Monday, March 29, 2010

Sources of Learning Outcomes

An excellent book by Driscoll and Wood (1) lists a number of sources for learning outcomes, opening up new ways for you to continually assess and improve your courses. In their book, they suggest the following:

1. Goals: Translating to Learning Outcomes. We should first articulate our goals and outcomes, because translating goals to outcomes is seen as a first step inn developing learning outcomes. Driscoll sees goals as broad nonspecific categories of learning, but which must be broken into smaller learning outcomes in order to be assessable. If we have a goal, what do you need to plan to do to meet that goal, and how would you demonstrate that you have met it? What pedagogy will help you achieve that goal? What evidence will you use to support that you have met that goal? We take our goals and translate them into learning outcomes that we- and students- can be clear in directing learning efforts. Driscoll also notes that articulating goals and translating them into learning outcomes is an opportunity for faculty to support the mission and values of the institution.

2. Professional and Disciplinary Associations. These may also be an important source of learning outcomes and should not be ignored. One reason is that these organizations may have developed outcomes which involve the use of experts within the organization, most of whom have discipline-specific expertise. This also can help harmonize with the accreditation process.

3. Community Sources. Community partners and others may be a source of learning goals of outcomes; that is, we need to be attentive to the reality of practice and its specific requirements, idiosyncrasies and challenges. A job analysis, such as was done by the National Board of Chiropractic Examiners (2), can provide significant information and direction to a chiropractic college curriculum. Ensuring that we have representation among test plan committees at NBCE is one way to ensure that we have information about the goals of the licensing board.

4. Faculty and Students. Driscoll states that faculty and students are an “important but often neglected “source of learning outcomes. Faculty members are, of course, best positioned and have the requisite knowledge to develop learning outcomes and translate goals into outcomes. They also have insight into process. But often faculty do not participate in development for fear their contributions may be ignored. Collaborative work may help to rectify this situation. Students are also a source of outcomes, and should input into process; they may have important ideas about their learning which should be disseminated.

This is a bit of a novel model for examining the development of learning outcomes, but one we might wish to investigate further and which may help you in moving forward in the future.

1. Driscoll A, Wood S. Developing outcomes-based assessment for learner-centered education: a faculty introduction. Sterling, VA; Stylus, 2007:54-60
2., accessed March 26, 2010

Monday, March 22, 2010

ACC-RAC 2010

This past weekend I attended the 20th Association of Chiropractic Colleges meeting, which as always was combined with the Research Agenda Conference, now in its 15th year; the last 9 years have held a combined conference. As always, the conference brings together researchers, academics, administrators and practitioners to share ideas that look at both teaching and research. This year was no different.

The open plenary session started with a presentation by Dr. Norton Hadler, a prominent professor of medicine and microbiology/immunology at University of North Caroline. Dr. Hadler is author of many books, the latest of which are “Worried Sick: A Prescription for Health in an Overtreated American” and “Stabbed in the Back: Confronting Back Pain in an Overtreated Society.” His discussion looked at the personal, social and policy implications of low back pain, noting the impact it has on our lives and yet how little we know for how much we spend looking at it. He was followed by the Dr. Georges Benjamin, the executive director for the American Public Health Association, which he has led since 2002. Dr. Benjamin is a long-time friend of the chiropractic profession, and he led the audience through an overview of how we can help improve population health, asking us to work to involve more of our profession in the public health movement. The final speakers of the morning were Drs. Scott Haldeman, Pierre Cote and Don Murphy, who looked at how our understanding of the purported role of manipulation and stroke is changing as we gather more evidence and show that stroke after manipulation in incredibly rare. We all know Dr. Haldeman, but Dr. Cote is a DC, PHD working at Toronto Western Research Institute and Toronto Western Hospital, while Dr. Murphy is a chiropractor who has assignment at the Albert Medical School of Brown University.

Workshops at ACCRAC included a discussion of back and spinal pain as it relates to public health, a session on the role of ethics in research (near and dear to my heart, but could have been better, just saying), and ones on understanding and implementing boundaries in college and practice, strategies for teaching and assessing clinical reasoning, understanding evidence-based practice, trends in supporting a transition from clinician to educator, taking care of geriatric patients, applying management tools to streamline work efforts in colleges, and accessing the chiropractic literature. We also had a session that looked at the advances made in several of the chiropractic colleges that have received an R25 award. Ours was presented by Dr. Cynthia Long.

Throughout the course of the program paper sessions presented new research to attendees. We were well represented in that effort by papers from Palmer faculty, including Bob Cooperstein, Morgan Young, Makani Lew (all PCCW), Todd Hubbard, Lisa Killinger, Rita Nafziger, Michelle Barber, Maria Anderson (PCCD),Christopher Meseke, Niu Zhang, Xiaohua He, Kim Keene, Anne Canty (PCCF). Palmer faculty and administration were involved in several of the workshops, including Lisa Killinger, Judy Silvestrone, Robert Percuoco, Phyllis Harvey and Cynthia Long. And many Palmer faculty had posters at the program, including Ron Boesch, Bob Cooperstein, Casey Crisp, Todd Hubbard, Stephen Grand, Kenice Morehouse, Dave Juehring, Mike Tunning, Barbara Mansholt, myself, Katherine Pohlman, Maria Hondras, Cynthia Long, Andrea Haan, Dewan Raja, Bahar Sultana, Hong Yu and Xiaohua He. All told, our college was incredibly well represented. We should be proud, and if you see any of the presenters here, give ‘em a pat on the back.

I am proud to say that 2 Palmer papers won prizes given by the National Board of Chiropractic Examiners, one by Niu Zhang and Xiaohua He ("Understanding the intrigue of extraocular muscles and Oculomotor, Trochlear and Abducens nerves through physcial examination: an innovative approach"), and one by Rita Nafziger, Christopher Meseke and Jamie Meseke ("Collaborative testing: the effect of group formation process on overall student performance"). Only 9 total prizes were awarded and we won 2 of them.

Next year’s session has as its general theme “integration.” A new call for papers will be out soon, with a new deadline of late August of this year, so time is already close at hand. Please think about going; it is a fertile arena with which to share ideas and well worth attending.

Monday, March 15, 2010

More New Articles of Interest

Reading through the journals on Biomed Central, I always find new and interesting articles, and wish to share abstracts of several of them with you.

1. Bronfort G, Haas M, Evans R, Leiniger B, Triano J. Effectiveness of manual therapies: the UK evidence report Chiropr Osteop 2010;18:3 doi:10.1186/1746-1340-18-3
Background: The purpose of this report is to provide a succinct but comprehensive summary of the scientific evidence regarding the effectiveness of manual treatment for the management of a variety of musculoskeletal and non-musculoskeletal conditions.
Methods: The conclusions are based on the results of systematic reviews of randomized clinical trials (RCTs), widely accepted and primarily UK and United States evidence-based clinical guidelines, plus the results of all RCTs not yet included in the first three categories. The strength/quality of the evidence regarding effectiveness was based on an adapted version of the grading system developed by the US Preventive Services Task Force and a study risk of bias assessment tool for the recent RCTs.
Results: By September 2009, 26 categories of conditions were located containing RCT evidence for the use of manual therapy: 13 musculoskeletal conditions, four types of chronic headache and nine non-musculoskeletal conditions. We identified 49 recent relevant systematic reviews and 16 evidence-based clinical guidelines plus an additional 46 RCTs not yet included in systematic reviews and guidelines. Additionally, brief references are made to other effective non-pharmacological, non-invasive physical treatments.
Conclusions: Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation. Massage is effective in adults for chronic low back pain and chronic neck pain. The evidence is inconclusive for knee osteoarthritis, fibromyalgia, myofascial pain syndrome, migraine headache, and premenstrual syndrome. In children, the evidence is inconclusive for asthma and infantile colic.

2. Myburgh C, Roessler KK, Larsen AH, Hartvigsen J. Neck pain and anxiety do not always go together. Chiropr Osteop 2010;18:6 doi:10.1186/1746-1340-18-6
Chronic pain and psychosocial distress are generally thought to be associated in chronic musculoskeletal disorders such as non-specific neck and back pain. However, it is unclear whether a raised level of anxiety is necessarily a feature of longstanding, intense pain amongst patient and general population sub-groups. In a cohort of 70 self-selected female, non-specific neck pain sufferers, we observed relatively high levels of self-reported pain of 4.46 (measured on the 11 point numerical pain rating scale (NRS-101)) and a longstanding duration of symptoms (156 days/year). However, the mean anxiety scores observed (5.49), fell well below the clinically relevant threshold of 21 required by the Beck Anxiety Inventory. The cohort was stratified to further distinguish individuals with higher pain intensity (NRS>6) and longer symptom duration (>90 days). A highly statistically significant difference (p=0.000) was observed with respect to pain intensity. However, no significant differences were noted in the sub-groups with respect to anxiety levels. Our results indicate that chronic, intense pain and anxiety do not always appear to be related. Explanations for these findings may include that anxiety is not triggered in socially functional individuals, that individual coping strategies have come into play or in some instances that a psychological disorder like alexithymia could be a confounder. More studies are needed to clarify the specific role of anxiety in chronic non-specific musculoskeletal pain before general evidence-driven clinical extrapolations can be made.

3. Watmough S, O’Sullivan H, Taylor D. Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews. BMC Med Educ 2009;9:64 doi:10.1186/1472-6920-9-64
Background: In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation.
Methods: From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum.
Results: The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments.
Conclusion: These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they didn't feel they received good preparation for working as a junior doctor. Although the graduates were happy with their undergraduate education these interviews do highlight some of the reasons why the traditional curriculum was reformed at Liverpool

Monday, March 8, 2010

And the Beginning of a New Term; Three Ethics Scenarios

I think that at times there is some confusion in separating out research ethics from clinical ethics. In the case of the latter, we are referring specifically to the ethics of patient care when patients seek care from a physician for a problem that they have. In such cases, it is assumed that the physician will do everything in his or her power to help the patient get better. A physician might try a particular drug, or perhaps a particular adjusting technique, and if that does not work, he or she might try something completely different. In research ethics, as contrast, the main goal is to obtain generalizable information, and in such cases researchers are constrained by the protocols of their study. Which means that they might not be able to try all possible avenues or interventions for their patient. All too often, neither patient nor researcher really understands this. And this is but one small point of difference. Just to illustrate some of the challenges in bioethics, I offer here a few scenaries, without providing any answer or resolution to them, just to give you an idea of the complexities I mentioned above.

Scenario 1: You have developed a new method of treating patients suffering from Alzheimer’s disease. You wish to compare your intervention to an established method of treating this debilitating and distressing condition, and the best way to do so is to conduct a two-arm clinical trial, randomizing treatment into one of two treatment groups (your method or the established method). However, you are well aware that you must receive informed consent from the patient, yet many of the patients are not lucid or have, at best, periods of lucidity. How should you proceed with obtaining consent?

Scenario 2: Professor Allan Sundry is the course director of a physiology laboratory taught to chiropractic students. One of the laboratory exercises involves students’ drawing blood from one another (under supervision) and using the serum to perform a variety of chemical and cellular analyses. The lab exercise is carried out successfully. At its conclusion Professor Sundry announces to the class of 50 students that he would like to retain their leftover blood sera. He informs them some of the sera will be used individually while some will be pooled. In all cases these sera will be used to gather baseline control data in a number of research projects. He asks if anyone wants to refuse having his or her serum used for research but receives no objections. Are Allan’s actions appropriate? Is an IRB-approved protocol needed? Do the students need to give informed consent?

Scenario 3: You have submitted a new paper to a reputable journal in which you present some exciting data based on a technology you are in the forefront of developing. A number of weeks go by and you do not hear anything from the journal, so you contact the editor to find out why. He tells you that the paper is still in review and the one reviewer has yet to return a completed review. Shortly after, you see a new paper in a different journal, and it contains information that can only have come from your paper. What ethical transgressions may have occurred and what should you do?

Think about how you might respond to each of these scenarios…

Monday, March 1, 2010

More Cultural Memes- The End of Another Term...

Meme: “a cultural unit (an idea or value or pattern of behavior) that is passed from one person to another by non-genetic means (as by imitation).”

As the Davenport campus heads to a between-terms break, herewith are a number of interesting, intriguing and just sheer fun youtube clips, of no special relation to education or anything else. I’ll be back posting on related topics on March 9, after we complete the Davenport in-service day.

1. Paul Potts sings “Nessum Dorma” on Britain’s You’ve Got Talent: Okay, he’s overweight, his shirt isn’t tucked in, and his teeth need serious work, but when he begins singing, the judges (which include American Idol’s Simon Cowell) are thunderstruck. This clip is worth it just to see Cowell take note about 4 seconds after Potts starts singing. This has been seen more than 60 million times and the crowd reaction at the end is priceless.

2. Surprised Kitty- this is a cultural phenomenon. How this entered into cultural memory isn’t well understood, but the clip has been seen more than 20 million times now. You can’t watch and not smile at it.

3. “Bear Grylls is a phony.” I love Man vs. Wild, but Bear isn’t always showing the whole picture. And maybe we can understand why, watching this clip- which slowly shows that the crevice isn’t really a crevice and he’s not maybe so out in the wild…

4. Franz Klammer, Innsbruck 1976: Over the past week we have seen wonderful races from Lindsey Vonn, Julia Mancuso and Bode Miller, but the greatest single downhill race of all time was Klammer’s race in the 1976 Olympics, when he ran the course at the very edges of sanity, nearly losing control several times, but managing to pull out an amazing gold medal run.

5. Usain Bolt breaks the world record in the 200m sprint: At the 2009 Berlin World Championships, Bolt set new records in the 100m and 200m races that will likely not be broken for a decade, unless he himself breaks them. In a sport where records improve in increments of a hundredth of a second, he knocked more than a tenth of a second off the 100m record and even more than that in the 200m. Against the fastest men in the world, look how much he wins by in over just 200m.

6. The Beatles on Ed Sullivan, 1964: If you have to ask, you weren’t there. If you were there, this is indelible in your mind. A cultural benchmark.

7. That’s all, folks!

See you soon!