CPC Steering Committee Supermeeting

1. CPC Steering Committee Supermeeting December 3, 2012

2. History and Goals of the CPC Dr. Patrick O'Connor, Ph.D.

3. 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.”

4. 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

5. 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”

6. 10 Goals of the CPC Curriculum 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

7. 10 Goals of the CPC Curriculum 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

8. 10 Goals of the CPC Curriculum 5. Less compressed and rigid curriculum • Limit classroom time • Integrate basic science material into years 3 & 4 learning activities • introduction • reinforcement

9. 10 Goals of the CPC Curriculum 6. Optimal commitment to OMM and OPP • OPP built into case studies • correlate concepts with clinical presentations • revisit and enhance in years 3 & 4

10. 10 Goals of the CPC Curriculum 7. Optimal commitment to life-long learning • independent learning • “prepared mind” • learn to learn • problem-solving approach

11. 10 Goals of the CPC Curriculum 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

12. 10 Goals of the CPC Curriculum 9. Foster a collegial – not– adversarial relationship between faculty and students • Closer faculty-student interaction • small groups • faculty facilitate discussion

13. 10 Goals of the CPC Curriculum 10. Nurture an inspiring learning environment • Clearly relevant knowledge base construction • Return of the “joy of discovery.”

14. Scheduling and Deadlines Rosemary Butcher

15. 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

16. 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.)

17. 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.)

18. 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

19. Block Planning: Overview, Goals and Schema DR. PATRICK O’CONNOR, PH.D.

20. 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

21. Block Overview • Provides students: • Clear understanding of the block’s purpose • Parameters of learning in the block • The expected outcomes for the block

22. 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….

23. 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

24. 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…

25. Schema • Description • A graphic representation of the basic science and clinicalconnections 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

26. 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

27. 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

28. Schema • Example

29. Standardized Clinical Behaviors (SCBs) Michael W. Tomc, DO, FOCOO December 3, 2012

31. What are “Standardized Clinical Behaviors?” • Never heard of them • Not sure, but it sounds vaguely familiar • Not sure, but if they have anything to do with boards, I’m willing to listen • Those annoying forms you have to fill out before seeing the doctor • 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

32. 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?

33. 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?

34. 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

35. 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

36. 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.

37. 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

38. LTs, MPG, Special Requirements and Cases Jill Richmond

39. 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.

40. 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

41. 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

42. 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”

43. 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

44. 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

45. 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 approval • Final materials are due back from IOR within two weeks • Specific deadlines for your block are listed on the block team deadlines sheet posted on blackboard.

46. Workflow/Deadlines

47. Exams & Assessments Angie Mowrer

48. 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.

49. NBOME question format • All COMLEX questions are multiple-choice questions presented in one of the following three formats. • Stand-AloneThese 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.

50. 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.