Student Assessment of a Tracking System for Initial Clinical Musculoskeletal Instruction
J. N. Chambers, D. Allen and D. B. Coulter
From the departments of Small Animal (Chambers),
Large Animal Medicine (Allen),
and the Office for Academic Affairs (Coulter)
College of Veterinary Medicine
University of Georgia, Athens, GA 30602.
Professional curricula at the North American Colleges of Veterinary Medicine are on the verge of significant changes, many of which were suggested in, called for, or outlined in the comprehensive report published by the Pew National Veterinary Education Program (1). Most veterinary educators have come to accept a principal thesis of the Pew Report, that it is impossible to learn all relevant clinical information about all animal species, and to continue to pretend otherwise does a disservice to veterinary students and the public. Offering students the choice of focused curricular tracks based on career objectives is the common proposition.
Curricular changes have caused caution and arguments against tracking to surface. The American Veterinary Medical Association's Council on Education has ruled that curricular changes "should be designed to maintain a core of performance criteria to assure that the graduate veterinarian will be able to serve society in the several generally accepted areas of veterinary medical responsibility."(1, 2) Some faculty have suggested that tracking will leave students ill-prepared to pass board examinations, unless and until such are likewise focused, and limited licensure is a reality. Others are concerned that partial curricular changes, or those in transition, may produce 4th-year students that are unable to function outside of their interest area in teaching hospitals. If tracking is fully implemented through the 4th year, faculty and hospital administrators have argued that disproportionate selection by students could leave some areas of the hospital with too few personnel to support and justify teaching and service activities. Indecision as to career objective, mixed career objectives, and the possibility of changing career objectives are additional dilemmas shared by faculty and students.
Although the faculty must remain ultimately responsible for curricular decisions, student opinions sampled at career junctures are valuable because they replace assumptions. The purpose of this paper is to describe a tracked approach to classroom instruction in clinical orthopedics, and to report the results for two consecutive classes, primarily the students' assessment of its effectiveness.
Description of Course
Prior to 1990, the present combined 3rd-year course in small and large animal musculoskeletal problems was taught as two separate courses with a sum total of 78 contact hours, disproportionally allocated as 47 hours for large animal and 31 hours for small animal. The original objectives for reorganization were derived from the Pew report and local sentiment and resources, and were stated as follows:
- Reduce required contact for each student regardless of career goals;
- Consolidate lectures covering information common to both courses ("core" material) into "common" lectures to prevent repetition;
- More evenly distribute contact time between species specific areas;
- Allow species preference to stimulate interest and retention of information;
- Allow more in-depth coverage of material within species specific areas.
The course that evolved thus contained 18 common lectures that all students attended, and 28 large animal or small animal oriented lectures that were only required for those students declaring such as being their primary area of interest. The total number of contact hours required of each student was reduced to 46. A complete course syllabus was given to each student, and the lectures were scheduled to allow students to attend both large animal and small animal sessions if they wished. Encouragement to do so was limited to a statement that prioritizing and allocating time for professional development was a problem that each would be responsible for throughout their careers.
Sample portions of the schedule are as follows:
Topic: Joint Physiology;Differential Diagnosis of Joint Disease with Fluid Analysis
Instructor: LA Surgeon
Small Animal Lecture
Topic: Septic arthritis; immune mediated arthritis; polyarthropahy.
Instructor: SA Surgeon
Large Animal Lecture
Topic: Septic arthritis and tenosynovitis; wounds involving joints.
Instructor: LA Surgeon
Topic: Pathophysiology of Osteochondroses (OC)
Small Animal Lecture
Topic: OC in the Dog
Instructor: SA Surgeon
Large Animal Lecture
Topic: OC in the Equine
Instructor: LA Surgeon
Examinations were given during a common period, items were multiple-choice, and each contained identical questions on the common material, plus varying items respective of declared interest area.
All students from two successive classes were asked to respond to an anonymous opinion poll, with each student being polled twice. The first survey was conducted immediately after the course (end of 3rd year), and the second was at the end of the 4th-year hospital rotations, and after state and national board examinations. The questions related to the student's:
- Declared interest area;
- Opinion on tracking;
- Opinion of how this course format affected student interest;
- Opinion of how this course format affected study time devoted to the discipline;
- Preference of this format vs. nontracked format;
- Opinion of whether this format was successful in reducing redundancy compared to other discipline clinical courses still taught in the traditional split manner;
- General attendance of lectures covering problems in species outside of declared area of interest, and motivation for doing so;
- Confidence level as musculoskeletal problem solver entering the hospital blocks;
- Opinion of effect of course on performance, and faculty evaluation of performance, during the small and large animal hospital blocks;
- Opinion of effect of course format on performance on board examinations;
- Opinion of effect of course format on ability to seek and achieve career objectives.
The opinions were compiled to ascertain the students' assessment in accomplishing the course objectives. Statistical comparisons were made between the classes and the students in each track to detect consistency or differences. Chi-square or t-tests were used where appropriate. Significance was established at P < .05.
Those students responding to both surveys comprised 85% and 87% of the first and second classes, respectively. The split between the students electing small or large animal tracks in each class was essentially identical, with 62% choosing small and 38% choosing large.
Combining both classes and polling times, there was an 87% agreement with a preference for the tracked course over the traditional method of requiring all lectures in the discipline on a split- species basis. Ninety percent of the combined students agreed with the concept of tracking at the end of the course, and one class was significantly more favorable (98%) than the other (82%). Seventy-nine percent of the students retained the favorable opinion at graduation, which was a significant decrease. There was also a significant difference between the classes on this issue at graduation, with 86% of one class and 71% of the other still favoring tracking. The same pattern between the classes was seen in similar questions relating to interest in the course material compared to traditional courses, and benefit in the course structure in achieving career goals. There was no significant difference in opinion on tracking at either polling time between the students electing the small animal versus large animal tracks. There was also no significant difference in opinion on tracking with respect to the grade that the student received in the course, but the students that elected the small animal tract were significantly more likely to receive a higher grade.
Students electing the small animal track were more likely to attend the required common lectures, and less likely to attend the "nonelected" lectures than the large animal students. These same students were more likely to rank preparation for hospital rotations as the most important reason for attending the lectures outside of their primary interest area, as opposed to the large animal students for which this was of lesser concern. Of the students mentioning motivational factors for attending the "optional" lectures, 98% listed preparation for hospital rotations, 92% preparation for board examinations, 89% knowledge, and 52% a possible mixed practice career goal. Overall, students that agreed with tracking were significantly less likely to attend lectures in the alternate discipline, although 89% of all the students attended at least a few, and 38% attended all or most.
Ninety-six percent of the students agreed that the course format reduced the redundancy often encountered in traditional split-species courses, although 95% believed that they had devoted the same (67%) or more (27%) study time to the discipline compared to other clinical courses. Eighty-nine percent felt that the course had adequately prepared them to be a musculoskeletal "problem solver" for the upcoming hospital rotations.
Both the small and large animal students were significantly more positive about the course structure relative to their subsequent performance and evaluation in corresponding clinical rotations, than their counterparts. There was no significant association of impact on instructor evaluation in the alternate discipline clinical rotations, but 22% of the students that had taken the small animal track believed that the course structure had a negative impact on their self- evaluation of performance in the large animal clinics. There was no like association on the part of the large animal tracked students in the subsequent small animal clinics.
Ninety-three percent of the students believed that the course format had either a positive (47%) or no (46%) effect on their performance on board examinations. Ninety-six percent believed that the format had a positive (72%) or no (24%) influence on their ability to achieve career goals.
The noted differences in opinion between classes and polling times not withstanding, it is apparent that a large majority of students favored this change to a tracked lecture format, and believed it was successful in its objectives, regardless of career perspective or the grade received in the course.
We were gratified that most of the students did attend some of the nonrequired lectures if given the opportunity, yet also displayed individual discrimination depending on career objectives. The option to attend all lectures apparently satisfied those concerned with preparing for mixed practice. All clinical disciplines could be presented in a similar fashion, but a scheduling problem might arise if total lecture hours were added, and the opportunity to attend all was retained. But it is doubtful that the popularity expressed for this course would continue if the tracking became more exclusive.
The significantly lower grades received by the large animal students may have been course related such as more material to study, or more difficult items on the species specific portion of the examinations. Factors such as these must be considered lest we have grade-conscience students electing courses against their best interests. But another logical explanation for the difference in this instance was overall academic prowess. A subsequent t-test comparing the graduating grade point averages of the two groups showed that those of the large animal students were significantly lower than those of the students electing the small animal track.
We were also pleased that the course format apparently did not impact the students' performance on board examinations. Additional evidence that this was true was provided by the report of the Professional Examination Service (3) showing that these students performed at least as well as the criterion population on the musculoskeletal portion of the National Board.
The proportion of the students electing the tracks was not only identical for these two classes, but only changed slightly in the subsequent two classes where 67% and 65% of the students elected small animal. This is probably a reflection of the national trend where 65% of practicing veterinarians are involved primarily in small animal activities (1). Regardless, if this ratio and the class size remained as it has for 4 consecutive years, there would be enough "large animal" students to fill and continuously cycle through the corresponding teaching-service rotations in the hospital as they are presently structured, even if no one elected a mixed practice clinical experience, which is highly unlikely. Whether it would be desirable to track a final clinical year in this fashion is still open to question. We conclude that restructuring the musculoskeletal course in this fashion successfully fulfilled the primary objectives. Specifically, the required contact hours were substantially reduced, a core of common material was maintained, lecture time was reapportioned to allow choice of in- depth species specific topics respective of career goals; and the majority of students approved of the format. Our results quell many of the concerns related to possible negative impacts. This course continued to produce students that could serve and practice clinical problem solving in both the large and small animal clinic rotations. And the clinical knowledge of the musculoskeletal system of these students was at least as good as the national average as assessed by the National Board exam. Therefore we believe that this course structure is a practical and viable option as a next step toward clinical tracking.
Two clinical lecture courses in small and large animal musculoskeletal problems were restructured to a single course with tracked options. Students were required to attend common lectures (18 hours), elected either of the species specific tracks for credit (28 hours), but were allowed to attend all lectures if they wished. The required lecture time for each student was thus reduced from 78 to 46 hours. The majority of students preferred this format over the traditional structure still used for most other courses, and there was no significant negative perception by the students relative to evaluation by instructors in subsequent clinical rotations, performance on the National Board Examination, or ability to achieve career goals.
References and Endnotes
1. Pritchard WR: Future Directions for Veterinary Medicine. Pew National Veterinary Education Program. Institute of Policy and Public Affairs. Durham, NC: Duke University, 1988.
2. Accreditation Policies and Procedures. Council on Education. Schaumburg, IL: American Veterinary Medical Association, 1987.
3. Report of the Veterinary Medical Licensing Examination for the National Board Examination. New York, NY: Professional Examination Service, December 1990 and 1991.