Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

Perspectives on Practical Solutions and Challenges in Attaining Optimum Instructor to Student Ratios

Western University Experience

Bartley Yee, DO, Assistant Professor of Family MedicineWestern University of Health Sciences

Society of Osteopathic Medical Educators

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

Objectives

• Illustrate how 2 different departments approach appropriate training ratios with a large class size

• Discuss issues and obstacles in achieving or maintaining ratio goals

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

Premise

• General agreement - to get to 1:6 to 1:8 ratio for psychomotor and skills training

• OMM and Department of Family Medicine (DFM) needed to work together to find good logistical solutions for OMS1 and 2 classes assuming about 220 students per class.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM• Continuum through 2 years - OMM palpatory,

diagnostic, positioning, and treatment skills

DFM• OMS1 – Interviewing skills, Physical exam skills

introduction, practice, facilitated training, and SP practice and OSCE

• OMS2 – Physical exam skills aligned with systems course, honing by practice and facilitated training, higher level SP encounters, note writing development, critical thinking.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM and DFM agree to split classes from 220 to 2 groups of 110

• OMS1 – 110 on Monday, 110 on Tuesday, both afternoon labs

• OMS2 - 110 on Wednesday, 110 on Thursday, both afternoon labs

• Solution is more time intensive for trainers repeating program on successive days but better for students

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM solution for both OMS1 and OMS2

From Michael Seffinger, DO, OMM Chair, mseffinger@westernu.edu

• Hired 13 OMM Fellows per semester, increased from previous 8-10, usually use 10 at a time. Fellows scheduled in a rotation format so they teach only 3 sessions/week to avoid burnout (seen at other schools).

• With 4 faculty overseeing 10 Fellows, ratio is 14 trainers / 110 students = 1:7.8

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM solution for both OMS1 and OMS2

• In addition, about 60 OMS2 students sign up to be Fellow’s assistants – then selected and scheduled to assist teaching staff at specified sessions for OMS1 only.

• Usually add 4-6 OMS2 students per selected session to assist OMS1 training with guidance of Fellows.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM solution for both OMS1 and OMS2

• Can then achieve 20/110 = about 1:5.5 ratio for OMS1

• OMS 2 remains at 1:8 ratio.

• Time spent with students between 1 to 2 hours per session.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

OMM Fall Feedback from OMS2 students who had previous system (ratio 1:12-15)

• They Like It!

• More 1:1 attention and interaction, faculty more accessible, less physical congestion and noise, increased confidence they are learning it correctly.

• Spring feedback and written test/practical results still to be analyzed for possible improved outcomes.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution

• Clinical Skills Training starts with full class lecture introduction to physical exam and selected skills training

• Followed by review, video demonstration and full class large group initial practice on each other – usually with 7-10 facilitators who provide general supervision

• Since introductory, not always a goal to get below 1:12 ratio here.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution

• Next week follow up Facilitated sessions• Small group (6-8 students) facilitated and focused

skills training and practice, 30-40 minutes• Usually followed with SP encounter of 35 minutes

(including SOAP note writing and SP feedback) and case review for remaining time.

• Total time 2 hours

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution• For small group training, DFM OMS1 splits 110 further

to 55 students in 2 x 2 hour sessions

• Students are divided into 9 facilitated groups of 6 using 9 trainers and 1 backup.

• Numbers partially dictated by current SP Clinical Skills Lab capacity of 18 students/cycle, run in 3 tracks of 6

• Goal is to get through 3 CSL cycles = 54 students in 2 hours.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution

• For 1st 2 hours, students are grouped in 6 per group • For 2nd 2 hours, students grouped in 6-8 per group,

absorbing any additional students

• 108 students run through over 4 hour session• Extra students run in their own cycle at the end,

needing an extra 35 minutes of CSL time but with just a few SP’s.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution

• For OMS1, trainers are a mix of DO Faculty, adjunct clinical faculty, Local 1st to 3rd year residents, and OMSIII students on local rotation.

• Assuming no cancellations, 9 + 1 faculty roamer are able to achieve 1:6 ratio. With cancellations, between 1:8 to 1:12 in a pinch.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution For OMS2Splits same as OMS1 to 2 groups of 55 students

• However, trainers restricted to DO Faculty, outside clinical faculty and local Residents.

• Attempting to maintain 1:6 to 1:9 ratio but not always able due to lack of trainer numbers, Facilitator scheduling conflicts, availability, and cancellations.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

DFM Solution For OMS2• With full facilitator supply, able to reach 1:6 to 1:9

goals given 18 student CSL cycle limit.

• Often must run 2 groups of 1:9 per cycle. When short facilitators, ratio typically runs 1:10 up to 1:12.

• Larger groups given to experienced faculty who can better manage interactions and keep most students engaged and accountable

• Not ideal for physical skills review & feedback, due to limited interaction with each student.

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

General issues for favorable ratios w/ large classIt’s a compromise of the # of facilitators & budget

• Funding can be and is a challenge• # of on campus faculty available at a given time• # of outside facilitators available is limited

• Sometimes declining interest in teaching• Scheduling around adjunct physician availability

or Resident / Student work schedule is difficult• Limited stipend or payment may be an obstacle

• Quality and experience of facilitators is variable and can be an issue for successful skills training

Psychomotor Skills Training in Osteopathic Medical School –Determining the Best Instructor to Student Ratio for Optimal Learning

Total team effort between both departments

• Must acknowledge the OMM and DFM support staff plus our Standardized Patient program staff and the Faculty clinical coordinators

• Arranging and scheduling 440 students almost every 2-3 weeks and making this work with such a large number of students and facilitators.