Post on 31-Mar-2015
transcript
Developing Case Presentations For
Clinical Training
Peter J. Katsufrakis, MD, MBA
Keck School of Medicine
Pacific AETC
Objectives
At the conclusion of this workshop, participants will be better able to: Describe benefits of using cases in
teaching. Identify steps used in developing a case. Employ cases effectively in training health
care providers.
Rationale for Case-based Training Effective educational technology Efficient use of trainee “down time” Means to capture “great cases” Supplement random clinical experience Different focus than “grand rounds”
cases
Uses for Cases
Independent study Stimulus for informal discussion &
teaching Evaluation
Program Learner
Formal didactic presentation
Steps in Case Development
Step 1: Identify goals & objectives. Step 2: Describe the patient. Step 3: Focus the learner on discrete clinical
decision points. Step 4: Present balanced, parallel, viable options. Step 5: Analyze options; choose course of action. Step 6: Introduce new information and proceed to
next clinical decision point.
From: Developing Clinical Case Studies: A Guide for Teaching. Eds: Ann Downer, MS, EdD and Sue Swindells, MBBS
Step 1Identify Goals & Objectives Characterize the audience Characterize the audience’s learning
needs Describe specific objectives for the
activity
Step 2Describe the patient Provides opportunity (challenge!) to
employ your creativity Often helpful to draw on real patients Beware HIPAA restrictions
Steps 3 and 4
Step 3: Focus the learner on discrete clinical decision points. Present sufficient information to justify
decision
Step 4: Present balanced, parallel, viable options. Avoid identifying the answer by how you
structure potential responses
Step 5: Analyze options and select course of action
Step 6: Build on Case, Moving to Next Decision Introduce new information and proceed
to next clinical decision point. Process allows return to step 3 Multiple iterations cycle through steps 3
to 6.
Select CourseOf Action
Provide NewInformation
Focus onClinical Decision
PresentOptions
Varying the Model to Add Excitement to the
Facilitator’s Life
Variant of Steps 3+4: Open-ended question Example: “What would you do next?” Appropriate for:
Smaller group Scenario with several viable options Promoting discussion and dissent Group where individuals will interact
Step 3+4 Variant: Open-ended question (cont.) Requires that the facilitator:
Be knowledgeable enough to respond to the various possible responses.
Be skilled enough to draw out participation from the group.
Be able to balance, focus, and redirect individual members.
Be comfortable with less “control.”
Modification of Step 5 for the Open-ended Question All options offered by participants
should be addressed at least briefly Rewards participants for voicing ideas Provides feedback re: correctness of the
response (for the clinical question being considered)
Provides feedback re: suitability of the response (for the purposes of the learning activity)
Revisiting the Model
Revisit Step 1: Learner Assessment By what means can we assess
learners? Formal assessment of knowledge,
attitudes, and/or behaviors prior to training session, e.g., written survey.
Ask organizer/inviter to characterize the audience.
Learner Assessment: What Else Can We Do?
2-3 brief, key questions asked of sample of participants (or representatives of participants)
Email Telephone
On-the-spot assessment or verification of assumptions
Learner Assessment: What Do We Need to Know? Content to include in assessment:
Educational training Specialty, if applicable Experience with HIV (years, no. patients) Characteristics of care system (resources,
colleagues) Baseline understanding of proposed
session content
Revisit Step 2: Describe the Patient What information is necessary, sufficient, or
excessive? May include:
Age Sex HIV status Current symptoms Pertinent medical history Social history PE and lab findings
Describe the Patient (cont.)
Need to provide sufficient information for an informed respondent to answer the question(s) posed
Limit information not needed to answer the question(s) posed Inefficient if unnecessarily wordy Distracts from intended educational message
Ultimately, a question of judgment
Advice to Avoid Pitfalls
Clarify definition of a “case” Ensure cases link to objectives Develop consistent process & format
guidelines Beware ambiguous questions & cases Allow for changing treatment standards Case approach may not be ideal for all
training objectives
Special Challenges When Teaching With Cases Converting didactic presentation into
case format Dealing with audience of very diverse
backgrounds and educational needs
Converting From Didactic to Case-oriented Teaching Revisit your educational objectives
Are they truly suitable to the audience and goals?
Are there areas less well addressed that could be strengthened with a case presentation?
Converting From Didactic to Case-oriented Teaching (cont.) Look at existing content
Can it be organized readily around a single case, or series of brief vignettes?
Could cases provide effective brief introductions to existing didactic material?
Converting From Didactic to Case-oriented Teaching (cont.) Look at your past successes &
challenges Have you (or audience members)
previously inserted personal experiences and enhanced a presentation?
Might using cases engage your audience in “dry” material?
Challenges of aDiverse Audience Different training background Different experiences Different assumptions Different expectations of training
Benefiting From a Diverse Audience Brief self-introductions by all Clarify expectations at outset Design activities so all participate Call on specific audience members Pose “How would this be different if we
were a . . . ?” questions, drawing on quiet audience members’ characteristics
Audiovisual Tools
Written cases complete, lengthy narrative brief, progressive disclosure
PowerPoint linking to other content “Jeopardy” presentation
Audiovisual Tools (cont.)
Audience response Computer-based system Colored index cards Show of hands
Case authoring software, e.g., DxR Development Group, Inc.
Summary
Using cases for clinical teaching can enhance training effectiveness
Following the steps described makes this complex task manageable
Incorporating cases into didactic presentations can revitalize existing material
Acknowledgements
Ann Downer, MS, EdD and Sue Swindells, MBBS
Ann Khalsa, MD, MSEd