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‟