Developing case studies for learning and e-learning

1. Developing case studies for learning and e-learning Dr Philip Bradley Sub-Dean for Teaching, Learning and Assessment Medical School University of Newcastle upon Tyne p.m.bradley@ncl.ac.uk

2. Welcome and introductions

3. To share experiences and work together To investigate the educational uses of cases To consider some basic rules for case development To consider mechanisms of case delivery To consider the use of cases in PBL Aims

4. Nothing new Nothing right

5. What are cases? Take ten minutes in your group to come up with a definition of a case Group session 1

6. Cases can be narratives be situations be data driven present a problem provide a solution stimulate discussion stimulate enquiry contextualise information All of the above Cases are what you want them to be.

7. Contextualising teaching The case scenario is presented to a class of students and the key issues outlined Subsequent teaching addresses the key issues A closing session deals with student questions and unresolved issues PromotingDiscussion The case scenario is given to a group of students and contains an unresolved dilemma The students discuss the dilemma and formulate a group solution The group solutions are presented back in a plenary session and further discussed Some possible applications

8. Promoting enquiry A case scenario is presented to a group of students and contains triggers which direct students to seek further knowledge Students seek out knowledge and then share it with group Problem solving A case is presented to a group of students and poses a specific problem to which there are one or more correct solutions The students collectively tackle the problem and present the results to the coordinator Some more applications

9. The following is a case used on a ‘So you want to be a doctor day’ for sixth formers to illustrate the case-based approach. A footballer who collapsed A simple example

10. Situated learning “The concept of situated learning is grounded in the belief that learning is most efficient and effective when it takes place within the context of realistic settings in which the learners are clear about the reasons for learning” Cases are proxies for realistic settings Educational theory Brown, Collins and Duguid (1989). Situated cognition and the culture of learning. Educational Researcher (18) 32-42.

11. It is possible to situate learning in two ways Micro contexts A separate real world case is used to explain each new dimension e.g. A man with a broken toe Macro contexts Situations that are sufficiently complex to be viewed from a number of perspectives e.g. A man with a broken toe Anchored instruction

12. Seen in casualty X-ray Splint Addresses a simple learning outcome At home with family Fall Seen in casualty Drunk? Incoherent Attendant wife bruised Splint What next? May address multiple and complex learning outcomes A man with a broken toe

13. Motivation through relevance and authenticity Linking theory and practice through contextualising learning Enabling vertical and horizontal integration of basic and clinical sciences Advantages of cases

14. Allow the learner to activate prior knowledge Provide opportunities for elaboration of learning Offer appropriate closure Cases should

15. In your group produce a list of specific ways in which cases are used or could be used in your educational settings Group session 2

16. As a focus for a group discussion session in ethics To develop diagnostic skills for a child with a fever To contextualise learning in basic metabolism To promote problem solving in physiology To stimulate enquiry into antibiotic over-prescription Possible uses

17. A case should appear authentic and realistic Use an efficient and basic case structure in writing Match the case to students’ learning needs A case should not contain all the answers A case must be sufficiently detailed to allow students to tackle the issues A case should be written in appropriate language for the stage of the learner Some basic rules Abell,D. (1997) What makes a good case? ECCHO:The Newsletter of European Case Clearing House (17) 4-7 Leenders, M and Erskin J.A.. (1989) Case research. The case writing process. Ontario. The School of Business Administration, University of Western Ontario.

18. Coffee

19. Define or adopt a set of learning outcomes Define the purpose of the case Produce a draft outline of the case Use the following guidelines Case writing session

20. Some basic guidelines

21. Give the patient a name, age & occupation Make the name sensible (avoid M.Mouse!) Provide some social context Make the patient believable

22. Use a sequential history Make the time course realistic (6 months wait or 2 weeks fast track) Not all investigations done at once e.g. visit blood count – results and further tests – specialist visit – biopsy – results at next visit – treatment . Make the presentation realistic

23. The level of detail should be sufficient to provide interest or to trigger prior knowledge but not to reveal all the answers e.g. coronary angiography revealed narrowing of the LAD and a left marginal Activate previous knowledge

24. Allow some mistakes or inappropriate conclusions Not all professionals will recognise all conditions on first presentation Let professionals consult or seek second opinion Don’t always make other vet’s look stupid! Make professionals realistic

25. Triggers are references within a case that will stimulate the student to seek more information Avoid triggers that will distract or detour the student away from key learning objectives Include appropriate triggers

26. Write

27. What did you find easy? What did you find difficult? Feedback

28. Lunch

29. Implementation of a case- based approach – The Newcastle experience

30. In staff student appraisal of our old curriculum (3rd revision) one of the key issues that arose in the first two years was why are we doing this. One answer is ‘Because its good for you’ The other is to say ‘why indeed!?’ Review of all curriculum relevance against knowledge required by PRHO – the terminal outcomes of the curriculum Curriculum revision

31. Recognition that though much of our teaching was integrated it was not contextualised Considered PBL Rejected PBL Decided to adopt a case led approach Educational justification as previously Contextualisation

32. Defined set of 50 core conditions either common or important Organised existing teaching sessions around these cases Study guide example Implementation 1

33. All cases mounted within our Networked Learning Environment Offers opportunity to provide additional resources Case 1. A young man with cystic fibrosis Deliver cases on web to aid realism

39. On line resources such as lab reports can be produced de novo and subsequently edited and are generated on the fly from a database.

41. For each case timetabled case launch by clinician For each case timetabled case round-up either by clinician or scientist depending on main learning outcomes See guidelines circulated Implementation 2

42. Makes learning relevant Useful for revision Makes you feel like a doctor from day one Can see where things fit in – even Medicine in Society Memorable patients Positive student feedback

43. Not all staff refer to cases (Staff development) Some clinicians criticise cases written by other clinicians (Ownership) Negative student feedback

44. Can be a valuable way of contextualising learning and integrating aspects such as social medicine Important to include good triggers in the case launch Important to engage all staff Important to keep cases up to date (NICE guidelines) and check links to resources regularly Needs a case coordinator to ensure consistency of style Lessons learnt

45. Cases are stories. They are not case reports. LM admitted off legs. Pyrexial, drowsy 100/85. HR 87. PO2 95. Poss od. Like a writer’s jottings on a journey these are the raw material of our narrative The story teller approach

46. What are features of a good story or narrative? Take 10 minutes to discuss. Group session 3

47. Memorable characters or incidents make memorable stories Unifying style Contextual descriptions of situations Portraits of realistic central characters Development of events Interesting plot Multiple perspectives Features of narrative

48. Take case you were developing this morning and think about how to apply a narrative style to it. List the additional features that you need? Group session 4

49. Does the case achieve the learning objectives Are the problem(s)/issue(s) presented in the case related to the learning objectives Are the learning triggers relevant and clear Is the case sufficiently complete, complex and focused Does the case present a situation, problem or issue Does the case appear to be realistic Are all the features of a narrative included in the case Are the events and actions sequenced in a realistic order Are the events connected with appropriate signposts Is the factual content accurate relevant and appropriate If there are external resources, are they appropriate Case evaluation

50. Take the circulated case which was intended to be delivered in a peer-led group session of 12 students following a case launch lecture. Identify its weaknesses How would you present it? How would you improve it? Group session 5