Developing Case Presentations For Clinical Training

1. Developing Case Presentations For Clinical Training Peter J. Katsufrakis, MD, MBA Keck School of Medicine Pacific AETC

2. 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.

3. 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

4. Uses for Cases • Independent study • Stimulus for informal discussion & teaching • Evaluation • Program • Learner • Formal didactic presentation

5. 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

6. Step 1Identify Goals & Objectives • Characterize the audience • Characterize the audience’s learning needs • Describe specific objectives for the activity

7. Step 2Describe the patient • Provides opportunity (challenge!) to employ your creativity • Often helpful to draw on real patients • Beware HIPAA restrictions

8.  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

9. Step 5: Analyze options and select course of action

10. 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

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

12. 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

13. 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.”

14. 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)

15. Revisiting the Model

16. 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.

17. 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

18. 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

19. 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

20. 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

21. 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

22. Special Challenges When Teaching With Cases • Converting didactic presentation into case format • Dealing with audience of very diverse backgrounds and educational needs

23. 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?

24. 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?

25. 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?

26. Challenges of aDiverse Audience • Different training background • Different experiences • Different assumptions • Different expectations of training

27. 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

28. Audiovisual Tools • Written cases • complete, lengthy narrative • brief, progressive disclosure • PowerPoint • linking to other content • “Jeopardy” presentation

29. Audiovisual Tools (cont.) • Audience response • Computer-based system • Colored index cards • Show of hands • Case authoring software, e.g., DxR Development Group, Inc.

30. 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

31. Acknowledgements • Ann Downer, MS, EdD and Sue Swindells, MBBS • Ann Khalsa, MD, MSEd