MSI Instructions

MLC I : Introduction and Guidelines for Students (2012-2013)
Course Director: Paul F. Shanley, M.D.
Assistant Director: Karen C. Kelly, M.S. (kellykc@upstate.edu)

What does this course consist of?

The essence of the course is the reading of a series of cases and articles from the medical literature. The readings for the year are available on the MLC web site. The cases are to be read with the overall objective “to understand and be able to explain what happens and what is discussed.” To this end, students will find it necessary to consult reference texts and other resources to fill in gaps in their knowledge. Other readings will be assigned to highlight or deepen understanding of aspects of basic science suggested by the case or to introduce topics in general pathology. The task is potentially daunting and students will find it useful to form study groups with their peers outside of class time to discuss issues raised by the cases and to share information and insights. The level of student understanding will be assessed by quizzes, by analysis of written assignments including a “pathophysiologic hypothesis” required of each student on most cases, and by a year-end cumulative assessment on principles of general pathology. Class time will largely consist of student questions to faculty members about issues that they were not able to satisfactorily resolve independently.

What is new for 2012-2013?

A prominent focus will be a series of readings and discussions introducing the biology of disease (“general pathology”), highlighting topics such as cell injury, inflammation, wound healing, infection and immunity, which will conclude with a year-end cumulative assessment. Most of the readings for this will come from the Rubin’s Pathology textbook (available as an e-book through the school library) or assigned papers.

Further introduction to the clinical reasoning process will be accomplished through the utilization of case-based exercises centered around common clinical complaints and the evidence-based process to evaluate, diagnose and treat patients with these symptoms. These sessions will be introduced in MLC I and further emphasized in MLC II.

What are the goals of the course?

The goal of the course is to make the student conversant in the language of medicine and to provide a conceptual and experiential framework for the student’s education and future training. Additional expected benefits of the approach include facilitation of integration of the basic science curriculum, smoother transition from basic science to clinical clerkships, and promoting independent, self-structured learning.

How will I find the cases?

The list with the dates that students will be responsible for having read and studied each case and any associated textbook pages, articles and/or handouts is found on the "Schedule" tab on the website under "MLC I ."  The full-text PDF files will come up by clicking on the title (off-campus access requires iPage log-in).

How do I study the cases? What am I expected to do?

The student’s overall objective is “to understand and be able to explain the underlying mechanisms of what happens to the patients and the rationale for what is done or discussed by the authors” in the case reports. The student will not be expected to “solve” the cases (i.e., make a diagnosis or determine appropriate management). Since the student will have the entire published report on each case, it is merely a matter of reading the report of how experts do these things and filling in the background information that allows one to follow along.  To this end, the student should pursue the following specific objectives:

• Attain an understanding of the biology of disease and apply knowledge of the relevant background concepts in the basic sciences to the case reports and readings.
• Define all medical terminology used in the case presentation.
• Compile notes on the facts of the case in standard format for case write-up.
• Generate a problem list and attempt to group findings into pathophysiologic syndromes.
• Formulate a differential diagnosis for each of the patient’s major problems at each stage of the clinical presentation, incorporating an evidence-based medicine framework for structuring and applying scientific knowledge into the clinical reasoning process.
• Relate the clinical data and further workup to sorting among the diagnostic possibilities and determine the basis for interpretation of any special studies used in the work-up of the case.
• Determine the mechanism of action and rationale for each drug or other therapeutic intervention used in the case.
• Summarize the prototypical features of each disease in the differential diagnosis suggested by the discussant in the case report and outline the author’s clinical reasoning in discussing the diagnostic hypotheses.
• Construct a “pathophysiologic hypothesis” to account for the clinical findings based on the patient’s underlying diseases.
• Acquire the ability to critically assess scientific data presented in terms of the conclusions drawn by the authors, identify what is established and what the question is with respect to the clinical issue being addressed and appropriately apply the findings to specific clinical problems.
• Develop awareness of the ethical issues raised by the case reports and/or readings (e.g., conflicts of interest, patient safety, informed consent, etc.).
• Demonstrate an attitude of curiosity, skepticism, humility in the face of the unknown and intent to pursue a career of lifelong diligent questioning and learning along with a commitment to professionalism.
  

Medical school program objectives related to the courses



Relationship of course objectives to medical program objectives and assessment



Where should I go to get information on what I don’t understand?

There will be a series of quizzes related to each case or reading (in addition to the quizzes, students will have various assignments, including a “pathophysiologic hypothesis” for most cases, other written assignments pertaining to the Rubin's textbook and a year-end concluding assessment on general pathology principles). The date on the schedule refers to the first quiz on a given case or reading. Most cases will have additional quizzes on the dates following the first quiz. The quiz will be the first thing done in class each day so please arrive on time; the case or reading will not be discussed by instructors prior to the quiz.
                       
1.     The quizzes will be in various formats. Most will be computer scored, multiple choice format, but open-ended short answer formats are also to be expected.

2.     Quizzes will generally proceed in the following sequence -

• The first quiz on a given case or reading
  • "Closed book" quiz assessing general understanding of the facts of the case or reading; no typed or handwritten material allowed
    
• Follow-up quizzes on a given case or reading
  • Quizzes will be “open paper, open notes” assessing deeper, mechanistic understanding of the events of the case or "general pathology" topic; both the published paper and any handwritten notes are allowed (along with your pathophysiologic hypothesis if applicable); no other typed/Xeroxed material is permitted. Textbooks may not be utilized during in-class quizzes.
• The usage of electronic devices during quizzes is prohibited.

3.     The quizzes related to each case or reading will cover the specific objectives listed previously. All class discussion on general or case-specific objectives will come after the quiz related to them. Please do not go to instructors for case-specific individual help before the quiz . One fundamental idea of this course is to learn how to gather, structure and evaluate information independently.

Are class sessions videotaped?

Class sessions will largely consist of interactive discussion with instructors and will not be videotaped.

What if I want to dispute an answer to a quiz question?

Rather than debate quiz answers during class time or with instructors afterwards, students are encouraged to send a formal written challenge, citing a published reference if possible, supporting a different answer to Karen Kelly via e-mail in a timely manner following posting of the quiz answers. Quiz answers will be posted on the MLC web page under the "Answer Keys" tab for the course following review by instructors, typically later that same day following the quiz. Faculty review of quiz questions will occur and will sometimes result in extra credit, dropped questions or alternative acceptable answers on quizzes. Any modifications will be posted to the online answer key; due to time constraints, students will not receive an individual response to quiz question challenges.

What is the “Pathophysiologic Hypothesis” that we have to hand in?

Submission of a pathophysiologic hypothesis outlining reasonable causes for the patient's problems in terms of known underlying disease processes is required on every case as a criterion for passing the course. The format for this exercise will be discussed and demonstrated. Instructions and examples are found on the course website by clicking on the following links for "Hypothesis Format" and "Sample Hypothesis." Students should include not only their own ID number on the assignment, but the ID number(s) of any students they collaborate with on the task as well.

Students must electronically submit their "pathophysiologic hypothesis" via Blackboard by 8 a.m. on the date of the last session scheduled for each case unless otherwise specified. Any student that does not submit a hypothesis for a given case will be required to complete a make-up exercise, necessitating reading a different case at the end of the academic year and submitting a hypothesis on it. Late submissions (i.e, prior to class discussion of the case) of a hypothesis will be dealt with on a case-by-case basis but may involve forfeiture of points.

Grading of hypotheses will be Pass/Fail. After submission, hypotheses will be randomly distributed to classmates, course faculty, guest faculty and upperclassmen for review of the hypothesis (determination of passing/failing status, offering of constructive feedback). This will occur immediately following the conclusion of the class session and will be due by 8 a.m. on the following Monday morning. Following the conclusion of the peer grading, comments will be viewable to the student.

What will happen in the class sessions?

Most classes will begin with a quiz. The remaining time in class will be utilized by instructors to respond to questions posed by the students about the case or reading. These will not be lecture sessions. Students should ask questions during class rather than waiting until after class. In the interest of fairness to all students, instructors will not answer case-specific questions individually outside of class time.

What is the grading policy?

Grading will be based on quizzes, peer-graded written assignmentsand a year-end general pathology cumulative assessment. Each of the three components must be passed in its own right to pass the course. Students must maintain a passing average of at least 75% for both the quiz and year-end general pathology assessment components and pass all written assignments (which will be graded Pass/Fail as indicated above).

There will be multiple quizzes related to each case report. Students should expect that there will be a quiz every session. This will add up to more than 20 quizzes during the year. Each question counts for one point and grades for the quiz component will be calculated by dividing the number of questions answered correctly by the total number of counted questions in all quizzes for the entire year.

The year-end cumulative assessment for general pathology will be held in class during the last class session on May 9, 2013 and must be passed with a score of 75% or better to successfully complete the course. The Rubin's Pathology review book has sample questions to help prepare for this task and all students are strongly encouraged to purchase this book from week 1 and practice questions during each unit that a chapter is assigned. The "final exam" will be variants of the specific questions in that practice book relating to assigned chapters.

Students will have written assignments, including a “pathophysiologic hypothesis” for most cases.  These will be scored on a Pass/Fail scale by classmates, faculty and upperclassmen. Successful completion of hypotheses will be required to pass the course; the best defense against being singled out for review is to make an honest effort; disregard for the spirit of the exercise may result in course failure or disciplinary action. Any student that submits a hypothesis that is deemed unsatisfactory by faculty may be asked to revise it and will have their entire portfolio reviewed. In addition, spot checking of peer grading of written assignments by faculty will be conducted and may result in warnings or penalties for graders, investigation into possible unprofessional patterns of grading and resulting adjustment of scores.

Grades of “honors” or “high pass” will be assigned according to class rank, which will reflect points accumulated in both the quiz component of the course and the year-end cumulative assessment for general pathology (i.e., the total number of points earned in both components will be added together). The number of students by class rank who are awarded grades of "honors" or "high pass" will follow school policy.

Cheating (e.g, infractions outlined in the honor code, such as utilizing unauthorized material or electronic devices for quizzes, academic dishonesty, etc.) will be actively monitored and a 25-point penalty assessed if confirmed and the matter referred to the College of Medicine Professionalism Officer for possible further action.

There are no questions for this course on MS I unit exams.

What happens if I have to be absent and miss a quiz?

• Students who are absent for an excused* reason (an e-mail to Karen Kelly stating the reason is required; * examples of legitimate excuses designated by the Curriculum Coordinating Committee include illness of oneself or a close family member, death of a close friend or family member, conference attendence, etc) will be allowed to make-up up to 10% of the total questions in the course by taking a new quiz later on in the year. The make-up quiz will be based on the reading of a one or more additional cases depending on the number of points needed. The case(s) will be assigned at that time. More extensive details regarding the make-up process can be found on Blackboard.
• Absences constituting more than 10% of the course will result in a grade of Incomplete. Additional cases beyond the make-up will be required.
• Absences constituting more than 20% of the course will result in the student being administratively withdrawn from the course and needing to repeat it the following academic year.

Some questions on individual quizzes or even entire quizzes may be designated as “extra credit.” These questions will be counted in the numerator but not the denominator of the quiz grade calculation. “Extra credit” questions cannot be made up.

What happens if need to withdraw from the course?

Students needing to withdraw from the course by the end of Unit 5 (December 21, 2012) will receive a grade of "W" for the course. After 50% of the course has been completed (start of Unit 6 on January 10, 2013 and beyond), a grade of "WP" or "WF" will be given depending on academic performance up to that point.

What happens if I fail the course?

Deficient grades will be remediated as prescribed by the Grades and Promotions Committee.

The recommendation for an isolated failure of the general pathology component (students who are unsuccessful in scoring a 75% or better) may be to re-take it after a prescribed period of study.

Who should I contact with questions or problems?

Please direct all correspondence, including absence notes and formal challenges to quiz questions to Karen Kelly (kellykc@upstate.edu).