Medical Microbiology and Infectious Diseases

Syllabus

I. Overview:

The Medical Microbiology and Infectious Disease Course is designed to give the prospective physician an understanding of the basic biology of microbial pathogens and the mechanisms by which they cause disease. The course will also give the prospective physician knowledge of the signs and symptoms of major infectious diseases and practice in developing differential diagnoses and fundamentals of treatment and prevention for these diseases. The course will run from September 13, 2010 through December 10, 2010.

The course is composed of the following:

1. Lectures in virology

2. Lectures in bacteriology

3. Lectures in mycology & parasitology

4. Computer exercises:
    a.  "Bugs" program, a self instructional computer program utilizing patient cases, is designed to integrate virology, bacteriology, mycology, and parasitology and to give the student practice in recognizing the signs and symptoms of and developing differential diagnoses for specific infectious diseases (http://www.mgm.ufl.edu/~gulig/mmid/bugs).
    b.  The Virtual Microbiology Lab (www.mgm.ufl.edu/~gulig/mmid/mmid-lab).

5. Small group discussions:
    a.  Three student-directed "Current Topics in Microbiology", in which students read original medical research literature.
    b.  Five Infectious Disease faculty-led "Clinical Microbiological Conferences".

Faculty:

Course Director
Paul A. Gulig, Ph.D.
392-0050, R1-250
gulig@ufl.edu
(All administrative matters regarding the schedule, course materials, absences, etc., should be referred to Dr. Gulig.)

Basic Science Lecturers
Richard C. Condit, Ph.D.
Virology Director
392-3128, R2-208
e-mail address: condit@mgm.ufl.edu

David Bloom, Ph.D.
Current Topics Director
392-8520, R2-291
dbloom@mgm.ufl.edu

Shouguang Jin, Ph.D.
392-8323, R1-293
sjin@mgm.ufl.edu

Jorge Girón, Ph.D.
273-8892, R1-133
jagiron@ufl.edu

Division of Infectious Diseases Chief
Frederick Southwick, M.D.
392-2928, R2-124A
southfs@medicine.ufl.edu

(Other clinical faculty are linked on the schedule)

Educational Philosophy

We believe that by understanding the basic structure and biology of pathogenic microorganisms and the principles of microbial pathogenesis, students will be able to better prevent, diagnose, and treat infectious diseases.  We believe that students learn best and teachers teach best in an atmosphere of mutual respect and caring.  Moreover, student interest should be nurtured and encouraged by acquainting students with the underlying scientific principles through a variety of teaching modalities, many of which originate with patient problems.  Lastly, we hope to foster, by example, the qualities of curiosity, industry, and compassion.

II. Learning Objectives:

Our goal is to help students become skillful and caring physicians with the knowledge and compassion to prevent, diagnose, and treat infectious diseases.

1.  Medical knowledge:

The student will acquire a foundation in the biology of bacteria, viruses, fungi, and parasites that will serve as a basis for his/her continuing understanding of infectious diseases, including any new diseases that may arise.

  1. At the end of the course the student will be able to demonstrate knowledge of the basic structure, physiology, and genetics of bacteria, viruses, fungi, and parasites; the student will also be able to correlate the structure, physiology and genetics of these microorganisms to the pathogenesis of the diseases they cause.
  2. The student will understand basic laboratory procedures used in the diagnosis of microbial diseases and will have the opportunity to perform some of the procedures.
  3. The student will be able to demonstrate knowledge of the pathogenesis of major infectious diseases, including their causative agents, epidemiology, and virulence mechanisms.
  4. The student will be able to demonstrate knowledge of the signs and symptoms of major diseases caused by infectious microorganisms.
  5. The student will have practice in developing differential diagnoses for major infectious diseases.
  6. The student will demonstrate knowledge of the principals of antimicrobial function. (Note: It is not our mission or intent to provide the specifics of usage of antibacterial and antiviral agents; the students will later be able to understand the specifics of antibiotic usage utilizing the frame work of knowledge they will gain in this course).
  7. The student will be able to demonstrate knowledge of the prevention, diagnosis, and treatment of major infectious diseases.
  8. In the CMC's (Clinical Microbiological Conferences) students will discuss with physicians diseases of the respiratory tract, endocarditis, central nervous system, gastrointestinal tract, and genitourinary tract.
  9. In the BUGS computer cases, the students will have practice diagnosing diseases of the respiratory tract, genitourinary tract, gastrointestinal tract, and nervous system in addition to endocarditis, wound infections, zoonotic infections, viral infections, and parasitic (worm and unicellular eukaryotic) infections.

    Instruction methods: We use a variety of methods including textbooks, lectures, clinical correlations, small group sessions, the "BUGS" computer program, and other on-line resources and exercises.

    Evaluation methods: Five formal examinations containing multiple choice, short answer, and short essay questions.

2.  Patient Care:  Clinical Microbiology Conferences. 
           Instruction methods: Students meet with Infectious Diseases clinical faculty in small groups and discuss cases.  Each session involves an assignment.
           Evaluation methods: Students will be assessed for their preparation and participation during the CMC by completing and submitting a brief homework assignment and contributing to small groups disucssions.

3.  Practice Based Learning Competencies: Current Topics in Microbiology.
          Instruction methods: Students will analyze the quality and implications of medical literature both assigned for reading and additional material they find on their own. They must attend, present a component of one of three topics to the group, and participate effectively in the current topics to satisfy this competency.
           Evaluation methods: Students will be assessed for their preparation and participation during the CTIM exercises.

4.  Professionalism: The student's evaluation for this competency will be based on the student's honesty and integrity, respectfulness, and compassion. This will be evaluated at each and every contact students have with faculty.

III.  Schedule of Activities for a Typical Week:

The structured time during a typical week would likely include 5-10 lectures or clinical correlations, 1-2 small groups, and 4-6 (on average) self-instructional computer cases. The work load for Bugs cases is heavier some weeks than others, so students are advised to work ahead on these if possible.  Learning from the cases is NOT dependent on having previously studied the subject matter. Lectures and clinical correlations are all in rooms C1-15 and C1-17 unless otherwise noted.

Lectures:
The lectures deal with the biology of human pathogens, mechanisms of pathogenesis, and how these relate to the symptoms, diagnosis,  treatment, and prevention of infectious diseases. Lectures are divided into three sections:

  1. virology
  2. bacteriology
  3. mycology and parasitology

Small Group Sessions:

Current Topics In Microbiology (CTIM) and Clinical Microbiological Conferences (CMC).

The CTIMs are student-led discussions about a current issue dealing with virology, while the CMCs small groups of students meeting with a physician to discuss selected infectious diseases in a case-based study.

BUGS computer cases (http://www.mgm.ufl.edu/~gulig/mmid/bugs):
This is a self-instructional, interactive program composed of 50 clinical cases. The case histories have interspersed multiple choice questions (MCQ's) for guided discovery of the case resolution and for learning the principles of basic microbiology, pathogenesis, and diagnosis of infectious diseases.

In response to previous evaluation comments to alleviate out of class responsibilties, most of the BUGS cases are now optional, i.e., exam material will not be derived exclusively from the cases (in the past exam material could come from any BUGS case, whether it was covered elsewhere in the course or not).  The few cases that do contain "unique testable material" are so indicated on the schedule.  However, it should be noted that even for cases that do not contain "unique testable material", the redundancy and reinforcement with lectures, small group exercises, and the Virtual Laboratory are taken into consideration for writing exams.

Cases may be done at anytime, but the most appropriate schedule is included on the course web page and schedule. The textbooks and other appropriate resources should be used to answer the MCQ's associated with the cases. Feedback is provided after both correct and incorrect responses to the MCQ's, and is an integral part of the learning process.

The cases do not always directly correspond to lecture material, but simulate the real life situation in which patients present with disease caused by an unknown spectrum of agents.  Thus students may encounter organisms in the cases that they have not yet been exposed to in lectures.  Students should consider these references as primers for material they will learn about later.  Some students may find it beneficial to spend some time learning about such organisms at the time they first appear.  Other students may wish to just register the fact that these organisms exist and wait to learn about them later. However, again, please note that learning from the cases is NOT dependent on having previously studied the subject matter.

The BUGS Cases Assignments are listed and linked on the course schedule.

IV.  Textbook Recommendations and Requirements:

We require that students purchase the two listed texts for reference and instruction. Students have also found the Levinson and Jawetz review to be very helpful and we do recommend it to students, but it is not required. Another book a lot of students like is Microbiology Made Ridiculously Simple, but it is not recommended by the faculty.

Textbook:

Required:
Infectious Disease: A Clinical Short Course by F.S. Southwick, McGraw-Hill, 2007.  The Clinical Microbiology Conferences are based on material in this book, as are several clinical correlation lectures.  Preparatory online assignments and class electronic quizzes are based on pre-reading this text for specific lectures. 

Highly Recommended:
Schaechter's Mechanisms of Microbial Disease, Fourth Edition.  Most of the basic science lectures are based and structured from this book.  Purchase of this book enables online access to its content, which is immensely helpful for searching for specific material. 

Recommended Review Books:
Because the final exam is the USMLE Microbiology Subject exam, students have found it useful to use a board review such as Medical Microbiology & Immunology, by Levinson and Jawetz (Appleton and Lange).  There is a wide range in detail, usefulness, and accuracy among the numerous board review books.  We leave it to the students to choose which works best for them.

V. Student Performance Criteria

Summative Evaluation: There are four section exams and a final exam. The final exam consists of the USMLE Microbiology Subject Exam. The exams are largely multiple choice but also contain short answer and essay questions.  A portion of each exam is cumulative.  Students are responsible for all lectures, Virtual Lab, and small group sessions.  Students are also responsible for the "Bugs" computer cases as assigned and other assigned self-study. Our broad medical knowledge objective is that the student will acquire a foundation in the biology of bacteria, viruses, fungi, and parasites that will serve as a basis for his/her continuing understanding of infectious diseases, including any new diseases that may arise.  Multiple choice (MCQ) and short answer questions are appropriate for this, while essay questions probe students’ understanding of disease and diagnostic skills. The specific objectives are given in bold type below together with the method of testing them.

At the end of the course the student will be able to demonstrate knowledge of the basic structure, physiology, and genetics of bacteria, viruses, fungi, and parasites; the student will also be able to correlate the structure, physiology and genetics of these microorganisms to the pathogenesis of the diseases they cause. This is tested by multiple choice (MCQ) and short answer questions.

The student will understand simple laboratory procedures used in the diagnosis of microbial diseases and will have the opportunity to perform some of the procedures.  We do not require that the student be able to perform the diagnostic tests, so to examine their understanding of the diagnostic tests MCQ’s and short answer questions are appropriate.  Some questions would ask what tests would be appropriate in certain clinical situations, injecting a “real world” aspect to the question.

The student will be able to demonstrate knowledge of the pathogenesis of major infectious diseases, including their causative agents, epidemiology, and virulence mechanisms. This is tested by multiple choice (MCQ) and short answer questions. Questions are often couched in clinical scenarios.

The student will be able to demonstrate knowledge of the signs and symptoms of major diseases caused by infectious microorganisms and will have practice in developing differential diagnoses for major infectious diseases. To test this objective students are given signs and symptoms and asked to diagnose the disease. Questions are either MCQ or short answer or short essay as is appropriate. In the essay questions, students must give a differential diagnosis and they are graded on their clinical reasoning by their CMC leaders who are clinicians.

The student will demonstrate knowledge of the principals of antimicrobial function. This is tested by multiple choice (MCQ) and short answer questions.

The student will be able to demonstrate knowledge of the prevention, diagnosis, and treatment of major infectious diseases. This is tested by multiple choice (MCQ) and short answer questions.

A.  Exam Schedule

TEST DATE % of Grade
Exam I: Virology October 8 25%
Exam II: Bacteriology 1 November 2 22.5%
Exam III: Bacteriology 2 November 24 22.5%
Exam IV: Mycology and Parasitology December 9 10%
Final Exam: NBME Subject December 10 20%

B.  Grades:

Grades in the course will be determined as follows: The grades on the NMBE Microbiology Subject Exam will be normalized to the class average and standard deviations for the other four exams.

PASS/FAIL GRADE
75% and higher - Pass
74.9% and lower - Fail

Anyone with a grade below 75 on ANY exam is required to consult with Dr. Gulig to formulate a plan for improved performance.

C.  Competency Evaluation:

All competency grades are pass/fail.

 

1.  Professionalism:

 Demonstrates respect; honesty; appropriate self assessment of personal values, knowledge, and ability; a consistently good work ethic; a positive attitude in the educational process; and full participation in educational activities. Professional behavior is expected towards faculty, staff, and students.

  

2.  Medical Knowledge:
Demonstrates knowledge and understanding of microbiology, as determined by a cumulative examination score of 75% or greater, and a nationally based percentile score on the USMLE microbiology subject exam of 10th percentile or higher.  If a student makes less than the 10th percentile, a competency grade of 1 (needs remediation) will be assigned.  Remediation of this grade will consist of passing the Step 1 exam taken at the end of the second year, in which case the 1 will be changed to a 2.  

3.  Patient Care:

Participates in Clinical Microbiology Conferences, prepares for and discusses cases, completes online assignments.  Must complete 4 of 5 CMC online warm-up assignments and attend 4 of 5 CMC sessions, unless approval for absence is granted by the faculty.

 

4. Practice-Based Learning:
Participates in Current Topics in Microbiology conferences. Demonstrates the ability to analyze the medical literature, communicate information through presentation, ask appropriate questions, and listen actively.Must present at one session and attend 2 of 3 CTIM sessions, unless approval for absence is granted by the faculty.

VI. Feedback to Students

Formative Evaluation: It is our intent to keep students informed of their progress and help them achieve their full potential.  We therefore post previous exams on the course web page in both quiz and review modes so that students can determine their own mastery of the material, as well as prepare for upcoming exams.  After each exam, answers are posted and wrong answers explained.  If implemented by the Medical Informations Office, space will be provided on the computerized exam forms for students to provide comments related to the clarity of exam questions.  If students have questions as to why a certain answer is wrong they may contact the course director or the relevant faculty member.  All challenges to exams must be completed within three business days of the posting of the grades and keys.  No changes will be made to earlier exams at the end of the course.  Protracted arguments regarding grades will be considered unprofessional conduct. 

VII. Administrative Policies:

Class Attendance: While we advise attendance at all classes, we believe mature students know best what helps them learn.  Attendance at small group exercises is mandatory and role is taken.  Any absences should be cleared with the small group leader ahead of time.

Make-up Exams or Other Work: Permission must be obtained PRIOR to any exam to miss that exam. If exams are missed without permission, the student may receive a zero on those exams. Excused exams due to unavoidable absences may be made up after the class has taken the exam. There is no mechanism to make up missed CTIM's or CMC's.

Class Demeanor: We expect that no one will receive cell phone calls during class except in the case of emergencies.  We expect students to be punctual and quiet so as not to disturb other students.

Class Room Accommodations: "Students requesting classroom accommodation should contact Robyn Sheppard, Chair of the Americans with Disabilities Act assessment committee for the College of Medicine, 392-4569."

Honesty Policy:

All students must agree to the following:
"I understand that the University of Florida expects its students to be honest in all of their academic work. I agree to adhere to this commitment to academic honesty and understand that my failure to comply with this commitment may result in disciplinary action, up to and including expulsion from the University." [From University of Florida Rule 6C1-4]