E- Port Final

Testwiseness

"A subject's capacity to utilize the characteristics and formats of the test and/or the test-taking situation to receive a high score" -->Millman, Bishop, and Ebel (1965) "Analysis of testwiseness" (1965)

When all else fails...GUESS

"Guessing nearly always pays off in a course for which you've studied, because when you have studied, you will rarely encounter a question about which you know absolutely nothing." Guessing always pays off when there's no penalty for it.

SOAP Notes: objectives

"Objective" Section •Usually starts with Vital Signs •Each section heading may contain more or less details depending upon problem list •Almost all with contain Lung/Heart Exam •May include recent test/procedure results

NYS Office of the Professions

"The State Education Department, under Regents' direction, administers professional regulation through its Office of the Professions, assisted by the State Boards for the Professions." http://www.op.nysed.gov/

Critical Thinking Defined

"active, persistent, and careful consideration of a belief or a supposed form of knowledge in the light of the grounds which support it and the further conclusions to which it tends" John Dewey - 'Thinking about thinking' (Metacognition) - 'Analyzing and evaluating thinking to improve thinking'

Test Taking Skills Three Pass Stategy

*1st Pass:* answers you're sure of and that come easily *2nd Pass:* go back to the ones you've marked to rethink. If still really uncertain, move on *3rd Pass:* the really tough ones. (but now you should have 'money in the bank')

Assumptions & Inferences

*Assumptions:* belief that was previously learned, not questioned - taken for granted (subway is a dangerous place; ulcers caused by stress) *Inferences:* deriving one idea from another - if this, then that (knife left on train used un crime, sedatives will prevent ulcers) *Logical inferences are based on sound assumptions*

Professionalism vs 'Ethical Integrity'

*Autonomy:* acknowledge a person's right to make choices *Beneficence:* (do good) - provide benefits *Nonmaleficience:* do no harm *Justice:* treat other equitably

Causal Explanation (2 of 2)

*Fallacy:* confusing cause with effect: 90% of patients having an MI have chest pain; I have chest pain, I must be having a heart attack; chest pain (symptom) is an effect of the condition (MI) not the cause; it still applies if 100% of patients having an MI have chest pain

Causal Explanation (1 of 2)

*Fallacy:* correlation proves causation *Fallacy:* Post hoc, ergo propter hoc: after that, therefore because of that - thinking that because one event preceded another proves that the earlier event caused the later one - Strongest (but not absolute) confirmation of causal hypotheses is the controlled experiment

Test Taking Skills Time Management

*KNOW ABOUT or LOOK over the test first* - See how many questions there are and how long you have to answer them - Subtract 10-15 minutes for checking your answers depending on your test-taking styles - Divide the rest by 2 --> the half-way point

Problem Solving #1

*Philanthropist* - Promote environmentalism - Reduce dependence on foreign oil *Choice* - SUV 15mpg --> Car 27 mpg (12 mpg difference) - Car 27 mpg --> Hybrid 60 mpg (33 mpg difference)

Medical Literature

*Publication Bias:* selective publication of research findings depending on the nature and direction of results - Inherent limitations of medical research using human subjects - controlled experiments usually just not possible

Problem Solving #1 Answers

*SUV* 10,000 mi/yr / 15 = 667 gallons 10,000 mi/yr / 27 = 370 gallons *Save 297 gallons* *Car* 10,000 mi/yr / 27 = 370 gallons 10,000 mi/yr / 60 = 167 gallons *Save 203 gallons*

Civility and Professionalism

*Structural Attributes* - Specialized Knowledge and Skills - Licensure/Certification - Professional Associations - Social Prestige - Code of Ethics *Attitudinal Attributes* - Belief in service to public - Self-regulation - Professional Organization sets standards

True/False Questions

- *if it is not completely true, it's false* - In a complicated question break it up into phrases and make sure that each one is correct (in other words, make each phrase a T/F statement) - On the other hand, don't over-read the question - remember the 6-chambered heart

Test Taking Skills Multiple Choice Hints

- A 'good test taker' has the calm and focus to stick with a difficult question to figure it out (AFTER you've answered the easier ones) - Use your partial knowledge to figure out the questions for which you don't immediately have an answer.

ABIM Challenges to Professionalism

- Abuse of Power - Arrogance - Greed - Misrepresentation - Impairment - Lack of conscientiousness - Conflict of Interest

Professionalism Framewoks *ABIM*

- Altruism - Accountability - Excellence - Duty - Honor and Integrity - Respect for Others (American Board of Internal Medicine 1995)

Test Taking Skills Multiple Choice - *Pay special attention to qualifying words*

- Always - Never - Except - Only - Necessarily - Must - Completely - Often - Sometimes - Perhaps - May - Generally

Problems

- Bias - Misinformed - Vague - Illogical

Critical Thinking Defined

- Careful application of reasoning to evaluate whether a claim is true - Widely applicable

Intellectual Standards

- Clarity - Accuracy - Precision - Relevance - Depth - Breadth - Logic

Emotional Intelligence

- Clinical interactions can result in happiness, guilt, grief, compassion, pride, anxiety, anger, etc - Professionals exhibit 'Emotional Intelligence:' --> Knowing one's own emotions --> Managing one's emotions --> Motivating oneself --> Recognizing emotions in others --> Handling relationships

Examples of Critical Thinking (2 of 3)

- Construct cogent arguments rooted in data rather than opinion - Attend to contradictory, inadequate or ambiguous information - Recognize that a problem may have no clear answer or single solution - Consider all stakeholders or parties affected in suggesting a course of action

Examples of Critical Thinking (3 of 3)

- Correctly and precisely use evidence to defend the argument - Present evidence in an order that contributes to a persuasive argument

Test Taking Skills Multiple Choice - Review

- Depending on the directions, the answer should be either completely correct or completely wrong before you choose it. If it's a mix of both, it's probably not the correct answer - For more difficult questions, *make your best guess, mark or flag the question and move on.*

Test Taking Skills Strategies for Difficult Questions

- Eliminate options that you *know* are incorrect - "All of the above" is probably correct if you can find 2 options you know are correct (UNLESS there is an answer like 'a&b are correct') - "None of the above" *cannot* be the answer if *any* of the other choices are correct - Choices which say exactly the same thing in different ways are probably wrong - Remember to look at other questions which may give a hint for the one you're stuck on - Use your medical terminology to figure things out - Don't get PARALYZED

Clinical Reasoning

- Expert thinking - Evidence-based -> scientific - Also - ethical, psychosocial, economic and legal aspects

When should you change your answer?

- Find out if you're generally a right --> wrong changer or a wrong --> right changer - NEVER change answers unless you have a good reason for doing so (not just second-guessing yourself)

*Rule Two* (via Kaplan PANCE Guide)

- If you truly can't eliminate any of them, have a favorite letter that you choose - Again - does not improve your odds, but it does keep you from getting stuck

Credibility

- Is the source credible enough to warrant belief? - Publisher's clearing house prizewinner call - Are degrees of credibility - "Interested Party" or conflicts of interest = less credible - Applies to literature, patients, co-workers, etc

AAPA Statement of Values (2 of 3)

- PAs assess their personal capabilities and limitations, striving always to improve their medical practice - PAs actively seek to expand their knowledge & skills, keeping abreast of advances in medicine

AAPA Statement of Values (3 of 3)

- PAs work with other members of the health care team to provide compassionate and effective care of patients - PAs use their knowledge and experience to contribute to an improved community - PAs respect their professional relationship with physicians - PAs share and expand knowledge within the profession

Professionalism Frameworks

- Patient-centered Care - Integrity & Accountability - Pursuit of Excellence - Fair and Ethical Stweardship of Healthcare Resources

AAPA Statement of Values (1 of 3)

- Physician assistants hold as their primary responsibility the health, safety, welfare and dignity of all human beings - Physician assistants uphold the tenets of patient Autonomy, Beneficence, Nonmaleficience and Justice - PA recognize and promote the value of diversity - PAs treat equally all persons who seek their care - PAs hold in confidence the information shared in the course of practicing medicine https://www.aapa.org/wp-content/uploads/2017/02/16-EthicalConduct.pdf

Test Taking Skills Read the Directions & Questions Carefully

- Read the directions and each question more than once - One of the most common reasons for getting questions wrong is misreading the test directions or the question stem

Test Taking Skills Multiple Choice - Approach

- Read the question at least twice and try to answer it BEFORE looking at the answers - *HOWEVER,* continue to look at all of the answers before actually marking your choice (sometimes you're looking for the BEST answer among several with correct parts) *EXCEPTION* On a long case question, the strategy changes: - Read the answers first and then the case

OP - Professional Misconduct Includes: (2 of 2)

- Releasing confidential information without authorization - Being convicted of a crime - Failing to return or provide copies of records on request - Being sexually or physically abusive - Abandoning or neglecting a patient in need of immediate care - Performing unnecessary work or unauthorized services - Practicing under the influence of alcohol or other drugs

Examples of Critical Thinking (1 of 3)

- Separate fact from opinion - Determine what information is or is not pertinent - Recognize the ways in which evidence is limited or compromised - Present his/her own analysis of data - Draw connections between discrete sources of data

Differential Diagnosis

- The determination of which one of two or more diseases or conditions a patient is suffering from, by systematically comparing and contrasting their clinical findings - Usually in order of most likely to least likely - Can also be of a clinical finding i.e. calcification on chest x-ray

Professionalism Issues

- Use of electronics while seeing patients - Appearance and language - Representation - Not enough time - Reaction to hostility - Attendance - Completing assigned tasks

Constructivism

-Unique perspective and understanding based on experiences (active learning) and reflection upon experiences to build deeper understanding -Foundation is existing knowledge and experiences -Concept of "creating" knowledge

Evidence-Based Medicine

1. Formulate Question 2. Gather & Assess Information 3. Apply to problem at hand "Integrates individual experience with best available external evidence" -- White B.

The Plagiarism Spectrum (1-5)

10 Types of Plagiarism Ordered from *MOST to LEAST severe*: 1. CLONE: An act of submitting another's work, word-for-word, as one's own. 2. CTRL-C: A written piece that contains significant portions of text from a single source without alterations. 3. FIND-REPLACE: The act of changing key words and phrases but retaining the essential content of the source in a paper. 4. REMIX: An act of paraphrasing from other sources and making the content fit together seamlessly. 5. RECYCLE: The act of borrowing generously from one's own previous work without citation; To self plagiarize.

The Plagiarism Spectrum (6-10)

6. HYBRID: The act of combining perfectly cited sources with copied passages—without citation—in one paper. 7. MASHUP: A paper that represents a mix of copied material from several different sources without proper citation. 8. 404 ERROR: A written piece that includes citations to non-existent or inaccurate information about sources 9. AGGREGATOR: The "Aggregator" includes proper citation, but the paper contains almost no original work. 10. RE-TWEET: This paper includes proper citation, but relies too closely on the text's original wording and/or structure http://turnitin.com/assets/en_us/media/plagiarism_spectrum.php

Professionalism vs unprofessional behavior

A professional is one who willingly 'adopts' and consistently applies the knowledge, skills and values of a chosen profession. (American Academy of Professional Coders) vs. 'Unprofessional Behavior: not displaying this or acting in a way that is inappropriate; not representative of your profession

CUNY Policy on Academic Integrity

Academic dishonesty is prohibited in The City University of New York. Penalties for academic dishonesty include academic sanctions, such as failing or otherwise reduced grades, and/or disciplinary sanctions, including suspension or expulsion.

•Georgetown ePortfolio Initiative

An ePortfolio is a digital archive that represents student work over time through a broad range of artifacts.

Cognitive Biases

CDR = Cognitive Disposition to Respond - Can be subconscious - Errors can be classified in three ways --> No-fault errors --> System errors --> Cognitive Errors

Problem #2

Father and son in a terrible car crash - Father dies - Son rushed to OR for Neurosurgery Neurosurgeon enters room and exclaims 'I can't operate! This boy is my son!' *Boy's MOTHER is the surgeon*

Husbands & Wives Examples

Fred, Ed and Ted are married to Joan, Sally and Vicky. Joan, who is Ed's sister, lives in Detroit. Fred dislikes animals. Ed weighs more than the man married to Vicky. The man married to Sally breeds Siamese cats as a hobby. Fred commutes over 200 hours each year from his home in Ann Arbor to his job in Detroit. Match them up!

Professionalism vs 'Professional Integrity'

Having moral principals guide behavior

The Up/Down Rule (via Kaplan PANCE Guide)

If down to 2 choices and you're stuck - Up for even numbered questions - Down for odd numbered questions --> this doesn't increase your chances of getting it right, but it does keep you from wasting your time being stuck

Clinical Judgment

Judgment A. the process of forming an opinion or evaluation by discerning and comparing B. an opinion or estimate so formed (Webster Online) *Knowledge base + experiences are basis for clinical judgment.*

Clinical Diagnostic Reasoning

Judith Bowen - University of Oregon *Classroom Learning* - parallels syllabus - compartmentalized - contextual clues *Clinical Learning* - patient-centered - complex, multi-system - contextualized in 'Patient Story'

Novice vs. Experienced (example)

My knee hurt so much last night, I woke up from sleep. It was fine when I went to bed. Now it's swollen. I've had problems before in the same knee, once nine months ago and once two years ago. It doesn't bother me between times.

Obtaining Unfair Advantage

Obtaining Unfair Advantage is any action taken by a student that gives that student an unfair advantage in his/her academic work over another student, or an action taken by a student through which a student attempts to gain an unfair advantage in his or her academic work over another student. Examples of obtaining unfair advantage include: - Stealing, reproducing, circulating or otherwise gaining advance access to examination materials. - Depriving other students of access to library materials by stealing, destroying, defacing, or concealing them. - Retaining, using or circulating examination materials which clearly indicate that they should be returned at the end of the exam. - Intentionally obstructing or interfering with another student's work.

Plagiarism

Plagiarism is the act of presenting another person's ideas, research or writings as your own. Examples of plagiarism include: •Copying another person's actual words or images without the use of quotation marks and footnotes attributing the words to their source. •Presenting another person's ideas or theories in your own words without acknowledging the source. •Failing to acknowledge collaborators on homework and laboratory assignments. •Internet plagiarism, including submitting downloaded term papers or parts of term papers, paraphrasing or copying information from the internet without citing the source, or "cutting & pasting" from various sources without proper attribution.

OP - Professional Misconduct Includes: (1 of 2)

Professional misconduct includes the following: - Engaging in acts of gross incompetence or gross negligence on a single occasion, or negligence or incompetence on more than one occasion - Permitting or aiding an unlicensed person to perform activities requiring a license - Refusing a client or patient service because of race, creed, color or national origin - Practicing beyond the scope of the profession

Problem #3

Rooster Problem - Rooster is on the peak of a roof - facing Northeast - If the rooster lays an egg, which direction would it roll down the roof? *It wouldn't as Rooster's don't lay eggs*

Testwiseness Example Question

The climate of LaBruk is: A. Damp *B. Warm and Sunny* C. Dark and rainy D. Frequently moist

Defining and Discriminating Features of a Set of Diagnostic Hypotheses for Acute Arthritis

The problem representation is "acute onset of a recurrent, painful, monoarticular process in an otherwise healthy middle-aged man." Defining features are descriptors that are characteristic of the diagnoses (e.g., gout, septic arthritis, osteoarthritis). Discriminating features are descriptors that are useful for distinguishing the diagnoses from one another.

Cheating

The unauthorized use or attempted use of material, information, notes, study aids, devices or communication during an academic exercise. *Examples of cheating include:* •Copying from another student during an examination or allowing another to copy your work. •Unauthorized collaboration on a take home assignment or examination. •Using notes during a closed book examination. •Taking an examination for another student, or asking or allowing another student to take an examination for you. •Changing a graded exam and returning it for more credit.

Paradigm Shift

Thomas Kuhn -- The Structure of Scientific Revolutions 1962 - Concept Continuity vs. Paradigm Shift - Copernican Revolution - Change in the 'rules' possible

Problem #4

Two elderly patients are seen separately by an expert clinician and diagnosed with moderate osteoarthritis. They are twins and have exactly the same clinical presentation. The clinician aggressively treats one twin with medications while the other is treated conservatively. How come? *Income differences, physical therapy options, housing (walk-up apt vs. home)*

Bloom's Taxanomy

evaluation synthesis analysis application: how to apply to real life comprehension: evaluating/judging knowledge: learning + describing

SOAP Note

method of documentation employed by healthcare providers to write out notes in a patient's chart Subjective: patient reported Objective: observed physical examination and diagnostic study results Assessment - includes differential diagnosis Plan - includes any type of intervention, further work-up or treatment

E-Portfolio: Wikipedia definition

s a collection of electronic evidence assembled and managed by a user...such electronic evidence may include input text, electronic files, images, multimedia, blog entries, and hyperlinks. E-portfolios are both demonstrations of the user's abilities and platforms for self-expression. If they are online, users can maintain them dynamically over time. One can regard an e-portfolio as a type of learning record that provides actual evidence of achievement.

Professionalism Defined

the conduct, aims or qualities that characterize or mark a profession or a professional person Annals of IM 2002: basis of medicine's contract with society -> no specific, common definition

ePortfolio as Thesis Alternative

•"Capstone" Project •Eportfolio broader, scaffolded, more iterative process •Each is unique •Better preparation for clinical practice •Better preparation for boards

HPPA 600 PA Portfolio I

•Description includes "... facilitate design and development of an electronic portfolio demonstrating integrative learning, professional development and evidence-based critical thinking." •Includes reflective statements/journaling, site visit summary, patient encounter logs, Clinically Focused Review, multiple other artifacts

Falsification of Records and Official Documents (examples)

•Forging signatures of authorization; falsifying information on an official academic record; falsifying information on an official document such as a grade report, letter of permission, drop/add form, ID card or other college document.

CUNY Academic Commons

•Free, "forever" student accounts •Live CUNY support •Utilizes open source WordPress •Can be made public/private/group •Easily accessible •Tutorials on Lynda.com (LinkedIn Learning)

ePortfolio as Thesis Alternative

•From Proposal to Establish PA Graduate Program: "An ePortfolio will be included as a thesis alternative which will allow inclusion of artifacts throughout the program to demonstrate achievement of learning and practice outcomes. It will culminate in a critically appraised topic (CAT) project - a structured review of the best published medical evidence available to answer a clinical question. This process links the curriculum design with the highest-level, most relevant desired learning outcomes."

HPPA 620 PA Portfolio III

•Full Critically Appraised Topic - design, conduct, defend •(Course includes Written Summative Exam) • •All portfolio courses are graded with a rubric

HPPA 610 PA Portfolio II

•Introduction to Critically Appraised Topics (CAT) •In PICO format; patient Problem intervention comparison outcomes

The ePortfolio at York's PA Program

•Is a "work in progress" - Follows you from next week through graduation •Will contain artifacts from various didactic courses •Are three separate online ePortfolio courses: -HPPA 600, 610 and 620

Medical Records

•Medical History •Physical Examination •Problem Oriented Medical Record -Comprehensive History/Physical -Diagnostic Test Results -Problem List -Medication List -Progress Note or SOAP Note (Subjective,Objective,Assessment,Plan) •Hospital Records -Admitting Orders, Orders, Progress Notes, Operative Reports, Diagnostic Test/Lab Reports, Pathology Reports, Consultant Reports, Ancillary Reports, Informed Consent, Discharge Summary

SOAP Note: plan

•Medications (including OTC) •Further Diagnostic Testing •Monitoring •Diet/Nutrition •Referrals - physical therapy, consultants •Next visit

Wu - Effective SOAP Notes

•Organize thoughts before writing •Not written for general public •Omit extraneous or non-contributory info •Avoid excessive use of acronyms or abbrv. •Underline abnormal findings •Date events by time (and absolute date best) •Document only what you did (or observed) •Assessment is short •Sign and legibly identify yourself

Connect to Learning Project: reflection

•Reflection is pivotal to meaningful student ePortfolios, which function as sites for prompting, documenting, and sharing students' reflection on their learning. And reflection helps to move outcomes assessment beyond accountability as individuals and programs reflect on assessment findings and their implications for curricular and pedagogical change. a pivotal point where students can look back on what they have done and think of what they did well and what can be improved

Reflective Journaling

•Reinforces learning •Form of self-directed learning •Encourages critical thinking •Encourages integrative learning •Documents changing skill sets •Encourages reflective professional practice

ePortfolio: reflection

•Select and upload artifact •Describe project/learning activity including design, resources utilized, any outcomes •May be able to add multimedia, embellish •Reflect upon: -Why did you choose this artifact? (if applicable) -Share your thinking/strategies while completing -Any obstacles/problems/setbacks? -What skills/knowledge gained? - Application: How will you use what you have gained in your professional or personal life? -What did you enjoy most/ what are your strengths? -What did you struggle with/ areas needing improvement? -How might you do it better next time? -What are next steps to further learning goals? •Make connections across courses/rotations!!

Connect to Learning Project: integration

•Students use ePortfolios to bring together work from multiple contexts, to consider the relation between their classrooms and their lives outside of class, and to construct new identities as learners. In ePortfolio-related professional development, an integrative approach prompts faculty to develop and test strategies that help students integrate their learning; and also helps faculty and staff to transfer knowledge and insight from specific instances to broader contexts and applications. students bring work from different sources to create new ideas. Programs can see what works well for students in terms of learning and expand info to broader context.

Academic Dishonesty

•Submitting substantial portions of the same paper to more than one course without consulting with each instructor. Preparing answers or writing notes in a blue book (exam booklet) before an examination. •Allowing others to research and write assigned papers or do assigned projects, including using commercial term paper services. •Giving assistance to acts of academic misconduct/ dishonesty. •Fabricating data (in whole or in part). •Falsifying data (in whole or in part). •Submitting someone else's work as your own. •Unauthorized use during an examination of any electronic devices such as cell phones, computers or other technologies to retrieve or send information.

Connect to Learning Project: inquiry

•ePortfolio pedagogy engages students in a recursive inquiry into their own learning and their evolving identities as learners. Through sustained collective inquiry in ePortfolio-related professional development and outcomes assessment, faculty, staff, and the broader institution construct new knowledge and understandings about the teaching and learning process. students are inquired and interested in their own learning and growth as learners.