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SESSION TITLE: Visual and auditory indicators of maxillary sinusitis pain.

1. Teacher goals (general statement of what you, as the teacher, hope to achieve in this lesson)
The purpose of this session is to introduce students to some commonly encountered visual and auditory indicators that imply a patient may be suffering from sinusitis. The teaching session will be framed by a hypothetical scenario in which a patient presents with some symptoms that are shared between sinusitis and toothache as well as unique features of sinusitis. This case will model clinical relevance as a motivation for learning and will provide a framework for summarising lecture content in addition to evaluation of key point teaching/learning efficacy at the end of the session. Visual, auditory and kinaesthetic learning aides will be used to reinforce the importance of different perceptive senses to the arousal of sinusitis suspicion.

2. Assumed student background (prior) knowledge and experience
Students participating in this session are in their second year of an undergraduate dental degree. They have only had one or two clinical exposure sessions in which they are treating patients directly. Students have covered sinus anatomy and pathology in detail and have an understanding of the aetiology of sinusitis through theoretical foundation lectures.

3. Resources

This session requires use of:

– A computer with projector link and PowerPoint software.
– Enough Vicks Vapour drops or other strong mints for each participant in the class.
– A tissue for each participant in case the mint is too strong to finish.
– A printed copy of the hypothetical scenario and supporting questions for each participant in the class.

4. Key evaluative /probing questions

What are the three visual clues that the hypothetical patient is suffering from sinusitis?
List three auditory clues that the hypothetical patient is suffering from sinusitis?
Construct three further questions to ask this hypothetical patient to clarify your suspicions of sinusitis?

OBJECTIVES
Learners will be able to:
1. List 3 visual clues that a patient may be suffering from sinusitis.
2. List 3 auditory clues that a patient may be suffering from sinusitis.
3. Structure 3 relevant questions to ask a patient that will assist in confirmation of sinusitis.

KEY EVALUATIVE/PROBING QUESTIONS
What are the visual indicators of possible sinusitis that can be found in the hypothetical patient description?
What are the auditory indicators of possible sinusitis that can be identified as part of the hypothetical patient description?
What are the main questions you would like to ask the hypothetical patient to clarify if he is suffering from sinusitis?

5. Major difficulties anticipated (conceptual and procedural)

– Eagerness of students to start ‘hands on’ diagnosis and management may inhibit patience for learning more passive diagnostic considerations.

– Students have not known each other or the teacher for a long time. This may cause some inhibition in asking questions and getting involved.

– Most lecture formats in the course to date have been a one-way delivery of information. Students will therefore be unfamiliar with interactive lecture

– Limited clinical experience of participants may make it difficult to link personal experience to lesson content for maximised value.

LESSON COMPONENTS

SET
Mood

LEARNERS’ ACTIVITIES
– Make sure they get an activity sheet with the hypothetical patient details and tasks related to the session objectives.
– Read through the hypothetical scenario as other resources are being distributed.
– Select a type of mint to suck on during the lesson and a tissue to remove the mint if needed.

TEACHER’S ACTIVITIES
– Hand out activity sheets with the patient scenario and key objective questions.
– Encourage students to read through the scenario as you distribute the other tools for this session.
– Hand out mints and tissues to create a sense of anticipation and novelty.

 

Motivate

LEARNERS’ ACTIVITIES
– Read the PowerPoint title slide and listen to the teacher’s introduction of the topic.
– Take note of the teacher’s phone contact details and email address for further questions.
– Take a random number from a container. Realise that there is a chance that anyone could be asked a question, that this is simply down to chance rather than the teacher selecting specific students or the same person answering every question.
– Listen to the teacher’s take on the primary benefits of absorbing lecture content.

 

TEACHER’S ACTIVITIES

– Introduce the topic with enthusiasm and welcome student questions throughout the lesson.
– Create a sense of ongoing support through provision of email and phone contact details.

– Ask students to select a number from a container being passed around. Explain that you have a container of matching numbers and you will select a number each time you have a specific question for the class. This way, everyone is equally likely to be asked a question.

– Explain that proficiency in applying knowledge from this lecture clinically is not only an important protection against inappropriate treatment provision, but also a great source of patient trust.

 

Orientate

LEARNERS’ ACTIVITIES

– Observe the graphic learning pathway flowchart from PowerPoint slide.

– Identify the anatomical origins of confusion between sinusitis and toothache.
– Reflect on the prevalence of sinusitis by considering presented data in addition to personal awareness of this condition.

– Watch the hypothetical patient summary slide briefly with the key words highlighted.
– Listen to and read along with the hypothetical patient summary slide.

 

TEACHER’S ACTIVITIES

– Show students where this lecture fits into their overall learning pathway via a PowerPoint visual tool (the yellow brick road).
– Show a radiographic visual representation of the location of maxillary sinuses relative to posterior upper teeth.
– Explain the high prevalence of sinusitis and encourage students to think about how commonly they have encountered this condition in their own lives.

– Show the hypothetical patient descriptions slide with the key words highlighted. Do not spend too much time on this since the students already have this in front of them and have probably already read it.
– Read through the hypothetical patient summary PowerPoint slide.

EVALUATION OF LEARNING

– What teeth in the OPG are in direct contact with the floor of the maxillary sinus?

 

Objectives

LEARNERS’ ACTIVITIES

– Read the two key objectives of the lesson on the PowerPoint presentation slide.

TEACHER’S ACTIVITIES

– Present the two key objectives of the lesson;
To identify the VISUAL and AUDITORY clues for maxillary sinusitis within the hypothetical patient description.

 

Probe prior knowledge

LEARNERS’ ACTIVITIES

Consider and share with the class any clinical experience with patients suffering from sinusitis. Specifically, discuss what hints you identified to lead you to discover that the patient had sinusitis.
TEACHER’S ACTIVITIES

Ask if any students have encountered patients with sinusitis in the clinic yet? If anyone has, ask what led them to believe that the patient had sinusitis. Can they remember seeing or hearing any specific clues?
If no one has, explain that they will certainly encounter this in the coming months since it is such a common finding.

EVALUATION OF LEARNING

Has anyone encountered a patient with sinusitis in the clinic? What were some of the clues that let you to believe they had sinusitis? 2.5 mins

 

TIME 2.5 mins

 

BODY

Objective 1
The student can state 3 visual clues that a patient may be suffering from sinusitis. – Consider how they personally present to the world when not feeling well.

LEARNERS’ ACTIVITIES

– Read through and listen to PowerPoint list of common visual signs. Look at pictures of these features on the slides.

– Turn to the person beside and point where the minty cool of the lozenge can be felt extending to apart from the mouth.

– Observe the way that the person next to you is using their hands to describe the extension of the minty sensation.

– Listen to, and read along with the physical flags slide in PowerPoint.

 

TEACHER’S ACTIVITIES

– Ask students how they generally present to the world when they are feeling unwell.

– List some of the main visual indicators that a patient may be suffering from sinusitis with reference to written PowerPoint text and photographs.
– Encourage students to turn to their neighbour and watch the hand gestures they are using to describe where the ‘mintiness’ is extending to beyond their mouth.
– Point out that everyone is indicating the same general area and that this area shows the approximate location of the maxillary sinuses.
– Highlight that a lot of students are using a few fingers or their whole hand to indicate the extension of minty sensation. Relate this to how a patient describes pain in their maxillary sinus.
– Read through (and extend upon) a PowerPoint list of physical flags of sinusitis. (Complete the following as part of the conclusion to summarise and evaluate the session.)

 

EVALUATION OF LEARNING
– A random number will be selected and the student holding this number will be asked to identify some VISUAL indicators (at least three) of maxillary sinusitis from the hypothetical patient scenario.
(If the student does not know, it is possible that the delivery of lesson content has not been effective and further investigation is warranted,)

– Students will complete a homework activity sheet in which they are asked to identify as many visual indicators as possible from the hypothetical patient. These will be marked and discussed in class. The responsibility to answer questions will again be randomised, so all students should be prepared to answer.
TIME 1.5 mins

 

Objective 2
The student can state 3 auditory clues that a patient may be suffering from sinusitis.

 

LEARNERS’ ACTIVITIES

– Listen to and read along with the PowerPoint slide that distinguishes auditory descriptors that are shared between toothache and sinusitis and unique to sinusitis.

 

TEACHER’S ACTIVITIES
– Read through PowerPoint slide that explains shared descriptors of toothache and sinusitis versus unique qualities of sinusitis. (Complete the following as part of the conclusion to summarise and evaluate the session.)

 

EVALUATION OF LEARNING

– A random number will be selected and the student holding this number will be asked to identify some AUDITORY indicators of maxillary sinusitis from the hypothetical patient scenario.
(If the student does not know, it is possible that the delivery of lesson content has not been effective and further investigation is warranted,)

– Students will complete a homework activity sheet in which they are asked to identify as many auditory indicators as possible (at least three) from the hypothetical patient. These will be marked and discussed in class. The responsibility to answer questions will again be randomised, so all students should be prepared to answer.

TIME 1.5 mins

 

Objective 3

The student can list 3 relevant questions to ask a patient that will assist in confirmation of sinusitis.

LEARNERS’ ACTIVITIES
– Listen to and read along with the key questions to ask suspected sinusitis sufferers

– Consider if they have any questions or concerns about the lecture content.

 

TEACHER’S ACTIVITIES

– Read through and elaborate on the key questions that should be asked a patient presenting with toothache in upper back teeth.

– Provide students with a specific opportunity to ask any questions they have.
Suggest some things the students may have questions about if necessary. Eg. Does anyone want to know if a sinusitis patient will always use more than 1 finger to point to their pain? Are you interested whether there is a difference in the severity of pain between sinus and toothache? You are already treating patients, so now is a really good time to clarify these things.

GIVE STUDENTS ADEQUATE TIME TO CONSIDER AND ASK. PAUSE FOR 10 SECONDS.

If no questions now, ask students to list any questions they have at the bottom of their activity sheet to discuss next time.
(Complete the following as part of the conclusion to summarise and evaluate the session.)

 

EVALUATION OF LEARNING
– A random number will be selected and the student holding this number will be asked to identify a further question to ask a patient presenting with pain in an upper molar tooth to clarify possible maxillary sinusitis.
(If the student does not know, it is possible that the delivery of lesson content has not been effective and further investigation is warranted,)

– Students will complete a homework activity sheet in which they are asked to identify at least three possible further questions for the hypothetical patient. These will be marked and discussed in class. The responsibility to answer questions will again be randomised, so all students should be prepared to answer.

TIME 1.5 mins
CLOSURE
Summarise

LEARNERS’ ACTIVITIES

– Read through the hypothetical patient summary slide again and be ready to offer one suggestion of one auditory and one visual indicator from the text if called upon.

 

TEACHER’S ACTIVITIES

–  Bring the hypothetical patient scenario summary slide up again on the PowerPoint presentation. Select one random number at a time. The student with the number selected needs to point out one visual AND one auditory indicator from the hypothetical patient.

 

Link back and forward

LEARNERS’ ACTIVITIES

– Observe the graphic PowerPoint flowchart of learning progress, noticing the broad topics of previous, current and future sessions.

 

TEACHER’S ACTIVITIES

– Use student answers as a basis to refresh linked aspects of the session.

– Bring the ‘yellow-brick road’ learning flow chart back up to show what the students have completed and what will be next.

 

Evaluate

LEARNERS’ ACTIVITIES

– Complete the question sheet at home to list all the visual and auditory indicators from the hypothetical patient description in addition to the two main questions to ask the patient.

TEACHER’S ACTIVITIES

– Ask students to complete the question sheets provided. Explain that the answers will be peer marked and discussed at the next seminar.

 

Nothing new.

 

– Provide a sense of closure and encouragement by linking back to the possibility for great professional satisfaction in being able to identify the clues of sinusitis as early as possible.

TIME 3 mins

 

Feedback from this microteach session indicated 2 main areas for improvement:

1) There was insufficient opportunity for participants to read through the hypothetical patient. The PowerPoint hypothetical slide was very wordy and overwhelming to read.
This limitation has been addressed by providing students with the full hypothetical scenario in their activity sheet so that the context is not lost, but outlining only the key words within the scenario using a summary slide. This accommodates the time limitations of the session that preclude reading out the full scenario, while also ensuring that each student is aware of the main characteristics of the hypothetical patient. The alternative summary slide seeks to avoid overwhelming students with too much content and models the way in which students are encouraged to filter key information from broad patient presentations.

2) Whilst students were given an option to ask questions, there was not an adequate opportunity created. This problem primarily related to allowing students enough time to ask questions and doing this with greater tact to encourage further enquiry. These problems will be addressed by:
a. Having some further questions ready for myself. By modelling the fact that the topic has further interesting facets and it is okay to desire further information, students may feel more comfortable to ask any further questions that they may have.

b. Selecting students to answer questions using a random number system. This will be beneficial since the odds of any student being asked a question are equal, eliminating any perceived bias. Use of this system means that all students may be called upon to answer a question and therefore pay attention. Students may also be more likely to ask a question if they do not understand a concept to avoid getting this wrong if called upon for an answer later.

c. Providing adequate time for students to consider and ask questions. This will entail a leap of faith to allow a silent pause of at least 8 seconds before assuming that no one has questions.