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New York College of Osteopathic Medicine

Learning Outcomes Assessment 2009-2010

January 2009

Taskforce Members

John R. McCarthy, Ed.D.

Pelham Mead, Ed.D.

Mary Ann Achziger, M.S.

Felicia Bruno, M.A.

Claire Bryant, Ph.D.

Leonard Goldstein, DDS, PH.D.

Abraham Jeger, Ph.D.

Rodika Zaika, M.S.

Ron Portanova, Ph.D.

Pre-

Doctoral

Data

Post-Graduate Data

Career

data

Pre-Matriculation

Table of Contents

OVERVIEW 4

I. Introduction and Rationale 5

II. Purpose and Design 9

III. Specifics of the Plan 11

Mission of NYCOM 11

Learning Outcomes 11

Compiling the Data 17

Stakeholders 17

IV. Plan Implementation 18

Next Steps 18

V. Conclusion 20

A. OUTCOME INDICATORS – DETAIL 24

1. Pre-matriculation data 24

Forms 26

2. Academic (pre-clinical) course-work 47

Forms – LDB / DPC Track 49

Forms – Institute for Clinical Competence (ICC) 55

3. Clinical Clerkship Evaluations / NBOME Subject Exams 86

Forms 88

4. Student feedback (assessment) of courses/Clinical clerkship

PDA project 92

Forms 94

5. COMLEX USA Level I, Level II CE & PE,

Level III data (NBOME) 120

6. Residency match rates and overall placement rate 121

2

7. Feedback from (AACOM) Graduation Questionnaire 122

Forms 123

8. Completion rates (post-doctoral programs) 142

9. Specialty certification and licensure 143

10. Career choices and geographic practice location 144

11. Alumni Survey 145

Forms 146

B. BENCHMARKS 151

Bibliography 152

Appendices: 153

Chart 1 Proposed Curriculum and Faculty Assessment Timeline

Institute for Clinical Competence:

Neurological Exam – Student Version Parts I & II

Taskforce Members

List of Tables and Figures

Figure 1 Cycle of Assessment 9

Figure 2 Outcome Assessment along the Continuum 15

Figure 3 Data Collection Phases 22

Table 1 Assessment Plan Guide 23

3

New York College of Osteopathic Medicine

Learning Outcomes Assessment Plan

February 2009

Overview

This document was developed by the NYCOM Task Force on Learning Outcomes

Assessment and was accepted by the dean in January 2009. Although a few of the assessment

tools and processes described in the document are new, most have been employed at NYCOM

since its inception to inform curriculum design and implementation and to gauge progress and

success in meeting the institution’s mission, goals and objectives.

The Learning Outcomes Assessment Plan documents the processes and measures used by

the institution to gauge student achievement and program (curricular) effectiveness. The results

of these activities are used by faculty to devise ways to improve student learning and by

administrators and other stakeholder groups to assess institutional effectiveness and inform

planning, decision-making, and resource allocation.

Certain of the measures described in later sections of this document constitute key

performance indicators for the institution, for which numerical goals have been set. Performance

on these measures has a significant effect on institutional planning and decision-making

regarding areas of investment and growth, program improvement, and policy.

4

Key performance indicators and benchmarks are summarized below and also on 􀁓􀁄􀁊􀁈 151

􀁒􀁉􀀃􀁗􀁋􀁈􀀃􀁓􀁏􀁄􀁑􀀑

Indicator Benchmarks

 Number of Applicants Maintain relative standing among Osteopathic Medical

Colleges

 Admissions Profile Maintain or improve current admissions profile based

on academic criteria (MCAT, GPA, Colleges attended

 Attrition 3% or less

 Remediation rate

(preclinical)

2% reduction per year

 COMLEX USA scores

(first-time pass rates,

mean scores)

Top quartile

 Students entering

OGME

Maintain or improve OGME placement

 Graduates entering

Primary Care careers

Maintain or improve Primary Care placement

 Career characteristics Regarding Licensure, Board Certification, Geographic

Practice, and Scholarly achievements–TBD

I. Introduction and Rationale

At NYCOM we believe it is our societal responsibility to monitor our students’ quality of

education through continual assessment of educational outcomes. On-going program evaluation

mandates longitudinal study (repeated observations over time) and the utilization of empirical

data based on a scientific methodology.

At Thomas Jefferson University, an innovative study was implemented circa 1970, which

was ultimately titled “Jefferson Longitudinal Study of Medical Education”.1 As a result of

implementation of this longitudinal study plan, Thomas Jefferson University was praised by the

1 Center for Research in Medical Education and Health Care: Jefferson Longitudinal Study of Medical Education,

Thomas Jefferson University, 2005.

5

Accreditation Team for the Middle States Commission on Higher Education for “…..their

academic interest in outcome data, responsiveness to faculty and department needs and the clear

use of data to modify the curriculum and teaching environment….their use of this data has

impacted many components of the curriculum, the learning environment, individual student

development, and program planning…” (TJU, 2005).

The Jefferson Longitudinal Study of Medical Education has been the most productive

longitudinal study of medical students and graduates of a single medical school. This study has

resulted in 155 publications in peer review journals. Many were presented before national or

international professional meetings prior to their publication (TJU, 2005).

According to Hernon and Dugan (2004), the pressure on higher education institutions to

prove accountability has moved beyond the acceptance and reliance of self-reports and anecdotal

evidence compiled during the self-regulatory accreditation process. It now encompasses an

increasing demand from a variety of constituencies to demonstrate institutional effectiveness by

focusing on quality measures, such as educational quality, and cost efficiencies.

Accountability focuses on results as institutions quantify or provide evidence that they are

meeting their stated mission, goals, and objectives. Institutional effectiveness is concerned, in

part, with measuring (Hernon and Dugan, 2004):

 Programmatic outcomes: such as applicant pool, retention rates, and graduation rates.

Such outcomes are institution-based and may be used to compare internal year-to-year

institutional performance and as comparative measures with other institutions.

 Student learning outcomes: oftentimes referred to as educational quality and concerned

with attributes and abilities, both cognitive and affective, which reflect how student

experiences at the institution supported their development as individuals. Students are

expected to demonstrate acquisition of specific knowledge and skills.

6

At NYCOM, we recognize that our effectiveness as an institution must ultimately be

assessed and expressed by evaluating our success in achieving our Mission in relation to the

following Outcomes:

1. Student Learning / Program Effectiveness

2. Research and Scholarly Output

3. Clinical Services

The present document focuses on #1, above, viz., Student Learning / Program Effectiveness.

That is, it is intended only as a Learning Outcomes Assessment Plan. At the same time, we are

cognizant that Institutional Effectiveness/Outcomes derive from numerous inputs, or “means” to

these “ends,” including:

1. Finances

2. Faculty Resources

3. Administrative Resources

4. Student Support Services

5. Clinical Facilities and Resources

6. Characteristics of the Physical Plant

7. Information Technology Resources

8. Library Resources

We believe it is our obligation to continually assess the impact of any changes in the inputs,

processes, and outputs of this institution.

The evaluation approach in this Assessment Plan provides for on-going data collection

and analysis targeted specifically at assessing outcomes of student achievement and program

effectiveness (educational quality). Assessment of achievement and program effectiveness is

based on objective, quantifiable information (data).

As a result of the NYCOM Learning Outcome Assessment Plan’s continual assessment

cycle, the report is available, with scheduled updates, as a resource in the decision-making

process.

7

The report provides outcomes data, recommendations, and suggestions intended to inform key

policy makers and stakeholders2 of areas of growth and/or improvement, together with proposed

changes to policy that strengthen both overall assessment and data-driven efforts to improve

student learning.

2 NYCOM Administration, academic committees, faculty, potential researchers, and students.

8

II. Purpose and Design

Well-designed plans for assessing student learning outcomes link learning outcomes,

measures, data analysis, and action planning in a continuous cycle of improvement illustrated

below.

Figure 1 Cycle of Assessment

Ten principles guide the specifics of NYCOM’s Learning Outcomes Assessment Plan:

1. The plan provides formative and summative assessment of student learning.3

2. The primary purpose for assessing outcomes is to improve student learning.

3. Developing and revising an assessment plan is a long-term, dynamic, and collaborative

process.

4. Assessments use the most reliable and valid instruments available.

3 Examples of the former include post-course roundtable discussions, Institute for Clinical Competence (ICC)

seminars, and data from the Course/Faculty Assessment Program. Examples of the latter include the AACOM

Graduation Questionnaire, COMLEX scores, NBOME subject exam scores, and clerkship evaluations.

Define

intended

Learning

Outcomes

Identify

methods

of measuring

outcomes

Collect Data

Review results

and use to make

decisions

regarding program

improvement

Start

Here

9

5. Assessment priorities are grounded in NYCOM’s mission, goals, and learning outcomes.

6. The assessment involves a multi-method approach.

7. Assessment of student learning is separate from evaluation of faculty.

8. The primary benefit of assessment is the provision of evidence-based analysis to inform

decision-making concerning program revision and improvement and resource allocation.

9. The assessment plan must provide a substantive and sustainable mechanism for fulfilling

NYCOM’s responsibility to ensure the quality, rigor, and overall effectiveness of our

programs in educating competent and compassionate physicians.

10. The assessment plan yields valid measures of student outcomes that provide stakeholders

with relevant and timely data to make informed decisions on changes in curricular design,

implementation, program planning, and the overall learning environment.

Outcomes assessment is a continuous process of measuring institutional effectiveness

focusing on planning, determining, understanding, and improving student learning. At

NYCOM, we are mindful that an integral component of this assessment plan is to ensure that the

plan and the reporting process measures what it is intended to measure (student achievement and

program effectiveness).

10

III. Specifics of the Plan

The NYCOM assessment plan articulates eleven student learning outcomes, which are

linked to both the institutional mission and the osteopathic core competencies

Mission of NYCOM

The New York College of Osteopathic Medicine of the New York Institute of

Technology is committed to training osteopathic physicians for a lifetime of learning and

practice, based upon the integration of evidence-based knowledge, critical thinking and the tenets

of osteopathic principles and practice. The college is also committed to preparing osteopathic

physicians for careers in primary care, including health care in the inner city and rural

communities, as well as to the scholarly pursuit of new knowledge concerning health and

disease. NYCOM provides a continuum of educational experiences to its students, extending

through the clinical and post-graduate years of training. This continuum provides the future

osteopathic physician with the foundation necessary to maintain competence and compassion, as

well as the ability to better serve society through research, teaching, and leadership.

Learning Outcomes

The following eleven (11) Learning Outcomes that guide this plan stem from NYCOM’s mission

(above) and the osteopathic core competencies:

1. The Osteopathic Philosophy: Upon graduation, a student must possess the ability to

demonstrate the basic knowledge of Osteopathic philosophy and practice, as well as

Osteopathic Manipulative Treatment.

2. Medical Knowledge: A student must possess the ability to demonstrate medical

knowledge through passing of course tests, standardized tests of the NBOME, post-

11

course rotation tests, research activities, presentations, and participation in directed

reading programs and/or journal clubs, and/or other evidence-based medicine activities.

3. Practice-based learning and improvement: Students must demonstrate their ability to

critically evaluate their methods of clinical practice, integrate evidence-based medicine

into patient care, show an understanding of research methods, and improve patient care

practices

4. Professionalism: Students must demonstrate knowledge of professional, ethical, legal,

practice management, and public health issues applicable to medical practice.

5. Systems-based practice: Students must demonstrate an understanding of health care

delivery systems, provide effective patient care and practice cost-effective medicine

within the system.

6. Patient Care: Students must demonstrate the ability to effectively treat patients and

provide medical care which incorporates the osteopathic philosophy, empathy, preventive

medicine education, and health promotion.

7. Communication skills: Students must demonstrate interpersonal and communication

skills with patients and other healthcare professionals, which enable them to establish and

maintain professional relationships with patients, families, and other healthcare providers.

8. Primary Care: Students will be prepared for careers in primary care, including health care

in the inner city, as well as rural communities.

9. Scholarly/Research Activities: Students will be prepared for the scholarly pursuit of new

knowledge concerning health and disease. Students in NYCOM’s 5-year Academic

Medicine Scholars Program will be prepared as academic physicians in order to address

12

this nation’s projected health care provider shortage and the resulting expansion of

medical school training facilities.

10. Global Medicine and Health policy: Students will be prepared to engage in global health

practice, policy, and the development of solutions to the world’s vital health problems.

11. Cultural Competence: Students will be prepared to deliver the highest quality medical

care, with the highest degree of compassion, understanding, and empathy toward cultural

differences in our global society.

The NYCOM assessment plan provides for analysis of learning outcomes for two

curricular tracks and four categories of student

NYCOM has historically tracked student data across the curriculum, paying particular

attention to cohorts of students (see below), as well as NYCOM’s two curricular tracks:

a) Lecture-Based Discussion track: integrates the biomedical and clinical sciences along

continuous didactic ‘threads’ delivered according to a systems based approach;

b) Doctor Patient Continuum track: a problem-based curriculum, whose cornerstone is

small-group, case-based learning.

Current data gathering incorporates tracking outcomes associated with several subcategories of

student (important to the institution) within the 4-year pre-doctoral curriculum and the 5-year

pre-doctoral Academic Medicine Scholars curriculum. The pre-doctoral populations are defined

according to the following subcategories:

 Traditional:4

 BS/DO: The BS/DO program is a combined baccalaureate/doctor of osteopathic

medicine program requiring successful completion of a total of 7 years (undergraduate, 3

years; osteopathic medical school, 4 years).

 MedPrep: A pre-matriculation program offering academic enrichment to facilitate the

acceptance of underrepresented minority and economically disadvantaged student

applicants.5

4 All other students not inclusive of BS/DO, MedPrep, and EPP defined cohorts.

5 The program is funded by the New York State Collegiate Science and Technology Entry Program and the

NYCOM Office of Equity and Opportunity Programs.

13

 EPP (Émigré Physician Program): A 4-year program, offered by NYCOM, to educate

émigré physicians to become DOs to enable them to continue their professional careers in

the U.S.

The NYCOM assessment plan includes data from four phases of the medical education

continuum (as illustrated in Figure 2 and Figure 3): pre-matriculation, the four-year predoctoral

curriculum6, post-graduation data, and careers and practice data

Within the NYCOM Learning Outcome Assessment Plan, the Task Force has chosen the

following outcome indicators for assessment of program effectiveness at different points in the

medical education continuum:

 Pre-matriculation data, including first-year student survey;

 Academic (pre-clinical) course-work (scores on exams, etc.) – attrition rate;

 Clinical Clerkship Evaluations (3rd/4th year) and NBOME Subject Exams;

 Student feedback (assessment) of courses and 3rd and 4th year clinical clerkships and

PDA-based Patient and Educational Activity Tracking;

 COMLEX USA Level I, Level II CE & PE, and Level III data, including:

o First-time and overall pass rates and mean scores;

o Comparison of NYCOM first time and overall pass rates and mean scores to

national rankings;

 Residency match rate and placement rate (AOA / NRMP);

 Feedback from AACOM Graduation Questionnaire;

 Completion rates of Post-Doctoral programs;

 Specialty certification and licensure;

 Career choices (practice type–academic, research, etc.);

 Geographic practice locations;

 Alumni survey.

The Outcome Indicators—Detail sections of this plan (􀁓􀁄􀁊􀁈􀁖 24 􀁗􀁋􀁕􀁒􀁘􀁊􀁋 150) show the various

data sources and include copies of the forms or survey questionnaires utilized in the data

gathering process.

The NYCOM assessment plan identifies specific sources of data for each phase

Figure 2 illustrates which of the above measures are most relevant at each phase of the medical

education continuum.

6 And the five-year pre-doctoral Academic Medicine Scholars program

14

15

16

The NYCOM assessment plan describes the collection and reporting of data,

responsibilities for analysis and dissemination, and the linkage to continuous program

improvement and institutional planning

Compiling the Data

Discussions with departmental leaders and deans confirmed that data gathering occurs at

various levels throughout the institution. Development of a central repository (centralized

database) facilitates data gathering, data mining and overall efficiency as it relates to data

analysis, report generation, and report dissemination. This includes utilization of internal

databases (internal to NYCOM) as well as interfacing with external organizations’ databases,

including the AOA (American Osteopathic Association), AACOM (American Association of

Colleges of Osteopathic Medicine), AMA (American Medical Association), and the ABMS

(American Board of Medical Specialties).

Stakeholders

Information from the data collection serves to inform NYCOM administration, relevant

faculty, appropriate research and academic/administrative committees, including the following:

 Curriculum Committee

 Student Progress Committee

 Admissions Committee

 Deans and Chairs Committee

 Clinical and Basic Science Chairs

 Research Advisory Group

 Academic Senate

The NYCOM assessment plan sets forth benchmarks, goals and standards of performance

The major elements of the plan are summarized in Table 1: Assessment Plan Guide:

Learning Outcomes/Metrics/Benchmarks found at the end of this chapter.

17

IV. Plan Implementation

As discussed earlier, most of the assessment tools and processes described in the

document have been employed at NYCOM since its inception to inform curriculum design and

implementation and to gauge progress and success in meeting the institution’s mission, goals and

objectives. Beginning in fall 2008, however, assessment efforts have been made more

systematic; policies, procedures, and accountabilities are now documented and more widely

disseminated.

The Office of Program Evaluation and Assessment (OPEA), reporting to the Associate

Dean for Academic Affairs is responsible for directing all aspects of plan refinement and

implementation.

Next steps

1. Develop a shared, central repository for pre-matriculation, pre-doctoral, and postgraduate

data (see Figure 3). Time Frame: Academic Year 2010-2011

Centralized database: Development of a (shared or central) repository

(database) utilized by internal departments of NYCOM. WEAVEonline is

a web-bases assessment system, utilized by numerous academic

institutions across the country, for assessment and planning purposes.

Utilizing this program facilitates centralization of data. The central

database is comprised of student data categorized as follows:

Pre-matriculation Data includes demographics, AACOM pre-matriculation survey, academic

data (GPA), and other admissions data (MCAT’s, etc.).

Data is categorized according to student cohort as previously written and

described (see item III. Specifics of the Plan on pages 13-14).

18

Pre-doctoral Data includes academic (pre-clinical) course work, course grades, end-ofyear

grade point averages, the newly implemented, innovative Course /

Faculty assessment program data (described in Section 4), ratings of

clinical clerkship performance, performance scores on COMLEX USA

Level I and Level II CE & PE, descriptors of changes in academic status

(attrition), and AACOM Graduation questionnaires.

Post-graduate/Career Data includes residency match rate, residency choice, hospitals of

residency, geographic location, chosen specialty, performance on

COMLEX Level III, geographic and specialty area(s) of practice

following graduation, licensure, board certification status, scholarly work,

professional activities/societies, faculty appointments, type(s) of practice

(academic, clinical, research).

This database supports and assimilates collaborative surveys utilized by

internal departments in order to capture requested data (see item III.

Specifics of the Plan on pages 13-14) essential for tracking students during

and after post-graduate training. Specific data (e.g., COMLEX Level III,

board certification, and licensure) is provided by external databases,

through periodic reporting means, or queries from NYCOM, therefore the

database provides for assimilation of this external data, in order to

incorporate into institutional reporting format.

2. Establish metrics. Time Frame: Academic Year 2010-2011

Benchmarks and Reporting: Conduct a retrospective data analysis in

order to establish baseline metrics (see Compiling the Data on page 17).

19

Following development of these metrics, institutional benchmarks are

established. Benchmarks align with Institutional Goals as written above.

Reporting of data analysis occurs on an annual basis. An annual

performance report is compiled from all survey data and external sources.

Timeframe for reporting is congruent with end of academic year. Updates

to report occur semi-annually, as additional (external) data is received.

Data reporting includes benchmarking against Institutional Goals

(mission), in order to provide projections around effectiveness of learning

environment, quality improvement indicators, long-range and strategic

planning processes, and cost analysis/budgetary considerations.

Report dissemination to key policy makers and stakeholders, as previously

identified (see Stakeholders on page 17) in addition to other staff, as

deemed appropriate for inclusion in the reporting of assessment analysis.

V. Conclusion

The impact on student learning of such things as changes in the demographics of medical school

applicants, admissions criteria, curricula, priorities, and methods of delivery of medical education

deserve careful discussion, planning, and analysis before, during, and after implementation. This

plan facilitates change management at three points:

o Planning, by providing evidence to support decision-making;

o Implementation, by establishing mechanisms for setting performance targets and

monitoring results, and

20

o Evaluation, by systematically measuring outcomes against goals and providing evidence

of whether the change has achieved its intended objectives.

At NYCOM, accountability is seen as both a requirement and a responsibility. As healthcare

delivery, pedagogy, and the science of medicine constantly change, monitoring the rigor and

effectiveness of the learning environment through assessment of student learning outcomes

throughout the medical education continuum becomes paramount.

21

Figure 3 Data Collection Phases

Pre-doctoral Data

Pre-matriculation

Data

Post-Graduate

Data

Career

Data

Assessment

Process

22

Learning Outcomes7 Data Collection Phases8 Assessment Methods Metrics9 Development of

benchmarks10

Students will:

Demonstrate basic knowledge of OPP

& OMT

Demonstrate medical knowledge

Demonstrate competency in practicebased

learning and improvement

Demonstrate professionalism and

ethical practice

Demonstrate an understanding of

health care delivery systems

Demonstrate the ability to effectively

treat patients

Demonstrate interpersonal and

communication skills

Be prepared for careers in primary

care

Be prepared for the scholarly pursuit

of new knowledge

Be prepared to engage in global

health practice, policy, and solutions

to world health problems

Be prepared to effectively interact

with people of diverse cultures and

deliver the highest quality of medical

care

• Pre-matriculation

• Pre-doctoral

• Post-graduate

• Career

• Didactic Academic

Performance

• LDB Curriculum

• DPC Curriculum

• Formative / Summative

Experiences: Patient

Simulations (SP’s /

Robotic)

• Student-driven Course,

Clerkship, and Faculty

Assessment

• Clinical Clerkship

Performance

• PDA-Based Patient and

Education Tracking

• Surveys

• Standardized Tests

• Alumni Feedback

Vis a Vis:

• Admissions Data

(Applicant Pool

demographics)

• Course Exams

• End-of-year pass rates

• Coursework

• Analysis of Residency

Trends Data

• Standardized Tests

Subject Exams

• COMLEX 1 & II Scores

• Analysis of Specialty

Choice

• Analysis of geographic

practice area

• Academic Attrition

rates

• Remediation rates

• Graduation and postgraduate

data

• External surveys

• Applicant Pool

• Admissions Profile

• Academic Attrition

rates

• Remediation rates

(pre-clinical years)

• COMLEX USA

Scores I & II (1st

time pass rate /

mean score)

• Number of

graduates entering

OGME programs

• Graduates entering

Primary Care (PC)11

• Career Data:

Licensure (within

3 years);

Board

Certification;

Geographic

Practice Area;

Scholarly

achievements

7 Complete detail of Learning Outcomes found in III., pages 11-13.

8 See Figure 3, page 22.

9 List of Metrics is not all-inclusive.

10 See complete detail of benchmarks—pages 5 & 151.

11 Primary Care: Family Medicine, Internal Medicine, and Pediatrics.

Table 1 – Assessment Plan Guide: Learning Outcomes / Data Sources / Metrics

23

Outcome Indicators – Detail

1. Pre-matriculation data

Data gathered prior to students entering NYCOM, and broken down by student

cohort, which includes the following:

Traditional, MedPrep, and BS/DO students

 AACOM pre-matriculation survey given to students;

 Total MCAT scores;

 Collegiate GPA (total GPA-including undergraduate/graduate);

 Science GPA;

 College(s) attended;

 Undergraduate degree (and graduate degree, if applicable;

 Gender,;

 Age;

 Ethnicity;

 State of residence;

 Pre-admission interview score.

Additional data is gathered on the MedPrep student cohort and incorporates the

following:

 Pre-matriculation lecture based exam and quiz scores;

 Pre-matriculation DPC (Doctor Patient Continuum) based facilitator assessment

scores and content exam scores;

24

 ICC (Institute for Clinical Competence) Professional Assessment Rating (PARS)

Scores.

Émigré Physician Program students

 TOEFL (Test of English as a Foreign Language) score;

 EPP Pre-Matriculation Examination score;

 Medical school attended;

 Date of MD degree;

 Age;

 Ethnicity;

 Country of Origin.

25

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 MedPrep 2008 Program Assessment

 MedPrep Grade Table

 NYCOM Admissions Interview Evaluation Form

 Application for Émigré Physicians Program (EPP)

 AACOM Pre-matriculation survey (first-year students)

 NYCOM Interview Evaluation Form – Émigré Physicians Program

Samples of the forms/questionnaires follow

26

MedPrep 2008 Program Assessment

Successful completion of the MedPrep Pre-Matriculation Program takes into consideration the

following 3 assessment components:

1. Lecture-Discussion Based (LDB)

2. DPC (Doctor Patient Continuum)

3. ICC (Institute for Clinical Competence)

A successful candidate must achieve a passing score for all 3 components. Strength in one

area will not compensate for weakness in another.

1. The first component assesses the Lecture-Discussion Based portion of the MedPrep Pre-

Matriculation Program. It is comprised of 3 multiple choice quizzes and 1 multiple choice exam.

 Histology

 Biochemistry

 Physiology

 Genetics

 Physiology

 OMM

 Pharmacology

 Pathology

 Microbiology

 Clinical Reasoning Skills

Each of the three quizzes constitutes 10% of an individuals overall LDB score and the final exam

(to be conducted on June 27) constitutes 70% of an individuals overall LDB score (comprising

100%) in the Lecture-Discussion portion of the program.

2. The second is based upon your performance in the DPC portion of the MedPrep Pre-

Matriculation Program. There will be a facilitator assessment (to be conducted on June 26),

which will comprise 30% of an individual’s grade and a final written assessment which will be

70% of an individual’s overall DPC score.

** Note – Both the Lecture-Discussion Based and DPC passing scores are calculated as

per NYCOM practice:

 Average (mean) minus one standard deviation

 Not to be lower than 65%

 Not to be higher than 70%

27

3. The third component is the ICC encounter designed to assess your Doctor Patient

Interpersonal skills. This assessment is evaluated on the PARS scale described to you in the

Doctor Patient Interpersonal Skills session on June 12, by Dr. Errichetti.

After the program ends, on June 27th, all three components of the assessment will be compiled

and reviewed by the MedPrep Committee. The director of admissions, who is a member of the

committee, will prepare notification letters that will be mailed to you within two weeks.

Please note:

The written communication you will receive ONLY contains acceptance information. NO

grades will be distributed. Exams or other assessments (with the exception of the Lecture-

Discussion Based quizzes, which have already been returned) will not be shared or returned.

Please DO NOT contact anyone at NYCOM requesting the status of your candidacy. No

information will be given on the phone or to students on campus.

Thank you for your participation in the MedPrep Pre-Marticulation Program. The faculty

and staff have been delighted to meet and work with you. We wish you success!

Sincerely,

Bonnie Granat

28

Last Name, First Name

Quiz #1

Score

(10% of

Overall

LDB

Score)

Quiz #2

Score

(10% of

Overall

LDB Score)

Quiz #3

Score

(10% of

Overall

LDB

Score)

LDB Final

Exam

Score

(70% of

Overall LDB

Score)

Overall LBD

Score

(Exam and

Quizzes

Combined)

Overall

DPC

Score

Overall

ICC

Score

29

NEW YORK COLLEGE OF OSTEOPAHTIC MEDICINE

ADMISSIONS INTERVIEW EVALUATION FORM

Applicant______________________________________________________ Date____/_____/____

CATEGORY

CRITERIA

VALUE

RATING

I. PERSONAL PRESENTATION

MATURITY

LIFE EXPERIENCE /TRAVEL

EXTRA CURRICULAR ACTIVITIES/HOBBIES

COMMUNICATION SKILLS

SELF ASSESSMENT (STRENGTHS/WEAKNESSES)

AACOMAS & SUPPLEMENTAL STATEMENT

50

II. OSTEOPATHIC MOTIVATION

KNOWLEDGE OF THE PROFESSION

TALKED TO A DO/LETTER FROM A DO

15

III. PRIMARY CARE MOTIVATION

INTEREST IN PRIMARY CARE

15

IV. OVERALL IMPRESSION

EXPOSURE TO MEDICINE

– VOLUNTEER EXPERIENCE

– EMPLOYMENT EXPERIENCE

– UNIQUE ACADEMIC EXPERIENCES

– RESEARCH

20

TOTAL RATING

100

OTHER COMMENTS: PLEASE USE OTHER SIDE

(REQUIRED)

INTERVIEWER:

Print

Name______________________________

Signed__________________________________________

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Comments on Applicant _____________________________________________________

COMMENTS:

Interviewer_______________________________________

31

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14. List all Colleges attended (Undergraduate, Graduate, Professional – US and Home Country) List in chronological order

Institution Name Location Dates of Major

Attendance Subject

Degree granted

or expected (Date)

Medical Specialty (if any) ___________________ No. of years in practice _________

15. Have you had any U.S. military experience ? Yes ( ) No ( )

If yes, was your discharge honorable? Yes ( ) No ( )

16. List employment in chronological order, beginning with your current position:

Title or Description Where Dates Level of Responsibility

17. Work/daytime telephone number________________________

area code phone

18. How do you plan to finance your NYCOM education? Personal funds ________ Loans

19. Were you ever the recipient of any action for unacceptable academic performance or conduct

violations (e.g. probation, dismissal, suspension, disqualification, etc.) by any

college or school? Yes ( ) No

If yes, were you ever denied readmission? Yes ( ) No

20. Have you ever been convicted of a misdemeanor or felony (excluding parking violations)? Yes ( ) No(

If your answer to #19 or #20 is yes, please explain fully:

21. Evaluation Service used: Globe Language Services ______ Joseph Silny & Assocs. ______

World Education Services ______ IERF _____

*22. TOEFL Score(s): ________________________________

*ALL CANDIDATES MUST TAKE TOEFL / TOEFL

Scores Cannot Be Older Than 2 YEARS

If you plan to take or retake the TOEFL, enter date: _____/_____/ mo.

yr.

(NYCOM’s TOEFL Code is #2486; copies cannot be accepted)

( )

( )

)

33

USMLE WILL NOT BE ACCEPTED IN LIEU OF TOEFL

All evaluations must be received directly from the evaluation service and are subject to approval by the New York

College of Osteopathic Medicine.

Personal Comments: Please discuss your reasons for applying to the EPP program.

Selection of candidates is competitive; achieving a minimum, passing TOEFL Score

does not automatically guarantee an interview.

I certify that all information submitted in support of my application is complete and correct to the best of my knowledge.

Date: Signature: ______________________________________

PLEASE MAIL APPLICATION AND FEE ($60.00 CHECK OR MONEY ORDER ONLY, PAYABLE TO NYCOM) TO:

New York College of Osteopathic Medicine

Of New York Institute of Technology

Office of Admissions/ Serota Academic Center Room 203

Northern Blvd.

Old Westbury, NY 11568-8000

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NEW YORK COLLEGE OF OSTEOPATHIC MEDICINE

INTERVIEW EVALUATION FORM – É MIGRE PHYSICIANS PROGRAM

Applicant:___________________________________ Date:________________

State:___________________________

CATEGORY

CRITERIA TO BE

ADDRESSED VALUE RATING

1. Oral Comprehension

Ability to understand questions, content

30

2. Personal Presentation

Appropriate response, ability to relate to

interviewers

30

3. Verbal Expression

Clarity, articulation, use of

grammar

30

4. Overall Impression

Unique experiences, employment ,

research

10

OVERALL

RATING

100

INTERVIEWER RECOMMENDATION:

Accept_____________

Reject_____________

COMMENTS:______________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

NAME:_____________________________

SIGNED:____________________________

46

2. Academic (pre-clinical) course-work

Data captured during NYCOM’s pre-clinical 4-year pre-doctoral program and 5-year

Academic Medicine Scholars program which includes the following:

Curricular Tracks: Lecture Based-Discussion / Doctor Patient Continuum

 Pre-clinical course pass/failure rate as determined by class year (year 1 and year

2) and overall at end of year 2 (tracking each class and in aggregate for two

years);

 Failure rates of (components) Nervous System course or Behavior course;

 Course grades (H/P/F);

 Exam scores;

 Scores (pass/fail rate) on Core Clinical Competency OSCE exams;

 Professionalism Assessment Rating Scale (PARS)

 Students determined as pre-clinical course dismissals (and remediated);

 Students determined double course failure (and remediated);

 Failure rates due to cognitive and/or OMM lab portions of course

 Repeat students (aligned with Learning Specialist intervention)

 Changes in academic status (attrition-as identified above);

 End-of-year class rankings.

47

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 Introduction to Osteopathic Medicine / Lecture-Based Discussion

 Doctor-Patient Continuum (DPC) – Biopsychosocial Sciences I

Grading and Evaluation Policy

 DPC – Clinical Sciences II – Grading Policy

 Assessing the AOA Core Competencies at NYCOM

 Institute for Clinical Competence (ICC) Professionalism Assessment

Rating Scale (PARS)

 SimCom-T(eam) Holistic Scoring Guide

 Case A – Dizziness, Acute (scoring guides)

Samples of the forms/questionnaires follow

48

Introduction to Osteopathic Medicine / Lecture-Based Discussion

Grading and Evaluation

1. At the conclusion of this course, students will receive a final cognitive score and a final OMM laboratory

score.

2. Both a student’s final cognitive score and a student’s final OMM laboratory score must be at a

passing level in order to pass this course.

3. Cognitive Score

a. A student’s cognitive score is comprised of the following two components:

i. Written Examinations and Quizzes pertaining to course lectures and corresponding

required readings, cases, course notes, and PowerPoint presentations

ii. Anatomy Laboratory Examinations and Quizzes

b. The weighting of the two components of the final cognitive score is as follows:

Summary of Cognitive Score Breakdown

Cognitive Score Component % of Final Cognitive Score

Written Examinations and Quizzes 75%

Anatomy Laboratory Examinations and

Quizzes

25%

Total Cognitive Score 100%

c. Written Examinations and Quizzes

i. There will be three written examinations and four written quizzes in this course.

ii. The written examinations and quizzes will consist of material from all three threads

(Cellular and Molecular Basis of Medicine, Structural and Functional Basis of Medicine,

Practice of Medicine).

iii. Up to 25% of the written exam and quiz material will come from directed readings.

iv. For the purpose of determining passing for this course, the written examinations will be

worth 90% of the final written score and the quizzes will be worth 10% (2.5% each) of the

final written score. This weighting is illustrated in the following table:

Summary of Written Exam/Quiz Score Breakdown

Written Exam/Quiz # % of Final Written Score

Written Exam #1 25%

Written Exam #2 30%

Written Exam #3 35%

Total Written Exam Score 90%

Written Quiz #1 2.5%

Written Quiz #2 2.5%

Written Quiz #3 2.5%

Written Quiz #4 2.5%

Total Written Quiz Score 10%

Total Written Score 100%

d. Anatomy Laboratory Examinations and Quizzes

i. There will be two Anatomy laboratory examinations in this course

ii. There will be Anatomy laboratory quizzes in this course, conducted during Anatomy

laboratory sessions.

iii. For the purpose of determining passing for this course, each Anatomy lab examination

49

will be worth 45% of students’ final Anatomy lab score and all Anatomy lab quizzes

combined will be worth 10% of students’ final Anatomy lab score. This weighting is

illustrated in the following table:

Summary of Anatomy Lab Exam/Quiz Score Breakdown

Anatomy Lab Exam/Quiz # % of Final Anatomy Score

Anatomy Lab Exam #1 45%

Anatomy Lab Exam #2 45%

Anatomy Lab Quizzes 10%

Total Anatomy Lab Exam/Quiz Score 100%

4. OMM Laboratory Score

a. A student’s OMM laboratory score in this course is comprised of an OMM laboratory examination

and laboratory quizzes, as follows:

i. There will be one OMM laboratory practical examination in this course

ii. There will be two OMM laboratory practical quizzes in this course conducted during OMM

laboratory sessions

iii. There will be a series of OMM laboratory written quizzes in this course conducted during

OMM laboratory sessions.

b. The weighting of the components of the OMM laboratory final score is as follows: For the purpose

of determining passing for this course, the OMM laboratory practical examination will be worth 70%

of the final OMM laboratory score, the OMM laboratory practical quizzes will be worth 20% (10%

each) of the final OMM laboratory score, and the OMM laboratory written quizzes will be worth 10%

(all OMM lab written quizzes combined) of the OMM laboratory score. This weighting is illustrated

in the following table:

Summary of OMM Laboratory Exam/Quiz Score Breakdown

OMM Laboratory Exam/Quiz % of Final OMM Laboratory Score

OMM Laboratory Practical Exam 70%

OMM Laboratory Practical Quiz #1 10%

OMM Laboratory Practical Quiz #2 10%

OMM Laboratory Written Quizzes (all quizzes

combined)

10%

Total OMM Laboratory Score 100%

5. Examinations and quizzes may be cumulative.

6. Honors Determination

a. For the purpose of determining who will be eligible to receive a course grade of Honors (“H”), the

final cognitive score and final OMM laboratory score will be combined in a 75%/25% ratio,

respectively.

b. Using the formula noted above, students scoring in the top 10% (and who have not taken a makeup

exam within the course or remediated the course) will receive a course grade of Honors.

50

DOCTOR PATIENT CONTINUUM(DPC) – BIOPSYCHOSOCIAL

SCIENCES I

Grading and Evaluation Policy:

The examinations and evaluations are weighed as follows:

Evaluation Criteria: Percent of Grade

Content Examination 55%

Component Examinations 25%

Facilitator Assessment 20%

Content Examination: There will a mid-term exam and an end of the term exam, each weighted equally. The

examinations will cover the learning issues submitted by the case-study groups. Questions will be based on the

common learning issues (covered by all groups) and learning issues specific to individual groups (unique issues).

Component Exams: Distribution of the component exams will be as follows:

 Exams based on Anatomy lectures and labs = 20%

 Graded assignments offered by problem set instructors, which might include quizzes, position papers,

and/or other exercises = 5%

Facilitator Assessment: Facilitators will meet individually with students twice during the term to evaluate their

performance. The first evaluation will be ‘formative’ only, i.e., to advise students of their progress and will not be

recorded for grade. The end of the term evaluation will be used to assess the student’s progress/participation in the

group and other class related activities. Students will also complete Self-Assessment Forms to supplement the

evaluation process.

The grading of this course is on a “PASS/FAIL/HONORS” basis.

1) Students will be evaluated each Term using the multiple components as described above.

2) Each year at the end of the 1st Term:

a) All students will be assigned an interim grade of I (Incomplete);

b) Each student will be informed of his/her final average, a record of which will be maintained in the office of

the DPC Academic Coordinator and the Director of the DPC program.

3) Students who earn less than a 1st-Term average of 70%, or a content exam score of <65%, will be officially

informed that their performance was deficient for the 1st Term. The student, in consultation with the Course

Coordinator, will present a plan designed to resolve the deficiency. This information will also be forwarded to

the Associate Dean of Academic Affairs for tracking purposes.

4) Students with a 1st-Term average <70%, or a content exam score of <65%, will be allowed to continue with the

class. However, in order to pass the year the student must achieve a final yearly average (1st- and 2ndterm)

of 70% or greater with a content exam average (for the two Terms) of 65% or greater.

5) All students who meet the requirements for passing the year (see 4) will then be awarded the grade of P (Pass)

or H (Honors) for each of the two Terms.

51

6) Students who fail the year (see 4) will be awarded a grade of I (Incomplete) and will be permitted (with

approval of the Associate Dean for Academic Affairs) to sit for a comprehensive reassessment-examination.

The reassessment exam will be constructed by the course faculty and administered by the Course Coordinator.

The exam may include both written and oral components. Successful completion of the reassessment

examination will result in the awarding of a grade of P for the two Terms. Failure of the comprehensive

reassessment exam will result in the awarding of a grade of F (Fail) for the two terms, and a recommendation to

the Associate Dean of Academic Affairs that the student be dismissed from the College.

7) Students whose failure of the year (i.e. overall yearly average <70%) can be attributed to low facilitator

assessment scores present a special concern. The student has been determined, by his/her facilitators, to be

deficient in the skills necessary to effectively interact with patients and colleagues. This deficiency may not be

resolvable by examination. Such failures will be evaluated by the Director of the DPC program, the Associate

Dean of Academic Affairs and/or the Committee on Student Progress (CSP) to determine possible remediation

programs or to consider other options including dismissal.

52

DOCTOR PATIENT CONTINUUM(DPC) – CLINICAL SCIENCES II

Grading Policy:

1. The grading of this course is on a “PASS/FAIL/HONORS” basis. Grades will be determined by performance

in the three components of the course, OMM, Clinical Skills, and Clinical Practicum, as follows:

Evaluation Criteria: Percent of Grade

OMM 40%

Clinical Skills 40%

Clinical Practicum 20%

In both the OMM and Clinical Skills components of the course, student evaluations will encompass written

and practical examinations. In order to pass the course, both the written and practical examinations in OMM

AND Clinical Skills must be passed. Students who fail to achieve a passing score in either Clinical Skills or

OMM will be issued a grade of “I” (Incomplete). Such students will be offered the opportunity to remediate

the appropriate portion of the course. Re-evaluation will be conducted under the supervision of the DPC

faculty. Successful completion of the re-evaluation examination, both written and practical, will result in the

awarding of a grade of P (Pass). Failure of the comprehensive reassessment exam will result in the

awarding of a grade of U (Unsatisfactory) for this course.

2. Grading of the OMM component will be evaluated according to the following criteria:

Evaluation Criteria: Percent of Grade

OMM written (weighted) 50%

OMM practical (average) 50%

3. Grading of the Clinical Practicum component will be evaluated according to the following criteria:

Evaluation Criteria: Percent of Grade

Attendance and Participation 15%

Case Presentation 35%

Clinical Mentor Evaluation 50%

53

4. Grading of the Clinical Skills component will be evaluated according to the following criteria:

Evaluation Criteria: Percent of Grade

Class participation/assignments 5%

ICC participation/assignments 10%

Timed examination #1

– Practical portion 20%

– Written portion 5%

Timed examination #2

– Practical portion 20%

– Written portion 5%

Timed Comprehensive examination

– Practical portion 25%

– Written portion 10%

Pre-clinical Years: Years I and II DPC Track

54

Assessing the American Osteopathic Association (AOA) Core Competencies at

New York College of Osteopathic Medicine (NYCOM)

A. Background

In recent years, there has been a trend toward defining, teaching and assessing a number

of core competencies physicians must demonstrate. The Federation of State medical Boards

sponsored two Competency-Accountability Summits in which a “theoretical textbook” on good

medical practice was drafted to guide the development of a competency-based curriculum. The

competencies include: medical knowledge, patient care, professionalism, interpersonal

communication, practice-based learning, and system-based practice. The AOA supports the

concepts of core competency assessment and added an additional competency: osteopathic

philosophy and osteopathic clinical medicine.

Arguably it is desirable to begin the process of core competency training and assessment

during the pre-clinical year. Patient simulations, i.e. using standardized patients and robotic

simulator, allow for such training and assessment under controlled conditions. Such a pre-clinical

program provides basic clinical skills acquisition in a patient-safe environment. NYCOM has

responded to this challenge by creating a two-year “Core Clinical Competencies” seminar that

requires students to learn and practice skills through various patient simulations in the Institute

For Clinical Competence (ICC). In this seminar the ICC assesses a sub-set of the above

competencies taught in the lecture-based and discussion-based clinical education tracks.

The following is a list of the competencies assessed during the pre-clinical years at

NYCOM, and reassessed during the third year (osteopathic medicine objective structured

clinical examination) and fourth year (voluntary Clinical Skills Capstone Program). It should be

noted that there is a fair amount of skills overlap between the competencies, for example, the

issue of proper communication can be manifested in a number of competencies.

B. Core Clinical Competencies

1. Patient Care: Provide compassionate, appropriate effective treatment, health promotion

Skills:

 Data-gathering: history-taking, physical examination (assessed with clinical skills

checklists)

 Develop differential diagnosis

 Interpret lab results, studies

 Procedural skills, e.g. intubation, central line placement, suturing, catheterization

 Provide therapy

2. Interpersonal and communication skills: Effective exchange of information and collaboration

with patients, their families, and health professionals.

Skills:

 Communication with patients and their families across a spectrum of multicultural

backgrounds (assessed with the Professionalism Assessment Rating Scale)

55

 Health team communication

 Written communication (SOAP note, progress note)

3. Professionalism: Commitment to carrying out professional responsibilities and ethical

committments

Skills:

 Compassion, respect, integrity for others

 Responsiveness to patient needs

 Respect for privacy, autonomy

 Communication and collaboration with other professionals

 Demonstrating appropriate ethical consideration

 Sensitivity and responsiveness to a diverse patient population including e.g. gender,

age, religion, culture, disabilities, sexual orientation.

4. Osteopathic Philosophy and Osteopathic Clinical Medicine: Demonstrate, apply knowledge

of osteopathic manipulative treatment (OMT); integrate osteopathic concepts and OMT into

medical care; treating the person, and not just the symptoms

Skills:

 Utilize caring, compassionate behavior with patients

 Demonstrate the treatment of people rather than the symptoms

 Demonstrate understanding of somato-visceral relationships and the role of the

musculoskeletal disease

 Demonstrate listening skills in interaction with patients

 Assessing disease (pathology) and illness (patient’s response to disease)

 Eliciting psychosocial information

C. Assessment of Core Competencies

The ICC utilizes formative assessment to evaluate learner skills and the effectiveness of

NYCOM’s clinical training programs. Data on student performance in the ICC is tracked from

the first through the fourth year. The ICC satellite at St. Barnabas assesses students during their

clerkship years as well as interns and residents in a number of clinical services. It uses a variety

of methods to assess competencies:

1. Written evaluations

 Analytic assessment – skills checklists that document data-gathering ability

 Global-holistic rating scales to assess doctor-patient communication (Professionalism

Assessment Rating Scale) and health team communication (SimCom-T)

 SOAP note and progress note assessment

2. Debriefing / feedback – a verbal review of learner actions following a patient simulation

program provided by standardized patients and instructors as appropriate.

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Core Clinical Competencies 590 (MS 1)

Core Clinical Competencies 690 (MS 2)

The courses provide a horizontal integration between clinical courses provided by the LDB and

DPC programs (small group discussion and demonstration) and the OMM department. It

provides practice with simulated patients (some variation in this aspect as noted below),

formative assessment, end-of-year summative assessment and remediation.

1. SP PROGRAM, METRICS AND HOURS

MS 1 Program – SP Different program, same standardized examination

LDB

 SP program: training with formative assessment (see next bullet for formative assessment

metrics)

 End of year OSCE assessing history-taking (checklists designed for each SP case), PE (see

attached physical examination criteria) and interpersonal communication (see attached

program in doctor-patient communication “Professionalism Assessment Rating Scale)

 Hours: 13.5 / year (including OSCE)

DPC

 Clinic visits to substitute for SP encounters

 End of year OSCE (same as LDB)

 Hours: Should be equivalent to the number of SP hours in the LDB program

NOTE: The purpose of the OSCE is to assess the clinical training of both the LDB and DPC

programs. It is assumed the LDB and DPC faculty will work on this OSCE together with the

OMM department.

MS 1 Program – Patient Simulation Program

LDB and DPC

 Same program in basic procedures for both LDB and DPC students as outlined in the

syllabus distributed during the curriculum committee

 Hours: 5 hours / year

57

MS 2 Program – SP

LDB and DPC – same program, different approaches, same standardized exam

 SP program: training with formative assessment (see next bullet for formative assessment

metrics)

 End of year OSCE assessing history-taking (checklists designed for each SP case), PE (see

attached physical examination criteria) and interpersonal communication (see attached

program in doctor-patient communication “Professionalism Assessment Rating Scale)

 Hours: 13.5 hours / year (including OSCE)

 NOTE: It is assumed that the LDB and DPC program schedules will vary but that the

content will be equivalent

MS 2 Program – Patient Simulation Program

LDB and DPC – same program, same standardized exam

 Students work in the same group throughout the year

End of year OSCE assessing medical team communication using the SimCom-T rating scale

(attached)

 Group grade assigned for the OSCE (reflecting the spirit of the SimCom-T rating scale)

 Hours: 11 / year (including OSCE)

2. Attendance

 All activities and exams are mandatory.

 Make ups are done at the discretion of the ICC

NOTE: Make ups will be done as close to an activity as possible because delaying them, e.g. to

the end of the year, will incur additional training expenses (e.g. re-training a SP for a case played

months earlier) for the ICC.

3. Grading and remediation

 Pass / fail

 Grading is based upon:

o Attendance

o Participation

o End-of-year OSCE (standards to be set)

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ICC Hours

MS1

Clinical Practice OSCE Total

Hours

LDB 8 SP exercises @1.5 hours each

12 hours per student

5 patient simulation program exercises @ 1 hours

each

5 hours per student

End-of-year SP OSCE

1.5 hours per student

(approximately 6.25 days)

13.5 hours

(SP)

5 hours

(Pat Sim)

Total = 18.5

DPC Clinic experience to substitute for SP exercises

 Students will receive information re:

communication and PE competencies

5 patient simulation program exercises @ 1 hours

each

5 hours per student

0 hours

(SP)

5 hours

Pat Sim

Total = 5

MS2

Clinical Practice OSCE Total

Hours

LDB

DPC

8 SP exercises @1.5 hours each

12 hours per student

6 patient simulation program exercises, plus ACLS

10 hours per student

End-of-year SP OSCE

1.5 hours per student

(approximately 6.25 days)

End-of-year Pat Sim OSCE

1 hour per student

(approximately 5 days)

13.5 hours

(SP)

11 hours

(Pat Sim)

Total = 24.5

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© 2007 NYCOM Do not reproduce or distribute without permission 9/4/07

Institute For Clinical Competence (ICC)

Professionalism Assessment Rating Scale (PARS)

Dear Students:

As part of your professional development, standardized patients (SPs) in the ICC will be

evaluating your interpersonal communication with them using the Professionalism Assessment

Rating Scale (PARS).

This scale evaluates two types of interpersonal communication, both important to quality health

care:

􀂃 Patient Relationship Quality – Rapport, empathy, confidence and body language.

􀂃 Patient Examination Quality – Questioning, listening, information exchanging and careful and

thorough physical examination.

Arguably patients (real or simulated) are in the best position to assess your interpersonal

communication with them because you are directly relating to them during an intimate, face-toface,

hands-on encounter. They are in the best position, literally, to observe your eye contact,

demeanor and body language because they are in the room with you. We would recommend you

take their feedback seriously, but perhaps “with a grain of salt.”

The term standardized patient is to some degree a misnomer – SPs can be standardized to

present the same challenge and the same medical symptoms to each student, but they cannot be

standardized to feel the same way about you and your work with them compared to other

students. This is true in life as well as clinical work – some people will like you better than others,

and patients are people! You may communicate with one patient the way you do with the next,

but receive slightly different ratings. This is to be expected. Unlike the analytic checklists we use

to document if you asked particular questions or performed certain exams correctly, there are no

dichotomous / “right or wrong” communication ratings. Patients are people who may tune into

different things during an encounter. We think this slight variation in observation is an asset that

will help you understand that patients are individuals who must be approached as individuals.

Another word about the ratings you will receive – the ratings are not absolute numbers that

constitute an unconditional assessment of your communication skills. Some days you may be

better than other days. We use the ratings numbers (1-8 holistic scale) to chart progress over

time. We do see improvements during the first two years of the typical student’s training but the

ratings are used to track your progress as much as to structure a conversation with the SP, or

faculty member, during debriefing. We would recommend you take responsibility during SP

debriefing and ask them questions about the work you just did.

The holistic 1 – 8 scale is broken down into two parts: Ratings of 1 – 4 are considered “lower

quality” communication, i.e. what might be considered acceptable at a novice or trainee level, but

less acceptable for an experienced professional. Ratings of 5 – 8 are considered “higher quality”

communication, i.e. more professional-quality communication regardless of the training or

experience level.

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© 2007 NYCOM DO NOT DISCLOSE, DISTRIBUTE OR REPRODUCE WITHOUT PERMISSION 3/18/07

Professionalism Assessment Rating Scale (PARS)

Standardized patients will rate “to what degree” you demonstrated relationship quality and

examination quality on the following nine factors:

RELATIONSHIP QUALITY

To what degree did the student …

Lower Higher

Quality Quality

1 Establish and maintain rapport 1 2 3 4 5 6 7 8

2 Demonstrate empathy 1 2 3 4 5 6 7 8

3 Instill confidence 1 2 3 4 5 6 7 8

4 Use appropriate body language 1 2 3 4 5 6 7 8

EXAMINATION QUALITY

To what degree did the student …

Lower Higher

Quality Quality

5 Elicit information clearly, effectively 1 2 3 4 5 6 7 8

6 Actively listen 1 2 3 4 5 6 7 8

7 Provide timely feedback / information / counseling 1 2 3 4

5 6 7 8

8 Perform a thorough, careful physical exam or

treatment

1 2 3 4 5 6 7

8

Less experienced, More

or unprofessional professional

The following pages are a guide to the PARS, giving examples of “lower quality” and

“higher quality” communication.

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© 2007 NYCOM DO NOT DISCLOSE, DISTRIBUTE OR REPRODUCE WITHOUT PERMISSION 3/18/07

1 Establish and maintain rapport

Establish and maintain a positive, respectful collaborative working relationship with the patient.

Lower Quality

1 2 3 4

Higher Quality

5 6 7 8

Overly familiar.

􀂃 “Hi Bill, I’m John. How are you doing

today.”

Appropriate address, e.g.

􀂃 “Hi Mr. Jones, I’m Student-doctor Smith. Is it

OK if I call you Bill?”

No agenda set. Set agenda, e.g.

No collaboration with the patient, i.e. carries

out the exam without patient consent or

agreement.

􀂃 “We have ___ minutes for this exam. I’ll take a

history, examine you…..etc.”

Collaborative mindset

􀂃 “Let’s figure out what’s going on.”

􀂃 “We’re going to work out this problem together.”

Took notes excessively, i.e. spent more time

taking notes than interacting.

Spent more time interacting with the patient than

taking notes.

Began physically examining patient without

“warming” patient up, asking consent, etc.

Asked consent for obtaining a physical

examination, e.g.

􀂃 “Is it OK for me to do a physical exam?”

Did not protect patient’s modesty, e.g.

􀂃 Did not use a drape sheet

Respected patient’s modesty at all times e.g.

􀂃 Used a drape sheet when appropriate

􀂃 Did not direct patient to get dressed after

exam

􀂃 Letting patient cover up follow an examination.

􀂃 Left door open when examining patient.

Talked “down” to patient, did not seem to

respect patient’s intelligence.

Seemed to assume patient is intelligent.

Rude, crabby or overtly disrespectful. Never rude, crabby; always respectful.

Dress, hygiene problems:

􀂃 Wore distracting perfume/cologne.

Dressed professionally, i.e. in a clean white coat,

clean clothes, etc.

􀂃 Poor hygiene, e.g. uncleanly, dirty nails,

body odor, did not wash hands, etc.

􀂃 Touched hair continually

􀂃 Unprofessional dress, e.g. wore jeans,

facial jewelry (e.g. tongue or nose studs),

overly suggestive or revealing garments

Seemed angry with the patient.

Seemed to like the patient.

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© 2007 NYCOM DO NOT DISCLOSE, DISTRIBUTE OR REPRODUCE WITHOUT PERMISSION 3/18/07

2 Demonstrate empathy

Demonstrate both empathy (compassion, understanding, concern, support) and inquisitiveness

(curiosity, interest) in the patient’s medical problem and life situation.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

EMPATHY

No expressions of concern about patient’s

condition or situation.

Expressed concern about patient’s condition or

situation, e.g.

􀂃 “That must be painful.”

􀂃 “I’m here to try to help you.”

Failed to acknowledge positive behavior /

lifestyle changes the patient has made.

Reinforced behavior/lifestyle changes the patient

has made, e.g. “That’s great you quit smoking.”

Failed to acknowledge suggested behavior /

lifestyle changes might be difficult.

Acknowledged that suggested behavior/lifestyle

changes might be difficult.

Empathic expression seemed insincere,

superficial.

Empathic expressions seemed genuine.

Detached, aloof, overly “business-like,” robotic in

demeanor.

Compassionate and caring, “warm.”

Seeming lack of compassion, caring.

Accused patient of being a non-compliant, e.g.

􀂃 “Why don’t you take better care of yourself?”

􀂃 “You should have come in sooner.”

Positive reinforcement of things patient is doing

well, e.g.

􀂃 “That’s great that you stopped smoking.”

􀂃 “I’m glad you are taking your medication on a

regular basis.

INQUISITIVENESS – An aspect of empathy is inquisitiveness, the ability to attempt to

understand the patient, both medically and personally.

Focused on symptoms, but not the patient, i.e.

did not explore how the medical problem /

symptoms affect the patient’s life.

Tried to understand how the medical problem /

symptoms affect the patient’s life, or vice versa.

􀂃 “How is this affecting your life?”

􀂃 “Tell me about yourself.”

Failed to explore activities of daily living. 􀂃 “Describe a typical day in your life.”

􀂃 “Tell me about your stress.”

Failed to explore patient’s response to diagnosis

and / or treatment.

Inquires as to patient’s response to diagnosis and

/ or treatment

Failed to explore barriers to behavior / lifestyle

change.

Explored barriers to behavior / lifestyle change.

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3 Instill confidence

Instilling confidence that the medical student or doctor is able to help and treat the patient.

Lower Quality

1 2 3 4

Higher Quality

5 6 7 8

Conveyed his / her anxiety, e.g. Conveyed an appropriately confident demeanor,

e.g.

􀂃 Made eye contact

􀂃 By avoiding eye contact

􀂃 Laughing or smiling nervously

􀂃 Sweaty hand shake

Made statement such as:

􀂃 “This is making me nervous.”

􀂃 “This is the first time I’ve ever done this.”

􀂃 “I don’t know what I’m doing.”

Apologized inappropriately to the patient. E.g.

􀂃 “I’m sorry, but I have to examine you.”

􀂃 Shook hands firmly, etc.

Overly confident, cocky.

Never cocky, appropriately humble without

undermining the patient’s confidence.

When making suggestions, used tentative

language, e.g.

􀂃 “Maybe you should try…”

􀂃 “I’m not sure but …”

When making suggestions, used authoritative

language, e.g.

􀂃 “What I suggest you do is…”

Made excuses for his/her lack of skill or

preparation by making statements such as:

Offered to help the patient or get information if he

/ she could not provide it by saying, e.g.

􀂃 “I’m just a medical student.”

􀂃 “Let me ask the attending physician”

􀂃 “They didn’t explain this to me.”

􀂃 “Do you know what I’m supposed to do next?”

􀂃 “I don’t know but let me find out for you.”

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4 Use appropriate body language

The ability to use appropriate gestures, signs and body cues.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

Overly casual posture, e.g. leaning against

the wall or putting feet up on a stool when

interviewing the patient.

Professional posture, i.e. carried himself / herself

like an experienced, competent physician.

Awkward posture, e.g.

• Stood stiffly when taking a history

• Stood as if he / she was unsure what to do

with his / her body.

Natural, poised posture.

Uncomfortable or inappropriate eye contact

e.g. stared at the patient too long and / or

never looked at the patient.

Used appropriate eye contact.

Avoided eye contact when listening.

Made eye contact when listening, whether eye

level of not.

Stood or sat too close or too distant from the

patient.

Maintained an appropriate “personal closeness”

and “personal distance.”

Turned away from the patient when listening.

Maintained appropriate body language when

listening to the patient.

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5 Elicit information clearly, effectively

Effectively ask questions in an articulate, understandable, straightforward manner.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

Used closed-ended, yes / no questions

exclusively, e.g.

Used open-ended questions to begin an inquiry,

and closed-ended questions to clarify, e.g.

􀂃 “How many days have you 􀂃 “Tell me about the problem.”

been sick?” 􀂃 “What do you do in a typical day?”

􀂃 “Ever had surgery?” 􀂃 “How is your health in general?”

􀂃 “Any cancer in your family?”

Used open-ended questions / non-clarifying

questions exclusively.

Used open-ended questions to begin an inquiry,

and closed-ended questions to clarify.

Student’s questions were inarticulate, e.g.

mumbled, spoke too fast, foreign accent

problems, stuttered*, etc.

* NOTE: Consider stuttering a form of inarticulation for

rating purposes, i.e. do not make allowances for

stuttering

Student was articulate, asked questions in an

intelligible manner.

Asked confusing, multi-part or overly complex

questions, e.g.

􀂃 “Tell me about your past medical

conditions, surgeries and allergies.”

Asked one question at a time, in a straight-forward

manner.

􀂃 “Tell me about your allergies.”

Asked direct questions, e.g.

Asked leading questions, e.g.

􀂃 “No cancer in your family, right?”

􀂃 “No surgeries?” 􀂃 “Do you have any cancer in your family?

􀂃 “You only have sex with your wife, right?” 􀂃 “Any surgeries?”

􀂃 “Are you monogamous?”

Jumped from topic to topic Organized interview.

in a “manic,” disjointed or

disorganized way.

Stayed focused, asked follow up questions before

moving to another topic.

Asked questions in a robotic way, Asked questions in a conversational way, i.e.

listened to the response, and then asked another

question.

i.e. as if reading from a prepared

checklist.

Constantly cut off patient, i.e. did

not let patient finish sentences.

Allowed patient to finish sentences and thoughts

before asking the next question.

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© 2007 NYCOM DO NOT DISCLOSE, DISTRIBUTE OR REPRODUCE WITHOUT PERMISSION 3/18/07

6 Actively listen

Both listen and respond appropriately to the patients’ statements and questions.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

Asked questions without listening to the

patient’s response.

Asked questions and listened to patient’s

response.

No overt statements made indicating he / she

was listening.

Said, e.g. “I’m listening.”

Turned away from the patient when listening.

Maintained appropriate body language when

listening to the patient.

Kept asking the same question(s) because

the physician didn’t seem to remember what

he / she asks.

If necessary, asked the same questions to obtain

clarification, e.g.

􀂃 “Can you tell me again how much you smoke?”

􀂃 “I know you told me this, but when was the last

time you saw your doctor?”

Wrote notes without indicating he / she was

listening.

When writing indicated he / she is listening, e.g.

􀂃 “I have to write down a few things down when

we talk, OK?”

Did not seem to be listening, seemed

distracted.

Attentive to the patient.

Kept talking, asking questions, etc. if the

patient was discussing a personal issue, a

health concern, fear, etc.

Was silent when necessary, e.g. if the patient was

discussing a personal issue, a health concern,

fear, etc.

67

7 Provide timely feedback / information / counseling

Explain, summarize information (e.g. results of physical exams, provides patient education

activities, etc.), or provide counseling in a clear and timely manner.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

Did not explain examination procedures, e.g.

just started examining the patient without

explaining what he / she was doing.

Explained procedures, e.g.

􀂃 “I’m going to check your legs for edema.”

􀂃 “I’m going to listen to your heart.”

Did not provide feedback at all, or provided

minimal feedback

Periodically provided feedback regarding what he /

she heard the patient saying.

􀂃 “It sounds like your work schedule makes it

difficult for you to exercise.”

􀂃 “I hear in your voice that your family situation is

causing you a lot of stress.”

Did not summarize information at all. Periodically summarized information.

􀂃 “You had this cough for 3 weeks, it’s getting

worse and now you’ve got a fever. No one is

sick at home and you haven’t been around

anyone who is sick.”

Provided empty feedback or unprofessional

feedback, e.g.

Feedback was meaningful, useful and timely.

􀂃 “OK…..OK…..OK…..OK…”

􀂃 “Gotcha..gotcha…gotcha,..”

􀂃 “Great ” “Awesome” “Cool”

Examined the patient without providing

feedback about the results of the exam.

Provided feedback about results of the physical

exam.

􀂃 “Your blood pressure seems fine.”

Refused to give the patient information he /

she requested, e.g.

“You don’t need to know that.”

“That’s not important.”

Give information to the patient when requested, or

offered to get it if he / she couldn’t answer the

patient’s questions.

Used medical jargon without explanation, e.g. Explained medical terms.

􀂃 “What you experienced was a myocardial

infarction.”

􀂃 “What you experienced is a myocardial

infarction, meaning a heart attack.”

Ended the exam abruptly.

Let the patient know what the next step was,

provided closure.

No closure, no information about the next

steps

􀂃 “Let’s review the exam and your health…”

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8 Conduct a thorough, careful physical exam or treatment

Conduct physical exams and / or treatment in a thorough, careful manner vs. a tentative or

superficial manner.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

Conducted a superficial examination, e.g. Conducted a careful examination, e.g.

􀂃 Avoided touching the patient 􀂃 Examined on skin when appropriate

􀂃 Touched patient with great tentativeness

Hurried through the exam. Used the full amount of time allotted to examine

the patient.

Avoided inspecting (looking at) the patient’s

body / affected area.

Thoroughly inspected (looked at) the affected

area e.g. with gown open.

Consistently palpated, auscultated and / or

percussed over the exam gown.

Consistently palpated, auscultated and / or

percussed on skin.

Exam not bi-lateral (when appropriate). Bi-lateral exam (when appropriate).

Rough exam, e.g. Conducted a smooth exam from beginning to

􀂃 Started, stopped, re-started the exam. end.

􀂃 Fumbled with instruments

Did not look to see what patient’s expressions

were during an examination in order to assess

pain.

Looked for facial expressions to assess pain.

Did not thoroughly examine the site of the

chief complaint, e.g.

Thoroughly examined the site of the chief

complaint.

􀂃 Did not examine heart and / or lungs if

chief complaint was a breathing problem

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9 Conduct the examination in an organized manner

Overall conduct the exam in an organized, systematic way vs. a disorganized or unsystematic

way.

Lower Quality Higher Quality

1 2 3 4 5 6 7 8

No clear opening, e.g. Clear opening, e.g.

􀂃 Did not set an agenda 􀂃 Set an agenda and followed it

􀂃 Abruptly began the exam 􀂃 Began the exam after a proper introduction

Medical interview not organized – history

jumped from topic to topic

Organize the medical interview vs. jumping from

topic to topic

No clear closure, e.g. Clear closure, e.g.

􀂃 Did not summarize information gathered

during the history and physical

examination

􀂃 Summarized information gathered during the

history and physical examination

􀂃 Did not ask patient “Any more questions?” 􀂃 Asked patient “Any more questions?”

􀂃 Did not clarify next steps 􀂃 Clarified next steps

70

SimCom-T(eam) Holistic Scoring Guide

The SimCom-T is a holistic health care team communication training program and rating scale. The nine-factor scale of SimCom-T

rates team members’ performance as a unit, i.e. individual team member performance should be considered a reflection upon the

entire team.

Rate each factor individually.

Ratings should be global, i.e. reflect the most characteristic performance of the team vs. individual incidents.

The following pages are a guide to SimCom-T, providing behavioral examples representative of each score for the SimCom-T

competencies.

Score Performance Level Description – The team…

1 Limited ….consistently demonstrates novice and / or dysfunctional team attributes

2 Basic ….inconsistently operates at a functional level

3 Progressing ….demonstrates basic and average attributes

4 Proficient ….proficient and consistent in performance

5 Advanced ….experienced and performing at a significant expert level

CNE Not applicable ….A factor could not be evaluated for some reason

Competency Lower

Quality

Higher

Quality

1 Leadership establishment and maintenance 1 2 3 4 5 CNE

2 Global awareness 1 2 3 4 5 CNE

3 Recognition of critical events 1 2 3 4 5 CNE

4 Information exchange 1 2 3 4 5 CNE

5 Team support 1 2 3 4 5 CNE

6 External team support 1 2 3 4 5 CNE

7 Patient support 1 2 3 4 5 CNE

8 Mutual trust and respect 1 2 3 4 5 CNE

9 Flexibility 1 2 3 4 5 CNE

10 Overall Team Performance 1 2 3 4 5 CNE

71

1. Leadership Establishment and Maintenance

Team members both establish leadership and maintain leadership throughout.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Leader not

established

▪ Roles not assigned

▪ No discussion

regarding role

assignment

▪ Unable to identify

leader

▪ Many leaders

▪ No clear role

definition

▪ Leadership not

explicit throughout

event

▪ Leadership not

maintained

throughout the event

▪ Role switching

without leader

involvement

▪ Leader explicitly

identified

▪ Roles defined

▪ Leadership explicitly

identified and

maintained

▪ Roles defined and

maintained

▪ Leader delegates

responsibility

Examples ▪ Team operating

dysfunctionally

without a leader

▪ Team members

taking on similar roles

and role switching

consistently

▪ Team members

unsure of who is

responsible for

different tasks

▪ Leader timid and

does not take charge

▪ Team member roles

unclear and/or

inconsistent

▪ A team member asks,

“Who is running the

code?” and another

says, “I am,” but does

not take communicate

leadership

responsibilities.

▪ Team members are

assigned roles but do

not take on the

assignment

▪ Team members

select a leader

▪ A team member

volunteers to handle

the situation

▪ Roles clearly defined

by team members

and/or leader

▪ Leadership and roles

are established very

early in the event and

is maintained

throughout the event

▪ Clarity of leadership

and roles is evident

throughout the event

and with the team

members

72

2. Global Awareness

Team members monitor and appropriately respond to the total situation, i.e. the work environmental and the patient’s condition.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Does not monitor the

environment and

patient

▪ Does not respond to

changes in the

environment and

patient

▪ Monitoring and

response to changes

in the environment

and patient rarely

occur

▪ Fixation errors

▪ Monitoring and

response to the

environment and

patient are not evident

throughout the event

▪ Monitors the

environment and

patient

▪ Respond to changes

in the environment

and patient

▪ Consistently monitors

the environment and

patient

▪ Consistently respond

to changes in the

environment and

patient

Examples ▪ There is no summary

of procedures, labs

ordered, or results of

labs

▪ Team is task oriented

and does not

communicate about

the event

▪ Event manager loses

focus and becomes

task oriented

▪ There is no clear

review of the lab

results and/or

summary of

procedures.

▪ Leader says, “Team,

lets review our

differential diagnosis

and labs,” and team

does not respond to

the leader.

▪ Some of the team

members discuss

among themselves

results and possible

problems.

▪ Leader says, “Team,

lets review our

differential diagnosis

and labs,” and team

reviews the situation.

▪ Event manager

remains at the foot of

the bed keeping a

global assessment of

the situation

▪ Leader announces

plan of action for the

event.

73

3. Recognition of Critical Events

Team promptly notes and responds to critical changes in the patient’s status and / or environment.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Does not monitor or

respond to critical

deviations from steady

state

▪ Fails to recognize or

acknowledge crisis

▪ “Tunnel Vision”

▪ Fixation errors are

consistently apparent

▪ Team reactive rather

than proactive

▪ Critical deviations

from steady state are

not announced for

other members

▪ Monitors and

responds to critical

deviations from steady

state

▪ Recognizes need for

action

▪ All team members

consistently monitors

and responds to

critical deviations from

steady state

▪ Anticipates potential

problems

▪ Practices a proactive

approach and attitude

▪ Recognizes need for

action

▪ “Big Picture”

Examples ▪ Patient stops

breathing, and team

does not recognize

the situation

throughout the event

▪ Patient is pulseless,

and no CPR is started

throughout the event

▪ Patient stops

breathing, and team

does not recognize

this situation for a

critical time period

▪ Patient is pulseless,

and no CPR is started

for a critical time

period

▪ ▪ Leader says, “Team,

lets review our

differential diagnosis,

are there any

additional tests that

we should request?”

▪ “John, the sats are

dropping, please be

ready, we might have

to intubate.”

▪ “Melissa, the blood

pressure is dropping.

Get ready to start the

2nd IV and order a

type and cross.”

74

4. Information Exchange

Patient and procedural information is exchanged clearly.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Communication

between team

members is not

noticeable

▪ Requests by others

are not acknowledged

▪ No feedback loop

▪ No orders given

▪ Vague

communication

between team

members

▪ Not acknowledging

requests by others

▪ Feedback loop left

opened

▪ Orders not clearly

given

▪ Communication

between team and

response to requests

by others inconsistent

▪ Feedback loops open

and closed

▪ Orders not directed to

a specific team

member

▪ Team communicates

and acknowledges

requests throughout

the event

▪ Feedback loops

closed

▪ Explicit

communication

consistently

throughout the event

▪ Team acknowledges

communication

▪ Closed loop

communication

throughout event

Examples ▪ No summary of

events.

▪ No additional

information sought

from the team

members.

▪ Event manager says,

“I need a defibrillator,

we might have to

shock this patient,”

and no team member

acknowledges the

order. The request

was not given

explicitly to a team

member.

▪ One team member

says to another in a

low voice, “We need

to place a chest tube,”

but the event

manager does not

hear the

communication.

▪ Event manager

requests a

defibrillator, but not

explicitly to a

particular team

member; several

team members

attempt to get the

defibrillator

▪ Jonathan says to

event manager, “We

need to place a chest

tube.” Event manager

responds, “OK, get

ready for it.”

▪ Leader says, “Team,

lets summarizes what

has been done so

far.”

▪ Leader says, “Mary

please start an IV.”

Mary responds,

“Sorry, I do not know

how, please ask

someone else to do

it.”

▪ Event manager

summarizes events.

▪ Event manager seeks

additional information

from all team

members

▪ Event manager says,

“Peter, I want you to

get the defibrillator,

we might have to

shock this patient.”

Peter responds, “Yes,

I know where it is and

I’ll get it.”

75

5. Team Support

The team works as a unit, asking for or offering assistance when needed vs. team members “going it alone.”

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ No assistance or help

asked for or offered

▪ Team members act

unilaterally

▪ No recognition of

mistakes

▪ Team members

watching and not

participating

▪ Team members take

over when not

needed

▪ Mistakes not

addressed to the

team

▪ Negative feedback

▪ Assistance is offered

when needed only

after multiple requests

▪ Team recognizes

mistakes and

constructively

addresses them

▪ Team member(s)

ask(s) for help when

needed

▪ Assistance provided

to team member(s)

who need(s) it

Examples ▪ During a shoulder

dystocia event, the

critical situation is

recognized, but no

help is requested or

attempts to resolve

situation on their own

▪ Wrong blood type

delivered and

administered, an no

backup behaviors to

correct the mistake

▪ Team member

administers

medication without

consulting the event

manager

▪ Charles knows that

the patient is a

Jehovah Witness and

does not let the team

know when a T&C is

ordered.

▪ Team does not

communicate that

he/she doesn’t know

how to use a

defibrillator and

attempts to do it

anyways and fails.

▪ ▪ ▪ During a shoulder

dystocia event, the

critical situation is

recognized, and event

manager calls for help

▪ Wrong blood type

delivered, attempt

made by team

member to administer

the blood but another

team member

recognizes the

mistake and stops the

transfusion before it

starts

▪ Team member

consults with the

event manager before

administering

medication

76

6. External Team Support

Work team provides “external team” (family members and / or other health care professionals) with information and support as

needed

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Team fails to

recognize or interact

with other significant

people who are

present during the

encounter

▪ Team recognizes

other significant

people who are

present during the

encounter but

ignores to interact

with them

▪ Team inconsistently

interacts with other

significant people who

are present during the

encounter

▪ Team interacts with

other significant

people who are

present during the

encounter

▪ Team effectively

interacts with other

significant people who

are present during the

encounter

Examples ▪ Team fails to interact

with a distraught

family member and/or

para-professional

▪ Team fails to interact

appropriately with a

distraught family

member

▪ Team does not

cooperate with a

para-professional

▪ ▪ ▪

77

7. Patient Support

Work team provides the patient and significant others with information and emotional support as needed.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Team fails to interact

with patient if

conscious

▪ Team fails to show

empathy or respect

for a patient

(conscious or

unconscious)

▪ Team fails to provide

appropriate

information when

requested to do so

▪ Teams interaction

with patient is

minimal and when

done so is lacking in

respect or empathy

▪ Team inconsistently

shows empathy or

respect for a patient

(conscious or

unconscious)

▪ Team inconsistently

provides information

when requested to do

so

▪ Team shows empathy

toward patient

▪ Team provides

appropriate

information when

requested to do so

▪ Team demonstrates

consistent and

significant respect

and empathy for

patient

▪ Appropriate

information is

provided consistently

Examples ▪ Team deals with an

unconscious patient

with a lack of respect,

e.g. by joking about

his / her condition

▪ Charles knows that

the patient is a

Jehovah Witness and

does not let the team

know when a T&C is

ordered.

▪ ▪ ▪ Charles lets the

leader know that the

patient is a Jehovah

Witness and that she

refused blood

products.

78

8. Mutual Trust and Respect

The team demonstrates civility, courtesy and trust in collective judgment.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Team exhibits e.g.

rudeness, overt

distrust/mistrust,

anger or overt doubt

or suspicion toward

each other

▪ Few team members

exhibit rudeness,

overt distrust, anger

or suspicion toward

each other

▪ Team inconsistently

demonstrates respect,

rudeness, distrust or

anger toward each

other

▪ Team exhibits e.g.

civility, courtesy, and

trust in collective

judgment

▪ Team is significantly

respectful of each

other

▪ Praise when

appropriate

Examples ▪ Angry, stressed event

manager says to team

member, “I can’t

believe you can’t

intubate the patient.

What’s the matter with

you?”

▪ Team member says

to another, “You don’t

know what you’re

doing-let me do it for

you.”

▪ Event manager

recognizes a chest

tube is needed, and

barks, “Michelle, I

want you to put in a

chest tube, I want you

to do it now, and I

want you to do it right

on your first attempt.”

▪ Leader overbearing

and intimidating

▪ ▪ Stressed but

composed leader

recognizes a team

member cannot

intubate the patient

and offers assistance

▪ Team member says

to another, “Are you

OK? Let me know if I

can help you.”

▪ Event manager

recognizes a chest

tube is needed and

says, “Michelle, this

patient needs a chest

tube-can you put it in

now?”

▪ Leader is clear, direct,

and calm.

▪ Team members will

thank each other

when appropriate.

79

9. Flexibility

The team adapts to challenges, multitasks effectively, reallocates functions, and uses resources effectively; team self correction.

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Team rigidly adheres

to individual team

roles

▪ Inefficient resource

allocation / use

▪ Minimal adaptability

and/or hesitation to

changing situations

▪ Team can adapt to

certain situations, but

not all

▪ Generally very flexible

▪ Multi-tasks effectively

▪ Reallocates functions

▪ Uses resources

effectively

▪ Team adapts to

challenges

consistently

▪ Engages selfcorrection

Examples ▪ Ambu-bag not

working, and no

reallocation of

resources established

▪ Team members stay

in individual roles,

failing to support each

other e.g. by failing to

recognize fatigue of

those giving CPR

▪ Patient’s hysterical

family member

disrupts the team and

team continues

providing care,

ignoring disruptive

relative

▪ ▪ ▪ Ambu-bag not

working, and an

airway team member

gives mouth-to-mouth

with a mask and

event manager asks

another team member

to retrieve a working

ambu-bag

▪ Team members

alternate giving CPR,

recognizing fatigue of

those giving CPR

▪ Patient’s hysterical

family member

disrupts the team and

a team manages the

situation, e.g.

removes, counsels, or

reassures the family

member

80

10. Overall Team Performance

Lower Quality Higher Quality

Score 1 2 3 4 5 CNE

Level Limited Basic Progressing Proficient Advanced

Description ▪ Consistently

operating at a novice

training level

▪ Demonstrates

inconsistent efforts to

operate at a

functional level

▪ Inconsistently

demonstrates below

and average

attributes

▪ Demonstrates

significant

cohesiveness as a

team unit;

▪ Performs proficiently

▪ Consistently operates

at an experienced

and professional

level; performs as

experts

Training

Level

▪ Team requires

training at all levels;

unable to function

independently

▪ Team needs training

at multiple levels to

function

independently

▪ Team needs focused

training to function

independently

▪ Team can function

independently with

supervision

▪ Team functions

independently

81

Case A – Dizziness, Acute

Student ___________________________ Student ID _________ SP ID _________

History Scoring: Give students credit (Yes) if they ask any of the following questions and / or SPs

give the following responses. If question(s) not asked or response(s) not give, give no credit (No).

HISTORY CHECKLIST Yes No

1 ONSET, e.g. “When did dizziness start?”

• “The dizziness started last night when I was cleaning up after dinner.”

2 PAST MEDICAL HISTORY OF PROBLEM, e.g. “Ever had this problem

before?”

􀂃 “I almost passed out once in restaurant a few months ago. The EMT

truck came and checked me out and they thought I was dehydrated

from exercising. I had just come from the gym.”

3 QUALITY, e.g. “Describe the dizziness.”

• “Every few minutes or so I get the feeling the room is spinning and I

feel a little nauseous, then it goes away and I feel OK. Then it starts all

over again.”

4 AGGRAVATING, e.g. “What makes the dizziness worse?”

􀂃 “Standing up with my eyes open makes me feel dizzy.”

5 PALLIATIVE, e.g. “What makes the dizziness better?”

􀂃 “Closing my eyes and laying down makes the dizziness better.”

6 HEAD INJURIES, e.g. “Have you bumped or injured your head?”

• “No head injuries.”

7 PAST MEDICAL HISTORY, e.g. “How is your health in general?”

􀂃 “In general I’ve been very healthy.”

8 MEDICATIONS, e.g. “Are you taking any medications for this problem or

anything else?”

􀂃 “I’m not taking anything. I thought of taking Dramamine but I wasn’t

sure it would help.”

9 DIET, e.g. “What do you eat in a typical day?”

􀂃 “A regular diet, toast and coffee in the morning, usually take out for

lunch, Chinese, a pizza or sub, something like that, and a regular meal

at night.”

10 TOBACCO USE, e.g. “Do you smoke?”

• “I used to smoke ó a pack a day, but now I’m down to 4 or 5,

sometimes a couple more if I’m stressed.”

11 ADLs, e.g. “How is this affecting your life?”

􀂃 “I couldn’t go to work today.”

82

Case A – Dizziness, Acute

PE SCORING:

􀂃 COLUMN 1: NO CREDIT: If any box is checked, exam was done “incorrectly” or

“incompletely.” Checked “Incorrect Details” box records reason(s) why.

􀂃 COLUMN 2: FULL CREDIT: If “Correct” box is checked, exam was done “Correctly /

Completely.”

􀂃 COLUMN 3: NO CREDIT: If “Not Done” box is checked, exam was not attempted at all.

Physical Examination Checklist 1

Incorrect

Details

2

Correct

3

Not

Done

12 Perform fundoscopic examination

􀂃 Did not ask the patient to fix their gaze at point in

front of them.

􀂃 Exam room not darkened.

􀂃 Otoscope used instead of ophthalmoscope

􀂃 “Left eye-left hand-left eye” or “right eye-right

hand -right eye rule” not followed.

􀂃 Exam not bilateral.

13 Assess Cranial Nerve II – Optic – Assess Visual

Fields by Confrontation

􀂃 Examiner not at approximate eye-level with

patient, and / or no eye contact.

􀂃 Examiner’s hands not placed outside of patient’s

field of vision.

􀂃 Did not ask “Tell me when you see my fingers.”

􀂃 Did not test both upper and lower fields, and / or

bilaterally.

14 Assess Cranial Nerves II and III – Optic and

Oculomotor: Assess direct and consensual

reactions

􀂃 Did not shine a light obliquely into each pupil

twice to check both the direct reaction and

consensual reaction.

􀂃 Did not assess bilaterally.

15 Assess Cranial Nerves II and III – Optic and

Oculomotor: Assess near reaction and near

response

􀂃 Did not test in normal room light.

􀂃 Finger, pencil, etc. placed too close or too far

from the patient’s eye.

􀂃 Did not ask the patient to look alternately at the

finger or pencil and into the distance.

83

Case A – Dizziness, Acute

PE SCORING:

􀂃 COLUMN 1: NO CREDIT: If any box is checked, exam was done “incorrectly” or

“incompletely.” Checked “Incorrect Details” box records reason(s) why.

􀂃 COLUMN 2: FULL CREDIT: If “Correct” box is checked, exam was done “Correctly /

Completely.”

􀂃 COLUMN 3: NO CREDIT: If “Not Done” box is checked, exam was not attempted at all.

1

Incorrect

Details

2

Correct

3

Not

Done

16 Assess Cranial Nerve III – Oculomotor: Assess

convergence

􀂃 Did not ask the patient to follow his / her finger or

pencil as he / she moves it in toward the bridge of

the nose.

17 Assess Cranial Nerve III, IV and VI – Oculomotor,

trochlear and abducens: Assessing extraocular

muscle movement

􀂃 Examiner did not assess extra-ocular muscle

movements in at least 6 positions of gaze using,

for example, the “H” pattern.

􀂃 Did not instruct patient to not move the head

during the exam.

18 Assess Cranial Nerve VIII – Acoustic / Weber test

􀂃 Did not produce a sound from tuning fork, e.g. by

not holding the fork at the base

􀂃 Did not place the base of the tuning fork firmly on

top middle of the patient’s head.

􀂃 Did not ask the patient where the sound appears

to be coming from.

19 Assess Cranial Nerve VIII – Acoustic / Rinne test

􀂃 Did not produce a sound from tuning fork, e.g. by

not holding the fork at the base

􀂃 Did not place the base of the tuning fork against

the mastoid bone behind the ear.

􀂃 Did not ask patient to say when he / she no longer

hears the sound, hold the end of the fork near the

patient’s ear and ask if he / she can hear the

vibration.

􀂃 Did not tap again for the second ear.

􀂃 Did not assess bilaterally.

20 Assess Gait

􀂃 Did not ask patient to walk, turn and come back to

look for imbalance, postural, asymmetry and type

of gait (e.g. shuffling, walking on toes, etc.)

21 Perform Romberg Test

􀂃 Did not direct patient to stand with feet together,

eyes closed, for at least 20 seconds without

support.

􀂃 Did not stand in a supportive position, e.g. behind

patient or with hand behind patient.

84

Case A – Dizziness, Acute

RELATIONSHIP QUALITY

To what degree did the student …

Lower Higher

Quality Quality

1 Establish and maintain rapport 1 2 3 4 5 6 7 8

2 Demonstrate empathy 1 2 3 4 5 6 7 8

3 Instill confidence 1 2 3 4 5 6 7 8

4 Use appropriate body language 1 2 3 4 5 6 7 8

EXAMINATION QUALITY

To what degree did the student …

Lower Higher

Quality Quality

5 Elicit information clearly, effectively 1 2 3 4 5 6 7 8

6 Actively listen 1 2 3 4 5 6 7 8

7 Provide timely feedback / information / counseling 1 2 3 4 5 6 7 8

8 Perform a thorough, careful physical exam or

treatment

1 2 3 4 5 6 7 8

85

3. Clinical Clerkship Evaluations / NBOME Subject Exams

Data compiled from 3rd/4th year clerkships includes:

 Student Performance Evaluations from specific hospitals (attending/supervising

physicians, and/or residents) based upon the 7 core Osteopathic Competencies.

Data is broken down further by student cohort: traditional, BS/DO, and Émigré

and is quantified according to curricular track (Lecture Discussion-Based and

Doctor Patient Continuum);

 NBOME Subject Exam scores for each of the (6) core clerkships and OMM.

Core clerkships include:

a) Family Medicine

b) Medicine

c) OB-GYN

d) Pediatrics

e) Psychiatry

f) Surgery

NBOME Subject Exam statistics are shared with 3rd year students as a frame of

reference to determine their performance relative to their NYCOM peers. These

data also serve as a general guide for COMLEX II CE preparation and

performance;

 Students provide feedback on their clinical experiences during their clerkships,

via the “PDA project”:

a) The PDA is a tool utilized for monitoring clerkship activities. The

DEALS (Daily Educational Activities Logs Submission) focuses on

educational activities, while the LOG portion focuses on all major

student-patient encounters. A rich data set is available for comparing

patient encounters and educational activities across all sites for all

clerkships.

86

b) PDA data is used as a multimodal quality assessment tool for curricular

exposure as well as OMM integration across all hospitals (including

“outside” clerkships) for Patient Encounters and Educational Activities.

 Reports from student focus groups—these reports are based upon in-person group

interviews by a full-time NYCOM Medical Educator and feedback is analyzed in

order to ensure consistency in clerkship education and experiences, as well as for

program improvement indicators.

87

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 Clinical Clerkship Student Performance Evaluation

Samples of the forms/questionnaires follow

88

NEW YORK COLLEGE OF OSTEOPATHIC MEDICINE

OFFICE OF CLINICAL EDUCATION

Northern Boulevard -– Old Westbury, NY 11568-8000

Tel.: 516-686-3718 – Fax: 516-686-3833

(*) Only ONE form, with COMPOSITE GRADE & COMMENTS should be sent to the Hospital’s Office of

Medical Education

for the DME SIGNATURE .

COURSE # _______________________________(For NYCOM Purpose

ONLY)

STUDENT: _____________________,_______________Class Year:

______HOSPITAL:_______________________

Last First

ROTATION(Specialty)_____________________________ROTATION DATES:

____/____/____ ____/____/____

From

To

EVALUATOR: _________________________________________ TITLE:

_______________________________________

(Attending Physician / Faculty Preceptor)

A. Student logs by PDA  REVIEWED (at least 10 patients)  NOT REVIEWED

B. Student’s unique “STRENGTHS” (Very Important –To be incorporated into the

College’s Dean’s Letter)

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

____________

C. Student’s LIMITATIONS (areas requiring special attention for future professional growth)

______________________________________________________________________________

______________________________________________________________________________

____________________________________

89

D. For items below CIRCLE the most appropriate number corresponding to the

following rating scale:

Exceptional=5 Very Good = 4 Average = 3 Marginal = 2 1 = FAILURE N/A OR no opportunity to observe

CORE COMPETENCY (See definitions on reverse side) RATING

Patient Care 5 4 3 2 1 N/A

Medical Knowledge 5 4 3 2 1 N/A

Practice-Based Learning & Improvement 5 4 3 2 1 N/A

Professionalism 5 4 3 2 1 N/A

System-Based Practice 5 4 3 2 1 N/A

Interpersonal and Communication Skills 5 4 3 2 1 N/A

Osteopathic Manipulative Medicine 5 4 3 2 1 N/A

OVERALL GRADE 5 4 3 2 1(FAILURE

Evaluator Signature:____________________________________________________ Date:

_______/________/_______

Student Signature: ____________________________________________________ Date:

_______/________/_______

(Ideally at Exit Conference)

(*) DME Signature: _________________________________________________ Date:

_______/________/_______

Please Return to:  Hospital’s Office of Medical Education

OVER 

The Seven Osteopathic Medical Competencies

Physician Competency is a measurable demonstration of suitable or sufficient

knowledge, skill sets, experience, values, and behaviors, that meet established

professional standards, supported by the best available medical evidence, that are in

the best interest of the well-being and health of the patient.

Patient Care: Osteopathic patient care is the ability to effectively determine and

monitor the nature of a patient’s concern or problem; to develop, maintain, and to

bring to closure the therapeutic physician-patient relationship; to appropriately

incorporate osteopathic principles, practices and manipulative treatment; and to

implement effective diagnostic and treatment plans, including appropriate patient

education and follow-up, that are based on best medical evidence.

90

Medical Knowledge: Medical Knowledge is the understanding and

application of biomedical, clinical, epidemiological, biomechanical, and social and

behavioral sciences in the context of patient-centered care.

Practice-Based Learning & Improvement: Practice-Based learning

and improvement is the continuous evaluation of clinical practice utilizing evidence-based

medicine approaches to develop best practices that will result in optimal patient care

outcomes.

Professionalism: Medical professionalism is a duty to consistently demonstrate

behaviors that uphold the highest moral and ethical standards of the osteopathic profession.

This includes a commitment to continuous learning and the exhibition of personal and social

accountability. Medical professionalism extends to those normative behaviors ordinarily

expected in the conduct of medical education, training, research, and practice.

System-Based Practice: System-based practice is an awareness of and

responsiveness to the larger context and system of health care, and the ability to effectively

identify and integrate system resources to provide care that is of optimal value to individuals

and society at large.

Interpersonal & Communication Skills: Interpersonal and

communication skills are written, verbal, and non-verbal behaviors that facilitate

understanding the patient’s perspective. These skills include building the physician-patient

relationship, opening the discussion, gathering information, empathy, listening, sharing

information, reaching agreement on problems and plans, and providing closure. These skills

extend to communication with patients, families, and members of the health care team.

Osteopathic Manipulative Medicine: Osteopathic philosophy is a holistic

approach that encompasses the psychosocial, biomedical, and biomechanical aspects of both

health and disease, and stresses the relationship between structure and function, with

particular regard to the musculoskeletal system.

Definitions Provided by the National Board of Osteopathic Medical Examiners

(NBOME)

91

4. Student feedback (assessment) of courses / Clinical clerkship / PDA project

 Data received on courses and faculty through the newly implemented, innovative

Course / Faculty Assessment program (see below-NYCOM Student Guide for

Curriculum and Faculty Assessment). Students (randomly) assigned (by teams)

to evaluate one course (and associated faculty) during 2-year pre-clinical

curriculum. Outcome of student-team assessment is presented to Curriculum

Committee, in the form of a one-page Comprehensive Report;

 Clerkship Feedback (quantitative and “open-ended” feedback) provided through

“Matchstix” (web-based feedback program): this information is shared with

NYCOM Deans and Clinical Chairs, Hospital Director’s of Medical Education

(DMEs), Hospital Department Chairs and Clerkship Supervisors. Also, the

information is posted on the “web” to assist and facilitate 2nd year students

choosing 3rd year Core Clerkship Sites (transparency). This data is also utilized

via two (2) year comparisons of quantitative data and student feedback shared

with NYCOM Deans & Chairs, as well as Hospital DMEs;

 Clerkship Feedback via PDA: quantitative and open-ended (qualitative) feedback

on all clerkships is collected via student PDA submission. The information is

utilized as a catalyst for clerkship quality enhancement. This data-set is used as a

multimodal quality assessment tool for curricular exposure as well as OMM

integration across all hospitals (including “outside” clerkships) for Patient

Encounters and Educational Activities;

92

 Reports from student focus groups—these reports are based upon in-person group

interviews by a full-time NYCOM Medical Educator and feedback is analyzed in

order to ensure consistency in clerkship education and experiences, as well as for

program improvement indicators;

93

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 NYCOM Student Guide for Curriculum and Faculty Assessment

 Clerkship (site) feedback from Clerkship students

 Clinical Clerkship Focus Group Form

 4th Year PDA Feedback Questionnaire

 Student End-of-Semester Program Evaluations (DPC)

 DPC Program Assessment Plan

 Osteopathic Manipulative Medicine (OMM) Assessment Forms

Samples of the forms/questionnaires follow

94

95

Site Feedback

Rotation: Surgery

Site: (*) MAIMONIDES MEDICAL CENTER

This is an anonymous feedback form. No student identification data is transmitted.

Questions marked with * are mandatory.

Section I. Please respond to each statement in this section according to the following

scale.

STRONGLY DISAGREE <-> STRONGLY AGREE

1* There were adequate learning opportunities (teaching patients, diversity of pathology and

diagnostic procedures)

Strongly Disagree Disagree Neutral Agree Strongly Agree

2* There were opportunities to practice osteopathic diagnosis and therapy

Strongly Disagree Disagree Neutral Agree Strongly Agree

3* There was adequate supervision and feedback (e.g., reviews of my H&P, progress notes and

clinical skills)

Strongly Disagree Disagree Neutral Agree Strongly Agree

4* I had the opportunity to perform procedures relevant for my level of training

Strongly Disagree Disagree Neutral Agree Strongly Agree

5* I was evaluated fairly for my level of knowledge and skills

Strongly Disagree Disagree Neutral Agree Strongly Agree

6* Attending physicians and/or house staff were committed to teaching

Strongly Disagree Disagree Neutral Agree Strongly Agree

7* Overall, I felt meaningfully engaged and well integrated with the clinical teams (e.g., given

sufficient patient care responsibilities)

Strongly Disagree Disagree Neutral Agree Strongly Agree

96

8* The DME and/or clerkship director was responsive to my needs as a student

Strongly Disagree Disagree Neutral Agree Strongly Agree

9* There were adequate library resources at this facility

Strongly Disagree Disagree Neutral Agree Strongly Agree

10* A structured program of directed readings and/or journal club was a component of this

rotation.

Strongly Disagree Disagree Neutral Agree Strongly Agree

11* The lectures were appropriate for this rotation (e.g., quality, quantity and relevance of

topics)

Strongly Disagree Disagree Neutral Agree Strongly Agree

12* Educationally useful teaching rounds were conducted on a regular basis.

Strongly Disagree Disagree Neutral Agree Strongly Agree

13* This rotation reflected a proper balance of service and education

Strongly Disagree Disagree Neutral Agree Strongly Agree

14* This rotation incorporated a psychosocial component in patient care

Strongly Disagree Disagree Neutral Agree Strongly Agree

15* Overall, I would recommend this rotation to others

Strongly Disagree Disagree Neutral Agree Strongly Agree

Section II. Psychomotor skills

Indicate the number you performed on an average week during this rotation for each of

the following:

16* History and Physicals

97

17* Osteopathic structural examinations

18* Osteopathic Manipulative Treatments

19* Starting IVs

20* Venipunctures

21* Administering injections

22* Recording notes on medical records

23* Reviewing X-Rays

24* Reviewing EKGs

25* Urinary catherizations

26* Insertion and removal of sutures

27* Minor surgical procedures (assist)

28* Major surgical procedures (assist)

29* Care of dressings and drains

98

30* Sterile field maintenance

Section III

31* Comment on unique STRENGTHS and Positive Features of this rotation

32* Comment on the LIMITATIONS and Negative Features of this rotation

33* Comment on the extent in which the Learning Objectives for the rotation were met (e.g.,

specific topics/patient populations to which you were or not exposed)

Section IV. Please list your clinical instructors with whom you had substantial contact

on this rotation and provide a general rating of their effectiveness as Teachers using the

scale below.

5=EXCELLENT, 4=VERY GOOD, 3=AVERAGE, 2=BELOW AVERAGE,

1=POOR

For example – John Smith – 4

34* List clinical instructors and rating in the box below

To submit your feedback, enter your password below and then click on Submit Feedback button

Submit Feedback

Cancel

99

Focus Groups on Clinical Clerkships

NAME OF HOSPITAL:

LOCATION:

DATE OF SITE VISIT:

The student’s comments on the clinical rotations are as follows:

(Name of Clerkship)

STRENGHTS:

WEAKNESSES:

100

4th Year PDA Feedback Questionnaire

1. Clinic Site

2. Rotation

3. Date

4. There were adequate learning opportunities

5. There were opportunities to practice Osteopathic diagnosis & therapy

6. I was evaluated fairly for my level of knowledge and skills

7. Attending physicians and/or house staff were committed to teaching

8. Overall, I felt meaningfully engaged and well integrated with the clinical teams

9. The DME and/or clerkship director was responsive to my needs as a student

10. This rotation reflected a proper balance of service and education

11. Overall, I would recommend this clerkship to others

12. Comments

13. Strengths/Positive Features of Rotation

14. Limitations/Negative Features of Rotation

15. List and Rate Clinical Instructors

101

Student End-of-Semester Program Evaluations

The DPC Student End-of-Semester Program Evaluation is an assessment of

each course that occurred during the semester and the corresponding faculty

members.

DPC END OF SEMESTER EVALUATION

Directions:

1. Please write in your year of graduation here: .

2. Enclosed you will find a blank scantron sheet.

3. Please make sure that you are using a #2 pencil to fill in your answers.

4. Please fill in the following Test Form information on the Scantron Sheet:

 DPC Class 2011 – Bubble in Test Form A

 DPC Class 2012 – Bubble in Test Form B

5. No other identifying information is necessary.

6. Please complete each of the following numbered sentences throughout

this evaluation using the following responses:

A. Excellent – couldn’t be better

B. Good – only slight improvement possible

C. Satisfactory – about average

D. Fair – some improvement needed

E. Poor – considerable improvement needed

7. There are spaces after each section in which you can write comments.

(When making comments, please know that your responses will be shared with DPC faculty,

Dept. chairs, and deans, as part of ongoing program evaluation.)

BIOPSYCHOSOCIAL SCIENCES COURSE EVALUATION:

102

I. CASE STUDIES COMPONENT

Excellent Good Satisfactory

Fair Poor

1. This course, overall is A B C D E

2. My effort in this course, overall is A B C D E

3. The case studies used in small

group are A B C D E

4. My preparation for each group

session was A B C D E

5. Other available resources for use in

small group are A B C D E

6. Facilitator assessments are A B C D E

7. Self assessments are A B C D E

8. Content Exams – midterm and final

are A B C D E

9. The group process in my group can

be described as A B C D E

10. The wrap-ups in my group were A B C D E

11. The quality of the learning issues

developed by my group was A B C D E

Overall comments on Case Studies

II. STUDENT HOUR COMPONENT:

Excellent Good Satisfactory

Fair Poor

12. The monthly student hours are A B C D E

Overall Comments On The Student Hour

103

III. FACILITATOR RATINGS

Please circle your group number/the name of your group facilitator(s).

Group Facilitators

A Dr. _____________________ and Dr. _______ ______________

B Dr. _____________________ and Dr. ________ ______________

C Dr. _____________________ and Dr. ______________________

D Dr. _____________________ and Dr. _______________________

Please bubble in your response to each of the following items:

Strongly

Agree Agree Disagree Strongly

Disagree

13. Maintained appropriate directiveness 5 (A) 4 (B) 2 (C) 1 (D)

14. Supported appropriate group process 5 (A) 4 (B) 2 (C) 1 (D)

15. Supported student-directed learning 5 (A) 4 (B) 2 (C) 1 (D)

16. Gave appropriate feedback to group 5 (A) 4 (B) 2 (C) 1 (D)

17. Ensured that learning issues were

Appropriate 5 (A) 4 (B) 2 (C) 1 (D)

18. Overall, these facilitators were

effective 5 (A) 4 (B) 2 (C) 1 (D)

Overall Facilitator Comments

(Comments on individual facilitators are welcome)

104

IV. PROBLEM SETS/DISCUSSION SESSIONS COMPONENT

A. Course Evaluation:

Excellent Good Satisfactory

Fair Poor

19. These sessions, overall were A B C D E

20. My effort in these sessions, overall

was A B C D E

21. The organization of these sessions

was A B C D E

22. Handouts in general were A B C D E

Problem Sets/Discussion Sessions Comments

(Please comment as to whether problem sets were too many, too few, too involved.)

105

V. PROBLEM SETS/DISCUSSION SESSIONS COMPONENT

B. Presenter Evaluation:

Excellent Good Satisfactory

Fair Poor

23. The Problem Set topic on

was A B C D E

24. The instructor,

, for the problem set named

in #23 was

A B C D E

25. The Problem Set topic on

was A B C D E

26. The instructor,

, for the problem set named

in #25 was

A B C D E

27. The Problem Set topic on

was A B C D E

28. The instructor,

, for the problem set named

in #27 was

A B C D E

29. The Problem Set topic on

was A B C D E

30. The instructor,

, for the problem set named

in #29 was

A B C D E

31. The Problem Set topic on

was A B C D E

32. The instructor,

, for the problem set named

in #31 was

A B C D E

Problem Sets/Discussion Sessions Comments

(Comments on individual instructors are welcome)

106

VI. ANATOMY COMPONENT

A. Course Evaluation:

Excellent Good Satisfactory

Fair Poor

33. This component, overall was A B C D E

34. My effort in this component was A B C D E

35. My preparation for each lab session

was A B C D E

36. Organization of the component was A B C D E

37. Quizzes were A B C D E

38. Resource Hour / Reviews were A B C D E

Anatomy Component Comments

107

VII. ANATOMY COMPONENT

B. Teaching Evaluation:

Please bubble in your response to each of the following items:

Strongly

Agree Agree Disagree Strongly

Disagree

39. The faculty were available to answer

questions in the lab 5 (A) 4 (B) 2 (C) 1 (D)

40. The faculty Initiated student

discussion 5 (A) 4 (B) 2 (C) 1 (D)

41. The faculty were prepared for each

lab session 5 (A) 4 (B) 2 (C) 1 (D)

42. The faculty gave me feedback on how

I was doing 5 (A) 4 (B) 2 (C) 1 (D)

43. The faculty were enthusiastic about

the course 5 (A) 4 (B) 2 (C) 1 (D)

44. Overall, the instructors were effective 5 (A) 4 (B) 2 (C) 1 (D)

Anatomy Component Comments

(Comments on individual instructors are welcome)

108

CLINICAL SCIENCES COURSE

I. CLINICAL SKILLS LAB COMPONENT

A. Course Evaluation:

Excellent Good Satisfactory

Fair Poor

45. This component, overall was A B C D E

46. My effort in this component was A B C D E

47. My preparation for each lab session

was A B C D E

48. Organization of the component was A B C D E

49. Examinations were A B C D E

50. Handouts/PowerPoints were A B C D E

51. I would rate my physical exam and

history taking skills at this time to

be

A B C D E

Overall Comments on Clinical Skills Component / Individual Labs

(Comments on individual instructors are welcome)

109

I. CLINICAL SKILLS LAB COMPONENT

B. Teaching Evaluation:

Please bubble in your response to each of the following items:

Strongly

Agree Agree Disagree Strongly

Disagree

52. The faculty were available to answer

questions in the lab 5 (A) 4 (B) 2 (C) 1 (D)

53. The faculty initiated student

discussion 5 (A) 4 (B) 2 (C) 1 (D)

54. The faculty were prepared for each

lab session 5 (A) 4 (B) 2 (C) 1 (D)

55. The faculty Gave me feedback on

how I was doing 5 (A) 4 (B) 2 (C) 1 (D)

56. The faculty were enthusiastic about

the course 5 (A) 4 (B) 2 (C) 1 (D)

57. Overall, the instructors were effective 5 (A) 4 (B) 2 (C) 1 (D)

Overall Comments on Clinical Skills Component / Individual Labs

(Comments on individual instructors are welcome)

110

II. OMM COMPONENT

A. Course Evaluation:

Excellent Good Satisfactory

Fair Poor

58. This component, overall was A B C D E

59. My effort in this component was A B C D E

60. My preparation for each lab session

was A B C D E

61. Organization of the component was A B C D E

62. Presentations / Lectures were A B C D E

63. Handouts were A B C D E

64. Quizzes were A B C D E

65. Practical exams were A B C D E

66. Resource Hour / Reviews were A B C D E

Overall Comments on OMM Component / Individual Labs

(Comments on individual instructors are welcome)

111

II. OMM COMPONENT

B. Teaching Evaluation

Please bubble in your response to each of the following items:

Strongly

Agree Agree Disagree Strongly

Disagree

67. The faculty were available to answer

questions in the lab 5 (A) 4 (B) 2 (C) 1 (D)

68. The faculty Initiated student

discussion 5 (A) 4 (B) 2 (C) 1 (D)

69. The faculty were prepared for each

lab session 5 (A) 4 (B) 2 (C) 1 (D)

70. The faculty gave me feedback on how

I was doing 5 (A) 4 (B) 2 (C) 1 (D)

71. The faculty were enthusiastic about

the course 5 (A) 4 (B) 2 (C) 1 (D)

72. Overall, the instructors were effective 5 (A) 4 (B) 2 (C) 1 (D)

Overall Comments on OMM Component / Individual Labs

(Comments on individual instructors are welcome)

112

III. ICC COMPONENT

A. Course Evaluation:

Excellent Good Satisfactory

Fair Poor

73. This component, overall was A B C D E

74. My effort in this component was A B C D E

75. My preparation for each lab session

was A B C D E

76. Organization of this component was A B C D E

77. The helpfulness/usefulness of the

ICC standardized patient

encounters was

A B C D E

78. The helpfulness/usefulness of the

ICC robotic patient encounters was A B C D E

79. Are Clinical Skills laboratory

exercises appropriate for the ICC?

[A] YES [B] NO

A YES B NO – – –

Overall Comments on the ICC Component

(Comments on individual instructors are welcome)

113

IV. CLINICAL PRACTICUM COMPONENT

80. I participated in Clinical Practicum this semester: [A] YES [B] NO

If you answered NO to this question, you have finished this evaluation, if you answered YES,

please continue this questionnaire until the end. Thank you.

A. Course Evaluation

Excellent Good Satisfactory

Fair Poor

81. This component, overall was A B C D E

82. My effort in this component was A B C D E

83. My preparation for each lab session

was A B C D E

84. Organization of this component was A B C D E

85. The helpfulness/usefulness of the

Clinical Practicum was A B C D E

86. The organization of the case

presentations was A B C D E

87. Are Clinical Skills laboratory

exercises appropriate for the

Clinical Practicum?

A YES B NO – – –

Please bubble in your response to each of the following items:

Strongly

Agree

Agree Disagree Strongly

Disagree

88. The case presentation exercise was a

valuable learning experience 5 (A) 4 (B) 2 (C) 1 (D)

Overall Comments on Clinical Practicum Course

114

IV. CLINICAL PRACTICUM COMPONENT

B. Mentor Evaluation:

Please bubble in your response to each of the following items:

Strongly

Agree Agree Disagree Strongly

Disagree

89. The preceptor was available to

answer my questions 5 (A) 4 (B) 2 (C) 1 (D)

90. I was supported in my interaction

with patients 5 (A) 4 (B) 2 (C) 1 (D)

91. Student-directed learning was

supported 5 (A) 4 (B) 2 (C) 1 (D)

92. I had appropriate feedback 5 (A) 4 (B) 2 (C) 1 (D)

93. Overall, this preceptor/site was

effective 5 (A) 4 (B) 2 (C) 1 (D)

Preceptor Name _______________________

Overall Comments on Clinical Practicum Mentor

(Comments on individual instructors are welcome)

115

DPC: Program Assessment Plan

I. Pre matriculated Evaluation – What determines that an applicant will pick the DPC

program?

 Comparison of the students who chose the LDB program vs. the DPC program with

regard to the following outcome measures:

 GPA scores (overall, science)

 MCAT scores

 Gender

 Age

 Race

 College size

 College Geographic location

 Prior PBL exposure

 OMM understanding

 Research Background

 Volunteer Work

 Employment Experience

 Graduate Degree

 Scholarships/Awards

II. Years at NYCOM – How do we evaluate if the DPC program is accomplishing its goals

while the students are at NYCOM?

 Comparison of Facilitator Assessments for each term, to monitor student growth

 Comparison of Clinical Practicum Mentor Evaluations from Term 2 and Term 3, to

evaluate the student’s clinical experience progress

 Comparison of Content exam scores from terms 1 through 4.

 Comparison of entrance questionnaire (administered during first week of medical

school) responses to corresponding exit questionnaire administered at the end of year

4

 Evaluation of the Student DPC End-of-Term Evaluations

 Comparison of the following measures to those outcomes achieved by the students in

the LDB program:

 OMM scores

116

DPC: Program Assessment Plan

 Anatomy scores

 ICC PARS scores

 ICC OSCE scores

 Summer research

 Summer Volunteerism

 Research effort (publications, abstracts, posters, presentations)

 Shelf-exams

 COMLEX I, II, III scores and pass rate

 Fellowships (Academic, Research)

III. Post Graduate Training Practice – What happens to the DPC student once they leave

NYCOM? How to they compare to those students who matriculated through the LDB

program?

 Comparison of the following measures to those outcomes achieved by the students in

the LDB program:

 Internships

 Residencies

 Fellowships

 Specialty (medicine)

 Specialty board certifications

 AOA membership

 AMA membership

 Publications

 Research

 Teaching

117

OMM Assessment Forms

118

119

5. COMLEX USA Level I, Level II CE & PE, and Level III data (NBOME)

a) First-time and overall pass rates and mean scores;

b) Comparison to national averages;

c) Comparison to college (NYCOM) national ranking.

Report provided by Associate Dean for Academic Affairs

120

6. Residency match rates and overall placement rate

Data compiled as received from the American Osteopathic Association (AOA) and

the National Residency Match Program (NRMP).

Report provided by Associate Dean for Clinical Education

121

7. Feedback from (AACOM) Graduation Questionnaire

Annual survey report received from AACOM comparing NYCOM graduates

responses to numerous questions/categories (including demographics, specialty

choice, overall perception of pre-doctoral training, indebtedness, and more) to nationwide

osteopathic medical school graduating class responses.

122

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 AACOM Survey of Graduating Seniors

Samples of the forms/questionnaires follow

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

8. Completion rates (post-doctoral programs)

Percent of NYCOM graduates completing internship/residency training programs.

Report provided by Office of Program Evaluation and Assessment

142

9. Specialty certification and licensure

Data compiled from state licensure boards and other specialty certification

organization (board certification) on NYCOM graduates.

Report provided by Office of Program Evaluation and Assessment

143

10. Career choices and geographic practice location

Data includes practice type (academic, research, clinical, and so on) and practice

location. Data obtained from licensure boards, as well as NYCOM Alumni survey.

Report provided by Office of Program Evaluation and Assessment

144

11. Alumni Survey

Follow up survey periodically sent to alumni requesting information on topics

such as practice location, specialty, residency training, board certification and

so on.

145

Specific forms/questionnaires utilized to capture the above-detailed information include the

following:

 Alumni Survey

Samples of the forms/questionnaires follow

146

ALUMNI SURVEY

NAME

LAST FIRST NYCOM CLASS YEAR

HOME ADDRESS

PRACTICE ADDRESS

HOME PHONE ( ) OFFICE PHONE ( )

E-MAIL ADDRESS

________________________________ _______________________________ _______________________

INTERNSHIP HOSPITAL RESIDENCY HOSPITAL FIELD OF STUDY

FELLOWSHIPS COMPLETED:

CERTIFICATIONS YOU HOLD:

IF SPOUSE IS ALSO A NYCOM ALUMNUS, PLEASE INDICATE SPOUSE’S NAME AND CLASS YEAR:

EXCLUDING INTERNSHIP, RESIDENCY AND FELLOWSHIP, HAVE YOU EARNED ANY ADDITIONAL ACADEMIC DEGREES OR CERTIFICATES BEYOND

YOUR MEDICAL DEGREE (I.E., MPH, MBA, MHA, PHD, MS)? (PLEASE LIST)

CURRENT PRACTICE STATUS: FULL-TIME PRACTICE___ PART-TIME PRACTICE _____ INTERN/RESIDENCY _____ RETIRED/NOT PRACTICING _____

147

What specialty do you practice most

frequently? (Choose one)

 Allergy and Immunology

 Anesthesiology

 Cardiology

 Colorectal Surgery

 Dermatology

 Emergency Medicine

 Endocrinology

 Family Practice

 Gastroenterology

 Geriatrics

 Hematology

 Infectious Diseases

 Internal Medicine

 Neruology

 Neonatology

 Nephrology

 Neurology

 Nuclear Medicine

 Obstetrics & Gynecology

 Occupational Medicine

 Ophthalmology

 Oncology

 Otolaryngology

 Orthopedic Surgery

 Psychiatry

 Pediatrics

 Plastic/Recon. Surgery

 Physical Medicine/Rehab

 Pathology

 Pulmonary Medicine

 Radiology

 Rheumatology

 Surgery (general)

 Thoracic Surgery

 Radiation Therapy

 Urology

 Other (Please specify)

____________________

Current military status (if applicable):

 Active Duty

 Inactive reserve

 Active Reserve

What is the population of the

geographic area of your practice?

(Choose one)

 5,000,000 +

 1,000,000 – 4,999,999

 500,000 – 999,999

 250,000 – 499,999

 100,000 – 249,999

 50,000 – 99,999

 25,000 – 49,999

 10,000 – 24,999

 5,000 – 9,999

 Less than 5,000

How would you describe this

geographic area? (Choose one)

 Inner City

 Urban

 Suburban

 Small Town – Rural

 Small town – industrial

Other ______________________

What functions do you perform in

your practice? (check all that apply)

 Preventive care/patient education

 Acute care

 Routine/non-acute care

 Consulting

 Supervisory/managerial responsibilities

 Research

 Teaching

 Hospital Rounds

What best describes the setting in

which you spend the most time ?

 Intensive Care Unit of Hospital

 Inpatient Unit of Hospital (not ICU/CCU)

 Outpatient Unit of Hospital

 Hospital Emergency Room

 Hospital Operating Room

 Freestanding Urgent Care Center

 Freestanding Surgical Facility

 Nursing Home or LTC Facility

 Solo practice physician office

 Single Specialty Group practice physician

office

 Multiple Specialty Group practice physician

office

 University Student Health facility

 School-based Health center

 HMO facility

 Rural Health Clinic

 Inner-city Health Center

 Other Community Health Center

 Other Freestanding Outpatient facility

 Correctional facility

 Industrial facility

 Mobile Health Unit

 Other (Please specify)

__________________________________

Do you access medical information

via the internet ?

 Never

 Sometimes

 Often

What percent of your time is spent in primary

care? (family medicine or gen. internal medicine)

 0%

 1 – 25%

 25 – 50%

 50 – 75%

 75 – 100%

What percent of your practice is outpatient?

 0%

 1 – 25%

 25 – 50%

 50 – 75%

 75 – 100%

148

Do you engage in any of the following

activities? (check all that apply)

 Professional organization

leadership position

 Volunteer services in the

community

 School or team physician

 Free medical care

 Leadership in church,

congregation

 Local government

 Speaking on medical

topics to community

groups

How many CME programs or other

professional training sessions did you

attend last year?

 none

 1-5

 5-10

 10-15

 more than 15

Have you ever done any

of the following?

 Author or co-author

a professional paper

 Contribute to an article

 Direct a research project

 Participate in clinical

research

 Present a lecture at a

professional meeting or

CME program

 Serve on a panel

discussion at a

professional meeting

How often do you read

medical literature regarding

new research findings?

 Rarely

 Several times a year

 Monthly

 Weekly

 Daily

How frequently do you apply

osteopathic concepts into

patient care?

 Never

 Rarely

 Often

 Always

In your practice do you employ any of

the following?

(check all that apply)

 Structural examination or

musculoskeletal

considerations in

diagnosis

 Indirect OMT techniques

 High Velocity OMT

 Myofascial OMT

 Cranial OMT

 Palpatory diagnosis

Please indicate how important each of the following skills

has been in your success as a physician, and how well

NYCOM prepared you in that skill.

Biomedical science knowledge base

Clinical skills

Patient educator skills

Empathy and compassion for patients

Understanding of cultural differences

Osteopathic philosophy

Clinical decision making

Foundation of ethical standards

Ability to communicate with other health care providers

Ability to communicate with patients and families

Knowing how to access community resources

Ability to understand and apply new medical information

Understanding of the payor/reimbursement system

How important to my practice



Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

How well NYCOM prepared me



Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

149

Ability to search and retrieve needed information

Manipulative treatment skill

Ability to use medical technology

Diagnostic skill

Skill in preventive care

Understanding of public health issues & the public health

system

Professionalism

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak

Strong  Moderate Weak 

Please return to:

NYCOM of NYIT, Office of Alumni Affairs

Northern Boulevard, Serota Bldg., Room 218

Old Westbury, New York 11568

or

fax to (516) 686-3891 or (516) 686-3822

as soon as possible.

Thank you for your cooperation!

150

NYCOM Benchmarks

1-Applicant Pool

Benchmark: To maintain relative standing among Osteopathic Medical Colleges based on

the number of applicants.

2-Admissions Profile

Benchmark: Maintain or improve current admissions profile based on academic criteria such

as MCAT, GPA, or Colleges attended.

3-Academic Attrition Rates

Benchmark: To maintain or improve our current 3% Academic Attrition rate

4-Remediation rates (pre-clinical years)

Benchmark: A 2% a year reduction in the students remediating in pre-clinical years.

5-COMLEX USA Scores

Benchmark: Top quartile in the National Ranking of 1st time pass rate and Mean Score.

6-Students entering Osteopathic Graduate Medical Education (OGME)

Benchmark: Maintain or improve the current OGME placement.

7-Graduates entering Primary Care (PC) 12

Benchmark: Maintain or improve the current Primary Care placement.

8-Career Data -Licensure (within 3 years, post-graduate), Board Certification , Geographic

Practice, and Scholarly achievements.

Benchmark: TBD

12 Family Medicine, Internal Medicine, and Pediatrics

151

BIBLIOGRAPHY

Gonnella, J.S., Hojat, M., & Veloski, J.J. Jefferson Longitudinal Study of Medical Education.

Retrieved December 17, 2008, from http://jdc.jefferson.edu/jlsme/1

Hernon, P. & Dugan, R.E. (2004). Outcomes Assessment in Higher Education. Libraries

Unlimited: Westport, CT

152

APPENDICES

153

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

1 Assess Cranial Nerve I

– Olfactory

Examiner checks for

patient’s sense of smell by,

e.g. coffee, soap,

peppermint, orange peels,

etc.

2 Assess Cranial Nerve II

– Optic: Assessing Visual

Fields by Confrontation

􀂃 Examiner stands at

approximate eye-level

with patient, making eye

contact.

􀂃 Patient is then asked to

return examiner’s gaze

e.g. by saying “Look at

me.”

􀂃 Examiner starts by

placing his / her hands

outside the patient’s field

of vision, lateral to head.

􀂃 With fingers wiggling (so

patient can easily see

them) the examiner

brings his / her fingers

into the patient’s field of

vision.

Hands diagonal

Or, hands horizontal

􀂃 Examiner must ask the patient “Tell me when you see my

fingers.”

􀂃 Assess upper, middle and lower fields, bilaterally.

154

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

3 Assess Cranial Nerve II –

Optic: Accessing Visual

Acuity

􀂃 For ICC purposes,

handheld Rosenbaum

Pocket Screener (eye

chart)

􀂃 NOTE: Use handheld

Snellen eye chart if

patient stand 20’ from

the chart

􀂃 Ask patient to cover one

eye while testing the

other eye

􀂃 Rosenbaum eye chart

is held in good light

approximately 14” from

eye

􀂃 Determine the smallest

line of print from which

patient can read more

than half the letters

􀂃 The patient’s visual

acuity score is recorded

as two numbers, e.g.

“20/30” where the top

number is the distance

the patient is from the

chart and the bottom

number is the distance

the normal eye can

read that line.

􀂃 Repeat with the other

eye

155

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

4 Assessing Cranial Nerves II and III

– Optic and Oculomotor:

Assessing direct and Consensual

Reactions

􀂃 Examiner asks the patient to look into the

distance, then shines a light obliquely into

each pupil twice to check both the direct

reaction (pupillary constriction in the same

eye) and consensual reaction (pupillary

constriction in the opposite eye).

􀂃 Must be assessed bilaterally.

5 Assessing Cranial Nerves II and III – Optic

and Oculomotor: Assessing Near Reaction

and Near Response

􀂃 Assessed in normal room light, testing one

eye at a time.

􀂃 Examiner holds a finger, pencil, etc. about

10 cm. from the patient’s eye.

􀂃 Asks the patient to look alternately at the

finger or pencil and then into the distance.

􀂃 Note pupillary constriction with near focus.

Close focus

Distant focus

156

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

6 Assessing Cranial Nerve III

– Oculomotor: Assessing Convergence

􀂃 Examiner asks the patient to follow his / her

finger or pencil as he / she moves it in

toward the bridge of the nose to within about

5 to 8 centimeters.

􀂃 Converging eyes normally follow the object

to within 5 – 8 cm. of the nose.

7 Assessing Cranial Nerve III, IV and VI

– Oculomotor, Trochlear And Abducens:

Assessing Extra Ocular Muscle Movement

􀂃 Examiner assesses muscle movements in at

least 6 positions of gaze by tracing, for

example, an “H pattern” with the hand and

asking the patient to follow the hand with

their eyes without turning the head.

157

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

8 Assessing Cranial Nerve V

– Trigeminal (Sensory) Ophthalmic Maxillary

Examiner assesses sensation in 3

sites:

􀂙 Ophthalmic

􀂙 Maxillary

􀂙 Mandibular

􀂃 Examiner may use fingers,

cotton, etc. for the

assessment.

􀂃 Assess bilaterally.

Mandibular

9 Assessing Cranial Nerve V

– Trigeminal (Motor)

􀂃 Examiner asks the patient to

move jaw his or her jaw from

side to side

OR

􀂃 Examiner palpates the

masseter muscles and asks

patient to clinch his / her teeth.

􀂃 Note strength of muscle

contractions.

OR

158

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

10 Assessing Cranial

Nerve VII – Facial:

Motor Testing

Examiner asks patient to

perform any 4 of the

following 6 exams:

􀂃 Raise both eyebrows

􀂃 Close eyes tightly,

then try to open

against examiner’s

resistance

􀂃 Frown

􀂃 Smile

􀂃 Show upper and lower

teeth

􀂃 Puff out cheeks

Note any weakness or

asymmetry.

Raise eyebrows Opening eyes against resistance

Frown Smile

Show teeth Puff cheeks

159

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

11

Assess Cranial Nerve VIII

– Acoustic

Weber test – for

lateralization

􀂃 Use a 512 Hz or 1024

Hz turning fork.

􀂃 Examiner starts the fork

vibrating e.g. by tapping

it on the opposite hand,

leg, etc.

􀂃 Base of the tuning fork

placed firmly on top of

the patient’s head.

􀂃 Patient asked “Where

does the sound appear

to be coming from?”

(normally it will be

sensed in the midline).

160

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

12 Assessing Cranial Nerve

VIII – Acoustic

Rinne test – to compare

air and bone conduction

􀂃 Use a 512 Hz or 1024

Hz turning fork.

􀂃 Examiner starts the fork

vibrating, e.g. by

tapping it on the

opposite hand, leg, etc.

􀂃 Base of fork placed

against the mastoid

bone behind the ear.

􀂃 Patient asked to say

when he / she no longer

hears the sound

Mastoid Bone

􀂃 When sound no longer

heard, examiner moves

the tuning fork (without

re-striking it) and holds

it near the patient’s ear

and ask if he / she can

hear the vibration.

􀂃 Examiner must vibrate

the tuning fork again for

the second ear.

􀂃 Bilateral exam.

NOTE: (AC>BC): Air

conduction greater than

bone conduction.

Ear

161

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

13 Assessing Cranial Nerve VIII –

– Gross Auditory Acuity

􀂃 Examiner asks patient to

occlude (cover) one ear.

􀂃 Examiner then whispers

words or numbers into nonoccluded

ear from

approximately 2 feet away.

􀂃 Asks patient to repeat

whispered words or

numbers.

􀂃 Compare bilaterally.

OR

􀂃 Examiner asks patient to

occlude (cover) one ear.

􀂃 Examiner rubs thumb and

forefinger together next to

patient’s non-occluded ear

and asks the patient if the

sound is heard.

􀂃 Compare bilaterally.

162

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

14 Assessing Cranial Nerve IX

and X – Glossopharyngeal

and Vagus: Motor Testing

􀂃 First, examiner asks the

patient to swallow.

Swallowing

􀂃 Next, patient asked to say

‘aah’ and examiner

observes for symmetrical

movement of the soft

palate or a deviation of the

uvula.

􀂃 OPTIONAL: Use a light

source to help visualize

palate and uvula.

NOTE: sensory component of

cranial nerves IX and X is

testing for the “gag reflex”

Saying “Aah”

163

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

15 Assessing Cranial Nerve XI

– Spinal Accessory:

Motor Testing

􀂃 Examiner asks the patient to

shrug his / her shoulders up

against the examiner’s

hands. Apply resistance.

􀂃 Note strength and

contraction of trapezius

muscles.

􀂃 Next, patient asked to turn

his or her head against

examiner’s hand. Apply

resistance.

􀂃 Observe the contraction of

the opposite sternocleidomastoid

muscle.

􀂃 Assess bilaterally.

164

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

16 Assessing Cranial Nerve

XII – Hypoglossal:

Motor Testing

􀂃 First, examiner inspects

patient’s tongue as it

lies on the floor of the

mouth.

􀂃 Note any asymmetry,

atrophy or

fasciculations.

􀂃 Next, patient asked to

protrude the tongue.

􀂃 Note any asymmetry,

atrophy or deviations

from the midline.

􀂃 Finally, patient asked to

move the tongue from

side to side.

􀂃 Note any asymmetry of

the movement.

Inspect tongue Protruding Tongue

Side to Side Movement

165

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

17 Assessing Lower Extremities –

Motor Testing

With patient in supine position, test

bilaterally

􀂃 Test flexion of the hip by placing

your hand on patient’s thigh, and

ask them to raise his / her leg

against resistance.

􀂃 Test extension of the hip by

having patient push posterior

thigh against your hand

CONTINUED

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18 Assessing Lower Extremities –

Motor Testing

With patient in seated position, test

bilaterally

􀂃 Test adduction of the hip by

placing hands firmly between the

knees, and asking them to bring

the knees together

􀂃 Test abduction of the hip by

placing hands firmly outside the

knees, and asking patient to

spread their legs against

resistance

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19 Assessing Upper Extremities –

Motor Testing

􀂃 Examiner asks patient to pull (flex)

and push (extend) the arms against

the examiner’s resistance.

􀂃 Bilateral exam.

Flexion

Extension

20 Assessing Lower Extremities –

Motor Testing

􀂃 Examiner asks the patient to pull

(flex) and push (extend) the legs

against the examiner’s resistance.

􀂃 Bilateral exam.

Flexion

Extension

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21 Assessing Lower Extremities –

Motor Testing

􀂃 Examiner asks patient to dorsiflex

and plantarflex the ankle against

resistance

􀂃 Compare bilaterally

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22 Assessing the Biceps Reflex

􀂃 Examiner partially flexes patient’s

arm.

􀂃 Strike biceps tendon with reflex

hammer (pointed or flat end) with

enough force to elicit a reflex, but not

so much to cause patient discomfort.

OPTIONAL: Examiner places the thumb

or finger firmly on biceps tendon with the

pointed end of reflex hammer only.

􀂃 Reflexes must be assessed

bilaterally.

􀂃 Examiner must produce a reflex for

credit.

OR

23 Assessing the Triceps Reflex

􀂃 Examiner flexes the patient’s arm at

the elbow, and then taps the triceps

tendon with reflex hammer.

􀂃 Reflexes must be assessed

bilaterally.

􀂃 Examiner must produce a reflex for

credit.

170

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24 Assessing the Brachioradialis

Reflex

􀂃 With the patient’s hand resting

in a relaxed position, e.g. on a

table, his / her lap or supported

by examiner’s arm, the

examiner strikes the radius

about 1 or 2 inches above the

wrist with the reflex hammer.

􀂃 Reflexes must be assessed

bilaterally.

􀂃 Examiner must produce a reflex

for credit.

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25 Assessing the Patellar Tendon Reflex

􀂃 First, patient asked to sit with their legs

dangling off the exam table.

􀂃 Reflexes assessed by striking the

patient’s patellar tendon with a reflex

hammer on skin.

􀂃 Reflexes must be assessed bilaterally.

􀂃 Examiner must produce a reflex for

credit.

OPTIONS:

􀂃 Examiner can place his / her hand on

the on patient’s quadriceps, but this is

optional.

􀂃 Patient’s knees can be crossed.

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25 Assessing the Achilles

Reflex

􀂃 Examiner dorsiflexes the

patient’s foot at the ankle

􀂃 Achilles tendon struck with

the reflex hammer on skin,

socks completely off

(removed at the direction

of the examiner).

􀂃 Reflexes must be

assessed bilaterally.

􀂃 Examiner must produce a

reflex for credit.

173

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26 Assessing the Plantar, or Babinski,

Response

􀂃 Examiner strokes the lateral aspect of

the sole from the heel to the ball of

the foot, curving medially across the

ball, with an object such as the end of

a reflex hammer.

􀂃 On skin, socks completely off

(removed at the direction of the

examiner).

􀂃 Assessment must be done bilaterally

􀂃 Note movement of the toes (normally

toes would curl downward).

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27 Assessing Rapid

Alternating Movements

Pronate Supinate

Examiner must do all three

assessments for credit:

􀂃 Examiner directs the

patient to pronate and

supinate one hand

rapidly on the other.

Touching Thumbs Rapidly 􀂃 Patient directed to

touch his / her thumb

rapidly to each finger

on same hand,

bilaterally.

Slapping Thighs Rapidly

􀂃 Patient directed to slap

his / her thigh rapidly

with the back side of

the hand, and then with

the palm side of the

hand, bilaterally.

175

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©2009 New York College of Osteopathic Medicine 011509

29 Assessing Finger-to-Nose

Movements

􀂃 Examiner directs the patient to touch

the examiner’s finger with his or her

finger, and then to place his or her

finger on their nose.

􀂃 Examiner moves his / her finger

randomly during multiple movements.

176

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30 Assessing Gait

Examiner asks patient to perform the

following:

Walk, turn and come back

􀂃 Note imbalance, postural asymmetry,

type of gait (e.g. shuffling, walking on

toes, etc.), swinging of the arms, and

how patient negotiates turns.

Heel-to-toe (tandem walking)

􀂃 Note an ataxia not previously obvious

Shallow knee bend

􀂃 Note difficulties here suggest

proximal weakness (extensors of

hip), weakness of the quadriceps (the

extensor of the knee), or both.

177

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31 Performing the Romberg Test

􀂃 Examiner directs the patient to stand

with feet together, eyes closed for

at least 20 seconds without support.

􀂃 During this test, examiner must stand

behind the patient to provide support

in case the patient loses his / her

balance.

32 Testing for Pronator Drift

􀂃 Examiner directs the patient to stand

with eyes closed, simultaneously

extending both arms, with palms

turned upward, for at least 20

seconds.

􀂃 During this test, examiner must stand

behind the patient to provide support

in case the patient loses his / her

balance.

178

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SPECIAL TESTING

1 Sensory Testing

􀂃 First, examiner

demonstrates what

sharp vs. dull means by

brushing the patient

with a soft object, e.g. a

cotton ball or smooth

end of tongue

depressor, and a semisharp

object, e.g.

broken end tongue

depressor.

􀂃 Examiner performs this

test on arms and legs

bilaterally by randomly

brushing the patient’s

arms and legs with the

soft and semi-sharp

objects, e.g. a cotton

ball, semi-sharp object,

etc..

􀂃 Patient directed to keep

his / her eyes closed

during the examination

as he or she identifies

sharp vs. dull on skin.

􀂃 Bilateral exam, upper

and lower extremities.

179

TASKFORCE MEMBERS

John R. McCarthy, Ed.D. Associate Director, Clerkship Education

Pelham Mead, Ed.D. Director, Faculty Development

Mary Ann Achziger, M.S. Associate Dean, Student Affairs

Felicia Bruno, M.A. Assistant Dean, Student Administrative

Services/Alumni Affairs/Continuing Education

Claire Bryant, Ph.D. Assistant Dean, Preclinical Education

Leonard Goldstein, DDS, PH.D. Director, Clerkship Education

Abraham Jeger, Ph.D. Associate Dean, Clinical Education

Rodika Zaika, M.S. Director, Admissions

Ron Portanova, Ph.D. Associate Dean, Academic Affairs

180

Featured

The Future of the College, Secondary and Elementary Classroom 2020+.

Due to the coronavirus Education in College and other levels will never be the same. Protection against the coronavirus and future pandemic viruses will require Social Distancing and the wearing of face masks to prevent spreading of a virus from one student to another or to the teacher. I have a solution for Elementary, Secondary and College schools to still have classrooms with live students instead of complete online courses. The average Secondary school grades 7-12 usually has 32 student except in some States it may rise to 45 in a classroom to one teacher. To allow for social distancing in the future the number of students in a classroom is going to have to drop from 32 to half that amount or 16 students.

This change would impact the Teacher contracts and agreements with the teacher Unions. Instead of having 8 classes a day of which teachers teach five, the new norm will be twice that number or 16 short classes a day. Short classes would be twenty minutes long instead of the usual 50 minutes. Teachers will have to teach ten short classes a day. Department chairpersons who use to be excused for teaching several classes a day would have to return to a full teaching regiment of 16 classes a day.

Online in school classes can be made available to help make the new curriculum easier to apply. Music auditoriums are the largest room in most schools next to the gyms. In auditoriums student could sit every other seat for social distancing with their own laptop or iPad and log on to the online course they were assigned for that period.

Lunch or cafeteria would have to change to allow social distancing . Every other seating might not work, so chairs might have to be placed in hallways near the cafeteria. Schools in warm climates could have an expanded outdoor picnic area with plenty of extra permanent seating installed.

Online course can supplement in class courses with support and guidance after school at home.

In College money walks and money talks. College Presidents will be tempted to go the all class online route to save massive amounts of money, while at the same time charging tuition to students who log on from home. Dormitories could become problem as the students at UCSD have complained, “why should they pay for a dorm or apartment when they can log on from home? At the NY College of Osteopathic medicine where I worked as. Director of Faculty Development and Assessment they had streaming for all lectures. The lucky thing is that only had two lectures going on at the same time. If a University were to apply instant streaming of all lectures and classrooms the cost would be prohibited due to the need for massive computer server storage space. The down side of streaming other than cost is that the students did not come to the lectures and instead remained at home with a cup of coffee and a donut. The administration at the NY College of Osteopathic medicine could not figure out how to get the students to attend the lectures. The solution was simple. Stop streaming the lectures and handing out of lecture notes in advance. Online course can be bought from third party companies or developed over time with the existing faculty. The problem there is intellectual property rights. Does the Professor had full rights to the classes and curriculum they write and teach or does the University or College have the full property rights to the recorded video copies of the lectures? That depends on the employment contract the Professors sign when they are hired. If they agree to give the University or College full legal rights to replay a Professor’s lectures for eternity than the Professor has no rights. Online courses save Colleges and Universities millions of dollars by not having to provide classroom space or pay a live professor to teach the course.

Some Universities provide a Professor at the beginning of the course and at the end for the final exam and the rest of the course is online. Blackboard is an online administrative system that I was certified and trained in that makes online teaching easy with computer testing, online grading reporting, lock boxes to record when an assignment is handed in onetime and the full curriculum can be posted in advance. Some textbook companies will provide the full text of their books to be uploaded to Blackboard for students to read and not have to pay for an expensive textbook.

Obviously the human interaction between student and teacher is going to suffer. There might be a decline in Teachers due to the new non personal online teaching approach? One big glitch is what happens when the servers go down? No server, no internet, no classrooms broadcast. Hacking will be a major problem and colleges, schools and universities will have to learn how to protect their online systems.

E-mailing a professor is always going to be risky if the student can upload a virus or deliver a link or app that tracks a Professors keyboard. Protected institution e-mails are the only way to prevent this.

Will the online system come the fall of 2020 be good? Probably not because schools have not had the time to train their teachers how to teach online. Early Kindergarten and first grade students will need software that is good for their age level. Who is to pay for these iPads or laptops, the district or college or the student. Many students come from poor families that cannot afford an iPad. They will need financial assistance to secure an iPad and the training how to use one on cds or dvds.

The shorter class time is actually a plus for student with a short attention span. It makes teaching more concentrated. Teachers tend to blab a lot and this will teach them to be concise. Online projects must be completed in 20 minutes.

Physical Education is more essential than ever as an outlet from being cooped up all day and for character development. Online instruction is not a good venue for character development. Good sportsmanship carries over into adult life and provides guidelines for interaction with others in sports. Learning to lose as well as win and profit from losses to eventually win says a lot about Physical Education. We live in an age of overeating students who are so obese they cannot do many things like run or hike. They run out of breath when walking or riding a bike. They are made fun of by their peers. Physical Education will teach students what they cannot learn on a computer. Live body practice is a great way to teach a person’s muscles how to coordinate a skill or sport. Just watching on a computer is not the same. Muscles have memory and the more you repeat a skill, the better you become using that skill.

This is only the beginning of the discussion. Next time the mathematics of setting up a school master schedule with 20 minute classes and 16 sections a day.

Dr. Pelham Mead, June 2020

A Quick Guide to Colleges and Universities how to Apply for U.S. Department of Education Title V and Title III grants.

By Dr. Pelham Mead

I had the good fortune to work on a Title V Hispanics Serving Institutions grant for five years and this is what I learned.

The Title V Grant is limited to Public and Catholic Universities and Colleges that have more than 25% of Hispanic Student enrolled. South Pacific students are allowed to be included. The grant I worked on was for. small Catholic College in the Bronx that had fallen behind the times technology-wise. They got 1.1 million dollars over five years. A Dean of Students wrote the grant but left on medical leave and never came back.

In order to apply for a Title V grant a College has to get together two or three head administrators and Professors to lay out the needs and goals of the College. The proposal has to start the year before with submission before Dec. of the year. The awards are announced June of the following year and go into existence on Oct. 1st the beginning of the Federal year.

It is a good idea to go on the Federal US Dept. of Education web online and read some of the past College and University submissions and copy some of the approaches.

The Title III Federal grant is for larger Universities of ten or twenty thousand or more and is highly competitive because large universities can hire top notch grant writers to target this grant. I began this job as The Senior Instructional Technologist of a Title III technology grant to upgrade the faculty in instructional technology and establish a new Faculty Training Lab in the Library building. St. Johns University where I was hired won 2.5 million dollars for five years. Actually, they were denied at first and went on a weekend seminar to study how they could improve their grant proposal. In the middle of the weekend they got a call that a University that had won had turned the grant down because it did not have the original grant people on board anymore. I tutored 55 professors in technology in the classroom, electronic whiteboards, pod casting and video taping lectures as well as MS Suite programs Powerpoint using animation and sound effects to bring the presentations alive. Blackboard was a big help in starting online courses which were rare in 2006. Obviously, the same application rules apply for Title III by applying the year before. Let me make that clearer. Getting the writers and source people together is the first difficult task. Putting down a list of College or University needs takes even longer and then committing to specific goals and hiring people that can do the job is also difficult.

When Two other professors and I wanted to write a Title V supplemental grant called a Cooperative grant we started in the spring of 2003 and submitted our Grant Proposal at the last minute because we had to make five copies and deliver them to Washington before the deadline. We were rejected but the reviewer told us where we needed to improve on the grant and we stated all over and re-submitted for $600,000 the next year and won. What a relief? Now we had to train Faculty from the Manhattan Community College a block from the World Trade Center. Their Nursing Faculty came to our campus for a one week seminar to train with our highly trained Nurse staff. It made for a good student feed from their two year college to our four year college.

Consider Mobile Learning for the Future.

We have the device right there in our hands, the iPhone or similar electronic phone. With the capability of logging onto the internet almost any student will be able to download information with having to go to the school library.

The personal touch of a motivating teacher will now be with a canned online lecture or a daily project to look up and write a response. In Biology you get a self learning chart with step by step reading assignments and then Unit tests online. If you fail, then you go back and repeat your mistakes by correcting them.

Perhaps 3-D visualization will become an invention of the future which will help students learn at home.

The teacher of the 21st Century has to adapt to change of teaching format, Time schedule, online teaching and controlling students properly so s not to burn them out.

Learning is what students allow to enter their brain. Their preconceived notions mislead students as to what to study most. Questionnairs for a community needs study can b complicated.

The Mechanics of Developing Online Courses

By Dr. Pelham Mead

With the sudden onset of the coronavirus schools and Colleges have been thrown into chaos by the necessity of using online courses to avoid virus infections. Ten years ago I was tell College Professors that Online Courses were the future for Education. They presented an economically cheaper way for Universities and Colleges to deliver courses with no overhead for classes and instructors running courses instead of PHD Professors. The Professors did not believe me. At St. Johns University the Professors were afraid to do Podcasts because they thought that the University would record their lectures for future use and eventually replace them with their own lectures. Well canned aonline courses may well seem good to avoid a virus and cheaper to run in the long run but their are many short comings. Students at US San Diego recently challenged their University as to why they should pay for Dorms when they do not need to be on campus for classes. They can dial up their classes from home and not have to pay the dorm fee. The second valid object the students had was why should they pay for classes where they never get to meet or talk with the Professor? Paying for a highly experience PHD or EDD Professor is one thing, but getting an instructor that does not have a Masters or Doctoral degree on the subject being taught cheapens the product. The UC San Diego University at this time, June 2020 is holding steadfast to the principal that all classes will be online this fall despite the fact that the students may decide to drop out instead of paying for canned online courses and paying for a dorm they do not need.

So how does a Professor develop an online course? To begin with they have to accept the fact that in person teaching with a blackboard and or project is not the same as teaching online. For online course lecturing and Powerpoint slide shows alone does not work. The NEW emphasis online is projects and the flipped classroom as it is called. Instead of the Professor spoon feeding the students in a live class, the emphasis changes to here is a task, solve it briefly and cite your references and return it to me in a timely fashion. Putting Assignments on a TIME basis changes the game greatly and requires active participation of the students online, whereas in a class a student could be dreaming or just taking mindless notes. For Instance in a Literature Course Studying Robert Frost and the Poem, “The Road Not Taken.” Students after you read Robert Frost’s Poem called, “The Road Not Taken,” what is the theme of the poem? How would you apply the meaning of the poem to your life in 100 words or less. You have one hour to finish this task. When you are done, send the Essay to my mailbox on Blackboard. This is a Lockbox remember which tells me what day and time your entered the mailbox with your assignment and your name and class section. If your assignment is late it will cost you one grade level penalty, so don’t waste time. I will be online in one hour.

A creative approach to a project is to assign two student to work together on one assignment. Let’s say the course is, “World Politics.” You discuss in an online Powerpoint briefly that status of NATO with regards to America. The question is, “Is President Trump right about NATO and that American is carrying them and paying all the fees? Second question should NATO allow Russia to join as President Trump has suggested?

Find Exact quotes and sources and cite them, however based on other sources state your informed opinion about NATO today and whether American should withdraw or what. Be specific and keep your project to two pages of 250 words maximum. You may add a Biblio at the end of one additional page of the current sources both or you found and used in your report.

Online teaching is all about the teacher as a Coordinator rather than a lecturer. Students can learn by themselves. They just need direction from the online teacher. Chat rooms can add to the positive motivation for a course. Immediate feedback is a vital success item. Friendliness on line is most important. For some reason because Students think they are anonymous they can be rude online to the instructor. This is a big mistake. Just because an Instructor is using Zoom or FaceTime or whatever online platform they have available doesn’t mean civility goes out the window. I have seen from experience that students for some reason forget this and they ending up with a backlash from the instructor. Some students feel their opinion is more important than the instructors opinion and end up being forced to drop the course by the instructor.

Some Universities will overcrowd an online class with 40 students which means the response rate will slow down from the Instructor because of the large class membership. The magic number for an online course is under 20 students to make it manageable.

To be continued.

Teaching Senior Faculty How To Use Technology in their classrooms.

By Dr. Pelham Mead, D.Ed.

My job listing at Colleges and Universities is called an Instructional Technologist. Originally, the

job was called a Staff Developer in the 1990’s. The demand for more technology created a void

of people to be able to both repair desktop and laptop computers and to be able to teach

educators how to use the software.

Early on Universities learned that you cannot just buy new computers and drop them in

Professors laps and expert them to learn how to use them and the software contained in the

computers. Hence, the development of the Instructional Technologist like myself who can show

Professors how to use their computers in classroom instruction and research and understand

how the various software programs work.

I was fortunate to have worked at several colleges and universities over 12 years that received

Federal funding grants for staff and technology improvement. The majority of the faculty at St.

Johns University, The College of Mount Saint Vincent, and New York University where I worked

funded by grant programs were in the 60’s and 70’s and one in his 80’s.

One faculty member of the Biology department of St. John’s university taught 100 Freshman

non-Biology students on an adjunct professor status. The pass/fail rate in his classes were well

below average for the University. He was recommended by the Biology Department chairmen

to me in the Faculty Training Lab which I was the Senior Instructional Technologist sponsored

by a 2.5-million-dollar five-year grant from the U.S. Department of Education.

When I first met this professor, I was surprised to learn the he was 83 years old and could speak

five different languages. As a standard procedure when I begin working with Senior Faculty

(Over 60) I interview them to determine their needs and technical ability, so I can plan an

individualized tutorial program to match their needs. This Senior Professor was a very likeable

man, but he had no concept of technology. He taught all his classes with chalk and blackboard

in a lecture hall designed for two hundred students. Students at the back of his classes must

have had binoculars to see the writing on the blackboard. He never took any questions in his

class and when the lecture was over he left immediately. I could see this situation was going to

be a challenge. I set up a schedule for us to meet twice a week at 10:00 a.m. I gave him a new

Lenovo Laptop with his name and password on it which I showed him how to use.

The first lesson he forgot to bring his laptop so we used another laptop instead. I tried to show

him how to open the Microsoft Powerpoint program which most younger professors used to

lecture their classes. Powerpoint is a slide show where the Professor can include titles and

information against a graphic or table. He had never seen Powerpoint before, so I showed him

how it worked. We made ten slides and I showed the small show we developed on the

electronic screen we had in the Faculty Development Lab. He was amazed, but thought it was

too entertaining and not educational. I gave him an assignment for the next lesson to make a

small five slide show based on part of any of his Biology lectures and he agreed he would try.

The second lesson the Senior Professor was late to his lesson. He was very late in fact by 30

minutes. I thought he forget his lesson and decided to go to the bathroom while I waited for my

next professor in a few hours. When I entered the men’s bathroom I was shocked to see the

Senior Professor hiding behind the bathroom door. Professor I exclaimed! How are you? Did

you remember you had a technology lesson with me today? Timidly he admitted that he was

afraid to come to his tutorial because he was too old and too stupid to learn computers and

software. It was then that I realized the greatest deterrent to Professors learning computer and

software was FEAR. Professors in their 60’s, 70’s and 80’s had skipped the technology

generation. Their strength was in the old-fashioned ways of chalk and blackboard for lectures.

I encouraged the Senior Professor to come to his lesson and I would go slowly with him. He

agreed and followed me back into the Faculty Development lab.

From that point on I was especially sensitive to the age of the Professor in their tutoring

programs.

Another Professor who was 72 at the time and taught Latin at St. Johns and was Director of the

Student Honors Program right next to the Faculty Development Lab was enrolled with 12 other

faculty in a “Technology Summer Camp program.” In this program which I created and

organized the professors gave up a week of their time to learn technology on a more

concentrated approach. They came in before 9:00 every morning and coffee and treats were

available for them. On the electronic white board in the background was several samples of

methods of animation in Powerpoint for lectures and how to create educational games during a

lecture to involve student participation. At 12:00 every day we had a catered lunch and social

interaction as I floated around working individually with every professor. By 3:00 everyday they

were done with various projects, games, animation, podcasts, etc. The 72-year-old professor

suddenly burst out the second day of the Technology Summer Camp and began screaming and

shouting he could not do this or that and it was all too difficult. Everyone turned to me to do

something. I tried to escort the 72-year-old professor out of the room to get him to calm down.

After much discussion, I managed to get him to go out into the hallway where we sat down in

two study chairs. “What is going on Professor? I asked.” “This is all really too hard for me. I am

too old. I cannot remember things as well as I used to,” he said. I responded, “You don’t want

to tell the University that or they will retire you on the spot. Everyone is different I told him and

no two people learn the same way every time. This Is what I am going to do for you Professor.

I am going to let you take an hour off to calm down and get yourself together and then during

the lunch break I am going to work with you in your office instead of the lab and slowly walk

you through the projects.” He thanked me on the edge of tears.

That day during lunch time I excused myself and went into the 72-year-old professor’s office to

work on the assignments. I was most grateful. This special approach worked and the next

morning he was early and eager to get started. His project was to create a game where his

students had to identify in Latin, graphics or pictures of something from the Story of Ulysses.

When the last day came for all the Professors to show off their projects, the 72-year-old

professor had the best Powerpoint slide show with full blown graphics of Greeks and historical

aspects of Greek stories in Latin. The entire room clapped when the 72-year old’s slide show

and class game came to an end. Everyone loved trying to identify the graphic or pictorial clue

with the Latin name. I made a life-long friend that week of that 72-year-old professor. He

learned to love technology he asked if he could teach in the Faculty Learning Lab in the morning

three times a week with his Latin classroom. At first I was about to say no because it would

overlap with my teaching schedule at 9:00. As it turned out his class was at 8:00 am and there

was no conflict. I told him I would ask for approval from the Provost and she agreed that it

would be fine, so he began to teach in the Faculty Learning Lab. Wow, did he put on a show?

When the students arrived each morning, he had classical music playing in the background. He took my suggestion to use a U-shaped table arrangement so that he could walk up and down the middle of the U shape to engage students face to face. His laptop provided a slide show or

One, Two, Three Approach to Teaching

by Dr. Pelham Mead, June 2020

With the coronavirus forcing change in the educational system in the USA and around the World, new solutions need to be applied. Here is a theoretical approach that I a teachers of 45 years experience would recommend. I call this method the one, two, three approach. One is for the Teacher involved in educating the student. Two is for the Support person or new position called a Counselor for Learning and Three is the Parent. Let me begin with the obvious three prong approach, the teacher. Teaching is more than lecturing and notes on the blackboard. Teaching is about motivating a student to read and do more than the facts taught. Learning concepts and applying them. Using facts to solve real life problems and challenges. The second position is the Counselor for Learning. This is not the traditional guidance counselor, but a professional that guides students through home assignments and projects. In addition they spend some time listening to student problems and life challenges, disagreements with parents, etc. Position number three is the parents who is the past have seen schooling as baby sitting while they work. Parents for the last few decades no longer share their child’s learning and assignments. They are too busy. They cannot understand modern Math and they do no read to keep ahead of new issues. It is the role of the Parent to provide a learning environment at home by having magazines available to read, shutting down the TV for study time, limiting video games and student addiction to fantasy shooting games with Nazis always being the bad guys. Parents that are involved with their children’s learning are the one that will have the most success. The problem in minority homes is there is no one but grandma around to teach the children anything. Alcohol in minorities and drug abuse in rich families have a direct effect on student learning.

Support institutions suc.h as temples and churches play a role in character development don’t forget. Community centers and after school sports teach good sportsmanship and positive qualities in competition. The real world is all about competition and whatevr a child can learn at a young age about dealing with competition and enjoying the challenge carries over to a work ethic. There are no free lunch in the real world. Students must learn to research, read, and apply reading lessons to real life development.

The One, Two, Three approach is pure theory, but not far from reality. Perhaps we should try it?

Pandemic and How A Virus can change Society.

by Dr. Pelham Mead

Stay indoors, isolate, social distancing, what the hell is going on in society today?

When one country drops the ball the rest of the Earth pays the price. China does it again by eating every creature on the Earth be killed for food. Bugs, frogs, birds, slugs, when does it every learn?

So the Virus comes to modern cities and what happens? No one is prepared. Even the CDC is caught with it’s pants down. As for President Trump he was watching cartoons on TV when someone told him that there was a bad virus in China. He never paid attention until Feb. rolled around.

Then it was too little too late. The virus swept across our nation like death wind.

For all our modern technology we were caught in out-sourcing and did not have enough ventilators which went from $25,000 each to $50,000 each. No masks or gowns for hospital workers, what a disaster.

Now we all sit in home looking out the windows. Our President is busy lying about his mistakes and shouting at women reporters. The best thing that could have happened is if he and Pence got the virus. Then they would know the pain that others have suffered.

What happened in 2020 should never happen again. We learned the hardware that we are unprepared for a pandemic or flu or virus attack on a large scale.

UNPREPARED….the opposite of the Boy Scout motto- Be Prepared.

The Fairy Tale Adventures of Tom Wolf

by Dr. Pelham Mead

THE FAIRY-TALE ADVENTURES OF TOM WOLF
Written by
Dr. Pelham Mead III
(c) 2015
ACT ONE- BEDLAM HOSPITAL, LONDON, 1800’S.
INT. -POEM-DAY.
TOM O’ BEDLAM
1800’s Poem By Anonymous
Note: The poem is to be read by a narrator with a deep voice and slowly with emphasis.
From the hag and hungry goblin
That into rags would rend ye,
The spirit that stands by the naked man
In the Book of Moons defend ye,
That of your five sound senses
You never be forsaken,
Nor wander from your selves with TOM
Abroad to beg your bacon,
While I do sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
Of thirty bare years have I
Twice twenty been enragèd,
And of forty been three times fifteen
In durance soundly cagèd
On the lordly lofts of Bedlam,
With stubble soft and dainty,
Brave bracelets strong, sweet whips ding-dong,
With wholesome hunger plenty,
And now I sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
With a thought I took for Maudlin
And a cruse of cockle pottage,
With a thing thus tall, sky bless you all,
I befell into this dotage.
I slept not since the Conquest,
Till then I never wakèd,
Till the roguish boy of love where I lay
Me found and stript me nakèd.
And now I sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
When I short have shorn my sow’s face
And swigged my horny barrel,
In an oaken inn I pound my skin
As a suit of gilt apparel;
The moon’s my constant mistress,
And the lowly owl my marrow;
The flaming drake and the night crow make
Me music to my sorrow.
While I do sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
The palsy plagues my pulses
When I prig your pigs or pullen,
Your culvers take, or matchless make
Your Chanticleer or Sullen.
When I want provant with Humphrey
I sup, and when benighted,
I repose in Paul’s with waking souls
Yet never am affrighted.
But I do sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
I know more than Apollo,
For oft, when he lies sleeping
I see the stars at bloody wars
In the wounded welkin weeping;
The moon embrace her shepherd,
And the Queen of Love her warrior,
While the first doth horn the star of morn,
And the next the heavenly Farrier.
While I do sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
The gypsies, Snap and Pedro,
Are none of TOM’s comradoes,
The punk I scorn and the cutpurse sworn,
And the roaring boy’s bravadoes.
The meek, the white, the gentle
Me handle, touch, and spare not;
But those that cross TOM Rynosseros
Do what the panther dare not.
Although I sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
With a host of furious fancies
Whereof I am commander,
With a burning spear and a horse of air,
To the wilderness I wander.
By a knight of ghosts and shadows
I summoned am to tourney
Ten leagues beyond the wide world’s end::
Methinks it is no journey.
Yet will I sing, Any food, any feeding,
Feeding, drink, or clothing;
Come dame or maid, be not afraid,
Poor TOM will injure nothing.
FADE IN:
EXT. -RAINY NIGHT-NIGHT.
NARRATOR:
It was a dark and gloomy night as the horse and carriage traveled over the cobblestones of Moorfields in London, England. There was a crescent moon that night that lit the pathway to St. Mary of Bethlem hospital, also called Bedlam. It was a notorious mental hospital having been rebuilt in the late seventeenth century. As the carriage entered the grounds of St. Mary of Bethlem Hospital, the crescent moon shown on the two human statutes of wracked with suffering named “Melancholy,” and “Raving Madness,”near the peak of the main building. The statute called “Melancholy” appeared with a blank, and vacant stare lying sideways and naked. “Raving Madness” the second human statute is bound in chains and shows fury on it’s face as it lies naked in the night.
The massive size of Bedlam was most impressive, as it stretched on for many meters. The horse and black carriage entered the half circle path in front of the main building. The driver and his assistant got down from their bench on the carriage, and unlocked the door of the carriage. Inside was a decrepit man bound in chains and dressed in rags. His hairy arms and legs stood out like a fur coat. His face was contorted, and hairy with a full black and grey beard. His eyes were dark and small. He howled with pain from the shackles and chains. The driver and his assistant dragged the poor wretch from the carriage up the marble steps to the main building at Bedlam Hospital.
Crashing through the doors the men dragged the poor chained man into the huge lobby which was surrounded with pictures of famous doctors who had served at St. Mary of Bethlem Hospital before.
FADE IN:
GEORGIE, BEDLAM ATTENDANT (40)(DRESSED IN A WHITE LAB COAT WITH LONG BLACK HAIR AND A MUSTACHE).
How may I help you gentlemen this evening?
MARKS LEBLUE, CARRIAGE DRIVER (50)(DRESSED IN A BLACK RIDING COAT AND BOOTS. STANDING SIX FEET TALL WITH A BLACK WIDE BRIMMED HAT AND GLASSES).
Aye, you may. We have here a prisoner from the public jails who seems to have lost his mind. He claims he is a wolf and howls all night long. We have been asked to remove him from the London prison and take him here for evaluation as to his mental condition.
BEDLAM ATTENDANT
What is his name?
CARRIAGE DRIVER
I believe his name is TOM Wolf or that is what he told us?
BEDLAM ATTENDANT
Alright, I will put his name down as TOM Wolf. How old is the prisoner? Ummm patient that is?
CARRIAGE DRIVER
We don’t know, but we estimate him to be in his forties.
BEDLAM ATTENDANT
Where does the patient live?
CARRIAGE DRIVER
We do not know. He was found drunken in an alley in London.
BEDLAM ATTENDANT
Well then, let’s take the chains off of him and put him in a room for the doctor to examine TOMorrow morning.
CARRIAGE DRIVER
Give me a hand in unlocking these locks on these chains. Easy, that is it. They are all removed.
BEDLAM ATTENDANT
Thank you. Now let’s take him to his room for the night. We will give him a shower and de-lice him TOMorrow when we have more attendants on staff.
CARRIAGE DRIVER
Aye, let’s throw him in this room. He is heavy and my partner and I are tired. Be gone with him now.
The carriage driver and his assistant dragged the unchained wretch to a room with a thick metal door with a small window. They open the door and throw the wretch into the room.
CARRIAGE DRIVER
Our job is done. The hell with ya. We are in need of a drink at the pub. Goodbye to ye.
BEDLAM ATTENDANT
I will lock the room. Thank you for coming this late at night. The patient will be fine here I am sure. Dr. Von Hess will see him in the morning.
TOM WOLF (40’S)(A VERY HAIRY FACE AND LONG NOSE AND BEADY EYES WITH GREY AND BLACK COLORING).
Ahhhh, my ribs are killing me. Someone help me. Is there anyone there? Help, help.
FADE OUT.
INT.- THE FIRST INTERVIEW-DAY.
After a long night of sleeping on the floor TOM Wolf awakens to find himself locked in a room with a steel door and a tiny window high above the floor with bars on the window. The sun is creeping through the window bars and casting a shadow on the floor. TOM looks at the stark dirty white walls with cracks running through them and roaches running everywhere on the floor. There is a rusty drain on the floor in the middle of the room and a privy seat in the corner. Suddenly, a man dressed in white knocks on the door.
BENJAMIN MEDLEY HOSPITAL ATTENDANT (30’S)(A TALL BLACK MAN WITH A BEND OVER SPINE AND SHORT BLACK HAIR).
Up and at ‘em lad. Doctor Von Hess wants to see ya. Come on get up now.
TOM WOLF
Where am I?
BENJAMIN MEDLEY HOSPITAL ATTENDANT
You are in St. Mary of Bethlem Hospital called Bedlam for short. Come let me help you get up. Easy now. Stand up. That is good. Now let us good and see the Doctor. After you meet with the Doctor you will get breakfast porridge.
TOM WOLF
My legs are killing me from the chains. Why am I here? All I did was have a few drinks at the local pub.
BENJAMIN MEDLEY HOSPITAL ATTENDANT
Never ye mind. Come lad and let’s talk with the Doctor. Doctor Von Hess this is the new patient brought in last night from the London jail. His name is TOM Wolf.
DR. SAMUEL VON HESS (50’S)(SPOKE WITH A GERMAN ACCENT, AND WORE RIMLESS GLASSES AND HAD SIDEBURNS TO HIS JAW).
What is your name lad?
TOM WOLF
TOM, TOM Wolf.
DR. SAMUEL VON HESS
Wolf is it. TOM Wolf, is that right? Where were you born Mr. Wolf?
TOM WOLF
I do not know. Why am I here?
DR. SAMUEL VON HESS
No need to get upset. Perhaps after you have had some porridge you will feel better? Attendant take this patient back to his room and give him a bowl of porridge and some water.
BENJAMIN MEDLEY HOSPITAL ATTENDANT
Yes, Doctor Von Hess. Right away sir.
TOM Wolf is taken back to his room and given a small bowl of porridge and a small jug of water.
BENJAMIN MEDLEY HOSPITAL ATTENDANT
Here is your porridge and water. I will come back in a few hours to take you to Doctor Von Hess again.
DR. SAMUEL VON HESS
(Speaking to another attendant) Let’s give Mr. Wolf a sedative to calm him down. I will meet with him again this afternoon.
2ND BEDLAM ATTENDANT (40)(A SHORT NONDESCRIPT MAN WITH HORN RIMMED GLASSES UNDER SIX FEET TALL AND OVERWEIGHT).
Yes, sir. I will take the pill to him right away.
Later that day.
BENJAMIN MEDLEY HOSPITAL ATTENDANT
TOM it is time to visit with Dr. Von Hess again. He wants to see what is bothering you. Can you walk by yourself?
TOM WOLF
Yes, thank you. I am feeling less dizzy now. I can walk on my own.
BENJAMIN MEDLEY HOSPITAL ATTENDANT
Let’s go see the Doctor then. (A few minutes later) Doctor Von Hess, Mr. Wolf is back to see you again.
DR. SAMUEL VON HESS
Welcome back Mr. Wolf. How are you feeling now? I gave you a pill to make you feel better. Are you more relaxed now? I will have a nurse bandage those sores on your wrists and ankles from the irons and chains. Now let’s talk about your previous life and why you are here. The jail guards said they you told them that you were a wolf in real life. But your name is Wolf. Was there some misunderstanding here?
TOM WOLF
No, Doctor. I was once a wolf that prowled the forests of England.
DR. SAMUEL VON HESS
Really? How is that possible. You seem very human to me. Where are your wolf teeth and wolf face with the long nose?
TOM WOLF
It is a long story.
DR. SAMUEL VON HESS
Well I have all the time in the world. Tell me Mr. Wolf how it is that you think you were at one time a wolf. Are you a Werewolf by any chance?
TOM WOLF
No, Just a plain old wolf who lived in the woods.
DR. SAMUEL VON HESS
How is you know yourself to be a wolf in another life?
TOM WOLF
It all began when I was a Wolf and I met a rich family called the Swine family who live on a hill near my town. The father was named William Swine and his wife Julia had triplets called Sam, Sally and Sanford Swine. I sold farms for a living and I came to know the Swine family when William Swine was very old and fearful of dying soon. He told me he made out a will to give his riches to one of his three triplets who showed him the best business sense in buying a farm and building a new manor house on it. He asked me to help his children find the land they needed to build their manor house.
DR. SAMUEL VON HESS
Did not Mr. Swine feel strange dealing with a wolf?
TOM WOLF
Not at all. I was a wolf but respected in the community because I did not eat or kill sheep or children. Most of the towns people trusted me.
DR. SAMUEL VON HESS
I see. That is strange?
TOM WOLF
The first triplet I met was Sam Swine who was in his twenties at the time. I showed Sam a farm that used to raise wheat and straw of 200 acres. The farm was hundreds of miles from the brick factory or the hills where the stone quarry was. Sam Swine bought the 200 acres cheap because the farm was so far away from the town or the brick mill.
DR. SAMUEL VON HESS
What did Sam Swine build on the farm land?
TOM WOLF
He was cheap to the bone and realizing he could not get brick to his farm without shipping it hundreds of miles and paying a fortune for it, he decided to build a manor house out of straw and mud.
DR. SAMUEL VON HESS
Straw and mud you say?
TOM WOLF
Yes, straw was already being grown on his farm land and was dirt cheap. This way he could say hundreds of dollars in building costs. I was jealous of his wealth and was happy that he was so foolish.
DR. SAMUEL VON HESS
Did you encourage him to build his manor house out of mud and straw?
TOM WOLF
Of course, I did not want him to receive the fortune from his father. I suggested the straw and mud would be the cheapest way to build a manor house and he believed me.
DR. SAMUEL VON HESS
So what happened next?
TOM WOLF
Well Sam Swine had his manor house build by local masons and he paid them little for their services. One day a severe storm hit the straw and mud manor house and all the mud washed away and the house collapsed on Sam Swine killing him under a ton of mud and straw.
DR. SAMUEL VON HESS
Really? What about the other Swine children? What did you do for them?
TOM WOLF
I met with Sally Swine and we talked about what she wanted to buy which was a large farm near the town of Lakeview in Northern England. The property was about 200 acres of unused farm land with a forest on a portion of the land. The brick mill was over 200 miles away and so was the stone quarry.
DR. SAMUEL VON HESS
So, did you sell Sally Swine the property?
TOM WOLF
Yes, I did with joy because I knew she would make the same mistake her brother had made because she was cheap. Since she did not want to pay for shipping the brick or stone hundreds of miles she decided to use wood to build her manor house from the forests on her property.
DR. SAMUEL VON HESS
She decided to build her home with wood instead of brick and stone?
TOM WOLF
Yes, she did with my help. I told her she would save hundreds of dollars by cutting down her forests and building her manor house with wood.
DR. SAMUEL VON HESS
And did the wooden manor house last?
TOM WOLF
No, I lit a fire to the manor house when Sally was inside. She burned to death.
DR. SAMUEL VON HESS
Really? Then you are guilty of murder.
TOM WOLF
Yes and No. Normally I would have eaten her, but instead I cooked her. Ha
DR. SAMUEL VON HESS
Attendant, take Mr. Wolf away, and put him in a cold treatment tank for a few hours. I will prescribe a heavier dose of medicine because he is suffering from hallucinations.
2ND BEDLAM ATTENDANT
Yes Dr. Von Hess. Cold tank for several hours and more medicine. Come on Mr. Wolf back to your room.
FADE TO BLACK.
So TOM Wolf was put in a cold therapy tank for four hours to cool him down and was then given a stronger dose of medicine.
The next day Dr. Von Hess met with TOM Wolf again.
FADE IN:
DR. SAMUEL VON HESS
Hello TOM. Do you remember what you told me yesterday? Do you still believe you were once a wolf?
TOM WOLF
Yes, but you did not let me tell you the best part of the story. The third child, Sanford Swine came to me and told me he wanted to buy land the same time that his sister and brother wanted to buy some land. I suggested many farms, but he was smarter and realized that he needed to buy a farm near a brick mill so he could build his manor house of brick that would last forever. So, I reluctantly sold him 200 acres of farm land for grazing cows and the brick mill was close by the land.
DR. SAMUEL VON HESS
So what happened next?
TOM WOLF
Well, Sanford Swine was so happy he held a party for his father and surviving members of his family and myself. His father was most proud of Sanford and since Sam and Sally were dead and spent their money foolishly, William the father decided to leave all his money to Sanford Swine for building and investing his money most wisely. The problem was Sanford built only one door, the front door in his brick house and there was no back door or side door to escape in case of fire or danger. Seeing this mistake I invited my wolf friends to attend the party with me and we killed and ate all the Swine ourselves having trapped them in the brick house with no escape door.
DR. SAMUEL VON HESS
Really, you killed and ate all the pigs? I mean all the swine family? That make you a murderer again.
TOM WOLF
That is why I was a Wolf. Wolves know only killing and eating, not being nice to pigs.
DR. SAMUEL VON HESS
Attendant take TOM Wolf away and give him electrical shock and chain him to the wall in his cell until he admits he was never a wolf.
BEDLAM ATTENDANT
Come on TOM, time for a little charge of electric to refresh you mind. Then we will hand you up on the wall in your room.
FADE OUT.
So TOM Wolf was taken and tied down and given electrical shock to get him to admit he was not a wolf and all his stories were just fake. TOM howled and howled when given the electrical shock but never relented that he was once a wolf. The attendants took TOM to his room and chained him to the wall in a standing position with his arms over his head to torture TOM into changing his mind about being a wolf.
FADE IN:
INT.- DR. VON HESS’ OFFICE-DAY.
A week later, Dr. Von Hess again called for TOM Wolf to be taken to his office.
FADE IN:
TOM WOLF
Where are we going?
DR. SAMUEL VON HESS
Hello TOM. How are you today? Is your thinking clearer now? How are the medication pills helping you? Do you still think you were once a wolf?
TOM WOLF
Yes, I am what I am, a Wolf.
DR. SAMUEL VON HESS
Do you have anymore tales to tell me of your Wolfing days TOM?
TOM WOLF
Yes, when I met the love of my life Little Red Riding Hood. Her real name was Rodalia Green and she was a little rich girl from Greenwood Glen. I first met Rodalia in the forest on her way to her Grandma’s house. I stopped and asked her where she was going and what was in the basket around her arm.
RODALIA GREEN-LITTLE RED RIDING HOOD (14)(FIVE FOOT TWO INCHES TALL, RED HAIR AND PALE WHITE SKIN, WEARING A LONG RED COAT WITH HOOD).
My name is Rodalia Green and I have a basket of sweet buns for my Grannie who lives in the forest. Who are you?
TOM WOLF
My name is TOM Wolf and I live in the forest too.
RODALIA GREEN-LITTLE RED RIDING HOOD
Really? I have never seen you before.
TOM WOLF
That is because our paths have never crossed before. That is a beautiful red riding hood you are wearing. Where did you buy it?
RODALIA GREEN-LITTLE RED RIDING HOOD
My grannie made it for me out of sheep skin.
TOM WOLF
I knew there was something familiar about the smell of the red riding hood. Can I walk with you to grannies house?
RODALIA GREEN-LITTLE RED RIDING HOOD
No, that will be fine. My mommie told me not to talk to strangers. Besides I am late to grannies house now.
TOM WOLF
Alright, well maybe we will meet again. May I call you little red riding hood? You have such a beautiful little red coat.
RODALIA GREEN-LITTLE RED RIDING HOOD
If it pleases you Mr. Wolf. Good bye for now.
FADE OUT.
Rodalia skipped away into the forest leaving TOM Green standing there.
FADE IN:
DR. SAMUEL VON HESS
What did you do next TOM?
TOM WOLF
Well, I gave it a lot of thought and decided that I liked Rodalia Green. I knew she might never get to like me because I was a wolf. I devised a plan to win her affection. I planned to meet with her again.
A week later TOM met Little Red Riding Hood in the forest again.
FADE IN:
TOM WOLF
Hello Little Red Riding Hood, I mean Rodalia, ha..laughing.
RODALIA GREEN-LITTLE RED RIDING HOOD
Well it is you again Mr. Wolf. How are you today?
TOM WOLF
I am fine and how are you little one?
RODALIA GREEN-LITTLE RED RIDING HOOD
I am off to see my grannie with fresh baked buns and sweat things in my basket.
TOM WOLF
Can I join you Little Red Riding hood?
RoDALIA GREEN-LITTLE RED RIDING HOOD
No, My mother told me not to talk to you. Sorry. I am off to grannies house.
FADE OUT.
Seeing that he was getting no where TOM WOLF decided to take a short cut through the forest to get to Grannies house before little Red Riding Hood got there.
FADE IN:
TOM WOLF
(Knocking on the door of Grannies house) Hello, hello, I am a friend of Rodalia. Open the door please.
GRANNIE GREEN (70’S)(GRANNIE WORE LITTLE SPECTICLE GLASSES A LONG FLOWERY DRESS AND HAD TOTALLY WHITE HAIR IN A BUN).
Who is there?
TOM WOLF
It is me, Rodalia’s friend TOM.
GRANNIE GREEN
Well alright then, come on in the door is unlocked.
FADE OUT
When TOM Wolf entered the house he hit Grannie over the head and knocked her unconscious. Tying her up he put a gag in her mouth and put her in the basement of the house. Quickly before Rodalia came to the house he dressed himself up in Grannies clothing.
FADE IN:
RODALIA GREEN-LITTLE RED RIDING HOOD
(Knock, knock) Hello Grannie it is me, Rodalia.
TOM WOLF
Come in my dear, I am in bed with a cold.
RODALIA GREEN-LITTLE RED RIDING HOOD
Grannie, I have brought you some hot buns and sweets that my mother baked for you. How are you feeling?
TOM WOLF
I have a cold and a horse throat my dear.
RODALIA GREEN-LITTLE RED RIDING HOOD
I will make you some tea grannie to make you feel better.
TOM WOLF
Thank you deerie.
RODALIA GREEN-LITTLE RED RIDING HOOD
Grannie here is your tea. My what a big nose you have grannie.
TOM WOLF
The better to smell you with my dear.
RODALIA GREEN-LITTLE RED RIDING HOOD
How is the tea grannie? My what big ears you have grannie. Is the cold making your ears swell?
TOM WOLF
Ahh, the better to hear you with dearie.
RODALIA GREEN-LITTLE RED RIDING HOOD
Grannie, what big eyes you have. Is the cold making your eyes big?
TOM WOLF
No, they help me better see you my dear.
RODALIA GREEN-LITTLE RED RIDING HOOD
But, grannie why are your teeth so big?
TOM WOLF
The better to eat you Little Red Riding Hood.
FADE OUT.
Just then TOM Wolf jumps out of the bed and attempts to catch Little Red Riding Hood. They race around the house and Little Red Riding Hood runs out the front door and into the forests yelling for help.
FADE IN:
RODALIA GREEN-LITTLE RED RIDING HOOD
Help, help, the wolf intends to eat me. Help.
FADE OUT.
Nearby was a HUNTER and he heard Little Red Riding Hood crying for help in the forest and he ran to help her.
FADE IN:
HUNTER (A TALL WHITE MAN IN A PLAID SHIRT AND FARMERS JEANS WITH BROWN HAIR AND A FULL BEARD).
Hello, hello, I am here in the forest little girl. Who is chasing you?
RODALIA GREEN-LITTLE RED RIDING HOOD
Thank God you can save me. The Big Bad wolf is chasing me and he wants to eat me.
HUNTER
I have a gun little girl, do not be afraid. I will shoot the wolf when I see him.
FADE TO BLACK.
Just then TOM Wolf jumps out of the bushes and attempts to attack the HUNTER and Little Red Riding Hood. The HUNTER grabs his rifle and shoots.
FADE IN:
HUNTER
Back away Mr. Wolf or I will shoot you through the heart.
TOM WOLF
Do not be afraid, we are only playing a game of tag.
HUNTER
I am giving you two seconds to turn and run away before I shoot you dead Mr. Wolf.
TOM WOLF
Thinking about the possibilities I think I will run into the forest instead. Maybe some other time little red riding hood.
DR. SAMUEL VON HESS
Well, that was quite a story TOM. Once again it seems you escaped again. Do your still believe that you were a wolf in another life?
TOM WOLF
Yes, I do but no one including you, Doctor, believes me.
DR. SAMUEL VON HESS
Attendant come in here. Take Mr. Wolf and put him in a straight jacket and hang him upside down in his cell for a day or so. Mr. Wolf is delusional and needs more therapy. I will triple the dose of medicine for him also.
BEDLAM ATTENDANT
Yes, Dr. Von Hess. I will take care of it. Here TOM put your arms in this straight jacket so I can tie your arms at your sides. Come with me to your cell.
FADE OUT.
Taking a hook handing from the ceiling the attendant lowers a rope from the ceiling with a hook and attaches it to TOM Wolf’s feet that are tied together, and he hoists TOM into the ceiling upside down and leaves him there for two days.
FADE IN:
INT. DARK DUNGEON CELL-DAY.
FADE IN:
After two days the attendant returns to TOM Wolf’s cell and lowers him down from the ceiling and takes off the restraining jacket from TOM.
BEDLAM ATTENDANT
Come TOM. Dr. Von Hess wants to see you right away. How are you feeling? Do you still think you are a wolf?
TOM WOLF
Howling….
DR. SAMUEL VON HESS
Hello TOM. How are you feeling today. Do you still think you are a wolf? Did the therapy help you focus on whether you are a man or a wolf?
TOM WOLF
No really doctor.
DR. SAMUEL VON HESS
Do your have any more silly stories to tell about your life as a wolf?
TOM WOLF
A few stories if you are interested.
DR. SAMUEL VON HESS
Really? After all the therapy and medicine we gave you. You still claim to be a wolf?
TOM WOLF
Once when I was in Russia I met a boy named Peter who lived with his grandfather in a little cottage in the middle of a meadow.
DR. SAMUEL VON HESS
Really, Russia you say?
TOM WOLF
Yes, Peter had many animal friends in the meadow, the duck, the bird and the cat. Everyday he would play with his animal friends. The bird in the tree would chirp, “All is well Peter.” Then his friend the duck came waddling around. Peter was told by his grandfather not to leave the gate open because of the bad wolf in the forest. This day Peter forgot to close the gate and from the edge of the forest I could see the duck heading to the lake to take a swim. Ducks taste very good. The bird and the duck got into an argument. The bird asked what kind of bird are you when you cannot fly? The duck said, what kind of bird are you when you cannot swim? Suddenly Peter noticed some movement in the high grass nearby and was worried. It was a cat.
THE CAT (NAMED KITTY,TABBY WHITE AND ORANGE COLORED FUR).
That little bird is busy arguing with the duck. I will just grab him while he is busy!
Very carefully the cat crept forward in the high grass.
PETER (15)(A TALL THIN BOY WITH SHORT BLONDE HAIR AND BLUE EYES).
Look out!
The little bird flew to safety in the tree.
THE DUCK (MR. QUACK, A MALLARD).
Quack, quack, go away cat. I am in the middle of the pond and you cannot swim.
FADE OUT:
Suddenly, Peter’s grandfather came out of the house.
FADE IN:
GRANDFATHER (60’S)(A WHITE HAIRED OLD MAN IN FARMERS PANTS, BROWN COAT AND BOOTS WITH A FULL GREY BEARD).
Peter what are you doing? Why did you let the duck out of the yard and the fence open? The meadow and forest are dangerous because the wolf lives there. If a wolf should come out of the forest, what will you do? You would be in great danger.
PETER
It is OK Grandfather. I am not afraid of the wolf.
GRANDFATHER
Take my hand Peter and lets us go into the house and lock the gate behind us. Come on duck, get into the yard behind the fence for your safety.
TOM WOLF
Just then I came out of the forest looking for something to eat for dinner.
THE CAT
Help me. I am going to climb up the tree. The wolf cannot get me high up in the tree.
THE BIRD (A BLUE BIRD).
Help me, I will fly away to safety from the wolf.
THE DUCK
Help, I forgot to come inside the yard. I cannot out run the wolf. Help Grandfather.
TOM WOLF
It was easy pickins for me to catch up with the big fat duck and I caught him and ate him on the spot, leaving just feathers.
PETER
Grandfather. Look out the window. The wolf has killed the duck because he did not come into the yard behind the fence for safety. What should we do?
GRANDFATHER
Stay in the house Peter. The wolf is too big and mean for you.
PETER
I am not afraid of the wolf but I must make a plan to kill him. Little bird, come here, I have a plan. Go and fly around the wolf’s face and taunt him into chasing you. Meanwhile, I will take a rope and make a lasso and lay it on the ground under the tree outside the cottage.
THE BIRD
I will fly around the Wolf’s head as you suggest Peter the bird chirped.
FADE OUT.
Flying around and around the wolf’s head the bird distracted TOM Wolf into following the bird to the tree where at the base was a lasso which Peter had placed.
FADE IN:
PETER
Now when the wolf steps into the lasso I will pull the rope over the tree branch and pull the wolf up into the air by his tail.
TOM WOLF
Come here you little bird. I will get you and eat you for sure. Just slow down so I can bite you. Oh, no what has happened I am hanging upside down by a rope. Help.
FADE OUT.
Just then two HUNTERs came out of the forest. They had been tracking TOM Wolf and wanted to kill him.
FADE IN:
TOM WOLF
Wait, wait, do not kill him. Let us take the wolf in a cage to the zoo.
So the HUNTERs lowered TOM Wolf into a cage and took him to a local zoo for the rest of his life.
DR. SAMUEL VON HESS
Is that the end of the story TOM?
TOM WOLF
Yes, I was fortunate enough to be spared being killed by the HUNTERs and brought to a zoo in Russia. Later on the zoo in Russia traded me for a Siberian tiger from the London zoo and that is how I was found in London after I escaped my cage in the London Zoo.
DR. SAMUEL VON HESS
Really? That was quite a story TOM. I am going to have to put you in a dungeon cell and chain you to a wall until you change your story.
TOM WOLF
Oh, please Doctor. Don’t put me in a dungeon. I have tried to be truthful and tell you the whole story about my life as a wolf and you still do not believe me.
FaDE TO BLACK.
Suddenly, it was dark out and a full moon shone over Bedlam hospital with light seeping through the windows in Dr. Von Hess’ office. Suddenly, TOM’s face began to change and grow hair. His body became bent up and his legs became hair also. Before Doctor Von Hess knew it, TOM had changed into a werewolf right in front of him.
DR. SAMUEL VON HESS
Oh, my God. What the hell?
Just then TOM Wolf became a Werewolf and jumped at Dr. Von Hess’ neck and bit him.
TOM WOLF
Well, this ought to convince you Doctor Von Hess as I bite you in the neck.
With that TOM leaped out Doctor Von Hess’ office and ran off into the distance never to be seen again.
The END