November 3, 2010

Integration of Case Studies Across the Nutrition Curriculum

Brenda Bertrand1, Brittny Pope1, Christopher Duffrin2, ElizabethWall-Bassett1, Diana Saum1

1Department of Nutrition Science, 2Department of Family Medicine, Brody School of Medicine

AbstractObjectives

This presentation reviews use of an integrated case study approach across the undergraduate nutrition curriculum. This teaching approach allows students to explore real world situations to better understand how to conduct nutrition assessment, explore the pathophysiology of disease, articulate relevant information about a client to healthcare professionals, and plan appropriate diet strategies based on a client's ever-changing clinical presentation. Basic and applied science disciplines may benefit from this format of instruction.

Faculty Objectives:Develop problem based learning instructional skills by writing case studies that are integrated across the curriculum.

Integrate case material into web-based format (iwebfolio) that will be accessed by students and faculty in 4 courses throughout 3 semesters of study.

Student Learning Objectives:Summarize and interpret relevant case information, synthesizing and highlighting the most important case materials.

Review the scientific literature and reflect upon factors that impact and change medical nutrition therapy recommendations for a client.

Develop clinical skills by critically reviewing the literature, generating medical nutrition therapy recommendations, and presenting the information orally, and food production skills by producing and modifying menu cycles for the hospital setting based on the changing clinical presentation of a client.

Case Study Based Courses

NUTR2400: Nutrition AssessmentStudents are presented case information for their virtual middle-aged client Clint Danes. The students complete nutrition assessment and use this information to determine Clint’s nutrition risk. Follow up questions place the student in the role of an outpatient dietitian to plan Clint’s diet for the home setting.

NUTR4312: Medical Nutrition Therapy It is 2 years later and the medical record that they review indicates to the students that Clint has been admitted to the hospital after suffering from a heart attack. In the role of an inpatient dietitian, students explore the pathophysiology of how Clint’s medical condition has worsened. They document in the medical record correspondence to the other healthcare team members, outlining a nutrition diagnosis for Clint, and plan medical nutrition therapy and monitoring and evaluation strategies to evaluate the success of their planned nutrition interventions.

NUTR4330: Food Production PrinciplesIn tandem with NUTR4312, students plan a therapeutic diet for Clint while he is in the hospital and help Clint select a diet for the home setting. The students reflect on how this diet is different from the one that they planned 2 years ago as a result of changes to Clint’s health status.

NUTR4313: Medical Nutrition Therapy 2Now 20 years later, Clint’s medical record reveals that he has stomach cancer, liver failure, stage IV lung cancer, kidney disease, or head trauma injury. A medical rounds presentation is given by student groups that explains the pathophysiology of the disease & treatment/healing process, evidence-based nutrition therapy recommendations, patient education strategies, and anticipated obstacles and long term outcomes/prognosis.

Overview

Purpose: To integrate a sequential case study into the undergraduate nutrition curriculum so that students use concepts learned in classes across the curriculum of study and connect what they have learned to real life situations.

Project OverviewA series of case scenarios that are based on 1 client whose health condition worsens over time guides students to develop their clinical and food skills as they learn by doing. Students are provided clinical and personal data about a client and then complete clinical assessments, prescribe medical nutrition therapy recommendations, review and interpret peer-reviewed research publications pertinent to the case, and formulate diet plans based on the patient’s health status and social situation. Case information is built upon in 4 courses across the undergraduate nutrition curriculum. The case materials generated by the instructor and the students are accessible using iwebfolio.

Sequence of Courses

NUTR2400:Nutrition

Assessment(Fall/Spring)

NUTR4312: Medical

Nutrition Therapy

(Fall)

NUTR4330: Food

Production

Principles(Fall)

NUTR4313: Medical

Nutrition Therapy 2(Spring)

Evaluation Criteria

Students will evaluate their learning experiences after each portion of the case (in each course). Areas of assessment:• Lecture impact on case learning • Case impact on skills development and attitude

Student Assessment of Their Learning Gains

No Help

A little Help

Moderate Help

Much Help

Great Help

Understanding how health-related information that is presented to me about a patient has real-life relevance

Assessing health-related information to evaluate a patients health status

Prioritizing nutrition-related problems of a patient

Planning nutrition related interventions that will improve a patients health

Learning new information

Enhancing my ability to answer questions on the spot

Improving my ability to think through situations when I am presented with information

Enhancing my skills to work with others

Funded in part by ECU Faculty SenateTeaching Grant Award (summer 2010)