The purpose of a Final Exam and other pedagogical mysteries

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The Party’s Over…..

The Big Class finished the eighth of our weekly teaching sessions Wednesday, July 20. Sixty two nurses in attendance despite the heavy rain. The rain did cool things off and some students wore light jackets.

The purpose of a Final Exam

We started with a simple list of what would be on next week’s final exam. Yes, dear, there will be a final. On the one hand I am an ageing hippie who is cynical about the grading game. I myself am impossible to motivate through use of external reward systems such as grades or praise. There are lots of nurses like me, and they tend to congregate in acute specialties, a phenomenon that will always present a challenge to anybody that wants to manage a bunch of cowboys and cowgirls. But on the other hand, the longer I teach and the longer I contemplate my approaching mortality, I have entered the age of zen-like pedagogical enlightenment. The purpose of a final exam is not merely to strike fear and anxiety in to the students’ heart, but to build a week of reflection as the students go on a self-guided pilgrimage through each week’s notes, contemplating the meaning of each cryptic pronouncement from their guru, grasping each concept anew and holding it up to the light to see their new knowledge shine and illuminate.

Maybe I have had enough coffee this morning. After going over what would be on next’s final exam, much of the morning of the eighth class was devoted to the subject of Arterial Blood Gas (ABG) analysis. My method to review this is very simple. I skip almost all the science. I don’t have time. Instead, I start with AADO2, since this is a useful concept with practical application toward predictive ability. To accompany it I share a short case study in which the students calculate examples of serial AADO2. Then an extremely quick review of the metabolic/respiratory/acidosis/alkalosis; finally I have about five “classic” examples and we discuss.

Serendipity and Student Acknowledgement

One student works in hemodialysis, and when I made passing reference to hyperkalemia, she pulled her iPhone and started to say “at our agency this is the protocol……” – when that happened I brought her to front of the classroom, handed her marker pens and gave her permission to use the whiteboard and speak in Nepali. So she then delivered a fifteen minute talk about cardiac arrest and ESRD. It was pretty good and she got a round of applause.

And now for the Photo Op

After lunch, the photo session. As with the other groups, everyone wants their photo with me, and it’s better to build in the time for this activity and not feel rushed.

Then on to megacode. This week we had five stations so the groups were small and we moved them along. Picking up on the ESRD trivia question. One group at megacode was composed of five of my nursing-faculty participants. The scenario I chose for them involved an ESRD patient with cardiac arrest. The leader was able to correctly identify and call for the drugs in the dosages specified during the off-the-cuff lecture that morning. I told them I was wicked impressed. They were proud of themselves and rightfully so.

Arranged Marriage Discussion Installment # 3,549

A small gaggle of students stuck around to shoot the breeze after class, among other things one told me she is awaiting an arranged marriage so there was an impromptu discussion about this, as she was focused on what occupation her husband would have. She was resigned to her fate. They laughed when I told them that I always bring up this topic in Honolulu when there is a lull in conversation at the Nepali events.

Tomorrow morning I go to TUTH and deliver a two-hour talk to their graduate students. It ought to be a college bull session par excellence. I will also pick up the very last of my photocopying. After the three-days course and the final exam, I am flirting with the idea of a quick trip to Manang. Some friends of mine are there. It’s at 11,000+ feet elevation. Google it.