TEACHING TRAINING AND SUPPORT:
TEACHING PORTFOLIO - DEVELOP - CURRICULUM DEVELOPMENT EXAMPLES

 

II. Curriculum Development Examples:
 
Associate Professor (Clinical Track)
 
I expanded and integrated the curriculum for medical students and residents (internal medicine and orthopedics) who rotate through rheumatology at the University of Iowa. The curriculum includes an orientation to the rheumatology clinic, a recommended reading list, a bibliography of important articles, a set of educational objectives, a self-assessment test (part 1) and an exit questionnaire to evaluate the rotation. The educational objectives are in question format and are designed to guide self-study during the rotation. The answers can be found in the Rheumatology Primer (which is provided to the rotators), textbooks, articles and discussions with staff. In addition, the "correct" answers are also available in the clinic if the answer to a question is not easily found. Finally, I provide the senior residents with a 3-hour "board-review" in rheumatology. I use a second self-assessment test which draws from the educational objectives they receive during their rotation. In this way, the residents have another chance to review the same objectives to remind themselves of the core material in rheumatology. They are also encouraged to keep the educational objectives, self-tests, lecture handouts, and bibliography together with their primer; a concise overview of rheumatology they can use prior to boards or in practice.
 
I also designed, tested and implemented a program to teach arthrocentesis to residents and students rotating through rheumatology. I initially designed a set of educational objectives, a written test and a practical test to measure the knowledge and skill level of the residents and students. A self-assessment (by the students and residents) of confidence in performing arthrocentesis was also included. A panel of experts reviewed the objectives, written test and practical test for applicability to medical practice and feasibility of teaching. These experts included specialists in Rheumatology, Orthopedics, Internal Medicine and Family Medicine as well as a Biostatistician. Modifications were made from the suggestions of the expert panel, a brief pilot study was performed, and the testing period was initiated. Residents and students were assigned to different groups: one group was tested at the beginning of their month rotation to give us an idea where resident knowledge begins; another group rotated through rheumatology without specific instruction in arthrocentesis; another group was given only the didactic lecture about arthrocentesis; another group was given the didactic lecture and the workshop; and finally some of the last group were retested 6 months later to evaluate recall. All groups were tested at the end of their month-long rotation. The students and residents who participated in the lecture and workshop scored significantly higher on both the written and practical tests and reported a significantly higher confidence level in performing arthrocentesis. This program has now become part of the curriculum for the rheumatology rotation and is being added to the Internal Medicine Core Curriculum for residents.
 
I improved the existing curriculum for rheumatology fellows by taking faculty expectations for learning and developing written learning objectives and a written curriculum. The program director and I (with faculty input) developed a new, written curriculum for a clinician-educator track with emphasis on clinical excellence and teaching. I started a book (chapter) review during which the fellows review a chapter from a standard textbook monthly with a faculty member. I also set up a continuity clinic for fellows that will allow long-term follow up of patients with minimal time spent waiting to "staff" the patient to allow a greater exposure to patients. Our rheumatology program was evaluated by the Accreditation Council for Graduate Medical Education (ACGME) and received full accreditation in 2000.
 
Professor (Tenure Track)
 
Undergraduate teaching: My first significant teaching assignment as a faculty member here was to teach the immunology section of a rather large undergraduate course, General Microbiology. For some years prior to this, the immunology section had been taught by non-immunologists, who were thus not exposed as part of their work to the most current developments in immunology. Thus, although both the previous immunology syllabus and the sections in the assigned Microbiology textbook were adequate, they were not up-to-date, and I felt contained both inaccuracies and dated emphasis. Thus, as it is difficult for a Microbiology textbook to be completely up-to-date and accurate in its immunology information, I decided to supplement the textbook section for the students by providing an extensive handout containing a detailed outline of each of my lectures. I hoped that this would also relieve the students from some note-taking, and allow them to spend more time listening and hopefully absorbing more of the lecture material. This approach turned out to be quite popular with the students, and I continued to use these handouts for each of the 4 years in which I taught the immunology section. Each year, I revised and updated the outlines to incorporate both new information, and to shift emphasis or clarify certain points, based upon student comments received on course evaluations. Since that time, a number of colleagues have used these handouts to give medical personnel and overview of immunology, or to form a basis for teaching introductory immunology sections themselves. A copy of a handout is in the Appendix material.
 
Graduate teaching: During the Spring of 1991, in my third year as an Assistant Professor, I agreed to assist a senior faculty member in teaching a course offered to both senior undergraduate and graduate students called Cellular Immunology, to be offered in Spring 1992. The senior faculty member had organized and taught in the course several times before, as had one other senior faculty member on campus. However, in the mid-fall of 1991, I learned that unexpectedly, neither of these faculty would be able to participate in teaching the course or provide any assistance in doing so.
 
As I had been thrust suddenly into the role of Course Director, with no senior faculty available to assist, I decided that this cloud might have a silver lining. The course had previously been taught as a didactic lecture course, and the topic had been restricted to cellular immunology. However, the past several years had led to an explosion in work done in the area of molecular immunology, and recent developments in this field were not being adequately covered in the advanced immunology curriculum. In addition, my teaching philosophy for advanced classes, as covered in the previous section, is that they should be taught using the primary scientific literature as the major source, and that class participation and Socratic teaching is preferable to didactic lecturing. I decided to develop a course taught according to this philosophy, and covering the major current areas most relevant to advanced students of immunology, renamed Advanced Immunology. To cover those areas in which I had less expertise, I enlisted the aid of Dr. Charles Lutz, who shares my philosophy of teaching and was willing to work within the framework of the kind of teaching I wanted to provide. The class turned out to be very successful - students were challenged by the approach, but by the end of the course most felt that they much preferred this method of learning in an advanced class. The course was continued as I had developed it, and in 1994 was expanded into a 2-semester course, called Immunology I and II. The first semester concentrates on antigen-specific immunity, and covers much of the topics emphasized in the original Advanced Immunology. The second semester focuses upon mechanisms of innate immunity. I have served as course director for Advanced Immunology/Immunology I three of the five times it has been offered since 1992, and am serving as Director again in Fall 1997. Even in years where I have not been the course organizer, I have contributed 9-12 hours of teaching plus exam questions. The course has continued to fllow my original design, which has the following features:
 
1) Students are expected to have had a basic immunology course before this class. A textbook is suggested if a reference is needed, but no textbook is assigned. Instead, for each topic, the instructor assigns a review article from the scientific literature. For each class session, 1-2 primary papers are assigned. These are chosen to best illustrate important advances which led to current understanding of a given area, and particular experimental approaches. Readings are placed on reserve in two locations. Typical course schedules and reading lists are provided in the Appendix.
 
2) For each topic covered, the instructor provides a brief didactic overview, but much of the class is devoted to discussion by the instructor of the assigned paper(s), with many questions to the class to stimulate them to learn to think critically about hypothesis building, experimental design and data interpretation. Typical questions include: Why was this control included/What control is missing here? What are the limitations/caveats of this approach? Do you agree with the authors’ interpretation - why or why not? What alternative approaches might be taken to address this question?, etc.
 
3) Exams are open-book, and consist of questions asking students to interpret hypothetical research findings, or design an experimental plan to test a given hypothesis, or some combination of these. A sample exam is provided in the Appendix to this document.
 
4) Students are requested to fill out evaluations after each topic covered, to provide instructors with more immediate feedback than waiting until the end of the entire course. Thus, if an instructor covers more than one topic, he or she can receive feedback between topics. I have provided sample summaries of my own evaluations for this course in the Appendix.
 
5) As part of the COM desire to have greater peer evaluation of teaching, a system has been set up for Immunology I by Dr. Lutz, in which two other Immunology faculty attend a session by a given instructor, and write evaluations which are shared with the instructor and the Program director. My evaluations from Fall 1996 are included in the Appendix.
 
I have also served on the Curriculum Committees for both the Microbiology Department and the Immunology Graduate Program. For the latter, this involved actually designing a curriculum from scratch, as the Program was new during the time I served on the committee. We based our course requirements on currently offered courses, but also designed a new course, Immunology II, based upon the Immunology I model, as well as a student seminar. In addition, the course Advanced Topics in Immunology was redesigned to offer a greater variety of topics. In Fall 1996, I served as Course Director for Advanced Topics in Immunology, and designed the first student evaluation form ever used for this course, to provide instructor feedback. This form, and my own evaluation results, are included in the Appendix.
 
Medical student teaching: In 1995-96, the COM began implementation of a new "problem-based" medical school curriculum. As part of this plan, Immunology became a separate subject, and the lecture section of the course is supplemented with sample "case analysis" sessions, using hypothetical patient cases to illustrate the basic immunology concepts being taught in lectures. Both in 1995 and 1996, I have served on a committee to write and revise these cases, and wrote one of the cases myself, which is included in the Appendix. The case is presented, and questions are provided to the students, to which they are expected to have found answers prior to the post-lecture discussion groups. The case author includes answers and extra questions for the discussion group leaders.