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Slo assessment: spring 2009

SLO Assessment: fall 2010
Assessment of program level SLO (Paramedic Program): # 4- Applies knowledge to
analysis of specific problems.
EMS 150: Patient Assessment

There were five (5) questions pre-selected from the final written examination for the
assessment of this outcome. The questions were scenario-based and required the student
to “weed out” distracting information, organize symptom chronology and determine the
most probable cause of the presentation. The following is a list of the questions and the
percentage of students who responded correctly to each item:
1. You arrive on scene and find an elderly male complaining of severe abdominal and back pain. He states the pain is “all over the left side.” On palpation you feel
a pulsating mass in the abdomen. This patient is most likely suffering from a/an:
100%
2. You are called to the home of a 67 year old female who is complaining of severe dyspnea. She states that it started about 45 minutes ago and has been
progressively been getting worse. She has a cardiac history but denies chest pain
at this time. Her breathing is labored. During your assessment you notice
accessory muscle usage and bilateral rales. What is the most likely cause of your
patients’ condition? 85%
3. You are called to the home of an 80 year-old male who is having difficulty breathing. The patient is sitting upright in a tripod position and you note
profound accessory muscle use. His skin is pale, cool and clammy. Vital sign
are: BP 180/82; HR 90, RR 40. His breathing is shallow and labored with a
coarse rattling sound during expiration. Auscultation reveals course rales to the
nipple line with no air movement in the bases. The family members inform you
that the patient was sleeping when the episode began and that this has happened
several times since his AMI a year ago. He has mild pedal edema without JVD.
Family states onset was about 25-30 minutes ago. Which disease is the patient
most likely exhibiting signs and symptoms of? 94%
4. Your patient is a 23 year old man who complains of abdominal pain. The patient states that the pain began suddenly and was originally located in the area around
the umbilicus. Now, it has shifted to the RLQ. The patient complains of nausea
and vomiting, and he has a fever of 102 degrees Fahrenheit. On palpation of the
abdomen you note rebound tenderness. What condition should you suspect?
67% 23 of 34
5. Your patient is a 29 year old female complaining of a sudden onset of shortness of breath and chest pain. She indicates she is recovering from surgical repair of her
left femur following an automobile accident. What is the patient most likely
suffering from? 100%

Narrative:

The evaluation of these results are consistent with the over all findings of the final
examination. Generally, students do well on these types of questions. Responding
correctly to these questions is directly related to the premise that students do apply
knowledge to analysis of specific problems. The lower number of correct responses
displayed on item #4 may suggest that this specific subject area (abdominal emergencies)
requires more focus. This evaluation is limited by the lack of input from students with
regard to specific questions and an overall perspective on the outcome itself. The next
assessment iteration will utilize the same test items to determine whether the suggested
actions result in desired outcome.



SLO Assessment: fall 2010
Assessment of program level SLO (Paramedic Program): #4- Applies knowledge to
analysis of specific problems

EMS 152: Cardiology

There were five (5) questions pre-selected fro the final written examination for the
assessment of this outcome. The questions were scenario-based and required students to
“weed out” distracting information, evaluate assessment findings and determine a
working diagnosis or appropriate medical intervention. The following is a list of the
questions and the percentage of students who responded correctly to each item:
1. Your patient is a 56 year-old male complaining of chest pain. He states that
The pain came on while watching television. He denies shortness of breath or N/V. the
patient has a history of ASHD and take Diltiazem. His B/P is 160/90, pulse is 110,
respirations are 16, skin is normal, normal, warm and lungs are clear bilaterally. He has
no other remarkable physical findings. On the cardiac monitor you see a sinus
arrhythmia. This patient is probably suffering from: 80% 29 of 36
2. You respond to a 45 year-old woman who complains of mild to moderate shortness of
breath and some chest discomfort. She states she has a long cardiac history and takes
digoxin, lasix, and Slo-K. Her B/P is 180/80, pulse is 94 and irregular, respirations are
20, and skin is cool and moist. She has bilateral crackles in the lower lobes. She has no
peripheral edema or JVD, the EKG shows atrial fibrillation. Based on this assessment
information, the patient is most likely suffering from: 94%

3. You find an 80 year-old man sitting bolt-upright, in severe respiratory distress, gasping
for each breath. During your assessment you discover he has a history of high blood
pressure and “breathing problems”. His B/P is 170/70, pulse is 110 and regular,
respirations are 40 and extremely labored, skin is warm and diaphoretic. Upon
assessment of lung sounds you note diffuse crackles and wheezing. The cardiac monitor
shows an atrial flutter. You also notice that the patient takes Inderal. Given these findings
you suspect you patient I suffering from: 75%

4. Your 27-year-old EMT partner passes out after stating “I don’t feel right”. You are
aware that she has a cardiac history and takes Cardizem. Your quick assessment reveals a
B/P of 70 by palpation, pulse 140, respirations 20 and shallow, skin is pale, cool, and
clammy. Her lungs sound mildly congested and her glucose reading is 130mg/dL. The
EKG shows a sinus tachycardia. Your partner is likely suffering from: 83% 30 of 36

5. A 56 year-old male complains of chest “discomfort”. On examination you note he is
pale, diaphoretic, with obvious dyspnea. His vital signs are B/P 112/70, pulse 66 strong
and regular, respirations reveal tachypnea. He is fully alert and oriented. The patient’s
medications are nitroglycerine, which he’s taken prior to your arrival without relief, and
propranolol. On the monitor you see a sinus rhythm with a first-degree block and no ST
segment elevation. The initial field management of this patient should include:
75% 29 of 36
Narrative:

In reviewing the assessment outcomes there were no major unintended or unexpected
results. Possible reason for the lower percentage of correct responses on item #3 is that
two different lung sound characteristics were given (crackles and wheezing). Often these
characteristics are recognized as individual hallmarks of a specific respiratory ailment.
Combining them in this scenario is appropriate and certainly within the realm of an actual
patient presentation. In subsequent learning activities more of these multi-layered,
multiple complaint scenarios will be utilized. The possibility exist to enhance the
understanding of this process by incorporating these finding in scenarios which utilize the
high fidelity mannequins in the simulation center.
Item #5 is a multiple/multiple response question which students tend to find more
difficult. The question requires the student to first determine which care from a list of
items is appropriate and then organize the treatment to select the correct corresponding
letter choice. These types of questions are infrequently used during unit exams
throughout the course. Increased exposure to this type of question will probably yield
better results on this item.
However, a part of the assessment was to draw some conclusion about students’ ability to
demonstrate that they do, in fact, apply knowledge to the analysis of specific problems.
Given the nature of the course those specific problems are well represented utilizing
scenario-based medical case analysis. The next assessment iteration will utilize the same
test items to determine whether the suggested actions result in desired outcome.

Source: http://www.craftonhills.edu/~/media/Files/SBCCD/CHC/About%20CHC/Research%20and%20Planning/Outcomes%20Reports/Courses/EMS_150_152.pdf

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