University of Bridgeport College of Naturopathic Medicine Reviews
Message from the Dean: University of Bridgeport, College of Naturopathic Medicine
Marcia Prenguber, ND, FABNO
The faculty and staff of the College of Naturopathic Medicine at the University of Bridgeport (UBCNM), similar our 
colleagues in other schools, are continuously looking for strategies and methods to heighten our program, to create better tools and techniques to improve our outcomes and the success of our students.
From a concrete environment standpoint, in the past 24 months we built a new 11 000 sq ft naturopathic medical dispensary within the UB clinics. This clinic encompasses the entire 8th floor of the Wellness Sciences Center building on campus, with spacious examination and treatment rooms and a new hydrotherapy suite, equally well equally 2 additional dispensary briefing rooms for case discussions. We are currently designing a new enquiry lab in conjunction with the other health sciences programs here at the University. On the instructional side, boosted faculty with specialty training have joined our team, enhancing both the academic and clinical programs, such as Patrick Fratellone, Physician, an integrative cardiologist, and Allison Buller, PhD, a total-time faculty member of the UB Counseling and Psychology program. One of our most recent efforts, implemented in March and April of 2016, is a redesign of the procedures for assessing students' clinical skills and competencies.
Improving Clinical Assessment
The clinical assessment process includes mid-term and stop-of-term evaluations by the clinical supervising physicians, intended to provide feedback to students regarding their demonstration of clinical skills on each rotation. In improver, clinical examinations are implemented nigh the end of the academic twelvemonth to evaluate each student's skills and competencies, and their readiness for the next step in preparation, or readiness to graduate. These applied clinical exams serve both formative and summative functions; students are evaluated for the progress that they take fabricated, and the evaluation is used to identify areas of need. At UBCNM, these exams appraise professionalism, communication skills, and competencies in assessment, evaluation and interpretation of findings, medical reasoning, diagnosis, and in the development of appropriate treatment recommendations, appropriate referrals, and charting skills. The exams are progressively challenging, demanding greater skill and broader competence at each level of the program. Dispensary Entrance Exams are administered nearly the end of the second year, Clinic Promotion Exams nearly the conclusion of the third year, and Clinic Exit Exams near 10 weeks earlier graduation. This provides adequate fourth dimension for remediation and reassessment of identified areas of need before the student moves to the side by side stride in the program or on to graduation.
In years past, the Clinic Exams consisted of a student's come across with a standardized patient (or volunteers trained to serve equally patient), with a faculty evaluator present in the exam room, observing and meantime documenting their findings as the patient run into proceeded. The kinesthesia evaluators would share the results with the student many days later on post-obit a clinic faculty coming together, to discuss findings. The arrangement worked, although we were largely unable to adequately evaluate inter-rater reliability. Redesigning the examination procedure allowed u.s.a. to ameliorate reliability and objectivity of the assessment. Evaluation rubrics had been developed and successfully implemented in our clinical examinations in recent years, and nosotros accept maintained that approach.
The most evident change to the process was to supercede the evaluator in the exam room with a camcorder or webcam, with evaluators viewing the exam recording at a later appointment. This removed the problem of an action or statement being missed if the evaluator glanced away or was unable to hear the discussion. It also eliminated any conscious or unconscious influence that an evaluator might have on the pupil or process during the exam. Each pupil'southward exam, consisting of the recorded patient come across, chart notes, and a recorded case presentation, was independently reviewed and scored past 2 or more evaluators. In turn, this has given the faculty and administrative team an opportunity to examine inter-rater reliability through the review and comparison of two or more scored rubrics for each examination-taker. This evaluation volition contribute to the ongoing redesign of the evaluator preparation procedure, toward a goal of developing more than constructive and more objective tools for assessing students' clinical competencies.
Nosotros accept administered each of the iii clinical exams (Entrance, Promotion, and Get out Exams) in this new format in one case thus far, and we accept learned from each. Having a few weeks betwixt the various exams allowed u.s.a. to brand revisions that improved the process. We learned what data was important to the students to have in advance of the twenty-four hours of the exam, altered some components of the procedure that improved the overall experience for the exam-taker, and refined the rubrics to improve inter-rater reliability.
Improving Clinical Exams Recordings
There are many elements to consider when approaching the process of recording clinical examinations, considerations that are different from the more traditional method of clinical exams with an evaluator present in the room. Here are a few recommendations:
- Edit the rubrics carefully for clarity and to express objective measures of competence. Varying interpretations by the evaluators of the salient aspects of the case and the level of competency demonstrated by a test-taker are signs of an unclear rubric. Look for wording that is unclear, inconsistent, disruptive, or simply as well broad, or competencies which crave subjective analysis past the evaluator. Piece of work with a series of readers, including evaluators, to create objective measures that are clearly written. Talk over linguistic communication used in each rubric, assessing the potential for multiple interpretations, and edit each until they are articulate and consistently interpreted.
- Hash out accepted variations in performing physical exams during evaluator training. Manner variation in the performance of physical exams may consequence in variable scoring. This preparation too reduces an evaluator'south inclination to assign extra points for skills demonstrated that are not appropriate to the case. Variation amidst evaluators' scores in other areas may point a like need for boosted discussion of how to assess the more than subtle aspects of each competency.
- Double-decker evaluators to make notes regarding the demonstration of the competency as the recording proceeds. These notes are indispensable in reviewing the outcomes with students, to clarify the concerns as seen in the viewing of the recording.
- Evaluate cases for "playability," assessing if the symptoms can be convincingly communicated by the actor. Can the recording equipment capture the interviewing process as well as all aspects of the physical exam(s)? Playing out the example in advance can determine the best camera angle for the exam.
- Identify each objective before creating the cases and associated rubrics. Overlap of skills noted in the scoring process can crusade defoliation in scoring most which competency is being evaluated. Creating the cases and rubrics around the previously identified objectives reduces the risk of defoliation.
- Go on scoring to a traditional method, using a more standard scale, such as 0-100, and building the weight of each category into the initial procedure. Using other approaches (eg, scale of 0-30) or weighing the scores after the evaluator has completed their process leads to confusion.
- Conceptualize students' concerns, and know that some anxiety is inevitable. While the students expressed anxiety near the recording process in advance of the examination day, the recording component was not a significant business during the patient encounters. Use of a familiar charting outline for documenting findings reduces another potential source of concern for students.
- Collaborate with faculty members who teach the aspects of the curriculum that are most clearly evaluated in these exams, such as concrete examination and orthopedic cess. Their involvement with the case and rubric development is instrumental in creating a cohesive process.
- Provide students a low-stakes encounter with the exam format. Recording skills in the classroom as they are learned can reduce students' anxiety in the exam-taking environment, too as support the learning procedure. Students can pic one another using smartphones, webcams, or whatsoever of a number of electronic devices. When they review and evaluate their own and/or their classmates' functioning(southward), they gain a measure of objectivity nearly what really took place, as compared to what they remember doing or proverb during the encounter.
Using the uncomplicated technology of a webcam and laptop to tape clinical exams has made a significant deviation in our power to assess and review with students their progress in the clinical realm. This detailed feedback, not only for the student, just also for the kinesthesia member, the evaluator, and the administrator, takes us to a new level, creating a feed-frontwards loop which allows us to evaluate and amend our own skills in instruction and assessment.
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Source: https://ndnr.com/education-web-articles/message-from-the-dean-university-of-bridgeport-college-of-naturopathic-medicine/
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