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DECEMBER 3, 2012
CPC Steering Committee Supermeeting
DR. PATRICK O'CONNOR, PH.D.
History and Goals of the CPC
History of the CPC(Clinical Presentation Continuum)
First implemented September 1999 Replaced the traditional Systems-Based
curriculum in place since the inception of the college in 1976
“The goal of a revised OU-COM curriculum will be to graduate D.O.’s who can excel in any type of postdoctoral training but who generally choose to become superior osteopathic primary care physicians.”
10 Goals of the CPC Curriculumfrom a 2005 PPT written and delivered by Dr. Peter Dane, D.O.
1.Organization to select content and demonstrate relevance to clinical medicine
Common, important clinical presentations Cough Headache Hypertension
Interdisciplinary Planning Teams Biomedical Science Family Medicine Social Medicine OMM Specialty Medicine
10 Goals of the CPC Curriculum
2. More effectively address the huge, exponentially increasing body of biomedical knowledge
move away from concept of learning as memorization of facts
move toward a concept of learning as the ability to retrieve information (facts) and apply it to clinical problem-solving
“learn to learn”
10 Goals of the CPC Curriculum
3. Horizontal integration among individual courses
Weekly themes (modules) based on a clinical presentation Back Pain Sore Throat Palpitations Jaundice
Eliminate discipline boundaries Learning activities structured around a clinical
context
10 Goals of the CPC Curriculum
4. Vertical integration between pre-clinical and clinical learning environments
Patient case studies are prominent learning tools All learning objectives (LTs)are related to clinical
skills Assessment items support clinical decision-making Revisit/reinforce BMS in years 3-4
10 Goals of the CPC Curriculum
5. Less compressed and rigid curriculum Limit classroom time Integrate basic science material into years 3 & 4
learning activities introduction reinforcement
10 Goals of the CPC Curriculum
6. Optimal commitment to OMM and OPP OPP built into case studies correlate concepts with clinical presentations revisit and enhance in years 3 & 4
10 Goals of the CPC Curriculum
7. Optimal commitment to life-long learning independent learning “prepared mind” learn to learn problem-solving approach
10 Goals of the CPC Curriculum
8. Strengthen learning and assessment methods Variety of learning methodologies
problem sets discussion groups panel discussions collaborative learning
Engaged learning Dual purpose lectures
provide overviews address traditionally challenging topics
Assessment items are based upon objectives (LTs) that derive from physician tasks, skills, responsibilities
Assessment items support clinical decision-making
10 Goals of the CPC Curriculum
9. Foster a collegial – not– adversarial relationship between faculty and students
Closer faculty-student interaction small groups faculty facilitate discussion
10 Goals of the CPC Curriculum
10. Nurture an inspiring learning environment Clearly relevant knowledge base construction Return of the “joy of discovery.”
ROSEMARY BUTCHER
Scheduling and Deadlines
Schedule Process
Starts 6 months in advance (This decision was made by the Executive Committee) Clinicians schedule clinic hours far in advance Department Chairs plan and schedule faculty workload for the
semester, sometimes the whole year
Schedule Process
Fall Semester Request schedule from IoR’s in January for July start DRAFT teaching assignments goes out in March
This is the time to review and revise Revisions should be returned to Rosemary within 30 days
FINAL teaching assignments goes out in May Once final schedules have been distributed, only
unavoidable/ unforeseen changes should be made (i.e. due to illness, weather, etc.)
Schedule Process
Spring Semester Request schedule from IoR’s in July for January start DRAFT teaching assignments goes out in September
This is the time to review and revise Revisions should be returned to Rosemary within 30 days
FINAL teaching assignments goes out in November Once final schedules have been distributed, only
unavoidable/ unforeseen changes should be made (i.e. due to illness, weather, etc.)
Meeting deadlines is imperative!
For individuals Clinicians schedule clinic hours months in advance To schedule teaching outside OU-HCOM (graduate teaching,
clinical teaching at OMH, etc.)For Departments
Department chairs need accurate teaching schedules to plan additional workload, such as research commitments, committee memberships, etc.
For the curriculum office Time spent on inappropriate last-minute schedule changes could
be more effectively spent Dominoes! That ‘one small change’ you want to make can cause
hours of phone calls emails, and scheduling headaches you may not be aware of.
For the College Room schedules are needed by college staff for non-academic
calendar activities
DR. PATRICK O’CONNOR, PH.D.
Block Planning: Overview, Goals and Schema
Block Overview
Provides block team: Provides the block team a road map for delivery of
content and review and revision of material A organizing tool to assist in preparation, review and
revision of the block Allows block team to highlight major areas of learning
and particular emphases of the block
Block Overview
Provides students: Clear understanding of the block’s purpose Parameters of learning in the block The expected outcomes for the block
Block Overview
Should include statements such as… During this block, students will be introduced to…. During this block, …will be examined. This block offers students the resources and
environment for learning…. This block will emphasize…. This block introduces students to key concepts
essential to caring for… by…. The skills of … are reinforced in lab sessions
devoted to….
Block Goals
Use block goals to Prepare for block planning Clarify Block Overview Tie in particular areas of planning, such as cases, S&I,
etc. Consider explicit goals regarding different aspects of
block material delivery
Block Goals
Block goals should be clear and specific, such as: The goals of this block are to introduce the Medical
Student to…. The major goals of this block are… The cases lead students into considerations of…. The cases encourage the student to develop…skills
based on principles of…. Synthesis and Integration sessions in this block will
focus on… Simulated patient encounters will strengthen students
’ skills in…
Schema
Description A graphic representation of the basic science and clinical
connections that underlie the specific clinical presentation The branches of a clinical schema illustrate the
relationships among the anatomical, immunological, biochemical, metabolic or physiological pathologies underlying the diverse conditions that present similarly
Each branch depicts at least feature that distinguishes it from the other branches at the same level of the diagram
The endpoints of the branches constitute a listing of protypical “differential diagnoses” associated with the patient presentation being studied
Schema
Purpose Help students discriminate differences in pathology Represent a logical graphic organization of
pathological processes underlying the various causes of the clinical presentation
Illustrate relationships (i.e. similarities, differences) among the various causes of the clinical presentation
Highlight the abnormal biomedical processes that differentiate one pathological condition from another
Conclude with a representative list of differential diagnostic entities associated with multiple causes of the clinical presentation
Schema
Block planning Discuss with the block team when and how students
use the schema Focus faculty by providing a block overview and an
opportunity to fill in details Add, remove or change schema as appropriate Make changes to the schema to strengthen both the
schema itself and its usefulness in the block
Schema
Example
MICHAEL W. TOMC, DO, FOCOODECEMBER 3, 2012
Standardized Clinical Behaviors (SCBs)
What are “Standardized Clinical Behaviors?”
A. Never heard of themB. Not sure, but it sounds vaguely familiarC. Not sure, but if they have anything to do with
boards, I’m willing to listenD. Those annoying forms you have to fill out
before seeing the doctorE. Those elements of the clinical encounter that
are particularly important for the physician to address when evaluating a patient with the clinical presentation being studied
Example: Hearing Loss Module
Standardized Clinical Behaviors Hearing Loss
For an encounter with a patient presenting with a chief complaint of hearing loss, the physician should: Elicit an appropriate medical history, with special attention to the
following questions: Onset: gradual or sudden? Duration: constant or intermittent? Unilateral or bilateral? Age of onset? History of noise exposure? History of exposure to ototoxic medications? Family history of hearing loss? History of head trauma? Otalgia?
Worsening with manipulation of the external ear or chewing? Presence or absence of discharge from the ear and its nature? Alleviating or exacerbating factors? Associated fevers or other systemic symptoms? Pressure in the ear?
Example: Continued
Associated tinnitus? Constant, intermittent, or pulsatile? Unilateral or bilateral? Alleviating or exacerbating factors?
Associated dizziness/vertigo? Severity? Impact on daily activities? Associated tinnitus? Associated nausea or vomiting? Alleviating or exacerbating factors? Other associated symptoms?
Current medications used? History of previous otologic problems or surgery?
Example: Continued
Conduct an appropriate physical exam, with particular attention to the following:
Inspection: Vital signs Configuration and shape of the pinna Otoscopic examination
Patency or edema of the external auditory canal Presence or absence of discharge in the external auditory canal Size, position, integrity, and configuration of the tympanic membrane Presence or absence of effusion in the middle ear and its nature (serous, mucoid,
purulent) Mobility of the tympanic membrane on pneumatic otoscopy
Oral cavity, oropharynx, and nasal cavity examination Palpation:
Temporomandibular joint crepitation Pain with tragal manipulation Presence or absence of cervical lymphadenopathy or neck masses
Other: Weber, Rinne’s, and Schwabach tuning fork tests Hallpike-Dix tests
Example: Continued
Order and interpret appropriate ancillary tests to further the clinical investigation, including: Pure tone audiometry Speech audiometry Impedance audiometry MRI CT scan
Perform or refer the patient for further specialized examination when appropriate: Nasopharyngoscopy Auditory evoked potential Otoacoustic emissions Electronystagmography Posturography
Example: Headache Module
Standardized Clinical Behaviors Headache
For an encounter with a patient with a chief complaint of headache, the physician should: Elicit an appropriate history, with special attention to the following questions:
onset of this episode? age of onset of initial episodes? duration? frequency? location (unilateral, bilateral, band-like, frontal, occipital, etc.)? character (throbbing, sharp, pressure, etc.)? severity (e.g. “worst headache of my life”)? premonitory symptoms? sequential progression of symptoms? provocative/palliative features:
specific foods? alcohol? menses? weather changes? stress? pain medications (NSAIDs, narcotics)?
etc., etc.
Current State
Medical Knowledge and Clinical Skills courses have steadily drifted apart for a variety of reasons
This has made the Standardized Clinical Behaviors too large to a degree unnecessary to Clinical Skills
JILL RICHMOND
LTs, MPG, Special Requirements and Cases
Learning Topics (LTs)
Learning Topics (LTs) serve to broadly characterize topic areas that the students are expected to master upon completion of the module.
Learning topics are defined by the content presented in any associated learning activities
lectures, problem sets, S&I sessions labs
the content of associated required readings (readings may be associated with a learning activity or may stand alone)
In some cases, an LT will not be associated with a specific, scheduled learning activity (lectures, etc.), but will be associated with required readings.
All LTs listed on the MPG are fair game for assessments. Conversely, content must have an associated LT in order to be assessed.
A course module will typically have 10-20 LTs listed for the week.
Module Preparation Guide (MPG)
Preparation guide for students
Lists Learning Topics (LTs) for the module
Includes learning activities, disciple codes, and required readings associated with each LT
Special Requirements
Will be the first page of the MPG
Vital for student preparation
Lists all requirements for the module, including: Special attire Problem sets Readings to be completed
before the learning activity (these should still be listed on the MPG with associated LTs)
Videos Online modules Any other information
students need to prepare for the module
Case Edits
Notes on Cases Suggested case edits Collected during the
block from CBL facilitators Students The block team
Posted on Blackboard Instructor site under “Block Teams”
Facilitator Packets
Include Group headshots Facilitator case list Updated cases Schema
Must be completed and delivered to facilitators one week prior to block start
All these materials are also posted in the facilitator section of Blackboard
Blackboard
Case edits, facilitator packets, guidelines for writing LTs and developing schema, IOR responsibilities, and many other resources are found on the Blackboard Instructor site
NOTE: Your page may look a bit different but it will still contain an area titled “My Courses”
Workflow/ Deadlines
Block team edits to cases, MPGs, special requirements documents, schema, SCBs and Block Goals are due to Jill no later than 3 months prior to block start
Jill will make all edits and email MPG requests to block faculty. These edits are due back no later than two months prior to block start. MPG requests ask for Faculty updates to texts, readings, etc. Materials to be posted to Blackboard (PowerPoint
presentations, articles, etc.)Jill then makes these edits and returns materials to
IOR for final approvalFinal materials are due back from IOR within two
weeksSpecific deadlines for your block are listed on the
block team deadlines sheet posted on blackboard.
Workflow/Deadlines
Blocks12-13
Term Start Date
Term/ Block
Start Date
Term/ Block End
Date
PlanningProcess Begins
(approximately 2 month after end of
previous year block)
Schedule & Block
Goals Due to
Curriculum Office(6 1/2 months before start of
quarter)
Teaching requests To Dept Chairs(6 months
before start of quarter)
MPG (IoR) Submis-
sion Deadline (3
months prior to block start)
Send MPG Request to
block faculty
(2 wks after IoR Deadline)
MPG edits (from faculty),
Schema, SCBs, Cases,
AOA CORE Competency
Updates, Due Date
(2 months prior to
block start)
Materials to IOR for Final
Review (2 weeks after cases
due date)
Final Materials back from
IOR (2 weeks after materials go to
IOR)
Assessment Due Date
(quizzes, all exams) (1 month prior to
Block Start)
Blackboard go live
(Exam Date of Previous Block)
Fall Immersion PCC 7/9/2012 7/9/2012 12/21/2012 2/13/2012 12/27/2011 1/9/2012 N/A N/A N/A N/A N/A N/A 7/6/2012
OCAO 7/9/2012 7/16/2012 8/10/2012 11/7/2011 12/27/2011 1/9/2012 4/16/2012 4/30/2012 5/14/2012 5/28/2012 6/11/2012 6/17/2012 7/6/2012
OMM/ CS 7/9/2012 7/9/2012 12/21/2012 2/13/2012 12/27/2011 1/9/2012 4/23/2012 N/A N/A 5/28/2012 6/11/2012 N/A 7/6/2012
Fall 1 Well Pt. 7/9/2012 8/13/2012 8/24/2012 11/14/2011 1/9/2012 1/9/2012 5/14/2012 5/28/2012 6/11/2012 6/25/2012 7/9/2012 7/13/2012 8/10/2012
MS 7/9/2012 8/27/2012 9/28/2012 12/19/2011 1/9/2012 1/9/2012 5/25/2012 6/8/2012 6/25/2012 7/9/2012 7/23/2012 7/27/2012 8/24/2012
Blood 7/9/2012 10/1/2012 10/19/2012 1/11/2011 1/9/2012 1/9/2012 7/2/2012 7/16/2012 7/30/2012 8/13/2012 8/27/2012 9/1/2012 9/28/2012
Neuro 8/13/2012 8/13/2012 9/21/2012 12/12/2011 1/9/2012 1/9/2012 5/14/2012 5/28/2012 6/11/2012 6/25/2012 7/9/2012 7/11/2012 8/10/2012
EENT 8/13/2012 9/24/2012 11/2/2012 1/23/2012 1/9/2012 1/9/2012 6/25/2012 7/9/2012 7/23/2012 8/6/2012 8/20/2012 8/22/2012 9/21/2012
Fall 2 I & I 7/9/2012 10/22/2012 11/16/2012 2/10/2012 1/9/2012 1/9/2012 8/24/2012 9/7/2012 8/20/2012 9/4/2012 9/18/2012 9/19/2012 10/19/2012
CV 7/9/2012 11/26/2012 1/25/2013 4/9/2012 1/9/2012 1/9/2012 8/27/2012 9/11/2012 9/24/2012 10/8/2012 10/22/2012 10/24/2012 11/16/2012
PSY 8/13/2012 11/5/2012 11/30/2012 2/13/2012 1/9/2012 1/9/2012 8/6/2012 8/20/2012 9/4/2012 9/18/2012 10/2/2012 10/3/2012 11/2/2012
2012-2013 E&M 8/13/2012 12/3/2012 1/25/2013 4/9/2012 1/9/2012 1/9/2012 9/4/2012 9/17/2012 10/1/2012 10/15/2012 10/29/2012 10/31/2012 11/30/2012
Spring 1 PCC 1/7/2013 1/7/2013 5/10/2013 5/14/2012 6/22/2012 7/6/2012 10/9/2012 N/A N/A N/A N/A N/A 12/21/2012
OMM/ CS 1/7/2013 1/7/2013 5/10/2013 5/14/2012 6/22/2012 7/6/2012 10/9/2012 N/A N/A 12/10/2012 12/26/2012 N/A 12/21/2012
RESP 1/7/2013 1/28/2013 3/1/2013 5/14/2012 6/22/2012 7/6/2012 10/29/2012 11/13/2012 11/26/2012 12/10/2012 12/26/2012 12/31/2012 1/25/2013
OBGYN 1/7/2013 1/28/2013 3/1/2013 5/14/2012 6/22/2012 7/6/2012 10/29/2012 11/13/2012 11/26/2012 12/10/2012 12/26/2012 12/31/2012 1/25/2013
Spring 2 GI 1/7/2013 3/11/2013 4/19/2013 6/25/2012 6/22/2012 7/6/2012 12/10/2012 12/26/2012 1/11/2013 1/25/2013 2/8/2013 2/11/2013 3/1/2013
UG 1/7/2013 4/15/2013 5/24/2013 8/6/2012 6/22/2012 7/6/2012 1/14/2012 1/28/2013 2/15/2013 3/1/2013 3/15/2013 3/11/2013 4/12/2013
PEDS 1/7/2013 3/11/2013 3/22/2013 6/4/2012 6/22/2012 7/6/2012 12/10/2012 12/26/2012 1/11/2013 1/25/2013 2/8/2013 2/11/2013 3/1/2013
GER 1/7/2013 3/25/2013 4/12/2013 6/25/2012 6/22/2012 7/6/2012 12/26/2012 1/9/2013 1/28/2013 2/11/2013 2/25/2013 2/25/2013 3/22/2013
2012-2013 AP&P 1/7/2013 4/15/2013 5/3/2013 7/16/2012 6/22/2012 7/6/2012 1/14/2012 1/28/2012 2/15/2013 3/1/2013 3/15/2013 3/11/2013 4/12/2013
Summer 2013 OCI 6/17/2013 6/17/2013 7/19/2013 9/21/2012 12/2/2012 2/15/2013 3/18/2013 4/1/2013 N/A 5/3/2013 5/17/2013 N/A 6/14/2013
E&M and CV start in Fall and overlap into Spring Semester: Grades will be recorded as a Spring Grades despite beginning in the Fall semester
ANGIE MOWRER
Exams & Assessments
CAC Multiple Choice Exam Policy
70% of multiple choice items shall be in the board-style structural format for exams in years 1 and 2 of the OUHCOM Curricula.
Questions shall be structurally consistent with the NBOME Comlex-level 1 Test Item Writing Guide.
When possible, item writers are encouraged to construct questions that assess basic science principles as they relate to clinical practice.
NBOME question format
All COMLEX questions are multiple-choice questions presented in one of the following three formats. Stand-Alone
These items consist of a stem, a lead-in question, and several choices, one of which is the correct answer to the lead-in question.
Item SetThese items consist of multiple questions that share a common stem, usually a clinical presentation.
Matching SetThese items include a list of similar choices (e.g., management steps, diagnoses) followed by several statements. One of the choices listed will best relate to each of the statements. Sometimes one of the choices is the best match for more than one statement.
Every question includes a set of choices, including one correct answer and several distractors.
The majority of examination questions consist of five choices, a few questions may have four choices.
Multiple Choice Item Construction Guidelines
The item should assess knowledge important (high impact/high frequency) in a generalist setting.
Basic science principles should be explored (scientific understanding of mechanisms), but particularly those directly related to clinical practice.
Test important concepts, preferably using questions testing higher-order thinking.
Multiple Choice Item Construction Guidelines
Question writing Do not be too general. There should be a specific objective/focus
evident in the stem. The stem should lead to one specific answer. The item should be so focused that the examinee can determine the answer even before looking at the answer options.
Do not teach in the stem. Avoid the use of unnecessary information
Do not use negative phrasing. Do not use stems including the words EXCEPT, LEAST, or NOT.
Do not use relative terms. Words like ALWAYS, NEVER, FREQUENTLY, and RARELY do not belong in any item.
No True/False questions. The question setting should be specific to a particular patient. Use only generic drug names.
Multiple Choice Item Construction Guidelines
Distractors Make each distractor concise, equivalent in length
and style to the others, and plausible. Each distractor should follow grammatically from the
stem, with the majority of the information included in the stem, not in the distractors.
Each distractor must be independent. "All of the above", "none of the above", and "A and B are both correct" are not acceptable distractors.
Exams
Students will be assessed on the Learning Topics as defined by the content presented in any associated learning activities (e.g., lectures, problem sets, S&I sessions) and by the content of associated required readings.
In courses where content lends itself to being assessed in this way, practical exams will be given.
Written Exam Deadlines
Draft Copies Due one month prior to block start
Final Copy Should be finalized AT LEAST 2 weeks prior to
exam date If Cheri would have an emergency/illness; we
need to allow time for another staff member to prepare the exam
Additionally, we need to allow time for the GA to create an answer key by hand for the test score office. This is a time intensive activity that cannot be done in a few minutes.
Blackboard Quizzes
Composition A formative quiz consisting of 20 or more
questions The questions should reflect the relative priorities
of the learning topics listed for the week. Students are to be given immediate feedback on
the accuracy of their answers, as such, all quiz questions should provide a reference for the correct answer or the correct answer with an explanation
Blackboard Quizzes
Format The questions are to be comparable to the exam
questions, 70% of quiz questions must follow the board format
Deadlines and Availability Quiz drafts are due to the Curriculum Office one
month prior to block starting. Quizzes are typically posted early each Monday
morning for the current module.
Importance of Deadlines
Presenter Input If you ask for faculty input in creating your exam (writing,
choosing or editing questions), this process takes time, please plan accordingly
It is important for Block Teams to notify faculty presenters of when the post-exam analysis will take place. If faculty presenters are unreachable during the post-exam time frame, grades may be delayed.
Workload Please keep in mind that there are often multiple written
exams that take place during the same week of curriculum. If your exam is not prepared until the last minute, there is the a higher chance of errors and delays.
Printing Copy and printing services need 48 hours advance notice to
print exam
Working with the test bank
Please refer to the test bank numbers when submitting edits or test/quizzes.
The orange portion below is the test bank number, please do not use the sequential number (1.) that automatically prints to the left of each question.
INTRO 075/PAT/12345/Q/Y//////1. An area of ischemic necrosis within an organ is called a/an:
A. thrombus B. abscessC. infarct D. clot
Jenkinson 99Intro Exam 2001; dropped from exam; edited by Jenkinson 9/01
Working with the test bank
INTRO 075/PAT/12345/Q/Y//////1. An area of ischemic necrosis within an organ is called a/an:
A. thrombus B. abscessC. infarct D. clot
Jenkinson 99Intro Exam 2001; dropped from exam; edited by Jenkinson 9/01
PAT is the discipline code 12345 is the LT#
MUST be a current LT number to be used on exams or quizzes This field can hold up to 3 Learning Topic numbers
Notes area Who submitted the question The year the question was submitted If the question has ever been edited, when and by whom If the question has been dropped or more than one answer has been accepted
Q or E (quiz/exam) and Y fields Please ignore, these fields are for curriculum office use
Post Exam
Adjustments (dropping questions, etc.) Are done manually for EACH student The more adjustments, the more time – this process
may take several hours, so please be timely with exam adjustments and patient when waiting for final scores.
Final Block Grades and Reports Assessment grades should be reported to the students
within 7 calendar days after the assessment. If you would like final grades to be released before
5:00 pm, please have all post-exam adjustments to Cheri by 1:00pm.
Grades
Composition Must be as specified in the syllabus and may include a
combination of the following: Problem Sets, quizzes, or other grade activity Self assessment quizzes on Bb Written Exams (Mid-Block and/or End of Block) Synthesis and Integration sign-in sheets or quizzes Lab attendance Practical Exams/Clinical Correlation Exams
Grades
Submitting Grades to the University At the end of the term in which your course took place, the
IOR submits grades on-line and sends a copy to the curriculum office for record keeping, or
The IOR may meet with Cheri Tarantelli during the last week of the term to submit grades to the Registrar
More information on on-line grading can be found at http://www.ohio.edu/registrar/onlinegrading.cfm
Incomplete Grades Failure by a student to satisfactorily complete all
assignments made in association with learning activities will result in an incomplete (I) for the course. This includes end-of-course evaluations and other curricular evaluation items.
After Incomplete grades are completed, there is a paper processing trail that may take several weeks depending on faculty/IOR/HCOM staff/Registrar’s staff availability.
If a block would like to pilot any non-standard assessments that requires curriculum office support,
we request that you discuss it with the curriculum office prior to listing it in the syllabus
Special Requests
Curriculum Office Staff
Rosemary Butcher – Administrative Coordinator 3-2195 Scheduling
Jill Richmond – Administrative Coordinator 7-2957 LTs, MPGs & Special requirements, cases, schema, SCBs,
Blackboard
Cheri Tarantelli – Records Management Associate 3-2194 Exams, quizzes, statistics
Angela Mowrer – Director, Pre-Clinical Education 3-1566
Laura Mitchell – Curriculum Coordinator 7-2377Patrick O’Connor – Curriculum Director 3-2100