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The White Eyes and the Native Americans

By Dr. Pelham Mead

If you country was invaded by a foreigner what would you do? Fight back of course. Supposing the invader had superior weapons and you had only bows and arrows? Such was the plight of the American Native Indians. Who were the good guys and the bad guys? That depends on who you think had the right to wipe out entire nations of American Natives. The white eyes lied to the American Indians time after time. No wonder there was no trust.

Was the Native American Indian worse than the white eyes. Taking scalps was a tradition for Native Americans, but what about hanging a person from a rope in public until their neck broke or they choked to death.

Who killed hundreds of thousands of Buffalo? Not the Native American Indians, it was the white eyes with guns that could shoot rapidly. Buffalo skins had a great market value as well as horns.

Who held the white eyes accountable for their crimes against the Native American Nations? No one did. Killing Native American Indians was like a fox hunt where the fox had no chance in hell of surviving with hunting dogs chasing them down and men on horseback armed with rifles shooting at them.

So, a Few hundred years later the Native American Indian is treated as a minority with little or no rights. Look at Brazil how they do not let the Amazon Indians own land and have no more rights than a teenager.

When there is talk about reparations for the black slaves of America, think first about the white men who stole the land away from the Native Americans to begin with before the slaves were brought to America.

The Native American Nations had wonderful cultures and practices that are fading into the air over time. What can we do? Perhaps renew their status in the American culture and give them more support to get educated and become part of this great American society. Always remember the place in History the Great Chiefs and their Nations played in our history and the Wild West.

Why are there no national holidays that celebrate Native American Holidays?

Think about the Washington Redskins football team. Is Redskin really an insult?

Do we have any teams called the white eyes or the yellow skins? Think about it.

Are there any Polish poppers, or Irish hacks, or British cavaliers, or French Frogs?

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Educational Articles

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__________________________________________

30

Comments on Applicant _____________________________________________________

COMMENTS:

Interviewer_______________________________________

31

32

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

34

35

36

37

38

39

40

41

42

43

44

45

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.

56

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)

58

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

59

© 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.

60

© 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.

61

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

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

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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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”

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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.

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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

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©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

166

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©2009 New York College of Osteopathic Medicine 011509

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

167

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

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

168

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©2009 New York College of Osteopathic Medicine 011509

21 Assessing Lower Extremities –

Motor Testing

􀂃 Examiner asks patient to dorsiflex

and plantarflex the ankle against

resistance

􀂃 Compare bilaterally

169

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©2009 New York College of Osteopathic Medicine 011509

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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©2009 New York College of Osteopathic Medicine 011509

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.

171

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©2009 New York College of Osteopathic Medicine 011509

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.

172

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©2009 New York College of Osteopathic Medicine 011509

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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©2009 New York College of Osteopathic Medicine 011509

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).

174

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©2009 New York College of Osteopathic Medicine 011509

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

NEUROLOGICAL EXAMINATION

©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

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

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

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

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

NEUROLOGICAL EXAMINATION

©2009 New York College of Osteopathic Medicine 011509

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

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Educational Articles

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

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Educational Articles

Making Social distancing work in 2020.

By Dr. Pelham Mead

Here are the numbers concerning elementary and secondary school classrooms. Normally on the secondary level 32 students in a class is the norm. This number is also part of the Teacher’s Union contract. The classrooms are built to hand no more than 32-35 desks and chairs. One solution to the Corona virus pandemic for schools is to cut the class size in half to 16 and shorten the class times to 20 minutes. The eight classes a day would be doubled to equal 16 shortened periods. In a day only five classes are academic courses. The lunch period takes up one period and the remaining two classes are often Study Halls, School service, and elective courses. What makes a change in the class times is negotiations with the Teacher Union to change an ages old eight period day to sixteen short Periods. If School districts could get over this obstacle, then Education can finally change it’s age old format.

I don’t believe two days of face to fact contact and three days of online courses is a wise approach. It does not provide for reduced class sizes with 32 students packed into the same small classrooms. This approach invites spreading of the virus by just one or two students.

School districts have historically never been able to make long term future changes in education easily. Politics get in the way and political interests over-ride the real needs of the students.

It is time to make some drastic school day changes.

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Educational Articles

The Nine Wives of Geronimo, Chief of the Chiricahua Apaches.

Geronimo, The Last Free Apache - Old Pictures

1840- First wife, she had two children. Slain in a massacre in 1851 by Mexicans. She was his first true love.

1852- Second wife- Chee-hash-kish. Married for 30 years until capture by Mexicans in 1882.

1852= Married  third wife, Nana-Tha-thtith, She and her child killed by Mexicans in 1855.

1860’s-1870-  married fourth wife- She-Gha, a relative of Cochise.

1860-1970- Married Fifth wife Shtsha-she. She was with Geronimo until 1884. She was captured by whites and died in captivity.

1882- Marries sixth wife. Zi-yeh (a diminutive Nednal girl).

1885- Marries seventh wife. IH-tedda. A captured Mescalero Apache.

1905- Married eighth wife, Sousche, a 58 year old apache Widow with a grown son.

1907- Marries nineth wife. Azul also called Sunsetso. A Chiricahua woman.

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Educational Articles

Teaching Senior Professors in 2020

By Dr. Pelham Mead III, Instructional Technologist

For twelve years I worked as an Instructional Technologist in several New York Universities and Colleges such as New York University 1998; The College of Mount Saint Vincent 2001-2005; St. John’s University 2006-2008 and the New York College of Osteopathic Medicine.  An Instructional Technologist is like a Staff Developer with advanced Software teaching skills, and in some cases IT skills also.

This is a collection of my experiences working with Senior age Faculty over age 65 at Universities and Colleges that had little or no knowledge of how to use a computer, let alone how to use MS Word or MS Powerpoint. Some Senior professors could turn a computer and send and receive e-mail and that was all. The reason for this gap in knowledge is that older professors have been passed by in terms of technology training. Colleges and Universities that I worked at would win Federal grants and then buy lots of computers and software and drop them in the professor’s laps with no training.

Computers to the younger generations is as natural as eating a peanut butter sandwich. For those in the baby boomer generation and age 65 plus computers are an unnecessary waste of time. College professors assume all college students are always playing games on their laptop computers and not doing anything educational. Likewise, from the student viewpoint, Professors that cannot use Powerpoint are dinosaurs in the world of technology.

When I began tutoring Professors on Federal Grants awarded to Colleges and Universities, I realized the FEAR was the major factor for preventing Older Professors from learning computers and understanding their teaching potential. My job was to build their confidence and work at their pace, not mine.

My first Senior Professor story is about a Professor who taught non-major Biology to Freshman at a Catholic University on Long Island. This professor was an adjunct professor that only taught part-time. He could speak five different languages and was highly respected in the University. The problem was he was 83 years old and completely unaware of computers or software. He taught 100 students in a large lecture hall with chalk on a blackboard. It was difficult to see his notes on the blackboard at the back of the class. He also spoke in a thick Eastern European accent. He was recommended to me for tutoring in how to use a laptop computer and Powerpoint by the Biology Department Chairperson. The senior professor had the highest failure rate of all the major and non-major mandatory Biology classes. The reason for the failures was a failure to communicate with the students on their level. Students of the 21st century were born into a visual world of stimulus. They play hand held electronic games from age one and are addicted to TV electronic games where the object is to shoot as many of the enemy as possible. Students are very familiar with the internet and searching for topics, but not as good with basic grammar and vocabulary because in their constant texting they have invented their own language with abbreviations for everything i.e. BFF best friend forever; Lol laughing out loud; word, word up and other bad English expressions.

Back to the 83-year-old professor of Biology. At his first class I had to show him how to open the lap top, plug it in, turn it on. That took 30 minutes instead of five minutes. He could not understand how this computer and showing visual Powerpoint slides shows could improve this teaching. I showed him several lecture samples I had using Powerpoint with everything including animation, sound clips, special effects and internet links. I spent two hours the first class with him instead of one to make sure he felt comfortable learning new material. I scheduled him for a tutoring session for the following week at the same time and gave him his brand-new IBM laptop.

The next week he was late, very late in fact. After 30 minutes I decided he wasn’t coming so I went to the men’s bathroom for a break. When I entered the bathroom by opening the door, there was the Senior Professor hiding behind the door. “Professor Smith what are you doing here in the bathroom?” I asked. Stuttering he answered “I am afraid to go to your office. Computers are too hard for an old man like me.” “Well if you are too old for computers the department chairman might decide you are too old to teach,” I replied.  “Don’t take away my teaching. It is all I live for. I love teaching but now the students are different than the old days,” he said. “Come let’s go to my office and let me help you modernize yourself and feel comfortable about computers and software,” I replied.

The following week the Senior Professor brought his wife who was 80 years of age and a retired RN at a local hospital. “Doctor Mead this is my wife Adelle and she is a retired RN and she has come along to help me through this lesson,” he said. “Nice to meet you Adelle,” I said. “Your husband is a well-respected Senior faculty member, but he is out of touch with the students and technology. All I want to do is to get him to learn how to create some Powerpoint slide shows for his lectures to become more informative to the students and increase their motivation to learn, rather than fail. “I understand,” Adelle replied.  I used computers for many years at the hospital where I worked. I tried to get Henry to learn how to use computers, but he always had an excuse.

Now in 2020 we are in the midst of a pandemic and the virus has caught private and public schools by surprise as well as Colleges and Universities. Teachers and Professors were caught unprepared to teach online which incorporates a whole different set of teaching tools. In fact, initially teachers will have to do more lesson preparation for teaching online than in person. The reason is the online environment is more controlled and restrictive. Zoom, facetime, canvas and blackboard are important visual tools to allow teachers to see their students. Secondly, teachers need to be more prepared to use instant quizzes or treasure hunts in research than normally. Online teachers need to get responses from everyone in the class and be positive about the responses. YouTube movies and other videos can be used or assigned to an online class.  Coming up with reward systems is a good motivator. Making the lesson personal and adapted to each student’s needs and learning curve is most important. The surprise element is always important in providing team projects and class discussion.

Reading from a book is not appropriate for online instruction. Powerpoint presentations can be useful if provided to the students afterward. Animation and sound effects can bring a Powerpoint presentation alive. Linking to the New York Times podcasts and other podcasts on a slide can make the presentation even more interesting. Testing, testing in different forms is important to make sure the students are all performing on task. Creating student pair teams adds a new dimension to learning. Students learn to cooperate and present their findings when they are done.

Placing emphasis on outlawing cut or copy and paste from the internet. Plagiarism should not be tolerated. Colleges have software programs that can detect plagiarism on student reports.

Original and creative work with good grammar should be encouraged.  Abbreviations and collegial expressions such as bff and other text short phrases should be discouraged. Teachers will find that when students think they are anonymous they can be impolite to the teacher. Stop this right from the start. Shut a student down who curses or uses inappropriate language. Be on the guard for the class clown who tried to be funny online.

Keep students informed of their average class grade at all times rather than making them have to ask how they are doing. Be open and transparent about grades. If a student is getting low grades, offer to help them and give additional assignments to bring up the average grade.

In a normal in person classroom a teacher learns student name by taking attendance every day. Online you need to make a special attempt to learn student’s first names. Read their student fil if one is available to find out what kind of student they are. Be aware of their life and career goals and try to tie in the assignments to that interest.

Teaching online requires more paperwork than normal teaching. After or during each online session make sure to mark down who is participating and who is not. Keep track of who is handing their assignments in on time and who is not. Do not let students fall behind in their assignments to the point you have to report them to their parents or your supervisor.

Prepare crossword puzzles, scrabble puzzles and other skill sheets to help student remember names and events or vocabulary . Most of all stay ahead of the students, especially the first time you teach the course online. The second years will be much easier with a whole semester to use from the previous year.

Finally, be cheerful, positive and most of all sup portative. Let students feel you are all on the same team.

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She Who Rode a Wolf

by Dr. Pelham Mead

Based on stories of the Pawnee and other Native American Indians.

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She Who Rode a Wolf

WOLF RIDER (OYADA-GE-A)

SHE WHO RODE A WOLF.

By Dr. Pelham Mead

ACT ONE- SHE WHO RIDES THE WOLF

Oyade-ge-a is pawnee for one who rode. Oyade-ge-a is an short innocent

Pawnee girl who becomes immortal and rides Sirius the Wolf constellation in the

sky. She has brown braided hair and a deerskin dress decorated with many

beads. Her tanned skin contrasts with her blue eyes. She speaks softly as she

tells the many history and Wolf stories of the Pawnee Indians during the 1800’s

before they moved to Oklahoma.

OYADE-GE-A, PAWNEE GIRL (10)

In 1824 the Pawnee nation had ten thousand

Indians. Over the next few decades the pale

face came and brought with the diseases the

Pawnee had no resistance to such as small

pox

OYADA-GE-A, PAWNEE GIRL (SHE WHO RODE

THE WOLF)

I am oyada-ge-a, the pawnee girl who rides

Sirius the Wolf in the stars in the sky. Sirius

and I travel over time and day, always watching

the Pawnee, Wolf worshippers. I see the pale

face coming to steal the land of the Pawnee.

Their many wooden wagons come in search of

land the golden rock they cherish so much. The

Pawnee were farmers and hunters, not

warriors. They did not seek a war with the pale

face. Rather they sought peace and joined the

pale face army as scouts.

SIRIUS THE WOLF STAR

Hang on oyada-ge-a as we stream across the

sky watching our Pawnee brothers and sisters

below. The Skidi Pawnee know the stars well,

for they have studied them for many winters.

2.

OYADA-GE-A, PAWNEE GIRL (SHE WHO RODE

A WOLF)

We Pawnee are known as chatiks si chatiks,

“Men of Men.” We are a proud nation. Look

down below on the Loup River there is a large

village of several thousand Pawnee hunting for

Buffalo.

SIRIUS THE WOLF STAR

When a Pawnee brother or sister is in trouble

we come to their rescue. Last hunting season

we saved a Pawnee warrior named Blue Crow,

who fell off his horse during a buffalo hunt. We

spoke to the lead buffalo, and convinced him to

turn to the left to allow the Pawnee to live as

they were stampeding across the plain.

SIRIUS THE WOLF STAR (CONT’D)

Oh great and boundless one, leader of the

Buffalo, turn left now and spare the life of the

Pawnee that fell off his horse.

LEAD BUFFALO

As you wish Wolf Star. Let us turn to the left my

brothers.

BLUE CROW, PAWNEE BRAVE

I am going to be crushed by the Buffalo. Sirius

save me. Oh, my spirit the Buffalo are turning.

Sirius has come to my rescue.

FADE OUT.

ACT 2 THE TWO WOLVES STORY

One night in a Pawnee village camped on a river there was a full moon and the

wolves in the forest all were howling. In the Pawnee village a young pawnee sat

his grandfather Bright Knife’s tepee.

INT. NIGHTOne

day in 1824 Montana.

Chief Bright Knife was a short, muscular and dark skinned Pawnee who had

fought many moons against the Sioux and Black Foot Indians. Little Elk was a

ten year old Pawnee boy.

3.

CHIEF BRIGHT KNIFE, PAWNEE

Grandson little Elk, come and sit by me in my

tepee and get warm by the fire.

LITTLE ELK, PANEE BOY (7)

Do you hear the wolves howling Grandfather.

Why do they howl at the full moon? Would you

tell me another story about Wolves

Grandfather?

CHIEF BRIGHT KNIFE, PAWNEE

A fight is going on inside me Little Elk. It is a

terrible fight and it is between two wolves. One

is evil and he is anger, envy, sorry, regret,

greed, self-pity and many other bad things. The

other wolf is good and he represents peace,

joy, hope, love, humility, kindness, empathy,

truth, faith and many more good qualities. The

same fight is going on inside you Little Elk.

Others have the same fight going on inside

them.

LITTLE ELK, PANEE BOY

What wolf will win Grandfather?

CHIEF BRIGHT KNIFE, PAWNEE

The one you feed my son.

FADE TO BLACK.

ACT 3 ATIUS TIRAWA, FATHER ABOVE

SCENE 1-EXT. DAYAtius

Tirawa, which means “Father Above” in the Pawnee language (often

translated, inaccurately, as “Great Spirit”) was the creator god. Other terms used,

and perhaps most used, are Tirawahat or Tirawahut. One day Chief Bright Knife

explained to Little Elk about the Pawnee gods and stars in the sky.

FADE IN:

4.

LITTLE ELK, PANEE BOY

Grandfather Bright Knife, tell me about the

Gods and the stars in the sky.

CHIEF BRIGHT KNIFE, PAWNEE

Gladly grandson. Bring a log over here to warm

the tepee on the fire. Let me tell you of all the

great spirits, Gods, and powers in the heavens

above. First that is Atius Tirawa. I will pretend

to be each of the Gods beginning with Atius

Tirawa.

LITTLE ELK, PANEE BOY

That sounds exciting Grandfather.

ATIUS TIRAWA, PAWNEE FATHER ABOVE

I will show you how to tame the flame for

cooking. I will give you corn, melon, and other

foods to grow. You are free to tattoo your body

and have a speech and clothing. I give you

also tobacco and sacred bundles and

sacrifices to the other God. My wife ATIRA,

Goddess of the Earth and Corn will help you

keep the Earth fertile. I give you also the male

morning Star in the east dressed as a warrior.

Next will come the female Evening Star in the

West. Each nigh and night Morning star will

have to fight with a number of forces in the

Western sky with his fireball.

NORTH STAR, SON OF SOUTH STAR

I am North Star, son of South Star and I will

watch over my people the Pawnee and keep

my position in the sky to guide travelers.

SOUTH STAR, FATHER OF NORTH STAR

I rule in the land of the dead. I rise every day

to see if my son North Star remains in his fixed

position. I require no prayers or ceremonies

from the Pawnee.

THUNDER GOD

We are the great four powers of the West.

Listen Pawnee to my noise in the sky.

(MORE)

5.

LIGHTENING GOD

We four powers obey the Evening star by

means of our constant song with Earth.

CLOUD GOD

I float above the Earth and obey the Evening

star. Beware when my clouds are black for a

storm is on the way.

WIND GOD

My might power belongs to the Evening Star.

Do not underestimate my power. The first girl,

the child of Evening and Morning Star rests

with me and the other three great Gods.

SHAKURU, DIETY OF SOLAR

I am Shakuru deity of the Pawnee sky.

PAH, DIETY OF THE LUNA MOON

I am Pah, diety of the Luna Moon in the

Pawnee sky. Together we are two minor deities

for the pawnee. We Were the last of the Gods

to be placed in the heavens.

CHIEF BRIGHT KNIFE, PAWNEE

Meteorites brought good fortune to the finders.

They were seen as the children of Tirawahut

sent down to Earth.

While the Skidi Pawnee relied a great deal on

the powers and the aid of stars and other

objects in cosmos, the South Bands came

through foremost by the assistance and advice

of a number of animals. Yet, the gods in

heaven existed, and the animals acted as gobetweens

when they instructed and guided the

South Bands.

LITTLE ELK, PANEE BOY

What of the Beaver Grandfather. Why is he

important?

CHIEF BRIGHT KNIFE, PAWNEE

The White Beaver ceremony of the Chawi

served nearly the same purpose as the

renewing or restarting Spring Awakening

ceremony (Thunder ceremony) of the Skidi.

CHIEF BRIGHT KNIFE, PAWNEE (CONT’D)

(MORE)

6.

However hibernating animals were revitalized

through this rite rather than the renewal of corn

crops.

Tirawa conferred miraculous powers on certain

animals. These spirit animals, the nahurac,

would act as Tirawa’s messengers and

servants, and could intercede with him on

behalf of the Pawnee. The nahurac had five

dwellings or lodges.

• The foremost among them was Pahuk,

usually translated “hill island”, a bluff on the

south side of the Platte River, near the town of

Cedar Bluffs where the pale face lived.

• Lalawakohtito, or “dark island”, was an island

in the Platte .

• Ahkawitakol, or “white bank”, was on the

Loup River opposite the mouth of the Cedar

River .

• Kitzawitzuk, translated “water on a bank”,

also known to the Pawnee as Pahowa, was a

spring on the Solomon River.

• The fifth lodge of the nahurac was known to

the Pawnee as Pahur (/pa’hur/, translated as

“hill that points the way” or “guide rock. Pass

me that gourd of water grandson for I am

thirsting .

Regular ceremonies were performed before

major events, such as semi-annual buffalo

hunts. Kawaha, an often-besought god of good

luck, was closely connected to buffalo hunts.

The most important ceremony of the Pawnee

culture, the Spring Awakening ceremony, was

meant to awaken the earth and ready it for

planting. It can be tied to celestial observation,

held at the time when the priest first tracked

“two small twinkling stars known as the

Swimming Ducks in the northeastern horizon

near the Milky Way.” and then heard a rolling

thunder from the West.[1]:14 and 53 (See

above for the role of Thunder in the Creation

myth).[13]

CHIEF BRIGHT KNIFE, PAWNEE (CONT’D)

7.

The Morning Star ceremony was a ritual

human sacrifice of a young girl, performed only

by a single village of the Skidi band of the

Pawnee. It was connected to the Pawnee

creation narrative, in which the mating of the

male Morning Star with the female Evening

Star created the first human being, a girl.

This is the story of Man Chief who tried to rescue a Comanche girl from the

Morning Star ceremony.

FADE IN:

MAN CHIEF, SKIDI PAWNEE

We captured some Comanches to use as

slaves, however the Priests want to sacrifice

one young Comanche girl for the Morning Star

Ceremony.

JOHN DOUGHERTY, INDIAN AGENT (32)

Man Chief I respect your traditions but the

Morning Star human sacrifice goes against the

laws of the pale faces. We have to stop this

sacrifice or some of the pale faces will come

and kill Pawnee braves as retaliation.

MAN CHIEF, PAWNEE

I have spoken to the Skidi Pawnee priests and

they will not listen. They say she must be

sacrificed to ensure a good spring planting.

The priests say the time is right when Mars is

the morning Star.

JOHN DOUGHERTY, INDIAN AGENT

We must stop this ceremony. Where is the girl

tied to a scaffold?

MAN CHIEF, PAWNEE

I know where the ceremony is to be held. We

will need many Pawnee scouts or pale faces

with thunder sticks to stop this ceremony. The

ceremony is by thunder rock by the Loop River.

We can get there in a day of riding.

Meanwhile at the ceremonial site near the

Loop river at Thunder Rock.

Back at Loop river at the ceremonial site.

8.

MORNING STAR SERVANT PRIEST

Tie the girl up to the scaffold between the two

trees. Treat her with respect at all times. She

must be cleansed. She will be sacrificed when

the Morning Star rises in the East.

SECOND PRIEST

I have selected two braves who will bring the

flaming branches to the armpits and groin of

the sacrifice. Four other braves will than touch

the sacrifice with their war clubs.

GREY BEAVER

Since I captured the Comanche girl it will be

my honor to shoot the sacred arrow from the

Skull bundle through her heart.

SECOND PRIEST

I will cut open the sacrifices chest and let the

blood drip onto buffalo eat. Following me all the

braves in the ceremony will shoot arrows into

the body.Come Morning we will take the body

out onto the plains and leave it facedown to

feed the Earth.

Just then Man Chief and the Indian agent appeared. The priests were started

and ran.

JOHN DOUGHERTY, INDIAN AGENT

Stop what you are doing. Take this woman

down from the scaffold. We cannot allow you to

kill a young woman.

MAN CHIEF, PAWNEE

I will cut her down. Get on my pony woman.

We must hurray before the braves return with

guns and bows

JOHN DOUGHERTY, INDIAN AGENT

Let’s ride. We have the girl and she is still alive

When the Priests returned with dozens of Pawnee braves they got on their

ponies and chased after Man Chief and John Dougherty along with their posse.

9.

MORNING STAR SERVANT PRIEST

Quick ride after them and bring the woman

back or we will have a bad year in our planting

FADE TO BLACK.

FADE IN:

This is a Lakota indian story called Mitakuye Oyasin Lakota, meaning We Are All

Related. As a girl I heard this story many times.

CHIEF BRIGHT KNIFE, PAWNEE

Come back tomorrow Grandson and I will tell

you of the story of the Black Wolf.

The next day

FADE TO BLACK.

LITTLE ELK, PANEE BOY

Grandfather are you in your tepee?

CHIEF BRIGHT KNIFE, PAWNEE

Yes, come in grandson. I made some birch tea

for us to drink. Come sit down by me. Where

are we? Oh, yet the story of the black wolf.

Many moons ago a young Pawnee girl walked

into the woods to play. It was a warm and

sunny day with a gentle breeze in the air. As

she explored her secret world, she heard the

faint sound of a beating drum. The rhythmic

beat was relaxing and so she sat against a

willow tree and drifted off to sleep.

As the young girl slept, she dreamt of her

secret woods and again heard the faint beating

of a drum. She was drawn to the sound and

walked toward it. A hawk flew above, guiding

the way.

RED TAILED HAWK

Follow me little one.

BLACK WOLF

Why are you not afraid of me human?

(MORE)

10.

PAWNEE GIRL

I am not afraid of you.

In the distance a Pawnee saw the wolf and the girl in a clearing

DANCING CROW, PAWNEE BRAVE

What is that foolish girl doing? The wolf will kill

her in a second.

A DRUM BEAT SOMEWHERE IN THE WIND AS THE GIRL APPROACHED THE

WOLF.

PAWNEE GIRL

I stand before you great wolf.

WOLF

You are brave little one. I lower my head in

respect to you.

PAWNEE GIRL

Can I kneel down oh great one? Can I look into

your golden eyes great one?

WOLF

Can you hear me little one? I speak to you in

the language of the wolves. Come nuzzle in my

legs little one.

Meanwhile the Pawnee brave observed everything from afar.

The young girl awoke from her dream and stood in the woods. She turned,

expecting to see the wolf but she was alone….

PAWNEE GIRL

Where am I? I must have fallen asleep. Where

is the wolf I spoke to? The was a weird dream

Years passed and the young girl grew up. She forgot about the wolf and Indian in

her dream.

PAWNEE GIRL (CONT’D)

Then one day the now woman came to a dark

place in her life. Feeling lost and alone, she fell

asleep crying and drifted off into a dream. And

in that dream the woman was given a vision. In

the distance, she heard the beating of the

drum. The black wolf came to her again. His

golden eyes illuminated and pierced the

darkness.

PAWNEE GIRL (CONT’D)

11.

Again in the distance the Indian stood silent.

In her sleep, the woman flashed back to her

childhood and remembered that day in the

woods. She knew that although she wandered,

she was not alone – she was not lost. Through

his eyes, the black wolf told her that he walked

within her.

She awoke and again looked for the black wolf

but this time she remembered… She looked

within herself and found him….And she

breathed in a new breath.

That woman now understands who she is. She

is one with the black wolf and the Indian…And

they are a part of her soul.

If you do not walk with the animals, you will not

know them –

And what you do not know, you will fear –

And what you fear, you will destroy.

I walk with the Black Wolf. Now I am Oyade-Ge-

A, one who rides the Black Wolf in the Sky.

FADE TO BLACK.

EXT. DAY

The Massacre Canyon battle took place in Nebraska on August 5, 1873 near the

Republican River. It was one of the last hostilities between the Pawnee and the

Sioux(or Lakota) and the last battle/massacre between Great Plains Indians in

North America.

FADE IN:

TWO STRIKE OGLALA/BRULE’ SIOUX CHIEF

Assemble the Braves, we are ready for the

Buffalo hunt.

LITTE WOUND OGLALA/BRULE’ SIOUX CHIEF

The pale face agent John Williamson has given

us permission to hunt along the great river

SPOTTED TAIL OGLALA/BRULE’ SIOUX CHIEF

Hurray or we will miss the Buffalo. We have

over 1500 braves ready to kill many buffalo

Chief Two Strike

The massacre occurred when a large Oglala/Brulé Sioux war party of over 1,500

warriors led by Two Strike, Little Wound, and Spotted Tail attacked a band of

12.

Across the river a few miles away were the Pawnee with a band of 100 braves

and chiefs Pawnee: Sky Chief, Sun Chief, Fighting Bear, Ruling His Son.

SKY CHIEF, PAWNEE

It is a good day to kill buffalo. Our scouts report

the herd is headed this way.

SUN CHIEF, PAWNEE

We can split our forces further down the river if

we run into the Buffalo herd.

FIGHTING BEAR, PAWNEE

I will sent six of my braves ahead to spot the

Buffalo in advance of our braves

Pawnee during their summer buffalo hunt. In the ensuing rout more than 75–100

Pawnees were killed, men with mostly women and children, the victims suffering

mutilation and some set on fire.

The Quaker Indian agent John W. Williamson stated that 156 Pawnee were

killed.

SPOTTED TAIL OGLALA/BRULE’ SIOUX CHIEF

There are only 80 to a 100 Pawnee in the

canyon below us. Attack.

CHIEF CHARGING BEAR, SIOIX CHIEF

I just killed three Pawnee braves. Now I need

to kill those woman. They are easy targets.

TWO STRIKE OGLALA/BRULE’ SIOUX CHIEF

We have the trapped in the canyon. Ride

around both cliffs overlooking the canyon and

shoot your arrows and guns down into the

canyon. They are easy kill. Time to avenge our

fathers.

SKY CHIEF (TIRAWAHUT LESHARO)

This skilling of my buffalo kill is taking forever.

Who are those riders on the hill? Oh, no it is

Sioux warriors. Woman run and hide with the

children in the canyon. I will try and hold off the

Sioux if they attack.

13.

LITTLE DOG, SIOUX WARRIOR

Look there, a Pawnee chief has killed a buffalo

and is skinning it. Let us kill him and take his

buffalo. Ah eeee, (war cry)

Elsewhere in the canyon Traveling Bear is being chased by Sioux warriors.

TRAVELING BEAR, PAWNEE

Spirits above help me to escape. Ohh an arrow

in my arm. I must ride fast and warn the others.

LITTLE DOG, SIOUX WARRIOR

Three feather hit that Pawnee with your war

club. We have him trapped in the narrow

canyon. Ride fast brother. Shoot the woman

and children hiding in the bushes.

JOHN WILLIAMSON, INDIAN AGENT (23)

I will be accompanying the Pawnee on their

buffalo hunt today. It is the 4th day of August

and the sun was beating down as we

approached the north bank of the Republican

river to make camp.

9:00 pm that evening.

HARRY DUGGAN, TRADER

Is the Indian Agent John Williamson in camp?

We have bad news. We just saw a Sioux camp

about 25 miles northwest of the Republican

river. It appears the Sioux have been waiting

for a few days for the Pawnee to move up the

river to follow the buffalo.

JOHN WILLIAMSON, INDIAN AGENT

What is all the noise about? Hey Harry, how is

trading?

HARRY DUGGAN, TRADER

John you are in trouble. We spotted a large

band of about 1,000 Sioux camped about 25

miles northwest of your campsite. They have

been shadowing you for days waiting for an

opportunity to attack.

14.

JOHN WILLIAMSON, INDIAN AGENT

I find that hard to believe. Let me take you to

Sky Chief who is in command. Sky Chief it is

Mr. Williamson, may I enter your tepee?

SKY CHIEF, PAWNEE

Come in Agent Williamson. What is it?

JOHN WILLIAMSON, INDIAN AGENT

Chief these three white men just rode into

camp to tell us that there are 1,000 Sioux

camps less than 25 miles northwest of our

camp.

SKY CHIEF, PAWNEE

You are liars white man. You are just trying to

scare the Pawnees away from our hunting

grounds. You are a squaw and a coward Agent

Williamson.

JOHN WILLIAMSON, INDIAN AGENT

You insult me Sky Chief. I believe the white

men. They are old friends of mine, and would

not lie to me. I will not go as far as you dare to

go. Don’t forget that when you see 1,000 Sioux

chasing you down.

FADE OUT.

EXT. DAYAugust

5th.

That morning the Pawnee broke camp and started north up the divide between

the Republican and Frenchman rivers.

FADE IN:

SKY CHIEF, PAWNEE

Shake brother. I am sorry for speaking harshly

last night. There is no reason to be on guard. I

did not send any scouts forward.

A Pawnee scout comes riding swiftly back to the long line of Pawnee braves,

shouting.

15.

RUNNING WOLF, PAWNEE

Buffalo, buffalo in the distance, come let us ride

quickly.

SKY CHIEF, PAWNEE

You see Agent Williamson, we have found the

buffalo and no Sioux are in sight. Come lets us

ride after the buffalo.

JOHN WILLIAMSON, INDIAN AGENT

I guess I was wrong Sky Chief. I hope you kill

many Buffalo today.

PAWNEE SCOUT

Come quickly and follow me up along the river.

SKY CHIEF, PAWNEE

They are close brothers. Leave the pack

horses behind with the old women. We will

return for them after the Buffalo kill.

SCAR NOSE, PAWNEE BRAVE

We can get there faster by going up the

canyon.

On the hills out of sight from deep in the canyon a band of Lakota Sioux were

hiding behind bushes waiting for the Pawnee braves to follow the narrow canyon

to where it rises to meet the open plains.

The morning of August 5 the Pawnees went up a canyon. Men looking for game

took the lead and the families followed with loaded down packhorses. Soon after

the battle was on.

La-Roo-Chuck-A-La-Shar (Sun Chief) was a Pawnee chief who died fighting the

Lakota at Massacre Canyon.

The Pawnees say that Sky Chief lived during the first part of the battle. He fought

for his tribe, shouting words of encouragement to it. “Today I may see the tribe

you protect here. This is the end. It is supposed to be better old men not to

become. Now, men, a man be.”[27] He killed his own little son with his knife,

telling the Sioux that they would not get his child.[28]

SUN CHIEF, PAWNEE (LA-ROO-CHURCK-A-LASHAR)

(45)

It is Sioux arrows I see. Woman take the

children and run. THe other braves and I will try

to slow the Sioux down. There are too many of

them compared to our small group.

16.

SKY CHIEF, PAWNEE

Ride on brothers. I will try to slow down the

Sioux

DOG CHIEF, PAWNEE

I am coming Big Brother to save you from the

Sioux.

SKY CHIEF, PAWNEE

Do not risk your life brother Dog Chief. Go run

for your life. The Sioux outnumber us greatly. I

will fight to my last breath. Now go before it is

too late.Take My Bear claw necklace and try to

escape. I want you to have it and I do not want

the Sioux to take possession of it.

DOG CHIEF, PAWNEE

Thank you brother. We will meet in the happy

hunting ground soon.

Meanwhile at the top of the canyon.

CHIEF LUTHER STANDING BEAR, LAKOTA

SIOUX CHIEF

We have them trapped between both sides of

the canyon. Shoot all your arrows down on

them.

CAPTAIN CHARLES MEINHOLD, FORT

MCPHERSON

Where are all these Pawnee Indians coming

from? They look like they were attacked by

Sioux warriors while hunting for Buffalo

WILLIAMSON INDIAN AGENT

We were surrounded by Lakota Sioux in a

canyon near here. They outnumber us by ten

to one or more. I was so surprised to see them.

We had a warning by some trappers but Sky

Chief would not believe that there were Lakota

Sioux within 25 miles of the Pawnee camp.

PLATT INDIAN AGENT

We managed to escape out the other end of

the canyon before the Sioux could surround us.

East of Culbertson camped Capt. Charles Meinhold with his small command from

(MORE)

17.

Fort McPherson, by twist of fate. All through the morning Pawnee survivors found

the camp as well as Williamson and Platt, who had made his escape early during

the fight. The Pawnees got instructions to proceed further east.[33]

PLATT INDIAN AGENT (CONT’D)

Look over there in the canyon. There is the

body of a dead Pawnee woman.

PRIVATE KEN JAMES

Captain there are a whole mess of Pawnees

dead inside the ravine.

CAPTAIN CHARLES MEINHOLD

Look for any survivors Private James.

PRIVATE KEN JAMES

Yes, Sir.

About an hour later.

PRIVATE KEN JAMES (CONT’D)

Captain we counted fifty-nine dead bodies.

That count includes women and men. For

some reason many of the woman were

stripped naked Sir.

Meanwhile, twenty miles away at the Lakota Sioux camp Luther Standing Bear a

ten year old boy watched the Lakota warriors return to the camp after the

Massacre Canyon battle.

CHIEF CLOUD SHIELD, LAKOTA SIOUX

I have the scalp of the great Pawnee Chief Sky

Chief. Ya ho, hee (Swinging the scalp around

in the air). We killed three hundred Pawnee

today.

SCENE…Ext. Day-Massacre Canyon, August 6, 1873.

People from nearby camps and towns visited the battle scene over the next few

days.

ROYAL BUCK, REPORTER FOR THE

NEBRASKA CITY NEWS

(Posted in the Nebraska City News) It was a

massacre and nothing more, and near 100

Pawnee victims were lying on the ground and

full two thirds were Squaws, and papooses.

ROYAL BUCK, REPORTER FOR THE NEBRASKA

18.

It was a slaughter the likes of I have never

seen before.

News of the defeat reached the remaining

Pawnees in the reservation on August 8

through a runner. “This produced intense

excitement in the village, sorrowful wailings

were heard all day”.[43]

INT. DAY-AUG.

1874-Dr. Bancroft’s office, Silver creek.

The Pawnee survivors made the 80 miles or so to Plum Creek near the Platte.

Here Dr. William M. Bancroft gave professional assistance to the wounded. By

train they arrived at Silver Creek, around ten miles south of the Pawnee Agency.

FADE IN:

RUNNING WOLF, PAWNEE

Keep riding my brothers. We have many days

to go to get to the Pale Face settlement at

Plum Creek.

LITTLE WEASLE, PAWNEE

I cannot go any further Running Wolf. I have an

arrow in my side.

SWEET WATER, PAWNEE SQUAW

I have seen a vision of our brothers in the

heavens guided by the Wolf Star.

FADE TO BLACK.

EXT.-DAYLast

week of August 1874.

Indian agent Williamson returns to Massacre canyon to cover up the dead bodies

of the Pawnee.

FADE IN:

19.

WILLIAMSON INDIAN AGENT

Captain Holden I am going back to the

Massacre Canyon to properly bury the dead

Pawnee women, children and braves.

CAPTAIN HOLDEN, US ARMY

I can send a small patrol to tend to the dead

bodies if you want Mr. Williamson.

WILLIAMSON INDIAN AGENT

That is fine Captain. I need to do this to relieve

my guilt in not preventing this tragedy. I am

leaving in a few minutes with a pack horse and

my horse. I expect I will be gone for several

days.

CAPTAIN HOLDEN, US ARMY

God speed Williamson.

Two days later Williamson arrives at Massacre Canyon. Buzzards weere flying

around in the air in droves and the stench of dead is in the air.

WILLIAMSON INDIAN AGENT

Oh my God the smell of the dead bodies is

overwhelming. There is so much rock that I will

have to use the dirt from the canyon banks to

cover the bodies. I need to remember to keep

an accurate count so that I can make a full and

accurate report to the Indian Bureau in

Washington, D.C. Let me see I count 20 dead

braves, 39 squaws and ten children. Many of

the bodies were already picked clean of their

flesh by the vultures. I am going to have

nightmares forever.

Hours later Williamson stopped in a pile of sweat to recover from covering all the

bodies. Sweat rolled down his face and he quietly cried to himself.

WILLIAMSON INDIAN AGENT (CONT’D)

Perhaps I could have prevented this by making

Sky Chief listen to the white Traders. They had

no reason to lie. I guess I will bury the indian

necklaces with the bodies, rather than bring

them back to the Fort.

Two days later Agent Williamson rode back into Fort.

20.

Far away to the north the Lakota Sioux Chief Cloud Shield remembers the winter

kill differently.

CLOUD-SHIELD, LAKOTA SIOUX CHIEF

I was a good kill that winter. The Pawnee have

always been our enemy and this was our

chance to even the score. In Lakota Sioux

history this battle will be recorded as a great

victory over 150 Pawnee braves who were

hunting Buffalo on our ancestral land.

FADE TO BLACK.

THE END.

Categories
Educational Articles

The Basics of Developing a Good Powerpoint Presentation

by Dr. Pelham Mead

To do a good powerpoint presentation start with a template that has embedded motion. These templates are more attractive to students and will get their attention.

Next find some free .wav files you can insert to give sound to a slide.

Find all the clip art and Vector art you can that is free on the subject. In the Washington powerpoint slide show I worked on I loaded real and cartoon clip art of General George Washington to appeal to the humorous side of students interest.

Always apply transitions of slides at the end of the project and don’t over do them.

Animation needs to be kept simple and use clip art with white backgrounds on a white background, not a colored background for realism.

Edit and reveal the show several times looking for errors.

Limit the amount of text on a screen.

Use current hip hop music or other music the students identify with.

Keep it short.

Categories
Educational Articles

Lesson Plan in Spanish

Plantilla de plan de lecciones en línea

ASUNTOPROFESORGRADOFECHA
Lección 3Nombre del profesor112020

VISIÓN GENERAL

Nos encanta el aspecto de este plan de lecciones profesional tal como es. Pero también creemos que debería tener opciones. Para personalizar fácilmente esta plantilla y hacerla suya, en la pestaña Diseño, echa un vistazo a una amplia gama de opciones en las galerías Temas, Colores y Fuentes. O bien, para usar los colores de la escuela, toca Colores y, a continuación, selecciona Personalizar colores. Para reemplazar cualquier texto de marcador de posición, como este, simplemente tóquelo y escriba.

FASESGUÍA DEL PROFESORGUÍA DEL ESTUDIANTE
OBJETIVOS1-Aprende la vida de Hamilton.1-Ver la obra de Broadway llamada, “Hamilton.”
INFORMACIÓNEn la clase Discusión. ¿Quién es Alexander Hamilton y cuál fue su contribución a las 13 colonias?¿Cuáles son los nombres de las canciones de Hamilton? ¿Quién canta las canciones? Haga una lista y envíela cuando haya terminado. Discutir.
VERIFICACIÓNFederalismo vs Derechos de los Estados.Hamilton apoyó el control federal de las colonias y estableció ¿qué parte del gobierno?El federalismo y los derechos de los Estados existen hoy en día con el presidente Trump. ¿Cuáles son los cinco asuntos de derechos de los Estados que el presidente Trump había tratado de anular?Racismo y Hamilton. ¿En qué país nació Alexander Hamilton? ¿Cómo obtuvo una educación?¿Cómo se sintió Hamilton hacia la esclavitud?¿Dónde vivía Hamilton?¿Su casa aún existe? ¿Dónde se encuentra la casa si existe? 
PROYECTO DE AVANCE RÁPIDO¿Qué Presidente fue responsable de ayudar a aprobar la Ley de Educación Primaria y Secundaria en la década de 1960?¿Qué prevé la Ley de Educación Primaria y Secundaria?Discusión.¿Aprobaría Alexander Hamilton el acto de Primaria y Secundaria? ¿Es actuar como una forma de federalismo o no?
RESUMENDiscusión.¿Quién escribió la obra, Hamilton?¿Qué tipo de estilo de canción se utiliza en la obra?¿Quién disparó y mató a Hamilton?¿El asesino fue juzgado alguna vez por su crimen?¿Quién era la hija del asesino?Hamilton Puzzle tg  resolver.Un proyecto de una semana para una sola persona.Encuentra una aplicación de crucigrama gratis en Internet y crear un rompecabezas de 20 palabras  cruzadas usando 20 nombres o términos de la biografía de Hamilton o jugar.Cree una hoja de respuestas y envíe ambas a la maestra en una semana.Sin pegar, cortar ni copiar.
REQUISITOSRECURSOSNOTAS
Requisito 1Requisito 2Requisito 3Recurso 1Recurso 2Recurso 3Añade tus notas aquí.
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Online Teacher lesson Plan

Courset: ___________Section_______

Dates: _________________________

Unit : ______________________________________

Summary of Unit

Online Games or special activity:

:

Objectives:

Resources: Books, Internet articles, Youtube, Other

Lesson 1 Title: ____________________________________Time ______________________

Lesson 2 Title: ____________________________________Time ______________________

Lesson 3 Title: ____________________________________Time ______________________

Lesson 4 Title: ____________________________________Time ______________________

Lesson 5 Title: ____________________________________Time ______________________

Assignment and Activities:

Assessment: ___Total participation; ___ Good demonstration and response; ___Average response, students interested. ___In effective presentation and response, do not repeat.

Which Student stood out with their preparation and verbal responses?

Students:

One Minute Test:

Five Minute Test

Powerpoint Quiz

One Week Project assignment.

Monthly Team Project

Notes:

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Adobe Photoshop online Projects 2020

Project Three- The Desert Coyote is another copyrighted photo from Adobe.Com. I take no credit for this photo. This project is found in all the Adobe Photoshop classroom books from version 4 forward.

Instructions:

This project uses more of the Adobe photoshop tool bar found in the left side of the program. Previously, we used different cut and copy tools and pasted them onto other layers or repeated the image by holding down the CONTROL key. In the coyote photo.psd we edit again by coloring and copying images and putting them into the photo. See below the image of the Adobe Photoshop toolbar. We are going to use the paint brush tool, The blur tool, magic wand, lasso.