Natural Language Question Activity

Transcription

1 Teacher s Manual Natural Language Question Activity Write Your Own Medical Adventure provided by: 2012 Reynolds Grantee 10 th Annual Meeting TEXAS Training Excellence in Aging Studies Division of Geriatric and Palliative Medicine The University of Texas Health Science Center at Houston School of Medicine The First Decade and funded by: The Donald W. Reynolds Foundation 1

2 Natural Language Question Structure Response Critical Thinking Question Evaluation 2

3 Step 1: Write a Critical Thinking Question: Write your question here Example Question: How does a comprehensive geriatric assessment differ from a standard adult medical exam? Why is it important to complete a comprehensive geriatric assessment of an older adult? 3

4 Write your response here Step 2: Write your expert response below. Example Response: A comprehensive geriatric assessment (CGA) exam goes beyond the standard adult history and physical examination. It is a more extensive evaluation that includes elements of special significance in older adults. A CGA ensures that you are providing the highest quality healthcare for this population. The comprehensive geriatric assessment differs from a standard medical evaluation in four important ways. (1) It focuses on elderly individuals with complex conditions. As older adults age, it is often the case that older patients will develop groups of related medical problems. These conditions are referred to as Geriatric Syndromes." Common geriatric syndromes include falls, cognitive impairments, polypharmacy (conducting regular medication review for all overthe-counter, as well as prescribed, drugs or supplements), delirium, depression, incontinence, impaired homeostasis and iatrogenic disorders. The CGA assists clinicians in uncovering such problems. (2) Obtaining an in-depth social history helps to fully understand overall health. Often, the concerns or problems of an older adult will not present themselves as purely physical ailments. A thorough social history includes questions about living environment, social 4

5 support, social activities, and advanced directives. These questions can reveal problems such as caregiver stress, elder abuse and mistreatment and financial concerns that would not be evident from a routine physical exam. (3) It emphasizes functional status. A comprehensive geriatric assessment addresses the most prevalent issues that affect functionality faced by an older adult patient. It involves a thorough evaluation of: a. Cognition: dementia and delirium; b. Mobility: fall risk, gait and balance, instrumental and basic activities of daily living (IADL and ADLs); c. Affect: depression and other mood disorders; d. Pain; e. Vision; f. Hearing; and, g. Nutrition. (4) It frequently takes advantage of an interprofessional team of providers. The interprofessional team can help with the comprehensive geriatric assessment, allowing for more expert assessment of and advice for the patient, and allowing the geriatrician more time for other patients. The interprofessional team provides the patient with more resources from other professionals (social workers, case managers, physical and occupation therapists, registered dieticians, and nurses). Using a team offers a holistic approach to healthcare. The CGA is a critical tool that geriatricians and geriatric interprofessional teams rely on to formulate an individualized plan of care for older patients. It is important because it is comprehensive and the approach is holistic. It utilizes an array of assessments that address issues faced by older adults with complex comorbidities. The CGA provides an integrated picture of older adult health, taking into account all the multifaceted domains that impact an older adult s health, well-being, independence, and quality of life. Step 3: Circle keywords in your response that are critical to the overall concept you are trying to convey and that you want the students to grasp and retain. In the example above, the keywords/short phrases are highlighted. 5

6 Step 4: Put keywords in table. Point range: Natural Language Table Point range: Point range: Grp Keyword Synonyms Alternatives Step 5: Identify suitable synonyms. Step 6: Identify acceptable alternatives (other potential words or phrases that are not synonyms, but would still be related and acceptable). Step 7: Assign grouping if needed. An example of a completed natural language table is on next page. 6

7 Example: Natural Language Table Natural Language Table Point Range: Point Range: Point Range: Grp Keyword Synonyms Alternatives 1 complex complex problems, interrelated, complexity, many problems, challenging, comorbidities, varied, multiple, diverse 1 social history social activities, social support, social environment friends, community, background 1 functional functioning, functional, ability, capacity, able, useful, purposeful, efficient, thriving, maintaining 1 interprofessional interdisciplinary, expert, specialist, team, care team, holistic multidisciplinary 1 individualized customized, tailored, personalized, specified, unique, thorough specific, particular, self-care, self 1 plan of care care plan, assessment and plan, therapeutic plan, regiment, routine therapeutic alliance 1 quality of life life of older adult, quality, value, worth, good life health, wellness 1 independence individuality, individualism maintenance 7

8 Step 8: Determine rubric categories, levels and rubric points Level A Level B Level C Trait 1 Trait 2 Trait 3 Trait 4 Example: Critical Thinking Rubric Trait Novice=1 Advanced=2 Mastered=3 Incorrect Response Demonstrates no Not applicable to this this knowledge of geriatric level terminology and/or strategies and/or strategies KNOWLEDGE (geriatric terminology) COMPREHENSION (grasp of geriatric essentials) Response is stated without clarification or description. Response is stated but description leaves some terms undefined, ambiguities unexplored, undetermined, and/or unknown. Correct Response Demonstrates thorough knowledge of geriatric terminology Response is stated clearly, insightfully, and described comprehensively, delivering all relevant information necessary for full understanding. 8

9 APPLICATION AND ANALYSIS (Evidence, perspective and Influence of geriatric concepts and context ) Response is minimally developed, simplistic and obvious with limited degree of clarity and with little confidence Response without any interpretation/evaluation. Shows an emerging awareness of geriatric concepts and geriatric context Response is partially developed with some clarity and confidence Response with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Identifies several relevant geriatric concepts when responding. Begins to identify some geriatric contexts when responding Response is fully developed, taking into account the complexities of geriatrics with a high degree of clarity and with confidence Response with enough interpretation/ evaluation to develop a comprehensive analysis or synthesis or application Thoroughly (systematically and methodically) analyzes responses in relation to geriatric concepts. Carefully evaluates the relevance of geriatric contexts when responding. SYNTHESIZING AND EVALUATING (Discover meaning or significance, draw conclusions, and make an assessment) Conclusion is inconsistently tied to some of the information discussed; related outcomes (consequences and implications) are oversimplified. Conclusion is logically tied to information; some related outcomes (consequences and implications) are identified clearly. Conclusions and related outcomes (consequences and implications) are logical and reflect informed evaluation and ability to place evidence and perspectives discussed in priority order. 9

10 Step 9: Add rubric level to your table on page 6 Step 10: Assign point range for question per rubric level to your table on page 6 Example: Completed Natural Language Table Natural Language Table Novice Point range: 0-2 Advanced Point range: 3-5 Mastered Point range: 6-8 Grp Keyword Synonyms Alternatives 1 complex complex problems, interrelated, complexity, many problems, challenging, comorbidities, varied, multiple, diverse 1 social history social activities, social support, social environment friends, community, background 1 functional functioning, functional, ability, capacity, able, useful, purposeful, efficient, thriving, maintaining 1 interprofessional interdisciplinary, expert, specialist, team, care team, holistic multidisciplinary 1 individualized customized, tailored, personalized, specified, unique, thorough specific, particular, self-care, self 1 plan of care care plan, assessment and plan, therapeutic regiment, routine plan, therapeutic alliance 1 quality of life life of older adult, quality, value, worth, good health, wellness life 1 independence individuality, individualism maintenance Step 11: Alpha and beta test your natural language questions to fine tune your system. It is best completed as an iterative process. At each iteration, modifications can be made thereby enhancing the evolving versions until you are satisfied with the system implemented. 10

11 The Training Excellence in Aging Studies (TEXAS) program promotes geriatric training from medical school through the practicing physician level. This project is funded by the Donald W. Reynolds Foundation to the division of Geriatrics and Palliative Medicine within the department of Internal Medicine at the University of Texas Health Science Center at Houston (UTHealth). 11