Department of Osteopathic Manipulative Medicine - …€¢ Department of Manipulative Medicine: ......
Transcript of Department of Osteopathic Manipulative Medicine - …€¢ Department of Manipulative Medicine: ......
Department of Osteopathic
Manipulative Medicine - Year I
• University of North Texas Health Science Center
• Texas College of Osteopathic Medicine
• Department of Manipulative Medicine: Semester I & II
• Reporting year end 2010-2011
“Making it HOT!”Quality Enhancement Project:
Higher Order Thinking
Intro
• Understanding what we mean by higher order
thinking…..
• Relative to what have we been teaching?
• Needs assessment:
– Where the students are
– Prior knowledge
– Types of students
– Types of knowledge
– Getting students on the „same page‟…..
What does this have to do with
manipulative medicine?
• Process of synthesis of information and
knowledge
• Creating structures:
– For learning
– For memory
– For pathways of deduction
Scaffolding Strategy
Time is….
• Money?
• Knowledge?
• How to add elements to an already crowded
curriculum without leaving out any of
“the good stuff”
• Using Bloom‟s heirarchy of learning to
……..“stay ahead of the curve”
The Educational Toolbox
• Realignment of goals,
strategies and assessments
How Much is TOO Much ?
Begin with the end in mind!
• “An objective is a description of a performance
you want learners to be able to exhibit before
you consider them competent.
• An objective describes an intended result of
instruction, rather than the process of
instruction itself.”
The Educational Toolbox
• Strategies
– Redefine goals
– Rewrite objectives
– Review and define the linkages
• Revisit assessment instruments
– Reconsider the value of different tasks that students
complete
– How should these accomplishments be reflected in
the grades given for the course
• Can we utilize different technologies to help
both assessment & strategy?
Challenges
Obstacles
Achievements
It is about THINKING
not LEARNING
No Points? No Point in Doing It!
• Getting students to be prepared for class
– The biggest challenge of HOT ……
– is that students have not done a LOT of preparation
• LOT: Lower Order Thinking!
• Readiness Assessment Modules
– Three - First order questions at the beginning of each
hands-on practice training session
• What was good ?
• What was the challenge ?
• Defining the value that we see in these
instruments
– Do they clearly show the students the relevance of
the time invested relative to the task of the PTR
Building a strong base
• Prevaluations:
• A series of first order questions based on the
objectives and assigned reading.
– (key words from Blooms taxonomy action verbs:
Remember. Understand)
• Must be completed and submitted by 7am on
the first day of each new unit on Blackboard
• Quiz at the end of unit introduction class to be
no less than 50% second order (Bloom‟s:
Apply. Analyze. action verbs)
Building a strong base
• How do we counter the Binge-Purge mentality?
• What is the perceived value of the post exam
review?
– Can we increased the perceived value to the student?
• Reapportionment of test questions
– Review questions:
• to bring forward key points missed on previous evaluation
tools
• Carry forward key fundamental concepts –
– Fundamental to the subject as a whole
– Important basic concepts that are common on standardized
exams
Building a Strong Base
• Readiness Assessment Modules: RAM‟s
• First order questions that assess the students
preparedness for the Practical Training Room
(PTR) experience.
• A “QUANTUM” leap in students being ready to
move more quickly up the Blooms ladder
Building a strong base
• Implementation of cumulative final for semester IV
– Inclusive of material I-IV
• Implementation of comprehensive clinical
competency for the first time
– This is to be more reflective of actual practice and
reinforces that medical education builds on prior
knowledge, reflection, and the ability to compare and
contrast new material what was previously learned
Reapportioning the Course
Grades• While historically, the educational value of the
medical student is determined by the written
national exam, osteopathic manipulative
medicine is an interactive, psychomotor ability
in which competence is determined by each
university granting the degree.
• How can we increase the standard and quality
of these skills in our graduates?
• Reformatted scheme of grading through the four
semester OMM path:
– Semester I = 10% of final grade is based on lab skills
– Semester II = 20%
– Semester III = 30%
– Semester IV = 40% Now we are HOT!
Assessing the Assessment Tool
• Does the exam adequately or appropriately
evaluate the objective that you have spend so
much time developing?
• How many first, second or third order test items
are included?
• What action is associated with the knowledge
you are assessing?
Assessing the Assessment Tool• A strategy to link objectives :
• From the syllabus for the course -
• to the objective for the class -
• to the material presented in class OR in the
DSA/assigned materials -
• and then to the degree of higher order thinking
evaluated on the examination .
• Use the facilitators PPT version to link this
material in the „notes „portion.
• Consider having a lower/middle and higher
order TQ for the same material (1st, 2nd, 3rd
order)
Assessing the Assessment Tool
• What constitutes the appropriate balance of
these questions?
– Semester I-IV
Technology?
Technology in the classroom has both benefit and
distraction
I-clickers as immediate feedback to the learner
and the facilitator for assessment of
comprehension of material in “real time”
Provoke the use of thoughtful reflection and self
questioning
Multiple Representation Principle:Video capture
• Building a video library of techniques taught
– Started Year I in 09-10
– Continued I & II in 10-11
• Challenge: consistency with written manuals
• Cost in manpower
• Technology challenges with file formats and posting
hardware issues
– Goal: to enhance the manuals and PTR
training room time.
– Not supposed to be a replacement for
attention and evaluation of other required
class materials
Lecture Hall Strategies
• Use of silence
• Use of class roster
• Use of seat position in class
• Use of „roaming‟ teaching
• Use of a „whiteboard‟ type tool
A Good Idea?
• Pre-quiz versus Real Quiz
• “Fill in the Blank” powerpoints
• Oral examination elements added to clinical
skills evaluation
• Voice over powerpoint posted presentations for
a verbal and visual model
• Add video clips to ppts??
–
OBJECTIVES• For the following conditions or areas, understand the key
clinical features, contraindications, general pathology
and how OPP/OMT may affect key or associated
features of each condition:
– Gastroesophageal Reflux disease
– Peptic ulcer disease
– Appendicitis
– Cholecystitis
– Pancreatitis
– Irritable bowel syndrome
• (Crohn‟s, Ulcerative colitis)
– Spleen: mononucleosis
PLEASE NOTE:
• PRIOR TO CLASS: You will complete the
treatment slides for each condition based upon
your previous knowledge, your DSA and refer
to your required texts: Somatic Dysfunction in
Osteopathic Family Medicine. (Nelson and
Glonek) and/or Foundations for Osteopathic
Medicine.
• You will not be provided with a “completed”
version of these slides. You may choose to
work in groups.
Osteopathic considerations for IBS
Somatic Dysfunction
Facilitated Segments
Sympathetics
Lymphatics
Parasympathetics
Treatment plan for IBS
Pelvic Diaphragm
Spleen
Presacral Fascia
T5-T9
T10-T11
T12-L2
Chapman reflexes
Sacrum
So….while waiting for labs, radiology, surgery consult, etc… ….here’s what we’re going to do.
Psoas muscle, piriformis
Peptic Ulcer Disease
• A break in the gastric or duodenal mucosa that arises
when normal defense factors are impaired or
overwhelmed by aggressive luminal factors such as acid
or pepsin
• 3:1 male:female
• Duodenal: 30-50 yoa
• Gastric: 55-70 yoa
– Incr with smoker and NSAID users
– H pylori, Zollinger-Ellison (acid hypersecretory)
• ¼ of all ulcers are IDIOPATHIC
“Lymphatic edema or venous congestion of the mesenteric tissue of the gut wall would reduce the amount of gas tolerated before pain from mesenteric pull would occur.”
Osteopathic considerations for PUD
Somatic Dysfunction
Facilitated Segments
Sympathetics
Lymphatics
Parasympathetics
Treatment Options
So….while waiting for labs, radiology, surgery consult, etc… ….here’s what we’re going to do.
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Concluding thoughts
• Does having internet access in the class
enhance learning?
• How do we stimulate students to think?
• How do we know if it is working?
• What is the tool that we use to quantify and
qualify this?
• Who is responsible for the consistency of the
curriculum?
• Who is responsible for the education that a
medical student graduates with?
• Can that be defined? or should it be defined by
a standardized testing instrument?
Responsibility
Implementation…….
Just when we all thought that we
were doing a good job…..
• We were……
• But it can be and needs to be better
• We need to train thinkers
• Peripheral brains are a „dime a dozen‟