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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.

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Developing Case Presentations For Clinical Training

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Developing case presentations for clinical training l.jpg

Developing Case Presentations For Clinical Training

Peter J. Katsufrakis, MD, MBA

Keck School of Medicine

Pacific AETC


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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.


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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


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Uses for Cases

  • Independent study

  • Stimulus for informal discussion & teaching

  • Evaluation

    • Program

    • Learner

  • Formal didactic presentation


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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


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Step 1Identify Goals & Objectives

  • Characterize the audience

  • Characterize the audience’s learning needs

  • Describe specific objectives for the activity


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Step 2Describe the patient

  • Provides opportunity (challenge!) to employ your creativity

  • Often helpful to draw on real patients

  • Beware HIPAA restrictions


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 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


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Step 5: Analyze options and select course of action


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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.

Focus on

Clinical Decision

Provide New

Information

Present

Options

Select Course

Of Action


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Varying the Model to Add Excitement to the Facilitator’s Life


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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


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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.”


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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)


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Revisiting the Model


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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.


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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


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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


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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


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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


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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


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Special Challenges When Teaching With Cases

  • Converting didactic presentation into case format

  • Dealing with audience of very diverse backgrounds and educational needs


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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?


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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?


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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?


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Challenges of aDiverse Audience

  • Different training background

  • Different experiences

  • Different assumptions

  • Different expectations of training


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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


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Audiovisual Tools

  • Written cases

    • complete, lengthy narrative

    • brief, progressive disclosure

  • PowerPoint

    • linking to other content

    • “Jeopardy” presentation


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Audiovisual Tools (cont.)

  • Audience response

    • Computer-based system

    • Colored index cards

    • Show of hands

  • Case authoring software, e.g., DxR Development Group, Inc.


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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


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Acknowledgements

  • Ann Downer, MS, EdD and Sue Swindells, MBBS

  • Ann Khalsa, MD, MSEd


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