DECEMBER 3, 2012 CPC Steering Committee Supermeeting

DECEMBER 3, 2012

CPC Steering Committee Supermeeting

DR. PATRICK O'CONNOR, PH.D.

History and Goals of the CPC

History of the CPC(Clinical Presentation Continuum)

First implemented September 1999 Replaced the traditional Systems-Based

curriculum in place since the inception of the college in 1976

“The goal of a revised OU-COM curriculum will be to graduate D.O.’s who can excel in any type of postdoctoral training but who generally choose to become superior osteopathic primary care physicians.”

10 Goals of the CPC Curriculumfrom a 2005 PPT written and delivered by Dr. Peter Dane, D.O.

1.Organization to select content and demonstrate relevance to clinical medicine

Common, important clinical presentations Cough Headache Hypertension

Interdisciplinary Planning Teams Biomedical Science Family Medicine Social Medicine OMM Specialty Medicine

10 Goals of the CPC Curriculum

2. More effectively address the huge, exponentially increasing body of biomedical knowledge

move away from concept of learning as memorization of facts

move toward a concept of learning as the ability to retrieve information (facts) and apply it to clinical problem-solving

“learn to learn”


3. Horizontal integration among individual courses

Weekly themes (modules) based on a clinical presentation Back Pain Sore Throat Palpitations Jaundice

Eliminate discipline boundaries Learning activities structured around a clinical

context


4. Vertical integration between pre-clinical and clinical learning environments

Patient case studies are prominent learning tools All learning objectives (LTs)are related to clinical

skills Assessment items support clinical decision-making Revisit/reinforce BMS in years 3-4


5. Less compressed and rigid curriculum Limit classroom time Integrate basic science material into years 3 & 4

learning activities introduction reinforcement


6. Optimal commitment to OMM and OPP OPP built into case studies correlate concepts with clinical presentations revisit and enhance in years 3 & 4


7. Optimal commitment to life-long learning independent learning “prepared mind” learn to learn problem-solving approach


8. Strengthen learning and assessment methods Variety of learning methodologies

problem sets discussion groups panel discussions collaborative learning

Engaged learning Dual purpose lectures

provide overviews address traditionally challenging topics

Assessment items are based upon objectives (LTs) that derive from physician tasks, skills, responsibilities

Assessment items support clinical decision-making


9. Foster a collegial – not– adversarial relationship between faculty and students

Closer faculty-student interaction small groups faculty facilitate discussion


10. Nurture an inspiring learning environment Clearly relevant knowledge base construction Return of the “joy of discovery.”

ROSEMARY BUTCHER

Scheduling and Deadlines

Schedule Process

Starts 6 months in advance (This decision was made by the Executive Committee) Clinicians schedule clinic hours far in advance Department Chairs plan and schedule faculty workload for the

semester, sometimes the whole year

Schedule Process

Fall Semester Request schedule from IoR’s in January for July start DRAFT teaching assignments goes out in March

This is the time to review and revise Revisions should be returned to Rosemary within 30 days

FINAL teaching assignments goes out in May Once final schedules have been distributed, only

unavoidable/ unforeseen changes should be made (i.e. due to illness, weather, etc.)

Schedule Process

Spring Semester Request schedule from IoR’s in July for January start DRAFT teaching assignments goes out in September

This is the time to review and revise Revisions should be returned to Rosemary within 30 days

FINAL teaching assignments goes out in November Once final schedules have been distributed, only

unavoidable/ unforeseen changes should be made (i.e. due to illness, weather, etc.)

Meeting deadlines is imperative!

For individuals Clinicians schedule clinic hours months in advance To schedule teaching outside OU-HCOM (graduate teaching,

clinical teaching at OMH, etc.)For Departments

Department chairs need accurate teaching schedules to plan additional workload, such as research commitments, committee memberships, etc.

For the curriculum office Time spent on inappropriate last-minute schedule changes could

be more effectively spent Dominoes! That ‘one small change’ you want to make can cause

hours of phone calls emails, and scheduling headaches you may not be aware of.

For the College Room schedules are needed by college staff for non-academic

calendar activities

DR. PATRICK O’CONNOR, PH.D.

Block Planning: Overview, Goals and Schema

Block Overview

Provides block team: Provides the block team a road map for delivery of

content and review and revision of material A organizing tool to assist in preparation, review and

revision of the block Allows block team to highlight major areas of learning

and particular emphases of the block

Block Overview

Provides students: Clear understanding of the block’s purpose Parameters of learning in the block The expected outcomes for the block

Block Overview

Should include statements such as… During this block, students will be introduced to…. During this block, …will be examined. This block offers students the resources and

environment for learning…. This block will emphasize…. This block introduces students to key concepts

essential to caring for… by…. The skills of … are reinforced in lab sessions

devoted to….

Block Goals

Use block goals to Prepare for block planning Clarify Block Overview Tie in particular areas of planning, such as cases, S&I,

etc. Consider explicit goals regarding different aspects of

block material delivery

Block Goals

Block goals should be clear and specific, such as: The goals of this block are to introduce the Medical

Student to…. The major goals of this block are… The cases lead students into considerations of…. The cases encourage the student to develop…skills

based on principles of…. Synthesis and Integration sessions in this block will

focus on… Simulated patient encounters will strengthen students

’ skills in…

Schema

Description A graphic representation of the basic science and clinical

connections that underlie the specific clinical presentation The branches of a clinical schema illustrate the

relationships among the anatomical, immunological, biochemical, metabolic or physiological pathologies underlying the diverse conditions that present similarly

Each branch depicts at least feature that distinguishes it from the other branches at the same level of the diagram

The endpoints of the branches constitute a listing of protypical “differential diagnoses” associated with the patient presentation being studied

Schema

Purpose Help students discriminate differences in pathology Represent a logical graphic organization of

pathological processes underlying the various causes of the clinical presentation

Illustrate relationships (i.e. similarities, differences) among the various causes of the clinical presentation

Highlight the abnormal biomedical processes that differentiate one pathological condition from another

Conclude with a representative list of differential diagnostic entities associated with multiple causes of the clinical presentation

Schema

Block planning Discuss with the block team when and how students

use the schema Focus faculty by providing a block overview and an

opportunity to fill in details Add, remove or change schema as appropriate Make changes to the schema to strengthen both the

schema itself and its usefulness in the block

Schema

Example

MICHAEL W. TOMC, DO, FOCOODECEMBER 3, 2012

Standardized Clinical Behaviors (SCBs)

What are “Standardized Clinical Behaviors?”

A. Never heard of themB. Not sure, but it sounds vaguely familiarC. Not sure, but if they have anything to do with

boards, I’m willing to listenD. Those annoying forms you have to fill out

before seeing the doctorE. Those elements of the clinical encounter that

are particularly important for the physician to address when evaluating a patient with the clinical presentation being studied

Example: Hearing Loss Module

Standardized Clinical Behaviors Hearing Loss

For an encounter with a patient presenting with a chief complaint of hearing loss, the physician should: Elicit an appropriate medical history, with special attention to the

following questions: Onset: gradual or sudden? Duration: constant or intermittent? Unilateral or bilateral? Age of onset? History of noise exposure? History of exposure to ototoxic medications? Family history of hearing loss? History of head trauma? Otalgia?

Worsening with manipulation of the external ear or chewing? Presence or absence of discharge from the ear and its nature? Alleviating or exacerbating factors? Associated fevers or other systemic symptoms? Pressure in the ear?

Example: Continued

Associated tinnitus? Constant, intermittent, or pulsatile? Unilateral or bilateral? Alleviating or exacerbating factors?

Associated dizziness/vertigo? Severity? Impact on daily activities? Associated tinnitus? Associated nausea or vomiting? Alleviating or exacerbating factors? Other associated symptoms?

Current medications used? History of previous otologic problems or surgery?

Example: Continued

Conduct an appropriate physical exam, with particular attention to the following:

Inspection: Vital signs Configuration and shape of the pinna Otoscopic examination

Patency or edema of the external auditory canal Presence or absence of discharge in the external auditory canal Size, position, integrity, and configuration of the tympanic membrane Presence or absence of effusion in the middle ear and its nature (serous, mucoid,

purulent) Mobility of the tympanic membrane on pneumatic otoscopy

Oral cavity, oropharynx, and nasal cavity examination Palpation:

Temporomandibular joint crepitation Pain with tragal manipulation Presence or absence of cervical lymphadenopathy or neck masses

Other: Weber, Rinne’s, and Schwabach tuning fork tests Hallpike-Dix tests

Example: Continued

Order and interpret appropriate ancillary tests to further the clinical investigation, including: Pure tone audiometry Speech audiometry Impedance audiometry MRI CT scan

Perform or refer the patient for further specialized examination when appropriate: Nasopharyngoscopy Auditory evoked potential Otoacoustic emissions Electronystagmography Posturography

Example: Headache Module

Standardized Clinical Behaviors Headache

For an encounter with a patient with a chief complaint of headache, the physician should: Elicit an appropriate history, with special attention to the following questions:

onset of this episode? age of onset of initial episodes? duration? frequency? location (unilateral, bilateral, band-like, frontal, occipital, etc.)? character (throbbing, sharp, pressure, etc.)? severity (e.g. “worst headache of my life”)? premonitory symptoms? sequential progression of symptoms? provocative/palliative features:

specific foods? alcohol? menses? weather changes? stress? pain medications (NSAIDs, narcotics)?

etc., etc.

Current State

Medical Knowledge and Clinical Skills courses have steadily drifted apart for a variety of reasons

This has made the Standardized Clinical Behaviors too large to a degree unnecessary to Clinical Skills

JILL RICHMOND

LTs, MPG, Special Requirements and Cases

Learning Topics (LTs)

Learning Topics (LTs) serve to broadly characterize topic areas that the students are expected to master upon completion of the module.

Learning topics are defined by the content presented in any associated learning activities

lectures, problem sets, S&I sessions labs

the content of associated required readings (readings may be associated with a learning activity or may stand alone)

In some cases, an LT will not be associated with a specific, scheduled learning activity (lectures, etc.), but will be associated with required readings.

All LTs listed on the MPG are fair game for assessments. Conversely, content must have an associated LT in order to be assessed.

A course module will typically have 10-20 LTs listed for the week.

Module Preparation Guide (MPG)

Preparation guide for students

Lists Learning Topics (LTs) for the module

Includes learning activities, disciple codes, and required readings associated with each LT

Special Requirements

Will be the first page of the MPG

Vital for student preparation

Lists all requirements for the module, including: Special attire Problem sets Readings to be completed

before the learning activity (these should still be listed on the MPG with associated LTs)

Videos Online modules Any other information

students need to prepare for the module

Case Edits

Notes on Cases Suggested case edits Collected during the

block from CBL facilitators Students The block team

Posted on Blackboard Instructor site under “Block Teams”

Facilitator Packets

Include Group headshots Facilitator case list Updated cases Schema

Must be completed and delivered to facilitators one week prior to block start

All these materials are also posted in the facilitator section of Blackboard

Blackboard

Case edits, facilitator packets, guidelines for writing LTs and developing schema, IOR responsibilities, and many other resources are found on the Blackboard Instructor site

NOTE: Your page may look a bit different but it will still contain an area titled “My Courses”

Workflow/ Deadlines

Block team edits to cases, MPGs, special requirements documents, schema, SCBs and Block Goals are due to Jill no later than 3 months prior to block start

Jill will make all edits and email MPG requests to block faculty. These edits are due back no later than two months prior to block start. MPG requests ask for Faculty updates to texts, readings, etc. Materials to be posted to Blackboard (PowerPoint

presentations, articles, etc.)Jill then makes these edits and returns materials to

IOR for final approvalFinal materials are due back from IOR within two

weeksSpecific deadlines for your block are listed on the

block team deadlines sheet posted on blackboard.

Workflow/Deadlines

Blocks12-13

Term Start Date

Term/ Block

Start Date

Term/ Block End

Date

PlanningProcess Begins

(approximately 2 month after end of

previous year block)

Schedule & Block

Goals Due to

Curriculum Office(6 1/2 months before start of

quarter)

Teaching requests To Dept Chairs(6 months

before start of quarter)

MPG (IoR) Submis-

sion Deadline (3

months prior to block start)

Send MPG Request to

block faculty

(2 wks after IoR Deadline)

MPG edits (from faculty),

Schema, SCBs, Cases,

AOA CORE Competency

Updates, Due Date

(2 months prior to

block start)

Materials to IOR for Final

Review (2 weeks after cases

due date)

Final Materials back from

IOR (2 weeks after materials go to

IOR)

Assessment Due Date

(quizzes, all exams) (1 month prior to

Block Start)

Blackboard go live

(Exam Date of Previous Block)

Fall Immersion PCC 7/9/2012 7/9/2012 12/21/2012 2/13/2012 12/27/2011 1/9/2012 N/A N/A N/A N/A N/A N/A 7/6/2012

OCAO 7/9/2012 7/16/2012 8/10/2012 11/7/2011 12/27/2011 1/9/2012 4/16/2012 4/30/2012 5/14/2012 5/28/2012 6/11/2012 6/17/2012 7/6/2012

OMM/ CS 7/9/2012 7/9/2012 12/21/2012 2/13/2012 12/27/2011 1/9/2012 4/23/2012 N/A N/A 5/28/2012 6/11/2012 N/A 7/6/2012

Fall 1 Well Pt. 7/9/2012 8/13/2012 8/24/2012 11/14/2011 1/9/2012 1/9/2012 5/14/2012 5/28/2012 6/11/2012 6/25/2012 7/9/2012 7/13/2012 8/10/2012

MS 7/9/2012 8/27/2012 9/28/2012 12/19/2011 1/9/2012 1/9/2012 5/25/2012 6/8/2012 6/25/2012 7/9/2012 7/23/2012 7/27/2012 8/24/2012

Blood 7/9/2012 10/1/2012 10/19/2012 1/11/2011 1/9/2012 1/9/2012 7/2/2012 7/16/2012 7/30/2012 8/13/2012 8/27/2012 9/1/2012 9/28/2012

Neuro 8/13/2012 8/13/2012 9/21/2012 12/12/2011 1/9/2012 1/9/2012 5/14/2012 5/28/2012 6/11/2012 6/25/2012 7/9/2012 7/11/2012 8/10/2012

EENT 8/13/2012 9/24/2012 11/2/2012 1/23/2012 1/9/2012 1/9/2012 6/25/2012 7/9/2012 7/23/2012 8/6/2012 8/20/2012 8/22/2012 9/21/2012

Fall 2 I & I 7/9/2012 10/22/2012 11/16/2012 2/10/2012 1/9/2012 1/9/2012 8/24/2012 9/7/2012 8/20/2012 9/4/2012 9/18/2012 9/19/2012 10/19/2012

CV 7/9/2012 11/26/2012 1/25/2013 4/9/2012 1/9/2012 1/9/2012 8/27/2012 9/11/2012 9/24/2012 10/8/2012 10/22/2012 10/24/2012 11/16/2012

PSY 8/13/2012 11/5/2012 11/30/2012 2/13/2012 1/9/2012 1/9/2012 8/6/2012 8/20/2012 9/4/2012 9/18/2012 10/2/2012 10/3/2012 11/2/2012

2012-2013 E&M 8/13/2012 12/3/2012 1/25/2013 4/9/2012 1/9/2012 1/9/2012 9/4/2012 9/17/2012 10/1/2012 10/15/2012 10/29/2012 10/31/2012 11/30/2012

Spring 1 PCC 1/7/2013 1/7/2013 5/10/2013 5/14/2012 6/22/2012 7/6/2012 10/9/2012 N/A N/A N/A N/A N/A 12/21/2012

OMM/ CS 1/7/2013 1/7/2013 5/10/2013 5/14/2012 6/22/2012 7/6/2012 10/9/2012 N/A N/A 12/10/2012 12/26/2012 N/A 12/21/2012

RESP 1/7/2013 1/28/2013 3/1/2013 5/14/2012 6/22/2012 7/6/2012 10/29/2012 11/13/2012 11/26/2012 12/10/2012 12/26/2012 12/31/2012 1/25/2013

OBGYN 1/7/2013 1/28/2013 3/1/2013 5/14/2012 6/22/2012 7/6/2012 10/29/2012 11/13/2012 11/26/2012 12/10/2012 12/26/2012 12/31/2012 1/25/2013

Spring 2 GI 1/7/2013 3/11/2013 4/19/2013 6/25/2012 6/22/2012 7/6/2012 12/10/2012 12/26/2012 1/11/2013 1/25/2013 2/8/2013 2/11/2013 3/1/2013

UG 1/7/2013 4/15/2013 5/24/2013 8/6/2012 6/22/2012 7/6/2012 1/14/2012 1/28/2013 2/15/2013 3/1/2013 3/15/2013 3/11/2013 4/12/2013

PEDS 1/7/2013 3/11/2013 3/22/2013 6/4/2012 6/22/2012 7/6/2012 12/10/2012 12/26/2012 1/11/2013 1/25/2013 2/8/2013 2/11/2013 3/1/2013

GER 1/7/2013 3/25/2013 4/12/2013 6/25/2012 6/22/2012 7/6/2012 12/26/2012 1/9/2013 1/28/2013 2/11/2013 2/25/2013 2/25/2013 3/22/2013

2012-2013 AP&P 1/7/2013 4/15/2013 5/3/2013 7/16/2012 6/22/2012 7/6/2012 1/14/2012 1/28/2012 2/15/2013 3/1/2013 3/15/2013 3/11/2013 4/12/2013

Summer 2013 OCI 6/17/2013 6/17/2013 7/19/2013 9/21/2012 12/2/2012 2/15/2013 3/18/2013 4/1/2013 N/A 5/3/2013 5/17/2013 N/A 6/14/2013

E&M and CV start in Fall and overlap into Spring Semester: Grades will be recorded as a Spring Grades despite beginning in the Fall semester

ANGIE MOWRER

Exams & Assessments

CAC Multiple Choice Exam Policy

70% of multiple choice items shall be in the board-style structural format for exams in years 1 and 2 of the OUHCOM Curricula.

Questions shall be structurally consistent with the NBOME Comlex-level 1 Test Item Writing Guide.

When possible, item writers are encouraged to construct questions that assess basic science principles as they relate to clinical practice.

NBOME question format

All COMLEX questions are multiple-choice questions presented in one of the following three formats. Stand-Alone

These items consist of a stem, a lead-in question, and several choices, one of which is the correct answer to the lead-in question.

Item SetThese items consist of multiple questions that share a common stem, usually a clinical presentation.

Matching SetThese items include a list of similar choices (e.g., management steps, diagnoses) followed by several statements. One of the choices listed will best relate to each of the statements. Sometimes one of the choices is the best match for more than one statement.

Every question includes a set of choices, including one correct answer and several distractors.

The majority of examination questions consist of five choices, a few questions may have four choices.

Multiple Choice Item Construction Guidelines

The item should assess knowledge important (high impact/high frequency) in a generalist setting.

Basic science principles should be explored (scientific understanding of mechanisms), but particularly those directly related to clinical practice.

Test important concepts, preferably using questions testing higher-order thinking.


Question writing Do not be too general. There should be a specific objective/focus

evident in the stem. The stem should lead to one specific answer. The item should be so focused that the examinee can determine the answer even before looking at the answer options.

Do not teach in the stem. Avoid the use of unnecessary information

Do not use negative phrasing. Do not use stems including the words EXCEPT, LEAST, or NOT.

Do not use relative terms. Words like ALWAYS, NEVER, FREQUENTLY, and RARELY do not belong in any item.

No True/False questions. The question setting should be specific to a particular patient. Use only generic drug names.


Distractors Make each distractor concise, equivalent in length

and style to the others, and plausible. Each distractor should follow grammatically from the

stem, with the majority of the information included in the stem, not in the distractors.

Each distractor must be independent. "All of the above", "none of the above", and "A and B are both correct" are not acceptable distractors.

Exams

Students will be assessed on the Learning Topics as defined by the content presented in any associated learning activities (e.g., lectures, problem sets, S&I sessions) and by the content of associated required readings.

In courses where content lends itself to being assessed in this way, practical exams will be given.

Written Exam Deadlines

Draft Copies Due one month prior to block start

Final Copy Should be finalized AT LEAST 2 weeks prior to

exam date If Cheri would have an emergency/illness; we

need to allow time for another staff member to prepare the exam

Additionally, we need to allow time for the GA to create an answer key by hand for the test score office. This is a time intensive activity that cannot be done in a few minutes.

Blackboard Quizzes

Composition A formative quiz consisting of 20 or more

questions The questions should reflect the relative priorities

of the learning topics listed for the week. Students are to be given immediate feedback on

the accuracy of their answers, as such, all quiz questions should provide a reference for the correct answer or the correct answer with an explanation

Blackboard Quizzes

Format The questions are to be comparable to the exam

questions, 70% of quiz questions must follow the board format

Deadlines and Availability Quiz drafts are due to the Curriculum Office one

month prior to block starting. Quizzes are typically posted early each Monday

morning for the current module.

Importance of Deadlines

Presenter Input If you ask for faculty input in creating your exam (writing,

choosing or editing questions), this process takes time, please plan accordingly

It is important for Block Teams to notify faculty presenters of when the post-exam analysis will take place. If faculty presenters are unreachable during the post-exam time frame, grades may be delayed.

Workload Please keep in mind that there are often multiple written

exams that take place during the same week of curriculum. If your exam is not prepared until the last minute, there is the a higher chance of errors and delays.

Printing Copy and printing services need 48 hours advance notice to

print exam

Working with the test bank

Please refer to the test bank numbers when submitting edits or test/quizzes.

The orange portion below is the test bank number, please do not use the sequential number (1.) that automatically prints to the left of each question.

INTRO 075/PAT/12345/Q/Y//////1. An area of ischemic necrosis within an organ is called a/an:

A. thrombus B. abscessC. infarct D. clot

Jenkinson 99Intro Exam 2001; dropped from exam; edited by Jenkinson 9/01

Working with the test bank

INTRO 075/PAT/12345/Q/Y//////1. An area of ischemic necrosis within an organ is called a/an:

A. thrombus B. abscessC. infarct D. clot

Jenkinson 99Intro Exam 2001; dropped from exam; edited by Jenkinson 9/01

PAT is the discipline code 12345 is the LT#

MUST be a current LT number to be used on exams or quizzes This field can hold up to 3 Learning Topic numbers

Notes area Who submitted the question The year the question was submitted If the question has ever been edited, when and by whom If the question has been dropped or more than one answer has been accepted

Q or E (quiz/exam) and Y fields Please ignore, these fields are for curriculum office use

Post Exam

Adjustments (dropping questions, etc.) Are done manually for EACH student The more adjustments, the more time – this process

may take several hours, so please be timely with exam adjustments and patient when waiting for final scores.

Final Block Grades and Reports Assessment grades should be reported to the students

within 7 calendar days after the assessment. If you would like final grades to be released before

5:00 pm, please have all post-exam adjustments to Cheri by 1:00pm.

Grades

Composition Must be as specified in the syllabus and may include a

combination of the following: Problem Sets, quizzes, or other grade activity Self assessment quizzes on Bb Written Exams (Mid-Block and/or End of Block) Synthesis and Integration sign-in sheets or quizzes Lab attendance Practical Exams/Clinical Correlation Exams

Grades

Submitting Grades to the University At the end of the term in which your course took place, the

IOR submits grades on-line and sends a copy to the curriculum office for record keeping, or

The IOR may meet with Cheri Tarantelli during the last week of the term to submit grades to the Registrar

More information on on-line grading can be found at http://www.ohio.edu/registrar/onlinegrading.cfm

Incomplete Grades Failure by a student to satisfactorily complete all

assignments made in association with learning activities will result in an incomplete (I) for the course. This includes end-of-course evaluations and other curricular evaluation items.

After Incomplete grades are completed, there is a paper processing trail that may take several weeks depending on faculty/IOR/HCOM staff/Registrar’s staff availability.

If a block would like to pilot any non-standard assessments that requires curriculum office support,

we request that you discuss it with the curriculum office prior to listing it in the syllabus

Special Requests

Curriculum Office Staff

Rosemary Butcher – Administrative Coordinator 3-2195 Scheduling

Jill Richmond – Administrative Coordinator 7-2957 LTs, MPGs & Special requirements, cases, schema, SCBs,

Blackboard

Cheri Tarantelli – Records Management Associate 3-2194 Exams, quizzes, statistics

Angela Mowrer – Director, Pre-Clinical Education 3-1566

Laura Mitchell – Curriculum Coordinator 7-2377Patrick O’Connor – Curriculum Director 3-2100

Documents

DECEMBER 3, 2012 CPC Steering Committee Supermeeting