TEACHING IN MEDICAL EDUCATION FACULTY FELLOWS PROGRAM

ADLT 672 , INSTRUCTIONAL STRATEGIES FOR TEACHING IN MEDICINE

NOVEMBER 14 , 2013

Developing an Effective Case Study

What is a Case?

The What

Cases are stories: real events or problems so learners experience the complexities, ambiguities, and uncertainties of participants

Cases come in all sizes: written cases, movie clips, radio/TV stories, pictures

Retrospective cases tell the whole story

Your Initial Moves

Provide an overview A brief summary of the facts of the case The story of the case Issues raised by the case

Create an analytic framework The time line Decisions to be made/ decision-makers Rational analysis

What is the problem? What are the alternatives? How should you evaluate the

alternatives? What’s the rationale for the solution you

propose?

Your Initial Moves

Use a Quick Question Pose a question to students to open

the case to elicit facts, opinions, interpretations, or issues

Ask students to summarize the story of the case in one sentence The subsequent discussion can pool

their ideas to create a larger, more complex picture of the case

Establish a baseline Poll students with their preliminary

judgments about the case

Deploying Your Power as Facilitator

Inquiring or badgering? Be sure your questions are designed in the spirit of

inquiry Avoid overly specific or skeptical questions

Your points or theirs? Demonstrate that you are wide open to their ideas and

suggestions. “I like your point; let’s use it.” Avoid asking students to guess what you want.

Instead, use questions like, “Have we covered all the main points?”

Deploying Your Power as Facilitator

Hearing or Listening? Focus on sensing what they really mean when you

listen to what they say. Are you sensing their concerns or their issues? More than “hearing” is required when you facilitate a case discussion.

Seeing or reacting? It is easy to see or react to learners who sit up front.

You’ll need to develop your peripheral vision to stay attuned to those who have something to add from the back of the room.

Deploying Your Power as Facilitator

Warm or cold? Avoid being the dispassionate observer. If learners think

you are remote or unresponsive, they will “check out” of the discussion. Warmth and enthusiasm go a long way!

Up here or out there? Students under pressure to answer questions will often

deflect the attention and pressure back to you by insisting that you provide answers or clarifications, putting you back in the expert role.

Avoid the “hub and spoke” discussion in which conversation moves back and forth from one student to you.

Moving the Discussion Forward

Consider using flip charts or a chalkboard to establish a sense of progress

Use transitions to mark the sequence of stages or steps in the discussion: In a seque, your transition seems natural to the

conversation, “that point raises another good issue.” In a shift, your transition is deliberately more abrupt. “I

want to ask you a different question.” In an interim summary, you (or the learners) sum up

what has been said so far

Skillful time management is essential

Remember, that with the best case discussions, students will all wish there was more time!

SPECIAL SITUATIONS

But what if it isn’t working?

Dealing with Problem Situations

Silence / ApathyPremature closureSitting at the teacher’s feetThe abyssThe problem student

Unmotivated student Uninformed student Defector Compulsive talker Show-off Conflict avoider The rude or abrasive student

How do you close a case discussion?

What’s the most important thing to remember?

Indicators of SuccessHow much did the instructor talk vs. how much did the students talk? How many

students were voluntarily

active in the discussion?

How many questions did the instructor

ask?

How “mobile” was the

instructor, i.e. traveling around the classroom?

How many times did students

laugh?

Was there a high level of energy in the

room?

Did the discussion

make sense? Was it

coherent?

The LCME definition of Active Learning

In active learning, The learner is given the opportunity to self-assess

learning needs

The learner is given the opportunity to independently identify, analyze, and synthesize relevant information

The learner is given the opportunity to appraise the credibility of information resources

All of this implies a new paradigm for teaching!

GoalsAre written as

broad statements of purpose or

intent Answer the question, “What

do I want my learners to be

able to do at the end of my course?”

Serve as criteria for selection of

curricular components

(such as assessments &

learning strategies)

Clearly communicate

what the learning experience addresses

Serve as benchmarks

against which courses can be

evaluated

Can be considered

“broad” educational objectives

Goals Differ from Learning Objectives

Goals Learning Objectives

Can use verbs such as “understand,” “know” or “appreciate”

Are often written, The purpose of this

course is ….

Use strong, action-oriented verbs in one of three domains of learning: Cognitive Psychomotor Affective

Can also be related to process or desired outcomes of the learning experience

Example of a Course Goal

The purpose of the End-of-Life elective for 4th year medical students is to develop the knowledge,

attitudes, and skills that will enable them to become compassionate care providers to patients and their

families in palliative care, sudden or traumatic death, pediatric death, transplant, and other end-of-

life situations.

Traditionally, behavioral objectives address three things:

The desired behavior

The conditions under which the behavior is performed

The performance standards that are to be met

A well-written objective answers the question:

Who will do how much (or how well) of what by

when?

Hint: When writing your objective, begin with

“By when”

Example of a Course Goal

The purpose of this course is for medical students to learn to identify normal from abnormal structures from pathologic gross images, glass slides, or digital images.

and a corresponding behavioral learning objective

By the end of this lesson, more than 95% of the students will have correctly connected the radiologic and microscopic images for the six

bone tumors presented in the class.