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

7. Step 2 Describe 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)
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 a Diverse 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 PowerPoint 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