ADLT 672, Instructional Strategies for Teaching in

Medical Education

October 20, 2016

Developing an Effective Case Study

Agenda

Instructional Strategy Projects - Blog (via Bb) Rampages accounts established? Look for email in Junk folder from “Wordpress” Need help writing to the blog? Ask me next week

when we meetMeetings to review project ideas –

scheduled?Case-based teaching 30 minutes to work with your

Appendices preso partners

What is a Case?A teaching case is a story, describing or based on actual events and circumstances, that is told with a definite teaching purpose in mind and that rewards careful study and analysis.

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 as it unfolds over time; cases can extend beyond one teaching session so that learners do their own research into the case as it proceeds.

Your Initial Moves

Provide or elicit 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 – be sure to use open-ended questions

Deploying Your Power as Facilitator

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

of inquiry – open, not closed 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 unresponsive, they will “check out” of the discussion. Warmth and enthusiasm go a long way!

Avoid the “expert” role Students will often deflect the attention and pressure

back to you, 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.

Ideally, discussion moves in multiple ways

Learner

Learner

Teacher

Learner

Learner

Learner

From you to the group

From the group into the “container” space

From learner to learner

Moving the Discussion Forward

Consider using flip charts or a whiteboard 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!

David Irby, MD , UCSF Medical Educator

Three Models of Case-Based Teaching for Rounds• Case bedside teaching with

conference room discussion, followed by demo at bedside

• Case-lecture teaching• Case-iterative teaching: discovery

learning using complex cases

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?

Ask: What’s the most important thing to remember about this case?

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?

Your Turn to Develop a Case - Three Scenarios

Organize yourselves into groups of 3-4, with specialties/disciplines that are unrelated (science and clinical specialties; very different clinical specialties, etc)

Spend some time discussing areas of common interest / focus and the type of case you might prepare for a group of early medical students

Develop your case, according to worksheet provided

Practice your opening lines with another group – How will you launch your case?

30 minutes - Work on Your Presentations

November 3 Self-Assessment- Jordan, Anshu, Laura Learning Objectives – Ramzi, Patty, Soundy Ground Rules- Mireille, Chao Rubrics – Terry

November 17 Exam Wrappers –Ben, Michael Checklists – Rabia, Ross, Stacey Concept Maps – Reed, Scott Reader Response/Peer Review - Emma, Ashlie, Mary