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.


About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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5 Responses to The purpose of a Final Exam and other pedagogical mysteries

  1. here is a link to YouTube video taken while posing for the group photo.

    and another in which the class is discussing ABG examples among themselves

    and one of the group photos
    LNC wed class 2 july 20 2011 namaste

  2. gaynor says:

    Sorry – ERSD? Not an abbreviation I’m familiar with

  3. End

    “by Jove, i don’t quite get your banter….”
    (Monty Python)

  4. End

    Dear Ms Sheahan: i don’t pretend to speak Ozzie, but for some reason the follwoing reply springs to mind:

    (Scene: a wartime RAF station)
    Jones: Morning, Squadron Leader.

    Idle: What-ho, Squiffy.

    Jones: How was it?

    Idle: Top-hole. Bally Jerry, pranged his kite right in the how’s-your-father; hairy blighter, dicky-birded, feathered back on his sammy, took a waspy, flipped over on his Betty Harpers and caught his can in the Bertie.

    Jones: Er, I’m afraid I don’t quite follow you, Squadron Leader.

    Idle: It’s perfectly ordinary banter, Squiffy. Bally Jerry, pranged his kite right in the how’s-your-father; hairy blighter, dicky-birded, feathered back on his sammy, took a waspy, flipped over on his Betty Harpers and caught his can in the Bertie.

    Jones: No, I’m just not understanding banter at all well today. Give us it slower.

    Idle: Banter’s not the same if you say it slower, Squiffy.

    Jones: Hold on then — Wingco! — just bend an ear to the Squadron Leader’s banter for a sec, would you?

    Chapman: Can do.

    Jones: Jolly good. Fire away.

    Idle: Bally Jerry… (he goes through it all again)

    Chapman: No, I don’t understand that banter at all.

    Idle: Something up with my banter, chaps?


    (Enter Palin, out of breath)

    Palin: Bunch of monkeys on the ceiling, sir! Grab your egg-and-fours and let’s get the bacon delivered!

    Chapman (to Idle): Do you understand that?

    Idle: No — I didn’t get a word of it.

    Chapman: Sorry, old man, we don’t understand your banter.

    Palin: You know — bally tenpenny ones dropping in the custard!

    (no reaction)

    Palin: Um — Charlie choppers chucking a handful!

    Chapman: No no — sorry.

    Jones: Say it slower, old chap.

    Palin: Slower banter, sir?

    Chapman: Ra-ther.

    Palin: Um — sausage squad up the blue end?

    Idle: No, still don’t get it.

    Palin: Um — cabbage crates coming over the briny?

    The others: No, no.

    (Film of air-raid)

    Idle (voice-over): But by then it was too late. The first cabbage crates hit London on July the 7th. That was just the beginning.

    (Chapman seen sitting at desk, on telephone)

    Chapman: Five shillings a dozen? That’s ordinary cabbages, is it? And what about the bombs?… Good Lord, they are expensive.

  5. gaynor says:

    Suitable choice given that I’m originally English. I actually understood at least some of the above which is a worry!

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