RESEARCH Design and Implementation of an Elective on the Ethnopharmacology of Appalachia for the PharmD Curriculum

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1 RESEARCH Design nd Implementtion of n Elective on the Ethnophrmcology of Applchi for the PhrmD Curriculum Rebecc S. Linger, PhD Americn Journl of Phrmceuticl Eduction 2017; 81 (10) Article University of Chrleston School of Phrmcy, Chrleston, West Virgini Submitted October 5, 2016; ccepted Mrch 14, 2017; published December Objective. To crete nd implement clss in ethnophrmcology tht would educte student phrmcists on folk medicine, including home remedies nd ntive plnts tht re used s lterntive medicinl sources; ctive components of medicinl plnts including toxicity issues nd the mechnism of ction of beneficil compounds, such s ctechins nd other flvonoids; nd nutrceuticls nd poisonous plnts. Methods. In this three-credit hour clss, herbl remedies re investigted from the stndpoints of medicl efficcy, potentil toxicities nd drug interctions with prescribed medictions. Clss discussions re conducted on the usefulness of remedies, the ttitudes of prctitioners towrd trditionl remedy use nd the risks of relying on herbl preprtions. Ech student prepres 15-minute presenttion on disese stte, which covers modern phrmceuticls nd herbl or folk remedy lterntives used in tht disese. Specil emphsis is given to drug-herb interctions. Results. The clss hs gined populrity mong students nd consistently fills within the first hour of computerized registrtion. Students gree tht being educted in the benefits nd potentil toxicities of herbl products will better prepre them to counsel their ptients who use these remedies. The elective hs been offered 10 times since Anecdotl comments from our lumni indicte tht they hve found the informtion to be very useful in their prctice environments. Conclusion. Providing our students with greter understnding of herbl remedies is essentil to prepre them for prctice. By including both the uses nd potentil toxicities, the student phrmcist is ble to counsel her ptients from stndpoint of expertise on these self-dministered remedies. Keywords: ethnophrmcology, Applchi, lterntive medicine, home remedies, folk medicine INTRODUCTION The populrity of herbl medicine nd lterntive remedies remins strong within the United Sttes. The Ntionl Center for Helth Sttistics hs conducted the Ntionl Helth Interview Survey (NHIS) on complementry nd lterntive medicines ntionwide since This survey, conducted every five yers, sks dults living in the United Sttes bout their use of herbl preprtions nd dietry supplements. In 2012, the NHIS reported tht 53.6 million Americns utilized herbl remedies nd dietry supplements. 1 The sle of botnicl dietry supplements ws estimted t $11.5 billion in A popultion-bsed survey of 2,982 respondents conducted by Emory University in 2004 indicted tht while 20% of the popultion used medicinl herbs, over 33% dmitted to dily use. 3 People who use dietry Corresponding Author: Rebecc S. Linger, University of Chrleston School of Phrmcy, 2300 McCorkle Ave. SE, Chrleston, WV Tel: Fx: E-mil: rebecclinger@ucwv.edu 47 supplements report feeling n increse in generl wellbeing nd energy nd feel tht the supplements will help them fight or prevent vrious diseses. 4 As our ntion continues its pursuit of helthier lifestyles, we cn expect the use of herbl supplements to continue to rise. Thus, the eduction of our student phrmcists in the uses of herbl supplements is of utmost importnce. In 1998 report on complementry nd lterntive medicine (CAM) eduction in U.S. phrmcy schools, Rowell nd Kroll indicted tht 60% of schools responding presented herbl medicine in their curriculum, either in stndlone clsses or s prt of the core curriculum. 5 The guidelines they developed for CAM coursework for phrmcy schools stress the criticl evlution of the efficcy of the herbl remedies discussed. In 2003, Shields nd collegues found tht 63% of schools responding hd specific course in nturl products within their curriculum, with the mjority of these clsses offered s electives. 6 In 2013, Noureldin nd collegues reported tht while the mjority of students surveyed hd positive

2 opinion of CAM, students who hd personl experience, phrmcy eduction nd fmily bckground with CAM hd more fvorble ttitude towrd its use. 7 The importnce of educting student phrmcists in the use nd risks of herbl remedies cnnot be overstted. The study of commercilly vilble herbl supplements nd n understnding of the lx regultory oversight in their production re essentil. The Dietry Supplement Helth nd Eduction Act of 1994 ws estblished to help regulte products to be used for nutritionl supplementtion, but does not require certifiction or registrtion of ctive ingredients or potencies. 8 Consequently, some commercilly vilble nutritionl supplements my contin insufficient quntities of ctive ingredients for efficcy, or competing brnds my hve significntly different concentrtions of ctive ingredient leding to overdose or significnt drug-herb interctions in the ptient who is unwre tht the concentrtion hs incresed from one brnd to the next. Given the lrge mrket for herbl supplements, it is interesting to note tht mny of the herbl remedies used tody in Applchi utilize forged plnts. The remedies hve been pssed down through orl trdition from ncestors who settled this re in the lte 18th nd erly 19th century. For the uninitited, descriptions of these remedies cn be found in publictions, such s lmncs, fmily medicine books nd herbl texts, mny of which dte bck to the homesteding period. Self-tretment with tried nd true fmily remedies is prt of the Applchin spirit of self-relince, which lso includes the reluctnce to seek outside medicl ttention. 9 Although mny Applchins will dmit to lck of medicl knowledge, their fith in fmily remedies will foment their relince on self-tretment. Economic issues lso influence their choices; mny fmilies do not hve dequte helth insurnce, or medicl personnel nd fcilities my be too fr wy. 10 Phrmcy eduction in these rurl res should tke these fctors into ccount nd include discussions of lterntive remedies nd prctices of the locl popultion. According to Stndrd 12 of the Accredittion Stndrds nd Guidelines for the Professionl Progrm in Phrmcy Leding to the Doctor of Phrmcy Degree (Accredittion Council for Phrmcy Eduction 2016), 11 the didctic portion of the pre-appe curriculum includes rigorous instruction in ll sciences tht define the profession including evidence-bsed evlution of the therpeutic vlue, sfety, nd regultion of phrmcologiclly ctive nturl products nd dietry supplements. Culturl prctices commonly selected by prctitioners nd/or ptients for use in the promotion of helth nd wellness, nd their potentil impct on phrmcotherpy 48 (Appendix 1 of Stndrds 2016). Ptient-centered cre must consider the helth-litercy of the ptient s well s ny culturl issues tht might need to be ddressed. Student phrmcists need to understnd the culturl bckground of their ptients nd be ble to describe prescribed therpies nd potentil interctions in terms tht cn be understood by the ptient. In this course, we expose the students to the folk lexicon of Applchin residents, such s risings for hives or boils, piles for hemorrhoids, dropsy for edem. 12 This sensitivity to the ptient is lso prescribed by the Center for the Advncement of Phrmceuticl Eduction (CAPE) 2013 Eductionl Outcomes, which describes within Domin 3 the need to dvocte for the ptients best interests in wy tht engges culturl sensitivity. 13 This rticle describes the design nd implementtion of clss in ethnophrmcology. The University of Chrleston resides in the hert of Applchi. Approximtely 70% of the students come from counties considered prt of Applchi by the Applchin Regionl Commission. Focusing on herbl supplement nd folk medicine use following the trditions of Applchi, this clss dequtely trins students to counsel their ptients in more culturlly sensitive mnner. METHODS Ethnophrmcology of Applchi (PHAR 531) is three-credit hour elective offered in the first professionl yer. The entire clss is tught by one professor nd enrollment is kept to mximum of 20 students to fcilitte in-clss discussion. The primry focus of the clss is to introduce students to the prctice of herbl nd home remedies. The review of student ssessments nd the evlution of the course ws submitted s reserch project to the University of Chrleston Institutionl Review Bord nd found to be exempt. Mny students re interested in studying folk medicine becuse their fmilies hve trditionlly used these types of remedies, nd the student is curious to lern the efficcy of these tretments. The clss seeks to present vrious medicinl plnts focusing on the reltive potencies of these remedies nd the potentil toxicities of use. Clss mteril is presented in vriety of formts. Videos by the Applchin nturlist, Il Htter, re presented where she discusses the uses of locl medicinl nd edible plnts. 14 Didctic lectures of medicinl herbs re given with PowerPoint slides supporting the discussion. Lbortory dys re included in the curriculum, where students re exposed to the methods of herbl remedy preprtion through hnds-on experience. Two herbl products re compounded: hnd crem consisting of beeswx,

3 lmond oil nd vitmin E, nd n insect repellent of te tree oil, lvender oil nd witch hzel. The use of infusions is investigted with dy of brewing nd discussion of the medicinl properties of vrious herbl tes. Finlly, ech student prepres n orl presenttion on disese stte nd the herbl remedies used to tret tht disese nd writes term pper on specific herbl remedy. The clss begins with discussions of the nture of folk medicine nd its roots in the history of medicine (Tble 1). This lecture includes discussion of ncient Western texts on medicinl plnts (eg. Disocorides Mteri Medic) 15 s well s Estern references (eg, The Yellow Emperor s Clssic of Medicine). 16 Applchin folk medicine is derived from the Europen ethnophrmcologicl trdition mixing with the knowledge of the indigenous peoples of the Americs. Europen settlers to Applchi brought with them useful Europen plnts but lso lerned of the medicinl properties of locl plnts from the Ntive Americn tribes of Applchi. An exmple of cross-culturl shring is seen with the Europen plnt, mullein. It ws used by the Europens s n expectornt for pulmonry issues, which the Ntive Americns dopted, but lso found tht the thick leves mde good insole cushion for their moccsins. The Doctrine of Signtures is discussed to explin why some plnts hve been ssocited with certin illnesses; specificlly, the shpe of the plnt or where it grows gives clues to how the plnt is to be used. In ll these discussions, hevy dose of skepticism is introduced nd supported by scientific evidence tht sometimes refutes, sometimes supports the vlidity of herbl remedies. The ide tht mny herbl remedies re effective nd cn cuse severe side effects for ptients on chronic therpy is emphsized. A gret del of time is devoted to herb/drug interctions nd is the focus of the first in-clss presenttion. Ech student will report on n herbl remedy nd discuss the potentil toxicities nd drug interctions with tht herbl. A clss discussion on herblists nd fith helers llows students to describe their experiences with these prctitioners. These discussions llow the students to lern compssion for others who my not hold the sme beliefs tht they hve regrding folk medicine nd fith heling. Students re encourged to shre their own experiences with the discussed remedies during lecture. A clss session is devoted to students describing the home remedies used by their fmily. To fcilitte this discussion, the clss ws given n ssignment prior to the first dy of clss to sk their fmilies bout ny home remedies they re using or my hve used in the pst. Our student body comes from diverse set of bckgrounds nd ech student s contribution is often unique. Finlly, ech student is expected to reserch disese stte nd prepre Microsoft PowerPoint (Redmond, WA) presenttion of minutes in length on the following topics: discussion of disese stte, herbls used to tret the disese, preprtion nd ctive compounds in the herbls used, mechnism of ction of these ctive compounds in the tretment of the disese presented, herbdrug interctions or other toxicities ssocited with the use of the herbl, nd the presenttion of ny officil medictions derived from these herbls. A rubric is used to ssess the student s bility to present (Appendix 1). Ares ssessed cover the nonverbl skills of eye contct, body lnguge nd poise, verbl skills of enthusism nd elocution, content issues such s subject knowledge, orgniztion nd mechnics of giving presenttion, spelling nd grmmr. The cretion of PowerPoint slides is ssessed, evluting the redbility of the slide set nd how the student uses the slides in the presenttion. Students who crete visully interesting slides tht re esily red with bullet points tht prompt their discussion re grded very highly in this section of the ssessment. Students were ssigned to write five-pge essy on prticulr herbl remedy, nswering the following Tble 1. Lecture Topics Introduction to Ethnophrmcology (1 hr) Herbl Preprtions (3 hrs) Abndoned Theories of Illness (2 hrs) Alterntive Medicine (2 hrs) Our Fmily Remedies (2 hrs) Poisonous Plnts (2 hrs) Some Commonly Used Herbl Remedies (4 hrs) Ptent Medicines (1 hr) Flvonoids nd Nutrceuticls (1hr) Herb-Drug Interctions (2 hrs) Ethnobotnicl Uses of Applchin Plnts (2 hrs) Compounding Lb: Beeswx/Almond Oil Hnd Crem, Te Tree Oil, Witch Hzel Insect Repellent (3 hrs) 49

4 questions: Wht disese(s) does this remedy ffect; how is the herbl prepred for use; wht is the ctive ingredient; is this ctive ingredient chemiclly relted to ny drugs in the formulry tody; wht is the mechnism of ction of the herbl in ech disese; re there herbl-drug interctions ssocited with this herbl; re there other toxicity concerns using this herbl (ie, concentrtion of toxins in other prts of the plnt, dosge toxicity or preprtions my concentrte toxins); re there commercil preprtions of this herbl vilble nd finlly, hs use of this herbl led to the development of officil medictions? A list of herbl remedies nd the diseses they re purported to tret ws given to the clss s suggestions for topics. Although most students chose from this list, some students chose to write on the ntive medicinl plnts of their home countries nd were ble to reserch these plnts to crete very informtive nd enlightening essys. The grding of the term ppers followed rubric (Appendix 2) nd students who could submit well written, scholrly ppers with in-depth descriptions of the mechnism of ction of the herbl nd expositive writing on the disese stte itself were highly grded. RESULTS The students overll grde in the course is bsed on their performnce on three short-nswer exmintions (70% of the course grde), term pper (10%) nd n orl presenttion (20%). This course hs been offered 10 times in our curriculum. Student performnce in the clss hs been outstnding (Tble 2). The dip in performnce in 2014 nd 2015 reflect the clss verge on the term pper ssignment; significnt portion of the students in these yers wrote filing term ppers. It is importnt to note tht from 2008 to 2013, no term pper ws ssigned. In this time, there were limited elective offerings in our curriculum nd the enrollment of this clss surged to 40 students. Tble 2. Performnce of Students Per Yer on Individul Course Assessments Yer Exms Pper Presenttion Finl No pper ws ssigned Men scores re presented s percentge of totl points 50 It ws felt tht the grding of 25 or more term ppers ws too difficult to complete in timely mnner for one professor nd tht ssessment ws eliminted. However, fculty discussions in 2013 reveled significnt deficiency in our students writing bility nd the decision ws mde to re-implement the ssignment s originlly conceived. Student evlutions for the 10 yers hve verged 4.6 (Tble 3), bsed on 5-point Likert scle (5 5 Strongly Agree). Although the clss ws held in the spring 2014, there ws no course evlution report generted. We hve received severl comments tht the students who took this course tended to spend more time on the course mterils becuse of their gret interest in the subject. The evlution comments lso indicte tht they feel more t ese ssisting customers who sk dvice on herbl remedies fter tking this course. Others hve indicted tht they hd previously thought herbl products to be hrmless but hve since recognized the potentil toxicities of using herbl remedies without foreknowledge of their effects (Tble 4). DISCUSSION Given the growing interest in lterntive remedies nd nturl products, including clss on herbl medicines cn only enhnce the rsenl of tools our students need to counsel their ptients effectively. 3 Designing course tht ddresses the prticulr herbl remedies used by ptients in the school of phrmcy locle will be of gret vlue to the students, especilly when counseling their ptients. The inclusion of commonly used herbl remedies tht re commercilly vilble, such s grlic, Gingko bilob, St. John s Wort, nd ginger, is lso essentil s ptients my be drwn to using these herbl remedies through the promotion of their uses nd efficcies on populr helth progrms. 17 Implementtion of the course typiclly will require didctic presenttions where the instructor presents novel Tble 3. Student Course Evlution Scores (55Excellent) Yer Score Respondents Enrollees No clss evlutions were mde during this period

5 Tble 4. Selected Student Comments s Prt of the Course Evlution The open discussions in clss re helpful in llowing the students to connect with the mteril s opposed to just memorizing it. Out of ll the clsses tken this semester, this single clss is most pplicble in regrd to the myths nd fcts of home remedies nd herbl therpy. The informtion from this clss leked into few other courses this semester. I m gld I chose this elective becuse it helped me with my other courses. I feel like [this course] is relly helpful in the prctice of phrmcy, especilly for me becuse I pln to prctice in West Virgini. I ctully hd ptient come in to my phrmcy nd sk question bout homeopthic remedies for gout. Someone hd told him to use cherries. I ws ble to pply my knowledge of the clss to my ctul phrmcy prctice This clss ws mzing; I loved lerning bout how nturl remedies nd synthetic remedies cn either work or hinder ech other in treting ptient. The lbs were fun nd informtionl. The stories told by the professor only enhnced the fun I hd in this clss. Gret clss overll, would recommend to others. Quite interesting. I thought the course ws extremely informtive nd interesting. Considering tht I grew up roming the hills nd being outdoors quite bit, nd hving the bility to lern bout some of the medicinl properties of the plnts ws very interesting. mteril to the students. Lecture development typiclly took severl hours per topic, with the totl clss requiring pproximtely two full weeks of preprtion to finlize the mteril. Discussion of concepts presented is essentil for the implementtion of this knowledge in ptient counseling. Discussions lso llow students within the clssroom to recognize the diversity of perceptions regrding herbl medicine use. Keeping the clss s informl s possible llows lively discourse tht cn sometimes drift wy from the intended subject of the discussion, but this often cretes strong environment of enlightenment. One discussion, relted to supernturl cure involves using potto to remove wrts. The potto is cut nd rubbed on the wrt. It is then either buried or wrpped in red ribbon nd plced such tht nother person might pick it up. The belief ws tht over time s the potto rots in the erth, the wrt would dispper, or tht the wrts would be trnsferred to the person who picked up the ribbon. Severl students who hd grown up in Applchi recognized the cure, while students from other cultures mrveled tht such n obscure mgicl cure ws so well known. There re significnt regionl differences cross the United Sttes, where folk beliefs nd prctices cn influence the helth cre of our ptients. For phrmcy schools in other regions, professors my wnt to nlyze the lterntive helth prctices in their re nd dpt these topics into course of folk medicine for their students. In the Southwest region of the country, there re strong influences from both Ntive Americn nd Mexicn Americn cultures tht could be discussed. In the Northest region of the country, mny old folk remedies re employed s tried nd true medicines tht could hve significnt interctions with prescription medictions. Future directions for our course involve expnding the mteril relted to herb-drug interctions, developing cse studies of phrmcodynmic nd phrmcokinetic interctions. We recognize tht offering this clss s n elective llows us to delve more deeply into the belief systems of our region, but the time limit prevents us from expnding to these other regions of the country where some of our students re from. CONCLUSION An elective course on herbl remedies in the phrmcy curriculum ws welcomed by both students nd dministrtion. The inclusion of coursework on herbl remedies enhnces student understnding of over-the-counter products nd will prepre them for ptient questions regrding herbl remedies. As the use of complementry nd lterntive medicine strtegies continues to be strong in our society, it is criticl tht eductors of phrmcists include such course mterils in their curriculum. By including the herbl prctices of the specific region of the country in which the school of phrmcy resides, professor my help the students better recognize potentil issues tht could impct the ptients helth by better understnding the specific interctions of herbs used in tht re nd the medictions their ptients re tking. REFERENCES 1. Wu CH, Wng CC, Tsi MT, Hung WT, Kennedy J. Trend nd pttern of herb nd supplement use in the United Sttes: results from the 2002, 2007 nd 2012 Ntionl Helth Interview Surveys. Evid Bsed Complement Alternt Med. 2014;2014(872320):7. 2. Jirtchriykul W, Mhdy GB. Overivew of botnicl sttus in EU, USA, nd Thilnd. Evid Bsed Complement Alternt Med. 2013;2013(480128): Wheton AG, Blnck HM, Gizlice Z, Reyes M. Medicinl herb use in popultion-bsed survey of dults: prevlence nd frequency of use, resons for use, nd use mong their children. Ann Epidemiol. 2005;15(9):

6 4. NIH Stte-of-the-Science Conference Sttement on multivitmin/ minerl supplements nd chronic disese prevention. NIH Consens Stte Sci Sttements. 2006;23(2): Rowell DM, Kroll DJ. Complementry nd lterntive medicine eduction in United Sttes phrmcy schools. Am J Phrm Educ. 1998;62(4): Shields KM, McQueen CE, Brynt PJ. Nturl product eduction in schools of phrmcy in the United Sttes. Am J Phrm Educ. 2003;67(1):Article Noureldin M, Murwski MM, Mson HL, Plke KS. Student phrmcists ttitudes towrd complementry nd lterntive medicine. J Am Phrm Assoc. 2013;53(6): Dwyer JT, Piccino MF, Betz JM, et l. Progress in developing nlyticl nd lbel-bsed dietry supplement dtbses t the NIH Office of Dietry Supplements. J Food Compost Anl. 2008;21:S83-S Coyne CA, Demin-Popescu C, Friend D. Socil nd culturl fctors influencing helth in southern West Virgini: qulittive study. Preventing Chronic Disese ;3(4):Article Behringer B, Friedell GH. Applchi: where plce mtters in helth. Preventing Chronic Disese. 2006;3(4):Article Accredittion Council for Phmrcy Eduction. Accredittion stndrds nd guidelines for the professionl progrm in phrmcy leding to the doctor of phrmcy degree. Chicgo, IL; Cvender A. A Folk Medicl Lexicon of South Centrl Applchi. Johnson City, TN: History of Medicine Society of Applchi, Jmes H. Quillen College of Medicine, Est Tennessee Stte University; Medin MS, Plz CM, Stowe CD, et l. Center for the Advncement of Phrmcy Eduction 2013 eductionl outcomes. Am J Phrm Educ. 2013;77(8):Article Htter I. Wildcrfting. Accessed June 14, Riddle JM. Dioscorides on Phrmcy nd Medicine. Austin, TX: University of Texs Press; Ni M. The Yellow Emperor s Clssic of Medicine: A New Trnsltion of the Neijing Suwen with Commentry. Boston, MA: Shmbhl Publictions; Bubel T, Koper M, Boon H, Culfield T. Medi portryl of herbl remedies versus phrmceuticl clinicl trils: impcts on decision. Med Lw. June ;26(2):

7 Appendix 1. Student Orl Presenttion Scoring Rubric Score Non-Verbl Skills Eye Contct Holds ttention of entire udience with the use of direct eye contct, seldom looking t notes. Consistent use of direct eye contct with udience, but still returns to notes. Displyed miniml eye contct with udience, while reding mostly from the notes. No eye contct with udience, s entire report is red from notes. Body Lnguge Movements seem fluid nd help the udience visulize. Mde movements or gestures tht enhnce rticultion. Very little movement or descriptive gestures. No movement or descriptive gestures. Poise Verbl Skills Enthusism Student is relxed nd selfconfident. Strong, positive ttitude during entire presenttion. Mkes minor mistkes, but quickly recovers. Appers clm. Occsionlly shows positive ttitude. Displys mild tension; hs trouble recovering from mistkes. Shows some negtivity towrd topic presented. Nervousness is obvious; hs trouble recovering from mistkes. Shows bsolutely no interest in topic presented. Elocution Content Subject Knowledge Student uses cler voice nd correct, precise pronuncition of terms so tht ll udience members cn her presenttion. Student demonstrtes knowledge by nswering ll clss questions with explntions nd elbortion. Student s voice is cler. Student pronounces most words correctly. Most udience members cn her presenttion. Student is t ese with expected nswers to ll questions, without elbortion. Student s voice is low. Student incorrectly pronounces terms. Student is uncomfortble with informtion nd is ble to nswer only rudimentry questions. Audience members hve difficulty hering presenttion. Student does not hve grsp of informtion; student cnnot nswer questions bout subject. Orgniztion Student presents informtion in logicl, interesting sequence. Introduction, Development of Mteril nd Conclusion included. Student presents informtion in logicl sequence which udience cn follow. Introduction, Development of Mteril nd Conclusion included. Audience hs difficulty following presenttion. Introduction, Development or Conclusion is missing. Audience cnnot understnd presenttion becuse there is no sequence of informtion. Mechnics Presenttion hs no misspellings or grmmticl errors. Presenttion hs no more thn two misspellings or grmmticl errors. Presenttion hs three misspellings nd/or grmmticl errors. Presenttion hs four or more spelling nd/or grmmticl errors. PowerPoint Presenttion Text All slides present one ide nd few supporting fcts. Most slides present one ide nd few supporting fcts. Most slides present one ide but too mny words. Most slides present multiple ides nd/or too mny words. (Continued) 53

8 Appendix 1. (Continued) Score Font Font on ll slides is lrge enough to be red t distnce. Font on most slides is lrge enough to be red t distnce. Fond on most slides is too smll to be red t distnce. Font on ll slides is too smll to be red t distnce. Contrst There is good contrst between the font nd bckground on ll slides. There is good contrst between the font nd bckground on most slides. The lck of contrst between the font nd bckground mkes the text difficult to red. The lck of contrst between the font nd the bckground mkes the text impossible to red. Imges nd Lyout All slides contin one powerful, high-qulity imge per slide which helps the udience understnd the content. Lyout is visully plesing. Most slides include one powerful, high-qulity imge per slide which enhnces the content. Lyout uses most spce ppropritely. Most imges re clip rt or imges re too lrge/smll or poor qulity. Lyout shows some structure. Imges re distrcting decortions tht crete busy feeling nd detrct from the content. Lyout is cluttered nd confusing. Presenttion Style Student uses text on slides s prompts for originl nrrtion. Student reds text on slides nd elbortes comfortbly. Adpted from NCTE/IRA Red Write Think Student reds text on slides, dding few comments. Student just reds text on slides. 54

9 Appendix 2. Term Pper Scoring Rubric Score Focus & Detils There is one cler, well-focused topic. Min ides re cler nd re well supported by detiled nd ccurte informtion. There is one cler, well-focused topic. Min ides re cler but re not well supported by detiled informtion. There is one topic. Min ides re somewht cler. The topic nd min ides re not cler. Orgniztion The introduction is inviting, sttes the min topic, nd provides n overview of the pper. Informtion is relevnt nd presented in logicl order. The conclusion is strong. The introduction sttes the min topic nd provides n overview of the pper. A conclusion is included. The introduction sttes the min topic. A conclusion is included. There is no cler introduction, structure, or conclusion. Voice The uthor s purpose of writing is very cler nd there is strong evidence of ttention to udience. The uthor s extensive knowledge nd/or experience with the topic is/re evident. The uthor s purpose of writing is somewht cler, nd there is some evidence of ttention to udience. The uthor s knowledge nd/or experience with the topic is/re evident. The uthor s purpose of writing is somewht cler, nd there is evidence of ttention to udience. The uthor s knowledge nd/or experience with the topic is/re limited. The uthor s purpose of writing is uncler. Word Choice The uthor uses vivid words nd phrses. The choice nd plcement of words seems ccurte, nturl, nd not forced. The uthor uses vivid words nd phrses. The choice nd plcement of words is inccurte t times nd/or seems overdone. The uthor uses words tht communicte clerly, but the writing lcks vriety. The writer uses limited vocbulry. Jrgon or clichés my be present nd detrct from the mening. Sentence Structure, Grmmr, Mechnics & Spelling All sentences re well constructed nd hve vried structure nd length. The uthor mkes no errors in grmmr, mechnics, nd/or spelling. Most sentences re well constructed nd hve vried structure nd length. The uthor mkes few errors in grmmr, mechnics, nd/or spelling, but they do not interfere with understnding. Most sentences re well constructed, but they hve similr structure nd/or length. The uthor mkes severl errors in grmmr, mechnics, nd/or spelling tht interfere with understnding. Adpted from RedWriteThink, copyright 2013 Interntionl Reding Assocition/Ntionl Council of Techers of English Sentences sound wkwrd, re distrctingly repetitive, or re difficult to understnd. The uthor mkes numerous errors in grmmr, mechnics, nd/or spelling tht interfere with understnding. 55