Snider Karen T, Dowling Dennis J, Seffinger Michael A, Channell Millicent K, Yao Sheldon C, Gustowski Sharon M, Johnson Jane C, Pryor Martin J
J Am Osteopath Assoc. 2015 Sep;115(9):556-64. doi: 10.7556/jaoa.2015.113.
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).
To determine the effect of TTR on knowledge and skill acquisition of cervical muscle energy OMT techniques in first-year osteopathic medical students.
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.
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.
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.
提高整骨手法治疗（OMT）技能的掌握程度可能会增强学生的信心，并增加他们日后对OMT的使用。这一过程的第一步是确定最佳的手法训练台与学生比例（TTR）。
确定TTR对整骨医学一年级学生颈椎肌肉能量OMT技术知识和技能掌握的影响。
3所整骨医学院的一年级学生在3个工作坊中的1个接受颈椎诊断和肌肉能量技术的指导，每个工作坊的TTR不同（1:4、1:8或1:16）。在工作坊开始前和结束后以及2周后进行书面评估，以测试所获知识的保留情况。在工作坊结束后和2周后进行实践评估，以测试所获技能的保留情况，并对技术和熟练程度要素进行评分。
92名学生完成了工作坊前后的评估，86名学生完成了保留评估。在工作坊前、工作坊后和保留书面分数方面，不同TTR之间没有差异（P≥0.15）。工作坊后的书面评估分数最高，其次是保留分数；工作坊前分数最低（P<0.001）。虽然1:4和1:8 TTR工作坊组的工作坊后平均（标准差）实践分数（分别为266.3[43.1]和250.6[47.5]）高于1:16 TTR组（230.3[62.2]），但差异不显著（P = 0.06）。对于保留实践评估分数，不同TTR之间没有显著差异（P = 0.19）。TTR与实践评估时间之间存在显著交互作用；1:4（P = 0.04）和1:8（P = 0.02）TTR工作坊组的分数从工作坊后到保留评估有所下降，但1:16 TTR工作坊组没有（P = 0.21）。在配对学生演示中，学生顺序对技术分数也有显著影响（P≤0.03）；第二个演示技术的学生分数高于第一个演示技术的学生。
TTR对书面或实践评估分数没有显著影响。1:4和1:8 TTR的实践评估分数在工作坊后和保留评估之间显著下降。需要进行更具统计效力的未来研究，以确定TTR对学生学习的影响。本研究还发现，配对演示中的学生顺序可能会影响实践评估分数，因为第二个演示的学生得分高于第一个；因此，整骨医学院在实践评估期间应考虑随机安排学生顺序。
