Expert Skills Program at Texas Tech
Non-TTUHSC Question Analysis/Study Group Workshop
(Room, date, and time TBA)
[Teacher’s notes in brackets]
“Just because we assign 100 pages in Moore doesn’t mean we expect
them to learn all of it!” (- anatomy professor)
Introduction
This workshop will last for 60 minutes. We will use the anatomy text, Clinically Oriented
Anatomy by Moore, et al., 6th Ed., although earlier editions will still also work.
 This material is essential learning in anatomy so the workshop is “study time.”
 The exercises are designed to comfortably simulate recommended activities once a week.
 This will be the method for weekly group study in the ESP Block 3: Step 1 Prep.
 This method is also highly effective individually, if extra practice is desired.
[Any content will work for this workshop. There is a special motivation if the students know
that what they are practicing in the workshop will help them immediately in the curriculum. Our
course director for anatomy was consulted to verify the content of the questions that are
analyzed. The students were also made aware of this to increase the credibility of the workshop.]
Team formation
Find the Early Clinical Experience group number to join your group. There will be less than 910 students in each group since ESP has a total registration of approximately 66. We will decide
at this point on merging some groups to have at least 5 in a group.
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All exercises will involve group dialogue.
Don’t worry if you are uncomfortable with this process at first. No one needs to be
forced to speak until they are ready.
Please note that by year 3 when clerkship training begins, you need to be ready.
There are three (or more?) goals for this workshop:
1. Helping you learn what you have organized during daily study.
a) The primary challenge is daily organization of new material.
 Organization alone is not enough.
 Hearing others think creates more thorough understanding – makes individual study
more efficient.
2. Helping you think like a physician.
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Physician thinking matches exam thinking.
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a) The physician uses facts that are collected in the history and physical and ordered
from the lab.
i. Exam thinking uses facts collected from lecture and reading.
b) The physician develops a list of possibilities that explain the facts collected from
the patient.
i. Exam thinking works with a list of possibilities that explain the facts you
remember – this list is given to you on a test as the answer choices.
c) The physician then rules out the list to the most likely answer, the diagnosis.
i. Exam thinking likewise narrows the answer choices to the most likely
answer – ideally there is a reason for ruling out each incorrect answer
just as a physician does.
3. Helping you experience how powerful group learning can be.
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Group learning can be a powerful use of time – or a total waste of time.
ESP conditions require no preparation and open resources – because it’s about
developing thinking not testing what you remember.
ESP conditions only require reasons for incorrect and correct answer choices.
Reasons need to be clear and in depth.
Group consensus is required.
Exercise # 1. Understanding incorrect answers – This exercise will demonstrate how
incorrect answers can help you do focused, active reading. (25 minutes)
1. You have 15 minutes to give an explanation for each incorrect answer for Questions #1 and
#2 that completes the following template, “[Insert answer] is incorrect because…”; try to
use both the annotated answers on the page following the questions and the textbook as
reference material.
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Give each member an opportunity to give an explanation in their own words.
Rationales may be simple and straightforward – they may also be involved and need
clarification.
Avoid direct reading unless it sounds too contrived.
Try to discuss how a textbook can be useful for clarifying answers to questions.
2. There will be 10 minute survey of what groups experienced.
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Was the material organized in the text the way you expected?
Was the material in the text harder or easier to read, or no difference?
[Question the groups about any examples of group interaction leading to clarifying explanations.
Encourage the process of dialog as a method to improve both individual thinking and group
thinking.
Did any groups go beyond the annotated answers and was it difficult to find the information in
text? Point out that reading in the text for answer clarification is more effective than simple
passive reading.]
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Exercise # 2. Understanding correct answers – This exercise will demonstrate how
understanding a correct answer can involve more than just memorization. (15 minutes)
1. You have 10 minutes to give an explanation for the correct answers that completes the
following template, “[Answer] is correct because…”; try to use the annotated answers on the
page following the questions and the textbook as reference material.
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Continue by trying to change the question to make the correct answer incorrect.
Use the information associated with some of the incorrect answers to aid you.
2. Compare notes on how you changed the question to make the correct answer incorrect.
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Evaluate whether you would have studied this way on your own.
Evaluate whether everyone in the group interpreted the explanation the same way.
3. There will be a 5 minute wrap-up.
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Appendix
Question #1
A 15-year-old male sustains a superficial laceration of the palm at the base of the thumb that is
closed with sutures. The following day, the patient returns to the emergency department
complaining of diminished hand function. Further examination shows that the recurrent branch
of the median nerve has been injured. Which of the following movements is most likely to be
affected?
A.
B.
C.
D.
E.
Abduction of fingers
Adduction of fingers
Flexion of finger 2
Flexion of thumb
Opposition
Question #2
An 85-year-old female loses her balance and falls against a table, fracturing the surgical neck of
the humerus. Which of the following structures is most likely to be damaged by this fracture?
A.
B.
C.
D.
E.
Axillary nerve
Brachial artery
Profunda brachii artery
Radial nerve
Scapular circumflex artery
Answers with explanations for Questions 1 & 2
Question #1
E (opposition) is correct. The recurrent branch of the median nerve innervates the opponens
pollicis, abductor pollicis brevis, and flexor pollicis brevis muscles. Although opposition,
abduction, and flexion of the thumb are all affected by injury to the recurrent branch of the
median nerve, only opposition is completely lost. The abductor pollicis longus muscle, which is
innervated by the radial nerve, also abducts the thumb. The flexor pollicis longus muscle, which
is supplied by the median nerve in the forearm, also flexes the thumb. In addition, the deep head
of the flexor pollicis brevis muscle often is innervated by the ulnar nerve.
A (abduction of fingers) and B (adduction of fingers) are incorrect. Abduction and adduction of
the fingers are functions of the palmar and dorsal interosseous muscles, all of which are
innervated by the ulnar nerve.
C (flexion of finger 2) is incorrect. The flexor digitorum superficialis and profundus muscles of
finger 2 are innervated by the median nerve in the forearm and are unaffected by loss of function
of the recurrent branch.
D (flexion of the thumb) is incorrect. Innervation of the superficial head of the flexor pollicis
brevis muscle would be lost, but the deep head of the flexor pollicis brevis muscle often is
innervated by the ulnar nerve and may be unaffected. The flexor pollicis longus muscle also
flexes the thumb and is supplied by the median nerve in the forearm.
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Question #2
A (axillary nerve) is correct. The axillary nerve and the posterior humeral circumflex artery pass
through the quadrangular space, crossing the surgical neck of the humerus, where they are
vulnerable in a fracture of the surgical neck and in dislocation of the shoulder joint.
B (brachial artery) is incorrect. The brachial artery lies in a superficial position as it descends
through the arm. Consequently, it is not particularly vulnerable to injury in fractures of the
humerus.
C (profunda brachii artery) is incorrect. The deep artery of the arm accompanies the radial nerve
in the spiral groove and, therefore, is most likely to be injured in a fracture of the humeral shaft.
D (radial nerve) is incorrect. The radial nerve is most susceptible to injury where it lies in the
spiral groove along the posterior aspect of the shaft of the humerus.
E (scapular circumflex artery) is incorrect. The scapular circumflex artery leaves the axilla
through the triangular space at the lateral border of the scapula. The scapular circumflex artery
is separated from the surgical neck of the humerus by the long head of the triceps brachii muscle;
it is not prone to injury by fracture of the surgical neck.
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