New web-based applications for mechanistic case diagramming

Teaching Pathology in an Integrated Preclinical Medical School Curriculum and Adaptations to COVID-19 Restrictions

The coronavirus disease 2019 (COVID-19) pandemic has had a major impact on education at all age levels, including professional schools and health professions programs. We describe the experience of adapting preclinical medical school courses within an integrated curriculum to virtual instruction. A major feature of two of the courses were pathology small groups adapted from pathology courses in the previous medical school curriculum. These small groups were designed to use facilitated groups of 8 to 10 students. With a sudden change to virtual learning, these small groups were shifted to large group virtual sessions. In general, the conversion went well, with ongoing optimization of the format of the large group sessions mainly occurring over the first several sessions. End-of-course student evaluations were generally positive, but with a preference toward returning to live sessions in the future. Scores on 5 multiple choice examinations in the spring 2020 course were essentially identical in mean, standard deviation, and distribution to examinations in the previous 2 years of the course that had similar layout and topic organization. We discuss the challenges and successes of the switch to virtual instruction and of teaching pathology content within an integrated medical school curriculum.

Investigating the validity of web-enabled mechanistic case diagramming scores to assess students' integration of foundational and clinical sciences

As medical schools have changed their curricula to address foundational and clinical sciences in a more integrated fashion, teaching methods such as concept mapping have been incorporated in small group learning settings. Methods that can assess students' ability to apply such integrated knowledge are not as developed, however. The purpose of this project was to assess the validity of scores on a focused version of concept maps called mechanistic case diagrams (MCDs), which are hypothesized to enhance existing tools for assessing integrated knowledge that supports clinical reasoning. The data were from the medical school graduating class of 2018 (N = 136 students). In 2014-2015 we implemented a total of 16 case diagrams in case analysis groups within the Mechanisms of Health and Disease (MOHD) strand of the pre-clinical curriculum. These cases were based on topics being taught during the lectures and small group sessions for MOHD. We created an overall score across all 16 cases for each student. We then correlated these scores with performance in the preclinical curriculum [as assessed by overall performance in MOHD integrated foundational basic science courses and overall performance in the Clinical and Professional Skills (CAPS) courses], and standardized licensing exam scores [United States Medical Licensing Exam (USMLE)] Step 1 (following core clerkships) and Step 2 Clinical Knowledge (at the beginning of the fourth year of medical school). MCD scores correlated with students' overall basic science scores (r = .46, p = .0002) and their overall performance in Clinical and Professional Skills courses (r = .49, p < .0001). In addition, they correlated significantly with standardized exam measures, including USMLE Step 1 (r = .33, p ≤ .0001), and USMLE Step 2 CK (r = .39, p < .0001). These results provide preliminary validity evidence that MCDs may be useful in identifying students who have difficulty in integrating foundational and clinical sciences.

Web-Enabled Mechanistic Case Diagramming: A Novel Tool for Assessing Students' Ability to Integrate Foundational and Clinical Sciences

PROBLEM

As medical schools move from discipline-based courses to more integrated approaches, identifying assessment tools that parallel this change is an important goal.

APPROACH

The authors describe the use of test item statistics to assess the reliability and validity of web-enabled mechanistic case diagrams (MCDs) as a potential tool to assess students' ability to integrate basic science and clinical information. Students review a narrative clinical case and construct an MCD using items provided by the case author. Students identify the relationships among underlying risk factors, etiology, pathogenesis and pathophysiology, and the patients' signs and symptoms. They receive one point for each correctly identified link.

OUTCOMES

In 2014-2015 and 2015-2016, case diagrams were implemented in consecutive classes of 150 medical students. The alpha reliability coefficient for the overall score, constructed using each student's mean proportion correct across all cases, was 0.82. Discrimination indices for each of the case scores with the overall score ranged from 0.23 to 0.51. In a G study using those students with complete data (n = 251) on all 16 cases, 10% of the variance was true score variance, and systematic case variance was large. Using 16 cases generated a G coefficient (relative score reliability) equal to 0.72 and a Phi equal to 0.65.

NEXT STEPS

The next phase of the project will involve deploying MCDs in higher-stakes settings to determine whether similar results can be achieved. Further analyses will determine whether these assessments correlate with other measures of higher-order thinking skills.

Exploring the pros and cons of mechanistic case diagrams for problem-based learning

PURPOSE

Mechanistic case diagram (MCD) was recommended for increasing the depth of understanding of disease, but with few articles on its specific methods. We address the experience of making MCD in the fullest depth to identify the pros and cons of using MCDs in such ways.

METHODS

During problem-based learning, we gave guidelines of MCD for its mechanistic exploration from subcellular processes to clinical features, being laid out in as much detail as possible. To understand the students' attitudes and depth of study using MCDs, we analyzed the results of a questionnaire in an open format about experiencing MCDs and examined the resulting products.

RESULTS

Through the responses to questionnaire, we found several favorable outcomes, major of which was deeper insight and comprehensive understanding of disease facilitated by the process of making well-organized diagram. The main disadvantages of these guidelines were the feeling of too much workload and difficulty of finding mechanisms. Students gave suggestions to overcome these problems: cautious reading of comprehensive texts, additional guidance from staff about depth and focus of mechanisms, and cooperative group work. From the analysis of maps, we recognized there should be allowance of diversities in the appearance of maps and many hypothetical connections, which could be related to an insufficient understanding of mechanisms in nature.

CONCLUSION

The more detailed an MCD task is, the better students can become acquainted with deep knowledges. However, this advantage should be balanced by the results that there are many ensuing difficulties for the work and deliberate help plans should be prepared.

Clinical Correlations as a Tool in Basic Science Medical Education

Clinical correlations are tools to assist students in associating basic science concepts with a medical application or disease. There are many forms of clinical correlations and many ways to use them in the classroom. Five types of clinical correlations that may be embedded within basic science courses have been identified and described. (1) Correlated examples consist of superficial clinical information or stories accompanying basic science concepts to make the information more interesting and relevant. (2) Interactive learning and demonstrations provide hands-on experiences or the demonstration of a clinical topic. (3) Specialized workshops have an application-based focus, are more specialized than typical laboratory sessions, and range in complexity from basic to advanced. (4) Small-group activities require groups of students, guided by faculty, to solve simple problems that relate basic science information to clinical topics. (5) Course-centered problem solving is a more advanced correlation activity than the others and focuses on recognition and treatment of clinical problems to promote clinical reasoning skills. Diverse teaching activities are used in basic science medical education, and those that include clinical relevance promote interest, communication, and collaboration, enhance knowledge retention, and help develop clinical reasoning skills.