Learning With Reflection: Practices in an Osteopathic Surgery Clinical Clerkship Through an Online Module.

CONTEXT: The value of reflective practices has gained momentum in osteopathic medical education. However, the use of reflective pedagogies has not been explored in the larger context of medical course delivery and design, to the authors' knowledge. OBJECTIVE: To determine the types of reflection demonstrated by osteopathic medical students on an online discussion board and to explore differences in discussion engagement caused by the use of a reflective learning self-assessment tool. METHODS: Using a mixed-method approach, reflection processes in an osteopathic surgery clinical clerkship online module were investigated in third-year osteopathic medical students. Discussion board messages were captured and coded. Both manual coding techniques and automated interrogation using NVivo9 (a computer program) for qualitative data were applied. Correlations of scores across 4 case-based discussion tasks and scores for self-reflection were computed as quantitative data. RESULTS: Twenty-eight students were included. Four main types of reflection (ie, content, contextual, dialogic, and personal) along with corresponding differentiated subthemes for each type of case-based discussion board group message were identified. Group collaboration revealed insights about the reflection process itself and also about the evidence of collective efforts, group engagements, and intragroup support among students. Student preparation revealed that students' metacognition was triggered when they judged their own contributions to group work. Challenges in completing readings and meeting deadlines were related to the students' long work hours. CONCLUSION: Reflective practices are essential to the practice of osteopathic medicine and medical education. Curricula can promote the development of reflective skills by integrating these deliberate practices in educational activities.

Uniform instruction using web-based, asynchronous technology in a geographically distributed clinical clerkship: analysis of osteopathic medical student participation and satisfaction.

CONTEXT: As medical schools in the United States increase their class sizes, many institutions are forced to extend their teaching affiliations outside of their immediate communities. Geographic distribution threatens the ability to provide the uniform learning opportunities that students need and accrediting bodies require. OBJECTIVE: To determine if a Web-based, asynchronous learning module can provide an effective, uniform learning opportunity for osteopathic medical students enrolled in clinical clerkship. METHODS: Third-year osteopathic medical students enrolled in an 8-week core clinical clerkship in surgery were required to participate in a Web-based, asynchronous, interactive instructional module designed to provide opportunities for higher-order thinking through analysis, synthesis, and reflective learning. The quantity and content of students' online course interactions were analyzed to determine quantitative and qualitative features of their course participation. At the completion of the clerkship, students completed a 10-item Likert-type survey of their experience to determine the most helpful attributes of the Web-based learning module. Responses were assigned numerical values from 1 (strongly disagree) to 5 (strongly agree) to obtain a mean score for each question. RESULTS: Sixty-three students completed the Web-based module. The content of their discussions, as determined by message coding, identified the critical thinking needed to acquire abstract conceptualization of the problems presented in a typical surgery clerkship. Students found the content of the module relevant to the clerkship (mean score, 4.18) and valued facilitator feedback (4.00). Although they did not prefer Web-based instruction of classroom lecture (2.66), students indicated that the Web-based module enhanced their overall learning experience in the clerkship (3.30). CONCLUSION: Web-based technology in the clinical education of third-year osteopathic medical students appears to afford an acceptable teaching alternative when face-to-face instruction cannot be provided. Further study of the impact of instructional design on the quality of higher-order thinking in this domain is needed, as is an appreciation for the dynamics of group learning in a virtual environment.

Osteopathic postdoctoral training institutions: a decentralized model for facilitating accreditation and program quality.

Osteopathic medicine has experienced significant growth in the number of accredited colleges and graduates over the past decade. Anticipating that growth and recognizing a responsibility to provide sufficient opportunities for quality postdoctoral training, the American Osteopathic Association created a national network of educational consortia to meet the needs of those graduates. These osteopathic postdoctoral training institutions (OPTIs) were to provide enhanced capability for the development and accreditation of new programs, quality oversight, and access to academic resources for their members. The plan reached full implementation in 1999 when all graduate training programs were required to become members of one of these consortia. Although several contributing factors can be considered, an increase in the rate at which training programs have obtained approval by the American Osteopathic Association has occurred under the OPTI model. Quality indicators are more elusive. Each OPTI provides peer-driven oversight to curriculum and faculty development and closely monitors outcomes such as in-service examination scores, certification board passage rates, and resident evaluations of programs.The strategy has enabled a much-sought-after transformation in osteopathic graduate medical education that has provided both strength and accountability to the preexisting infrastructure. As a decentralized accreditation model, OPTI is still evolving and warrants continued application and study.