1. Case of the Month – using the virtual learning environment to consolidate learning in the final year of medical school CaseoftheMonth Dr Sarah Bennett, UCL Medical School

2. Aims of this presentation Discuss the purpose and value of Case of the month Outline the format of the cases on Moodle Discuss student feedback Questions

3. Rationale for VLE development Preparation for practice data (Tomorrow’s Doctors 2009) Integrated medical curriculum Students tend to be on placement off central site Transition from medical student to doctor Simulating the real environment Practice difficult/complex clinical situations in a virtual environment –Prescribing –Ethics and Law –Data interpretation

4. Purpose of Case of the Month Self directed (adult) learning Integrates the learning about professionalism and the challenges of clinical practice Students can follow a case from beginning to end Gives a taste of what clinical practice means and the need for decision-making Includes authentic junior doctor tasks and competencies Emphasis on personalised feedback

5. Value of Case of the Month for students Case of the Month tries to reach ‘hard to reach’ areas Often delves into areas not easily learned from the textbooks Moodle format allows students to work on cases at a time and place that suits their timetable Provides valuable feedback on a range of practical, professional and conceptual issues: in situations when there is a right answer and when there is not

6. Case of the month during the year All final year (year 6) students complete 6 cases 4 weeks in which to complete each case Each case takes 3-4 hours to complete Tutors mark the case in 2 weeks All cases available for revision

7. Case of the month format Learning objectives Initial scenario What happens next What would you do? Summary and relevance to assessment Review by COTM tutor 8-12 elements Personalised feedback Instant feedback Student summary of performance and learning needs Students respond by answering multiple choice questions, or ~100 words of text Student feedback to Case Author

8. Each case includes... Data interpretation Prescribing Ethical, legal or professional situation Communication skills exercise Evaluation of evidence Decision making and justification Assessment of an acutely unwell patient

10. You are a Foundation Year (FY1) doctor working in Medicine for the Elderly in hospital. Shortly after you arrive for your day, you review the list of patients under your Consultant. One of the new inpatients under your care is a 91 year old man who was admitted from a nursing home at 07:45 hr

12. Your consultant suggests that Mr Smith should be started on the Liverpool Care Pathway for the dying patient. You have never heard of this so you quickly, look it up on Google http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/What_is_the_LCP_-_Healthcare_Professionals_-_April_2010.pdf Having read this article, do you think that the LCP should be started? Justify your decision below: http://www.liv.ac.uk/media/livacuk/mcpcil/migrated-files/liverpool-care-pathway/What_is_the_LCP_-_Healthcare_Professionals_-_April_2010.pdf

13. Results Students views on feedback

14. Results The value of cases for finals and for future career This case was useful for finals This case was useful for my first year in practice

15. Positive feedback “ Overall, I think it can prepare us to be FY1 doctors as numerous elements were dealt with throughout the cases such as prescribing, LCP, death certification etc.” “It’s been really good. Highlights hard or poorly understood topics so is a very good revision aid. Thanks for designing it.” “I think it is an excellent addition to the course and should be introduced for the entire MBBS. It puts the theory that we learn into practice and also provides guidance on learning about specific topics that are clinically relevant.” Although they're a pain in the neck, in the end you actually learn a lot from them. They manage to be useful as revision as well as filling in the gaps of clinical knowledge needed from foundation training

16. Areas for improvement “ Overall useful but no substitute for teaching in these areas.” “I have gained less from the last two because i have felt stressed for time this close to finals” “I prefer multiple shorter focused questions to the larger white space ones where you are meant to write lots of text.” “Would be nice if we could have some face to face tutoring arranged to go with these as well.”

17. Conflict between resources for exam revision and being a doctor “ Generally the case of the months have worked well. I think they are good as a preparation for next year and being a junior doctor on the wards. I do not think they work well as a preparation for finals because they don't really represent the type of questions that we will get in the written papers or as part of the OSCEs” “Best if relevant to Finals and revision which was the case for the majority.”

18. Conclusion Well recognised that students are not as well prepared to be FY1s as we would like Students like the format and find the cases useful for their final exam revision as well as for their future career VLE has many advantages Case of the Month allows students to think about the more esoteric/complex parts of the curriculum