Johnnie P.Frazier, MD
CUIN 6373: Instructional Design
REPORT 2
Performance Objectives:
__________________________________________________________
Goal Statement:
Third year medical students will perform ear examinations under supervision in the clinic using
an otoscope/insufflators and be able to identify and describe the landmarks/mobility of normal
and abnormal tympanic membranes (eardrums).
This goal statement is classifies as verbal information and intellectual skill.
Performance Objectives:
1. Given an otoscope/insufflator learners in the clinic will prepare the instruments for ear
examinations.
2. Given pediatric patients attending the pediatric clinic learners will prepare patients for
ear examinations.
3. During the exam of the ears, learners in the pediatric clinic will visualize the patient’s
tympanic membranes with 100% accuracy.
4. During the exam of the ears,learners who visualize cerumen occluding the tympanic
membranes will decide to remove cerumen with the cerumen scoop or by irrigation.
5. During examination of the ears on patients while in the clinic, learners will identify the
landmarks of the tympanic membranes with 100% accuracy.
6. During examination of the ears on patients while in the pediatric clinic, learners will
interpret/recognize normal and abnormal characteristics of the tympanic membranes
with 100% accuracy.
7. During examination of the ears on patients in the pediatric clinic, learners will
interpret/recognize normal and abnormal tympanic membranes mobility with 90%
accuracy.
8. Learners after examination of the patient’s ears will be able to communicate to parents
their results with 100% confidence and accuracy.
9. When using an otoscope/speculum or cerumen scoop, learners will be able to recognize
the risks and complications associated with these instruments while examining an ear
with 100% accuracy.
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Johnnie P. Frazier, MD
CUIN 6373: Instructional Design
REPORT 2:
Developing Assessment Instruments ( Post Test )
Performance Objective 1: (select the best choice)
Given an otoscope/insufflator learners in the clinic will prepare the instruments for ear
examinations.
After identifying the otoscope/insufflator, you will need the following to exam the ear:
a) cerumen scoop
b) someone to help immobilze the patient
c) correct speculum for age and size of patient
d) retractor to pull the pinna back for proper visualization
Performance Objective 2: (select the best choice)
Given pediatric patients attending the pediatric clinic learners will prepare patients for
ear examinations.
After observing a 9 month old patient, you will determine the best immobilization
technique as:
a)
b)
c)
d)
supine
prone
body double wrap in sheets
use a papoose board
The best position to place the otoscope speculum is:
a)
b)
c)
d)
directly into the ear canal until a tight snug seal is created
directly into the ear canal until you see the tympanic membrane
apply lateral traction on the pinna and insert speculum in the ear canal
apply lateral traction on the pinna and insert speculum in the ear canal to create a
tight seal while visualizing the tympanic membrane
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Performance Objective 3:
During the ear exam, learners in the pediatric clinic will visualize the patient’s tympanic
membranes with 100% accuracy.
Yes
No
________________________________________________________________________
a) visualize tympanic membrane
___
___
b) cerumen occluding visualization of tympanic membrane
___
___
c) cerumen partially occluding visualization of tympanic membrane
___
___
Performance Objective 4:
During the exam of the ear, learners who visualize cerumen occluding the tympanic
membrane will decide to remove cerumen.When asked how to remove cerumen from
the ear canal, list the two common methods used for removal.
Name two methods to use to remove cerumen from the ear canal:
1.______________________________________________________________________
2.______________________________________________________________________
Performance Objective 5:
During examination of the ear on patients while in the clinic, learners will identify the
landmarks of the tympanic membrane with 100% accuracy.
List the ten landmarks of the tympanic membrane:
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________
4.______________________________________________________________________
5.______________________________________________________________________
6.______________________________________________________________________
7.______________________________________________________________________
8.______________________________________________________________________
9.______________________________________________________________________
10._____________________________________________________________________
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Performance Objective 6:
During examination of the ear on patients while in the clinic, learners will
interpret/recognize normal and abnormal tympanic characteristics of the tympanic
membrane with 100% accuracy.
Using the following pictorials on Exhibit A, identify and record the following:
Picture 1
Picture 4
Picture 7
Picture 2
Picture 5
Picture 8
Picture 3
Picture 6
Picture 9
Normal
Yes
No
a)
b)
c)
d)
e)
___
___
___
___
___
___
___
___
___
___
Abnormal
Yes
No
a)
b)
c)
d)
e)
f)
g)
h)
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
___
Sharp landmarks
Clear w/o erythema
Light reflex present
Mobile
No fluid
erythematous
no or poor light reflex
non-mobile
fluid present
no landmarks visible
bulging
retracted
opaque/thickened
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Performance Objective 7:
During examination of the ears on patients in the clinic, learners will
interpret/recognize normal and abnormal tympanic membrane mobility with 90%
accuracy.
Normal
Yes
No
Tympanic membrane mobile
___
___
Abnormal
Yes
No
Tympanic membrane non-mobile
___
___
Performance Objective 8:
Learners after examination of the patient’s ears will be able to communicate to
parents their results with 100% accuracy.
Using the tympanic membrane descriptions below write a dialogue to communicate
the results to the parent.
Tympanic membrane description: tympanic membrane on the right is clear with
good landmarks, no erythema, no fluid and mobile.
Tympanic membrane description: tympanic membrane retracted, opaque, with
central erythema, and non-mobile.
_____________________________________________________________________
_____________________________________________________________________
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Performance Objective 9: (select the best choice)
When using an otoscope/speculum or cerumen scoop,learners will be able to
recognize the risks and complications associated with the instruments while
examining an ear with 100% accuracy.
When examining the ear complications may occur (select two).
a)
b)
c)
d)
otoscope/speculum gets stuck in canal
speculum touches tympanic membrane and ruptures
cerumen scoop scratches canal and bleeding occurs
cerumen perforates the tympanic membrane
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Johnnie P. Frazier, M.D.
CUIN 6373: Instructional Design
Report 2
Developing an Instructional Strategy
Instructional Sequences:
 The learners will prepare and select the correct ear examination instruments (otoscope,
insufflators, ear speculum) for the age and size of patient after review of the pictorials
and with the assistance of the supervisor.
 The learners will prepare the patient for ear examination by reviewing the pictorials of
proper immobilization techniques and how to apply traction of pinna.
 Learners will be presented with a tympanic membrane pictorial indicating all the normal
landmarks labeled.
 The learners will observe the supervisor removing cerumen with a cerumen scoop and
irrigation method.
 Learners will be presented with several pictorials depicting abnormal tympanic
membranes and correct diagnosis for each with the abnormalities identified.
 The learners will view video/pictorials of tympanic membrane insufflations and mobility
correlated with different diagnoses.
 Learners will observe the supervisor initially discussing ear exams with parents then
practice talking with parents after ear examinations with confirmation by the
supervisor.
 Learners will be given information concerning the potential risks associated with ear
examinations and improper use of ear instruments.
Preinstructional Activities:
Motivation: Prior to main step 1, “Prepare for ear exam “the learners will tour the clinic and
exam rooms and observe how the equipment is set up in each room. The supervisor will discuss
with the learners tricks of the trade methods for successfully examining the ear of different age
patients with varying attitudes/behaviors. The supervisor will review with learners why it is
important to do a thorough ear exam and complications of misdiagnosed ear infections. The
supervisor will demonstrate a mock ear exam with real time demonstration of examining
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techniques and how to relate the results to the parents. The supervisor will stress the
importance of accuracy for successful performance.
Objectives: An overview of all the objectives will be presented and reviewed with the learners.
The supervisor will play a critical role in monitoring the learners and this role will be described
in detail.
Entry behaviors: Learners will all have completed the physical diagnosis course and are familiar
with the external ear anatomy, otoscope/insufflator/speculum, how to select the correct size
speculum for patient, and the different immobilization techniques. A pretest will not be
necessary. A brief review of entry behaviors will be available as an option for learners as
needed on the web.
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OBJECTIVE 1
Given an otoscope/insufflators learners in the clinic will prepare the instruments for the ear
exam.
CONTENT PRESENTATION
CONTENT: The learners will be presented with the standard ear instruments
(otoscope,insufflator,speculums,cerumen scoops) in the exam room. The supervising attending
will orientate learners to preparation of instruments and discuss the instruments use.
EXAMPLES: Show the ear exam instruments in the exam room.
STUDENT GROUPINGS AND MEDIA SELECTION:
Learners will work independently or in small groups
Web-based
STUDENT PARTICIPATION:
PRACTICE ITEMS AND ACTIVITIES: Given the ear exam instruments learners will prepare the
instruments as demonstrated and discussed by the supervising attending.
FEEDBACK: Illustrate recognition and preparation of ear exam instruments.
STUDENT GROUPINGS AND MEDIA SELECTION: Learners will work independently or in small
groups
Web-based
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OBJECTIVE 2
Given pediatric patients attending the pediatric clinic learners will prepare patients for ear
examinations.
CONTENT PRESENTATION
CONTENT: A pictorial will be presented demonstrating preparation (lateral traction of the
pinna) of the patient. The supervising attending will discuss the various positions to place
lateral traction when preparing the patient and demonstrate.
EXAMPLES: Pictorials showing examples of lateral traction on pinna.
STUDENT GROUPINGS AND MEDIA SELECTION:
Learners will work independently
Web-based
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Given the pictorial and demonstration learners will practice
preparation of patients for ear exams.
Where and how should you apply lateral traction on the ear?
FEEDBACK: Show how to apply lateral traction and explain positions of traction.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Web-based
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OBJECTIVE 3
During the exam of the ears, learners in the pediatric clinic will visualize the patient’s
tympanic membranes with 100% accuracy.
CONTENT PRESENTATION:
CONTENT: Visualize tympanic membranes of different ages.
EXAMPLES: Verbalize success in visualization.
Readily admit unable to visualize.
Resists abandoning ear exam due to external pressures (patient’s behavior,
parent dissatisfaction, cerumen).
STUDENT GROUPINGS AND MEDIA SELECTION:
Learners will work independently
STUDENT PRESENTATION:
PRACTICE ITEMS AND ACTIVITIES: List positive reactions from visualization of tympanic
membranes. What other techniques made it easier to visualize the tympanic membrane?
FEEDBACK: Learners verbalize and discuss success of visualizing tympanic membranes.
Confirmation by supervising attending
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will perform independently
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OBJECTIVE 4
During the exam of the ears, learners who visualize cerumen occluding the tympanic
membrane will decide to remove cerumen with the cerumen scoop or by irrigation.
CONTENT PRESENTATION
CONTENT: Sometimes in examining the ear cerumen is present. Whether partially or totally
obscuring visualization of the tympanic membrane, learners will need to decide the optimal
removal method. The supervising attending will be present to discuss and demonstrate the two
common methods for cerumen removal.
EXAMPLES: Show learners two common methods of cerumen removal ( cerumen scoop and
irrigation).
STUDENT GROUPINGS AND MEDIA SELECTION:
Small group
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Discuss and practice cerumen removal methods.
FEEDBACK: Review reactions and success from each cerumen methods.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Small group
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OBJECTIVE 5
During examination of the ears on patients while in the clinic, the learners will identify the
landmarks of the tympanic membrane with 100% accuracy.
CONSENT PRESENTATION:
CONTENT: Learners will be presented with a pictorial identifying the landmarks of the tympanic
membranes.
EXAMPLE: Pictorial/image of a typical tympanic membrane with the landmarks identified and
located.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Pictorials
Web-based
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Given a tympanic membrane identify and locate landmarks
FEEDBACK: Complete checklist with names of landmarks identified and located on tympanic
membrane.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Pictorial
Wed-based
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OBJECTIVE 6
During examination of the ears on patients while in the pediatric clinic, learners will
interpret/recognize normal and abnormal characteristics of the tympanic membranes with
100% accuracy.
CONTENT PRESENTATION
CONTENT: Learners will be presented with multiple pictorials characterizing normal/abnormal
tympanic membranes’. A list of terms used to characterize normal/abnormal tympanic
membrane will be used to describe each with discussion from the attending supervision to add
value.
EXAMPLES: Pictorials/images of normal/abnormal tympanic membranes with detail
descriptions (terms listed).
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Pictorials/images
Web-based
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Using a checklist , identify and describe the
normal/abnormal characteristics of the tympanic membranes presented.
FEEDBACK: Complete checklist with the descriptive terms of the tympanic membranes
presented.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Web-based
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OBJECTIVE 7
During examination of the ears on patients in the pediatric clinic, learners will
interpret/recognize normal and abnormal tympanic membrane mobility with 90 % accuracy.
CONTENT PRESENTATION
CONTENT: Learners will demonstrate successful insufflations on normal tympanic membranes.
The supervising attending will discuss this procedure in detail and provide a video for viewing
for reinforcement and added value.
EXAMPLES: Show pictorial and video of normal insufflations. Show pictorials of abnormal
tympanic membranes.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Web-based
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Patients with normal tympanic membranes will have learner
insufflations demonstrated under supervision.
FEEDBACK: With each insufflation the supervising attending will observe and repeat for
confirmation and additional reactions from learners.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Wed-based
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OBJECTIVE 8
Learners after examination of the patient’s ear will be able to communicate to parents their
results with 100% accuracy.
CONTENT PRESENTATION
CONTENT: A written normal/abnormal ear exam scenario will be presented with
characterizations of the tympanic membrane. The scenario will include positive/negative results
and a final disposition. The supervising attending will discuss/review appropriate
communication of findings.
EXAMPLES: Given written scenarios of normal/abnormal ear tympanic membrane findings
demonstrate how to communicate the final disposition.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently and in small groups
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: Given written scenarios with positive/negative findings
communicate the final disposition.
FEEDBACK: Discuss the actions/reactions of communications.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Small group
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OBJECTIVE 9
When using an otoscope/speculum or cerumen scoop, learners will be able to recognize the
risks and complications associated with these instruments while examining an ear with 100%
accuracy.
CONTENT PRESENTATION
CONTENT: Written information will be presented reviewing potential complications/risks from
ear exams.
EXAMPLES: View images depicting various complications from ear exams.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Small group
Wed-based
STUDENT PARTICIPATION
PRACTICE ITEMS AND ACTIVITIES: None required
FEEDBACK: Review proper techniques in handling patients and ear instruments.
Complete checklist identifying potential complications.
STUDENT GROUPINGS AND MEDIA SELECTIONS:
Learners will work independently
Small group
Web-based
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