Monday, November 29, 2010

Introduction to Rubrics

A rubric can be defined as “as assessment tool often shaped like a matrix, which describes levels of achievement in specific area of performance, understanding, or behavior.” (1) Rubrics are generally classified into one of two groups, the analytic rubric and the holistic rubric.

The analytic rubric provides a student with the criteria to be assessed at each level of performance and gives a score for each of those criteria. Thus, it can provide a student with a significant level of feedback, and allows for some consistent scoring among students and across evaluators (if more than one is to be used). However, these take more times to score. Analytic rubrics are best used when you wish to see the specific strengths and weaknesses of your students, and when you wish to have detailed feedback about individual performance.

The holistic rubric provides one single score for a student based on an overall impression of that student’s performance in the activity or task being assessed. These types of rubrics allow for quick scoring, an overview of achievement with detail and are efficient when you have to grade a large number of students. Obviously, it cannot provide detailed performance information, and it can be hard to determine one single overall score for a given student. Thus, this is best used a “snapshot” of student performance, and when you find that a single dimension is sufficient to evaluate quality.

Using a rubric allows you to examine complex behaviors or products efficiently using a common framework for assessment and evaluation. They are criteria-based rather than norm-based; you are not comparing student behavior to each other but to a set criterion standard. Another positive attribute of rubrics is that when used among several teachers, a rubric allows for collaboration and cooperation, leading to better assessments. There are shared expectations and grading practices.

An excellent reference text for using rubrics in higher education is “Introduction to Rubrics,” by Stevens and Levi (2). Next week I will describe the components of a rubric and the steps necessary to develop one. A good number of Palmer faculty members use them in assessment, and I hope that if you do not, you may wish to consider doing so moving forward.

1., accessed November 29, 2010
2. Stevens DD, Levi AJ. Introduction to rubrics. Sterling, VA: Stylus Publishing LLC, 2005

Monday, November 22, 2010

2011 ACC-RAC and Palmer College Represent!

The schedule for the 2011 ACC-RAC conference was recently announced and I am happy to say that Palmer College of Chiropractic is extensively represented. Please note all of the following papers and presentations and give a short note of congratulations to all involved. And consider submitting something yourself next year!

Papers accepted for platform presentation

Enhancing the Use of Evidence-Based Clinical Practice Methods Through Diffusion of Innovation Theory and a Train-the-Trainer Model in Chiropractic Education
Michelle Barber, Ron Boesch, Lia Nightingale, Michael Tunning, John Stites

WIKI a Collaborative Faculty Development Tool
Ron Boesch, Robert Illingworth

Mentored research opportunities for students in a doctor of chiropractic program
Lori Byrd, Cynthia Long, Liang Zhang, Robert Cooperstein, Joel Pickar, Charles Henderson

Improving targeting accuracy in mapping upright spinal levels to the prone position
Robert Cooperstein, Young Corlette

At What Angle of Hip Flexion Is the Gillet Test the Most Effective for Detecting Sacroiliac Motion?
Robert Cooperstein, Morgan Young, Michael Haneline

Characterizing the Toggle-Recoil Delivery of Practicing Clinicians
James DeVocht, Ram Gudavalli

Empowering student learning through rubric-referenced self-assessment
Xiaohua He, Anne Canty

Helping uni-professionally trained students to think integratively: An interactive educational intervention
Lisa Killinger

Using evidence based clinical practice principles to utilize and enhance student clinical reasoning skills in a classroom-based case management course: A pilot project
Nancy Kime

Human Subject Research: Reporting Informed Consent and Ethics Approval in Three Chiropractic Journals
Dana Lawrence

Application of the MIRC radiology database in a chiropractic educational environment
Ian McLean

The case for collaborative assessment of students: a meta-analysis
Christopher Meseke, Jamie Meseke, Rita Nafziger

For the Good of All: A Collaborative Effort to Develop and Deliver an Excellence in College Teaching Certificate Program for Chiropractic College Faculty
Rita Nafziger

Concept Mapping as a Study Tool for Chiropractic Students in a Basic Science Course
Lia Nightingale

Integration of Evidenced-Based Clinical Practice into a Basic Science Course
Lia Nightingale

Paraspinal muscle function assessed with the flexion-relaxation ratio at baseline in a population of patients with back-related leg pain
Edward Owens, M. Ram Gudavalli, Craig Schulz, David Wilder, Maria Hondras, Gert Bronfort

Effect of the mechanical characteristics (magnitude and duration) of a spinal manipulative thrust on lumbar paraspinal muscle spindle discharge
Joel Pickar, William Reed, Dong-Yuan Cao, Gregory Kawchuk

Evidence-based clinical practice in chiropractic: Description of a class assignment and survey of student knowledge and attitudes
Robert Rowell, Michael Tunning

Immunization Status of Adult Chiropractic Patients: Analyses of National Health Interview Survey (NHIS )
Monica Smith, Matthew Davis

Usual Source of Care for persons with and without Back Pain (MEPS data)
Monica Smith

Preparing for teaching moments in evidence-based clinical practice
John Stites, Ron Boesch

Developing a Clinical Practice Journal Club
John Stites, Dana Lawrence

Teaching evidence based clinical practice concepts using radiology case types at a chiropractic college
John Stites, Ian McLean

Evidence-based clinical practice: experience of an early adopter adding an assignment in EBCP to a class
Michael Tunning, Robert Rowell

Reliability of the standing hip flexion test: A systematic review
Morgan Young, Robert Cooperstein

The Effect of Problem-Based Video Instruction on Learning in Physical Examination: An Alternative Paradigm for Chiropractic Students
Niu Zhang, Sudeep Chawla

Papers accepted for poster presentation

Management considerations in a transtibial amputee with Charcot-Marie-Tooth disease
Maria Anderson, Craig Butler

Kinetic chain dysfunction in a 16-year-old soccer player with ankle pain
Maria Anderson, Michelle Barber

Cervical Spondylitic Myelopathy: A Case Report
Ron Boesch, James Owens, Steven Silverman, Mary Klimek

Glioma with Subdural Hematoma Initial Management: A Case Report
Ron Boesch, Misty Stick, Robert Illingworth, Elizabeth Borcher

Chiropractic Management of Cycling Induced Median and Ulnar Neuropathy
Richard Cole, Ron Boesch, Bradford Cole

Reliability of the Blair Upper Cervical Radiographic Analysis for the Base Posterior View: A Feasibility Study
Todd Hubbard, Joel Pickar, Dana Lawrence, Stephen Duray

Essential tremor, Migraine and upper cervical chiropractic: a case report
Todd Hubbard, Janice Kane

A Case Study Utilizing Vojta/Dynamic Neuromuscular Stabilization Therapy to Control Symptoms of a Chronic Migraine Sufferer
Dave Juehring


Challenges with chiropractic technique research
Arlan Fuhr, Ron Rupert, Christine Goertz, Rodger Tepe, Tony Rosner, Charles Woodfield III

Addressing the Hidden Curriculum in Chiropractic Education
Kinsinger and Lawrence

Monday, November 15, 2010

New Papers of Interest

The following are three new papers that I found interesting and intriguing and thought you would benefit by knowing about. They give us pause for thought.

1. Mirtz TA, Hebert JH, Wyatt LH. Attitudes of non-practicing chiropractors: a pilot survey concerning factors related to attrition. Chiro Osteop 2010;18:29 doi:10.1186/1746-1340-18-29

Background: Research into attitudes about chiropractors who are no longer engaged in active clinical practice is non-existent. Yet non-practicing chiropractors (NPCs) represent a valid sub-group worthy of study. Aim: The purpose of this research was to assess attrition attitudes of NPCs about the chiropractic profession and develop a scale to assess such attitudes.
Methods: A 48 item survey was developed using the PsychData software. This survey included 35 Likert-style items assessing various aspects of the profession namely financial, educational, psychosocial and political. An internet discussion site where NPCs may be members was accessed for recruitment purposes.
Results: A total of 70 valid responses were received for analysis. \. A majority of respondents were male with 66% being in non-practice status for 3 to 5 years and less with 43% indicating that they had graduated since the year 2000. Most respondents were employed either in other healthcare professions and non-chiropractic education. A majority of NPCs believed that business ethics in chiropractic were questionable and that overhead expense and student loans were factors in practice success. A majority of NPCs were in associate practice at one time with many believing that associates were encouraged to prolong the care of patients and that associate salaries were not fair. Most NPCs surveyed believed that chiropractic was not a good career choice and would not recommend someone to become a chiropractor. From this survey, a 12 item scale was developed called the "chiropractor attrition attitude scale" for future research. Reliability analysis of this novel scale demonstrated a coefficient alpha of 0.90.
Conclusion: The low response rate indicates that findings cannot be generalized to the NPC population. This study nonetheless demonstrates that NPCs attrition attitudes can be assessed. The lack of a central database of NPCs is a challenge to future research. Appropriate investigation of attrition within the chiropractic profession would be helpful in the analysis of attitudes regarding both chiropractic education and practice. Further research is needed in this area.

2. Langworthy J, Forrest L. Withdrawal rates as a consequence of disclosure of risk associated with manipulation of the cervical spine: a survey. Chiro Osteop 2010;18:27 doi: 10.1186/1746-1340-18-27

Background: The risk associated with cervical manipulation is controversial. Research in this area is widely variable but as yet the risk is not easily quantifiable. This presents a problem when informing the patient of risks when seeking consent and information may be witheld due to the fear of patient withdrawal from care. As yet, there is a lack of research into the frequency of risk disclosure and consequent withdrawal from manipulative treatment as a result. This study seeks to investigate the reality of this and to obtain insight into the attitudes of chiropractors towards informed consent and disclosure.
Methods: Questionnaires were posted to 200 UK chiropractors randomly selected from the register of the General Chiropractic Council.
Results: A response rate of 46% (n=92) was achieved. Thirty-three per cent (n=30) of respondents were female and the mean number of years in practice was 10. Eighty-eight per cent considered explanation of the risks associated with any recommended treatment important when obtaining informed consent. However, only 45% indicated they always discuss this with patients in need of cervical manipulation. When asked whether they believed discussing the possibility of a serious adverse reaction to cervical manipulation could increase patient anxiety to the extent there was a strong possibility the patient would refuse treatment, 46% said they believed this could happen. Nonetheless, 80% said they believed they had a moral/ethical obligation to disclose risk associated with cervical manipulation despite these concerns. The estimated number of withdrawals throughout respondents' time in practice was estimated at 1 patient withdrawal for every 2 years in practice.
Conclusion: The withdrawal rate from cervical manipulation as a direct consequence of the disclosure of associated serious risks appears unfounded. However, notwithstanding legal obligations, reluctance to disclose risk due to fear of increasing patient anxiety still remains, despite acknowledgement of moral and ethical responsibility.

3. Peets AD, Cooke L, Wright B, Coderre S, McLaughlin K. A prospective randomized trial of content expertise versus process expertise in small group teaching. BMC Medical Education 2010, 10:70 doi:10.1186/1472-6920-10-70

Background: Effective teaching requires an understanding of both what (content knowledge) and how (process knowledge) to teach. While previous studies involving medical students have compared preceptors with greater or lesser content knowledge, it is unclear whether process expertise can compensate for deficient content expertise. Therefore, the objective of our study was to compare the effect of preceptors with process expertise to those with content expertise on medical students' learning outcomes in a structured small group environment.
Methods: One hundred and fifty-one first year medical students were randomized to 11 groups for the small group component of the Cardiovascular-Respiratory course at the University of Calgary. Each group was then block randomized to one of three streams for the entire course: tutoring exclusively by physicians with content expertise (n = 5), tutoring exclusively by physicians with process expertise (n = 3), and tutoring by content experts for 11 sessions and process experts for 10 sessions (n = 3). After each of the 21 small group sessions, students evaluated their preceptors' teaching with a standardized instrument. Students' knowledge acquisition was assessed by an end-of-course multiple choice (EOC-MCQ) examination.
Results: Students rated the process experts significantly higher on each of the instrument's 15 items, including the overall rating. Students' mean score (±SD) on the EOC-MCQ exam was 76.1% (8.1) for groups taught by content experts, 78.2% (7.8) for the combination group and 79.5% (9.2) for process expert groups (p = 0.11). By linear regression student performance was higher if they had been taught by process experts (regression coefficient 2.7 [0.1, 5.4], p < .05), but not content experts (p = .09).
Conclusions: When preceptors are physicians, content expertise is not a prerequisite to teach first year medical students within a structured small group environment; preceptors with process expertise result in at least equivalent, if not superior, student outcomes in this setting.

Monday, November 8, 2010

Creating One-Piece Posters via PowerPoint in MS PowerPoint 2007

This was originally prepared by a former member of the Center for Teaching and Learning, but it holds great advice for all of us as we move toward planning for possible trips to ACC-RAC in March of 2011.

To Begin
The average size of a poster is 5’ wide x 3.5’ tall. We will be using these measurements for this tutorial. This document is also written with the intent that the user has a basic knowledge of Microsoft PowerPoint.

We view the creation of a poster in PowerPoint as one big slide; all the aspects are the same except the pasteboard is approximately 600% bigger. The posters are printed on a HP Designjet 5500 ps which has a print area of 3.5’ x 100’; the printer is physically located in The Center for Teaching and Learning.

Setting the Pasteboard
Open PowerPoint. It will open a blank slide for you. If it does not, go to the Microsoft icon in the top left corner, click there and choose Blank Presentation, and then click OK. You now have a basic pasteboard that is set up for slide or onscreen output. We will now change the dimensions of the pasteboard to reflect our poster. In the menu bar at the top of the screen choose the Design Tab, then find the Page Setup…. You will then be prompted with a dialog box that allows you to make changes to the size.

IMPORTANT NOTE: PowerPoint 2007 will not allow you to change the pasteboard size larger than 56 inches, and you will need 60 inches. Because of this, we will create the poster in half scale and print it at 200%. So instead of our pasteboard being 60” x 42” we are going to set it up at 30” x 21.” In the dialog box, here would be our settings:
Width = 30
Height = 21
Pages = 1
Slides = Landscape
Notes = (doesn’t matter)

Now is when you will cut and paste text, import graphics and drop in backgrounds in the pasteboard. Many people use textboxes for importing everything. You will find this tool as a little square with the letter “A” and some lines in it (you can also access this by going to Insert and then Text Box in the top menu bar). Click the button and move your cursor to the page, then click and drag to create a text box. The reasoning behind using a textbox it that you can move the boxes around, resize, and even overlap them.

To import graphics or pictures, go to Insert in the tool bar, then to Picture, then From File. You will be prompted to move through the hierarchy to find your graphic. When you have found it, highlight it and click insert. You can change the size of your graphic by clicking once on the graphic (this will select it, and show 8 hollow squares around the image). To scale the picture proportionally, click and drag on the corner squares; if you click and drag the top and side squares it will distort your image.

REMEMBER: you are working in half scale; if your image says it is 3x5 it will actually print at 6x10. Whatever font you are using, the point size will double in the end product. You will not be able to print the poster from your PC and should contact Nina Brooks in The Center for Teaching and Learning (x5617) to arrange for her to print your poster on the HP large-format printer mentioned previously. Please contact her well in advance of the date you will need your poster.

And last but not least, save your work often (Just in case of a crash).

Monday, November 1, 2010

ASBH 12th Annual Conference Report

Last week I attended the 12th Annual Conference of the American Society for Bioethics and Humanities. I found it a fascinating meeting, and was thrilled to see that some of the nation’s leading ethicists were in attendance; they are sort of like idols to me. But as I went to each session, I was struck by how difficult a field bioethics has become. And I was equally struck by how, within chiropractic, we often do not need to confront the issues that are daily challenges in medicine.

For example, one of my sessions addressed this problem: for children with medulloblastomas, there are three possible therapies which can be offered. Each carries a mix of difficult decisions. In one case, there survival rate for Therapy A is highest (90%), but it also carries the highest rate of leaving a child with reduced capacity for intelligence (after treatment, intelligence will be 40% what it was before treatment). In Therapy B, the survival rate falls a bit, but the rate of mental retardation decreases a bit as well. And in Therapy C, the survival rate is lowest, but intelligence is generally preserved. The question was not, which one should a parent choose? The question was, do we even tell the parent about option A, which has best survival rate but almost invariably will impair the future mental capacity of the child. And the program was devoted to discussing when and where medical paternalism might be justified.

A second session was less life-threatening in its question, but was equally interesting. How honest should a medical student be in revealing to a patient that he or she is indeed a student at all? In training, medical students (and chiropractic students, of course) gain skills by treating actual patient under the supervision of attending physicians. Do patients want to know that the person treating them is a student? Do we have an obligation to tell them? How do we respect autonomy?

Can we benefit from past wrongs? Should we use data from Nazi concentration camp experiments? Should Roman Catholics allow their children to be vaccinated using vaccines grown in the tissues of aborted fetuses or accept treatment that came from the use of human stem cell lines? Do we apply consequentialist theories here or deontological ones? Is it right to make a good from an evil? There are no easy answers here.

It turns out that bioethics is a vibrant field that can cast light onto difficult subjects and issues. And we are confronting them- genetic research, stem cell research, gene therapy, the Human Genome Project, organ transplantation, public health ethics (population as opposed to personal level bioethics) and so on. It is why I find this so fascinating.