MSI Instructions

MLC I : Introduction and Guidelines for Students (2009-2010)
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 from the medical literature. The cases 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.  In some instances, supplemental readings will be assigned to highlight or deepen understanding of aspects of basic science suggested by the case. 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 and by analysis of written assignments including a “pathophysiologic hypothesis” required of each student on most cases. Class time will largely consist of student questions to faculty members about issues that they were not able to satisfactorily resolve independently.

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 supplemental 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 LEAP 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:

• Define all terms used in the case presentation and discussion.
• Make notes on the facts of the case in standard format for case write-up.
• Make a problem list. Attempt to group findings into pathophysiologic syndromes.
• Generate a differential diagnosis for each of the patient’s major problems at each stage of the clinical presentation and relate the clinical data and further workup to sorting among the diagnostic possibilities.
• Determine the basis for interpretation of any special studies used in the work-up of the case or in furthering the study of the disease in question.
• 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.
• Outline the author’s reasoning in discussing the diagnostic hypotheses or the results of the study.
• Construct a “pathophysiologic hypothesis” to account for the clinical findings based on the patient’s underlying diseases.  

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

How are the quizzes going to work?

• Students can bring any personally hand-written notes related to their study of the case into the auditorium
• No Xerox or typed material is allowed. The usage of electronic devices is also prohibited.

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

Are class sessions videotaped?

Discussion of cases with instructors will not be videotaped.

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

Argument about quiz answers during class time or with instructors afterwards will not be tolerated. A formal challenge, citing a published reference if possible, supporting a different answer should be sent 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.

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

The format for this 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."

How will the “Pathophysiologic Hypotheses” be used in grading?

Students must electronically submit their "pathophysiologic hypothesis" by midnight prior to the date of the last session on each case unless otherwise specified. Failure to submit a hypothesis will result in a 15-point penalty; late submissions will incur a 5-point penalty. After collection, the hypotheses will oftentimes be electronically redistributed among students and scored by peers. Failure to participate in the grading of a classmate's hypothesis will result in a penalty in the form of a zero (0) for the exercise unless appropriately excused.

The procedure will be as follows: To insure anonymity, the hypothesis itself should always be identified only with your 6-digit ID number (no names). After exchange of hypotheses, students should fill out the appropriate electronic grading form by the posted deadline.

Appropriateness of scoring by individual students will be tracked and arbitrary or variant practice will be addressed (if necessary in collaboration with the College of Medicine Professionalism Officer). The best defense against being singled out for review is to make an honest effort to be fair and true to the spirit of the exercise. Students will be instructed on what to score in each individual instance.

In the past, students have been reluctant to make judgments on the work of peers or accept judgment by peers. This is not an acceptable attitude. You are entering into a profession where needing to make judgments in difficult situations is commonplace and where you will be judged by a variety of people including many whom you do not consider qualified to do such (including representatives of Medicare and insurance companies and, not least of all, the patients themselves). Your only defense is clear communication of sound concepts with the faith that consistent quality will ultimately be rewarded. There is no challenge allowed in the subjective scoring part of the course but review of individual instances may occur if statistical analysis reveals irregularities.

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. These will not be lecture sessions. Students should ask questions during class rather than waiting until after class. Instructors will not answer questions individually outside of class time.

What is the grading policy?

Evaluation will be primarily through the use of 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 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. In addition to the quizzes, students will have written assignments, including a “pathophysiologic hypothesis” for most cases.  These will be scored numerically and included in the point totals.

No make-up quizzes will be given on any case.

• Students who are absent for a legitimate* 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 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 quiz during the last week of classes. 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 cases will be assigned at that time.
• Absences constituting more than 10% of the course will result in a grade of Incomplete. Additional cases beyond the make-up will be required and students should be aware that this will likely cause disruption of their schedules going forward.
• Absences constituting more than 20% of the course will result in the student being administratively withdrawn from the course and having 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 grade calculation. “Extra credit” questions cannot be made up.

Cheating (e.g, infractions outlined in the honor code, such as utilizing typewritten material for quizzes, plagiarism, etc.) will be actively monitored and a 25-point penalty assessed if confirmed and the matter referred to the College of Medicine Professionalism Officer.

There are no questions for this course on MS I exams and there is no final exam in this course.

The passing grade is 75%. Grades of “honors” or “high pass” will be assigned according to school policy.

New for 2009-2010

For the 2009-2010 academic year, the school has been chosen to participate in a pilot program with the National Board of Medical Examiners to assess a web-based clinical progress test. The test is a 3-hour multiple-choice exam spanning the major organ systems (e.g., renal, cardiovascular, neurologic, pulmonary, etc.) and physician tasks (diagnosis, treatment, prevention, etc.). The testing dates for MS1 students will occur in mid-January 2010, and completion of the test will be a requirement of this course. However, while you will receive confidential individualized feedback on your performance, this is a non-graded exam (thus, it will not be factored into your MLC I course average, nor will it show up on your transcript). Failure to participate in this exercise may result in a grade of Incomplete for the course.

What happens if I fail the course?

A failure will require that the student repeat the course the following academic year. There is no summer remedial course that fulfills this requirement.

Who should I contact with questions or problems?

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