Abstract
This exercise satisfies the Liaison Committee on Medical Education Standard 7.3 for medical student training in the scientific method. The students are challenged, individually and in small groups, to state and test hypotheses based on real patient data concerning risk factors for the development of hepatocellular carcinoma.
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Acknowledgments
The authors gratefully acknowledge the patience and skill of the SUNY Upstate Medical University Undergraduate Medical Education Office support staff, particularly Colleen Denniston and Ashley Scott. Dr. Lauren Germain and Joanna Suser from the SUNY Upstate Medical University Office of Evaluation, Assessment, and Research made helpful contributions. We also thank our former unit coordinator Jennifer Pinkel and reference librarian Sarah Lawler.
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Appendix. Hepatocellular carcinoma/scientific method exercise
Appendix. Hepatocellular carcinoma/scientific method exercise
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A.
Learning Objectives:
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1)
Apply the basic principles of hypothesis testing to data from patients with liver diseases.
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2)
Cite common risk factors for contracting liver diseases and for suffering poor outcomes.
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B.
Prework/IRAT:
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1)
Prompt the class to review the concept of an odds ratio and how to calculate one. Give them the data from [3] pertaining to Hepatitis B and Hepatitis C virus infections in patients with HCC vs control patients, and ask how much of a risk hepatitis virus infection represents for HCC.
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2)
Divide the class into thirds and ask each third to submit a hypothesis about the risk represented by one of three non-virus factors: alcohol consumption, smoking, and comorbid diabetes.
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C.
Narrative Feedback:
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1)
Review the students’ odds ratio calculations and prompt them to re-learn the concept, as necessary.
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2)
Review the students’ hypotheses and prompt them to improve their logic or clarity, as necessary.
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1)
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D.
Class Session/GRAT:
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1)
Provide each third of the class with the data from [3] that pertains to their hypothesis (ie, the data pertaining to alcohol consumption, smoking, or comorbid diabetes alone). Prompt them to individually use the data to test their hypothesis, or to state what additional data would be needed to properly test it.
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2)
Prompt the class to form small groups including members from each third, so that each group has access to the entire data set. Prompt them to compare hypotheses and conclusions.
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3)
Challenge each group to answer additional questions together: In this study, which risk factor was the most strongly predisposing for HCC? Which was the second-strongest? If you knew that some patients had multiple risk factors, what would you hypothesize about the magnitude of their HCC risk? What is another hypothesis that you could propose concerning these patients, and what data would you need to test it?
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4)
Share the groups’ answers to the challenge questions with the whole class for discussion.
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1)
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E.
After-Class Review of Key Points:
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1)
Post the correct answers for the odds ratio calculations.
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2)
Post additional related points concerning HCC, epidemiology, and biostatistics, indicating which points are important for the course exam, and which are important for the Step 1 exam.
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1)
The handouts for the Class Session and the odds ratio calculations and Key Points for Studying for After-Class Review are available from the corresponding author on request.
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Greenblatt, R., Hobart, T., Formica, M. et al. Quick and Clean: LCME Scientific Method Training Without a Teaching Laboratory. Med.Sci.Educ. 31, 7–9 (2021). https://doi.org/10.1007/s40670-020-01130-9
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DOI: https://doi.org/10.1007/s40670-020-01130-9