MSII Instructions

MLC II : Introduction and Guidelines for Students (2008-2009)
Course Director: Paul F. Shanley, M.D.
Coordinator: Karen C. Kelly (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 SUNY library website. 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 given approximately two times per week and by analysis of written assignments including a “pathophysiologic hypothesis” required of each student on each case. 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. The emphasis is on “pathophysiology” which is understood as mechanisms of disease at the organ system level.  Pathophysiology provides the transition from basic to clinical science since organ dysfunction is still the level at which most clinical assessment and intervention occurs. 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 II ." The full-text PDF files will come up by clicking on the title.

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?

Interaction and discussion of the cases among students is strongly encouraged. Ultimately the individual student is responsible for ensuring that the information obtained from peers (or instructors) is accurate. There is no recourse to “authority” (course instructors, other faculty, upper-class students, family members) other than a consensus of published material.

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. Students will be informed on a case-by-case basis whether access to the assigned readings is allowed during the quiz. In general, assume that the case report or reading is not allowed.

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.

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 then 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 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 hand in their "pathophysiologic hypothesis" electronically by 8 a.m. on the date of the last session on each case unless other specified. Failure to submit a hypothesis at the end of each case will result in a zero (0) for the assignment (with eligibility to read an additional case at the end of the year and create a hypothesis for make-up if appropriately excused). After collection, the hypotheses will oftentimes be electronically redistributed among students and scored by peers. Failure to participate in the grading of classmates ’ hypotheses will result in a penalty in the form of a zero (0) for the assignment 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 electronic “Hypothesis Grading Form” with space provided for the ID number of the student being scored and the name of the student doing the scoring. There will be zero tolerance for errors in the mechanics of filling in the names and ID numbers; students responsible will be scored zero (0) for the exercise.

Appropriateness of scoring by individual students will be tracked and arbitrary or variant practice will be addressed (if necessary in collaboration with the Offices of the Dean of Curriculum and the Dean of Student Affairs). 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 exactly 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 or assigned supplemental reading. There will be several quizzes per week. This will add up to more than 50 quizzes during the course. Each question counts for one point and the final grade will be calculated by dividing the number of questions answered correctly by the total number of questions in all quizzes. In addition to the quizzes, students will have various assignments, including a “pathophysiologic hypothesis” for each case.  These will be scored numerically and included in the point totals. Exceptional class participation and/or superb quality of submitted hypotheses may also be considered in the case of borderline grades.

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) will be allowed to make-up up to 10% of the total questions in the course by taking a quiz during Final Exam week. The make-up quiz will be based on the reading of an additional case to be assigned at that time.

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, using previous years' quizzes, etc.) will be actively monitored and a 50-point penalty assessed if confirmed and the matter referred to the Offices of the Dean of Curriculum and the Dean of Student Affairs.

These rules apply in general. Exceptional situations* will be evaluated on a case-by-case basis in consultation with the Offices of the Dean of Curriculum and the Dean of Student Affairs (* in general, absences constituting more than one-third of the course automatically necessitate that a student repeat the course).

There are no questions for this course on the unit 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.

What happens if I fail the course?

A failure will require that the student repeat the course. 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).