Specialist

Assistant Professor

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Marc Gosselin, MDAssociate Professor Dept. of Diagnostic Radiology

Cezary Wojcik, MD, PhDAssociate ProfessorDept. of Family Medicine

Steve Planck, PhDProfessorDept. of Opthomology

Gabrielle Meyers, MDAssociate ProfessorDept. of Medicine

Evan Shereck, MDAssociate ProfessorDept. of Pediatrics

Lynne Morrison, MDAssociate ProfessorDept. of Dermatology

Nels Carlson, MDAssociate ProfessorDept. of Orthopaedics & Rehabilitation

Bart Moulton, MDAssistant ProfessorDept. of Medicine

Sandra Iragorri, MDAssociate ProfessorDept. of Pediatrics

Skin, Bones & Musculature Block Directors

Foundations of Medicine Lead

Fundamentals of Medicine Block Director

Blood & Host Defense Block Directors

FoM 2015/16 Director Team

Cardiopulmonary & Renal Block Leads

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Jessica Castle, MDAssistant ProfessorDept. of Medicine

Amy Garcia, MDAssistant ProfessorDept. of Pediatrics

Meg Cary, MDAssistant ProfessorDept. of Psychiatry

Suzanne Mitchell, PhDProfessorDept. of Behavioral Neuroscience

Amy Stenson, MDAssistant ProfessorDept. of Obstetrics & Gynecology

Diane Stadler, PhD, RDAssistant ProfessorDept. of Medicine

Nervous System & Function

Developing Human

Hormones & Digestion Block Directors

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Cliff Coleman, MD, MPHAssistant ProfessorDept. of Family Medicine Professionalism, Ethics and Communication Thread

Peter Mayinger, PhDAssociate ProfessorDept. of MedicineNephrology & Hypertension Cell Biology, Genetics, Biochemistry and Nutrition Thread

Paul Gorman, MDProfessorDept. of Medical Informatics & Clinical Epidemiology Epidemiology, EBM, Informatics and Health Policy, Quality, Safety Thread

David H. Farrell, PhDProfessorDept. of Surgery Physiology, Pathology and Pharmacology Thread

Preceptorship DirectorMark Kinzie, MD, PhDAssociate Professor Dept. of Psychiatry

Narrative Medicine Director

Erin Bonura, MDAssistant ProfessorDept. of Internal Medicine Microbiology and Immunology Thread

Peter Sullivan, MDAssociate ProfessorDept. of Medicine Patient Interview, Examination and Clinical Reasoning Thread

Sylvia Nelsen, PhD Assistant Professor Dept. of Integrative Biosciences Anatomy, Embryology and Histology Thread

Elizabeth Lahti, MDAssistant Professor Dept. of Medicine

Thread Directors

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Foundations of Medicine Team Foundations of Medicine Lead

• Marc Gosselin, M.D., Associate Professor, Department of Diagnostic Radiology Block directors Pre-Matriculation Block Director

• Erin Bonura, M.D., Assistant Professor, Department of Medicine Fundamentals Co-Block Directors

• Steve Planck, Ph.D., Professor, Department of Ophthalmology • Cezary Wojcik, M.D., Ph.D., Assistant Professor, Department of Family Medicine

Blood & Host Defense Co-Block Directors

• Gabrielle Meyers, M.D., Associate Professor, Department of Medicine • Evan Shereck, M.D., Associate Professor, Department of Pediatrics

Skin, Bones & Musculature Co-Block Directors

• Nels Carlson, M.D., Associate Professor, Department of Orthopaedics and Rehabilitation • Lynne Morrison, M.D., Associate Professor, Department of Dermatology

Cardiopulmonary & Renal Co-Block Directors

• Sandra Iragorri, M.D., Associate Professor, Department of Pediatrics • Bart Moulton, M.D., Assistant Professor, Department of Medicine

Hormones & Digestion Co-Block Directors

• Jessica Castle, M.D., Assistant Professor, Department of Medicine • Amy Garcia, M.D., Assistant Professor, Department of Pediatrics

Nervous System & Function Co-Block Directors

• Meg Cary, M.D., Assistant Professor, Department of Psychiatry • Suzanne Mitchell, Ph.D., Professor, Department of Behavioral Neuroscience

Developing Human Co-Block Directors

• Amy Stenson, M.D., Assistant Professor, Department of Obstetrics and Gynecology • Diane Stadler, Ph.D., R.D., Assistant Professor, Department of Medicine

Thread directors Professionalism, Ethics and Communication Thread Director

• Cliff Coleman, M.D., MPH, Assistant Professor, Department of Family Medicine Patient Interview, Examination and Clinical Reasoning Thread Director

• Peter Sullivan, M.D., Clinical Associate Professor, Department of Medicine Epidemiology, EBM, Informatics and Health Policy, Quality, Safety Thread Director

• Paul Gorman, M.D., Professor, Department of Medical Informatics and Clinical Epidemiology Anatomy, Embryology, Histology Thread Director

• Sylvia M. Nelsen, Ph.D., Assistant Professor, Department Dentistry Cell Biology, Genetics, Biochemistry and Nutrition Thread Director

• Peter Mayinger, Ph.D., Associate Professor, Department of Medicine Physiology, Pathology and Pharmacology Thread Director

• David H. Farrell, Ph.D., Professor, Department of Surgery Microbiology and Immunology Thread Director

• Erin Bonura, M.D., Assistant Professor, Department of Medicine

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Foundations of Medicine Team (continued) Preceptorship Thread Director

• Mark Kinzie, M.D., Clinical Associate Professor, Department of Psychiatry Narrative Medicine Director

• Elizabeth Lahti, M.D., Assistant Professor, Department of Medicine Faculty Development Directors

• David Pollack, M.D., Professor, Department of Psychiatry Educational Theory Faculty

• Sarah Jacobs, M.Ed., Faculty Development Specialist, Teaching and Learning Center Educational Informaticist

• Gretchen Scholl, B.S., Informaticist, School of Medicine SOM UME Curriculum Committee Chair

• Paul Gorman, M.D., Professor, Department of Medical Informatics and Clinical Epidemiology

Colleges Team College program director

• Nicole Deiorio, M.D., Professor, Department of Emergency Medicine College leads Acute College

• Dawn Dillman, M.D., Associate Professor, Department of Anesthesiology & Perioperative Medicine • David Jones, M.D., Assistant Professor, Department of Emergency Medicine

Rural Medicine • Rebecca Cantone, M.D., Instructor, Department of Family Medicine • Tim Herrick, M.D, Assistant Professor, Department of Family Medicine

Hospital-Based Diagnostics and Therapeutics • Joseph Chiovaro. M.D., Instructor, Department of Medicine • David Pettersson, M.D., Instructor, Department of Diagnostic Radiology

Urban Medical Subspecialties • Rebecca Harrison, M.D., Associate Professor, Department of Medicine • Kara Connelly, M.D., Assistant Professor, Department of Pediatrics

Surgical Specialties • Aaron Caughey, M.D., Ph.D., Professor, Department of Obstetrics and Gynecology • Laszlo Kiraly, M.D., Associate Professor, Department of Surgery

Metropolitan Primary Care • Sean Robinson, M.D., Instructor, Department of Family Medicine • Elizabeth Bower, M.D., MPH, Associate Professor, Department of Internal Medicine

Global Health/Urban Underserved • Jay Kravitz, M.D., Affiliate Assistant Professor, Department of Public Health & Preventive Medicine • Molly Osborne, M.D., Ph.D., Associate Dean, Professor, Department of Medicine

College coaches

• Laurel Berge, M.D., Adjunct Assistant Professor, Department of Emergency Medicine • Fran Biagioli, M.D., Professor, Department of Family Medicine • Evan Bilstrom, M.D., Assistant Professor, Department of Medicine • Carol Blenning, M.D., Associate Professor, Department of Family Medicine • Jim Boehnlein, M.D., Professor, Department of Psychiatry • Nate Brigham, M.D., Assistant Professor, Department of Medicine • Hans Carlson, M.D., Associate Professor, Department of Orthopaedics and Rehabilitation • Dan Clayburgh, M.D., Assistant Professor, Department of Otolaryngology, Head & Neck Surgery • Rob Cloutier, M.D., Associate Professor, Department of Emergency Medicine • Mary Anna Denman, M.D., Assistant Professor, Department of Obstetrics and Gynecology • Sharlene D’Souza, M.D., Assistant Professor, Department of Medicine

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• Ilse Larson, M.D., Assistant Professor, Department of Pediatrics • Paul Gorman, M.D., Professor, Department of Medical Informatics and Clinical Epidemiology • Kyle Johnson, M.D., Associate Professor, Department of Psychiatry • Janice Jou, M.D., Assistant Professor, Department of Medicine • David Kagen, M.D., Assistant Professor, Department of Medicine • Kyle Kent, M.D., Assistant Professor, Department of Medicine • Sheevaun Khaki, M.D., Assistant Professor, Department of Pediatrics • Karen Kwong, M.D., Clinical Associate Professor, Department of Surgery • Abigail Lenhart, M.D., Assistant Professor, Department of Medicine • Emily Myers, M.D., Assistant Professor, Department of Family Medicine • Amit Mehta, M.D., Assistant Professor, Department of Pediatrics • Michelle Noelck, M.D., Assistant Professor, Department of Pediatrics • Joel Papak, M.D., Assistant Professor, Department of Medicine • Kerry Rhyne, M.D., Assistant Professor, Hospitalist, VAMC • Shinpei Shibata, M.D., Assistant Professor, Department of Pediatrics • Sonia Sosa, M.D., Assistant Professor, Department of Family Medicine • Jamie Warren, M.D., Assistant Professor, Department of Pediatrics • Amy Wiser, M.D., Assistant Professor, Department of Family Medicine • Eric Wiser, M.D., Assistant Professor, Department of Family Medicine

Scholarly Projects Team Scholarly projects director

• Heidi Nelson, M.D., MPH., Research Professor, Department of Medical Informatics and Clinical Epidemiology Concentration leads Basic Science & Biomedical Engineering

• Peter Mayinger, Ph.D., Associate Professor, Department of Cell Biology & Developmental Biology

Clinical Research

• Lisa Silbert, M.D., Associate Professor, Department of Neurology

• Eneida Nemecek, M.D., MBA, Associate Professor, Department of Pediatrics

Ethics, Quality Improvement, & Education

• Erik Fromme, M.D., MCR, Associate Professor, Department of Medicine

Epidemiology, Community-based Research, & Global Health

• Craig Warden, M.D., MPH, MS, Professor, Department of Emergency Medicine

Law, Business, & Policy

• Mark Baskerville, M.D., J.D., MBA, Clinical Assistant Professor, Department of Anesthesia and Perioperative Medicine

Clerkship/Clinical Experiences Director Team Clinical Sciences sub-committee Chair

• Jeff Kraakevik, M.D., Assistant Professor, Department of Neurology Family Medicine

• Frances Biagioli, M.D., Professor, Department of Family Medicine Internal Medicine 3

• Kerry Rhyne, M.D., Assistant Professor, Hospitalist, VAMC Internal Medicine 4

• Rebecca Harrison, M.D., Associate Professor, Department of Medicine Neurology

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• Jeff Kraakevik, M.D., Assistant Professor, Department of Neurology Obstetrics and Gynecology

• Meg O’Reilly, M.D., Assistant Professor, Department of Obstetrics and Gynecology (50%) • Susan Tran, M.D., Assistant Professor, Department of Obstetrics and Gynecology (50%)

Pediatrics 1 • Carrie Philipi, MD, Ph.D., Associate Professor, Department of Pediatrics

Pediatrics 2

• Michelle Noelck, M.D., Assistant Professor, Department of Pediatrics Psychiatry

• Marian Fireman, M.D., Associate Professor, Department of Psychiatry (75%) • Daniel Haupt, M.D. , Associate Professor, Department of Psychiatry (25%)

Surgery

• Laszlo Kiraly, M.D., Associate Professor, Department of Surgery Rural and Community Health

• Carol Blenning, M.D., Associate Professor, Department of Family Medicine

Clinical Experience Development Team

• Jared Austin, M.D., Assistant Professor, Pediatrics, Department of Medicine • Mark Baskerville, M.D., J.D., MBA, Clinical Assistant Professor, Department of Anesthesia and Perioperative Medicine • Marian Fireman, M.D., Associate Professor, Department of Psychiatry • Jeff Kraakevik, M.D., Assistant Professor, Neurology • Suzanne Mitchell, Ph.D., Professor, Department of Behavioral Neuroscience • Bart Moulton, M.D., Assistant Professor, Department of Medicine • Stephanie Nonas, M.D., Assistant Professor, Department of Medicine • Meg O’Reilly, M.D., Assistant Professor, Department of Obstetrics and Gynecology • Jennifer Rossi, M.D., Adjunct Assistant Professor, Department of Emergency Medicine • Philippe Thuillier, Ph.D., Assistant Professor, Department of Public Health and Preventive Medicine

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Appendix

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NSF Syllabus provided as an example only- Information subject to change for each block Block Purpose Statement Students who complete this block will have a basic understanding of the structural and biochemical foundations of neural functioning in the context of neurophysiology and neuropathology. They will identify the genetic, congenital, developmental, endogenous, and exogenous factors that influence neurologic and behavioral function. They will learn the clinical presentation, diagnostic strategy, and management of common disorders of nervous and sensory systems. Students will also apply principles of professionalism, ethics, communication, epidemiology, biostatistics, informatics, health policy, patient interviewing and physical examination in relation to neuroscience, psychiatric conditions, and the senses. Block Dates

Instruction: August 10 - October 16, 2015 Holidays: No class September 7, 2015 (Labor Day) Fall Break: No class September 21 - 25, 2015 End-of-block Assessments: October 19 - 23, 2015 Enrichment/Remediation Week: October 26 - 30, 2015

Component 1 Assessments: end-of-week ExamSoft MCQ quiz; lowest weekly quiz will be dropped:

o August 14, 2015 o August 21, 2015 o August 28, 2015 o September 4, 2015 o September 11, 2015 o September 18, 2015 o October 2, 2015 o October 9, 2015 o October 16, 2015

Component 2 Assessments: end-of-week Clinical and Science Skills assessments; each worth 1/7 of final component grade:

o August 14, 2015 – Histology Quiz in learning studio o August 21, 2015 - Histology Quiz in learning studio o August 21, 2015 - Clinical skills assessment (CSA) in CLSB simulation center or learning studio o August 28, 2015 - Gross Anatomy Image Based Quiz in learning studio o September 4, 2015 - Clinical skills assessment (CSA) in CLSB simulation center or learning studio o September 11, 2015 - Gross Anatomy Image Based Quiz in learning studio o September 18, 2015 - Clinical skills assessment (CSA) in CLSB simulation center or learning studio

Component 3 Assessment- final ExamSoft assessment:

o October 23, 2015 - Administered from 1-3pm in learning studio

Component 4 Assessment: NBME cumulative block board exam

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o October 21, 2015 - Administered from 9:00am to 11:00am in learning studio Component 5 Assessments: End-of-block cumulative science and clinical skills exams; each worth 1/5 of final component

o October 22, 2015: Objective Structured Clinical Exam (OSCE) 8:00am to 5:00pm, groups of 20 students assigned specific times (20%)

o October 23, 2015: Science skills assessments in Richard Jones Hall (Times dependent on group) • Neuro anatomy (20%) • Histology (20%) • Microbiology (20%) • Gross Anatomy Practical (20%)

Block Goals

1. Describe the normal development of the central and peripheral nervous system, including the molecular biology of neural tissue.

2. Describe biological and social processes involved in neurological homeostasis, including basic neuroendocrine and neuroimmunological processes.

3. Describe contribution of somatic and mitochondrial genetic disorders to major nervous system disorders. 4. Describe early life events and epigenetic mechanisms that increase the risk for nervous systems disorders. 5. Identify neural structures and neurophysiological correlates of attention, consciousness, sleep, emotion,

memory, language, praxis, visuospatial function, and other higher cortical functions. 6. Describe underlying pathophysiology and localize the neuroanatomical correlates of the major congenital

and acquired neurological, psychiatric, and sensory organ diseases and disorders. 7. Describe diagnostic strategies and tools for identifying the pathophysiology of the major neurological,

psychiatric, and sensory organ diseases and disorders. 8. Describe the mechanisms of action of neuropharmacological treatment agents and complementary

medicines, including their indications, contraindications, and major side effects. 9. Be familiar with non-pharmacologic acute and chronic treatment of major nervous system disorders,

including their indications, contraindications, and major side effects. 10. Demonstrate competence and professionalism in clinical assessment by obtaining a relevant history and

performing a complete physical, neurological and psychiatric examination, pertinent to presenting signs and symptoms, epidemiology and cultural contexts.

11. Demonstrate understanding of basic biostatistical strategies and informatics principles and how these can be applied to health policies and behavioral science research.

12. Demonstrate conscientious participation in the classroom and groups by attending to all duties responsibly, contributing to clinical activities, and respectfully engaging with colleagues and staff.

13. Demonstrate the ability to acquire data from multiple sources, to define clinical problems, to generate a differential of diagnostic hypotheses, to apply information in comparing and contrasting plausible explanations, and to present clinical cases in oral and written forms.

14. Demonstrate creativity in development of clinical management plans that specifically address the defined clinical problem while attending to the triple aim of better health, better care, and lower costs.

15. Describe the impact of environment and social determinants of health, and systems of healthcare delivery on the quality of health outcomes for individual patients and populations.

16. Demonstrate ability to acquire data from multiple sources including patient interview, examination, EHR, diagnostic tests and scholarly resources, and apply that information in creating a differential diagnosis.

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Block Leadership and Contacts

Block Directors Margaret Cary, MD, MPH

Assistant Professor, Psychiatry carym@ohsu.edu

Suzanne Mitchell, PhD Professor, Behavioral Neuroscience

mitchesu@ohsu.edu

Foundations of Medicine Thread Directors

Sylvia Nelsen, PhD Anatomy, Embryology, Histology

nelsens@ohsu.edu

Cliff Coleman, MD Professionalism, Ethics, Communication

colemanc@ohsu.edu

Peter Mayinger, PhD Biochemistry, Cell Biology, Genetics, & Nutrition

mayinger@ohsu.edu

Peter Sullivan, MD Patient Interviewing, Exam, & Clinical Reasoning

sullivap@ohsu.edu

David Farrell, PhD Physiology, Pharmacology, Pathology

farrelld@ohsu.edu

Paul Gorman, MD Informatics, Epidemiology, Quality & Policy

gormanp@ohsu.edu Erin Bonura, MD

Microbiology & Immunology bonura@ohsu.edu

Teaching Services Office

Office: CLSB 4A026, Phone: 503-494-8428 tso@ohsu.edu

Attendance Expectations

Students training to become physicians are expected to be present and actively engaged in their education. Regular attendance and punctuality for all required sessions are essential in demonstrating your professional development as an aspiring physician. You will know which sessions are required by looking at your weekly schedule in Sakai. Not only will your own learning be enhanced by attending all required sessions, but your classmates and instructors will count on your participation in large and small group activities to enrich their learning. This focus on being present is analogous to what will be expected of you during your clinical experiences, your residency training, and ultimately, your professional practice as a physician. The OHSU School of Medicine Undergraduate Medical Education (MD) program leaders have established the above attendance expectations for students in the Foundations of Medicine curriculum. Your attendance will not be tracked on a daily basis because we know you are all adults, and we expect you to adhere to the attendance expectations explicitly stated above. Indirect measures of attendance will be used and acted upon when student performance is near or below the passing threshold, or whenever there is concern about student

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engagement or performance. Such indirect measures may include your iClicker responses during learning sessions, your participation in group learning activities, etc. Requests for Time Off - Any student who anticipates an unavoidable conflict and cannot attend a required end-of-week or end-of-block (cumulative) assessment for any reason must fill out and submit a “Foundations of Medicine Request for Time Off” form to the Block Directors ahead of time. This form can be found on the Student Portal. If the request for time off is approved by the Block Directors, then an alternate assessment will be arranged. Any approved requests for CSA’s will be rescheduled during enrichment week on a designated day (subject to availability and may change per block). All of these requests will typically only be granted in rare instances on a case-by-case basis. It is the student’s responsibility to complete all of the requirements of the block in order to progress as expected in the curriculum.

Required Texts and Materials Equipment:

• Stethoscope—3M, Littmann Cardiology III S.E. (all lengths and colors): http://www.ohsu.edu/xd/education/student-services/student-center/virtual-stores/medical-equipment/index.cfm

• Percussion Hammer (Reflex hammer) - Tomahawk or Babinski style

http://www.ohsu.edu/xd/education/student-services/student-center/virtual-stores/medical-equipment/index.cfm

• Penlight

http://www.ohsu.edu/xd/education/student-services/student-center/virtual-stores/medical-equipment/index.cfm

Books:

• A short Course in Psychiatry 2012 (Morrison): Electronic book available on Sakai • Atlas of Descriptive Histology 1st ed (Ross, Pawlina & Barnash) • Basic and Clinical Pharmacology 12th ed (Katzung): Electronic book available through the OHSU

Library: http://librarysearch.ohsu.edu/OHSU:CP71204874780001451 • Basic and Clinical Endocrinology (Greenspan): Electronic book available through the OHSU

Library: https://login.liboff.ohsu.edu/login?url=http://accessmedicine.mhmedical.com.liboff.ohsu.edu/book.aspx?bookid=380

• Basic Histology 13th ed (Junqueira): Electronic book available through the OHSU Library: http://librarysearch.ohsu.edu/OHSU:CP71204873500001451

• Basic Immunology 4th ed (Abbas, Lichman, and Pillai): Electronic book available through the OHSU Library: http://librarysearch.ohsu.edu/OHSU:CP71205363830001451

• Basics of Bioethics, 3rd ed (Robert Veatch) • Bates’ guide to physical exam and history-taking 11th ed ISBN#9781609137625

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• Before we are born: essentials of embryology and birth defects 8th ed (Moore): Electronic book available through the OHSU Library: http://librarysearch.ohsu.edu/OHSU:CP71152176230001451

• Clinical Epidemiology 5th ed (Fletcher and Fletcher) • Essential of Cell Biology 4th ed (Alberts) • Evidence-Based Physical Diagnosis: Expert Consult 3rd ed (McGee): Electronic book available through the OHSU

Library: http://librarysearch.ohsu.edu/OHSU:CP71117404620001451 • First Aid for the USMLE Step 1, 2014 edition • Gastrointestinal Physiology (Lange): Electronic book available through the OHSU

Library: https://login.liboff.ohsu.edu/login?url=http://accessmedicine.mhmedical.com/book.aspx?bookid=691 • Genetics in Medicine 7th ed (Nussbaum, Thompson and Thompson): Electronic book available through the

OHSU Library: http://librarysearch.ohsu.edu/OHSU:CP71129306130001451 • Human Brain, 6th ed. (Nolte): Electronic book available through the OHSU

Library: https://login.liboff.ohsu.edu/login?url=http://site.ebrary.com/lib/ohsu/detail.action?docID=10662111 • Lippincott’s Illustrated Review: Biochemistry 6th ed (Ferrier) • Medical Microbiology 6th ed (Sherris) • Neuroanatomy through clinical cases, 2nd ed (Blumenfeld) • Pathoma - fundamentals of pathology (Sattar) (collection of videos/media) • Pharmacokinetics Made Easy 2nd ed (Birkett) • Physiology 6th ed (Berne and Levy) ISBN# 032307362x

Dress Code in Foundations of Medicine Classroom Activities

When there are patient visitors present in class or in small groups, students should dress professionally, just as you would when you are seeing patients in a clinical setting. If patient visitors are going to be to be examined by students, students should wear white coats. This increases patient confidence and allows patients to be more comfortable with being examined by a group of medical students. Students should look ahead in the schedule for days they will have patient visitors and dress accordingly. All Objective Structured Clinical Examinations (OSCE) days are also "white coat" days. Clinical skills laboratories will offer opportunities for guided practice of examination skills and all students are encouraged to both examine and be examined by their peers to maximize their learning. However, no student is required to do so, nor is any student’s grade dependent upon allowing others to examine them. Both male and female students may feel more comfortable for the heart/lung and abdominal exams wearing swimwear rather than their usual undergarments. Genitourinary/pelvic exams are practiced first on plastic models and then —after students have reached an appropriate level of experience—with actual patients as models. These examinations are never done on classmates.

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Uniform Foundations of Medicine Block Grading and Student Assessment Your final grade in each Foundations of Medicine block will be either “Pass” (P) or “No Pass” (NP) and this grade will be listed on your official University Transcript. Blocks with durations that span two terms of the University academic calendar will be listed initially in the first term as “In Progress” (IP), and listed again in the following term with the final grade. Once the final block grade has been determined, all of the “In Progress” grades for that block will be changed to the final grade. Unlike your Clinical Experiences Curriculum that follows Foundations of Medicine, numerical scores for all Foundations of Medicine block assessments described below will not be used in calculating a student’s GPA, class quartile rankings, or selection into Alpha Omega Alpha Honor Medical Society, but may be used by UME administrative staff to determine eligibility for a select number of academic scholarships given in the School of Medicine. For more information about scholarship selection criteria and process, see the OHSU Medical Student Handbook. Numerical scores for individual and cumulative student assessments will be shared with you, your Portfolio Coach, and curriculum leaders to evaluate student progress in attainment of student learning objectives, as well as identify targeted areas for improvement of the curriculum.

Assessments

Non-graded Assessments You will have many opportunities throughout the block to receive feedback on your progress in mastering learning objectives. Non-graded assessments do not contribute to your final grade in the block, but are important frequent checks for you, your Portfolio Coach, and curriculum leaders to assess your progress and identify targeted areas for improvement. Examples of these assessments include your iClicker responses during instructional sessions, quantitative and narrative assessments of students by faculty in small groups and laboratories, peer assessments of students by fellow students in small groups and laboratories, and self-assessments completed by students regarding personal performance. These assessments will be used to frequently monitor and track student performance over time, with the intended outcome of demonstrated continual improvement.

Weekly Graded Assessment Components 1. Weekly Quizzes - Weekly computer-based multiple choice and/or short answer quizzes, approximately 25-

35 questions on each quiz. 2. Weekly Clinical and/or Science Lab Skills Assessments - Weekly clinical skills assessments (CSAs) and/or

science skills assessments (SSAs), approximately 0-2 per week (i.e., some weeks may not have any CSAs or SSAs, other weeks may have more than 1.)

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Cumulative Graded Assessment Components 3. Final Block Examination - End-of-block computer-based multiple choice and/or short answer examination

developed by OHSU, approximately 50 questions per examination. 4. NBME “Board” Examination - End-of-block National Board of Medical Examiners (NBME) computer-based

multiple choice customized board examination, approximately 100 questions per examination. 5. Final Skills Examination - End-of-block clinical and science skills assessments consisting of Objective

Structured Clinical Examinations (OSCEs), other clinical skills assessments and several science skills assessments, approximately 4-5 different assessments in this Component.

Assessment/Exam Tardiness

Students are expected to arrive on time, so that assessments and exams can begin as scheduled. When a student arrives late, classmates are disrupted and initial information may be missed. Students who arrive late will be allowed to take the assessment or exam but only within the remaining assessment or exam timeframe and at the discretion of the exam proctor. Once students have finished the assessment or exam, they are expected to leave the room and not reenter until all students have finished taking their assessment. Restroom breaks will be allowed during the assessment or exam at the discretion of the exam proctor.

Final Block Grade

The threshold for a passing score for all graded assessments is 70%. This threshold may be lowered in select circumstances by the block directors and UME leadership if the post-assessment analysis indicates this is necessary. All of the five graded assessment components above are treated separately and each component must be passed in order to maintain satisfactory academic progress. An assessment component will be considered passed when the average of the achieved scores (example: average of all block quiz scores) equals or exceeds the average of the passing thresholds for each assessment (example: 70%). As long as each component is passed, the student’s overall final block grade will be “Pass”. There is no rounding upward when calculating student scores.

Remediation of Non-Passing Scores

1. Students are required to meet the overall passing threshold for each assessment component.

2. Students who do not meet the passing threshold on any of the individual weekly graded assessments are not required to formally remediate these to achieve a passing score, as long as the total average score at the end of the block for the weekly graded assessment components meets the passing threshold. However, any non-passing score for individual weekly graded assessments should be used in a timely fashion by the student, their Portfolio Coach, and curriculum leaders to focus the student’s additional studying to achieve the student learning objectives.

3. Students who do not meet the passing threshold on the final block examination or the NBME board

examination are required to remediate these to achieve a passing score.

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4. The final skills examination will require remediation when the average of the achieved scores for all OSCE

and skills assessments combined is less than the average of the passing thresholds. In some instances, the Foundations of Medicine Thread Directors may require a student to remediate a portion of the final skills examination to improve a significant deficiency based upon demonstrated performance, despite achieving an average passing score for the component overall.

5. Remediation will nearly always occur during the block assessment dates listed above. The remediation

activities and re-testing will be coordinated under the direction of the block and thread directors, and other curriculum leaders as appropriate. The student’s Portfolio Coach will also be notified when a student requires remediation. Remediation activities will be individualized for each student requiring remediation based upon the student’s identified deficiencies in the block.

Students who are successful and meet the passing threshold for their remediation re-testing will have their final block grade posted as “Pass” and their University Transcript will reflect only the “Pass.” However, because a required remediation is an indicator of a student experiencing academic difficulty, the remediation history of all students will be tracked by the Associate Dean for Undergraduate Medical Education. Any student who requires remediation re-testing in two or more components in the entire Foundation of Medicine curriculum, regardless of whether the student successfully passes during remediation re-testing, will be referred by the Associate Dean for Undergraduate Medical Education for further action, including referral to the Student Progress Board.

Students who do not meet the passing threshold for their remediation re-testing in a block will have their final block grade posted as “No Pass” and be referred to the Associate Dean for Undergraduate Medical Education for further action, including referral to the Student Progress Board.

Accommodations Our program is committed to all students achieving their potential. If you have a disability or think you may have a disability (physical, learning, hearing, vision, psychological) which may need a reasonable accommodation, please contact Shelby Acteson, Director of Student Access at 503-494-0082 or email: studentaccess@ohsu.edu to discuss your needs. Because accommodations can take time to implement, it is important to have this discussion as soon as possible. All information regarding a student’s disability is kept in accordance with relevant state and federal laws. The MD Program Accommodation Liaison (PAL) is Nicole Deiorio, MD, Assistant Dean for Student Affairs.

Student Evaluation of Instructors, Curriculum Leaders, and Blocks

You are expected to regularly complete evaluations of instructors, curriculum leaders, and the block as a whole. Your perspective on your educational experience is crucial for feedback and continued improvement for individual teacher effectiveness as well as for the curriculum overall. In addition, student evaluations of

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instructors and curriculum leaders are important for faculty annual reviews as well as promotion and tenure decisions. You will be given time during the weekly schedule to complete these required evaluations. The student’s identity is never included on instructor and block evaluations, including written comments. Each week, you are asked to rate the teaching effectiveness of instructors by answering the following five prompts:

1. The instructor was knowledgeable about the subject 2. The instructor was well prepared 3. Overall, I rate this instructor highly 4. What are the strengths of this instructor? (free text) 5. What recommendations for improvement do you suggest for this instructor? (free text)

At the end of each block, you are asked to rate the block as a whole by answering the following seven prompts:

1. The stated objectives were understandable 2. The course as a whole was well organized 3. The educational materials and resources enhanced my learning 4. Evaluation of my performance was based on stated objectives 5. Overall, I rate this course highly 6. What are the strengths of the course? (free text) 7. What recommendations do you suggest for improving this course? (free text)

You will receive auto-generated email notifications with a link to the Sakai site for both instructor and block evaluations. You are expected to complete all assigned evaluations no later than one week after the end of the block. Failure to complete your evaluations on time is contrary to professionalism expectations for medical students. As such, a Professionalism Monitoring Form may be submitted to the Associate Dean for Student Affairs for students who have not completed their required evaluations.

Inclement Weather Procedures Inclement weather procedures can be found in the Medical Student Handbook on the Student Portal. In the case of inclement weather, instructions will be posted to the Block’s Sakai Announcement space by 6:00 am to give instructions to students about the class schedule.

Copyright Information Every reasonable effort has been made to protect the copyright requirements of materials used in this Block. Recording (video and/or audio) by students of class sessions is strictly prohibited. Sessions will be digitally captured on a routine basis with Echo360, and be available on Sakai following processing for all students enrolled in the block. Copyrighted material will be kept on reserve in the library or made available online for student access. Copyright law allows for making one personal copy of each article from the original article. This limit also applies to electronic sources. It is highly recommended that students build a personal repository of material to support USMLE exam preparation.

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Academic Honesty, Examination Confidentiality, Scholarship and Clinical Performance

Medical students are responsible for their own academic work. All assessments are confidential, including content of computer-based examinations and OSCE stations. Discussion between students of any year of the MD program related to specific OSCE station content that could give any student an unfair advantage is prohibited. Students are expected to have read, embrace, and practice principles of academic honesty as presented in the Medical Student Handbook. The School of Medicine reserves the privilege of retaining only those students who, in the judgment of the faculty and dean’s office, satisfy the requirements of honesty, scholarship and clinical performance necessary for the safe practice of medicine. The Medical Student Handbook has information about academic standards, probation, and disciplinary policies and procedures.

Syllabus Change and Retention

This syllabus outlines the procedures that guide this block, and was prepared with the best information available at the time of creation. It is subject to change and will be updated as needed. Students will be informed of any changes to the originally posted syllabus through Sakai. Students are responsible for the information contained within this syllabus. This document should not be construed in any way as forming the basis of a contract.

Last revised August 3, 2015

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Scholarly Projects Syllabus 2015/16

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Scholarly Projects Purpose Statement

Scholarly Projects is an in-depth investigation of topics of interest to medical students during the course

of their undergraduate medical education (UME) experiences with the goal of creating critical thinkers

and lifelong learners. Students who complete Scholarly Projects will be able to think critically about

complex clinical problems; expand beyond the established curriculum to investigate topics and problems

in more depth; identify, define, and answer important questions relevant to clinical practice and

healthcare delivery; and work effectively within a learning community. Students will also understand

and apply principles of professionalism, ethics, communication, and collaboration while pursuing their

projects.

Scholarly Project Goals

Identify an important scientific or clinical question for investigation.

Assess, evaluate, and apply scientific literature relevant to the question.

Formulate a project hypothesis based on current evidence and concepts in the field.

Learn appropriate approaches to addressing the question that are based on methodologic standards in the relevant fields of study.

Design, conduct, and interpret results of your own project based on the question and hypothesis.

Identify project relevance to medicine and healthcare.

Communicate effectively in oral and written form.

Apply ethics and professionalism throughout the project.

Associated Competencies

Scholarly Projects provides students the opportunity to learn and be assessed on eight School of

Medicine UME competencies:

Competency Domain: Practice-based Learning and Improvement (PBLI)

PBLI 1-Demonstrate skills necessary to support independent lifelong learning and ongoing

professional development by identifying one’s own strengths, deficiencies, and limits in knowledge

and expertise, set learning and improvement goals, and perform learning activities that address gaps

in knowledge, skills or attitudes.

PBLI 2-Participate in the education of peers and other healthcare professionals, students and

trainees.

PBLI 7-Participate in scholarly activity thereby contributing to the creation, dissemination,

application, and translation of new healthcare knowledge and practices.

Competency Domain: Interpersonal and Communication Skills (ICS)

ICS 6-Effectively communicate with colleagues, other health professionals, and health related agencies in a responsive and responsible manner.

Competency Domain: Professionalism and Personal and Professional Development (PPPD)

PPPD 1-Demonstrate a commitment to ethical principles pertaining to provision, withholding or

withdrawal of care, confidentiality, informed consent, and business practices, including conflicts of

interest, compliance with relevant laws, policies, and regulations.

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PPPD 9-Demonstrate accountability by completing academic and patient care responsibilities in a

comprehensive and timely manner.

PPPD 10-Demonstrate trustworthiness that engenders trust in colleagues, patients, and society at

large.

System-based Practice and Interprofessional Collaboration (SBPIC)

SBPIC 4-Effectively work with other healthcare professionals to establish and maintain a climate of

mutual respect, dignity, diversity, integrity, honesty, and trust.

Scholarly Projects Structure

A scholarly project is conducted throughout the student’s time of enrollment in the UME program.

There are three phases:

Phase Description Credit Awarded

Developing the Scholarly Project Proposal course Competencies: PBLI 1, 7; PPPD 3, 9; SBPIC 4

12 hours of sessions total (large and small group sessions plus work outside of class); must be completed and approved prior to beginning subsequent steps of the scholarly project (data collection, analysis, etc.)

1 credit (36 hours total)

Scholarly Project work Competencies: PBLI 1, 7; ICS 6; PPPD 3, 9, 10; SBPIC 4

Student is supported by a concentration lead and project mentor throughout the project. Students can enroll in Scholarly Project coursework in various ways depending on the type of project: o Full-time work on project (1,

2, 3, and 4 week options) o Part-time or intermittent

work on project

6 credits (= 216 hours of effort) total minimum; no maximum amount, although all other graduation requirements must also be fulfilled. Course credits for Scholarly Project work are allocated during an academic term on either a full-time or part-time basis during the week, or term, as follows: Full-time: student is working full-time on the scholarly project during the week(s) o 1 credit = 36 hours effort per

week for 1 week o 2 credits = 36 hours effort

per week for 2 weeks o 3 credits = 36 hours effort

per week for 3 weeks o 4 credits = 36 hours effort

per week for 4 weeks

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Part-time: student is working part-time on the scholarly project during the academic term, and may also be enrolled in other courses or clinical experiences during the same time period o 1 credit = 36 hours effort

over entire 11-12 week term o 2 credits = 72 hours effort

over entire 11-12 week term o 3 credits = 108 hours effort

over entire 11-12 week term o 4 credits = 144 hours effort

over entire 11-12 week term o 5 credits = 180 hours effort

over entire 11-12 week term o 6 credits = 216 hours effort

over entire 11-12 week term

Scholarly Project Capstone Yearly event held in May; a second time may be added as needed Competencies: PBLI 2, 7; ICS 6; PPPD 3, 9; SBPIC 4

Students prepare and present their scholarly projects to university community

1 credit

TOTAL 8 credits (minimum)

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Scholarly Projects Leadership and Contacts

Director, Scholarly Projects

Heidi Nelson, MD, MPH Research Professor and Vice Chair,

Medical Informatics and Clinical Epidemiology nelsonh@ohsu.edu

Scholarly Projects Concentration Leads

Peter Mayinger, PhD Basic Science/Biomedical Engineering Lead

Associate Professor, Medicine mayinger@ohsu.edu

Mark Baskerville MD, JD, MBA Law/Business/Policy Lead

Assistant Professor, Anesthesiology and Perioperative Medicine

baskervi@ohsu.edu

Lisa Silbert, MD, MCR Clinical Research Lead

Associate Professor, Neurology silbertl@ohsu.edu

Erik Fromme MD, MCR Ethics/Quality Improvement/Education Lead

Associate Professor, Medicine, Radiation Medicine, and Nursing frommee@ohsu.edu

Eneida Nemecek MD, MS, MBA Clinical Research Lead

Associate Professor, Pediatrics nemeceke@ohsu.edu

Craig Warden, MD, MPH, MS Epidemiology/Community/Global Health

Professor, Emergency Medicine and Pediatrics wardenc@ohsu.edu

Scholarly Projects Coordinator

To be determined, coming soon!

Attendance Expectations

Students training to become physicians are expected to be present and actively engaged in their

education. Regular attendance and punctuality for all required sessions and activities are

essential in demonstrating your professional development as an aspiring physician. Not only will

your own learning be enhanced by attending all required sessions and activities, but your

classmates and faculty instructors and mentors will count on your participation to enrich their

learning. This focus on being present is analogous to what will be expected of you during your

residency training, and ultimately, your professional practice as a physician.

Required Texts and Materials

Equipment: Equipment needs will vary by project.

Books: Designing Clinical Research 4th Ed (Hulley, Cummings, Browner, Grady, Newman). Electronic

book available through the OHSU Library: https://login.liboff.ohsu.edu/login?url=http://site.ebrary.com/lib/ohsu/detail.action?docID=10825766

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Dress Code in Scholarly Projects Activities

The dress code will vary depending on the nature of individual projects. Your dress should

appropriately match the professional setting in which you are working (i.e., laboratory, patient

care setting, business office, etc.).

Scholarly Projects Grading and Student Assessment

Your final grades for all credits associated with the Scholarly Project will be either “Pass” (P) or

“No Pass” (NP) and these grades will be listed on your official University Transcript. Students

must meet benchmarks in order to progress, and final grades will be given after all benchmarks

are attained in each phase as outlined below. Note that within each phase, benchmarks are not

necessarily sequential.

Assessments

Phase Benchmarks

Developing the

Scholarly Project

Proposal course (1

credit)

Identify a project topic and mentor; complete the Scholarly Project

Mentor/Student Agreement Form and submit it on the Sakai site.

Identify a scholarly project concentration lead that best fits your topic of

interest and type of project.

Attend 12 hours of large and small group sessions of the Developing the

Scholarly Project Proposal course.

Perform a formal literature search with the assistance of the Scholarly

Projects librarians on the project topic; record the data sources, search

dates, search terms, and yield.

In conjunction with the project mentor, submit all Institutional Review

Board (IRB) forms and/or other regulatory forms for the project, as

applicable.

Outline a plan to complete any special training required for the project

(e.g. human subjects, regulated products, etc.) and describe it in the

project proposal, as applicable.

Outline a project timeline that explicitly describes when the project work

will be conducted and when major goals will be achieved; ensure that the

timeline aligns with upcoming scheduled clinical blocks and other

activities.

Describe the project deliverable or product that will be evaluated at the

end of the project.

Complete a project proposal that includes all components listed in the

checklist provided during the course; obtain approval by the project

mentor and concentration lead; submit the final version on the Sakai site.

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Scholarly Project work

(6 credits minimum)

Execute the project activities described in the approved project proposal.

Provide monthly progress reports to the project mentor and concentration

lead once project work has begun.

Provide proposal addendums for important changes in the project (e.g.,

changes in protocol, modification of timeline, etc.).

Accomplish major goals of the project as identified in the project proposal

and as determined as acceptable by the project mentor.

Complete a draft of a report summarizing the project according to the

Scholarly Projects template (e.g., purpose, methods, results, conclusions).

Scholarly Project

Capstone event (1

credit)

Finalize the report by completing further analysis, interpretation, literature

reviews, as needed.

Complete the Scholarly Project Mentor/Student Completion Form and

submit it and the final report to the Sakai site; obtain approval by the

concentration lead.

Prepare a presentation for the Capstone event (e.g., poster, oral

presentation, demonstration) in accordance with Scholarly Projects

guidelines for presentations.

Present your scholarly project to the university community.

Remediation

Scholarly Projects is a required component of the UME Curriculum. Activities of Scholarly Projects are

organized into three sequential phases, each of which contains specific benchmarks. Benchmarks within

each phase must be completed to pass and before progressing to the next phase. Each phase is graded

as Pass/No Pass and passing all three is required for graduation. Students who do not pass any phase of

the Scholarly Projects will be required to remediate as directed by the associated Scholarly Project

concentration lead and Director of Scholarly Projects.

Student progress is based on whether benchmarks have been met. These will be tracked and evaluated

by the topic-specific faculty concentration lead in partnership with the project mentor. If they

determine that a student has not met benchmarks and is not likely to meet them with additional

focused effort, the Scholarly Projects director and the student’s concentration lead will propose a

remediation plan that will involve the project mentor and other relevant individuals as appropriate,

constituting the student’s remediation team. The Director of Scholarly Projects will notify the Associate

Dean for Undergraduate Medical Education in the event a student requires remediation for their

Scholarly Project. The Associate Dean for Undergraduate Medical Education will then refer this student

to the Medical Student Progress Board who will accept or modify the proposed remediation plan for the

student.

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Development of Student Remediation Plan:

The remediation plan will be based on specific deficiencies in meeting benchmarks or competencies, and

remediation activities will be targeted to resolving them.

1. All students requiring remediation will receive a Remediation Information Sheet from the

Scholarly Projects director. See “communication” section below.

2. The remediation team will provide appropriate support as needed to meet the missed

benchmark.

3. The project mentor and the concentration lead will work individually with the student as needed

to aid in the student’s areas of deficiency.

Communication Process:

1. Identify students requiring remediation for any phase or benchmark based on project tracking

by the concentration lead and project mentor.

2. Identify student’s area(s) of deficiency.

3. Concentration lead to contact the Scholarly Projects director with the following:

a. Name of student who requires remediation.

b. The process for remediation.

c. Remediation plan for the student to improve comprehension of the identified topic and

to facilitate completion of the benchmark.

4. Scholarly Projects director will notify the student and the Associate Dean for Undergraduate

Medical Education that the student has not passed a phase of the scholarly project, specific

areas of deficiency, and the proposed remediation plan.

5. The Associate Dean will then refer this information to the Medical Student Progress Board who

will either accept or modify the remediation plan. The Associate Dean will then communicate

this decision in writing to the student, their portfolio coach, the Scholarly Project director and

concentration lead.

6. Scholarly Projects director and concentration lead will contact the student requiring

remediation, cc’ing the student’s project mentor, with the final remediation plan including:

a. Specific deficiency and benchmarks affected.

b. Key concept areas.

c. Remediation Information Sheet including the key areas to study, remediation details

including expected completion of benchmarks and expected time for evaluation by

project mentor and concentration lead.

7. After the student successfully completes the remediation and all benchmarks have been met,

this information will be communicated to the student by the Scholarly Project director, who will

also notify the Associate Dean for Undergraduate Medical Education. The student’s official

university transcript will then show that the scholarly project remediation has been passed.

8. All original benchmark evaluation results, as well as remediation assessments, are tracked by

the UME program and Associate Dean for UME. All communications to students regarding their

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overall progress/status in the MD program will come from the Associate Dean for

Undergraduate Medical Education.

Accommodations

Our program is committed to all students achieving their potential. If you have a disability or

think you may have a disability (physical, learning, hearing, vision, psychological) which may

need a reasonable accommodation, please contact Shelby Acteson, Director of Student Access

at 503-494-0082 or email: studentaccess@ohsu.edu to discuss your needs. Because

accommodations can take time to implement, it is important to have this discussion as soon as

possible. All information regarding a student’s disability is kept in accordance with relevant

state and federal laws.

Student Evaluation of Course Instructors, Concentration Leads, and Project Mentors

You are expected to complete evaluations of course instructors, concentration leads, project

mentors and the Scholarly Project experience as a whole. Your perspective on your educational

experience is crucial for feedback and continued improvement for individual teacher

effectiveness as well as for the curriculum overall. In addition, student evaluations of faculty are

important for faculty annual reviews as well as promotion and tenure decisions. The student’s

identity is never included on evaluations, including written comments.

You will receive auto-generated email notifications with a link to the Sakai site for evaluations.

Failure to complete your evaluations on time is contrary to professionalism expectations for

medical students. As such, a Professionalism Monitoring Form may be submitted to one of the

Assistant Deans for Student Affairs for students who have not completed their required

evaluations.

Inclement Weather Procedures

Inclement weather procedures can be found in the Medical Student Handbook on the Student

Portal. For scheduled course activities, in the case of inclement weather, instructions will be

posted to the Sakai Announcement space by 6:00 am.

Copyright Information

Every reasonable effort has been made to protect the copyright requirements of materials used

in this curriculum. Recording (video and/or audio) by students of class sessions is strictly

prohibited. Materials from in-class sessions will be available on Sakai for all students enrolled in

Scholarly Projects following each presentation. Copyrighted material will be kept on reserve in

the library or made available online for student access. Copyright law allows for making one

personal copy of each article from the original article. This limit also applies to electronic

sources.

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Academic Honesty, Examination Confidentiality, Scholarship and Clinical Performance

Medical students are responsible for their own academic work. Students are expected to have

read, embrace, and practice principles of academic honesty as presented in the Medical Student

Handbook. The School of Medicine reserves the privilege of retaining only those students who,

in the judgment of the faculty and dean’s office, satisfy the requirements of honesty, scholarship

and clinical performance necessary for the safe practice of medicine. The Medical Student

Handbook has information about academic standards, probation, and disciplinary policies and

procedures.

Syllabus Change and Retention

This syllabus outlines the procedures that guide this course, and was prepared with the best

information available at the time of creation. It is subject to change and will be updated as

needed. Students will be informed of any changes to the originally posted syllabus through

Sakai. Students are responsible for the information contained within this syllabus. This

document should not be construed in any way as forming the basis of a contract.

Last revised July 6, 2015

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Time Monday Tuesday Wednesday Thursday Friday

8am TBL- Case introduction

(8-9 a.m.) Clinical skills lab

Group B- 1/3 class Large Group / Small Groups

(8-9 a.m.)

Large Group / Small Groups

(8-9 a.m.)

Week’s closure and review of major concepts

9am Large Group / Small Groups

(9:10-10:00 a.m.)

Large Group / Small Groups

(9:10-10:00 a.m.)

Large Group / Small Groups

(9:10-10:00 a.m.)

Week’s closure and review of major concepts

10am Large Group / Small Groups

(10:10-11:00 a.m.)

Large Group / Small Groups

(10:10-11:00 a.m.)

Large Group / Small Groups

(10:10-11:00 a.m.)

Weekly Examsoft/Science Skills

Assessments 10 a.m. to noon

11am

Large Group / Small Groups

(11:11-12 noon)

Large Group / Small Groups

(11:11-12 noon)

Large Group / Small Groups

(11:11-12 noon)

12pm Break Break Break Break Break

1pm Clinical skills lab

Group A- 1/3 class Large Group / Small Groups

(1:00 – 1:50 p.m.)

Colleges

Clinical skills lab Group C- 1/3 class

CSA Assessment time

(only when Clinical Skills Assessments occur)

Or instructional sessions

2pm Large Group / Small Groups

(2:00 p.m. – 2:50 p.m.)

3pm Large Group / Small Groups

(3:00 – 3:50 p.m.)

4pm Large Group / Small Groups

(4:00 – 4:50 p.m.)

*Science Skills Labs: are interchangeable among any white blocks (Large group/small group) *Each 1 hour session should incorporate a 10 minute break

Fundamentals Hormones & Digestion Weekly Schedule Template (plug in)

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Nervous System & Function + Developing Human Block Weekly Schedule Template (plug-in)

Time Monday Tuesday Wednesday Thursday Friday

8am TBL- Case introduction

(8-9 a.m.) Large Group / Small Groups

(8-9 a.m.)

Large Group / Small Groups

(8-9 a.m.)

Clinical skills lab Group C- 1/3 class

CSA Assessment time (when Clinical Skills

Assessments occur 8/14, 8/28, 9/11, 10/2, 10/16,

11/13, 11/20)

Or can be split up for instructional sessions

Excludes new material to be tested

or Examsoft assessments

9am Large Group / Small Groups

(9:10-10:00 a.m.)

Large Group / Small Groups

(9:10-10:00 a.m.)

Large Group / Small Groups

(9:10-10:00 a.m.)

10am Large Group / Small Groups

(10:10-11:00 a.m.)

Large Group / Small Groups

(10:10-11:00 a.m.)

Large Group / Small Groups

(10:10-11:00 a.m.)

11am Large Group / Small Groups

(11:11-12 noon)

Large Group / Small Groups

(11:11-12 noon)

Large Group / Small Groups

(11:11-12 noon)

12pm Break

Break

Break

Break

Break

1pm Clinical skills lab

Group A- 1/3 class Clinical skills lab

Group B- 1/3 class

Colleges

Large Group / Small Groups

(1:00 – 1:50 p.m.)

Weekly Examsoft/Science Skills

Assessments (if not completed in AM)

Or instructional sessions 2pm

Large Group / Small Groups

(2:00 p.m. – 2:50 p.m.)

3pm Large Group / Small Groups

(3:00 – 3:50 p.m.)

Large Group / Small Groups

(3:00 – 3:50 p.m.)

4pm Large Group / Small Groups

(4:00 – 4:50 p.m.)

Large Group / Small Groups

(4:00 – 4:50 p.m.)

*Science Skills Labs: are interchangeable among any white blocks (Large group/small group) *Each 1 hour session should incorporate a 10 minute break

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OHSU UME Curriculum Terminology Competency-based Education: Education that measures students’ learning and demonstration of competencies. This is in contrast to time-based education, which measures students’ learning after a pre-determined time devoted to the educational program or course. In a competency-based educational program, students progress by demonstrating their competence, which means they prove that they have mastered competencies required for a particular course, regardless of how long it takes. Competencies are descriptors of physicians (or physicians-in-training) in terms of their knowledge, skills, and/or attitudes (KSA’s.) Domain of Competence: A category of a set of knowledge, skills, and attitudes required to perform a job or broad task. In medical education, the Accreditation Council for Graduate Medical Education (ACGME) (i.e., governing body for post-medical school residency training programs) has identified six domains of competence for resident physicians. These include 1) Patient Care and Procedural Skills; 2) Medical Knowledge; 3) Interpersonal Communication; 4) Professionalism; 5) Systems-Based Practice; and 6) Practice-Based Learning and Improvement. This framework has gained widespread adoption in the residency community, and is the framework used by the OHSU undergraduate medical education program as well. Competency Sub-Domain: Statements of activities that further organize a competency domain into smaller units and defines the scope of the competency domain. Student Learning Outcomes: Outcomes defined in terms of the knowledge, skills, and abilities that students have attained as a result of their involvement in a particular set of educational experiences, sometimes referred to as “graduation requirements.” Example: By the end of the M.D. program . . . . . . the student will be able to demonstrate compassionate, appropriate, and effective patient care for the treatment of health problems and the promotion of health. Milestones: Stages in the development of specific competencies. Milestones are attained progressively by students during their education, and each milestone describes specific, observable behaviors of a student at that stage. Entrustable Professional Activities (EPAs): EPAs are units of professional practice, defined as tasks or responsibilities to be entrusted to the unsupervised execution by a trainee once he or she has attained sufficient specific competence. EPAs are independently executable, observable, and measurable in their process and outcome. EPAs encompass

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multiple Domains of Competence and are descriptors of work. Example: Care of the well newborn in pediatric practice; performing an appendectomy in surgical practice. Block Purpose Statement: A broad statement of intent or desired accomplishment for the block; what you would find in a course catalogue describing the block. Example: This block is designed to provide students with a basic understanding of the form and function of DNA, genomic organization, cytogenetics, principles of simple and complex inheritance, whole genome association, and genomic diversity in disease. Translational and clinical applications will be emphasized throughout the block, utilizing case presentations, problem-based learning, and lectures. Block Goals: Block Purpose Statements include a number of subordinate skills or goals which are further identified and clarified as instructional objectives. Example: Distinguish between various types of higher cognitive dysfunction, and to describe the cardinal manifestations of focal CNS damage that results in memory dysfunction, speech problems, spatial reasoning problems, and other aspects of higher cognition. Eight to fifteen goals would be considered reasonable for a typical block. As you define the important content and concepts to be learned, keep these two questions in mind: What would I like the impact of this course to be on students in two to three years after this course is over? What would distinguish students who have taken this course from students who have not? Learning Objectives: Narrow, discrete, intentions of student performance. Objectives are measurable and observable. Well-stated objectives clearly tell the student what they have to do, under what conditions the performance takes place, by following a specified degree or standard of acceptable performance. Formative Assessment: Formative assessment is a range of formal and informal assessment procedures employed by teachers during the learning process in order to modify teaching and learning activities to improve student achievement before a final determination of student performance is made. Summative Assessment: Summative assessment is generally carried out at the end of a group of related tasks, or at the end of a course. In an educational setting, summative assessments are typically thought of as tests at the end of instruction, and used to assign students a grade for their performance.

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Educational Leader Position Descriptions

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Foundations of Medicine Lead Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description The Foundations of Medicine Lead is responsible for oversight of the operations of the Foundations of Medicine UME curriculum. The Foundations of Medicine Lead is an essential member of the curriculum operations team implementing our student-centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The individual selected for this position will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Foundations of Medicine Lead is appointed by, and reports to, the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine for all matters related to medical student education.

Duration of position: 1 year, with opportunity for yearly renewal.

Expected time commitment: Approximately 8-10 hours/week throughout the year. Funding: Financial support for these positions will be provided by the SoM Dean’s Office at 0.2 FTE, and includes OPE and OCA. Expected duties: The Foundations of Medicine Lead will work collaboratively with the ADUME to:

1. Support and work collegially with all members of the Foundations of Medicine curriculum operations team including the Teaching Services and teaching and Learning Center office staff to achieve the goals of the UME program. This includes, but is not limited to, assisting with: implementation of block and thread learning objectives; recruitment of faculty teachers; development and delivery of instructional material; and development of assessment methods to measure student learning outcomes.

2. Ensure instructional content within blocks and threads is integrated and spiraled throughout the Foundations of Medicine curriculum.

3. Participate in direct teaching and delivery of instructional content in individual areas of expertise for the Foundations of Medicine curriculum, including the delivery of the weekly teaser.

4. In conjunction with the Educational Informaticist, finalize weekly exemplar case information by solidifying details for EPIC integration and case rollout.

5. In conjunction with the Thread Directors, develop diverse sessions/activities for the enrichment week that is delivered after the block assessment week.

6. In conjunction with the Thread and Block Directors, review end-of-Block evaluation data, as well as USMLE Step 1 student performance data and develop strategies for change to improve student learning outcomes.

7. Continually seek to improve the teaching and student learning across the Foundations of Medicine curriculum to achieve higher student performance on USMLE Step 1 and enhanced student readiness for their Core Clinical Experiences.

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P a g e | 2 8. Participate in and facilitate faculty development training for Block and Thread Directors, and

faculty teachers in the Foundations of Medicine curriculum. 9. Lead the monthly Foundations of Medicine sub-committee meetings, working

collaboratively with the Manager of Teaching Services Office and the ADUME for agenda creation and review and edit minutes taken at the meetings to ensure accuracy.

10. Maintain compliance with all Dean’s office policies and procedures associated with medical student education.

Qualifications: 1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in providing leadership in medical education 4. A sustained record of success in teaching medical students with an exemplary teaching record 5. Evidence of innovative and creative approaches to medical education 6. Evidence of ability to work collegially and implement change in a multi-disciplinary setting,

working with various constituents including students/trainees, faculty, and staff Last revised June 12, 2015

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Foundations of Medicine Block Director Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description The Foundations of Medicine Block Directors are responsible for co-administering a specified Block in the Foundations of Medicine curriculum. The Block Directors are essential members of the curriculum operations team implementing our student-centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The individuals selected for these positions will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Foundations of Medicine Block Directors are appointed by, and report to, the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine.

Duration of position: 1 year, with opportunity for yearly renewal.

Expected time commitment: Varied per block and heaviest during the weeks the Block is delivered. In addition, there will be a pre-operations ramp-up time commitment leading to the start of the block.

Funding: Financial support for these positions will be provided by the SoM Dean’s Office and includes OPE and OCA.

Blocks

1. Fundamentals (FUND 710) 5. Hormones & Digestion (HODI 710)

2. Blood & Host Defense (BLHD 710)

6. Nervous System & Function (NSF 710)

3. Skin, Bones & Musculature (SBM 710)

7. Developing Human (DEVH 710)

4. Cardiopulmonary & Renal (CARE 710)

Expected duties: The Foundations of Medicine Co-Block Directors will work collaboratively with the ADUME to:

1. Work collegially with all members of the Foundations of Medicine curriculum operations team including the Teaching Services Office and Teaching & Learning Center staff to achieve the goals of the UME program.

2. Proactively lead all aspects of the Block, functioning as the main point of contact for students, staff, and faculty teachers during the Block.

3. Finalize weekly instructional schedules during the Block, ensuring that all block goals, thread and session objectives are met by students.

4. Assist Thread Directors in recruiting teachers for all instructional content delivered in the Block.

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5. Participate in direct teaching and delivery of instructional content in individual areas of expertise for the

Foundations of Medicine curriculum. 6. Coordinate with Block Co-Director and Thread Directors to ensure that at least one Director is present for

all instructional sessions. 7. Coordinate with Thread Directors to finalize all formative and summative student assessments given

during the Block, and at the conclusion of the Block. 8. In conjunction with the assessment team, regularly review all student assessment data, and implement

strategies to continually improve student learning outcomes. 9. Participate in post-examination reviews offered to students to improve student learning outcomes. 10. Determine final Block grade for each student based upon the multi-modal assessment tools, to document

whether students are making satisfactory academic progress. 11. Propose remediation strategies for students who have not met the intended student learning outcomes

for the Block to the ADUME and the Medical Student Progress Board as directed. 12. In conjunction with the Foundations of Medicine curriculum team, review end-of-Block evaluation data,

as well as USMLE Step 1 performance data and develop strategies to improve student learning outcomes.

14. Participate in and facilitate faculty development training for Block and Thread Directors, and faculty teachers in the Foundations of Medicine curriculum.

15. Attend monthly Curriculum Sub-committee meetings comprised of all of the Foundations of Medicine Block and Thread Directors, and Course Directors in the second-year UME curriculum.

16. Attend weekly meetings with all Thread Directors while the Block is in session, working to ensure the Foundations of Medicine curriculum is successfully implemented.

17. Maintain compliance with all Dean’s office policies and procedures associated with student education.

Qualifications: 1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in providing leadership in medical education 4. A sustained record of success in teaching medical students with an exemplary teaching record 5. Evidence of innovative and creative approaches to medical education 6. Evidence of ability to work collegially and implement change in a multi-disciplinary setting, working with

various constituents including students/trainees, faculty, and staff

Last revised June 11, 2015

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Foundations of Medicine Thread Director Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description The Foundations of Medicine Thread Directors are responsible for the integration of a specified set of thread topics and objectives that are spiraled throughout the Foundations of Medicine curriculum. The seven Thread Directors are essential members of the curriculum operations team implementing our student-centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The individuals selected for these positions will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Foundations of Medicine Thread Directors are appointed by, and report to, the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine.

Duration of position: 1 year, with opportunity for yearly renewal.

Expected time commitment: Approximately 12 hours/week throughout the year. Funding: Financial support for these positions will be provided by the SoM Dean’s Office at 0.3 FTE, and includes OPE and OCA.

Threads

1. Professionalism, Ethics, Communication 4. Anatomy, Embryology, Histology 2. Patient Interviewing, Examination, Clinical

Reasoning 5. Biochemistry, Cell Biology, Genetics, Nutrition

3. Informatics, Epidemiology, Evidence-Based Medicine, Quality, Safety, Health Policy

6. Physiology, Pathology, Pharmacology

7. Microbiology, Immunology

Expected duties: The Foundations of Medicine Thread Directors will work collaboratively with the ADUME to:

1. Work collegially with all members of the Foundations of Medicine curriculum operations team as well as the Teaching Services Office and Teaching and Learning Center staff to achieve the goals of the UME program.

2. Ensure their specified set of thread topics and objectives in each block of the Foundations of Medicine curriculum are successfully introduced, reinforced, and then mastered by students (i.e., spiraled.)

3. Take primary responsibility for recruiting teachers for the specified threads content across all blocks. 4. Assist teachers with development and delivery of instructional material for specified threads content. 5. Participate in direct teaching and delivery of instructional content in individual areas of expertise for

the Foundations of Medicine curriculum. 6. Coordinate with Block Directors and other Thread Directors to ensure that at least one Director is

present for all instructional sessions. 7. Coordinate with Thread and Block Directors to develop and finalize all formative and summative

student assessments pertaining to the specified threads, to measure student learning outcomes.

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8. In conjunction with all Thread and Block Directors, and the Foundations of Medicine Lead, regularly

review all student assessment data, and implement strategies to improve student learning outcomes. 9. Participate as requested by the Block Directors in post-examination reviews offered to students to

improve student learning outcomes. 10. Determine a final thread grade for all students each term to document whether students are making

satisfactory academic progress with respect to their specific set of thread topics. 11. Propose remediation strategies for students who have not met the intended student learning

outcomes pertaining to the specified thread to the Block Directors, who will inform the ADUME and the Medical Student Progress Board.

12. In conjunction with the Foundations of Medicine curriculum team, review end-of-Block evaluation data, as well as USMLE Step 1 performance data and develop strategies to improve student learning outcomes pertaining to the specified thread.

13. Continually seek to improve the teaching and student learning of specified threads in the Foundations of Medicine curriculum to achieve higher student performance on USMLE step 1 and enhanced student readiness for their Core Clinical Experiences.

14. In conjunction with the Foundations of Medicine Lead, develop diverse activities for the enrichment week that is delivered in each block.

15. Participate in and facilitate faculty development training for Block and Thread Directors, and faculty teachers in the Foundations of Medicine curriculum.

16. Attend monthly Curriculum Sub-committee meetings comprised of all of the Foundations of Medicine Block and Thread Directors, and Course Directors in the second-year UME curriculum.

17. Attend weekly meetings with all the Foundations of Medicine Thread Directors, and the two Block Directors who have Blocks in session at any given time, working to ensure the Foundations of Medicine curriculum is successfully implemented.

18. Maintain compliance with all Dean’s office policies and procedures associated with student education.

Qualifications: 1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in providing leadership in medical education 4. A sustained record of success in teaching medical students with an exemplary teaching record 5. Evidence of innovative and creative approaches to medical education 6. Evidence of ability to work collegially and implement change in a multi-disciplinary setting, working

with various constituents including students/trainees, faculty, and staff

Last revised June 11, 2015

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Pre-matriculation Block Director Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description The Pre-matriculation Block Director is responsible for the development and implementation of the pre-matriculation block in the Foundations of Medicine curriculum of YourMD. The Pre-matriculation Block Director is an essential member of the curriculum transformation operations team implementing our student-centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The individual selected for this position will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Pre-matriculation Block Director is appointed by, and reports to, the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine for all matters related to medical student education. Duration of position: full academic year, with opportunity for yearly renewal Funding and FTE: provided by the SoM dean’s office, approximately 0.1 FTE. Expected duties: The Foundations of Medicine Pre-Matriculation Block Director will work collaboratively with the ADUME to:

1. Work collegially with all Block and Thread Directors in the Foundations of Medicine curriculum as well as Teaching Services Office staff to achieve the goals of the UME program. This includes, but is not limited to: identifying a set of thread topics and objectives suitable for pre-matriculation level students is successfully introduced, reinforced, and then mastered by students (i.e., spiraled); recruitment of faculty teachers for the specified pre-matriculation content; development and delivery of instructional material; and development of assessment methods to measure student learning outcomes for the specified pre-matriculation content.

2. Collaborate with the Teaching and Learning Center and education specialists to ensure educational content is appropriate for the learner level, displayed in a user friendly format, utilizes innovative technology, and is effective.

3. Participate in and facilitate faculty development training in online pedagogy. 4. Participate in direct teaching and delivery of instructional content in individual areas of

expertise for the Pre-Matriculation Block. 5. Attend monthly Foundations of Medicine curriculum sub-committee meetings comprised of all

of the Foundations of Medicine Block and Thread Directors and education leaders in the UME curriculum.

6. Advance OHSU’s education mission by engaging in scholarly work and disseminating that work in the novel field of pre-matriculation medical education.

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7. Maintain compliance with all Dean’s office policies and procedures associated with medical student education.

Qualifications:

1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in providing leadership in medical education 4. A sustained record of success in teaching undergraduate medical students with an exemplary

teaching record 5. Evidence of innovative and creative approaches to medical education 6. Evidence of ability to work collegially and implement change in a multi-disciplinary setting,

working with various constituents including students/trainees, faculty, and staff Last revised June 11, 2015

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Director of Clinical Skills Lab Faculty Development Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

Position Description The Director of Clinical Skills Lab Faculty Development is responsible for providing leadership, coaching, and guidance from the perspective of education sciences to the faculty involved in the Clinical Skills Labs as part of the Foundations of Medicine UME curriculum. The position reports to the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine for all aspects related to the medical student educational program. The Director will assist the curriculum operations team with implementing our student-centered, integrated, competency-based curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The new curriculum builds upon and expands the strengths of our current curriculum, while embracing innovative teaching methods and student assessments. The individual in this position will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum.

Duration of position: 1 year, with opportunity for yearly renewal. Expected time commitment: Approximately 4-6 hours/week throughout the year.

Funding: Financial support for these positions will be provided by the SoM Dean’s Office at approximately 0.1 FTE, and includes OPE and OCA.

Expected duties: The Director Clinical Skills Lab Faculty Development will work will work collaboratively with the ADUME to:

1. Create and deliver curriculum transformation faculty preparation teaching sessions for Clinical Skills teachers in the Foundations MD curriculum using a learner-centered, active learning approach designed to achieve three goals: a) faculty with skills to develop an integrated basic science-clinical science-social science curriculum, b) faculty with skills to select and use instructional methodologies that support students’ active learning and demonstrated achievement of learning targets, and c) faculty with skills to select, develop, and implement assessment methods linked to learning objectives and instruction.

2. Train and assist educational leaders and teachers for the Clinical Skills Labs using conceptual models grounded in evidence from learning sciences and/or other medical schools’ experiences with outcomes from curricular transformation.

3. Anticipate, organize, and manage logistical issues related to faculty development for clinical skills laboratory sessions.

4. Develop focused expertise in teaching faculty how to facilitate discussions that makes the students’ interactions with each other the primary focus of active learning linked to the learning objectives and assessment methods for each discussion session.

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5. Review education literature and select appropriate background reading materials for development sessions.

6. Observe (by random selection) clinical skill laboratory sessions over the 18-months of the Foundations curriculum, synthesize observations and make recommendations for revisions of the development of discussion teachers in an iterative fashion.

7. Attend and participate in regular meetings with the curriculum transformation educational leadership teams as requested.

8. Complete other tasks as assigned by the ADUME.

Qualifications:

• M.D. and/or Ph.D. degree or equivalent

• Current OHSU faculty appointment

• Experience teaching undergraduate medical students with an exemplary teaching record

• Demonstrated evidence of innovative and creative approaches to medical education

• Evidence of ability to work collegially and implement change in a multi-disciplinary setting, working with various constituents including students/trainees, faculty, and staff

Last revised June 29, 2015

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Foundations of Medicine Core Clinical Skills Lab Instructor

Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description

The Foundations of Medicine Core Clinical Skills Lab (CSL) Instructors are responsible for teaching clinical skills

content to small groups of students over the course of the 18-month Foundations of Medicine curriculum (FoM).

Core CSL Instructors are essential members of the curriculum operations team implementing our student-

centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to

meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20

to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health

care delivery and discovery environment which includes reform, team-based health care, personalized medicine,

and an explosion of information technology. The individuals selected for these positions will support the

Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Core CSL Instructors are appointed by the

Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine but will report to the

three Clinical Thread Directors for all matters relating to the Clinical Skill Labs.

Duration of position: 1 year starting July, 2015, with opportunity for annual renewal.

Expected minimum time commitment: Core CSL Instructors are expected to commit to four hours per week

either of direct instruction or other activities related to the Clinical Skill Labs. Some non-instructional weeks of the

FoM include, but are not limited to, end-of-block assessment weeks, enrichment weeks, and student vacation

weeks. In these instances Core CSL Instructors are still expected to contribute on average four hours per week by

fulfilling additional job duties listed below.

Funding: Financial support for these positions will be provided by the SoM Dean’s Office, approximately 0.1 FTE.

Expected duties: The Core CSL Instructors will:

1. Work collegially with all members of the Foundations of Medicine curriculum operations team including

the Director of CSL Faculty Development to achieve the goals of the UME program.

2. Participate in direct teaching and delivery of CSL sessions for the FoM curriculum, ensuring that all session

objectives are covered.

3. Provide formative feedback to students in respective small groups.

4. Provide narrative evaluations of competence for each student in respective small groups.

5. Continually seek to improve the teaching and student learning within clinical skills labs to achieve

enhanced student readiness for their Clinical Experiences (following the FoM curriculum).

6. Participate in faculty development opportunities and help develop new faculty including, but not limited

to, attending an orientation, assisting Thread Directors in recruitment of new clinical lab instructors on an

as needed basis, supporting the Director of CSL Faculty Development by encouraging participation in

and/or co-facilitating development trainings.

7. Attend the “Community of Teaching Practice” meetings comprised of all Clinical Skills Lab Instructors,

Clinical Skills Thread Directors and the Director of CSL Faculty Development as scheduled (approximately

3-4 times per year).

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8. Be available to substitute for CSL Instructors who have planned absences, when clinical schedule allows.

9. Maintain compliance with all Dean’s office policies and procedures associated with student education.

Qualifications:

1. Clinical degree or equivalent, (e.g., M.D., D.O, PA-C , NP.)

2. Current OHSU faculty appointment

3. A sustained record of success in teaching medical students with an exemplary teaching record

4. Evidence of innovative and creative approaches to medical education

5. Evidence of ability to work collegially and implement change in a multi-disciplinary setting, working with

various constituents including students/trainees, faculty, and staff

Interested applicants should forward a:

1. Cover letter, specifying reasons for interest and availability (i.e. Mondays 1-5pm, Tuesday 8-noon or 1-

5pm, Thursday 8-noon or 1-5pm)

2. Current Curriculum Vitae

3. Educator’s Portfolio

no later than June 1, 2015, to:

Tracy Bumsted, MD, MPH

Associate Dean for Undergraduate Medical Education, OHSU SoM

bumstedt@ohsu.edu

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Director of Narrative Medicine Position Description

Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum General Description The Director of Narrative Medicine is responsible for integrating and teaching reflective practice & narrative competence within the Fundamentals and Foundations of Medicine blocks and in the Core Clinical Experience of the UME Curriculum. Reflective practice is best described as the skills to reflect on an event or experience in order to change practice. Narrative competence is best described as the ability to listen, absorb, and react to a story. As students develop in reflective practice and narrative competence over the course of the curriculum, they will learn skills necessary to provide more meaningful patient centered care, demonstrate interprofessional team effectiveness and engage in personal reflection. The Director of Narrative Medicine will introduce and teach the concepts of Narrative medicine, and then spiral reflective practice and narrative competence through the direct patient care experiences, initially in the Preceptorship Program, with expansion to the Core Clinical Experience. The Director of Narrative Medicine will support the philosophy and guiding principles of the OHSU MD Curriculum.

Duration of position: 1 year, with opportunity for yearly renewal. Expected time commitment: Approximately 8 hours per week. Funding: Financial support for this position will be provided by the SoM Dean’s Office at 0.2 FTE, and includes OPE and OCA. Expected duties: The Director of Narrative Medicine will work collaboratively with the ADUME to:

1. Create pre-matriculation writing exercise for all incoming 1st year Medical Students to be used as a baseline sample of reflection.

2. Develop and implement Intro to Narrative Medicine curriculum for students in the pre-matriculation period via two online lectures.

3. Develop curriculum to compliment the Preceptorship Program Student Learning Outcomes, specifically for students to “Demonstrate ability to reflect upon the healthcare system they experience during their Preceptorship.” The curriculum will integrate the Twelve Preceptorship Competencies under the headings: Practice Based Learning & Improvement, Interpersonal & Communication Skills, Professionalism, and System Based Practice.

a. Small group facilitation (2 hours per week divided according to ADUME) b. Create writing assignments c. Develop a “reflection rubric” to assess student level of reflection d. Assess (participation and written work)

4. Develop and implement elective experiences in narrative Medicine for Enrichment weeks 5. Develop scholarly project in collaboration with the Preceptorship & Narrative Medicine team 6. Work closely and collegially with the leadership of the Fundamentals and Preceptorship Program to

achieve the stated goals and objectives in student learning.

Qualifications:

1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in teaching narrative medicine to medical students with an

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exemplary teaching record 4. Evidence of innovative and creative approaches to medical education 5. Evidence of ability to work collegially and implement change in a multi-disciplinary setting,

working with various constituents including students/trainees, faculty, and staff Last revised June 11, 2015

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Preceptorship Director Position Description Operations of the OHSU SoM Undergraduate Medical Education (UME) Curriculum

General Description The Preceptorship Director is responsible for the oversight and management of the Preceptorship component of the Foundations of Medicine newly transformed UME curriculum. Students will spend half a day each week during the Foundations curriculum in a clinical environment that provides exposure to patients, faculty preceptors, and clinical settings. The essential components of the Preceptorship program include the following:

1. Students have continuity with a preceptor/group of preceptors to foster relationship building between students and preceptor(s). Eligible preceptors include any licensed independent practitioner (MD, DO, PA, NP.)

2. Students have contact with patients, and the ability to interact with them, in an active-learning, hands-on experience.

3. Students are in a setting/system that provides healthcare services as part of an interprofessional team. The number of Preceptorship options available to students will be maximized to promote alignment of student interest with Preceptorship opportunities.

The Preceptorship Director is an essential member of the curriculum operations team implementing our student-centered, integrated, competency-driven curriculum that utilizes active learning and engagement of students to meet the goals of the School of Medicine. In order to produce physicians most needed by society over the next 20 to 30 years, the M.D. Curriculum Transformation initiative aims to prepare physicians to be leaders in a health care delivery and discovery environment which includes reform, team-based health care, personalized medicine, and an explosion of information technology. The individual selected for this position will support the Philosophy and Guiding Principles of the OHSU M.D. Curriculum. The Preceptorship Director is appointed by, and reports to, the Associate Dean for Undergraduate Medical Education (ADUME) in the School of Medicine. Duration of position: 1 year, with opportunity for yearly renewal. Expected time commitment: Approximately 8 hours/week throughout the year. Funding: Financial support for these positions will be provided by the SoM Dean’s Office at 0.2 FTE, and includes OPE and OCA. Expected duties: The Preceptorship Director will work collaboratively with the ADUME to:

1. Support and work collegially with all members of the Foundations of Medicine curriculum operations team including the Teaching Services Office staff to achieve the goals of the UME program.

2. Participate in direct teaching and delivery of instructional content related to the Preceptorship program in the Foundations of Medicine curriculum.

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3. Recruit faculty preceptors in wide variety of clinical disciplines, and work collaboratively with the UME Preceptorship coordinator to match students to multiple preceptors during the course of the Foundations of Medicine curriculum.

4. Participate in and facilitate faculty development training for faculty Preceptors, including development of orientation materials, formative and summative student performance evaluations, and Preceptorship program evaluation for continual improvement.

5. Develop competency-based assessments for students in the Preceptorship. 6. Determine final Preceptorship grade for each student each term. 7. Propose remediation strategies for students who have not met the intended student learning

outcomes for the Preceptorship to the ADUME and the Medical Student Progress Board as directed.

8. Continually seek to improve the teaching and student learning across the Foundations of Medicine curriculum to achieve higher student performance on USMLE Step 1 and enhanced student readiness for their Core Clinical Experiences.

9. Attend monthly Curriculum Sub-committee meetings comprised of all of the Foundations of Medicine Block and Thread Directors, and Course Directors in the second-year UME curriculum.

10. Maintain compliance with all Dean’s office policies and procedures associated with medical student education.

Qualifications:

1. M.D. and/or Ph.D. degree or equivalent 2. Current OHSU faculty appointment 3. A sustained record of success in teaching medical students with an exemplary teaching record 4. Evidence of innovative and creative approaches to medical education 5. Evidence of ability to work collegially and implement change in a multi-disciplinary setting,

working with various constituents including students/trainees, faculty, and staff

Last revised June 11, 2015

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May 28, 2015 Recruitment packet for new CSL Instructors This announcement provides:

1. General introduction to the CSL Instructor role 2. UME Foundations of Medicine Curriculum weekly schedule, CSL session

schedule, CSL Instructor teaching options, Substitute pool 3. CSL Instructor orientation, training, and support 4. CSL Student Evaluation Form, Individual meetings with students 5. How to register to be a CSL Instructor 6. Funded Core CSL Instructor positions.

Please read the attached document thoroughly before attempting to register as a CSL Instructor. It is essential that you understand the roles, responsibilities, and schedules, so that you know your options and potential commitments. Because the schedule changes are somewhat complicated and there is additional information that may be of ongoing importance to CSL Instructors, we will also keep a version of this document posted within the CSL Instructor tab in Sakai, so that you can reference it and other relevant resources whenever you need to do so. Please contact David Pollack (pollackd@ohsu.edu) with any questions or concerns. 1. General Introduction We invite you to be a Clinical Skills Lab (CSL) Instructor for the newly transformed OHSU Undergraduate Medical Education Curriculum. This is an opportunity for you to share your knowledge, expertise, and teaching skills with the next generation of Oregon physicians. For more details about the overall curriculum, see YourMD Brochure. The CSL Instructors for the past year have consistently reported positive experiences with their student groups and many have renewed their commitment to this role as their schedules have allowed. We are currently recruiting more CSL Instructors for the next academic year.

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Clinical Skills Labs. These small group sessions occur in half-day blocks, generally divided into two 2-hour segments, covering two different topic areas, three times weekly. We are asking for your commitment to one or two 2-hour segments per week. The CSL sessions are a pivotal component of the new curriculum, in which the relevance of the basic science threads is linked to clinical cases and to a wide range of clinical issues. The Clinical threads are roughly divided between Clinical Assessment/Management and Clinical Context, with most weeks having one 2-hour segment of each. Clinical Assessment/Management refers primarily to the patient care competency domain, focusing mainly on physical and mental exam skills, interviewing skills, clinical documentation, and clinical reasoning. The CSL Instructors for these sessions should have sufficient physical exam skills and be comfortable teaching them to others. We will provide detailed faculty guides and reading materials for each session that should enable you to teach the targeted patient exam skills. In addition to these clinical assessment/management sessions, there may be occasional weeks when your session will be more focused on Clinical Context issues, described next.

Clinical Context refers to several competency domains (see list below), especially professionalism, systems-based practice, practice-based learning and improvement, and interpersonal and communication skills, including topics such as cultural competency, ethical issues, epidemiology, evidence-based medicine health systems, social determinants of health, public health, and health policy. You are not expected to be a content expert on these subjects. We will provide detailed faculty guides and reading materials for each session that should enable you to facilitate discussions and other instructional activities.

The CSL sessions will be organized such that CSL Instructors, who choose to teach for 4 hours per week, can teach their preferred topic area to each of two groups in that half-day. Some of the groups will cover one topic during the first 2-hour segment and another topic during the next 2-hour segment. The remaining groups will cover the same topics, but in reverse order. In this way, the same CSL Instructor can teach the same material to two different groups, which will require no additional preparation time. OHSU UME Core Competency Domains

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Patient Care and Procedures: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Knowledge for Practice: Demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Practice-Based Learning and Improvement: Demonstrate the ability to investigate and evaluate the care provided to patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on analysis of performance data, self-evaluation, and lifelong learning. Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. Professionalism and Personal and Professional Development: Demonstrate a commitment to carrying out professional responsibilities, an adherence to ethical principles, and the qualities required to sustain lifelong personal and professional growth. System-Based Practice and Interprofessional Collaboration: Demonstrate an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to effectively call upon other resources in the system to provide optimal care, including engaging in interprofessional teams in a manner that optimizes safe, effective patient and population-centered care.

2. UME Foundations of Medicine curriculum weekly schedule, CSL session

schedule, CSL Instructor teaching options, CSL Instructor substitute pool • The UME Foundations of Medicine curriculum is divided into the following

Sections*, which are defined as the time intervals during which the CSL small group member composition remains the same: 1. Summer B + Fall Term (from early August through December), including

Fundamentals (FUND) and Blood & Host Defense (BLHD) Blocks 2. Winter Term (from January until Spring Break in March), including Skin,

Bones, & Musculature (SBM) and Cardiopulmonary/Renal (CARE, first 4 weeks) Blocks

3. Spring + Summer A Term (from late March through July), including remainder of CARE and Hormones and Digestion (HODI) Blocks

4. Summer B + Fall Term (from August through December in the 2nd year), including Nervous System & Function (NSF) and Developing Human (DEVH) Blocks

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Foundations of Medicine – 4 Sections, with anticipated CSL Instructor need for each section:

• Since there are two classes in the Foundations phase during the simultaneous Sections 1 and 4 each year (Med19 will be in Section 1 beginning in August and Med18 will be in Section 4), we will need approximately double the number of CSL Instructors during that double sections time period, as compared to the Sections 2 and 3 (as reflected in the projected number needed to teach in the yellow sections in the above illustration).

• Students are assigned to one of three cohorts (Groups A, B, or C) during the curriculum Sections. These cohorts have separate half-days for Clinical Skills Laboratory (CSL), Preceptorship, and Independent Learning each week. The students are reassigned to different small groups 4 times during the Foundations of Medicine curriculum, corresponding to the four sections of the curriculum.

• CSL weekly schedule. The weekly schedule for the two classes differs slightly (see below). The incoming students follow the first schedule template for Sections 1-3, and then switch to the second schedule template for Section 4 only.

Sections 1 (Med19*) & 4 (Med18) Summer B + Fall 2015 Aug-Dec 70-82 two-hour CSL segments per week

Section 2 Winter 2016 Jan-March 36-42 two-hour CSL segments per week

Section 3 Spring + Summer A 2016 March-July 36-42 two-hour CSL segments per week

Sections 1 (Med20) & 4 (Med19) Summer B + Fall 2016 Aug-Dec 73-86 two-hour CSL segments per week

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• Teaching options. CSL Instructors can elect to provide one or two (or more)

2-hour teaching segments in the same half-day. Some clinicians cannot provide clinical services for any portion of a half-day ambulatory clinic, even if they just teach for 2 hours. This arrangement allows such faculty to get 4 hours of teaching credit instead, since their clinical work option is precluded. CSL Instructors can still limit their teaching commitment to one 2-hour segment per week, depending on the schedule and number of Instructors needed.

• Substitute pool. We need a pool of substitute instructors for days when

regular CSL Instructors experience schedule conflicts that prevent their participation in the groups. Ideally, this occurs only once or twice for any particular CSL instructor. We have found that having a small pool of potential substitute CSL Instructors allows us to provide a more consistent learning experience for the students. The large number of CSL Instructors inevitably results in the need for substitutes during most weeks. Since there is a reduced need for additional CSL Instructors for Sections 2 and 3, being a member of the substitute pool is a way to continue intermittently teaching CSL. Therefore, we welcome any current or previous CSL Instructors to volunteer to be in that on-call pool. If you have the opportunity to substitute, when given sufficient advance notice, please indicate this on the CSL registration website. For any substitute teaching events, we will contact you at least 3 days prior to the scheduled CSL session to give you time to prepare.

3. CSL Instructor orientation, training, and support

• New CSL Instructor Orientation. With each incoming cohort of new CSL

Instructors, we will provide at least one orientation session in which we provide a more detailed introduction to the UME curriculum and specific teacher preparation in small group discussion facilitation. One key component is the expectation that each CSL group develop a collaborative “learning contract”, the details and process for which is covered in the orientation session. Another component of the orientation involves providing guidance for how to address certain problems that may arise in the context of facilitating CSL sessions. In addition, we provide orientation to the technical aspects of the CSL Instructor

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functions, including the computer software used to access the session guides and other resources associated with the instructor’s tasks, layout of the Collaborative Life Sciences Building, how to use the computers and flat screen monitors in the small group rooms, and where to access help.

• Training opportunities. We have made an online self-directed training

resource available to all CSL Instructors. This module, part of the “Teaching Knowledge” series, provides specific guidance for discussion-based teaching. The module takes approximately 2 hours to complete and can be revisited as often as desired.

• Community of Teaching Practice (CoTP) meetings. We will provide periodic

(3-4 times per year) opportunities for CSL Instructors to meet as a group. This will be during the same time slot when their groups would normally meet, but during one of the weeks when the students are not in small group (e.g., assessment week or anatomy sessions). We call these sessions our Community of Teaching Practice meetings, at which time the CSL Instructors come together to provide and receive feedback about how the sessions have gone, share best teaching practices with one another, get updated information regarding curriculum changes or refinements, and identify any other technical or teaching support needs.

4. Student Evaluations

• The CSL Instructors are expected to provide meaningful feedback to the students in their groups. We are using an online evaluation form with content that assesses observable behaviors that are linked to relevant UME Core Competencies. CSL Instructors will complete these formative evaluations twice during each section, midway and at the end. In addition to the 9 rating items, there will be space on the form for required specific constructive comments. Rarely demonstrates this behavior

Occasionally demonstrates this behavior

Often demonstrates this behavior

Consistently demonstrates this behavior

Unable to answer

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1. Attends regularly and is well prepared for sessions; presents extra

material; supports statements with appropriate references. 2. Explains reasoning processes clearly and effectively with regard to

solving problems, basic mechanisms, concepts, etc. 3. Demonstrates respect, compassion and empathy. 4. Seeks to understand others’ views. 5. Takes initiative and provides leadership. 6. Shares information/resources; helps others learn; contributes to the

group process; defers to the group’s needs. 7. Seeks appropriate responsibility. Identifies tasks and completes them

efficiently and thoroughly. 8. Seeks feedback from peers and instructors and puts it to good use. 9. Small group behavior is appropriate.

• Individual meetings with CSL students. In order to enhance CSL

Instructors’ knowledge of their students, we strongly recommend that they provide at least one opportunity during the last 5-6 weeks of each Section to meet privately with each student. An efficient method for doing this would be to schedule to meet with 2 students separately for 5-7 minutes each week in the last 15 minutes of their break prior to the beginning of the CSL sessions, i.e., from 10-10:15 AM or 3-3:15 PM. The 1:1 meetings could be used to find out how students feel the CSL sessions are going, what issues are going well, whether they are struggling with any topics or issues, how the CSL Instructor might help, etc. This should allow the CSL Instructors to have greater awareness of their students and their needs, especially those who tend to be less active in the group discussions or exercises.

5. How to register to be a CSL Instructor

• Once you understand the particulars of the CSL Instructor role, you will be able to make the best decisions about your preferences for teaching CSL sessions. Go to the website for online registration as a CSL Instructor (http://www.tfaforms.com/370714 ). At that site, you will be asked a series

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of questions to determine your best or preferred options for CSL teaching. These include:

• Which topic areas you wish to teach: Clinical

Assessment/Management skills and/or Clinical Context skills, • What day or days you prefer to teach, • How many CSL sessions per week you would like to teach, • Whether you agree to be in the substitute pool, and • What future Sections you wish to teach.

• After you complete the registration form, we can determine how many CSL

Instructors we have, and then make tentative assignments of days and sessions for each CSL Instructor. We will contact you soon after the CSL Instructor registration period ends. Once the selection of the Core CSL Instructors (see below) has been completed and those positions have been scheduled, we will contact the other prospective CSL Instructors to finalize the remaining group assignments.

6. Core CSL Instructor positions There will now be several Core CSL Instructor positions, funded at 0.1 FTE of effort for the full year. The decision to directly fund these positions is based on the desire to have a consistent nucleus of faculty for the CSL sessions. The Core CSL Instructor positions are limited to OHSU employees who commit to four hours (one half-day) of teaching CSL weekly for the entire year (from August through July). It may be possible for 2 OHSU faculty members to job-share one Core CSL Instructor position. These funded positions will require some additional faculty development time and responsibilities. The job description and process for applying for the Core CSL Instructor position are posted on the OHSU SOM Blog. We encourage any interested OHSU faculty to apply for these positions. The deadline for applications is June 1. In addition to the Core CSL Instructor cohort, we will continue to need a substantial number of other CSL Instructors who wish to teach, but who may not

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be able or willing to commit to a full half-day and/or an entire year of CSL instruction. We depend upon and the students clearly benefit from all the CSL Instructors, who have proven to be dedicated teachers from the active and retired clinical practice community, from within OHSU and the other health systems in the Portland metropolitan area. *A note about terminology. You will undoubtedly notice some new or unfamiliar words or phrases that seem unique to this new curriculum. This deserves some explanation. The new curriculum is sufficiently complex in several ways that we have had to apply new words to describe key elements of the curriculum:

1. “Section” is the word that applies to the duration of a period of time in the curriculum that corresponds to when the CSL groups meet with the same group of students and CSL Instructors. The curriculum has several different instructional components operating simultaneously but following different calendars, many of which do not exactly correspond to the traditional academic “term” (i.e., Fall, Winter, Spring, and Summer). The main instructional components, during the Foundations of Medicine phase, are the organ system based Blocks, which vary in length from 7 to 13 weeks, including the 2 weeks following each Block for Assessment and Remediation, Enrichment, and Independent Learning. The preceptorship experiences correspond to the Sections, but are not operative during the entire duration of Sections 1 and 3 (i.e., the students have no preceptorship until the beginning of the Fall term during Section 1 nor during the Summer A component of Section 3). The College (Learning Community) and Scholarly Project activities span the entire duration of the students’ time in the undergraduate curriculum. During the Clinical Experiences phase, the required and elective clinical blocks are each 4 weeks long, and will generally begin and end within the academic terms.

2. “MedXX” is the identifying word used to distinguish the various class cohorts in the UME. Since the curriculum is organized around two phases (Foundations of Medicine and Clinical Experiences) that do not correspond to specific “years” of the traditional curriculum, it would be confusing to refer to students as MS1, MS2, etc. Rather, we are now using the convention of referring to students in relation to the cohort with which we

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anticipate them to graduate. Therefore the first class to go through the new curriculum is referred to as Med18, the next as Med19, and so on.

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This handbook was last revised on August 7, 2015

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