Outline
Fall, 2008
Objectives and Class Participation
TiMM is structured to provide you with the experience of learning about an area of clinical medicine and reading state-of-the-art papers in a related discipline of basic science. Creating connections between scientific advances and clinical need is something that you, as physician-scientists, will do for the remainder of your career, and is one of the reasons this course has been popular with the students who take it as well as the faculty who participate as instructors.
The success of the class depends on you – in particular, on the quality of the discussion. Half of your grade will reflect your participation during the semester, and half will depend on the quality of two presentations. To make the sessions interactive, we expect you to have read the papers and thought about the topic before each class. This class is different from other courses during your first year – it will challenge you to read papers critically, design thought experiments, and generate hypotheses that (if you do your job well) no one in the class will have thought of before.
Presenting in TiMM
Below is an outline of how to approach a TiMM presentation. You and the other member(s) of your group should plan to meet as a group with your preceptor twice, the first time at least two weeks before the presentation. Although each member of the group is responsible for covering a specific part of the topic, you should work as a team: the best sessions come from groups that coordinate their presentations. Once you have a presentation prepared try to practice it a few times with your partners and (even better) in front of colleagues who are unfamiliar with the material. You should guide but not dominate the discussion – the goal of your presentation is to stimulate discussion on the part of your colleagues, who will all have read and thought about the assigned papers. You should pose questions directly to the class to stimulate discussion. In addition, some students in past years have found it helpful to include slides that highlight important questions and discussion points.
Clinical review: 10-15 minutes
Overall: When learning about a new disease process it’s helpful to approach it in several ways:
Intellectually: What is going wrong and where? Is the molecular basis of the disease understood? Is this disease representative of a class of disorders or does it stand alone? It’s important to focus your presentation – know enough to understand the disease and place it in context, but don’t present minutiae you won’t be using for years to come, if ever.
Clinically: Given what you’ve read, what does this disease really look like in people? What are the complaints and symptoms, the physical findings, the available diagnostic tests and therapies, the prognosis and outcome? Your preceptor will be important in preparing this part of the presentation; much can be gained from reading but there is an irreplaceable element of experience in the clinical assessment of a patient.
Investigatively: Given what you know about this disease process, what are the limitations of our knowledge of its pathogenesis and treatment? Once you are something of an expert on the disease this will become painfully obvious and you will begin to form ideas and questions to better understand the disease. With adequate training you will ultimately come up with methods to test your ideas. This is the ultimate goal of MD/PhD training.
Outline for presentation:
***We strongly encourage you to include a case as part of your clinical presentation. This can help the members of the class better “visualize” the disease. Your preceptor will be invaluable in helping you prepare a case and highlight the essential features of the disease. Keep in mind that it’s not necessary to be exhaustive – one of the most effective case presentations given in this class was a graph of Lou Gehrig’s batting average to illustrate the effects of ALS.
Definition: Define the disease in one or two sentences. For example: myocardial infarction results from the formation of thrombi in the coronary arteries at sites of atherosclerosis leading to secondary death of heart muscle.
Epidemiology: In two or three sentences introduce the importance of this disease by discussing the who, where, and when of the disease. Some diseases will be so rare as to affect fewer than 1000 individuals; other diseases will likely affect most of us as we age.
Clinical presentation and diagnosis: For TiMM purposes, keep this lean and mean. Briefly tell us how people with this disease present: what do they complain about (i.e. symptoms), what is found on physical examination, what are the clinical laboratory findings? For genetic diseases, is there a screen that can be performed in utero or on potential carriers? Be brief and don’t worry about mentioning everything.
Clinical treatment and prognosis: What is the current treatment and how effective is it? What is the long-term outlook for individuals with this disease? Again, don’t be exhaustive. The idea is to discuss how effective modern medicine is in treating and preventing the disease. Try to focus your clinical presentation keeping in mind the associated research papers.
Pathogenesis: This is the segue into the research paper. Briefly summarize what is believed to underlie the disease process at the cellular and molecular level. Be very specific and limit your discussion to one slide related specifically to the disease. Summarize the outstanding questions that need to be answered to understand this disease at a basic level.
Method review: 10-15 minutes
(Optional; at the discretion of the preceptor, the second student will discuss either a specific method from the research paper OR will discuss one of two complementary research papers.)
Overall: A scientific paper is usually based on a few important methods. One student may take the opportunity to explain one of these in detail before discussing the paper. The method should be one that has fairly broad application but is not widely understood and would benefit from a detailed explanation.
Presentation: should address the following questions:
- What is the method in practical terms: how is it performed, what does it measure?
- How is this method applied scientifically?
- Are there complementary methods that might be used to confirm or test results obtained using this approach?
Science Paper(s): 20-25 minutes
(Depending on whether or not a method is reviewed, there will be one or two students covering the research part of the presentation.)
Overall: These papers have all been chosen because they represent the state of the art, thus the goal of this part of the presentation is not to critique the papers as in a journal club but rather to focus on explaining the research from a broad perspective. Why were the authors interested in a particular question, how did they choose to answer it, what did they learn? The idea behind this part of the session (and indeed the whole course) is explore the link between a clinical question (which may be centuries old) and the scientific approach to an answer (which is often based on a method or data available for less than a few years).
Outline for the science paper discussion:
What is the question? What aspect of a disease that is not understood is being addressed? Be specific and state this in one or two sentences. The importance of this question should be clear after hearing the clinical overview.
Background: Scientific questions are usually specific and build on previous experiments. Summarize using a diagram the specific state of the field prior to this paper. Don’t be exhaustive; use the details that pertain to this paper only. Try to make it simple, even if it isn’t! We can hammer out the important details together during discussion. Most selected papers will have enough background in the introduction or in accompanying editorials (e.g. news and views) to help you here but you may need a review paper. Ask your preceptor for guidance.
The scientific approach: How was the experiment designed and why? Sometimes the findings are fortuitous but most scientific discovery is planned. Briefly outline the approach to the question. Don’t talk about standard scientific techniques but do elaborate on the use of a new method if you feel it was crucial to the success of the investigators (keeping in mind that one of your colleagues may have already discussed a key method in detail).
Keep in mind that, although the typical format is for the clinical problem to be discussed first, followed by the research paper, you can be flexible – it is often particularly effective for the clinical presenter to come back at the end to provide a summary of the clinical relevance of the research paper.
In planning the presentation, try to stick to the indicated timing. There are normally many interruptions for discussion, and attempting to include too much information ends up in a rushed presentation at the end. Stay focused on the important concepts you want to convey!
• Last updated: 06/05/2008