Now we are going to move on and discuss the assignments in the course. We are going to start off by discussing the case studies.
There are 2 problem-based learning case studies in this course. The first is in week 3 and the 2nd is in week 6. The format is a bit different than you may have had for previous courses, so it is important for you to follow the directions and use the resources given to you.
Each case study will cover a topic that has been covered in your weekly lesson (which includes the readings, lectures and videos) and represents COMMON primary care problems that you will see in the clinical setting. This should be your first hint, when formulating a differential diagnosis, keep it simple to include common types of problems.
In each case, you will be given the patient’s history and physical for Part 1. Using this information, you will answer the Part 1 questions in the discussion threads. Additionally, each case will evolve, so in Part 2 you are given more information and you must answer some additional questions.
Part 1 of the case study is due on Tues by 11:59pm MT of Week 3.
Part 2 of the case study is due on Thurs. by 11:59pm MT of Week 3.
Each part is worth 50pts for a total of 100 points for the assignment.
There is NO Part 3 and there is not a written SOAP note in any form for these 2 assignments as you had in previous classes. A 10% deduction will be taken for Part 1 & 2 if a post is made after the deadline. Nothing can be submitted after the close of the course on Sunday night. If you did not post your discussion by this time, you will receive an automatic 0.
Peer and faculty responses are due by Sunday at 11:59pm MT and I highly encourage you to review the grading rubric before you submit your response.
I want to emphasize a very important concept about these case studies which is very different than previous case studies in the core courses. The case studies in your clinical courses are now an assessment of your diagnostic reasoning skills, rather than just what you learned previously. In other words, we want you to apply what you have learned and make a clinical decision for the patient that is in your office right now. Don’t tell me all of the things that can be done or all of the tests or referrals that can be considered, I want to know what are YOU going to do? Just as if you are in the clinical setting seeing this patient. You want to convey the same diagnostic reasoning skills that you do when you are presenting a plan to your preceptor.
I am going to show you an example of what I am mean. Let’s say that a patient comes to see you in the clinic with a headache for 2 days. You are given all of the information in the case that you would have asked in your history and you are also provided with a focused exam. For the purposes of this example, I want you to assume that there are no abnormal neurological findings.
Now, let’s say you came up with the following 3 diagnoses in your differential: 1) tension headache 2) migraine headache and 3) cluster headache.
In terms of testing, common responses from students might be: get a CT or MRI to rule out intracranial bleed, or order CBC, CMP, ESR for whatever reason. Students also might mention that a lumbar puncture would be appropriate in some cases or a referral to neurology, etc. but these are not reasonable or appropriate decisions to make for this patient-even though technically they are all things that can be done in certain scenarios.
What I want to see is what are you going to do right now for this patient? Just because you can do a test doesn’t mean you should. In this case an appropriate response might be to have the patient keep a headache diary looking for triggers, giving them an NSAID, and having them follow-up in a few weeks. Of course, this all needs to be supported with an EBM argument but you see what I am getting at here.
As was mentioned in your preview week announcement, there are a few critical resources for you to use when completing your case studies and they can be found in the Modules tab under eBooks and Resources. Scroll down to NR511 Documents and Templates and you will see this list. Let’s take a look at one of these documents on the next slide.
The “Guide to NR511 Case Studies” provides you with a written example of the case study and how to answer the questions as you can see here.
The next document that you want to look at is the “Expectations for use of Scholarly Sources in NR511”. This is your guide on how to select an EBM reference. It will help you decide what can and what cannot be used as references which is specific to this course.
You absolutely want to avoid using nursing journals and non-US based journals as well as websites and quick reference sources like Medscape, Dynamed, UptoDate, etc. While you might have gotten away with it in the past, it is not an acceptable EBM reference for the clinical courses.
There is also a quick reference table where you can find what type of reference is appropriate when citing sources for the different parts of your case study.
In the treatment section of the case studies you will be expected to write an appropriate prescription as if you were handing it to the patient in your office at that moment. This method should be followed for prescription and all OTC medications for this assignment. There is a specific document called “Writing NR511 Prescriptions for Case Studies” and it looks like this.
Making an EBM argument for your decisions.
Students often are confused when it comes to making an EBM argument so I want to go over that now. First, it is imperative that you know that EVERY TREATMENT AND EVERY TESTING DECISIONS MUST BE SUPPORTED WITH AN EBM ARGUMENT. Notice, I said argument and not just reference. There is a distinct difference and this is a classic example showing the difference.
The first response is a classic example of what NOT to do. In this case, the student has chosen Bactrim DS as the prescription and while this might be the correct treatment choice, it is not supported with an EBM ARGUMENT for WHY it is the right choice. Even though a scholarly reference is provided, there is not an ARGUMENT to the reader on why the student chose that treatment (or test, etc.).
The second scenario is a good example on how to provide an EBM argument made for the treatment decision. Keep in mind that your goal when providing a good EBM argument for your treatment or testing decision should be to convince the reader (your instructor) on WHY that is the best choice not just what your choice is.
The case study format is exactly the same for Week 6, but there is a different scenario and the case will be a little harder. I will point out that it would be EXTREMELY unlikely for a student in 511 to get a perfect score on a case study. This would mean that every aspect of the case was executed perfectly. You are being graded on your first attempt not on your ability to re-write material.
In the case studies, you must also respond to at least 1 peer and all faculty questions that are directed at you using an EBM reference. This is true for both Part 1 and Part 2. Your peer response and responses to faculty are due by the normal Sunday deadline.
Let’s now move onto the SNAPPS assignment in Week 2. This is the first assignment where you will need to be able to use Kaltura as you present a patient to the class.
The purpose of the SNAPPS assignment is to provide a learner centered approach to case presentation where the student takes an active role. One of the most comment criticisms that we have heard from your preceptors at this level is that the students in the first clinical course do not know how to summarize their patient and present to the preceptor or group.
This assignment is meant to help you to organize patient information in a meaningful way and fine tune your patient presentation skills.
In this assignment, you will select a patient seen in your clinical setting and you will give an oral presentation (via Kaltura) using the 6-step learner-centered presentation model known as SNAPPS.
The acronym SNAPPS stands for:
(S) Summarize briefly the history and findings;
(N) Narrow the differential to 3 possibilities;
(A) Analyze the differential by comparing and contrasting the possibilities
(P) Probe the preceptor/instructor by asking questions about uncertainties, difficulties, or alternative approaches;
(P) Plan the management for the patient's medical issues;
(S) Select a case related topic to further self-learning
There are 2 specific parts to this assignment, an oral and a written part and again you will chose a patient seen in your practicum experience for your presentation.
The directions and rubric are located on the assignment page in week 2.
Part 1 consists of the oral presentation and this is designed to simulate the actual presentation that you would give your preceptor. For this part of the assignment you will record your presentation using Kaltura following the format in the video and on the assignment directions. You can practice the recording as many times as you like before posting the final presentation. The final product should be posted to the discussion board in Week 2 by Sunday 11:59pm MT. Take the time to view your peer’s presentations too. While a peer response is not required for this assignment it is always nice to have some additional feedback.
You will need 2 documents to complete this assignment and they can be found in the NR511 Documents and Templates section under eBooks and Resources.
The first document is the Oral Presentation Template. It looks like this and it is designed to help you organize your presentation using the SNAPPS model and will help you when you record your presentation. This template is for your use only, you SHOULD NOT SUBMIT THIS to the discussion board or assignment box
The written portion of this assignment (Part 2) is where you provide research for your self-directed learning topic. The self-directed learning topic is NOT the actual condition or primary diagnosis itself. Rather, it should be about something that you came across that was interesting or you wanted to learn more about when doing this assignment.
For example, if my patient had abnormal uterine bleeding as a diagnosis and I wasn’t sure what endometriosis was, I could research that a little further. It does not need to be extensive, but it should serve the purpose of the assignment. The written portion of this assignment must be completed according to the directions and submitted to the Week 2 assignment box by Sunday 11:59pm MT.
The template for the written portion of the assignment looks like this and you should follow the directions using the SNAPPS Presentation Guidelines & Rubric as previously discussed. Make sure that you include the reference page and that the references are listed according to APA format.
In summary for the SNAPPS assignment both the oral and written parts of the assignment are due by Sunday 11:59pm MT in Week 2. The oral presentation should be posted to the discussion board in week 2. The written portion of the assignment will be submitted to the assignment box in Week 2.
It should be noted there are no partial points that can be awarded-so be sure to follow the rubric carefully so that you are meeting all of the required elements.
Let’s move onto the next big assignment which is the CPG or Clinical Practice Guidelines assignment in Week 7.
Clinical guidelines provide recommendations on the diagnosis and management of certain conditions. They provide recommendations which are based on evidence from a rigorous systematic review and synthesis of the published medical literature. This assignment is designed to provide you with the experience needed to interpret and apply guidelines in practice which is necessary to develop and enhance diagnostic reasoning skills. It is also designed to expose you to some of the most common guidelines used in Primary Care.
You will be assigned a specific CPG by you instructor in Week 1 along with the name of a peer whose presentation you will also review. You will be providing an overview of the guidelines for this assignment. There is also an additional part where you will be comparing the treatment of a patient seen in the clinic with the same condition. If by week 4 you have not come across a patient with the same condition that you were assigned, you need to reach out to your instructor for a new CPG.
For this assignment you will create a Power Point presentation which meets the directions and rubric requirements.
Power Point presentations should be of professional quality. The key to a good presentation is to keep it straight and simple on the slides. Use keywords only. A good method to do this is to limit each slide to no more than 6 bullets and no more than 6 words per bullet when possible. Keep the font readable and consistent.
Once your Power Point is complete, you will create an audio voice over to coincide with your slides. You will do this using Kaltura. When your presentation is complete with both the audio and visual content, you will post your Kaltura video for your peers to view on the Week 7 discussion board. This is due before the usual Sunday deadline.
To post to the discussion board you will first go to the Modules tab and then scroll down to week 7. You will see the Week 7 CPG Presentation under the Translate to Practice section as shown here. It will say 0 points.
Once you click on that link, you will be taken to the Discussion Board where you will post your presentation AND a copy of the CPG article as shown in these examples here.
If your instructor cannot open your presentation, you will not receive credit, which is why it is vitally important that you practice using the technology in advance. Technical difficulties that arise in the last hours before the deadline, is not a reasonable excuse. In almost all cases, it is due to user error, and not an IT glitch.
For the last step, you will submit a written transcript of the presentation to the assignment box. A written transcript is NOT a paper per se’. Instead it is a word for word written script of what you said and recorded in your presentation. This is a great way for you to organize your thoughts so that the information can be communicated concisely. It can actually serve as your speaker notes! It should contain everything that you said in the actual presentation. No more, no less. It does not need to be written in APA format but your references used in the presentation should be included.
So, let’s take a minute to review all of that so that it’s clear to everyone. You want to start by preparing your power point presentation of your assigned CPG article using the rubric for the assignment. You will then record the audio portion of your slides using Kaltura. Post this completed (both audio & visual) presentation to the W7 discussion board and attach a copy of the CPG article using the paperclip in the bottom left hand corner. Prepare a written transcript of your presentation (word for word) and upload to the W7 CPG Assignment page.
All portions of the assignment are due by 11:59pm MT on Wed. of W7. You will incur a 10% deduction for the total amount of points (which is 10pts) for any part of this assignment is not submitted. A maximum of 30 points can be deducted if any part of the assignment is submitted on the 3rd day. After 3 days late, you will receive an automatic 0.
The last comments I want to make about this assignment is that your references should be noted on the last slide or slides of your presentation. Refer to the grading rubric to ensure that you are meeting all of the requirements before submitting the assignment.
Moving onto the W7 Peer Review Assignment. This is a separate but linked assignment to your CPG presentation and it is also due in Week 7
A peer review is a process in which students constructively evaluates the work of another student’s work which promotes mutual learning. By providing feedback to another peer, the learner can better master the concepts of an assignment. At the same time, the peer who provides the feedback on a student assignment learns to critically analyze the learner’s work. Ultimately, by reviewing a peer’s presentation you will be exposed to and learn another Clinical Practice Guideline rather than just the one you presented.
For this assignment, you will want to start by downloading the Peer Review Template located in the Modules tab under eBooks and Resources.
The Peer Review Guidelines and Rubric are located on the Week Clinical Practice Guideline Peer Review page which contains detailed directions for completing the assignment as well as the grading rubric which you are evaluated on for this project. Keep in mind that although you will be reviewing your peer, your instructor will be reviewing YOU to make sure you meet the criteria on the rubric. I will get back to this in a few minutes.
The first part of the assignment starts in Week 1 when you will be randomly assigned the name of a peer whose presentation you will be critiquing. In week 7, you will review your designated peer’s CPG presentation which was due on Wed by 11:59pm MT.
You will be grading your peer’s presentation using the same set of criteria that your instructor used to grade your presentation. However, the grade that you assign your peer is not counted.
Your critique must be completed on the Peer Review Template.
You will submit the completed peer review to the Week 7 Peer Review assignment box. This assignment is worth 50pts and is due by Sunday 11:59pm MT of week 7.
In the event that your assigned peer does not post their presentation by the deadline on Wed., you will be assigned another peer by your instructor.
Finally, please send a copy of your peer review to your assigned peer via email for their reference.
Moving on, let’s briefly discuss the week 8 reflection assignment. The directions are listed in the Week 8 Reflection Guidelines and Rubric Document located in Course Resources. I just want to point out though that this is different than reflections that you have done in previous course so read it thoroughly. Be sure to use the NONPF competency website link that is listed in the directions.
Finally, we are going to discuss the Clinical VISE Assignment. VISE stands for “Virtual Interactive Student Evaluation” and this assignment is one of the clinical requirements for the course. The assignment is an evaluation of your progress in clinical, and is based on clinical objectives.
The purpose of this exercise is to identify and assist students struggling with critical thinking and communication. If you are unsuccessful at your 1st attempt, you will be placed on a Performance Improvement Plan and a 2nd attempt will be given prior to the course end. You must successfully pass the Clinical VISE assignment as just one portion of the clinical requirements for this class.
What will happen is that your instructor will schedule a meeting with you between weeks 3-5. You will both pull up your clinical logs and your instructor will ask you to present, in SNAPPS format, one of the patients that you saw in clinical that week. The patient will be chosen by the instructor at the time of the call.
Your grade is determined based on the following rubric. You must achieve a score of Proficient or Average in order to pass the assignment. Again, if you do not pass the 2nd attempt you cannot pass the course, regardless of your didactic grade in the class and even if you received a passing evaluation from your preceptor.
And that’s it. I hope you have found this review of the NR511 assignments to be helpful and I want to wish you the best of luck.