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Continuing professional development activity
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International Journal of Osteopathic Medicine 11 (2008) 120–121 www.elsevier.com/locate/ijosm SELF ASSESSMENT
Continuing Professional Development Activity This CPD section was co-ordinated by Steven Vogel, The British School of Osteopathy, London, UK.
We hope you enjoy the CPD section. Let us know your views by email to: “[email protected]”
Self-assessment Instructions 1. Read the relevant article in the current issue of the journal. 2. Record your answers in the space provided. For the ‘Reflection on own practice’ section you will need to use a separate sheet. 3. Ensure that you retain your responses for the purpose of demonstrating completion of the activity. 4. Note that CPD requirements vary depending on your registration agency. As such you should consult your own registration agency to determine whether this activity satisfies your particular CPD requirements.
Questions The first three questions relate to the Research Report by Scarr p. 80-89.
In relation to the case study by Leach p. 106-111, please answer the following three questions (select all that apply):
Questions 1. The tension cords in the model described in the article had to be attached at the bone margins: A
True
B
False
2. The model was developed to provide support for the argument that stability in the cranial vault relies on expansive force from the brain. A
True
B
False
3. On a separate sheet, consider your current understanding of the stability of the cranial vault and how this informs your practice. Summarise what changes, if any, the tensegrity model proposed by Scarr has on your own understanding and how this may impact upon your practice as an osteopath or educator.
IJOSM 11:3
4. Following gastrectomy for gastric cancer, the patient can expect the following: A
Reduction in the amount of food or drink able to be consumed.
B
Risk of developing pernicious anaemia due to lack of intrinsic factor production by the stomach.
C
Dumping syndrome, which occurs after eating and includes faintness, light-headedness, drowsiness, flushing, sweating, tachycardia and abdominal pain.
D
Weight loss.
5. The key historical findings that indicated that a recurrence of the cancer was not a likely cause of the patient’s symptoms were reported to be: A
Recent MRI indicating no cancer.
B
Recent blood tests indicating that there was no active inflammation (e.g. negative CRP and ESR).
© 2008 Published by Elsevier Ltd.
SELF ASSESSMENT
C
Long duration of symptoms.
Reflection on own practice
D
Recent review with the patient’s oncologist.
Consider your own personal clinical practice. Review your case notes of the last new patient you saw before reading Tyreman’s paper on professional values p. 90-95.
6. The osteopathic management plan implemented for this patient included: A
Consideration of psychosocial issues, and provision of education and reassurance.
B
High velocity, low amplitude thrust manipulation of the upper thoracic spine.
C
Positional release techniques applied to the cervical spine.
D
Dietary modification.
Consider how you made your diagnosis and the evidence on which it was based. Identify which epistemic values you were using to select the evidence on which you based your decision. Do you think there was a good outcome from the first consultation? What makes you think that? Which pragmatic values are you basing that decision on? What was the nature of the problem the patient presented with? Which ontological value(s) are you basing that judgement on?
The final four questions and the reflection on own practice section relate directly to Tyreman’s paper on professional values p. 90-95, but you may also find it helpful to refer to Tyreman’s commentary on science and osteopathy p. 102-105.
Now apply the same questions to the next new patient that you see. To what extent does making values more explicit help you to understand the patient’s problem and your response to it?
7. Identify and list the main differences between a profession and a trade/craft.
Answers to previous questions Answers to questions 1 – 9 from the CPD activity published in Volume 11, Issue 2, 2008.
8. List 3 characteristics of osteopathic practice that highlight it as a profession and 3 that demonstrate its craft-like nature.
9. On a scale of 1 to 10, with profession at one end and trade/craft at the other, where do you place osteopathy at the present time? Trade/craft 1
2
3
A
(2)
A
(3)
G
(4)
B
(5)
Various authors’ critique of the way EBM has been implemented in healthcare included: EBM as having a rigid dogma; Application of EBM principles as a cost-cutting tool; EBM ‘hierarchy of evidence’ ranks evidence by method not relevancy or effectiveness; Paradigm of ‘truth’ gleaned exclusively from statistical studies; Practice of EBM has failed to take into account other kinds of medical knowledge eg clinical experience; Overemphasis on value of scientific evidence while underplaying role of clinical judgement and individual expertise.
(6)
The three day interval between the three measurement sessions was intended to be representative of the common interval between consecutive consultations in clinical practice.
(7)
Investigators applied 1mm diameter ‘dots’ of ‘correction fluid’ (TiO2)
Profession 4
5
6
7
8
9
10
to the skin underlying each anatomical marker. This was undertaken so as to minimise errors in relocation of markers between measurement sessions.
10. Tyreman’s paper suggests that values are more significant in health care practice than is often recognised. Professional values in particular entail implicit assumptions and beliefs about the nature of the profession. List 3 values that you believe to be fundamental to osteopathic practice.
IJOSM 11:3
(1)
121
(8)
For standing posture, viewed laterally, the variables with the highest reliability coefficients were: Head angle (0.92); Ankle-fib angle (0.89); distance between T12-L5 (0.72); Arm angle (0.69); distance between C7-T4 (0.69); distance between T8-T12 (0.68); Forward head position (0.67). [see Fig.2 Int J Osteopath Med 2008;11. p.46 for variable descriptions]
(9)
For seated posture, viewed laterally, the variables with the highest reliability coefficients were: Head angle (0.92); Greater troch angle (0.93);distance between T4-T8 (0.70); distance between T8-T12 (0.66); distance between T12-L5 (0.66). [see Fig.2 Int J Osteopath Med 2008;11. p.46 for variable descriptions]
© 2008 Published by Elsevier Ltd.
International Journal of Osteopathic Medicine 11 (2008) 120–121 www.elsevier.com/locate/ijosm SELF ASSESSMENT
Continuing Professional Development Activity This CPD section was co-ordinated by Steven Vogel, The British School of Osteopathy, London, UK.
We hope you enjoy the CPD section. Let us know your views by email to: “[email protected]”
Self-assessment Instructions 1. Read the relevant article in the current issue of the journal. 2. Record your answers in the space provided. For the ‘Reflection on own practice’ section you will need to use a separate sheet. 3. Ensure that you retain your responses for the purpose of demonstrating completion of the activity. 4. Note that CPD requirements vary depending on your registration agency. As such you should consult your own registration agency to determine whether this activity satisfies your particular CPD requirements.
Questions The first three questions relate to the Research Report by Scarr p. 80-89.
In relation to the case study by Leach p. 106-111, please answer the following three questions (select all that apply):
Questions 1. The tension cords in the model described in the article had to be attached at the bone margins: A
True
B
False
2. The model was developed to provide support for the argument that stability in the cranial vault relies on expansive force from the brain. A
True
B
False
3. On a separate sheet, consider your current understanding of the stability of the cranial vault and how this informs your practice. Summarise what changes, if any, the tensegrity model proposed by Scarr has on your own understanding and how this may impact upon your practice as an osteopath or educator.
IJOSM 11:3
4. Following gastrectomy for gastric cancer, the patient can expect the following: A
Reduction in the amount of food or drink able to be consumed.
B
Risk of developing pernicious anaemia due to lack of intrinsic factor production by the stomach.
C
Dumping syndrome, which occurs after eating and includes faintness, light-headedness, drowsiness, flushing, sweating, tachycardia and abdominal pain.
D
Weight loss.
5. The key historical findings that indicated that a recurrence of the cancer was not a likely cause of the patient’s symptoms were reported to be: A
Recent MRI indicating no cancer.
B
Recent blood tests indicating that there was no active inflammation (e.g. negative CRP and ESR).
© 2008 Published by Elsevier Ltd.
SELF ASSESSMENT
C
Long duration of symptoms.
Reflection on own practice
D
Recent review with the patient’s oncologist.
Consider your own personal clinical practice. Review your case notes of the last new patient you saw before reading Tyreman’s paper on professional values p. 90-95.
6. The osteopathic management plan implemented for this patient included: A
Consideration of psychosocial issues, and provision of education and reassurance.
B
High velocity, low amplitude thrust manipulation of the upper thoracic spine.
C
Positional release techniques applied to the cervical spine.
D
Dietary modification.
Consider how you made your diagnosis and the evidence on which it was based. Identify which epistemic values you were using to select the evidence on which you based your decision. Do you think there was a good outcome from the first consultation? What makes you think that? Which pragmatic values are you basing that decision on? What was the nature of the problem the patient presented with? Which ontological value(s) are you basing that judgement on?
The final four questions and the reflection on own practice section relate directly to Tyreman’s paper on professional values p. 90-95, but you may also find it helpful to refer to Tyreman’s commentary on science and osteopathy p. 102-105.
Now apply the same questions to the next new patient that you see. To what extent does making values more explicit help you to understand the patient’s problem and your response to it?
7. Identify and list the main differences between a profession and a trade/craft.
Answers to previous questions Answers to questions 1 – 9 from the CPD activity published in Volume 11, Issue 2, 2008.
8. List 3 characteristics of osteopathic practice that highlight it as a profession and 3 that demonstrate its craft-like nature.
9. On a scale of 1 to 10, with profession at one end and trade/craft at the other, where do you place osteopathy at the present time? Trade/craft 1
2
3
A
(2)
A
(3)
G
(4)
B
(5)
Various authors’ critique of the way EBM has been implemented in healthcare included: EBM as having a rigid dogma; Application of EBM principles as a cost-cutting tool; EBM ‘hierarchy of evidence’ ranks evidence by method not relevancy or effectiveness; Paradigm of ‘truth’ gleaned exclusively from statistical studies; Practice of EBM has failed to take into account other kinds of medical knowledge eg clinical experience; Overemphasis on value of scientific evidence while underplaying role of clinical judgement and individual expertise.
(6)
The three day interval between the three measurement sessions was intended to be representative of the common interval between consecutive consultations in clinical practice.
(7)
Investigators applied 1mm diameter ‘dots’ of ‘correction fluid’ (TiO2)
Profession 4
5
6
7
8
9
10
to the skin underlying each anatomical marker. This was undertaken so as to minimise errors in relocation of markers between measurement sessions.
10. Tyreman’s paper suggests that values are more significant in health care practice than is often recognised. Professional values in particular entail implicit assumptions and beliefs about the nature of the profession. List 3 values that you believe to be fundamental to osteopathic practice.
IJOSM 11:3
(1)
121
(8)
For standing posture, viewed laterally, the variables with the highest reliability coefficients were: Head angle (0.92); Ankle-fib angle (0.89); distance between T12-L5 (0.72); Arm angle (0.69); distance between C7-T4 (0.69); distance between T8-T12 (0.68); Forward head position (0.67). [see Fig.2 Int J Osteopath Med 2008;11. p.46 for variable descriptions]
(9)
For seated posture, viewed laterally, the variables with the highest reliability coefficients were: Head angle (0.92); Greater troch angle (0.93);distance between T4-T8 (0.70); distance between T8-T12 (0.66); distance between T12-L5 (0.66). [see Fig.2 Int J Osteopath Med 2008;11. p.46 for variable descriptions]
© 2008 Published by Elsevier Ltd.