Department of Osteopathic Manipulative Medicine - Year I

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1 Department of Osteopathic Manipulative Medicine - Year I

2 Making it HOT! Quality Enhancement Project: Higher Order Thinking University of North Texas Health Science Center Texas College of Osteopathic Medicine Department of Manipulative Medicine: Semester I & II Reporting year end

3 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..

4 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

5 Scaffolding Strategy

6 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

7 The Educational Toolbox Realignment of goals, strategies and assessments

8 How Much is TOO Much?

9 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.

10 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?

11 Challenges Obstacles Achievements

12 It is about THINKING not LEARNING

13 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

14 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)

15 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

16 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

17 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

18 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!

19 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?

20 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 (1 st, 2 nd, 3 rd order)

21 Assessing the Assessment Tool What constitutes the appropriate balance of these questions? Semester I-IV

22 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

23 Multiple Representation Principle: Video capture Building a video library of techniques taught Started Year I in Continued I & II in 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

24 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

25 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??

26 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

27 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.

28 Osteopathic considerations for IBS Somatic Dysfunction Facilitated Segments Sympathetics Psoas muscle, piriformis Parasympathetics T5-T9 T10-T11 T12-L2 Chapman reflexes Treatment plan for IBS Lymphatics Pelvic Diaphragm Spleen Presacral Fascia Sacrum So.while waiting for labs, radiology, surgery consult, etc.here s what we re going to do.

29 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: yoa Gastric: yoa Incr with smoker and NSAID users H pylori, Zollinger-Ellison (acid hypersecretory) ¼ of all ulcers are IDIOPATHIC

30

31 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.

32 Osteopathic considerations for PUD Somatic Dysfunction Facilitated Segments Sympathetics Treatment Options Lymphatics Parasympathetics _ So.while waiting for labs, radiology, surgery consult, etc.here s what we re going to do.

33 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?

34 Responsibility 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?

35 Implementation.

36 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

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