Karen T. Snider, Dennis J. Dowling, Michael A. Seffinger, Millicent K. Channell, Sheldon C. Yao, Sharon M. Gustowski, Jane C. Johnson, Martin J. Pryor. Effect of Table Trainer–to-Student Ratios on Outcome in Student Assessments of Cervical Muscle Energy Techniques. J Am Osteopath Assoc 2015;115(9):556–564. doi: 10.7556/jaoa.2015.113.
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Context: Improving the acquisition of osteopathic manipulative treatment (OMT) skills may increase student confidence and later use of OMT. A first step in this process is determining the optimal table trainer–to-student ratio (TTR).
Objective: To determine the effect of TTR on knowledge and skill acquisition of cervical muscle energy OMT techniques in first-year osteopathic medical students.
Methods: First-year students at 3 colleges of osteopathic medicine received instruction on cervical diagnosis and muscle energy techniques at 1 of 3 workshops, each having a different TTR (1:4, 1:8, or 1:16). Written assessments were conducted immediately before and after the workshop and again 2 weeks later to test retention of the knowledge acquired. Practical assessments were conducted immediately after the workshop and 2 weeks later to test retention of the skills acquired and were graded for technical and proficiency elements.
Results: Ninety-two students completed pre- and postworkshop assessments, and 86 completed the retention assessment. No difference was found between TTRs on the preworkshop, postworkshop, and retention written scores (P≥.15). Postworkshop written assessment scores were highest, followed by retention scores; preworkshop scores were lowest (P<.001). Although the mean (SD) postworkshop practical scores for the 1:4 and 1:8 TTR workshop groups (266.3 [43.1] and 250.6 [47.5], respectively) were higher than those for the 1:16 TTR groups (230.3 [62.2]), the difference was not significant (P=.06). For the retention practical assessment scores, no significant difference was found between TTRs (P=.19). A significant interaction was noted between TTR and the timing of practical assessments; scores declined from postworkshop to retention assessments for the 1:4 (P=.04) and 1:8 (P=.02) TTR workshop groups but not the 1:16 TTR workshop groups (P=.21). Student order in paired student demonstrations also had a significant effect on technical scores (P≤.03); students who demonstrated techniques second had higher scores than those who demonstrated techniques first.
Conclusion: The TRR had no significant effect on written or practical assessment scores. Practical assessment scores for the 1:4 and 1:8 TTRs declined significantly between postworkshop and retention assessments. Future studies with more statistical power will be necessary to determine the effect of TTRs on student learning. The current study also found that student order in paired demonstrations may affect practical assessment scores, because the second-demonstrating student scored higher than the first; colleges of osteopathic medicine should therefore consider randomizing student order during practical assessments.
a The final practical assessment score was calculated by multiplying the criterion and proficiency scores for a maximum score of 300 points. The maximum criterion score was 30 points, and the initial proficiency score, before deductions, was 10 points.
b Negative values represent deductions.
c No partial credit was given for this element. If the student repeated the contraction 3 or more times, he or she received a score of “2”. If the student repeated the contraction less than 3 times, he or she received a score of “0”.
d Deduction was given if the student demonstrated the assigned technique on a vertebra that was more than 2 vertebral segments away from the assigned vertebra.
a Each written assessment included 10 multiple-choice, case-based items, for a maximum score of 10 points.Sample sizes shown (n) equal the number of student participants who completed the indicated assessment.
b P values were derived from Friedman tests for within-group comparisons of assessment scores by timing of the assessment.
e P values were derived from stratified Kruskal-Wallis tests (preworkshop) or stratified nonparametricanalyses of covariance (postworkshop and retention) for between-group comparisons of TTR.
a Each written assessment included 10 multiple-choice, case-based items, for a maximum score of 10 points. Practical assessment scores were calculated for each technique performed, and each student performed 2 techniques; there was no significant interaction between study site and timing of the practical assessment (P=.61). Number of students indicates number who completed the indicated assessment at the indicated site.
b For written assessment scores, P values were derived from Friedman tests for within-group comparisons of scores by timing of the assessment. For practical assessment scores, P values were derived from general linear mixed models for within-site comparisons of scores by timing of the assessment.
d P values were derived from Kruskal-Wallis test (preworkshop) and nonparametric analyses of covariance (postworkshop and retention) for between-group comparisons of study sites.
f P values were derived from general linear mixed models for between-group comparisons of study sites.
Abbreviation: COM, college of osteopathic medicine.
a Practical assessment scores were assigned for each technique performed, and each student performed 2 techniques. A significant interaction was found between TTR and the timing of the assessment (P=.02).
b n=number of student participants who completed the indicated assessment and nT=number of graded techniques.
c P values derived from general linear mixed models for within-group comparisons of assessment scores by timing of the assessment.
d P values derived from general linear mixed models for between-group comparisons of scores by TTR.
a Practical assessment scores represent scores for individually graded cervical muscle energytechniques; each student performed 2 techniques, and all students performed in pairs.
b nT=number of graded techniques.
c P values derived from general linear mixed models for between-group comparisons of assessment scores by student order.
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